Ch 3 - Models of Abnormality PDF

Model: a set of assumptions and concepts that help scientists explain and interpret observations (aka paradigms) The Biological Model Proponents believe that a full understanding of thoughts, emotions, and behaviors must be understood through a biological basis because...

Model: a set of assumptions and concepts that help scientists explain and interpret observations (aka paradigms) The Biological Model Proponents believe that a full understanding of thoughts, emotions, and behaviors must be understood through a biological basis because we are biological beings How Do Biological Theorists Explain Abnormal Behavior Behavioral theorists view abnormal behavior as an illness brought about by malfunctioning brain anatomy or brain chemistry Brain Anatomy and Abnormal Behavior Large groups of neurons and glia form distinct brain regions, and the neurons in each brain region control important functions ○ At the top of the brain is the cerebrum Includes Cortex – outer layer of the brain Corpus collosum – connects the hemispheres basal ganglia – planning and movement Hippocampus – regulate emotions and memory Amygdala – key role in emotional memory Clinical researchers discovered connections between certain psychological disorders and problems in specific brain areas ○ Huntington’s disease Marked by violent emotional outbursts, memory loss, suicidal thinking, involuntary body movements, and absurd beliefs Traced to a loss of cells in the basal ganglia and cortex Brain Chemistry and Abnormal Behavior Psychological disorders can be related to problems in message transmissions from neuron to neuron Abnormal activity by certain neurotransmitters can lead to specific mental disorders ○ Depression is linked to low activity of serotonin and norepinephrine Mental disorders are sometimes related to abnormal chemical activity in the endocrine system  ○ Endocrine glands work with neurons to control vital activities such as growth, reproduction, sexual acivity, heart rate, body temp, energy, stress responses ○ Glands release hormones into bloodstream that propel body organs into action Adrenal glands (top of kidneys) secrete cortisol to help body deal with stress Abnormal secretions of cortisol tied to anxiety and mood disorders Sources of Biological Abnormalities Genetics ○ Brain anatomy/chemistry abnormalities are sometimes result of genetic inheritance Passed through genes in chromosomes that control characteristics and traits we inherit ○ Inheritance plays a part in mood disorders, schizophrenia, and other mental disorders ○ Several genes combine to produce our actions and reactions Functional and dysfunctional Evolution ○ Human reactions and genes responsible for them have survived because they have helped individuals thrive and adapt ○ Capacity to experience fear was, may still be, adaptive Fear altered to dangers, threats, and losses ○ The very genes that helped ancestors survive now leave individuals prone to fear reactions, anxiety disorders, or related psychological disorders Viral Infections ○ Schizophrenia may be related to exposure to certain viruses during childhood or before birth Mothers contracted influenza or related viruses while pregnant ○ Damaging viruses may enter fetus brain and remain dormant until individual reaches adolescence/young adulthood Virus may produce symptoms of schizophrenia for example Biological Treatments Three leading kinds of biological treatments are: ○ Drug therapy  The most common 1950s - Discovery of psychotropic medication Those that mainly affected emotions and thought processes Now in use alone or alongside other forms of therapy While drugs are effective, they do not help everyone Concern is that drugs are overused 4 major psychotropic drugs Antianxiety drugs (minor tranquilizers, anxiolytics) ○ Help reduce tension and anxiety Antidepressant drugs ○ Help improve mood of people Antibioplar drugs (mood stabilizers) ○ Help steady mood swings from mania to depression Antipsychotic drugs ○ Help reduce confusion, hallucinations, and delusions of psychotic disorders ○ Electroconvulsive therapy Used primarily on depressed patients Two electrodes are attached to a patient’s forehead and an electrical current of 60 - 140 volts is briefly passed through the brain Causes brain seizure that lasts a few minutes After 7-9 sessions, spaced 2-3 days apart, many patients feel less depressed Used on many depressed ppl annually, particularly those whose depression fails to respond to other treatments ○ Psychosurgery (Neurosurgery) Psychosurgery procedures are similar to lobotomy but much more precise in cutting the connections between the brain’s frontal lobes and lower regions of the brain Considered experimental and used only after certain severe disorders have continued for years with no response to other treatments Assessing the Biological Model Has considerable respect Biological research provides valuable new insights Biological treatments often bring relief when other treatments fail Shortcomings ○ Proponents expect all human behavior can be explained biologically and treated using biological methods  Limits understanding of abnormal functioning Can have biological and nonbiological factors ○ Several biological treatments can cause undesirable effects Certain antipsychotic drugs can cause movement problems Severe shaking, bizarre contractions of face/body, restlessness The Psychodynamic Model Psychodynamic theorists believe that a person’s behavior is determined