MODULE 6

Psychotherapy

People grow and develop through interaction with others -- their parents, friends, and associates. Psychotherapy is another opportunity to grow through relationships with other people, but with the added help of a skilled observer. Psychotherapy can take place individually or in groups.

By sampling the wide variety of therapeutic techniques, we will survey the theory and practice of psychotherapy as it currently exists.

As you read the text, try to answer the following questions.

EXPRESSIVE THERAPY

Expressive therapies are developments of the psychoanalytic theory of personality. The goal of expressive therapies is to help the patient understand why he behaves as he does by allowing him to express himself in a nonthreatening situation. Expressive therapies can be sharply contrasted with the behavior therapies, which attempt to change behavior by using applications of learning theory -- conditioning and extinction.

The major type of expressive therapy is psychoanalysis. Other schools of expressive therapy also use Freudian ideas, but with different emphases. Three of the most widely used and most important kinds of expressive therapy are described in this module.

TRANSACTIONAL ANALYSIS

Theories of expressive psychotherapy attempt to devise a conceptual framework that is applicable to a wide variety of human experiences. Each kind of psychotherapy develops a vocabulary and standardized procedures for dealing with human behavior problems.

A transaction consists of a stimulus and a response in a human interaction

Eric Berne (1964) developed transactional analysis. The basic unit of his analysis is the "transaction," a unit of social exchange. If two or more people encounter each other... sooner or later one of them will speak, or give some other indication of acknowledging the presence of the others. This is called the transactional stimulus. Another person will then say or do something which is in some way related to the stimulus, and that is called the transactional response.

There are three possible states of personality that an individual may assume: parent, adult, and child. The states of parent and child are both primitive; that is, these states are formed during the first five years of life. The parent is an accumulation of a person's early experience with his own parents, including a large number of admonitions and rules. The child is a reservoir of pleasant and unpleasant emotional memories, containing the original childlike interpretations of what the individual saw, heard, felt, and understood.

The adult gradually emerges, beginning at around ten months when the individual first becomes capable of self-direction. The adult is like a computer; it processes the information coming from the parent, the child, and the part of the adult that perceives the outside world.

The aspects of the personalities of two individuals engaging in a transaction can be illustrated by a wife and husband relating to each other as a parent, adult, or child. For example the wife might intiate a stimulus and the husband responds, both in an adult way .

Here, the transactional stimulus proceeds from the adult aspect of Wife to the adult aspect of Husband. The response is also adult-adult. When, as in this case, the response follows the same route as the stimulus, the transaction is complementary. The actual transaction could have been:

A: Do you know where the car keys are? (adult-adult)
B: yes, they're in the top drawer. (adult-adult)

Communication is smooth when transactions are complementary. Here is complementary transaction between husband and wife, with the husband exhibiting his "child" component.

Wife: Don't forget to wear your scarf to work today, dear. (parent-child)
Husband: Okay, but you'll have to find it for me. (child-parent)

Communication breakdowns occur as a result of crossed transactions, in which the transactional response follows a route that differs from the transactional stimulus. Here is an example of a crossed transaction.

A Co-worker makes an adult comment to another "adult." But the worker who was absent responds as if a parent to a child.

The actual transaction could have been:

Co-worker: I sure hope you get well soon. We all miss you at the office. (adult-adult)
Worker who was absent: If everybody at the office would mind their own business, they would be better off. (parent-child)

In crossed transactions, the participants are not using the same aspect of personality, so communication is usually suspended until one of the individuals shifts his approach.

One of the more significant transactional phenomena observed by Berne is the game. A game is a series of complementary transactions which move toward a predictable outcome. The motivations of the participants in a game are almost always concealed from each other and from themselves. The concealment of the true motivations allows the underlying feelings to go unnoticed and, hence, these feelings are maintained. A typical game is the Why don't you--Yes but game. The transactions may proceed as follows. White: My husband al ways insists on d oing our own repairs, but he never
builds anything right.

Black: Why doesn't he take a course in carpentry?
White: Yes, but he doesn't have time.

Blue: Why don't you buy him some good tools?
White: Yes, but he doesn't know how to use them.

Red: Why don't you have your building done by a carpenter?
White: Yes, but that would cost too much.

Brown: Why don't you just accept what he does the way he does it?
White: Yes, but the whole thing might fall down.

