Learn Psychology with

Vishal Pandey
Chapter 5
Therapeutic Approaches
 Characteristics of psychotherapeutic approach

1.There is systematic application of principles underlying the different theories of

therapy.

2. Persons who have received practical training under expert supervision can
practice psychotherapy and not everybody.

3. The therapeutic situation involves a therapist and a client who seeks and receives
help for her/his emotional problems.

4. The interaction of these two persons – the therapist and the client is confidential,
interpersonal and dynamic relationship.
 Goals of psychotherapies:-

i. Reinforcing client’s resolve for betterment

ii. Lessening emotional pressure
iii. Unfolding the potential for positive growth.
iv. Modifying habits
v. Changing thinking patterns
vi. Increasing self-awareness
vii. Improving interpersonal relations and communication.
viii. Facilitating decision-making
ix. Becoming aware of one’s choices in life.
x. Relating to one’s social environment in a more creative and self-aware manner.
 What is Therapeutic Relationship?

The special relationship between the client and the therapist is known as the
therapeutic relationship.

There are two major components of therapeutic alliance

1. The first component is the contractual nature of the relationship in which two
willing individuals, the client and the therapist, enter into a partnership which
aims at helping the client overcome her/his problems.

2. The second component of therapeutic alliance is the limited duration of the

therapy.
 Properties of therapeutic relationship:-

1. It is a trusting and confiding relationship by

therapist encouraging this by being accepting,
empathic, genuine & warm to the client.
2. Nonjudgmental - This is unconditional positive
regard.
3. The therapist has empathy for the client.
4. Confidentiality
 Classification of Psychotherapies:-

1. What is the cause, which has led to the problem?

Psychodynamic Therapy: Intrapsychic Conflicts

Behaviour Therapy: Faulty learning of Behaviours and
Cognitions.
Existential Therapy: Meaning of one’s life & existence
 Classification of Psychotherapies:-

2. How did the cause come into existence?

Psychodynamic Therapy: Unfulfilled desires of childhood &

unresolved childhood fears
Behaviour Therapy: Faulty conditioning patterns, faulty
learning & faulty thinking & beliefs
Existential Therapy: Importance on present. Current feelings
of loneliness, alienation, etc.
 Classification of Psychotherapies:-

3. What is the chief method of treatment

Psychodynamic Therapy: Free association, reporting of dreams to elicit

feelings

Behaviour Therapy: set up of alternate behaviour contingencies

Existential Therapy: providing Positive, accepting & nonjudgmental

therapeutic environment
 Classification of Psychotherapies:-

4. What is the nature of the therapeutic relationship between the client and the
therapist?

Psychodynamic Therapy: assumes that the therapist understands the client’s

intrapsychic conflicts better than the client.

Behaviour Therapy: assumes the therapist is capable of finding out the correct
behaviour & thought patterns, which would be adaptive for the client.

Existential Therapy: therapist merely provides a warm, empathic relationship with

client to explore the nature and causes of problems by herself/himself.
 Classification of Psychotherapies:-

5. What is the chief benefit to the client?

Psychodynamic Therapy: Emotional insight – understands, accepts &

able to change his/her conflicts

Behaviour Therapy: changing faulty behaviour to adaptive ones.

Existential Therapy: Personal growth by gaining understanding of

oneself, and aspirations, emotions & motives.
 Classification of Psychotherapies:-

6. What is the duration of treatment?

Psychodynamic Therapy: might go upto several years.

