CBSE Class 12 Psychology Chapter 5 Therapeutic approaches and counselling Notes

FACTS THAT MATTER

Psychotherapy is a voluntary relationship between the one seeking treatment or the client and the one who treats or the therapist and is given under therapeutic conditions.
1. Purpose: To help the client to solve the psychological problems being faced by her or him.
2. Aim: To change the maladaptive behaviours, decrease the sense of personal distress, and help the client to adapt better to his/her environment.
3. The relationship is conducive for building the trust of the client so that problems may be freely discussed.

Characteristics:
1. All psychotherapies are systematic application of some theory or principle.
2. The therapist must be a trained professional.
3. Psychotherapy is an interactive process in which two people are involved—the client and the therapist.
4. Psychotherapy functions, under therapeutic relationship which is trusting, accepting; confiding, dynamic, professional relationship.

Goals:
(i) Reinforcing client’s resolve for betterment.
(ii) Lessening emotional pressure.
(iii) Unfolding the potential for positive growth.
(iv) Modifying habits.
(v) Changing thinking patterns.
(vi) Increasing self-awareness.
(vii) Improving interpersonal relations and communication.
(viii) Facilitating decision-making.
(ix) Becoming aware of one’s choices in life.
(x) 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.

Components:
1. Contractual Nature of the Relationship: Two willing individuals, the client and the therapist, enter into a partnership which aims at helping the client overcome his/ her problems.
2. Limited Duration of the Therapy: This alliance lasts until the client becomes able to deal with his/her problems and take control of his/her life.

Properties:
(i) It is a trusting and confiding relationship.
(ii) 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.

Classification of Psychotherapies

A. PSYCHODYNAMIC THERAPY (Sigmund Freud, Carl Jung, Neo-Freudians)

Methods of Eliciting the Nature of Intrapsychic Conflict:

1. Free Association: Ist window to peep in the unconscious.
(i) Therapeutic relationship is established, client feels comfortable—therapist makes client lie down on the couch, close their eyes and asks them to speak whatever comes to mind without censoring it. Client provides verbal narration.
(ii) Client is encouraged to freely associate one thought with another (free association).
(iii) Censoring supere go and the watchful ego are kept in abeyance—client speaks whatever comes to mind in a relaxed and trusting atmosphere.
(iv) Therapist does not interrupt; the free flow of idea, desires and conflicts of the unconscious, which had been suppressed by the ego, emerge into the conscious mind.

2. Dream Analysis:
(i) Client is asked to write down his/her dreams upon waking up.
(ii) Drams are symbols of the unfulfilled desires of the unconscious.
(iii) Dreams use symbols which signify intrapsychic forces because they are indirect expressions and hence would not alert the ego.
(iv) If unfulfilled desires are expressed directly, the ever-vigilant ego would suppress them, leading to anxiety.
(v) Symbols are interpreted according to an accepted convention of translation as the indicators of unfulfilled desires and conflicts.

Modality of Treatment:

(a) Transference: The client starts identifying the therapist with the authority figures of the past, usually childhood.
(i) The therapist maintains a non-judgmental and permissive attitude and allows the client to continue with this process of emotional identification.
(ii) Transference Neurosis: The therapist becomes a substitute for that person in the present—the client acts out the frustrations, anger, fear, that he/she harboured towards that person in the past, but could not express at the time.

• Positive Transference: The client idolizes, or falls in love with the therapist, and seeks the therapist’s approval.
• Negative Transference: The client has feelings of hostility, anger and resentment towards the therapist.

(b) Resistance: The client opposes the progress of therapy in order to protect himself/herself from the recall of painful unconscious memories.
(i) Conscious Resistance: The client deliberately hides some information
(ii) Unconscious Resistance: The client becomes silent during the therapy session, recalls trivial details without recalling the emotional ones, misses appointments, and comes late for therapy sessions.
(iii) 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.

(c) Interpretation: The therapist uses the unconscious material that has been uncovered to make the client aware of the psychic contents and conflicts which have led to the occurrence of certain events, symptoms and conflicts.
(i) Subtle process, the pinnacle of psychoanalysis.
(ii) Two analytical techniques:
• Confrontation: The therapist points out to the client an aspect of his/her psyche that must be faced by the client.
• Clarification: The therapist brings a vague or confusing event into sharp focus by separating and highlighting important details about the event from unimportant ones.
(d) Working Through: The repeated process of using confrontation, clarification and interpretation.
(i) Helps the patient understand the source of the problem and to integrate the uncovered material into his/her ego.
(e) Insight: 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.
(i) End-point of psychoanalysis, client gains a new understanding on him/ herself- conflicts of the past, defence mechanisms and physical symptoms are no longer present.
(ii) Intellectual Insight: The client starts understand herself/himself better at an intellectual level.
(iii) Emotional Insight: The emotional understanding, acceptance of one’s irrational reaction to the unpleasant events o the past, and the willingness to change emotionally as well as making the change.

Duration of Treatment
• Lasts of several years with a one hour session for 4-5 days per week.
• Intense treatment, three phases.
(i) Initial Phase: Client becomes familiar with the routines, establishes a therapeutic relationship, and recollects the superficial material from the consciousness about the past and present.
(ii) Middle Phase: Characterised by transference, resistance on the part of the client, and confrontation, clarification and working through on the therapist’s part; all these processes finally lead to insight.
(iii) Third Phase: Termination; the relationship with the analyst is dissolved and the client prepares to leave the therapy.

B. BEHAVIOUR THERAPY

• Focused on the behaviour and thoughts of the client in the present.
• The past is relevant only to the extent of understanding the origins of the faulty behaviour and thought patterns, not relieved.
• Behaviour therapies are clinical application of learning theories.
• Consists of a large set of specific techniques and interventions—symptoms of the client and the clinical diagnosis are the guiding factors in the selection of the specific techniques or interventions to be applied.
• Open therapy, i.e., the therapist shares his/her method with the client.

Method of Treatment:

(i) The client is interviewed with a view to analyse his/her behaviour patterns.
(ii) Behavioural analysis is conducted to find:
(a) Malfunctioning Behaviours: Behaviours which cause distress to the client.
(b) Antecedent Factors: Those causes which predispose the person to indulge in that behaviour
(c) Maintaining Factors: Those factors which lead to the persistence of the faulty behaviour.

(iii) Aim: To eliminate the faulty behaviours and substitute them with adaptive behaviour patterns.
(a) Antecedent Operations: Control behaviour by changing something that precedes such a behaviour.
(b) Establishing Operations: Induce a change in behaviour by increasing or decreasing the reinforcing value of a particular consequence.
(c) Consequent Operation: i.e., Giving reinforcement eg. Praise.

Behavioural Techniques:

1. Negative Reinforcement: Following an undesired response with an outcome that is painful or not liked.

2. Aversive Conditioning: Repeated association of undesired response with an aversive consequence present reality.

3. Positive Reinforcement: Given to increase the deficit if an adaptive behaviour occurs rarely.

4. Token Economy: Give a token as a reward every time a wanted behaviour occurs,which can be collected and exchanged for a reward.

