Class 12 Psychology – Chapter 5: Therapeutic Approaches
1. Nature and Process of Psychotherapy
- Psychotherapy is a professional treatment aimed at helping individuals overcome emotional, cognitive, and behavioral difficulties.
- It is a planned, structured, and systematic process designed to modify maladaptive thoughts, emotions, and behaviors.
- Psychotherapy involves active participation of the client and the therapist.
- Process of Psychotherapy:
- Assessment: Understanding clientโs problem, symptoms, and life context through interviews, observation, and sometimes testing.
- Goal Setting: Formulating specific, measurable, and achievable therapeutic goals including short-term and long-term objectives.
- Intervention: Application of appropriate psychotherapeutic techniques based on nature of disorder and client characteristics.
- Evaluation: Monitoring progress during therapy and modifying strategies if required.
- Therapy can be short-term or long-term depending on the severity of issues.
- Effective psychotherapy requires mutual trust, cooperation, and commitment from both client and therapist.
2. Characteristics of Psychotherapeutic Approach
- Professional Relationship: Guided by trained therapist.
- Planned and Systematic: Structured steps of assessment, intervention, and evaluation.
- Problem-Focused: Addresses specific emotional, behavioral, or cognitive difficulties.
- Mutual Participation: Active involvement of both client and therapist.
- Scientific Basis: Techniques grounded in psychological theories and principles.
- Ethical Practice: Includes confidentiality, informed consent, and respect for client rights.
- Time-Bound: Therapy organized with specific duration and frequency of sessions.
3. Goals of Psychotherapy
- Alleviate Emotional Distress: Reduce anxiety, depression, and emotional discomfort.
- Modify Maladaptive Behaviors: Correct dysfunctional patterns.
- Enhance Self-Awareness: Promote insight into thoughts, feelings, and actions.
- Improve Interpersonal Relationships: Facilitate better communication and social interactions.
- Promote Personal Growth: Encourage self-development and self-actualization.
- Facilitate Problem-Solving: Develop coping skills and resilience.
- Prevent Relapse: Equip clients to avoid recurrence of psychological issues.
4. Therapeutic Relationship
- Definition: Professional, supportive relationship between therapist and client that facilitates change.
- Importance: Strong relationship enhances trust, understanding, and effective outcomes.
- Key Elements:
- Trust: Client feels safe to share personal thoughts and feelings.
- Empathy: Therapist understands and validates client experiences.
- Unconditional Positive Regard: Acceptance without judgment.
- Genuineness: Therapist is authentic and honest.
- Confidentiality: Protection of client information.
- Role: Provides a secure environment for exploring problems and practicing new behaviors.
- Outcome: Strong therapeutic relationship improves engagement and effectiveness of therapy.
5. Types of Therapies
A. Psychodynamic Therapy
Methods of Eliciting the Nature of Intrapsychic Conflict
- Free Association: Client expresses all thoughts, feelings, and memories freely to reveal unconscious conflicts.
- Dream Interpretation: Dreams analyzed to uncover hidden desires and unresolved conflicts.
- Manifest Content: Actual storyline of the dream.
- Latent Content: Hidden psychological meaning.
Modality of Treatment
- Transference: Client projects feelings from significant past relationships onto the therapist.
- Resistance: Unconscious defense mechanisms that hinder progress.
- Interpretation: Therapist explains meanings of thoughts, feelings, and behaviors.
- Working Through: Repeated exploration and understanding of conflicts over time.
- Insights: Client gains awareness of unconscious conflicts, enabling changes in emotion and behavior.
Duration of Treatment
- Long-term therapy, often months to years.
- Frequency depends on severity and client progress.
- Therapy ends when insight is gained and symptoms managed, but may continue for maintenance.
B. Behaviour Therapy
Method of Treatment
- Malfunctioning Behaviour: Identify specific problematic behaviors.
- Antecedent Factors: Events or conditions preceding maladaptive behavior.
- Maintaining Factors: Reinforcements that sustain maladaptive behavior.
- Antecedent Operations: Modify triggers to reduce undesired behaviors.
- Consequent Operations: Modify outcomes to strengthen adaptive behaviors and reduce maladaptive behaviors.
Behavioural Techniques
- Negative Reinforcement: Removal of unpleasant stimuli to increase desired behavior.
- Aversion Conditioning: Pairing undesired behavior with unpleasant stimulus to reduce it.
