CHAPTER 5: THERAPEUTIC APPROACHES

THERAPEUTIC RELATIONSHIP
The special voluntary relationship between a client and therapist is known as therapeutic
alliance. There are two components of therapeutic alliance; the contractual nature of relationship
in which two individuals willingly enter a partnership. This relationship is time bound. This
relationship lasts until the client is able to deal with their problems. This relation is also entrusted
by warmth and trust. The therapist with words and behavior to show a non judging environment
to the client, even if the client shows rude behavior and this is known as POSITIVE
UNCONDITIONAL REGARD. The therapist also shows intellectual understanding of another
person’s situation called EMPATHY.

Behavior therapy
This postulates that the cause of psychological distress ; faulty behavior pattern or thought
pattern.
Thus the focus on the behavior and the thought of the client in present. The past events are
relevant only to understand the cause of faulty thought and behavior patterns. This is not to
activate or relive the past.
This includes specific techniques and interventions. Not an unified theory ; applied irrespective
of the clinical diagnosis are the guiding factors in the selection and application of intervention
and techniques.
The foundation is to formulate on the dysfunctional or faulty behavior ; and the factors reinforce
and to maintain them, To alternate them .
Method of treatment : the client with psychological distress or any physical symptoms and
analyzed to understand the behavior pattern (no attribute of physical disease). The analysis is to
find the dysfunctioning behavior or thought pattern, antecedents of faculty learning and the

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factors continuing it.

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Malfunctioning behavior: any behavior which causes distress to the client.

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Antecedents factors: these are factors that predispose a person to indulge in the behavior.
Maintaining factors: the factors that lead to the persistence of faulty behavior.

Example: smoking - relief from anxiety - anxiety provoking - relief -acquired the operant
response( the relief make the smoking to be repeated to release anxiety)
When the faulty behavior is identified the treatment plan is chosen. The aim is to eliminate the
faulty behavior and to substitute them for adaptive behavior. This is done establishing antecedent
and consequent operations.
Antecedent operation: control behavior by changing something that precedes such as behavior.
The change can be done by increasing or decreasing the reinforcing value of a particular
response.
BEHAVIORAL TECHNIQUES
The aim of behavioral techniques is to reduce the arousal level of the client, alter their behavior
by classical or operant conditioning. Negative reinforcement
Aversive conditioning
Responses that lead organisms to get rid of painful stimuli or avoid and escape from it. NR
The repeated association of undesired response with aversive consequence. AC
Positive reinforcement is given to increase the elicit behavior.
TOKEN ECONOMY : the person with behavior problems is given a token as a reward every
time a wanted behavior is done by them. the n tokens can be collected and exchanged for a
reward.
Differential reinforcemnt : the positive reinforcement for wanted behavior and negative
reinforcement for unwanted behavior both done together.

SYSTEMATIC DESENSITISATION
The technique by WOLPE for treating phobias /irrational fears.
The client is inerviewed to elicit the fear provoking situstion.
With the help of clients an hierarchy is created from the least provoking to most.
The therapist relaxes the client and thinks of the provoking situation from the least. The sessions
are stopped when the client feels a slightest anxiety. As the session proceeds the client is able to
imagine the provoking situations while maintaining relaxation. Thus the client is getting
systematically desensitised to the fear.
RECIPROCAL INHIBITION
The principle is that two mutually opposing forces at same time inhibit the weaker force.
MODELLING
The client learns to behave in a certain way by observing the behavior; the role model is initially
the therapist.
RELAXING PROCEDURE
Anxiety is the manifestation of a psychological distress. Progressive muscle relaxation and
meditation induce a state of relaxation. In PMR the client is thought to contact individual muscle
groups in order to give awareness of their muscle tension .Once the client learns about the
individual muscle group tenseness, the client is asked to let it go. The client has tension in the
present and has to go to the other state. By repeated practice the client learns to relax all the body
muscles.

COGNITIVE THERAPY
The cause of psychological distress is in irrational thoughts and beliefs.
ALBERT ELLIS formulated RATIONAL EMOTIVE THERAPY (RET) , this postulates that the
irrational belief mediates between antecedent event and consequences.
First step RET is ABC
A ;ANALYSIS the antecedent events that caused psychological distress.
B; BELIEFS the client is interviewed to understand their irrational beliefs, that are distorted in
reality. This is not supported by any empirical evidence but by the thoughts of must, should.
C ; CONSEQUENCE that are negative emotions and behavior.
The distorted perception of antecedent events due to irrational beliefs leads to consequence. The
irrational beliefs are assessed by interview or questionnaire in RET. The irrational beliefs are
refuted by the therapist by non-directive questioning.(gentle and indirective). Thus slowly they
are able to change their philosophy of life. The irrational belief system is replaced by a rational
belief system.
ARON BECK : the cognitive therapy of him in the assumption that psychological distress is
caused by anxiety or depression,states that the childhood experience provided by the family and
society develop the care schemas.
schema : mental concept that is collected from experience.
During the course of their life their environment can trigger them on critical thoughts, which lead
to automatic negative thoughts; these are characterized by cognitive distortion. These thought
patterns are called DYSFUNCTIONAL COGNITIVE STRUCTURE.
Repeated occurrences of these thoughts will lead to anxiety and depression. The therapist
questions the client to think in the opposite direction of automatic negative thoughts. Focuses on
specific problems and are short term.
COGNITIVE BEHAVIORAL THERAPY(CBT): This is a effective treatment in borderline
personality, anxiety, depression