5. Differential Reinforcement: Unwanted behaviour can be reduced (negative reinforcement) and wanted behaviour (positive reinforcement) can be increased simultaneously.
The other method is to positively reinforce the wanted behaviour and ignore the unwanted behaviour—less painful and equally effective.

6. Systematic Desensitization: A technique introduced by Wolpe for treating phobias or irrational fears.
(i) The client is interviewed to elicit fear provoking situations.
(ii) With the client, the therapist prepares a hierarchy of anxiety—provoking stimuli with the least anxiety-provoking stimuli at the bottom.
(iii) The therapist relaxes the client and asks the client to think about the least anxiety-provoking situation.
(iv) The client is asked to stop thinking of the situation if tension is felt.
(v) Over sessions, the client is able to imagine more severe fear provoking situations while maintaining the relaxation.
(vi) The client gets systematically desensitized to the fear.
Operates on the principle of reciprocal inhibition—the presence of two mutually opposing forces (relaxation response vs. anxiety-provoking scene) at the same time, inhibits the weaker force.
The client is able to tolerate progressively greater levels of anxiety because of his/her relaxed state.

7. Modelling: 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, 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.

C. COGNITIVE THERAPY

1. Rational Emotive Therapy (RET) (Albert Ellis):
• Irrational beliefs mediate between the antecedent events and their consequences.
• The first step in RET is the antecedent-belief-consequence (ABC) analysis.

(i) Antecedent events, which caused the psychological distress, are noted. Client is interviewed to find out.
(ii) irrational beliefs, which distorting the reality.
The therapist encourages this by being accepting, empathic, genuine and warm to the client.
The therapist conveys by his/her words and behaviours that he/she is not judging the client and will continue to show the same positive feelings towards the client even if the client is rude or confides all the ‘wrong’ things that he/she may have done or thought about. This is the unconditional positive regard which the therapist has for the client.
The clinical formulation is an ongoing process. Formulations may require reformulations as clinical insights are gained in the process of therapy.
Distorted perception of the antecedent event due to the irrational belief leads to the consequence, i.e., negative emotions and behaviours.

• Antecedent analysis: Client is interviewed and the cause of distress is noted.
• Belief analysis: Therapist identifies that irrational beliefs developed by the client which are distorting the reality.
Therapist provides an accepting, empathic, genuine and warm environment to the client. He/She is non judgemental and provides unconditional position with regard to the client and develops understanding of client is irrational beliefs.

• Consequence analysis: Distorted perceptions of the antecedent event due to the irrational beliefs lead to the consequences, i.e. negative emotions and behaviours.
• Non-directive questioning: Process by which irrational beliefs are refuted by the therapist.
(i) Nature of questioning is gentle, without probing or being directive.
(ii) Make the client think deeper into his/her assumptions about life and problems.

• Client changes the irrational beliefs by making a change in his/her philosophy about life—rational belief system replaces the irrational belief system.

2. Aaron Beck’s Cognitive Therapy:
(i) Childhood experiences provided by the family and society develop core schemes or systems, which include beliefs and action patterns in the individual.
(ii) Critical events in the individual’s life trigger the core, leading to the development of negative automatic thoughts.
(iii) Negative thoughts are persistent irrational thoughts characterised by cognitive distortions.
(iv) Dysfunctional Cognitive Structures: Patterns of thought which are general in nature but which distort the reality in a negative manner.
(v) 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.
• The questions make the client think in a direction opposite to that of the negative automatic thoughts whereby she/he gains insight into the nature of her/his dysfunctional schemas, and is able to alter her/his cognitive structures

3. Cognitive Behaviour Therapy (CBT):
• Short, comprehensive, effective treatment for a wide range of psychological disorders such as anxiety, depression, panic attacks and borderline personality.
• Adopts a biopsychosocial approach to the delineation of psychopathology.
• Combines cognitive therapy with behavioural techniques.
• Rationate—distress has its origins in the biological, psychological, and social realms.
• Addresses the biological (relaxation procedures), psychological (behaviour and cognitive therapy) and social (environmental manipulations) aspects.

D. Humanistic-Existential Therapy:

• Therapy emphasises that psychological distress arises from feeling of loneliness,alienation, incongruence between real and ideal self, curbing of natural emotional expression and usability to find measuring and genuine fulfilment of life. Human beings are motivated by the desire for personal growth and self
actualization.
Self-actualisation is defined as an innate force that moves the person to become more complex, balanced, and integrated; integrated means a sense of whole, being a complete person.

1. Self-actualization requires free emotional expression:
(a) The family and society curb emotional expression, as it is feared that a free expression of emotions can harm society by unleashing destructive forces.
(b) When emotionally expression is curbed, destructive behaviour and negative emotions by thwarting the process of emotional integration.
2. Healing occurs when the client is able to perceive the obstacles to self-actualization in his/her life and is able to remove them.
3. Therapy creates a permissive, non-judgmental and accepting atmosphere in which the client’s emotions can be freely expressed.
4. The client has the freedom and responsibility to control his/her own behaviour; the therapist is merely a facilitator and guide. The chief aim of the therapy is to expand the client’s awareness.

1. Existential Therapy [Logotherapy (Victor Frankl):]
• Treatment for the soul.
• Meaning making: Process of finding meaning even in life-threatening circumstances, the basis of which is a person’s quest for finding the spiritual truth of one’s existence.
• Spiritual Unconscious: The storehouse of love, aesthetic awareness and values of life.
• Existential Anxiety: Neurotic anxiety of spiritual origin (spiritual anxieties leading to meaninglessness).
• Goal: To help the patients find meaning and responsibility in their life irrespective of their life circumstances.
• The therapist emphasizes the unique nature of the patient’s life and is open (shares his/her feelings, values and own existence).
• Emphasis is on here and now, the therapist reminds the client about the immediacy of the present. 

2. Client-centered Therapy (Carl Rogers):
• Introduced the concept of self and freedom and choice as the core of one’s being.
• Provides a warm relationship in which the client can reconnect with his/her disintegrated feelings.
• The therapist:
(i) Shows empathy—understands the client’s experience as if it were his/her own—sets up an emotional resonance between client and therapist.
(ii) Warmth—the client feels secure and can trust the therapist.
(iii) Has unconditional positive regard, i.e., total acceptance of the client as he/she is, indicates that the positive warmth of the therapist is not dependent on what the client reveals or does in the therapy sessions.
• Client feels secure enough to explore his/her feelings; 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.

3. Gestalt Therapy (Frederick and Laura Pearl):
• Goal: To increase an individual’s self-awareness and self -acceptance.
• Client is taught to recognize the bodily processes and the emotions that are being blocked out from awareness.
• Therapist encourages the client to act out fantasies about feelings and conflicts can also be used in group settings.

E. BIOMEDICAL THERAPY

• Prescription of medicines is done by psychiatrists (qualified medical doctors who have specialized in the understanding, diagnosis and treatment of mental disorders).
• The nature of medicines used depends on the nature of the disorder:
(i) Anti-psychotic drugs—severe mental disorders (schizophrenia, bipolar disorder).
(ii) Milder drugs—common mental disorders (generalized anxiety, reactive depression).
• Cause side-effects which need to be understood and monitored—essential that medication is given under proper medical supervision.

