Therapeutic Approaches | CBSE Class 12 Psychology Notes

This note covers psychological treatment, the therapist-client relationship, types of therapy, problem formulation, changes in behaviour and thinking, personal growth, healing factors, professional ethics, yoga and meditation, and support for returning to everyday life.

What is psychotherapy and what does it aim to achieve?

Definition: Psychotherapy is a voluntary relationship between a client, who seeks treatment, and a therapist, who provides treatment, to help the client solve psychological problems.

Psychological distress is the emotional suffering for which the client seeks help. Psychotherapy aims to reduce this distress, change maladaptive behaviours, meaning behaviours that interfere with adjustment, and help the client adapt better to the environment.

All therapeutic approaches are corrective and helping. Some emphasise self-understanding; others emphasise action. Their effectiveness depends on factors including the severity of the disorder, distress experienced by others, and the availability of time, effort and money.

What features do the approaches share?

• They systematically apply principles derived from theories of therapy.
• Practitioners require practical training under expert supervision. An untrained person may unintentionally cause harm.
• The client seeking help with emotional problems remains the focus of attention.
• Interaction between therapist and client forms a confidential, interpersonal and dynamic relationship that enables change.

What are the goals?

Psychotherapies aim at a few or all of the following goals. The range extends beyond reducing symptoms, meaning the manifestations of a disorder, to improving the person's understanding of choices and relationships.

• Strengthening the client's resolve to improve.
• Reducing emotional pressure.
• Developing the potential for positive growth.
• Modifying habits.
• Changing patterns of thinking.
• Increasing self-awareness.
• Improving interpersonal relationships and communication.
• Helping decision-making.
• Increasing awareness of choices in life.
• Helping the client relate to the social environment more creatively and with greater self-awareness.

Difficulties in marital, occupational and social adjustment also require major changes in the person's environment. Thus, treatment considers both the person's patterns and the setting in which the person lives.

How does the therapeutic alliance support change?

The therapeutic alliance is the special professional relationship between therapist and client. It is neither a passing acquaintance nor a permanent relationship. Its two major components are a contractual partnership and a limited duration.

Contractual nature means that two willing individuals enter a partnership to help the client overcome problems. Limited duration means that the alliance lasts until the client can deal with those problems and take control of life.

Why are acceptance and trust important?

The relationship is trusting and confiding. The therapist is accepting, genuine, warm and empathic. These qualities help the client discuss personal problems freely and unburden difficult feelings without fearing judgement.

Unconditional positive regard means accepting the client without making positive feelings depend on what the client says or does. The therapist continues to show positive regard even when the client is rude or reveals thoughts and actions regarded as wrong.

Empathy turns the therapeutic relationship into a healing relationship. It involves entering the client's perspective, rather than merely recognising the facts of a difficult situation.

Confidentiality means keeping the client's disclosed experiences, events, feelings and thoughts private. The therapist must not exploit the client's confidence. Even when the relationship is warm and close, it must remain professional.

How do the main approaches to psychotherapy differ?

Psychotherapies may be classified into three broad groups: psychodynamic, behaviour and existential therapies. They differ in their explanations of distress and methods of change, although all use psychological means to reduce distress.

Psychodynamic therapy focuses on intrapsychic conflicts, meaning conflicts within the person's psyche or mental life. Behaviour therapy focuses on faulty learning of behaviours and cognitions, meaning thoughts and beliefs. Existential therapy focuses on questions about the meaning of life and existence. Conditioning is learning through associations or consequences. Alienation means a feeling of estrangement or disconnection.

How do explanations guide treatment?

Emotional insight involves understanding conflicts intellectually, accepting them emotionally and changing emotions towards them. In psychodynamic therapy, symptoms and distress decrease as a consequence. Personal growth means increasing understanding of oneself, including aspirations, emotions and motives.

Psychodynamic methods include free association, in which clients report thoughts as they come to mind, and asking clients to report dreams. Both provide material that the therapist interprets. Behavioural methods change the conditions under which behaviours occur, while existential work allows clients to arrive at solutions through growth.

How do the approaches differ in duration?

Classical psychoanalysis, the earlier form of psychodynamic treatment, may continue for several years. Several recent psychodynamic versions take 10 to 15 sessions. Behaviour, cognitive behaviour and existential therapies are shorter and are completed in a few months.

