COUNSELING & PSYCHOTHERAPY

Syllabus -

1. Introduction to Counseling & Psychotherapy

2. Existential Therapy
3. Introduction to Psychodynamic & Psychoanalysis
4. Person Centered Counseling
5. Ethical & Legal Guidelines

Introduction to Counselling & Psychotherapy

Definition & Introduction: Counselling

The term counseling covers all types of two-person situations in which one the client or the counselee is
helped by the counselor to adjust more effectively to himself or herself and to his or her environment.
Counseling may be defined as an interactive process conjoining a person known as counselee who needs
assistance and the other person called the counselor who is trained and educated to give this assistance.

Informal vs Formal Counselling: Parents, Friends, Teachers, Elderly vs Trained Professional

Practice of Professional Counseling (For our reading):

It may be defined as the application of mental health, psychological or human development principles
through cognitive, affective, behavioral or systematic interventions, strategies that address wellness,
personal growth, or career development as well as pathology (American Counseling Association, 1997).
Certain implicit and explicit points of the definition may further be delineated as following:

1. Counseling deals with wellness, personal growth, career and pathological concern: This part of
the definition means that the counselor works in the areas that involve relationships. These areas
include intra and interpersonal concerns, related to finding meaning and adjustment in such
settings as school, families and careers.
2. Counseling is conducted with persons who are considered to be functioning well and those who
are having no serious problem. Counseling meets the needs of a wide spectrum of people.
Clients seen by counselors have developmental or situational concerns that require help in
regards to adjustment or remediation. Their problems require short term intervention, but
treatment may be extended to encompass mental disorders.
3. Counseling is theory based: Counselor draws from a number of theoretical approaches including
those that are cognitive, affective, behavioral and systematic. These theories may be applied to
individuals, groups and families.
 4. Counseling is a process that may be developmental or intervening. Counselors focus on their
client’s well-being. Thus, counseling involves both choice and change. In some cases,
“Counseling is a rehearsal for action.” (Casey, 1996).
In addition to defining counseling in general the ACA has also defined a professional counseling specialty
which is an area that is narrowly focused, requiring advanced knowledge in the field of counseling.
Among the specialties within counselors are those dealing with settings such as marriage, mental health,
rehabilitation, aging, addiction and careers.

Counselling Process:

Systematic steps of counselling process to reach the counselling goals involves five broad categories:
- Rapport Establishment: Establishing rapport is the first crucial step in counseling. It forms the
foundation of trust, confidence, and open communication between the counselor and the client.
This relationship relies on trust, empathy, genuineness, warmth, mutual understanding, and
confidentiality. Successful rapport building paves the way for the effectiveness of subsequent
counseling steps.
- Assessment of Problem: Assessing the problem in counseling involves using various skills and
techniques, like observation, interviews, case history, and psychological tests, to uncover the
client's true concerns, as the initial problem they present may not be the actual issue. The
counselor gains clarity by exploring the client's motives, beliefs, insecurities, and perceptions
during the interaction.
- Goal Setting: Goal setting in counseling is a collaborative process between the client and
counselor. It's crucial for mutual agreement and serves purposes like motivation, education,
evaluation, and clarity, as stated by Cornier and Hackney (1987). As Galileo noted, true learning
comes from helping individuals discover within themselves.
- Intervention Strategies: Intervention strategies follow goal setting in counseling. They're chosen
based on the client's nature and feasibility. If they don't work, the counselor and client revisit
previous steps to refine goals or problem understanding—it's a cyclical process.
- Termination and Follow Up: The counselor should prepare the client, ensure a gradual ending,
address client dependence, tackle resistance, resolve any lingering issues, plan follow-up, and
boost the client's self-confidence for independent coping.

