Psychology: Class 12 — Chapter 5: Therapeutic Approaches

• Systematic application of principles underlying different theories of therapy.
• Practiced only by persons who have received practical training under expert supervision.
• Involves a therapeutic situation with a therapist and a client who is the focus of attention.
• Results in the formation of a confidential, interpersonal, and dynamic therapeutic relationship.

1. Reinforcing client's resolve for betterment.
2. Lessening emotional pressure.
3. Unfolding the potential for positive growth.
4. Modifying habits.
5. Changing thinking patterns.
6. Increasing self-awareness.
7. Improving interpersonal relations and communication.
8. Facilitating decision-making.
9. Becoming aware of one's choices in life.
10. 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 therapeutic alliance. It has two major components:

• Contractual Nature: Two willing individuals entering into a partnership to help the client overcome problems.
• Limited Duration: The alliance lasts only until the client becomes able to deal with their problems independently.

Key properties of this relationship include:

• Unconditional Positive Regard: The therapist shows total, non-judgmental acceptance of the client, regardless of their behavior or disclosures.
• Empathy: The therapist understands the client's plight from the client's perspective ("putting oneself in the other person's shoes"). Empathy is distinct from sympathy (compassion/pity without feeling like the other) and intellectual understanding (cold cognitive awareness).
• Strict confidentiality of all disclosures.

Clinical formulation refers to conceptualizing the client's problem within the therapeutic model being used. It serves three main advantages:

1. Understanding of the problem: Understanding the full implications of the distress.
2. Identification of target areas: Pinpointing specific areas for therapeutic intervention (e.g., lack of assertiveness and anxiety).
3. Choice of techniques: Selecting specific therapeutic methods based on the formulation.

A behavioural analysis is conducted to identify:

• Malfunctioning Behaviours: Behaviours causing distress to the client.
• Antecedent Factors: Causes that predispose the person to indulge in the behavior.
• Maintaining Factors: Factors that lead to the persistence of the behavior.

The therapist modifies behavior by establishing antecedent operations (changing what precedes behavior) and consequent operations (changing the reinforcement that follows behavior).

• Negative Reinforcement: Responses that lead to escaping or avoiding painful stimuli (e.g., wearing woollens to avoid cold).
• Aversive Conditioning: Associating an undesired response with an painful consequence (e.g., pairing the smell of alcohol with a mild electric shock).
• Positive Reinforcement: Providing a pleasant stimulus to increase a deficit adaptive behavior (e.g., preparing a child's favorite dish when homework is completed).
• Token Economy: Giving tokens as rewards for wanted behaviors, which can later be exchanged for privileges or treats.
• Differential Reinforcement: Simultaneously reinforcing wanted behavior while ignoring or negatively reinforcing unwanted behavior.
• Systematic Desensitisation: A technique introduced by Wolpe to treat phobias. The therapist builds a hierarchy of anxiety-provoking stimuli, teaches relaxation, and guides the client to imagine progressively fearful scenes while remaining relaxed. This operates on the principle of reciprocal inhibition (two opposing forces cannot exist together; relaxation inhibits anxiety).
• Modelling: Learning a behavior by observing a role model or the therapist.
• Vicarious Learning: Learning by observing others being rewarded or punished for their actions.

Anxiety increases arousal levels, acting as an antecedent for maladaptive behaviors (like smoking or overeating). Progressive Muscular Relaxation teaches clients to contract and release muscle groups to achieve a deep state of physical and mental calm.

Formulated by Albert Ellis, the central thesis of Rational Emotive Therapy is that irrational beliefs mediate between antecedent events and their emotional consequences. It uses the ABC Analysis:

• A (Antecedent Event): The external event causing distress.
• B (Belief System): Irrational beliefs characterized by "musts" and "shoulds" (e.g., "I must be loved by everyone").
• C (Consequence): Negative emotions and dysfunctional behaviors resulting from the irrational belief.

The therapist refutes these beliefs through gentle, non-directive questioning, helping the client replace irrational beliefs with a rational belief system.

Aaron Beck's theory states that childhood experiences develop core schemas (e.g., "I am not wanted"). Critical life incidents trigger these schemas, leading to negative automatic thoughts characterized by cognitive distortions (dysfunctional cognitive structures). The therapist uses gentle questioning to achieve cognitive restructuring, reducing anxiety and depression.

Cognitive Behaviour Therapy is a highly popular, short, and efficacious treatment that combines cognitive and behavioral techniques. It adopts a bio-psychosocial approach, addressing biological aspects (via relaxation), psychological aspects (via cognitive and behavior therapy), and social aspects (via environmental manipulations).

Propounded by Victor Frankl, Logotherapy (treatment for the soul) focuses on meaning making even in life-threatening circumstances. It addresses existential anxiety (neurotic anxiety of spiritual origin) and helps patients find meaning and responsibility in their lives.

Developed by Carl Rogers, Client-centred therapy provides a warm, empathic relationship with unconditional positive regard. The therapist acts as a facilitator, reflecting the client's feelings in a non-judgmental manner to help them become their real self.

Founded by Fritz and Laura Perls, Gestalt therapy aims to increase self-awareness and self-acceptance. Clients are taught to recognize bodily processes and emotions blocked from awareness by acting out fantasies and conflicts.

1. Therapeutic Techniques: Specific methods like relaxation or cognitive restructuring.
2. Therapeutic Alliance: The warmth, empathy, and regular availability of the therapist.
3. Catharsis: The process of emotional unburdening in early sessions.
4. Patient Variables: Motivation for change and expectation of improvement.
5. Therapist Variables: Positive nature, absence of unresolved conflicts, and good mental health.

• Informed consent must be obtained.
• Strict confidentiality of the client must be maintained.
• Alleviating personal distress must be the therapist's primary goal.
• Integrity of the practitioner-client relationship must be preserved.
• Respect for human rights and dignity.
• Professional competence and skills are essential.