心理学与生活-第84章

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assessed　
2。　Placebo　therapy：　A　neutral　therapy　that　creates　expectations　of　heating　
3。　Meta…analysis：　A　statistical　technique　that　evaluates　general　
conclusions　from　data　across　many　different　experiments　or　
evaluation　studies　
B。　Treatment　Evaluations：　
1。　A　study　by　the　National　Institutes　of　Mental　Health　pared　
treatments　for　depression　
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a）　Therapies　evaluated　were　cognitive　behavioral　therapy；　
interpersonal　psychotherapy；　and　drug　therapy　

b）　Evidence　suggests　that　cognitive　behavioral　and　
interpersonal　therapies　had　an　intermediate　level　of　
effectiveness；　and　drug　therapy　had　the　greatest　effect　

c）　Research　indicates　that　virtually　all　therapies　will　bring　
some　relief　

C。　Prevention　Strategies　
1。　Preventing　a　problem　is　the　best　solution。　
2。　Goal　of　prevention　can　be　realized　at　different　levels　
a）　Primary　prevention　tries　to　prevent　a　condition　from　ever　
beginning　

b）　Secondary　prevention　attempts　to　limit　duration　and　severity　
of　a　disorder；　once　it　has　begun　

c）　Tertiary　prevention　limits　the　long…term　impact　of　a　
psychological　disorder　by　seeking　to　prevent　a　relapse　

3。　Implementation　of　these　three　types　of　prevention　focuses　on　
paradigm　shifts　in　mental　health　care；　with　most　important　being：　
a）　Supplementing　treatment　with　prevention　

b）　Going　beyond　a　medical　disease　model　to　a　public　health　
model　

c）　Focusing　on　situations　and　ecologies　that　put　people　at　risk　
and　away　from　“at…risk”　individuals　

d）　Looking　for　precipitating　factors　in　life　settings；　rather　than　
predisposing　factors　in　people　

4。　Clinical　ecology　expands　the　boundaries　of　biomedical　therapies　by　
relating　disorder　to　environmental　irritants　
5。　Ultimate　goal　of　prevention　programs　is　to　safeguard　the　mental　
health　of　all　members　of　society　
DISCUSSION　QUESTIONS　