by underlying psychological forces of which they are not consciously aware of Internal forces are dynamic (interact with each other), and their interactions give rise to behavior, thoughts, and emotions Conflicts between internal forces result in abnormal symptoms Psychological conflicts are tied to early relationships and to traumatic experiences that occurred during childhood Rest on the deterministic assumption ○ No symptom or behavior is accidental All behavior is determined by past experiences Psychodynamic model was first formulated by Sigmund Freud ○ Developed the theory of psychoanalysis ○ Conversational approach is also called psychoanalysis How Did Freud Explain Normal and Abnormal Functioning? Believed three central forces shape the personality ○ Instinctual needs ○ Rational thinking ○ Moral standards Believed these forces operate at the unconscious level; out of immediate awareness ○ Are dynamic (interactive) ○ Called them the id, the ego, and the superego The Id ○ Refers to instinctual needs, drives, and impulses ○ Operates under the pleasure principle – it always seeks gratification ○ Id instinct tend to be sexual, freud thought bc of course Child’s pleasure obtained from nursing, defecating, masturbating, other activities w sexual ties ○ Suggested person’s libido fuels id The Ego ○ Part of the ego splits to become the ego  ○ Unconsciously seeks gratification but with the reality principle – the knowledge we acquire through experience that it can be unacceptable to outright express id impulses ○ Employs reason, guides id impulses ○ Ego develops ego defense mechanisms to control unacceptable impulses and avoid and reduce the anxiety they arouse Most basic is repression Prevents unacceptable impulses from reaching consciousness The Superego ○ Grows from the ego ○ Operates under the morality principle – sense of right and wrong ○ As we learn from our parents that id impulses are unacceptable, we unconsciously adopt out parents values Judging ourselves by their standards, we feel good when we uphold their values and guilty when we go against them The id, ego and superego are often in some conflict ○ Healthy personality - an effective working relationship, compromise, has formed among the three forces ○ Excessive conflict results in behavioral signs of dysfunction Defense Mechanisms Repression: person avoids anxiety by simply not allowing painful or dangerous thoughts to become conscious Denial: person simply refuses to acknowledge the existence of an external source of anxiety Projection: person attributes own unacceptable impulses, motives, or desires to other individuals Rationalization: person creates a socially acceptable reason for an action that reflects unacceptable motives Displacement: person displaces hostility away from a dangerous object onto a safer substitute Intellectualization: person represses emotional reactions in favor of overly logical response to a problem Regression: person retreats from an upsetting conflict to an early developmental stage at which no one is expected to behave maturely or responsibly Developmental Stages  Proposed that at each stage of development, from infancy to maturity, new events challenge individuals and require adjustments in their id, ego, and superego ○ Successful adjustments lead to personal growth ○ Unsuccessful adjustments lead to fixations at an early stage of development All subsequent developmental suffers; abnormal functioning in the future ○ Oral Stage (first 18 months of life) Children dear their mother will disappear If mother consistently fails to meet oral needs, child may become fixated on oral stage Extreme dependence or mistrust ○ Prone to depression ○ Anal stage (18 months - 3 years old) ○ Phallic (3 - 5 years old) ○ Latency (5 to 12 years old) ○ Genital (12 years old - adulthood) How Do Other Psychodynamic Explanations Differ from Frued’s? Carl Jung and Alfred Alder developed new theories but held onto the belief that human functioning is shaped by dynamic psychological forces ○ Thus all such theories are referred to as psychodynamic Today’s most influential psychodynamic theories: ○ Ego theory Emphasizes the role of the ego and considers it a more independent and powerful force than Frued did ○ Self-theory Give the greatest attention to the self—the unified personality Believe the basic human motive is to strengthen the wholeness of the self ○ Object relations theory Proposes that people are motivated mainly by a need to have relationships with others Severe problems in the relationships between children and caregivers may lead to abnormal development Psychodynamic Theories Range from Freudian psychoanalysis to modern therapies based on self-theory or object relations theory  Psychodynamic therapies seek to uncover past traumas and inner conflicts that have resulted from them ○ Try to help client resolve/settle conflicts and resume personal development Therapists must guide therapy discussions so patients discover underlying problems themselves ○ To aid the process, they use Free association, therapist interpretation, catharsis, and working through Free Association Patient is responsible for starting and leading conversations Therapists tell patients to describe thoughts, feelings, or images that come to mind, even if unimportant Therapists expects patient’s associations will uncover unconscious events Therapist Interpretation Psychodynamic therapists listen, looking for clues, drawing conclusions, and sharing interpretations when