Psychology- a Complete Introduction

by Sandi Mann

  Behaviour therapy is based on the theories of conditioning, which were discussed in Chapter 5. Based on these theoretical underpinnings, various therapeutic approaches are identified that include those based on either classical or operant conditioning.

  Examples of therapies based on classical conditioning include:

  • Systematic desensitization: this is a gradual exposure to a feared stimulus (such as spiders if the client has a phobia of arachnoids) so that the patient can unlearn conditioned responses to those stimuli. By teaching the client relaxation skills that can be used at the same time as exposure to the arousing stimulus, pairing of the fear-inducing item and newly learned relaxation behaviour aims to eliminate the conditioned response of fear to the stimulus. This technique is used successfully when treating phobias and panic attacks.

  • Aversion therapy: this is the opposite of systematic desensitization in that it does not try to break the link between a stimulus and a negative response – rather, it tries to create such a link. Aversion therapy pairs undesirable behaviour with some form of aversive stimulus with the aim of reducing that unwanted behaviour. For example, a patient with OCD might snap an elastic band against their wrist whenever an unwanted thought intrudes into their minds.

  Therapies based on operant conditioning include:

  • Token economies: using positive reinforcement approaches, this is where individuals are offered ‘tokens’ that can be exchanged for privileges or goods when desired behaviour occurs. This is commonly used with people who have learning difficulties to help ‘shape’ desirable behaviours.

  • Modelling: This relies on learning through observation and imitation and can be used within mentoring or buddying schemes for children or with people with learning difficulties.

  Cognitive behaviour therapy (CBT)

  CBT builds on behaviour therapy by adding in a cognitive component. It works to change maladaptive thinking in order to change feelings and behaviour. CBT, developed from the work of Albert Ellis in the mid-1950s and Aaron Beck a decade later, is a way of talking about:

  • how a person thinks about themselves, the world and other people

  • how what they do affects their thoughts and feelings.

  CBT can thus help to change how people think (‘cognitive’) and what they do (‘behaviour)’. Like behaviour therapy and unlike some of the other ‘talking treatments’, it focuses on the ‘here and now’ rather than on possible causes of the problem. CBT has been shown to be effective for a wide range of problems, especially anxiety, depression, panic attacks, phobias, stress and OCD. It can also help with anger and self-esteem issues and even pain management.

  CBT works by breaking seemingly overwhelming problems down into smaller parts. This makes it easier to see how they are connected and how they affect the person. These parts might include an event or a situation that led to maladaptive:

  • thoughts

  • emotions

  • physical feelings

  • actions.

  The underlying assumptions of CBT are that emotions and behaviour are determined by thinking processes. Problems arise from maladaptive thinking which is negative, unrealistic and unhelpful. By altering these ways of thinking, the emotional problems can be alleviated.

  CBT uses various means to challenge maladaptive thinking. Techniques include:

  • questioning

  • giving information

  • analogies

  • humour

  • role reversal

  • self-instructional training.

  Spotlight: Computerized CBT

  Computerized cognitive behavioural therapy (CCBT) has been described by NICE (the National Institute of Clinical Excellence) in the UK as a ‘generic term for delivering CBT via an interactive computer interface delivered by a personal computer, Internet, or interactive voice response system’, instead of face to face with a human therapist. It has proven effectiveness and in 2006 NICE recommended that CCBT be made available for use within the NHS across England and Wales for patients presenting with mild to moderate depression, rather than immediately giving them antidepressant medication.

  One of the most distinctive features of maladaptive thinking is that thoughts are often very negative. People can get stuck in a cycle of thinking negatively and these thoughts often have specific qualities:

  • They appear automatically.

  • They are often distorted, so don’t fit the facts or match reality.

  • They tend to be unhelpful because they make the patient feel bad or depressed.

  • The thoughts are plausible so it doesn’t occur to the patient to question them.

  • They are involuntary, which means that they are very hard to control.

  The negative thoughts often reflect negative opinions of oneself, self-criticism and self-blame, a negative interpretation of events and negative expectations of the future. Part of CBT, then, is challenging these thoughts; the patient is often asked to keep thought diaries in which they record their thoughts in relation to certain events and then they bring those diaries to the sessions where the therapist will challenge them (eventually the client will learn to challenge their thoughts themselves) by asking:

  • What is the evidence for your views?

  • What alternative views could there be?

  • What is the effect of thinking the way you do?

  • What thinking errors are you making?

  Thinking errors refer to the erroneous ways of thinking about oneself, the world and the future (such as all-or-nothing thinking, self-blame, double standard, etc.); some of these were outlined in Chapter 14 in the section on depression.

  Case study: Beth

  Beth suffered from depression and lack of self-esteem. She was convinced that no one liked her and that she had nothing interesting to say or to contribute to a conversation. She felt that she had no friends and that she was ‘useless’. CBT was used to help her challenge her cognitive distortions. For example, she was asked to carry out ‘experiments’ to test out her claims that no one ‘liked’ her to see whether they were based in reality. She was asked why she thought no one liked her and she said that no one spoke to her, smiled at her or asked her to join them for coffee and so on.

