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THER APEUTIC APPROACHES

After reading this chapter, you would be able to:


familiarise yourself with the basic nature and process of psychotherapy,
appreciate that there are different types of therapies for helping people,
understand the use of psychological forms of intervention, and
know how people with mental disorders can be rehabilitated.

Nature and Process of Psychotherapy


Therapeutic Relationship
Type of Therapies
Steps in the Formulation of a Client’s Problem (Box 5.1)
Behaviour Therapy
Relaxation Procedures (Box 5.2)
Cognitive Therapy
Humanistic-existential Therapy
Alternative Therapies
Rehabilitation of the Mentally Ill
CONTENTS

Key Terms
Summary
Review Questions
Project Ideas
Weblinks
Pedagogical Hints

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In the preceding chapter, you have studied about major psychological
disorders and the distress caused by them to the patient and others. In this
chapter, you will learn about the various therapeutic methods that are used
by psychotherapists to help their patients. There are various types of
psychotherapy. Some of them focus on acquiring self-understanding; other
therapies are more action-oriented. All approaches hinge on the basic issue
of helping the patient overcome her/his debilitating condition. The
effectiveness of a therapeutic approach for a patient depends on a number
Introduction of factors such as severity of the disorder, degree of distress faced by others,
and the availability of time, effort and money, among others.
All therapeutic approaches are corrective and helping in nature. All of
them involve an interpersonal relationship between the therapist and the
client or patient. Some of them are directive in nature, such as
psychodynamic, while some are non-directive such as person-centred. In
this chapter, we will briefly discuss some of the major forms of
psychotherapy.

An untrained person may unintentionally


NATURE AND PROCESS OF PSYCHOTHERAPY
cause more harm than any good, (iii) the
Psychotherapy is a voluntary relationship therapeutic situation involves a therapist
between the one seeking treatment or the and a client who seeks and receives help
client and the one who treats or the for her/his emotional problems (this
therapist. The purpose of the relationship person is the focus of attention in the
is to help the client to solve the therapeutic process), and (iv) the
psychological problems being faced by her interaction of these two persons — the
or him. The relationship is conducive for therapist and the client — results in the
consolidation/formation of the therapeutic
building the trust of the client so that
relationship. This is a confidential,
problems may be freely discussed.
interpersonal, and dynamic relationship.
Psychotherapies aim at changing the
This human relationship is central to any
maladaptive behaviours, decreasing the
sort of psychological therapy and is the
sense of personal distress, and helping
vehicle for change.
the client to adapt better to her/his
All psychotherapies aim at a few or
environment. Inadequate marital, all of the following goals :
occupational and social adjustment also (i) Reinforcing client’s resolve for
requires that major changes be made in betterment.
an individual’s personal environment. (ii) Lessening emotional pressure.
All psychotherapeutic approaches have (iii) Unfolding the potential for positive
the following characteristics : (i) there is growth.
systematic application of principles (iv) Modifying habits.
underlying the different theories of therapy, (v) Changing thinking patterns.
(ii) persons who have received practical (vi) Increasing self-awareness.
training under expert supervision can (vii) Improving interpersonal relations
practice psychotherapy, and not everybody. and communication.

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(viii) Facilitating decision-making. sympathy, one has compassion and pity
(ix) Becoming aware of one’s choices in towards the suffering of another but is
life. not able to feel like the other person.
(x) Relating to one’s social environment Intellectual understanding is cold in the
in a more creative and self-aware sense that the person is unable to feel
manner. like the other person and does not feel
sympathy either. On the other hand,
Therapeutic Relationship empathy is present when one is able to
understand the plight of another person,
The special relationship between the
and feel like the other person. It means
client and the therapist is known as the
understanding things from the other
therapeutic relationship or alliance. It is
person’s perspective, i.e. putting oneself
neither a passing acquaintance, nor a
in the other person’s shoes. Empathy
permanent and lasting relationship.
enriches the therapeutic relationship and
There are two major components of a
transforms it into a healing relationship.
therapeutic alliance. The first component
The therapeutic alliance also requires
is the contractual nature of the
that the therapist must keep strict
relationship in which two willing
confidentiality of the experiences, events,
individuals, the client and the therapist,
enter into a partnership which aims at feelings or thoughts disclosed by the
helping the client overcome her/his client. The therapist must not exploit the
problems. The second component of trust and the confidence of the client in
therapeutic alliance is the limited anyway. Finally, it is a professional
duration of the therapy. This alliance relationship, and must remain so.
lasts until the client becomes able to deal
with her/his problems and take control A classmate or friend of yours or your Activity
of her/his life. This relationship has favourite character in a TV serial may 5.1
several unique properties. It is a trusting have recently experienced a negative
and confiding relationship. The high or a traumatic life event (e.g., death
level of trust enables the client to of a loved one, break-up of an
important friendship or relationship)
unburden herself/himself to the therapist
of which you are aware. Try to put
and confide her/his psychological and yourself in the other person’s shoes,
personal problems to the latter. The try to experience how that person is
therapist encourages this by being feeling, what s/he is thinking and try
accepting, empathic, genuine and warm to take her/his perspective of the
to the client. The therapist conveys by entire situation. This will help you to
her/his words and behaviours that s/he understand better how that person is
is not judging the client and will continue feeling.
to show the same positive feelings (Note : This exercise may be done in
towards the client even if the client is class, so that teachers can help
rude or confides all the ‘wrong’ things students in overcoming any distress
that s/he may have done or thought experienced).
about. This is the unconditional positive
regard which the therapist has for the TYPE OF THERAPIES
client. The therapist has empathy for the
client. Empathy is different from Though all psychotherapies aim at
sympathy and intellectual understanding removing human distress and fostering
of another person’s situation. In effective behaviour, they differ greatly in

