GEETANJALI MEDICAL COLLEGE AND HOSPITAL

SUBJECT – Introduction to clinical psychology

UNIT – 4

TOPIC: CLINICAL INTERVENTIONS

PRESENTER:- BHAWNJALLANDHRA
MODERATOR:- DR.SHIKHA SHARMA

M.SC.CLINICAL PSYCHOLOGY
DEPARTMENT OF PSYCHIATRY
 CONTENTS :-
 What is Psychotherapy
 The Psychotherapists
 The Psychotherapy client
 The Psychotherapy Relationship
 Psychodynamic Theories
 Behavior Therapies
 Cognitive Behavior Intervention
 Humanistic Therapies
 Conclusion
 Reference
What is Psychotherapy?
➢ Psychotherapy is the informed and intentional
application of clinical methods and interpersonal
stances derived from established psychological
principles for the purpose of assisting people to modify
their behaviors, cognitions, emotions, and/or other
personal characteristics in directions that the
participants deem desirable.

⮚ In other words , Psychotherapy essentially is treatment

conducted within a professional relationship by trained
therapists to help/facilitate clients in distress.

⮚This definition, allows us to identify the participants (i.e.,

the client and therapist).
THE PSYCHOTHERPAISTS :-
⮚While, therapists are trained professionals at dealing with
clients problems issues, the type of training, theoretical
orientation, years of education, scope of ability vary.

⮚People from a wide variety of other disciplines function as

psychotherapists, including social work, psychiatry, nursing,
counseling psychology, educational psychology, and others.

⮚In general the following individuals are considered

therapists
I. Clinical Psychologists (PhD PsyD)
II. Masters level psychologists
III. Psychiatrists
IV. MSW
V. Marriage and Family therapists (MFT)
Characteristics associated with good therapists?
*Clients prefer therapists with advanced training.

Advanced Training Includes

• Communication, relationship-building, self-monitoring skills.
• Good Interpersonal Skills.
• Should be able to listen to clients effectively communicate with
them.
• Good Listening Ability.
• Genuineness.
• Empathy.
• Unconditional positive regard.

These promote rapport with the client build trust.

THE PSYCHOTHERAPY CLIENTS :-

• While, therapists are trained professionals at dealing with clients problems issues, the type of

training, theoretical orientation, years of education, scope of ability vary.

● Carl Rogers (1957) described psychotherapy clients as

those “in a state of incongruence” , meaning that there
is a discrepancy between their true self and their
experience of themselves.

● Most clients that seek help from a therapist have

reached a point where their coping mechanisms no
longer function.
● Occasionally, some clients seek therapy because
someone else is distressed (e.g., a parent, judge,
employer, spouse, or other family member).

These clients tend to be less motivated than clients

seeking help for themselves.

● There are two difficulties with defining who are

appropriate psychotherapy clients by looking at
their presenting problems. First, not all problems for
which people seek psychotherapy fall neatly into
one diagnostic category or another. Second, a
careful look at the research supporting
psychotherapy for specific problems reveals that not
all clients improve to the same degree
THE PSYCHOTHERAPY RELATIONSHIP :-

A. Professional Guidelines- therapists have commitments to

honor in their relationship with a client. These commitments
protect the client therapeutic relationship.

❖ These commitments are

a) Confidentiality information about the client isnt revealed
with anyone except for unique circumstances (e.g., client is
danger to himself/herself, is a danger to others).
b) Informed consent
c) therapists must tell clients what the guidelines are for
confidentiality.
d) Ethics - Clients have a right to know what is appropriate
conduct for therapists within a therapeutic relationship. The
ethics code for these issues are published in the American
Psychological Associations Ethical Principles of
Psychologists and Code of Conduct.
B. Therapist Objectivity Self-Disclosure

▪Although therapists need to be empathetic understanding, there will be

situations in which therapists will have to push their clients to overcome
resistance in dealing with a problem.

▪ This requires objectivity on the therapists part, because the therapist

will have to determine when to detach themselves from their clients so
they can insist their clients progress towards a solution to their
problems.

▪ However, there will also be occasions in which therapists may want to

use self-disclosure (divulging something about themselves to their
client) as a means of building trust and rapport with their clients.

