Chapter 5

Therapeutic Approaches
Psychotherapy is a voluntary relationship between the one seeking treatment or
the client and the one who treats or the therapist.
The purpose of the relationship is to help the client to solve the psychological
problems being faced by her or him.
The relationship is conducive for building the trust of the client so that problems
may be freely discussed.
Psychotherapies aim at:
 changing the maladaptive behaviours
 decreasing the sense of personal distress
 and helping the client to adapt better to her/his environment.
 Inadequate marital, occupational and social adjustment also requires that
major changes be made in an individual’s personal environment
All psychotherapeutic approaches have the following characteristics:
(i) there is systematic application of principles underlying the different
theories of therapy
(ii) persons who have received practical training under expert supervision
can practice psychotherapy, and not everybody. An untrained person
may unintentionally cause more harm than any good,
(iii) The therapeutic situation involves a therapist and a client who seeks
and receives help for her/his emotional problems (this person is the
focus of attention in the therapeutic process)
(iv) the interaction of these two persons — the therapist and the client —
results in the consolidation/formation of the therapeutic relationship.
This is a confidential, interpersonal, and dynamic relationship. This
human relationship is central to any sort of psychological therapy and
is the vehicle for change.
All psychotherapies aim at a few or all of the following goals:
(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

Therapeutic Relationship
The special relationship between the client and the therapist is known as the
therapeutic relationship or alliance.
There are two major components of a therapeutic alliance.
 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.

 The second component of therapeutic alliance is the limited duration of

the therapy. This alliance lasts until the client becomes able to deal with
her/his problems and take control of her/ his life.

This relationship has several unique properties:

(i) It is a trusting and confiding relationship. The high level of trust
enables the client to unburden herself/himself to the therapist and
confide her/his psychological and personal problems to the latter.

(ii) The therapist encourages this by being accepting, empathic, genuine

and warm to the client.

(iii) The therapist conveys by her/his words and behaviours that s/he is not
judging the client and will continue to show the same positive feelings
towards the client even if the client is rude or confides all the ‘wrong’
things that s/he may have done or thought about.
This is the unconditional positive regard which the therapist has
for the client.

(iv) The therapist has empathy for the client. Empathy is different from
sympathy and intellectual understanding of another person’s situation.

In sympathy, one has compassion and pity towards the suffering of

another but is not able to feel like the other person.
On the other hand, empathy is present when one is able to
understand the plight of another person, and feel like the other
 person. It means understanding things from the other person’s
perspective, i.e., putting oneself in the other person’s shoes.
Empathy enriches the therapeutic relationship and
transforms it into a healing relationship.

(v) The therapeutic alliance also requires that the therapist must keep
strict confidentiality of the experiences, events, feelings or thoughts
disclosed by the client.

The therapist must not exploit the trust and the confidence of the
client in anyway. Finally, it is a professional relationship, and must
remain so.

Types of Therapies
Psychotherapies may be classified into three broad groups, viz. the
psychodynamic, behaviour, and existential psychotherapies.
In terms of the chronological order, psychodynamic therapy emerged first
followed by behaviour therapy while the existential therapies which are also
called the third force, emerged last.
The classification of psychotherapies is based on the following parameters:

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

Psychodynamic therapy is of the view that intrapsychic conflicts, i.e., the
conflicts that are present within the psyche of the person, are the source of
psychological problems.
Intrapsychic conflict:
conflict between incompatible or opposing wishes, impulses, needs, thoughts, or
demands within one's own mind.
According to behaviour therapies, psychological problems arise due to faulty
learning of behaviours and cognitions.
The existential therapies postulate that the questions about the meaning of
one’s life and existence are the cause of psychological problems.
2. How did the cause come into existence?
In the psychodynamic therapy, unfulfilled desires of childhood and unresolved
childhood fears lead to intrapsychic conflicts.
The behaviour therapy postulates that faulty conditioning patterns, faulty
learning, and faulty thinking and beliefs lead to maladaptive behaviours that, in
turn, lead to psychological problems.
The existential therapy places importance on the present. It is the current
feelings of loneliness, alienation, sense of futility of one’s existence, etc., which
cause psychological problems.