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concepts, methods, and techniques. thoughts and feelings of the client.
Psychotherapies may be classified into This material is interpreted to the
three broad groups, viz. the client to help her/him to confront and
psychodynamic, behaviour, and existential resolve the conflicts and thus overcome
psychotherapies. In terms of the problems. Behaviour therapy identifies
chronological order, psychodynamic the faulty conditioning patterns and
therapy emerged first followed by sets up alternate behavioural
behaviour therapy while the existential contingencies to improve behaviour.
therapies which are also called the third The cognitive methods employed in this
force, emerged last. The classification of type of therapy challenge the faulty
psychotherapies is based on the following thinking patterns of the client to help
parameters: her/him overcome psychological
distress. The existential therapy
1. What is the cause, which has led to the provides a therapeutic environment
problem? which is positive, accepting, and non-
Psychodynamic therapy is of the view judgmental. The client is able to talk
that intrapsychic conflicts, i.e. the about the problems and the therapist
conflicts that are present within the acts as a facilitator. The client arrives
psyche of the person, are the source at the solutions through a process of
of psychological problems. According personal growth.
to behaviour therapies, psychological
4. What is the nature of the therapeutic
problems arise due to faulty learning
relationship between the client and the
of behaviours and cognitions. The
therapist?
existential therapies postulate that
Psychodynamic therapy assumes
the questions about the meaning of
that the therapist understands the
one’s life and existence are the cause
client’s intrapsychic conflicts better
of psychological problems.
than the client and hence it is the
2. How did the cause come into existence? therapist who interprets the thoughts
In the psychodynamic therapy, and feelings of the client to her/him
unfulfilled desires of childhood and so that s/he gains an understanding
unresolved childhood fears lead to of the same. The behaviour therapy
intrapsychic conflicts. The behaviour assumes that the therapist is able to
therapy postulates that faulty discern the faulty behaviour and
conditioning patterns, faulty learning, thought patterns of the client. It
and faulty thinking and beliefs lead to further assumes that the therapist is
maladaptive behaviours that, in turn, capable of finding out the correct
lead to psychological problems. The behaviour and thought patterns,
existential therapy places importance which would be adaptive for the
on the present. It is the current client. Both the psychodynamic and
feelings of loneliness, alienation, sense the behaviour therapies assume that
of futility of one’s existence, etc., which the therapist is capable of arriving at
cause psychological problems. solutions to the client’s problems. In
3. What is the chief method of treatment? contrast to these therapies, the
Psychodynamic therapy uses the existential therapies emphasise that
methods of free association and the therapist merely provides a
reporting of dreams to elicit the warm, empathic relationship in
which the client feels secure to
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explore the nature and causes of her/ oneself, and one’s aspirations,
his problems by herself/himself. emotions and motives.
5. What is the chief benefit to the client? 6. What is the duration of treatment?
Psychodynamic therapy values The duration of classical psycho-
emotional insight as the important analysis may continue for several
benefit that the client derives from years. However, several r ecent
the treatment. Emotional insight is versions of psychodynamic therapies
present when the client understands are completed in 10–15 sessions.
her/his conflicts intellectually; is Behaviour and cognitive behaviour
able to accept the same emotionally; therapies as well as existential
and is able to change her/his therapies are shorter and are
emotions towards the conflicts. The completed in a few months.
client’s symptoms and distresses Thus, different types of psycho-
reduce as a consequence of this therapies differ on multiple parameters.
emotional insight. The behaviour However, they all share the common
therapy considers changing faulty method of providing treatment for
behaviour and thought patterns to psychological distress through psycho-
adaptive ones as the chief benefit of logical means. The therapist, the
the treatment. Instituting adaptive or therapeutic relationship, and the process
healthy behaviour and thought of therapy become the agents of change
patterns ensures reduction of in the client leading to the alleviation of
distress and removal of symptoms. psychological distress. The process of
The humanistic therapy values psychotherapy begins by formulating the
personal growth as the chief benefit. client’s problem. Steps involved in the
Personal growth is the process of formulation of a client’s problem are
gaining increasing understanding of given in Box 5.1.

