Abnormal Psychology,

Psychopathology & Psychotherapy

What should be labeled deviant?
What psychiatrists, clinical psychologists or other trained professionals
label deviant? (DSM-IV)
Or,
Only organically based behavioral disorders (Szaz).

Treating Insanity
Hippocrates recognized depression and epilepsy as
medical problem.
Middle ages deviant people were locked up
Bedlam (Bethlehem hospital, London)

Reform movement
Pinel (1790)
Dorothea Dix (1850)
Medical Model (late 19th century)

Trephination

ExorcizingtheDeviltoalleviatemadness

Anoldfashionedstraightjacket

St.MarysofBethlehemHospital
(Bedlam)

DorotheaDix

Medical Model of Mental Illness

Psychiatry an offshoot of neurology (Charcot (1860), Breuer & Freud
(1896), Bleuler (1911).
Freud: Too little was known about the brain; opted for psychoanalysis.
Classified mental illness into two major categories: neuroses and
psychoses.
General paresis discovered by Krafft-Ebbing to have a physical cause
in 1905 (syphilis).
Pavlov (1904). Concept of conditioning and experimental neurosis that
was mediated by specific brain circuits.

Reactions to the Medical Model

Harry Stack Sullivan (broke with psychoanalytic tradition).
Clinical (lay) psychologists allowed to treat patients with mental
disorders.
Carl Rogers, Ph.D. Published first transcript of a therapeutic session.
Behavior Therapy (Wolpe, Lazarus). Began in 50s.
Cognitive Therapy (Seligman). Began in 60s.
Thomas Szaz: Mental illness should only refer to behavioral deviations that have a
well defined organic basis. Other deviant behaviors the product of problems of
living.

DSM-III (1983) & IV (1994)

What is a normal personality?

Least deviant?
What is deviant?
Statistical (does 1/10 of population
have mental illness?)
Adaptive sublimation?
Self-actualization?
Quantitative vs. qualitative differences
between normal and abnormal.

SheldonsBodyTypes

TypesofPersonalityTests
Objective
MMPI(MinnesotaMultiPhasicInventory)
Projective
TAT(ThematicApperceptionTest)
RorschachTest

MMPICATEGORIES

MMPICategories(contd)

InterpretationofSampleMMPIScore

Overlyselfcritical
Personalitydisorder
Poorsocialadjustment
Unusualthinkingandbehavior
Highlevelofanxiety

Sample Tat Card

Sample Tat Card

Sample Responses On TAT Test

(1) My first thought is that it looks like a mother comng to
the door.
(2) --the doorbell just rang and shes expecting someone
probably pretty dear.
(3) maybe its her son--that shows Im homesick.
(4) stuff in the room--furniture, flowers, bookshelves and
books--looks roughly like the middle-class home I came from
(5) she doesnt look like my mother, but somebodys mother
(6) even if she has one nude leg.

TAT STORIES IN RESPONSE TO BOY

LOOKING AT VIOLIN
45-year old business man:
This is a child prodigy dreaming over his violin,
thinking more of the music that anything else.
But of wonderment that so much music can be in
an instrument and in the fingers of his own
hand. . . .I would say that possibly he is in
reverie about what he can do with his music in
the times that lay ahead. He is dreaming of
concert halls, tours, and . . . the beauty he will be
able to express and even now can express with
his own talents.

TAT STORY 2
45-Year old clerk:
. . . This is the son of a very well-known, a
very good musician. . . . The father has
probably died. The only thing the son has left
is this violin which is undoubtedly a very
good one. . . . To the son, the violin is the
father and the son sits there daydreaming of
the time that he will understand the music and
interpret is on the violin that his father had
played.

AdministeringaRorschachTest

SampleRorschachCard

IncidenceofMentalIllness

IncidenceofDepressionbyCountry

DSMIII
(1983)
Disorders first evident in childhood (e.g., mental retardation,

hyperactivity).
Organic mental disorders: symptoms directly related to injury to
brain or to abnormality (syphilis, Alzheimers disease, extreme
alcoholism, brain tumor).
Substance use disorders.
Schizophrenic disorders.
Paranoid disorders.
Affective disorders (manic and/or depressed moods).
Somatoform disorders (hysteria, hypochodriasis).
Dissociative disorders (amnesia, multiple personalities).
Psychosexual disorders (transsexualism, frigidity, exhibitionism,
sexual sadism, homosexuality-but only if
individual is
unhappy).
Personality disorders (anti-social behavior, narcissistic
personality).
Anxiety disorders (generalized anxiety or panic, phobias,
posttraumatic stress disorder, obsessive-compulsive disorder).
Leftovers (marital problems, family therapy).

