134 CHAPTER 4
when a member of the family was too far away to attend sessions and with people
who have severe medical problems that make it diffi cult to come to a therapist’s
offi ce (King, Engi, & Poulos, 1998), its effectiveness in such situations has not yet
been tested rigorously.Targeting Psychological Factors in Younger
and Older Populations
As when biomedical treatments are given to children and older adults, treatments that
target psychological factors in these special populations may need to be modifi ed.Targeting Psychological Factors in Younger Patients
Many of the treatments that target psychological factors can be used with children
and adolescents, although a mental health clinician may need to modify a particular
method so that it is appropriate for the cognitive and emotional level of the younger
patient. In addition, the clinician may ask parents to assist with between-session
homework assignments. A therapist employing CBT with a child, for instance, may
ask the parents to become directly involved by helping the child complete daily
self-monitoring logs or by providing reinforcement in response to the child’s desired
behavior change.
In addition, special therapeutic methods have been developed for younger
children, who may not be able to discuss their problems in detail or may have
poor insight into their problems. One such method is play therapy, which uses
toys, games, and play-based activities to elicit therapeutic change. Play therapy is
used in varying ways by clinicians with different therapeutic approaches. For in-
stance, a psychodynamic child therapist may view a child’s play during a therapy
session as a communication of unconscious feelings, much like free association is
viewed for adults in psychodynamic therapy; the role of the clinician is then to
interpret the child’s play. In contrast, a cognitive-behavior therapist is likely
to use play therapy to enhance a child’s social and problem-solving skills; in that
case, play therapy might be the medium through which modeling or role- playing
occurs, where new behaviors are practiced and reinforced (Waas & Kleckler,
2000). Unfortunately, researchers have yet to evaluate whether specifi c uses of
play therapy are effective.Targeting Psychological Factors in Older Patients
To the extent that elderly patients have signifi cant cognitive slowing or mem-
ory problems (or other types of impaired cognition), psychosocial treatments
may need to be modified. For instance, with CBT, elderly patients may need
the therapist to explain information more frequently, or they may require more
opportunities to practice changing their behaviors.In sum, we’ve seen that various approaches to therapy directly target psycho-
logical factors: thoughts, feelings, and behaviors. The methods of psychodynamic
therapies, client-centered therapy, CBT, and DBT—and the technological innova-
tions that can supplement such treatments—all address the psychological factors
that contribute to psychological disorders.
Although in this section we have focused on psychological factors, note that the
relationship between the therapist and patient is a social event: A patient’s interac-
tion with a therapist can provide support, advice, a framework for understanding
symptoms and problems and the sense that someone cares. Moreover, as with all
successful treatments, changing a psychological factor affects neurological factors
as well as social factors: As patients more successfully regulate their emotions, think
about themselves more realistically, and behave differently, their neurological func-
tioning also changes.P SN