Facts That Matter
Psychotherapy is a voluntary relationship between the one seeking treatment or the
client and the one who treats or the therapist.
(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.
The special relationship between the client and the therapist is known as the therapeutic
relationship or alliance.
(i) It is a trusting and confiding relationship.
(ii) 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.
Classification of Psychotherapies
A. PSYCHODYNAMIC THERAPY (Sigmund Freud, Carl Jung, Neo-Freudians) Methods of Eliciting the Nature of Intrapsychic Conflict:
1. Free Association:
(i) Therapeutic relationship is established, client feels comfortable—therapist makes client lie down on the couch, close their eyes and asks them to speak whatever comes to mind without censoring it.
(ii) Client is encouraged to freely associate one thought with another (free association).
(iii) Censoring supere go and the watchful ego are kept in abeyance—client speaks whatever comes to mind in a relaxed and trusting atmosphere.
(iv) Therapist does not interrupt; the free flow of idea, desires and conflicts of the unconscious, which had been suppressed by the ego, emerge into the conscious mind.
2. Dream Analysis:
(i) Client is asked to write down his/her dreams upon waking up.
(ii) Drams are symbols of the unfulfilled desires of the unconscious.
(iii) Dreams use symbols which signify intrapsychic forces because they are indirect expressions and hence would not alert the ego.
(iv) If unfulfilled desires are expressed directly, the ever-vigilant ego would suppress them, leading to anxiety.
(v) Symbols are interpreted according to an accepted convention of translation as the indicators of unfulfilled desires and conflicts.
Modality of Treatment:
(a) Transference: The client starts identifying the therapist with the authority figures of the past, usually childhood.
(i) The therapist maintains a non-judgmental and permissive attitude and allows the client to continue with this process of emotional identification.
(ii) Transference Neurosis: The therapist becomes a substitute for that person in the present—the client acts out the frustrations, anger, fear, that he/she harboured towards that person in the past, but could not express at the time.
(b) Resistance: The client opposes the progress of therapy in order to protect himself/herself from the recall of painful unconscious memories.
(i) Conscious Resistance: The client deliberately hides some information
(ii) Unconscious Resistance: The client becomes silent during the therapy session, recalls trivial details without recalling the emotional ones, misses appointments, and comes late for therapy sessions.
(iii) The therapist overcomes the resistance by repeatedly confronting the patient about it and by uncovering emotions such as anxiety, fear 0’r shame, which are causing the resistance.
(c) Interpretation: The therapist uses the unconscious material that has bee n uncovered to make the client aware of the psychic contents and conflicts which, have led to the occurrence of certain events, symptoms and conflicts.
(i) Subtle process, the pinnacle of psychoanalysis.
(ii) Two analytical techniques:
Working Through: The repeated process of using confrontation, clarification and interpretation.
(i) Helps the patient understand the source of the problem and to integrate the uncovered material into his/her ego.
Insight: A gradual process wherein the unconscious memories are repeatedly integrated into conscious awareness; these unconscious events and memories are re-experienced in transference and are worked through.
(i) End-point of psychoanalysis, client gains a new understanding on him/ herself- conflicts of the past, defence mechanisms and physical symptoms are no longer present.
(ii) Intellectual Insight: The client starts understand herself/himself better at an intellectual level.
(iii) Emotional Insight: The emotional understanding, acceptance of one’s irrational reaction to the unpleasant events o the past, and the willingness to change emotionally as well as making the change.
Duration of Treatment
(i) Initial Phase: Client becomes familiar with the routines, establishes a therapeutic relationship, and recollects the superficial material from the consciousness about the past and present.
(ii) Middle Phase: Characterised by transference, resistance on the part
of the client, and confrontation, clarification and working through on the therapist’s part; all these processes finally lead to insight.
(iii) Third Phase: Termination; the relationship with the analyst is dissolved and the client prepares to leave the therapy.
B. Behaviour Therapy
Method of Treatment:
(i) The client is interviewed with a view to analyse his/her behaviour patterns.
