CU-MSC-PSY-SEM-III-PSYCHOTHERAPIES- Second Draft

MASTER OF ARTS PSYCHOLOGY SEMESTER-III PSYCHOTHERAPIES MAP613

2 CU IDOL SELF LEARNING MATERIAL (SLM)

CHANDIGARH UNIVERSITY Institute of Distance and Online Learning Course Development Committee Prof. (Dr.) R.S.Bawa Pro Chancellor, Chandigarh University, Gharuan, Punjab Advisors Prof. (Dr.) Bharat Bhushan, Director – IGNOU Prof. (Dr.) Majulika Srivastava, Director – CIQA, IGNOU Programme Coordinators & Editing Team Master of Business Administration (MBA) Bachelor of Business Administration (BBA) Coordinator – Dr. Rupali Arora Coordinator – Dr. Simran Jewandah Master of Computer Applications (MCA) Bachelor of Computer Applications (BCA) Coordinator – Dr. Raju Kumar Coordinator – Dr. Manisha Malhotra Master of Commerce (M.Com.) Bachelor of Commerce (B.Com.) Coordinator – Dr. Aman Jindal Coordinator – Dr. Minakshi Garg Master of Arts (Psychology) Bachelor of Science (Travel &Tourism Management) Coordinator – Dr. Samerjeet Kaur Coordinator – Dr. Shikha Sharma Master of Arts (English) Bachelor of Arts (General) Coordinator – Dr. Ashita Chadha Coordinator – Ms. Neeraj Gohlan Academic and Administrative Management Prof. (Dr.) R. M. Bhagat Prof. (Dr.) S.S. Sehgal Executive Director – Sciences Registrar Prof. (Dr.) Manaswini Acharya Prof. (Dr.) Gurpreet Singh Executive Director – Liberal Arts Director – IDOL © No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording and/or otherwise without the prior written permission of the authors and the publisher. SLM SPECIALLY PREPARED FOR CU IDOL STUDENTS Printed and Published by: TeamLease Edtech Limited www.teamleaseedtech.com CONTACT NO:- 01133002345 For: CHANDIGARH UNIVERSITY Institute of Distance and Online Learning 3 CU IDOL SELF LEARNING MATERIAL (SLM)

First Published in 2021 All rights reserved. No Part of this book may be reproduced or transmitted, in any form or by any means, without permission in writing from Chandigarh University. Any person who does any unauthorized act in relation to this book may be liable to criminal prosecution and civil claims for damages. This book is meant for educational and learning purpose. The author of the book has/have taken all reasonable care to ensure that the contents of the book do not violate any existing copyright or other intellectual property rights of any person in any manner whatsoever. In the event, Authors has/ have been unable to track any source and if any copyright has been inadvertently infringed, please notify the publisher in writing for corrective action. 4 CU IDOL SELF LEARNING MATERIAL (SLM)

CONTENT Unit - 1 Introduction To Psychotherapy................................................................................. 6 Unit - 2 Types Of Psychotherapy......................................................................................... 23 Unit - 3: Psychoanalytic Therapy ........................................................................................ 44 Unit - 4 Problem Focused Psychotherapy ............................................................................ 68 Unit - 5 Problem Solving..................................................................................................... 92 Unit - 6 Psychotherapy...................................................................................................... 124 Unit – 7 Stress Inoculation Therapy .................................................................................. 154 Unit - 8 Modelling Therapy............................................................................................... 170 Unit - 9 Reality Therapy.................................................................................................... 193 Unit 10: Integrative Counselling........................................................................................ 221 Unit 11: Life Skill Counselling.......................................................................................... 245 5 CU IDOL SELF LEARNING MATERIAL (SLM)

UNIT - 1 INTRODUCTION TO PSYCHOTHERAPY Structure 1.0 Learning Objectives 1.1 Introduction 1.2 Definition 1.3 Guidance, Counselling and Psychotherapy 1.4 Objectives of Psychotherapy 1.5 Principles of Psychotherapy 1.6 History of Psychotherapy 1.7 Ethical Issues in Psychotherapy 1.7.1 Privacy, Confidentiality, and Security Issues 1.7.2 Therapist Competence and Training 1.7.3 Communication Issues 1.7.4 Research Gaps 1.7.5 Informed Consent Issue 1.7.6 Emergency Issues 1.7.7 Technological Competence 1.8 Summary 1.9 Keywords 1.10 Learning Activity 1.11 Unit End Questions 1.12 References 1.0 LEARNING OBJECTIVES After studying this unit, student will be able to:  Explain the concepts of psychotherapy.  State the definition and guidance of psychotherapy.  Describe the objectives and principles of psychotherapy.  Illustrate history of psychotherapy.  Explain ethical issues in psychotherapy. 1.1 INTRODUCTION As social beings, humans are dependent on each other for maintenance of their biological and psychological wellbeing. When this threatened in any way, they typically turn to each other for help. Learning how to help people with psychological problems has been a challenge for any mental health professional. This is where psychotherapy comes into the picture. 6 CU IDOL SELF LEARNING MATERIAL (SLM)

Psychotherapy plays an important role to help individuals suffering from psychological problems. Psychotherapy is a technical term used in clinical fraternity to treat sufferings of an emotional nature using the theories and principals of Psychology. However, it not very structured as psychotherapy is today; we get reflections in philosophical writings in epics and so on about the concepts that were quite psychotherapeutic Psychotherapy is the treatment. It is a type of treatment termed as re-education, helping process, and guidance that describes the course of treatment. It reveals the therapeutic nature of the process. Forms of intervention other than therapy do exist in the mental health field discussed later. Psychotherapy is a generic term covering the entire spectrum of psychological treatment methods. These range from  Designed manoeuvres of the therapist-patient relationship.  Indoctrinations fashioned to change value systems. 7 CU IDOL SELF LEARNING MATERIAL (SLM)

 Tactics aimed at intrapsychic processes.  Techniques attempted to alter neural mechanisms. There are wide range of strategies and varied formats e.g., individuals, couples, and groups. They are not based on the sufficient communication, verbal and non-verbal. This excluded somatic therapies (drugs, convulsive therapy, surgery), trial action therapies (occupational therapy, dance therapy, music therapy, psychodrama) some words in the mental health field lexicon are as ambiguous and termed as psychotherapy. psychotherapy helped to connote, among other meanings, helping, treating, advising, guiding, educating, and even influencing. psychotherapy definitions are depending on disciplinary operation fields such as psychiatry, psychology, casework, etc. the arena of psychotherapy turned into dull ideas, which is give birth to many theories and techniques. this unit covers the psychotherapy definition, its aims and psychotherapy’s historical and ethical issues. 1.2 DEFINITION Psychotherapy is use of a human relationship as a therapy to alleviate emotional distress by effecting enduring changes in a client’s thinking, feelings, and behaviour. Psychotherapy consists of three distinct components: a healing agent, a sufferer, and a healing or therapeutic relationship. The cognitive and emotional consent of the client and the psychotherapist is the base of effective psychotherapeutic work. Earlier the psychotherapy means mental disorders treatment by using `psychological technique. A smiled professional builds a relationship with a client and helps to overcome mental illness, behavioural problems or help him in personal growth. Psychotherapy help to alter the behaviour and attitude of a maladjusted patient. Wolberg defines psychotherapy as, “a form of treatment for problems of an emotional nature in which a trained person deliberately establishes a professional relationship with a client with the object of removing, modifying or retarding existing symptoms, mediating disturbed patterns of behaviour, and promoting positive personality growth and development”. This needs more elaboration. Psychotherapy is the kind of treatment. No matter how much effort we put in Psychotherapy, it is form of treatment. Such terms as: These forms of intervention other than therapy do exist in the mental health field and described later. Psychotherapy term is generic that covers the all of psychological treatment methods. These considered from designed manoeuvres of the therapist-patient relationship:  To indoctrinations fashioned  To change value systems 8 CU IDOL SELF LEARNING MATERIAL (SLM)

 To tactics aimed at intrapsychic processes  To conditioning techniques that attempt to alter neural mechanisms. Techniques are legion, and formats are varied, e.g., individuals, couples, and groups. They are never dependent upon the establishment of adequate communication, verbal and non-verbal. Excluding:  Somatic therapies  Trial action therapies Above mentioned have a psychotherapeutic effect, and not a form of psychotherapy. 1.3 GUIDANCE, COUNSELLING AND PSYCHOTHERAPY Guidance Guidance is the term given to several procedures that provide active help, in the form of fact giving and interpretation, in such matters as education (educational guidance), employment (vocational guidance), health, and social relationships. Many casework, counselling, and educational operations come under the category of guidance. Guidance based on an authoritarian relationship established between therapist and patient. One of the problems inherent in such a relationship is that a dependent patient may tend to overestimate the capacities and abilities of the therapist to a point where the patient reasoning abilities and rights to criticize are suspended. Under these circumstances, any doubt regarding the strength or wisdom of the authority will arouse strong insecurity. Hostility and guilt feelings, if they develop at all, rigidly repressed for fear of counter hostility or disapproval. One may recognize in such irrational patterns the same attitudes that the child harbours toward an omnipotent parent. The emotional helplessness of the neurotic individual resembles, to a strong degree, the helplessness of the immature child. The neurotic person may project the original authority that invested in parents and may be seeking from the therapist extravagant evidence of support and love. Character logically dependent persons particularly demand demonstrations of infallibility. Should the therapist display human frailties or appear to lack invincible qualities, the faith of the person may be shattered, precipitating helplessness and anxiety. Mastery is then be sought by annexing oneself to another agency in whom magical and godlike features lacking in the previous host are anticipated. The life history of such dependent individuals shows a flitting from one therapist to another, from clinic to clinic, from shrine to cult, in a ceaseless search for a parental figure who can guide them to paths of health and accomplishment. Because they have so often been disappointed in this search, some persons will resent guidance, even though they feel too insecure within themselves to direct their own activities. Others will reject guidance because of previous experiences with an authority who has been hostile or rejecting or who has made such demands on them for compliance as to thwart their impulses for self-growth. Acceptance of advice, to certain individuals, be virtually the same as to giving up their independent claims on life. 9 CU IDOL SELF LEARNING MATERIAL (SLM)

