NCERT Solutions for Class 12 Psychology Chapter 5: Therapeutic Approaches

Chapter at a glance

Exercises

Answer

Nature: Psychotherapy is a voluntary relationship between the one seeking treatment (client) and the one who treats (therapist). Its purpose is to help the client solve psychological problems. The relationship builds the client’s trust so that problems can be freely discussed.

Characteristics of psychotherapy: 1. Systematic application of principles underlying the different theories of therapy. 2. Only persons who have practical training under expert supervision can practise it, not untrained persons. 3. The therapeutic situation involves a therapist and a client who seeks and receives help for emotional problems. 4. The interaction results in the consolidation/formation of the therapeutic relationship — a confidential, interpersonal and dynamic relationship.

Scope / goals of psychotherapy: 1. Reinforcing the 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.

Psychotherapy is used to treat psychological disorders, adjustment problems, and to promote growth and well-being.

Importance of the therapeutic relationship (therapeutic alliance)

The special relationship between the client and therapist is called the therapeutic relationship or alliance. It has two major components: 1. Contractual nature – two willing individuals (client and therapist) enter into a partnership which aims at helping the client overcome problems. 2. Limited duration – the alliance lasts until the client becomes able to deal with problems and take control of life.

Unique properties: - It is a trusting and confiding relationship; the client can freely discuss problems. - The therapist shows unconditional positive regard (accepts the client without judgment), empathy (understanding the client’s feelings from the client’s perspective) and warmth. - Confidentiality – the therapist keeps the client’s information private; ethical standards are maintained. - The relationship is professional and should not be exploited.

A strong therapeutic alliance is one of the most important factors contributing to healing: research shows it predicts improvement across all types of therapy.

Psychotherapy is a voluntary, systematic relationship between a client and a trained therapist aimed at solving psychological problems — lessening distress, changing habits and thinking, increasing self-awareness and improving relationships. The therapeutic alliance (contractual, time-limited, trusting, confidential, with empathy and unconditional positive regard) is central because it lets the client open up and is a key factor in healing.

Answer

Psychotherapies fall into three broad groups: psychodynamic, behaviour and existential (humanistic) therapies. (Cognitive and cognitive-behaviour therapies are also major systems.) They are classified on the following bases:

The main types are psychodynamic, behaviour (and cognitive/cognitive-behaviour) and humanistic-existential therapies. They are classified by: the cause of the problem, how the cause originated, the chief method of treatment, the nature of the therapist–client relationship, the chief benefit to the client, and the duration of treatment.

Answer

Behaviour therapy holds that psychological distress arises from faulty behaviour patterns or thought patterns. Following a behavioural analysis (identifying malfunctioning behaviours, their antecedents and consequences), therapy uses principles of conditioning to change them.

Techniques

1. Antecedent operations – control behaviour by changing something before the behaviour occurs; the establishing operation increases or decreases the reinforcing value of a consequence (e.g. if a child does not eat dinner, the therapist may advise no snacks in the afternoon so that dinner becomes reinforcing).
2. Negative reinforcement – following an undesired response with an outcome that is painful or not liked; the person learns to avoid it (e.g. a person who leaves the tap open gets doused with cold water).
3. Aversive conditioning – repeated association of an undesired response with an aversive consequence (e.g. an alcoholic is given a mild electric shock or a drug that causes nausea on smelling alcohol, so alcohol becomes associated with discomfort).
4. Positive reinforcement – if an adaptive behaviour occurs rarely, it is followed by a reward (e.g. a child who does homework regularly is given a favourite dish).
5. Token economy – persons with behavioural problems are given a token every time a wanted behaviour occurs; tokens are collected and exchanged for a reward (e.g. in hospitals, tokens for self-care that can be exchanged for an outing).
6. Differential reinforcement – unwanted behaviour can be reduced and wanted behaviour increased simultaneously: positively reinforce the wanted behaviour and ignore the unwanted behaviour (e.g. a girl who sulks when she doesn’t get a dress: the parents ignore sulking and praise her when she asks politely).
7. Systematic desensitisation (Wolpe) – for phobias/irrational fears. The client is interviewed to elicit fear-provoking situations and, with the therapist, prepares a hierarchy of anxiety-provoking stimuli from least to most. The therapist relaxes the client and asks her/him to imagine the least anxiety-provoking situation; gradually the client moves up the hierarchy. It is based on reciprocal inhibition — two mutually opposing forces (relaxation and anxiety) cannot exist together.
8. Modelling – the client learns to behave in a certain way by observing the behaviour of a role model (therapist); vicarious reinforcement — approximations of the target behaviour are rewarded.

