Psychotherapy: Nature and Process

• The chapter is about various therapeutic methods employed by psychotherapists.
• Some psychotherapies focus on acquiring self-understanding.
• Other therapies are more action-oriented, aiming to help patients overcome their debilitating conditions.
• The effectiveness of therapy depends on factors like the severity of the disorder, the distress faced, and the availability of resources.
• Therapeutic approaches are corrective and involve an interpersonal relationship between the therapist and the client.
• Some approaches are directive, like psychodynamic therapy, while others are non-directive, like person-centered therapy.

Nature and Process of Psychotherapy

• Psychotherapy requires a voluntary relationship between the client and the therapist.
• The goal is to resolve psychological problems through building trust.
• Psychotherapies aim to change maladaptive behaviors, reduce distress, and improve adaptation to the environment.
• They systematically apply therapeutic principles.
• Trained and supervised individuals can practice psychotherapy, not just anyone.
• The therapeutic situation involves a therapist and a client seeking help for emotional problems.
• Interaction between therapist and client leads to the formation of a confidential, interpersonal, and dynamic therapeutic relationship.

Goals of Psychotherapy include

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

Therapeutic Relationship

• The therapeutic relationship or alliance is the special connection between client and therapist.
• It is contractual, involving willing individuals in a partnership to overcome problems.
• It has a limited duration, lasting until the client can manage their problems independently.
• Trust and confidentiality are paramount.
• Unconditional positive regard from the therapist involves acceptance, empathy, genuineness, and warmth towards the client.
• Empathy involves understanding and feeling the client's plight from their perspective.
• Therapists must maintain strict confidentiality and avoid exploiting the client's trust.
• It remains a professional relationship.

Types of Therapies

• Psychotherapies can be classified into psychodynamic, behavior, and existential approaches.
• The classification is based on the cause of the problem, its origin, the method of treatment, and the nature of the therapeutic relationship.

Key Classification Parameters

• Cause of the problem: Psychodynamic therapy attributes it to conflicts within the psyche. Behaviour therapies cite faulty learning and cognitions. Existential therapies focus on questions about the meaning of life.
• Origin of the cause: Psychodynamic therapy links it to unfulfilled childhood desires and unresolved fears, behavior therapy links it to faulty conditioning and existential therapy emphasizes current feelings.
• Chief method of treatment: Psychodynamic therapy uses free association and dream analysis, behavior therapy sets up alternate behavioral contingencies, existential therapy provides a therapeutic environment.
• Nature of the therapeutic relationship: Psychodynamic therapy involves therapist interpretation, behavior therapy involves therapist discerning faulty patterns, and existential therapy requires therapist providing a warm, empathic environment.
• Chief benefit to the client: Psychodynamic therapy provides emotional insight. Behavior therapy changes faulty behavior. Humanistic therapy achieves personal growth.
• Duration of treatment: Psychodynamic therapy can last for years but recent versions can be completed in 10-15 sessions, behaviour and existential therapies are shorter.

Steps in the Formulation of a Client's Problem

• Clinical formulation means framing the client's problem within the used therapeutic model.
• It enables understanding the full implications of the client's distress.
• It identifies the problem areas for targeted treatment.
• It informs the choice of treatment techniques.
• It is an ongoing process that may require reformulations.
• It is not advisable to start psychotherapy without it.

Behavior Therapy

• Psychological distress arises from faulty behavior or thought patterns.
• Focus is on the present, with the past relevant only for identifying the origins of faulty patterns.
• The clinical application of learning theory constitutes this therapy.
• It is not a unified theory but rather a set of specific techniques and interventions guided by the client’s symptoms and diagnosis.
• The aim is to extinguish faulty behaviors and substitute adaptive ones through antecedent and consequent operations.
• Antecedent operations control behavior by changing what precedes it.
• Consequent operations involve increasing or decreasing the reinforcing value of a consequence through establishing operations.

