Chapter-5 NOTES

Therapeutic Approaches
Ques-1 What is psychotherapy?

Ans-1 Psychotherapy is a voluntary relationship between the one seeking

treatment or the client and the one who treats or the therapist.

The purpose of the relationship is to help the client to solve the psychological
problems being faced by her or him. The relationship is conducive for building the
trust of the client so that problems may be freely discussed.

Psychotherapies aim at changing the maladaptive behaviors, decreasing the sense

of personal distress, and helping the client to adapt better to her/his environment.
Inadequate marital, occupational and social adjustment also requires that
major changes be made in an individual’s personal environment.

Ques-2 What are the characteristics that are common to all psychotherapeutic
approaches?

Ans-2 The 4 characteristics that are common to all psychotherapeutic approaches

are:

(i) There is systematic application of principles underlying the different

theories of therapy.

(ii) Persons who have received practical training under expert supervision
can practice psychotherapy.

(iii) The therapeutic situation involves a therapist and a client who seeks and
receives help for her/his emotional problems (this person is the focus of
attention in the therapeutic process).

(iv) The interaction of these two persons — the therapist and the client —
results in the consolidation/formation of the therapeutic relationship. This
is a confidential, interpersonal, and dynamic relationship. This human
 relationship is central to any sort of psychological therapy and is the
vehicle for change.

Ques-3 What are the goals of psychotherapy?

Ans-3 The goals of all psychotherapies are:

• Reinforcing client’s 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.

Ques-4 What is nature and scope of psychotherapy?

Ans-4 (Ans-1 + 2 + 3)

Ques-5 Highlight the importance of therapeutic relationship in psychotherapy

Ans-5

1. Definition of Therapeutic Relationship

The special relationship between the client and the therapist is known as the
therapeutic relationship or alliance. It is neither a passing acquaintance, nor a
permanent and lasting relationship.

2. Components of Therapeutic Relationship

The first component is the contractual nature of the relationship in which
two willing individuals, the client and the therapist, enter into a partnership
which aims at helping the client overcome her/his problems. The second
component of therapeutic alliance is the limited duration of the therapy. This
 alliance lasts until the client becomes able to deal with her/his problems and
take control of her/ his life.

3. Therapeutic relationship has several unique properties

• It is a trusting and confiding relationship. 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.

• The therapist shows unconditional positive regard encourages this

by being accepting, empathic, genuine and warm to the client. The
therapist conveys by her/his words and behaviors that s/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 s/he may have done or thought about.

• The therapist has empathy for the client. Empathy is different from
sympathy and intellectual understanding of another person’s 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 the sense that the person is

unable to feel like the other person and does not feel sympathy either.

• 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 the other person’s perspective, i.e. putting oneself in the
other person’s shoes. Empathy enriches the therapeutic relationship
and transforms it into a 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 the
 confidence of the client in anyway. Finally, it is a professional
relationship, and must remain so.

Ques-6 What are the major therapeutic approaches?

Ans-6 There are three major therapeutic approaches

1. Psychodynamic
2. Behavioral
3. Humanistic. Existential

Ques-7 What are the parameters on which psychotherapies are classified?

Ans-7 The 6 parameters on which the psychotherapies are classified are:

1. The cause which has lead to the problem

2. How the cause came into existence?
3. Chief method of treatment
4. Nature of therapeutic relationship between client and the therapist
5. The chief benefits to the client
6. Duration of the treatment

Ques-8 What is clinical formulation?

Ans-8 Clinical formulation refers to formulating the problem of the client in the
therapeutic model being used for the treatment.

Ques-9 Explain how are different psychotherapeutic approaches classified on

different parameters?

Parameter Psychodynamic Behavioral Humanistic.