3. What is the chief method of treatment?

Psychodynamic therapy uses the methods of free association and reporting of
dreams to elicit the thoughts and feelings of the client.
 This material is interpreted to the client to help her/him to confront and
resolve the conflicts and thus overcome problems.
Behaviour therapy identifies the faulty conditioning patterns and sets up
alternate behavioural contingencies to improve behaviour.
The cognitive methods employed in this type of therapy challenge the faulty
thinking patterns of the client to help her/him overcome psychological distress.
The existential therapy provides a therapeutic environment which is positive,
accepting, and non-judgmental.
 The client is able to talk about the problems and the therapist acts as a
facilitator. The client arrives at the solutions through a process of
personal growth.
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 and hence it is the therapist who
interprets the thoughts and feelings of the client to her/him so that s/he gains an
understanding of the same.
The behaviour therapy assumes that the therapist is able to discern the faulty
behaviour and thought patterns of the client.
  It further assumes that the therapist is capable of finding out the correct
behaviour and thought patterns, which would be adaptive for the client.
Both the psychodynamic and the behaviour therapies assume that the therapist
is capable of arriving at solutions to the client’s problems.
In contrast to these therapies, the existential therapies emphasise that the
therapist merely provides a warm, empathic relationship in which the client
feels secure to explore the nature and causes of her/his problems by
herself/himself.

5. What is the chief benefit to the client?

Psychodynamic therapy values emotional insight as the important benefit that
the client derives from the treatment.
 Emotional insight is present when the client understands her/his conflicts
intellectually; is able to accept the same emotionally; and is able to
change her/his emotions towards the conflicts.
 The client’s symptoms and distresses reduce as a consequence of this
emotional insight.
The behaviour therapy considers changing faulty behaviour and thought
patterns to adaptive ones as the chief benefit of the treatment.
 Instituting adaptive or healthy behaviour and thought patterns ensures
reduction of distress and removal of symptoms.
The humanistic therapy values personal growth as the chief benefit.
 Personal growth is the process of gaining increasing understanding of
oneself, and one’s aspirations, emotions and motives.

6. What is the duration of treatment?

The duration of classical psychoanalysis may continue for several years.
However, several recent versions of psychodynamic therapies are completed in
10–15 sessions.
Behaviour and cognitive behaviour therapies as well as existential therapies are
shorter and are completed in a few months.
Thus, different types of psychotherapies differ on multiple parameters.
However, they all share the common method of providing treatment for
psychological distress through psychological means.
The therapist, the therapeutic relationship, and the process of therapy become
the agents of change in the client leading to the alleviation of psychological
distress.
The process of psychotherapy begins by formulating the client’s problem.
The following sections explain representative therapies from each of the three
major systems of psychotherapy mentioned earlier.

Psychodynamic Therapy
Psychodynamic therapy is considered as the oldest form of therapy which was
given by Dr. Sigmund Freud and this therapy explained the sources of
psychological distress, conceptualized the structure of the psyche, dynamics
between different components of the psyche.
Psychodynamic therapy is of the view that intrapsychic conflicts, i.e., the
conflicts that are present within the psyche of the person, are the source of
psychological problems.
Intrapsychic conflict:
conflict between incompatible or opposing wishes, impulses, needs, thoughts, or
demands within one's own mind.
In the psychodynamic therapy, unfulfilled desires of childhood and unresolved
childhood fears lead to intrapsychic conflicts.

Methods of Eliciting Nature of Intrapsychic Conflict

Since the psychoanalytic approach views intrapsychic conflicts to be the cause
of psychological disorder, the first step in the treatment is to elicit this
intrapsychic conflict.
1. Free Association is used for understanding the problem of the client and
in this technique, the client is asked to lie down on the couch and after the
therapeutic relationship has been established, the client is encouraged to
speak whatever comes to his/her mind without any filter.
 2. This technique aids in understanding the nature of the client’s psyche and
what goes on into the unconscious mind of the client. free flow of ideas,
desires and conflicts of the unconscious, which had been suppressed by
the ego, emerge into the conscious mind.
3. This free uncensored verbal narrative of the client is a window into the
client’s unconscious to which the therapist gains access.
4. Dream Analysis is a technique in which the client is asked to write down
his/her dreams after waking up and the client’s dreams give a clear
picture of their unconscious mind and unresolved problems in their life.

Modality of Treatment
Transference and Interpretation are the methods of treating the patient.
 After Dream Analysis and Free Association, the client starts identifying
the therapist as an authority figure of the past which may be a punitive
father or a negligent mother. This process of identification is termed
Transference
 This process is important as the therapist is able to understand the client’s
problems in a more clear and accurate manner
 The therapist becomes a substitute for the person against whom the client
has harboured anger, frustrations and the therapist encourage the client to
express those feelings. The therapist becomes a substitute for that person
in the present. This process is termed Transference Neurosis
If a patient’s mother was extremely judgmental to her as a child, and the
therapist makes an observation that the patient perceives as judgmental,
the patient might express that and even lash out at the therapist. This
response could be interpreted as her applying to her therapist the same
feelings that she felt toward her mother.
 Transference is further of two types, Positive Transference in which the
client falls in love or idolizes the client, and Negative Transference in
which the client harbours feelings of resentment towards the therapist
 Transference is further met with resistance as Transference involves the
expression of those feelings which makes the client feel uncomfortable
and hence, clients may avoid therapy sessions at times, oppose the
progress of therapy, etc
Resistance
Due to resistance, the client opposes the progress of therapy in order to protect
herself/himself from the recall of painful unconscious memories. Resistance can
be conscious or unconscious.
 Conscious resistance is present when the client deliberately hides some
information.

