Class 12 Physology Notes Chapter 5 (Therapeutic Approaches) – Physocology Book

Alright class, let's delve into Chapter 5: Therapeutic Approaches. This is a crucial chapter, not just for understanding psychological disorders but also for appreciating the methods used to alleviate distress and promote well-being. Pay close attention, as these concepts frequently appear in various government examinations.

Chapter 5: Therapeutic Approaches - Detailed Notes

1. Introduction: What is Psychotherapy?

• Definition: Psychotherapy is a voluntary relationship between a client seeking help and a therapist trained to help them solve psychological problems.
• Purpose: To change maladaptive behaviours, decrease personal distress, reduce felt conflict, and help individuals understand themselves better to improve their adjustment to the environment.
• Key Elements:
  • Systematic application of psychological principles.
  • Conducted by trained professionals.
  • Based on a specific theory of psychological problems and their resolution.
  • Centrality of the Therapeutic Relationship/Alliance: A trusting, confiding relationship marked by warmth, empathy, and mutual understanding between client and therapist. This alliance is crucial for successful therapy, regardless of the specific approach used.

2. Nature and Process of Psychotherapy

• Characteristics:
  • Systematic process using established principles.
  • Involves a therapist and a client.
  • Aims to modify cognitions, feelings, and behaviours.
  • Requires a strong therapeutic alliance.
• Goals (Vary depending on approach and client needs):
  • Reinforcing client's resolve for betterment.
  • Lessening emotional pressure (Catharsis).
  • Modifying maladaptive habits.
  • Changing thinking patterns (Cognitive Restructuring).
  • Increasing self-awareness and insight.
  • Improving interpersonal relations and communication.
  • Facilitating decision-making.
  • Becoming aware of choices in life.
  • Relating effectively to one's social environment.
• Therapeutic Alliance:
  • Components: Trust, rapport, empathy, unconditional positive regard (therapist accepts client non-judgmentally), confidentiality (ethical requirement, broken only under specific conditions like danger to self/others).
  • Importance: Research consistently shows the quality of the therapeutic relationship is a significant predictor of therapeutic outcome.

3. Major Types of Psychotherapies

Therapies can be classified based on various parameters: underlying cause identified, primary benefit sought, and treatment modality.

(A) Psychodynamic Therapy (Founder: Sigmund Freud)

• Core Assumption: Psychological problems stem from unresolved, unconscious intrapsychic conflicts, often rooted in early childhood experiences. Repressed desires and conflicts exert pressure, leading to symptoms.
• Aim: To bring repressed unconscious material (conflicts, desires) into conscious awareness (Insight). This allows the client to understand and work through these issues.
• Methods:
  • Free Association: Client says whatever comes to mind without censorship. Therapist looks for patterns and hidden meanings.
  • Dream Analysis: Dreams are seen as the "royal road to the unconscious." Manifest content (what is remembered) hides the latent content (symbolic meaning).
  • Interpretation: Therapist points out patterns in behaviour, thoughts, feelings, and dreams to help the client gain insight. Confrontation and Clarification are key steps. Working Through involves repeated examination of insights.
  • Transference: Client unconsciously transfers feelings and attitudes from past significant relationships (e.g., parents) onto the therapist.
    • Positive Transference: Feelings of affection, dependency.
    • Negative Transference: Feelings of hostility, anger. Analysing transference is crucial.
  • Resistance: Client's conscious or unconscious attempts to block or avoid confronting difficult unconscious material (e.g., missing sessions, silence). Therapist interprets resistance.
• Duration: Classical psychoanalysis is intensive and long-term (years). Modern psychodynamic therapies are shorter.

(B) Behaviour Therapy

• Core Assumption: Psychological distress arises from faulty learning of behaviours and cognitions. Focus is on current behaviours and the conditions (antecedents, consequences) that maintain them. Past is relevant only for understanding the origins of faulty learning.
• Aim: To identify maladaptive behaviours and their maintaining factors, and then use learning principles (classical conditioning, operant conditioning, observational learning) to substitute adaptive behaviour patterns.
• Methods:
  • Behaviour Analysis: Identifying maladaptive behaviours, their antecedents (triggering events), and consequences (maintaining factors). Often uses functional analysis (ABC: Antecedent-Behaviour-Consequence).
  • Techniques based on Conditioning:
    • Negative Reinforcement: Removing an unpleasant stimulus to increase a behaviour (e.g., stopping nagging when a chore is done). Aversive Conditioning pairs an undesirable behaviour with an unpleasant stimulus (e.g., mild shock for alcohol consumption); ethical concerns limit its use.
    • Positive Reinforcement: Providing a reward after a desired behaviour. Token Economy uses tokens (exchangeable for rewards) to reinforce desirable behaviours, often in institutional settings. Differential Reinforcement involves reinforcing desired behaviours while ignoring or not reinforcing undesired ones.
    • Systematic Desensitisation (Joseph Wolpe): Effective for phobias. Based on the principle of reciprocal inhibition (two opposing states like relaxation and anxiety cannot coexist).
      • Steps: 1) Relaxation training (e.g., progressive muscle relaxation). 2) Creating an anxiety hierarchy (ranking anxiety-provoking stimuli from least to most fearful). 3) Pairing relaxation with gradual exposure to items in the hierarchy (imaginal or real).
    • Modelling (Albert Bandura): Learning by observing others (models) perform desired behaviours. Effective for social skills deficits, phobias. Client observes and then imitates the model.