DSM-IV (1994)

Anxiety disorders.
Mood disorders.
Somatoform disorders.
Dissociative disorders.
Schizophrenia and other psychotic disordcrs (delusional).
Substance-related disorders
Eating disorders (aneroxia nervosa, bulimia nervosa).
Sleep disorders.
Impulse control disorders (kleptomania, pyromania,
pathological gambling)
Personality disorders (anti-social behavior, narcissistic
personality).
Disorders first evident in childhood (e.g., mental
retardation, hyperactivity).
Delerium, dementia, amnestic and other cognitive disorders.
Adjustment disorder (Maladaptive, excessive emotional
reaction to a stressful event within previous 6 months).

DSM III (1983)

Childhood mental retardation, hyperactivity

DSM IV (1994)

Childhood (e.g., mental retardation,

hyperactivity).
Organic mental disorders: symptoms directly Delerium, dementia, amnestic and other
related to injury to brain or to abnormality
cognitive disorders.
Substance use
Substance-related disorders
Schizophrenia and other psychotic
disordcrs (delusional

Schizophrenic
Paranoid
Affective disorders (manic and/or depressed
moods).
Somatoform disorders (hysteria,
hypochodriasis).
Dissociative disorders (amnesia, multiple
personalities).
Psychosexual disorders transsexualism,
frigidity, exhibitionism, sexual sadism,
homosexuality-but only if individual is
unhappy).
Personality disorders (anti-social behavior,
narcissistic personality)
Anxiety disorders (generalized anxiety or
panic, phobias, posttraumatic stress disorder,

Mood disorders.

Leftovers (marital problems, family therapy).

Adjustment disorder (Maladaptive,

excessive emotional reaction to a stressful
event within previous 6 months).
Eating disorders (aneroxia nervosa , bulimia
nervosa).
Sleep disorders.
Impulse control disorders (kleptomania,
pyromania, pathological gambling)

Somatoform disorders
Dissociative disorders.

Personality disorders (anti-social behavior,

narcissistic personality).
Anxiety disorders

Psychoanalysis
Based on Freuds theory of personality
Many varieties, e.g., Jung, Adler, Sullivan
M.D. usually required; Ph.D. in clinical psychology now

acceptable (lay analysts)

Training performed by certified institutes in three stages:

-formal courses
-personal analysis with an institute analyst
-control analyses supervised by a training analyst.
Patients: usually brighter than average; in most cases

neurotic. Typically excluded are homosexuals, alcoholics,

psychotics, patients with character disorders.

ConditionsforPsychoanalysis
MD originally required
No psychotics, alcoholics, homosexuals, sociopaths
Time commitment: ~ 5 years
Financial commitment: $150 x 4; $600/week; $27,000/year.
Life decisions placed on hold. No marriage, divorce,
moving, changing jobs without consulting analyst.

Freudscouch

PsychoanalyticMethod
Treatment consists of three to five 50 minute sessions per
week .
Patient is instructed to free associate. He does this while
lying on a couch that is facing away from the analyst.
- less fatiguing to the analyst than face-to-face
relationships
-facilitated free association.
Basic goal is to have awareness of ones motives and
memories.
Dream interpretation
Transference

Goals of Psychoanalysis
Genetic progression - bring the patient from his point of
fixation in the psychosexual development to the genital stage.
Structural - the ego should be strengthened in satisfactory
relationships with the super ego.
Dynamic - direct energy from the defense mechanism to more
productive outlets.
Topographic - makes the unconscious conscious - specifically,
the defense mechanisms.

