haL7069X_ch01_002-035.

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Case R
Rebecc
eport
T O T H E C A S E
R E T U R N (continued)

a Hasb
idered this pos-
Re be cca initially cons be-
el less bu rd en ed ded against it,
th ou gh w hi ch she would fe pe op le w ho sibility, she deci rta nt to m ak ea
at ie nt therapy. Al g to interact with e sh e felt it im po
w ee k for ou tp - by ha vin life. ca us pr ov e to
r grief always
re personal order to
inquire about her lean break” in

rouck
dealing with he or k, in w ou ld un fo ld ed “c be tru ly in de -
ne d a co m po ne nt of our w Th e su cc es s story that - he rs elf th at she could w ed , I
mai on a fairy follo
d our attention seemed to have very pendent. In the years that
time we refocuse and abilities so for Rebecca riting w as cca only on ce . Ab ou t
tapping her tale
nts
an d so - ta le quality to it. Her w turned to a heard from Rebe te rm in at ed , I re -
at sh e co uld re turn to work w el l re ce ive d, and she re th e 4 ye ar s after we had ce m en t
th
with other people
. ate over announ
cial involvement lle n he al th y psychological st ild cogni- ceived an engraved ch she wrote,
she had fa , although m ding on whi
Rebecca felt that actice of law, course of a year used considerable of her wed everything. I’ve now
ith th e pr ct io n ca nk s fo r
out of touch w tive dysfun . In our work to
- “Tha cause
ha d lit tle de sir e to return to st ra tio n at tim es co m e ba ck to the world.” Be con-
and she in ue d fru ired a se ns e ad dr es s, I
She also cont wly reacqu as no return
that kind of work. ve problems that gether, she slo d learned to compart- there w cc a di d no t ne ed, or
to experience co
gniti
n, of he r id en tity an rie nc e, cl ud ed that Rebe He r no te did
ntion, concentratio ic expe
talize her traumat trusive in her wish for, me to re to me, however. I
spond.
impaired her atte la rg e in- m en
less in
cause of a so that it would be also developed mean a grea to have a sense of
t deal
and memory. Be she did not feel W e ab le
se ttl em en t, to -d ay life. w as no w d, in
surance
a hi gh-p ay ing posi- day- ai m ed at co m pe nsating
io n ab out our work, an ith
pressured to find d that it was im- techniques m em or y. complet he r ca se s w
ize ild problems w ith st to man y ot
tion, but she real to fo r he r m
regular th er ap y co nt ra es , I was
ychological health After a year of less-than-happy
outcom
portant for her ps k. Always having d th at sh e e of co m fo rt that
ac tive an d to wor se ss io ns , Re becca decide te d ab le to feel a sens e in st ru-
be a es wer
r writing, Rebecc end therapy. I sugg rts with Rebecca k.”
had an affinity fo career as a free- was ready to wish to gradually re- my effo ac
a ht in bringing her “b
decided to pursue ure articles for that she mig ency of sessions, a mental
of fe at duce the fre qu
lance writer ul with
. This route seemed have found usef ough Sarah Tobin, PhD
popular magazines e it permitted her practice I
us rm clients. th Al
ideal for her, beca private space, in other long-te
e
to work in a mor

