PSYCHOLOGICAL TREATMENT/
THERAPIES
Psychotherapy is a form of mental health treatment that involves a
collaborative process between a trained therapist and an individual, couple,
family, or group. The primary goal of psychotherapy is to help people overcome
emotional or psychological difficulties, improve their mental well-being, and
enhance their overall quality of life. It helps in learning more adaptive ways of
perceiving, evaluating, and behaving.
The three types of mental health professionals who most often administer
psychological treatment in mental health settings are clinical psychologists,
psychiatrists, and psychiatric social workers. In addition to their being able to
provide psychotherapy, the medical training and licensure qualifications of
psychiatrists enable them to prescribe psychoactive medications and also to
administer other forms of medical treatment such as electroconvulsive therapy.
Why people seek mental therapy?
These are the motivations to involve in a therapy
 Stressful Current Life Circumstances
 People with Long-Standing Problems
 People Who Seek Personal Growth
What are key elements of therapeutic alliance?
(1) a sense of working collaboratively on the problem,
(2) agreement between patient and therapist about the goals and tasks of
therapy, and
(3) an affective bond between patient and therapist for a limited duration
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
Steps in the Formulation of a Client’s Problem1.Understanding of the problem
2.Identification of the areas to be targeted for treatment in psychotherapy
3.Choice of techniques for treatment
Clinical Approaches
1.Behavioural therapy- 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.
Method of Treatment- A range of Behavioural 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.
1.Exposure therapy (Systematic desensitisation) – Joseph Wolpe introduced
this technique for treating phobias or irrational fears.
-In this the client is interviewed to elicit fear - provoking situations and
together with the client, the therapist prepares a hierarchy of anxietyprovoking stimuli with the least anxiety-provoking stimuli at the bottom of
the hierarchy.
-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.
-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. 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.
2. Modelling – It 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. For example, modelling may be used to
promote the learning of simple skills such as self-feeding for a child with
profound mental retardation or more complex skills such as being more
effective in social situations for a shy, withdrawn adolescent.
3. Aversive therapy – It 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.
4.Token economy- 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. Differential reinforcement - 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. The latter method is less painful and
equally effective. For example, let us consider the case of 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 behaviour of politely asking to be taken to
the cinema increases and the unwanted behaviour of crying and sulking
decreases.
2. Cognitive Therapy- Cognitive therapies locate the cause of
psychological distress in irrational thoughts and beliefs.
A. Rational emotive therapy (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-beliefconsequence (ABC) analysis.
- 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 ‘should’, 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”.
-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. 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.
B.
Beck’s Cognitive Therapy (Aaron Beck) - According to Beck,
Childhood experiences provided by the family and society develop core
schemas or systems, which include beliefs and action patterns in the
individual. During the course of life, a critical incident occurs in her/his
life. This critical incident triggers the core schema Like “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 characterised 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.
-During the therapy, clients are made aware of the connection between
their patterns of thinking and their emotional responses by the therapist
using questioning, which is gentle, non-threatening disputation of the
client’s beliefs and thoughts. They are first taught simply to identify their
own automatic thoughts (such as, “This event is a total disaster”) and to
keep records of their thought content and their emotional reactions.
With the therapist’s help, they then identify the logical errors in their
thinking and learn to challenge the validity of these automatic
thoughts. It is important to note, however, that in Beck’s cognitive
therapy, clients do not change their beliefs by debate and confrontation
as is common in RET. Rather, they are encouraged to gather information
about themselves. The aim of the therapy is to achieve this cognitive
restructuring which, in turn, reduces anxiety and depression.
C. COGNITIVE BEHAVIOUR THERAPY - CBT adopts a biopsychosocial approach to the delineation of psychopathology. It
combines cognitive therapy with behavioural techniques. The rationale is
that the client’s distress has its origins in the biological, psychological,
and social realms.
Hence, addressing the biological aspects through relaxation procedures
(Relaxation procedures are used to decrease the anxiety levels. For
instance, progressive muscular relaxation and meditation induce a state
of relaxation.),
the psychological ones through behaviour therapy (use of behavioural
techniques to reduce the faulty behavioural learning and engaging in
constructive, desired and adaptive behaviour) and cognitive therapy
techniques (This involves identifying and challenging irrational or
distorted thought patterns. Clients work to replace negative thoughts
with more balanced and realistic ones.)
and the social ones with environmental manipulations (modifying
aspects of a person's surroundings or context to influence thoughts,
feelings, and behaviours, for instance, someone struggling with insomnia
might be advised to associate their bed only with sleep and relaxation,
avoiding stimulating activities in the bedroom.) makes CBT a
comprehensive technique which is easy to use, applicable to a variety of
disorders, and has proven efficacy.
The collaborative nature of CBT allows therapists and clients to work
together to develop and implement strategies tailored to the individual's
specific challenges and goals.
D.