Behaviour Therapy: 10-15 sessions

Existential Therapy: 10-15 sessions

 Steps in the formulation of a Client’s Problem

1. Understanding of the problem

2. Identification of the areas to be targeted for

treatment in psychotherapy

3. Choice of techniques for treatment

 Psychodynamic Therapy
– By Sigmund Freud
– Analytical Psychotherapy – Carl Jung

Psychodynamic Therapy
Psyche + Dynamics between diff components of psyche + source
of distress

a. Methods of Eliciting the nature of Intrapsychic conflict

b. Modality of Treatment
c. Duration of Treatment
 Psychodynamic Therapy
a. Methods of Eliciting the nature of Intrapsychic conflict
1. The first step in the treatment is to elicit the intrapsychic
conflict
o Psychoanalysis has invented ‘free association’ & ‘dream
interpretation’ as two methods for eliciting the intrapsychic
conflicts.
o The free flow of ideas, desires & conflicts of the
unconscious, which has been suppressed by the ego,
emerge into the conscious mind
 Psychodynamic Therapy
a. Methods of Eliciting the nature of Intrapsychic conflict
2. The client is asked to write her/his dreams upon waking up
o Psychoanalysts look upon dreams as symbols of the
unfulfilled desires present in the unconscious
o The images of dreams are symbols which signify the
intrapsychic forces.
o Dreams use symbols because they are indirect expressions &
hence would not alert the ego. If the unfulfilled desires are
expressed directly, the ego would suppress them causing
anxiety.
 Psychodynamic Therapy
b. Modality of Treatment
– The Intellectual
understanding is
Intellectual Insights

– The Emotional
understanding,
acceptance of irrational
reaction to the unpleasant
events of the past is
emotional Insights.

– Insight is the end of

Therapy
 Psychodynamic Therapy
c. Duration of Treatment

Initial Phase Familiar with Routines

Middle Phase Transference, Resistance – Insights

Final Phase Termination of relationship

 Behaviour Therapy
• Method of Treatment:
o Malfunctioning behaviours, Antecedent behaviours, Maintaining factors.
o Adaptive behaviour patterns through antecedent operations & consequent operations.
• Behavioural Techniques
– Negative reinforcement (to get rid of Painful Stimuli)
– Aversive Conditioning (repeated association of undesired responses)
– Positive reinforcement (Gift or reward for desired behaviour)
– Token economy (Small tokens of rewards)
– Differential reinforcement (+ve for wanted & -ve for unwanted) (+ve for wanted & ignore the
unwanted)
– Systematic desensitization (used to treat phobias)
– Principal of reciprocal inhibition (the presence of two mutually opposing forces at the same
time, inhibits the weaker force)
– Modelling (observing the role model)
 Questions to Practice

• What is the purpose of Behavioural Therapy?

• What do you understand by the term “Aversive Conditioning”?
• How does token economy improve the behavioural pattern in an individual?
• What do you understand from the principle of reciprocal inhibition?
• A client approaches a therapist to overcome her/his phobia for heights. Describe a behavioural technique
that the therapist might choose to help her/him to overcome this phobia for heights.
Answer:
 Systematic Desensitization: the therapist prepares a hierarchy of anxiety-provoking stimuli with the least anxiety-provoking
stimuli at the bottom of the hierarchy. E.g., the fear of lifts.
 Each session is accompanied by relaxation exercises. Reciprocal inhibition principle -Wolpe.
 Over sessions, the client is able to imagine more severe fear-provoking situations while maintaining the relaxation. The client
gets systematically desensitized to the fear.
 Cognitive Therapy

Locate the cause of psychological distress in irrational thoughts & beliefs

• Rational Emotive Therapy (RET): Albert Ellis,

1. Antecedent – Belief – consequence (ABC) analysis
- Irrational belief are assessed through questionnaries & interviews.
- Non-directive questioning from therapist
2. Core Schemas: Aaron Beck – Childhood experiences provided by the family & society develop core schemas (beliefs &
action patterns in the individual)
- Negative automatic thoughts (dysfunctional cognitive structures) – distort in negative manner
• Cognitive Behaviour Therapy (CBT) :
- Treatment of anxiety, depression, panic attacks & borderline personality, etc.
- It combines cognitive therapy with behavioural techniques.
- Distress comes from biological, psychological & social realms.
Biological Relaxation procedures
Psychological Behaviour therapy & cognitive therapy
Social Realms Environmental manipulations
 Humanistic – Existential Therapy