patient is ready Interpretations of resistance, transference, and dreams are particularly important ○ Resistance – an unconscious refusal to participate fully in therapy When they suddenly can’t free associate or change the subject to avoid a painful discussion ○ Transference – when patient acts or feel toward the therapist as they did or do toward important persons in their lives, especially their parents, siblings, and spouses ○ Dreams – can reveal unconscious instincts, needs, and wishes if interpreted correctly because defense mechanisms operate less completely while asleep Freud called dreams the “royal road to the unconscious” Two dream content Manifest – the consciously remembered dream Latent – symbolic meaning To interpret dreams, therapist must translate its manifest content into its latent content Catharsis A reliving of past repressed feelings Psychodynamic therapists believe patients must experience catharsis to settle internal conflicts and overcome their problems  Working Through A single episode of catharsis will not change the way a person functions Must examine the same issues over and over in the course of many sessions, each time with greater clarity – walking through Takes a long time, sometimes years Current Trends in Psychodynamic Therapy Two current trends that illustrate the increased demand for focused, time-limited psychotherapies to make psychodynamic therapy more efficient and affordable ○ Short-term psychodynamic therapies Patients choose a single problem—dynamic focus–to work on Focus on this single problem throughout treatment andn work only on the psychodynamic issues related to the issue Limited number of studies on effectiveness, but findings suggest that the approaches are sometimes quite helpful ○ Relational psychoanalytic therapy Therapists are key figures in patients lives whose reactions and beliefs should be included in the therapy process Key principle is that therapists should also disclose things about themselves, particularly their own reactions to patients, and try to establish more equal relationships with patients Assessing the Psychodynamic Model Psychodynamic theorists have helped understand that abnormal functioning may be rooted in the same processes as normal functioning Psychological conflict is a common experience; leads to abnormal functioning only if the conflict is excessive Freudians were first to demonstrate the potential of psychological treatment ○ Their ideas served as starting points for other psychological treatments Shortcomings ○ Concepts are hard to research ○ Psychodynamic explanations and treatments have received limited research support ○ Psychodynamic theorists rely largely on evidence provided by individual case studies ○ Recent research suggests long-term psychodynamic therapy may be helpful for people w long-term complex disorders The Behavioral Model Believe that our actions are determined largely by our experiences in life Concentrates on behaviors, the responses an organism makes to its environment ○ External or internal Behavioral theorist base their explanations and treatments on principles of learning ○ The process by which these behaviors change in response to the environment Abnormal behaviors can be learned Behavioral model began in labs with experiments on conditioning ○ manipulated stimuli and rewards, then observed how their manipulations affected the responses of their research participants How Do Behaviorists Explain Abnormal Functioning? Serval forms of conditioning that produce abnormal behavior as well as normal behavior In operant conditioning, humans and animals learn to behave in certain ways as a result of receiving rewards/consequences whenever they do In modeling, individuals learn responses simply by observing others and repeating their behaviors In classical conditioning, learning occurs by temporal association ○ When two events repeatedly occur close together in time, they become fused in a person’s mind, and before long the person responds in the same way to both events ○ Ivan Pavlov ○ Explains many familiar behaviors The romantic feelings a young man experiences when he smells his girlfriend’s perfume, say, may represent a conditioned response Every time the dog barks and lunges at the boy, the sandbox is there too. After repeated pairings of this kind, the child comes to fear sand as much as he fears the dog Behavioral Therapies Behavioral therapists aim to identify the behaviors that are causing a person’s problems and then try to replace them with more appropriate ones by applying the principles of classical conditioning, operant conditioning, or modeling Systematic desensitization – clients learn to react calmly to they objects of situations they dread ○ Often applied in cases of phobia ○ Taught relaxation over several sessions Next, construct a fear hierarchy  List of feared objects, starting with those less feared and ending with most feared Then, have client imagine or confront each item on hierarchy while in a state of relaxation ○ In step-by-step pairings of feared items and relaxation, clients move up the hierarchy until at last they can face every one of the items without experiencing fear Assessing the Behavioral Model It can be tested in a lab ○ Stimulus, response, and reward can be observed measured Experimenters have successfully used the principles of learning to create clinical symptoms in lap participants, suggesting psychological disorders may develop this way Behavioral treatments can be helpful