Foundations of Treatment 135
Treatments That Target Social Factors
Treatments that target social factors aim to reduce symptoms or improve quality
of life by changing a person’s relationships for the better and by creating, expand-
ing, or improving a person’s sense of community. Such treatments may directly or
indirectly address the patient’s problems. For example, when treatment that directly
targets improving a family’s communication leads to better family functioning, the
positive change can lead to the patient’s feeling more supported, which in turn can
reduce symptoms. As we shall see, some treatments that target social factors would
be appropriate for Leon’s problems of depression and social anxiety, whereas other
treatments that target social factors would be less appropriate. All these treatments
have in common their focus on the patient in the context of other people: family
members, group therapy members, coworkers, community members.
Interpersonal Therapy
Interpersonal therapy focuses on the patient’s relationships and is loosely based on
psychodynamic theory.
Key Concepts and Facts About Treatments That Target Psychological Factors
- Psychodynamic therapy and psychoanalysis are intended to
help patients more adaptively manage unconscious conflicts
that arise in large part from id-driven impulses and urges. They
do so by helping a patient develop insight into events in his or
her past (especially interactions with parents) and how these
events and unconscious forces influence current difficulties.
Psychoanalysis is more time-consuming than is psychodynamic
therapy. - Psychodynamic therapy and psychoanalytic methods focus on
the therapeutic alliance, and use free association, interpreta-
tion, dream analysis, resistance, and transference. - Client-centered therapy is designed to integrate the sense of self
by decreasing the incongruence between a patient’s real and
ideal selves. According to the theory of client-centered therapy,
with an integrated sense of self comes reduced emotional pain.
To accomplish these aims, therapists show the patient genuine
empathy and unconditional positive regard. - Behavioral methods often focus attention on the antecedents
and consequences of a maladaptive behavior, as well as on the
behavior itself. Specifi c methods based on classical conditioning
include exposure (sometimes with response prevention), sys-
tematic desensitization, and stimulus control. Methods based
on operant conditioning make use of reinforcement and punish-
ment and may involve shaping, extinction, and self-monitoring. - Cognitive methods based on Ellis’s rational emotive behavior
therapy (REBT) may follow steps (A through F) that are designed
to dispute beliefs that lead to maladaptive consequences.
Methods based on Beck’s cognitive restructuring challenge pa-
tients’ maladaptive automatic negative thoughts and encourage
patients to test the accuracy of their beliefs through real-life
experiments. This hypothesis testing leads patients to develop
more rational responses to the automatic thoughts.- The behavioral aspects of cognitive-behavior therapy (CBT) are
intended to transform maladaptive behaviors that stem from
previous learning, whereas the cognitive aspects of CBT are
intended to modify irrational thoughts and incorrect beliefs that
influence feelings and behavior maladaptively. Changing be-
haviors and thoughts in turn alters feelings as well. CBT often
includes psychoeducation. - Dialectical behavior therapy (DBT) relies on CBT methods and
also has the therapist validate the patient’s experience, help
the patient accept and integrate contradictory feelings and
thoughts, and teach the patient a Zen Buddhist approach of
being nonjudgmental. - Technology is being incorporated into treatment through the
use of electronic methods for self-monitoring and cognitive
restructuring. Virtual reality exposure is also sometimes used
in therapy. Moreover, cybertherapy brings treatment to patients
who are unable or unwilling to go to the offi ce of a mental health
clinician, and it can be a means through which patient and thera-
pist can maintain contact between visits. However, cybertherapy
has drawbacks: The therapist could be an imposter, confi dential
information may not remain private, and the lack of nonverbal
cues for the therapist may skew the treatment in a less helpful
direction. - Treatments for children and older patients that target psycho-
logical factors may need to be modifi ed for those populations.
For instance, children may engage in play therapy (however, cli-
nicians who have different theoretical orientations will use this
method differently).