Existential
Cause Intrapsychic Faulty learning of Questions about
conflicts: the behavior and the meaning of
person(dynamics cognitions one’s life and
between different esxistence
components of
psyche)
Cause came into Unfulfilled desires Faulty Importance on
existence of childhood. conditioning present-current
 Unresolved patterns, learning, feelings of
childhood fears thinking and loneliness,
beliefs. alienation, sense
of futility of one’s
existence.
Treatment Free association Alternate Positive,
and reporting of behavioral accepting, and
dreams-elicit the contingencies. non-judgmental
thoughts and Cognitive environment.
feelings of the methods which Client is able to
client challenge faulty talk about the
Interpreted to the thinking patterns. problems.
client to help Therapist acts as a
him/her to facilitator.
confront and
resolve the
conflicts.
Nature of Therapists Therapist Therapists
relationship understand discovers faulty provides a warm,
conflicts better behavior and empathic
than the client- thought patterns- relationship-client
interprets the capable of finding feels secure to
thoughts and out correct and explore the nature
feelings of the adaptive patterns. and causes of
client to his/her. his/her problems
by himself/herself.
Chief Benefit to Emotional Instituting Personal growth:
Client Insight- Client adaptive or The process of
understands healthy behavior gaining increasing
conflicts, accepts and thought understanding of
the same patterns. oneself, ones
emotionally, aspirations,
changes his/her emotions and
emotions towards motives.
the conflicts
Duration Several years Few months Few months
(classical
psychoanalysis),
10-15 sessions
(recent versions)
 • Different types of psychotherapies differ on multiple parameters.
• However, they all share the common method of providing treatment for
psychological distress through psychological means.
• The therapist, the therapeutic relationship, and the process of therapy
become the agents of change in the client leading to the alleviation of
psychological distress.
• The process of psychotherapy begins by formulating the client’s problem

Ques-10 What are the steps in the clinical formulation of client’s problem? Or
what are the advantages of clinical formulation?

Ans-10 Clinical formulation refers to formulating the problem of the client in the
therapeutic model, being used for the treatment. The clinical formulation has
following steps or advantages:

1. Understanding the problem of the client-

The therapist is able to understand the full implications of the distress being
experienced by the client
2. Identification of the areas to be targeted for treatment in psychotherapy
The theoretical formulation clearly identifies the problem areas to be
targeted for therapy. Thus, if a client seeks help for inability to hold a job
and reports inability to face superiors, the clinical formulation in behavior
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.

Ques-11 Explain the Psychodynamic Therapy

Ans-11

1. Psychodynamic therapy pioneered by Sigmund Freud is the oldest therapy.

His close collaborator Carl Jung modified it to what came to be known as
the analytical psychotherapy.
2. Freud’s successors, known as Neo-Freudians, established their own
versions of classical psychodynamic therapy.
3. Broadly, the psychodynamic therapy has conceptualized the structure of the
psyche, dynamics between different components of the psyche, and the
source of psychological distress.

Methods of Eliciting the Nature of Intrapsychic Conflict:

The first step in the treatment is to elicit this intrapsychic conflict. Psychoanalysis
has invented free association and dream interpretation as two important methods
for eliciting the intrapsychic conflicts.

1. The Free Association

• It is the main method for understanding the client’s problems. Once a
therapeutic relationship is established, and the client feels
comfortable, the therapist makes her/him lie down on the couch, close
her/his eyes and asks her/ him to speak whatever comes to mind
without censoring it in anyway.
• The client is encouraged to freely associate one thought with another,
and this method is called the method of free association.
• The censoring superego and the watchful ego are kept in abeyance
as the client speaks whatever comes to mind in an atmosphere that is
relaxed and trusting.
• The therapist does not interrupt the free flow of ideas, desires and
conflicts of the unconscious, which had been suppressed by the ego,
emerge into the conscious mind.
 • This free uncensored verbal narrative of the client is a window into
the client’s unconscious to which the therapist gains access.

2. Dream Analysis/Interpretation
• In this technique, the client is asked to write down her/his dreams
upon waking up. Psychoanalysts look upon dreams as symbols of
the unfulfilled desires present in the unconscious.
• The images of the dreams are symbols which signify intrapsychic
forces. Dreams use symbols because they are indirect expressions and
hence would not alert the ego.
• If the unfulfilled desires are expressed directly, the ever-vigilant ego
would suppress them and that would lead to anxiety.
• These symbols are interpreted according to an accepted convention of
translation as the indicators of unfulfilled desires and conflicts

Modality of Treatment

1. Transference
• As the unconscious forces are brought into the conscious realm
through free association and dream interpretation the client starts
identifying the therapist with the authority figures of the past,
usually childhood. The therapist may be seen as the punitive father,
or as the negligent mother.