F. ELECTRO-CONVULSIVE THERAPY (ECT)

(i) Mild electric shock given via electrodes to the brain of the patient to induce convulsions.
(ii) The shock is given by the psychiatrist only when necessary for the improvement of the patient.
(iii) Not a routine treatment and is given only when drugs are not effective Factors Contributing to Healing:
1. Techniques adopted by the therapist and the implementation of the same with the client, e.g., CBT for an anxious client—relaxation procedures and cognitive restructuring contribute to the healing.
2. The therapeutic 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. Catharsis: A process of emotional unburdening by a client when he/she is being interviewed in the initial sessions of therapy to understand the nature of the problem.
4. Non-specific Factors: These factors occur across different systems of psychotherapy and across different clients/patients and different therapists.
(i) Patient Variables (motivation for change, expectation of improvement).
(ii) Therapist Variables (positive nature, good mental health, absence of unresolved emotional conflicts).

Ethics in Psychotherapy:
1. Informed consent needs to be taken.
2. Confidentiality of the client should be maintained.
3. Alleviating personal distress 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.

F. ALTERNATIVE THERAPIES

Yoga:
• An ancient Indian technique detailed in the Ashtanga Yoga of Patanjali’s Yoga Sutras.
• Refers to only the asanas (body posture component) or to pranayama (breathing practices).
• Techniques enhance well-being, mood, attention, mental focus, and stress tolerance.
• Reduces the time to go to sleep and improves the quality of sleep.
• Proper training by a skilled teacher and 30-minute practice everyday maximizes the benefits.
Meditation refers to the practice of focusing attention on breath or on an object or thought of a mantra.

A. Sudarshana Kriya Yoga (SKY)
(i) Rapid breathing techniques induce hyperventilation.
(ii) Beneficial, low risk, low cost.
(iii) Used as a public health intervention technique to alleviate PTSD in survivors of mass disasters.
(iv) Reduces depression (research conducted at the National Institute of Mental Health and Neurosciences (NIMHANS).
(v) Reduces stress levels in substance abuse patients. e.g., alcoholics.

B. Kundalini Yoga
(i) Effective in treatment of mental disorders and OCD.
(ii) Combines pranayama (breathing techniques) with chanting of mantras.

C. Vipasana Meditation
(i) Mindfulness-based meditation; no fixed object or thought to hold to attention.
(ii) Person passively observes the various bodily sensations and thoughts that are passing through in his or her awareness.
(iii) Helps prevent repeated episodes of depression.
(vi) Helps patients process emotional stimuli better and prevents biases in the processing of these stimuli.

Rehabilitation of the Mentally Ill:
• Aim: to empower the patient to become a productive member of society to the maximum extent possible.
• 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.
• In rehabilitation, the patients are given:
(i) Occupational Therapy: teaches skills such as candle making, paper bag making and weaving to help them to form a work discipline
(ii) Vocational Therapy: Once the patient improves sufficiently, gains skills necessary to undertake productive employment.
(iii) Social Skills Training: Develops interpersonal skills through role play, imitation and instruction; objective is to teach the patient to function in a social group.
(iv) Cognitive Retraining: Improves the basic cognitive functions of attention, memory and executive function.

WORDS THAT MATTER

• Alternative Therapy: Alternative treatment possibilities to the conventional during treatment or Psychotherapy. e.g. yoga, Meditation etc.
• Behaviour Therapy: Therapy based on the principles of behaviouristic learning theories in order to change the maladaptive behaviour.
• Biomedical Therapy: Refer to medicines which are prescribed to treat Psychological disorders.
• Client-centered (Rogerian) Therapy: The therapeutic approach developed by Carl Rogers in which therapist helps clients to clarify their true feeling and come to value who they are.
• Cognitive Therapies: Forms of therapy focused on changing distorted and maladaptive patterns of thought.
• Counselling: A board name for a wide variety of procedures for helping individuals achieve adjustment, such as the giving of advice, therapeutic discussion, the administration and interpretation of tests, and vocational assistance.
• Counselling Interview: An interview whose purpose is counselling or providing guidance in the area of personality, vocational choice, etc.
• Electro Convulsive Therapy (ECT): Commonly called ‘shock treatment’. A biological treatment for unipolar depression in which electrodes attached to a patient’s head send an electric current through the brain, causing a convulsion. It is effective in the treatment of cases of several depression that fail to respond to drug therapy.
• Empathy: Reacting to another’s feelings with an emotion response that is similar to the other’s feeling.
• Free Association: A psychodynamic technique in which the patient describes verbally any thought, feeling or image that comes to mind, even if it seems unimportant.
• Gestalt Therapy: An approach to therapy that attempts to integrate a clients thoughts, feelings and behaviour into a unified whole.
• Humanistic Therapy: A therapy in which the underlying assumption is that people have control over their behaviour, can make choices about their lives, and are essentially responsible for solving their own problems.
• Modelling: A process of learning in which an individual acquires responses by observing and imitating others.
• Psychodynamic Therapy: First suggested by Frend. Therapy based on the premise that the primary sources of abnormal behaviour are unresolved past conflicts and the possibility that unacceptable unconscious impulses will enter consciousness.
• Psychotherapy: The use of any psychological technique in the treatment of mental/ psychological disorder or maladjustment.
• Rational Emotive Therapy (RET): A therapeutic system developed by Albert Ellis. It seeks to replace irrational problem-provoking outlooks with more realistic ones.
• Rehabilitation: Restoring an individual to normal or a satisfactory a state as possible,following an illness, criminal episode, etc.
• Resistance: In psychoanalysis, attempts by the patient to block treatment.
• Self actualisation: A state of self fulfilment in which people realise their highest potential in their own unique way.
• Systematic Desensitization: A form of behavioural therapy in which phobic client learns to induce a relaxed state and then exposed to stimuli that elicit fear or phobia.
• Therapeutic Alliance: The special relationship between the client and the therapist; contractual nature of the relationship and limited duration of the therapy are its two major components.
• Transference: Strong positive or negative feelings toward the therapist on the part of individual undergoing psychoanalysis.
• Unconditional Positive Regard: An attitude of acceptance and respect on the part of an observer, no matter what the other person says or does.

Question. Describe the nature and scope of psychotherapy. Highlight the importance of therapeutic relationship in psychotherapy
Answer. Psychotherapy is a voluntary relationship between two people, one who seeks help and the other who is ready to provide the help, i.e., the therapist. It is given under
therapeutic conditions.

Various psychotherapeutic approaches have the following characteristics:
1. All psychotherapies are systematic application of some theory or principle of different therapies.
2. Only trained professionals can practise psychotherapy.
3. Therapeutic situation is a two-way process in which therapist as well as client actively interact.
4. Psychotherapy functions under formation of therapeutic relationship which is confidential, interpersonal and dynamic in nature.

Psychotherapy has very broad scope to deal with disorders which are as follows:
• Reinforcing client’s resolve for betterment.
• Lessening emotional pressure.
• Unfolding the potential for positive growth.
• Modifying habits.
• Changing thinking patterns.
• Increasing self-awareness.
• Improved interpersonal relations and communication.
• Facilitating decision-making.
• Becoming aware of ones preferences in life.
• Development of adaptive behaviour.