Like more traditional types of therapy, transactional analysis assumes that undesirable behaviors and responses are holdovers from an individual's childhood. A patient will carry on his transactions as a child or as a parent (his own remembered parent) because he has not learned to feel secure in responding as an adult. The job of the transactional analyst is "to distinguish between melodrama, institutionally encouraged acting-out, and authentic expressions of feeling." (Berne, op. cit., p. 215.) In short, the therapist must be able to tell when his patient is playing a game and when he is being relatively honest.

The analyst attempts to make the Adult predominant

Although transactional analysts often give therapy on an individual basis, it is in the group session that a patient has a wider variety of stimuli to which he can respond. When an individual plays a game with many different types of people, the game itself becomes more obvious. I

The goal of transactional analysis is independent behavior, free of rigid game behavior. The following is a transcript of part of a therapeutic session in which a therapist, D, discusses the use of parent-adult-child analysis (P-A- C) with S. an adolescent patient (Harris, 1967).

S: I have a very close friend and he's almost insane, I think. He won't go to a psychiatrist, I have known him for years, and he's so far out of reality it's pathetic, and he psychoanalyzes himself all the time. He reads books.
D: Is he a teen-ager?
S: Yes.
D: Well, it's one thing to psychoanalyze yourself without tools, but you have P-A-C to psychoanalyze yourself and P-A-C will give you the answer you need
S: Well, still -- OK, I'll tell you something. I don't know whether or not I want to be, to use my Adult all the time. And I try to use it most of the time. Sometimes I just don't want to, it's just kind of a battle, it's almost being actually perfect, it's handling everything the correct way at the right time. It's almost not human sometimes.
D: I know what you mean. Of course we have said before that your Child is what makes you charming and delightful to others, so it isn't that we want to kick the Child out, but let's say that P-A-C is always around, I mean the Parent, the Adult, and the Child are always present. It's true the Child may crowd out the Adult and the emotions take over, or the Parent may crowd out the Adult and the Parent takes over. I guess the trick is to always keep the Adult plugged in even though the Child is playing. If the Child wants to play, let the Adult go along to make sure that everything remains appropriate, because the way that girls get into trouble is when the Child takes over and plays, but plays games that are dangerous. Right?
S: Yes. You mean like being a teaser, something like this?
D: Well --
S: Not knowing when to stop?
D: Yes, right, not being able to -- When the Adult is unable to say no to the Child and make it stick, any of us is in trouble.
S: That means for anything, not just for
D: That's true. Everything. The Child may want to take something that doesn't belong to him or the Child may want to use another person. The Child may want to manipulate another person.
S: Oh, stop talking that way.

CARL ROGERS' CLIENT-CENTERED THERAPY

The central concept in Carl Rogers' theory of personality is the self. Each individual has a self, which is an ever-changing accumulation of his experiences. Some of the individual's experiences are positively valued and some are negatively valued, so the self has a concept of how far it is from the ideal person, as the individual perceives it. The self strives constantly to attain this ideal.

For client-centered therapy to be effective it must not pose a threat to the self

In order for effective change to take place, a person must be in an atmosphere in which he is not attacked, for the self becomes rigid and unchanging when threatened. The unthreatened self is fluid and tolerant. Thus Rogers' technique of expressive therapy, client-centered therapy, emphasizes caring, accept- ance, and the avoidance of advice. Carl Rogers (1970) describes his therapeu- tic goals in the following way.

If I can create a relationship characterized on my part: by a genuineness and transparency, in which I am my realfeelings; by a warm acceptance of and prizing of the other person as a sepa- rate individual; by a sensitive ability to see his world and himself as he sees them;

Then the other individual in the relationship will experience and understand aspects of himself which previously he has repressed; will find himself becoming better integrated, more able to function effectively; will become more similar to the person he would like to be; will become more self-directing and self-confident; will become more of a person, more unique and more self-expressive; will be more understanding, more acceptant of others; will be able to cope with the problems of life more adequately and more comfortably.

Client-centered therapy is characterized by non-directiveness. Out of respect for the client's own goals, the therapist deals with whatever is brought to each session instead of influencing the direction of the interview. The patient, or client as Rogers prefers to call him, presents his problems, which the therapist accepts without challenge or criticism. While the client talks, the therapist listens to and, when appropriate, reflects upon, what the client is saying and what emotion he is expressing. The client always determines the direction and the pace of the session. The therapist tries to experience the world as the client sees it, in part to reflect it to the client and in part to understand the perceived world to which the client is reacting. In general the emphasis is placed on the current situation rather than the unconscious or historical roots of the problem. The following excerpt from an interview with a young graduate student iliustrates these aspects of client-centered therapy.

