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personality disorders rarely e in for treatment on their own。 Often； their only reason
for attempting therapy is external pressure； such as a court order or a demand by a
spouse who threatens to leave them。 Is it ethically justifiable to subject someone to an
intensive； expensive effort to alter his or her style of life； especially when that person
doesn't want to be there and the chances of success are often minimal？ One might argue
that if the person is not harming anyone else； such efforts are not ethically justifiable。 On
the other hand； people with certain types of personality disorders； such as antisocial；
narcissistic； and paranoid personality disorder； can represent a real danger to others in
some cases。 The duty to protect others might then justify “forced” therapy in these cases。
One might also argue； however； that since success rates in treatment are often so low； the
best way to protect others is to imprison people with these disorders when their behavior
harms others in an illegal manner。 What do students think about these issues？
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SUPPLEMENTAL LECTURE MATERIAL
The Role of Critical Thinking in Emotional Problems
Cognitive therapists feel that certain emotional disorders； like anxiety and depression； can be
traced to irrational and illogical ways of thinking。 Let us look at some of the fallacies that
cognitive psychologists have noted in the thought processes of some people with emotional
disorders。
Faulty generalization。 This is the tendency to use a particular event or item of information as
the basis for a general conclusion。 The man whose wife leaves him concludes that no one
could ever love him。 The student who fails a test concludes that she is a failure。 The woman
who gets an occasional headache concludes that she is an unhealthy person。
Polarized thinking。 This is the tendency to classify people； events； behavior； and thoughts
rigidly as polar opposites： right or wrong； good or bad。 This is also called dualistic thinking；
black…and…white thinking； and bifurcation。 This tendency is often described as an effort to
oversimplify reality。 A woman feels that if a person does not give clear evidence of liking her；
then the person must dislike her。 An adolescent feels that thinking about anything related to
sex is bad and tries unsuccessfully to have only pure thoughts。
Incorrect assumptions about what is safe and what is threatening。 The maladjusted person may feel
that it is threatening to express his views or to show her anger。 Taking the initiative to talk
with a person of the opposite sex may be perceived as threatening。 The person could just
walk away； or could say something hurtful。
Maladaptive attitudes toward pleasure and pain。 These are the attitudes that say if an activity is
pleasant； it must be sinful； and if it is unpleasant； it means you have done the right thing。
This is analogous to thinking that a medicine is no good unless it is painful to apply or tastes
bad。 This type of thinking may result from selectively remembering pleasurable behaviors
that were punished and unpleasant activities that were rewarded。 Erikson； who was a
psychodynamic psychologist； suggested that while the superego； or conscience； can be very
powerful； it also has a tendency to be juvenile； simply because it was established in
childhood。 He thought that some people could suffer terrible guilt because of this juvenile
superego’s conviction that pleasurable things are “bad。”
Tyranny of “shoulds。” This is the tendency to dedicate one’s life to self…imposed obligations
and responsibilities； and to feel anxious； depressed； or guilty if a “should” is left undone。 “I
should go to that meeting；” “I should write to Aunt Hattie；” “I should change the sheets on
my bed。” It is conceivable that a person could have more “shoulds” than there are hours in
the day to execute them。 Psychodynamic psychologists would attribute this situation to a
domineering superego。
Biased attributions。 Attributions are an attempt to understand events by proposing a cause for
them。 In the case of the maladjusted person； the primary problem is the causes proposed to
explain personal behavior or events that involve the self。 The bias may be in the direction of
protecting the self； in which case the maladjusted person attributes successes and positive
events to other people or environmental circumstances； and failures and negative events to
his or her own efforts or abilities。 A psychodynamic psychologist might describe this as
overuse of defense mechanisms； like rationalization and projection。 What does a well…
adjusted individual do？ He or she internalizes； or takes credit for success； and externalizes
experiences of failure。 Maladjusted individuals must do the opposite； he or she may go to the
opposite extreme； attributing successes and positive events to others or environmental factors
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CHAPTER 16： THERAPIES FOR PERSONAL CHANGE
and failure and negative events to his or her own lack of initiative or ability。 In one case； the
maladjusted person is protecting a fragile self…esteem； and in the other； the person is
confirming low self…esteem。
Personalization of events。 This is a mild form of delusions of reference； a condition in which
there is a tendency to see personal significance in the behavior of others。 A person goes to a
party at which the host serves Mexican food。 The person does not like Mexican food and
thinks that the host served it to spite him or her。 The professor scolds the class for poor
performance on a test。 A student feels that the message is intended for him or her personally。
You may have noticed that the types of faulty thinking described by cognitive psychologists as
roots of emotional disorders are similar to uncritical； rigid thinking in general。 Faulty thinking
can distort our interpretation of events； and it can cause us to make unfortunate decisions。
Why Does Therapy Sometimes Fail？
Putting the blame on science。
We do not know the causal agent for most mental disorders because mental disorders； unlike
most physical illnesses； have no easily identifiable germ； bacteria； virus； organic damage； or
psychosocial factor that has been associated with the majority of cases。 The medical model
contends that we will eventually identify biological causes for mental disorders。 The psychosocial
model points to life experiences； stress； and sociocultural forces as causes。 Currently； a synthesis
of these two theories prevails； biological and psychosocial forces interact as causal agents。 Mental
disorders seem to be like headaches in that they may result from any of many causes。 Therapists
of different theoretical orientations have their own explanations for mental disorders。
Diagnosis of most mental disorders must be made based on signs and symptoms； what the
mental health professional observes in the patient’s behavior； and the patient’s description of his
plaint。 Symptom patterns are usually not clear…cut or easily associated with a particular
diagnostic category； and mental health professionals do not get diagnostic help from analysis of
blood or urine or X…rays。
Putting the blame on the therapists。
Research suggests that the personality； experience； and talent of the therapist are more important
in determining the success of therapy than the type of therapy utilized。 In other words； the
person…therapist is more important than whether the therapy is psychoanalytic； humanistic；
behavioral； or eclectic。
It is more difficult for therapists to be objective than it is for medical practitioners to be so；
because the therapist cannot entirely avoid intrusions of his or her own values and preferences
into the perception and interpretation of the patient’s behavior and disclosures。 This problem is
accentuated when the therapist and the patient have divergent socioeconomic； cultural； or ethnic
backgrounds； or perhaps are of different genders。
Carl Rogers said that to be effective a therapist must be empathic； able to feel with the client；
warm and accepting； and genuine。 Empathy and warmth cannot be merely a professional facade。
Yet； the important criteria for admission to most graduate and professional schools are
intellectual ability and academic achievement； rather than warmth and genuineness。 There may
well be a gift or a talent that is an important ingredient in therapy that many therapists do not
possess—or that was selected out of postgraduate admissions。
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PSYCHOLOGY AND LIFE
Putting the blame on the patients。
For convenience； we can put people who undergo psychotherapy into one of two categories。
First； there are those who are in therapy because they were coerced or forced by family； authority
figures； or the courts。 Second； there are those who voluntarily seek therapy because their
abnormal behavior is causing them pain or problems。 It is not difficult to understand why
therapy often fails when patients are coerced or forced； but why does it fail to help those who
actively seek help with the intention of cooperating and