Chapter 5

Therapeutic Approaches

Nature of Psychotherapy
Psychotherapy is defined as a voluntary relationship between the one seeking
treatment who is known as the client and the one who treats the client is known as
the therapist. Therapeutic Relationship aims at resolving the psychological problems
of the client.

Goals of Psychotherapy

 Modifying Changing Patterns

 Increasing Self-Awareness
 Facilitate Decision-Making
 Improving Habits
 Unleashing the potential of the client to the fullest
 Improving interpersonal relationships
 Help the client in living a fulfilling life

Therapeutic Relationship 
The therapeutic relationship is defined as the special relationship between the client
and therapist and this is not a long-lasting professional relationship instead it is very
professional in nature. Two components of the therapeutic relationship are:

 Contractual nature of the relationship in which two willing individuals, the

client, and the therapist, enter into a partnership that is propelled by the aim of
resolving the problems of the client
 Limited duration of the psychotherapy

Types of Therapies
There are various types of therapies like psychodynamic therapy, behavioral therapy,
cognitive therapy, and the factors which determine the classification of kinds of
therapies are mentioned below:

1. What is the cause of the problem?

2. How did the cause come into existence?
3. What is the chief method of treatment?
 4. What is the nature of the therapeutic relationship between the client and the
therapist?
5. What is the chief benefit to the client?
6. What is the duration of treatment?

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.

Methods of Eliciting Nature of 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
3. 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.

Transference

 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 harbored anger, frustrations and the therapist encourages the client to
express those feelings. This process is termed Transference Neurosis
 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 harbors 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

Interpretation

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
 By using interpretation the therapist makes the client aware of the
intrapsychic conflict happening in the client’s mind
 The repeated process of Confrontation, Clarification, and interpretation is
termed as Working Through and 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

Duration of Treatment
Psychodynamic Therapy lasts for several years with one-hour session  4-5 days a
week. The three stages of Psychodynamic Therapy are:

 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

Behavior Therapy
Behavior Therapies lay focus on the fact that Psychological distress arises because
of faulty thinking or behavioral patterns. The ultimate focus is laid on present
thinking patterns and thoughts and the past is just relevant for understanding the
cause of clients’ maladaptive behavior. The past is not relived, unlike Psychodynamic
Therapy.

Method of Treatment
 1. Behavioral Analysis is conducted to find maladaptive behaviors, antecedent,
and maintaining factors of the maladaptive behavior
2. Antecedent factors are the causal factors behind the malfunctioning
Behaviour and maintaining factors are those factors that maintain the
maladaptive Behaviour
3. Once the above-mentioned factors are identified, the way of treatment is
identified and that can be either antecedent operations in which the
antecedent factors are controlled by the therapist and in establishing
operations the reinforcing value of the consequence is increased or
decreased

Techniques of Behavioral Therapy 

Various techniques of behavioral therapy are discussed below:

1. Aversive Conditioning – Here an association is made between an undesirable

response and an unfavorable consequence and this Technique is used in
rehabilitation centers
2. Positive Reinforcement- When the adaptive Behaviour occurs rarely, positive
reinforcement is used to cover up the deficit
3. Negative Reinforcement- It is provided in order to escape the painful stimulus
in the environment.
4. Modeling – In order to bring the desired change in the behavior, the client will
try to imitate or shadow the movements of the person whom they consider as
their role model
5. Other techniques of behavioural therapy are token economy, differential
reinforcement, principle of reciprocal inhibition, and systematic
desensitisation

Cognitive Therapy
As per cognitive Therapies, the underlying cause of our psychological distress lies in
our irrational beliefs and thoughts.

Rational Emotive Therapy

Albert Ellis formulated rational-emotive therapy. The first step in this therapy is ABC
(Antecedent-Behaviour-Consequence) analysis where Antecedent events are the
causal factors of Psychological distress, Irrational beliefs are found out by
interviewing the client and these beliefs distort the reality. Irrational Beliefs are
characterized by ‘musts’ and ‘shoulds’. An example of an Irrational belief is that one
should be loved by everyone all the time. Irrational beliefs about the Antecedent
event lead to consequences which negative emotions and Behaviours. Irrational
beliefs in this therapy are assessed by non-directive questioning which is subtle and
gentle in nature. The client overcomes their psychological distress by replacing their
irrational belief system with a rational belief system.

Cognitive Therapy by Aaron Beck

Society, peers, and parents shape up the Beliefs of an individual and as per the
cognitive therapy given by Aaron Beck, these beliefs are known as core schemas. For
example- If a child didn’t have any friends in childhood then he may develop a belief
that “I am worthless” which leads to the development of automatic negative
thoughts called cognitive distortions which distort reality in a negative way. The
Therapist in this case uses a way of questioning which is gentle and subtle in nature.

Cognitive Behaviour Therapy

CBT is considered as a short and efficacious treatment for a plethora of
Psychological Disorders like anxiety, panic attacks, borderline personality, etc. It
combines Techniques of Behaviour Therapy along with Cognitive Therapy and it is
based on the BioPsychosocial approach. CBT addresses Biological aspects through
relaxation procedures, Psychological problems through Behaviour Therapy and
cognitive therapy techniques, and social problems through changing environments.