(C) Cognitive Therapy

• Core Assumption: Psychological distress is caused by irrational thoughts, distorted perceptions, and dysfunctional beliefs. How we think (cognition) influences how we feel and behave.
• Aim: To identify and modify irrational/dysfunctional thought patterns and beliefs, replacing them with more rational and adaptive ones (Cognitive Restructuring).
• Types:
  • Rational Emotive Therapy (RET) (Albert Ellis):
    • Focuses on irrational beliefs (e.g., "I must be loved by everyone").
    • Uses the ABC Analysis: A (Antecedent event) -> B (Belief system about A) -> C (emotional Consequence). Therapy focuses on disputing the irrational Belief (B) to change the Consequence (C).
    • Therapist uses direct, persuasive, and confrontational questioning to challenge irrational beliefs.
  • Cognitive Therapy (Aaron Beck):
    • Focuses on core schemas (deep-seated dysfunctional beliefs) developed in childhood that shape dysfunctional cognitive structures. These lead to negative automatic thoughts (persistent, intrusive negative thoughts) often related to the cognitive triad (negative views of self, world, future), especially in depression.
    • Identifies cognitive distortions (errors in thinking like overgeneralization, magnification).
    • Therapist uses gentle, non-directive questioning ("Socratic dialogue") to help clients discover their own irrationalities.
  • Cognitive Behaviour Therapy (CBT):
    • Integrates cognitive and behavioural techniques.
    • Widely used, evidence-based therapy for various disorders (depression, anxiety, panic, OCD).
    • Focuses on changing both thoughts and behaviours. Often short-term and problem-focused.

(D) Humanistic-Existential Therapy

• Core Assumption: Psychological distress arises from feelings of loneliness, alienation, meaninglessness, and the frustration of the innate human potential for growth and self-actualisation. Focus is on the individual's subjective experience and capacity for choice.
• Aim: To help individuals achieve personal growth, self-acceptance, find meaning, and realise their potential. Focus is on the present and future, rather than the past.
• Types:
  • Logotherapy (Viktor Frankl): Therapy through meaning. Emphasises finding meaning in one's life, even in suffering. Existential anxiety (related to finding meaning, freedom, death) is central. Goal is to facilitate the process of finding meaning.
  • Client-Centred Therapy (Carl Rogers):
    • Belief in the client's innate tendency towards self-actualisation.
    • Non-directive approach; client leads the therapy.
    • Therapist provides core conditions:
      • Unconditional Positive Regard: Complete acceptance and non-judgmental attitude towards the client.
      • Empathy: Understanding the client's feelings and experiences from their perspective.
      • Authenticity/Genuineness: Therapist is real and transparent.
    • Goal: To create a supportive environment where the client can explore their feelings, gain self-understanding, and move towards self-actualisation. Reflection is a key technique (therapist rephrases client's statements).
  • Gestalt Therapy (Fritz Perls & Laura Perls):
    • Focuses on increasing self-awareness and self-acceptance in the 'here and now'.
    • Aims to help clients integrate fragmented parts of their personality ('gestalt' means 'whole').
    • Encourages clients to take responsibility for their feelings and behaviours.
    • Uses techniques like role-playing, empty chair technique.

(E) Biomedical Therapy

• Core Assumption: Psychological disorders have biological causes (e.g., neurotransmitter imbalances, genetic predispositions).
• Aim: To treat symptoms using biological methods.
• Methods:
  • Medication (Psychotropic Drugs): Prescribed by psychiatrists. Different classes for different disorders (e.g., anti-depressants, anti-anxiety drugs, anti-psychotics, mood stabilizers). Can have side effects and require careful monitoring. Often used in conjunction with psychotherapy.
  • Electro-Convulsive Therapy (ECT): Involves inducing a brief seizure via electrical current passed through the brain. Used primarily for severe depression unresponsive to other treatments. Controversial, but can be effective under specific circumstances. Requires anaesthesia and muscle relaxants.