• The therapist maintains a non-judgmental yet permissive attitude and

allows the client to continue with this process of emotional
identification.

• Transference Neurosis: The therapist becomes a substitute for that

person in the present. The therapist encourages this process because it
helps her/him in understanding the unconscious conflicts of the
client. The client acts out her/his frustrations, anger, fear, and
depression that s/he harboured towards that person in the past, but
could not express at that time. A full-blown transference neurosis is
 helpful in making the therapist aware of the nature of intrapsychic
conflicts suffered by the client.

• Positive transference- The client idolizes, or falls in love with the

therapist, and seeks the therapist’s approval.

• Negative transference-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 resists transference.

• Due to resistance, the client opposes the progress of therapy in order

to protect herself/himself from the recall of painful unconscious
memories.

• Conscious resistance- When the client deliberately hides some

information.

• Unconscious resistance- When the client becomes silent during the

therapy session, recalls trivial details without recalling the emotional
ones, misses appointments, and comes late for therapy sessions.

• 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.

2. Interpretation
• It is the fundamental mechanism by which change is effected.

• 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 which have led to the occurrence of certain events,
symptoms and conflicts.

• Interpretation can focus on intrapsychic conflicts or on deprivations

suffered in childhood.

• Confrontation and clarification are the two analytical techniques of

interpretation.

• 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 into sharp focus. This is done by separating and
highlighting important details about the event from unimportant ones.

• Working Through- The repeated process of using 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
her/his ego. The outcome of working through is insight.

• Insight- It is not a sudden event but a gradual process wherein the

unconscious memories are repeatedly integrated into conscious
awareness; these unconscious events and memories are re-experienced
in transference and are worked through.

1. As this process continues, the client starts to understand

herself/himself conflicts of the past, defence mechanism
and physical symptoms are no longer present and client
becomes psychologically healthy person.
 2. Intellectual Insight-The intellectual understanding is the
intellectual insight where the client starts to understand
himself/herself better at an intellectual level.
3. 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

Psychoanalysis lasts for several years, with one hour session for 4–5 days per
week. It is an intense treatment. There are three stages in the treatment.

• Initial phase- The client becomes familiar with the routines, establishes a
therapeutic relationship with the analyst, and gets some relief with the
process of recollecting the superficial materials from the consciousness
about the past and present troublesome events.
• Middle phase- which is a long process. It is characterized by transference,
resistance on the part of the client, and confrontation and clarification, i.e.
working through on the therapist’s part. All these processes finally lead to
insight.
• Termination- is the termination phase wherein the relationship with the
analyst is dissolved and the client prepares to leave the therapy.

Ques-12 What is Behavioral Therapy?

Ans-12

• Behavior therapies postulate that psychological distress arises because of

faulty behavior patterns or thought patterns.

• It is focused on the behavior and thoughts of the client in the present. The
past is relevant only to the extent of understanding the origins of the faulty
behavior and thought patterns. The past is not activated or relived. Only the
faulty patterns are corrected in the present.
 • Behavioral therapies are clinical application of learning theory. Behavior
therapy consists of a large set of specific techniques and interventions.

• It is not a unified theory, which is applied irrespective of the clinical

diagnosis or the symptoms present. The symptoms of the client and the
clinical diagnosis are the guiding factors in the selection of the specific
techniques or interventions to be applied.

• For example- The treatment of phobias or excessive and crippling fears

would require the use of one set of techniques while that of anger outbursts
would require another. A depressed client would be treated differently from
a client who is anxious.

• The foundation of behavior therapy is on formulating dysfunctional or faulty

behaviors, the factors which reinforce and maintain these behaviors, and
devising methods by which they can be changed

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
analyze her/his behavior patterns.

• Behavioral analysis is conducted to find malfunctioning behaviors, the

antecedents of faulty learning, and the factors that maintain or continue
faulty learning.