Historically, psychodynamic therapy emerged first, followed by behaviour therapy. Existential therapies emerged last and are also known as the third force. The therapist, the relationship and the process of therapy all act as agents of change.

Why does therapy begin with a clinical formulation?

Clinical formulation means expressing the client's problem within the therapeutic model being used for treatment. It links the problem to an explanation and helps the therapist decide what treatment should address.

What does formulation help the therapist do?

• Understand the problem: recognise the full implications of the distress the client experiences.
• Identify treatment targets: specify the areas that therapy should address, rather than leaving the problem as a broad complaint.
• Choose techniques: decide which methods to use, when to use them and what outcomes to expect within the therapist's trained system.

For example, a client cannot hold a job and reports being unable to face superiors. A behavioural formulation identifies anxiety, meaning apprehension or uneasiness, and a lack of assertiveness skills, meaning difficulty asserting oneself. These become the treatment targets.

Formulation is an ongoing process. It may require revision as new clinical understanding develops during therapy. Usually, the first one or two sessions provide enough material for an initial formulation. Beginning psychotherapy without one is not advisable.

The formulation therefore guides the choice of techniques without becoming a fixed description that cannot change. The therapist's training provides the broad framework; understanding this particular client's problem shapes the treatment within that framework.

How does behavioural analysis identify and change faulty patterns?

Behaviour therapy applies principles of learning theory to clinical problems. It holds that distress arises from faulty behaviour or thought patterns and concentrates on correcting these patterns in the present.

The past matters only for understanding how faulty patterns originated. It is not relived or activated. Behaviour therapy includes many specific techniques; symptoms and the clinical diagnosis guide their selection. Phobias, meaning excessive and crippling fears, require different techniques from anger outbursts.

What does behavioural analysis examine?

Behavioural analysis examines distressing behaviour, factors that predispose a person to it, and factors that keep it going. Interviews with the client, and where relevant family members, provide information for this analysis.

The smoking response is maintained by the reinforcing value of relief. Reinforcement refers here to a consequence that increases or maintains behaviour. Treatment aims to eliminate faulty behaviours and substitute adaptive patterns, meaning patterns that support better adjustment.

How are antecedents and consequences changed?

Antecedent operations alter something before a behaviour. An establishing operation changes how reinforcing a consequence is. In the dinner example, reducing food at tea time increases hunger and makes dinner more reinforcing.

Consequent operations concern what follows the behaviour. Praising the child for eating dinner properly tends to encourage that behaviour. Here, reducing tea-time food is the antecedent operation and praise after dinner is the consequent operation.

Which reinforcement and learning techniques change behaviour?

Behavioural techniques reduce the client's level of arousal, meaning activation associated with anxiety, and change learned responses. Stimuli are events or objects that evoke responses; stimulus is the singular form. Learning can involve associations, consequences of behaviour, or observation of others. The therapist selects a treatment package following accurate behavioural analysis.

How do reinforcement and aversive conditioning differ?

In aversive conditioning, aversive means unpleasant. The repeated pairing makes the unwanted response associated with that unpleasant consequence. In negative reinforcement, the response allows the person to get rid of, avoid or escape an unpleasant stimulus.

The favourite-dish example links positive reinforcement to a particular wanted behaviour: doing homework at the appointed time. A token economy similarly connects a reward to the occurrence of the wanted behaviour, while allowing tokens to be collected before exchange.

What are differential reinforcement and modelling?

Differential reinforcement increases wanted behaviour while reducing unwanted behaviour. One method positively reinforces the wanted behaviour and ignores the unwanted behaviour.

For example, a girl cries and sulks when not taken to the cinema. The parent takes her when she asks without crying or sulking, does not take her when she cries, and ignores the crying. Polite requests increase and sulking decreases.

Modelling means learning a way of behaving by observing a role model, who may initially be the therapist. It uses vicarious learning, meaning learning through observation. Rewarding small changes helps the client gradually acquire the model's behaviour.

How do relaxation and systematic desensitisation address anxiety?

Anxiety can increase arousal and act as an antecedent factor in faulty behaviour. A client may smoke or eat to reduce anxiety, or may be unable to concentrate on study for long periods. Relaxation procedures are used to lower anxiety.