HUMANISTIC EXISTENTIAL THERAPY

This postulates the psychological distress arises from the feelings of loneliness, alienation and
inability to find meaning and fulfillment in life. As human beings we are always motivated by
desire for personal growth and SELF ACTUALIZATION: an innate need to grow emotionally.
When the needs of a person are restrained by society this arises psychological distress.
Healing occurs when the person is able to find the meaning of life by understanding the
obstacles. Self actualization is also accompanied by free emotional expression, and society
restrains it as free expression can cause destructive forces. This restraining leads to destructive
behavior and negative emotions that prevent the human being from emotional integration. The
therapy aims to create a non judgemental and accepting atmosphere in which the client can freely
express their emotions . the client has full responsibility to control their own behavior. The aim
of the therapy is to create client’s awareness, the healing in this by the process of understanding
the unique personal experience by the client themself and also initiates self growth.

EXISTENTIAL THERAPY
Victor Frankl was a psychiatrist who introduced LOGOTHERAPY, LOGO means soul in Greek
as logotherapy is understanded as treatment of the soul. Frankl also introduced the meaning
making process of finding the quest for the finding the spiritual truth of existence. According to
this neurotic anxiety arises from the physical, psychological or spiritual existence of one's
living. This arises existential anxiety where spiritual anxieties can lead to meaningfulness. The
aim is to help the client find the meaning and responsibility in their life irrespective of their
circumstances. In this therapist share their feelings, values and own existence. The emphasis is
on the present and transference is discouraged.

CLIENT CENTERED THERAPY

This is introduced by Carl Roger, as he combined self concept into psychotherapy. It focuses on
freedom and choice as one’s core. The therapy provides a warm relation to reconnect with the
disintegrated feelings. The therapist shows empathy, positive unconditional regard to enhance
their personal resonance and creates a trustful relationship and non judgemental environment to
accept the client. The therapist uses simple clarification to enhance the client’s statement. This
helps the client to become their own self where the therapist works as a facilitator.
GESTALT THERAPY
The gestalt is a German word meaning whole introduced by Freiderick (Fritz) and Laura. The
aim is to increase an individual's self awareness and acceptance. The client is taught to
understand their bodily process and emotions that are kept out from awareness. The therapist
encourages the client to act out on their fantasies about feeling and conflicts and is widely used
in group settings.

ALTERNATIVE THERAPIES
These are alternative possibilities to conventional drug therapy and psychotherapy. Which
include yoga , meditation, acupuncture, herbal remedies.
YOGA: This is an ancient Indian technique known as ashtanga yoga in patanjali yoga sutra. The
asana refers to the body posture or breathing practices. The rapid breathing technique found in
Sudarshan kriya yoga(SKY) is found to be beneficial, low risk, low cost. This can be used for
stress, PTSD, depression, substance abuse.this will enhance mood, mental focus and stress
tolerance. Kundalini yoga is found to be an effective way to treat mental health disorders, this
focus on breathing techniques by chanting mantras.
MEDITATION: this focuses on attention to breathing or on an object or a thought or a mantra.
The person observes the bodily sensations and thoughts that are passing through their awareness.
Depression can be reduced by mindful meditation; this helps the client to focus emotional stimuli
better and prevents biases in processing of these stimuli.

FACTORS CONTRIBUTE TO HEALING IN PSYCHOTHERAPY

The adoption and implementation of the healing techniques.
the relation of the therapist and client as therapist being available, warmth and empathy
provided.
The initial session to understand the nature of the problem and also provides catharsis: the
process of emotional unburdening.
The healing through psychotherapy is influenced by nonspecific factors including motivation for
change, expectation and improvement from the treatment. This will lead to a positive nature,
absence of unresolved emotional conflicts, presence of good mental health.

REHABILITATION OF MENTALLY ILL

Two components of rehabilitation include reduction of symptoms and improving the level of
functioning and quality of life. Most of them suffer from negative symptoms with disinterest,
lack of motivation to do work and to interact with people. The aim of rehabilitation is to
empower the patients to be productive. The patients are equipped with occupational therapy,
social skill training, and vocational therapy.
OCCUPATIONAL THERAPY: the client is taught skills of paper making, candle making and
also weaving to help from a work discipline.
SOCIAL SKILL TRAINING: the patients are trained to develop interpersonal skills through role
play, imitation and instruction. Cognitive training is to improve the basic cognitive functions of
attention, memory and executive functions .
VOCATIONAL TRAINING: the patients are helped to gain skills necessary to undertake a
productive employment.

ETHICS OF PSYCHOTHERAPY
INFORMED CONSENT
CONFIDENTIALITY
REDUCE PERSONAL DISTRESS
INTEGRITY OF PRACTITIONER - CLIENT RELATION
RESPECT FOR HUMAN RIGHTS
PROFESSIONAL COMPETENCE