Chapter 5 – Therapeutic Approaches

Q. What is psychotherapy?
1. Psychotherapy is a voluntary relationship between the one
seeking treatment or the client and the one who treats or the
therapist.
2. The purpose of the relationship is to help the client to solve the
psychological problems being faced by her or him.
3. The relationship is conducive for building the trust of the client so
that problems may be freely discussed.
4. Psychotherapies aim at changing the maladaptive behaviours,
decreasing the sense of personal distress, and helping the client
to adapt better to her/his environment.
Q. What are the characteristics of psychotherapy?
All psychotherapeutic approaches have the following characteristics :
(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, and not everybody. An
untrained person may unintentionally cause more harm than any good,
(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.
Q. What are the goals of psychotherapy?
All psychotherapies aim at a few or all of the following goals :
(i) Reinforcing client’s resolve for betterment.
(ii) Lessening emotional pressure.
(iii) Unfolding the potential for positive growth.
(iv) Modifying habits.
(v) Changing thinking patterns.
(vi) Increasing self-awareness.
(vii) Improving interpersonal relations and communication.
(viii)Facilitating decision-making.
(ix) Becoming aware of one’s choices in life.
(x) Relating to one’s social environment in a more creative and self
aware manner.
Q. Describe a therapeutic relationship.
1. The special relationship between the client and the therapist is
known as the therapeutic relationship or alliance. (1) It is neither a
passing acquaintance, nor a permanent and lasting relationship. There
are two major components of a therapeutic alliance.
2. 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.
3. 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. This relationship
has several unique properties.
4. 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.
5. The therapist encourages this by being accepting, empathic, genuine
and warm to the client. The therapist creates an atmosphere of
unconditional positive regard and is empathetic towards the client.
6. 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. It is a professional relationship, and
must remain so.
Q. Explain unconditional positive regard.
A therapist conveys by her/his words and behaviours 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. This is the
unconditional positive regard which the therapist has for the client.
Q. What is empathy?
1. Empathy is reacting to another’s feelings with an emotional response
that is similar to the other’s feelings. Empathy is different from
sympathy and intellectual understanding of another person’s situation.
2. In sympathy, one has compassion and pity towards the suffering of
another but is not able to feel like the other person.
3. Intellectual understanding is cold in the sense that the person is
unable to feel like the other person and does not feel sympathy either.
4. 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.
Q. What are the different types of therapies?
1. Psychotherapies may be classified into three broad groups : the
psychodynamic, behaviour, and existential psychotherapies.
2. In terms of the chronological order, psychodynamic therapy emerged
first followed by behaviour therapy while the existential therapies
which are also called the third force, emerged last.
Q. What are the causes of abnormal behaviour according to the
different psychotherapies?
Different psychotherapies have different explainatins for the causes of
psychological problems. They are briefly described below.
1. Psychodynamic therapy is of the view that intrapsychic conflicts, i.e.
the conflicts that are present within the psyche of the person, are the
source of psychological problems. In the psychodynamic therapy,
unfulfilled desires of childhood an unresolved childhood fears lead to
intrapsychic conflicts.
2. According to behaviour therapies, psychological problems arise due
to faulty learning of behaviours and cognitions. The behaviour therapy
postulates that faulty conditioning patterns, faulty learning, and faulty
thinking and beliefs lead to maladaptive behaviours that, in turn, lead
to psychological problems.
3. The existential therapies postulate that the questions about the
meaning of one’s life and existence are the cause of psychological
problems. The existential therapy places importance on the present. It
is the current feelings of loneliness, alienation, sense of futility of one’s
existence, etc., which cause psychological problems.
Q. What is the chief method of treatment in the different
psychotherapy approaches?
Different psychotherapy approaches use different treatment methods
to help a client deal with their problems.
1. Psychodynamic therapy uses the methods of free association and
reporting of dreams to elicit the thoughts and feelings of the client. This
material is interpreted to the client to help her/him to confront and
resolve the conflicts and thus overcome problems.
2. Behaviour therapy identifies the faulty conditioning patterns and sets
up alternate behavioural contingencies to improve behaviour. The
cognitive methods employed in this type of therapy challenge the faulty
thinking patterns of the client to help her/him overcome psychological
distress.
