UNIT-2 COUNSELLING THERAPIES

A.RISHIKULYA.,M.SC.,M.PHIL.,PGDCA
GOALS OF PSYCHOTHERAPIES

 It reinforce clients resolve for betterment

 Lessening emotional pressure

 Unfolding the potential for positive growth

 Modifying habits

 Changing thinking patterns

 Increasing self awareness

 Improving interpersonal relations and communication

 Facilitating Decision making

 Becoming aware of one’s choices in life

 Relating to one’s social environment in a more creative and self aware manner.
THERAPEUTIC RELATIONSHIP

 Relationship between the client and therapist known as Therapeutic relationship or alliance.
 The first component is the contractual nature of the relationship in which two willing individuals.
 The second component is the limited duration of the therapy.(alliance lasts until the client becomes able to
deal with his/her problems.
 It is a trusting and confiding relationship
 Empathy is different from sympathy and intellectual understanding of another persons situation.
APPROACHES TO COUNSELLING

1.Psychodynamic
2.Behaviorist
3.Humanistic
4.Gestalt
 counseling or psychotherapy usually overlaps some of these techniques.
 ‘integrative’ therapy,
 ‘eclectic’ way
 PSYCHOANALYTICAL AND PSYCHODYNAMIC
THERAPIES
 Psychoanalytical and psychodynamic therapies are based on an individual’s unconscious thoughts and
perceptions that have developed throughout their childhood, and how these affect their current behaviour and
thoughts. It is the view that intrapsychic conflicts.(ie)the conflicts that are present within the psyche of the
person, are the source of psychological problems.
 Eg: Childhood experiences greatly affect emotions and behavior as adults.
 Used for OCD,Phobias,general exercises
 Lifting the defense mechanism
 It is a long term therapy(4/5times a week for years)
 In Psychoanalysis which was developed by Sigmund Freud and focuses on an individual’s unconscious,
deep-rooted thoughts that often stem from childhood. Through free associations, dreams or fantasies, clients
can learn how to interpret deeply buried memories or experiences that may be causing them distress.
 Based on Psychoanalysis, Psychoanalytic Therapy also focuses on how an individual’s unconscious thoughts
are influencing them. However, Psychoanalytic Therapy is usually less intensive than Psychoanalysis.
1.Free
Association(
 Three main Treatments: Express
anything)
2.Word
Association(
Response to
stimulus
word
3.Dream
Analysis(inve
stigating the
symbolism in
dreams)
PSYCHODYNAMIC THERAPY
 Psychodynamic Therapy evolved from Psychoanalytic Therapy and seeks to discover how unconscious
thoughts affect current behaviour. Psychodynamic Therapy usually focuses on more immediate problems and
attempts to provide a quicker solution.
 It enhance the client’s self-awareness and
 It foster understanding of the client’s thoughts, feelings, and beliefs in relation to their past experiences,
especially his or her experiences as a child
 Eg: Depression or anxiety related disorders.
 Calming emotions , Guided Imagery,Dream recall
MODALITY OF TREATMENT

 Transference and Interpretation are the means of treating the patient

 Unconscious forces are brought into the conscious realm through free association and dream interpretation
described above, the clients starts identifying about the past.
 The therapist maintain a non judgemental yet permissive attitude and allows the client to continue with this
process of emotional identification is called Transference.
 The therapist encourages this process because it helps her/ him understanding the unconscious conflicts of
the client.
 The Client acts out his/her frustrations, anger , fear and depression that s/he harboured toward that person in
the past, but could not express at that time.
 The therapist becomes a substitute for that person in the present. This stage is called Transference Neurosis.
 A full blown transference is helpful in making the therapist aware of the nature of intrapsychic conflicts
suffered by the client.
 Positive transference in which the client idolizes,or falls in love with the therapist ,and seeks therapist
approval
 Negative transference is present when the client has feelings of hostility, anger , and resentment towards the
therapist.
 The process of transference is met with resistance.

 Since the process of transference exposes the unconscious wishes and conflicts , thereby increasing the distress levels, the client
resist transference.
 Due to resistance, the client opposes the progress of therapy in order to protect himself/ herself from the recall of painfull
unconscious memories.
 Resistance can be Conscious or Uncoscious

 Conscious resistance present when client deliberately hides somes information.

 Unconscious resistance is assumed to be present when the client becomes silent during the therapy session, recalls trivial details
without recalling the emotional ones, misses appointments and comes late for therapy.
 The therapist overcomes the resistance by repeatedly confronting the patient about it and by uncovering emotions such as anxiety,
fear or shame which are causing the resistance
CONFRONTATION AND CLARIFICATION

 Confrontation and Clarification are the two analytical techniques of interpretation.

