THERTHERTHERTHERAPEUTICAPEUTIC APPROACHESAPPROACHES After reading this chapter, you would be able to: familiarise yourself with the basic nature and process of psychotherapy, appreciate that there are different types of therapies for helping people, understand the use of psychological forms of intervention, and know how people with mental disorders can be rehabilitated. Nature and Process of Psychotherapy Therapeutic Relationship Type of Therapies Steps in the Formulation of a Client’s Problem (Box 5.1) Psychodynamic Therapy Behaviour Therapy Relaxation Procedures (Box 5.2) Cognitive Therapy Humanistic-existential Therapy Biomedical Therapy CONTENTS Alternative Therapies Rehabilitation of the Mentally Ill Key Terms Summary Review Questions Project Ideas Weblinks Pedagogical Hints 89 Chapter 5 • Therapeutic Approaches 2021–22 In the preceding chapter, you have studied about major psychological disorders and the distress caused by them to the patient and others. In this chapter, you will learn about the various therapeutic methods that are used by psychotherapists to help their patients. There are various types of psychotherapy. Some of them focus on acquiring self-understanding; other therapies are more action-oriented. All approaches hinge on the basic issue of helping the patient overcome her/his debilitating condition. The effectiveness of a therapeutic approach for a patient depends on a number Introduction of factors such as severity of the disorder, degree of distress faced by others, and the availability of time, effort and money, among others. All therapeutic approaches are corrective and helping in nature. All of them involve an interpersonal relationship between the therapist and the client or patient. Some of them are directive in nature, such as psychodynamic, while some are non-directive such as person-centred. In this chapter, we will briefly discuss some of the major forms of psychotherapy. everybody. An untrained person may NATURE AND PROCESS OF PSYCHOTHERAPY unintentionally cause more harm than any Psychotherapy is a voluntary relationship good, (iii) the therapeutic situation involves between the one seeking treatment or the a therapist and a client who seeks and client and the one who treats or the receives help for her/his emotional therapist. The purpose of the relationship problems (this person is the focus of is to help the client to solve the attention in the therapeutic process), and psychological problems being faced by her (iv) the interaction of these two persons — or him. The relationship is conducive for the therapist and the client — results in the consolidation/formation of the building the trust of the client so that therapeutic relationship. This is a problems may be freely discussed. confidential, interpersonal, and dynamic Psychotherapies aim at changing the relationship. This human relationship is maladaptive behaviours, decreasing the central to any sort of psychological therapy sense of personal distress, and helping the and is the vehicle for change. client to adapt better to her/his All psychotherapies aim at a few or all environment. Inadequate marital, of the following goals : occupational and social adjustment also (i) Reinforcing client’s resolve for requires that major changes be made in an betterment. individual’s personal environment. (ii) Lessening emotional pressure. All psychotherapeutic approaches have (iii) Unfolding the potential for positive the following characteristics : (i) there is growth. systematic application of principles (iv) Modifying habits. underlying the different theories of (v) Changing thinking patterns. therapy, (ii) persons who have received (vi) Increasing self-awareness. practical training under expert supervision (vii) Improving interpersonal relations and can practice psychotherapy, and not communication. 90 Psychology 2021–22 (viii)Facilitating decision-making. suffering of another but is not able to feel (ix) Becoming aware of one’s choices in like the other person. Intellectual life. understanding is cold in the sense that the (x) Relating to one’s social environment in person is unable to feel like the other a more creative and self-aware person and does not feel sympathy either. manner. On the other hand, empathy is present when one is able to understand the plight Therapeutic Relationship of another person, and feel like the other person. It means understanding things The special relationship between the client from the other person’s perspective, i.e. and the therapist is known as the putting oneself in the other person’s shoes. therapeutic relationship or alliance. It is Empathy enriches the therapeutic neither a passing acquaintance, nor a relationship and transforms it into a permanent and lasting relationship. There healing relationship. are two major components of a therapeutic The therapeutic alliance also requires alliance. The first component is the that the therapist must keep strict contractual nature of the relationship in confidentiality of the experiences, events, which two willing individuals, the client feelings or thoughts disclosed by the client. and the therapist, enter into a partnership The therapist must not exploit the trust which aims at helping the client overcome and the confidence of the client in anyway. her/his problems. The second component Finally, it is a professional relationship, of therapeutic alliance is the limited and must remain so. duration of the therapy. This alliance lasts until the client becomes able to deal with A classmate or friend of yours or your Activity her/his problems and take control of her/ favourite character in a TV serial may 5.1 his life. This relationship has several have recently experienced a negative unique properties. It is a trusting and or a traumatic life event (e.g., death confiding relationship. The high level of of a loved one, break-up of an trust enables the client to unburden important friendship or relationship) herself/himself to the therapist and confide of which you are aware. Try to put her/his psychological and personal yourself in the other person’s shoes, problems to the latter. The therapist try to experience how that person is feeling, what s/he is thinking and try encourages this by being accepting, to take her/his perspective of the empathic, genuine and warm to the client. entire situation. This will help you to The therapist conveys by her/his words understand better how that person is and behaviours that s/he is not judging feeling. the client and will continue to show the (Note : This exercise may be done in same positive feelings towards the client class, so that teachers can help even if the client is rude or confides all the students in overcoming any distress ‘wrong’ things that s/he may have done or experienced). thought about. This is the unconditional positive regard which the therapist has for the client. The therapist has empathy for TYPE OF THERAPIES the client. Empathy is different from sympathy and intellectual understanding Though all psychotherapies aim at of another person’s situation. In sympathy, removing human distress and fostering one has compassion and pity towards the effective behaviour, they differ greatly in 91 Chapter 5 • Therapeutic Approaches 2021–22 concepts, methods, and techniques. thoughts and feelings of the client. This Psychotherapies may be classified into material is interpreted to the client to three broad groups, viz. the help her/him to confront and resolve psychodynamic, behaviour, and existential the conflicts and thus overcome psychotherapies. In terms of the problems. Behaviour therapy identifies chronological order, psychodynamic the faulty conditioning patterns and therapy emerged first followed by sets up alternate behavioural behaviour therapy while the existential contingencies to improve behaviour. therapies which are also called the third The cognitive methods employed in this force, emerged last. The classification of type of therapy challenge the faulty psychotherapies is based on the following thinking patterns of the client to help parameters: her/him overcome psychological distress. The existential therapy 1. What is the cause, which has led to the provides a therapeutic environment problem? which is positive, accepting, and non- Psychodynamic therapy is of the view judgmental. The client is able to talk that intrapsychic conflicts, i.e. the about the problems and the therapist conflicts that are present within the acts as a facilitator. The client arrives psyche of the person, are the source of at the solutions through a process of psychological problems. According to personal growth. behaviour therapies, psychological problems arise due to faulty learning of 4. What is the nature of the therapeutic behaviours and cognitions. The relationship between the client and the existential therapies postulate that the therapist? questions about the meaning of one’s Psychodynamic therapy assumes that life and existence are the cause of the therapist understands the client’s psychological problems. intrapsychic conflicts better than the client and hence it is the therapist who 2. How did the cause come into existence? interprets the thoughts and feelings of In the psychodynamic therapy, the client to her/him so that s/he gains unfulfilled desires of childhood and an understanding of the same. The unresolved childhood fears lead to behaviour therapy assumes that the intrapsychic conflicts. The behaviour therapist is able to discern the faulty therapy postulates that faulty behaviour and thought patterns