 Unconscious resistance is assumed to be present when the client

becomes silent during the therapy session, recalls trivial details without
recalling the emotional ones, misses appointments, and comes late for
therapy sessions.
The therapist overcomes the resistance by repeatedly confronting the patient
about it and by uncovering emotions

Confrontation and Clarification are two analytical techniques of

interpretation
 In a confrontation, the therapist encourages the client to face that aspect
of their psyche which is important for them to resolve their problems.

 Clarification is the process in which the therapist clears all the ambiguity
in the client’s mind regarding the past events by highlighting it’s relevant
details.
This is done by separating and highlighting important details about
the event from unimportant ones.

 Interpretation is a more subtle process. It is considered to be the

pinnacle of psychoanalysis

 By using interpretation, the therapist makes the client aware of the

intrapsychic conflict happening in the client’s mind.

The therapist uses the unconscious material that has been

uncovered in the process of free association, dream interpretation,
transference and resistance to make the client aware of the psychic
contents and conflicts which have led to the occurrence of certain events,
symptoms and conflicts.
  The repeated process of Confrontation, Clarification, and interpretation is
termed as Working Through.

 Insight is the outcome of Working Through which is not a sudden event

but a gradual process in which the client understands their problem in a
clear way accepts it and gains intellectual and emotional insight

As this process continues, the client starts to understand herself/himself better at

an intellectual and emotional level, and gains insight into her/his conflicts and
problems.
The intellectual understanding is the intellectual insight. The emotional
understanding, acceptance of one’ irrational reaction to the unpleasant events of
the past, and the willingness to change emotionally as well as making the
change is emotional insight. Insight is the end point of therapy as the client has
gained a new understanding of herself/himself. In turn, the conflicts of the past,
defence mechanisms and physical symptoms are no longer present and the
client becomes a psychologically healthy person
Duration of Treatment
Psychodynamic Therapy lasts for several years with one-hour session 4-5 days a
week. The three stages of Psychodynamic Therapy you have to study in Chapter
5 Psychology Class 12:
 Stage 1 comprises dream interpretation and free association in which the
nature of the client’s problem is understood
 Stage 2 comprises Transference, Resistance, Confrontation, Clarification
in which the client’s problem is Fully uncovered and brought to utmost
clarity
 In stage 3, emotional and intellectual insight is gained as an outcome of
working through

Behaviour Therapy
Behavioural Techniques
A range of techniques is available for changing behaviour.
The principles of these techniques are to reduce the arousal level of the client,
alter behaviour through classical conditioning or operant conditioning with
different contingencies of reinforcements, as well as to use vicarious learning
procedures, if necessary.
Negative reinforcement and aversive conditioning are the two major techniques
of behaviour modification.

Negative Reinforcement
Responses that lead organisms to get rid of painful stimuli or avoid and escape
from them provide negative reinforcement.
 An undesirable stimulus is removed to increase a behaviour.

 For example, car manufacturers use the principles of negative

reinforcement in their seatbelt systems, which go “beep, beep, beep” until
you fasten your seatbelt. The annoying sound stops when you exhibit the
desired behaviour, increasing the likelihood that you will buckle up in the
future.

 For example, one learns to put on woollen clothes, burn firewood or use
electric heaters to avoid the unpleasant cold weather.
 One learns to move away from dangerous stimuli because they provide
negative reinforcement.

 negative reinforcement is NOT the same thing as “punishment.”

Punishment implies that you receive a penalty for doing something you’re
not supposed to do — whereas negative reinforcement implies not
receiving a penalty for doing something.
 For instance, if you misbehave and your mom spanks you, that’s
punishment: adding a bad stimulus when you did something bad. If you
get charged money–or electrically shocked by your Facebook friends—
because you don’t exercise, that’s negative reinforcement

Aversive conditioning refers to repeated association of undesired response with

an aversive consequence.
 For example, an alcoholic is given a mild electric shock and asked to
smell the alcohol. With repeated pairings the smell of alcohol is aversive
 as the pain of the shock is associated with it and the person will give up
alcohol.
If an adaptive behaviour occurs rarely, positive reinforcement is given to
increase the deficit.
 For example, if a child does not do homework regularly, positive
reinforcement may be used by the child’s mother by preparing the child’s
favourite dish whenever s/he does homework at the appointed time.