 In Confrontation , the therapist points out to the client an aspect of her/ his psyche that must be faced by the
client.
 Clarification is the process by which the therapist brings a vague or confusing event from unimportant ones.
 Interpretation is a more subtle process
 It is considered to be the pinnacle of psychoanalysis.
 The therapist uses the unconscious material that has been uncovered in the process of free association, dream
interpretation, transference and resistance to make the client aware of the psychic contents and conflicts or
on deprivations suffered in childhood.
 The repeated process of confrontation, clarification and interpretation is known as ‘working through’
 Working through helps the patient to understand herself/ himself and the source of the problem and to
integrate the uncovered material into his /her ego.
 The outcome of working through is Insight.
 Insight is not a sudden event but a gradual process wherein the unconscious memories are repeatedly
integrated into conscious awareness.
 Insight is the end of the point of therapy as the client has gained a new understanding of herself/ himself
 In turn, the conflicts of the past,defense mechanisms and physical symptoms are no longer present and client
becomes psychologically healthy person.
 COGNITIVE AND BEHAVIOURAL THERAPIES

 Behavioural Therapies are based on the way you think (cognitive) and/or the way you behave. These
therapies recognise that it is possible to change, or recondition, our thoughts or behaviour to overcome
specific problems.

 The foundation of behaviour therapy is on formulating dysfunctional or faulty behaviours, the factors which
reinforce and maintain these behaviours, and devising methods by which they can be changed.
THREE BASIC APPROACHES

1. Applied Behavior Analysis or radical behaviorism focus on overt behavior , with cognition seen as excess
baggage,- unnecessary to the modification of behavior.(B.F.Skinner –Operant Conditioning)
2.The Neurobehaviors mediational stimulus – response model- learning theories of Clark Hull
exp. ,Mediational model pay attention to what goes on inside the organism: Wolpe’s Systematic desensitization.
As a part of this process, the client uses imagery (another internal event) to visualize scenes that arouses
anxiety.. Internal processes are considered to follow the same laws of learning as do overt behaviours.
3.Behavioural and cognitive perspective is the social-cognitive model(Albert bandura concept)-how the
environment affects the behaviour depends on how the person perceives and interprets these environmental
stimuli, rather than on environmental events themselves.
WHO CAN REAP THE BENEFITS OF BEHAVIORAL
THERAPY
People most commonly look for behavioural therapy to take care of:
 1.Depression
 2.Anxiety
 3.Panic disorders
 4.Anger Issues
Additionally , it may help treat circumstances and disorders such as for example:
 1.Eating Disorders
 2.Post-traumatic stress disorder(PTSD)
 3.ADHD
 4.bipolar disorder
 5.Obsessive Compulsive disorder
 6.phobias,(including interpersonal phobias)
 7.Self Harm
 8.Substance Abuse
METHOD OF TREATMENT

 The client with psychological distress or with physical symptoms, which cannot be attributed to physical
disease, is interviewed with a view to analyse her/his behaviour patterns.
 Behavioural analysis is conducted to find malfunctioning behaviours, the antecedents of faulty learning, and
the factors that maintain or continue faulty learning.
 Malfunctioning behaviours are those behaviours which cause distress to the client.
 Antecedent factors are those causes which predispose the person to indulge in that behaviour
 Maintaining factors are those factors which lead to the persistence of the faulty behaviour
 The aim of the treatment is to extinguish or eliminate the faulty behaviours and substitute them with adaptive
behaviour patterns.
 The therapist does this through establishing antecedent operations and consequent operations.
 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.
TECHNIQUES OF COGNITIVE BEHAVIOUR THERAPY
 Behavioural Therapy focuses on an individual’s learnt, or conditioned , behaviour and how this can be
changed. The approach assumes that if a behaviour can be learnt, then it can be unlearnt (or reconditioned)
so is useful for dealing with issues such as phobias or addictions
 Classical conditioning
 Operant conditioning 
BEHAVIOR THERAPY BASED ON CLASSICAL
CONDITIONING

 Flooding

 Systematic Desensitization

 Aversion Therapy
BEHAVIOR THERAPY BASED ON OPERANT
CONDITIONING

 Token Economies

 Contingency Management
 Modeling
 Extinction
 Assertiveness and Social skills training
COGNITIVE RESTRUCTURING (METHODS)

 It includes in identifying and changing anxiety-causing cognitions.