Steps in the Formulation of a Client’s Problem Box


5.1
Clinical formulation refers to formulating the problem of the client in the therapeutic model
being used for the treatment. The clinical formulation has the following advantages:
1. Understanding of the problem : The therapist is able to understand the full implications
of the distress being experienced by the client.
2. Identification of the areas to be targetted for treatment in psychotherapy : The theoretical
formulation clearly identifies the problem areas to be targetted for therapy. Thus, if a
client seeks help for inability to hold a job and reports inability to face superiors, the
clinical formulation in behaviour therapy would state it as lack of assertiveness skills
and anxiety. The target areas have thus been identified as inability to assert oneself
and heightened anxiety.
3. Choice of techniques for treatment : The choice of techniques for treatment depends on
the therapeutic system in which the therapist has been trained. However, even within
this broad domain, the choice of techniques, timing of the techniques, and expectations
of outcome of the therapy depend upon the clinical formulation.
The clinical formulation is an ongoing process. Formulations may require reformulations
as clinical insights are gained in the process of therapy. Usually the first one or two sessions
yield enough clinical material for the initial clinical formulation. It is not advisable to start
psychotherapy without a clinical formulation.

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Method of Treatment
Activity Gather infor mation about some
5.2 institutions you know which offer The client with psychological distress or
psychiatric/psychotherapeutic help. with physical symptoms, which cannot
be attributed to physical disease, is
interviewed with a view to analyse her/
his behaviour patterns. Behavioural
The following sections explain different analysis is conducted to find
types of therapies three major systems malfunctioning behaviours, the
of psychotherapy mentioned earlier. antecedents of faulty learning, and the
factors that maintain or continue faulty
Behaviour Therapy
learning. Malfunctioning behaviours are
Behaviour therapies postulate that those behaviours which cause distress to
psychological distress arises because of the client. Antecedent factors are those
faulty behaviour patterns or thought causes which predispose the person to
patterns. It is, therefore, focused on the indulge in that behaviour. Maintaining
behaviour and thoughts of the client in factors are those factors which lead to the
the present. The past is relevant only to persistence of the faulty behaviour. An
the extent of understanding the origins example would be a young person who
of the faulty behaviour and thought has acquired the malfunctioning
patterns. The past is not activated or behaviour of smoking and seeks help to
relived. Only the faulty patterns are get rid of smoking. Behavioural analysis
corrected in the present. conducted by interviewing the client and
The clinical application of learning the family members reveals that the
theory principles constitute behaviour person started smoking when he was
therapy. Behaviour therapy consists of a preparing for the annual examination.
large set of specific techniques and He had reported relief from anxiety upon
interventions. It is not a unified theory, smoking. Thus, anxiety-provoking
which is applied irrespective of the situation becomes the causative or
clinical diagnosis or the symptoms antecedent factor. The feeling of relief
present. The symptoms of the client and becomes the maintaining factor for him
the clinical diagnosis are the guiding to continue smoking. The client has
factors in the selection of the specific acquired the operant response of
techniques or interventions to be applied. smoking, which is maintained by the
Treatment of phobias or excessive and reinforcing value of relief from anxiety.
crippling fears would require the use of Once the faulty behaviours which
one set of techniques while that of anger cause distress, have been identified, a
outbursts would require another. A treatment package is chosen. The aim of
depressed client would be treated the treatment is to extinguish or
differently from a client who is anxious. eliminate the faulty behaviours and
The foundation of behaviour therapy is substitute them with adaptive behaviour
on formulating dysfunctional or faulty patterns. The therapist does this through
behaviours, the factors which reinforce establishing antecedent operations and
and maintain these behaviours, and consequent operations. Antecedent
devising methods by which they can be operations control behaviour by changing
changed. something that precedes such a
behaviour. The change can be done by

