Therapeutic Approaches and Counselling

Psychotherapy is a voluntary relationship between the one seeking treatment or the

client and the one who treats or the therapist.
1. Purpose: To help the client to solve the psychological problems being faced by her or
him.
2. Aim: To change the maladaptive behaviors, decrease the sense of personal distress,
and help the client to adapt better to his/her environment.
3. The relationship is conducive for building the trust of the client so that problems may
be freely discussed.
Characteristics:
1. There is systematic application of principles underlying the different theories of
therapy.
2. Only persons who have received practical training under expert supervision can
practise psychotherapy.
3. The situation involved a therapist and client who seeks and receives help for his/her
emotional problems (this person is the focus of attention in the therapeutic process).
4. The interaction of the therapist and the client results in the consolidation or
formation of the therapeutic relationship. This is a confidential, interpersonal, and
dynamic relationship.
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.
(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.
Therapeutic Relationship:
The special relationship between the client and the therapist is known as the
therapeutic
relationship or alliance.
Components:
1. Contractual Nature of the Relationship: Two willing individuals, the client and the
therapist, enter into a partnership which aims at helping the client overcome his/ her
problems.
2. Limited Duration of the Therapy: This alliance lasts until the client becomes able to
deal with his/her problems and take control of his/her life.
Properties:
(i) It is a trusting and confiding relationship.
(ii) 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.
Classification of Psychotherapies

A. BEHAVIOUR THERAPY
• Focused on the behaviour and thoughts of the client in the present.
• The past is relevant only to the extent of understanding the origins of the faulty
behaviour and thought patterns, not relieved.
• Behaviour therapies are clinical application of learning theories.
• Consists of a large set of specific techniques and interventions—symptoms of the
client and the clinical diagnosis are the guiding factors in the selection of the specific
techniques or interventions to be applied.
• Open therapy, i.e., the therapist shares his/her method with the client.
Method of Treatment:
(i) The client is interviewed with a view to analyze his/her behaviour patterns.
(ii) Behavioral analysis is conducted to find:
(a) Malfunctioning Behaviors: Behaviors which cause distress to the client.
(b) Antecedent Factors: Those causes which predispose the person to indulge in that
behaviour
(c) Maintaining Factors: Those factors which lead to the persistence of the faulty
behaviour.
(iii) Aim: To eliminate the faulty behavior and substitute them with adaptive behaviour
patterns.
(a) Antecedent Operations: Control behaviour by changing something that precedes
such a behaviour.
(b) Establishing Operations: Induce a change in behaviour by increasing or decreasing
the reinforcing value of a particular consequence.
(c) Consequent Operation: i.e., Giving reinforcement eg. Praise.
Behavioural Techniques:
1. Negative Reinforcement: Following an undesired response with an outcome that is
painful or not liked.
2. Aversive Conditioning: Repeated association of undesired response with an aversive
consequence present reality.
3. Positive Reinforcement: Given to increase the deficit if an adaptive behaviour occurs
rarely.
4. Token Economy: Give a token as a reward every time a wanted behaviour occurs,
which can be collected and exchanged for a reward.
5. Differential Reinforcement: Unwanted behaviour can be reduced (negative
reinforcement) and wanted behaviour (positive reinforcement) can be increased
simultaneously.
The other method is to positively reinforce the wanted behaviour and ignore the
unwanted behaviour—less painful and equally effective.
6. Systematic Desensitization: A technique introduced by Wolpe for treating phobias or
irrational fears.
(i) The client is interviewed to elicit fear provoking situations.
(ii) With the client, the therapist prepares a hierarchy of anxiety—provoking stimuli with
the least anxiety-provoking stimuli at the bottom.
(iii) The therapist relaxes the client and asks the client to think about the least anxiety-
provoking situation.
(iv) The client is asked to stop thinking of the situation if tension is felt.
(v) Over sessions, the client is able to imagine more severe fear provoking situations
while maintaining the relaxation.
(vi) The client gets systematically desensitized to the fear.
Operates on the principle of reciprocal inhibition—the presence of two mutually
opposing forces (relaxation response vs. anxiety-provoking scene) at the same time,
inhibits the weaker force.
The client is able to tolerate progressively greater levels of anxiety because of his/her
relaxed state.
7. Modelling: 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 rok;
model. Vicarious learning, 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.