to people with specific fears, compulsive behavior, social deficits, mental retardation Weaknesses ○ Symptoms can be produced in participants, but are they ordinarily acquired this way? No indisputable evidence that most ppl with psychological disorders are victims of improper conditioning ○ Improvements from therapies do not always extend to real life or last without continued therapy ○ Critics hold behavioral view is too simplistic; concepts fail to account for complexity of behavior Albert Bandura (leading behaviorist) argues ppl must develop a positive sense of self-efficacy in order to feel happy and function effectively They must know they can master and perform needed behaviors whenever necessary Cognitive-behavioral therapy ○ Help clients change both counterproductive behaviors and dysfunctional ways of thinking The Cognitive Model Albert Ellis and Aaron Beck proposed that cognitive processes are at the center of behaviors, thoughts, and emotions and that we can best understand abnormal functioning by looking at cognition  ○ Claimed clinicians should ask questions about the assumptions and attitudes of clients perceptions, thoughts running through their minds, and the conclusions to which they are leading How Do Cognitive Theorists Explain Abnormal Functioning? Abnormal functioning can develop from several kinds of cognition problems ○ Some people make assumptions and adopt attitudes that are disturbing and inaccurate ○ Illogical thinking processes are another source of abnormal functioning Beck found that some ppl consistently think in illogical ways and keep arriving at self-defeating conclusions Cognitive Therapies People with psychological disorders can overcome their problems by developing new, more functional ways of thinking Cognitive therapy – therapists help clients recognize the negative thoughts, biased interpretations, and errors in logic that dominate their thinking and cause them to feel depressed (beck) ○ Therapists also guide clients to challenge their dysfunctional thinking, try new interpretations, and apply new ways of thinking in their lives Assessing the Cognitive Model Cognitive model has very broad appeal Focuses on a process unique to human beings Cognitive theories lend themselves to research Impressive performance of cognitive and cognitive-behavioral therapies in formats ranging from individual and group therapy to cybertherapy ○ Proved effective for treating depression, panic disorder, social phobia, and sexual dysfunction Drawbacks ○ Precise role of disturbed cognitive process in abnormality is tbd ○ Cognitive and behavioral-cognitive therapies do not help everyone ○ Growing body of research suggests that it is not always possible to achieve the kind of cognitive changes proposed by beck ○ Still narrow bc it only focuses on one part of human functioning New wave of cognitive therapies has emerged ○ These new approaches, such as Acceptance and Commitment Therapy (ACT), help clients to accept many of their problematic thoughts rather than judge them, act on them, or try to change them Hope is that by recognizing them as just thoughts, clients will eventually let them pass their awareness Employs mindfulness-based techniques  Mindfulness meditation which teaches individuals to pay attention to the thoughts and feelings in their minds during meditation and to accept such thoughts in nonjudgmental way The Humanistic-Existential Model Humanists, the more optimistic of the two groups, believe that human beings are born with a natural tendency to be friendly, cooperative, and constructive ○ People are driven to self-actualize—that is, to fulfill this potential for goodness and growth only if they honestly recognize and accept their weaknesses as well as their strengths and establish satisfying personal values to live by Humanists further suggest that self-actualization leads naturally to a concern for the welfare of others and to behavior that is loving, courageous, spontaneous, and independent Existentialists agree that human beings must have an accurate awareness of them selves and live meaningful—they say “authentic”—lives in order to be psychologically well adjusted ○ Do not believe that people are naturally inclined to live positively They believe that from birth we have total freedom, either to face up to our existence and give meaning to our lives or to shrink from that responsibility Those who choose to “hide” from responsibility and choice will view themselves as helpless and may live empty, inauthentic, and dysfunctional lives as a result Carl Rogers – pioneer of humanistic perspective ○ developed client-centered therapy – a warm and supportive approach that contrasted sharply with the psychodynamic techniques of the day ○ proposed a theory of personality that paid little attention to irrational instincts and conflicts The humanistic and existential theories, and their uplifting implications, were extremely popular during the 1960s and 1970s, years of considerable soul-searching and social upheaval in Western society ○ have since lost some of their popu larity, but they continue to influence the ideas and work of many clinicians In particular, humanistic principles are apparent throughout positive psychology Rogers’ Humanistic Theory and Therapy According to Carl Rogers, the road to dysfunction begins in infancy ○ We all have a basic need to receive positive regard from the important people in our lives (primarily our parents)  Those who receive unconditional (nonjudgmental) positive regard early in life are likely to develop unconditional self-regard some children repeatedly are made to feel that they are not worthy of positive regard As a result, they acquire conditions of worth, standards that tell them they are lovable and acceptable only when they conform to certain guidelines ○ To maintain positive self-regard, these people have to look at themselves very selectively, denying or distorting thoughts and actions that do not measure up to their conditions of worth They thus acquire a distorted view of themselves and their experiences They do not know what they are truly feel ing, what they genuinely need, or what values and goals would be meaningful for them Clinicians who practice Rogers’ client-centered therapy try to create a supportive climate in which clients feel able to look at themselves honestly and acceptingly The therapist must display three important qualities throughout the therapy ○ unconditional positive regard ○ Accurate empathy ○ Genuineness Clients begin to value their own emotions, thoughts, and behaviors, and so they are freed from the insecurities and doubts that prevent self-actualization Client-centered therapy is in between on if it works or not in research Roger’s therapy was the first major alternative to psychodynamic therpy helped open up the clinical field to new approaches. Rogers also helped pave the way for psychologists to practice psychotherapy, which had previously been considered the exclusive territory of psychiatrists Gestalt Theory and Therapy Fredrick (Fritz) Perls Guide clients towards self-recognition and self-acceptance, but by challenging and frustrating clients ○ Skillful frustration technique gestalt therapists refuse to meet their clients’ expectations or demands This use of frustration is meant to help people see how often they try to manipulate others into meeting their needs  ○ Role-playing technique Role playing can become intense, as individuals are encouraged to express emotions fully. Many cry out, scream, kick, or pound. Through this experience they may come to “own” (accept) feelings that previously made them uncomfortable ○ employing numerous rules and exercises rules to ensure that clients will look at themselves more closely Spiritual Views and Interventions During the past decade, many articles and books linking spiritual issues to clinical treatment have been published, and the ethical codes of psychologists, psychiatrists, and counselors have each concluded that religion is a type of diversity that mental health professionals must respect Researchers have learned that spirituality does, in fact, often correlate with psychological health ○ In particular, studies have examined the mental health of people who are devout and who view God as warm, caring, helpful, and dependable individuals are found to be less lonely, pessimistic, depressed, or anxious than people without any religious beliefs or those who view God as cold and unresponsive Such people also seem to cope better with major life stressors—from illness to war—and to attempt suicide less often. In addition, they are less likely to abuse drugs Correlation does not indicate causation Existential Theories and Therapy Like humanists, existentialists believe that psychological dysfunctioning is caused by self-deception; existentialists, however, are talking about a kind of self-deception in which people hide from life’s responsibilities and fail to recognize that it is up to them to give meaning to their lives many people become overwhelmed by the pressures of present-day society and so look to others for explanations, guidance, and authority ○ They overlook their personal freedom of choice and avoid responsibility for their lives and decisions Such people are left with empty, inauthentic lives. Their dominant emotions are anxiety, frustration, boredom, alienation, and depression In existential therapy, people are encouraged to accept responsibility for their lives and for their problems ○ Therapists try to help clients recognize their freedom so that they may choose a different course and live with greater meaning Precise techniques vary from clinicians to clinician  ○ most ex istential therapists place great emphasis on the relationship between therapist and client and try to create an atmosphere of honesty, hard work, and shared learning and growth Assessing the Humanistic-Existential Model In recognizing the special challenges of human existence, humanistic and existential theorists tap into an aspect of psychological life that typically is missing from the other models ○ self-acceptance, personal values, personal meaning, and personal choice—are certainly lacking in many people with psychological disturbances. Theorists who follow the principles of the humanistic-existential model offer great hope when they assert that, despite past and present events, we can make our own choices, determine our own destiny, and accomplish much Limits ○ the humanistic-existential focus on abstract issues of human fulfillment gives rise to a major problem from a scientific point of view ○ Difficult to research ○ In fact, with the notable exception of Rogers, who tried to investigate his clinical methods carefully, humanists and existentialists have tradi tionally rejected the use of empirical research Starting to change tho The Sociocultural Model: Family-Social and Multicultural Perspectives Abnormal behavior is best understood in light of broad forces that influence the