CHAPTER 5: THERAPEUTIC APPROACHES

NATURE OF PSYCHOTHERAPY

Psychotherapy is a voluntary relationship between the client (one seeking

treatment) and the therapist (the one who treats).

The purpose of the relationship is to help the client to solve the

psychological problems being faced by her or him.

The relationship is conducive for building the trust of the client so that
problems may be freely discussed.

Psychotherapies aim at:

1. Changing the maladaptive behaviours
2. Decreasing the sense of personal distress
3. Helping the client to adapt better to her/his environment
(Inadequate marital, occupational and social adjustment requires that
major changes be made in an individual’s personal environment)

Characteristics of psychotherapeutic approaches:

(i) There is systematic application of principles underlying the different

theories of therapy.
(ii) Persons who have received practical training under expert
supervision can practice psychotherapy, and not everybody. An
untrained person may unintentionally cause more harm than any
good.
(iii) The therapeutic situation involves a therapist and a client who seeks
and receives help for her/his emotional problems (this person is the
focus of attention in the therapeutic process).
(iv) The interaction of these two persons — the therapist and the client
— results in the consolidation/formation of the therapeutic
relationship.

This is a confidential, interpersonal, and dynamic relationship.

Goals of psychotherapy:

• Reinforcing client’s resolve for betterment.

• Lessening emotional pressure.
• Unfolding the potential for positive growth.
• Modifying habits.
1
 • Changing thinking patterns.
• Increasing self-awareness.
• Improving interpersonal relations and communication.
• Facilitating decision-making.
• Becoming aware of one’s choices in life
• Relating to one’s social environment in a more creative and self-aware
manner.

Therapeutic Relationship

The special relationship between the client and the therapist is known
as the therapeutic relationship or alliance.

❖ It is neither a passing acquaintance, nor a permanent and lasting

relationship.

❖ There are two major components of a therapeutic alliance:

• The first component is the contractual nature of the

relationship in which two willing individuals, the client and the
therapist, enter into a partnership which aims at helping the
client overcome her/his problems.

• The second component of therapeutic alliance is the limited

duration of the therapy. This alliance lasts until the client
becomes able to deal with her/his problems and take control of
her/ his life.

This relationship has several unique properties:

This is a confidential, interpersonal, and dynamic relationship. It is a

trusting and confiding relationship.

• The high level of trust enables the client to unburden herself/himself

to the therapist and confide her/his psychological and personal
problems to the latter.

• The therapist encourages this by being accepting, empathic, genuine

and warm to the client. The therapist conveys by her/his words and
behaviours that s/he is not judging the client and will continue to show

2
 the same positive feelings towards the client even if the client is rude or
confides all the ‘wrong’ things that s/he may have done or thought
about. This is the unconditional positive regard which the therapist
has for the client.

Empathy Sympathy Intellectual understanding

of situation
Empathy is present One has Intellectual understanding is
when one is able to compassion and cold in the sense that the
understand the plight pity towards the person is unable to feel like
of another person, suffering of another the other person and does
and feel like the other but is not able to not feel sympathy either.
person. It means feel
understanding things like the other
from the other person
person’s perspective,
i.e. putting oneself in
the other person’s
shoes.

Empathy enriches the therapeutic relationship and transforms it into a

healing relationship.

• The therapeutic alliance also requires that the therapist must keep
strict confidentiality of the experiences, events, feelings or thoughts
disclosed by the client. The therapist must not exploit the trust and the
confidence of the client in anyway.

• Finally, it is a professional relationship, and must remain so.

3
TYPE OF THERAPIES

Though all psychotherapies aim at removing human distress and fostering

effective behaviour, they differ greatly in concepts, methods, and techniques.

Psychotherapies may be classified into three broad groups, viz. the

psychodynamic, behaviour, and existential psychotherapies.

In terms of the chronological order, psychodynamic therapy emerged first

followed by behaviour therapy while the existential therapies which are also
called the third force, emerged last.

