Chapter 5

Therapeutic Approaches
This chapter may help you understand

• What are the basic nature and processes

involved in psychotherapy?
• There are many therapy approaches for
helping people
• What are the uses of various
psychological approaches?
• How can we help rehabilitate people with
mental disorders?
 Goals of Psychotherapy:
● Ensuring the client’s decision for improvement
● Reduce emotional pressure
● Finding the strengths leading to growth
● Modify habits
● Change faulty thinking patterns
● Understanding ourselves (self awareness)
● Improving relations and rectifying faulty communication patterns
● Assist decision making
● Recognizing that we have choices in life
 FEATURES OF A THERAPEUTIC RELATIONSHIP

I. The relationship between a client and therapist is called a

therapeutic relationship or alliance
II. It is not a lasting or permanent relationship
III. It is a contractual relationship where the client is to be helped by the therapist.
IV. The alliance is only till the client is able to deal with his/her problems, so
limited duration
V. It involves trust and confiding to the maximum
VI. Being accepting, genuine and warm is the base of the interaction with a
therapist
VII. A non-judgmental attitude and positive attitude is important for the client to
share even the most “wrong” things done.
VIII.Empathy is crucial for a therapist-intellectual understanding of the situation of
the client.
IX. Confidentiality has to be exercised by the therapist in all experiences, events,
feelings and thoughts of the client.
X. To be always professional is of primary importance
 Types of Therapies
All therapies aim at relieving humans of distress and build effective
behaviors But they differ from each other in concept and techniques.

Behavioral
Psychodynamic
Therapies
Therapies

Existential
Therapies
 The reasons why such different therapies:

What is How did the What is the

the causes problem chief method
to the come into of treatment?
problem? existence?

What is the nature

What is the
of the therapeutic What is the duration of the
relationship chief benefit treatment?
between the client to the client?
and the therapist?
 Steps in
formulation of
a client’s problem
Case for Psychodynamic therapy (Not for board exam):
Case:
BOB is a 28 year old man. Very
good at his work.
Extremely fearful of seniors, especially men, at
work.
Takes a lot of leaves due to this
reason.
Cannot perform well when seniors are
around.
Therefore a lot of meetings and
presentations go waste.
Now job is at stake as he is extremely
nervous.
 3rd stage
2nd Stage
1st Stage Transference can Termination
Resistance may
be positive/ develop due to phase
Methods to find Middle Phase
Initial Phase negative. transference Make the client
out the causes of Modality of because aware through
Find the cause of intrapsychic treatment: Positive-likes the transference is each stage of the
the disorder conflicts- free transference therapist painful. Therapist association of the
(Intrapsychic and interpreting has to confront problem with the
associations/ it. Negative-hates
conflict) and clarify these past experiences
dream Probably seeing and is angry resistances. and therapy
interpretations the therapist as a towards the progresses. Thus
punishing father therapist. Insight is
developed which
leads to change.
Treatment could last for several years.
(Not for 2021-22):
Case for Behavior therapy:
Case:
BOB is a 28 year old man.
Very good at his work.
Extremely fearful of seniors, especially
men, at work.
Takes a lot of leaves due to this
reason.
Cannot perform well when seniors are
around.
Therefore a lot of meetings and
presentations go waste.
Now job is at stake as he is extremely
nervous.
 A range of behavior
Once these are techniques could be Behavioral
identified, a package applied.
is chosen to change analysis>
If the reason for the the behavior. -Negative Deciding/
behavioral issues reinforcement
are not physical This is done by Designing a
changing the -Aversive
then the behavior is conditioning treatment
caused due to antecedent (occurring
before) OR -Positive
package>
faulty learning due
Find the cause to Malfunctioning consequent reinforcement Applying by
of the behavior behaviors. (occurring after) -Token economy managing the
pattern through operations. different
Antecedent factors -Differential
interview. techniques>
are the causes of For e.g BOB is reinforcement
such behavior. And encouraged for bold Evaluate and
Maintaining factors -Systematic
communications
lead to the (consequent)/instead of desensitization proceed to next
maintenance of such not giving responsible -Reciprocal inhibition target behavior.
behaviors. duties he could be -Modeling (Vicarious
given more reinforcement)
(antecedent).