 The positive reinforcement of food will increase the behaviour of doing

homework at the appointed time.

Token Economy
 Persons with behavioural problems can be given a token as a reward
every time a wanted behaviour occurs.

 The tokens are collected and exchanged for a reward such as an outing
for the patient or a treat for the child. This is known as token economy.

Differential Reinforcement
Unwanted behaviour can be reduced and wanted behaviour can be increased
simultaneously through differential reinforcement.
Positive reinforcement for the wanted behaviour and negative reinforcement for
the unwanted behaviour attempted together may be one such method.

The other method is to positively reinforce the wanted behaviour and ignore the
unwanted behaviour.
 The latter method is less painful and equally effective.
For example, let us consider the case of a girl who sulks and cries when she is
not taken to the cinema when she asks.
 The parent is instructed to take her to the cinema if she does not cry and
sulk but not to take her if she does.
  Further, the parent is instructed to ignore the girl when she cries and
sulks.
 The wanted behaviour of politely asking to be taken to the cinema
increases and the unwanted behaviour of crying and sulking decreases.
For example, consider a human resources manager who implements specific
rules regarding interoffice communication.
 Namely, that all employees must use email when they have questions.
 If an employee chooses not to follow this rule and instead leaves a
voicemail with a question regarding his pay, the human resources
manager would ignore his request until the employee sends the request in
an email.

Systematic desensitisation
It is a technique introduced by Wolpe for treating phobias or irrational fears.
The client is interviewed to elicit fear provoking situations and together with the
client, the therapist prepares a hierarchy of anxiety-provoking stimuli with the
least anxiety-provoking stimuli at the bottom of the hierarchy.
The therapist relaxes the client and asks the client to think about the least
anxiety-provoking situation.
The client is asked to stop thinking of the fearful situation if the slightest tension
is felt.
Over sessions, the client is able to imagine more severe fear provoking
situations while maintaining the relaxation.
The client gets systematically desensitised to the fear.

The principle of reciprocal inhibition operates here.

This principle states that the presence of two mutually opposing forces at the
same time, inhibits the weaker force.
Thus, the relaxation response is first built up and mildly anxiety-provoking
scene is imagined, and the anxiety is overcome by the relaxation.
The client is able to tolerate progressively greater levels of anxiety because of
her/his relaxed state.
Modelling
Modelling is the procedure wherein the client learns to behave in a certain way
by observing the behaviour of a role model or the therapist who initially acts as
the role model.
Modelling is not quite as simple as ''monkey see, monkey do.'' It's actually a
complex process that involves observing a behaviour performed by another
person (for example a ''model''), retaining what you've observed, and then
reproducing the behaviour on your own.
Bobo doll experiment, Bandura studied the responses of school-aged children
after watching a short film in which an adult ''model'' hits an inflatable doll.
One group of children saw a version of the film that showed the model behaving
aggressively towards the doll without any consequence to his actions; another
group saw a version in which a second adult scolds the model for their behavior;
and a third group saw a version in which a second adult rewards the model for
their behavior with candy.
After viewing the film, each child was left alone in a room with the same
inflatable doll and props used by the model in the film. Children who saw the
no-consequence modelling scenario and those who saw the model being
rewarded were more likely to imitate the aggressive behavior compared to
children who saw the model being punished.

Vicarious learning, i.e., learning by observing others, is used and through a

process of rewarding small changes in the behaviour, the client gradually learns
to acquire the behaviour of the model.

Cognitive Therapy
Cognitive therapies locate the cause of psychological distress in irrational
thoughts and beliefs.

Rational emotive therapy

Albert Ellis formulated the Rational Emotive Therapy (RET).
 The central thesis of this therapy is that irrational beliefs mediate between the
antecedent events and their consequences.
The first step in RET is the antecedent-belief-consequence (ABC) analysis.
Antecedent events, which caused the psychological distress, are noted.
The client is also interviewed to find the irrational beliefs, which are distorting
the present reality.
 Irrational beliefs may not be supported by empirical evidence in the
environment.
 These beliefs are characterised by thoughts with ‘musts’ and ‘shoulds’,
i.e., things ‘must’ and ‘should’ be in a particular manner.
 Examples of irrational beliefs are, “One should be loved by everybody all
the time”, “Human misery is caused by external events over which one
does not have any control”, etc.
This distorted perception of the antecedent event due to the irrational belief
leads to the consequence, i.e., negative emotions and behaviours.
Irrational beliefs are assessed through questionnaires and interviews.