The focus is on the client's perception of the present, rather than the past

Client: I was kinda letting it seep through But I also tied it in with you and with my relationship with you. And that's one thing I feel about it is kind of a fear of it going away; or that's another thing it's so hard to get hold of -- there's kind of two pulling feelings about it. Or two "me's" somehow. One is the scared one that wants to hold on to things, and that one I guess I can feel pretty clearly right now. You know, I kinda need things to hold on to and I feel kinda scared.

Therapist: M-hm. That's something you can feel right this minute, and have been feeling and perhaps are feeling in regard to our relationship, too.
C: Won't you let me have this, because, you know, I kinda need it. I can be so lonely and scared without it.
T: M-hm, m-hm. Let me hang on to this because I'd be terribly scared if I didn't. Let me hold on to it. (Pause)
C: It's kinda the same thing. Won't you let me have my thesis or my PhD. so then... 'Cause I kinda need that little world. I mean..
T: In both instances it's kind of a pleading thing, too, isn't it? Let me have this because I need it badly. I'd be awfully frightened without it. (Long pause.)
C: I get a sense of . . . I can't somehow get much further . . . It 's this kind of pleading little boy, somehow, even. .. What's this gesture of begging? (Putting his hands together as if in prayer) Isn't it funny? 'Cause that...
T: You put your hands in sort of a supplication.
C: Ya, that's right! Won't you do this for me, kinda. . . Oh that's terrible! Who, me, beg?

Unlike many therapists, Carl Rogers actively collects research data. Tape recordings of client-centered therapy sessions are frequently kept. When the course of therapy is complete, these recordings are analyzed to yield data about trends in personality change. For example, the number of self- confident statements or the number of self-derogatory statements may be counted. On the basis of such empirical data, Rogers can make fairly definitive statements about the course and effectiveness of client-centered therapy, as shown in the following chart of stages in the therapeutic process.

Rogers and his associates have also collected data on the changes in patients' performances on standardized personality tests, on their perception of the therapist, on their responses to various kinds of therapeutic statements, and on the psychogalvanic skin response in emotion-laden therapy sessions. The large body of data collected by Rogers is a significant contribution to psychotherapeutic research.

STAGES IN THE PROCESS OF CLIENT-CENTERED THERAPY

Stage Characteristics:

1. There is an unwillingness to communicate the self is is about externals Example: "Well, I'll tell you, it always seems a little bit nonsensical to talk about one's self except in times of dire necessity." There is no desire to change. Example: "l think I'm practically healthy."

2. Problems are perceived as external to the self
Example "Disorganization keeps cropping up in my life."
Personal constructs are rigid and are not recognized as being constructs, they are thought of as facts
Example: "I can't ever do anything right can't ever finish it."
3. There is a freer flow of expression about the self as an object
Example: "I try hard to be perfect with her cheerful, friendly, intelligent, talkative, because I want her to love me."
There Is also expression about the self as a reflected object existing primarily in others
Example: "I can feel myself smiling sweetly the way my mother does, or being gruff and important the way my father does sometimes slipping into everyone else's personalities but mine."
4. Feelings are described as objects in the present
Example: "It discourages me to feel dependent because it means I'm kind of hopeless about myself." The c//ens describes more intense feelings of the not-now-present variety. Example: "Well, I was really t hit me down deep."

5. There is an increasing ownership of self feelings and a desire to be these, to be the "real me "
Example: .`The real truth of the matter is that I'm not the sweet, forbear- ing guy that I try to make out that I am. I get irritated at things. I feel like snapping at people, and I feel like being selfish at times; and I don't know why I should pretend I'm not that way."
This is a clear instance of the greater degree of acceptance of all feelings.
There is an increasingly clear facing of contradictions and incongruences in experience Example: "My conscious mind tells me I'm worthy. But some place inside I don't believe it. I think I'm a rat, a no-good. I've no faith in my ability to do anything."

6. The self as an object tends to disappear.
Example: The self is, subjectively, in the existential moment. It is not something one perceives.
Differentiation of experiencing is sharp and basic.
Example: Because each of these moments is a referent, a specific entity, it does not become confused with anything else. The process of sharp differentiation builds on it and about it.