The classification of psychotherapies is based on the following parameters:

4
PSYCHODYNAMIC THERAPY

The psychodynamic therapy pioneered by Sigmund Freud is the oldest form

of psychotherapy. His close collaborator Carl Jung modified it to what came
to be known as the analytical psychotherapy.
Broadly, the psychodynamic therapy has conceptualised the structure of the
psyche, dynamics between different components of the psyche, and the source
of psychological distress.

Methods of Eliciting the Nature of Intrapsychic Conflict

The first step in the treatment is to elicit this intrapsychic conflict.

Psychoanalysis has invented free association and dream interpretation as
two important methods for eliciting the intrapsychic conflicts.
Once a therapeutic relationship is established, and the client feels
comfortable, the therapist makes her/him lie down on the couch, close
her/his eyes and asks her/him to speak whatever comes to mind without
censoring it in anyway. The client is encouraged to freely associate one
thought with another, and this method is called the method of free
association. The censoring superego and the watchful ego are kept in
abeyance as the client speaks whatever comes to mind in an atmosphere that
is relaxed and trusting. This free uncensored verbal narrative of the client is
a window into the client’s unconscious to which the therapist gains access.

Along with this technique, the client is asked to write down her/his dreams
upon waking up. Psychoanalysts look upon dreams as symbols of the

5
unfulfilled desires present in the unconscious. If the unfulfilled desires are
expressed directly, the ever-vigilant ego would suppress them and that would
lead to anxiety. These symbols are interpreted according to an accepted
convention of translation as the indicators of unfulfilled desires and conflicts.

Modality of Treatment

Transference and Interpretation are the means of treating the patient.

As the unconscious forces are brought into the conscious realm through free
association and dream interpretation, the client starts identifying the
therapist with the authority figures of the past, usually childhood. The
therapist may be seen as the punitive father, or as the negligent mother.
The therapist maintains a non-judgmental yet permissive attitude and allows
the client to continue with this process of emotional identification. This is the
process of transference.

The therapist encourages this process because it helps her/him in

understanding the unconscious conflicts of the client. The client acts out
her/his frustrations, anger, fear, and depression that s/he harboured
towards that person in the past, but could not express at that time. The
therapist becomes a substitute for that person in the present. This stage is
called transference neurosis. A full-blown transference neurosis is helpful in
making the therapist aware of the nature of intrapsychic conflicts suffered by
the client.

There is the positive transference in which the client idolises, or falls in love
with the therapist, and seeks the therapist’s approval.
Negative transference is present when the client has feelings of hostility,
anger, and resentment towards the therapist.

The process of transference is met with resistance. Since the process of

transference exposes the unconscious wishes and conflicts, thereby
increasing the distress levels, the client resists
transference.

Resistance can be conscious or unconscious.

Conscious resistance is present when the client deliberately hides some
information.
Unconscious resistance is assumed to be present when the client becomes
silent during the therapy session, recalls trivial details without recalling the
emotional ones, misses appointments, and comes late for therapy sessions.

6
The therapist overcomes the resistance by repeatedly confronting the patient
about it and by uncovering emotions such as anxiety, fear, or shame, which
are causing the resistance.

Interpretation is the fundamental mechanism by which change is effected.

Confrontation and clarification are the two analytical techniques of
interpretation.

In confrontation, the therapist points out to the client an aspect of her/his

psyche that must be faced by the client.

Clarification is the process by which the therapist brings a vague or confusing

event into sharp focus. This is done by separating and highlighting important
details about the event from unimportant ones.

Interpretation is a more subtle process. The therapist uses the unconscious

material that has been uncovered in the process of free association, dream
interpretation, transference and resistance to make the client aware of the
intrapsychic conflicts.

The repeated process of using confrontation, clarification, and interpretation

is known as working through. Working through helps the patient to
understand herself/himself and the source of the problem and to integrate
the uncovered material into her/his ego.