individual Composed of two major perspectives ○ The family-social perspective ○ The multicultural perspective How Do Family-Social Theorists Explain Abnormal Functioning? Proponents of the family-social perspective argue that clinical theorists should concentrate on those broad forces that operate directly on an individual as he or she moves through life—that is, family relationships, social interactions, and community events. ○ believe that such forces help account for both normal and abnormal behavior, and they pay particular attention to three kinds of factors: social labels and roles, social networks, and family structure and communication Social Labels and Roles Abnormal functioning can be influenced greatly by the labels and roles assigned to troubled people When people stray from the norms of their society, the society calls them deviant and, in many cases, “mentally ill.” Such labels tend to stick Moreover, when people are viewed in particular ways, reacted to as “crazy,” and perhaps even encouraged to act sick, they gradually learn to accept and play the assigned social role Social Connections and Supports Family-social theorists are also concerned with the social environments in which people operate, including their social and professional relationships They have observed, for example, that people who are isolated and lack social support or intimacy in their lives are more likely to become depressed when under stress and to remain depressed longer than are people with supportive spouses or warm friendships Some clinical theorists believe that people who are unwilling or unable to communicate and develop relationships in their everyday lives will often find adequate social contacts online Family Structure and Communication According to family systems theory, the family is a system of interacting parts—the family members— who interact with one another in consistent ways and follow rules unique to each family Family systems theorists believe that the structure and communication patterns of some families actually force individual members to behave in a way that otherwise seems abnormal ○ If the members were to behave normally, they would severely strain the family’s usual manner of operation and would actually increase their own and their family’s turmoil Family systems theory holds that certain family systems are particularly likely to produce abnormal functioning in individual members ○ Some families, for example, have an enmeshed structure in which the members are grossly overinvolved in one another’s activities, thoughts, and feelings Children from this kind of family may have great difficulty becoming independent in life ○ Some families display disengagement, which is marked by very rigid boundaries between the members Children from these fami lies may find it hard to function in a group or to give or request support Family-Social Treatments The family-social perspective has helped spur the growth of several treatment approaches, including group, family, and couple therapy, and community treatment. However, more and more of the clinicians who use these formats believe that psychological problems emerge in family and social settings and are best treated in such settings, and they include special sociocultural strategies in their work Group Therapy Group therapy – A therapy format in which a group of people with similar problems meet together with a therapist to work on those problems ○ The group format also has been used for purposes that are educational rather than therapeutic, such as “consciousness raising” and spiritual inspiration ○ Research suggests that group therapy is of help to many clients, often as helpful as individual therapy A format similar to group therapy is the self-help group (or mutual help group) ○ A group made up of people with similar problems who help and support one another without the direct leadership of a clinician. Also called a mutual help group Family Therapy A therapy format in which the therapist meets with all mem bers of a family and helps them to change in therapeutic ways Family therapists may follow any of the major theoretical models, but many of them adopt the principles of family systems theory family systems theory holds that each family has its own rules, structure, and communication patterns that shape the individual members’ behavior ○ In structural family therapy, therapists try to change the family power structure, the roles each person plays, and the relationships between members ○ In conjoint family therapy, therapists try to help members recognize and change harmful patterns of communication Couple Therapy A therapy format in which the therapist works with two people who share a long-term relationship. Also called marital therapy. couple need not be married or even living together  Like family therapy, couple therapy often focuses on the structure and communication patterns in the rela tionship Couple therapy, like family and group therapy, may follow the principles of any of the major therapy orientations ○ Cognitive-behavioral couple therapy, for example, uses many techniques from the cognitive and behavioral perspectives Therapists help spouses recognize and change prob lem behaviors largely by teaching specific problem-solving and communication skills A broader, more sociocultural version, called integrative couple therapy, further helps partners accept behaviors that they cannot change and embrace the whole relationship nevertheless Couples treated