- Positive Reinforcement: Rewarding desired behavior to encourage repetition.
- Token Economy: Tokens as reinforcement, exchangeable for rewards.
- Differential Reinforcement: Reinforce desired behaviors, ignore undesired behaviors.
- Systematic Desensitisation: Gradual exposure to fear-provoking stimuli while practicing relaxation.
- Principle of Reciprocal Inhibition: Reducing anxiety by eliciting incompatible response, such as relaxation.
- Modelling: Learning behaviors by observing and imitating others.
- Shaping: Reinforcing successive approximations of desired behavior until goal achieved.
- Self-Management Techniques: Clients monitor and reinforce own behaviors to encourage adaptive patterns.
Applications of Behaviour Therapy
- Phobias: Systematic desensitisation, flooding, and modelling reduce fear responses.
- Addictions: Aversion therapy, token economy, and reinforcement strategies support behavior change.
- Anxiety Disorders: Relaxation training, exposure therapy, and behavior modification are effective.
- Maladaptive Habits: Reinforcement strategies help replace undesirable habits with adaptive behaviors.
Cognitive Therapy โ Albert Ellis & Aaron Beck
Albert Ellis โ Rational Emotive Therapy (RET)- Developed by Albert Ellis as a form of cognitive therapy.
- Focuses on changing irrational beliefs that cause emotional distress.
- Based on the principle that thoughts influence emotions and behaviour.
- Distress results from irrational ways of thinking, not from events themselves.
A. ABC Model (AntecedentโBeliefโConsequence)
- A โ Activating Event (Antecedent): An event or situation that triggers a reaction.
- B โ Belief: The personโs interpretation or belief about the event.
- C โ Consequence: Emotional or behavioural response to the belief.
- Emphasis: it is not the event (A) but the belief (B) about the event that leads to the emotional consequence (C).
- Changing the belief system leads to changed emotional outcomes.
B. Irrational Beliefs
- People hold rigid, unrealistic, and illogical beliefs that lead to selfโdefeating emotions.
- Examples: โI must be loved and approved by everyone.โ; โI must succeed in everything I do.โ
- Such beliefs produce anxiety, guilt, and depression when expectations are unmet.
C. NonโDirective Questioning
- Therapist uses guided, nonโdirective questions to help clients identify and challenge irrational beliefs.
- Encourages selfโreflection and discovery of illogical thought patterns.
- Clients are led to replace irrational beliefs with rational, flexible, and realistic thoughts.
D. Goal of RET
- Help individuals recognise irrational beliefs, dispute them, and adopt rational, adaptive thinking.
- Result: improved emotional wellโbeing and positive behavioural change.
2. Aaron Beck โ Cognitive Therapy
- Developed by Aaron T. Beck to identify and correct faulty, negative thought patterns.
- Focuses on the role of cognition in disorders such as depression and anxiety.
A. Core Schemes
- Core schemes are deepโseated beliefs about the self, the world, and the future.
- Formed from early experiences and shape automatic thoughts and interpretations.
- Examples of negative core schemes in depression: โI am worthless.โ; โThe world is unfair.โ; โThe future is hopeless.โ
- Core schemes provide the framework for perceiving and interpreting events.
B. Dysfunctional Cognitive Structures
- Refer to distorted patterns of thinking that produce negative emotions and maladaptive behaviour.
- These structures bias perception and interpretation of experience.
- Common cognitive distortions include:
- โข AllโorโNothing Thinking: Viewing situations in extremes.
- โข Overgeneralisation: Drawing broad conclusions from a single incident.
- โข Mental Filtering: Focusing only on negative details and ignoring positives.
- โข Catastrophising: Expecting the worst possible outcome.
- โข Personalisation: Assuming undue personal responsibility for external events.
C. Method of Therapy (Beck)
- Therapist helps clients recognise automatic negative thoughts arising from dysfunctional cognitive structures.
- Clients evaluate evidence for and against their beliefs.
- Through repeated sessions, distorted thoughts are replaced with balanced, realistic interpretations.
- Therapy aims to reduce distress and promote adaptive behaviour.
D. Goal of Cognitive Therapy (Beck)
- Make clients aware of maladaptive thought patterns and help them develop rational, adaptive thinking.
- Encourage selfโmonitoring of negative thoughts and restructuring into healthier alternatives.