Introduction to Psychotherapy:

It refers to procedures in which persons with disorders interact with a trained psychotherapist who helps
them change certain behaviors, thoughts or emotions, so that they feel and function better (Nietzel et al.,
1998). Traditionally psychotherapy focuses on serious problems associated with intrapsychic, internal and
personal issues and conflicts. It deals with the “recovery of adequacy” (Casey, 1996). Many forms of
psychotherapy exist ranging from the famous procedure devised by Freud to modern techniques.

Psychotherapy, according to the more orthodox view, acts both at the conscious and unconscious levels.
Psychotherapy is more concerned with alleviating pathological conditions. Counseling on the other hand
lays stress on rational planning to solve problems of adjustment. Robbinson (1950) holds that counseling
is concerned with aiding normal people to achieve better adjustment skills which manifest themselves in
increased maturity, independence, and integrated personality and responsibility.

Psychotherapy is the treatment of problems of emotional nature. Counseling also treats such problems the
difference being in counseling the emphasis is on the individual and psychotherapy is related to
reconstructive goals. Counseling is concerned with reeducation and supportive goals; it means counseling
intends to make individuals more self-directed and autonomous.

Differences between counselling and psychotherapy:

Counseling and psychotherapy share significant similarities, making their distinction somewhat blurred:
● Nature of Clients: Initially, counseling was thought to focus on personal development, while
psychotherapy handled deficiencies. However, both address clients with adjustment problems,
making this distinction less clear.
● Nature of Problem: Psychotherapy typically addresses severe emotional disturbances, while
counseling deals with less severe issues that hinder personal growth but don't incapacitate the
individual.
● Relation with Reality: Counseling clients are reality-oriented, aware of their issues, while
psychotherapy delves into unconscious aspects. However, this distinction isn't always clear-cut.
● Affective Problems: Both counseling and psychotherapy address cognitive, affective, and
conative dimensions of personality, including mood problems. Counseling closely approaches
psychotherapy in handling affective issues.
● Depth: Counseling isn't an emergency treatment; it emphasizes cognitive and rational factors.
Psychotherapy focuses on severe emotional growth distortions and the total personality structure.
Likewise, in counseling no pathology is involved. It deals with problems which do not require
prolonged interventions as in the field of psychotherapy. Notably, counseling assistance cannot go
for providing intra-psychic insight.
● Duration: Counseling deals with issues that don't involve pathology and require shorter
interventions. Psychotherapy involves prolonged interventions and deeper issues.
Anxiety: Counseling addresses anxiety by helping clients overcome inhibitions and make rational
decisions. It serves both preventive and restorative purposes.practice, the distinction between counseling
and psychotherapy is blurred. Professionals often decide based on the client's needs, and some theories
can work in both settings.

Functions of Counselor:

The term "professional counselor" distinguishes individuals from those who use the title "counselor" in
non-professional contexts. Professional counselors are fully committed to their profession and bear
specific responsibilities:
1. Training and Qualification: Professional counselors must undergo comprehensive training, typically
at the master's level, to understand and apply systematic theories relevant to their chosen client
population.
2. Certification or Licensure: They actively pursue and obtain the appropriate certification or licensure in
alignment with their training and practice environment.
3. Continuous Skill Development: Professional counselors are dedicated to continuous improvement,
regularly enhancing their skills and staying updated with the latest developments in their field.
4. Contributing to Advancement: They contribute to the profession's progress by conducting research
studies and sharing their findings through professional publications and presentations.
5. Active Professional Engagement: Professional counselors actively participate in professional
organizations at various levels, such as national, regional, state, and local levels.
6. Ethical & Legal Compliance: They adhere to all legal and ethical guidelines relevant to the counseling
profession. Many states legally protect the use of the title "counselor."

Skills of Counselor:

1. Psychological Knowledge: A practical understanding of modern psychology principles and

methods.
2. Human Insight: Experience with diverse human interactions to grasp human nature, motives,
interests, and character traits.
3. Empathetic Communication: The ability to connect with young people in a sympathetic, earnest,
candid, helpful, and appealing manner.
4. Industry Knowledge: Familiarity with industry-specific requirements, conditions, compensation,
prospects, and advantages/disadvantages.
5. Educational Guidance: Information about educational paths and ways to prepare for various
careers, fostering efficiency.
6. Scientific Analysis: Proficiency in scientific analysis and investigative principles to discern
essential facts, classify them correctly, and draw appropriate conclusions in each case.

