FACTS THAT MATTER

Psychotherapy is a voluntary relationship between the one seeking treatment or the client
and the one who treats or the therapist.
Purpose: To help the client to solve the psychological problems being faced by her or him.
Aim: To change the maladaptive behaviours, decrease the sense of personal distress, and
help the client to adapt better to his/her environment.

Inadequate Marital ,occupational on social adjustment also requires that major changes be
made in an individual personal environment

The relationship is conducive for building the trust of the client so that problems may be
freely discussed.
Psychotherapeutic approaches have following 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.
Psychotherapies 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 of this alliance :

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 of alliance

(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.

Efforts by therapists

 The therapist encourages this relationship by being accepting , emphatic, genuine

and warm to the client.
 The therapist conveys by her or his words and behaviours that she or 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 she or he may
have done or thought about that. this is the unconditional positive regard which
therapist has for the client .
 therapist has empathy for the client . Empathy is different from sympathy and
intellectual understanding of another person situation
 in sympathy one has compassion and pity towards the suffering of another but is not
able to feel like the other person
 intellectual understanding is cold in sense that the person is unable to feel
  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
other person’s prospective. putting oneself in the another person's shoes . Empathy
enriches the therapeutic relationship and transform it into the healing relationship.
 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 confidence of client in anyway. finally it
is a professional relationship and must remain so.

Classification of Psychotherapies

Psychotherapies may be classified into three broad groups pyschodynamic , behavior and
existential

The pyschodyanamic therapy emerged first then behaviour therapy then existential therapy
also called third force

A. PSYCHODYNAMIC THERAPY (Sigmund Freud, Carl Jung, Neo Freudians)

Methods of Eliciting the Nature of Intrapsychic Conflict:

1. Free Association:
(i) Therapeutic relationship is established, client feels comfortable—therapist makes client
lie down on the couch, close their eyes and asks them to speak whatever comes to mind
without censoring it.
(ii) Client is encouraged to freely associate one thought with another (free association).

(iii) Censoring superego and the watchful ego are kept in abeyance—client speaks whatever
comes to mind in a relaxed and trusting atmosphere.
(iv) Therapist does not interrupt; the free flow of idea, desires and conflicts of the
unconscious, which had been suppressed by the ego, emerge into the conscious mind.
2. Dream Analysis:
(i) Client is asked to write down his/her dreams upon waking up.
(ii) Drams are symbols of the unfulfilled desires of the unconscious.
(iii) Dreams use symbols which signify intrapsychic forces because they are indirect
expressions and hence would not alert the ego.
(iv) If unfulfilled desires are expressed directly, the ever-vigilant ego would suppress them,
leading to anxiety.
(v) Symbols are interpreted according to an accepted convention of translation as the
indicators of unfulfilled desires and conflicts.
Modality of Treatment:
(a) Transference: The client starts identifying the therapist with the authority figures of the
past, usually childhood.
(i) The therapist maintains a non-judgmental and permissive attitude and allows the client
to continue with this process of emotional identification.
(ii) Transference Neurosis: The therapist becomes a substitute for that person in the
present—the client acts out the frustrations, anger, fear, that he/she harboured towards
that person in the past, but could not express at the time.
• Positive Transference: The client idolizes, or falls in love with the therapist, and seeks the
therapist’s approval.
• Negative Transference: The client has feelings of hostility, anger and resentment*towards
the therapist.
(b) Resistance: The client opposes the progress of therapy in order to protect
himself/herself from the recall of painful unconscious memories.
(i) Conscious Resistance: The client deliberately hides some information
(ii) Unconscious Resistance: The client becomes silent during the therapy session, recalls
trivial details without recalling the emotional ones, misses appointments, and comes late
for therapy sessions.
(iii) The therapist overcomes the resistance by repeatedly confronting the patient about it
and by uncovering emotions such as anxiety, fear 0’r shame, which are causing the
resistance.

(c) Interpretation: The therapist uses the unconscious material that has been uncovered to
make the client aware of the psychic contents and conflicts which, have led to the
occurrence of certain events, symptoms and conflicts.
(i) Subtle process, the pinnacle of psychoanalysis.
(ii) Two analytical techniques:
• Confrontation: The therapist points out to the client an aspect of his/her psyche that
must be faced by the client.
• Clarification: The therapist brings a vague or confusing event into sharp focus by
separating and highlighting important details about the event from unimportant ones.
Working Through: The repeated process of using confrontation, clarification and
interpretation.
(i) Helps the patient understand the source of the problem and to integrate the uncovered
material into his/her ego.
Insight: A gradual process where in the unconscious memories are repeatedly integrated
into conscious awareness; these unconscious events and memories are re-experienced in
transference and are worked through.
(i) End-point of psychoanalysis, client gains a new understanding on him/ herself- conflicts
of the past, defence mechanisms and physical symptoms are no longer present.
(ii) Intellectual Insight: The client starts understand herself/himself better at an intellectual
level.
(iii) Emotional Insight: The emotional understanding, acceptance of one’s irrational
reaction to the unpleasant events of the past, and the willingness to change emotionally as
well as making the change.