Behaviour therapy techniques: antecedent operations (establishing operations), negative reinforcement, aversive conditioning, positive reinforcement, token economy, differential reinforcement, systematic desensitisation (graded hierarchy with relaxation, based on reciprocal inhibition) and modelling.

Answer

Cognitive distortions are ways of thinking which are general in nature and which distort reality in a negative manner. These patterns of thought are called dysfunctional cognitive structures, leading to errors of cognition about social reality.

Aaron Beck’s explanation: 1. Childhood experiences provide the basis for core schemas or systems of beliefs about how a person views reality. 2. E.g. a client who has been neglected by parents may develop the core belief “I am not wanted”. 3. During the course of life, a critical incident occurs (e.g. being publicly ridiculed by the teacher in school). This triggers the core belief and leads to the development of negative automatic thoughts — persistent irrational thoughts such as “Nobody loves me”, “I am ugly”, “I am stupid”, “I will not succeed”. 4. These thoughts are characterised by cognitive distortions and lead to anxiety and depression.

Albert Ellis’ ABC analysis (REBT): - A – Antecedent event (e.g. a friend doesn’t reply to your message). - B – Belief – irrational beliefs (e.g. “She must hate me; everyone should always like me; I am worthless”). - C – Consequence – negative emotions and behaviour (sadness, anxiety, avoidance). Irrational beliefs are characterised by “musts” and “shoulds”, e.g. “One should be loved by everyone all the time”.

Example: Rahul scores 70% in a test when he expected 90%. He thinks: “I am a total failure; I will never get into a good college; my parents will be ashamed of me.” Here he shows: - Overgeneralisation – from one test to his whole future; - All-or-nothing thinking – either 90% or total failure; - Catastrophising – imagining the worst outcome; - Mind reading – assuming what his parents will think. These distortions make him depressed and he stops studying, which may actually worsen performance.

Therapy: the therapist uses gentle, non-confrontational questioning (Beck) or the disputation of irrational beliefs (Ellis) to help the client replace distortions with rational, realistic thoughts (“70% is a decent score; I can improve”).

Cognitive distortions are general, negative ways of thinking that distort reality. Childhood experiences create core schemas (e.g. “I am not wanted”); a critical incident triggers negative automatic thoughts. E.g. a student who scores 70% instead of 90% thinks “I am a total failure and will never succeed” — overgeneralisation, all-or-nothing thinking and catastrophising — leading to depression (Ellis’ A-B-C: event → irrational belief → emotional consequence).

Answer

Humanistic-existential therapies encourage the client to seek personal growth and self-actualisation. They hold that psychological distress arises from feelings of loneliness, alienation and inability to find meaning and genuine fulfilment in life. Humans have an innate desire for personal growth; when society or family restrict this, distress results. Therapy creates a permissive, non-judgmental, accepting atmosphere in which the client’s emotions can be freely expressed; the client is the healer and the therapist a facilitator.

Therapies based on this principle

1. Existential therapy – Logotherapy (Victor Frankl)

• Frankl, a psychiatrist and neurologist, survived Nazi concentration camps; he observed that even in such conditions people could find meaning in life.
  • Logos = soul/spirit; logotherapy is “treatment of the soul”. It is a process of meaning-making even in the most bleak situations.
  • Distress arises from existential anxiety — the inability to find meaning in life.
  • The therapist helps the client find meaning irrespective of life circumstances, through openness, genuineness and empathy.