 Cognitive events- what people say to themselves, and the images they have, that they are aware of…
 Cognitive process operate at an automatic and ‘unconscious’ level and include the way people process
information – how they appraise events and incoeporate information consistent with their belief.
COGNITIVE RESTRUCTURING PROCEDURE INVOLVES:

 Evaluating how valid and viable are the client’s thoughts and beliefs
 Assessing what client expect, what they tend to predict about their behaviour and others responses to them.
 Exploring what might be a range of causes for clients behaviours and others reactions
 Training clients to make more effective attributions about these causes and
 Altering absolutistic, catastrophic thinking styles.
TWO PRIMARILY COGNITIVE APPROACHES TO
COUNSELLING

Aaron • Cognitive Therapy

Beck’s
• Rational Emotive
Albert Ellis behaviour therapy
 COGNITIVE THERAPY

 Cognitive Therapy deals with thoughts and perceptions, and how these can affect feelings and behaviour. By
reassessing negative thoughts an individual can learn more flexible, positive ways of thinking, which can ultimately affect
their feelings and behaviour towards those thoughts. developed by American psychiatrist Aaron T. Beck.
 Cognitive therapies locate the cause of psychological distress in irrational thoughts and beliefs.
 AARON BECK’S COGNITIVE THERAPY

 His theory of psychological distress characterised by anxiety or depression, states that childhood experiences provided
by the family and society develop core schemas or systems, which include beliefs and action patterns in the individual.
 Any negative automatic thoughts are characterised by cognitive distortions.

 Cognitive distortions are ways of thinking which are general in nature but which distort the reality in a negative
manner.
 These patterns of thought are called dysfunctional cognitive structures.

 They lead to errors of cognition about the social reality.

 The therapist uses questioning, which is gentle, nonthreatening disputation of the client’s beliefs and thoughts.
 It is short, lasting between 10–20 sessions.
SEVERAL KINDS OF SYSTEMATIC ERRORS IN REASONING(COGNITIVE
DISTORTIONS) THAT APPEAR PEOPLE IN DISTRESS
 Arbitrary Inference: entails drawing conclusions in the absence of supporting evidence( ex: counsellor who
concludes after an especially difficult day with her clients” I am an ineffectual counsellor”.
 Selective abstraction: Conceptualizing a situation on the basis of a detail taken out of context(ex: a man
becomes jealous on seeing his fiancée lean toward another man to hear him at a noisy gathering.
 Overgeneralization: abstracting a general rule from a few instances and applying it too broadly.(eg: based on
the indifferent response of students in one undergraduate class to a few of his lecturers , a college professor
concludes, “ All students are alike;my lectures will never be received .
 Magnification and Minimization : involves perceiving something as far more or less significant than it is (ex.
“ If I don’t do well on this date, that will be a disaster “, “ this course will be a piece of cake for me”(think of
the situations in which this form of minimization occurs).
 Personalization: entails attributing blame for some event to oneself without any evidence,(ex: when an
acquaintance does not return a woman’s hello from across a crowded room , the woman concludes that, “ I
must have offended him”.
 Dichotomous thinking: is a rigid either/or thinking; for example , a man makes the cognitive assumption that
“ either woman will reject and hate you or they will love you and give you everything you want”.
OTHER MAJOR TECHNIQUES INCLUDE:

Socratic questioning: involves the creation of a series of questions to

 a) clarify and define problems,
 b) assist in the identification of thoughts, images and assumptions,
 c) examine the meanings of events for the patient, and
 d) assess the consequences of maintaining maladaptive thoughts and behaviors
 Examples of socratic questions are:

• ‘Describe the way you formed your viewpoint originally.‘

• ‘What initially convinced you that your current view is the best one available?‘
• ‘Think of three pieces of evidence that contradict this view, or that support the opposite view. Think
about the opposite of this viewpoint and reflect on it for a moment. What's the strongest argument in
favor of this opposite view?‘
• ‘Write down any specific benefits you get from holding this belief, such as social or psychological
benefits. For example, getting to be part of a community of like-minded people, feeling good about
yourself or the world, feeling that your viewpoint is superior to others', etc Are there any reasons that
you might hold this view other than because it's true?‘
FOUR COMMON SPECIFIC COGNITIVE ARE:

 Decatastrophizing
 Reattribution
 Redefining
 Decentering
 Deatastrophizing: or ‘what if” hypothesizing , helps clients think through the outcomes they most fear and to
make plans to cope with them.
 Reaattribution: moves clients toward alternative causes for events and reactions
 Redefining: The problem seeks to make it more concrete and specific , and to state it in terms of the client’s
behaviour. Eg. “ client who feels nobody cares about me” may lead to redefine the problem to : “I need to
reach out to people and show that I care about them”
 Decentering: Technique for treating anxious people who believe they are the constant focus of others’s
attention.
KEY CONCEPTS OF COGNITIVE THERAPY

 Cognitive Distortions

 Arbitrary inference
 Selective abstraction

 Overgeneralization

 Magnification and minimization

 Personalization
 It is a collaborative approach
 Empiricism

 Socratic dialogue