Therapeutic Relationship:
The special professional relationship between the client and the therapist is known as
therapeutic relationship or alliance.
There are two major components of this relationship:

1. 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 his problems.
2. Limited Duration of the Therapy: This alliance lasts until the client becomes able to deal with his problems and take control of his life.
Through therapeutic relationship the therapist wins the trust of the client. The quality of this relationship/alliance determines early healing in psychotherapy.

Question. What are the different types of psychotherapy? On what basis are they classified?
Answer. Following are the main psychotherapies:
• Psychodynamic Therapy
• Behaviour Therapy
• Humanistic Therapy or Existential Therapy
Parameters of classification are as follows :

1. What is the cause of the problem?
(a) Psychodynamic therapy–Intrapsychic conflicts (id, ego and super ego) causes problems.
(b) Behaviour therapy–Faulty learning of behaviours and unrealistic cognition (thinking process) cause problems.
(c) Existential therapy–Answer about the meaning of one’s life and existence is not available.

2. How did the cause come into existence?
(a) Psychodynamic therapy–Intrapsychic conflicts are caused due to unfulfilled desires of childhood or unresolved fears which cause fixation and repression during psycho-sexual stages of life.
(b) Behaviour therapy–Faulty conditioning patterns, faulty learning through improper rewards, faulty thinking and beliefs.
(c) Existential therapy–Current feelings of loneliness, aimless life or meaningless existence.

3. What is the chief method of treatment?
(a) Psychodynamic therapy–Free association and reporting of dream to make the person confront and resolve the conflict.
(b) Behaviour therapy–To identify faulty conditioning patterns and faulty learning and to challenge the faulty thinking patterns.
(c) Existential therapy–Providing positive, non-judgmental and accepting therapeutic environment. Therapist acts as a facilitator helping client solve his own problems and arrive at solution through personal growth.

4. What is the nature of the therapeutic relationship?
(a) Psychodynamic therapy–Therapist understands the client and is more capable in interpreting his thoughts and feelings.
(b) Behaviour therapy–Therapist is able to identify faulty behaviour and thought patterns and is capable of finding out correct behaviour and realistic thought patterns.
(c) Existential therapy–Therapist provides warm and emphatic relationship helping the client feel secured to explore the causes of his problems himself and herself.

5. What is the chief benefit to the client?
(a) Psychodynamic therapy–Emotional insight to resolve problems.
(b) Behaviour therapy–Adaptive and healthy behaviour and thought pattern to reduce stress.
(c) Existential therapy–Personal growth by increasing understanding of one’s aspirations, emotions and motives.

6. What is the duration of treatment?
(a) Psychodynamic therapy–Classical psychoanalysis lasts for several years. New versions 10-15 sessions.
(b) Behaviour therapy–Short and completed within few months.
(c) Existential therapy–Short and completed within few months.

Question. A therapist asks the client to reveal all his/her thoughts including early childhood experiences. Describe the technique and type of therapy being used.
Answer. Psychoanalysis is a method of treatment of neurotic patients which emphasized the thoughts and experiences of childhood. It was developed by Dr. Sigmund Freud.
The whole modality of treatment occurs in three phases:

1. Initial Phase: The client becomes making client familial with the routines.
• Establishment of a therapeutic relationship with the analyst.
• Relief with the process of recollecting the superficial materials from the unconscious about the past and present troublesome events.

2. Middle Phase: Transference and interpretation are the means of treating the patient.
• Transference: The client starts identifying positively or negatively to the therapist with other significant people often with father and mother, in his childhood.
• Parent-child relationships are often replayed in this way.
• The therapist may be seen as the punitive father or as negligent mother or vice-versa.
• The therapist maintains a non-judgmental yet permissive attitude towards the client and overcomes the resistance showed by the client.
• This whole process is known as transference and when the therapist becomes a substitute for the client in the present is known as transference neurosis.

Stage of Transference Neurosis:
In the process of transference the client acts out his/her frustrations, anger, fear and depression that he/she carried toward that person in the past, but could not express at that time.
• The therapist becomes a substitute for that person in the present.
This substitution which is known as transference neurosis is helpful in making the therapist aware of the nature of intrapsychic conflicts suffered by the client.
The transference neurosis may develop in two forms:
(i) Positive Transference: Here the client may fall in love with the therapist and seeks the therapist’s approval.
(ii) Negative Transference: When the client develops feeling of hostility, anger and resentment towards the therapist.

• Stage of Resistance: During the process of transference an individual may develop resistance. Since process of transference exposes the unconscious wishes and conflicts, client’s distress level increases and so the client resists transference.
(i) Conscious Resistance: It is present when the client intentionally hides some information.
(ii) Unconscious Resistance: It is present when the client becomes silent during the therapy session or starts coming late for the sessions, flight into sickness or show unwillingness to talk about certain things, sudden blocks forgetting and so on.

• According to Freud, resistance is patient’s unconscious struggle to prevent painful material from being brought to the surface and faced directly.
• Interpretation: Interpretation is the fundamental mechanism to bring change in the client. Interpretation is done through two analytical techniques:
(i) Confrontation: The therapist points out to the client an aspect of his psyche that must be faced by the client. It is a subtle process and considered to be the pinnacle of psychoanalysis.
(ii) Clarification: It is the process by which the therapist brings a vague or confusing event into clarity.
Both the process are done by sharpening and pruning of the material which is brought from unconscious to conscious level.

• The therapist highlights certain important aspects and deletes the unimportant ones.
Working Through: The repeated process of using confrontation, clarification and interpretation is known as working through.
• This process helps the patient to understand himself and the source of the problem.
• It integrates the uncovered material into his ego.
• Insight: The end product of working through is insight.
It is a gradual process wherein the unconscious memories are again and again integrated into conscious awareness.
As this process continues, the client starts to understand himself better at an intellectual and emotional level and gains insight into his/her conflicts and problems.
The insight is of two types:
(i) Intellectual Insight: It is intellectual understanding of the event.
(ii) Emotional Insight: The emotional understanding, acceptance of one’s irritations due to unpleasant events of the past and the willingness to change emotionally is known as emotional insight.

3. Third Phase:
• Termination: Insight is the end part of therapy. Now the client is supposed to gain new understanding of himself. Conflicts of the past, excessive usage of defence mechanism and physical symptoms are no longer present and he/she becomes a healthy person.

Question. Discuss the various techniques used in behaviour therapy. 
Answer. The techniques used in behaviour therapy are not based on any unified theory. These are developed on the basis of various principles particularly on classical conditioning, operant conditioning and modelling. The main objective of the techniques are to modify maladaptive behaviour. Negative reinforcement and aversive conditioning are the two major techniques of behaviour modification.