2. Client-centred therapy (Carl Rogers)

• Combines scientific rigour with individualised practice.
  • The therapist provides empathy (understanding the client’s experience as if it were one’s own), warmth and unconditional positive regard (total acceptance of the client).
  • The therapist reflects the client’s feelings in a non-judgmental way; this helps the client become more stable, accept herself/himself, integrate the self and move towards a fully functioning person (reducing the gap between the real and ideal self).

3. Gestalt therapy (Fredrick/Fritz Perls and Laura Perls)

• Gestalt = whole. The goal is to increase the individual’s self-awareness and self-acceptance.
  • The client is taught to recognise bodily processes and emotions being blocked from awareness, through fantasy (e.g. the empty-chair technique) and role-play, focusing on the “here and now”.

Humanistic-existential therapies promote personal growth and self-actualisation in an accepting, non-judgmental atmosphere. They include existential therapy/logotherapy (Frankl — finding meaning in life), client-centred therapy (Rogers — empathy, warmth and unconditional positive regard) and Gestalt therapy (Perls — increasing self-awareness and self-acceptance in the here and now).

Answer

Factors contributing to healing in psychotherapy

1. The techniques adopted by the therapist and their implementation with the client (e.g. behaviour therapy techniques, client-centred methods, analysis of free associations).
2. The therapeutic alliance – the relationship between therapist and client; regular availability of the therapist, warmth and empathy.
3. Catharsis (emotional unburdening) – at the very beginning, when the client is being interviewed, s/he unburdens emotional problems; this process of emotional release is itself healing.
4. Non-specific factors associated with the client – the motivation for change, expectation of improvement, etc. These are called patient variables.
5. Non-specific factors associated with the therapist – positive nature, absence of unresolved emotional conflicts, presence of good mental health, etc. These are therapist variables.

Alternative therapies – alternatives to conventional drug treatment or psychotherapy: 1. Yoga – an ancient Indian technique detailed in Patanjali’s Yoga Sutras; asanas (body postures), pranayama (breathing) or the combination. 2. Meditation – focusing attention on breath or an object, thought or mantra; vipasana (mindfulness-based) meditation, in which attention is not fixed but one passively observes bodily sensations and thoughts. 3. Sudarshan Kriya Yoga (SKY) – rapid breathing techniques; found beneficial in stress, anxiety, PTSD, depression and stress-related medical illnesses (NIMHANS research); also increases well-being, optimism. 4. Kundalini yoga – found effective in treating mental disorders. 5. Acupuncture, herbal remedies, homeopathy and other traditional systems.

These are holistic in nature, and their effectiveness for some disorders is supported by research.

Healing factors: the therapist’s techniques, the therapeutic alliance, catharsis (emotional unburdening), patient variables (motivation, expectation of improvement) and therapist variables (positive nature, good mental health). Alternative therapies include yoga, meditation (incl. vipasana), Sudarshan Kriya Yoga, kundalini yoga, acupuncture and herbal remedies.

Answer

The treatment of psychological disorders has two components: reduction of symptoms and improving the level of functioning or quality of life. In milder disorders, symptom reduction may also improve quality of life; but in severe disorders such as schizophrenia, patients may still have negative symptoms — lack of interest and motivation, social withdrawal — even after active symptoms are controlled. Rehabilitation aims to empower the patient to become a productive member of society to the extent possible.

Techniques

1. Occupational therapy – patients are taught skills such as candle making, paper bag making and weaving, to help them form a work discipline.
2. Social skills training – helps patients develop interpersonal skills through role play, imitation and instruction.
3. Cognitive retraining – given to improve basic cognitive functions of attention, memory and executive functions.
4. Vocational training – after the patient improves sufficiently, s/he is given vocational training to gain skills necessary to undertake productive employment.