Despite its disadvantages, guidance may be the only type of treatment to which some patients will respond. Desperately helpless in the grip of their neurosis, such individuals have neither the motivation nor the strength to work with a technique that requires self-direction. Resistance to self-assertiveness is so strong that a parental figure must prod them into performing their daily tasks. Counselling Counselling, on the other hand is more dynamic. It aims at the solution of clients’ problems. Counselling is a much-misunderstood concept. To the nonprofessional it is an occasion where an expert solves the problems of others. Non-professionals believe that the expert has readymade solutions for all the problems of human beings. On the contrary, counsellors do not give solution to any problem they only facilitate the client to such an extent that they are able to find solution to their own problems. Thus, Counselling is a process between the counsellor and the client in which solutions emerge as a joint venture of the two. Indian scholars have consistently pointed out that modern western psychotherapy and counselling have had a failure on Indian soil, as the development of India has been a largely Euro-American enterprise. Historically, psychology in the west actively distinguishes itself from theology and metaphysics, separated itself from its earlier preoccupation with the soul, and oriented itself instead to the study of human behavior. It committed itself to logical positivism and chose as its tool the inductive process of logical scientific reasoning. The discipline of psychology emerged from this framework in direct response to psychological needs that had their roots in western socio-cultural milieu. This continues to be the ethos founded on materialist individualism: a culture that celebrates the individual’s freedom for self-determinism. The notion of cultural preparedness is critical here. Members of a particular culture in created the methods of counselling that emerged in the west response to needs expressed from within this culture. The approaches in effect developed by a people and for a people with certain cultural orientations. One of the reasons for the success of these approaches could be that both the creators of the service and the consumers of the service had been culturally prepared in a very similar manner to offer and partake of the service. They share a similar vocabulary of values and cherish a particular approach to life. A counselling approach that is empirical and individualistic in its orientation, for example, may not find resonance amongst Indians, whose culture has prepared them from over the ages to approach their existence in an intuitive, experimental, and community-oriented manner. To flourish in the contemporary globalized context, counselling cannot be viewed only solely or even primarily as a western specialty. 1.4 OBJECTIVES OF PSYCHOTHERAPY Psychotherapy is more than a talk between two people regarding some problem. It is a collaborative undertaking, started and maintained on a professional level towards specific therapeutic objectives. These are: 10 CU IDOL SELF LEARNING MATERIAL (SLM)

Eliminating existing symptoms: Remove the symptoms that are causing distress and impediments is one of the prime goals in psychotherapy. Updating existing symptoms: Some circumstances may work against the object of removing symptoms for example, inadequate motivation, diminutive ego strength or financial constraints; the objective can be modification rather than cure of the symptoms. Retarding existing symptoms: There are some malignant forms of problems e.g., dementia where psychotherapy serves merely to delay an inevitable deteriorative process. This helps in preserving client’s contact with reality. Mediating disturbed patterns of behaviour: It is inspired by certain occupational, educational, marital, interpersonal, and social problems. Important role is played by psychotherapy from mere symptom relief to correction of disturbed interpersonal patterns and relationships. Promoting positive personality growth and development: Deals with the immaturity of the normal person and characterological difficulties associated with inhibited growth. Here purpose of psychotherapy is to develop more complete creative self-fulfilment, productive attitudes, and connections that gratify people. It also aims at:  Strengthening the client’s motivation to do the right things.  Reducing emotional pressure by facilitating the expression of feeling.  Releasing the potentials for growth.  Changing maladaptive habits.  Modifying the cognitive structure of the person.  Helping to gain self-knowledge.  Facilitating interpersonal relations and communications. 1.5 PRINCIPLES OF PSYCHOTHERAPY No single mechanism or theory can explain what happens in successful therapy. A variety of factors, specific and non-specific, is co-ordinately operative. Some theorists believe that therapy essentially is a relearning process where old destructive patterns become extinguished and new constructive behaviour learned through conditioning tactics and sustained by reinforcement. There are others who avow that psychotherapy is effective because it supplies the patient with a second chance for personality development, but this time with an empathetic surrogate parent who makes up for the deficits of the original developmental period. To some, psychotherapy provides a corrective emotional experience within the matrix of a good therapeutic interpersonal relationship, which manipulated to avoid the mistakes of the past. To some, the seeds of change are latent within each individual requiring a mere accepting, warm, non-judgmental relationship to sprout into blossoms of maturity. There are many other theories of why psychotherapy works, probably because so many different factors account for change in different patients. Actually, theorists, espousing a special point of view, appear to select a single item out of a field of multiple responsible agencies, all of which are undoubtedly operative at one time or another. 11 CU IDOL SELF LEARNING MATERIAL (SLM)

When we try to examine the processes of change in therapy, we find that they contain many hypothetical assumptions that are difficult to subject to experimental validation. This is largely because the therapeutic interpersonal relationship on which psychotherapy embraces sundry variables that do not readily lend themselves to measurement. It is consequently difficult to apply to an evaluative study of psychotherapy the precise principles on which scientific method is based namely, an unprejudiced compilation of facts and information, the formulation of reasonable hypotheses, the retention of objectivity in observation, and the retesting of findings with an attempt to reduplicate results. For the most part, descriptions of psychotherapeutic technique reflect the personal values and convictions of the observer. The clinical attitudes expressed are more practical and empiric than they are scientific. A broad structure of therapy must consider this factor of spontaneity of style in the psychotherapist. For without spontaneity, therapists are truly handicapped in relating to their patients and in allowing their intuition to help them grasp the dynamic forces that are operative during the treatment process. Dynamics of Therapeutic Change Before describing a structure of psychotherapy that provides for this kind of flexible framework, it may be helpful to consider the dynamics of psychotherapy in terms of an example of what happens to the typical individual exposed to a reconstructive psychotherapeutic approach. Modifications consonant with re-educative and supportive therapies considered later. When average patients enter into therapy, they are usually bewildered, confused, and upset by what is happening to them. Their symptoms seem more or less dissociated from the matrix of their life. Consequently, they confused by attempts to investigate in detail aspects of their experience that they consider irrelevant to their complaint factor. Not realizing that their symptoms stem from deep problems of long standing that are presently being reflected in disturbances in relationships with people, patients expect rapid results. In this respect, they are rather like the obese patients who want the physician to remove, in 2 weeks, the excess weight that has taken 10 years to accumulate, while at the same time refusing to exercise or diet. Patients seek to retain fixed ways of dealing with people and situations, which provoke and exaggerate their symptoms, while demanding that the products of their disturbed way of living extirpated. To bring patients to such an understanding, however, may prove to be more than an ambitious undertaking. The patients habituate to themselves, their character traits and attitudes. These are so “ego-syntonic” that the patients can only perceive them as an incontrovertible everyday component of life. The possibility that their behaviours are abnormal may not only be unacceptable but also unbelievable. Nearly all neurotic people assume that their own particular pattern for living is average, if not universal. If they do recognize themselves as variant, then that in itself regarded as a special attribute, contingent upon the possession of a unique constitution and the existence of external conditions that offer them no other course than the one they are pursuing. 12 CU IDOL SELF LEARNING MATERIAL (SLM)

It is this attitude that makes obstinate resistance to change. The patient is not readily be persuaded to see that he or she projects attitudes and fears without actual basis. In the course of therapy, however, the patients may gain an understanding that what they once assumed to be normal may actually be unusual. The therapist will piece clues to their fundamental difficulties together for them. The unique relationship that has developed between the patients and the therapist will help them to accept interpretations of their behaviour and their symbolic life as revealed in their verbalizations, dreams, and fantasies. The exact form of resistances will depend to a large degree on the kinds of defences that patients customarily employ to avert danger. They may feel helpless, hopeless, or hostile or they may get discouraged, inhibited, fatigued, or listless. They may succumb to irritability or to contempt for the therapist, or they may develop feelings of being misunderstood. Some patients may become forgetful and fail to show up for appointments, or they may manifest depression and complain incessantly about their health, presenting a vast assortment of physical symptoms. They may express suspicions regarding the therapist’s intentions or training or political convictions as a possible justification for halting therapy, or they may try to disarm the therapist with strong professions of praise or devotion. They may even evince a forced and artificial “flight into health.” Mechanics of Therapeutic Change Therapeutic change is the medium of the patient-therapist relationship. Through verbalization, patients become aware of the forces within themselves that produce their symptoms and interfere with a successful adaptation. Based on this understanding they then proceed to challenge those designs that interfere with their adjustment and to substitute for them mature patterns that will gratify basic biologic and social needs. As they abandon archaic fears and liberate themselves from paralyzing past forces, they achieve a progressive mastery of their environment, the ability to relate better with people, and the capacity to express their impulses in a culturally accepted manner. The function of the therapist during this evolution as an agent, who catalyses change, helping patients to resolve resistances to maturity. Breaking a successful treatment process down into component parts, the following sequences usually encountered:  The patients, concerned with their symptoms and complaints, elaborate on these.  The patients discuss upsetting feelings that are usually associated with their symptoms.  Patients believe that their feelings relates to certain dissatisfactions with their environment and that they inescapably controlled by a mysterious turmoil that ranges within them.  Along with their feelings, they recognize patterns of behaviour that frustrate them, are repetitive, and compulsive. Soon they appreciate that some of these patterns are responsible for their tension. This causes them to doubt their value. 13 CU IDOL SELF LEARNING MATERIAL (SLM)

 As they become aware of how dissatisfied they are with their behaviour, they begin to try to stop it; yet they find that it persists in spite of themselves.  Patients slowly perceive, then, that their behaviour serves a function of some sort and that they cannot give it up easily. Indeed, they find that their patterns repeat themselves in various settings, perhaps even with the therapist.  If they have the incentive to explore their operations, they discover that some have a long history, going as far back as their early relationships with their parents, siblings, and other significant personages.  Gradually they discern that they influenced by occasional impulses and feelings similar to those present in them as children. They measure that by carrying over certain attitudes into their present life they are reacting to people as facsimiles of past authorities.  With great trepidation, patients begin to challenge their early attitudes; progressively they inhibit automatic and repetitive behaviour patterns, slowly mastering their anxieties as they realize that fantasied dangers and expectations of injury do not happen. In the therapeutic relationship, particularly, they show change, especially in their attitudes toward the therapist.  Patients begin to entertain hopes that they are not the weak and contemptible people who have constituted their inner self-image, that they actually have stature and integrity, that they need not be frustrated in the expression of important needs, and that they can relate themselves productively to people.  This causes them to resent even more the devices that they customarily employ, which are products of devaluated feelings toward themselves and their devastating fears of their environment.  Slowly patients experiment with new forms of behaviour that are motivated by a different conception of themselves as people.  Finding fulfilment in these improvisations, patients become more and more capable of liberating themselves from old goals and styles of action.  Growing strength within themselves contributes to a sense of mastery and produces healthy changes in their feelings of security, self-esteem, and their attitudes toward others.  Patients liberate themselves more and more from anxieties related to experiences and misconceptions. They approach life as a biologic being, capable of gaining satisfactions for their inner impulses and demands, and as a social being, participating in community living and contributing to the group welfare. 1.6 HISTORY OF PSYCHOTHERAPY The idea of being able to integrate the psychotherapies has intrigued mental health professionals since the early part of the twentieth century. It is only since the 1980s; however, 14 CU IDOL SELF LEARNING MATERIAL (SLM)