1. Reinforcement Techniques:
(a) Negative Reinforcement: It refers to following an undesired response with an outcome that is painful or not liked. For example, a mother may cover her son’s thumb with a bitter NEEM paste so that he should not develop habit of thumb sucking. Due to the bitterness, the child tries to avoid or withdraw the bitterness of thumb and will leave the habit of thumb-sucking.Aversive Conditioning:
• It is establishing relationship between undesirable behaviour and aversive consequences.
• Aversive therapy is a therapeutic technique which uses an unpleasant stimulus to change a deviant behaviour.
• It works by pairing together the stimulus that normally invites the deviant behaviour (such as an alcoholic drink or sexual image) with an unpleasant (aversive) stimulus such as an electric shock or a nausea-inducing drug,with repeated presentations.
• The two stimuli become associated and the person develops an aversion toward the stimulus that formerly gave rise to the deviant behaviour.
(b) Positive Reinforcement: If an adaptive behaviour occurs, positive reinforcement may be used by the therapist. For example, the child’s mother may prepare child’s favourite dish on the day when most of the time child was being observed not keeping his thumb in the mouth.
Token Economy: A behaviour therapy is based on positive reinforcement.
• A package or deal is being established between the therapist and the client.
• Persons with behavioural problems can be given a token as a reward every time a wanted behaviour occurs.
• The tokens are collected and exchanged with for a predetermined reward such as outing for the patient or a treat for the child.
• The technique is widely used in hospitals, schools and reformatory.
(c) Differential Reinforcement: In differential reinforcement, both positive and negative reinforcements are used together. By using this method, unwanted behaviour can be reduced and wanted behaviour can be increased simultaneously.
(d) Method of ignoring Unwanted Behaviour: In this method, the therapist positively reinforces the wanted behaviour and ignores the unwanted behaviour. For example, the parents are instructed to praise the child or give chocolate to him or to take him to cinema if the child does not suck the thumb, but ignore the unwanted behaviour that is sucking the thumb. This method is less painful and equally effective for modifying the unwanted behaviour.

2. Systematic Desensitisation: It is a technique introduced by Wolpe, for treating phobias or irrational fears. This technique is based on the principle of reciprocal inhibition. This principle states that the presence of two mutually opposing forces at the same time, inhibits the weaker force. e.g., distress, at the same time,relaxation, can not occur.
The technique follows four steps:
(i) Initial interview.
(ii) Training in relaxation exercises.
(iii) Preparation of hierarchy of anxiety-provoking situation. This is a subjective process and changes from problem to problem.
(iv) Desensitization: When the client becomes relaxed, he/she is exposed to least
anxiety-provoking situation. Over sessions, the client is able to deal with more
severe fear-provoking situations while maintaining with relaxation.

3. Modelling: It is the procedure wherein the client learns to behave in a certain way by observing the behaviour of a role model or the therapist.
• It is role playing.
• Vicarious learning (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.

Question. Explain with the help of an example how cognitive distortions take place. 
Answer. Aaron Beck devised cognitive therapy.
• It is also known as cognitive restructuring therapy.
• Basic Assumption: Negative thinking, irrational beliefs and faulty generalization caused disorder.
• This therapy believes that repeated cognitive distortions play significant role in causing disorder. Cognitive distortion means way of thinking which are general in nature but which distorts the reality in a negative manner. e.g., persistent negative and irrational thoughts such as: “Nobody loves me”, “I am ugly”, “ I am stupid” etc. Step I – Analysis of Core Schemata: Childhood experiences provided by the family and society develop core schemata or systems, which include beliefs and action patterns of the individual.
• A client, who was neglected by the parents as a child, develops the core schema of “I am not wanted.” This may be validated by the teachers in the school.
• Such negative automatic thoughts cause cognitive distortions.
• Cognitive distortions are ways of thinking which are general in nature but which distort the reality in a negative manner. Their patterns are called Dysfunctional cognitive structure.
• Repeated occurrence of these distorted thoughts leads to the development of feelings of anxiety and depression.
Treatment Method:
• The therapist uses questioning, which is gentle, non-threatening and nonjudgmental, non probing but thought proviking questions.
• The questions make the client to think deeper into her/his assumptions about his life and problems.
• These questions make the client to think in a direction opposite to his negative thoughts and gains insight of his dysfunctional schemas and able to restructure his thoughts in positive direction.
• Beck’s cognitive approach does not attempt to disprove the ideas held by depressed persons, rather the therapist and client work together to identify the individual’s assumptions, beliefs and expectations and to formulate ways of testing them.

Aim of the Therapy:
• Cognitive restructuring by helping people to recognize and reject the false assumptions that are central to their difficulties.

Question. Which therapy encourages the client to seek personal growth and actualise their potential? Write about the therapies which are based on this principle. 
Answer.
• The humanistic-existential therapies encourage personal growth and actualize the potential.

Fundamental Assumption:
• The client has the freedom and responsibility to control his/her own behaviour.
• Psychological distress arises from feeling of loneliness, alienation and an inability to find meaning and genuine fulfilment in life.
• All individuals have desire for personal growth and self-actualization and an innate need to grow emotionally.

Causes of Distress:
1. Obstacles created by the society and family to achieve personal growth.
2. Obstacles in attainment of self-actualization, because it requires free emotional expression.

Treatment Modalities:
• The therapist is merely facilitator and guide. It is the client who is responsible for the success of the therapy.
• The client initiates the process of self-growth through which healing takes place.
Therapies based on Humanistic-existential Approach:
Logo therapy is a form of existential therapy.
Victor Frankl, a psychiatrist and neurologist propounded logo therapy.

Basic Assumption: ‘Logo’ is the Greek word for ‘soul’ and ‘logo’ therapy ‘means treatment of the soul’.
• Person’s desire of finding the spiritual truth of ones existence is the source of motivation.
• Finding meaning of self even in life-threatening circumstances is process of meaning making.
• There is a spiritual unconscious, which is the store house of love, aesthetic awareness and values of life.
Aim of Therapy: To help the client to find meaning and responsibility in their life irrespective of their life circumstances.

Treatment Modality:
• The therapist emphasizes the unique nature of the patients life and encourages them to find meaning in their life.
• The therapist is open and shares his/her feelings, values and his/her own existence with the client.
• The emphasis is on here and now.
• In the therapy, transference is actively discouraged.
• The goal is to facilitate the client to find meaning of his/her being.

Gestalt Therapy:
• It is humanistic therapy developed by Fritz Pearl and his wife Laura Pearl.
• It helps the client to develop self-awareness and self-acceptance.
• The client is taught to bring his disowned thoughts, conflicts and anxieties to his awareness.
• The therapist does this by encouraging the client to act out or speak out his/her fantasies about feelings and conflicts.
• This therapy can also be used in group setting.

Client-Centered Therapy:
This kind of therapy is developed by Carl Rogers.
• It is based on non-directive approach.
• To understand individual, we must look at the way they experience events rather than at the events themselves.
• The therapy provides a warm relationship in which the client can reconnect with his/her disintegrated feeling.
• The therapist shows empathy, i.e., understanding the client’s experience as if it were his/her own, is warm and has unconditionally positive regard, i.e., total acceptance.
• The therapist reflects the feelings of the clients 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 clients statements.
• According to this therapy personal relationships improve with an increase in adjustment. In essence, this therapy helps the client to become his/her real self with the therapist working as a facilitator.