7. New feelings are experienced with immediacy and richness of detail both in the therapeutic relationship and outside of it The experiencing of such feelings is used as a clear referent
Example: The client Quite consciously endeavors to use these referents in order to know in a clearer and more differentiated way who he is, what he wants, and what his attitudes are. This is true even when the feelings are unpleasant or frightening.
Personal constructs are tentatively reformulated, to be validated against further experience, but even then to be held loosely.
Internal communication is clear, with feelings and symbols well matched, and fresh terms for new feelings.
There is the experiencing of effective choice of new ways of being.

FREDERICK S. PERLS' GESTALT THERAPY

Gestalt therapy tries to develop specific qualities in the patient

Gestalt therapy focuses on the present. Although Perls acknowledged his debt to Freud, he largely discarded the techniques and concepts of psychoanalysis with its emphasis on childhood fixations and historical probing. His goal, and the goal of Gestalt therapy, is to make the individual responsive, spontaneous, and aware. Gestalt therapy is an attempt to explore and expose the patterns of rigidity within an individual and to make these patterns flexible so that the individual has fewer predetermined actions and more real choices. Perls (1569) described character in the following way. Once you have a character, you have developed a rigid system. Your behavior becomes petrif ed, predictable, and you lose your ability to cope freely with the world with all your resources. You are predetermined just to cope with events in one way, namely, as your character prescribes it to be. So it seems a paradox when I say that the richest person, the most productive, creative person, is a person who has no character. In our society, we demand a person to have a character, and especially a good character, because then you are predictable, and you can be pigeonholed and so on.

According to Perls, neurosis is a growth disorder. Most people learn to manipulate others and to be untrue to themselves at some time during childhood. Instead of meeting challenges head-on, we learn to think about them: we organize, we plan, and we play roles. We become fragmented into a "top dog" (like the righteous, authoritarian superego) and an "underdog" which manipulates by being defensive, apologetic, and weak.

Now, any time the child, in his development, is prevented from growth by the adult world, any time the child is beingspoiled by not teeing given enough frustration, the child is stuck. So instead of using his potential to grow, he now uses his potential to control the adults, to control the world Instead of mobilizing his own resources, he creates dependencies. He invests his energy in manipulating the environment for support. He controls the adults by starling to manipulate them, by discerning their weak spots. As the child begins to develop the means of manipulation, he acquires what is called character.

The process of becoming mature involves giving up support that has been obtained from the environment and learning to support oneself emotionally. It means giving up external control, in favor of responsiveness to the present situation. Manipulation of the environment by playing roles ceases. Fragments of the self that have been underutilized, hidden, or disowned are reincorporated. Responsibility for one's own behavior is assumed. The person learns to "stand on his own two feet."

The therapist looks for visible signs in the patient's behavior

The Gestalt therapist does not delve into the unconscious. Instead, he pays attention to the most obvious aspects of the patient's behavior: the sound of his voice, its hesitations and rhythm; his posture, facial expression. These gestures convey a message that is less distorted than the content of his words. The therapist gives the patient feedback about his words and actions to create and increase his self-awareness. There are the two legs upon which Gestalt Therapy walks: now and how. The essence of the theory of Gestalt Therapy is in the understanding of these two words. Now covers all that exists. The past is no more, the future is not yet. Now includes the balance of being here, is experiencing, involvement, phenomenon, awareness. How covers everything that is structure, behavior, all that is actually going on -- the ongoing process. All the rest is irrelevant -- computing, apprehending, and so on.

Unresolved problems that continue to influence present behavior are explored in Gestalt therapy. According to Perls, resentments are always signs of unfinished situations. A typical unfinished situation is parent-blaming, which is present in most of us.

Dreamwork is also used to help the individual reawaken parts of himself that he has rejected or disowned. Instead of analyzing the dream, the patient reenacts it in the present. The following fragment is an account of a dreamwork seminar conducted by Frederick Perls. Notice the focus on obvious, here-andnow aspects of the patient's gestures, expressions, and tone of voice.