that psychotherapy integration has developed into a clearly delineated area of interest. Prior to that, it was more of a latent theme that ran through the literature. As is the case with any attempt to trace the historical origins of contemporary thought, one never knows the influence that earlier contributions have made to later thinking. More often than not, innovative ideas and findings initially ignored, only to have assimilated into the mainstream at a later point in time. It is possible that the ultimate contribution of an idea lies in its consciousness-raising function. Thus, quite apart from their specific merits, new ideas sensitize us to otherwise neglected areas of thought. With regard to psychotherapy, some notions have continued to live on over the years whereas others have failed to pass the test of time. Still others disappear after their introduction only to reappear later when the zeitgeist has become more hospitable. As observed by Boring (1950) in his historical analysis of psychology, “an idea too strange or preposterous thought in one period be readily accepted as true”. The marked interest in developing a rapprochement across the psychotherapies dramatically illustrates this phenomenon. In what represented one of the earliest attempts at integrating the psychotherapies, French delivered an address at the 1932 meeting of the American Psychiatric Association in which he drew certain parallels between psychoanalysis and Pavlovian conditioning (e.g., the similarities between repression and extinction). The following year, the text of French’s presentation published, together with comments by members of the original audience. As one might expect, French’s presentation resulted in very mixed audience reaction. Recent trend approach to therapeutic rapprochement seriously addressed by only a handful of writers in the 1950s, due, no doubt, to the fact that no single approach to psychotherapy had yet gained enough momentum to challenge psychoanalytic therapy. Perhaps also the conservative social and political climate of the 1950s served to discourage therapists from questioning their paradigms. The 1960s, along with the broad array of societal challenges that came with them, brought a sharp increase in the number of books and articles dealing with rapprochement. During the 1980s, psychotherapy integration made a significant advance as a defined area of interest indeed, a movement. Geometric increase in the number of publication and presentations on the topic, making it unwieldy and impractical for us to offer an adequate. Description of the hundreds of publication that appeared during this decade the one that followed noting past attempts to find commonalities across psychotherapies, Goldfried (1980) argued that a fruitful level of abstraction at which such a comparative analysis might take place would be somewhere between the specific technique and theoretical explanation for the potential effectiveness of that technique. He maintained that it is at this intermediate level of abstraction at the level of clinical strategy that potential points of overlap may exist. One clinical strategy that may very well cut across orientations entails providing the client/patient 15 CU IDOL SELF LEARNING MATERIAL (SLM)

with “corrective experiences,” particularly with regard to fear-related activities. For example, Fenichel on the topic of fear reduction, noted that “When a person is afraid but experiences a situation in which what was feared occurs without any harm resulting, he will not immediately trust the outcome of his new experience; however, the second time he will have a little less fear, the third time still less”. The 1990s - If the 1980s witnessed the establishment of integration as a movement, then the 1990s saw the ideas of this movement become generally recognises and adopted by a wide variety of researchers and clinicians alike. Indeed, integrative themes became part of the prevailing zeitgeist and increasingly incorporated into mainstream writing. Moreover, Jensen Bergin, and Greaves (1990) surveyed psychotherapists and found that a majority of them. Subscribed to eclectic/integrative forms of therapy. There is evidence that integrative concepts continued to expand into diverse modalities during the latter part of the 1990s. Budman(1999) discussed time-effective couples’ therapy, which integrates aspects of psychoanalytic behavioural, solution-oriented, and cognitive approaches. In addition, Shirk (1999) drew from the empirical literature to propose the utility of integrative child therapy. 1.7 ETHICAL ISSUES IN PSYCHOTHERAPY Kitchener (1984) has identified moral principles, which often help to clarify the issues involved in a given situation. The five principles are privacy, therapist Competence and Training, communication Issues, Research gaps, Informed consent issues. 1.7.1 Privacy, Confidentiality, and Security Issues This consists of belief in loyalty, faithfulness, and honouring commitments. In short, it means to comprehend and resolve ethical issues. Practitioners following this principle, they act according to ensure that clients expectations are:  Ones that have reasonable prospects are met, agreements and promises are honoured  Regard confidentiality  Restrict disclosure of client’s confidential information 1.7.2 Therapist Competence and Training The freedom of choice and action permitted by this principle. It helps to develop client’s ability to be self-directing in all aspects of life. The counsellor encourage clients to make decisions and to act ethically. There are two important considerations in encouraging clients to be autonomous:  First, help the client to understand how their decisions and their values may or may not be received.  Second consideration relates the client’s ability to make sound and rational decisions. 16 CU IDOL SELF LEARNING MATERIAL (SLM)

1.7.3 Communication Issues It is essential to ask effective questions, which helps to encourage exploration and clarification of thoughts, feelings, and attitudes, obtain specific information and to help the client focus his/her thoughts. Questions provide information about the client her lifestyle and surroundings. The information relates to his/her personality, his/her interactions with the surroundings, his/her cultural beliefs and role, his/her interaction patterns since childhood. If any of this information is missing, a picture of the client is incomplete. A client is very often unable to see a clear picture of oneself. The client needs help to perceive his or her own resources and inherent strengths. Appropriate questioning can help the client gain a complete understanding of the situation and strengthen them to decide. 1.7.4 Research Gaps Psychology researchers found that therapists do not use of research findings in their clinical work. Some clinicians have confronted that some researchers has not addressed the issues adequately. This difference between research and practice continues to exist, even in the face of growing external pressures for empirical accountability among policymakers and insurance companies. There were n number of reasons for this wide gap. Clinicians and researchers have different worlds. The researchers consist of publications and research grants and the clinicians anxious about particular patients related to referrals and insurance reimbursement. Also, there are opportunities where two can interact. Science practice and these domains can result in disconnect. The possible reason for the clinical-research is “One-Way Bridge” that connects the two worlds. The purpose of Two-Way Bridge initiative is to drag attention to the important mechanism and the dissemination of clinical observations sent to therapy researchers. This permits clinicians and researchers helps to develop guidelines. The advanced psychological practice is generated with research in psychotherapy to inform and advance by clinical practice. This forms basis for the future research that is timely and that has greater clinical relevance. 1.7.5 Informed Consent Issues This includes performing on the basis of the client based professional assessment. Beneficence shows counsellor’s contribution . In short it means:  To do good  To be vigilant  To protect. It show how to work within limits of competence and provide services based on adequate training or experience. To improve the quality services , it uses regular and constant supervision by continuing professional development. An obligation is client’s favour whose autonomy capacity diminishes due to:  Immaturity 17 CU IDOL SELF LEARNING MATERIAL (SLM)

 Lack of understanding d  Distress, serious disturbance or other significant personal constraints The investigators get participants’ approval which is not enough to get skilled participants to agree. In short, the psychologist in advance proves involvement and get the participants consent. Prior research is done by the researcher and then desires for permission. An adult (18ys +) can provide consent. The children can be allowed by the parents, guardians of minors to participate in a research. It is worrying the researcher to question the real participants, a similar group of people to share their experience . If the real participants agree then it is known as presumptive consent. An issue develops with this mismatch is:  How people understand they would feel/behave?  How they feel and behave during a study? In order that consent may need to accompany by an information sheet for participants setting out information about the proposed study . 1.7.6 Emergency Issues Entrapment is unique and reflects an individual’s attitude of being in uncontrollable, unremitting, and inescapable situations. This helps to identify that entrapment alters the process or not. According to psychiatric emergency services, the surge in patients’ number insists medical centres to develop crisis intervention facilities. These medical facilities deliver psychological and medical care to patients facing acute distress. Immediate interventions by well-trained professionals is given by the crisis units in the fields of psychiatry, psychology, social work, and psychiatric nursing. The settings, treatment, and intervention durations are different. The present crisis-focused interventions began with the excellent work of several practicing clinicians who treated survivors of catastrophic situations. These formulations describe the goals of crisis intervention to include:  Stabilization  Mitigation of acute signs and symptoms of distress  Restoration of adaptive independent functioning The strategies are temporary and are determined pragmatically in response to the patients’ needs. These strategies reflect psychotherapeutic practices, such as setting a bond and an agreement on therapy goals and aims. It shares common principles with other psychotherapeutic approaches, and subjects to scientific research using common psychotherapy research approaches 1.7.7 Technological Competence Technology acquisition infuses throughout counsellor education curriculum at the master’s and doctoral program levels. Technology integration in curriculum shows recognition that education, practice and research competence strengthened through focused and appropriate use of computer-mediated technology. 18 CU IDOL SELF LEARNING MATERIAL (SLM)

Types of knowledge and skills mentioned in these guidelines will foster the development of a level of technological literacy that enables students to participate fully in 21st century counselling practice and provide a foundation upon which emerging technologies evaluated and integrated into practice where appropriate. Application of technology into counselling practice holds promise to enhance practice management, client and professional education, and access to information that can directly affect counselling effectiveness. Use of various forms of technology can be adjunctive to practice and designed to facilitate the human interactions that are the foundation of counselling efficacy. In recognition of the role of technology applications in contemporary society and in practice, as well as the role of counselling professionals as influential leaders in policy and advocacy within the profession, counsellor education programs will work toward integration of technology proficiency development into curriculum over time and in concert with ongoing curriculum development initiatives. 1.8 SUMMARY  Having delineated the important aspects of process, can we reasonably assume that these will bring good results? In the main, yes; but, as has been indicated, there are important qualifications. There are certain limitations to change in all people; there are certain potentialities for change in all people. If the psychotherapist applies himself or herself to the task with disciplined process, he or she will be best equipped to foster in patients a successful outcome.  In Indian context the needs of counselling emerged against the social change. Additionally, the last ten years of economic reform have increased the changes and lifestyles. Available counselling services influenced by Western strategies. These strategies have been not accepted in Indian cultural context. A relevant and culturally valid counselling psychology therefore has remained a fledgling discipline. Psychological is an integral part of India, and present ideas that can be applied.  This paper investigates the Western and the traditional Indian approaches. These approaches helps in the psychology development of counselling that is sound and appropriate to the Indian context.  The challenge of working ethically means that counsellors will inevitably encounter situations where there are competing obligations. Counsellors are having code of ethics to guide them in the practice of helping others.  Counsellors generally consult ethical standards of ACA when they face ethical dilemmas. In making ethical decisions, counsellors rely on personal values as well as ethical standards.  They also consult with professional colleagues. It is imperative that counsellors know regarding ethics for their as well as their client’s welfare. Counsellors should have academic and working knowledge of ethics. 19 CU IDOL SELF LEARNING MATERIAL (SLM)

 These ethics assist in such circumstances by presenting attention to ethical factors that can be considered and may prove to be more useful. Ethics statements alleviate the possibility of making professional judgments in situations that are changing and full of uncertainties.  Approving statement of ethics, members of the American Counselling Association are committing themselves to engaging with the challenge of striving to be ethical, even when doing so involves making difficult decisions or acting courageously. 1.9 KEYWORDS  Psychoanalysis defined as a set of psychological theories and therapeutic methods, which have their origin in the work, and theories of Sigmund Freud. The primary assumption of psychoanalysis is the belief that all people possess unconscious thoughts, feelings, desires, and memories.  Zeitgeist (spirit of the age) is a concept from eighteenth- to nineteenth-century German philosophy, meaning \"spirit of the age\". It refers to an invisible agent or force dominating the characteristics of a given epoch in world history.  Dementia a chronic or persistent disorder of the mental processes caused by brain disease or injury and marked by memory disorders, personality changes, and impaired reasoning.  Rapprochement (especially in international affairs) an establishment or resumption of harmonious relations.  Omnipotent Parent - One who has unlimited power or authority: one who is omnipotent. 1.10 LEARNING ACTIVITY 1. Choose one of the major topic of psychology and provide some evidence from your own experience. ………………………………………………………………………………………………… …………………………………………………………………………………………………. 2. Conduct a session with a person, list down the session points, and measure the outcome. ………………………………………………………………………………………………… …………………………………………………………………………………………………. 1.11 UNIT END QUESTIONS A. Descriptive Questions Short Questions 1. Define psychotherapy. 2. List down any two objectives of psychotherapy. 20 CU IDOL SELF LEARNING MATERIAL (SLM)

