Therapeutic Approaches

Written and reviewed by Subhra Gupta, Humanities faculty at UniDrill (M.A. Sociology, University of Delhi · 7 years teaching Humanities). Based on NCERT Psychology Class XII (Psychology), Chapter 5.

Why does talking to a stranger help?

Imagine telling someone your deepest worry. Not a friend who might repeat it, not a relative who might judge you, but a trained person who listens, does not judge and never shares what you say. For many people this is the first time they feel truly heard, and it can be the first step toward feeling better. That experience, shaped into a method, is psychotherapy.

The previous chapter described what goes wrong in psychological disorders. This one asks how people are helped. The answer is not one treatment. There are many types of psychotherapy, and the approach that suits a person depends on factors such as the severity of the disorder, how much distress others around the person face, and the time, effort and money available.

What psychotherapy is

Psychotherapy is a voluntary relationship between the person seeking treatment (the client) and the person who treats (the therapist). Its purpose is to help the client solve the psychological problems they face. The relationship builds trust so that problems can be discussed freely. Psychotherapies aim to change maladaptive behaviours, decrease personal distress and help the client adapt better to their environment.

All psychotherapies share four characteristics.

Therapies pursue some or all of these goals: strengthening the client's resolve to improve, lessening emotional pressure, unfolding the potential for positive growth, modifying habits, changing thinking patterns, increasing self awareness, improving relationships and communication, facilitating decisions, and becoming aware of one's choices and one's social environment.

The therapeutic relationship

The special bond between client and therapist is the therapeutic relationship or therapeutic alliance. It is neither a passing acquaintance nor a permanent relationship. It has two components.

The alliance is a trusting, confiding relationship. The therapist encourages this by being accepting, empathic, genuine and warm. The therapist does not judge and continues to show the same positive feelings even if the client is rude or confides things that they feel are wrong. This is unconditional positive regard. The therapist must also keep strict confidentiality, must never exploit the client's trust and must stay professional.

The therapist also needs empathy, and the textbook separates it from two look alikes.

Empathy enriches the relationship and turns it into a healing relationship.

Types of therapies: the big picture

Though all psychotherapies aim to remove distress and encourage effective behaviour, they differ greatly in concepts, methods and techniques. They fall into three broad groups: psychodynamic, behaviour and existential (humanistic existential) therapies. In order of emergence, psychodynamic therapy came first, then behaviour therapy, and existential therapies, called the third force, came last.

The classification rests on six questions. This table is a favourite for statement based items.

Pause and predict: a therapist asks a client to describe her dreams and say whatever comes to mind, then helps her see how childhood fears are behind her present worries. Which system is this?

Check your answer: psychodynamic. Free association and dream reporting, interpreted by the therapist, are its chief methods, and unresolved childhood fears and desires are the cause it points to.

The clinical formulation. Psychotherapy begins by formulating the client's problem in the model the therapist uses. The formulation helps the therapist understand the full implications of the distress, identify the areas to target in therapy, and choose techniques. It is an ongoing process that may be revised as insight grows, the first one or two sessions usually give enough material, and it is not advisable to start therapy without one. For example, a client who cannot face superiors and cannot hold a job would be formulated in behaviour therapy as lacking assertiveness skills and having heightened anxiety.

Behaviour therapy

Behaviour therapy holds that distress arises from faulty behaviour patterns or thought patterns, so it works on the present. The past matters only to understand how the faulty patterns began. It is the clinical application of learning principles, and it is not one unified theory. Techniques are chosen according to the symptoms and diagnosis: a phobia needs one set, anger outbursts another, and a depressed client is treated differently from an anxious one.

Behavioural analysis. The therapist interviews the client (and family) to find malfunctioning behaviours, the antecedent factors that predispose the person to the behaviour, and the maintaining factors that keep it going. Example: a young person who started smoking while preparing for annual exams reports relief from anxiety. The anxiety provoking situation is the antecedent factor and the relief is the maintaining factor, because smoking is an operant response kept going by the reinforcing value of relief.

The therapist then tries to extinguish the faulty behaviour and substitute adaptive behaviour using antecedent operations (changing something before the behaviour) and consequent operations (changing what follows the behaviour). Example: a child troubles the family at dinner. Reducing the food served at tea time is the antecedent operation, because hunger at dinner increases the reward value of food, and praising the child for eating properly is the consequent operation.

How systematic desensitisation works. It rests on the principle of reciprocal inhibition: when two mutually opposing forces are present together, the weaker is inhibited. Relaxation is first built up, then a mildly anxiety provoking scene is imagined, and the anxiety is overcome by the relaxation. The client can then tolerate progressively greater levels of anxiety. If the slightest tension appears, the client stops imagining the scene.

The steps in one line: interview to find fear situations → build the anxiety hierarchy (least to most) → relax the client → imagine the least feared scene → move gradually up the hierarchy.

Relaxation procedures. Behaviour therapists see anxiety as raising the arousal level and acting as an antecedent for faulty behaviour such as smoking or overeating, so reducing anxiety reduces those behaviours. In progressive muscular relaxation the client learns to tense individual muscle groups (such as the forearm) to feel the tension, then lets go and moves into the opposite state. With practice the whole body can be relaxed. Meditation also induces relaxation.