Client-centered Therapy
Does not assume medical model (client vs. patient; counsellor
vs. therapist/doctor
Brief duration (~ 10 vsits)
Non-directive
Counselor reflects rather than interprets
No dream analysis
No specific retracing of psychosexual history

PROCESS OF CLIENTCENTERED THERAPY

1. Rigidity - little desire to change. Little recognition of
feelings.
2. Perception of problems, externally dispassionate
display of feeling. Little recognition of contradictory
feelings...
3. Free expression of feelings. Source of feelings
considered. Increased awareness of the real me.
Awareness of contradictions.
4. Immediacy of feelings. Real direct experience. High
self-regard. Less intellectualization about self.
5. Acceptance of self and problem.

EXCERPTS FROM THE FIRST

INTERVIEW IN ROGERIAN THERAPY
P (patient): I hesitate to meet people - I hesitate to
canvas for my photographic business. I feel a terrific
aversion to any kind of activity, even dancing. I
normally enjoy dancing very much. But when my
inhibition, or whatever you wish to cal it, is on me
powerfully, it is an ordeal for me to dance. I notice a
difference in my musical ability. On my good days I
can harmonize with other people singing.
C (counselor): M-hm.

EXCERPTS FROM THE FIRST INTERVIEW IN

ROGERIAN THERAPY (contd.)
P: I have a good ear for harmony then. But when
Im blocked, I seem to lose that, as well as my
dancing ability. I feel very awkward and stiff.
C: M-hm. So that both in your work and in your
recreation you feel blocked.
P: I dont want to do anything. I just lie around. I
get no gusto for any activity at all.
C: You just feel rather unable to do things, is that it?
************************

EXCERPTS FROM THE FIRST INTERVIEW IN

ROGERIAN THERAPY (contd.)
P: Well, its just reached the point where it becomes
unbearable. Id rather be dead than alive as I am
now.
C: Youd rather be dead than alive as you are now?
Can you tell me a little more about that?
P: Well, I hope. Of course, we always live on hope.
C: Yes.

EXCERPT FROM THE EIGHTH AND

FINAL INTERVIEW IN ROGERIAN
THERAPY
P: Well, Ive been noticing something
decidedly new. Rather than have
fluctuations, Ive been noticing a very
gradual and steady improvement. Its just as
if I have become more stabilized and my
growth had been one of the hard way and the
sure way rather than the wavering and the
fluctuating way.
C: M-hm.

EXCERPT FROM THE EIGHTH AND

FINAL INTERVIEW IN ROGERIAN
THERAPY

P: I go into situations, and even though its an effort, why, I go

ahead and make progress, and I find that when you sort of
seize the bull by the horns, as it were, why it isnt so bad as if
you deliberate and perhaps - well, think too long about it, like
I used to. I sort of say to myself, Well, I know absolutely that
avoiding the situation will leave me in the same rut Ive been
talking, and I realize that I dont want to be in the same old
rut, so I go ahead and go into the situation, and even when I
have disappointments in the situation, I find that they dont
bring me down as much as they used to.

EXCERPT FROM THE EIGHTH

AND FINAL INTERVIEW IN
ROGERIAN THERAPY (contd.)

C: That sounds like very real progress.

P: And what pleases me is that my feelings are on an even keel, steadily

improving, which gives me much more of a feeling of security than if I had
fluctuations. You see, fluctuations lead you from the peaks to the valleys,
and you cant get as much self-confidence as when youre having gradual
improvement.
C: M-hm.
P: So that the harder way is really the more satisfactory way.
C: Then youre really finding a step-by-step type of improvement that you
hadnt found before.

Phobia

DescripionPhobia Description

Acrophobia

Heights

Monophobia

Aerophobia

Flying

Mysophobia

Agoraphobia

Publicplaces

Nyctophobia

Aichmophobia

Sharppointed Ophidiophobia
objects
Spiders
Parthenophobia

Snakes

Claustrophobia

Thunder
Porphyrophobia
storms
Closedspaces Triskaidekaphobia

Thecolor
purple
#13

Entomophobia

Insects

Xenophobia

Strangers

Zoophobia

Animals

Arachnophobia
Brontophobia

Hematophobia Blood

Being
alone
Dirt&
Germs
Darkness

Virgins

RelativeFrequencyofPhobias

HowPhobiasVaryWithAge

BEHAVIOR THERAPISTS
INSTRUCTIONS
Let all your muscles go loose and heavy.
Just settle back quietly and
comfortably. Wrinkle up your forehead
now; wrinkle it tighter....And now stop
wrinkling your forehead, relax and
smooth it out. Picture the entire
forehead and scalp becoming smoother
as the relaxation increases....

