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Psychology Journal

Recommend a treatment forthe following problems: com-pulsive overeating, inability tofinish work, severe depression.Write your recommendations inyour journal. ■

Chapter Overview Visit the Understanding PsychologyWeb site at psychology.glencoe.comand click on Chapter 17—ChapterOverviews to preview the chapter.

PSYCHOLOGY

http://www.glencoe.com/sec/socialstudies/psychology/psych2001/chapter17/overview.html

At certain times of transition and crisis in life, we may feel an urgentneed to find someone trustworthy with whom to share ourdoubts and problems. A parent, relative, or close friend is often

helpful in such times of need. Many psychological problems, however,are too bewildering and complex to be solved in this way. When peoplebecome dissatisfied or distraught with life and suspect that the reason lieswithin themselves, they are likely to seek help from someone with train-ing and experience in such matters. These people seek therapy, whichrefers to treatment of behavioral, bodily, or psychological disorders.Mental health professionals who have been trained to deal with the psy-chological problems of others include psychologists, psychiatrists, and

What Is Psychotherapy?

■ Main IdeaPsychotherapy is a general term for theseveral approaches used by mentalhealth professionals to treat psychologi-cal disorders.

■ Vocabulary• psychotherapy• eclectic approach• placebo effect• empathy• group therapy

■ Objectives• Explain the nature of psychotherapy.• Describe the role of a therapist.

Reader’s GuideExploring Psychology

When Should You Seek Help?Her husband had brought her to the

hospital because she had refused to eat forabout three days, slept fitfully, and spentlong hours staring off into space. Shewould speak to those around her, but onlyafter more or less continuous coaxing. Invery slow monotonous speech, she com-mented that she was talking to her deadsister who was wearing a white gown, butwith a face eaten up by worms and withpart of her eyesocket missing. This hallu-cination was intermixed with some discus-sion between the patient and God thatseemed to center around a mixture ofpleading with Him to do something abouther sister and reprimanding Him for let-ting her get into that condition.

—from Abnormal Behavior, Psychology’s View by F.B. McMahon, 1976

Chapter 17 / Therapy and Change 485

psychotherapy: any treat-ment used by therapists to helptroubled individuals overcometheir problems

social workers. The special kind of help they provide is called psy-chotherapy. Psychotherapy involves three things: verbal interactionbetween a therapist and client; the development of a supportive and trust-ing relationship; and an analysis by the therapist of the client’s problems,including suggestions for overcoming those problems.

THE NATURE OF PSYCHOTHERAPYPsychotherapy literally means “healing of the soul,” and in early times

people often thought that psychological disturbances represented some sortof moral or religious problem. People with personal problems were sometimes

viewed as being inhabited by demons, and treatment con-sisted of exorcism—the driving out of these demons byreligious ceremonies or by physical punishment. Withinthe last 200 years, however, views of psychological disorders have changed. Psychological disorders slowlycame to be thought of as diseases, and the term mental illness was applied to many psychological problems.

That psychological disturbance is now seen as thesymptom of a disease has helped reduce the stigmaassociated with such problems, and it has done muchto convince society that troubled people need careand treatment. Nevertheless, many psychotherapistsfeel that the term mental illness has outlived its useful-ness and that, in fact, it may now be doing more harmthan good.

The trouble with letting a person think of himselfas mentally ill is that he sees himself in a passive,helpless position. He sees his troubles as beingcaused by forces over which he has no control. Bythinking of himself in this way, the person can avoidtaking responsibility for his own situation and forhelping himself change.

Functions of PsychotherapyOne of the functions of psychotherapy is to help

people realize that they are responsible for their ownproblems and that, even more importantly, they arethe only ones who can really solve these problems.This approach does not imply that people becomedisturbed on purpose or that no one should need out-side help. People often adopt certain techniques forgetting along in life that seem appropriate at the timebut that lead to trouble in the long run. Such patternscan be difficult for the individual to see or change.The major task of the therapist, therefore, is to helppeople examine their way of living, to understand

486 Chapter 17 / Therapy and Change

Is This Treatment?

In earlier times, people with serious psy-chological disorders were labeled mad orlunatics. These people were often tortured,hanged, burned at the stake, or sent to seain “ships of fools” to be saved by fate.How do you think society regards peoplewith psychological disorders today?

Figure 17.1

how their present way of liv-ing causes problems, and tostart living in new, more ben-eficial ways. The therapist canbe thought of as a profession-al hired by the individual tohelp him find the source ofhis problems and some pos-sible solutions.

Main Kinds of Therapy There are many different

kinds of therapy. However,only a few of them will bedescribed in this chapter,including psychoanalysis,humanistic, cognitive,behavioral, and biologicalapproaches to treatment(see Figure 17.2). Each oneis based on different theo-ries about how humanpersonality works, andeach one is carried out in a different style. Some psychotherapists stick rig-orously to one style andconsider the other stylesless useful. Other psycho-therapists use an eclecticapproach to therapy,choosing methods frommany different kinds oftherapy and using the onethat works best. Whateverthe style or philosophy, alltypes of psychotherapyhave certain characteris-tics in common.

Goals of Therapy The primary goal of psychotherapy is to strengthen the patient’s control

over his or her life. People seeking psychotherapy need to change theirthoughts, feelings, and behaviors. Over the years, they have developed notonly certain feelings about themselves but also behaviors that reinforce thosefeelings. Their behaviors and feelings make it difficult or impossible for themto reach their goals.


A lthough at the early ageof 14 Dorothea Dix

established her own schoolfor young children, she isbest remembered as anactivist for the rights of thementally ill. In 1841 a member of the clergy asked Dix to teach a Sunday school class at a local prison in Massachusetts. When she arrived at the prison, Dix became horrified to see mentally ill patients locked up with prisoners in dark, unheated, and filthy rooms.

Dix set out on a crusade that would last a lifetime. She touredsimilar jails throughout several states, reporting to the public theappalling things she witnessed. She saw people chained up and sitting in filth. She found people whose worst crimes were havingpsychological disorders confined and beaten in prisons. Sheobserved men, women, and children thrown together in jail cells.

At a time when women were thought incapable of speaking inpublic, Dix reported her findings to state legislatures. Her strugglesresulted in the reform of prisons and the treatment of people withpsychological disorders.

Dorothea Dix1802–1887

“I proceed, Gentlemen,briefly to call your

attention to the presentstate of Insane Persons

confined within thisCommonwealth, in

cages, closets, stalls,pens! Chained, naked,beaten with rods, and

lashed into obedience!”

Profiles In Psychology

eclectic approach: methodthat combines various kinds oftherapy or combinations oftherapies

One of the most important factors in effective treatment is the patient’sbelief or hope that he can change. The influence that a patient’s hopes andexpectations have on his improvement is often called the placebo effect.This name comes from giving medical patients placebos, inert sugar pills,when they complain of ailments that do not seem to have any physiologi-cal basis. The patients take the tablets, and their symptoms disappear.

The placebo effect does not imply that problems can be solved simplyby fooling the patient. It does demonstrate, however, the tremendousimportance of the patient’s attitude in finding a way to change. A patientwho does not believe he can be helped probably cannot be. A patient whobelieves he can change and believes he has the power to change will finda way. Therapy goes beyond the placebo effect. It combines the patient’sbelief that he can change with hard work and professional guidance.

WHO ARE THERAPISTS? In American society, there are many people who practice psy-

chotherapy. Some, like clinical psychologists, are trained in psychologicaltesting, assessment, and diagnosis. Counseling psychologists have beentrained to deal with problems of adjustment. The various kinds of thera-pists and the training that each goes through before practicing psy-chotherapy are shown in Figure 17.3.

What Makes a Good Therapist? Before going to a professional therapist, most people first turn to a friend

or other nonprofessional for help and advice. Sometimes, this is exactlywhat’s needed. Professional therapists, however, are likely to be more skillfulin encouraging the person to examine uncomfortable feelings and problems.


Types of Psychotherapies

There are several types of therapies. The ones listed in this chart arecommonly used methods. Which method would probably be mosteffective for treating someone with an eating disorder?

Figure 17.2

Therapy Method Main Technique(s) Main Goal Means of Achieving Goal

Psychoanalysis free association, dreamanalysis, transference

reduce anxiety and guiltfrom unconscious urges

verbal processes

Humanistic Therapy active listening, accep-tance, support

fulfill one’s potential andimprove self-concept

verbal processes

Cognitive Therapytalking, listening, role-playing, and completion ofassignments

unite behaviors andthought

revising thoughts

Behavior Therapy counterconditioning, operant conditioning, systematic desensitization

change one’s unwanted orabnormal behaviors andacquire desirable behaviors

behavioral training

placebo effect: the influ-ence that a patient’s hopesand expectations have on his or her improvementduring therapy

There are three characteristics found in effective therapists. First, a ther-apist needs to be psychologically healthy. A therapist who is anxious, defen-sive, and withdrawn will not be able to see the patient’s problems clearly. Asecond important characteristic is empathy, a capacity for warmth andunderstanding. Troubled people are usually fearful and confused aboutexplaining their problems. The therapist needs to be able to give the patientconfidence that he is capable of caring and understanding. Finally, a goodtherapist must be experienced in dealing with people and understandingtheir complexities. Only by having worked with many people can a thera-pist learn when to give support, when to insist that the patient stand on hisown feet, and how to make sense of the things people say.

GROUP THERAPIES In some forms of therapy, the patient is alone with the therapist. In

group therapy, however, she is in the company of other patients. Thereare several advantages to this situation. A person in group therapy has a

empathy: capacity for warmthand understanding


Clinical psychologists are therapists with a Ph.D. or a Psy.D., a Doctor of Psychology. They treat people with psy-chological disorders in hospitals, clinics, and community health centers.

