Therapeutic Approaches

Nature and Process of Psychotherapy

Psychotherapy is a voluntary relationship between the one seeking treatment (client) and the one who treats (therapist). The purpose is to help the client solve psychological problems.

Characteristics of Psychotherapy

1. Systematic application of principles underlying different theories of therapy
2. Practiced by persons who have received practical training under expert supervision
3. Involves a therapist and client who seeks help for emotional problems
4. Results in the formation of a therapeutic relationship

Goals of Psychotherapy

• Reinforcing client's resolve for betterment
• Lessening emotional pressure
• Unfolding 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 social environment in a more creative manner

Therapeutic Relationship

The special relationship between client and therapist is known as therapeutic alliance with two major components:

1. Contractual nature of the relationship
2. Limited duration of the therapy

Properties of therapeutic relationship:

• Trusting and confiding relationship
• Therapist shows unconditional positive regard
• Therapist has empathy (understanding client's experience as if it were their own)
• Strict confidentiality maintained
• Professional relationship

Types of Therapies

Psychotherapies are classified into three broad groups:

1. Psychodynamic therapies
2. Behaviour therapies
3. Existential therapies (third force)

Classification Parameters

Steps in Formulation of a Client's Problem

Clinical formulation refers to formulating the client's problem in the therapeutic model being used.

Advantages:

1. Understanding of the problem
2. Identification of areas to be targeted for treatment
3. Choice of techniques for treatment

Behavior Therapy

Postulates that psychological distress arises from faulty behavior patterns or thought patterns. Focused on present behavior and thoughts.

Method of Treatment

1. Behavioral analysis to find malfunctioning behaviors
2. Identify antecedents (causes) and maintaining factors
3. Choose treatment package to eliminate faulty behaviors and substitute with adaptive patterns
4. Establish antecedent and consequent operations

Behavioral Techniques

• Negative reinforcement: Responses that help avoid painful stimuli
• Aversive conditioning: Repeated association of undesired response with aversive consequence
• Positive reinforcement: Given to increase deficit behaviors
• Token economy: Tokens given as reward for wanted behavior, exchanged later
• Differential reinforcement: Positive reinforcement for wanted behavior and ignoring unwanted behavior
• Systematic desensitization: For treating phobias using hierarchy of anxiety-provoking stimuli
• Modeling: Client learns by observing behavior of role model

Relaxation Procedures

Used to decrease anxiety levels:

• Progressive muscular relaxation
• Meditation

Cognitive Therapy

Locates cause of psychological distress in irrational thoughts and beliefs.

Rational Emotive Therapy (RET) by Albert Ellis

Central thesis: Irrational beliefs mediate between antecedent events and consequences.

ABC Analysis:

• A: Antecedent events
• B: Irrational beliefs
• C: Consequences (negative emotions and behaviors)

Process: Irrational beliefs are refuted through non-directive questioning to change client's philosophy.

Aaron Beck's Cognitive Therapy

Psychological distress characterized by anxiety/depression stems from childhood experiences that develop core schemas (beliefs and action patterns).

Negative automatic thoughts: Persistent irrational thoughts ("nobody loves me", "I am stupid") characterized by cognitive distortions.

Therapist uses gentle questioning to help client gain insight into dysfunctional schemas.

Cognitive Behavior Therapy (CBT)

Most popular therapy currently, combines cognitive therapy with behavioral techniques.

Features:

• Short and efficacious for wide range of disorders
• Bio-psychosocial approach
• Addresses biological aspects through relaxation
• Psychological aspects through behavior and cognitive techniques
• Social aspects through environmental manipulations

Humanistic-existential Therapy

Postulates that psychological distress arises from feelings of loneliness, alienation, and inability to find meaning in life.

Key Concepts

• Motivation for personal growth and self-actualization
• Self-actualization: Innate force to become more complex, balanced and integrated
• Healing occurs when client perceives obstacles to self-actualization
• Therapy creates permissive, non-judgmental atmosphere
• Client has freedom and responsibility to control behavior
• Therapist is facilitator and guide

Existential Therapy (Logotherapy) by Victor Frankl

Logos = Greek for soul; treatment for the soul.

Process: Finding meaning even in life-threatening circumstances (meaning making).

Spiritual unconscious: Storehouse of love, aesthetic awareness, and values.

Goal: Help patients find meaning and responsibility in life.

Techniques:

• Therapist is open and shares feelings/values
• Emphasis on here and now
• Transference discouraged

Client-centered Therapy by Carl Rogers

Provides warm relationship where client can reconnect with disintegrated feelings.

Therapist qualities:

• Empathy
• Unconditional positive regard (total acceptance)
• Genuineness

Process: Therapist reflects client's feelings in non-judgmental manner to help client become integrated.

Gestalt Therapy by Fritz and Laura Perls

Gestalt = 'whole' in German.

Goal: Increase self-awareness and self-acceptance.

Technique: Client taught to recognize blocked bodily processes and emotions by acting out fantasies about feelings.

Factors Contributing to Healing in Psychotherapy

1. Techniques adopted by therapist: Specific to therapeutic approach
2. Therapeutic alliance: Regular availability, warmth and empathy
3. Catharsis: Emotional unburdening at outset of therapy
4. Non-specific factors:
   • Patient variables: Motivation for change, expectation of improvement
   • Therapist variables: Positive nature, good mental health, absence of unresolved conflicts

Ethics in Psychotherapy

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
4. Integrity of the practitioner-client relationship is important
5. Respect for human rights and dignity
6. Professional competence and skills are essential

Alternative Therapies

Alternative to conventional drug treatment or psychotherapy:

Yoga

Ancient Indian technique involving:

• Asanas (body postures)
• Pranayama (breathing practices)

Meditation

Practice of focusing attention:

• Fixed object/thought/mantra
• Vipasana (mindfulness): Passive observation of bodily sensations and thoughts

Sudarshana Kriya Yoga (SKY)

Rapid breathing techniques to induce hyperventilation found beneficial for:

• Stress, anxiety, PTSD, depression
• Stress-related medical illnesses
• Substance abuse
• Rehabilitation of criminal offenders

Kundalini Yoga

Combines pranayama with chanting of mantras, effective for:

• Obsessive-compulsive disorder

Benefits of Yoga and Meditation

• Enhances well-being, mood, attention, mental focus, stress tolerance
• Reduces depression (shown by NIMHANS research)
• Helps alcoholic patients reduce depression and stress
• Treats insomnia - reduces time to sleep and improves quality
• Mindfulness meditation prevents repeated episodes of depression

Rehabilitation of the Mentally Ill

Treatment has two components:

1. Reduction of symptoms
2. Improving level of functioning/quality of life

For severe disorders (e.g., schizophrenia): Symptom reduction may not improve quality of life, requiring rehabilitation.

Rehabilitation Techniques

• Occupational therapy: Teaching skills like candle making, paper bag making
• Social skills training: Developing interpersonal skills through role play
• Cognitive retraining: Improving attention, memory and executive functions
• Vocational training: Gaining skills for productive employment

Review Questions

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

Project Ideas

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