In the process of RET, the irrational beliefs are refuted by the therapist through
a process of non-directive questioning.
 The nature of questioning is gentle, without probing or being directive.

 The questions make the client to think deeper into her/his assumptions
about life and problems.
Gradually the client is able to change the irrational beliefs by making a change
in her/his philosophy about life.
The rational belief system replaces the irrational belief system and there is a
reduction in psychological distress.

Aaron Beck
His theory of psychological distress characterised by anxiety or depression,
states that childhood experiences provided by the family and society develop
core schemas or systems, which include beliefs and action patterns in the
individual.
  Individuals tend to maintain their core beliefs about themselves, their
world, and their future.
 Examples of schemas commonly problematic for young people with
emotional and behavioural problems include: ‘I am unlovable’, ‘I am a
troublemaker’, ‘I am never going to succeed at anything’, ‘If I don’t
show aggression first, then they will walk all over me’, ‘If I had been well
behaved, then my mother would not have had a breakdown’, ‘If I don’t
go along with whatever my friends do then they will abandon me and I’ll
be lonely’, ‘I must get the approval of everyone to be worthwhile’.

Thus, a client, who was neglected by the parents as a child, develops the core
schema of “I am not wanted”.
 During the course of life, a critical incident occurs in her/his life. S/he is
publicly ridiculed by the teacher in school.

 This critical incident triggers the core schema of “I am not wanted”

leading to the development of negative automatic thoughts.

 Negative thoughts are persistent irrational thoughts such as “nobody

loves me”, “I am ugly”, “I am stupid”, “I will not succeed”, etc.

 Such negative automatic thoughts are characterised by cognitive

distortions.

Cognitive distortions
These negative automatic thoughts tend to be maintained by cognitive
distortions.
They cause systematic errors in reasoning that lead to faulty assumptions and
misconceptions
Cognitive distortions are ways of thinking which are general in nature but which
distort the reality in a negative manner.
 These patterns of thought are called dysfunctional cognitive structures.
They lead to errors of cognition about the social reality.
When people overgeneralize, they reach a conclusion about one event and then
incorrectly apply that conclusion across the board.
For example, you make a low score on one math test and conclude that you’re
hopeless at math in general. You have a negative experience in one relationship
and develop a belief that you just aren’t good at relationships at all.

This distorted type of thinking leads people to dread or assume the worst when
faced with the unknown. When people catastrophize, ordinary worries can
quickly escalate.
For istance, an expected check doesn’t arrive in the mail. A person who
catastrophizes may begin to fear it will never arrive, and that as a consequence
it won’t be possible to pay rent and the whole family will be evicted.

One of the most common errors in thinking is taking things personally when
they’re not connected to or caused by you at all.
You may be engaging in personalization when you blame yourself for
circumstances that aren’t your fault, or are beyond your control.

Repeated occurrence of these thoughts leads to the development of feelings of

anxiety and depression.

The therapist uses questioning, which is gentle, nonthreatening disputation of

the client’s beliefs and thoughts.
Examples of such question would be, “Why should everyone love you?”,
“What does it mean to you to succeed?”, etc.
The questions make the client think in a direction opposite to that of the
negative automatic thoughts whereby s/he gains insight into the nature of
her/his dysfunctional schemas, and is able to alter her/his cognitive structures.
The aim of the therapy is to achieve this cognitive restructuring which, in
turn, reduces anxiety and depression.

Cognitive Behaviour Therapy

The most popular therapy presently is the Cognitive Behaviour Therapy (CBT).
Research into the outcome and effectiveness of psychotherapy has conclusively
established CBT to be a short and efficacious treatment for a wide range of
psychological disorders such as anxiety, depression, panic attacks, and
borderline personality, etc.
CBT adopts a biopsychosocial approach to the delineation of
psychopathology.
 It combines cognitive therapy with behavioural techniques.

The rationale is that the client’s distress has its origins in the biological,
psychological, and social realms.
 Hence, addressing the biological aspects through relaxation procedures,
the psychological ones through behaviour therapy and cognitive therapy
techniques and the social ones with environmental manipulations makes
CBT a comprehensive technique which is easy to use, applicable to a
variety of disorders, and has proven efficacy.

Humanistic-existential Therapy
The humanistic-existential therapies postulate that psychological distress arises
from feelings of loneliness, alienation, and an inability to find meaning and
genuine fulfilment in life.
Human beings are motivated by the desire for personal growth and self-
actualisation, and an innate need to grow emotionally.
When these needs are curbed by society and family, human beings experience
psychological distress.
Healing occurs when the client is able to perceive the obstacles to self-
actualisation in her/his life and is able to remove them.
Self-actualisation requires free emotional expression.
  The family and society curb emotional expression, as it is feared that a
free expression of emotions can harm society by unleashing destructive
forces.
 This curb leads to destructive behaviour and negative emotions by
thwarting the process of emotional integration.