Humanistic-existential Therapy- 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-actualization, and an innate need to grow emotionally.
When these needs are curbed by society and family, human beings
experience psychological distress. 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. 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-actualisation requires free emotional expression.
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. 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. 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.
Therapies –
A. Logotherapy - Logotherapy is administered through dialogue and
therapeutic conversation (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.)
between the logo therapist and the individual seeking treatment. The
therapist helps the individual explore and discover meaning in their life,
addressing existential concerns and guiding them toward a deeper
understanding of their purpose.
B. Client-centred Therapy (Carl Rogers) - Client-cantered therapists
establish a psychological climate in which clients can feel unconditionally
accepted (unconditional positive regard, i.e. total acceptance of the
client as s/he is), understood, and valued as people. Within this context,
the therapist employs nondirective techniques such as empathic
reflecting, or restatement of the client’s descriptions of life difficulties. If
all goes well, clients begin to feel free, for perhaps the first time, to
explore their real feelings and thoughts and to accept hates and angers
and ugly feelings as parts of themselves. As their self-concept becomes
more congruent with their actual experience, they become more selfaccepting and more open to new experiences and new perspectives; in
short, they become better-integrated people. This therapy helps a client
to become her/his real self with the therapist working as a facilitator.
C. Motivational Interviewing - MI differs from client-cantered
counselling because it also employs a more direct approach that explores
the client’s own reasons for wanting to change. The therapist encourages
this “change talk” by asking the client to discuss his or her desire, ability,
reasons, and need for change. These are reflected back by the therapist,
thus exposing the client to periodic summaries of his or her own
motivational statements and thoughts about change. The result is that
clients can develop and strengthen their commitment to change in an
active, accepting, and supportive atmosphere.
D. Gestalt Therapy (Freiderick (Fritz) Perls with his wife Laura
Perls) - In German, the term gestalt means “whole,” and gestalt therapy
emphasizes the unity of mind and body—placing strong emphasis on the
need to integrate thought, feeling, and action. The goal of gestalt
therapy is to increase an individual’s self-awareness and self-acceptance.
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.
E. Psychodynamic therapy - Psychodynamic therapy is an approach to
psychotherapy that explores the unconscious mind and its influence on
an individual's thoughts, emotions, and behaviours. Rooted in
psychoanalytic principles, psychodynamic therapy seeks to uncover and
understand the deep-seated psychological processes that shape a
person's experiences and behaviours. Psychodynamic therapy posits that
much of human behaviour is determined by unconscious factors,
including unresolved conflicts, repressed memories, and unconscious
desires. These factors may influence current thoughts and behaviours
without the individual's awareness.
The therapy focuses on the dynamic interplay between different parts of
the mind, such as the id, ego, and superego, as proposed by Sigmund
Freud. The therapist helps the individual explore conflicts and tensions
within these psychological structures.
Therapies-
Freudian Psychoanalysis - Psychoanalysis is a form of psychotherapy and
a comprehensive psychological theory developed by Sigmund Freud. It
aims to explore the unconscious mind and bring repressed thoughts and
feelings into conscious awareness.
Key concepts and techniques in psychoanalysis include:
Free Association: A key technique in psychoanalysis, free association
involves clients expressing thoughts and feelings without censorship.
This process allows the emergence of unconscious material, providing
insight into the individual's inner conflicts.
Dream Analysis: Freud believed that dreams are the "royal road to the
unconscious." Psychoanalysts analyse dream content to uncover hidden
meanings and symbols, aiming to bring unconscious material into
conscious awareness. Dream has two kinds of content: (1) manifest
content, which is the dream as it appears to the dreamer, and (2) latent
content, which consists of the actual motives that are seeking expression
but are so painful or unacceptable that they are disguised. It is a
therapist’s task, in conjunction with the associations of the patient, to
uncover these disguised meanings by studying the images that appear in
the manifest content of a client’s dream and in the client’s associations
to them. For example, a client’s dream of being engulfed in a tidal wave
may be interpreted by a therapist as indicating that the client feels in
danger of being overwhelmed by inadequately repressed fears or
hostilities.
Analysis of Resistance: During the process of free association or of
associating to dreams, an individual may evidence resistance—an
unwillingness or inability to talk about certain thoughts, motives, or
experiences. Because resistance prevents painful and threatening
material from entering awareness, its sources must be sought if an
individual is to face the problem and learn to deal with it in a realistic
manner. Therapist helps client to uncover such emotions causing
resistance
Transference neurosis: Transference occurs when clients unconsciously
transfer feelings and attitudes from past relationships onto the therapist.
Analysing transference can provide insights into the client's interpersonal
patterns. (Countertransference, the therapist's emotional reactions to
the client, is also explored as it can provide insight into the client's
dynamics but countertransference must be checked and handles
properly as it can undervalue the effect of therapy.)