Counseling psychologists generally have a master’s or Ph.D. degree in counseling psychology. They usually workin educational institutions, where they are available for consultation about personal problems. They customarily referclients with serious problems to clinical psychologists or psychiatrists.

Clinical Neuropsychologists have Ph.D. degrees. They have extensive education in neurophysiology regarding themechanisms and operation of the brain. They typically work with patients who have a brain injury that is interferingwith normal behavior. Such damage may result from drug use, accidents, or normal aging. Their primary role hasbeen in assessing neurological damage; some are now involved in therapy.

Psychiatrists are medical doctors. They take postgraduate training in the causes and treatment of abnormal behavior. Because of their medical background, psychiatrists are licensed to prescribe medicines and are the onlygroup that can perform operations.

Psychoanalysts are usually medical doctors who have taken special training in the theory of personality and tech-niques of psychotherapy of Sigmund Freud, typically at a psychoanalytic institute. They must themselves be psy-choanalyzed before they can practice.

Psychiatric social workers are people with a master’s degree in social work. They counsel people with everydayproblems.

Psychiatric nurses have a standard nursing license and advanced training in psychology. They dispense medicineand act as a contact person between counseling sessions.

Counselors have a master’s degree from a counseling program. They dispense advice and may or may not have anytraining in psychology. Nevertheless, more troubled people turn to counselors than to other kinds of therapists.

Kinds of Therapists

Several groups of people practice psychotherapy. Not all of them have professional training inpsychology. What is the difference between a counselor and a psychoanalyst?

Figure 17.3

group therapy: patientswork together with the aid of a leader to resolve interpersonalproblems

chance to see how other people are struggling with problems similar toher own, and she discovers what other people think of her. She, in turn,can express what she thinks of them, and in this exchange she discoverswhere she is mistaken in her views of herself and of other people andwhere she is correct (Drum, 1990). In group therapy she can also seeother people with similar problems recovering, giving her the hope ofrecovery.

Another advantage to group therapy is that one therapist can help alarge number of people at a reduced cost. Most group-therapy sessionsare led by a trained therapist who makes suggestions, clarifies points, andkeeps activities from getting out of hand. In this way, her training andexperience are used to help as many as 20 people at once, although 8–10is a more comfortable number. It is possible to use psychoanalytical, cog-nitive, and behavioral techniques in a group setting.

Family Therapy Therapists often suggest, after talking to a patient, that the entire

family unit should work at group therapy. In family therapy, the focusis on the interactions among the family members. This method is particularly useful because it untangles the twisted web of relationshipsthat has led one or more members of the family to experience emotional suffering.

Often family members are unhappy because they are mistreating orare being mistreated by other family members in ways no one under-stands or wants to talk about. The family therapist can point out what is

happening from an objec-tive viewpoint and can sug-gest ways of improvingcommunication and fair-ness in the family. Not allgroup therapies are run by professionals, however.Some of the most suc-cessful examples are pro-vided in nonprofessionalorganizations, such as self-help groups.

Self-Help Groups An increasing number

of self-help groups haveemerged in recent years.These voluntary groups,composed of people whoshare a particular problem,are often conducted with-out the active involvementof a professional therapist.


Family Therapy

In a family-therapy session, the therapist observes the interactions inorder to discern, describe, and treat the patterns that may contributeto the disturbance of one or more of its members. What does askilled therapist provide in a family-therapy session?

Figure 17.4

Reading CheckWhat are the advantages

of group therapy?

During regularly scheduled meetings, members of the group cometogether to discuss their difficulties and to provide one another withsupport and possible solutions.

Self-help groups have been formed to deal with problems rang-ing from alcoholism, overeating, and drug addiction to childabuse, widowhood, single parenting, adjusting to cancer, and gam-bling. The best-known self-help group is Alcoholics Anonymous(AA), which was founded in 1935. Far more people find treatmentfor their drinking problems through AA than in psychotherapy ortreatment centers. Many self-help groups have based their organi-zations on the AA model in which individual members can call onother members for help and emotional support.

The purpose of Alcoholics Anonymous is “to carry the AA messageto the sick alcoholic who wants it.” According to AA, the only way foralcoholics to change is to admit that they are powerless over alcoholand that their lives have become unmanageable. Alcoholics must cometo believe that some power greater than themselves can help them.Those who think they can battle the problem alone will not be suc-cessful. There are also AA-based groups, such as Al-Anon and Alateen,for family members for mutual support.

Members of AA usually meet at least once a week to discuss themeaning of this message, to talk about their experiences with alcohol, andto describe the new hope they have found with AA. Mutual encourage-ment, friendship, and an emphasis on personal responsibility are used tokeep an individual sober.

DOES PSYCHOTHERAPY WORK? In 1952 Hans Eysenck published a review of five studies of the effec-

tiveness of psychoanalytic treatment and 19 studies of the effectiveness ofeclectic psychotherapy, treatment in which several different therapeuticapproaches are combined. Eysenck concluded that psychotherapy wasno more effective than no treatment at all. Accordingto his interpretation of these 24 studies, only 44 per-cent of the psychoanalytic patients improved withtreatment, while 64 percent of those given eclecticpsychotherapy had improved.

Most startling, Eysenck argued that even this 64 percent improvement rate did not demonstrate theeffectiveness of psychotherapy, since it has beenreported that 72 percent of a group of hospitalizedneurotics improved without treatment. If no treatmentat all leads to as much improvement as psychother-apy, the obvious conclusion is that psychotherapy isnot effective. Eysenck (1966) vigorously defended hiscontroversial position, which generated a large num-ber of additional reviews and a great many studies ofthe effectiveness of psychotherapy.


?Did You Know?Did You Know?

Conducting Therapy There are fourareas of concern that a therapist might discuss with the patient.

1) Identify the problem behavior based onthe classification scheme for psycho-logical disorders.

2) Propose some ideas about the historyand cause of the problem.

3) Explain the details of what is included inthe treatment program.

4) Make a time line for the course of treatment.

AA logo

Allen Bergin (1971) wrote one of the most thought-ful and carefully reasoned reviews. Bergin’s review leadsone to question the validity of Eysenck’s sweeping gen-eralization that psychotherapy is no more effective thanno treatment at all. Much of Bergin’s argument is basedon differences of opinion about how patients should beclassified. Precise criteria for improvement are difficultto define and apply. Some people may experience spon-taneous remission, or the sudden, unaccountable disap-pearance of symptoms without any therapy at all.However, such people may have received help fromunacknowledged sources—family, friends, relatives, reli-gious advisers, or family physicians. If, as someresearchers believe, the prime ingredient in therapy isthe establishment of a close relationship, then sponta-neous remission in people who have received continu-ing help from such sources is not spontaneous at all.

An analysis of nearly 400 studies on the effectiveness of psychothera-py, conducted by Mary Lee Smith and Gene V. Glass (1977), used elabo-rate statistical procedures to estimate the effects of psychotherapy. Theyfound that therapy is generally more effective than no treatment and thaton the average most forms of therapy have similar effects; that is, therapymay improve the quality of life for the patients. Will any therapy do forany client? Probably not. Smith and Glass were able to show that for somespecific clients and situations, some forms of therapy would be expectedto have a greater effect than others. Together, the psychologist and clientmay discuss the appropriate form of psychotherapy to achieve a cure.

1. Review the Vocabulary Cite anddescribe two examples of group therapyand how these types of therapy helppatients.

2. Visualize the Main Idea In a diagramsimilar to the one below, list anddescribe the characteristics that make agood, effective therapist.

3. Recall Information What are the goals of therapy? What is the eclecticapproach to therapy?

4. Think Critically When should a person seek psychotherapy? Explainyour answer.

Assessment

5. Application Activity You are unsure of yourself. You do not know what to do with yourfuture. As a result, you decide that you need thehelp of a professional to get your personal life ontrack. Identify the kind of psychotherapist andthe kind of therapy that might help you. Explainyour answers.

Therapy and HMOsRecent economic trends have affected

the length of time a person spends in psychotherapy. People who receive theirhealth care through health maintenanceorganizations (HMOs) pay a fixed amountof money per month for health care. The HMO will then pay for only a certainamount of therapy per month. The HMO in effect minimizes the amount of servicesa person can obtain, so a person whorequires extensive therapy may not be ableto get it unless he pays for it on his own.

Characteristics of a Good Therapist


The dream above was experienced by an elderly woman fighting aserious illness. Psychoanalysts might interpret the dream in thefollowing manner: the earth symbolized the illness as well as the

woman’s concern that she might die. As a child, she had never beenallowed to own a bicycle, so having one represented freedom. The bikesymbolized something she badly wanted—good health. Psychoanalystswould then use this information—the dream interpretation—to help thewoman understand the psychological dilemmas she faces.

Psychoanalysis andHumanistic Therapy

■ Main IdeaPsychoanalysis is an analysis of the con-scious and unconscious mind based onthe theories of psychiatrist SigmundFreud. Humanistic therapy helps peoplereach their full potential.

■ Vocabulary• psychoanalysis• insight• free association• resistance• dream analysis• transference• humanistic therapy• client-centered therapy• nondirective therapy• active listening• unconditional positive regard

■ Objectives• Describe psychoanalysis and its aims.• Explain humanistic therapy and its

goals.

Reader’s GuideExploring Psychology

What Does This Dream Mean?I was a child again, and riding my

bicycle along the village street, but itswheels began to sink into sticky, muddyearth, so that I could barely move. Finally,however, the earth began to dry, and Ifound that I was able to cycle along quiteeasily once more.