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increasing or decreasing the reinforcing or avoid and escape from them provide
value of a particular consequence. This negative reinforcement. For example, one
is called establishing operation. For learns to put on woollen clothes, burn
example, if a child gives trouble in eating firewood or use electric heaters to avoid the
dinner, an establishing operation would unpleasant cold weather. One learns to
be to decrease the quantity of food served move away from dangerous stimuli
at tea time. This would increase the because they provide negative
hunger at dinner and thereby increase reinforcement. Aversive conditioning
the reinforcing value of food at dinner. refers to repeated association of undesired
Praising the child when s/he eats response with an aversive consequence.
properly tends to encourage this behaviour. For example, an alcoholic is given a mild
The antecedent operation is the reduction electric shock and asked to smell the
of food at tea time and the consequent alcohol. With repeated pairings the smell of
operation is praising the child for eating alcohol is aversive as the pain of the shock
dinner. It establishes the response of is associated with it and the person will
eating dinner. give up alcohol. If an adaptive behaviour
Behavioural Techniques occurs rarely, positive reinforcement is
given to increase the deficit. For example,
A range of techniques is available for
if a child does not do homework regularly,
changing behaviour. The principles of
positive reinforcement may be used by the
these techniques are to reduce the
child’s mother by preparing the child’s
arousal level of the client, alter behaviour
favourite dish whenever s/he does
through classical conditioning or operant
homework at the appointed time. The
conditioning with different contingencies
positive reinforcement of food will increase
of reinforcements, as well as to use the behaviour of doing homework at the
vicarious learning procedures, if appointed time. Persons with behavioural
necessary. problems can be given a token as a reward
Negative reinforcement and aversive every time a wanted behaviour occurs. The
conditioning are the two major techniques tokens are collected and exchanged for a
of behaviour modification. As you have reward such as an outing for the patient or
already studied in Class XI, responses that a treat for the child. This is known as
lead organisms to get rid of painful stimuli token economy.

Box
Relaxation Procedures 5.2
Anxiety is a manifestation of the psychological distress for which the client seeks treatment.
The behavioural therapist views anxiety as increasing the arousal level of the client, thereby
acting as an antecedent factor in causing the faulty behaviour. The client may smoke to
decrease anxiety, may indulge in other activities such as eating, or be unable to concentrate
for long hours on her/his study because of the anxiety. Therefore, reduction of anxiety would
decrease the unwanted behaviours of excessive eating or smoking. Relaxation procedures are
used to decrease the anxiety levels. For instance, progressive muscular relaxation and meditation
induce a state of relaxation. In progressive muscular relaxation, the client is taught to contract
individual muscle groups in order to give the awareness of tenseness or muscular tension.
After the client has learnt to tense the muscle group such as the forearm, the client is asked
to let go the tension. The client is told that the tension is what the client has at present and
that s/he has to get into the opposite state. With repeated practice the client learns to relax all
the muscles of the body. You will learn about meditation at a later point in this chapter.

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Unwanted behaviour can be reduced The principle of reciprocal inhibition
and wanted behaviour can be increased operates here. This principle states that
simultaneously through differential the presence of two mutually opposing
reinforcement. Positive reinforcement for forces at the same time, inhibits the
the wanted behaviour and negative weaker force. Thus, the relaxation
reinforcement for the unwanted response is first built up and mildly
behaviour attempted together may be anxiety-provoking scene is imagined, and
one such method. The other method is the anxiety is overcome by the relaxation.
to positively reinforce the wanted The client is able to tolerate progressively
behaviour and ignore the unwanted greater levels of anxiety because of her/
behaviour. The latter method is less his relaxed state. Modelling is the
painful and equally effective. For procedure wherein the client learns to
example, let us consider the case of a behave in a certain way by observing the
girl who sulks and cries when she is not behaviour of a role model or the therapist
taken to the cinema when she asks. The who initially acts as the role model.
parent is instructed to take her to the Vicarious lear ning, i.e. lear ning by
cinema if she does not cry and sulk but observing others, is used and through a
not to take her if she does. Further, the process of rewarding small changes in the
parent is instructed to ignore the girl behaviour, the client gradually learns to
when she cries and sulks. The wanted acquire the behaviour of the model.
behaviour of politely asking to be taken There is a great variety of techniques
to the cinema increases and the
unwanted behaviour of crying and Your friend is feeling very nervous Activity
sulking decreases. and panicky before the examinations. 5.3
You read about phobias or irrational S/he is pacing up and down, is
fears in the previous chapter. unable to study and feels s/he has
Systematic desensitisation is a forgotten all that s/he has learnt. Try
to help her/him to relax by inhaling
technique introduced by Wolpe for
(taking in a deep breath), holding it
treating phobias or irrational fears. The for sometime (5–10 seconds), then
client is interviewed to elicit fear - exhaling (releasing the breath). Ask
provoking situations and together with her/him to repeat this 5–10 times.
the client, the therapist prepares a Also ask her/him to remain focused
hierarchy of anxiety-provoking stimuli on her/his breathing. You can do
the same exercise when you feel
with the least anxiety-provoking stimuli
nervous.
at the bottom of the hierarchy. The
therapist relaxes the client and asks the
client to think about the least anxiety-
in behaviour therapy. The skill of the
provoking situation. Box 5.2 gives details
therapist lies in conducting an accurate
of relaxation procedures. The client is
behavioural analysis and building a
asked to stop thinking of the fearful
treatment package with the appropriate
situation if the slightest tension is felt.
techniques.
Over sessions, the client is able to
imagine more severe fear -provoking Cognitive Therapy
situations while maintaining the
relaxation. The client gets systematically Cognitive therapies locate the cause of
desensitised to the fear. psychological distress in irrational