Interpretation: It is a subtle process, 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 by using 2
techniques – confrontation (that his psyche must be faced by the client)
and clarification (therapist brings confusing or vague event into sharp
focus).
Repeated process of confrontation, clarification and interpretation is
known as working through, this helps patients to understand themselves
and the source of problem and to integrate uncovered material into their
ego.
Insight and Self-Reflection: The goal of psychodynamic therapy is to
increase self-awareness and insight into unconscious processes. Through
this self-reflection, individuals can gain a better understanding of their
emotions, motivations, and ways of relating to others.
F. Couple and Family Therapy
Couple Therapy - Relationship problems are a major cause of emotional
distress. The large numbers of couples seeking help with troubled
relationships have made couple counselling a growing field of therapy.
Typically, the couple is seen together. Improving communication skills
and developing more adaptive problem-solving styles are both major foci
of clinical attention.
For many years the gold standard of couple therapy has been traditional
behavioural couple therapy (TBCT)- TBCT is based on a social-learning
model and views marital satisfaction and marital distress in terms of
reinforcement. The treatment is usually short term (10 to 26 sessions)
and is guided by a manual. The goal of TBCT is to increase caring
behaviours in the relationship and to teach partners to resolve their
conflicts in a more constructive way through training in communication
skills and adaptive problem solving. But this therapy didn’t work for all
couples and hence a newer therapy developed known as IBCT.
Integrative behavioural couple therapy (IBCT)- IBCT focuses on
acceptance and includes strategies that help each member of the couple
come to terms with and accept some of the limitations of his or her
partner. Of course, change is not forbidden. Rather, within IBCT,
acceptance strategies are integrated with change strategies to provide a
form of therapy that is more tailored to individual characteristics,
relationship “themes” (long-standing patterns of conflicts), and the
needs of the couple. r data show that couples who stay together after
receiving IBCT are significantly happier than couples who stay together
following treatment with TBCT
Family Therapy- Family therapy began with the finding that many
people who had shown marked clinical improvement after individual
treatment—often in institutional settings—had a relapse when they
returned home.
Structural family therapy - This approach is based on systems theory
which holds that if the family context can be changed, then the
individual members will have altered experiences in the family and will
behave differently in accordance with the changed requirements of the
new family context. Thus, an important goal of structural family therapy
is changing the organization of the family in such a way that the family
members will behave more supportively and less pathogenically toward
each other. For this therapist tries to get along with the family members
and try to get the reason for maladaptive behaviours and conflict
generating casual factors and then therapist acts as an altering agent of
family interactions to achieve the goal of therapy.
Eclecticism and Integration
Eclecticism and integration in psychotherapy refer to the incorporation
of diverse therapeutic approaches and techniques into a cohesive and
tailored treatment plan.
Therapists may draw on various techniques, interventions, and
perspectives based on the individual needs of the client.
Integration involves combining different theoretical frameworks or
methods into a unified and coherent therapeutic approach. Therapists
may integrate elements from cognitive-behavioural, psychodynamic,
humanistic, and other approaches to address the complexity of clients'
issues.
This approach recognizes that no single therapeutic model fits all clients,
and flexibility is essential for effective treatment. For example, a
therapist might use cognitive-behavioural techniques to address anxiety
while incorporating psychodynamic exploration for underlying issues.
Therapists practicing eclecticism or integration need to be well-trained
and competent in multiple therapeutic approaches. A case study is given
for the same
Let's consider a client named Sarah who is struggling with anxiety and
low self-esteem. A therapist practicing eclecticism might integrate
elements from cognitive-behavioural therapy (CBT), humanistic therapy,
and psychodynamic therapy.
1. Cognitive-Behavioural Therapy (CBT):
 The therapist may incorporate CBT techniques to help Sarah
identify and challenge irrational thoughts contributing to her
anxiety.
 Sarah might be taught cognitive restructuring exercises to reframe
negative thought patterns and replace them with more realistic
and positive beliefs.
2. Humanistic Therapy:
 Drawing from humanistic approaches like person-cantered
therapy, the therapist might emphasize creating a safe and
empathetic therapeutic relationship.
 The therapist may encourage Sarah to explore her feelings,
express herself authentically, and work towards self-actualization.
3. Psychodynamic Therapy:
Exploring the root causes of Sarah's anxiety and low self-esteem,
the therapist may use psychodynamic techniques.
 Uncovering unconscious conflicts, examining past experiences,
and understanding the impact of early relationships on Sarah's
current emotional state could be key components.
4. Mindfulness and Relaxation Techniques:
 Integrating techniques from mindfulness-based therapies, the
therapist might teach Sarah relaxation exercises and mindfulness
practices to manage her anxiety symptoms in the present
moment.
5. Goal Setting and Behavioural Interventions:
 Incorporating behavioural therapy elements, the therapist may
work with Sarah to set realistic goals and implement behavioural
interventions to gradually confront and overcome anxietyprovoking situations.