Frederick: Do you realize something is going on in your body?
Elaine: Yes.
F: What do you experience?
E: My stomach is fluttering, and my heart is ticking, but I really don't feel -- I'm starting to relax now... I had a dream that I wanted to talk to you. I was on...
F: Did you hear the tears in your voice when you said "I was on "? Did you hear the tears? This is what Hike to draw your attention to -- the voice. All the things the voice tells you -- every second.
E: Well, I was in my bed and, uh-
F: Please tell the dream in the present tense.
E: Yes. I am Iying down, and . . . I'm sleeping, and a priest, a Catholic priest comes, and he is draped in black robes, and he comes to the bed and, ah, he asks me to come with him. And I'm frightened, at f rst, because I have no control of the situation. And he asks me -- F: May I interrupt for a moment? Tell the group, "I have to be in control of the situation."
E: I have to be in control of the situation. F: Tell this to a few people here.
E: I have to be in control of the situation. (crying haltingly) I have to be in control of the situation. Uh, ah -- he comes to me draped in robes, and he asks me to come, and I wasn't in control -- I'm not in control.
F: Now you notice this kind of rushing. So Elaine acts as if she has emotional blindness. She experiences something -- crying or so -- something is going on, but she has to go through to the dream as if nothing must disturb her achievement. Apparently she is goal-oriented. Okeh

The constant attention to both the physical and the emotional here-and-now is the essence of the Gestalt approach. Over a period of time, self-awareness breaks down the rigid energy-consuming patterns that have been habitual since childhood. The goal of this approach is a responsive and spontaneous adult. This state of being is expressed in the Gestalt Prayer." I do my thing, and you do your thing.
I am not in this world to live up to your expectations
And you are not in this world to live up to mine.
You are you and I am 1,
And if by chance we fi nd each other, it's beautiful.
If not, it can't be helped

BEHAVIOR THERAPY

Behavior therapies differ from expressive therapies in that they concentrate on direct work with observable behavior rather than on the motivations or unconscious processes which may underlie it. Behavior therapists owe a historical debt not to Freud, but to John B. Watson, founder of behaviorism, to Ivan Pavlov, discoverer of classical conditioning, and to B. F. Skinner, who developed operant conditioning. Neurotic symptoms are regarded as learned responses. The behavior therapist believes that there is no disease underlying the disordered behavior -- if you remove the symptom, you remove the neurosis.

There are many techniques available to the behavior therapists, but all of the techniques utilize the same basic rule of systematically arranging contingencies in order to alter the patient's undesirable responses to stimuli. Some of the techniques used are discussed below.

1. Extinction: Extinction is the withholding of reinforcement. This technique is used to remove undesirable patterns of behavior. Allyon and Michael (1959) demonstrated the effectiveness of extinction in modifying the behavior of psychotic patients. They trained psychiatric nurses to withhold attention when undesirable behaviors were present. By ignoring her delusional talk, they were able to sharply reduce the amount of "crazy" verbal behavior in one woman patient.

Extinction procedures combined with reinforcing incompatible responses have been effective in eliminating pathological vomiting, in reducing the extent of skin rashes, and in controlling temper tantrums in children.

2. Systematic desensitization: Jacobson (1938) developed a method for teaching relaxation to his patients. Relaxation is incompatible with anxiety. If threatening situations can be met with the response of relaxation, anxiety cannot occur. While a patient is fully relaxed, he is exposed to a sequence of stimuli that resemble more and more closely the situation he finds threatening. For example, Lang and Lazovic (1963) treated patients who were afraid of snakes by presenting the word, then the picture, and finally an actual snake.

3. Operant shaping: Reinforcement is given for successive approximations of the desired response in operant shaping. This technique is widely used in behavior modification. Selective positive reinforcement has been used to get psychotics to speak relatively normally, to cure stuttering, to help autistic children, and to control alcoholism and overeating.

4. Conditioned avoidance: Conditioned avoidance uses classical conditioning procedures. An aversive stimulus is paired with the appearance of a desired object. For example, Wolpe (1958) was able to treat a person with an obsession to overeat by pairing electric shock with the stimuli associated with food. This patient had not been helped by psychoanalysis or by electro-convulsive shock treatment, but conditioned avoidance of food was successful. Conditioned avoidance techniques have also been effective in treating sexual deviations, bed wetting, and alcoholism.


MODULE 6
PROGRESS CHECK 1

Now test yourself without looking back.