E.g., a family counselor whose been divorced may carefully divulge

something about his/her own experience so as to build common ground
with a client going through a divorce. The client identifies with the
therapist, thereby promoting trust in the therapeutic relationship.
▪Caution therapists should only divulge a minor bit of information
about themselves to their clients. Too much or too little
information may impair the relationship between the therapist and
client.

C. Therapeutic Alliance
-determined by two factors

Factor 1:The emotional ties that develop between the therapist

client (trust, respect, etc.).

Factor 2: The common goal of the therapeutic relationship which

is to help the client achieve his/her goals.
Goals of Psychotherapy

1. Fostering insight
• Therapy should improve a clients insight into why he or she behaves
the way they do.

• The rationale here is that by understanding your behavior problems

(mistakes), you are empowered to make behavior changes that are
adaptive healthy.

❑One method for facilitating insight in your patients, is for the therapist to
interpret the clients behavior. This is done to motivate clients to examine
their own behavior and draw inferences about the meaning of their actions.

Note: this is not to show clients the therapist is right!!!!!

Caution :Therapists will want to avoid divulging information that is too
confrontational to clients who are disturbed or who have a fairly severe
diagnosis that may not be able to handle such news at the time.
2. Reducing emotional discomfort

▪Therapists often are faced with clients who are in severe

emotional pain anguish, This makes therapy challenging as
the patient is greatly distressed.

▪Therapists don’t want to completely reduce the clients

distress as this may eliminate their desire to address their
problems, but will want to reduce the clients distress to
some extent to promote a positive treatment outcome.
▪One way to achieve this goal is for therapists to
use the therapeutic relationship to improve the
clients emotional strength.
For instance, if the client feels they can count on
the therapist be understanding and non-
judgmental, they are better equipped to deal with
the onslaughts from the others.

▪Therapists can convey the message to clients that

although things seem hopeless and insurmountable
now, you will be able to make changes in your life
that improve your outlook considerably.
3. Encouraging Catharsis
▪Catharsis, involves releasing pent-up emotions (frustration, anger,
helplessness) that have been bothering the client for a long period
of time.

▪Therapists should encourage catharsis, by empowering clients to

express their emotions, frustrations, and issues in therapy.

▪Therapist to client
✔Tell me how you feel about that?.
✔How did that make you feel when he/she did that to you?...

▪There is some evidence that such emotion-focused techniques may

be helpful in easing tension for clients who are distressed or
repressing their problems.
4. Providing New Information

Among other things, therapists help their clients by

educating them. That is, therapists provide information to
clients about their

• Maladaptive thought patterns (e.g., identifying irrational

or inaccurate beliefs)

• Problem behaviors (e.g., self-destructive behaviors such

as addictions, actions designed to hurt others).
Psychodynamic Therapies

⮚Psychodynamic therapies assume that an individuals

behavior is determined by the interaction of powerful
competing forces within the person.

These forces are :

⮚Largely unconscious (outside the persons awareness)
⮚Develop in early childhood.
⮚Result in coping mechanisms designed to deal with
anxiety.
Origins of Psychoanalysis

✔Shortly into Freuds career as a physician, he examined several

patients who displayed neurological symptoms with no known
organic cause (e.g., some patients complained of paralysis, yet
could move their limbs in their sleep).

✔Freud labeled these patients as, neurotics.

✔Most of these patients exhibited hysterical paralyses, amnesia,

blindness, speech loss.

✔Treatment for these neuroses consisted of baths or electrically

generated heat, which Freud believed resulted in symptom relief
due to the power of suggestion (e.g., placebo effect).

✔Freud decided to try hypnosis as a method of suggestion that

might alleviate neurotics symptoms.
Freuds use of hypnosis other treatments
● Freud took Breuers advice used hypnosis to treat neurotics.

● However, because not all patients could be easily hypnotized,

he started simply requiring patients to close their eyes and
recall emotions, thoughts, feelings, and events that came to
mine.

● Later, he simply asked the to mention whatever they were

thinking.

● He also started to ask patients to describe their dreams as he

felt dreams may divulge hidden motives/events that were the
route of their problems.
Goals of Psychoanalysis
● The goal of psychoanalysis is to make a clients unconscious
motives, drives, and conflicts available to them so they can
deal with it.

