Therapeutic ApproachesClass 12 Psychology NCERT Solutions

Nature and Scope of Psychotherapy

• Reinforcing the client's resolve for improvement.
• Lessening emotional pressure and distress.
• Unfolding the potential for positive growth and self-actualisation.
• Modifying habits and changing thinking patterns.
• Increasing self-awareness and facilitating decision-making.
• Improving interpersonal relations and communication.

Importance of Therapeutic Relationship

• Trust and Confidentiality: It is a trusting and confiding relationship where the client feels safe to unburden themselves. The therapist must maintain strict confidentiality.
• Empathy and Unconditional Positive Regard: The therapist encourages the client by being accepting, empathic, genuine, and warm. The therapist shows unconditional positive regard, meaning they maintain positive feelings towards the client without judgment, regardless of what the client reveals. Empathy allows the therapist to understand things from the client's perspective, transforming the relationship into a healing one.
• Contractual Nature: The relationship is a partnership where both the client and therapist willingly work towards helping the client overcome their problems. It has a limited duration, lasting only until the client can manage their problems independently.

1. What is the cause of the problem?
   • Psychodynamic: Intrapsychic conflicts (conflicts within the person's psyche).
   • Behaviour: Faulty learning of behaviours and cognitions.
   • Existential: Questions about the meaning of one's life and existence.
2. How did the cause come into existence?
   • Psychodynamic: Unfulfilled childhood desires and unresolved childhood fears.
   • Behaviour: Faulty conditioning patterns, faulty learning, and faulty thinking.
   • Existential: Current feelings of loneliness, alienation, and a sense of futility.
3. What is the chief method of treatment?
   • Psychodynamic: Free association and dream interpretation to help the client confront and resolve conflicts.
   • Behaviour: Identifying faulty conditioning and using techniques to set up alternate behavioural contingencies to improve behaviour and challenge faulty thinking.
   • Existential: Providing a positive, accepting, and non-judgmental environment where the client can find solutions through personal growth, with the therapist acting as a facilitator.
4. What is the nature of the therapeutic relationship?
   • Psychodynamic & Behaviour: The therapist is seen as an expert who understands the client's problems and can arrive at solutions.
   • Existential: The therapist provides a warm, empathic relationship, and the client is responsible for exploring their own problems and solutions.
5. What is the chief benefit to the client?
   • Psychodynamic: Emotional insight into one's conflicts.
   • Behaviour: Changing faulty behaviour and thought patterns to adaptive ones.
   • Existential: Personal growth and an increased understanding of oneself.
6. What is the duration of treatment?
   • Psychodynamic: Can last for several years, though recent versions are shorter.
   • Behaviour & Existential: Generally shorter, completed in a few months.

• Negative Reinforcement and Aversive Conditioning:
  • Negative Reinforcement: This involves learning to avoid or escape painful stimuli. For example, moving away from a dangerous stimulus.
  • Aversive Conditioning: This technique repeatedly associates an undesired response (e.g., drinking alcohol) with an aversive consequence (e.g., a mild electric shock). This leads to the person giving up the undesired behaviour.
• Positive Reinforcement and Token Economy:
  • Positive Reinforcement: This is used to increase the occurrence of a desired behaviour by rewarding it. For example, a mother preparing a child's favourite dish when they complete their homework.
  • Token Economy: A system where a person receives a token (as a reward) for exhibiting a wanted behaviour. These tokens can be collected and exchanged for a larger reward, like an outing or a treat.
• Differential Reinforcement: This technique involves reinforcing a wanted behaviour while simultaneously reducing an unwanted behaviour. This can be done by positively reinforcing the desired behaviour and ignoring the unwanted one.
• Systematic Desensitisation: Introduced by Wolpe for treating phobias, this technique works on the principle of reciprocal inhibition. It involves three steps:
  1. Creating a hierarchy of anxiety-provoking situations, from least to most fearful.
  2. Teaching the client relaxation techniques.
  3. Asking the client to imagine the least anxiety-provoking situation while remaining relaxed. Over sessions, the client progresses up the hierarchy, becoming desensitised to the fear.
• Modelling: The client learns to behave in a certain way by observing a role model (often the therapist). This process of vicarious learning helps the client gradually acquire the desired behaviour through observation and reinforcement.

