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Psychotherapy

Once we have identified someone with a disorder, we have to treat it. There are many approaches to therapy but not all are appropriate for every person and for every disorder. Thus the secret is matching the person and the disorder to the appropriate therapy.

Therapy is a general term for many types of interventions. It is systematic interaction between a therapist and a client that brings psychological principles to bear on a client's thoughts, feelings and behavior in order to help a client overcome abnormal behavior. Unconditional trust and confidentiality are two cornerstones of the therapeutic process.

Many different types of mental health professionals may offer therapy services. Each is trained for certain types of therapy and most have expertise with one or two types of clients/problems.

There are several major approaches to therapy. The oldest is psychoanalysis (based on Freud) which seeks to uncover the childhood origins of conflicts in the unconscious. Dream analysis and free association are among their tools.

Humanistic therapies are based on the work of Rogers and Perls. Their goal is insight into the self with an increase in self-esteem. Empathy and unconditional positive regard are key. The empty chair is a typical Gestalt technique.

Behavioral therapies focus on changing the behavior by changing the reward structure. In systematic desensitization, fears are unconditioned. In aversive therapy punishment is associated with an unwanted behavior.

In the cognitive therapies, the focus is on changing the thought system. Albert Ellis's Rational Emotive Therapy (RET) looks at the illogical nature of thoughts. Beck's cognitive therapy is geared toward overcoming the negative bias that contributes to depression.

Biological therapies include both drugs as well as more seldom used surgical procedures such as electroconvulsive therapy.

The key is to match the problem with the appropriate therapy. As you can see, someone with schizophrenia does not need humanistic therapy. Most people with schizophrenia are treated with medication and behavior therapy.

The other controversy with therapy revolves around its effectiveness. There is some evidence that for many problems (not severe ones like schizophrenia) clients will get better without therapy. Therapy just speeds up the process. What do you think?