(F) Alternative Therapies

• Focus on holistic well-being, often integrating mind and body.
• Yoga: Ancient Indian practice combining physical postures (asanas), breathing techniques (pranayama), and meditation. Widely recognised for improving mental and physical health, reducing stress and anxiety.
• Meditation: Practices focusing attention and awareness (e.g., Vipassana, Mindfulness-Based Stress Reduction - MBSR). Helps regulate attention, emotions, and reduce stress.
• Acupuncture: Traditional Chinese medicine technique involving inserting thin needles at specific body points.
• Herbal Remedies: Use of plant-based substances for healing (consultation with qualified practitioners essential).

4. Factors Contributing to Healing in Psychotherapy

• Techniques: Specific methods used by the therapist tailored to the problem.
• Therapeutic Alliance: Quality of the client-therapist relationship (most significant factor).
• Catharsis: Process of emotional release and unburdening.
• Client Variables: Motivation for change, expectation of improvement ('placebo effect' component).
• Therapist Variables: Empathy, warmth, genuineness, positive regard, credibility, expertise.
• Non-specific Factors: Support, hope, reassurance common across different therapies.

5. Ethics in Psychotherapy

• Informed Consent: Clients must understand the process, risks, benefits, and alternatives before agreeing to therapy.
• Confidentiality: Information shared by the client is kept private (exceptions: imminent danger to self/others, child abuse, court orders).
• Competence: Therapists must practice within their areas of expertise and training.
• Avoiding Dual Relationships: Therapists should avoid multiple relationships (e.g., friend, business partner) with clients that could impair objectivity or exploit the client.
• Respect for Human Rights and Dignity: Non-discrimination, respect for autonomy.
• Professional Boundaries: Maintaining appropriate limits in the therapeutic relationship.

6. Rehabilitation of the Mentally Ill

• Aim: To empower individuals with severe mental disorders to function as effectively as possible in society. Focus on reducing symptoms and improving quality of life and social integration.
• Methods:
  • Occupational Therapy: Teaching skills (e.g., self-care, work skills) to help individuals become more independent.
  • Social Skills Training: Improving interpersonal communication and interaction skills.
  • Vocational Therapy: Assisting individuals in finding and maintaining suitable employment.
  • Cognitive Retraining: Helping improve cognitive functions like attention, memory, and problem-solving.
  • Community support services and halfway houses.

Multiple Choice Questions (MCQs)

1. The quality of the relationship between the client and therapist, characterized by trust, empathy, and warmth, is known as:
   a) Transference
   b) Therapeutic Alliance
   c) Free Association
   d) Interpretation

2. Which therapeutic approach emphasizes the role of irrational beliefs in causing psychological distress?
   a) Psychoanalysis
   b) Behaviour Therapy
   c) Rational Emotive Therapy (RET)
   d) Client-Centred Therapy

3. Systematic Desensitisation, developed by Wolpe, is based on the principle of:
   a) Operant Conditioning
   b) Observational Learning
   c) Reciprocal Inhibition
   d) Free Association

4. In Psychoanalysis, the process where the client unconsciously directs feelings from past significant relationships towards the therapist is called:
   a) Resistance
   b) Catharsis
   c) Transference
   d) Working Through

5. Carl Rogers' Client-Centred Therapy emphasizes the importance of which core condition provided by the therapist?
   a) Interpretation of dreams
   b) Disputing irrational beliefs
   c) Unconditional Positive Regard
   d) Functional Analysis

6. A behavioural technique where desirable behaviours are increased by rewarding them with points or chips that can be exchanged for privileges is known as:
   a) Systematic Desensitisation
   b) Aversive Conditioning
   c) Modelling
   d) Token Economy

7. Logotherapy, developed by Viktor Frankl, primarily focuses on helping clients find:
   a) Unconscious conflicts
   b) Meaning in life
   c) Conditioned responses
   d) Cognitive distortions

8. Which of the following is primarily a biomedical therapy?
   a) Gestalt Therapy
   b) Cognitive Behaviour Therapy (CBT)
   c) Electro-Convulsive Therapy (ECT)
   d) Psychoanalysis

9. The ethical principle ensuring that information shared by the client during therapy is kept private is:
   a) Informed Consent
   b) Competence
   c) Confidentiality
   d) Dual Relationship Avoidance

10. Aaron Beck's Cognitive Therapy focuses on identifying and modifying:
    a) Repressed childhood memories
    b) Conditioned emotional responses
    c) Negative automatic thoughts and core schemas
    d) The need for self-actualisation

Answer Key for MCQs:

1. b) Therapeutic Alliance
2. c) Rational Emotive Therapy (RET)
3. c) Reciprocal Inhibition
4. c) Transference
5. c) Unconditional Positive Regard
6. d) Token Economy
7. b) Meaning in life
8. c) Electro-Convulsive Therapy (ECT)
9. c) Confidentiality
10. c) Negative automatic thoughts and core schemas

Remember to revise these notes thoroughly. Understanding the core assumptions, goals, and techniques of each major therapeutic approach is essential. Good luck with your preparation!