1. Development of Core Schemas: Childhood experiences provided by family and society lead to the development of core schemas. These are systems that include beliefs and action patterns.
2. Triggering of Core Schemas: A critical incident in the person's life triggers these core schemas.
3. Emergence of Negative Automatic Thoughts: The activated core schema leads to the development of persistent, irrational thoughts known as negative automatic thoughts.
4. Cognitive Distortions: These negative automatic thoughts are characterized by cognitive distortions, which are errors in cognition about social reality. They lead to dysfunctional cognitive structures.

• Core Schema Development: A client was neglected by their parents as a child. This experience leads them to develop the core schema of "I am not wanted".
• Critical Incident: Later in life, the person is publicly ridiculed by a teacher in school. This event acts as a critical incident.
• Negative Automatic Thoughts: The incident triggers the core schema ("I am not wanted"), leading to negative automatic thoughts like "nobody loves me", "I am stupid", or "I will not succeed".
• Cognitive Distortion: The person distorts the reality of the situation (a single instance of ridicule) into a generalized, negative belief about themselves and their worth. This repeated occurrence of negative thoughts leads to feelings of anxiety and depression.

1. Existential Therapy (Logotherapy): Propounded by Victor Frankl, Logotherapy means 'treatment for the soul'. It focuses on helping patients find meaning and responsibility in their lives, regardless of their circumstances. It addresses 'existential anxiety', which arises from a sense of meaninglessness. The therapist helps the client find meaning by exploring their spiritual unconscious, which is a storehouse of love, aesthetic awareness, and life values.
2. Client-Centred Therapy: Developed by Carl Rogers, this therapy emphasizes the client's self, freedom, and choice. The therapist provides a warm, supportive environment characterized by:
   • Empathy: Understanding the client's experience from their perspective.
   • Unconditional Positive Regard: Total acceptance of the client as they are, without judgment.
   • Genuineness: The therapist is authentic in the relationship. In this non-judgmental atmosphere, the client feels secure enough to explore their disintegrated feelings and reconnect with their real self. The therapist acts as a facilitator, not a director.
3. Gestalt Therapy: Developed by Fritz and Laura Perls, the goal of this therapy is to increase an individual's self-awareness and self-acceptance. The client is encouraged to recognise and integrate bodily processes and emotions that have been blocked from their awareness, often by acting out fantasies about feelings and conflicts. The term 'gestalt' means 'whole', and the therapy aims to help the client become a more complete and integrated person.

Factors Contributing to Healing

1. Therapeutic Techniques: The specific techniques used by the therapist, such as relaxation procedures in behaviour therapy or cognitive restructuring in CBT, are a major factor in healing.
2. The Therapeutic Alliance: The relationship between the therapist and the client is crucial. The regular availability of the therapist, along with the warmth and empathy they provide, has healing properties.
3. Catharsis: This is the process of emotional unburdening. In the initial sessions, as the client shares their emotional problems, this release of pent-up feelings provides relief and contributes to healing.
4. Non-specific Factors: These are factors that occur across different types of therapies and are not specific to any one approach.
   • Patient Variables: Factors attributable to the client, such as their motivation for change and their expectation of improvement.
   • Therapist Variables: Factors attributable to the therapist, such as their positive nature, good mental health, and absence of unresolved emotional conflicts.