What is progressive muscular relaxation?

Progressive muscular relaxation teaches the difference between muscle tension and relaxation. The client contracts a muscle group, such as the forearm, to recognise tension, then lets the tension go. Repeated practice teaches relaxation of the body's muscles.

This procedure helps the client recognise the tense state and learn its opposite. Reduction of anxiety would decrease unwanted behaviours such as excessive eating or smoking when these behaviours are linked to that anxiety.

How does systematic desensitisation proceed?

Systematic desensitisation, introduced by Wolpe, treats phobias or irrational fears. It combines relaxation with gradual imagined encounters with fear-provoking situations. A hierarchy is an ordered arrangement of these situations according to the anxiety they provoke.

1. The therapist interviews the client to identify fear-provoking situations.
2. Therapist and client prepare a hierarchy, placing the least anxiety-provoking stimuli at the bottom.
3. The therapist relaxes the client and asks the client to imagine the least anxiety-provoking situation.
4. The client stops thinking about the fearful situation if the slightest tension appears.
5. Across sessions, the client imagines more severe fear-provoking situations while maintaining relaxation.

Reciprocal inhibition is the principle that when two mutually opposing forces occur together, the weaker is inhibited. Here, relaxation is established first and overcomes the anxiety associated with a mildly frightening imagined scene.

As the client remains relaxed, progressively greater anxiety can be tolerated. The gradual progression and attention to tension are central: the procedure begins with the least anxiety-provoking situation and builds from it over sessions.

How do cognitive therapies change distressing thought patterns?

Cognitive therapies locate the cause of psychological distress in irrational thoughts and beliefs. They help clients examine these patterns and change the way they interpret experiences, rather than treating the external event as the whole explanation.

What is Rational Emotive Therapy?

Albert Ellis developed Rational Emotive Therapy (RET). It proposes that irrational beliefs mediate between antecedent events and their consequences. ABC analysis means antecedent-belief-consequence analysis: A is the antecedent event, B the belief, and C the consequence.

Irrational beliefs may not be supported by empirical evidence, meaning evidence available in the environment. They contain rigid demands expressed through musts and shoulds. An example is the belief that everybody should love a person all the time.

Interviews and questionnaires help assess these beliefs. The therapist refutes them through gentle, non-directive questioning, without probing or directing. The client examines assumptions more deeply and gradually changes the underlying philosophy of life.

A rational belief system replaces the irrational system and psychological distress decreases. The aim is a change in the beliefs through which events are interpreted, rather than merely identifying which event occurred.

How does Aaron Beck explain cognitive distortions?

Aaron Beck proposed that childhood experiences in family and society develop core schemas, meaning systems of beliefs and action patterns. Later critical incidents can activate these schemas and produce persistent, irrational negative automatic thoughts.

For example, parental neglect leads a child to a schema of being unwanted. Public ridicule by a teacher later activates that schema. Negative thoughts about being unloved, unattractive, unintelligent or unlikely to succeed can then develop.

Cognitive distortions are general ways of thinking that distort reality negatively. These thought patterns are called dysfunctional cognitive structures because they generate errors in understanding social reality. Their repeated occurrence leads to feelings of anxiety and depression, a state of low mood and loss of interest.

Gentle, non-threatening questioning challenges the client's beliefs. It encourages thinking in a direction opposite to negative automatic thoughts, helping the client understand and alter faulty schemas. Cognitive restructuring is this change in cognitive structures, which reduces anxiety and depression.

Like behaviour therapy, cognitive therapy addresses a specific client problem. The focus remains on understanding and changing the faulty patterns connected with that problem.

How does cognitive behaviour therapy combine different methods?

Cognitive Behaviour Therapy (CBT) combines cognitive therapy with behavioural techniques. It is a short and efficacious treatment for a wide range of psychological disorders, including anxiety and depression.

Its bio-psychosocial approach explains distress through biological, psychological and social aspects together. The rationale is that distress has origins in all these realms, so treatment should address them through corresponding methods.

This combination makes CBT comprehensive, applicable to a variety of disorders and easy to use. For an anxious client, relaxation and cognitive restructuring can make major contributions to healing within this approach.

