Therapeutic Approaches Notes in English Class 12 Psychology Chapter-5 Book-1

Introduction

The previous chapter discussed psychological disorders and their impact on individuals and others. This chapter focuses on various psychotherapies used to help patients recover. Psychotherapies differ—some aim to build self-understanding, while others are action-based. Their success depends on factors like the severity of the disorder, distress level, and available resources. All therapies aim to help and involve a relationship between therapist and client. Some therapies are directive (like psychodynamic), while others are non-directive (like person-centred). This chapter introduces the major forms of psychotherapy.

NATURE AND PROCESS OF PSYCHOTHERAPY

Psychotherapy is a voluntary and professional relationship between a client and a therapist, aimed at resolving the client’s psychological problems. It creates a trusting environment for open communication. The goal is to reduce personal distress, change maladaptive behaviors, and help the client adapt better in life areas like work, marriage, or society. Key features of psychotherapy include: (i) use of systematic, theory-based methods, (ii) practice only by trained professionals, (iii) a focused interaction between therapist and client, and (iv) a confidential and dynamic therapeutic relationship. Common goals of psychotherapy include reducing emotional stress, promoting personal growth, changing thought patterns and habits, improving relationships, enhancing self-awareness, and aiding better decision-making.

Therapeutic Relationship 

The therapeutic relationship, or alliance, is a special, temporary bond between the therapist and the client, aimed at helping the client overcome psychological problems. It is built on two key components: (1) a mutual, goal-oriented partnership, and (2) a limited duration lasting only until the client gains independence. This trusting relationship allows the client to share deeply personal issues. The therapist supports this by showing unconditional positive regard (non-judgmental acceptance), empathy (feeling from the client’s perspective), and genuineness. Empathy here means understanding and emotionally connecting with the client's experiences, unlike sympathy or cold intellectual understanding. Confidentiality is crucial — the therapist must protect the client’s privacy and maintain professionalism at all times. This respectful, supportive bond forms the foundation for healing and growth.

TYPE OF THERAPIES

Psychotherapy helps people deal with emotional distress and improve behaviour. Though the goal is the same, different types of therapy use different concepts, methods, and techniques.

Three Main Types of Psychotherapy

• Psychodynamic Therapy – Focuses on inner conflicts (First to emerge)

• Behaviour Therapy – Focuses on learned behaviour (Second)

• Existential Therapy (Humanistic) – Focuses on meaning and personal growth (Third force)

Comparison Based on Key Questions

1. What causes the problem?

2. How did the problem develop?

3. What is the method of treatment?

4. What is the therapist–client relationship like?

5. What does the client gain?

6. How long does it take?

Common Elements in All Therapies

Psychotherapies aim to reduce psychological distress and improve mental well-being using psychological methods rather than medication. The process involves a collaborative effort between the therapist and the client, where the therapy setting and techniques are used to bring about positive emotional and behavioral change.

Beginning of Psychotherapy

Psychotherapy begins with problem formulation, which involves identifying the client’s main issue, understanding their personal background, and collaboratively setting specific goals for therapy. This helps guide the treatment process effectively and ensures it is tailored to the client’s needs.

Making a treatment plan

Behaviour Therapy

Behaviour therapy is based on the idea that psychological problems arise from faulty behaviour or thought patterns. It focuses on correcting these patterns in the present, rather than reliving the past. The origins of these issues may be understood from past experiences, but therapy works to change current behaviours and thoughts. It uses techniques derived from learning theory, and is not a one-size-fits-all approach. The choice of technique depends on the client’s specific symptoms and diagnosis—for example, treating phobias, anger issues, or depression would each require different methods. The main goal is to identify problematic behaviours, understand what reinforces them, and then apply strategies to modify or eliminate them effectively.

Method of Treatment 

Behavioural analysis helps understand a client's distress by identifying faulty behaviours, their causes (antecedent factors), and what maintains them (maintaining factors). For example, a person who smokes to reduce exam-related anxiety finds relief, making anxiety the cause and relief the reward that keeps the behaviour going. Through interviews, therapists identify such patterns and then apply treatments aimed at replacing faulty behaviours with healthier ones. This is done using antecedent operations (changing what happens before the behaviour) and consequent operations (changing what happens after). For instance, reducing snacks before dinner (antecedent) and praising a child for eating dinner (consequent) helps reinforce healthy eating habits.

Behavioural Techniques

Behaviour therapy uses various techniques to change faulty behaviours by reducing arousal, using reinforcement, and applying learning principles. Negative reinforcement involves escaping unpleasant stimuli (like wearing woollens to avoid cold), while aversive conditioning pairs an unwanted behaviour (like drinking alcohol) with an unpleasant consequence (like a shock). Positive reinforcement increases good behaviour—e.g., rewarding a child for doing homework. In token economy, desired behaviour earns tokens which are later exchanged for rewards. Differential reinforcement reduces unwanted behaviour while increasing desired actions, often by ignoring bad behaviour and reinforcing good behaviour—like ignoring a child’s sulking but rewarding polite requests. Systematic desensitisation (by Wolpe) treats phobias by gradually exposing clients to feared situations while keeping them relaxed, based on the principle of reciprocal inhibition. Modelling helps clients learn by observing a role model or therapist. The therapist’s skill lies in selecting and combining the right techniques after analysing the client’s behaviour.