3. What are the lists of ethical issues in psychotherapy? 4. List down two principles of psychotherapy. 5. Write a short note history of psychotherapy. Long Questions 1. Meaning of psychotherapy and list down its objectives. 2. Explain the principles of psychotherapy. 3. Explain the importance of having ethical code. 4. What are the different ethical principles of counselling? 5. Explain the difference between Guidance and counselling. B. Multiple Choice Questions 1. Guidance based on an authoritarian relationship established between _____and _____? a. Therapist and patient b. Doctor and patient c. Guider and counsellor d. None of these 2. Which of the following is a not a principle of psychotherapy? a. Mechanics of therapeutic change b. Dynamics of therapeutic change c. Both a and b d. None of these 3. ___________ aims at the solution of clients’ problems and is a much-misunderstood concept. a. Counselling b. Guidance c. Therapy d. None of these 4. -------------------------- is the term given to a number of procedures that provide active help, in the form of fact giving and interpretation. a. Counselling b. Guidance c. Therapy d. None of these 5. Which of the below needs to be taken in consideration while conducting psychotherapy? a. Informed Consent Issues b. Privacy, Confidentiality 21 CU IDOL SELF LEARNING MATERIAL (SLM)

c. Security Issues d. All of these Answers 1 a) 2 c) 3 a) 4 b) 5 d) 1.12 REFERENCES Textbooks  Corey G. (2001).Theory and Practice of Counselling and Psychotherapy, Brooks/ Cole, Thomson Learning: U.S.A.  Sharf R. S. (2000). Theories of Psychotherapy & Counselling, (2nd edition). University of Delaware: Brooks/Cole, Thomson Learning: U.S.A. Reference Books  Corsini Raymond J; Danny Wedding. (1995). Current Psychotherapies, London,  F. E. Peacock Publishers, 5th Edition  Sharma, Ramnath and Sharma, Rachna (2010). Guidance and Counselling in India. Atlantic publishers, New Delhi. Websites  https://www.simplypsychology.org/  https://www.freepsychotherapybooks.org/ 22 CU IDOL SELF LEARNING MATERIAL (SLM)

UNIT - 2 TYPES OF PSYCHOTHERAPY Structure 2.0 Learning Objectives 2.1 Introduction 2.2 Psychodynamic Therapy 2.3 Behaviour Therapy 2.4 Cognitive Analytical Therapy 2.5 Cognitive Behavioural Therapy 2.6 Interpersonal Therapy 2.7 Systemic (Family) Therapy 2.8 Reminiscence/ Life Review Therapy 2.9 Effectiveness of Psychotherapy 2.10 Summary 2.11 Keywords 2.12 Learning Activity 2.13 Unit End Questions 2.14 References 2.0 LEARNING OBJECTIVES After studying this unit, student will be able to: ● Explain the different types of therapies. ● Describe the various phases of psychotherapy. ● Explain the effectiveness of psychotherapy. ● Different ways of conducting psychotherapy. 2.1 INTRODUCTION The most acceptable kind of therapy used to treat issues associated with a person’s emotions and conditions pertaining to mental stability is termed as Psychotherapy. This therapy facilitates face-to-face communication or group discussion with trained therapist, with closest partner or the traumatic patient. This treatment enables oneself to be conscious of the 23 CU IDOL SELF LEARNING MATERIAL (SLM)

problems and worries in depth, and to handle them tactfully traumatic habits and a broad range of mental health issues, like depression and schizophrenia. Psychotherapy usually involves captivating and convincing communication skills as well as other methods that may be used ‐ for example, art, music, drama and movement. Moreover, it can enable opening up of one’s feelings through continuous consultations with self, other people, particularly family and those who are close enough to us. In some cases, couples or families offered joint therapy sessions. It is very important that one have to meet their therapist regularly, usually once a week, for several months, or sometimes even years to attain the best outcome. Individual sessions can last about 50 minutes, but group sessions are often a bit longer. Psychotherapists Psychotherapists are mental health professionals who listens to the problems of people and tries to find a proper solution to the stress and mental trauma they are facing. Simultaneously the therapist can also share and discuss significant issues with you, and they can also provide valuable suggestions to overcome mental health related problems and also attempt to give guidance to change one’s perspective and behaviour. There are therapists who also impart particular skills that could help one to overcome agonising emotions, sort out relationships and also refine behaviour. They may also motivate you to come up with your own answers. Group therapy involves members supporting one another with guidance and motivation. A therapist will conduct sessions in a confidential manner, and this implies that they can be trusted with confidential or personal information. What Is Psychotherapy Used To Treat? Psychotherapy used to give treatment to a wide range of mental health issues, including:  Depression  Anxiety disorders  Borderline personality disorder (BPD)  Obsessive compulsive disorder (OCD)  Post-traumatic stress disorder (PTSD)  Long-term illnesses  Extreme eating disorders  Drug misuse People with serious emotional issues get benefitted from psychotherapy which includes people dealing with stress, bereavement, separation, redundancy, or relationship problems. 24 CU IDOL SELF LEARNING MATERIAL (SLM)

2.2 PSYCHODYNAMIC THERAPY Background Of Psychodynamic Therapy The theory supporting psychodynamic therapy originated in and informed by psychoanalytic theory. There are four major school of thoughts in psychoanalytic theory, each of which has deeply affected psychodynamic therapy. They are Freudian, Ego Psychology, Object Relations, and Self Psychology. Freudian Psychology is established on the basis of the theories which were initially developed by Sigmund Freud in the beginning of the century, and it is also called as the drive or structural model. The most vital feature of Freud's theory is that sexual and aggressive energy that emerges gets regulated by the ego, which operates between the Id and the Superego. Defence mechanisms are identified as creations of the ego that function to reduce pain and sustain psychic equilibrium. The superego, created during latency (between age 5 and puberty), works to control Id drives with the help of guilt (Messer and Warren, 1995). Ego Psychology is based on Freudian psychology. Its supporters showcase their work on improving and sustaining the ego function in accordance with the demands of reality. It also impresses upon an individual’s capacity for security, adjustment, and reality testing (Pine, 1990). Object Relations Psychology was articulated by various British analysts, and more specifically like Melanie Klein, W.R.D. Fairbairn, D.W. Winnicott, and Harry Guntrip. As per this theory, humans always shape themselves in connection with the others around them. Our difficulties and aims in life focus mainly on maintenance of such relationship with other people, while transforming ourselves at the same time. The internal descriptions of self and others obtained in childhood later comes into play in adult relations. Individuals replicate old object relationships in an attempt to conquer them, and be liberated from them (Messer and Warren, 1995). Self-Psychology was established by Heinz Kohut, M.D., in Chicago during the 1950s. Kohut was of the view that the self refers to an individual’s understanding of his experience which comprises the presence or absence of a sense of self-respect. \"The explanatory power of the new psychology of the self is nowhere as evident as with regard to the addictions\" (Blaine and Julius, 1977, p. vii). Also, it was put forth by Kohut that persons suffering from narcotic substance abuse disorders also have the tendency to feel weakness which in turn cause a harm or defect in the core of their personalities thereby acting as a hindrance towards the formation of the \"self.\" The drug that is injected gives the person the self-esteem, which he has not attained or possessed earlier. This drug supplies the feeling of making him self-confident; or he creates 25 CU IDOL SELF LEARNING MATERIAL (SLM)

in his conscious the experience of being merged with the immense power that boosts him the feeling of being strong and worthy. The four of schools of psychoanalytic theory have their own distinct theories of formation of personality, psychopathology and change; methods to conduct therapy; and symptoms and contraindications for therapy. Psychodynamic therapy is different from psychoanalysis in several ways, including the fact that psychodynamic therapy need not include all analytic methods and is not possible to be conducted by psychoanalytically trained analysts. Psychodynamic therapy also happens over a lesser period of time and frequency than psychoanalysis. Many other related kinds of psychodynamic therapy are considered less appropriate for experimental use with persons having substance abuse disorders. This is because their altered perceptions is quite tough to achieve favourable insight and problem resolution. Also, majority of psychodynamic therapists coordinate with their narcotic substance-abusing clients with conventional drug and alcohol treatment programs or persists as the sole therapist for their clients having coexisting disorders, using various kinds of psychodynamic therapy methods as elaborately explained below. Meaning of Psychodynamic Therapy Psychodynamic therapy is regarded as a “global therapy,” or type of therapy having a holistic focus on the perspective of the client. The alternative, “problem-based” therapies, like cognitive behavioural therapy, aims at elimination of basic symptoms instead of exploring the client’s in-depth requisites and desires. Dynamic psychotherapy, facilitates the patient’s life rewritten depicting a picture of himself, his past, present, and future, will seems to be uniquely positioned to address the depth of individual’s experience.” Psychodynamic therapy sessions are intense and open-ended, dictated by the client’s free association rather than a pre-set schedule or agenda. These sessions are generally scheduled once a week and last for over an hour. While the psychoanalytic theory by Freud required greater time to be invested, psychodynamic therapy is much less intensive. Few of the important objectives of psychodynamic theory are  To encourage and increase the self-awareness of the client thereby understanding the mind and their emotions and beliefs with respect to their past experiences, specifically during their childhood. The therapist gives support to the client through the analysis of unsolved conflicts and important events that occurred in the client’s past relationships. 26 CU IDOL SELF LEARNING MATERIAL (SLM)

 The supposition in psychodynamic therapy is that persistent problems have their roots in the unconscious memory of the individual and it should be brought to the fore for catharsis to occur. Thus, the client should have the consciousness to locate these unconscious memories and must study them in order to handle them. Clients Most Suitable for Psychodynamic Therapy An elaborate and brief psychodynamic therapy is more appropriate for specific kinds of clients having narcotic substance abuse disorders than others. This treatment is compatible for some patients and can be undertaken when they are well along in recovery and are receptive to a higher level of self-knowledge. In spite of disagreement in the details, this type of brief and concise therapy treatment is generally thought to be more suitable for the following types of clients:  Those who have prolonged psychopathology linked with their alcoholic substance abuse disorder  Those who do not need or who have completed inpatient hospitalization or detoxification  Those whose recovery is stable  Those who do not have organic or brain damage or other limitations due to their mental capacity Etiology Wurmser, a traditional drive theorist, propounded that people with substance abuse disorders have problems and suffer from extreme harsh and destructive superegos that threaten to overwhelm the person with rage and fear. Alcoholic abusive substances are an effort to escape from these dangerous effects. These effects are the result of the friction between the ego and superego, which are the reasons of the origination of harsh effects of the superego. On the basis of this understanding, Wurmser laid his emphasis and attention on the analysis of the superego. He believed that taking a moralistic attitude towards the narcotic substance- abusing behaviour is ineffective and he also put forth recommendations that the therapist impart a solid emotional support and a warm and flexible attitude. 2.3 BEHAVIOUR THERAPY Behaviour therapy is an umbrella term for different types of therapy that are used to treat mental health disorders. This form of therapy seeks to identify and help in the consecutive transition either potentially through self-destructive or unhealthy behaviours. It functions on the idea that all behaviours are learned and that unhealthy behaviours changed. The intent of the treatment is often emphasised on current problems, to change them. How Does Behavioural Therapy Work? 27 CU IDOL SELF LEARNING MATERIAL (SLM)