The outcome of working through is insight. Insight is not a sudden event but
a gradual process wherein the unconscious memories are repeatedly
integrated into conscious awareness; these unconscious events and memories
are re-experienced in transference and are worked through.

The intellectual understanding is the intellectual insight.

The emotional understanding, acceptance of one’s irrational reaction to the
unpleasant events of the past, and the willingness to change emotionally as
well as making the change is emotional insight.
Insight is the end point of therapy.

Duration of Treatment

Psychoanalysis lasts for several years, with one hour session for 4–5 days per
week. It is an intense treatment.

7
There are three stages in the treatment:

• Stage one is the initial phase. The client becomes familiar with the
routines, establishes a therapeutic relationship with the analyst, and
gets some relief with the process of recollecting the superficial materials
from the consciousness about the past and present troublesome events.

• Stage two is the middle phase, which is a long process. It is

characterised by transference, resistance on the part of the client, and
confrontation and clarification, i.e. working through on the therapist’s
part. All these processes finally lead to insight.

• The third phase is the termination phase wherein the relationship with
the analyst is dissolved and the client prepares to leave the therapy.

BEHAVIOURAL THERAPY

Behaviour therapies postulate that psychological distress arises because of

faulty behaviour patterns or thought patterns. The past is relevant only to
the extent of understanding the origins of the faulty behaviour and thought
patterns. The past is not activated or relived.

Behavioural therapy is based on the clinical application of learning principles.

The therapy consists of a large set of specific techniques and interventions.
The symptoms and clinical diagnosis are the guiding factors in the selection
of specific techniques or intervention to be applied. For example – treatment
of phobias, anger outbursts, depression, anxiety, etc would require different
set of techniques.

The foundation of behaviour therapy is on formulating dysfunctional or faulty

behaviours, the factors which reinforce and maintain these behaviours, and
devising methods by which they can be changed.

Method of Treatment

The client with psychological distress is interviewed with a view to analyse

her/his behaviour patterns.

Behavioural analysis is conducted to find malfunctioning behaviours, the

antecedents of faulty learning, and the factors that maintain or continue
faulty learning.

8
Malfunctioning behaviours are those behaviours which cause distress to
the client.
Antecedent factors are those causes which predispose the person to indulge
in that behaviour.
Maintaining factors are those factors which lead to the persistence of the
faulty behaviour.
An example would be a young person who has acquired the malfunctioning
behaviour of smoking.
Behavioural analysis conducted by interviewing the client and the family
members reveals that the person started smoking when he was preparing for
the annual examination. He had reported relief from anxiety upon smoking.
Thus, anxiety provoking situation becomes the causative or antecedent factor.
The feeling of relief becomes the maintaining factor for him to continue
smoking.

The aim of the treatment is to extinguish or eliminate the faulty behaviours

and substitute them with adaptive behaviour patterns.

The therapist does this through establishing antecedent operations and

consequent operations.
Antecedent operations control behaviour by changing something that
precedes such a behaviour. The change can be done by increasing or
decreasing the reinforcing value of a particular consequence. This is called
establishing operation.
For example, if a child gives trouble in eating dinner, an establishing operation
would be to decrease the quantity of food served at tea time. This would
increase the hunger at dinner and thereby increase the reinforcing value of
food at dinner. Praising the child when s/he eats properly tends to encourage
this behaviour.
The antecedent operation is the reduction of food at tea time and the
consequent operation is praising the child for eating dinner. It establishes the
response of eating dinner.

Behavioural Techniques

A range of techniques is available for changing behaviour. The principles of

these techniques are to reduce the arousal level of the client, alter behaviour
through classical conditioning or operant conditioning or vicarious learning
procedures, if necessary.

Negative reinforcement and aversive conditioning are the two major

techniques of behaviour modification.

9
• Negative reinforcement are responses that lead organisms to get rid
of painful stimuli or avoid or escape from them.
For example, one learns to put on woollen clothes, burn firewood or use
electric heaters to avoid the unpleasant cold weather.

