chemotherapy. It is used, most often, for severe cases of depression after other methods have failed.
Although the means by which ECT works is not completely understood, one theory suggests that the
benefits are the result of a change in the brain’s blood flow patterns.
The most intrusive and rarest form of somatic therapy is psychosurgery. Psychosurgery involves the
purposeful destruction of part of the brain to alter a person’s behavior. Clearly, such a procedure is used
only as a last resort and only on people suffering to a great extent. An early, and unfortunately
widespread, form of psychosurgery was the prefrontal lobotomy. This operation involved cutting the
main neurons leading to the frontal lobe of the brain. Although this procedure often calmed the behavior of
patients, it reduced their level of functioning and awareness to a vegetative state. Even today, when
surgical procedures have grown much more precise, debate remains over the risks of psychosurgery, and
such procedures are done as a last resort.
Eclectic Therapies
If you asked a therapist which of the preceeding orientations they use, you might hear something like: “It
depends. I use what works.” Many therapists do not exclusively use one type of therapy. Therapeutic
orientations can be combined in effective ways. For example, cognitive behavioral therapies combine
some of the techniques you read about in the cognitive and behavioral therapies sections. Research
indicates that cognitive behavioral therapies can be particularly effective for some anxiety and some
mood disorders. For example, to treat an anxiety disorder a therapist might combine a behavioral
intervention, such as a systematic desensitization, with talk therapy that helps the client understand his or
her unrealistic cognitions about the source of the anxiety.
Table 13.3. Chemotherapy
Type of Disorder Type of Drug(s)
Anxiety disorders Barbiturates, benzodiazepines
Unipolar depression Monoamine oxidase (MAO) inhibitors, tricyclic antidepressants,
serotonin-reuptake-inhibitors
Bipolar disorder Lithium
Schizophrenia Antipsychotics (neuroleptics)Somatic cognitive therapy is another very common combination eclectic therapy. Many therapists
combine drug therapy along with cognitive talk therapy for mood and other disorders. For example, a
person diagnosed with unipolar depression might receive a prescription for one of the serotonin-reuptake
inhibitor (SSRI) drugs, such as Prozac or Zoloft, while going through cognitive talk therapy to explore
negative cognitions that might be contributing to his or her depression.
KINDS OF THERAPISTS
In addition to the different orientations discussed above, therapists have various levels and kinds of
training.
■ Psychiatrists are medical doctors and are therefore the only therapists permitted to prescribe
medication in most U.S. states. Not surprisingly, because of their backgrounds, psychiatrists often
favor a biomedical model of mental illness and are often less extensively trained in psychotherapy.
■ Clinical psychologists earn doctoral degrees (Ph.D.s) that require four or more years of study. Part