Existential Therapy

Introduction

Existential therapy is not a very well-defined or structured approach to therapy. It is more like a
philosophical approach towards therapy, asking deeper existential questions on human suffering, issues of
freedom, meaning of life, anxiety, search of values, responsibility, isolation and death. The approach is
often considered to just ‘assist clients’ in finding meanings through reflection and by recognizing various
alternatives and by making them decide on their own.

View of Human Nature:

Helps people suffering from existential crises such as meaninglessness and alienation. It strikes to draw a
balance between recognizing limits of human existence (anxiety, dread & death) at one end of the
spectrum and to limitless possibilities (hope, courage & meaning) and potentials of human life on other. It
also emphasizes the inquisitive human nature that constantly questions about the self and the world.
Existential Therapy (or existential psychotherapy) is based on some of the main ideas behind
existentialism as a philosophy, including:
- We are responsible for our own choices. (Choice & Responsibility)
- We are all unique individuals due to the choices we make, and we are constantly remaking
ourselves through these choices - Paradox of creating one’s distinct identity describes life
(Uniqueness & Individuality)
- We make our own meaning in life.
- Anxiety is a natural feature of human life. (Anxiety)
- We must come to terms with this anxiety to live authentically

Existential Therapy aims to aid the client in accepting and overcoming the existential fears inherent in
human beings. These fears include:
a. Freedom and Responsibility
b. Death
c. Isolation
d. Meaninglessness

Coming face to face with any of the above, or realizing that you will confront one or all of these
eventually, can provoke an overwhelming sense of dread or anxiety, potentially leading to a multitude of
psychological and emotional dysfunctions. Without accepting and finding a way ro live with these
realities of being human it is impossible to live authentically.
Existential Therapy guides clients in learning to take responsibility for their own choices and making
choices that align with their values (matching value systems), developing freedom to make choices,
avoiding pretentious living, balanced psychic blend and help them live a fulfilling life by being more
authentic. Here the goal is not necessarily to learn particular skills or pick up certain habits but to form a
realistic and authentic relationship with life.

Right Circumstances for Existential Therapy:

Existential therapy is not appropriate for every individual or for every situation. Here are some conditions
for which it is the most suitable:
1. It is an excellent method for treating the psychological and emotional instabilities rising from
dysfunctions stemming from basic anxieties such as freedom and responsibility, death, isolation
and meaninglessness. Ex: Anxiety, Depression, Substance Abuse and Posttraumatic Stress.
2. It is effective for people who are open minded and willing to explore the heavier themes in life, as
well as those searching for and struggling to find meaning.
3. Due to its nature existentialism is likely to bring a lasting change in perspective, it thus
encourages a long-term effort rather than a short-term one in which the client may lose motivation
as session ends.
4. Existential therapy’s focus on the main anxieties of human life may result in blindness to more
immediate concerns or ignorance of the underlying issues a client is facing. E.g. It’s good to
overcome fear of death but if a client is having paranoid delusions, overcoming existential dread
of death shouldn’t be the top priority.
 5. Individuals who are looking for a quick fix to problems or who do not wish to dive into the
existential depths may not be ready to delve into such intense forms of therapy. For some
individuals pushing them into consideration of death, isolation and meaninglessness may result in
unintended consequences including depression, or suicidal thoughts.

Therapeutic Relationship: The therapist is not a distant expert who is guiding client through
self-discovery rather he or she is a fellow human who has also experienced existential anxiety and fear,
aims to guide through the process of accepting inevitabilities of human life by being an active participant
in the therapy room.