• Aversive conditioning refers to repeated association of undesired

response with an aversive consequence.
For example, an alcoholic is given a mild electric shock and asked to
smell the alcohol. With repeated pairings the smell of alcohol is aversive
as the pain of the shock is associated with it and the person will give
up alcohol.

• Positive reinforcement - If an adaptive behaviour occurs rarely,

positive reinforcement is given to increase the deficit.
For example, if a child does not do homework regularly, positive
reinforcement may be used by the child’s mother by preparing the
child’s favourite dish whenever s/he does homework at the appointed
time.

• Token economy - Persons with behavioural problems can be given a

token as a reward every time a wanted behaviour occurs. The tokens
are collected and exchanged for a reward such as an outing for the
patient or a treat for the child. This is known as token economy.

• Differential reinforcement - Unwanted behaviour can be reduced and

wanted behaviour can be increased simultaneously through differential
reinforcement.

Positive reinforcement for the wanted behaviour and negative

reinforcement for the unwanted behaviour attempted together may be
one such method.
The other method is to positively reinforce the wanted behaviour and
ignore the unwanted behaviour. The latter method is less painful and
equally effective.
For example, let us consider the case of a girl who sulks and cries when
she is not taken to the cinema when she asks.
The parent is instructed to take her to the cinema if she does not cry
and sulk but not to take her if she does. Further, the parent is
instructed to ignore the girl when she cries and sulks. The wanted
behaviour of politely asking to be taken to the cinema increases and the
unwanted behaviour of crying and sulking decreases.

10
 • Systematic desensitisation is a technique introduced by Wolpe for
treating phobias or irrational fears. The client is interviewed to elicit
fear provoking situations and together with the client, the therapist
prepares a hierarchy of anxiety-provoking stimuli with the least
anxiety-provoking stimuli at the bottom of the hierarchy. The therapist
relaxes the client and asks the client to think about the least anxiety-
provoking situation. The client is asked to stop thinking of the fearful
situation if the slightest tension is felt. Over sessions, the client is able
to imagine more severe fear-provoking situations while maintaining the
relaxation. The client gets systematically desensitised to the fear.
The principle of reciprocal inhibition operates here. This
principle states that the presence of two mutually opposing forces at
the same time, inhibits the weaker force.
Thus, the relaxation response is first built up and mildly anxiety-
provoking scene is imagined, and the anxiety is overcome by the
relaxation. The client is able to tolerate progressively greater levels of
anxiety because of her/his relaxed state.

• Modelling is the procedure wherein the client learns to behave in a

certain way by observing the behaviour of a role model or the therapist
who initially acts as the role model.

• Vicarious learning, i.e. learning by observing others, is used and

through a process of rewarding small changes in the behaviour, the
client gradually learns to acquire the behaviour of the model.

There is a great variety of techniques in behaviour therapy. The skill of the

therapist lies in conducting an accurate behavioural analysis and building a
treatment package with the appropriate techniques.

11
COGNITIVE THERAPY

Cognitive therapies locate the cause of psychological distress in irrational

thoughts and beliefs.

• Albert Ellis formulated the Rational Emotive Therapy (RET). The

central thesis of this therapy is that irrational beliefs mediate between
the antecedent events and their consequences.

The first step in RET is the antecedent-belief-consequence (ABC) analysis.

Antecedent events, which caused the psychological distress, are noted.

Irrational beliefs which are distorting the present reality are assessed through
questionnaires and interviews. These beliefs are characterised by thoughts
with ‘musts’ and ‘shoulds’, i.e. things ‘must’ and ‘should’ be in a particular
manner.
Example of irrational belief is, “One should be loved by everybody all the time”
This distorted perception of the antecedent event due to the irrational belief
leads to the consequence, i.e. negative emotions and behaviours.

In the process of RET, the irrational beliefs are refuted by the therapist
through a process of non-directive questioning. The nature of questioning is
gentle, without probing or being directive.