• Malfunctioning behaviors- These are the behaviors which cause distress to

the client.

• Antecedent factors- These are the causes which predispose the person to
indulge in that behavior.
• Maintaining factors- These are the factors which lead to the persistence of
the faulty behavior.

• An example would be a young person who has acquired the malfunctioning

behavior of smoking and seeks help to get rid of smoking. Behavioral
analysis conducted by interviewing the client and the family members
reveals that the person started smoking when he was preparing for the
annual examination. He had reported relief from anxiety upon smoking.
Thus, anxiety provoking situation becomes the causative or antecedent
factor.

• The feeling of relief becomes the maintaining factor for him to continue
smoking. The client has acquired the operant response of smoking, which
is maintained by the reinforcing value of relief from anxiety.

• The faulty behaviors which cause distress, have been identified, a treatment
package is chosen. The aim of the treatment is to extinguish or eliminate
the faulty behaviors and substitute them with adaptive behavior
patterns. The therapist does this through establishing antecedent operations
and consequent operations.

• Antecedent operations- They control behavior by changing something that

precedes such a behavior.

• Establishing Operation-The change can be done by increasing or

decreasing the reinforcing value of a particular consequence.

• Consequent Operation- i.e., giving reinforcement eg. Praise

• For example, if a child gives trouble in eating dinner, an establishing

operation would be to decrease the quantity of food served at tea time. This
would increase the hunger at dinner and thereby increase the reinforcing
value of food at dinner. Praising the child when s/he eats properly tends to
encourage this behavior. The antecedent operation is the reduction of food at
 tea time and the consequent operation is praising the child for eating dinner.
It establishes the response of eating dinner.

Behavioral Techniques

• A range of techniques is available for changing behavior. The principles of

these techniques are to reduce the arousal level of the client, alter behavior
through classical conditioning or operant conditioning with different
contingencies of reinforcements, as well as to use vicarious learning
procedures, if necessary. Behavioral Techniques are as follows:

• Negative reinforcement- Following an undesired response that lead

organisms to get rid of painful stimuli or avoid and escape from them
provide negative reinforcement. For example, one learns to put on woolen
clothes, burn firewood or use electric heaters to avoid the unpleasant cold
weather. One learns to move away from dangerous stimuli because they
provide negative reinforcement.

• Aversive conditioning- refers to repeated association of undesired

response with an aversive consequence. For example, an alcoholic is given
a mild electric shock and asked to smell the alcohol. With repeated pairings
the smell of alcohol is aversive as the pain of the shock is associated with it
and the person will give up alcohol.

• Positive Reinforcement- If an adaptive behavior occurs rarely, positive

reinforcement is given to increase the deficit. For example, if a child does
not do homework regularly, positive reinforcement may be used by the
child’s mother by preparing the child’s favorite dish whenever s/he does
homework at the appointed time. The positive reinforcement of food will
increase the behavior of doing homework at the appointed time.

• Token economy-Persons with behavioral problems can be given a token as

a reward every time a wanted behavior occurs. The tokens are collected and
 exchanged for a reward such as an outing for the patient or a treat for the
child.

• Differential Reinforcement- Unwanted behavior can be reduced and

wanted behavior can be increased simultaneously through differential
reinforcement.

1. Positive reinforcement for the wanted behavior and negative

reinforcement for the unwanted behavior attempted together may be
one such method. The other method is to positively reinforce the
wanted behavior and ignore the unwanted behavior. The latter
method is less painful and equally effective.

2. For example, a girl who sulks and cries when she is not taken to the
cinema when she asks. The parent is instructed to take her to the cinema
if she does not cry and sulk but not to take her if she does. Further, the
parent is instructed to ignore the girl when she cries and sulks. The
wanted behavior of politely asking to be taken to the cinema increases
and the unwanted behavior of crying and sulking decreases.

• Systematic desensitization- It is a technique introduced by Wolpe for

treating phobias or irrational fears.

1. The client is interviewed to elicit fear provoking situations and

together with the client, the therapist prepares a hierarchy of
anxiety-provoking stimuli with the least anxiety-provoking stimuli
at the bottom of the hierarchy.

