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years the hospital’s mental patients were chained； tortured；
and exhibited to an admission…paying public。 Through
mispronunciation of Bethlehem； the hospital became known
as Bedlam； or chaos； due to the confusion that reigned and
the dehumanized treatment of its patients。
b） Late 1700s： French physician Philippe Pinel described
psychological problems as mental illness
c） Mid…1800s： Psychology was gaining credence as a field of
study in the U。S。； and a “cult of curability” emerged
d） 1900s： Clifford Beers spurred on the mental hygiene
movement； with confinement of the mentally ill taking on a
rehabilitative goal； and the asylum became a fixture of the
emerging sociopolitical movement
2。 Cultural Symbols and Rituals of Curing
a） Western views and practices emphasize the individual’s
uniqueness； independence； and personal responsibility for
success and failure； consistent with both the disease model
and demonology。 Mental disorder is viewed as the failure of
the individual。
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PSYCHOLOGY AND LIFE
b） Cultural anthropology analyzes explanations and treatments
for psychological disorders across various cultures
（i） Shamanism personalizes the forces of fate or chance
that intervene in one’s life； creating problems。
Personalization permits action to be taken against
presumed evildoers and directs help to be sought
from assumed divine healers。
（ii） Ritual healing ceremonies infuse emotional intensity
and meaning into the process of healing。
II。Psychodynamic Therapies
A。 Freudian Psychoanalysis
1。 Psychoanalytic therapy is an intensive； prolonged technique for
exploration of the neurotic and anxiety…ridden individual’s
unconscious motivations and conflicts
2。 The goal is establishment of intrapsychic harmony and
understanding of the patient’s use of repression to handle conflicts
3。 Psychodynamic therapy is often called insight therapy
4。 The “talking cure” began with Joseph Breuer in 1880； as treatment for
hysterical conversion resulting from psychogenic causes
5。 Free Association and Catharsis
a） Free association involves allowing the mind to wander and
giving a running account of thoughts； wishes； while relaxing
fortably
（i） Freud maintained free associations were
predetermined； not random
（ii） Encouraged expression of strong feelings； repressed
through fear of punishment or retaliation； an
emotional release termed catharsis
6。 Resistance is an inability or an unwillingness to discuss certain ideas；
desires； or experiences
7。 Dream analysis is a therapeutic technique that examines content of
dreams to discover underlying or disguised motivations and
symbolic meanings of significant life experiences and desires
8。 Transference and Countertransference
a） Transference is the development by the patient of emotional
feelings toward the therapist
b） Countertransference occurs when the therapist es to like
or dislike a patient because the patient is perceived as
similar to significant people in the therapist’s life
B。 Neo…Freudian Therapies
1。 Freud’s followers placed more emphasis than did Freud on：
a） Patient’s current social environment； less focus on past
b） Patient’s continuing life experiences
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CHAPTER 16： THERAPIES FOR PERSONAL CHANGE
c） The role of social motivation and interpersonal relations of
love
d） The significance of ego functioning and development of self…
concept
2。 Harry Stack Sullivan felt Freudian therapy failed to recognize the
importance of social relationships
a） Posited building of a self…system to keep anxiety at a
tolerable level； with the system deriving from the child’s
interpersonal experiences。
3。 Karen Horney stressed importance of environmental and cultural
contexts in which neurotic behavior is expressed； rejecting Freudian
phallocentrism in favor of gynocentrism
4。 Heinz Kohut emphasized the self； and founded the object relations
school of psychodynamics
III。 Behavior Therapies
A。 Behavior therapy and behavior modification both refer to the systematic use of principles
of learning to increase the frequency of desired behaviors and/or decrease that of problem
behaviors
B。 Counterconditioning
1。 A new response is conditioned to replace or “counter” a maladaptive
response
2。 Systematic Desensitization and Other Exposure Therapies
a） Joseph Wolpe’s theory of reciprocal inhibition states that the
nervous system cannot be relaxed and agitated
simultaneously。