  So, she was asked to test this out by smiling and saying hello to someone to test out her conviction that no one ‘liked’ her. She found that people did respond and say hello back. This then allowed the therapist to challenge her assumptions that no one liked her and look for other explanations for people not smiling/talking to her – Beth realized that it could be that other people were shy, preoccupied or, perhaps, when she didn’t smile and avoided eye contact, they were put off from approaching her.

  A further ‘experiment’ was encouraged in which Beth was to ask friends to meet for coffee. She predicted that they would make excuses but in fact they didn’t. This allowed her to challenge some of her cognitive distortions (such as mindreading, all-or-nothing thinking). She started to realize that her thoughts were distorted and holding her back, which was the first step in lifting her from her low self-esteem and depression.

  Psychodynamic therapies

  The roots of psychodynamic therapy lie in Freud’s psychoanalysis approach (see Chapter 9), but the work of Carl Jung, Alfred Adler, Otto Rank and Melanie Klein have also influenced the methodology. The aim of psychodynamic therapy is to bring the unconscious mind into awareness. The goals are to increase self-awareness and understanding of how the past can affect the present. Psychodynamic therapy helps people to unravel and understand hidden, subconscious and deep-rooted feelings, which it is felt is required if the problems they cause are to be fully resolved. Psychodynamic therapists believe that our unconscious mind suppresses painful feelings and memories, using defences such as denial and projections (see Chapter 9). Although these defences protect in the short term, in the longer term they are often harmful and prevent us from dealing with difficult situations and resolving them.

&nb
sp; The basic assumptions underlying the psychodynamic approach are that:

  • most of our behaviour has its root in the unconscious

  • psychic determinism, which means that all behaviour has a cause/reason

  • different parts of the unconscious mind (e.g. the id, ego and superego) are in constant struggle with one another

  • our behaviour and feelings as adults (including psychological problems) are caused by our childhood experiences

  • we develop defences in order to avoid the unpleasant consequences of conflict.

  Techniques used in psychoanalytic therapy include free association, which is where the client talks freely to the therapist – saying the first things that come to mind without any attempt to censor ideas and thoughts. This is thought to allow true feelings to emerge and thus uncover defences. Sometimes the therapist will read words out (e.g. mother, father) and the patient has to say the first things that spring to mind. For this technique to work, the patient has to feel confident that the therapist is not going to judge them for what they say.

  ‘The importance of free association is that the patients spoke for themselves, rather than repeating the ideas of the analyst; they worked through their own material, rather than parroting another’s suggestions.’

  Pamela Thurschwell, Sigmund Freud, 2nd edition (London: Routledge, 2009), p. 24

  Freud called free association ‘this fundamental technical rule of analysis… We instruct the patient to put himself into a state of quiet, unreflecting self-observation, and to report to us whatever internal observations he is able to make’ – taking care not to ‘exclude any of them, whether on the ground that it is too disagreeable or too indiscreet to say, or that it is too unimportant or irrelevant, or that it is nonsensical and need not be said.’

  S. Freud, Introductory Lectures on Psycho-Analysis, Penguin Freud Library vol. 1, new edn (Harmondsworth: Penguin, 1991), p. 328

  The use of free association was intended to help discover notions that a patient had developed, initially, at an unconscious level, including:

  • transference: unwittingly transferring feelings about one person and applying them to another person

  • projection: projecting internal feelings or motives by ascribing them to other things or people

  • resistance: holding a mental block against remembering or accepting some events or ideas.

  Spotlight: Freudian slips

  Freudian slips are typically errors of speech that are interpreted as occurring through the interference of unconscious thoughts. Thus, these slips are thought to be more revealing of the speaker’s true feelings. They are named after Sigmund Freud, who, in his 1901 book The Psychopathology of Everyday Life described and analysed a large number of seemingly trivial, bizarre or nonsensical errors and slips. However, he never coined the term ‘Freudian slips’ and it is not known who did. Examples of such gaffes include thanking a host for their ‘hostility’ (rather than ‘hospitality’) or asking for ‘bed and butter’ (rather than ‘bread and butter’).

  President George W. Bush made a now-famous gaffe in 1988 that would have given a psychoanalyst a lot to work with: ‘For seven-and-a-half years, I’ve worked alongside President Reagan. We’ve had triumphs. Made some mistakes. We’ve had some sex … uh … setbacks.’ Did this reflect a desire to have sex with President Reagan? Not necessarily; a skilled psychoanalyst working with the President (Bush) might well uncover that he connects ideas like triumphs or mistakes with sex, rather than with President Reagan (though such an observation might still be rather insightful).

  Here are some other famous Freudian slips:

  Gordon Brown, former Prime Minister of the UK, may have secretly considered himself to be a superhero when he told MPs that ‘we not only saved the world’ before quickly correcting himself, saying ‘er, saved the banks…’

  Manchester City boss Manuel Pellegrini’s assertion in 2014 that ‘To manage a big team like Manchester United and to have pressure in all the competitions is very good’ may have reflected a hidden desire to manage the competition.