2. The therapist relaxes the client and asks the client to think about
the least anxiety-provoking situation. The client is asked to stop
thinking of the fearful situation if the slightest tension is felt.

3. Over sessions, the client is able to imagine more severe fear

provoking situations while maintaining the relaxation. The client
gets systematically desensitized to the fear.
 4. The principle of reciprocal inhibition operates here. This
principle states that the presence of two mutually opposing forces
at the same time inhibits the weaker force.

5. The relaxation response is first built up and mildly anxiety-

provoking scene is imagined, and the anxiety is overcome by the
relaxation. The client is able to tolerate progressively greater levels
of anxiety because of her/his relaxed state.

• Modeling- It is the procedure wherein the client learns to behave in a certain

way by observing the behavior of a role model or the therapist who initially
acts as the role model. Vicarious learning- It learning by observing others,
is used and through a process of rewarding small changes in the behavior,
the client gradually learns to acquire the behavior of the model.

• There is a great variety of techniques in behavior therapy. The skill of the

therapist lies in conducting an accurate behavioral analysis and building a
treatment package with the appropriate techniques.

Duration

• Unlike psychodynamic therapy, behavior therapy is open, i.e. the therapist

shares her/his method with the client. It is short, lasting between 10–20
sessions.

Ques-13 Explain the Cognitive Therapy

Ans-13 Cognitive therapies locate the cause of psychological distress in irrational

thoughts and beliefs. It has two therapies. Rational emotive Therapy by Albert
Ellis and Aaron Beck’s Cognitive Therapy

Rational Emotive Therapy

• It is formulated by Albert Ellis. The central thesis of this therapy is that

irrational beliefs mediate between the antecedent events and their
 consequences. The first step in RET is the antecedent belief-consequence
(ABC) analysis.
1. Antecedent events- which caused the psychological distress are noted.

2. The client is also interviewed to find the irrational beliefs, which are
distorting the present reality. Irrational beliefs may not be supported by
empirical evidence in the environment. These beliefs are characterized by
thoughts with ‘musts’ and ‘shoulds’, i.e. things ‘must’ and ‘should’ be
in a particular manner. Examples of irrational beliefs are, “One should be
loved by everybody all the time”, “Human misery is caused by external
events over which one does not have any control”, etc.

3. This distorted perception of the antecedent event due to the irrational

belief leads to the consequence, i.e. negative emotions and behaviors.

4. Irrational beliefs are assessed through questionnaires and interviews. In

the process of RET, the irrational beliefs are refuted by the therapist
through a process of non-directive questioning. The nature of
questioning is gentle, without probing or being directive.

5. The questions make the client to think deeper into her/his assumptions
about life and problems. Gradually the client is able to change the
irrational beliefs by making a change in her/his philosophy about life.

6. Conclusion-The rational belief system replaces the irrational belief

system and there is a reduction in psychological distress.

Cognitive therapy of Aaron Beck

• His theory of psychological distress characterized 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. Thus, a client, who was neglected by the parents as a child,
develops the core schema of “I am not wanted”.
 • During the course of life, a critical incident occurs in her/his life. S/he is
publicly ridiculed by the teacher in school. This critical incident triggers the
core schema of “I am not wanted” leading to the development of negative
automatic thoughts.

• Negative thoughts are persistent irrational thoughts such as “nobody loves

me”, “I am ugly”, “I am stupid”, “I will not succeed”, etc. Such negative
automatic thoughts are characterized 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.

• 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.

• Examples of such question would be, “Why should everyone love you?”,
“What does it mean to you to succeed?” etc. The questions make the client
think in a direction opposite to that of the negative automatic thoughts
whereby s/he gains insight into the nature of her/his dysfunctional schemas,
and is able to alter her/his cognitive structures.

• The aim of the therapy is to achieve this cognitive restructuring which, in

turn, reduces anxiety and depression.

• Duration- Cognitive therapy focuses on solving a specific problem of the

client. It is short, lasting between 10–20 sessions.