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thoughts and beliefs. Albert Ellis society develop core schemas or systems,
formulated the Rational Emotive which include beliefs and action patterns
Therapy (RET). The central thesis of this in the individual. Thus, a client, who was
therapy is that irrational beliefs mediate neglected by the parents as a child,
between the antecedent events and their develops the core schema of “I am not
consequences. The first step in RET is wanted”. During the course of life, a
the antecedent-belief-consequence (ABC) critical incident occurs in her/his life. S/
analysis. Antecedent events, which he is publicly ridiculed by the teacher in
caused the psychological distress, are school. This critical incident triggers the
noted. The client is also interviewed to core schema of “I am not wanted” leading
find the irrational beliefs, which are to the development of negative automatic
distorting the present reality. Irrational thoughts. Negative thoughts are
beliefs may not be supported by empirical persistent irrational thoughts such as
evidence in the environment. These “nobody loves me”, “I am ugly”, “I am
beliefs are characterised by thoughts stupid”, “I will not succeed”, etc. Such
with ‘musts’ and ‘shoulds’, i.e. things negative automatic thoughts are
‘must’ and ‘should’ be in a particular characterised by cognitive distortions.
manner. Examples of irrational beliefs Cognitive distortions are ways of thinking
are, “One should be loved by everybody which are general in nature but which
all the time”, “Human misery is caused distort the reality in a negative manner.
by external events over which one does These patterns of thought are called
not have any control”, etc. This distorted dysfunctional cognitive structures.
perception of the antecedent event due They lead to errors of cognition about the
to the irrational belief leads to the social reality.
consequence, i.e. negative emotions and Repeated occurrence of these
behaviours. Irrational beliefs are assessed thoughts leads to the development of
through questionnaires and interviews. feelings of anxiety and depression. The
therapist uses questioning, which is
In the process of RET, the irrational
gentle, non-threatening disputation of
beliefs are refuted by the therapist
the client’s beliefs and thoughts.
through a process of non-directive
Examples of such question would be,
questioning. The nature of questioning is
“Why should everyone love you?”, “What
gentle, without probing or being directive.
does it mean to you to succeed?”, etc.
The questions make the client to think
The questions make the client think in
deeper into her/his assumptions about
a direction opposite to that of the
life and problems. Gradually the client
negative automatic thoughts whereby s/
is able to change the irrational beliefs
he gains insight into the nature of her/
by making a change in her/his
his dysfunctional schemas, and is able
philosophy about life. The rational belief
to alter her/his cognitive structures. The
system replaces the irrational belief
aim of the therapy is to achieve this
system and there is a reduction in
cognitive restructuring which, in turn,
psychological distress.
Another cognitive therapy is that of reduces anxiety and depression.
Aaron Beck. His theory of psychological Similar to behaviour therapy,
distress characterised by anxiety or cognitive therapy focuses on solving a
depression, states that childhood specific problem of the client. Unlike
experiences provided by the family and psycho-dynamic therapy, behaviour

