Psychotherapies in Psychology – UGC NET – Notes

Introduction

Psychotherapy is a general term for treating mental health problems by talking with a psychiatrist, psychologist, or other mental health provider. During psychotherapy, you learn about your condition and your moods, feelings, thoughts, and behaviors. It helps you understand how to take control of your life and respond to difficult situations using healthy coping skills. There are many different types of psychotherapy, each with its own approach, and the most suitable one depends on your individual needs. Psychotherapy is also known as talk therapy, counseling, or psychosocial therapy.

Psychotherapy is used to treat a wide range of mental health problems, including:

• Anxiety disorders such as obsessive-compulsive disorder (OCD), phobias, panic disorder, and post-traumatic stress disorder (PTSD)
• Mood disorders like depression and bipolar disorder
• Addictions, including alcoholism, drug dependence, and compulsive gambling
• Eating disorders such as anorexia and bulimia
• Personality disorders like borderline or dependent personality disorder
• Schizophrenia and other psychotic disorders involving loss of contact with reality

Not everyone who benefits from psychotherapy has a diagnosed mental illness. It can also help individuals deal with everyday stress and life challenges. For example, psychotherapy can help you:

• Resolve conflicts in relationships
• Reduce stress and anxiety related to work or life situations
• Cope with major life changes like divorce, loss, or unemployment
• Manage unhealthy reactions such as anger or passive-aggressive behavior
• Adjust to chronic physical illnesses like diabetes or cancer
• Recover from abuse or trauma
• Address sexual or sleep-related problems

In some cases, psychotherapy can be as effective as medication, such as antidepressants. However, depending on the severity of the condition, a combination of therapy and medication may be required for effective treatment.

Definition

Psychotherapy can be broadly defined as consisting of three key components: a healing agent, a sufferer, and a therapeutic relationship (Frank and Frank, 1991). Strupp (1986) described psychotherapy as the systematic use of a human relationship for therapeutic purposes, aimed at reducing emotional distress by bringing about lasting changes in a client’s thinking, feelings, and behaviour. The active involvement of both the client and the therapist—on cognitive and emotional levels—forms the basis of effective psychotherapy.

Traditionally, psychotherapy refers to the treatment of mental disorders through psychological techniques within a structured client–therapist relationship. It involves a trained professional working with a client to address symptoms of mental illness, resolve behavioural problems, or support personal growth.

Wolberg (1988) viewed psychotherapy as a process aimed at changing the attitudes and behaviours of a maladjusted individual toward more constructive outcomes. He defined it as a professional relationship established to:

• Remove or reduce symptoms
• Modify disturbed behaviour patterns
• Promote positive personality growth and development

Aims of Psychotherapy

Psychotherapy is more than just a conversation between two people about a problem. It is a collaborative and professional process aimed at achieving specific therapeutic goals. These objectives include:

• Removing existing symptoms: One of the primary goals is to eliminate symptoms that cause distress and interfere with daily functioning.
• Modifying existing symptoms: In situations where complete removal is not possible—due to factors like low motivation, limited coping ability, or practical constraints—the aim shifts to symptom modification rather than total cure.
• Retarding existing symptoms: In certain conditions such as dementia, psychotherapy may help slow down deterioration and maintain the person’s contact with reality for as long as possible.
• Mediating disturbed behaviour patterns: Many life problems—whether occupational, educational, marital, or social—are influenced by emotional factors. Psychotherapy helps in addressing disturbed interpersonal relationships and improving behavioural patterns.
• Promoting positive personality growth: This involves working on emotional immaturity and barriers to development. The goal is to achieve personal growth and self-fulfillment, leading to more productive attitudes and satisfying relationships.

Additionally, psychotherapy aims to:

• Strengthen the client’s motivation for positive change
• Reduce emotional stress by encouraging expression of feelings
• Unlock the individual’s potential for growth
• Change maladaptive habits
• Modify the person’s cognitive patterns
• Enhance self-knowledge
• Improve interpersonal communication and relationships

Schools of Psychotherapy

Psychodynamic Therapy

Psychodynamic theory originated with the work of Sigmund Freud and focuses on strengthening the ego and reducing the pressure of unconscious impulses, allowing individuals to better manage their lives. This approach is based on the idea that psychological problems arise from unresolved unconscious conflicts, often rooted in childhood experiences. The therapy aims to increase self-understanding and improve coping abilities.