—from Parker’s Complete Book of Dreams byJulia and Derek Parker, 1995


psychoanalysis: therapyaimed at making patients awareof their unconscious motives sothat they can gain control overtheir behavior

insight: the apparent suddenrealization of the solution to aproblem

free association: a methodused to examine the uncon-scious; the patient is instructedto say whatever comes into hisor her mind

resistance: the reluctance ofa patient either to reveal painfulfeelings or to examine long-standing behavior patterns

WHAT IS PSYCHOANALYSIS?For a long time psychoanalysis was the only formalized psy-

chotherapy practiced in Western society. It was this type of therapy thatgave rise to the classic picture of a bearded Viennese doctor seatedbehind a patient who is lying on a couch.

Psychoanalysis is based on the theories of Sigmund Freud. Accordingto Freud, psychological disturbances are due to anxiety caused by hiddenconflicts among the unconscious components of one’s personality.(Freud’s theory of personality is described in Chapter 14.) One job of thepsychoanalyst, therefore, is to help make the patients aware of the uncon-scious impulses, desires, and fears that are causing the anxiety.Psychoanalysts believe that if patients can understand their unconsciousmotives, they have taken the first step toward gaining control over theirbehavior and freeing themselves of their problems. Such understanding iscalled insight.

Free Association Psychoanalysis is a slow procedure. It may take years of 50-minute

sessions several times a week before the patient is able to make funda-mental changes. Throughout this time, the analyst assists the patient in athorough examination of the unconscious motives behind his or herbehavior. This task begins with the analyst telling the patient to relax andtalk about everything that comes to mind. This method is called freeassociation. The patient may consider some passing thoughts too unim-portant or too embarrassing to mention. The analyst suggests that every-thing should be expressed; the thought that seems most inconsequentialmay, in fact, offer insight into the unconscious.

As the patient lies on the couch, he or she may describe dreams, dis-cuss private thoughts, or recall long-forgotten experiences. The psycho-analyst often says nothing for long periods of time. The psychoanalystalso occasionally makes remarks or asks questions that guide the patient.The analyst also may suggest an unconscious motive or factor thatexplains something the patient has been talking about, but most of thework is done by the patient.

The patient is understandably reluctant to reveal painful feelings andto examine lifelong patterns that need to be changed and, as the analysisproceeds, is likely to try unconsciously to hold back the flow of informa-tion. This phenomenon—in fact, any behavior that impedes the course oftherapy—is called resistance. The patient may have agreed to cooper-ate fully, yet at times his or her mind is blank, and he or she feels power-less and can no longer think of anything to say. At such times the analystwill simply point out what is happening and wait for the patient to con-tinue. The analyst may also suggest another line of approach to the areaof resistance. By analyzing the patient’s resistances, both the therapist andthe patient can understand the source of the anxieties and how thepatient deals with anxiety-provoking material.


Dream Analysis Freud believed that dreams express

unconscious thoughts and feelings. In a tech-nique known as dream analysis, the psycho-analyst interprets the client’s dream to find theunconscious thoughts and feelings in it.

Freud believed that dreams contain mani-fest and latent content. Manifest content refersto what you remember about your dream. Forinstance, you recall seeing your house fallapart, brick by brick, in last night’s dream.Latent content refers to the hidden meaningsrepresented symbolically in the dream that thetherapist interprets from the manifest content.For example, a therapist might interpret adream involving a deteriorating house tomean that you are upset about current healthproblems or are worried about your health.

TransferenceSooner or later, the analyst begins to appear in the patient’s associa-

tions and dreams. The patient may begin feeling toward the analyst theway she feels toward some other important figure in her life. This processis called transference.

If the patient can recognize what is happening, transference mayallow her to experience her true feelings toward the important person.Often, instead of experiencing and understanding her feelings, the patientsimply begins acting toward the therapist in the same way she used to acttoward the important person, usually one of her parents.

The therapist does not allow the patient to resort to these tactics.Remaining impersonal and anonymous, the therapist always directs thepatient back to herself. The therapist may ask, for example, “What doyou see when you imagine my face?” The patient may see the therapistas an angry, frowning, unpleasant figure. The therapist never takes thispersonally, instead asking, “What does this make you think of?”Gradually, it will become clear to both patient and therapist that thepatient is reacting to the neutral therapist as though he or she were athreatening parent, for example.

By understanding transference, the patient becomes aware of hiddenfeelings and motivations. She may begin to understand, for example, theroots of trouble with her boss at work. The boss, the therapist, or any per-son in a position of authority may be viewed in the same way that, as achild, she saw her parents.

The purpose of psychoanalysis is to show the role of the unconsciousand to provide insight for the client. This type of classical psyche (mind)analysis, however, is not for everyone. It requires an average of 600 ses-sions and years of meeting with a psychoanalyst. Psychoanalysis has


What Do Our Dreams Mean?

While we sleep, our dreams probably do not followlogical thought patterns. Because of this, Freudconsidered dreams the purest form of free associa-tion. What do therapists hope to learn from ana-lyzing dreams?

Figure 17.5

dream analysis: a techniqueused by psychoanalysts tointerpret the content ofpatients’ dreams

transference: the process,experienced by the patient, offeeling toward an analyst ortherapist the way he or shefeels or felt toward some otherimportant figure in his or her life

humanistic therapy:focuses on the value, dignity,and worth of each person;holds that healthy living is theresult of realizing one’s fullpotential

client-centered therapy:reflects the belief that the clientand therapist are partners intherapy

changed with patients, disorders, and the prevailing cultures. Thereare many versions available today of this classical psychoanalysis. For

example, short-term dynamic psychotherapy is a shortened version ofpsychoanalysis. This type of therapy focuses on a client’s prob-lems. The therapist uses a direct and more active approach inidentifying and resolving the problems. This approach to

therapy, along with psychoanalysis, works well for clients who areable to gain insight into their behavior. People who lose

touch with reality—for instance, a person sufferingfrom schizophrenia—will probably not benefit frompsychoanalysis, though.

HUMANISTIC THERAPY The goal of humanistic therapy is to help

people fulfill their human potential. Humanistic psy-chology has given rise to several approaches to psy-chotherapy, known collectively as client-centeredtherapy. Humanistic psychologists stress the actu-alization of one’s unique potentials through per-sonal responsibility, freedom of choice, andauthentic relationships.

Client-Centered TherapyClient-centered therapy, or person-centered therapy, is based on the

theories of Carl Rogers (1951, 1977). This therapy depends on the person’sown motivation toward growth and self-actualization. The use of the termperson or client instead of patient gives one an insight into the reasoningbehind Rogers’s method. Patient may suggest inferiority or passivity, whereas person or client implies an equal relationship between the therapistand the individual seeking help. According to Rogers, this equal relationshipreflects three therapeutic components—positive regard, empathy, and gen-uineness. Positive regard refers to the therapist’s ability to demonstrate car-ing and respect for the client. Empathy is the ability to understand what theclient is feeling. Genuineness refers to the therapist’s ability to act toward theclient in a real and nondefensive manner.

Client-centered therapists assume that people are basically good and thatthey are capable of handling their own lives. Psychological problems arisewhen the true self becomes lost and the individual comes to view the selfaccording to the standards of others. One of the goals of therapy is to help theperson recognize his or her own strength and confidence, thereby learning tobe true to his or her own standards and ideas about how to live effectively.

Techniques of Client-Centered Therapy In the course of an interview, theclient is encouraged to speak freely about any troubling matters. The topicsdiscussed are entirely up to the client. This method is called nondirectivetherapy because the therapist does not direct it. The therapist listens andencourages conversation but tries to avoid giving opinions.


Reading CheckWhy did Rogers choose

to refer to a patient as a“client”?

“Of course you have strengths, dear. It’s just that you don’t communicate them.”

Humanistic Approaches to Therapy

Humanistic therapies attempt to help clientsmake better use of their own abilities. Howdoes this cartoon reflect a humanisticapproach?

Figure 17.6

nondirective therapy: thefree flow of images and ideas,with no particular direction


The therapist tries to echo back, as clearly as possible, the feelings the client has expressed. This communication technique is called active listening. The therapist may try to extract the main points fromthe client’s hesitant or rambling explanations. Between them, the clientand therapist form a clearer picture of how the client really feels about self,life, and important others.

Client-centered therapy is conducted in an atmosphere of emotionalsupport that Rogers calls unconditional positive regard. The therapistnever says what he or she thinks of the client or whether what the client hassaid is good or bad. Instead the therapist shows the client that anything saidis accepted without embarrassment, reservation, or anger. The therapist’smain responsibility is creating and maintaining a warm and accepting relationship with the client. This acceptance makes it easier for clients toexplore thoughts about themselves and their experiences. They are able toabandon old values without fear of disapproval, and can begin to see them-selves, their situations, and their relationships with others in a new light andwith new confidence.

As they reduce tensions and release emotions, the clients feel thatthey are becoming more complete people. They gain the courage toaccept parts of their personalities that they had formerly consideredweak or bad. By recognizing their self-worth, they can set up realisticgoals and consider the steps necessary to reach them. The clients’movements toward independence signal the end of the need for thera-py; they can assume the final steps to independence on their own.

Although client-centered therapy has proved more effective than notreatment, it seems to be no more or less effective than other types of ther-apy. Client-centered therapy has helped, though, make therapists aware ofthe importance of developing supportive relations with their clients.

active listening: empatheticlistening; a listener acknowl-edges, restates, and clarifiesthe speaker’s thoughts andconcerns

unconditional positiveregard: a therapist’s consis-tent expression of acceptanceof the patient, no matter whatthe patient says and does

PSYCHOLOGY

Student Web Activity Visit the UnderstandingPsychology Web site at psychology.glencoe.com andclick on Chapter 17—Student Web Activitiesfor an activity about psychotherapy.

