1. 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).

2. 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)

3. Trephination

4. Exorcizing the Devil to alleviate madness

5. An old-fashioned straight-jacket

6. St. Mary’s of Bethlehem Hospital
(“Bedlam”)

7. Dorothea Dix

8. 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.

9. 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 50’s.
• Cognitive Therapy (Seligman). Began in 60’s.
• 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)

10. 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.

11. Sheldon’s Body Types

12. Types of Personality Tests
• Objective
MMPI (Minnesota Multi Phasic Inventory)
• Projective
TAT (Thematic Apperception Test)
Rorschach Test

13. MMPI CATEGORIES

14. MMPI Categories (cont’d)

16. Interpretation of Sample MMPI Score
• Overly self-critical
• Personality disorder
• Poor social adjustment
• Unusual thinking and behavior
• High level of anxiety

17. Sample Tat Card

18. Sample Tat Card

19. 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 she’s expecting someone
probably pretty dear.
• (3) maybe it’s her son--that shows I’m homesick.
• (4) stuff in the room--furniture, flowers, bookshelves and
books--looks roughly like the middle-class home I came
from
• (5) she doesn’t look like my mother, but somebody’s mother
• (6) even if she has one nude leg.

20. 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.

21. 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.

22. Administering a Rorschach Test

23. Sample Rorschach Card

24. Incidence of Mental Illness

25. Incidence of Depression by Country

26. 
DSM childhood (e.g., mental retardation,
Disorders first evident in
III (1983)
hyperactivity).
 Organic mental disorders: symptoms directly related to
injury to brain or to abnormality (syphilis, Alzheimer’s
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).

27. 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).

28. DSM III (1983) DSM IV (1994)
Childhood mental retardation, hyperactivity 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
Schizophrenic Schizophrenia and other psychotic
disordcrs (delusional
Paranoid
Affective disorders (manic and/or depressed Mood disorders.
moods).
Somatoform disorders (hysteria, Somatoform disorders
hypochodriasis).
Dissociative disorders (amnesia, multiple Dissociative disorders.
personalities).
Psychosexual disorders transsexualism,
frigidity, exhibitionism, sexual sadism,
homosexuality-but only if individual is
unhappy).
Personality disorders (anti-social behavior, Personality disorders (anti-social behavior,
narcissistic personality) narcissistic personality).
Anxiety disorders (generalized anxiety or Anxiety disorders
panic, phobias, posttraumatic stress disorder,
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)

29. Psychoanalysis
• Based on Freud’s 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.

30. Conditions for Psychoanalysis
•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.

31. Freud’s couch

32. Psychoanalytic Method
• 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 one’s motives and
memories.
• Dream interpretation
• Transference

33. 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.

34. 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

35. PROCESS OF CLIENT-
CENTERED 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.

36. 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.

37. EXCERPTS FROM THE FIRST INTERVIEW IN
ROGERIAN THERAPY (cont’d.)
• P: I have a good ear for harmony then. But when I’m
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 don’t 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?
• ************************

38. EXCERPTS FROM THE FIRST INTERVIEW IN
ROGERIAN THERAPY (cont’d.)
• P: Well, it’s just reached the point where it becomes
unbearable. I’d rather be dead than alive as I am
now.
• C: You’d 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.

39. EXCERPT FROM THE EIGHTH AND
FINAL INTERVIEW IN ROGERIAN
THERAPY
• P: Well, I’ve been noticing something
decidedly new. Rather than have
fluctuations, I’ve been noticing a very
gradual and steady improvement. It’s 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.

40. EXCERPT FROM THE EIGHTH AND
FINAL INTERVIEW IN ROGERIAN
THERAPY
• P: I go into situations, and even though it’s 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 isn’t 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 I’ve been
talking,” and I realize that I don’t 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 don’t
bring me down as much as they used to.

41. EXCERPT FROM THE EIGHTH
AND FINAL INTERVIEW IN
ROGERIAN THERAPY (cont’d.)
• 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 can’t get as much self-confidence as when you’re having gradual
improvement.
• C: M-hm.
• P: So that the harder way is really the more satisfactory way.
• C: Then you’re really finding a step-by-step type of improvement that you
hadn’t found before.

42. Phobia Descripion Phobia Description
Acrophobia Heights Monophobia Being
alone
Aerophobia Flying Mysophobia Dirt &
Germs
Agoraphobia Public places Nyctophobia Darkness
Aichmophobia Sharp pointed Ophidiophobia Snakes
objects
Arachnophobia Spiders Parthenophobia Virgins
Brontophobia Thunder- Porphyrophobia The color
storms purple
Claustrophobia Closed spaces Triskaidekaphobia #13
Entomophobia Insects Xenophobia Strangers
Hematophobia Blood Zoophobia Animals

43. Relative Frequency of Phobias

44. How Phobias Vary With Age

45. BEHAVIOR THERAPIST’S
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....

46. BEHAVIOR THERAPIST’S
INSTRUCTIONS (cont’d.)
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....

47. BEHAVIOR THERAPIST’S
INSTRUCTIONS (cont’d.)
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]

48. Behavioral
Therapy
Treatment of
A Phobia
(Sensitization)

49. 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.

50. BEHAVIOR THERAPY
TRANSCRIPT (cont’d.)
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.

51. BEHAVIOR THERAPY
TRANSCRIPT (cont’d.)
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.

52. BEHAVIOR THERAPY TRANSCRIPT (cont’d.)
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)].

53. Comparisons of Different
Approaches to Psychotherapy
Behavior Modification Psychoanalysis
What is to be modified? Learned behavior Symptoms
Role of therapist: Deliberate None - minimal
Active Indirect
Direct Passive
Philosophy of treatment: Scientific Intuitive
Interpretation
of behavior: Real Symbolic
Aim: Goal directed General
restructuring
Basis of change: Training Insight
What is dealt with: Present behavior Past behavior