 Therefore, the therapy creates a permissive, non-judgmental and

accepting atmosphere in which the client’s emotions can be freely
expressed and the complexity, balance and integration could be achieved.

The fundamental assumption is that the client has the freedom and
responsibility to control her/his own behaviour.

The therapist is merely a facilitator and guide.

 It is the client who is responsible for the success of therapy.

 The chief aim of the therapy is to expand the client’s awareness.

 Healing takes place by a process of understanding the unique personal

experience of the client by herself/himself.

 The client initiates the process of self-growth through which healing takes
place.

Self-actualisation is defined as an innate or inborn force that moves the person

to become more complex, balanced, and integrated, i.e., achieving the
complexity and balance without being fragmented.
 Integrated means a sense of whole, being a complete person, being in
essence the same person in spite of the variety of experiences that one is
subjected to.

 Just as lack of food or water causes distress, frustration of self-

actualisation also causes distress.
Existential Therapy
Victor Frankl, a psychiatrist and neurologist propounded the Logotherapy.
Logos is the Greek word for soul and Logotherapy means treatment for the soul.
Humans have desire to seek and make meaning in life.
Frankl calls this process of finding meaning even in life-threatening
circumstances as the process of meaning making.
The elderly man was struggling with depression following the loss of his wife.
After Frankl showed him how his wife’s death had actually spared her of losing
him, the elderly man saw how his own experiences had preserved his wife from
the same.
The new perspective imbued the his suffering with meaning and significantly
relieved his depression.

Human beings are made up of body (soma), mind (psyche) and spirit (noos).
Frankl held that while we have a body and a mind, the spirit is who we are, our
identity and essence.
 The basis of meaning making is a person’s quest for finding the spiritual
truth of one’s existence.

 Just as there is an unconscious, there is a spiritual unconscious, which is

the storehouse of love, aesthetic awareness, and values of life.

Neurotic anxieties arise when the problems of life are attached to the physical,
psychological or spiritual aspects of one’s existence.
 Frankl emphasised the role of spiritual anxieties in leading to
meaninglessness and hence it may be called an existential anxiety, i.e.,
neurotic anxiety of spiritual origin.

The goal of logotherapy is to help the patients to find meaning and

responsibility in their life irrespective of their life circumstances.
The therapist emphasises the unique nature of the patient’s life and encourages
them to find meaning in their life.
Frankl believed that it was possible to turn suffering into achievement and
accomplishment. He viewed guilt as an opportunity to change oneself for the
better and life transitions as the chance to take responsible action
Dereflection is aimed at helping you focus away from yourself and toward other
people allowing you to become "whole" and to spend less time feeling
preoccupied with a problem or worry.
 For instance, if one is struggling with one’s finances, the logotherapist
might ask the patient to focus more on the people he or she is working to
provide for, rather than constantly thinking of how the problem is
affecting himself or herself.
Paradoxical intention is a technique that invites you to wish for the thing that
you fear most.
 Forexample, if you have a fear of looking foolish, you might be
encouraged to try to look foolish on purpose. Paradoxically, your fear
would be removed when you set an intention to behave as foolishly as
possible.
In Logotherapy, the therapist is open and shares her/his feelings, values and
his/her own existence with the client.
The emphasis is on here and now.
Transference is actively discouraged.
The therapist reminds the client about the immediacy of the present.
The goal is to facilitate the client to find the meaning of her/his being.

Client-centred Therapy
Client-centred therapy was given by Carl Rogers.
Rogers combined scientific rigour with the individualised practice of client
centred psychotherapy.
Rogers brought into psychotherapy the concept of self, with freedom and
choice as the core of one’s being.
The therapy provides a warm relationship in which the client can reconnect
with her/his disintegrated feelings.
The therapist shows empathy, i.e., understanding the client’s experience as if it
were her/his own, is warm and has unconditional positive regard, i.e. total
acceptance of the client as s/he is.
 Empathy sets up an emotional resonance between the therapist and the
client.

Unconditional positive regard indicates that the positive warmth of the

therapist is not dependent on what the client reveals or does in the therapy
sessions.
 This unique unconditional warmth ensures that the client feels secure and
can trust the therapist.
 The client feels secure enough to explore her/his feelings.

The therapist reflects the feelings of the client in a non-judgmental manner.

 The reflection is achieved by rephrasing the statements of the client, i.e.
seeking simple clarifications to enhance the meaning of the client’s
statements.

 This process of reflection helps the client to become integrated.

In essence, this therapy helps a client to become her/his real self with the
therapist working as a facilitator.