● Freud reasoned that if individuals were confronted with the

reasons why they behaved in maladaptive ways, they would
be forced to change their behaviors.

● However, the client must figure these things out for

himself/herself, with the therapist as a guide.
Three main goals of Psychoanalytic treatment

1. Intellectual emotional insight into the underlying causes of

the clients issues.
2. Working through the implications of these insights.
3. Strengthening the egos control over the id superego.

*This takes on average (3-5 sessions per week for 3-5 years)
with a psychoanalyst.
Psychoanalytic Treatment Methods

1. Free Association
● Evolved from a non-hypnotic way for Freud's patients to
consciously recover emotional memories.

● The client needs to say everything that comes to mind

without editing or censorship . This should allow bits pieces
of unconscious material to appear.

● The therapist will have to look for patterns of association

that indicate something important.

● Clients who only talk about trivial issues (small-talk) are

seen as constructing barriers that impedes their progress.
Thus, there should be something of substance mentioned in
the session.
2. Dream Analysis

❖ Freud believed dreams represented repressed memories,

wishes, and desires.

❖ Freud argued dreams contained two kinds of content

➢ Manifest content- the actual events or images that occur
in the dream.
➢ Latent content -the unconscious information in the dream
that occurs in the forms of symbols.

❖ Freud had clients recall the manifest content of their dreams,

to see if he could detect the unconscious material masked in
the dreams images and actions.

❖ Psychoanalysts may examine several dreams produce by a

given client to see if any common themes develop and how
these may relate to their problems in daily life.
3. Transference

● The client's feelings toward the therapist and their relationship is

known as transference.

● Freud argued the unconscious information regarding authority figures

from childhood lie at the root of many clients current problems.

● Therapists will try to remain a bit detached divulge very little about
themselves to their clients to encourage clients to project onto them
unconscious attributes motives associated with parents, spouses, other
people in their lives
(e.g., client may see therapist as neglectful parent, loving spouse,
jealous lover, etc.).

● When transference occurs it provides the therapist and client with an

opportunity for the client to discover the issues that are bothering
them with other people in their lives.
● Therapists need to be careful that they dont project their own
unconscious desires, feelings, so forth onto their clients,
something called countertransference.

4.Abreaction

● Abreaction entails recalling a painful experience that had

been repressed, working through that painful experience
and the conflicts it created by reliving in memory the
experience and its associated emotions, analyzing that
experience, and achieving an emotional release as the
culmination of that process.
● This technique is used today not only in psychoanalytic
treatment but also in other treatment approaches that help
people cope with strong emotional reactions to past events
Alfred Adler and individual
psychology :-
● Adler departed from the ideas of Freud in his
conception of the client-clinician relationship.
● Clinicians following Adler's approach have a
complex role that calls for the application of a broad
range of skills.
● These clinicians are educators, fostering social
interest and teaching people ways to modify their
lifestyles, behaviors, and goals.
● They are supportive and encouraging, urging clients
to take risks and helping them accept their own
mistakes and imperfections.
–Adler's Individual Psychology offers a wide range of creative and
useful interventions. Additional interventions include the following:
1.Catching oneself encourages people to be more conscious of
their repetitive faulty goals and thoughts.
● Clinicians facilitate this by identifying warning signs of
difficulties and encouraging clients to view them as stop signs
that remind them to pause and redirect themselves.
● This concrete approach helps people develop self-awareness
and monitor themselves without being self-critical.
● For example, a man who often lost his temper and became
inappropriately angry recognized that his whole body
became tense before he exploded. He was taught to
● Identify signs of physical tension, view them as stop signs,
and use deep breathing as a quick and effective way to
diffuse his anger
2. Pushing the button is designed to help people become more
aware of the control they can have over their emotions, rather
than allowing their emotions to control them.