1. Match.

1) Transactional analysis_______________________

2) Systematic desensitization______________________

3) Client-centered therapy _______________________

4) Conditioned avoidance_________________________

5) Gestalt therapy____________________________

a. A sequence of stimuli, resembling the feared situation more and more, are presented to the relaxed patient.
b. The therapist interprets statements and gestures made by the patient, focusing on the immediate situation rather than on the past. The therapist reflects the patient's thoughts and feelings. The patient determines the direction and the pace of the session.
d. The therapist provides reinforcement for successive approximations of the desired response without analyzing patterns verbally with the patient.
e. The therapist pairs shock or another unpleasant stimulus with the undesired response.
f. The therapist helps the patient to analyze the maladaptive patterns he has developed in terms of parent-adult-child interactions and games.

2. In which of the following expressive therapies would the patient receive shock paired with his maladaptive response?
a. Gestalt therapy
b. Transactional analysis
c. Client-centered therapy
d. (none of these)

3. The top dog in Gestalt therapy corresponds to which Freudian personality structure?
a. Id
b. Ego
c. Superego
d. (none of these)

4. The expressive therapies owe an historical debt to:
a. Sigmund Freud.
b. Ivan Pavlov.
c. B. F. Skinner.
d. John B. Watson.

5. Research data taken from tape-recorded therapy sessions were analyzed for the change in types of statements as therapy progressed. Investigators found that patients disowned their feelings early in therapy. Near the end of therapy they reported sharply differentiated, deep feelings.
The work described above was probably done by a research team interested in:
a. Gestalt therapy.
b. transactional analysis.
c. client-centered therapy.
d. behavior therapy.

6. An emotionally disturbed child does not talk or even look at the people around him. His therapist attempts to get him to behave more normally in the following way. She watches him very closely and pops a small candy into his mouth when he turns his head toward her. When he is doing this reliably, she requires a sound, any sound, to accompany the head turning before she gives the candy. After a while the child is looking directly into her eyes and speaking coherently.
The type of therapy used in this case is:
a. conditioned avoidance.
b. systematic densensitization.
c. operant shaping.

7. Lazarus (1961 ) treated a group of phobic patients by teaching them to relax, and then describing a series of events to them that more and more closely approximated the situations they feared. The claustrophobics had to consider the thought of being enclosed in a small space and eventually learned to relax in a small space. The agoraphobias, on the other hand, learned to relax while thinking about wide open spaces.
Lazarus used the technique of:
a. systematic densensitization.
b. psychodrama.
c. conditioned avoidance.
d. operant shaping.

8. Kushner (1965) cured a man of a fetish for women's underwear by a technique involving electric shock. First, the patient was given a mild shock while he looked at pictures of women's panties. Then he was instructed to imagine various situations involving panties. He was given another mild shock. His fetish was entirely gone within three months.
Kushner used:
a. systematic densensitization.
b. extinction.
c. conditioned
avoidance.
d. operant shaping.

9. Match the quotations from major psychological theorists to the varieties of psychotherapy listed below

1) "When a person comes to me, troubled by his unique combination of difficulties, i have found it most worthwhile to try to create a friendship with him in which he is safe and free. It is my purpose to understand the way he feels in his own inner world, to accept him as he is, to create an atmosphere in which he can move in his thinking and feeling and being, in any direction he desires."__________________________________________

2) "Authenticity, maturity, responsibility for one's actions and life, response-ability, and living in the now, having the creativeness of the now available, is all one and the same thing. Only in the now, are you in touch with what's going on." ______________________________

3) "The most important thing to remember is that the definition of a game is quite precise, and unless a series of transactions is ulterior and has a definite pay-off it does not constitute a game." ______________________________________.

a. Client-centered therapy
b. Transactional analysis
c. Gestalt therapy
d. Conditioned avoidance

ANSWER KEY PAGE 117


MODULE 6
EXERCISES

Use the chart below to answer the exercises following it.
EXPRESSIVE
Technique Developed by Description

Client-centered therapy

Transactional analysis

Gestalt therapy

Carl Rogers

.

Eric Berne

Frederick Perls

The therapist reflects the patient's thoughts and feel ings. The problems analyzed are those which the patient brings to the thera- pist. It is often re ferred to as nondi rective therapy.

The therapist helps the patient analyze his maladaptive pat terns of relationship in terms of parent- adult-child interac tions and games.

The therapist interprets statements and gestures made by the patient, focusing on the im- mediate situation rather than on the past.

BEHAVIORAL

Technique Developed by Description

Conditioned avoidance

Systematic desensitization

Operant shaping

Extinction

Wolpe

.