Gradually the client is able to change the irrational beliefs by making a change
in her/his philosophy about life. The rational belief system replaces the
irrational belief system and there is a reduction in psychological distress.

• Another cognitive therapy is that of Aaron Beck.

His theory of psychological distress characterised by anxiety or depression,

states that childhood experiences provided by the family and society develop
core schemas or systems, which include beliefs and action patterns in the
individual.

Thus, a client, who was neglected by the parents as a child, develops the core
schema of “I am not wanted”. During the course of life, he/she is publicly
ridiculed by the teacher in school.
This critical incident triggers the core schema of “I am not wanted” leading to
the development of negative automatic thoughts.

Negative thoughts are persistent irrational thoughts such as “nobody loves

me”, “I am ugly”, “I am stupid”, “I will not succeed”, etc.

12
Such negative automatic thoughts are characterised by cognitive distortions.

Cognitive distortions are ways of thinking which are general in nature but
which distort the reality in a negative manner.

These patterns of thought are called dysfunctional cognitive structures.

They lead to errors of cognition about the social reality.

Repeated occurrence of these thoughts leads to the development of feelings of

anxiety and depression.

The therapist uses questioning, which is gentle, nonthreatening disputation

of the client’s beliefs and thoughts. Examples of such question would be, “Why
should everyone love you?”.
The questions make the client think in a direction opposite to that of the
negative automatic thoughts whereby s/he gains insight into the nature of
her/his dysfunctional schemas, and is able to alter her/his cognitive
structures.

The aim of the therapy is to achieve this cognitive restructuring which, in

turn, reduces anxiety and depression.

• Cognitive Behaviour Therapy

The most popular therapy presently is the Cognitive Behaviour Therapy

(CBT) which is a short and efficacious treatment for a wide range of
psychological disorders such as anxiety, depression, panic attacks, and
borderline personality, etc. It combines cognitive therapy with behavioural
techniques.

CBT adopts a biopsychosocial approach to the delineation of psychopathology

The rationale is that the client’s distress has its origins in the biological,
psychological, and social realms.
Hence, addressing the biological aspects through relaxation procedures, the
psychological ones through behaviour therapy and cognitive therapy
techniques and the social ones with environmental manipulations.

Thus, CBT a comprehensive technique which is easy to use, applicable to a

variety of disorders, and has proven efficacy.

13
HUMANISTIC-EXISTENTIAL THERAPY

The humanistic-existential therapies postulate that psychological distress

arises from feelings of loneliness, alienation, and an inability to find meaning
and genuine fulfilment in life.

Human beings are motivated by the desire for personal growth and self-
actualisation, and an innate need to grow emotionally. When these needs are
curbed by society and family, human beings experience psychological
distress.

Self-actualisation is defined as an innate or inborn force that moves the

person to become more complex, balanced, and integrated, i.e. achieving the
complexity and balance without being fragmented.

Healing occurs when the client is able to perceive the obstacles to self-
actualization in her/his life and is able to remove them.

Self-actualisation requires free emotional expression. The family and society

curb emotional expression, as it is feared that a free expression of emotions
can harm society by unleashing destructive forces.
The therapy creates a permissive, non-judgmental and accepting atmosphere
in which the client’s emotions can be freely expressed and the complexity,
balance and integration could be achieved.

The fundamental assumption is that the client has the freedom and
responsibility to control her/his own behaviour. The client initiates the
process of self growth through which healing takes place. The therapist is
merely a facilitator and guide.

Existential Therapy

Victor Frankl propounded the Logotherapy. Logos is the Greek word for soul
and Logotherapy means treatment for the soul.

Frankl calls the process of finding meaning even in life-threatening

circumstances as the process of meaning making. The basis of meaning
making is a person’s quest for finding the spiritual truth of one’s existence.

Just as there is an unconscious, which is the repository of instincts, there is

a spiritual unconscious, which is the storehouse of love, aesthetic awareness,
and values of life.