B. COGNITIVE THERAPY
1. Rational Emotive Therapy (RET) (Albert Ellis):
• 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.
(ii) Client is interviewed to find out irrational beliefs, which distorting the
(iii) The therapist encourages this by being accepting, empathic, genuine and warm to
the client.
(iv) The therapist conveys by his/her words and behaviours that he/she 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 he/she may have done or
thought about. This is the unconditional positive regard which the therapist has for the
client.
The clinical formulation is an ongoing process. Formulations may require
reformulations as clinical insights are gained in the process of therapy. Distorted
perception of the antecedent event due to the irrational belief leads to the consequence,
i.e., negative emotions and behaviours.
• Non-directive questioning: Process by which irrational beliefs are refuted by the
therapist.
(i) Nature of questioning is gentle, without probing or being directive.
(ii) Make the client think deeper into his/her assumptions about life and problems.
• Client changes the irrational beliefs by making a change in his/her philosophy about
life—rational belief system replaces the irrational belief system.
2. Aaron Beck’s Cognitive Therapy:
(i) Childhood experiences provided by the family and society develop core schemes or
systems, which include beliefs and action patterns in the individual.
(ii) Critical events in the individual’s life trigger the core, leading to the development of
negative automatic thoughts.
(iii) Negative thoughts are persistent irrational thoughts characterised by cognitive
distortions.
(iv) Dysfunctional Cognitive Structures: Patterns of thought which are general in nature
but which distort the reality in a negative manner.
(v) Repeated occurrence of these thoughts leads to the development of feelings of
anxiety and depression.
• The therapist uses questioning, which is gentle, non-threatening disputation of the
client’s beliefs and thoughts.
• The questions make the client think in a direction opposite to that of the negative
automatic thoughts whereby she/he gains insight into the nature of her/his
dysfunctional schemas, and is able to alter her/his cognitive structures.
3. Cognitive Behaviour Therapy (CBT):
• Short, comprehensive, effective treatment for a wide range of psychological disorders
such as anxiety, depression, panic attacks and borderline personality.
• Adopts a biopsychosocial approach to the delineation of psychopathology.
• Combines cognitive therapy with behavioral techniques.
• Rationate distress has its origins in the biological, psychological, and social realms.
• Addresses the biological (relaxation procedures), psychological (behaviour and
cognitive therapy) and social (environmental manipulations) aspects.
C. Humanistic-Existential Therapy
Self-actualization is defined as an innate force that moves the person to become more
complex, balanced, and integrated; integrated means a sense of whole, being a
complete person.
1. Self-actualization requires free emotional expression:
(a) The family and society curb emotional expression, as it is feared that a free
expression of emotions can harm society by unleashing destructive forces.
(b) When emotionally expression is curbed, destructive behaviour and negative
emotions by thwarting the process of emotional integration.
2. Healing occurs when the client is able to perceive the obstacles to self-actualization
in his/her life and is able to remove them.
3. Therapy creates a permissive, non-judgemental and accepting atmosphere in which
the client’s emotions can be freely expressed.
4. The client has the freedom and responsibility to control his/her own behaviour; the
therapist is merely a facilitator and guide. The chief aim of the therapy is to expand the
client’s awareness.
1. Existential Therapy [Logotherapy (Victor Frankl)]:
• Treatment for the soul.
• Meaning making: Process of finding meaning even in life-threatening circumstances,
the basis of which is a person’s quest for finding the spiritual truth of one’s existence.
• Spiritual Unconscious: The storehouse of love, aesthetic awareness and values of life.
• Existential Anxiety: Neurotic anxiety of spiritual origin (spiritual anxieties leading to
meaninglessness).
• Goal: To help the patients find meaning and responsibility in their life irrespective of
their life circumstances.
• The therapist emphasizes the unique nature of the patient’s life and is open (shares
his/her feelings, values and own existence).
• Emphasis is on here and now, the therapist reminds the client about the immediacy of
the present.
2. Client-centered Therapy (Carl Rogers):
• Introduced the concept of self and freedom and choice as the core of one’s being.
• Provides a warm relationship in which the client can reconnect with his/her
disintegrated feelings.
• The therapist:
(i) Shows empathy—understands the client’s experience as if it were his/her own—sets
up an emotional resonance between client and therapist.
(ii) Warmth—the client feels secure and can trust the therapist.
(iii) Has unconditional positive regard, i.e., total acceptance of the client as he/she is,
indicates that the positive warmth of the therapist is not dependent on what the client
reveals or does in the therapy sessions.
• Client feels secure enough to explore his/her feelings; therapist reflects the feelings of
the client in a non-judgemental 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.
3. Gestalt Therapy (Frederick and Laura Pearl):
• Goal: To increase an individual’s self-awareness and self -acceptance.
• Client is taught to recognize the bodily processes and the emotions that are being
blocked out from awareness.
• Therapist encourages the client to act out fantasies about feelings and conflicts can
also be used in group settings.