The biological, psychological and social components explain why CBT combines techniques rather than focusing on a single source of distress. Relaxation deals with bodily arousal, cognitive methods address thoughts, and environmental changes deal with the setting in which distress occurs.

How do humanistic-existential therapies promote personal growth?

Humanistic-existential therapies connect distress with loneliness, alienation, meaninglessness and blocked growth. They assume that people desire emotional development and personal fulfilment. When family and society curb these needs, psychological distress results.

Self-actualisation is the inborn force moving a person towards greater complexity, balance and integration. Integration means being a whole person, retaining a sense of completeness across varied experiences rather than being fragmented.

Healing occurs as the client recognises and removes obstacles to self-actualisation. The therapist provides a permissive, accepting and non-judgemental atmosphere for free emotional expression. The client has freedom and responsibility for behaviour; the therapist facilitates and guides self-growth.

How does logotherapy seek meaning?

Victor Frankl developed logotherapy, a therapy that helps people find meaning and responsibility in life irrespective of their circumstances. Meaning making is the process of finding meaning even in life-threatening circumstances.

Frankl's spiritual unconscious is the storehouse of love, aesthetic awareness and values of life. He emphasised spiritual anxieties that lead to meaninglessness. This may be called existential anxiety, meaning anxiety of spiritual origin connected with questions about one's existence.

The therapist emphasises the uniqueness of the client's life and encourages the search for meaning. The therapist is open about personal feelings and values. The focus is on the here and now, reminding the client of the immediacy of the present. Transference, the redirection of feelings from significant past relationships towards the therapist, is actively discouraged.

How does client-centred therapy work?

Carl Rogers developed client-centred therapy, which supports the client's real self through a warm, empathic relationship. Freedom and choice are central. Unconditional positive regard helps the client feel secure enough to explore feelings.

The therapist reflects feelings without judging them. Reflection involves rephrasing the client's statements and seeking simple clarifications to enhance their meaning. This helps the client reconnect with disintegrated feelings and become integrated.

As adjustment increases, personal relationships improve. The therapist remains a facilitator while the client moves towards becoming the real self. Acceptance does not depend on what the client reveals during a session.

What does Gestalt therapy emphasise?

Gestalt means whole. Fritz Perls and Laura Perls developed Gestalt therapy to increase self-awareness and self-acceptance. It helps clients recognise bodily processes and emotions that have been excluded from awareness.

The therapist encourages clients to act out fantasies concerning feelings and conflicts. This brings blocked experiences into awareness. Gestalt therapy can also be used in groups.

What contributes to healing and what ethics guide psychotherapy?

Healing depends on more than the name of a therapy. The methods used, the relationship formed and characteristics of both participants contribute. These factors explain why professional skill and the quality of the interaction matter together.

Which factors contribute to healing?

• Techniques and their implementation: the selected methods contribute directly. Relaxation and cognitive restructuring largely contribute when behavioural methods and CBT are used with an anxious client.
• Therapeutic alliance: the therapist's regular availability, warmth and empathy give the relationship healing properties.
• Catharsis: emotional unburdening during initial interviews has healing properties as the client describes the problems being faced.
• Non-specific factors: influences shared across different therapies, clients and therapists also contribute to improvement.

Patient variables are non-specific factors associated with the client, such as motivation to change and expectation of improvement. Therapist variables include a positive nature, absence of unresolved emotional conflicts and good mental health.

Which ethical standards are essential?

Informed consent, meaning consent based on an understanding of treatment, is required. Ethical practice also protects confidentiality and the integrity of the professional relationship. The therapist's work must aim at alleviating the client's suffering.

1. Obtain informed consent.
2. Maintain the client's confidentiality.
3. Direct therapeutic attempts towards relieving personal distress and suffering.
4. Protect the integrity of the practitioner-client relationship.
5. Respect human rights and dignity.
6. Maintain essential professional competence and skills.

These standards are connected with the trust required for therapy. The client's willingness to disclose difficult experiences depends on a professional relationship that respects the person and does not exploit confidence.

What role do yoga and meditation have as alternative therapies?

Alternative therapies are treatment possibilities offered as alternatives to conventional drug treatment or psychotherapy. Examples include yoga, meditation, acupuncture, which uses needles at selected body points, and herbal remedies, which use plant preparations. Yoga and meditation are used as treatment programmes for psychological distress.