3. The existential therapy provides a therapeutic environment which is
positive, accepting, and non - judgmental. The client is able to talk
about the problems and the therapist acts as a facilitator. The client
arrives at the solutions through a process of personal growth.
Q. What is the nature of the therapeutic relationship between the
client and the therapist?
1. All the three psychotherapy approaches have different dynamics
between the therapist and the client. Both the psychodynamic and the
behaviour therapies assume that the therapist is capable of arriving at
solutions to the client’s problems.
2. Psychodynamic therapy assumes that the therapist understands the
client’s intrapsychic conflicts better than the client and hence it is the
therapist who interprets the thoughts and feelings of the client to
her/him so that s/he gains an understanding of the same.
3. The behaviour therapy assumes that the therapist is able to discern
the faulty behaviour and thought patterns of the client. It further
assumes that the therapist is capable of finding out the correct
behaviour and thought patterns, which would be adaptive for the
client.
4. In contrast to these therapies, the existential therapies emphasise
that the therapist merely provides a warm, empathic relationship in
which the client feels secure to explore the nature and causes of
her/his problems by herself/himself.
Q. What are the main benefits of psychotherapy approaches to the
client?
1. Psychodynamic therapy values emotional insight as the important
benefit that the client derives from the treatment.
2. Emotional insight is present when the client understands her/his
conflicts intellectually; is able to accept the same emotionally; and is
able to change her/his emotions towards the conflicts. The client’s
symptoms and distresses reduce as a consequence of this emotional
insight.
3. The behaviour therapy considers changing faulty behaviour and
thought patterns to adaptive ones as the chief benefit of the treatment.
Instituting adaptive or healthy behaviour and thought patterns ensures
reduction of distress and removal of symptoms.
4. The humanistic therapy values personal growth as the chief benefit.
Personal growth is the process of gaining increasing understanding of
oneself, and one’s aspirations, emotions and motives.
Q. What is the duration of treatment?
1. The duration of classical psycho- analysis may continue for several
years. However, several recent versions of psychodynamic
therapies are completed in 10–15 sessions.
2. Behaviour and cognitive behaviour therapies as well as existential
therapies are shorter and are completed in a few months.
Q. What are the steps in the formulation of a client's problem?
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.
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.
Q. How is psychodynamic therapy administered?
1. The psychodynamic therapy pioneered by Sigmund Freud is the
oldest form of psychotherapy. Broadly, the psychodynamic therapy has
conceptualised the structure of the psyche, dynamics between different
components of the psyche, and the source of psychological distress.
2. Since the psychoanalytic approach views intrapsychic conflicts to be
the cause of psychological disorder, 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.
3. The free association method 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.
4. The superego and the ego are kept away as the client speaks
whatever comes to mind in an atmosphere that is relaxed and trusting.
As 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 narrative of the
client is a window into the client’s unconscious to which the therapist
gains access.
5. Along with 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.
6. Dreams use symbols because they are indirect expressions and hence
would not alert the ego. If the unfulfilled desires are expressed directly,
the 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.
Q. What is the nature of the therapeutic relationship and the expected
outcome of psychoanalysis?
1. Transference and Interpretation are the means of treating the
patient. As the unconscious forces are brought into the conscious mind
through free association and dream interpretation, the client starts
identifying the therapist with the authority figures of the past. The
therapist maintains a non-judgmental and allows the client to continue
with this process of emotional identification. This is the process of
transference.
2. The therapist encourages this process because it helps her/him in
understanding the unconscious conflicts of the client. The client acts
out their frustrations, anger, fear, and depression that s/he harboured
towards 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.
3. A full-blown transference neurosis is helpful in making the therapist
aware of the nature of intrapsychic conflicts suffered by the client.
There is the positive transference in which the client idolises, or falls in
love with the therapist, and seeks the therapist’s approval. Negative
transference is present when the client has feelings of hostility, anger,
and resentment towards the therapist.
4. The process of transference is met with resistance. Since the process
of transference exposes the unconscious wishes and conflicts,
increasing 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.
5. Resistance can be conscious or unconscious. Conscious resistance is
present when the client deliberately hides some 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 sessions.
6. 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 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 into sharp focus.