Gestalt Therapy
The German word gestalt means ‘whole’.
This therapy was given by Freiderick (Fritz) Perls together with his wife Laura
Perls.
Gestalt, by definition, refers to the form or shape of something and suggests that
the whole is greater than the sum of its parts.
 Gestalt psychologists argued that human beings perceive entire patterns
or configurations, not merely individual components.
  This is why when we see a group of dots arranged as a triangle, we see a
triangle instead of random dots. Our brains organize information into
complete configurations, or gestalts (O’Leary, 2013).
Additionally, the individual is thought of as being involved in a constant
construction of gestalts, organizing and reorganizing their experience, searching
for patterns and a feeling of wholeness.
Gestalt therapy associates feeling whole with feeling alive and connected to
one’s own unique experience of existence.
Gestalt therapists apply this philosophy of wholeness to their clients. They
believe that a human being cannot be understood by generalizing one part of the
self to understand the whole person (O’Leary, 2013).
 For example, the client cannot be understood solely by their diagnosis, or
by one interaction, but must be considered the total of all they are.
Rubin Vase.
There is a black outline of a vase on the screen, and at first, this is all the viewer
notices, but after a moment, the viewer’s attention shifts and they notice the two
faces outlined in the white part of the screen, one on either side of the vase.
In the first perception, the black vase is called the figure, and the white faces
are called the ground. But the viewer can shift their attention, and through this
act, the figure and ground switch, with the white faces becoming the figure, and
the black vase the ground.
Gestalt therapists apply this perceptual phenomenon to human experience.
 Going through the world, we are engaged in a constant process of
differentiating figures and grounds.
 The figure is whatever we are paying attention to.
 while the ground is whatever is happening in the background.
Healthy functioning is the ability to attend flexibly to the figure that is most
important at the time (O’Leary, 2013).
 Here is another example of this process: As I am writing, I realize that
my lips are dry and my mouth is parched. I get up, pour a glass of
water, and then return to my writing. In response to my feeling of thirst, I
shift my frame of awareness from my writing, to drinking water, and then
back to my writing. The act of drinking water, satisfying my thirst,
completes the gestalt, and I am free to return to my work.
In contrast, unhealthy living results when one’s attention flits from one figure to
the other without ever achieving wholeness.
 An easy example of this can be seen through our relationships with our
phones. If we are working on something important and our phone rings,
we can make a decision to ignore it for the moment, finish our work, and
then call the person back later. If there is a deadline for our project, this
may be the healthy choice. But if we allow our attention to be divided
each time our phone rings, we may never finish our project.
Healthy living requires the individual to attend flexibly and intentionally to the
most crucial figure in their awareness.

Awareness
The goal of gestalt therapy is to increase an individual’s self-awareness and
self-acceptance.
Gestalt therapists prioritize present moment awareness and the notion that
paying attention to the events unfolding in the here-and-now is the way to
achieve healthy living.
Gestalt therapists focus on helping their clients restore their natural awareness
of the present moment by focusing on the here-and-now in the therapy room.
Experiences and feelings that have not been fully processed in the past are
revisited and worked through in the present, such as with the empty chair
technique.
The client is taught to recognise the bodily processes and the emotions that are
being blocked out from awareness.

Empty chair technique

Things that are in our awareness but incomplete are called “unfinished
business.”
Because of our natural tendency to make gestalts, unfinished business can be a
significant drain of energy, as well as a block on future development (O’Leary,
2013).
The most popular and well-known technique in gestalt therapy, the empty chair
technique or empty chair dialogue (ECH), is a method of resolving unfinished
business in the therapy room.
Unfinished business is often the result of unexpressed emotion, such as not
grieving a loss (O’Leary, 2013), and/or unfulfilled needs, such as unaired
grievances in a relationship.
 The client may have chosen to avoid the unfinished business in the
moment, deciding not to rock the boat or to preserve the relationship.
After the fact, these unexpressed feelings may lack a suitable outlet or may
continue to be avoided because of shame or fear of being vulnerable. Most
people tend to avoid these painful feelings instead of doing what is necessary to
change (Perls, 1969).
The empty chair technique is a way of bringing unexpressed emotion and
unfulfilled needs into the here-and-now.
In ECH, the therapist sets up two chairs for the client, one of which is left
empty.
 The client sits in one chair and imagines the significant other with whom
they have unfinished business in the empty chair.
 The client is then instructed and helped to say what was left unsaid to the
imaginary significant other.
 Sometimes the client switches chairs and speaks to themselves as though
they were the significant other.
 Through this dialogue, the client’s past emotions are brought into the
present. They are then processed and worked through with the therapist.