1. Review the Vocabulary Cite anddescribe the techniques involved inclient-centered therapy.

2. Visualize the Main Idea In a chartsimilar to the one below, list anddescribe the main processes involved in psychoanalysis.

3. Recall Information What is the purpose of dream analysis? How dotherapists use it?

4. Think Critically What are the maindifferences between psychoanalysis andhumanistic therapy?

Assessment

5. Application Activity Some therapists mayview therapy as a process of teaching a client aphilosophy of life. Do you think this therapy goalis appropriate? Does this goal assume the thera-pist has the better philosophy of life? Argue yourpoint in an editorial-type essay.

Processes of Psychoanalysis

1

2

3

4

http://www.glencoe.com/sec/socialstudies/psychology/psych2001/chapter17/webact.html


began to beat him immediately after the incidentoccurred. Rat Man responded to the beatings witha multitude of angry and harsh words directedtoward his father. After hearing those words, RatMan’s father never beat him again. Freud sug-gested that the act of Rat Man biting the nurse wasa sexual action. Since his father beat him forindulging in his sexual needs (biting), Rat Man’sfear of fulfilling his needs for a relationshipstemmed from fear he would be punished.

A major breakthrough occurred when Rat Manrevealed another fantasy he had been having. Inthis fantasy, Rat Man was persuaded to marry

Freud’s daughter. These wishescame directly from Freud him-self (according to Rat Man’s fantasy). Freud immediatelyinterrupted and stated that RatMan was replacing the role ofhis father with Freud. Momentslater Rat Man became emotion-ally enraged at his therapist, andthis rage ended with an intensefear that Freud would beat him.This signified a chief discovery.Freud convinced Rat Man he

was reliving the event with his father by placingthe therapist in the father’s role.

Results: Before therapy, Rat Man had neverconsciously experienced anger toward his father.This anger came out in therapy sessions. To Freud,the rats biting into and destroying Rat Man’s fatherand girlfriend symbolized significant past events—Rat Man biting his first love, or the nurse, and inanother essence biting his father with angry words.According to Freud, Rat Man’s conscious accep-tance of the feelings of fear and anger toward hisfather would lead to a recovery. However, Rat Manwas never able to fully enjoy the newly foundinsights. Shortly after his sessions with Freud, RatMan was killed in World War I.

The Case of Rat ManPeriod of Study: Early 1900s

Introduction: Sigmund Freud used psycho-analysis with a patient Freud referred to as Rat Man.A 29-year-old man came to Freud complaining ofvarious fears, obsessions, and compulsions, orcravings, which had been occurring for approxi-mately six years. These symptoms had preventedthe man from completing his university studies andattaining success at work. Freudfocused on Rat Man’s uncontrol-lable fantasy in which the manwould see his father and girlfriendtied down and being torturedby hungry rats strapped totheir flesh.

Hypothesis: Freud’s earli-est hypothesis was that Rat Manmaintained a conflict overwhether he should marry his girl-friend or not. Since Rat Man wasunable to decide consciously, heresolved this issue through his unconscious mind.These unconscious thoughts produced disturbingpictures in his mind, thus making him unable tocarry out daily activities such as school and work.Freud also theorized that past love and hate issuesbetween Rat Man and his father caused the fatherto be in Rat Man’s dreams and fantasies.

Method: Freud began therapy with Rat Manby using a psychoanalytic technique called free association. Freud asked Rat Man to free-associate with the word rats. Rat Man came upwith the word rates, referring to installments ormoney. In an earlier session, Rat Man indicated hisgirlfriend had little money and his father had alwayswanted him to marry a wealthy woman. Freuddeduced the rat fantasies were related to thefather’s opposition to Rat Man’s girlfriend.

In another instance during therapy, Rat Mandescribed an event relayed to him by his mother,which had taken place when he was around fouryears of age. Rat Man claimed his mother had toldhim that as a little boy he had once bitten the nursewho was taking care of his father. Rat Man’s father

Analyzing the Case Study 1. Why did Rat Man seek therapy?

2. What was Freud’s strategy in treating Rat Man?

3. Critical Thinking How did Rat Man demonstratetransference? How did this transference help in therapy?

Reader’s Guide


2-line headH: 9p7.5

1-line headH: 8p7.5

Why would someone purposefully imagine the scene in the storyabove? Brooks’s behavior was not as strange as it sounds. Shewas trying to cut down on the number of soft drinks she had

each day. To achieve her goal, Brooks Workman used a method known asbehavior modification—one of several forms of behavior therapy oftenused to eliminate or alter an undesirable voluntary behavior. In this sectionwe will examine behavior and cognitive therapies.

COGNITIVE THERAPYThe goal of cognitive therapies focuses on changing the way people

think (Beck, 1991). Basic assumptions that cognitive therapies share are thatfaulty cognitions—our irrational or uninformed beliefs, expectations, and

behavior modification: asystematic method of changingthe way a person acts and feels

cognitive therapy:using thoughts to control emo-tions and behaviors

■ Main IdeaCognitive and behavior therapies helpclients develop new ways of thinkingand behaving.

■ Vocabulary• behavior modification• cognitive therapy• rational-emotive therapy (RET)• behavior therapy• systematic desensitization• aversive conditioning• contingency management• token economy• cognitive-behavior therapy

■ Objectives• Describe cognitive therapies and

their aims.• Explain the processes and goals of

behavior therapy.

Exploring Psychology

Imagine That!Five times a day for several days,

Brooks Workman stopped what she wasdoing and vividly imagined herself open-ing a soft drink can. She made a specialpoint of picturing herself bringing the canto her mouth and placing her lips on it.Just as she was about to drink, hordes ofroaches poured out of the can and scur-ried into her mouth, writhing, twitching,and wiggling their feelers.

—from Toward a Self-Managed Life Style byR.L. Williams and J.D. Long, 1979

Cognitive and BehaviorTherapies

ways of thinking—distort ourbehaviors, attitudes, and emo-tions. So to improve our lives, wemust work to change our pat-terns of thinking.

In what other ways are cognitive therapies similar?According to some psycholo-gists (Ross, 1977), all of thesetheories follow one or more ofthree principles—disconfirma-tion, reconceptualization, andinsight. Disconfirmation meansclients may be confronted withevidence that directly contra-dicts their existing beliefs. Inreconceptualization, clients worktoward an alternative belief sys-tem to explain their experiencesor current observations. Ininsight, clients work towardunderstanding and deriving newor revised beliefs.

Rational-Emotive TherapyAlbert Ellis developed a form of therapy called rational-emotive

therapy (RET) (1973). Ellis believed that people behave in deliberate andrational ways, given their assumptions about life. Emotional problemsarise when an individual’s assumptions are unrealistic (see Figure 17.7).

Suppose a man seeks therapy when a woman leaves him. He cannotstand the fact that she has rejected him. Without her, his life is emptyand miserable. She has made him feel utterly worthless. He must get herback. Like a spoiled child, the man is demanding that the woman lovehim. He expects, even insists, that things will always go his way. Giventhis assumption, the only possible explanation for her behavior is thatsomething is dreadfully wrong, either with him or with her.

What is wrong, in the therapist’s view, is the man’s thinking. Bydefining his feelings for the woman as need rather than desire, he—notshe—is causing his depression. When you convince yourself that youneed someone, you will in fact be unable to carry on without that per-son in your life. When you believe that you cannot stand rejection, youwill in fact fall apart when you encounter rejection. This kind of faultythinking is based on unreasonable attitudes, false premises, and rigidroles for behaviors.

The goal of rational-emotive therapy is to correct these false andself-defeating beliefs. Rejection is unpleasant but not unbearable. A relationship may be desirable, but it is not irreplaceable. To teach theindividual to think in realistic terms, RET therapists may use a


Examples of Irrational Thinking

Albert Ellis (1961) asserted that the irrational ideas we believe standin the way of achieving lives that are free of anxiety. How might aRET therapist counter these irrational beliefs?

Figure 17.7

Everything I do must be approved and loved by virtually everybody.

I have to be completely competent, totally in control, and successful in every-thing I do.

It is catastrophic when things are not going the way I want them to go.

My unhappiness is not my fault. People and events over which I have no control are responsible.

Anytime I encounter something that I fear, I need to be consumed with worries and upset about it.

It is easier to avoid life’s difficulties and responsibilities than to develop a better system for meeting them.

My life and the people with whom I work should be changed from the way they are.

The best I can do for myself is to relax and enjoy life. Inaction and passiv-ity are the best bet to maximize my own enjoyment.

rational-emotive therapy(RET): a form of psychologicalhelp aimed at changing unreal-istic assumptions about oneselfand other people

number of techniques. One is role playingso that the person can see how hisbeliefs affect his relationships. Anothertechnique is modeling to demonstrateother ways of thinking and acting. Athird is humor to underline the absurdityof his beliefs. Still another technique issimple persuasion. The therapist may alsoassign homework to give the man practicein acting more reasonably. For example,the therapist may instruct him to askwomen who are likely to reject him outon dates. Why? He will learn that he cancope with things not going his way.

Ellis liked to teach that behaviors arethe result of the ABCs. A refers to theActivating event. B is the person’s Beliefsystem about the event. C refers to theConsequences that follow. Ellis claimed itis not the event that causes trouble but rather the way a person thinksabout the event. In other words, A does not cause C, but instead B caus-es C (see Figure 17.8).

In therapy, the therapist and client work to change B, the belief. Ellisbelieves that the individual must take three steps to cure or correct him-self. First, he must realize that some of his assumptions are false. Second,he must see that he is making himself disturbed by acting on false beliefs.Finally, he must work to break old habits of thought and behavior. Hehas to practice self-discipline and learn to take risks.