Behavioural therapy has its origin in American “behaviourism.” According to this theory, human behaviour is acquired by learning and can therefore be relearned or unlearned. It also strives to discover whether specific patterns of behaviour contribute to an increase in problems in life. As the next step, you work towards modifying these behavioural issues. For instance, people with depression tend to become unsociable and even abandon their hobbies. This leads to an increase in their stress and anxiety. Cognitive therapy assists to recognise this mechanism and identify ways to be more active again. For anxiety disorders, this therapy involves studying methods that can be used to soothe the individual. For instance, anxiety can be reduced by taking deep breaths to relax your body and mind. This way, you can focus on your breathing instead of the problems that cause anxiety. Who Can Benefit From Behavioural Therapy? Behavioural therapy has a massive number of beneficiaries having varied illness symptoms. People in general, seek this therapy treatment for mental health related sickness such as: ● Depression ● Anxiety ● Panic disorders ● Anger issues 2.4 COGNITIVE ANALYTICAL THERAPY A time–limited, integrated psychotherapy is referred to as Cognitive analytical therapy (CAT). It emerged as a formal psychotherapy method in 1990 and progressed forward with the aim of providing psychotherapy within the NH7. This theory coordinates and inter-links many theories such as psychoanalytical, cognitive and behavioural methods in practice thus retaining a distinct method simultaneously. The most vital and significant features of CAT are the joint descriptive reformulation of the patient’s problem and their active participation in therapy. Therapy is normally 16 weekly session that is introduced initially with clarification of the patient’s persistent problems and case history. The psychotherapy treatment that is initiated after the first session acts as a self–completion aid to help the patient understand themselves better by recognising problem patterns. It establishes the terms of CAT and describes how to keep track of unwanted symptoms and behaviours. Reformulation happens during the fourth session and comprises of the therapist penning a letter to the client. This is done in order to connect the client’s history to the pattern of 28 CU IDOL SELF LEARNING MATERIAL (SLM)

problems in the CAT formulation. The core problems (the focus of upcoming therapy) and the dysfunctional processes that support them are given importance. The possible usage of CAT for treating psychiatric issues is either through hands-on usage of tools used in conventional CAT therapy or by formulating clients within its framework. CAT is implemented in a shortened format (covering only 3 to 8 sessions) as the model of client illness. This permits the client to acknowledge and share the primary information. It can also assist in controlling and reducing the client’s anxiety by having a stability that can be referred to later, which may be useful for clients who are prone to lose touch with reality. The worth of writing to patients is thus a highlight (Pierides, 1999). A written personal history is original and valuable as it is written by the therapist in their own words and it is thus extremely insightful, which is appreciated and valued by the patient. For some clients, concentrating on their psychiatric record (helped by the psychiatrist with the help of old documentation if needed) can give supportive ‘facts’ or ‘evidence’ in future analysis of earlier treatments that were successful or relapse indicators. Clients with restricted insight may need to try harder but this is feasible if a therapeutic relationship is set up in the reformulation procedure. In the same manner, focusing on positive phases in the client’s history such as stable employment or achievements will help both self-regard and help build the rapport. Diagrams are often used in CAT to illustrate sequences or recurrence of problems (e.g., The steps that bring on brutal outbursts or self-harm episodes). If the patient is unable to understand the diagram, it is necessary to re-inspect the procedures together to verify their correctness. The flow of events can be changed by giving proper alternative behaviour patterns or thoughts (exits) that can be incorporated into the diagram. They should return at applicable points during the therapy, and it may be useful to incorporate details of the reformulation and care programme documentation. 2.5 COGNITIVE BEHAVIOURAL THERAPY Brief History CBT lays emphasis on the significant role of thinking in our emotions and actions. It is not considered to be a separate therapeutic technique. Beck and Ellis are two names associated with Cognitive Behavioural Therapy. Albert Ellis’s system has its origin during the beginning of 1950s and was developed Rational Emotive Therapy (RET), the first discrete therapeutic approach to CBT. Encouraged by Albert Ellis concept, Aaron T. Beck had established cognitive therapy during the 1960s. Ellis developed and made popular the ABC model of emotions, and later on altered the model to the A-B-C-D-E approach. This theory was redefined and renamed by Ellis during 1990s as 29 CU IDOL SELF LEARNING MATERIAL (SLM)

Rational Emotive Behaviour Therapy. Behavioural therapy emphasises on an individual’s actions and objectives to modify unhealthy behaviour patterns. A new approach was propounded by Aaron Beck known as the Cognitive Therapy which lays focus on a person’s ideas and beliefs and its corresponding influence it may have on an individual’s frame of mind and actions. It also focuses on transforming a person’s line of thoughts in a healthier manner. Aaron Beck put forth the fundamental principles of CBT, which apply to various psychiatric and medical problems. It lays emphasis on observing and analysing maladaptive patterns of information processing and associated behaviours. CBT methods are based upon psychological understanding of symptoms. It shares certain fundamental propositions: ● The therapy related outcome has adverse effects on behaviour. ● Cognitive based performance may be changed and monitored. ● It is possible to achieve desired behavioural change with the help of cognitive change. The approach proposed by Beck is well-known for its efficacious treatment of traumatic disorders and depression. ● Cognitive behavioural approach assumes that anxiety, depression, and negative emotions develop from maladaptive thought processes. The most unique form of psychotherapeutic treatment that aids people to recognise and modify disastrous or disturbing thought patterns that would have a negative impact on behaviour and emotions is Cognitive behavioural therapy (CBT). One of the best methods to demonstrate cognition therapy is by implementing ‘ABC’ model. Here, ‘A’ depicts a situation, the beliefs/thoughts about A is denoted as ‘B, and ‘C’ the emotions/feelings and behaviours that follow from them. To illustrate this feature, we can witness an ‘emotional episode’, as experienced by a person who is prone to depression and has the tendency to misinterpret the actions of other people: A) Activating event: Friend passed me in the street without acknowledging my presence. B) Thoughts related with A: He is neglecting my presence and I think he dislikes my presence. To make myself happy and worthy, people must like me. C) Consequence: Emotions: hurt, depressed. Actions: Ignoring people. It must be observed that ‘A’ is not the reason for ‘C’, ‘A’ sparks off ‘B’, ‘B’ then leads to ‘C’. Also, combination of ABC cannot be separated: they run in chains, which in turn cause ‘C’. 30 CU IDOL SELF LEARNING MATERIAL (SLM)

The concept cognitive has its origin from Latin terminology “cognoscere”, meaning, “to recognize.” The most vital aspect of cognitive therapy is to establish a clear idea of your own thoughts, attitudes and expectations. The final goal is thus to disclose and alter untrue and distressing beliefs, as it is usually not only the things and circumstances that often lead to problems, but the bond that we have with them. For instance, dangerous thinking patterns might happen when someone instantly draws negative opinions from an event, generalizes them and starts applying them to similar situations. In psychology, this generalized manner of thinking is known as “over- generalising.” Another damaging error in reasoning is “catastrophising”: In case something negative takes place, people will start assuming that the worst will occur. These kind of thought patterns can further progress into predictions that actually take place thereby making life tough for the people who are impacted. Cognitive therapy assists people in modifying their thought process by replacing damaging thoughts with positive ones. It also allows people to think more productively and to manage their own thoughts better. Simultaneously, it makes us familiar with training matrices and thus anchors it for evaluating course completion rates and test scores. What is important at this stage is to understand predictive models built using Big Data and Analytics, its impact on the learner’s behaviour post the learning activity, percentage of learners implementing the learning at work, the learning path adopted by them, and subsequent business goals that they would choose. CBT thus makes an individual concentrate on their present problems and provides relevant solutions. Both patient and therapist need to show equal participation and involvement in this process. The therapist helps the client to recognise unhelpful thought patterns, modify erroneous beliefs, form positive relationships with others and to make behavioural changes. There are several approaches associated with cognitive behavioural therapy as follows:  Rational Emotive Behaviour Therapy  Rational Behaviour Therapy 31 CU IDOL SELF LEARNING MATERIAL (SLM)

 Rational Living Therapy  Cognitive Therapy  Dialectic Behaviour Therapy Goals of CBT Following are the goals linked with CBT  To change the perception regarding a specific condition by identifying the cognitive traps.  To support the patient in identifying less harmful alternatives.  To check the viability of these alternatives in reality.  It also endeavours to make the clients have a right to their choice of emotions, actions and lifestyle (within social, economic and physical boundaries).  To help fix the root cause and modify the problematic belief system of the client instead of treating only the symptoms.  To empower the clients by imparting self-help techniques to handle issues in the future. 2.6 INTERPERSONAL THERAPY IPT is established on the basic factors of psychotherapy like the treatment alliance, in which the therapist coordinates and helps the patient to feel and understand their problem and thereby presenting a clear, concise treatment trend and yields success experiences. On this foundation, IPT implies two major principles as follows: ● Depression is a medical illness, rather than the patient’s fault and hence, it is a treatable condition. It observes and analyses the issues and relieves the patient from psychic self-blame disorder. ● Conditions related to one’s attitudes and life are inter-related. Based on interpersonal theory and psychosocial research on depression, IPT practically connects the depressing mood of the patient with the problematic events that could either be the root cause or the possible outcome of the mood disorder. Research suggests that depression is usually the outcome of a disturbing event in an individual’s interpersonal relationship such as the passing away of someone close (complicated bereavement), a struggle with others (role dispute), or some other’s life upheaval: the start or end of a relationship or becoming physically unwell (transition in role). If the patient is depressed, outcome of the illness impacts their interpersonal performance which results in follow up of bad incidents. These observations may seem ordinary, but the fact remains that depressed people tend to become unsociable and withdrawn thereby blaming themselves for the troubles. It doesn’t matter if the problematic event preceded or 32 CU IDOL SELF LEARNING MATERIAL (SLM)