SUMMARY
■ We are defining abnormality in terms of four criteria: dis- theme regards abnormality as due to improper treatment by
tress, impairment, risk to self or others, and behavior that society; this theme predominated during the reform move-
is outside the norms of the social and cultural context within ments of the eighteenth century and is still evident in con-
which it takes place. temporary society.
■ In trying to understand why people act and feel in ways that ■ Researchers use various methods to study the causes and
are regarded as abnormal, social scientists look at three treatment of psychological disorders. The scientific method
dimensions—biological, psychological, and sociocultural— involves applying an objective set of methods for observing
and use the term biopsychosocial to characterize the inter- behavior, hypothesizing about the causes of behavior, setting
actions among these three dimensions. Related to the up proper conditions for studying the hypothesis, and draw-
biopsychosocial approach is the diathesis-stress model, ing conclusions about its validity. In the experimental
according to which people are born with a diathesis (or method, the researcher alters the level of the independent
predisposition) that places them at risk for developing a variable and observes its effects on the dependent variable.
psychological disorder. The quasi-experimental method is a variant of this proce-
■ The history of understanding and treating people with psy- dure and is used to compare groups that differ on a prede-
chological disorders can be considered in terms of three termined characteristic. The correlational method studies
recurring themes: the mystical, the scientific, and the associations, or co-relations, between variables. The survey
humanitarian. The mystical theme regards abnormality as method enables researchers to estimate the incidence and
due to demonic or spirit possession. This theme was preva- prevalence of psychological disorders. In the case study
lent during prehistoric times and the Middle Ages. The sci- method, one individual is studied intensively, and a detailed
entific theme regards abnormality as due to psychological and careful analysis of that individual is conducted. In the
or physical disturbances within the person. This theme had single-subject design, one person at a time is studied in both
its origins in ancient Greece and Rome, and it has predom- the experimental and control conditions, as treatment is ap-
inated since the nineteenth century. The humanitarian plied and removed in alternating phases.

34
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Internet Resource 35

■ Psychological disorders affect not only the people who suffer stigma. On a broader level, the social and financial costs of
from them but also the family, community, and society. Indi- mental health problems are inestimable. In this book, we will
viduals with psychological disorders are stigmatized, which use a clinical perspective rooted within a life-span approach to
adds to their emotional problems. Family members are affected gain an understanding of the range of psychological disorders
by the distress of their loved ones, and also share a sense of and the methods used to treat people with these conditions.

KEY TERMS
See Glossary for definitions

Adoption study 28 Double-blind technique 24 Placebo condition 24

Asylums 13 Experimental group 23 Population 23
Baseline 27 Experimental method 23 Pragmatic case study 26
Biological markers 28 Genetic mapping 28 Prevalence 26
Biopsychosocial 10 Hypnotism 17 Probability 23
Case study method 26 Hypothesis formation process 23 Psychoanalysis 18
Concordance rate 27 Hysteria 17 Psychoanalytic model 16
Control group 23 Incidence 26 Psychotherapy 18
Correlation 25 Independent variable 23 Quasi-experimental design 25
Crossfostering study 28 Medical model 16 Representativeness 23
Deinstitutionalization Mental health parity 21 Sample 23
movement 19 Mesmerized 17 Single-subject design 27
Demand characteristics 24 Monozygotic twins 27 Stigma 28
Dependent variable 23 Moral treatment 15 Survey method 26
Diathesis-stress model 10 Multiple baseline approach 27 Trephining 11
Dizygotic twins 27 Observation process 22 Variable 23

ANSWERS TO REVIEW QUESTIONS

What Is Abnormal Behavior? (p. 10) have ever had the disorder at a given time or over a spec-
ified period.
1. Distress; impairment; risk to self or other people; socially
3. Concordance rate
and culturally unacceptable behavior
2. The intense trauma that threw Rebecca into chaos and
The Human Experience of
profound disturbance, which lasted for years
Psychological Disorders (p. 32)
3. A predisposition that places a person at risk of developing
a disorder 1. People with psychological disorders are often labeled as
different, defective, and set apart from mainstream mem-
Abnormal Psychology Throughout History (p. 21) bers of society.
1. Sanguine, melancholic, phlegmatic, and choleric 2. A standard that would require health insurers to pro-
2. Moral treatment vide equal levels of coverage for physical and mental
3. Deinstitutionalization movement illnesses
3. Underserving of minority populations; barriers faced by
Research Methods in Abnormal Psychology (p. 28) minority individuals to receiving appropriate care; and
limited access to mental health care in rural America
1. Independent; dependent
2. Incidence is the frequency of new cases within a given
period, and prevalence is to the number of people who