Jacobsen

B. F. Skinner

B. F. Skinner

The therapist pairs shock or another another unpleasant stimulus with the undesired response.

A sequence of stimuli, resembling the feared situation more and more, are presented to the relaxed patient.

The therapist pro vides reinforcement for successive approximations of the desired response without analyzing , pattern verbally with the patient.

The therapist ignores the patient when he engages in undesirable behav iors.

In which of the therapy approaches does the therapist attempt to reflect the patient's thoughts and feelings so that the patient can reach his own solutions?
_______________________________________________________________3

Which of the approaches in the chart are behavioral techniques?
________________________________________________________1

ANSWERS

1 Conditioned avoidance, sys- tematic desensitization oper ant shaping, extinction

3 client-centered therapy


Which two psychologists are important in the of behavior therapy?
a. Freud and Adler
b. Skinner and Pavlov
c. Jung and Fromm
d. Perls and Rogers
_________________________________________________2

Describe briefly the difference between expressive therapies and behavior therapies.
___________________________________________________5

A patient says to his therapist, "I am angry at you. My idea in telling you this is not a personal unfriendliness, but rather because I am trying to work things out myself."
The therapist replies, "You mean it was a very real feeling in yourself and that's why you wanted to bring it out?"
Which of the therapeutic methods is being employed here?
a. Expressive
b. Behavioral
________________________________________________________4

ANSWERS

4 a

5. Expressive therapies attempt to help the patient understand why he behaves as he does by allowing him to express his feelings in nonthreatening situations. Behavior therapies attempt to change behavior by using techniques developed from reaming theory.

A mother brings her child to a therapist, complaining that her child throws terrible tantrums. `'He stops breathing until he turns blue in the face unless I let him have what he wants." The psychologist instructs the mother to quickly leave the room any time her child begins these tantrums and to completely ignore him until he stops. The mother says she's afraid her son will hurt himself, but she does as the therapist suggests. In two weeks the tantrums have ceased.

The type of approach being used above is called:
a. systematic desensitization.
b. transactional analysis.
c. extinction.
d. conditioned avoidance.
_______________________________________1

In the previous example, d is incorrect because:
a. the therapist is not asking the mother to reinforce successive approximations of the desired response.
b. the therapist is not asking the mother to punish the child by spanking or pairing some other unpleasant stimulus with the tantrums.
c . the therapist is not analyzing the temper tantrum in terms of parent-adult-child transactions.
d. (none of these)
________________________________________2

Suppose the following interchange occurred between a therapist and patient.

PATIENT: I came to you because I can't get along with people -- mostly my family. I'm glad I finally came here, it's a relief just to come here.

THERAPIST: You are telling me that you're relieved to be here, but your hands were shaking when you lighted your cigarette and you are moving around as though you were very nervous.... You give me the impression that you definitely don't like being here.

What kind of therapy might this be?________________________________________________3

ANSWERS

1 c

3 Gestalt therapy

2 b


Flanagan, Goldiamond, and Azrin (1958) successfully reduced chronic stuttering by presenting a tone each time a patient stuttered. The stutterer could avoid the tone by not stuttering. This technique is called:
a. extinction.
b. conditioned avoidance.
c. systematic desensitization.
d. operant shaping.
___________________________________________________________ 2

Bachrach, Erwin, and Mohr treated a severe case of anorexia (inability to eat) in the following manner. The patient, a woman who initially weighed 120 pounds, began to lose weight in 1943 when she refused to eat. By 1960, she was hospitalized weighing 47 pounds. The psychologists found her in 1961 in a nice hospital room with flowers and pictures, TV, and visitors. With her family's permission she was removed from these surroundings and placed in a bare room with only a bed, a sink, and a chair. Each of the experimenters had one meal a day with her. As long as she ate they remained with her. She was also given a TV and a radio on occasions when she ate. If she did not eat, she was left alone. Gradually she began eating more and eventually was permitted to go out and eat with her family. She was discharged on March 25,1961, weighing 61 pounds. Psychologists taught her family to use similar techniques and she continued to improve, eating more with each meal and becoming more active.

This therapeutic approach is called:
a. desensitization.
b. operant shaping.
c. conditioned avoidance.
__________________________________________________1

Match the kind of therapy with the quotation that reflects it.