Beck’s Cognitive Therapy Aaron T. Beck (1967, 1970) introduced another form of cognitive

therapy that is similar to Ellis’s rational-emotive therapy. The primarydifference in Beck’s therapyis the focus on illogicalthought processes (seeFigure 17.9). Beck has ther-apists—through using per-suasion and logic to changeexisting beliefs—also en-courage clients to engagein actual tests of their ownbeliefs. For example, if aclient believes that “I neverhave a good time,” thetherapist might point outthat this is a hypothesis,not a fact. The therapistmight then ask the client to


Ellis’s ABCs

Many cognitive thera-pists believe that ouremotional reactions tosituations are the resultnot of the situations butof our beliefs about thesituations or our inter-pretations of the situa-tions. On whataspect—A, B, or C—do cognitive thera-pists focus? Why?

Figure 17.8

AActivating event(e.g., a criticism)

BBelief

(e.g., “I must be loved byeveryone to be happy”)

CConsequent emotion

(e.g., unhappiness)

Beck’s Maladaptive Thought PatternsBeck believed that maladaptive thought patterns cause a distortedview of oneself and one’s world, leading to various psychologicalproblems. What is polarized thinking?

Figure 17.9

Overgeneralization Making blanket judg-ments about oneself

I’m a failure.

Polarized Thinking Categorizing informationinto two categories

Most people don’t likeme.

Selective Attention Focusing on only onedetail of many

People always criticizeme.

Maladaptive Thought Patterns Definition Example

test the hypothesis by looking at the evidence dif-ferently and note the times in her life when sheactually did have a good time. The therapist’sgoal is to demonstrate to the client that her auto-matic thinking may be incorrect and that thingsare not as bad as they seem.

Beck’s work has been very successful withpeople who are depressed. He believed thatdepressed people blame themselves instead oftheir circumstances. He also believed thatdepressed people focus on only negativeevents and ignore the positive events. Theymake pessimistic projections about the future.Finally, he believed they make negative con-clusions about self-worth based on events thatare not significant.

The goal of Beck’s cognitive therapy is tochange the way people think. The therapist’s

job is to determine the pace and direction of thetherapy and to help the client detect negative

thinking patterns. Therapists also help the clientuse more reasonable standards for self-evaluation.

Beck may also have clients do homeworkassignments to assess the true value of his or her

beliefs. They may be asked to engage in behaviorsthat test these beliefs outside of the office. For example,

a person who is not very assertive may be asked to cutinto a line at the grocery store, to interrupt people who are

talking, or to ask someone for a favor.

BEHAVIOR THERAPIES In behavior therapy there is emphasis on one’s behavior rather

than one’s thoughts, as in cognitive therapy. Rather than spending largeamounts of time going into the patient’s past or the details of his or herdreams, the behavior therapist concentrates on determining what isspecifically troubling in the patient’s life and takes steps to change it. Thegoal of behavior therapy is to modify one’s behavior.

The idea behind behavior therapy is that a disturbed person is onewho has learned to behave in an undesirable way and that any behaviorthat is learned can be unlearned. The therapist’s job, therefore, is to helpthe patient learn new behaviors. The reasons for the patient’s undesirablebehavior are not important; what is important is to change the behavior.By changing one’s behavior, one’s thoughts change as well. The person isasked to list concrete examples of desired behaviors and behavioral goals.Once these behaviors have been targeted, a program to achieve thesegoals is developed. To bring about such changes, the therapist uses con-ditioning techniques first discovered in animal laboratories.


How can someone overcome anirrational fear?Systematic desensitization is most often usedto help individuals overcome fears and anxi-eties. How is this technique applied?

Procedure1. Identify a situation that makes someone

you know fearful, or you can make up afear for an imaginary person.

2. Imagine that you are that person. List allthe aspects of the situation that you findfrightening and rank them in order from themost frightening to least frightening.

3. Suggest a step-by-step plan. Apply the systematic desensitization technique to helpovercome the fear.

Analysis1. Prepare a flowchart showing the steps

you would use to help the individualchange his or her behavior.

2. Why do you think this technique is ofteneffective in overcoming irrational fears?

See the SkillsHandbook, page 622,

for an explanation of designingan experiment.

behavior therapy:changing undesirable behav-ior through conditioning techniques

Counterconditioning One technique used by behavior therapists is counterconditioning.

This technique pairs the stimulus that triggers an unwanted behavior(such as the fear of snakes) with a new, more desirable behavior. The ther-apist helps the client reduce anxiety by pairing relaxation with anxiety-producing situations. Counterconditioning is a three-step process: (1) theperson builds an anxiety hierarchy with the least feared situation on thebottom and the most feared situation on top; (2) the person learns deepmuscle relaxation; (3) the person imagines or experiences each step in thehierarchy, starting with the least anxiety-provoking situation, while learn-ing to be relaxed. Since it is impossible to maintain both relaxation andanxiety, the idea is to teach the person that the situation does not have tobe anxiety producing. Using the anxiety hierarchy, the person progressesthrough each step after successfully completing the previous one.

Systematic desensitization is a counterconditioning techniqueused to overcome irrational fears and anxieties the patient has learned(Wolpe, 1961). The goal of systematic desensitization therapy is toencourage people to imagine the feared situation while relaxing, thusextinguishing the fear response (see Figure17.10). For example, suppose a student is ter-rified of speaking in front of large groups—that, in fact, his stage fright is so tremendousthat he is unable to speak when called uponin class. How would systematic desensitiza-tion therapy effectively change this person’sbehavior?

The therapist might have the studentmake a list of the frightening aspects of talk-ing to others. Perhaps the most frighteningaspect is actually standing before an audi-ence, whereas the least frightening is speak-ing to a single other person. The client ranksthese fears, from the most frightening ondown. Then the therapist begins teachingthe client muscle relaxation. Once he knowshow to relax completely, the client is readyfor the next step. The client tries to imagineas vividly as possible the least disturbingscene on his list of fears. Thinking aboutspeaking to a single stranger may cause mildanxiety. Because the therapist has taughthim how to relax, he learns to think aboutthe experience without feeling anxious. The basic logic is that a person cannot feelanxious and relaxed at the same time. Thetherapist attempts to replace anxiety with its opposite, relaxation, through counter-conditioning.

systematic desensitiza-tion: a technique to help apatient overcome irrationalfears and anxieties


Most anxious situation

No leash3

4

2

1

Moves closer

Alexa has an irrationalfear of dogs(least anxioussituation)

Losing Fears

Counterconditioning techniques, such as sys-tematic desensitization, are used to help peopleovercome their irrational fears and anxieties.What steps might be used to desensitize achild’s fear of the dark?

Figure 17.10

The patient and therapist then progress step-by-step through the list of anxiety-arousing events. Thepatient reaches a point where he is able to imagine themost threatening situations without feeling anxiety.Now the therapist starts to expose the person to real-life situations that have previously frightened him. Therapy finally reaches the point where the student is able to deliver an unrehearsed speech to a full auditorium.

Flooding refers to another treatment in which atherapist exposes the client to a feared object or situ-ation. For example, let’s say that you are deathlyafraid of snakes. Your therapist might have you imag-ine yourself in a room full of snakes or have you holda snake. This makes your heart rate soar, but it can-

not stay that way forever. Eventually your heart rate returns to normal,and you realize that you have survived this test—you have faced yourfear. You have begun to overcome your fear.

Behavior therapists also use modeling to teach a client to do some-thing by watching someone else do it. For example, when teaching clientshow to be assertive, a therapist might demonstrate ways to be assertive.The client watches and then tries to imitate the behavior.

Aversive Conditioning In aversive conditioning, the goal is to make cer-tain acts unpleasant so that they will be avoided. For example, alcoholicscan be given medication that will make them sick when they take alcohol.The relearning process involved is to try to associate the aversive (negative)feeling with taking the alcohol and hence reduce its appeal and use. Therate of improvement for this method is about 50 percent, with the effectlasting about six months. Thus it is not a solution as much as a good begin-ning for a number of alcoholics (Ullmann & Krasner, 1969, 1975).

Operant Conditioning Operant conditioning is based on the assumption that behavior that is

reinforced tends to be repeated, whereas behavior that is not reinforcedtends to be extinguished. In contingency management the therapistand patient decide what old, undesirable behavior needs to be eliminatedand what new, desirable behavior needs to appear.

Arrangements are then made for the old behavior to go unrewardedand for the desired behavior to be positively reinforced. In its simplestform, contingency management consists of the therapist agreeing withthe patient: “If you do X, I will give you Y.” This form of agreement is sim-ilar to systems of reward that people often use on themselves or parentsuse on children. For instance, a student may think, “If I get a good gradeon the exam, I’ll treat myself to a new CD.” The reward is contingent(dependent) upon getting a good grade.

Contingency management is used in prisons, mental hospitals,schools, army bases, and with individual patients. In these situations it is


aversive conditioning:links an unpleasant state withan unwanted behavior in anattempt to eliminate the behavior

Reading CheckHow does aversive

conditioning differ from counterconditioning?

contingency manage-ment: undesirable behavior isnot reinforced, while desirablebehavior is reinforced

?Did You Know?Did You Know?

