1. Describe the nature and scope of psychotherapy. Highlight the importance of therapeutic relationship in psychotherapy.
Answer : Nature and scope of psychotherapy: 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 behaviours, 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.
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.
(ix) Becoming aware of one’s choices in life.
(x) Relating to one’s social environment in a more creative and self-aware manner.
The special relationship between the client and the therapist is known as the therapeutic relationship or alliance. There are two major components of a therapeutic alliance:
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.
This 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 encourages this by being accepting,
empathic, genuine and warm to the client. The 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.
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.
2. What are the different types of psychotherapy? On what basis are they classified?
Answer : Different types of psychotherapy are:
(i) Psychodynamic therapy
(ii) Behaviour therapy
(iii) Humanistic-existential therapy
(iv) Biomedical therapy
Also, there are are many alternative therapies such as yoga, meditation, acupuncture, herbal remedies etc.
Basis of classification of psychotherapy:
(i) On the cause which has led to the problem: 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.
(ii) On how did the cause come into existence: The psychodynamic therapy, unfulfilled desires of childhood and unresolved childhood fears lead to intrapsychic conflicts.
(iii) What is the chief method of treatment?: Psychodynamic therapy uses the methods of free association and reporting of dreams to elicit the thoughts and feelings of the client.
(iv) What is the nature of the therapeutic relationship between the client and the therapist?: 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.
(v) What is the chief benefit to the client?: Psychodynamic therapy values emotional insight as the important benefit that the client derives from the treatment. 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.
(vi) On the duration of treatment: The duration of classical psycho- analysis may continue for several years. However, several recent versions of psychodynamic therapies are completed in 10–15 sessions.
3. A therapist asks the client to reveal all her/his thoughts including early childhood experiences. Describe the technique and type of therapy being used.
Answer : In this case psychodynamic therapy is used in the treatment of the client. 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. 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. 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. 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 verbal narrative of the client is a window into the client’s unconscious to which the therapist gains access. 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. 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 egowould 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.
4. Discuss the various techniques used in behaviour therapy.
Answer : Various techniques used in behaviour therapy:
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.
Negative reinforcement and aversive conditioning are the two major techniques of behaviour modification.
(i) Negative reinforcement refers to following an undesired response with an outcome that painful or not liked. For example, one learns to put on woollen 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.
(ii) 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.
(iii) Positive reinforcement is given to increase the deficit if an adaptive behaviour occurs rarely. 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. The positive reinforcement of food will increase the behaviour of doing homework at the appointed time.
(iv) Token economy in which 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.
(v) 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. 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.
5. Explain with the help of an example how cognitive distortions take place.
Answer : 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.
Aaron Beck's theory of psychological distress 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 characterised by cognitive distortions. 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.