–Clinicians encourage people to alternately imagine pleasant and

unpleasant experiences
–Observe the emotions that accompany each image, and
recognize that they can determine which button to push.
3..In spitting in the client's soup, clinicians identify
the underlying motivations behind clients' self-
defeating behaviors and then spoil their imagined
payoff by making it unappealing.
Carl Jung and analytical psychology :-
–GOALS OF PSYCHOTHERAPY
Jungian analysis is deep and intensive, encouraging the
emergence and understanding of material from both the
personal and the collective unconscious
1.Use of symbols:-
● Jung's model of the psyche rests on his concepts of the
Self and the arche types Therefore, Jungian work
stresses the capacity to think symbolically and see the
underlying dynamics and patterns driving clients'
thoughts, feelings, and actions.
● These patterns may appear in symbolic and indirect forms
in people's dreams, symptoms, fantasies, and other
material.
● Clinicians' ability to understand this psychological subtext
can be enhanced by knowledge of the wide range of
symbols found in myths, fairy tales, art, literature, and
religions

2.Dream interpretation :-

● Jung (1964) saw dreams as providing easiest access to the

unconscious and viewed them as reflecting people's inner
lives as well as their unconscious responses.
● Jung took a broader view of dreams than did Freud.
● Jung believed they not only represented wishes and fears but also
fantasies, memories, experiences, visions, truths, and more.

● Jungian dream interpretation involves retelling the recalled dream;

describing its impact on consciousness; exploring events that may
have triggered the dream; investigating the dream's objective and
subjective content for archetypal images and symbols of the
unconscious; and assimilating the dream into consciousness, having
made sense of it.
3.Word association tests :-
● In word association tests, the clinician reads single words, one at a
time, to the client, who replies with the first word that comes into
mind.
● Unusual responses, repeated responses, hesitations, and physiological
changes such as flushing and visible tension all provide clues to the
presence of complexes and other unconscious material. Associations
also are used to explore the meaning of dreams.
Behavior Therapies
A. Assumptions of behavior therapies
1. Behavior disorders are assumed to have developed through
learning (conditioning, modeling, etc.).

2. Therapies should be based on results of research in learning

based methods.

3. The goal of behavior therapies is to modify overt,

maladaptive behaviors.

4. Therapies should focus on clients current problems in their

natural environments.

5. Treatment should be based on carefully controlled empirical

studies examining the efficacy of therapies on treatment
outcomes.
B. Origins of Behavior Therapy
● The link between behavioral methods and psychopathology
actually began in the 1920s and 30s when Pavlov examined
experimental neuroses in dogs after exposing them to electric
shock.

● The dogs symptoms included agitation, barking, biting the

equipment, forgetting previously learned events .

● Watson Raynors work on Little Albert was a follow-up to

Pavlovs work described above. They showed you could
condition fear responses in an 11-month old infant through
classical conditioning.

● By the 1950s 60s behavior treatment was used totreat a

variety of problems (anxiety disorders, sexual disorders,
schizophrenia, etc.).
● Today, behavior therapies rank high among treatments for a
variety of psychopathology and is the gold standard for treating
certain disorders (phobias, anxiety, autism).
Behavior therapy treatment methods

1. Systematic Desensitization
● First developed by Joseph Volpe in 1958, the goal of this
treatment is to extinguish fear and/or anxiety in individuals
(and organisms).

● This is accomplished by systematically exposing individuals to

fear-eliciting stimuli that are gradually increased in intensity
over trials.

● Therapy consists of three parts

➔ Relaxation training
➔ Creating a graduated hierarchy of fear-evoking
events
➔ Imagined /virtual reality desensitization
Formula for Systematic Desensitization

Part I :Clients are trained to employ a relaxation method to reduce

anxiety.

● Progressive relaxation training, a common relaxation method,

requires that clients voluntarily tense specific muscle groups
(hands, arms, etc.) for a period of time then focus on the
sensations of relaxation that follow muscle release.

E.g., require clients to clench the fist for several seconds followed
by release.

Part II :The therapist creates a graduated hierarchy of

events/situations the client finds as increasingly anxiety-provoking.

● Each event (or stimulus) should be perceived as more anxious

than the preceding event.
Part III :The client may use either imagined desensitization or
more realistic desensitization.
● On the first trial on imagined desensitization, the client
mentally visualizes the first event on the graduated
hierarchy and tries to remain relaxed until fear/anxiety is
extinguished. If they can do this for 10 seconds, the
therapist encourages them to visualize the next event on the
hierarchy, and so forth.