14
Neurotic anxieties arise when the problems of life are attached to the physical,
psychological or spiritual aspects of one’s existence. Frankl emphasised the
role of spiritual anxieties (existential anxiety), i.e. neurotic anxiety of
spiritual origin.

The goal of logotherapy is to help the patients to find meaning and

responsibility in their life irrespective of their life circumstances.

In Logotherapy, the therapist is open and shares her/his feelings, values and
his/her own existence with the client. Transference is actively discouraged.
The therapist reminds the client about the immediacy of the present as the
emphasis is on here and now.

Client-centred Therapy

Client-centred therapy was given by Carl Rogers. Rogers brought into

psychotherapy the concept of self, with freedom and choice as the core of one’s
being. The therapy provides a warm relationship in which the client can
reconnect with her/his disintegrated feelings.

The therapist shows empathy, i.e. understanding the client’s experience as if

it were her/his own, is warm and has unconditional positive regard, i.e. total
acceptance of the client as s/he is.

Empathy sets up an emotional resonance between the therapist and the

client.

Unconditional positive regard indicates that the positive warmth of the

therapist is not dependent on what the client reveals or does in the therapy
sessions. It ensures that the client feels secure and can trust the therapist.

The therapist reflects the feelings of the client in a non-judgmental manner.

The reflection is achieved by rephrasing the statements of the client, i.e.
seeking simple clarifications to enhance the meaning of the client’s
statements. This process of reflection helps the client to become integrated.

In essence, this therapy helps a client to become her/his real self with the
therapist working as a facilitator.

Gestalt Therapy

The German word gestalt means ‘whole’. This therapy was given by Freiderick
(Fritz) Perls together with his wife Laura Perls.

15
The goal of gestalt therapy is to increase an individual’s self-awareness and
self-acceptance.

The client is taught to recognise the bodily processes and the emotions that
are being blocked out from awareness. The therapist does this by encouraging
the client to act out fantasies about feelings and conflicts.

This therapy can also be used in group settings.

BIOMEDICAL THERAPY

Medicines may be prescribed to treat psychological disorders. Prescription

of medicines for treatment of mental disorders is done by qualified medical
professionals known as psychiatrists. They are medical doctors who have
specialised in the understanding, diagnosis and treatment of mental
disorders. The nature of medicines used depends on the nature of the
disorders. Severe mental disorders such as schizophrenia or bipolar disorder
require anti-psychotic drugs. Common mental disorders such as generalised
anxiety or reactive depression may also require milder drugs. The medicines
prescribed to treat mental disorders can cause side-effects which need to be
understood and monitored. Hence, it is essential that medication is given
under proper medical supervision.

Electro-convulsive Therapy (ECT) is another form of biomedical therapy.

Mild electric shock is given via electrodes to the brain of the patient to induce
convulsions. The shock is given by the psychiatrist only when it is necessary
for the improvement of the patient. ECT is not a routine treatment and is given
only when drugs are not effective in controlling the symptoms of the patient.

ALTERNATIVE THERAPIES

Alternative therapies are alternative treatment possibilities to the

conventional drug treatment or psychotherapy. These include yoga,
meditation, acupuncture, herbal remedies and so on.

Yoga

Yoga is an ancient Indian technique detailed in the Ashtanga Yoga of

Patanjali’s Yoga Sutras.

Yoga refers to only the asanas or body posture component or to breathing

practices or pranayama, or to a combination of the two.

16
 • Yoga techniques enhance well-being, mood, attention, mental focus and
stress tolerance. Proper training by a skilled teacher and a 30-minute
practice everyday will maximize the benefits.

• Insomnia is treated with Yoga. Yoga reduces the time to go to sleep and
improves the quality of sleep.

Sudarshana Kriya Yoga (SKY) includes rapid breathing

techniques to induce hyperventilation.

• SKY is beneficial, low-risk, low cost adjunct to the treatment of stress,

anxiety, post-traumatic stress disorder (PTSD), depression, stress-
related medical illnesses, substance abuse and rehabilitation of
criminal offenders.