How do yoga and forms of meditation differ?

Yoga is an ancient Indian technique detailed in the Ashtanga Yoga of Patanjali's Yoga Sutras. Common usage refers to asanas, meaning body postures, pranayama, meaning breathing practices, or a combination of these.

Meditation involves focusing attention on breathing, an object, a thought or a mantra, meaning a repeated word or phrase. In Vipasana, also called mindfulness-based meditation, no fixed object or thought holds attention. The person passively observes bodily sensations and thoughts passing through awareness.

Sudarshana Kriya Yoga (SKY) uses rapid breathing techniques. It has been found to be a beneficial, low-risk, low-cost adjunct, meaning an addition, to treatment for stress, anxiety, depression and other conditions. It has also been used with survivors of mass disasters.

Yoga techniques enhance well-being, mood, attention, mental focus and stress tolerance. Proper training by a skilled teacher and 30 minutes of daily practice maximise benefits. Research at the National Institute of Mental Health and Neurosciences (NIMHANS), India, has shown that SKY reduces depression.

Alcoholic patients practising SKY have reduced depression and stress levels. Yoga reduces the time taken to fall asleep and improves sleep quality. Kundalini Yoga combines breathing techniques with chanting of mantras and has been found effective in treating mental disorders.

Note: Prevention of repeated episodes of depression may be helped by mindfulness-based meditation or Vipasana. This would help patients process emotional stimuli better and prevent biases in that processing.

Why is rehabilitation needed after symptoms are reduced?

Rehabilitation helps people with mental illness become self-sufficient and productive members of society to the extent possible. Treatment has two components: reducing symptoms and improving functioning or quality of life.

In milder disorders, symptom reduction is associated with better quality of life. In severe disorders such as schizophrenia, a disorder involving disturbances in thought, perception, emotion and behaviour, symptom reduction may not be associated with such improvement. Many patients have negative symptoms, such as disinterest and lack of motivation to work or interact.

How do rehabilitation methods support everyday functioning?

Executive functions are cognitive abilities involved in organising and directing activity. Cognitive retraining addresses these abilities along with attention and memory. Occupational therapy, by comparison, uses practical activities to develop a pattern of working.

Social skills training focuses on interaction with others. Vocational training addresses employment and follows sufficient improvement. These methods support functioning beyond the reduction of active symptoms.

The aim is empowerment to the extent possible, so rehabilitation keeps both self-sufficiency and participation in society in view. Reduced symptoms alone may leave difficulties in motivation, work and social relationships that still require help.

Glossary

• Psychotherapy — A voluntary therapist-client relationship that uses psychological means to address the client's psychological problems.
• Therapeutic alliance — A trusting professional partnership with a contractual nature and a duration limited by the client's needs.
• Empathy — Understanding another person's situation from that person's perspective and being able to feel like that person.
• Unconditional positive regard — Acceptance and positive warmth that do not depend on what the client reveals or does.
• Clinical formulation — An account of the client's problem within the therapeutic model guiding understanding, targets and treatment techniques.
• Negative reinforcement — Reinforcement provided when a response enables escape from or avoidance of painful or unpleasant stimuli.
• Token economy — A system rewarding wanted behaviour with tokens that can later be exchanged for other rewards.
• Systematic desensitisation — A method combining relaxation with progressively more anxiety-provoking imagined situations to reduce phobic fear.
• Reciprocal inhibition — The principle that the weaker of two mutually opposing forces is inhibited when both occur together.
• Cognitive distortion — A general pattern of thinking that distorts reality negatively and produces errors in understanding social reality.
• Cognitive restructuring — Alteration of dysfunctional cognitive structures through questioning and insight, reducing anxiety and depression.
• Self-actualisation — An inborn force moving a person towards greater complexity, balance and integration as a whole person.
• Catharsis — Emotional unburdening when a client shares distressing problems during the initial stages of psychotherapy.
• Rehabilitation — Support that develops self-sufficiency and helps a patient participate productively in society to the extent possible.