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therapy is open, i.e. the therapist shares become more complex, balanced, and
her/his method with the client. It is integrated, i.e. achieving the complexity
short, lasting between 10–20 sessions. and balance without being fragmented.
Integrated means a sense of whole, being
Cognitive Behaviour Therapy a complete person, being in essence the
The most popular therapy presently is the same person in spite of the variety of
Cognitive Behaviour Therapy (CBT). experiences that one is subjected to. Just
Research into the outcome and as lack of food or water causes distress,
effectiveness of psychotherapy has frustration of self-actualisation also
causes distress.
conclusively established CBT to be a short
Healing occurs when the client is able
and efficacious treatment for a wide
to perceive the obstacles to self-
range of psychological disorders such as
actualisation in her/his life and is able
anxiety, depression, panic attacks, and
to remove them. Self-actualisation
borderline personality, etc. CBT adopts a
requires free emotional expression. The
bio-psychosocial approach to the
family and society curb emotional
delineation of psychopathology. It
expression, as it is feared that a free
combines cognitive therapy with
expression of emotions can harm society
behavioural techniques.
by unleashing destructive forces. This
The rationale is that the client’s
curb leads to destructive behaviour and
distress has its origins in the biological,
negative emotions by thwarting the
psychological, and social realms. Hence,
process of emotional integration.
addressing the biological aspects through
Therefore, the therapy creates a
relaxation procedures, the psychological
permissive, non-judgmental and accepting
ones through behaviour therapy and
atmosphere in which the client’s emotions
cognitive therapy techniques and the
can be freely expressed and the
social ones with environmental
complexity, balance and integration could
manipulations makes CBT a
be achieved. The fundamental assumption
comprehensive technique which is easy
is that the client has the freedom and
to use, applicable to a variety of disorders,
responsibility to control her/his own
and has proven efficacy.
behaviour. The therapist is merely a
facilitator and guide. It is the client who
Humanistic-existential Therapy
is responsible for the success of therapy.
The humanistic-existential therapies The chief aim of the therapy is to expand
postulate that psychological distress the client’s awareness. Healing takes
arises from feelings of loneliness, place by a process of understanding the
alienation, and an inability to find unique personal experience of the client
meaning and genuine fulfilment in life. by herself/himself. The client initiates the
Human beings are motivated by the desire process of self-growth through which
for personal growth and self- healing takes place.
actualisation, and an innate need to
grow emotionally. When these needs are Existential Therapy
curbed by society and family, human Victor Frankl, a psychiatrist and
beings experience psychological distress. neurologist propounded the Logotherapy.
Self-actualisation is defined as an innate Logos is the Greek word for soul and
or inborn force that moves the person to Logotherapy means treatment for the soul.

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Frankl calls this process of finding client’s experience as if it were her/his
meaning even in life-threatening own, is war m and has unconditional
circumstances as the process of meaning positive regard, i.e. total acceptance of
making. The basis of meaning making is the client as s/he is. Empathy sets up
a person’s quest for finding the spiritual an emotional resonance between the
truth of one’s existence. Just as there is therapist and the client. Unconditional
an unconscious, which is the repository positive regard indicates that the
of instincts (see Chapter 2), there is a positive warmth of the therapist is not
spiritual unconscious, which is the dependent on what the client reveals or
storehouse of love, aesthetic awareness, does in the therapy sessions. This
and values of life. Neurotic anxieties arise unique unconditional warmth ensures
when the problems of life are attached to that the client feels secure and can
the physical, psychological or spiritual trust the therapist. The client feels
aspects of one’s existence. Frankl secure enough to explore her/his
emphasised the role of spiritual anxieties feelings. The therapist reflects the
in leading to meaninglessness and hence feelings of the client in a non-
it may be called an existential anxiety, judgmental manner. The reflection is
i.e. neurotic anxiety of spiritual origin. achieved by rephrasing the statements
The goal of logotherapy is to help the of the client, i.e. seeking simple
patients to find meaning and clarifications to enhance the meaning of
responsibility in their life irrespective of the client’s statements. This process of
their life circumstances. The therapist reflection helps the client to become
emphasises the unique nature of the integrated. Personal relationships
patient’s life and encourages them to find improve with an increase in adjustment.
meaning in their life. In essence, this therapy helps a client
In Logotherapy, the therapist is open to become her/his real self with the
and shares her/his feelings, values and therapist working as a facilitator.
his/her own existence with the client. The
emphasis is on here and now. Gestalt Therapy
Transference is actively discouraged. The The German word gestalt means ‘whole’.
therapist reminds the client about the This therapy was given by Freiderick
immediacy of the present. The goal is to (Fritz) Perls together with his wife Laura
facilitate the client to find the meaning Perls. The goal of gestalt therapy is to
of her/his being. increase an individual’s self-awareness
and self-acceptance. The client is taught
Client-centred Therapy to recognise the bodily processes and the
Client-centred therapy was given by Carl emotions that are being blocked out from
Rogers. Rogers combined scientific awareness. The therapist does this by
rigour with the individualised practice encouraging the client to act out
of client-centred psychotherapy. Rogers fantasies about feelings and conflicts.
brought into psychotherapy the concept This therapy can also be used in
of self, with freedom and choice as the group settings.
core of one’s being. The therapy provides
a warm relationship in which the client Factors Contributing to Healing in
can reconnect with her/his Psychotherapy
disintegrated feelings. The therapist As we have read, psychotherapy is a
shows empathy, i.e. understanding the treatment of psychological distress. There