1。　Does　your　university　have　a　psychological　counseling　center　for　students？　The　years　one　
spends　in　college　are　often　some　of　the　more　trying　years　of　one’s　entire　life。　If　your　
school　is　one　that　does　provide　counseling　services　for　its　students；　check　it　out；　in　terms　
of　cost；　usual　duration　of　therapeutic　intervention；　treatment　modality；　and　any　
underlying　philosophies。　You　may　wish　to　prepare　a　summary　of　this　information　for　the　
class。　
2。　Ask　the　class　what　would　be　most　frightening　to　them　if　it　was　learned　that　tomorrow　all　
the　mental　hospitals　were　to　close；　and　all　patients　were　to　be　released　without　
supervision；　medications；　or　treatment。　Elaborate　on　and　discuss　your　class’s　concerns。　
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3。　Have　the　class　propose　situations　of　transference　and　countertransference　in　the　
therapeutic　environment　and　in　their　own　personal　relationships　outside　of　the　
therapeutic　milieu。　Help　them　to　understand　the　dynamics　of　these　manifestations。　
4。　Phobias　are　a　part　of　life　for　many　of　us；　and　many　of　us　feel　foolish　in　discussing　them。　
Ask　students　if　they　know　someone　who　is　phobic　in　some　area　（this　lets　them　off　the　
hook；　relative　to　self…identification）　and　ascertain　what；　if　any；　coping　mechanisms　may　
be　employed。　Is　the　individual　in　therapy？　Are　they　“toughing　it　out”？　Do　they　avoid　
situations　that　might　trigger　the　phobia？　How　do　various　individuals　deal　with　their　
phobias？　
5。　Is　aversion　therapy　worth　the　“price”；　in　terms　of　the　physical　and　emotional　stress　that　it　
may　cause？　How　effective　does　the　class　believe　it　to　be？　Ask　if　any　of　the　class　would　
engage　in　aversion　therapy　for　a　problem　such　as　smoking　or　weight　loss？　Why　or　why　
not？　Have　them　be　specific。　
6。　Discuss　with　the　class　situations　in　which　social…skills　training　might　be　beneficial。　What　
about　situations　in　which　it　may　be　less　than　effective？　Are　social　skills　really　something　
that　can　be　“learned”　by　an　adult；　or　are　we　hopeless　if　we　fail　to　learn　these　skills　in　
childhood？　Outline　a　treatment　program　for　a　shy　friend。　
7。　Ask　the　class　if　they　think　cognitive　behavior　modification　might　be　more　successful　with　
one　segment　of　the　population　than　with　another？　Have　them　discuss　the　potential　for　
success　with　a　38…year…old　attorney；　as　pared　to　a　75…year…old　widower。　What　might　
be　the　motivations　involved　in　accepting　therapy；　as　displayed　by　these　very　different　
individuals？　Why　is　this　relevant？　
8。　What　is　the　class’s　“take”　on　electroconvulsive　（shock）　therapy？　Many　people　have　little　
if　any　understanding　of　what　the　procedure　entails。　Help　the　class　develop　an　
understanding　of　this　treatment　modality；　and　the　reasons　for　its　success　in　certain　
disorders；　as　well　as　why　it　is　feared　by　some　individuals。　
9。　People　with　personality　disorders　do　not　respond　well　to　most　attempts　at　psychological　
therapy。　Success　rates　in　treating　males　with　antisocial　personality　disorder　have　been　
estimated　to　be　as　low　as　2　to　5　percent。　Success　rates　with　other　types　of　personality　
disorders　vary；　but　are　often　not　significantly　higher。　Additionally；　persons　with　
personality　disorders　rarely　e　in　for　treatment　on　their　own。　Often；　their　only　reason　
for　attempting　therapy　is　external　pressure；　such　as　a　court　order　or　a　demand　by　a　
spouse　who　threatens　to　leave　them。　Is　it　ethically　justifiable　to　subject　someone　to　an　
intensive；　expensive　effort　to　alter　his　or　her　style　of　life；　especially　when　that　person　
doesn't　want　to　be　there　and　the　chances　of　success　are　often　minimal？　One　might　argue　
that　if　the　person　is　not　harming　anyone　else；　such　efforts　are　not　ethically　justifiable。　On　
the　other　hand；　people　with　certain　types　of　personality　disorders；　such　as　antisocial；　
narcissistic；　and　paranoid　personality　disorder；　can　represent　a　real　danger　to　others　in　
some　cases。　The　duty　to　protect　others　might　then　justify　“forced”　therapy　in　these　cases。　
One　might　also　argue；　however；　that　since　success　rates　in　treatment　are　often　so　low；　the　
best　way　to　protect　others　is　to　imprison　people　with　these　disorders　when　their　behavior　
harms　others　in　an　illegal　manner。　What　do　students　think　about　these　issues？　
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SUPPLEMENTAL　LECTURE　MATERIAL　

The　Role　of　Critical　Thinking　in　Emotional　Problems　

Cognitive　therapists　feel　that　certain　emotional　disorders；　like　anxiety　and　depression；　can　be　
traced　to　irrational　and　illogical　ways　of　thinking。　Let　us　look　at　some　of　the　fallacies　that　
cognitive　psychologists　have　noted　in　the　thought　processes　of　some　people　with　emotional　
disorders。　

Faulty　generalization。　This　is　the　tendency　to　use　a　particular　event　or　item　of　information　as　
the　basis　for　a　general　conclusion。　The　man　whose　wife　leaves　him　concludes　that　no　one　
could　ever　love　him。　The　student　who　fails　a　test　concludes　that　she　is　a　failure。　The　woman　
who　gets　an　occasional　headache　concludes　that　she　is　an　unhealthy　person。　

Polarized　thinking。　This　is　the　tendency　to　classify　people；　events；　behavior；　and　thoughts　
rigidly　as　polar　opposites：　right　or　wrong；　good　or　bad。　This　is　also　called　dualistic　thinking；　
black…and…white　thinking；　and　bifurcation。　This　tendency　is　often　described　as　an　effort　to　
oversimplify　reality。　A　woman　feels　that　if　a　person　does　not　give　clear　evidence　of　liking　her；　
then　the　person　must　dislike　her。　An　adolescent　feels　that　thinking　about　anything　related　to　
sex　is　bad　and　tries　unsuccessfully　to　have　only　pure　thoughts。　