This technique can be done with either an ongoing relationship or a relationship

that has ended.
The resolution of the work is to help the client shift their self-perception.
 Clients undergoing ECH may shift from viewing themselves as weak and
victimized to a place of greater self-empowerment.

 They may see the significant other with greater understanding or hold
them accountable for harm (Paivio & Greenberg, 1995).
This therapy can also be used in group settings.
Alternative Therapies
Alternative therapies are so called, because they are alternative treatment
possibilities to the conventional drug treatment or psychotherapy.
There are many alternative therapies such as yoga, meditation, acupuncture,
herbal remedies and so on.
In the past 25 years, yoga and meditation have gained popularity as treatment
programmes for psychological distress.

Yoga
It is an ancient Indian technique detailed in the Ashtanga Yoga of Patanjali’s
Yoga Sutras (texts on yoga)
Yoga as it is commonly called today either refers to only the asanas or body
posture component or to breathing practices or pranayama, or to a combination
of the two.

Meditation
It refers to the practice of focusing attention on breath or on an object or thought
or a mantra.
Here attention is focused.
In Vipasana meditation, also known as mindfulness-based meditation, there is
no fixed object or thought to hold the attention.
Vipassana, you simply observe your inner self instead of consciously
controlling the experience. The goal is to help you:
 quiet your mind
 focus on the present
 accept thoughts, emotions, and sensations for what they really are
 reduce regrets by dwelling less on the past
 worry less about the future
 respond to situations based on reality, instead of worries or preconceived
notions
  The person passively observes the various bodily sensations and thoughts
that are passing through in her or his awareness.

 Prevention of repeated episodes of depression may be helped by

mindfulness-based meditation or Vipasana.

 This meditation would help the patients to process emotional stimuli

better and hence prevent biases in the processing of these stimuli

The rapid breathing techniques to induce hyperventilation as in Sudarshana

Kriya Yoga (SKY) is found to be a beneficial, low-risk, low-cost adjunct to the
treatment of stress, anxiety, post-traumatic stress disorder (PTSD), depression,
stress-related medical illnesses, substance abuse, and rehabilitation of criminal
offenders.
Sudarshan Kriya is a combination of pranayam and breathing techniques
beginning with slow inhalation and exhalation and gradually progressing to a
series of rapid breathing techniques.
The word “sudarshan” means positive appearance or outlook and “kriya” is an
act of purification.
The whole process of Sudarshan Kriya is based on controlling the mind by
focusing on regulated breathing and thereby improving overall wellness.
Rhythm between mind and body broken-that’s why used.
 SKY has been used as a public health intervention technique to alleviate
PTSD in survivors of mass disasters.

 Yoga techniques enhance well-being, mood, attention, mental focus, and

stress tolerance.

 Proper training by a skilled teacher and a 30-minute practice every day

will maximise the benefits.
  Research conducted at the National Institute of Mental Health and
Neurosciences (NIMHANS), India, has shown that SKY reduces
depression.
 Further, alcoholic patients who practice SKY have reduced depression
and stress levels.
Insomnia is treated with yoga.
 Yoga reduces the time to go to sleep and improves the quality of sleep.

Kundalini Yoga combines pranayama or breathing techniques with chanting of

mantras.
 Kundalini Yoga taught in the USA has been found to be effective in
treatment of mental disorders.

 The Institute for Nonlinear Science, University of California, San Diego,

USA has found that Kundalini Yoga is effective in the treatment of
obsessive-compulsive disorder.

REHABILITATION OF THE MENTALLY ILL

The treatment of psychological disorders has two components:
 reduction of symptoms,
 and improving the level of functioning or quality of life.

In the case of milder disorders such as generalised anxiety, reactive depression

or phobia, reduction of symptoms is associated with an improvement in the
quality of life.

However, in the case of severe mental disorders such as schizophrenia,

reduction of symptoms may not be associated with an improvement in the
quality of life.
 Many patients suffer from negative symptoms such as disinterest and lack
of motivation to do work or to interact with people.
  Rehabilitation is required to help such patients become self-sufficient.

 The aim of rehabilitation is to empower the patient to become a

productive member of society to the extent possible.

In rehabilitation, the patients are given occupational therapy, social skills

training, and vocational therapy.
In occupational therapy, the patients are taught skills such as candle making,
paper bag making and weaving to help them to form a work discipline.

Social skills training helps the patients to develop interpersonal skills through
role play, imitation and instruction.
 The objective is to teach the patient to function in a social group.

Cognitive retraining is given to improve the basic cognitive functions of

attention, memory and executive functions.
 After the patient improves sufficiently, vocational training is given
wherein the patient is helped to gain skills necessary to undertake
productive employment.