followed the mood disorder, it is necessary for the affected person in therapy to come to terms with the root cause event, build social relationships and organise their life. By resolving the issues, the depression could be handled as well. Clinical trials have proven the efficacy of IPT technique in handling depression. Structure of Treatment IPT is a limited time-frame (acutely, 12-16 weeks) treatment comprising of three phases: origin (1-3 sessions), middle, and end (3 sessions). In the initial phase the therapist identifies the target diagnosis (MDD) and the interpersonal context which is presented. The therapist also creates an “interpersonal inventory”, an analysis of the patient’s patterns in relationship, capability to have intimate relationships, and most importantly, an assessment of current relationships. A focal point for treatment is derived: someone close may have passed away (complicated bereavement), personal problems with the partner (role dispute), or there could be some crucial change in life (role transition). In cases where there are no such significant issues to deal with, the focus shifts by default to interpersonal deficits, which indicates the absence of a current life event. The therapist associates the target diagnosis to the interpersonal circumstances: “The major depression that you are suffering from is the result of current happenings in your life and is not your fault in anyway. You seem to have lost your appetite and sleep after the death of your loved one and you are finding it difficult to come out of this terrible phase. It is known as complicated bereavement, which is an ordinary, treatable form of depression. It is my suggestion that we make use of the next 12 weeks to help you come to terms with this loss. If this interpersonal issue is resolved, your life and mood will change for the better”. This formulation sets the basis for the rest of the therapy. The association between mood and life events is practical, not etiological: there is no perception that the depression is caused due to a specific factor. Once the patient agrees to this focus, the treatment shifts to the middle phase. In the middle phase, the therapist puts to use definite strategies to handle the focus based on problem areas they arise from. This could involve appropriate grieving in complicated bereavement, sorting out interpersonal issues in role dispute, supporting the patient in expressing grief over the loss of a loved one or taking on a new role in role transition or reducing social withdrawal in interpersonal deficits. Irrespective of the focus, the therapy helps the patient to be assertive of their needs and wants in interpersonal relationships, validates their expression of anger as normal and encourages its effective expression, and taking social risks that are suitable. During the closing sessions, the therapist points out that the completion is approaching and enables the clients to feel more efficient and independent by assessing their note-worthy achievements during the course of the treatment, and also indicates that conclusion of the therapy is itself a role transition, with both positive and negative aspects. Given that IPT is proven to be effective as a maintenance treatment for 33 CU IDOL SELF LEARNING MATERIAL (SLM)

recurrent MDD, there is very high probability that patients who have had past episodes are likely to have them in the future too, the therapist and the patient may agree to conclude acute treatment and have less-intensive treatment. For instance, having monthly sessions instead of weekly ones. The IPT therapist needs to be encouraging and supportive. The aim is to be the patient’s friend. The limited time frame puts pressure on the patient to act. Even if there is no homework as such for the patient, the goal is to solve major interpersonal issues which is the overall task. The schedule of having weekly sessions implies that the focus is on the patient’s real life, not work. In the sessions, therapist and patient analyse the earlier incidents. Whenever the patient achieves success in an interpersonal circumstance, the therapist praises him, thus, strengthening the healthy interpersonal relationship. When the outcome is unfavourable, the therapist sympathises, thus allowing the patient to review what went wrong in the situation, discusses new interpersonal alternatives, and role-plays them with the patient as practice for real scenarios. The patient then tries them out. Given this focus on interpersonal relationship, it is unsurprising that depressed people acquire new interpersonal skills from IPT that they have not encountered in pharmacotherapy. Goals of Interpersonal Therapy The vital objective of IPT is to transform the person’s interpersonal behaviour by motivating adaptation to current interpersonal roles and situations. It also emphasises the ways in which a person’s current relationship and social context cause or maintain symptoms rather than exploring the in-depth origin of the symptoms. Its goals are rapid symptom reduction and improved social adjustment. This therapeutic treatment was formulated in the earlier phase in treating depression, especially in adults. Later, it was extended in treating the elderly, and in patients having Human Immunodeficiency Virus (HIV) infection. Stages of Interpersonal Counselling (IPC) IPC comprises of brief treatment of six sessions, each with an explicit focus: assessment, education about the interaction between interpersonal relationships and psychological symptoms, which highlights and identifies current stress areas and thus enabling the patient to deal with these more positively and termination of the IPC relationship. Further this method can be employed in general practice to reduce psychological symptoms, restore morale, and improve self-esteem and the value of the client’s social adjustment and interpersonal relationship. Visit 1 – The Treatment Contract The first is normally the lengthiest session the counsellor determines the client’s suitability for IPC. People with major depression, bipolar disorder, who are psychotic or suicidal, are not suitable for IPC. In order to establish an interpersonal diagnosis, the counsellor asks the client about recent changes in their life, mood and social functioning, and explores how life 34 CU IDOL SELF LEARNING MATERIAL (SLM)

circumstances relate to the onset of symptoms. By the conclusion of the session, the counsellor should prepare a detailed treatment contract with the client that emphasises: ● The non-psychiatric intention of the intervention, i.e., the intent is on recognising how life stresses and trauma are contributing to feelings of the clients. ● The short time-frame of the intervention (maximum of six sessions with duration of 30 minutes each). ● The expected benefits – to reduce symptoms and to find better ways of coping, and ● IPC besides usual medical care. At the conclusion of the visit, the counsellor gives the client homework on life situations and ask him/her to bring in back to the next visit. Visit 2 – Determining The Specific Problem Area(S) The counsellor must discover the definite problem area(s), which helps to analyse the following: ● Onset and time span of current symptoms ● Present life situation ● Close interpersonal relationship, and ● Recent changes in any of these. Overall, the counsellor’s task is to help the client identify the main person(s) with whom he/she is having problems, what type of issues are faced, and whether there are methods to make the relationship more satisfactory. Visits 3–5 – Working on Specific Stress Areas The counsellor along with the client deal with particular problem areas e.g. Grief or loss – Assist the patient in reconnecting with other important relationships that could substitute for the loss. Speak about the deceased – the sort of person they were, relationship with them, situation surrounding the illness and death. ● Have a look at old photographs, pay a visit to old friends and converse at subsequent sessions. ● Encourage participation in new social interests. Helping the client view the new role in a more open and less constricted manner, or view in similar to those for grief – give up old role – provide chance for growth evaluation of what has been lost. 35 CU IDOL SELF LEARNING MATERIAL (SLM)

● Restore self-esteem by building in the client an affection and build social support system. Visit 6 – Termination This session is usually held across 2 weeks wherein the client is observed to assess if they have achieved their goals. The counsellor should analyse the earlier sessions and the client’s present condition and converse regarding the termination of IPC. The counsellor should highlight the advancement made, the support system available to the client, and capability to handle future problems. The counsellor has to engage with the patient to recognise possible sources of stress and the manner in which the client could handle these, especially by making use of strategies that were found to be efficacious during counselling. In some cases, a supplementary visit can be arranged to conclude the termination procedure. At the final stages of this treatment, the therapist consolidate and treat the client’s gains, discuss critical issues that might need further response and feedback, analyse and process emotions related to conclusion of therapy. 2.7 SYSTEMIC (FAMILY) THERAPY Family therapy (also known as systemic therapy) helps members of a family to communicate effectively in order to express and analyse problematic thoughts and feelings. This helps them understand each other’s requirements and helps make beneficial modifications to their relationship thereby strengthening family bonds. Current Mainstream Scientific Standards From the beginning of the 90’s, there has been a constant increase in studies that provide positive evidence regarding the usefulness of family therapy in various scenarios. Currently, research conducted based on different designs and methodologies have produced strong evidence for both the efficiency and the effectiveness of various family interventions. Other reviews also indicate that family therapy is not expensive and even costs much lesser than other therapies that do not involve the family. This cost-effectiveness of family therapy is also one of reasons why it is attractive to people who are involved in public services organisation or treatment programs focusing on development in health care institutions. According to research, inclusion of family therapy in the treatment process leads to notable reduction in health care expenses. There are a number of studies that show the efficacy of family therapy, systemic intervention or family work in treating problems like depression, behavioural issues, eating disorder, addiction, schizophrenia, childhood or adolescence issues etc. Even though the efficiency and effectiveness of family therapy and family-based interventions vary in accordance with the research techniques and conditions, family therapy is presently used as an evidence-based psychotherapy approach. Evidence from few recent 36 CU IDOL SELF LEARNING MATERIAL (SLM)

papers in this support is listed at the end of this text as a part of references. Therefore, it comes as no surprise that in some European nations this method of family therapy is acknowledged as an evidence-based approach by scientific organisations, for example in the United Kingdom, Germany, Finland etc. 2.8 LIFE REVIEW THERAPY/REMINISCENCE Dr Robert Butler, a psychiatrist put forth a theory in the 1960s, that making an adult look back on their life experiences could be therapeutic. The observations of Dr Butler form the basis of life review therapy. In this therapy adults refer back to their past in order to achieve a measure of tranquillity or empowerment in their lives. This therapy may not be appropriate for everyone but there are certain sections of people who may find it beneficial. It also helps change the perception of life and even reveal significant recollections about friends and loved ones. Who Can Benefit From Life Review Therapy? Life review therapy can serve several purposes:  Therapeutic  Educational  Informational The therapeutic benefits are only for the person reflecting upon their life experiences. It can help with emotions about end-of-life problems and help find a higher meaning in life. The following people may especially be benefitted from life review therapy:  People with dementia or Alzheimer’s disease  Elderly adults having depression or anxiety  Those diagnosed with a terminal condition  Those who have experienced the loss of a loved one Benefits Of Life Review Therapy Life review therapy aims to allow older adults and those who are having end-of-life problems to seek hope, value, and meaning in their lives. This therapy is also used to treat depression in older adults. This therapy may also be used in addition to other medical treatments, such as medications to reduce anxiety or depression. It can also help improve self-regard. People may not be aware of the importance of their achievements such as raising children or being the first person in their family to get a 37 CU IDOL SELF LEARNING MATERIAL (SLM)

university degree. Taking a look at their life experiences can help many people take pride in what they have achieved. 2.9 EFFICIENCY OF PSYCHOTHERAPY In the early stages of any treatment effort, irrespective of type, extra therapeutic helping agencies operate to bring about improvement in symptoms. Counteracting these positive non- specific influences during early treatment phases are:  Defective motivation  Continuing conflict that, increases anxiety, revitalises symptoms, and  The defensive dividends and secondary gains that make the retention of symptoms advantageous for the patient. Therapists with the help of technical pursuits must deal with these interferences energetically. Assuming that negative forces are not too prominent, or that they handled with proper therapeutic quality, the patient will register symptomatic improvement. This boon is the conjoint product of such forces as the placebo influence, emotional catharsis, the projection of an idealized relationship, suggestion, and group dynamics in earlier sections. A decline in increased pressure and anxiety and skill expertise is restored which thus help in the promotion of a better outlook toward life. If therapy stopped at this period, the patient may be able to continue improvement, particularly if the sources of difficulty dealt with constructively. If accomplished the best during the brief therapeutic effort after existing troubles are explored and especially when a continuity establishes between the immediate complaints, habitual personality operations, and determining childhood experiences and conditionings. However, therapy continues beyond this early phase, initial benefits may soon expend themselves in the wake of the patient’s realisation that the idealised properties with which he or she has invested the therapist are truly non-existent. Faith, hope, and trust no longer will temper the therapeutic climate. It is, of course, possible where the patient’s need is sufficiently great—as in certain character logically dependent personalities—the client bestow the psychotherapist with divine qualities, particularly where the therapist narcissistically shares the patient’s omnipotent delusions. Under these circumstances, the patient will bask in the therapist’s sun, soaking up the power of celestial exposure, and feel protected and continue symptom free as a result. On the other hand, neither the patient nor the therapist may be capable of keeping alive such a saintly image. Indeed, the therapist may purposefully retreat from playing a protective role and, particularly where striving for reconstructive goals, may even challenge the patient’s defences by pointing out existing behavioural improprieties. An inescapable increment of the protracted therapeutic time to which patients are exposed for purposes of extensive personality alteration is the furtive or dramatically 160 explosive obtrusions of resistance and 38 CU IDOL SELF LEARNING MATERIAL (SLM)