Virtual-Reality Therapy Some thera-pists use virtual reality in therapy. Theyequip their clients with helmets that displaya virtual-reality scene. For instance, if youare afraid of heights, your therapist mightexpose you to a virtual-reality scene inwhich you are riding a glass elevator to the74th floor of a building. The therapist canclosely monitor your situation and turn offthe display or remove your helmet if youbecome too agitated.

possible to set up whole miniature systems of rewards, called tokeneconomies. For example, psychologists in some mental hospitals selectbehavior they judge desirable. Patients are then rewarded for these behav-iors with tokens. Thus if a patient cleans his room or works in the hospi-tal garden, he is rewarded with token money. The patients are able tocash in their token money for things they want, such as candy or ciga-rettes, or for certain privileges, such as time away from the ward. Thesemethods are successful in inducing patients to begin leading active lives.They learn to take care of themselves and to take on responsibility insteadof having to be cared for constantly.

COGNITIVE-BEHAVIOR THERAPYMany therapists combine aspects of cognitive and behavior therapies.

Cognitive-behavior therapy focuses on setting goals for changing aclient’s behavior and then, unlike other behavior therapies, placing moreemphasis on changing the client’s interpretation of his or her situation.This type of therapy seeks to help clients differentiate between serious, realproblems and imagined or distorted problems. A cognitive-behavior ther-apist might work with a client to change certain behaviors by monitoringcurrent behaviors and thought patterns, setting progressively difficultgoals, reinforcing positive changes, substituting positive thoughts for neg-ative thoughts, and practicing new behaviors in a safe setting. Many self-help programs use this approach. For example, you might begin a programof developing positive self-esteem by using these techniques. Cognitive-behavior therapies are becoming increasingly widespread and have proveneffective for treating a wide range of problems.


1. Review the Vocabulary How doescognitive therapy differ from behaviortherapy?

2. Visualize the Main Idea In a diagramsimilar to the one below, list anddescribe rational-emotive therapy techniques.

3. Recall Information How does aversiveconditioning work?

4. Think Critically Sheila was not pickedto be a basketball captain in gym class.She thought the gym teacher didn’tpick her because Sheila is short. Sheilabecame angry with the teacher andacted rudely in gym class. Explain thisscenario using what psychologist AlbertEllis calls the ABCs.

Assessment

5. Application Activity Pick something of which you are afraid. Construct a plan for usingsystematic desensitization to help you overcomethis fear.

Rational-Emotive Therapy Techniques

cognitive-behavior therapy: based on a combi-nation of substituting healthythoughts for negative thoughtsand beliefs and changing dis-ruptive behaviors in favor ofhealthy behaviors

token economy: desirablebehavior is reinforced with val-ueless objects or points, whichcan be accumulated andexchanged for various rewards

Reader’s Guide


People with ear infections are given antibiotics, and within about 10days, most infections are gone. Could the same approach be usedfor people with psychological problems? According to Susan A.’s

testimonial, the drug Prozac seemed to alleviate her psychological prob-lems. Some experts believe that biological therapies, such as medications,should be reserved for people who fail to respond to psychotherapy.Other experts believe that a combination of psychotherapy and biologi-cal therapy is the answer for many patients.

Biological Approaches to Treatment

■ Main IdeaBiological approaches to treatment relyon methods such as medications, elec-tric shock, and surgery to help clients.

■ Vocabulary• drug therapy• antipsychotic drugs• antidepressants• lithium carbonate• antianxiety drugs• electroconvulsive therapy (ECT)• psychosurgery• prefrontal lobotomy

■ Objectives• Explain biological approaches to

treatment.• Give examples of treatment medicines

and their effects on patients.

Exploring Psychology

Medical Miracles?Susan A. has spent most of her adult

life fighting with people—her parents, herneighbors, her co-workers, and her hus-band. The 39-year-old Seattle woman hassuffered bouts of depression and bulimia,abused drugs and alcohol, and twice triedto kill herself. She once sought relief in an antidepressant called doxepin, but shedidn’t like the way it made her feel.

Two years ago her therapist, Dr.Michael Norden, suggested she try a newdrug called Prozac. She did. Within amonth, Susan had given up psychotherapyin favor of school and a full-time job. Shehad also given up tranquilizers and streetdrugs. “I feel 1,000%,” she said in a writtennote. “I actually like Mom and Dad now,I’m well liked at work, I don’t ruminate onthe negatives, I don’t have murderousrages, my marriage is five times better.”

—from “The Promise of Prozac” by G. Cowley, in Newsweek, March 26, 1990


drug therapy: biolog-ical therapy that uses medications

antipsychotic drugs:medication to reduce agita-tion, delusions, and hallucina-tions by blocking the activity of dopamine in the brain; tranquilizers

BIOLOGICAL THERAPYIt is not possible for therapists to help all

people with the therapies described so far inthe chapter. The various talking and learningtherapies have been aimed primarily atpatients who are still generally capable offunctioning within society.

Biological approaches to treatmentassume there is an underlying physiologicalreason for the disturbed behavior, the faultythinking, and the inappropriate emotionsthe person displays. Biological therapy usesmethods such as medication, electric shock,and surgery to help people with psycholog-ical disorders.

Since these treatments are medical innature, physicians or psychiatrists typicallyadminister them. Psychologists do not usu-ally prescribe drugs or administer biologicaltreatments, but they may help decidewhether a biological approach to treatmentis appropriate for a particular patient.

Drug TherapyThe most widely used biological therapy for psychological disorders is

drug therapy. Drug therapy involves four main types of psychoactivemedications: antipsychotic drugs, antidepressant drugs, lithium, andantianxiety drugs. All the medications used in drug therapy can be obtainedonly with a prescription and alleviate psychiatric symptoms. It is importantto note that when patients undergoing drug therapy stop taking the med-ication, their symptoms typically reappear. Often, drugs treat only thesymptoms; drug therapy does not remove the causes of the disorder.

Antipsychotic Drugs For a long time the most common method of help-ing dangerous or overactive schizophrenic patients was physicalrestraint—the straitjacket, wet-sheet wrapping, and isolation. Doctorscalmed the patient by means of psychosurgery or electroconvulsive shock(discussed later).

Today patients with schizophrenia are usually prescribed antipsy-chotic drugs. These drugs have helped schizophrenics stay out of men-tal institutions. Many patients with schizophrenia who take these drugsimprove in a number of ways: they become less withdrawn, become less confused and agitated, have fewer auditory hallucinations, and are less irri-table and hostile (Cole, 1964). One theory of schizophrenia proposes thatwhen a person’s dopamine neurotransmitter system somehow becomesoveractive, that person develops schizophrenia. These medicines inhibitdopamine receptor sites. Drugs like chlorpromazine (such as Thorazine)

The patient is meeting with her doctor to discuss hertreatment and evaluate how she is doing and whatshould happen next. When would a psychiatristsuggest that a patient try medications?

Starting Biological TherapyFigure 17.11

antianxiety drugs: med-ication that relieves anxiety andpanic disorders by depres-sing the activity of the centralnervous system


and haloperidol (such as Haldol) blockor reduce the sensitivity of dopaminereceptors. Clozapine (such as Closaril)decreases dopamine activity andincreases the serotonin level, whichinhibits the dopamine system. Whilethese drugs reduce the symptoms ofschizophrenia, there can be unpleasantside effects, such as muscular rigidity,impaired coordination, and tremors.

Antidepressant drugs Another class ofdrugs, called antidepressants, relievesdepression. Depression is accompaniedby imbalances in the nuerotransmittersserotonin and norepinephrine.Monoamine oxidase (MAO) inhibitors,such as Nadril, elevate the levels of cer-tain neurotransmitters by inhibitingtheir breakdown. Tricyclicantide-pres-sants, such as Elail, increase levels ofthese neurotransmitters by preventingthe reuptake of these transmitters intothe axon terminals. Antidepressantsmay have unpleasant side effects, suchas dizziness, fatigue, forgetfulness, andweight gain. Selective serotonin reup-take inhibitors (SSRI), such as those inProzac, work the same way but targetthe neurotransmitter serotonin.

Lithium Carbonate The chemical lithium carbonate is widely used bypeople with a bipolar disorder in order to counteract extreme moodswings. While all of the other medicines described here are synthetic, lithi-um is a natural chemical element that controls levels of norepinephrine.Lithium can cause side effects if it is not administered under proper med-ical supervision. The finding that lithium salts reduce the symptoms ofsomeone with a bipolar disorder, more so than those with a unipolardepression, suggests to researchers that these may be two different illness-es (Pokorny & Prein, 1974).

Antianxiety Drugs Commonly known as sedatives or mild tranquil-izers, antianxiety drugs are used to reduce excitability and causedrowsiness. First the barbiturates, then Miltown (meprobamate), andeventually the benzodiazepines have been very popular prescriptions inrecent decades. At one time Valium was the most popular prescriptiondrug in the country. Now several benzodiazepines, which are prescribedfor panic attacks and agoraphobia and include Xanax (alprazolam), havejoined it among the 50 most prescribed drugs.

antidepressants: medication to treat majordepression by increasing theamount of one or both of theneurotransmitters noradrenalineand serotonin

Homelessness: A Legacy of Deinstitutionalization

Homelessness is a major problem in the United States,and it is likely that you come into contact with the home-less at least occasionally. When you do, you may be observinga person with a psychological disorder.

It is estimated that 25 percent of the homeless are men-tally ill, overlapping partially with 33 percent of the home-less estimated to be severely addicted (National Coalitionfor the Homeless, 1999). This seems to be a direct result ofdeinstitutionalization.

Since the introduction of antipsychotic drugs in the1950s, the number of patients confined to mental institu-tions has steadily dropped. Unfortunately, most antipsy-chotic drugs do not cure disorders. Rather, they merely control the more obvious symptoms of psychological disor-ders so that patients are no longer dangerous. Thus, there isno longer any reason to keep these people institutionalized.