Factors Contributing to Healing:

1. Techniques adopted by the therapist and the implementation of the same with the
client, e.g., CBT for an anxious client—relaxation procedures and cognitive restructuring
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. Catharsis: A process of emotional unburdening by a client when he/she is being
interviewed in the initial sessions of therapy to understand the nature of the problem.
4. Non-specific Factors: These factors occur across different systems of psychotherapy
and across different clients/patients and different therapists.
(i) Patient Variables (motivation for change, expectation of improvement).
(ii) Therapist Variables (positive nature, good mental health, absence of unresolved
emotional conflicts).
Ethics in Psychotherapy:
1. Informed consent needs to be taken.
2. Confidentiality of the client should be maintained.
3. Alleviating personal distress 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.

DEFINITIONS
• Alternative Therapy: Alternative treatment possibilities to the conventional during
treatment or Psychotherapy, e.g. yoga, Meditation etc.
• Behaviour Therapy: Therapy based on the principles of behaviouristic learning
theories in order to change the maladaptive behaviour.
• Client-centered (Rogerian) Therapy: The therapeutic approach developed by Carl
Rogers in which therapist helps clients to clarify their true feeling and come to value
who they are.
• Cognitive Therapies: Forms of therapy focused on changing distorted and
maladaptive patterns of thought.
• Counselling: A board name for a wide variety of procedures for helping individuals
achieve adjustments, such as the giving of advice, therapeutic discussion, the
administration and interpretation of tests, and vocational assistance.
• Counselling Interview: An interview whose purpose is counselling or providing
guidance in the area of personality, vocational choice, etc.
• Empathy: Reacting to another’s feelings with an emotion response that is similar to
the other’s feeling.
• Gestalt Therapy: An approach to therapy that attempts to integrate a client’s thoughts,
feelings and behaviour into a unified whole.
• Humanistic Therapy: A therapy in which the underlying assumption is that people have
control over their behaviour, can make choices about their lives, and are essentially
responsible for solving their own problems.
• Modelling: A process of learning in which an individual acquires responses by
observing and imitating others.
• Psychotherapy: The use of any psychological technique in the treatment of mental/
psychological disorder or maladjustment.
• Rational Emotive Therapy (RET): A therapeutic system developed by Albert Ellis. It
seeks to replace irrational problem-provoking outlooks with more realistic ones.
• Rehabilitation: Restoring an individual to normal or a satisfactory a state as possible,
following an illness, criminal episode, etc.
• Self-actualisation: A- state of self-fulfillment in which people realise their highest
potential in their own unique way.
• Systematic Desensitisation: A form of behavioural therapy in which phobic client
learns to induce a relaxed state and then exposed to stimuli that elicit fear or phobia.
• Therapeutic Alliance: The special relationship between the client and the therapist;
contractual nature of the relationship and limited duration of the therapy are its two
major components.
• Unconditional Positive Regard: An attitude of acceptance and respect on the part of
an observer, no matter what the other person says or does.