CHAPTER 5

THERAPEUTIC APPROACHES

PSYCHOTHERAPY
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.
AIMS
 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

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), and
(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.

OTHER 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. It is neither a passing acquaintance, nor a permanent and lasting relationship.
2 major components
(i) contractual nature
(ii) limited duration
Properties
(i)It is a trusting and confiding relationship.
(ii) Unconditional positive regard 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.
(iii)Empathy- putting oneself in the other person’s shoes.
(iv) therapeutic alliance
(v)Confidentiality
(vi)Finally, it is a professional relationship

TYPES OF THERAPIES SUMMARY

 BEHAVIOUR THERAPY
CAUSE- Behaviour therapies postulate that psychological distress arises because of faulty behaviour
patterns or thought patterns. It is, therefore, 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. The past is not activated or relived. Only the faulty patterns are corrected in the
present

Method of Treatment
(I) INTERVIEW
(II)BEHAVIOURAL ANALYSIS
 Malfunctioning behaviours-Behaviours that are distressing.
 Antecedent factors- causes
 Maintaining factors- factors which lead to the persistence(continuity) of the faulty behaviour
(III) TREATMENT PACKAGE IS CHOSEN
 Antecedent operations control behaviour by changing something that precedes such a
behaviour. The change can be done by increasing or decreasing the reinforcing value of a
particular consequence. This is called establishing operation
 Consequent operations control behaviour by changing something that succeeds such a
behaviour.
 TECHNIQUES IN BEHAVIOUR THERAPY

1. POSITIVE 3. DIFFERNTIAL 5. AVERSIVE 7. MODELLING

REINFORCEMENT REINFORCEMENT CONDITIONING client learns to behave by
If an adaptive Positive reinforcement for (for alcohol/ drugs/ observing the behaviour of a
behaviour occurs wanted behaviour and addiction) role model / therapist who acts
rarely, positive negative reinforcement for repeated as the role model.
reinforcement is unwanted behaviour ASSOCIATION of Vicarious learning- learning by
given to increase undesired response observing others, is used and
the deficit with an aversive through a process of rewarding
consequence small changes in the behaviour

2. NEGATIVE [Link] ECONOMY 6. SYSTEMATIC DESENSITZATION (fears)

REINFORCEMENT
Persons with behavioural  by Wolpe for treating phobias or
responses that lead problems can be given a irrational fears
organisms to get rid token as a reward every time  The client is interviewed to elicit
of painful stimuli or a wanted behaviour occurs. fear - provoking situations
avoid and escape The tokens are collected and  together with the client, the
from them exchanged for a reward such therapist prepares a hierarchy of
as an outing anxiety-provoking stimuli with the
least anxiety-provoking stimuli at
the bottom of the hierarchy
 Over sessions, the client is able to
imagine more severe fear -
provoking situations while
maintaining the relaxation.
 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.
 TECHNIQUES IN COGNIVE THERAPY

[Link] Emotive Therapy (RET) - Cognitive Behaviour Aaron Beck’s Cognitive

Albert Ellis Therapy therapy

Basic concept- Irrational beliefs mediate Most popular therapy CHILDHOOD experiences provided
between the antecedent events and their presently by the family and society develop
consequences CORE SCHEMAS or systems, which
Efficacious treatment for a
include beliefs and action patterns in
The first step in RET is the antecedent- wide range of psychological
the individual.
belief-consequence (ABC) analysis. disorders such as anxiety,
depression, panic attacks, E.g , a client, who was neglected by
A- ANTECEDENT EVENTS-cause of distress
and borderline personality, the parents as a child, develops the
B- IRRATIONAL BELIEFS - These beliefs are etc. core schema of “I am not wanted”
characterised by thoughts with ‘musts’ and
Bio-psychosocial approach Such negative automatic thoughts
‘shoulds’, i.e. things ‘must’ and ‘should’ be
are characterised by COGNITIVE
in a particular manner. “One should be  biological aspects- DISTORTIONS (ways of thinking
loved by everybody all the time”, relaxation
which are general in nature but
procedures
C- This distorted perception of the which distort the reality in a
 psychological negative manner.)These patterns of
antecedent event due to the irrational
aspects - behaviour thought are called dysfunctional
belief leads to the CONSEQUENCE, i.e.
therapy and cognitive structures. They lead to
negative emotions and behaviours
cognitive therapy errors of cognition about the social
Irrational beliefs are assessed through techniques reality.
questionnaires and interviews.  social aspects-
environmental Repeated occurrence of these
Therapy-irrational beliefs are refuted by manipulations thoughts leads to the development
the therapist through a process of non- of feelings of anxiety and depression
directive questioning. The nature of
questioning is gentle, without probing or therapist uses questioning, which is
being directive gentle, non-threatening disputation
of the client’s beliefs and thoughts
Factors Contributing to Healing in Psychotherapy
1. techniques adopted by the therapist
2. therapeutic alliance
3. catharsis
4. non-specific factors
 Patient variables- motivation for change, expectation of improvement due to the
treatment
 Therapist variables- positive nature, absence of unresolved emotional conflicts, presence
of good mental health