● Clients may also use a more real-world approach, by being

exposed to carefully monitored levels of the fear-eliciting
stimulus. Again, if clients can go 10 seconds with little to no
anxiety, they are then exposed to a slightly more intense
version of the fear-eliciting stimulus, and so forth.
Desensitization Hierarchy

1. Imagine writing the word, spider.

2. Image while reading a book you notice a small spider on the
cover.
3. Imagine a spider the size of your hand across the room from
you.
4. Imagine the big spider has crawled closer to you its about 3
feet from you.
5. Imaging the spider is now 1 foot away and crawling towards
your hand.
6. Imagine the spider is crawling onto your hand.
2. Exposure techniques

● The goal of exposure therapy is to fully expose the client to

the fear-eliciting stimuli so that they experience anxiety and
wait until it finally extinguishes.

● One common exposure method is flooding.

● Flooding requires that client is exposed to a maximally

intense level of the fear-eliciting stimulus. This should cause
a severe anxiety response that with prolonged exposure (time)
should diminish, thus extinguishing the association between
anxiety the fear-eliciting stimulus.

E.g., putting a tarantula in the hand of a client with

arachnophobia!!!!
*Important points for exposure methods

● Exposure methods will only work if enough time is allowed

for the anxiety responses to extinguish.

● Removing the fear-eliciting stimulus too early will only

reinforce avoidance behavior, thus strengthening the
association between the anxiety fear-eliciting stimulus.

● Therefore, exposure therapies require a strong commitment

on the part of both client therapist.
*Efficacy of Exposure treatments

● Exposure treatments have been shown to be successful in

treating obsessive-compulsive disorder (OCD), phobias,
panic disorder.

-In treating OCD, clients are exposed to the stimulus linked with
their obsessive thoughts
(e.g., dirt) not allowed to engage in the ritualistic behaviors that
usually reduce their anxiety (e.g., compulsive hand-washing).

#This is called exposure and response prevention (ERP).

3. Modeling

● Has been used to treat phobias, social withdrawal, OCD,

antisocial conduction,
aggressiveness, autism.

● A client with a clinical problem, can observe live or

videotaped models performing behaviors that the client
avoids with no negative consequences experienced.

● Treatment is most effective when are very similar to the

client, have high status, are reinforced for their responses .
Contingency management
Refers to operant conditioning methods where behaviors are
strengthened or reduced based on consequences.

1. Shaping - develops new behaviors by strengthening

successive approximations of desired responses.

2. Time out- reduces frequency of undesirable behaviors by

removing client from setting where being has been reinforced.

3. Contingency contracting-a formal contract is written out by a

therapist client stating what consequences will be for
undesirable behaviors.

4. Token Economies- tokens are earned for desired behaviors,

lost for unwanted behaviors.
Tokens may be used to obtain something else
(e.g., like money to buy things).
Cognitive-Behavioral Interventions

● All cognitive therapies attempt to modify individuals thoughts

(cognitions), thereby resulting in changes in the clients
responses.

● Cognitive approaches assume psychopathology results from

faulty/inaccurate cognitions (beliefs, schemas, problem-solving
strategies) that are linked with our affectivity (emotions).

E.g., depression results from negative thoughts beliefs about the

self (I am worthless, No one loves me, I'm a failure, etc.). These
negative beliefs result in negative affectivity, thereby leading to
depressive symptoms.

If you change the faulty perception, the maladaptive actions

underlying affectivity resulting in depressed mood will dissipate.
The combination of behavior cognition in cognitive-
behavioral therapy

● Cognitive-Behavioral therapy represents the blending of

cognitive behavioral techniques to treat psychopathology.

● Therapists with a behavioral orientation, recognized the

importance of perception and thoughts in treating disorders,
while cognitive therapists recognized the significance of
change maladaptive actions in improving self-esteem.
Cognitive-Behavioral treatment methods

1. Becks Cognitive Therapy

● Developed by Aaron Beck, this method attempts to improve

mental problems by identifying correcting the distorted beliefs
(thoughts) that result in the abnormal behaviors.

● Beck argues that logical errors distortions in thinking result in

depression other forms of negative affectivity.