Question. What are the factors that contribute to healing in psychotherapy? Enumerate some of the alternative therapies. 
Answer. There are several factors which contribute to the healing process. Some of these factors are as follows:
• The techniques adopted by the therapist and the implementation of the same with the client.
• The quality of therapeutic alliance—the regular availability of the therapist, and the warmth and empathy provided by the therapist has its importance.
• The quality of emotional unburdening (catharsis) has significant impact on healing.
• Non-specific factors are associated with psychotherapy. These are patient variable and therapist variable.
• Patient variable refers to attributed to the client. e.g., clients motivation for change and expectation of improvement due to the treatment etc. Therapist variable refers to his/her good mental health, absence of his/her unresolved emotional conflicts and expertise.
Alternative therapies are so called, because they are alternative treatment possibilities to the conventional drug treatment or psychotherapy. There are many alternative therapies such as yoga, meditation, herbal remedies and so on.

1. Yoga is an ancient Indian technique detailed in the Ashtanga Yoga of Patanjali’s Yoga Sutra. Yoga, as it is commonly called today either refers to only the asanas or body positive component or to breathing practices or pranayama or to a combination of the two.
2. Meditation refers to the practice of focusing attention on breath or an object or thought or a mantra.
3. Vipasana Meditation, also known as mindfulness-based meditation, has no fixed object or thought to hold the attention. The person possibly observes the various bodily sensation and thoughts that are passing through his awareness.
4. The rapid breathing techniques to induce hyperventilation as in Sudarshana Kriya Yoga (SKY) is found to be a beneficial, low-risk, low-cost, adjunct to the treatment of stress, anxiety, post-traumatic stress disorder (PTSD) depression, stress-related medical illness, substance abuse, and rehabilitations of criminal offenders.
5. Kundalini Yoga taught in USA has found to be effective in treating mental disorders, obsessive-compulsive disorder. It combines pranayama or breathing with chanting of mantras.

Question. What are the techniques used in the rehabilitation of the mentally ill?
Answer. Rehabilitation of the mentally ill is necessary to improve their quality of life once their active symptoms are reduced.
• In the case of milder disorders, such as generalized anxiety disorder, reduction of symptoms improves their quality of life and such patients need not to help rehabilitation.
• However in severe mental disorders, such as schizophrenic disorders, reduction of symptoms does not mean that patient is cured. Such patients develop negative symptoms like apathy or lack of motivation and their cognitive social and occupational skills get impaired. So they need rehabilitation.
• Rehabilitation provides:
1. Social Skill Training: It helps the patients to develop interpersonal skills through role play, imitation and instruction.
2. Cognitive Retraining: It helps the patients to improve the basic cognitive functions of attention, memory and executive functions.
3. Occupational Therapy: The patients are taught skills such as candlemaking, paper bag making and weaving to develop work discipline.
4. Vocational Training: When the patient becomes self-sufficient, vocational training is given wherein the patient is helped to gain skills necessary to undertake productive employment.

Question. How would a social learning theorist account for a phobic fear of lizards/cockroaches?
How would a psychoanalyst account for the same phobia? (CBSE 2013)
Answer. Social learning theories work on the principle that our experience—be it positive or negative—such as phobia of lizards/cockroaches are the result of learning process which start early in life. Small children can play with snakes, they are not aware of the danger involved. For them it is just another play object, as they grow up the fear of these things are instilled by their parents and society which is reinforced and accounts for reactions like phobia.
A psychoanalytical account for the same could involve attribution to some unconscious or/and repressed experiences. For example, suppose in your childhood you watched a group of roudy boys brutally torturing a cockroach/snake, which eventually died, although you going about the incidence after some days, but it might remain in back of your mind forever, which might explain your phobia to cockroaches which might remind you of the incidence and disturbs you emotionally.

Question. Should Electro-convulsive Therapy (ECT) be used in the treatment of mental disorders?
Answer. Electro-convulsive Therapy (ECT):
• It is used to alleviate sudden and severe depression.
• In this method one electrode is placed on each side of the person’s temples and a mild current is turned on for a very short period.
• In the beginning, it was done by injecting metrazol and other drugs in mental patients. These shocks are continued until the patient has a seizure, a muscle contraction of the entire body, lasting at least twenty to twenty-five seconds. ECT seems to work at least for some disorders.
• Unfortunately, there are hazardous risk connected with it. There is amnesia for the whole treatment and after several treatments. There is memory impairment, which may last for several weeks. However, no permanent loss of memory occurs.
ECT use has declined since 1950.
• ECT is still used in various hospitals in India because it is economical and effective. In my opinion as a last resort this therapy should continue to be used in India.
Drug Therapy:
• It has been used mainly with four types of disorders—schizophrenia, mania, depression and anxiety.
• These drugs are referred as ‘psychotropic drugs’ because their main effect is on psychological behaviour.
• They are also called as ‘antipsychotic drugs’.
• They are used for the treatment of schizophrenia. ‘Antimanic drugs’ are used to treat patients who are highly agitated, excited and at times unmanageable.
‘Antidepressant drugs’ are used for patients having depression and suicidal risk.
‘Antianxiety drugs’ are known to be minor tranquillisers.

Question. What kind of problems is cognitive behaviour therapy best suited for?
Answer. CBT is a short and effective treatment for a wide range of psychological disorders such as anxiety, depression, panic attacks and borderline personality, etc.
• It combines cognitive therapy and behavioural technique.
• According to CBT, the cause of client’s distress is biological, psychological and social relations in combination.
• CBT focuses on the biological aspects through relaxation procedures and the psychological ones through behaviour therapy. Social aspects are dealt with environmental manipulations.
• This multi-axial approach makes CBT a comprehensive technique, which is easy to use, applicable to a variety of disorders and has full potential to deal effectively with psychological disorders.

CBSE Class 12 Psychology Chapter 5 Therapeutic approaches and counselling Multiple Choice Question

Question. ___________ is a technique to treat Phobia.
(a) Sublimation
(b) Rationalization
(c) Systematic desensitization
(d) None of the above
Answer. C

Question. Systematic desensitization begins with some form of—
(a) Instrumental conditioning
(b) Relaxation training
(c) Instrumental training
(d) None of the above
Answer. B

Question. In ___________, the aim is establishing relationship between undesirable behaviour with painful consequences.
(a) Bio feedback
(b) Aversion therapy
(c) Creative visualization
(d) None of the above
Answer. B

Question. Cognitive therapy for the treatment of depression is given by—
(a) Albert Ellis
(b) Sigmund Freud
(c) Aaronoeck
(d) None of the above
Answer. C

Question. In ___________ approach, the therapist uses ‘pointed but friendly questioning’ to root out depressed people’s faulty ‘depressogenic cognitions’.
(a) Psychodynamic
(b) Cognitive
(c) Behaviourist
(d) None of the above
Answer. B

Question. Trusting and Accepting Relationship between the therapist and the client is called Therapeutic relationships. (T/F)
Answer. T

Question. Total acceptance of client despite of him being rude is called Unconditional positive regard. (T/F)
Answer. F

Question. Empathy is showing compassion and pity towards the clients. (T/F)
Answer. F

Question. When the therapist reciprocates the transference shown by client, it is called Transference neurosis. (T/F)
Answer. T

Question. Learning by observing others, is used through a process of rewarding small changes in the behaviour— (token economy/vicarious learning)
Answer. vicarious learning

Question. “I should be loved by everybody.” This irrational thought can be treated by—
(a) Psychodynamic Therapy
(b) Behaviour Therapy
(c) RET
(d) Existential Therapy
Answer. C

Question. Logotherapy is given by—
(a) Victor Frankl
(b) Sigmund Freud
(c) Ivan Pavlov
(d) Care Rogers
Answer. A

CBSE Class 12 Psychology Chapter 5 Therapeutic approaches and counselling Very Short Answer Type Questions 

Question. What is therapeutic alliance?
Answer. Therapeutic alliance is the typical relationship between the therapist and the client in which the client has trust in the therapist and the therapist has empathy for the
client.