*Rank - founding father of existential therapy

*Paul Tilich and Rollo May brought it into mainstream
*Irvin Yalom - 11 therapeutic factors

Introduction to Psychodynamic and Psychoanalysis

Psychodynamic therapy is a holistic approach focused on understanding clients' deep-seated needs and
desires, different from problem-based therapies like CBT.

- Holistic Focus: Psychodynamic therapy takes a global perspective, emphasizing the client's
overall well-being, in contrast to problem-based therapies that target symptom reduction
(McLeod, 2014).
- Interpretation of Processes: Instead of solely addressing behavior, psychodynamic therapy
interprets mental and emotional processes (Strupp, Butler, & Rosser, 1988).
- Exploration of Patterns: Psychodynamic therapists help clients identify recurring emotional,
thought, and belief patterns, often rooted in childhood experiences, shaping their current selves
(Matthews & Chu, 1997). Then, reorganize these patterns, fostering a more functional and
positive self-narrative.
- Open-Ended Sessions: Sessions are intense and open-ended, guided by the client's free
association rather than a fixed agenda, usually scheduled weekly for about an hour.
- Client-Therapist Interaction: Unlike the traditional couch setup, modern psychodynamic
therapy positions the therapist and client face-to-face, encouraging open conversation about the
client's conscious thoughts and feelings.

In essence, psychodynamic therapy seeks to explore the client's deeper psyche, uncovering and
reconfiguring patterns to promote personal growth and self-understanding.

The main goals of psychodynamic therapy are to (1) enhance the client’s self-awareness and (2) foster
understanding of the client’s thoughts, feelings, and beliefs in relation to their past experiences, especially
his or her experiences as a child (Haggerty, 2016).
Differences:

While psychoanalysis and modern psychodynamic therapy grew from the same source, there are several
important differences between the two forms of therapy.

1. First, the timeline and duration of psychoanalysis are far more intensive than modern
psychodynamic therapy. Psychoanalysis is generally conducted in two to five sessions per week,
lasting several years (McLeod, 2014).
2. Second, the physical layout of the office or therapy room is significant—in psychoanalysis, the
client (or patient, as they are usually called) lies on his or her back on a couch while the therapist
sits behind them, out of their line of sight. In modern psychodynamic therapy, it is much more
common for therapist and client to face one another, or at least remain in the other’s field of
vision.
3. Third, the relationship between therapist and client/patient is much more imbalanced than in
modern psychodynamic therapies. The position of the therapist and client suggests a significant
imbalance of power, with the therapist acting as a distant and detached expert with techniques and
knowledge that will not be shared with the client. Meanwhile, the client acts as a troubled
supplicant who relies on the therapist for their expertise in teasing out the dysfunctional thoughts
and beliefs that plague them (McLeod, 2014).

Some of the psychoanalytical practices have survived or been adapted for modern use, but this uneven
relationship between therapist and client generally does not carry over to current psychodynamic therapy.
The therapist’s role has been modified over the last century to alter the hierarchy and provide a more
equal setting for treatment.

Freud’s Theory and Background:

Psychodynamic therapy and Psychoanalytic Therapy traces its origins to Sigmund Freud's
groundbreaking work in late 19th-century psychology. Freud's theory, though modified over time, laid the
foundation for modern psychodynamic therapy. He proposed that the human mind comprises three parts:
the id (instinctual), superego (moral), and ego (mediator). These components develop through childhood
stages, shaping one's personality. Environment and family relationships influence this development,
impacting mental health.
Freud identified three mind levels:

1. The Unconscious: Home to instincts, deep beliefs, and behavior patterns, mostly hidden from
conscious awareness.
2. The Subconscious or Preconscious: Situated between consciousness and the unconscious, its
contents can surface with effort.
3. The Conscious: The smallest part of the mind where full awareness exists.

Freud emphasized the need to delve into the unconscious to address issues and understand hidden values,
unrecognized beliefs, and childhood-derived thought patterns.
Modern psychodynamic therapy retains key aspects of Freud's work:

- The unconscious mind significantly influences behavior and emotions.