Ques-14 Write a short note on Cognitive Behavioral Therapy.

Ans-14 The most popular therapy presently is the Cognitive Behavior Therapy
(CBT).
 • Research into the outcome and effectiveness of psychotherapy has
conclusively established CBT to be a short and efficacious treatment for a
wide range of psychological disorders such as anxiety, depression, panic
attacks, and borderline personality, etc.

• CBT adopts a biopsychosocial approach to the delineation of

psychopathology. It combines cognitive therapy with behavioral techniques.

• The rationale is that the client’s distress has its origins in the biological,
psychological, and social realms.

• It addresses the biological aspects through relaxation procedures, the

psychological ones through behavior therapy and cognitive therapy
techniques and the social ones with environmental manipulations.

• It makes CBT a comprehensive technique which is easy to use, applicable

to a variety of disorders, and has proven efficacy. (Advantages of CBT)

Ques-15 What are the main postulates of Humanistic Existential Therapy?

(Or)

How is self-Actualization related to psychological well-being?

Ans-15

• The humanistic-existential therapies postulate that psychological distress

arises from feelings of loneliness, alienation, and an inability to find
meaning and genuine fulfillment in life.

• Human beings are motivated by the desire for personal growth and self-
actualization, and an innate need to grow emotionally. When these needs
are curbed by society and family, human beings experience psychological
distress.
 • Self-actualization is defined as an innate or inborn force that moves the
person to become more complex, balanced, and integrated, i.e.
achieving the complexity and balance without being fragmented.
Integrated means a sense of whole, being a complete person, being in
essence the same person in spite of the variety of experiences that one is
subjected to. Just as lack of food or water causes distress, frustration of self-
actualization also causes distress.

• Healing occurs when the client is able to perceive the obstacles to self
actualization in her/his life and is able to remove them. Self-actualization
requires free emotional expression.

• The family and society curb emotional expression, as it is feared that a free
expression of emotions can harm society by unleashing destructive forces.
This curb leads to destructive behavior and negative emotions by
thwarting the process of emotional integration.

• Therefore, the therapy creates a permissive, nonjudgmental and accepting

atmosphere in which the client’s emotions can be freely expressed and
the complexity, balance and integration could be achieved.

• The fundamental assumption is that the client has the freedom and
responsibility to control her/his own behavior. The therapist is merely a
facilitator and guide. It is the client who is responsible for the success of
therapy.

• The chief aim of the therapy is to expand the client’s awareness. Healing
takes place by a process of understanding the unique personal experience of
the client by herself/himself. The client initiates the process of self growth
through which healing takes place.

Ques-16 Write a short note on Existential Therapy.

Ans-16 Victor Frankl, a psychiatrist and neurologist propounded the Logotherapy.

 • Logos is the Greek word for soul and Logotherapy means treatment for the
soul. Frankl calls this process of finding meaning even in life-threatening
circumstances as the process of meaning making.

• The basis of meaning making is a person’s quest for finding the spiritual
truth of one’s existence. Just as there is an unconscious, which is the
repository of instincts, there is a spiritual unconscious, which is the
storehouse of love, aesthetic awareness, and values of life.

• Neurotic anxieties arise when the problems of life are attached to the
physical, psychological or spiritual aspects of one’s existence.

• Frankl emphasized the role of spiritual anxieties in leading to

meaninglessness and hence it may be called an existential anxiety, i.e.
neurotic anxiety of spiritual origin.

• Goal-It is to help the patients to find meaning and responsibility in their life
irrespective of their life circumstances. The therapist emphasizes the unique
nature of the patient’s life and encourages them to find meaning in their life.
The goal is to facilitate the client to find the meaning of her/his being

• In Logotherapy, the therapist is open and shares her/his feelings; values and
his/her own existence with the client. The emphasis is on here and now.
Transference is actively discouraged. The therapist reminds the client
about the immediacy of the present.

Ques- 17 What is Client Centered Therapy

Ans-17 Client-centered therapy was given by Carl Rogers. Rogers combined

scientific rigor with the individualized practice of client centered psychotherapy.