One of the main techniques used is free association, where the client is encouraged to express whatever comes to mind without censorship. This helps reveal hidden thoughts and conflicts from the unconscious. Another important method is dream analysis, based on the belief that during sleep, normal ego controls are relaxed, allowing unconscious processes to emerge more freely. Thus, dreams provide valuable insight into unconscious desires and needs.

A central concept in this therapy is transference, where clients project strong emotions onto the therapist that are not directly related to the present situation. These reactions can be positive (such as love or admiration) or negative (such as anger or hostility). Freud believed that transference, rather than being an obstacle, can serve as a powerful therapeutic tool, as it brings repressed feelings into awareness.

By examining and understanding these transferred emotions, psychotherapy helps uncover and resolve deep-seated conflicts, leading to emotional healing and personal growth.

Behaviour Therapy

Behaviour therapy mainly focuses on modifying undesirable behaviour. In this form of psychotherapy, maladaptive behaviours are first identified and then changed or replaced using specific therapeutic techniques. It is strongly based on principles of learning theories, which explain how behaviours are acquired and can be altered.

The contributions of Ivan Pavlov, particularly classical conditioning, and B. F. Skinner, especially operant conditioning, have been highly significant in the development of behaviour therapy.

Classical Conditioning:

Classical conditioning was proposed by Ivan Pavlov. His famous experiment demonstrated how a dog could be conditioned to salivate at the sound of a bell, even in the absence of food. This experiment forms the basis of this important learning theory.

Classical conditioning is a learning process that occurs through associations between stimuli. It involves pairing a conditioned stimulus (CS) with an unconditioned stimulus (US), so that eventually the conditioned stimulus alone can produce a response. Thus, learning takes place through the repeated pairing of environmental and natural stimuli, leading to a conditioned response.

Operant Conditioning:

This learning theory was proposed by B. F. Skinner.
This is also known as instrumental conditioning. Here the learning takes place as a result of reinforcement, reward and punishment that determine whether a particular behaviour will be repeated or not.

Let us now discuss some of the techniques used in behaviour therapy:

• Simple Extinction: This is based on the principle that particular learned behaviour will become weak and eventually disappear if it is not reinforced. One of the simplest ways to decrease or eliminate a particular maladaptive behaviour is by removing the reinforcements that encourage such behaviours. The behaviour may not be consciously reinforced but may be unknowingly reinforced by people around the client.
• Aversive Conditioning: This is based on the principle that a learned behaviour will be weakened when it is followed by pain or punishment. Thus a maladaptive behaviour can be reduced or removed when it is paired with pain/punishment. Such a technique can be used with clients with substance abuse, destructive behaviours, sexual problems, and deviant behaviours. In certain cases such a technique can also be used in such a way that there is positive reinforcement of stimuli that are related to termination of pain.
• Response Shaping: This can be described as a process in which the responses of individuals are shaped in such a way that he/she is able to use responses that are not initially present in his/her behavioural inventory. Behaviours can also be shaped with suitable reinforcements that lead to increase in certain behaviours.
• Assertive Training: This technique can be used to increase assertive behaviour on the part of the client. This includes appropriate expression of emotions. Increased assertiveness can help the client by improving wellbeing, enhancing social skills, achieving social rewards and increasing life satisfaction.
• Token Economy: The focus of using tokens rather than using primary reinforcers is that they bridge the delay between the occurrence of the desired behaviour and the ultimate reinforcement. Thus as the client performs tasks like making the bed or completing responsibilities, he/she immediately receives tokens. The goal is to develop behaviour that will lead to social reinforcement, enhance necessary skills, and help the individual live successfully outside the institution. This method is also useful with children to increase desirable behaviour.
• Modelling: Response shaping can be tedious and time consuming, especially when complex responses are to be learned. Such responses can be acquired more easily if the subject observes a model and is then reinforced for imitating the model’s behaviour. Albert Bandura developed this form of behaviour modification based on social modelling. According to Bandura, modelling can:

1. 1. Help in learning new skills and behaviour

   2. Eliminate fears and inhibitions

   3. Facilitate existing behaviour patterns

• Systematic Desensitization: This technique was developed by Joseph Wolpe and aims at reducing maladaptive anxiety. It involves pairing relaxation with imagined anxiety-provoking situations. Over time, anxiety is reduced as it gets associated with relaxation. This method is especially effective for phobias.