BEHAVIOR THERAPISTS
INSTRUCTIONS (contd.)
Now frown and crease your brows and study the
tension....Let go of the tension again. Smooth
out the forehead once more....Now, close your
eyes tighter and tighter...feel the tension...and
relax your eyes. Keep your eyes closed, gently,
comfortably, and notice the relaxation .... Now
clench your jaws, bite your teeth together;
study the tension throughout the jaws....Relax
your jaws now. Let your lips part
slightly....Appreciate the relaxation....

BEHAVIOR THERAPISTS
INSTRUCTIONS (contd.)
Now press your tongue hard against the roof of
your mouth. Look for the tension....All right, let
your tongue return to a comfortable and relaxed
position .... Now purse your lips, press your lips
together tighter and tighter....Relax your lips.
Note the contrast between tension and
relaxation. Feel the relaxation all over your
face, all over your forehead and scalp, eyes,
jaws, lips, tongue and throat. The relaxation
progresses further and further.... [from Wolpe
and Lazarus (1966), p. 178]

Behavioral
Therapy
Treatmentof
APhobia
(Sensitization)

BEHAVIOR THERAPY
TRANSCRIPT
The patient, a 14-year-old boy, suffered from
an intense fear of dogs which lasted for two
and one-half to three years. He would take
two buses on a roundabout route to school
rather than risk exposure to dogs on a direct
300-yard walk. He was rather a dull (IQ =
93), sluggish person, very large for his age,
trying to be cooperative, but sadly
unresponsive---especially to attempts at
training in relaxation.

BEHAVIOR THERAPY
TRANSCRIPT (contd.)
In his desire to please, he would state that he had
been perfectly relaxed even though he had
betrayed himself by his intense fidgetiness.
Training in relaxation was eventually
abandoned, and an attempt was made to
establish the nature of his aspirations and goals.
By dint of much questioning and after following
many false trails because of his inarticulateness,
a topic was eventually tracked down that was
absorbing enough to form the subject of his
fantasies, namely, racing motor-cars.

BEHAVIOR THERAPY
TRANSCRIPT (contd.)
He had a burning ambition to own a certain Alfa Romeo
sports car and race it at the Indianapolis 500. Emotive
imagery was induced as follows: Close your eyes. I
want you to imagine, clearly and vividly, that your wish
has come true. The Alfa Romeo is now in your
possession. It is your car. It is standing in the street
outside your house. You are looking at it now. Notice the
beautiful, sleek lines. You decide to go for a drive with
some friends of yours. You sit down at the wheel, and
you feel a thrill of pride as you realize that you own this
magnificent machine.

BEHAVIOR THERAPY TRANSCRIPT (contd.)

You start up and listen to the wonderful roar of the exhaust.
You let the clutch in and the car streaks off. You are out in a
clear open road now; the car is performing like a pedigree;
the speedometer is climbing into the nineties; you have a
wonderful feeling of being in perfect control; you look at
trees whizzing by and you see a little dog standing next to
one of them-- if you feel any anxiety, just raise your
finger.... An item fairly high up on the hierarchy was: You
stop at a cafe in a little town, and dozens of people crowd
around to look enviously at this magnificent car and its
lucky owner; you swell with pride; and at this moment a
large boxer comes up and sniffs at your heels. If you feel any
anxiety....
[from Lazarus and Abramovitz (1962)].

Comparisons of Different
Approaches to Psychotherapy
Behavior Modification Psychoanalysis
What is to be modified? Learned behavior
Role of therapist:

Deliberate

Active

Indirect

Direct

Passive

Philosophy of treatment:

Symptoms

None - minimal

Scientific

Intuitive

Interpretation
of behavior:

Real

Symbolic

Aim:

Goal directed

General

restructuring
Basis of change:Training
What is dealt with:

Insight

Present behavior

behavior
Past