Cognitive Behaviour Therapy (CBT)
- Cognitive Behaviour Therapy (CBT) is the most popular therapy.
- Research shows it is a short and effective treatment for anxiety, depression, panic attacks, and borderline personality.
- CBT follows a biopsychosocial approach, combining cognitive and behavioural techniques.
- Clientโs distress arises from biological, psychological, and social factors.
- Relaxation procedures, behaviour therapy, cognitive techniques, and environmental changes address these aspects.
- CBT is comprehensive, easy to use, applicable to many disorders, and has proven efficacy.
Humanistic-Existential Therapy โ Quick Notes
- Distress comes from loneliness, alienation, lack of meaning.
- Humans are motivated by personal growth & self-actualization.
- Self-actualization: Becoming balanced, integrated, and whole.
- Causes of distress: Unmet basic needs or blocked self-actualization.
Healing
- Recognize and remove obstacles to growth.
- Free emotional expression is essential; suppression causes negative behavior.
- Therapy provides a safe, accepting, non-judgmental space.
- Focus: complexity, balance, integration of personality.
- Clients have freedom & responsibility for their behavior.
- Therapist: guide/facilitator, not problem-solver.
- Goal: Expand awareness and understanding of personal experiences.
- Healing happens through client-initiated self-growth.
Existential Therapy: Victor Frankl (Logotherapy)
1. Meaning
- Victor Frankl developed Logotherapy, a type of existential therapy.
- Focuses on helping individuals find meaning and purpose in life, even in difficult situations.
2. Central Idea
- The primary motivation of a person is the search for meaning.
- Psychological problems arise when a person fails to find meaning in life.
3. Key Concepts of Logotherapy
- Freedom of Will: Every person has the freedom to make choices, regardless of circumstances.
- Will to Meaning: The main drive in humans is to find meaning in life, not just pleasure or power.
- Meaning in Life: Life has meaning under all conditions, even suffering and hardships.
4. Goals of Logotherapy
- Help individuals discover personal meaning in life.
- Encourage people to take responsibility for their choices.
- Enable individuals to face existential anxiety positively.
5. Techniques / Approach
- Dereflection: Redirecting focus from problems to meaningful goals.
- Paradoxical Intention: Encouraging clients to confront fears in a humorous or exaggerated way.
- Socratic Dialogue: Guiding clients to discover meaning through reflective conversation.
6. Importance
- Helps people cope with suffering and stress by finding purpose.
- Promotes personal growth, self-understanding, and resilience.
- Encourages responsible living and decision-making.
7. Summary
- Logotherapy emphasizes meaning in life as central to mental health.
- Even in adverse circumstances, a person can find purpose, growth, and fulfillment.
Client-Centred Therapy (CCT)
1. Meaning
- Developed by Carl Rogers, client-centred therapy is also called person-centred therapy.
- Focuses on helping the individual realize their potential and self-actualize.
- It is a humanistic approach emphasizing the clientโs personal experience.
2. Key Idea
- Psychological problems arise when a personโs self-concept is incongruent with their actual experiences.
- Therapy aims to create conditions for personal growth and self-understanding.
3. Goals of Client-Centred Therapy
- Help individuals accept themselves and reduce incongruence.
- Encourage self-exploration and self-awareness.
- Promote personal growth and self-actualization.
4. Role of the Therapist
- Acts as a facilitator, not a director.
- Provides unconditional positive regard, empathy, and genuineness.
- Creates a supportive and non-judgmental environment.
5. Techniques / Approach
- Active Listening: Therapist listens carefully and reflects feelings.
- Empathy: Understanding the clientโs experiences from their perspective.
- Unconditional Positive Regard: Accepting the client without judgment.
- Congruence / Genuineness: Therapist is genuine and authentic with the client.
6. Importance
- Helps clients resolve inner conflicts and improve self-concept.
- Encourages autonomy, responsibility, and personal growth.
- Widely used for treating emotional and adjustment problems.
Gestalt Therapy
1. Meaning
- Developed by Fritz Perls, a humanistic therapy focusing on awareness and present experiences.
- Emphasizes wholeness of personality.
2. Key Idea
- Problems arise when a person is unaware of feelings or present experiences.
3. Goals
- Increase self-awareness and personal responsibility.
- Integrate thoughts, feelings, and behavior.