  UK Prime Minister David Cameron gave his opponents real ammunition for attack when he claimed in 2012 that ‘We are raising more money for the rich.’

  ‘Almost invariably I discover a disturbing influence from something outside of the intended speech. The disturbing element is a single unconscious thought, which comes to light through the special blunder.’

  S. Freud on slips of the tongue in The Psychopathology of Everyday Life (1904)

  Humanistic therapies

  Humanistic therapies, originating with the American psychologist Carl Rogers (1902–87), focus on holistic approaches to human development and on the role of self-development, growth and free will. They aim to help individuals recognize their strengths, creativity and choices with a focus on self-actualization (reaching one’s potential). This drive to self-fulfilment is what motivates much of our behaviour. Humanistic approaches tend to focus on the ‘here and now’ – looking at where the patient is now rather than how they got there or what the future might hold. There are various schools of humanistic therapy, including:

  GESTALT THERAPY

  Gestalt therapy, developed by Fritz Perls (1893–1970), Laura Perls (1905–90) and Paul Goodman (1911–72) in the 1940s and 1950s, focuses on the whole of an individual’s experience, including their thoughts, feelings and actions. In gestalt therapy, self-awareness is key to personal growth and developing one’s full potential. Problems can occur when this self-awareness becomes blocked by negative thought patterns and behaviour that can leave people feeling troubled and unhappy.

  Gestalt therapy focuses on the skills and techniques that a person needs to develop in order to be more aware of their feelings. According to the gestalt approach, it is much more important to understand what individuals are feeling in the ‘here and now’ than to spend a lot of time worrying about why they are feeling the way they do, as other therapies do (e.g. psychodynamic approaches).

  The goal, then, of gestalt therapy is to develop self-awareness – of feelings, thoughts, ideas and beliefs. This can be achieved with a range of techniques:

  • Role-play: the therapist might play the role of spouse or parent and ask the client to interact within those roles. Sometimes, the client might take on the role of the other person so that they can experience different feelings and emotions that can aid their own self-awareness.

  • The ‘empty chair’ technique: here, the client sits opposite an empty chair and imagines that it is occupied by someone significant (e.g. their parent, spouse or even themselves). They then interact with this imaginary person – asking questions and talking to them. They then switch chairs so that they are now sitting in the empty chair and the roles are reversed as the interaction continues. The aim is to help the client become aware of suppressed feelings that might be fuelling conflicts or distress.

  HUMAN GIVENS THERAPY

  All humans have a common set of innate physical and emotional needs coupled with appropriate physical and emotional resources (see the table below). We deploy our ‘given’ resources in order to meet our ‘given’ needs in the environment in the course of our daily lives. When our innate needs are met we will be satisfied and content but when they are not met (especially our emotional needs) we get distressed or depressed. The human givens approach believes that we will be happier if we are more aware of and more sensitive to our innate needs and resources.

  Needs Resources

  Security Memory

  Autonomy and control Rapport

  Status. Imagination

  Privacy Instincts and emotions

  Attention A rational mind

  Connection to the wider community A metaphorical mind

  Intimacy An observing self

  Competence and achievement A dreaming brain

  Meaning and purpose

  A human givens therapist then uses techniques such as deep relaxation, visualization, guided imagery and use of metaphors
to help their client to identify their unmet emotional needs and then to find ways to meet these needs using their own resources.

  PERSON-CENTRED THERAPY (ALSO KNOWN AS ‘CLIENT-CENTRED’ COUNSELLING)

  Person-centred therapy is a humanistic approach developed by Carl Rogers during the 1940s and 1950s that views the therapist and client as equal partners in trying to solve a problem, rather than as an expert treating a patient. The client takes responsibility for changing their life rather than the therapist.

  Client-centred therapy (sometimes referred to as Rogerian therapy) operates according to three basic principles:

  • The therapist is congruent with the client, which means that they act in a genuine and authentic way (rather than offering the more blank façade of the psychodynamic therapist).

  • The therapist provides the client with unconditional positive regard; the therapist should care and have deep concern for the client and must show acceptance and non-judgemental attitudes.

  • The therapist shows empathetic understanding to the client.

  It is important to note that Rogers was deliberate in his use of the term ‘client’ rather than ‘patient’ as he felt that this implied a more equal relationship than that of the ‘sick’ patient being cured by the all-knowing doctor. While psychodynamic therapy focuses on trying to interpret the unconscious issues that would appear to have caused the problems, the person-centred approach is far less directive; the therapist does not direct the client, judge them or offer solutions to problems. Rather, the therapist tries to help the client come to their own conclusions.

  When people embark on client-centred therapy, they are said to be in a state of incongruence, meaning there is a difference between how they see themselves and the reality. A key aim of client-centred therapy is that the client gains ‘congruence’ – that is, an accurate view of themselves and good self-awareness. The therapist aims to help the client reach congruence so that there is a better match between their self-concept and reality. The therapist achieves this by helping the client identify their own mismatch rather than by directing it themselves. In this way, there are some similarities between person-centred approaches and CBT (although CBT is more directive than CCT).