• SKY has been used as a public health intervention technique to alleviate

PTSD in survivors of mass disasters.

• National Institute of Mental Health and Neurosciences (NIMHANS),

India has shown that SKY reduces depression.

• Alcoholic patients who practice SKY have reduced depression and

stress levels.

Kundalini Yoga which is taught in USA combines pranayama or

breathing techniques with chanting of mantras and is found to
be effective in treatment of mental disorders.

• The Institute for Non-linear Science, University of California, San Diego,

USA has found that Kundalini Yoga is effective in the treatment of
obsessive compulsive disorder.

Meditation

Meditation refers to the practice of focusing attention on breath or an object

or thought or a mantra.

Although, in Vipasana meditation, also known as mindfulness-based

meditation, there is no fixed object or thought to hold attention. The person

17
passively observes the various bodily sensations and thoughts that are
passing through in his/her awareness.

Prevention of repeated episodes of depression may be helped by mindfulness-

based meditation or Vipasana. This meditation would help the patients to
process emotional stimuli better and hence prevent biases in the processing
of these stimuli.

REHABILITATION OF THE MENTALLY ILL

The treatment of psychological disorders has two components:

1. Reduction of symptoms
2. Improving the level of functioning or quality of life.

In the case of milder disorders such as generalised anxiety, reactive

depression or phobia, reduction of symptoms is associated with an
improvement in the quality of life.

However, in the case of severe mental disorders such as schizophrenia,

reduction of symptoms may not be associated with an improvement in the
quality of life.

Many patients suffer from negative symptoms such as disinterest and lack of
motivation to do work or to interact with people.

Rehabilitation is required to help such patients become self-sufficient.

The aim of rehabilitation is to empower the patient to become a
productive member of society to the extent possible.

In rehabilitation, the patients are given occupational therapy, social skills

training, and vocational therapy.

• In occupational therapy, the patients are taught skills such as candle

making, paper bag making and weaving to help them to form a work
discipline.

• Social skills training helps the patients to develop interpersonal skills

through role play, imitation and instruction. The objective is to teach
the patient to function in a social group.

• Cognitive retraining is given to improve the basic cognitive functions

of attention, memory and executive functions.

18
 • After the patient improves sufficiently, vocational training is given
wherein the patient is helped to gain skills necessary to undertake
productive employment.

Factors Contributing to Healing in Psychotherapy

Some of the factors which contribute to the healing process are as follows:

1. Techniques adopted by the therapist and its implementation

with the patient/client:
If the behavioural system and the CBT school are adopted to heal an
anxious client, the relaxation procedures and the cognitive
restructuring largely contribute to the healing.

2. The therapeutic alliance:

The alliance which is formed between the therapist and the
patient/client, has healing properties, because of the regular
availability of the therapist, and the warmth and empathy provided
by the therapist.

3. Emotional unburdening/catharsis:
At the outset of therapy while the patient/client is being interviewed
in the initial sessions to understand the nature of the problem, s/he
unburdens the emotional problems being faced. This process of
emotional unburdening is known as catharsis, and it has healing
properties.

4. Non-specific factors associated with psychotherapy:

Some of these factors are attributed to the patient/client and some
to the therapist These factors are called non-specific because they
occur across different systems of psychotherapy and across different
clients/patients and different therapists.

Non-specific factors attributable to the client/patient are motivation

for change, expectation of improvement due to the treatment, etc.
These are called patient variables.

Non-specific factors attributable to the therapist are positive nature,

absence of unresolved emotional conflicts, presence of good mental
health, etc. These are called therapist variables.

19
Ethics in Psychotherapy

Some of the ethical standards that need to be practiced by professional

psychotherapists are:

1. Informed consent needs to be taken.

2. Confidentiality of the client should be maintained.
3. Alleviating personal distress and suffering should be the goal of all
attempts of the therapist.
4. Integrity of the practitioner-client relationship is important.
5. Respect for human rights and dignity.
6. Professional competence and skills are essential.

20