The steps include:

1. Practicing relaxation techniques regularly

2. Creating a hierarchy of fears (e.g., fear of lifts from looking at a lift to travelling to higher floors)

3. Gradually imagining each level while practicing relaxation whenever anxiety occurs

• Implosive Therapy: This technique is similar to systematic desensitization but involves intense exposure to anxiety-provoking situations. The therapist deliberately creates a strong “flood” of anxiety through imagination. With repeated exposure in a safe setting, the stimulus loses its power to produce anxiety and avoidance behaviour is reduced. However, due to its intensity, it is considered less ethical and is used less frequently.

Humanistic Psychotherapy

Humanistic therapy is an approach where the main emphasis is on client’s subjective, conscious experiences. The therapist’s focus is more on the present. The client plays a far active role as compared to the therapist who mainly creates a conducive environment.

The major form of humanistic therapy is developed by Carl Rogers. The therapy by Carl Rogers is known as Client Centered Therapy or more recently as Person Centered Therapy. This therapy mainly focuses on empathy, unconditional positive regard by the therapist towards the client and effective communication of these attitudes.

Existential Psychotherapy

Existential approaches to psychotherapy have tended to emerge in regions where there was strong interest in existential philosophy. Viktor Frankl and Rollo May were major contributors. Existentialism is concerned with the meaning of human existence.

They believe that people are free to choose among alternatives and have a major role in shaping their own lives. Problems of moral conflicts are addressed through Logotherapy. In this approach, an individual searches for the meaning of life, where uniqueness, destiny, and personal heritage combine to give purpose to existence.

Gestalt Therapy

Perls’s Gestalt Therapy originated in Germany. Psychologists such as Wertheimer, Koffka, Kohler, Lewin and Goldstein contributed to its development.

Gestalt theory emphasises organisation and relatedness, in contrast to reductionism and mechanical behaviourism. It focuses on understanding the individual as a whole, integrating dynamic, affective, cognitive, and social aspects into a unified system.

Interpersonal Therapy

Interpersonal Therapy was developed by Gerald L. Klerman and Myrna Weissman, based on the ideas of Harry Stack Sullivan. As the name suggests, this therapy focuses on social roles and interactions of the client, both present and past.

The therapy usually targets one or two current problem areas such as conflicts with family, friends, or colleagues. It is also useful in dealing with grief and loss, as well as life transitions like retirement and divorce.

Phases of Psychotherapy

Beginning Phase

The beginning stage of therapy has as its principal objective the establishing of a working relationship with the client. Without such mutual understanding, there will be no therapeutic progress. Because this relationship is so vital, all tasks must be subordinated to achieving it.

To ensure an adequate working relationship, the client must be motivated by:

• Clarifying and removing misconceptions about therapy
• Convincing the client that the therapist understands his/her sufferings and is capable of helping
• Clearly defining the objectives of the therapy

Middle Phase

Once the therapeutic relationship is well established and the client takes an active role, therapy enters the middle stage. One of its main objectives is to uncover the causes and consequences of the client’s disorder.

The middle phase is further divided into:

Early Middle Phase: The main objective here is to explore environmental frustrations and maladaptive interpersonal drives through interviews, and to probe unconscious conflicts that generate anxiety and disturb basic needs.

Late Middle Phase: In this stage, the therapist helps the client bring changes in maladaptive behaviour and provides encouragement for these changes. The therapist also assists the client in:

• Dealing with forces that block action
• Managing anxieties related to normal life goals
• Correcting environmental distortions
• Adjusting to conditions that cannot be changed
• Coping with persistent symptoms and abnormal patterns

Terminal Phase

Theoretically, psychotherapy is continuous, as emotional growth can occur throughout life. However, in practical terms, therapy is terminated when the stated goals are achieved.

The terminal phase begins with the therapist and client reviewing the client’s current status and future prospects to decide whether goals have been sufficiently met. Termination may also occur before full goal achievement.

Conditions indicating termination include:

• Achievement of treatment goals
• Decision by client or therapist despite incomplete goals
• Reaching an impasse or strong resistance
• Counter-transference that the therapist cannot manage
• Practical issues like relocation

It is also important to consider how long therapy takes to bring change. According to Frank (1973), therapeutic change occurs in phases:

• Restoration of well-being (remoralization)
• Relief of symptoms (remediation)
• Improvement in functioning (rehabilitation)

To move through all these phases, an adequate number of sessions is necessary. Although there is no fixed number, therapies like CBT and IPT generally require about 8 to 12 weeks of twice-weekly sessions, followed by maintenance sessions at longer intervals.

If the client is not responding after multiple sessions, the therapist should re-evaluate the chosen method. Similarly, even when progress is good, too many sessions may become counterproductive and lead to diminishing returns.