transference. Where the patient’s inherent personality strengths are sufficient to reconstitute personal defences in a new condition of strife, and where the therapist is sufficiently skilled and by disposition equipped to handle the patient’s insurgency, the patient best enabled to proceed toward a remodelling of relationships and toward values beyond the benefactions of symptom relief. At any rate, we may expect that by-products of most therapeutic endeavours that extend themselves in time are an eruption of symptoms and a mobilisation of pressure and anxiety. Stopping treatment in the middle will usually expose a patient who insists that therapy has brought little benefit. Yet, had treatment halted earlier, at the crest of the non- specific improvement wave, the effectiveness of the effort endorsed. In reconstructive therapy, therefore, we may expect a recrudescence of symptoms. Challenge of resistance, manoeuvres toward insight and proceeding towards development are vital features in regard with the therapeutic process. It has to be expected that the prolonged therapy will tend to promote dependency. This silent saboteur may interfere with the patient’s efforts toward self- actualisation. It may keep the patient reduced to an infantile status, violently promoting a return of original symptoms when the patient perceives a threat of termination of therapy. When the psychotherapist works further on this “separation anxiety,” the patient depends on a large extent on himself or herself and gradually expand the feelings of assertiveness. 2.10 SUMMARY ● Psychoanalysis is a type of psychotherapy that focuses on allowing people to have insight into their unconscious inner conflicts and repressed wishes. ● The aim of Freudian psychoanalysis is to achieve insight into the unconscious dynamics that are the root cause of behavioural issues so that they can deal adaptively with their current environment. The major way for gaining insight is the interpretation of the client’s free associations, dream content, resistance and transference reactions. ● Psychodynamic therapists view maladaptive behaviours as indicators of an underlying conflict that have to be resolved if behaviour is to be changed. ● Behaviour therapy can be used successfully for various disorders and can be easily taught. It requires a shorter timeframe than other therapies which are less expensive to administer. Although useful for circumscribed behavioural symptoms, the method is not valid to treat global areas of dysfunction (e.g., neurotic conflicts, personality disorders). ● CBT based on the concept that mental disorders are associated with characteristic alterations in cognitive and behavioural functioning and that this pathology modified with pragmatic problem-focused techniques. CBT established as a treatment for depression, anxiety disorders, and eating disorders. There is a growth of evidence that it can play an effective role in the clinical management of a large range of other disorders, including schizophrenia, bipolar disorder, and axis II conditions. 39 CU IDOL SELF LEARNING MATERIAL (SLM)

● A systemic perspective in its broadest sense can contribute to strengthening solidarity, tolerance, trust and collaboration, the cornerstones of a healthy society. ● CBT provides necessary support to patients thereby enabling them to understand the thoughts and feelings that have great impact on patient’s behaviour. It is generally short-term process that concentrate on helping clients to handle tactfully a very specific problem. ● The main objective of cognitive behaviour therapy is to make the patients learn and understand that though they do not have the ability to control every aspect of the world around them, they can interpret and deal with their environment. This treatment has gained increased prominence in recent years in mental health patients and treatment professionals. ● CBT comprises of a wide range of therapies that are derived from psychological models of human emotions and behaviour. ● It is the extensively explored form of therapy since the treatment focuses on most important goals in which the final outcome is easily validated. This therapy is well suited to patients having short-term treatment preferences that do not consider pharmacological medication. The major advantage of therapy is that it induces clients develop coping skills both in the current stage and in the future. ● Interpersonal counselling is a practical and effective approach for the treatment of common mental health problems that is easily integrated into general practice. The focus on life events, social, and interpersonal problems is familiar to counsellors. ● The expected outcomes of interpersonal therapy are a reduction or the elimination of symptoms and improved interpersonal functioning. There will also be a greater understanding of the presenting symptoms and ways to prevent their recurrence. For instance, a person can terminate the consultation with tactics that may reduce and resolve depressive sessions in the future efficiently. 49 Some researchers have criticised positive psychology for studying positive processes in Interpersonal Counselling isolation from negative processes. Similarly, it can be better understood that these processes are inter-linked with each other and should not be treated as opposites. ● Family therapy based on systemic perspective is a distinctive psychotherapy approach having primary focus on family and other relationships of an individual. It is a well- researched approach with strong evidence of efficacy and effectiveness in a wide range of specific conditions. Provision of family therapy offer for the following reasons: 40 CU IDOL SELF LEARNING MATERIAL (SLM)

● Family therapy is considered as a highly effective approach in the prevention and treatment of various emotional and behavioural problems during childhood and adolescence age. ● Family therapy can help family members to use both their own resources in providing support to each other in various stressful situations including mental and physical illness. ● Properly trained family therapists and systemic consultants may use their skills in diverse contexts such as organisations and institutions, where they can foster teamwork and problem solving. They can also participate in conflict resolutions and negotiation processes in social and political crises. 2.11 KEYWORDS  Counsellor is a person who helps people in need by providing them with support at times of emotional difficulties and guides people on personal, career, lifestyle, and relationship issues. A counsellor works with individuals and groups to improve their mental health and well-being.  Therapists are certified professionals who focus in helping patients develop improved intellectual and emotional skills, minimising disorders pertaining to mental illness, and handle tactfully varied life challenges towards improvement.  Adolescence is the developmental period that occurs between childhood and adulthood. This is a transitional period marked by substantial changes in physical maturation, cognitive abilities, and social interactions. Physical maturation most clearly distinguishes adolescence from childhood.  Self-awareness refers to individual experiences which at the same time, should not be jumbled with consciousness in the aspect of qualia.  Psychological Mechanisms are the processes and systems, or activities and entities, frequently appealed to in causal explanations within the psychological science. 2.12 LEARNING ACTIVITY 1. Conduct a Psychodynamic Therapy session with an individual and measure the outcome. ………………………………………………………………………………………………… …………………………………………………………………………………………………. 2. Gather a detailed investigation on CBT conducted previously by hospitals. ………………………………………………………………………………………………… …………………………………………………………………………………………………. 41 CU IDOL SELF LEARNING MATERIAL (SLM)

2.13 UNIT END QUESTIONS A. Descriptive Questions Short Questions 1. What is psychotherapy used to treat? 2. What is psychodynamic therapy? 3. List down the types of psychotherapy. 4. What is cognitive behaviour therapy? 5. What are the two features of family therapy? Long Questions 1. Illustrate the background of psychodynamic therapy. 2. Explain interpersonal therapy. 3. Explain the CBT structure of treatment. 4. Describe strategy and its application in context to training and development. 5. How does strategy play an overarching role in HRD? Explain. B. Multiple Choice Questions 1. Which one of the following is regarded as the pivotal school of psychoanalytic theory? a. Freudian b.Ego-Psychology c.Self-Psychology d. All of these 2. How many sessions are conducted in CAT to client ________? a. Two –five sessions b. Three – eight sessions c. Four – seven sessions d. Five - nine sessions 3. CBT means: a. Cognitive behaviour therapy b. Cognitive based therapy c. Cognitive belief therapy d. Cognitive believing therapy 4. Family therapy is based on ______ perspective. a. Creative 42 CU IDOL SELF LEARNING MATERIAL (SLM)

b. guidance c. routine d. Systematic 5. The main distinguishing feature of CAT_____ a. the joint descriptive reformulation b. their active participation in therapy c. are patient’s problem d. All of these Answers 1 a) 2 b) 3 a) 4 d) 5 d) 2.14 REFERENCES Textbooks  Bloch, S. (1996). An Introduction to Psychotherapies (3rd ed).  Lambert, J.M., (2004). Bergin & Garfield’s handbook of psychotherapy and Behavioural change. (5th eds). Reference Books  Gabbard, Glen O. (2009). Textbook of Psychotherapeutic Treatments. U.S.A: American Psychiatric Publishing, Inc.  Gabbard, Glen O., Beck, Judith S. and Holmes, Jeremy. (2005). Oxford Textbook of Psychotherapy, 1st Edition. Oxford: Oxford University Press.  American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. Washington, DC: American Psychiatric Association, 2000. Websites  https://manhattanmentalhealthcounseling.com/  https://www.webmd.com/mental-health/mental-health-psychotherapy  https://www.health.harvard.edu/mind-and-mood/types-of-psychotherapy 43 CU IDOL SELF LEARNING MATERIAL (SLM)

UNIT - 3: PSYCHOANALYTIC THERAPY 44 Structure 3.0 Learning Objectives 3.1 Introduction 3.2 Freudian Psychoanalytic Therapy 3.2.1 Basic Human Drives 3.2.2 Structural and Topographical Models of Personality 3.2.3 Stages of Psychosexual Development 3.2.4 Ego Defence Mechanisms 3.2.5 Limitations 3.3 Goals of Psychoanalytic Theory 3.4 Techniques used in psychoanalytical therapy 3.4.1 Free Association 3.4.2 Dream Analysis 3.4.3 Interpretation 3.4.4 Transference 3.5 Client Centred Therapy 3.6 Steps in Client Centred Therapy 3.7 Techniques in Client Centred Therapy 3.7.1 Empathy 3.7.2 Unconditional Positive Regard 3.7.3 Genuineness or Congruence 3.7.4 Transparency 3.7.5 Concreteness 3.7.6 Self-Disclosure 3.7.7 Cultural Awareness in Client Centred Counselling 3.8 Clinical Utility of Client Centred Therapy 3.9 Summary 3.10 Keywords CU IDOL SELF LEARNING MATERIAL (SLM)

3.11 Learning Activity 3.12 Unit End Questions 3.13 References 3.0 LEARNING OBJECTIVES After studying this unit, student will be able to: ● Define and describe the psychoanalytic theory of Sigmund Freud. ● Illustrate the Freudian psychoanalytic therapy. ● Understand the goals of psychoanalytic theory. ● Define and describe the steps in client centred therapy. ● Illustrate the techniques on client centred therapy. 3.1 INTRODUCTION The Psychoanalytic Theory proposed by Sigmund Freud is considered to be more controversial than any other theory in the field of Human Behaviour as it deals with subjects such as sexual behaviour, dream interpretation and the nature of the unconscious. The theory, however, acted as a starting point for the development of several other theories that are aimed at studying human behaviour. Such as Carl Jung’s own mix of Analytical Psychology, and Erik Erikson’s Psychosocial Stages of Development, a more subdued and a greater supplement to Freud’s Psychosexual Stages of Development In present times, psychotherapy has evolved to the extent that it now uses more responsive methods in order to handle psychological disorders. There are various techniques that are being followed to study the incongruous nature of the personality based on the unconscious. Psychoanalysis is considered to be among the most effective methods to handle cases where there are internal psychological disturbances that impacts a person’s sense of reality. Sigmund Freud is credited as the originator of the psychoanalytic theory. Being the eldest child, he was totally devoted to the study of psychoanalytic theory and was instrumental in pushing the boundaries of this theory further. His own experiences such as paranoia about death, internal stress and conflicts that he had at around the age of 40, helped him understand people behaviour. This ultimately led to him dedicating the rest of his life to establish the psychoanalytic theory that propounds the manner in which the unconscious impacts people behaviour. A very gifted and dynamic person, Freud had little patience when it came to people who disagreed with his theory and thought process. This led him to cut ties with two of his intimate associates, Carl Jung and Alfred Adler as they had perspectives that differed from his own and they put forth their own theories based on Freud’s theory. Freud passed away in 45 CU IDOL SELF LEARNING MATERIAL (SLM)