E.g., A man concludes that he is worthless,because a woman he

asked on a date turns him down. There may be multiple reasons
for her response that has nothing to do with him, but he focuses on
his unworthiness.
#Applying Becks therapy

● Distorted inaccurate beliefs are identified and corrected by

therapists using these strategies (see Neitzel et al., 2003,
p255).

1.Recognizing the connections between cognitions, affect,

behavior.

2. Monitoring occurrences of cognitive distortions.

3. Examining the evidence for against these distortions.

4. Substituting more realistic interpretations for dysfunctional

thoughts.

5. Providing assignments that allow clients to practice new

thinking strategies more effective problem-solving.
2. Rational Emotive Behavior Therapy REBT,

★ Developed by Albert Ellis, attempts to treat abnormal

behavior that results from irrational thoughts beliefs.

★ Individuals with irrational, self-defeating thoughts, develop

unrealistic expectations of what is needed for them to be
happy. When these expectations/beliefs are unmet, depression
& anxiety result.

★ The goal of REBT is to replace the clients irrational self-

destructive beliefs with rational, logical thinking patterns that
do not result in negative affectivity.

★ Therapists need to be strong, direct, and focused when

working with clients.
Humanistic Therapies

● These therapies focus on helping clients deal with their

anxieties, focus on clients positive/healthy thoughts
behaviors, and strive to help clients recognize their full
potential as individuals.

● Behavior problems result from anxieties, which impair an

individual's ability to grow develop into health well adjusted
adults.

● Clients are seen as in charge of their own therapeutic

intervention basically good people
Humanistic Therapy Methods

1. Client-Centered Therapy
● Carl Rogers developed this form of treatment which views the
client as the one in charge of his or her therapeutic outcome.

● He argued that therapists need to enable clients to discover for

themselves the cause of their problems as well as the
mechanisms by which the client could resolve their problems.

● If the therapist provides a comfortable, empathetic

environment for the client to focus on their problems, then
client will improve (if-then statements).

● Therefore, the goal of client-centered therapy is to provide the

client with an opportunity to further his/her personal growth.
Therapists need to express unconditional positive regard,
empathy, congruence to help their clients.
*Unconditional Positive Regard

● According to Rogers, this conveys three important pieces of

information to clients
1. The therapist cares about the client.
2. The therapist accepts the client (for who they are).
3. The therapist trusts the client's ability to change.

● In a nutshell, unconditional positive regard, means not placing

conditions of worth on others. Rather, people are cared about
and accepted as they are. You don't need to earn someone's
love, but are given it freely, regardless of your behavior.
*Empathy

● Therapists can only help their clients if they possess the ability
to place themselves in their clients positions. That is, the
therapist must try to see the world as the client does to
understand what the client is feeling.

● Empathy is conveyed via active listening. In particular,

therapists, reflect what the client has said to the client.

● This serves two purposes

1. Communicates the therapists knowledge of the clients
problems.
2. Indicates the therapists desire to understand the clients
problem.
*Congruence

● Therapists responses to clients should be consistent with their

feelings.

#That is, therapists need to be honest open with their own

feelings so as to be sensitive and genuine with their clients.

● Clients need to be able to trust their therapists. If the therapist

makes a comment to the client, they should feel they can
believe the therapist.

● Thus, actions should reflect real the therapists real feelings and
thoughts.
CONCLUSION :-
Psychotherapy is the informed and intentional application of clinical methods and
interpersonal stances derived from established psychological principles for the
purpose of assisting people to modify their behaviors, cognitions, emotions, and/or
other personal characteristics in directions that the participants deem desirable.
While, therapists are trained professionals at dealing with clients problems issues,
the type of training, theoretical orientation, years of education, scope of ability
vary.
While, therapists are trained professionals at dealing with clients problems issues, the type of training, theoretical orientation, years of
education, scope of ability vary.

Freud advocated having the patient lie on a couch while the therapist sat in a chair
positioned behind the patient's head so the therapist could not be observed during
the session. This was designed to both relax and reduce distractions for the patient
and to allow the therapist to remain as anonymous as possible.
REFERNCE :-
Thorpe L. Geoffrey and Hecker E. Jeffrey; Introduction to clinical psychology
; Pearson Publication