INTERNET RESOURCE

To get more information on the material covered in this chapter, visit our website at www.mhhe.com/halgin6e.
There you will find more information, resources, and links to topics of interest.
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C H A P T E R 2

OUTLINE Classification and

Case Report: Peter Dickinson 37
Psychological Disorder:
Experiences of Client and
Treatment Plans
Clinician 38
The Client 38
The Clinician 40
The Diagnostic and Statistical
Manual of Mental Disorders 40
How the DSM Developed 41
Controversial Issues Pertaining
to the DSM 42
Definition of Mental Disorder 43
Assumptions of the DSM-IV-TR 44
The Five Axes of the DSM-IV-TR 45
The Diagnostic Process 50
The Client’s Reported and
Observable Symptoms 51
Diagnostic Criteria and Differential
Diagnosis 51
Final Diagnosis 52
Case Formulation 53
Cultural Formulation 53
Treatment Planning 57
Goals of Treatment 57
Real Stories: Patty Duke: Mood
Disturbance 58
Treatment Site 59
Modality of Treatment 61
Determining the Best Approach
to Treatment 61
Treatment Implementation 62
The Course of Treatment 63
The Outcome of Treatment 63
Return to the Case 64
Summary 65
Key Terms 66
Answers to Review Questions 66
Internet Resource 67
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Case R
Peter D
ep o rt
as pursuing
re co rd companies, he w example,

ickins
rough. Pe te r’s ses. For
id th at he had gone th n him out of outlandish purcha r dealer-
as an un be ar ab ly hot and hu m
w ife , Ch ris tin e, had throw e, he ha d go ne to a luxury ca credit
It w vorc a
in July. As I was the house and had filed for di d had submitted car. He
Friday afternoon k fo r th e w ee k, lt he w as a “lo se r with ship an to bu y a $7 5, 00 0
wor e fe applicatio n
wrapping up my le because sh who spent
re lie ve d that I would be ab us y jo b and no future.” al so w ent to a realtor, e
in g a lo ed ing him expensiv