September 1939 due to a cancer that had affected his jaw, and which turned out to be inoperable. 3.2 FREUDIAN PSYCHOANALYTIC THERAPY Background of Freudian Psychoanalytic Therapy From recorded history, it is obvious that there were people in every age and in almost every culture who had some understanding of the significance of people’s psychic life in the scheme of things. The Bible and the writings of the early philosophers contain a wealth of psychological wisdom. However, none of the insights then integrated into an organized form until a man from Moravia. Sigmund Freud, through his genius for understanding people’s inner motivations and his unflagging determination when confronted with violent opposition, broke through and laid a foundation for the science of the psychic processes which is today known as psychoanalysis. In 1880, Joseph Breuer discovered a hysterical girl under hypnosis induced to speak freely; she expressed profound emotion and experienced relief from her symptoms. Under the impression that her hysteria originated in certain painful experiences while caring for her sick father, Breuer enjoined her, while she was in a hypnotic state, to remember and to relive the traumatic scenes in her past. This seemed to produce a cure for her hysteria. Ten years later, in conjunction with Freud, Breuer continued his research, In 1895, the two men published their observations in the book, Studien Uber Hysteria (1936). Their conclusions were that hysterical symptoms originated due to experiences so traumatic to the individual that they repressed. The mental energy associated with the experiences blocked off, and not being able to reach consciousness converted into bodily innervations. The discharge of strangulated emotions (abreaction), through normal channels during hypnosis, would relieve the need to divert the energy into symptoms. This method was termed “catharsis.” Freud soon found that equally good therapeutic results obtained without hypnosis by permitting the patient to talk freely, expressing whatever ideas came to mind. Freud invented the term “psychoanalysis” for the procedures followed for uncovering and permitting the verbal expression of hidden traumatic experiences. Freud discovered that several forces could repress memories and it was necessary to counterbalance these forces before an effort could be made to recall particular memories. An effective way to overcome resistances was to permit the patient to relax and to talk freely about any ideas or fantasy that entered their mind even if they thought it was insignificant. Freud could observe in this “free association” a sequential theme that gave clues regarding to the characteristics of the repressed memory. Sigmund Freud is considered as one of the pioneers of the field for advocating theories that involved acknowledging and treating mental disorders with approaches that were not biological. This led to conditions such as hysteria that were considered as biological up until that point of time to be considered as mental disorders. 46 CU IDOL SELF LEARNING MATERIAL (SLM)

3.2.1 Basic Human Drives Sigmund Freud suggested that there are 2 fundamental drives, sex and aggression, that influence the thought processes, feelings and behaviour traits of a person. Also known as Eros and Thanatos, sex and aggression serve as the motivating force behind each and every human action and behaviour. Sex and aggression are also aptly known as life and death. Freud’s theory emphasised sex as a major driving force in human nature. This might seem as an exaggeration, but it is a fact that sex serves as a means for humans to procreate and thereby continue life. Not only humans, but in every other species in the world, sex is means of survival. Meanwhile, aggression, which is also known as instinct of death serves a contradictory purpose. Aggression is the instinct that protects us from our enemies. This drive helps us protect ourselves while trying to destroy our adversaries who are trying to do us harm. This might sound primeval wherein it looks as if sex and aggression are the only acts that matter. But it cannot be denied that they form the basis of survival of a species which can be summed up as: The Drive to Be Breathing, Living and Procreating and Not Allowing Others to Terminate or Diminish These Basic Needs. Looking at the animal kingdom it is easy to see these forces driving most, if not all, of their behaviour. Let us look at a few examples. Why does an adult decide to go to college and get a degree? Freud suggests that people drive themselves towards improvement so as to attract people from the opposite gender with the hopes of attracting a superior mate. With a superior mate, it is possible to procreate and thereby have a chance to carry on the lineage. Moreover, by attending college, it is possible to get a better income thereby having an advantage over one’s competitors. 3.2.2 Structural and Topographical Models of Personality The theory proposed by Sigmund Freud is complicated and his work on psychosexual development forms the basis of how personality development happened in individuals and is only a part of his Theory of Personality which consists of 5 stages. According to him, there are different influencing factors in each of these stages that determine how an individual interacts with the external environment. Structural Model (Id, ego, and superego): Freud suggests that, each one of us has an Id that we are born with. The Id plays a significant role in shaping our personality and it allows our needs to be met when we are newly born. It is derived from the pleasure principle. Basically, 47 CU IDOL SELF LEARNING MATERIAL (SLM)

the Id looks for and seeks whatever give it pleasure at that point of time without considering the ground reality. For example, when the baby is hungry, the Id gets food by crying. When the baby feels wet and uncomfortable, the baby cries so that the nappy can be changed which is what the Id wants. When a child is in pain or is simply uncomfortable, the Id comes out and says what is in the mind so that the child gets what he or she wants. The Id just wants to be satisfied and is not bothered about other’s wishes or convenience. In this case, babies can be demanding and only care about what they want without being considerate to their parents or anyone else’s wishes. During the course of the next 3 years in a child’s life, the second personality trait develops which is the Ego. Ego is derived from the reality principle. That is, the Ego recognises that others too have their own wants and needs and therefore it is not prudent to be selfish. Thus, the Ego caters to the requirements of the Id while remaining connected to the ground reality of a situation. By 5 years of age, the Superego comes into picture. This also marks the conclusion of the phallic developmental stage. The Superego forms the moral attribute in the personality of an individual. This is developed due to the morals and ethics that are imparted to a child through lessons and experiences that the child undergoes. This superego can be associated to conscience as it directs the sense of what is right and what is wrong. As per Freud, the Ego part of the personality will be the most dominant for a normal person. This is because the Ego has the capability to please the Id by giving it what it wants while not upsetting the Superego and also assessing the reality of the situation. If Id is dominant, the person becomes impulsive and thinks only about self-gratification. On the other hand, if the Superego is dominant, the person only gives importance to morals and can end up being rigid and judgemental in their interactions with others. Topographical Model: According to Freud, an individual is driven by his unconscious mind. All that we experience and the feelings, passions, impulses, etc. associated with the experiences are not present in the conscious mind. For example, when it comes to Oedipus and Electra complex, the feelings and emotions that a child has towards a parent of its own sex is put deep down into the unconscious because of the awareness and the high-level anxiety that is caused due to these feelings. But even when pushed into the unconscious, these feelings and thoughts do affect us significantly. 48 CU IDOL SELF LEARNING MATERIAL (SLM)

Figure 3.1 : Structural and Topographical Models of Personality 3.2.3 Stages of Psychosexual Development Sigmund Freud was well known for his theory on Personality Development. Freud’s Stages of Psychosexual Development are like other stage theories, completed in a predetermined sequence and can result in either successful completion or a personality that is healthy or can result in failure, leading to an unhealthy personality. This theory is well known as well as the most controversial; as Freud believed that, we develop through stages based upon a particular erogenous zone. During each stage, an unsuccessful completion means that a child becomes fixated on that particular erogenous zone and either over– or under-indulges once he or she becomes an adult. Considered to be controversial, this well-known theory states that each person develops in stages which have a specific erogenous zone. When the completion is not accomplished in a particular stage, the child gets obsessed with that specific erogenous zone. This leads them to overindulge or not indulge much with that erogenous zone once they become an adult.  Oral Stage (Birth to 18 months): At this stage, the child is preoccupied with sucking which is an oral pleasure. When the indulgence is too high or low, there is a possibility of the child developing Oral Fixation or Personality. The people with this kind of personality are preoccupied with all activities that are oral-related. For example, they might overeat, smoke, drink or have the habit of nail-biting. Such people are over-dependent on others and are too trustful. There is also the possibility of such individuals trying to come out of this personality trait by being aggressive and pessimistic towards others. 49 CU IDOL SELF LEARNING MATERIAL (SLM)

 Anal Stage (18 months to three years): The child’s focus of pleasure here is on eliminating and retaining faeces. Societal pressure, which is reinforced by the parents, makes the child learn to manage anal pressure. As far as personality development is concerned, exerting too much control over anal stimulation can lead to a fixation that can make an individual over obsessed on cleanliness and orderliness (anal retentive). On the opposite end of the spectrum, they may become messy and disorganised (anal expulsive).  Phallic Stage (age is three to six): At this stage, the focus is on the genitals. According to Freud, boys develop sexual desires towards their mothers in their unconscious mind. This leads them to think of their fathers as their rival for mother’s love and affection. They also have an anxiety that they could be punished with castration by their father for developing such feelings. These feelings are called Oedipus Complex based on the character from Greek Mythology who mistakenly took the life of his father and ended up marrying his mother. Later on, another theory called the Electra complex was put forth which suggested that girls also undergo a similar phase wherein they are attracted sexually to their father in their unconscious mind. However, Freud did not agree with this theory. He suggested that boys eventually repress the sexual feelings towards their mother by starting to identify themselves with their father. This is due to the strong competition from the father and also the anxiety of being castrated. They eventually develop masculine tendencies by following the father and identifying themselves with him. In this stage, a fixation could lead to a sexually devious mind or a fragile or chaotic sexual identity. Latency Stage (age six to puberty): In this stage, the sexual feelings are repressed, and the children mostly focus of interacting and playing with their peers of the same sex. Genital Stage (puberty on): At the onset of puberty, the sexual feelings that were previously repressed are again aroused. From the lessons learnt from the past stages, the adolescent children focus their sexual feelings on members from the opposite sex. Here genitals are main focal point of pleasure. 3.2.4 Ego Defence Mechanisms As mentioned earlier, the Ego is responsible for satisfying the needs of the Id without impacting the moralistic requirements of the superego while considering the ground reality. We can consider the Id and the Superego as 2 sides of a coin, one being the angel and the other the devil. It is not prudent to allow either of them to take the upper hand, so it is necessary to understand the perspectives of both before arriving at a decision. The decision that we arrive at can be considered to be that of the Ego’s as it is seeking a wholesome balance. Before we move further, there is a requirement to recognize the motivating factor behind Id, Ego and Superego. Freud suggests that there are basically only two factors that drive everything we do: they are sex and aggression. Sex which is also known as Eros is 50 CU IDOL SELF LEARNING MATERIAL (SLM)