7. In Interpretation 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. The
repeated process of using confrontation, clarification, and
interpretation is known as working through.
8. The outcome of working through is insight. Insight is a gradual
process wherein the unconscious memories are repeatedly integrated
into conscious awareness. The client starts to understand themselves
intellectually, which is the intellectual 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 is emotional insight.
Thus, Insight is the end point of therapy as the client has gained a new
understanding of herself/himself. Psychoanalysis is terminated at this
stage.
Q. What is the duration of psychoanalysis?
1. 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.
2. 2.Stage one is the 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.
3. 3.Stage two is the middle phase, which is a long process. It is
characterised 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.
4. 4.The third phase is the termination phase wherein the
relationship with the analyst is dissolved and the client prepares
to leave the therapy.
Q. Explain behaviour therapy.
a. 1.Behaviour therapies postulate that psychological distress
arises because of faulty behaviour patterns or thought
 patterns. It is, therefore, focused on the behaviour and
thoughts of the client in the present.
2. The past is relevant only to the extent of understanding the
origins of the faulty behaviour and thought patterns. The past is
not activated or relived. Only the faulty patterns are corrected in
the present.
3. The clinical application of learning theory principles constitute
behaviour therapy. Behaviour 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.
4. 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. 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.
5. 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.
Q. What is the method of treatment in behavioural therapy?
1. 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.
2. 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 bbehaviour.
3. Once the faulty behaviours which cause distress, have been
identified, a treatment package is chosen. 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.
4. 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.
Q. Discuss the various techniques used in behaviour therapy.
Or
Q. What are some behavioural techniques used to change behaviour?
1. A range of techniques is available for changing behaviour. The
principles of these techniques are to reduce the arousal level of the
client, alter behaviour through classical conditioning or operant
conditioning with different contingencies of reinforcements, as well as
to use vicarious learning procedures, if necessary.
2. Negative reinforcement and aversive conditioning are the two major
techniques of behaviour modification. Negative reinforcement refers to
following an undesired response with an outcome that is painful or not
liked. For example, the teacher reprimands a child who shouts in class.
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.
3. If an adaptive behaviour 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 favourite dish whenever s/he does
homework at the appointed time.
4. Persons with behavioural problems can be given a token as a reward
every time a wanted behaviour occurs. The tokens are collected and
exchanged for a reward such as an outing for the patient or a treat for
the child. This is known as token economy.
5. Unwanted behaviour can be reduced and wanted behaviour can be
increased simultaneously through differential reinforcement. Positive
reinforcement for the wanted behaviour and negative reinforcement
for the unwanted behaviour attempted together may be one such
method. The other method is to positively reinforce the wanted
behaviour and ignore the unwanted behaviour.
6. Modelling is the procedure wherein the client learns to behave in a
certain way by observing the behaviour of a role model or the therapist
who initially acts as the role model. Vicarious learning, i.e. learning by
observing others, is used and through a process of rewarding small
changes in the behaviour, the client gradually learns to acquire the
behaviour of the model.
Q. Describe the technique of systematic desensitisation.
1. Systematic desensitisation is a technique introduced by Wolpe for
treating phobias or irrational fears. 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. Over sessions, the
client is able to imagine more severe fear-provoking situations while
maintaining the relaxation. The client gets systematically desensitised
to the fear.
3. 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.
4. Thus, 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.
Q. Describe the Rational Emotive Therapy.
1. Albert Ellis formulated the Rational Emotive Therapy (RET). 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.
2. Antecedent events, which caused the psychological distress, are
noted. 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
characterised by thoughts with ‘musts’ and ‘shoulds’, i.e. things ‘must’
and ‘should’ be in a particular manner.
3. This distorted perception of the antecedent event due to the
irrational belief leads to the consequence, i.e. negative emotions and
behaviours. 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.
4. The nature of questioning is gentle, without probing or being
directive. 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. The rational belief system replaces the irrational belief
system and there is a reduction in psychological distress.
Q. Describe Aaron Beck’s cognitive therapy.
1. Aaron Beck’s 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.
2. 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 characterised by cognitive distortions.
3. 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 social reality.
4. 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.
5. 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.

Q. Describe Cognitive Behaviour Therapy?

1. The most popular therapy presently is the Cognitive Behaviour
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.