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are several factors which contribute to Ethics in Psychotherapy
the healing process. Some of these factors
Some of the ethical standards that need
are as follows :
to be practiced by professional psycho-
1. A major factor in the healing is the
therapists are :
techniques adopted by the therapist
1. Informed consent needs to be taken.
and the implementation of the same
2. Confidentiality of the client should be
with the patient/client. If the
maintained.
behavioural system and the CBT
3. Alleviating personal distress and
school are adopted to heal an anxious
suffering should be the goal of all
client, the relaxation procedures and
attempts of the therapist.
the cognitive restructuring largely
4. Integrity of the practitioner -client
contribute to the healing.
relationship is important.
2. The therapeutic alliance, which is
5. Respect for human rights and dignity.
formed between the therapist and the
6. Professional competence and skills are
patient/client, has healing properties,
essential.
because of the regular availability of
the therapist, and the warmth and
Alternative Therapies
empathy provided by the therapist.
3. At the outset of therapy while the Alternative therapies are so called,
patient/client is being interviewed in because they are alternative treatment
the initial sessions to understand the possibilities to the conventional drug
nature of the problem, s/he treatment or psychotherapy. There are
unburdens the emotional problems many alternative therapies such as yoga,
being faced. This process of emotional meditation, acupuncture, herbal
unburdening is known as catharsis, remedies and so on. In the past 25 years,
and it has healing properties. yoga and meditation have gained
4. There are several non-specific factors popularity as treatment programmes for
associated with psychotherapy. Some psychological distress.
of these factors are attributed to the Yoga is an ancient Indian technique
patient/client and some to the detailed in the Ashtanga Yoga of
therapist. These factors are called Patanjali’s Yoga Sutras. Yoga as it is
non-specific because they occur commonly called today either refers to
across different systems of only the asanas or body posture
psychotherapy and across different component or to breathing practices or
clients/patients and different pranayama, or to a combination of the
therapists. Non-specific factors two. Meditation refers to the practice of
attributable to the client/patient are focusing attention on breath or on an
motivation for change, expectation of object or thought or a mantra. Here
improvement due to the treatment, attention is focused. In Vipasana
etc. These are called patient variables. meditation, also known as mindfulness-
Non-specific factors attributable to based meditation, there is no fixed
the therapist are positive nature, object or thought to hold the attention.
absence of unresolved emotional The person passively observes the
conflicts, presence of good mental various bodily sensations and thoughts
health, etc. These are called therapist that are passing through in her or his
variables. awareness.

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The rapid breathing techniques to REHABILITATION OF THE MENTALLY ILL
induce hyperventilation as in Sudarshana
Kriya Yoga (SKY) is found to be a beneficial, The treatment of psychological disorders
low-risk, low-cost adjunct to the treatment has two components, i.e. reduction of
of stress, anxiety, post-traumatic stress symptoms, and improving the level of
disorder (PTSD), depression, stress-related functioning or quality of life. In the case
medical illnesses, substance abuse, and of milder disorders such as generalised
rehabilitation of criminal offenders. SKY anxiety, reactive depression or phobia,
has been used as a public health reduction of symptoms is associated with
intervention technique to alleviate PTSD in an improvement in the quality of life.
survivors of mass disasters. Yoga However, in the case of severe mental
techniques enhance well-being, mood, disorders such as schizophrenia,
attention, mental focus, and stress reduction of symptoms may not be
tolerance. Proper training by a skilled associated with an improvement in the
teacher and a 30-minute practice every day quality of life. Many patients suffer from
will maximise the benefits. Research negative symptoms such as disinterest
conducted at the National Institute of and lack of motivation to do work or to
Mental Health and Neurosciences interact with people. Rehabilitation is
(NIMHANS), India, has shown that SKY required to help such patients become
reduces depression. Further, alcoholic self-sufficient. The aim of rehabilitation
patients who practice SKY have reduced is to empower the patient to become a
depression and stress levels. Insomnia is productive member of society to the
treated with yoga. Yoga reduces the time extent possible. In rehabilitation, the
to go to sleep and improves the quality patients are given occupational therapy,
of sleep. social skills training, and vocational
Kundalini Yoga taught in the USA has therapy. In occupational therapy, the
been found to be effective in treatment patients are taught skills such as candle
of mental disorders. The Institute for Non- making, paper bag making and weaving
linear Science, University of California, to help them to form a work discipline.
San Diego, USA has found that Kundalini Social skills training helps the patients
Yoga is ef fective in the treatment of to develop interpersonal skills through
obsessive-compulsive disorder. Kundalini role play, imitation and instruction. The
Yoga combines pranayama or breathing objective is to teach the patient to
techniques with chanting of mantras. function in a social group. Cognitive
Prevention of repeated episodes of retraining is given to improve the basic
depression may be helped by cognitive functions of attention, memory
mindfulness-based meditation or and executive functions. After the patient
Vipasana. This meditation would help the improves sufficiently, vocational training
patients to process emotional stimuli is given wherein the patient is helped to
better and hence prevent biases in the gain skills necessary to undertake
processing of these stimuli. productive employment.