by couple therapy seem to show greater improvement in their relationships than couples with similar problems who do not receive treatment, but no one form of couple therapy stands out as superior to others Community Treatment Community mental health treatment – programs allow clients, particularly those with severe psychological difficulties, to receive treatment in familiar social surroundings as they try to recover a key principle of community treatment is prevention ○ This involves clinicians actively reaching out to clients rather than waiting for them to seek treatment Community workers recognize three types of prevention, which they call primary, secondary, and tertiary ○ Primary prevention consists of efforts to improve community attitudes and policies. Its goal is to prevent psychological disorders altogether. Community workers may, for example, consult with a local school board, offer public workshops on stress reduction, or construct Web sites on how to cope effectively. ○ Secondary prevention consists of identifying and treating psychological disorders in the early stages, before they become serious. Community workers may work with teachers, ministers, or police to help them recognize the early signs of psychological dysfunction and teach them how to help people find treatment ○ The goal of tertiary prevention is to provide effective treatment as soon as it is needed so that moderate or severe disorders do not become long-term problems. Community agencies across the United States successfully offer tertiary care for millions of people with moderate psychological problems but, as you read in Chapter  1, they often fail to provide the services needed by hundreds of thousands with severe disturbances How Do Multicultural Theorists Explain Abnormal Functioning? The view that each culture within a larger society has a particular set of values and beliefs, as well as special external pressures, that help account for the behavior and functioning of its members. Also called culturally diverse perspective seek to understand how culture, race, ethnicity, gender, and similar factors affect behavior and thought and how people of different cultures, races, and genders differ psychologically the model holds that an individual’s behavior, whether normal or abnormal, is best understood when examined in the light of that individual’s unique cultural context, from the values of that culture to the special external pressures faced by members of the culture Each of these groups is subjected to special pressures in American society that may contribute to feelings of stress and, in some cases, to abnormal functioning ○ Multicultural researchers have also noted that the prejudice and discrimination faced by many minority groups may contribute to various forms of abnormal functioning ○ Researchers have learned, for example, that psychological abnormality, especially severe psychological abnormal ity, is indeed more common among poorer people ○ African Americans, Hispanic Americans, and American Indians are more likely than white Americans to experience se rious psychological distress or extreme sadness Multicultural Treatments Studies conducted throughout the world have found that members of ethnic and racial minority groups tend to show less improvement in clinical treatment, make less use of mental health services, and stop therapy sooner than members of majority groups A number of studies suggest that two features of treatment can increase a therapist’s effectiveness with minority clients: ○ greater sensitivity to cultural issues ○ inclusion of cultural morals and models in treatment, especially in therapies for children and adolescents Culturesensitive therapies – approaches that are designed to help address the unique issues faced by members of cultural minority groups  Therapies geared to the pressures of being female – gender sensitive, or feminist, therapies Culture-sensitive approaches typically include the following elements ○ 1. Special cultural instruction for therapists in their graduate training program ○ 2. The therapist’s awareness of a client’s cultural values ○ 3. The therapist’s awareness of the stress, prejudices, and stereotypes to which minority clients are exposed ○ 4. The therapist’s awareness of the hardships faced by the children of immigrants ○ 5. Helping clients recognize the impact of both their own culture and the dominant culture on their self-views and behaviors ○ 6. Helping clients identify and express suppressed anger and pain ○ 7. Helping clients achieve a bicultural balance that feels right for them ○ 8. Helping clients raise their self-esteem—a sense of self-worth that has often been damaged by generations of negative messages Assessing the Sociocultural Model The family-social and multicultural perspectives have added greatly to the understanding and treatment of abnormal functioning the treatment formats offered by the sociocultural model sometimes succeed where traditional approaches have failed Limits ○ sociocultural research findings are often difficult to interpret Studies show a link between family conflict and schizophrenia, for example, but that finding does not necessarily mean that family dysfunction causes schizophrenia. ○ inability to predict abnormality in specific individuals If, for example, social conditions such as prejudice and discrimination are key causes of anxiety and depression, why do only some of the people subjected to such forces experience psychological