• Rogers brought into psychotherapy the concept of self, with freedom and
choice as the core of one’s being. The therapy provides a warm relationship
in which the client can reconnect with her/his disintegrated feelings.
 • The therapist shows empathy, i.e. understanding the client’s experience
as if it were her/his own, is warm and has unconditional positive regard,
i.e. total acceptance of the client as s/he is.

• Empathy sets up an emotional resonance between the therapist and the

client. Unconditional positive regard indicates that the positive warmth of
the therapist is not dependent on what the client reveals or does in the
therapy sessions. This unique unconditional warmth ensures that the client
feels secure and can trust the therapist.

• The client feels secure enough to explore her/his feelings. The therapist
reflects the feelings of the client in a nonjudgmental 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.
This process of reflection helps the client to become integrated.

• Personal relationships improve with an increase in adjustment. In essence,

this therapy helps a client to become her/his real self with the therapist
working as a facilitator.

Ques-18 Write a short note on Gestalt Therapy.

Ans-18 The German word gestalt means ‘whole’. This therapy was given by
Frederick (Fritz) Perls together with his wife Laura Perls.

• The goal of gestalt therapy is to increase an individual’s self-awareness

and self acceptance. The client is taught to recognize the bodily processes
and the emotions that are being blocked out from awareness.

• The therapist does this by encouraging the client to act out fantasies about
feelings and conflicts. This therapy can also be used in group settings.

Ques-19 Name the Humanistic Existential-Therapies.

Ans-19
 1. Existential therapy by Frankl
2. Client Centered Therapy by Rogers
3. Gestalt Therapy By Perls

Ques-20 Explain the Biomedical therapy

Ans-20

• Medicines may be prescribed to treat psychological disorders. Prescription

of medicines for treatment of mental disorders is done by qualified medical
professionals known as psychiatrists. They are 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 disorders. Severe
mental disorders such as schizophrenia or bipolar disorder require anti-
psychotic drugs. Common mental disorders such as generalized anxiety or
reactive depression may also require milder drugs.

• The medicines prescribed to treat mental disorders can cause side-effects

which need to be understood and monitored. Hence, it is essential that
medication is given under proper medical supervision.

• Even the drugs which normal individuals use to stay awake to study for
examinations or to get a ‘high’ at a party have dangerous side-effects. These
drugs can cause addiction, and harm the brain and the body. Therefore, it is
dangerous to self medicate with drugs which affect the mind.

• Electro-convulsive Therapy (ECT) is another form of biomedical therapy.

Mild electric shock is given via electrodes to the brain of the patient to
induce convulsions. The shock is given by the psychiatrist only when it is
necessary for the improvement of the patient. ECT is not a routine
treatment and is given only when drugs are not effective in controlling the
symptoms of the patient.

Ques-21 what are the factors contributing to Healing in Psychotherapy?

Ans-21 There are several factors which contribute to the healing process. Some of
these factors are as follows: (FACT= Factors, Alliance, Catharsis and Techniques)

1. Techniques- A major factor in the healing is the techniques adopted by the

therapist and the implementation of the same with the patient/client. If the
behavioral system and the CBT school are adopted to heal an anxious client, the
relaxation procedures and the cognitive restructuring largely 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- At the outset of therapy while the patient/client is being interviewed

in the initial sessions to understand the nature of the problem, s/he unburdens the
emotional problems being faced. This process of emotional unburdening is known
as catharsis, and it has healing properties.

4. Non-specific factors- There are several non-specific factors associated with

psychotherapy. Some of these factors are attributed to the patient/client and some
to the therapist. These factors are called non-specific because they occur across
different systems of psychotherapy and across different clients/patients and
different therapists. Non-specific factors attributable to the client/patient are
motivation for change, expectation of improvement due to the treatment, etc. These
are called patient variables. Non-specific factors attributable to the therapist are
positive nature, absence of unresolved emotional conflicts, presence of good
mental health, etc. These are called therapist variables.

Ques-22 What are the ethics in psychotherapy?

Ans-22 Some of the ethical standards that need to be practiced by professional

psychotherapists are:

1. Informed consent needs to be taken.

2. Confidentiality of the client should be maintained.
3. Alleviating personal distress and suffering 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.