on
fe el sion had la st
on time, I received This deep depres mehow Peter many hours show f that Peter was
to leave the office itable call from
ev th, and so in the belie
the seemingly in The head nurse about a mon ll himself out of it. He homes e amount
s un it. ed to pu t to come into a larg , Peter
the admission a- m an ag n as “a ab ou
e even gs in
nk Mahar, emph pressio
acterized the de ith stern em- of money. In th reportedly look-
on the unit, Ha w n to ch ar
ld get right do g hell” and stated
w rs,
spent time at ba nger who would
sized that I shou hi s gu y’s out of livin that he “would never become le nt ed si
ca us e “t phasis g fo r a ta
the unit be
ai n. ” At th is po int, Pe- in to re co rd his songs. Peter
control!” an d de pressed ag ro om to go be willing nie, who was
I entered the ad
mitting ro om
in sis te d on leaving th e
ha d m et a woman ar , M
s
ce with Peter, w
ho te r r a ciga re tte . r’s dramatic tale
came face-to-fa ed to ou t in to the hallway fo d informa- captivated by Pete ture potential.
s chair and tri ld me that, if I w
ante and fu
leaped out of hi of past success de-
g. W ith ar de nt enthusi- He to ould talk to his brother. sp en t 48 ho urs together and
give me a hu nk tio n, I sh d be en Th ey bu t M ar nie
Peter said, “Tha Peter ha arried,
asm in his voice, . Please tell my Don agreed that ve ra l w ee ks cided to get m r th ei r pl an ne d
ar riv ed “h yp er” for se r sh owed up fo
Go d yo u’ ve ac tin g di st ur - ne ve fo r a m ar -
I don’t need to be and had been causing quite a to apply
idiot brother that ot he r, g se ve ra l m eeting at city hall as de va st ated
n!” Peter’s br ecedin ter w
in this looney bi nce for the pr riage license. Pe g
ie tly ne ar by and softly ba Peter’s mother had called Don in fu ria te d. He made threatenin
Don, sat qu n da ys . to be an d al th ou gh
w
“Please calm do t to tell him that Peter seem
ed arnie,
spoke to Peter, mments about M no real likeli-
te ll th e do ct or wha w ar d a ps yc ho logical cri- co lt th at th er e w as
so that we can heading to d th at sh e ha d Don fe
r w ou ld harm her. For
.” to the kin od that Pete
has been going on wn a bit, Peter sis similar earlier in he r lif e. ho
he had no way of nd of
finding
After settling do y questions struggled with d received a call one thing, he w as th e ki
er m son ha ermore,
agreed to answ nd and to tell me Mrs. Dickin Pe te r’s ro om ing her; furth hose “bark was worse
of al w
about his backgr
ou from the owner eas- individu ted.
t ha d be en go ing on in his life house, who had become incr d than his bite,” Don commen terest-
wha ks pr io r to ou t Pe te r’s od rta in ly an in
during the days
and wee
ex - ingly concer
ned ab
in g up Peter was ce ck by his air
the ho sp ita l. He ha d be en st ay vidua l. I w as st ru
being brought to d behavior. He g his electric guitar, ing indi me time I
d th at he w as 23 years old an l ni gh t, pl ay in of br av ad o, while at the sa ar-
pl ai ne
ning that he wor
ked al ribed as hi s had many ende
divorced. Explai ed in w rit in g what he desc rding hit.” believed that he hi s lo ud an d
bank and liv dollar reco ities. Beneath
as a janitor at a he quickly inter- “first million- sions, he ran from ing qual demeanor, there seemed
a rooming hous
e, On several occa e middle of the demanding was terrified by
at he w ou ld be “moving up to room in th to be a man who
jected th ct ro om ur gi ng riencing
e w or ld as so on as the co nt ra
ni gh t, w ak in g everyone up ,
w ha t he had been expe e, left
in th m- s a cr e- Christin
e recording co me and “witnes what since the day his wife,
arrives from th w ai t to as k hi m them to co w or k. ” Fr om nfi de nt th at the hospital
to at as co
pany.” I decided is, feeling that it ative genius Peter was operating him. I w d he lp Peter, but
th ll, t staff coul
what he meant by at that moment Don could te ergy,” as he hadn’t treatmen re whether he would let
nt on “nervous en ral I wasn’t su
was more importa symptoms. anything for seve r us. In as calming a manner
as pos-
cu s on sp ec ifi c sl ep t or ea te n te opera-
to fo my qu es tio ns e no sig ns th at Pe d Pe te r fo r hi s co
In response to feeling, Peter days. There wer or abusing drugs, sible, I aske at it was m y sense
about how he ha
d been
d be en ha d been drinking su bs ta nc e tion, explaining th rough very diffi-
e that he ha no history of th
that he had been wife had left him.
did acknowledg outs of anxiety,” and he had te r ni ght, Peter had ce hi s
ha vi ng “b N ig ht af lt tim es sin
recently ” abuse. on his song. He
de- cu ould take
m to feel “hyper plained that it w
which caused hi ct, throughout been working ime hours to making I also ex le of weeks to get him
fa dayt - only a coup
and restless. In r showed a great voted 4 or 5 e calls to record vel of function—
our inte rv ie w , Pe te
ca m e co un tle ss te le ph on
an ef fo rt ba ck to a normal le the deeply de-
ss as he be executives in re between
deal of edgine ble and annoyed ing company . He had called one somewhe d the highly energized
tly irr ita hi s so ng es se d an
intermitten at to sell insist- pr he had experie
nced in
so mentioned th e than 40 times,
with me. He al ly he had expe- company mor ne listen to him play extremes ths.
4 months previo
us g that someo recent mon
a se rio us de pression in in ng ov er th e ph one.
rienced kill his so behaviors were Sarah Tobin, PhD
if he wanted to Peter’s strange
which he felt as ns iv e rooming
himself. Peter
became de fe
as al so ev id ent outside the ing to
the depression, had stopped go the
when discussing the depression house. He wasn’t calling
he explained th at
lig ht of al l work. Whe he n
able in
was understand
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38 Chapter 2 Classification and Treatment Plans