b） Systematic desensitization： A behavioral therapy technique in
which a client is taught to prevent the arousal of anxiety by
confronting the feared stimulus while relaxed。
Desensitization therapy involves three major steps：
（i） Identification of anxiety…provoking stimuli； and
arranging them hierarchically； from weakest to
strongest
（ii） Training in progressive deep…muscle relaxation
（iii） Actual process of desensitization； the progressive
imagining of stimuli； from weakest to strongest
c） Implosion therapy： the opposite of desensitization。 Client is
exposed immediately to the most frightening stimuli at the
top of his or her anxiety hierarchy； but in a safe setting
d） Flooding： similar to implosion； but involves clients being
placed in the phobic situation
3。 Aversion therapy uses counterconditioning to pair stimuli with strong
noxious stimuli
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PSYCHOLOGY AND LIFE
C。 Contingency Management
1。 Relies on operant conditioning principles pioneered by B。 F。 Skinner
2。 Refers to the general treatment strategy of changing behavior by
modifying its consequences。 Major techniques are：
a） Positive reinforcement strategies
（i） Token economies
（ii） Shaping
（iii） Behavioral contracts
b） Extinction strategies are useful when dysfunctional
behaviors have been maintained by unrecognized
reinforcing circumstances
D。 Social…Learning Therapy
1。 Social…learning therapy is designed to modify problematic behavior
patterns by arranging conditions in which the client will observe
models being reinforced for a desirable form of responding。
2。 Two aspects of this approach include imitation of models and social
skills training
a） Imitation of models： Individuals acquire responses through
observation of others （models）
b） Social…skills training： Training individuals with inadequate
social skills to be more effective using behavioral rehearsal
E。 Generalization Techniques
1。 Do clients use new behavior patterns generated in the therapeutic
setting in everyday situations？
2。 Generalization techniques attempt to increase similarity of target
behaviors； reinforcers； models； and stimulus demands between
therapy and real…life settings
IV。 Cognitive Therapies
A。 Cognitive Therapies attempt to change problem feelings and behaviors by changing the
way the client thinks about significant life experiences
B。 Cognitive Behavior Modification
1。 Approach bines cognitive emphasis on the role of thoughts and
attitudes influencing motivations and response with behaviorist
focus on changing performance through reinforcement contingencies
2。 Unacceptable behavior patterns are modified by cognitive
restructuring
3。 Critical aspect is discovery by therapist and client of how the client
thinks about and expresses the problem for which therapy is sought
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CHAPTER 16： THERAPIES FOR PERSONAL CHANGE
C。 Changing False Beliefs
1。 Some cognitive therapists argue that many psychological problems
arise as a function of how people think about themselves relative to
other people and the events they face。 Faulty thinking can be based
on：
a） Unreasonable attitudes
b） False premises
c） Rigid rules that put behavior on “autopilot”
2。 Cognitive Therapy for Depression
a） The therapist helps the client to identify his or her irrational
ways of thinking and to learn more realistic ways to
formulate personal experiences
b） Four tactics used to change the cognitive foundation that
supports the depression：
（i） Challenging basic assumptions about his or her
functioning
（ii） Evaluating evidence the client has for and against
accuracy of automatic thoughts
（iii） Reattributing blame to situational factors rather than
client’s inpetence
（iv） Discussing alternative solutions to plex tasks
that could otherwise lead to experiences of failure
3。 Rational…Emotive Therapy （RET）： A prehensive system of
personality change based on transformation of irrational beliefs that
cause undesirable emotional reactions
a） RET teaches clients to recognize “shoulds；” “oughts；” and
“musts” that are controlling their actions and preventing
them from choosing the lives they want
b） RET’s goal is to increase sense of self…worth and potential for
self…actualization
V。Existential…Humanistic Therapies
A。 Background
1。 Existential crises include problems in everyday living； lack of
meaningful human relationships； and absence of goals or purpose
2。 Existential…humanistic philosophy gave rise to the human…potential
movement； which enpassed practices and methods enhancing the
potential of th