- All behavior has underlying causes.
- Childhood experiences profoundly impact adult thoughts and emotions.
- Early developmental conflicts shape adult personality.

While psychodynamic therapy has evolved, Freud's ideas remain central, informing therapeutic
techniques used today.

Strategies and Skills of Psychodynamic Therapist:

1. Unconscious Interpretation: Psychodynamic therapists are trained to interpret unconscious

thoughts, feelings, and motivations underlying a client's behaviors and symptoms. They help
clients become aware of these hidden aspects of their psyche.
2. Transference Analysis: Therapists analyze how clients project their feelings and attitudes toward
significant figures from their past onto the therapist. This allows clients to explore unresolved
issues and gain insight into their relationships and past experiences.
3. Countertransference Awareness: Psychodynamic therapists monitor their own emotional
reactions and biases that may arise in response to the client. By understanding their own
countertransference, therapists can better help clients without letting their own issues interfere.
4. Exploration of Defense Mechanisms: Therapists assist clients in identifying and understanding
defense mechanisms, which are unconscious strategies used to protect against distressing
thoughts or emotions. This exploration helps clients cope with challenges in healthier ways.
5. Free Association: Clients are encouraged to freely express their thoughts, emotions, and
associations without censorship. This technique allows therapists to uncover hidden conflicts and
patterns.
6. Freudian Slip: Therapists pay attention to Freudian slips or unintentional verbal errors that may
reveal underlying thoughts or feelings. These slips can provide valuable insights into the client's
unconscious mind.
7. Projective Techniques: Psychodynamic therapists may use projective tests or techniques like the
Rorschach inkblot test or the Thematic Apperception Test (TAT) to elicit unconscious thoughts
and emotions through the interpretation of ambiguous stimuli.
8. Dream Analysis: Therapists explore the content and symbolism of clients' dreams to gain insight
into their unconscious processes. Dreams are seen as windows into the unconscious mind.

By employing these strategies and skills, psychodynamic therapists facilitate the exploration of the
unconscious, the resolution of inner conflicts, and the development of insight, ultimately helping clients
improve their emotional well-being and relationships.

Role of Psychodynamic Therapist:

The role of the therapist in psychodynamic therapy is to work with the client to identify and disengage the
basis of their dysfunction.
 - The therapist plays this role by encouraging the client to talk about the emotions they are feeling
and helping the client to identify recurring patterns in their thoughts, emotions, and behaviors.
- Investigate the significance of these patterns often by delving into the client's past, especially
childhood experiences as they have a significant impact on the client’s current issues.
- The therapist observes how the client interacts within the therapeutic relationship and adds their
own insight into the client’s relationship habits to the discussion.
- The psychodynamic theory holds that how the client acts in the relationship with the therapist
usually mirrors how they act in other relationships, such as with a parent or other important adult
from their childhood (WebMD, 2014).

In general, the therapist’s role is to aid the client in connecting the dots between their past experiences and
their current problems, and leverage their internal resources to address these problems.

Criticisms:

- Lack of Empirical Evidence: Critics argue that these therapies lack robust scientific evidence
compared to more structured and evidence-based therapies like CBT.
- Subjectivity: Interpretations of unconscious processes and symbolism can be highly subjective,
leading to potential bias in therapy.
- Limited Applicability: Some critics claim that these therapies may not be suitable for treating
certain psychological disorders or issues, especially those requiring more immediate and focused
interventions.
- Focus on the Past: The emphasis on childhood experiences and the past may not always be
relevant or effective for clients with more immediate concerns or those who prefer a more
solution-focused approach.

Person Centered Counselling

Basis: In essence, person-centered therapy operates on the fundamental belief in individuals' innate
strengths and capacity for self-growth, aiming to create a nurturing environment for clients to explore and
develop their authentic selves.