(ii) Behavioural analysis is conducted to find:
(a) Malfunctioning Behaviours: Behaviours which cause distress to the client.
(b) Antecedent Factors: Those causes which predispose the person to indulge in that behaviour
(c) Maintaining Factors: Those factors which lead to the persistence of the faulty behaviour.
(iii) Aim: To eliminate the faulty behaviours and substitute them with adaptive behaviour patterns.
(a) Antecedent Operations: Control behaviour by changing something that precedes such a behaviour.
(b) Establishing Operations: Induce a change in behaviour by increasing or decreasing the reinforcing value of a particular consequence.
(c) Consequent Operation: i.e., Giving reinforcement eg. Praise.
C. Cognitive Therapy
1. Rational Emotive Therapy (RET) (Albert Ellis):
Antecedent events, which caused the psychological distress, are noted.
(ii) Client is interviewed to find out irrational beliefs, which distorting the
(iii) The therapist encourages this by being accepting, empathic, genuine and warm to the client.
(iv) The therapist conveys by his/her words and behaviours that he/she 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 he/she may have done or thought about. This is the unconditional positive regard which the therapist has for the client.
The clinical formulation is an ongoing process. Formulations may require reformulations as clinical insights are gained in the process of therapy. Distorted perception of the antecedent event due to the irrational belief leads to the consequence, i.e., negative emotions and behaviours.
(i) Nature of questioning is gentle, without probing or being directive.
(ii) Make the client think deeper into his/her assumptions about life and problems.
2. Aaron Beck’s Cognitive Therapy:
(i) Childhood experiences provided by the family and society develop core schemes or systems, which include beliefs and action patterns in the individual.
(ii) Critical events in the individual’s life trigger the core, leading to the development of negative automatic thoughts.
(iii) Negative thoughts are persistent irrational thoughts characterised by cognitive distortions.
(iv) Dysfunctional Cognitive Structures: Patterns of thought which are general in nature but which distort the reality in a negative manner.
(v) Repeated occurrence of these thoughts leads to the development of feelings of anxiety and depression.
3. Cognitive Behaviour Therapy (CBT):
D. Humanistic-Existential Therapy
Self-actualizationn is defined as an innate force that moves the person to become more complex, balanced, and integrated; integrated means a sense of whole, being a complete person.
1. Self-actualization requires free emotional expression:
(a) The family and society curb emotional expression, as it is feared that a free expression of emotions can harm society by unleashing destructive forces.
(b) When emotionally expression is curbed, destructive behaviour and negative emotions by thwarting the process of emotional integration.
2. Healing occurs when the client is able to perceive the obstacles to self-actualization in his/her life and is able to remove them.
3. Therapy creates a permissive, non-judgemental and accepting atmosphere in which the client’s emotions can be freely expressed.
4. The client has the freedom and responsibility to control his/her own behaviour; the therapist is merely a facilitator and guide. The chief aim of the therapy is to expand the client’s awareness.
1. Existential Therapy [Logotherapy (Victor Frankl)]:
2. Client-centered Therapy (Carl Rogers):
(i) Shows empathy—understands the client’s experience as if it were his/her own—sets up an emotional resonance between client and therapist.
(ii) Warmth—the client feels secure and can trust the therapist.
(iii) Has unconditional positive regard, i.e., total acceptance of the client as he/she is, indicates that the positive warmth of the therapist is not dependent on what the client reveals or does in the therapy sessions.
3. Gestalt Therapy (Frederick and Laura Pearl):
E. Biomedical Therapy
Prescription of medicines is done by psychiatrists (qualified medical doctors who have specialized in the understanding, diagnosis and treatment of mental disorders). The nature of medicines used depends on the nature of the disorder:
(i) Anti-psychotic drugs—severe mental disorders (schizophrenia, bipolar disorder).
(ii) Milder drugs—common mental disorders (generalized anxiety, reactive depression).
Cause side-effects which need to be understood and monitored—essential that medication is given under proper medical supervision.