Many patients who have been released from institu-tions often find it impossible to hold steady jobs or to liveon their own. In this way, the noble goal of deinstitutional-ization has contributed to the problem of homelessness andhas affected all our lives. Most communities lack efficientsystems for aiding these people.

lithium carbonate: a chem-ical used to counteract moodswings of bipolar disorder


While these drugs are effective for helping normal people cope withdifficult periods in their lives, they are also prescribed for the alleviation ofvarious anxiety-based symptoms, psychosomatic problems, and symptomsof alcohol withdrawal. The major effect of Valium, Librium, and Miltownis to depress the activity of the central nervous system by stimulating theaction of the neurotransmitter GABA (gamma-aminobutyric acid).

If antianxiety drugs are taken properly, the side effects are few andconsist mainly of drowsiness. However, prolonged use may lead todependence, and heavy doses taken along with alcohol can result indeath. These drugs do reduce anxiety, but the best use seems to be fordealing with acute rather than chronic anxiety. (Mellinger, Balter, &Uhlenhuth, 1985).

Electroconvulsive TherapyElectroconvulsive therapy (ECT), commonly called shock treat-

ment, has proved extremely effective in the treatment of severe depres-sion, acute mania, and some types of schizophrenia (Koop, 2001). Noone understands exactly how it works, but it involves administering,over several weeks, a series of brief electrical shocks of approximately70–150 volts for 0.1–1.0 seconds. The shock induces a convulsion in thebrain similar to an epileptic seizure that may last up to a minute.

Many people consider ECT a controversial treatment. In the past, it was not always used judiciously. As a result, some peopleexperienced extensive amnesia, as well as problems with languageand verbal abilities. Today, electroconvulsive therapy entails very little discomfort for the patient. Prior to treatment, the

Deinstitutionalization

Over the past three decades the national policy has been one ofdeinstitutionalization. Deinstitutionalization refers to the release ofpatients from mental hospitals. These patients rejoin the communityto attempt to lead independent lives. How has the number ofdays patients spend in mental hospitals changed since 1980?

Figure 17.12

0

50

100

150

200

250

300

1980

Source: American Hospital Association, Chicago, IL, Hospital Statistics, 2000 edition, annual (copyright).

Year

Day

s in

ho

spit

al p

er1,

000

po

pu

lati

on

1985 1990 1992 1993 1994 1995 1996 1997 1998

Reading CheckWhat is the major effect

of antianxiety drugs?

electroconvulsive therapy(ECT): an electrical shock issent through the brain to try toreduce symptoms of mentaldisturbance


patient is given a sedative and injected with a muscle relaxant to alleviateinvoluntary muscular contractions. Even with these improvements, how-ever, electroconvulsive therapy is a drastic treatment and must be used withgreat caution. Many people experience some memory problems afterreceiving this treatment. When ECT is applied bilaterally—with the elec-tric current running across both of the brain’s hemispheres—the patientmay lose memory for events occurring one to two days before the treat-ment. Today physicians usually apply ECT unilaterally to the right hemi-sphere only. This technique results in little memory loss. The use of ECThas declined somewhat, but it remains a highly effective treatment fordepression (Thienhaus et al., 1990).

PsychosurgeryBrain surgery performed to treat psychological disorders is called

psychosurgery. The most common operation, prefrontal lobotomy,involves destruction of the front portion of the brain, just behind the fore-head. This part of the brain, the frontal lobe, contains most of the nerveconnections that control emotions. From the late 1930s to the early1950s, doctors performed prefrontal lobotomies on people who wereextremely violent or diagnosed with schizophrenia, depression, bipolardisorder, and obsessive-compulsive disorder. The use of prefrontal lobot-omies decreased significantly in the mid-1950s, when newly developeddrugs offered alternative treatments. At the same time, mounting evi-dence indicated that lobotomized patients showed an inability to plan.Furthermore, destroyed brain tissue never regenerates, so the effects arepermanent. Patients may become apathetic and less creative after surgery.Although specific nerve tracts and areas of the brain can now be locatedvery precisely, less than 200 prefrontal lobotomies are performed annuallyin the United States (Sabbatini, 1997).

1. Review the Vocabulary Describe howantipsychotic drugs, antidepressants,and antianxiety drugs work as therapy.

2. Visualize the Main Idea In a graphicorganizer similar to the one below, listand explain the biological approachesto treatment.

3. Recall Information Why is psy-chosurgery controversial? Why is itused?

4. Think Critically Describe a situation inwhich you believe a therapist wouldsuggest biological therapy involvingpsychosurgery for a patient.

Assessment

5. Application Activity Imagine that you havebeen asked to give a talk about the biologicalapproaches to psychological problems. Create anoutline for your speech.

Biological Approaches to Treatment

psychosurgery: a medicaloperation that destroys part ofthe brain to make the patientcalmer and freer of symptoms

prefrontal lobotomy:a radical form of psychosurgeryin which a section of the frontallobe of the brain is destroyed

Summary and Vocabulary

Chapter Vocabularypsychotherapy (p. 486)eclectic approach (p. 487)placebo effect (p. 488)empathy (p. 489)group therapy (p. 489)psychoanalysis (p. 494)insight (p. 494)free association (p. 494)resistance (p. 494)dream analysis (p. 495)transference (p. 495)humanistic therapy (p. 496)client-centered therapy (p. 496)nondirective therapy (p. 496)active listening (p. 497)unconditional positive regard (p. 497)behavior modification (p. 499)cognitive therapy (p. 499)rational-emotive therapy (RET)(p. 500)behavior therapy (p. 502)systematic desensitization (p. 503)aversive conditioning (p. 504)contingency management (p. 504)token economy (p. 505)cognitive-behavior therapy (p. 505)drug therapy (p. 507)antipsychotic drugs (p. 507)antidepressants (p. 508)lithium carbonate (p. 508)antianxiety drugs (p. 508)electroconvulsive therapy(ECT) (p. 509)psychosurgery (p. 510)prefrontal lobotomy (p. 510)

What Is Psychotherapy?■ Mental health professionals who have been

trained to deal with the psychological problems ofothers include counseling and clinical psycholo-gists, psychiatrists, and social workers.

■ An important function of psychotherapy is to helppeople realize that they are responsible for theirown problems and that they are the only oneswho can really solve these problems.

People who suffer from emotional problems often seek therapyfrom mental health professionals. The help these professionalsprovide is called psychotherapy.

Main Idea:Psychotherapy is a gen-eral term for the severalapproaches used bymental health profes-sionals to treat psycho-logical disorders.

Psychoanalysis and Humanistic Therapy■ A main goal of a psychoanalyst is to help make

patients aware of the unconscious impulses,desires, and fears that are causing their anxieties.

■ Humanistic psychology has given rise to severalapproaches to psychotherapy known as client-centered therapy.

■ Client-centered therapists believe that psychologicalproblems arise when the true sense of self becomeslost and the individual comes to view himself orherself according to the standards of others.

Main Idea:Psychoanalysis is ananalysis of the consciousand unconscious mindbased on the theories ofpsychiatrist SigmundFreud. Humanistic ther-apy helps people reachtheir full potential.


Cognitive and Behavior Therapies■ Cognitive therapists focus on changing the way

people think.■ Behavior therapists concentrate on determining

what is specifically troubling with a patient’s lifeand taking steps to change it.

Main Idea: Cognitiveand behavior therapieshelp clients develop newways of thinking andbehaving.

Biological Approaches to Treatment■ Biological approaches to treatment assume there

is an underlying physiological reason for the disturbed behavior, faulty thinking, and inappro-priate emotions an individual displays.

■ Drug therapy involves four main types of medications—antipsychotic drugs, antidepressantdrugs, lithium, and antianxiety drugs.

■ Electroconvulsive therapy is a rare, drastic treat-ment that is used with great caution.

■ Psychosurgery involves destroying part of thebrain to free the patient of symptoms.

Main Idea:Biological approaches totreatment rely on meth-ods such as medica-tions, electric shock, andsurgery to help clients.

Recalling Facts1. How do self-help groups help people deal with

problems?2. What is the goal of psychoanalysis? What does

the therapist do to achieve this goal?3. Using a diagram similar to the one below,

describe the main techniques of client-centeredtherapy.

4. What steps does a rational-emotive therapistexpect the client to take to solve his or her problems?

5. Identify the effects of antipsychotic drugs, anti-depressants, and antianxiety drugs.

Critical Thinking1. Making Inferences One technique that client-

centered therapists use is active listening. Whatdoes this technique involve? Do you think activelistening might be effective in improving day-to-day communication between people? Explain.

2. Demonstrating Reasoned Judgment Do youagree with Albert Ellis that it is not the event ina person’s life that causes trouble but rather theway a person thinks about the event? Explain.

3. Evaluating Information Make a list of a fewfears that you have. Rank them from least fear-ful to most fearful. Do you think any of yourfears are based on conditioning? Describe amethod of counterconditioning that you thinkwould remove the fear or make it less intense.

4. Making Comparisons What do you think arethe major differences between psychoanalysisand behavior therapy?

5. Analyzing Information Do you think psy-chosurgery should ever be used to treat psycho-logical problems? Why?

Assessment

Reviewing VocabularyChoose the letter of the correct term or conceptbelow to complete the sentence.

1. Some psychotherapists use a(n) __________ totherapy, using many different methods.

2. Patients with schizophrenia are often treatedwith __________.

3. A technique in which people are urged to imag-ine a feared situation in order to extinguish thefear is called __________.

4. In a communication technique called ________,the client-centered therapist tries to echo backthe feelings the client has expressed.

5. __________, or people’s understanding of theirunconscious motives, is the first step towardgaining control over their behavior.

6. An effective psychotherapist has __________,or a capacity for warmth and understanding.

7. In a technique called __________, individualslearn to associate negative feelings with thebehavior they want to avoid.