Key Concepts:

1. Human Potential: People are strong and capable to handle their difficulties, grow, develop and realize
their potential. (Actualising Tendency)

2. Conditions of Worth: Children's self-concepts are shaped through interactions with significant
individuals in their lives and the messages they receive from them, as per Rogers (1981). (Positive
Regard–Need of love and acceptance from other)-----(Conditional Worth–Impairs Growth)
(Positive Self Regard–As we grow older comes from self)
3. Organismic Valuing Process (OVP): People instinctively evaluate their experiences and actions to
determine their authenticity. A sense that "something isn't right" can lead to motivation for personal
growth and connection (Sheldon Kopp, 1960).
(Incongruence comes when people abandon their OVP accept others for maintaining positive regard)

4. Fully-Functioning Person: The primary aim of person-centered therapy is to guide individuals toward
achieving optimal emotional well-being, often referred to as "fully functioning" (Carl Rogers, 2006).

5. Phenomenological Perspective: Each person possesses a unique perception of their world. Therefore,
individuals interpret and respond to life events in a manner consistent with their own reality, as seen in
phenomenology.

Treatment:

Necessary Conditions for Therapeutic Process

Carl Rogers (1959) identified 6 conditions necessary for initiation of ‘constructive personality change”
1. A relationship exists out of the two people being in psychological contact.
2. The client is in a state of incongruence, causing him/her to be vulnerable or anxious
3. The therapist is congruent (genuine/authentic) in the relationship.
4. The therapist experiences unconditional positive regard for the client
5. The therapist experiences and attempts to express an empathetic understanding of the client’s
internal frame of reference.
6. The therapist’s unconditional positive regard, empathetic understanding and congruence must be
perceived by the client to some degree.

Goals
The goals of person-centred therapy are (Seligman, 2006):
- To facilitate client’s trust and ability to be in the present moment. This allows the client to be
honest in the process without feeling judged by the therapist.
- To promote client’s self-awareness and self-esteem.
- To empower the client to change.
- To encourage congruence in the client’s behaviour and feelings.
- To help people to gain the ability to manage their lives and become self-actualised
Goals are to provide a climate of acceptance, free of conditions of worth, counteract negative messages
received, and enable them to have complete freedom to be and to choose for themselves and realize their
potential as fully functioning.

Approach doesn’t focus on presenting problems but developing internal locus of control – a fully
functioning person with deeper self understanding capable of creating fruitful lives and dealing
successfully with life’s joy and challenges.
Therapeutic Alliance & Facilitative Conditions:
Clinician and client are two equal and capable human beings who become collaborators in a shared
journey in which both grow and are enriched by the process. Here, the clinician is not an expert giving out
advice but the client takes the lead and is the focus of the treatment process.

Roger’s identified three core conditions which are necessary to create a climate in which the a person can
grow:

a. Congruence: It refers to the clinician’s ability to be genuine and authentic, well integrated and
aware of themselves and how they are perceived by others. This genuineness promotes clients'
trust and openness. Clinicians must be aware that subjective interpretation may lead to
misinterpretation, hence must be consistent– clear and coherent, inner and outer and in verbal and
nonverbal messages and also address clients' reactions which indicate confusion.

Client– “After my father faced heavy losses in business, I could hardly buy anything I wanted.”
Counselor– “I understand how hard it must have been” – A confused look on the face indicates
incongruence. Here, the client may become uncomfortable with expressing their feelings.

b. Unconditional Positive Regard: Refers to the therapist accepting, respecting and caring about
clients for who they are without placing any requirements on them to act, feel in a certain way to
please the therapist. It doesn’t mean to agree with everything the client says or does but see
him/her as doing the best they can, expressing concern rather than disagreeing. E.g. “You are a
lazy person”- “It seems like you’re not being able to handle your chores well.” This helps clients
believe they are worthy and can trust their own feelings and thoughts–counter devaluing
messages–change undesirable behaviour while feeling likable and worthwhile.