disorders? ○ most clinicians view the family-social and multicultural explanations as operating in conjunction with the biological or psychological explanations Summing Up MODELS OF PSYCHOLOGICAL ABNORMALITY Scientists and clinicians use models, or paradigms, to understand and treat abnormal behavior. The principles and techniques of treatment used by clinical practitioners correspond to their preferred models. pp. 55–57  THE BIOLOGICAL MODEL Biological theorists look at the biological processes of human functioning to explain abnormal behavior, pointing to anatomical or biochemical problems in the brain and body. Such abnormalities are sometimes the result of genetic inheritance of abnormalities, normal evolution, or viral infections. Biological therapists use physical and chemical methods to help people overcome their psychological problems. The leading methods are drug therapy, electroconvulsive therapy, and, on rare occasions, psychosurgery. pp. 57–62 THE PSYCHODYNAMIC MODEL Psychodynamic theorists believe that an individual’s behavior, whether normal or abnormal, is determined by underlying psychological forces. They consider psychological conflicts to be rooted in early parent-child relationships and traumatic experiences. The psychodynamic model was formulated by Sigmund Freud, who said that three dynamic forces—the id, ego, and superego—interact to produce thought, feeling, and behavior. Freud also proposed that individuals who do not make appropriate adjustments in the id, ego, and superego during their early years may become fixated at an early stage of development. Other psychodynamic theories are ego theory, self-theory, and object relations theory. Psychodynamic therapists help people uncover past traumas and the inner conflicts that have resulted from them. They use a number of techniques, including free association and interpretations of psychological phenomena such as resistance, transference, and dreams. The leading contemporary psychodynamic approaches include short-term psychodynamic therapies and relational psychoanalytic therapy. pp. 62–69 THE BEHAVIORAL MODEL Behaviorists concentrate on behaviors and propose that they develop in accordance with the principles of learning. These theorists hold that three types of conditioning—classical conditioning, operant conditioning, and modeling—account for all behavior, whether normal or dysfunctional. The goal of the behavioral therapies is to identify the client’s problematic behaviors and replace them with more appropriate ones, using techniques based on one or more of the principles of learning. The classical conditioning approach of systematic desensitization, for example, has been effective in treating phobias. pp. 69–72 THE COGNITIVE MODEL According to the cognitive model, we must understand human thought to understand human behavior. When people display abnormal patterns of functioning, cognitive theorists point to cognitive problems, such as maladaptive assumptions and illogical thinking processes. Cognitive therapists try to help people recognize and change their faulty ideas and thinking processes. Among the most widely used cognitive treatments is Beck’s cognitive therapy. pp. 72–75  THE HUMANISTIC-EXISTENTIAL MODEL The humanistic-existential model focuses on the human need to confront philosophical issues such as self-awareness, values, meaning, and choice successfully to be satisfied in life. Humanists believe that people are driven to self-actualize. When this drive is interfered with, abnormal behavior may result. One group of humanistic therapists, client-centered therapists, tries to create a very supportive therapy climate in which people can look at themselves honestly and acceptingly, thus opening the door to self-actualization. Another group, gestalt therapists, uses more active techniques to help people recognize and accept their needs. Recently the role of religion as an important factor in mental health and in psychotherapy has caught the attention of researchers and clinicians. According to existentialists, abnormal behavior results from hiding from life’s responsibilities. Existential therapists encourage people to accept re sponsibility for their lives, to recognize their freedom to choose a different course, and to choose to live with greater meaning. pp. 76–82 THE SOCIOCULTURAL MODEL The family-social perspective looks outward at three kinds of factors. Some proponents of this perspective focus on social labels and roles; they hold that society calls certain people “mentally ill” and that those individuals in turn follow the role implied by such a label. Others focus on social connections and supports, believing that isolation, poor social supports, and similar factors may contribute to psychological difficulties. Still, others emphasize the family system, believing that a family’s structure or communication patterns may force members to behave in abnormal ways. Practitioners from the family-social model may practice group, family, or couple therapy, or community treatment. The multicultural perspective holds that an individual’s behavior, whether normal or abnormal, is best understood when examined in the light of his or her unique cultural context, including the values of that culture and the special external pressures faced by members of that culture. Practitioners of this model may practice culture-sensitive therapies, approaches that seek to address the unique issues faced by members of cultural minority groups. pp. 82–92