Key Terms
Alternative therapy, Behaviour therapy, Client-centred therapy, Cognitive behaviour therapy,
Empathy, Gestalt therapy, Humanistic therapy, Psycho dynamic therapy, Psychotherapy,
Rehabilitation, Resistance, Self-actualisation, Therapeutic alliance, Unconditional positive regard.

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• Psychotherapy is a treatment for the healing of psychological distress. It is not a
homogenous treatment method. There are about 400 different types of psychotherapy.
• Psychoanalysis, behavioural, cognitive and humanistic-existential are the important
systems of psychotherapy. There are many schools within each of the above systems.
• The important components of psychotherapy are the clinical formulation, i.e. statement
of the client’s problem and treatment in the framework of a particular therapy.
• Therapeutic alliance is the relation between the therapist and the client in which the
client has trust in the therapist and the therapist has empathy for the client.
• The predominant mode of psychotherapy for adults with psychological distress is
individual psychotherapy. The therapist requires to be professionally trained before
embarking on the journey of psychotherapy.
• Alternative therapies such as some yogic and meditative practices have been found
to be effective in treating certain psychological disorders.
• Rehabilitation of the mentally ill is necessary to improve their quality of life once their
active symptoms are reduced.

Review Questions
1. Describe the nature and scope of psychotherapy. Highlight the importance of
therapeutic relationship in psychotherapy.
2. What are the different types of psychotherapy? On what basis are they classified?
3. Discuss the various techniques used in behaviour therapy.
4. Explain with the help of an example how cognitive distortions take place.
5. Which therapy encourages the client to seek personal growth and actualise their
potential? Write about the therapies which are based on this principle.
6. What are the factors that contribute to healing in psychotherapy? Enumerate
some of the alternative therapies.
7. What are the techniques used in the rehabilitation of the mentally ill?
8. How would a social learning theorist account for a phobic fear of lizards/
cockroaches? How would a psychoanalyst account for the same phobia?
9. What kind of problems is cognitive behaviour therapy best suited for?

Project 1. In school at times you get good points (or gold points or stars) when you do well and
Ideas bad or black points when you do something wrong. This is an example of a token
system. With the help of your classmates make a list of all those school and classroom
activities for which you are rewarded or receive praise from your teacher or appreciation
from your friends. Also make a list of all those activities for which your teacher scolds
you or your classmates get angry with you.
2. Describe a person in your past or present who has consistently demonstrated
unconditional positive regard towards you. What effect, if any, did (or does) this have
on you? Explain. Gather the same information from more friends and prepare a report.

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Weblinks
http://www.sciencedirect.com
http://allpsych.com
http://mentalhealth.com

Pedagogical Hints
1. Students could be asked to connect
the dif fer ent therapeutic
approaches to some of the theories
of personality they have studied in
Chapter 2 on Self and Personality.
2. Role-play and dramatisation of
certain student-related behavioural
issues, such as br eak-up of
relationship with a friend would
evoke interest among the students
and also emphasise the application
of psychology.
3. As therapy is a highly skilled
process requiring professional
training, students should be
refrained from treating it in a
frivolous manner.
4. Any activity/discussion, which may
have a serious impact on the psyche
of the students, should be properly
transacted in the presence of the
teacher.

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