1) It has been found that personal change is facilitated when the psychotherapist is what he is, when in the relationship with his client he is genuine and without "front" or facade, openly being the feelings and attitudes which at that moment are flowing in him. If a patient is treated as though he had a "weak ego," he is likely to respond accordingly; if he is treated as though he had a perfectly good ego which only needs to be activated, experience shows that there is a good chance that his Adult ego state will become more and more active in his life; that is, he will become more rational and objective toward the outside world and toward himself.

3. The crazy person says, "I am Abraham Lincoln," and the neurotic says, "I wish I were Abraham Lincoln," and the healthy person says, "I am 1, and you are you."

a. Behavior therapy

b. Client-centered therapy

c. Gestalt therapy

d. Transactional analysis

___________________________________________________3

NOW TAKE PROGRESS CHECK 2

1 b
2 b

3
1) b
2) d
3) c
4) a

MODULE 6
PROGRESS CHECK 2

1In which of the following therapies does the therapist let the patient have relatively complete control over the direction of the interview?
a. Gestalt therapy
b. Transactional analysis
c. Client-centered therapy
d. Behavior therapy

2. Operant shaping owes an historical debt to the research work of:
a. Ivan
b. Carl Rogers.
c. B. F. Skinner.
d. Sigmund Freud.

3. "The Child in us demands certainty. The Child wants to know the sun will come up every morning, that Mother will be there, that the bad guy will always get it in the end; but the Adult can accept the fact that there is not always certainty."

The quotation above is probably taken from which author?
a. Frederick Perls
b. Carl Rogers
c. Sigmund Freud
d. Eric Berne

4. Match.

1 ) Client-centered therapy________________

2) Operant shaping__________________

3) Extinction__________________

4) Gestalt therapy________________

5) Transactional analysis__________________

a. The therapist helps the patient see how he relates to others in terms of parent, adult, and child.
b. The therapist ignores the patient's speech whenever it is incoherent.
c. The therapist concentrates on the here and now, pointing out the ways in which the patient is reacting to him.
d. The therapist works with the patient on the problem that seems most crucial to him, never challenging or judging him.
e. The therapist delivers an electric shock every time the patient touches a bottle of liquor.
f. The therapist gives a hospitalized patient points each time he eats without spilling his food. The points can be traded in for television privileges or other ward privileges. At first, points are given for any attempt to eat at the table, but later requirements become stricter.

Wolf, Risley, and Mees (1964) treated a seriously disturbed boy who had to wear eyeglasses because he had cataracts. They deprived him of food and then gave him food when he approximated wearing the glasses. Early in therapy, they reinforced holding the glasses, then they required the child to put the glasses up to his eyes, and finally they required that he wear them for a considerable period of time before they rewarded him with food.

The technique used by Wolf, Risley, and Mees is:
a. conditioned avoidance.
b. systematic desensitization.
c. operant shaping.

6. Lang (1962) treated a case of nervous anorexia (inability to eat) with brief psychotherapy. The patient was taught to relax. Then she was presented with descriptions of feared situations. Some of these involved eating and others were apparently unrelated but threatening. The therapist proceeded slowly through the sequence of imagined events, making sure that the patient could completely relax with one imagined event before going on to the next. This technique is:

a. conditioned avoidance.
b. systematic desensitization.
c. operant shaping.
d. (none of these)

7. Match the following important psychologists with the kinds of therapy they influenced.

1) Expressive therapy________________________

2) Behavior therapy_______________________
a. John B. Watson
b. Ivan Pavlov
c. Sigmund Freud

8. The therapy that views character as a set of inflexible patterns of behavior which keep the individual from spontaneous free choice is:
a. Gestalt therapy.
b. client-centered therapy.
c. transactional analysis.
d. behavior therapy.

9. "The great error of psychoanalysis is in assuming that memory is reality. All the so-called traumata, which are supposed to be the root of the neurosis, are an invention of the patient to save his self-esteem. None of these traumata has ever been proved to exist. I haven't seen a single case of infantile trauma that wasn't a falsification. They are all lies to be hung on to in order to justify one's unwillingness to grow. To mature means to take responsibility for your life, to be on your own."

Which of the following therapeutic systems probably produced the quotation above?
a. Frederick Perls' Gestalt therapy
b. Carl Rogers' client-centered therapy
c. Eric Berne's transactional analysis
d. Carl Jung's analytical psychology

ANSWER KEY

UNIT TEST

Unit 12 Table of Contents

Psych 200 Home Page

November 12, 2005