2. CBT adopts a bio-psychosocial approach to the delineation of
psychopathology. It combines cognitive therapy with behavioural
techniques.
3. The rationale is that the client’s distress has its origins in the
biological, psychological, and social realms.
4. Hence, addressing the biological aspects through relaxation
procedures, the psychological ones through behaviour therapy and
cognitive therapy techniques and the social ones with environmental
manipulations makes CBT a comprehensive technique which is easy to
use, applicable to a variety of disorders, and has proven efficacy.
Q. Describe the humanistic existential therapy.
1. The humanistic-existential therapies postulate that psychological
distress arises from feelings of loneliness, alienation, and an inability to
find meaning and genuine fulfilment in life. Human beings are
motivated by the desire for personal growth and self-actualisation, and
an innate need to grow emotionally. When these needs are curbed by
society and family, human beings experience psychological distress.
2. Self-actualisation 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.
3. Healing occurs when the client is able to perceive the obstacles to
self- actualisation in her/his life and is able to remove them. Self-
actualisation requires free emotional expression. The family and society
curb emotional expression. This curb leads to destructive behaviour
and negative emotions by thwarting the process of emotional
integration.
4. Therefore, the therapy creates a permissive, non-judgmental and
accepting atmosphere in which the client’s emotions can be freely
expressed and the complexity, balance and integration could be
achieved.
5. The fundamental assumption is that the client has the freedom and
responsibility to control her/his own behaviour. The therapist is merely
a facilitator and guide. The chief aim of the therapy is to expand the
client’s awareness.
6. 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. It is the
client who is responsible for the success of therapy.
Q. What is logotherapy?
1. 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.
2. 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.
3. Neurotic anxieties arise when the problems of life are attached to the
physical, psychological or spiritual aspects of one’s existence. Frankl
emphasised 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.
4. The goal of logotherapy is to help the patients to find meaning and
responsibility in their life irrespective of their life circumstances. The
therapist emphasises the unique nature of the patient’s life and
encourages them to find meaning in their life.
5. 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. The goal is to
facilitate the client to find the meaning of her/his being.
Q. What do you understand by client centred therapy?
1. Client-centred therapy was given by Carl Rogers. Rogers combined
scientific rigour with the individualised practice of client-centred
psychotherapy. Rogers brought into psychotherapy the concept of self,
with freedom and choice as the core of one’s being.
2. 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.
3. 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.
4. 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 non-judgmental manner.
5. 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.
Q. What is gestalt therapy?
1. The German word gestalt means ‘whole’. This therapy was given
by Freiderick (Fritz) Perls together with his wife Laura Perls. The
goal of gestalt therapy is to increase an individual’s self-
awareness and self-acceptance.
2. The client is taught to recognise 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.
Q. What are some of the methods of biomedical therapy?
1. 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 specialised in the understanding, diagnosis
and treatment of mental disorders.
2. 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 generalised anxiety or reactive depression may also require milder
drugs.
3. 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.
4. 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.
5. 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.
6. 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.
Q. What are the factors contributing to healing in psychotherapy?
Psychotherapy is a treatment of psychological distress. There are
several factors which contribute to the healing process. Some of these
factors are as follows :
1. 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 behavioural 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. 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. There are several non-specific factors associated with psychotherapy
and can occur across different systems of psychotherapy and across
different clients/patients and therapists.
5. Non-specific factors attributable to the client/patient are motivation
for change, expectation of improvement due to the treatment, etc and
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.
Q. What are some ethics in psychotherapy?
Some of the ethical standards that need to be practiced by professional
psycho-therapists 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 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.
Q. What are some alternative therapies?
1. 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.
2. 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 asanas or body posture component or to breathing
practices or pranayama, or to a combination of the two.
3. 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.
4. The rapid breathing techniques to induce hyperventilation as in
Sudarshana Kriya Yoga (SKY) is found to be a beneficial, low-risk, low
cost adjunct to the treatment of stress, anxiety, post-traumatic stress
disorder (PTSD), depression, stress-related medical illnesses, substance
abuse, and rehabilitation of criminal offenders.
5. Kundalini Yoga has been found to be effective in treatment of mental
disorders. The Institute for Non-linear Science, University of California,
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.
6. 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.