Y
ou have just read the case of a young man whose
life was thrown into havoc by the experience of
extreme psychological symptoms ranging from deep
depression to frenzied hyperactivity. Imagine that you are a
professional and are faced with the responsibility of treating
an individual like Peter. How would you begin? One of the
first things you might try to do is establish a working rela-
tionship, so that you can gain a better understanding of
what is going on with Peter and how you might be of assis-
tance to him. In addition, you would attempt to determine
which diagnostic label might best apply to his symptoms, so
that you could implement the most appropriate treatment.
In this chapter, we will take you through the issues that
clinicians face every time they encounter a new client.

Psychological Disorder: Experiences

of Client and Clinician
The field of abnormal psychology goes beyond the academic
concern of studying behavior. It encompasses the large range In therapy, the client and clinician work jointly to help the client resolve
psychological problems.
of human issues involved when a client and a clinician work
together to help the client resolve psychological difficulties.
Throughout this text, we will continually return to these used, in recent years other terms have been suggested, such
human issues and focus on the individual experiences of the as resident, consumer, and member. It may be helpful for you
client and the clinician, as well as the drama that unfolds to think about how you would want to be referred to if you
when they interact. Here, we will orient you to these issues were seeking professional psychological services. In this
with a discussion of who these people are. book, we will use the term client, except in instances in which
other terms have been more commonly used, as in the
phrases “outpatient treatment” and “patients’ rights.”
The Client
While we are on the topic of appropriate terms, it is
We use the term client in this text to refer to a person seek- important to understand that people are not disorders. Call-
ing psychological services. This term conveys certain mean- ing someone a “schizophrenic” implies that the individual is
ings that are important to clarify at the outset of our discussion. synonymous with the disorder, and it hides the person’s iden-
After providing clarification on the meaning of the term, tity as an individual behind the label. A more sensitive
we will go on to another major point that underlies this phrase is “a person with schizophrenia.” Even though this
book: The client can be anyone. Because psychological dis- may sound unwieldy, it communicates respect for the indi-
orders are so prevalent, we should be aware of the fact that vidual by putting the person first.
many people in our lives will at some point seek psycho-
logical help. Prevalence of Psychological Disorders Although this book
focuses on people with severe psychological problems, it is
Definitions What do you think when you hear that some- important to keep in mind that everyone faces crises, dilem-
one you know is in psychotherapy? Do you think of the mas, or a desire for greater self-understanding. The Surgeon
person being treated as a “patient”? This is a common view, General’s report on mental health (U.S. Department of Health
with roots in the medical model, and it is reinforced by pop- and Human Services, 1999) states that 21 percent of Ameri-
ular characterizations of therapy on television and in films. cans have experienced a mental disorder during the preceding
Patient is a term used to refer to someone who is ill and, year. Two comprehensive investigations in recent years have
consistent with the medical model, someone who passively provided ample documentation of the extent to which people
(“patiently”) waits to be treated. Some people, including of all ages and walks of life experience psychological distur-
those who provide as well as those who receive treatment, bance at some point. We will refer to these studies through-
object to the term patient because of its association with out this book when we provide epidemiological data on each
illness. They prefer to use an alternative term, client. In this of the disorders.
sense, client refers to the person seeking psychological treat- Researchers at the National Institute of Mental Health
ment, to reflect the fact that psychotherapy is a collaborative designed the Epidemiological Catchment Area (ECA) study
endeavor. Although these are the terms most commonly to determine the prevalence of psychological disorders in the