Treatment and results are quicker

Case for Cognitive therapy:
Case:
BOB is a 28 year old man. Very
good at his work.
Extremely fearful of seniors, especially men,
at work.
Takes a lot of leaves due to this
reason.
Cannot perform well when seniors are
around.
Therefore a lot of meetings and
presentations go waste.
Now job is at stake as he is extremely
nervous.
 AARON BECK
Cognitive therapy These lead to Cognitive Behavior
(CT): anxiety or Therapy (CBT):
2.Then these depression. Uses the bio-
ALBERT ELLIS Find out the core
beliefs are Reality is distorted. psychosocial
Rational schemas i.e. the beliefs approach.
contradicted by and action patterns in Therapist uses
Emotive
the therapist. questioning in a Combines
Here the source Therapy (RET): an individual. gentle and cognitive and
of distress are The therapist nonthreatening
1. Find out the For e.g. Bob may be behavioral
the irrational should be gentle manner.
thoughts and A-B-C while doing this. neglected as a child techniques.
beliefs. (Antecedent - > thought- “I am not Who are the
3. The therapist is Makes use of
Belief- wanted”> at school people in your
For e.g. I could gradually procedures
not perform well Consequence). teacher scolds> workplace that can involving relaxation,
successful in
in school so I Antecedent- triggers “I am not function without questioning &
changing these
will not be able Stimulus wanted”> At work you? arguments and
beliefs. some mistake
to function at Belief-“Everyone Leads to insight behavioral
The client happens> “I am not about one’s
work. must love manipulations and
changes his wanted” Dysfunctional
me”/”I should Cognitive environmental
outlook about life. These are called
not commit Structures manipulations.
mistakes.” Dysfunctional
Cognitive Structures.
Case for Humanistic –Existential therapy:
Case:
BOB is a 28 year old man.
Very good at his work.
Extremely fearful of seniors, especially
men, at work.
Takes a lot of leaves due to
this reason.
Cannot perform well when seniors
are around.
Therefore a lot of meetings
and presentations go
 Here the source Unhelpful societal Responsibility EXISTENTIAL 2.Client-centered 3. Gestalt
of distress are of the growth in THERAPY: therapy
compulsion Therapy
the feelings of
loneliness,
>emotional therapy lies 1. Logotherapy Given by Carl Rogers. Gestalt means
alienation and blocks> with the client “whole”.
destructive Victor Frankl In CCT the concept of
inability to be himself. The focus is on
behaviors/ >psychiatrist> self along with
fully satisfied in Healing freedom and choice is self-awareness
life. negative propounded
happens when the core of one’s and self-
emotions. LOGOTHERAPY>logos
Humans have the client is existence. acceptance.
Therapy provides able to find a -soul in The therapist is Acting out, role-
the desire for non-judgmental, way to reach Greek>So, treatment for empathetic ,warm play, switching
self permissive and
his self the soul. and has roles, etc. are
actualization. accepting
actualization Frankl says as instincts unconditional given
Self environment that positive regard importance.
facilitates the goals are stored in
actualization unconscious in the same (accepting the client Gestalt
needs are as growth of the as he/she is)
client. way there is spiritual Therapy can
strong as unconscious. Being non- be practiced in
hunger or thirst. judgmental and
Anxieties in the groups also.
reflecting through
spiritual areas give rise rephrasing to attain
to Existential clarity is required in
Self actualization is the internal force that Anxieties. CCT.
pushes a person to be balanced and integrated. Treatment: Then the client
Balanced means being well-adjusted and holding Whatever the improves in
all the different elements of life together. circumstance find integrating and being
Integrated means being the same person in spite responsibility and comfortable with
of a lot of varied experiences in life. meaning in life. himself.
 BIOMEDICAL THERAPY
• Psychiatric drugs to help manage psychosis and neurosis
• Prescribed by psychiatrists
? Who is a Psychiatrist?
Medically trained doctors, specialized in Psychiatry.
? Psychiatric drugs are dangerous. Why?
Psychiatric drugs are not dangerous. It helps treat many conditions.
When self- medication is done then it is dangerous.
Therefore Psychiatric drugs can be bought only with prescription from a
psychiatrist.
ECT (Shock treatment)
• Mild electric shock is given to the patient to induce fits (convulsions)
• Not a routine treatment. Given only when drugs are not effective.
 What helps healing take place?
Please answer these questions:

❑How do you heal from a small bruise?

❑When do you decide when to go to a doctor?
❑What happens when you take medicine?
❑How do you know you have healed?
 How does healing take place in Psychology?
1. What technique is applied by the therapist?
- For e.g. if psychodynamic then free association may help heal the client.
- If behavioral is used then relaxation techniques may help heal.
- If cognitive methods are used then cognitive restructuring using debates may help
heal.

2.The warmth and empathy provided by the therapist helps strengthen the
therapeutic cooperation.

3. Emotional unburdening or venting gives the client relief and the therapist details
about the client’s problem.

4. Non specific factors also contribute to healing.

-Patient Variables: They are motivation for change, expectation of improvement from
treatment, etc.
-Therapist Variables: They are positive nature, absence of internal unresolved issues,
presence of good mental health, etc.
 Ethics in Psychotherapy:
1)Informed consent
2)Confidentiality
3)Primary goal-reducing distress of the client
4)Honesty of the therapist-client relationship
5)Respect and dignity (for yourself as a
therapist) for all humans
6)Professional competence and skills through
updating yourself with the developments in
the field.
Alternative therapies

-Alternative because they are not in the list of usually used

treatment like therapy or drugs
-They include Yoga, meditation, acupuncture, herbal remedies,etc.
Take 10 mins to read the portion and let us discuss
⮚ What is yoga? What are its benefits?
⮚ In what psychological illnesses is yoga seen to be effective?
⮚ What are the 3 components of yoga?
(Asanas, Pranayama and Dhyana or meditation)
● What is vipasana meditation?
● What is SKY? To which problems is it found to be effective?
● Which system of Yoga has been found to be effective in treating
mental illnesses?
IMP: Please note that the alternative therapies portion has points
placed all over the section. While preparing answers you have to be
careful to gather points from the entire passage.
Treatment of Psychological
disorders

Improve their level of

functioning/ quality of life

Reduction in
symptoms
 But for cases of
severe mental
For milder disorders like
schizophrenia
symptoms like
anxiety/phobia • There may be
• When symptom reduction
• But better quality of life
symptoms may be possible
reduce through rehabilitation
• Better quality of life • Rehabilitation includes
occupational
therapy/social skills
training/vocational
training
⮚ Please read what is occupational therapy, social skills training
and cognitive retraining and vocational training.
 Occupational therapy:
Skills like candle making, paper bag
making or weaving to form a work
discipline.
Social skills training:
Develop interpersonal skills-role play, imitation and instruction.
Cognitive skills for improving attention, memory and executive
functions are helpful. To help function in a social group.
Vocational training:
After significant changes are made in
social skills productive employment
skills are taught.