Behavioral Techniques

• These techniques aim to reduce arousal, alter behavior through conditioning, and use vicarious learning.
• Responses that help someone avoid painful stimuli provide negative reinforcement.
• Aversive conditioning pairs undesired responses with aversive consequences.
• Positive reinforcement increases adaptive behavior through rewards.
• Token economy provides tokens as rewards for desired behaviors, which can be exchanged for treats.
• Differential reinforcement can reduce unwanted behavior while increasing wanted behavior.
• Systematic desensitization is a technique for phobias where the client is gradually exposed to anxiety-provoking stimuli while relaxed.
• Modelling involves learning by observing a role model.

Reciprocal Inhibition

• It operates in systematic desensitization.
• This occurs when oppositng forces at work, inhibits the weaker force.
• Relaxation response is built up, the anxiety is overcome by the relaxation
• The client is able to tolerate progressively greater anxiety due to relaxed state

Cognitive Therapy

• Psychological distress stems from irrational thoughts and beliefs.
• Rational Emotive Therapy (RET) focuses on irrational beliefs mediating between events and consequences.
• The first step is the ABC analysis (antecedent-belief-consequence).
• Irrational beliefs are unsupported by evidence and are characterized by "musts" and "shoulds."
• In RET, the therapist refutes irrational beliefs through non-directive questioning.
• A change is made in philosophy bout life

Beck's Cognitive Therapy

• Characterized by anxiety and depression
• Childhood experiences provided by family
• Focuses of correcting cognitive distortions and dysfunctional cognitive structures formed in the mind
• Negative thoughts are persistant and irrational. Such negative automatic thoughts are characterized by cognitive distortions.

Dysfunctional Cognitive Structures

• Cognitive restructuring
• Can lead to feelings of anxiety and depression
• Non-threatening disputation of beliefs and thoughts

Cognitive-Behavior Therapy (CBT)

• It is efficacious for a wide range of psychological disorders.
• It combines cognitive therapy with behavioral techniques.
• The rationale is that distress originates from biological, psychological, and social realms. It addresses biological aspects through relaxation, psychological aspects through behavioral and cognitive techniques etc.

Humanistic-Existential Therapy

• Psychological distress arises from feelings of loneliness, alienation, and an inability to find meaning in life.
• Human beings are motivated by personal growth and innate need to grow emotionally.
• Self-actualization involves becoming integrated.
• Healing occurs when the client removes obstacles to self-actualization through free emotional expression.
• The therapy creates a permissive accepting atmpsphere
• The central assumption is that a client has the freedom to control their own behaviour

Existential Therapy

• Logotherapy is treatment for the soul through meaning-making.
• Basis of meaning making is to search for truth of one's existence
• Neurotic anxieties arrive when the problems of life are attached to life (physical, psychological or spirtual)

Roger's client-centred therapy

• Roger's combined scientific rigour with the individualised practice
• Rogers brought into psychotherapy the concept of self, with freedom and choice as the core's being
• Therapist shows empathy & understanding the client's experience as if one's own
• Warm positive regard

Gestalt Therapy

• Individual's self awareness and self-acceptance
• Gestalt means as whole
• Recognition of bodily processes and emotions that get blocked from awayness

Factors Contributing to Healing in Psychotherapy

• Technique adopted by therapist, is a major factor in healing and implementing it to patient/client
• Formation of Therapuetic alloance (regular availability of therapist, warmth, empathy
• Therapy helps unburden the emotional problems known as catharsis and its healign properties
• Non specific factors occur in psychotherapy and across clients/patients. They occur across across systems of pschotherapy

Ethics in Psychotherapy

• Informed consent is important
• Confidentiality needs to be maintained
• Alleviating personal distress and suffering should be an attempt of therapists
• Integrity of practitioners & clients relationship is important
• Professional competence needs to be essential

Alternative Therapies

• Yoga and Meditation have helped aid programmes for psychological distress
• Yoga Sutra is an ancient technique of Patanjali's Ashtanga
• It refers to postures and body component, breathing or parayama
• Meditation refers to practicing attention when a thought happens
• In vasana meditation there is no fix but passing bodily sensations and thoughts in awareness

Rehabilitation of the Mentally ill

• Treatment of pschological disorders have two componenents:
• reduction of symptoms
• Improving functional or quality of life
• Given Occupational, social skill and vocational therapy
• In rehab give patients work discipline, social skills training, communication, memory etc