• Existential therapy – Victor Frank- Logotherapy, Meaning making, Neurotic anxieties,

existential anxiety

• Client-centered therapy – Carl Rogers – Concept of self, with freedom and choice,
empathy, unconditional positive regard

• Gestalt therapy – Freiderick (Fritz) – self awareness & self acceptance

 Questions to Practice

• What is cognitive therapy ? Explain about the importance of RET

• What do you mean by CBT?
• Explain about the importance of humanistic –Existential Therapy with suitable examples
• What is Existential Therapy ?
• Explain the different cognitive therapies that are used to reduce distress.
 Factors contributing to healing in psychotherapy

1.A major factor in the healing is the techniques adopted by the therapist and the implementation of the same with the patient/client.
If the behavioural system and the CBT school are adopted to heal an anxious client, the relaxation procedures and the cognitive
restructuring largely contribute to the healing.

2. The therapeutic alliance, which is formed between the therapist and the patient/client, has healing properties, because of the
regular availability of the therapist, and the warmth and empathy provided by the therapist.

3. At the outset of therapy while the patient/client is being interviewed in the initial sessions to understand the nature of the
problem, s/he unburdens the emotional problems being faced.
This process of emotional unburdening is known as catharsis, and it has healing properties.

4. There are several non-specific factors associated with psychotherapy. Some of these factors are attributed to the patient/client and
some to the therapist. These factors are called non-specific because they occur across different systems of psychotherapy and
across different clients/patients and different therapists.
Non-specific factors attributable to the client/patient are motivation for change, expectation of improvement due to the treatment,
etc. These are called patient variables.
Non-specific factors attributable to the therapist are positive nature, absence of unresolved emotional conflicts, presence of good
mental health, etc. These are called therapist variables.
 Ethics in Psychotherapy

1. Informed consent needs to be taken.

2. Confidentiality of the client should be maintained.
3. Alleviating personal distress and suffering should be the goal of all attempts of the therapist.
4. Integrity of the practitioner – client relationship is important.
5. Respect for human rights and dignity.
6. Professional competence and skills are essential.
 Alternate Therapies
Yoga, Meditation, acupuncture, herbal remedies
Yoga – Ashtanga Yoga of Patanjali’s Yoga Sutras, only the asanas or body posture or breathing practices or pranayama or a
combination of two
Meditation – Practice of focusing attention on breath or on an object or thought or a mantra.
Vipasana Meditation – Mindfulness-based meditation – there is no fixed object or thought to hold the attention. Observes
various bodily sensations and thoughts that are passing through in her or his awareness. Repeated episodes of depression
can be treated.
Sudarshana Kriya Yoga (SKY) – Rapid breathing techniques - Treatment of stress, anxiety, PTSD, depression, stress-related
medical illnesses, substance-abuse, and rehabilitation of criminal offenders. It enhance well being, mood, attention, mental
focus, and stress tolerance.
Research conducted at National Institute of Mental Health & Neurosciences (NIMHANS), India, has shown that SKY reduces
depression. Insomnia can be treated.
Kundalini Yoga – It has been found effective in the treatment of mental disorders.
The institute of Non-linear Science, University of California, San Diego, USA has found that Kundalini Yoga is effective in the
treatment of OCD.
It includes pranayama or breathing techniques with chanting of mantras.
 Rehabilitation of the Mentally Ill

The treatment of psychological disorders has two components,

1. Reduction of symptoms
2. Improving the level of functioning or quality of life.

The aim of rehabilitation is to empower the patient to become a productive member of society to
the extent possible. The patients are given
a. Occupational therapy
b. Social skills training
c. Cognitive retraining – to improve the basic cognitive functions of attention, memory & executive
functions.
d. Vocational therapy
 Questions to Practice

• Elaborate about the alternative therapies

• What are the factors contributing to healing in psychotherapy
• Discuss about the ethics in psychotherapy
• Discuss about the rehabilitation of the mentally ill
• Explain the alternative treatment possibilities to psychotherapy. How does rehabilitation of the mentally ill
improve the quality of their life?