Pause and predict: a school gives students a badge every time they hand in homework on time, and badges can be exchanged for a trip at the term end. Which behavioural technique is this?

Check your answer: token economy. The badge is the token, awarded for the wanted behaviour and exchanged later for a reward. Because the badge is rewarding a wanted behaviour, it also uses positive reinforcement, but "tokens exchanged for rewards" is the name of the technique.

Beyond the textbook. For the exam: systematic desensitisation uses imagined scenes, a hierarchy and relaxation. In reality: many modern treatments of phobias also use real life exposure, where the person gradually faces the feared object or situation itself with support. The shared idea is graded, supported contact with fear until fear fades. Why it matters: it shows how a classic technique has grown, while the exam still asks for Wolpe, hierarchy and reciprocal inhibition.

Cognitive therapy and CBT

Cognitive therapies locate the cause of distress in irrational thoughts and beliefs. Two names matter.

Reading the chains. In Ellis's ABC, the problem is not the event but the belief about it. In Beck's model, the problem builds from the inside out: schema, trigger, automatic thought, distortion, distress.

Cognitive therapy, like behaviour therapy, focuses on solving a specific problem. Unlike psychodynamic therapy, it is open, because the therapist shares the method with the client. It is short, lasting 10 to 20 sessions.

Cognitive behaviour therapy (CBT) is the most popular therapy at present. It combines cognitive therapy with behavioural techniques and has been established as short and effective for a wide range of disorders such as anxiety, depression, panic attacks and borderline personality. Its rationale is that distress has its origins in the biological, psychological and social realms, so it addresses the biological aspect through relaxation, the psychological through behaviour and cognitive techniques, and the social through changes to the environment. This is why it is called a bio psychosocial approach.

Two views. For the exam: each system explains the cause of distress differently, and CBT is the most popular, short and effective therapy. Another reading: researchers have long observed that, across very different therapies, a good therapeutic alliance, a client's motivation and expectation of improvement and a warm therapist are linked with better outcomes. This is exactly why the textbook lists non specific factors. Neither view cancels the other; techniques matter, and so does the relationship.

Humanistic existential therapy

These therapies hold that distress arises from loneliness, alienation and inability to find meaning and genuine fulfilment in life. People have an innate need to grow, and the aim is self actualisation, an inborn force moving the person toward a more complex, balanced and integrated self. When family and society curb emotional expression, this process is blocked and distress follows. The therapist creates a permissive, non judgmental and accepting atmosphere. The client has freedom and responsibility, the therapist is a facilitator and guide, and the chief aim is to expand the client's awareness.

Easy anchor: Frankl = meaning, Rogers = acceptance (client centred), Perls = wholeness (gestalt).

What makes therapy work: healing factors and ethics

Ethics in psychotherapy. Professional therapists must follow six ethical standards: informed consent, confidentiality, alleviating personal distress and suffering as the goal, integrity of the practitioner client relationship, respect for human rights and dignity, and professional competence and skills.

Why it matters. Therapy depends on trust. If a counsellor shared a student's disclosures with others, it would break confidentiality and the alliance, and it could discourage the student from seeking help again. That is why confidentiality is both an ethical standard and a core feature of the therapeutic relationship.

Alternative therapies and rehabilitation

Alternative therapies are alternatives to conventional drug treatment or psychotherapy. They include yoga, meditation, acupuncture and herbal remedies. In the past 25 years yoga and meditation have become popular for psychological distress.

Beyond the textbook. For the exam: yoga and meditation are alternative therapies that help in treating several disorders. In reality: the sources describe SKY as an adjunct, meaning an addition to the main treatment, and the same sensible rule applies to alternative therapies in general. They are most useful alongside professional care, not as a replacement for it, especially in severe conditions. Why it matters: it protects people from delaying proper treatment, and it explains why the textbook uses the word adjunct.

Rehabilitation of the mentally ill. Treatment has two aims: reducing symptoms and improving the level of functioning or quality of life. For milder problems such as generalised anxiety, reactive depression or phobia, reducing symptoms usually improves quality of life too. In severe disorders such as schizophrenia it may not, because negative symptoms like disinterest and lack of motivation remain. Rehabilitation then helps people become self sufficient and productive members of society to the extent possible.

If you are reading this and feel that you or someone close needs support, remember that trained professionals such as counsellors, clinical psychologists and doctors can help, and seeking help is a sign of strength.

Exam traps

60-second revision

Where this chapter connects

• Previous: Psychological Disorders describes the disorders these therapies treat, and the models of disorder (psychodynamic, behavioural, cognitive, humanistic existential) map directly onto the therapies here.
• Next: Attitude and Social Cognition moves from the individual to how we think about and judge other people.
• Related: Self and Personality introduces Freud, Rogers and the self concept behind these therapies. Learning covers classical conditioning, operant conditioning and observational learning, the basis of behaviour therapy.