Ques-23 Enumerate and explain the alternative therapies.

Ans-23 Alternative Therapies are so called, because they are alternative treatment
possibilities to the conventional drug treatment or psychotherapy. There are many
alternative therapies such as yoga, meditation, acupuncture, herbal remedies and so
on. In the past 25 years, yoga and meditation have gained popularity as treatment
programmes for psychological distress.

Yoga

• Yoga is an ancient Indian technique detailed in the Ashtanga Yoga of

Patanjali’s Yoga Sutras.

• Yoga as it is commonly called today either refers to only the asana or body
posture component or to breathing practices or pranayama, or to a
combination of the two.

• Techniques enhance well-being, mood, attention, mental focus and stress

tolerance.

• Reduces the time to go sleep and improves the quality of sleep.

• Proper training by a skilled teacher and 30-minute practices everyday

maximizes the benefits.

Meditation

• Meditation refers to the practice of focusing attention on breath or on

an object or thought or a mantra. Here attention is focused.

• In Vipasana meditation, also known as mindfulness-based meditation,

there is no fixed object or thought to hold the attention. The person
passively observes the various bodily sensations and thoughts that are
passing through in her or his awareness.
 • SKY-The rapid breathing techniques to induce hyperventilation as in
Sudarshana Kriya Yoga (SKY) is found to be a
1) Beneficial
2) Low-risk
3) Low-cost adjunct to the treatment of stress
4) Anxiety
5) Post-traumatic stress disorder (PTSD)
6) Depression
7) Stress related medical illnesses
8) Substance abuse
9) Rehabilitation of criminal offenders.

• SKY has been used as a public health intervention technique to alleviate

PTSD in survivors of mass disasters.

• Research conducted at the National Institute of Mental Health and

Neurosciences (NIMHANS), India, has shown that SKY reduces
depression.

• Further, alcoholic patients who practice SKY have reduced depression and
stress levels. Insomnia is treated with yoga. Yoga reduces the time to go to
sleep and improves the quality of sleep.

• Kundalini Yoga taught in the USA has been found to be effective in

treatment of mental disorders. The Institute for Nonlinear Science,
University of California, and San Diego, USA has found that Kundalini
Yoga is effective in the treatment of obsessive compulsive disorder.

• Kundalini Yoga combines pranayama or breathing techniques with

chanting of mantras. Prevention of repeated episodes of depression may
be helped by mindfulness based meditation or Vipasana. This meditation
would help the patients to process emotional stimuli better and hence
prevent biases in the processing of these stimuli.
Ques-24 Explain the rehabilitation of mentally ill

Ans-24 The treatment of psychological disorders has two components,

1. Reduction of symptoms,

2. Improving the level of functioning or quality of life.

• In the case of milder disorders such as generalized anxiety, reactive

depression or phobia, reduction of symptoms is associated with an
improvement in the quality of life.

• In the case of severe mental disorders such as schizophrenia, reduction of

symptoms may not be associated with an improvement in the quality of life.
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. The

aim of rehabilitation is to empower the patient to become a productive
member of society to the extent possible.

• In rehabilitation, the patients are given occupational therapy, social skills

training, and vocational therapy.

• Occupational Therapy
The patients are taught skills such as candle making, paper bag making and
weaving to help them to form a work discipline.

• Social Skills
The training helps the patients to develop interpersonal skills through role-
play, imitation and instruction. The objective is to teach the patient to
function in a social group. Cognitive Retraining- It is given to improve the
basic cognitive functions of attention, memory and executive functions.

• Vocational Therapy
 Once patient improves sufficiently, vocational training is given wherein the
patient is helped to gain skills necessary to undertake productive
employment.

Ques-25 Explain the concept of relaxation procedures.

Ans-25

• Anxiety is a manifestation of the psychological distress for which the client

seeks treatment. The behavioral therapist views anxiety as increasing the
arousal level of the client, thereby acting as an antecedent factor in causing
the faulty behavior.

• 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.

• The reduction of anxiety would decrease the unwanted behaviors 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.