Cognitive Therapy

Cognitive therapies aim to reduce psychological distress by identifying and changing irrational thoughts and beliefs. Albert Ellis’s Rational Emotive Therapy (RET) explains that it is not events themselves but our irrational beliefs about them that cause distress. RET uses the ABC model—Antecedent (event), Belief (irrational thought), and Consequence (emotional/behavioural outcome). The therapist helps the client identify and challenge irrational beliefs (like “I must be loved by everyone”), replacing them with rational ones to reduce distress.

Aaron Beck’s Cognitive Therapy focuses on how early experiences form negative core schemas (like “I am unwanted”), which trigger automatic negative thoughts during stressful events. These thoughts (e.g., “I am a failure”) lead to anxiety and depression. Such thoughts involve cognitive distortions, which misinterpret reality negatively. The therapist gently questions these beliefs to promote cognitive restructuring—helping the client see things more realistically and positively.

Cognitive therapy is short-term (10–20 sessions), transparent, and problem-focused, making it more direct and collaborative compared to psychodynamic therapy.

Cognitive Behaviour Therapy

Cognitive Behaviour Therapy (CBT) is currently the most widely used and effective form of psychotherapy. It is a short-term treatment proven to work well for disorders like anxiety, depression, panic attacks, and borderline personality. CBT follows a bio-psychosocial approach, combining cognitive therapy (to change irrational thoughts) with behavioural techniques (to modify faulty behaviour). It addresses biological factors through relaxation, psychological issues through cognitive and behavioural strategies, and social factors through environmental changes. This makes CBT a comprehensive, practical, and highly effective therapy for various psychological problems.

Humanistic-existential Therapy

Humanistic-existential therapies view psychological distress as arising from loneliness, alienation, and lack of meaning in life. These therapies focus on personal growth, self-actualisation, and emotional integration. When society or family blocks emotional expression and self-growth, it leads to distress. Therapy creates a non-judgmental, accepting space for clients to freely express emotions and find balance and wholeness. The therapist acts as a guide, but the client takes responsibility for healing through self-awareness. Existential therapy, especially Logotherapy by Viktor Frankl, helps individuals find meaning even in suffering. It focuses on spiritual aspects of life and treats existential anxiety by guiding clients to discover purpose and responsibility.

Client-centred Therapy

Client-centred therapy, developed by Carl Rogers, focuses on helping individuals reconnect with their true selves through a warm, accepting, and empathetic therapeutic relationship. The therapist offers unconditional positive regard and empathy, allowing the client to feel safe, understood, and free to explore their feelings. By reflecting the client’s thoughts in a nonjudgmental way, the therapist facilitates emotional integration and personal growth. Gestalt therapy, developed by Fritz and Laura Perls, aims to enhance self-awareness and self-acceptance. It encourages clients to become aware of blocked emotions and bodily sensations, often through role-play or acting out feelings.

Factors Contributing to Healing in Psychotherapy

Psychotherapy helps reduce psychological distress through various healing factors. First, the techniques used by the therapist, like relaxation in CBT or behaviour therapy, play a major role in treatment. Second, the therapeutic alliance—a warm, empathetic, and consistent relationship between client and therapist—supports recovery. Third, the process of catharsis, where clients release emotional pain during initial sessions, also aids healing. Lastly, non-specific factors, such as the client’s motivation and hope (patient variables), and the therapist’s emotional stability and positivity (therapist variables), contribute to success across all therapy types.

Ethics in Psychotherapy

Some of the ethical standards that need to be practiced by professional psychotherapists are :

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 of all attempts of the therapist.

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 therapies offer treatment options beyond conventional medicine or psychotherapy. Popular approaches include yoga, meditation, acupuncture, and herbal remedies. Yoga, based on Patanjali’s Ashtanga Yoga, and meditation practices like Vipasana (mindfulness), are effective in managing psychological distress. Techniques such as Sudarshan Kriya Yoga (SKY) improve mood, focus, stress tolerance, and are useful in treating depression, PTSD, insomnia, and substance abuse. Research at NIMHANS shows that SKY reduces depression and stress in alcoholics. Kundalini Yoga, combining breathing and chanting, has helped treat obsessive-compulsive disorder (OCD). A daily 30-minute practice with expert guidance enhances these benefits. 

REHABILITATION OF THE MENTALLY ILL 

Treatment of psychological disorders involves two main goals: reducing symptoms and improving quality of life. In milder conditions like anxiety or phobia, symptom relief often leads to better living. However, in severe disorders like schizophrenia, even after symptoms reduce, patients may still lack motivation or social interest. Rehabilitation helps such individuals become more self-sufficient through occupational therapy (e.g., candle or bag making), social skills training (via role-play and instruction), cognitive retraining (to improve attention and memory), and vocational training (to build employable skills). The overall aim is to help them function productively in society.