Ethics in Psychotherapy
1. Informed consent
2. Confidentiality
3. Alleviating personal distress and suffering should be the goal of all attempts of the therapist.
4. Integrity of the practitioner -client relationship
5. Respect for human rights and dignity.
6. Professional competence and skills

Alternative Therapies
There are many alternative therapies such as yoga, meditation, acupuncture, herbal remedies
Yoga is an ancient Indian technique detailed in the Ashtanga Yoga of Patanjali’s Yoga Sutras.
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 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 mindfulnessbased meditation, there is no fixed
object or thought to hold the attention. The person passively observes the various bodily
sensations and thoughts that are passing through in her or his awareness.

 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.
  Kundalini Yoga has found that Kundalini Yoga is effective in the treatment of obsessive-
compulsive disorder. Kundalini Yoga combines pranayama or breathing techniques with
chanting of mantras.

REHABILITATION OF THE MENTALLY ILL

1. 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.
2. 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.
3. After the patient improves sufficiently, vocational training is given wherein the patient is
helped to gain skills necessary to undertake productive employment.
 TECHNIQUES IN HUMANISTIC-EXISTENTIAL THERAPY

HUMANISTIC –EXISTENTIAL/HUMANISTIC CLIENT-CENTRED THERAPY(SELF)

(PERSONAL GROWTH) (OVERVIEW) Carl Rogers
Causes -[Link] distress arises from feelings of the CONCEPT OF SELF, with freedom and
loneliness, alienation, and an inability to find meaning
choice as the core of one’s being.
and genuine fulfilment in life.
The therapist
ii. Human beings are motivated by the desire for personal
growth and selfactualisation, and an innate need to grow  shows EMPATHY
[Link] these needs are curbed by society and  has UNCONDITIONAL POSITIVE
family, human beings experience psychological distress. REGARD, i.e. total acceptance of the
client as s/he is
Healing occurs when the client is able to perceive the
obstacles to selfactualisation
The therapist reflects the feelings of the
client has the freedom and responsibility to control client in a non judgmental manner by
her/his own behaviour. The therapist is mere a facilitator rephrasing the statements of the client
and guide.
Therapist-facilitator

EXISTENTIAL THERAPY (MEANING IN LIFE)

[Link] Frankl, a psychiatrist and neurologist propounded the

GESTALT THERAPY
LOGOTHERAPY (treatment for the soul)
Freiderick (Fritz) Perls & his wife Laura
[Link] calls this process of FINDING MEANING even in life-
Perls.
threatening circumstances as the process of meaning making
The German word gestalt means
[Link] as there is an unconscious, which is the repository of
‘whole’.
instincts there is a SPIRITUAL UNCONSCIOUS, which is the
storehouse of love, aesthetic awareness, and values of life. GOAL - SELF-AWARENESS and SELF-
ACCEPTANCE.
[Link] anxieties arise when the problems of life are
attached to the physical, psychological or spiritual aspects of The client is taught to recognise the
one’s existence, Frankl emphasised the role of spiritual anxieties bodily processes and the emotions
in leading to meaninglessness and hence it may be called an that are being blocked out from
EXISTENTIAL ANXIETY awareness. The therapist does this by
encouraging the client to act out
[Link]- to help the patients to find meaning and responsibility
fantasies about feelings and conflicts.
in their life irrespective of their life circumstances.
This therapy can also be used in group
[Link] is open and shares her/his feelings, values and
settings.
his/her own existence with the client. The emphasis is on here
and now. Transference is actively discouraged