Common errors and misconceptions

• Misconception: Anyone who gives helpful advice can practise psychotherapy. Correct: Psychotherapy requires practical training under expert supervision; an untrained person may unintentionally cause harm.
• Misconception: A therapeutic alliance is a permanent personal friendship. Correct: It is a professional, contractual partnership lasting until the client can manage problems and take control of life.
• Misconception: Empathy and sympathy mean the same thing. Correct: Sympathy involves compassion and pity, whereas empathy involves understanding and feeling from the other person's perspective.
• Misconception: Behaviour therapy makes clients relive their past. Correct: It corrects present faulty patterns; the past matters only for understanding their origins.
• Misconception: Negative reinforcement means pairing an unwanted response with an unpleasant consequence. Correct: That describes aversive conditioning. Negative reinforcement involves escape from or avoidance of unpleasant stimuli.
• Misconception: Systematic desensitisation begins with the strongest fear. Correct: It starts with relaxation and the least anxiety-provoking situation, progressing over sessions while relaxation is maintained.
• Misconception: Symptom reduction necessarily restores quality of life in severe mental disorders. Correct: It may not do so; rehabilitation addresses remaining difficulties in functioning and self-sufficiency.
• Misconception: Vipasana guarantees that depression will not recur. Correct: Mindfulness-based meditation may help prevent repeated episodes; that is a qualified claim, not a guarantee.

Exam-style questions with model answers

Q1. State the two major components of a therapeutic alliance and explain what each means. [2 marks]

1. Contractual nature: the client and therapist willingly enter a partnership aimed at helping the client overcome psychological problems.
2. Limited duration: the alliance lasts until the client can deal with the problems and take control of life.

Q2. A young person began smoking while preparing for the annual examination, reports relief from anxiety after smoking, continues smoking and now seeks help to stop. Identify and explain the malfunctioning behaviour, antecedent factor and maintaining factor. [3 marks]

1. Malfunctioning behaviour: smoking is the behaviour causing concern, since the young person seeks help to stop it. It is the faulty behaviour to be addressed.
2. Antecedent factor: the anxiety-provoking situation of preparing for the annual examination preceded smoking and predisposed the person to that response.
3. Maintaining factor: reported relief from anxiety after smoking reinforces the response. This consequence explains why the person continues smoking.

Q3. Explain systematic desensitisation for phobias, giving five steps and the principle on which the technique works. [6 marks]

1. The therapist interviews the client to identify situations that provoke fear. This supplies the situations to be addressed during treatment.
2. Therapist and client jointly arrange anxiety-provoking stimuli in a hierarchy, with the least anxiety-provoking stimuli at the bottom.
3. The therapist establishes relaxation and asks the client to imagine the least anxiety-provoking situation while remaining in that relaxed state.
4. If the slightest tension appears, the client stops thinking about the fearful situation. Relaxation is central to the procedure.
5. Over sessions, the client imagines progressively more severe fear-provoking situations while maintaining relaxation and becomes systematically desensitised to the fear.
6. Reciprocal inhibition explains the process: when opposing forces occur together, the weaker is inhibited. Established relaxation overcomes the anxiety associated with the imagined situation.

Q4. A client experienced parental neglect in childhood and developed the belief of being unwanted. Later, public ridicule by a teacher activated that belief, followed by persistent thoughts of being unloved and unable to succeed. Using Beck's approach, explain the core schema, trigger, automatic thoughts, cognitive distortion and therapeutic response. [5 marks]

1. Core schema: parental neglect contributed to a system of beliefs and action patterns centred on being unwanted. Such schemas develop through childhood experience.
2. Trigger: public ridicule by the teacher is the later critical incident that activates the existing schema. It connects present experience with the earlier belief.
3. Negative automatic thoughts: persistent thoughts of being unloved and unable to succeed arise after activation of the schema and express its negative interpretation.
4. Cognitive distortion: these general negative thought patterns distort social reality. Their repeated occurrence leads to feelings of anxiety and depression, a state of low mood and loss of interest.
5. Therapeutic response: gentle, non-threatening questioning challenges beliefs and encourages insight into faulty schemas. Altering these cognitive structures is cognitive restructuring, which reduces anxiety and depression.

Q5. Explain the four factors contributing to healing in psychotherapy: techniques, therapeutic alliance, catharsis and non-specific factors. [4 marks]

1. Techniques: the therapist's selected methods and their implementation contribute to healing. Relaxation and cognitive restructuring are examples when treating an anxious client.
2. Therapeutic alliance: regular availability, warmth and empathy give the relationship between therapist and client healing properties.
3. Catharsis: sharing problems during initial interviews allows emotional unburdening, which itself contributes to healing.
4. Non-specific factors: client motivation and expectations, and therapist qualities such as a positive nature and good mental health, operate across different therapeutic systems.