Rehabilitation also includes psycho-education of families, community support (day-care centres, half-way homes), and reducing stigma so that patients can be reintegrated into society.

Rehabilitation of the mentally ill uses occupational therapy (work skills and discipline), social skills training (role play, imitation, instruction), cognitive retraining (attention, memory, executive functions) and vocational training (skills for employment), aiming to make patients productive members of society.

Answer

Social learning theorist (Bandura): Phobias are learned through observation and imitation (modelling). - A child may have watched her/his mother, siblings or friends scream, jump and run away on seeing a lizard or cockroach. Through observational learning, the child acquires the same fear response. - The adult model’s fear is vicariously reinforced (e.g. the model gets attention or comfort, or the cockroach is removed). - Fear may also be learned from films, stories and warnings (“cockroaches are dirty and dangerous”). - Later, avoidance reduces anxiety and is reinforced, maintaining the phobia. - Treatment: modelling — watching a model handle lizards/cockroaches calmly, with gradual exposure and reinforcement (plus systematic desensitisation).

Psychoanalyst (Freud): Phobias are a symptom of unconscious intrapsychic conflict. - Anxiety arising from an unacceptable unconscious impulse (sexual or aggressive) or a repressed childhood conflict is displaced onto an external object — the lizard or cockroach. - The defence mechanisms of repression and displacement make it possible to avoid the real source of anxiety by avoiding the phobic object. - The lizard/cockroach may symbolically represent the feared impulse or person (e.g. Freud’s case of “Little Hans”, whose fear of horses was interpreted as displaced fear of his father). - Treatment: psychoanalysis — free association, dream interpretation and analysis of transference to bring the unconscious conflict to awareness, leading to insight and working through.

A social learning theorist would say the phobia was learned by observing and imitating others’ fear of lizards/cockroaches (modelling, vicarious reinforcement), maintained by avoidance. A psychoanalyst would say it results from unconscious conflicts whose anxiety is repressed and displaced onto the lizard/cockroach as a symbol, to be resolved through insight in psychoanalysis.

Answer

Cognitive Behaviour Therapy (CBT) is a short and efficacious therapy that combines cognitive therapy with behavioural techniques. It adopts a bio-psycho-social approach to delineating psychopathology: it combines cognitive therapy with behavioural techniques, the rationale being that the client’s distress has its origin in the biological, psychological and social realms. Thus, addressing the biological aspects through relaxation procedures, the psychological ones through behaviour therapy and cognitive therapy techniques, and the social ones with environmental manipulations makes CBT a comprehensive technique.

Problems for which CBT is best suited: 1. Anxiety disorders – generalised anxiety, panic attacks, phobias, social anxiety. 2. Depression. 3. Obsessive-compulsive disorder. 4. Schizophrenia (as an adjunct to medication). 5. Stress and stress-related disorders, PTSD. 6. Eating disorders (bulimia, binge eating). 7. Substance abuse/addiction. 8. Anger and aggression, interpersonal problems. 9. Problems like sleep disorders, chronic pain and psychosomatic disorders.

It is easy to use, short-term, structured and evidence-based, and can be applied to a wide range of psychological disorders.

CBT, a short, bio-psycho-social therapy combining cognitive and behavioural techniques, is best suited for anxiety disorders (panic, phobias), depression, OCD, stress and PTSD, schizophrenia (with medication), eating disorders, substance abuse and anger problems.

Topic checklist

• ☒ Nature, goals and types of psychotherapy (Q 1, 2)
• ☒ Behaviour, cognitive and CBT (Q 3, 4, 9)
• ☒ Humanistic-existential therapies (Q 5)
• ☒ Healing factors, alternative therapies, rehabilitation (Q 6, 7)
• ☒ Comparing approaches to phobia (Q 8)

Total questions answered: 9 of 9