Incorrect　assumptions　about　what　is　safe　and　what　is　threatening。　The　maladjusted　person　may　feel　
that　it　is　threatening　to　express　his　views　or　to　show　her　anger。　Taking　the　initiative　to　talk　
with　a　person　of　the　opposite　sex　may　be　perceived　as　threatening。　The　person　could　just　
walk　away；　or　could　say　something　hurtful。　

Maladaptive　attitudes　toward　pleasure　and　pain。　These　are　the　attitudes　that　say　if　an　activity　is　
pleasant；　it　must　be　sinful；　and　if　it　is　unpleasant；　it　means　you　have　done　the　right　thing。　
This　is　analogous　to　thinking　that　a　medicine　is　no　good　unless　it　is　painful　to　apply　or　tastes　
bad。　This　type　of　thinking　may　result　from　selectively　remembering　pleasurable　behaviors　
that　were　punished　and　unpleasant　activities　that　were　rewarded。　Erikson；　who　was　a　
psychodynamic　psychologist；　suggested　that　while　the　superego；　or　conscience；　can　be　very　
powerful；　it　also　has　a　tendency　to　be　juvenile；　simply　because　it　was　established　in　
childhood。　He　thought　that　some　people　could　suffer　terrible　guilt　because　of　this　juvenile　
superego’s　conviction　that　pleasurable　things　are　“bad。”　

Tyranny　of　“shoulds。”　This　is　the　tendency　to　dedicate　one’s　life　to　self…imposed　obligations　
and　responsibilities；　and　to　feel　anxious；　depressed；　or　guilty　if　a　“should”　is　left　undone。　“I　
should　go　to　that　meeting；”　“I　should　write　to　Aunt　Hattie；”　“I　should　change　the　sheets　on　
my　bed。”　It　is　conceivable　that　a　person　could　have　more　“shoulds”　than　there　are　hours　in　
the　day　to　execute　them。　Psychodynamic　psychologists　would　attribute　this　situation　to　a　
domineering　superego。　

Biased　attributions。　Attributions　are　an　attempt　to　understand　events　by　proposing　a　cause　for　
them。　In　the　case　of　the　maladjusted　person；　the　primary　problem　is　the　causes　proposed　to　
explain　personal　behavior　or　events　that　involve　the　self。　The　bias　may　be　in　the　direction　of　
protecting　the　self；　in　which　case　the　maladjusted　person　attributes　successes　and　positive　
events　to　other　people　or　environmental　circumstances；　and　failures　and　negative　events　to　
his　or　her　own　efforts　or　abilities。　A　psychodynamic　psychologist　might　describe　this　as　
overuse　of　defense　mechanisms；　like　rationalization　and　projection。　What　does　a　well…
adjusted　individual　do？　He　or　she　internalizes；　or　takes　credit　for　success；　and　externalizes　
experiences　of　failure。　Maladjusted　individuals　must　do　the　opposite；　he　or　she　may　go　to　the　
opposite　extreme；　attributing　successes　and　positive　events　to　others　or　environmental　factors　

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and　failure　and　negative　events　to　his　or　her　own　lack　of　initiative　or　ability。　In　one　case；　the　

maladjusted　person　is　protecting　a　fragile　self…esteem；　and　in　the　other；　the　person　is　

confirming　low　self…esteem。　

Personalization　of　events。　This　is　a　mild　form　of　delusions　of　reference；　a　condition　in　which　

there　is　a　tendency　to　see　personal　significance　in　the　behavior　of　others。　A　person　goes　to　a　

party　at　which　the　host　serves　Mexican　food。　The　person　does　not　like　Mexican　food　and　

thinks　that　the　host　served　it　to　spite　him　or　her。　The　professor　scolds　the　class　for　poor　

performance　on　a　test。　A　student　feels　that　the　message　is　intended　for　him　or　her　personally。　

You　may　have　noticed　that　the　types　of　faulty　thinking　described　by　cognitive　psychologists　as　
roots　of　emotional　disorders　are　similar　to　uncritical；　rigid　thinking　in　general。　Faulty　thinking　
can　distort　our　interpretation　of　events；　and　it　can　cause　us　to　make　unfortunate　decisions。　

Why　Does　Therapy　Sometimes　Fail？　

Putting　the　blame　on　science。　

We　do　not　know　the　causal　agent　for　most　mental　disorders　because　mental　disorders；　unl