c. Empathy: To Roger’s the most powerful force for change, which enhances a person’s
self-awareness is deeply grasping the subjective world of another person through sensitive,
accurate and active listening and thereby transmitting understanding of that world. (Perceive the
internal frame of reference of other person without losing ‘as if’ quality)
Sympathy– “I am so sorry you had to face such a loss” (Understand Emotion)
Empathy– “Such a traumatic experience leaves a deep scar, that too as a child.” (Feel Emotion)

d. Other techniques:
- Reflection of feelings: Client– “I was so ashamed of myself” Counselor– “So, you feel
embarrassed there”
- Open questions: Client– “They laughed at me I forgot my lines” Counselor– “How did
you react there”
- Paraphrasing: Client– “I couldn’t sleep for 2 weeks. I wish I could help my brother when
he needed me” Counselor– “So you’re feeling guilty on your brother’s accident”
- Encouragers: Client– “I don’t wanna cry but tears are rolling down. I can’t help”
Counselor– “It’s okay to let yourself out sometimes”
e. Rogers called his work non directive as the aim of the counselor is not passive recipient but busy
to create necessary conditions that are conducive to client’s growth. Clients are the focus of the
 session and not counselors giving advice or setting strategies for them. But later decided complete
nondirectiveness is not possible and the therapist may be able to explain or elucidate for chosen
interventions (being the best directive).

Strengths and Limitations:

Strengths Limitations

- Provided basis for many therapies by - Not comfortable in cultures where

emphasis on client-clinician relationship.
- Clients feel empowered due to the
responsibility of decision.
- Clients can express themselves freely
when active, empathetically listened and
not feel judged.
- Theory is optimistic, affirming and has a
positive outlook on human nature
empathetic responses aren’t accepted.
- Nondirective focus – not for clients who
look clinician as an expert. Therapist is
just supportive not challenging.
- Uses a therapist as a tool and not a
workbook or a manual.
- Fails to prepare client for real world
- Not for clients having significant
psychopathology and those not motivated
to change
- Limited understanding of the client as it
doesn’t draw upon development and
psychodynamic aspects.

Ethical & Legal Guidelines

For Counselors, at least 2 basic Statements of ethical practice and behavior apply to work in the
profession:
1. ACA Code of Ethics (2005)
2. Ethical Principles of Psychologists & Code of Conduct of APA (2002)

Competence -

Competence is defined as “the possession of required skill, knowledge, qualification or capacity.”

Therapists are expected to be aware of their competence and limitations, i.e., the level of their knowledge,
training, and supervised experience for particular kinds of therapies.

1. Emotional competence: Whether the therapist is aware of his emotional state while dealing with
their clients. The therapists are expected to refrain from starting or continuing with a therapy, if
there are chances of their personal problems to hinder the therapy process.
2. Professional help: In case personal problems do interfere in performing their role of a therapist
adequately, they can limit, suspend, or terminate the therapy, often seeking help from the
supervisors. Therapists are expected to seek supervision from their mentors or fellows colleagues,
so as to be aware of their competence.
 3. Clarification: In India, many of the clinicians are not formally trained in specific kinds of
psychotherapies. In such a scenario, while offering a particular therapy, it is needed to clearly
mention the same to the prospective client during the initial interactions itself. The therapists can
mention that they have not had any formal training in that particular module; however, they have
expertise in the practice and based on that they may be in position to help him/her.

Confidentiality & Exceptions -

Confidentiality is crucial in psychotherapy, creating a safe space for clients to share sensitive information.
Without assurance of confidentiality, clients may hesitate to disclose personal and potentially damaging
details. Therapists, as part of the medical profession, are ethically obligated to maintain client
confidentiality.

This ethical requirement aligns with legal expectations, making it vital for therapists to navigate both
ethical and legal considerations. In situations where ethical and legal aspects are unclear, therapists can
seek legal consultation to ensure they make informed decisions and uphold both ethical standards and
legal requirements.