Q6. Explain four rehabilitation methods: occupational therapy, social skills training, cognitive retraining and vocational training. [4 marks]

1. Occupational therapy: patients learn practical skills such as candle making, paper bag making and weaving to develop work discipline.
2. Social skills training: role play, imitation and instruction build interpersonal abilities needed to function within a social group.
3. Cognitive retraining: training improves basic cognitive functions, including attention, memory and executive functions.
4. Vocational training: after sufficient improvement, patients develop skills needed for productive employment, supporting participation in society.

Q7. State six ethical standards of professional psychotherapy and explain their focus. [6 marks]

1. Informed consent: the therapist needs to obtain the client's informed consent as an ethical requirement of professional psychotherapy.
2. Confidentiality: the therapist must keep private the personal experiences, events, thoughts and feelings disclosed by the client during therapy.
3. Relief of suffering: all therapeutic attempts should be directed towards alleviating the client's personal distress and suffering.
4. Relationship integrity: the practitioner-client relationship must remain professional. The therapist must not exploit the client's trust and confidence.
5. Rights and dignity: practice must respect human rights and the dignity of the person who seeks psychological help.
6. Competence: essential professional skills and competence are required. Practical training under expert supervision prepares a person to practise psychotherapy.

Q8. Explain the chief aim and method of logotherapy, client-centred therapy and Gestalt therapy. [3 marks]

1. Logotherapy: Frankl's approach helps clients find meaning and responsibility regardless of circumstances. An open therapist emphasises the uniqueness of the client's life and the present.
2. Client-centred therapy: Rogers uses empathy, unconditional positive regard and reflection of feelings to support integration and help the client become the real self.
3. Gestalt therapy: Fritz and Laura Perls emphasise self-awareness and self-acceptance. Acting out fantasies helps clients recognise bodily processes and emotions excluded from awareness.

Key takeaways

• Psychotherapy is a trained professional's voluntary partnership with a client, aiming to reduce distress and improve adjustment.
• A therapeutic alliance combines a contractual relationship and limited duration with trust, empathy, acceptance and confidentiality.
• Clinical formulation connects the client's problem with a therapeutic model and guides treatment targets and techniques.
• Behaviour therapy analyses antecedents and maintaining factors, then replaces faulty present patterns with adaptive behaviour.
• Cognitive therapies examine irrational beliefs and negative thought patterns, using questioning to support changes in thinking.
• Humanistic-existential therapies emphasise personal growth, meaning, self-awareness and the client's responsibility within an accepting therapeutic relationship.
• Healing involves techniques, the therapeutic alliance, emotional unburdening and non-specific client and therapist factors.
• Rehabilitation supports self-sufficiency and productive participation because reduced symptoms may not restore quality of life in severe disorders.

Test yourself

How does empathy differ from sympathy?

Empathy involves understanding and feeling from another person's perspective. Sympathy involves compassion and pity without being able to feel like that person.

Why may a clinical formulation change during treatment?

Formulation is ongoing. New clinical understanding gained during therapy may require the initial account of the client's problem to be revised.

What makes a token economy different from an immediate treat?

Wanted behaviour earns tokens. The person collects these tokens and later exchanges them for a reward, such as an outing or treat.

What do A, B and C mean in RET's ABC analysis?

A is the antecedent event, B the belief through which it is interpreted, and C the resulting emotional and behavioural consequence.

What is the purpose of reflection in client-centred therapy?

Non-judgemental rephrasing and simple clarification enhance the meaning of the client's statements, helping the client reconnect with feelings and become integrated.

What distinguishes Vipasana from meditation on a fixed object?

Vipasana has no fixed object or thought for attention. The person passively observes bodily sensations and thoughts passing through awareness.

Why are motivation and expectation called non-specific factors?

They occur across different therapeutic systems and clients, rather than belonging to a single method. They are examples of patient variables.

When is vocational training introduced in rehabilitation?

It follows sufficient improvement and helps the patient acquire skills needed to undertake productive employment.