8. Talking about everything that comes to mind iscalled __________.

9. Client-centered therapy is conducted in an atmos-phere of emotional support called __________.

10. __________ is often used to bring manic-depressive people to a state of equilibrium.

Self-Check QuizVisit the Understanding Psychology Web site at psychology.glencoe.com and click on Chapter 17—Self-Check Quizzes to prepare for the Chapter Test.

a. eclectic approachb. empathyc. insightd. free associatione. active listeningf. unconditional positive

regard

g. systematic desensitization

h. aversive conditioningi. antipsychotic drugsj. lithium carbonate

PSYCHOLOGY


Client-CenteredTherapy

http://www.glencoe.com/sec/socialstudies/psychology/psych2001/quiz.shtml?BOOK=006&CHAPTER=17&TITLE=Therapy+and+Change

1. What percentage of psychologists uses behav-ior therapies? Interpersonal therapies?

2. Which type of psychotherapy is used by thegreatest percentage of psychologists? Why doyou think this is so?

3. Psychodynamic therapy (or short-term dynamicpsychotherapy) is an approach that is similar topsychoanalysis. Why do you think more thera-pists practice psychodynamic therapy ratherthan classical psychoanalysis?

4. How popular do you think biological approachesare? Why do you think so? Investigate this ques-tion and report your findings to the class.

Psychology Projects1. What Is Psychotherapy? Attend an open meet-

ing of one of the following self-help supportgroups: Alcoholics Anonymous, Al-Anon,Alateen, Smokenders, Narcotics Anonymous,Weight Watchers, or Overeaters Anonymous.Go with a classmate so that you can share yourobservations and experiences. Notice and reportto the class on the ways in which the group pro-vides support for people.

2. Humanistic Therapies Research existentialtherapies and transactional analysis, which aretwo other types of client-centered therapies.What are the basic beliefs? Summarize yourresearch and report your findings in an essay orbrief presentation to the class.

3. Behavior Therapies Operant conditioning isbased on the assumption that reinforced behav-ior tends to be repeated. Behavior therapy ofteninvolves a system of rewards called tokeneconomies. Propose a token economy thatcould be used in your school. Describe whatrewards would be used and what behaviors theywould reinforce.

4. Biological Approaches to Treatment Go toyour local library or video store to find a moviethat portrays mental illness. You might view OneFlew Over the Cuckoo’s Nest or Awakenings.Describe and classify some of the patients’symptoms and the kinds of treatments that wereadministered. Describe the effectiveness of thetreatments in a written report.

Technology ActivitySearch the Internet for sites thatprovide online psychotherapy ser-

vices. Find out what types of problems are gener-ally addressed in these sites. Report your findings ina written report.

Psychology Journal Reread the recommendations for treatmentthat you wrote in your journal. How do the

techniques you suggest resemble the therapiesdescribed in this chapter? Answer this question inyour journal.

Assessment


0

5

10

15

20

25

30

Practice and assess key socialstudies skills with Glencoe SkillbuilderInteractive Workbook CD-ROM, Level 2.

Building SkillsInterpreting a Graph Review the graph below,then answer the questions that follow.

See the Skills Handbook, page 628, for an explanation of interpreting graphs.

45%

24%

8%

Cognitive behavioral

Psychodynamic

Interpersonal

Behavioral/Social learning

Humanistic

Systems

7%

7%

6%

Source: Greenberg, Smith, and Muenzen, 1995.

Other 3%

In the novel The Bell Jar, nineteen-year-old Esther Greenwood wins a dream assign-ment on a New York fashion magazine, but she quickly finds herself sinking intodespair. In this excerpt, Esther receives electroshock therapy at Belsize hospitalafter attempting to commit suicide. This novel is largely autobiographical—poet-author Sylvia Plath ended her own life a month after the book’s publication in 1963.

B Y S Y LV I A P L A T H

The nurse rapped on my door and, withoutwaiting for an answer, breezed in.

It was a new nurse—they were always chang-ing—with a lean, sand-colored face and sandy hair,and large freckles polka-dotting her bony nose. Forsome reason the sight of this nurse made me sick atheart, and it was only as she strode across the roomto snap up the green blind that I realized part of herstrangeness came from being empty-handed.

I opened my mouth to ask for my breakfast tray,but silenced myself immediately. The nurse wouldbe mistaking me for somebody else. New nursesoften did that. Somebody in Belsize must be havingshock treatments, unknown to me, and the nursehad, quite understandably, confused me with her.

I waited until the nurse had made her little cir-cuit of my room, patting, straightening, arranging,and taken the next tray in to Loubelle one door far-ther down the hall.

Then I shoved my feet into my slippers, drag-ging my blanket with me, for the morning wasbright, but very cold, and crossed quickly to the

kitchen. The pink-uniformed maid was filling a rowof blue china coffee pitchers from a great, batteredkettle on the stove. . . .

“There’s been a mistake,” I told the maid, lean-ing over the counter and speaking in a low, confi-dential tone. “The new nurse forgot to bring me inmy breakfast tray today.”

I managed a bright smile, to show there wereno hard feelings.

“What’s the name?”“Greenwood. Esther Greenwood.”“Greenwood, Greenwood, Greenwood.” The

maid’s warty index finger slid down the list ofnames of the patients in Belsize tacked upon thekitchen wall. “Greenwood, no breakfast today.”

I caught the rim of the counter with both hands. . . .

I strode blindly out into the hall, not to myroom, because that was where they would come toget me, but to the alcove. . . .

I curled up in the far corner of the alcove withthe blanket over my head. It wasn’t the shock treat-ment that struck me, so much as the bare-facedtreachery of Doctor Nolan. I liked Doctor Nolan, Iloved her, I had given her my trust on a platter andtold her everything, and she had promised, faith-fully, to warn me ahead of time if ever I had to haveanother shock treatment.

If she had told me the night before I would havelain awake all night, of course, full of dread and fore-boding, but by morning I would have been com-posed and ready. I would have gone down the hallbetween two nurses, past DeeDee and Loubelle andMrs. Savage and Joan, with dignity, like a personcoolly resigned to execution.

The nurse bent over me and called my name.I pulled away and crouched farther into the cor-

ner. The nurse disappeared. I knew she wouldreturn, in a minute, with two burly men attendants,

Reader’s Dictionaryalcove: a small recessed section of a room

electrotherapy: treatment or therapy that useselectricity; electroconvulsive therapy (ECT)

pallid: lacking sparkle or liveliness

514 Unit 6 / Adjustment and Breakdown

R E A D I N G S I N P S Y C H O L O G YR E A D I N G S I N P S Y C H O L O G Y

THE BELL JAR

and they would bear me, howling and hitting, pastthe smiling audience now gathered in the lounge.

Doctor Nolan put her arm around me andhugged me like a mother.

“You said you’d tell me!” I shouted at herthrough the dishevelled blanket.

“But I am telling you,” Doctor Nolan said. “I’vecome specially early to tell you, and I’m taking youover myself.”

I peered at her through swollen lids. “Why didn’t you tell me last night?”

“I only thought it would keep you awake. If I’dknown . . .”

“You said you’d tell me.”“Listen, Esther,” Doctor Nolan said. “I’m going

over with you. I’ll be there the whole time, so every-thing will happen right, the way I promised. I’ll be there when you wake up, and I’ll bring you back again.”

I looked at her. She seemed very upset.I waited a minute. Then I said, “Promise you’ll

be there.”“I promise.”Doctor Nolan . . . led me down a flight of stairs

into the mysterious basement corridors that linked,in an elaborate network of tunnels and burrows, allthe various buildings of the hospital.

The walls were bright, white lavatory tile withbald bulbs set at intervals in the black ceiling.Stretchers and wheelchairs were beached here andthere against the hissing, knocking pipes that ranand branched in an intricate nervous system alongthe glittering walls. I hung on to Doctor Nolan’sarm like death, and every so often she gave me anencouraging squeeze.

Finally, we stopped at a greendoor with Electrotherapy printedon it in black letters. I held back,and Doctor Nolan waited. Then Isaid, “Let’s get it over with,” andwe went in.

The only people in the wait-ing room besides Doctor Nolanand me were a pallid man in ashabby maroon bathrobe and hisaccompanying nurse. . . .

“Do you want to sit down?”Doctor Nolan pointed at awooden bench, but my legsfelt full of heaviness, and Ithought how hard it wouldbe to hoist myself from a sit-ting position when the shocktreatment people came in.

“I’d rather stand.”At last a tall, cadaverous

woman in a white smockentered the room from an innerdoor. I thought that she wouldgo up and take the man in themaroon bathrobe, as he was first,so I was surprised when she cametoward me. . . .

Through the slits of my eyes, which I didn’tdare open too far, lest the full view strike me dead,I saw the high bed with its white, drumtight sheet,and the machine behind the bed, and the maskedperson—I couldn’t tell whether it was a man or awoman—behind the machine, and other maskedpeople flanking the bed on both sides.

Miss Huey helped me climb up and lie down onmy back.

“Talk to me,” I said.Miss Huey began to talk in a low, soothing

voice, smoothing the salve on my temples and fit-ting the small electric buttons on either side of myhead. “You’ll be perfectly all right, you won’t feel athing, just bite down. . . .” And she set something onmy tongue and in panic I bit down, and darknesswiped me out like chalk on a blackboard.

Unit 6 / Adjustment and Breakdown 515

Analyzing the Reading

1. What is the setting of this excerpt?2. How does Esther realize that she is scheduled for a shock

treatment that morning?3. Critical Thinking Despite its risks, ECT is still used to treat

severe depression. Do you think this is ethical? Under whatcircumstances would such treatment be administered?

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