Humanistic-Existential Therapy
The main cause of Psychological distress is feelings of loneliness, alienation, and
inability to find meaning and responsibility in life. The main features of existential
therapy are explained as follows-

1. Humans are propelled by the notion of personal growth and attaining a state
of self-actualization which is defined as the tendency of humans to become
more integrated and achieve a state of balance in life
2. Free emotional expression is a prerequisite for self-actualization but it is
curbed by society as complete emotional expression releases negative
emotions like anger, sadness, etc
3. In humanistic therapy, a non-judgemental and permissive atmosphere is given
to the client where the client completely expresses his/her emotions
4. In this therapy, the therapist is a mere facilitator and success mainly depends
upon the client
5. Existential Therapy was proposed by a famous psychiatrist and neurologist
Victor Frankl and this therapy is also known as Logotherapy
6. The main motive of the therapist is to help the client find meaning and
purpose in his/her life irrespective of life circumstances and this process is
called the process of meaning-making
Client-Centered Therapy
This Therapy was given by Carl Rogers. The main focus is to provide a warm
relationship so that the client can reconnect and understand his/her disintegrated
feelings. In client-centered therapy, the Therapist provides unconditional positive
regard which means total acceptance of what the client actually is, empathy which
means understanding the client’s problems from their perspective, and that helps
clients feel secure.

Biomedical Therapy
In some cases, medicines are used to treat mental Disorders and these medicines
can be given by professional doctors called Psychiatrists. Key features of biomedical
Therapy are given below:

1. Psychiatrists specialize in understanding, diagnosis, and treatment of mental

disorders.
2. Severe mental Disorders like Schizophrenia or bipolar disorder require
antipsychotic drugs whereas disorders like generalized anxiety disorder or
depression require milder drugs.
3. Medicine should be given under proper medical supervision as medicines can
cause side effects at times.
4. Electro-convulsive therapy (ECT) is another form of biomedical therapy where
Electric shock is given via electrodes to the brain of the patient to induce
convulsions.
5. ECT is not a routine treatment and is given only when drugs are not effective
in controlling the symptoms of the patient.

Factors Contributing to Healing in Psychotherapy

The technique adopted by the therapist and its execution is a major factor that
contributes to healing in Psychotherapy. Factors contributing to healing in
Psychotherapy are given as follows:

1. The therapeutic alliance between the Therapist and client is also an important
factor as the healing of the client depends on warmth and empathy provided
by the Therapist.
2. The process of complete emotional expression which is called catharsis is
important for healing.
3. Some non-specific factors like patient variables like motivation for change, the
expectation of improvement due to therapy, and therapist variables like
warmth, positive nature, etc
Ethics in Psychotherapy
Just like every job role, psychotherapy also has some ethics to be followed by every
individual. Ethical standards that need to be adhered to by psychologists are
mentioned below:

1. Informed Consent needs to be taken

2. Respect for human rights and dignity
3. Confidentiality of the client’s problem must be maintained
4. Professional competence and skills are musts
5. Alleviating the personal distress of the client must be the goal of therapy
6. The integrity of the practitioner-client relationship must be there

Alternative therapies
They are mainly categorized under two heads – Yoga and Meditation. alternative
therapies as well which are explained as follows:

1. Yoga has gained immense importance in the last 25 years and it includes
either practice of Asanas or Breathing practices or both
2. The two most popular yoga techniques are Sudarshan Kriya Yoga and
Kundalini Yoga
3. Sudarshan Kriya Yoga is a beneficial, low-cost treatment of stress, anxiety,
post-traumatic stress disorder. Research conducted at the National Institute
of Mental Health and Neurosciences, India has arrived at a conclusion that
Sudarshan Kriya Yoga enhances mood, well-being, and mental state of mind
4. Kundalini Yoga is considered to be effective in the treatment of mental
disorders
5. Institute of Nonlinear Sciences, University Of California, San Diego, USA  has
found that kundalini yoga to be an effective treatment of OCD. Kundalini Yoga
includes Pranayama and Chanting Of Mantras
6. Meditation is a set of techniques that helps in enhancing focus, attention and
altering the state of consciousness by focussing on the inner self.
Mindfulness meditation helps in improving focus, treatment of depression,
and proper processing of stimuli

Rehabilitation of Mentally Ill

Treatment of psychological disorders have two components 

 Reduction Of Symptoms
 Improvement In Quality Of Life
 1. Above mentioned points are applicable in mild problems like Generalised
Anxiety Disorders(GAD), but in case of severe disorders like schizophrenia it is
not applicable
2. Rehabilitation is propelled by the purpose to empower clients to become
productive members of society
3. In rehabilitation, patients are given occupational therapy, social skills training,
vocational therapy, and cognitive training and they are described below:

 Occupational Therapy- Clients are taught work therapy and they are taught
skills like weaving, paper making, etc
 Social skills training-  Clients are taught interpersonal skills like empathy,
communication skills, cooperation, etc
 Vocational therapy-employability skills are taught to clients in vocational
therapy
 Cognitive training-patients are taught cognitive skills like decision-making,
memory, etc

NCERT Solutions
What are the different types of Psychotherapy? On what basis are they classified?
There are various types of therapies like psychodynamic therapy, behavioral therapy,
cognitive therapy, etc and the factors which determine the classification of kinds of
therapies are mentioned below:
1. What is the cause of the problem?
2. How did the cause come into existence?
3. What is the chief method of treatment?
4. What is the nature of the therapeutic relationship between the client and the
therapist?
5. What is the chief benefit to the client?
6. What is the duration of treatment?

Discuss various techniques used in behavior therapy.

Various techniques used in behavior therapy are token economy, positive
reinforcement, negative reinforcement, aversive conditioning, etc.

What kind of Problems is cognitive behavior therapy best suited for?

CBT is best suited for anxiety, depression, borderline personality, etc.