4. Techniques
- Empty Chair, Role Play, Experiments to express feelings and gain insight.
5. Importance
- Promotes personal growth, self-awareness, and emotional integration.
Biomedical Therapy
1. Meaning
- Involves the use of drugs or medical procedures to treat psychological disorders.
- Focuses on the biological aspects of mental disorders.
2. Key Idea
- Psychological problems may have biological causes, such as chemical imbalances, brain abnormalities, or genetic factors.
- Therapy aims to restore normal brain functioning.
3. Types of Biomedical Therapy
- Drug Therapy: Use of medications to treat symptoms.
- Antidepressants: Reduce depression.
- Antianxiety drugs: Reduce anxiety.
- Antipsychotics: Reduce hallucinations and delusions.
- Electroconvulsive Therapy (ECT): Electrical stimulation of the brain, used in severe depression.
- Psychosurgery: Rarely used, involves surgical procedures to treat mental disorders.
4. Goals
- Relieve symptoms of mental disorders.
- Restore normal functioning in daily life.
5. Importance
- Effective for severe mental disorders.
- Often combined with psychotherapy for better results.
Factors Contributing to Healing in Psychotherapy
- The therapeutic relationship between the client and the therapist is the most important factor contributing to healing.
- The quality of this relationship determines the effectiveness of the therapy.
- The therapist must have empathy, warmth, and unconditional positive regard for the client.
- The client should have faith in the therapist and the therapy process.
- The clientโs motivation and willingness to participate in the healing process are crucial.
- The therapistโs competence and skill in using techniques and methods appropriately help in recovery.
- The setting in which therapy is conducted, i.e., a comfortable and private environment, facilitates healing.
- Cultural factors, such as the clientโs belief system and social support, also influence the outcome of therapy.
- The process of catharsis (release of emotional tension) contributes to healing.
- Insight and self-understanding gained through therapy help the client make positive changes in their life.
Ethics in Psychotherapy โ
- The therapist must maintain confidentiality of the client.
- Informed consent should be taken before therapy begins.
- The therapist should not misuse the trust placed by the client.
- Professional competence must be ensured by the therapist.
- No exploitation or harm should be caused to the client.
- Respect for clientโs autonomy and dignity must be maintained.
- Therapist should avoid dual relationships and conflicts of interest.
- The aim should be the clientโs welfare and well-being.
Alternative Therapies โ Yoga and Meditation
- Alternative therapies are non-traditional methods promoting mental, physical, and spiritual well-being.
- They aim for holistic healing, addressing body, mind, and spirit together rather than just symptoms.
- These therapies emphasize prevention, self-awareness, and self-healing, complementing conventional treatments.
- Encourages active participation in personal health and growth.
Yoga and Meditation โ Alternative Therapy
- Yoga is an ancient Indian practice that harmonizes body and mind.
- Ashtanga Yoga, explained in the Yoga Sutras, includes eight aspects guiding physical, mental, and spiritual discipline.
- Asanas (physical postures) improve flexibility, strength, posture, and overall physical health.
- Pranayama (breathing techniques) regulates energy, calms the nervous system, reduces stress, tension, and insomnia, and improves respiratory function.
- Meditation (dhyana) enhances concentration, calms the mind, reduces mental fatigue, and promotes emotional balance
Rehabilitation of the Mentally Ill
Objective
To help individuals with mental illness to live as independently and productively as possible in the community.
Approach
Focuses on social, vocational, and psychological functioning rather than just medical treatment.
Rehabilitation Methods
- Occupational Therapy: Helps patients to engage in productive activities and develop work habits.
- Social Skills Training: Enables individuals to interact effectively and adjust better in social situations.
- Vocational Therapy: Provides training in skills to earn a livelihood and encourages suitable employment opportunities.
Rehabilitation Settings
- Day Care Centres: Provide structured activities, therapy, and social support.
- Halfway Homes: Offer transitional living arrangements for those who cannot immediately return home.
- Community-Based Rehabilitation: Mental health services provided within the community to promote inclusion.
- Family Support: Active involvement of family members is crucial for long-term recovery and adjustment.
Importance
- Helps reduce stigma and social isolation.
- Encourages self-reliance and productivity.
- Improves quality of life for the person and their family.
Challenges
- Lack of trained professionals and resources.
- Social stigma and discrimination.
- Limited awareness about mental health in society.