Duration of Treatment
• Lasts of several years with a one-hour session for 4-5 days per week.
• Intense treatment, three phases.
(i) Initial Phase: Client becomes familiar with the routines, establishes a therapeutic
relationship, and recollects the superficial material from the consciousness about the past
and present.
(ii) Middle Phase: Characterised by transference, resistance on the part
of the client, and confrontation, clarification and working through on the therapist’s part;
all these processes finally lead to insight.
(iii) Third Phase: Termination; the relationship with the analyst is dissolved and the client
prepares to leave the therapy.

B. 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 analyse his/her behaviour patterns.
(ii) Behavioural analysis is conducted to find:
(a) Malfunctioning Behaviours: Behaviours 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 behaviours 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 role
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.

C. 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 them
(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 behavioural techniques.
• Rationale—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.

D. 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 feeltngs, 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.

E. BIOMEDICAL THERAPY

Prescription of medicines is done by psychiatrists (qualified medical doctors who have

specialized in the understanding, diagnosis and treatment of mental disorders). The nature
of medicines used depends on the nature of the disorder:
(i) Anti-psychotic drugs—severe mental disorders (schizophrenia, bipolar disorder).
(ii) Milder drugs—common mental disorders (generalized anxiety, reactive depression).
Cause side-effects which need to be understood and monitored—essential that medication
is given under proper medical supervision.

ELECTRO-CONVULSIVE THERAPY (ECT)

(i) Mild electric shock given via electrodes to the brain of the patient to induce convulsions.
(ii) The shock is given by the psychiatrist only when necessary for the improvement of
patient.
(iii) Not a routine treatment and is given only when drugs are not effective

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.

F. ALTERNATIVE THERAPIES Yoga:

• An ancient Indian technique detailed in the Ashtanga Yoga of Patanjali’s Yoga Sutras.
• Refers to only the asanas (body posture component) or to pranayama (breathing
practices).
• Techniques enhance well-being, mood, attention, mental focus, and stress tolerance.
• Reduces the time to go to sleep and improves the quality of sleep.
• Proper training by a skilled teacher and 30-minute practice everyday maximises the
benefits.
Meditation refers to the practice of focusing attention on breath or on an object or thought
of a mantra.
A. Sudarshana Kriya Yoga (SKY)
(i) Rapid breathing techniques induce hyperventilation.
(ii) Beneficial, low risk, low cost.
(iii) Used as a public health intervention technique to alleviate PTSD in survivors of mass
disasters.
(iv) Reduces depression (research conducted at the National Institute of Mental Health and
Neurosciences (NIMHANS).
(v) Reduces stress levels in substance abuse patients, e.g., alcoholics.
B. Kundalini Yoga
(i) Effective in treatment of mental disorders and OCD.
(ii) Combines prandyama (breathing techniques) with chanting of mantras.
C. Vipasana Meditation
(i) Mindfulness-based meditation; no fixed object or thought to hold to attention.
(ii) Person passively observes the various bodily sensations and thoughts that are passing
through in his or her awareness.
(iii) Helps prevent repeated episodes of depression.
(vi) Helps patients process emotional stimuli better and prevents biases in the processing of
these stimuli.

Rehabilitation of the Mentally 111:

• Aim: to empower the patient to become a productive member of society to the maximum
extent possible.
• 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.
• In rehabilitation, the patients are given:
(i) Occupational Therapy: teaches skills such as candle making, paper bag making and
weaving to help them to form a work discipline
(ii) Social Skills Training: Develops interpersonal skills through role play, imitation and
instruction; objective is to teach the patient to function in a social group.
(iii) Cognitive Retraining: Improves the basic cognitive functions of attention, memory and
executive function.
(iv) Vocational Therapy: Once the patient improves sufficiently, gains skills necessary to
undertake productive employment.

WORDS THAT MATTER

• 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.
• Biomedical Therapy: Refer to medicines which are prescribed to treat Psychological
disorders.
• Client-centred (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.
• Electro Convulsive Therapy (ECT): Commonly called ‘shock treatment’. A biological
treatment for unipolar depression in which electrodes attached to a patient’s head send an
electric current through the brain, causing a convulsion. It is effective in the treatment of
cases of several depression that fail to respond to drug therapy.
• Empathy: Reacting to another’s feelings with an emotion response that is similar to the
other’s feeling.
• Free Association: A psychodynamic technique in which the patient describes verbally any
thought, feeling or image that comes to mind, even if it seems unimportant.
• 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.
• Psychodynamic Therapy: First suggested by Frend. Therapy based on the premise that
the primary sources of abnormal behaviour are unresolved past conflicts and the possibility
that unacceptable unconscious impulses will enter consciousness.
• 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.
• Resistance: In psychoanalysis, attempts by the patient to block treatment.
• Self-actualisation: A- state of self-fulfilment 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.
• Transference: Strong positive or negative feelings toward the therapist on the part of
individual undergoing psychoanalysis.
• Unconditional Positive Regard: An attitude of acceptance and respect on the part of an
observer, no matter what the other person says or does.