David Kraft

Spring Term, 2007

The purpose of this report is to identify the main therapeutic approaches in psychology and succinctly to explain and consider their role in treating human behaviour. Gross (1996) has defined psychology as, ‘the science of mind and behaviour’; however, although it is beyond the scope of this report to review the literature with regard to scientific studies and the artistry involved in the paradigms of psychological therapy, suffice it is to say that some techniques are more scientific than others. One may divide the approaches into five categories as follows:

1 Somatic Therapies (pharmacotherapy, ECT, psychosurgery)
2 Psychodynamic Therapies (psychoanalysis, psychodynamic psychotherapy)
3 Behavioural Therapies (pure behaviourism, radical behaviourism, social learning, soft behaviourism, behaviour modification)
4 Cognitive Therapies (cognitive and cognitive-behaviour therapy, automatic thought treatment, RET)
5 Humanistic (phenomenological)

Each of these types of therapy can be subdivided still further into more specific sub-categories, each one having an entirely distinct theoretical framework; and yet, all of them are bound by the same general philosophical principle, that they are designed to help individuals overcome their emotional disturbance(s) in order for them to cope better in society.

The most commonly used textbook for abnormal behaviour is the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994), and this, in great detail, lists and categorizes all the abnormal mental conditions. Some of these conditions are better treated by certain therapies, but, it is important to note that very few therapists use techniques associated solely with one therapeutic paradigm; often, the clinician will use a combination of approaches to suit the needs of the patient. What follows, is an overview of the therapies available and an outline of their main aims and uses.

Somatic therapy is often referred to as ‘biological therapy’ and it is inextricably interconnected with the ‘medical model’ which views mental disorder as an illness. Psychiatrists prescribe drugs in order to break the cycle of emotional disturbance or to help patients with more prolonged mental illness. Drugs can be divided into five basic types-(1) minor tranquillisers (anxiolytic drugs), (2) major tranquillisers (antipsychotics), (3) antidepressants (monoamine oxidase inhibitors, tricyclics and specific serotonin re-uptake inhibitors), (4) antimanic drugs and (5) stimulants.

Typically, minor tranquillisers (e.g. Chlordiazepoxide and Diazepam) are used to reduce tension and anxiety and are also employed in managing stress-related disorders, generalized anxiety disorder and phobias. Now known as anti-anxiety drugs, these should be prescribed for short periods of time; however, some patients get repeat prescriptions and become dependent. After prolonged use, some individuals suffer withdrawal symptoms when they stop their use. Major tranquillisers (e.g. Chlopromazine) are used to treat severe disorders such as schizophrenia. Prolonged use can cause impotence in males, and tardive dyskinesia characterized by grimacing, rapid eye blinking, twitching and even lip smacking.

All antidepressants increase 5-HT function (serotonin) and may also increase noradrenaline function. As their name indicates, they are used to treat varying levels of depression. Examples in MIMS (2007) include Phenelzine (MAOI), Imipramine (TCA) and Fluoxetine or Prozac (SSRI). Antimanic drugs are also employed although they are only used to treat clients with bipolar affective disorder.

Stimulants, although they were originally used to treat depressed and lethargic patients, paradoxically are given to children suffering from ADHD-the drugs work on the autonomic nervous system and block the re-uptake of dopamine. More evasive somatic methods include ECT and psychosurgery.

Psychodynamic psychotherapy is a long-term therapy. Patients visit their therapist once or twice a week for a significant period of time, and each session typically lasts for 50 minutes. The principle aim of the therapy is to uncover and ‘work through’ unconscious conflicts: this can be achieved by free association, by analyzing parapraxes (Freudian slips) and through the interpretation of dreams.

Behaviour therapy is sometimes used in conjunction with psychotherapy and there are very few ‘pure behaviourists’; however, the main principle of this approach focuses on the individual’s behaviour-that is to say, it looks at ‘observable behaviour’. Here, the following techniques can be used: (1) simple behaviour modification, characterized by reinforcing adaptive behaviour patterns with positive rewards, (2) systematic desensitization (Wolpe, 1958), gradually helping phobic clients to cope with an unwanted stimulus (e.g. spiders), and (3) aversion therapy (Rachman, 1965), helping clients to eliminate maladaptive behaviour, e.g. smoking. Some therapists also use role play and modelling techniques.

The general principle of cognitive therapies is that it centres its attention on the thoughts and perceptions of the client. Unlike psychotherapy, this approach addresses the present and immediately conceptualizes the client’s social problems, providing a therapeutic strategy for its day-to-day use. The therapist uses a number of techniques. The client may be encouraged to become a passive observer in his own ruminations (‘distancing’), or told to think of something else whenever an unwanted thought is present (‘distraction’). In addition, a cognitive therapist might help the client with his or her assertive skills and social skills; he or she might also be given ‘ego-strengthening’ (Zimberoff & Hartman, 2000). Cognitive therapy is very helpful in the treatment of phobias, panic attacks, depression and anxiety.

Humanistic therapists believe that a mental disorder is caused by an individual’s belief that their personal growth has been stopped or blocked in some way. In the humanistic approach, it is extremely important that the client sees the therapist as a genuine and honest person. The therapist must also have an unconditional, positive regard for the client; at all times, the client should feel liked. In addition, the therapist attempts to understand the client’s situation and tries to empathize with him or her. The therapist does this by ‘checking in’-that is to say, asking the client to explain certain terms or points of view. These are the general principles of Rogerian (1959) therapy. Humanistic therapy also stresses the importance of understanding and maintaining positive, purposive meaning (aesthetic experience, loving relationships), achieving one’s potential, joy, one’s own unique self identity and personal growth. Other humanistic methods include Gestalt therapy (Perls, 1969) which occurs in a group setting, family therapy (Jackson & Weakland, 1961) and Milieu therapy (Gunderson, Will & Mosher, 1983), where patients are rehabilitated in a therapeutic community.

This brief report has identified, categorized and explained the general principles associated with the main therapeutic approaches in psychology.

References

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington DC: Author.

Gross, R. (1996). Psychology, the science of mind and behaviour. London: Hodder and Stoughton.

Gunderson JG, Will OA & Mosher LR. (1983). Principles and practice of milieu therapy. New York: J Aronson.

Jackson, D & Weakland, J. (1961). Conjoint family therapy: some considerations on theory, technique and results. Psychiatry, 24: 30-45.

Monthly Index of Medical Specialities (February 2007 ed.). London: Haymarket Medical Publications Ltd.

Perls, F. (1969). Gestalt therapy verbatim. New York: Bantam.
Rachman, S.(1965). Aversion therapy: chemical or electrical? Behaviour, Research and Therapy 2: 289-99.

Rogers, CR. (1959). A theory of therapy, personality and interpersonal relationships as developed in the client-centred framework. In S. Koch (ed.) Psychology: a study of a science. Formations of the Person in the Social Context, Vol. 3. New York: McGrawhill.

Wolpe, J. (1958). Psychotherapy by Reciprocal Inhibition. Stanford, CA: Stanford University Press.

Zimberoff D & Hartman D (2000). Ego strengthening and ego surrender. Journal of Heart-Centered Therapies, 3 (2): 3-66.