Question. How can a therapist maintain the trust of his client?
Answer. The therapist encourages the client to discharge his/her emotions and feel free from the conflicts and anxiety by providing unconditional positive regard and empathy.
The therapist provides an accepting, empathic, genuine, non-judgmental and warm relationship so that the client may confide in him.

Question. Explain the principle of reciprocal inhibition.
Answer. The Wolpe’s theory of systematic desensitization is based on this principle.
This principle states that “the presence of two mutually opposing forces at the same time, inhibit the weaker force.” In other words, one cannot be both relaxed and anxious at the same time. Thus, the relaxation response dominates on the imagination of mild anxiety provoking stimulus.
The client becomes able to tolerate progressively greater levels of anxiety because of his/her relaxed state.

Question. What is Vicarious learning? 
Answer. Vicarious learning is a part of modelling technique propounded by Bandura in which the client learns by observing others and even smallest changes in behaviour are rewarded by the therapist.

Question. What is integration in humanistic existential therapy?
Answer. Integration is an aspect of self-actualisation. The concept was given by Abraham Maslow.
‘Integrated’ means a sense of whole, being a complete person, maintaining the traits of personality despite of the variety of experiences that one is subjected to.

Question. What is existential anxiety? 
Answer.
• Neurotic anxieties arise when the problems of life are attached to physical,psychological or spiritual aspects of one’s existence.
• The role of spiritual anxiety leads to meaninglessness.
• It is called an existential anxiety, i.e., neurotic anxiety of spiritual origin which causes problems/disorders.

Question. Explain Zen as a form of Psychotherapy.
Answer. Zen is a school of Mahayana Buddhism that asserts that enlightenment can be attained through meditation, self-contemplation and intuition rather than through fait and devotion.

CBSE Class 12 Psychology Chapter 5 Therapeutic approaches and counselling Short Answer Type Questions

Question. How would the therapist formulate the problem of a client?
Answer. Steps in the Formulation of a Client’s Problem:
Understanding of the Problem: The therapist tries to understand the full implications of the distress being experienced by the client. It is done during the first few sessions of establishing therapeutic relationship.
Identification of the Areas to be targeted for Treatment in Psychotherapy: The theoretical formulation clearly identifies the problem areas to be targeted for therapy. Thus, if a client seeks help for inability to hold a job and reports inability to face superiors, the clinical formulation in behaviour therapy would state it as lack of assertiveness skills and anxiety. The target areas have thus been identified as inability to assert oneself and heightened anxiety.
Choice of Techniques for Treatment: The choice of techniques of treatment depends on the therapeutic system in which the therapist has been trained. However, even within this broad domain, the choice of techniques, timing of the techniques, and expectations of outcome of the therapy depend upon the clinical formulation.
The clinical formulation is an ongoing process, formulations may require reformations as clinical insights are gained in the process of therapy. Usually the first one or two sessions yield enough clinical material for the initial clinical formulation. It is not advisable to start psychotherapy without a clinical formulation.

Question. What is unconditional positive regard in the process of psychotherapy?
Answer. The concept unconditional positive regard was given by Carl Rogers.
• It is an attitude of acceptance and respect on the part of an observer, no matter what the other person says or does.
• The therapist provides acceptance and warmth to the client.
• Therapist is non-judgmental.
• The therapist continues to show positive feelings towards the client even if he is rude or confides all the ‘wrong’ things that he may have done or thought about.

Question. What is ‘Empathy’? How it is different from sympathy?
Answer.
• Empathy means understanding things from the other person’s perspective, i.e., putting oneself in the other person’s shoes.
• Empathy is present when one is able to understand the plight of another person and feel like other person.
• Empathy enriches the therapeutic relationship and develops a healing relationship.
• It is a cognitive process.
Sympathy is different from empathy.
• It is compassion and pity towards the suffering of another but not being able to feel like the other person.
• It is an affective process.

Question. Explain main features of therapeutic relationship. 
Answer. Therapeutic relationship or alliance is a special relationship between the therapist and the client.
It has following features:
• It is trusting and confiding relationship.
• The therapist provides unconditional positive regard to the client.
• This relationship develops in a permissive environment.
• The relationship is based on empathy.
• The relationship maintains strict confidentiality of the disclosures, feelings and thoughts of the client.
• The relationship maintains warmth, trust and confidence towards each other.
• It is purely a professional relationship.

Question. Explain the nature of the therapeutic relationship between the client and the therapist in different Psychotherapies.
Answer. Psychodynamic therapy assumes that the therapist understands the intrapsychic conflicts of the client better because of his training and maturity. He interprets the thoughts and feelings of the client and provides insight of the same to then client.
Behaviour therapy assumes that the therapist is capable of finding out the correct behaviour and thought patterns, which would be adaptive for the client. Existential and humanistic therapy assumes that therapist simply listens and develops a relationship with the client in which the client himself resolves his problems.

Question. How Psychodynamic therapies are different from Logo therapy?
Answer. Psychodynamic therapy:
• According to Psychodynamic therapies cause of problem is intrapsychic conflicts.
• Belief in unconscious which is reservoir of instinctive and animal drives.
• Past, i.e., psychosexual development is important in personality development/ disorder.
• Transference is actively encouraged.
Logo Therapy:
• Cause of problems is not getting meaning of ones life and existence.
• Belief in spiritual unconscious which is full of positive emotions and aesthetic values.
• Present is important for personality development/disorder.
• Transference is actively discouraged.

Question. How dream interpretation is used in psycho-analysis to elicit the nature of intrapsychic conflict?
Answer. According to Freud, dreams are the royal road to the unconscious.
The client is asked to write down his/her dreams. Psycho-analysts believe that dreams satisfy the repressed libidinal desires which get many in the dreams in disguised and symbolic form.
The images of dreams are symbols which signify intra-psychic forces.
These symbols are interpreted and the client develops awareness with his/her unfulfilled desires and conflicts at conscious level.

Question.How Yoga is useful for good mental health?
Answer. Yoga is a form of alternative therapy.
• Yoga techniques enhance well-being, happy mood and increased power of attention and consideration.
• It reduces depression and stress level.
• Insomnia (Sleep Disorder) can be retreated through yoga. It reduces time to go to sleep and improves quality of sleep.