Alternative Therapies

• Yoga: An ancient Indian technique involving asanas (body postures) and pranayama (breathing practices). It has been found to enhance well-being, mood, attention, and stress tolerance. It is also used to treat insomnia.
• Meditation: The practice of focusing attention on breath, an object, a thought, or a mantra. One specific form is Vipasana meditation (mindfulness-based meditation), where the person passively observes their bodily sensations and thoughts. It helps in processing emotional stimuli and can prevent repeated episodes of depression.
• Sudarshana Kriya Yoga (SKY): A rapid breathing technique found to be a beneficial, low-cost treatment for stress, anxiety, PTSD, and depression. It has been used as a public health intervention for survivors of mass disasters.
• Kundalini Yoga: This form of yoga, which combines breathing techniques with chanting mantras, has been found effective in the treatment of obsessive-compulsive disorder (OCD).

• Occupational Therapy: Patients are taught skills like candle making, paper bag making, and weaving. The goal is not just the skill itself, but to help them form a work discipline and feel productive.
• Social Skills Training: This helps patients develop interpersonal skills. Through methods like role play, imitation, and instruction, patients learn how to function effectively in a social group and improve their interactions with others.
• Cognitive Retraining: This is given to improve the patient's basic cognitive functions that may be impaired by their illness, such as attention, memory, and executive functions.
• Vocational Training: Once a patient has improved sufficiently, vocational training is provided. This helps the patient gain the specific skills necessary to undertake productive employment and become self-sufficient.

• Modelling: A person, especially a child, may develop a phobia by observing a role model (like a parent or sibling) reacting with extreme fear and panic to a lizard or cockroach.
• Vicarious Learning: By witnessing the model's fearful behaviour, the observer learns to associate the neutral stimulus (lizard/cockroach) with a fear response, even without having a direct negative experience with it. The fear is thus learned through observation.

• Symbolism and Displacement: The object of the phobia (the lizard or cockroach) is not the real source of the fear. It is a symbolic representation of an unconscious, repressed fear or desire, often originating from unresolved childhood conflicts (e.g., unresolved Oedipal conflicts or childhood fears).
• Intrapsychic Conflict: The intense fear and anxiety that should be attached to the repressed thought or memory is displaced onto the external, neutral object (the lizard). This allows the person to avoid confronting the true, underlying conflict, which is too threatening to face consciously. The phobia serves as a defense mechanism to keep the real anxiety at bay.

• Anxiety disorders
• Depression
• Panic attacks
• Borderline personality disorder

Activities for which we are Rewarded/Praised:

• Academic Performance:
  • Getting a perfect score on a test.
  • Answering a difficult question correctly in class.
  • Submitting homework on time consistently.
  • Doing a creative and well-researched project.
• Behaviour and Conduct:
  • Helping a classmate who is struggling with a topic.
  • Maintaining silence and discipline when the teacher is not in class.
  • Volunteering to clean the classroom or decorate the bulletin board.
  • Being honest about a mistake.
• Extracurricular Activities:
  • Winning a prize in a competition (sports, debate, art).
  • Actively participating in school events or assemblies.

Activities for which we are Scolded/Face Disapproval:

• Academic Negligence:
  • Not completing homework or submitting it late.
  • Talking or not paying attention during a lesson.
  • Scoring poorly on tests due to lack of preparation.
  • Copying work from others.
• Behaviour and Conduct:
  • Making noise and disturbing the class.
  • Bullying or making fun of another student.
  • Arriving late to class.
  • Arguing with the teacher or classmates.
  • Damaging school property.

Personal Description:

Effect on Me:

• Increased Self-Worth: Her acceptance helped me separate my self-worth from my academic performance. I learned that it was okay to make mistakes and that failure did not make me a bad person.
• Safety and Trust: It created a safe emotional space where I felt I could be my true self without fear of rejection. This built a deep sense of trust and security in our relationship.
• Motivation for Growth: Paradoxically, her acceptance of my failure motivated me to do better. Because I was not crippled by fear or shame, I was able to analyse my mistakes objectively and work harder, eventually improving my grades significantly. It fostered personal growth because I was free to explore my potential without the pressure of conditional approval.