1. Exceptions: When establishing the therapeutic contract, therapists must inform clients about
exceptions to confidentiality. Failure to do so puts therapy and the therapist at risk. Exceptions
include -
- Disclosure of the confidential information without the consent of the client in different
situations (E.g., reporting abuse, protecting clients and their potential threatened victims,
defending oneself from inappropriate, or threatening client behavior)
- Disclosure of information as evidence in a legal proceeding.
- For protecting self, in case threatened or sued by the client.
2. Legal Obligation for Abuse: Therapists are obligated to report child, elder, or dependent adult
abuse to the appropriate authorities. In case of child abuse, it is an obligation to report directly to
police or through an appropriate channel, under Section 21(1) of the Protection of Children
against Sexual Offences. Failure to do so is punishable by imprisonment up to six months
with/without fine.
3. Privileged Information: Certain situations, like marital negotiations during reconciliation or
separation, may be privileged from disclosure. Therapists should exercise discretion and consider
the context before deciding to disclose information.
4. Grey areas in Confidentiality: Some situations, such as confidentiality issues in case of minors,
when the parents are having conflictual relationship or are undergoing the divorce proceedings;
confidentiality in case the client is dead, and confidentiality issues in case of marital or family
therapy, are not defined specifically by the law enforcement agency. In such cases, general laws
related to confidentiality in medical practice may apply. However, for things which are not clear,
it is always advisable for the therapist and the client to seek the opinion of colleagues and
lawyers.

It is to be noted that if a therapist decides to breach confidentiality, the information conveyed should be
limited to what is necessary for the given situation.
Ethical Boundaries:

1. Time: Adhering to the designated session time is crucial in psychotherapy as it provides structure
and containment for clients.
- This time boundary is essential, especially for those dealing with traumatic experiences,
as it reassures them that the process is limited, preventing potential harm from extended
or unpredictable sessions.
- Beginning or ending sessions beyond the scheduled time can lead to boundary crossings.
Maintaining clear time boundaries helps establish a therapeutic structure and prevents
potential misunderstandings.
- Scheduling or rescheduling therapy sessions outside regular working hours, especially at
the end of the day, can raise concerns, particularly regarding allegations of sexual
misconduct. Choosing peak movement hours when others are around is advised to
enhance safety and avoid potential risks.
2. Location: The place of meeting of therapist and client should be limited to the psychotherapy
sessions in the therapists working place, with exceptions being the client is admitted to
emergency/intensive care unit after a suicide attempt. In terms of the therapist meeting the client
outside the office (attending the personal/family get-togethers of the client), this does not have
one answer and should be interpreted and scrutinized in the light of the type of therapy being
conducted and the situation.
3. Money or Fee: If the therapist decides to see a client free of cost, he may do so, but it should be
right from the beginning with appropriate documentation in the therapeutic contract. However, if
the therapist was charging earlier, but now ignores nonpayment of fees, or stops collecting fees,
especially when there are no issues related to affordability, this needs to be scrutinized as a
boundary violation.
4. Gifts: Any kind of gift from the therapist to the client, how small it may be, must be interpreted as
a boundary violation. Similarly, seeking favor or services from the client for personal benefit by
the therapist must be considered a boundary violation. However, some of the issues of social
manners/obligations must not be outrightly interpreted as boundary violations.
5. Dressing & Language: Dressing that is excessively revealing or frankly seductive, on the part of
the therapist may represent a boundary violation as it can be potentially harmful to the client.
Language as a boundary includes the words, tone of the speech (which can be seductive), and
how the therapist addresses the client.
6. Self-disclosure: In dynamic therapy, self-disclosure, especially regarding personal fantasies,
dreams, social, sexual, financial, or vacation-related aspects, is generally seen as a boundary
violation. However, context matters, and some forms of self-disclosure like using examples from
their own life or trying to explain the effect of a borderline client on the therapist, may be
appropriate based on therapy goals and clinical needs.
7. Physical Contact: Anything beyond hand shake needs to come under scrutiny. Since it's a
sensitive topic, therapists must carefully consider the appropriateness and necessity of any
physical contact with clients.
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