CBSE Class 12 Psychology Chapter 5 Therapeutic approaches and counselling Short Answer Type Questions 

Question. Describe main features of RET. 
Answer. Albert Ellis formulated Rational Emotive therapy (RET).
Basic Assumption: Irrational beliefs, negative thinking and faulty generalization are the cause of disorders. These negative thoughts intervene between the antecedent events and their consequences.
• RET is a form of cognitive therapy that focuses on persuading individuals to recognize and change irrational assumptions that underlie their thinking.
[Here is an example. suppose that one day, your current romantic partner dumps you (break up). This is certainly an unpleasant event, but it thrashes your selfesteem and causes you to become deeply depressed?
Ellis argues that this depends on how you think about it if you develop irrational beliefs such as ‘everyone must love me’ or I can’t control my emotions. I must feel totally crushed by this reflection!” you may well become depressed.]
• The first step in RET is the ABC analysis (antecedent–belief–consequence analysis).
Antecedent analysis refers to identify cause of the psychological distress (i.e., break up in relationship in the given example).
Analysis of belief refers to understanding of ones own thinking which is not based on facts. e.g., No body loves me.
Consequence analysis refers to negative emotions and behaviour, i.e., depression.
Treatment Method:
• Antecedent events are identified.
• Irrational beliefs are assessed through questionnaires and interviews.
• Therapist persuades and sometimes challenges the irrationality of clients belief through gentle, nondirective, non probing questioning, non judgemental but though provoking questions.
• The questions make the client to think deeper into his/her assumptions about life and problems.
• Gradually the client is able to change the irrational beliefs by making change in his/her outlook towards life.
• The rational belief system replaces the irrational belief system and there is a reduction in psychological distress.

Question. How RET is different from Aaron Beck’s Cognitive therapy?
Answer.
• Ellis in RET probes the client’s behaviour and belief system by gentle questioning and sometimes challenging the irrational beliefs and negative thinking of the client.
• Aaron Beck in his Cognitive therapy does not attempt to disprove the ideas held by depressed person rather the therapist and client work together to identify the individual’s faulty assumptions. Beck uses ‘pointed, but friendly questioning’ to root out depressed people’s faulty cognitions.
• Ellis focuses on the client’s present circumstances to search the cause of irrational beliefs.
• Aaron Beck emphasises client’s core schemata formed during childhood as dysfunctional cognitive structure causing depressive behavioural pattern.

Question. Discuss main features of Humanistic-existential therapies.
Answer.
• The humanistic-existential therapy postulates that psychological distress arises from feeling of loneliness, alienation and an inability to find meaning and genuine fulfilment of life.
• Human beings are motivated by the desire for personal growth and self actualisation and an innate need to grow emotionally.
• Society believes that free emotional expression can harm the social network. So emotional control is to be developed in the individual for once owned growth and for the healthy social network which leads to distinctive behaviour and negative emotions.
• The therapy creates a permissive, non-judgmental and accepting atmosphere in which the clients emotions can be freely expressed and the complexity, balance and integration in personality could be achieved.
• The fundamental assumption of this therapy is that the client has the freedom and responsibility to control his/her own behaviour. The therapist is merely a facilitator and guide. It is the client who is responsible for the success of therapy.
• The chief aim of the therapy is to expend the clients awareness.

Question. What is self-actualisation?
Answer.
• 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.
• ‘Integrated’ means a sense of whole, being a complete person, being the same person inspite of the variety of experiences that one is subjected to.
• In short ‘self-actualisation’ refers to individual’s innate tendency to make best use of his potential, for one’s own growth and well-being.
• The concept of self-actualisation was given by Abraham Maslow.

Question. Discuss the ethics of Psychotherapy?
Or
State the ethical standards in Psychotherapy.
Answer.
• Some of the ethical standards that need to be practised by professional psychotherapist are:
• Informed consent needs to be taken.
• Confidentiality of the client should be maintained resolving personal distress and suffering should be the goal of all attempts of the therapist.
• Integrity of the therapist-client relationship is important.
• Respect for human rights and dignity.
• Professional competence and skills are essential.

Question. Discuss modelling as a form of behaviour therapy.
Answer.
• Bandura has worked extensively on developing the modelling technique. It is a procedure in which the client learns to behave in a certain way by observing the behaviour of a role model or the therapist who mutually acts as a role model. Modelling can influence behaviour as it serves as a basis for learning new skills.
• To eliminate fears and inhibitions.
• It facilitates socially existing behaviour patterns.
• Learning through observing others and through a process of rewarding small changes in the behaviour, the client gradually learns to acquire the behaviour of the model.

Question. How existential and humanistic therapies are different from psychodynamic and behaviour therapies?
Answer. The existential therapies emphasise that the therapist merely provides:
1. A warm, empathic relationship.
2. In such relationship client feels secure to explore the nature and causes of his problems himself because the client requires a facilitator not a problem-solver.
The psychodynamic and behavioural therapies assume that the therapist being a trained professional is capable of arriving at solutions to the client’s problems.

Question. What are ‘dysfunctional cognitive structures’?
Answer.
• Some negative thoughts develop in the mind due to core schemata established in the childhood. Such negative 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 thoughts are called dysfunctional cognitive structures.
• They lead to errors of cognition about the social reality.

CBSE Class 12 Psychology Chapter 5 Therapeutic approaches and counselling Long Answer Type Questions 

Question. What are the basic assumptions of behaviour therapy?
Answer. The basic assumptions of behaviour therapies are the following:
• Psychological distress arises because of faulty behaviour patterns or thought patterns.
• The past is relevant only to the extent of understanding of origin of the faulty behaviour and thought pattern.
• Only the faulty patterns are corrected in the present.
• The clinical application of learning theory principles constitute behaviour therapy.
• All behaviour therapies use specific techniques and interventions for modification in behaviour.
• It is not a unified theory which is applied irrespective of the diagnosis and the symptoms present.
• The symptoms of the client and the clinical diagnosis are the guiding factors in selection of the specific technique. e.g., treatment of phobias would require the use of one set of technique while that of anger outburst would require another.
• The foundation of behaviour therapy is dysfunctional or faulty behaviour, the factors which reinforce and maintain these behaviours, and devising methods by which they can be changed.

Question. Discuss method of treatment used in behaviour therapies.
Answer. In behavioural therapies, behavioural analysis is conducted to find the following aspects:
• Malfunctioning behaviour refers to those behaviours which cause distress to the client.
• Antecedent factors refers to the causes which predispose the person to indulge in that behaviour.
• Maintaining factors refer to those factors which lead to the persistence of the faulty behaviour.
Example: An example would be a young person who has acquired the malfunctioning behaviour of smoking and seeks help to get rid 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.
Once the faulty behaviours, which cause distress, have been identified a treatment package is chosen.
The aim of treatment is to eliminate the faulty behaviours and substitute them with adaptive behaviour patterns.

Behaviour therapist does this through the following operations:
• Antecedent Operations: This controls behaviour by changing something that causes distress.
• Establishing Operations: This refers to the change which can be achieved by increasing or decreasing the reinforcing value of a particular consequence.
• Consequent Operation: It is praising the student by the teacher in the classroom when he performed better in academics and otherwise.
Example: The young man was provided professional help to prepare his examination.
This help was not always available. He was counselled to make best use of his potential to attain the required goal. At the time of frustration, the help was again provided.
Gradually the student started using adaptive ways of goal management. Now the therapist, teacher and parents admired him. Everybody around was praising him for his positive efforts.
In this case antecedent operation is the professional help to cope up the scholastic demands, establishing co-operation is encouraging to confront with the problem himself and providing help at the time of frustration and consequent of operation is praising him for his positive efforts for goal attainment.