Psychotherapy involves various approaches to treating mental disorders and improving mental well-being. Some major types discussed are psychodynamic therapies, which aim to help clients gain insight into problem behaviors by exploring unconscious dynamics. Approaches include Freud's traditional psychoanalysis using free association and dream analysis, as well as dissident theories from Jung, Adler, and Horney emphasizing individuation, social factors, and basic anxiety. Biomedical therapies can include electroconvulsive therapy, psychosurgery, and various psychiatric drugs to treat conditions like depression and schizophrenia. Money availability, client characteristics, and treatment location all impact who receives therapy.

1. PSYCHOTHERAPY
(INTRODUCTION TO PARADIGMS IN
PSCHOPATHOLOGY AND THERAPY)
GENERAL PSYCHOLOGY
Dr.BALDEV NEGI (PT)

3. Contents : Psychotherapy
❑ Who needs therapy?
❑ Who provides therapy?
❑ Where does therapy happen? Trends over recent decades
❑ Who gets therapy? Money matters and YAVISes versus QUOIDS
❑ Biomedical therapies
➢ Electroconvulsive/ electroshock therapy
➢ Psychosurgery
➢ Chemotherapy
❑ Psychodynamic therapies
➢ Freud’s traditional psychoanalysis
➢ Traditional versus contemporary psychoanalysis
➢ Dissident theories and their techniques : Jung, Adler and Horney
❑ Humanistic and existential therapies
➢ Client- centered therapy
➢ Gestalt therapy
➢ Existential therapy

4. Psychotherapy
❑ Behavioral therapies
➢ Instrumental , or Operant , Condititioning techniques
➢ Classical conditioning techniques
➢ Modelling techniques
❑ Cognitive approaches
➢ Ellis’s rational – emotive theory
➢ Beck’s cognitive theory
➢ Meichenbaum’s self- instructional training
❑ The emerging field of behavioral medicine
➢ Relaxation training
➢ Hypnosis
➢ Biofeedback: it sometimes work, but how?
❑ Therapy for groups
➢ Family therapy
➢ Group therapy
❑ Community psychology: outreach and prevention in real- life settings
➢ Solving problems where they happen
➢ Prevention
➢ Social support: person- to- person helping

5. Who needs therapy?
❑DSM-III disorders (Diagnostic and statistical
manual of mental disorders) : it includes
clinical syndromes (disorders in the traditional
brain syndrome, psychosis and neurosis) and
personality disorders .
❑Individuals experiencing anxiety disorders,
substance abuse or dependence disorders and
affective disorders.

6. Who provides therapy?
❑ Clinical psychologists: they are trained in psychological principles
and methods and in the identification and treatment of
psychological disorders. They are also trained in psychological
assessment and testing. They possess graduate degrees in clinical
psychology.
❑ Psychiatrists: they possess general medical degree and have done 3
years postdoctoral residency training in psychiatry. they are trained
in the treatment of psychological disorders with and without drugs.
❑ Psychiatric social workers: they have masters degree in social work
and sometimes more advanced degrees. They are trained regarding
mental- health problems and have special skills like interviewing,
assembling family histories of their clients, and assessing social
factors involved in behavior problem.
❑ Psychiatric nurses: they are registered nurses trained to help people
with psychological disorders. These specialists are employed in
institutional settings such as mental hospitals and the psychiatric
wards of general hospitals.
❑ Psychoanalysts : they can be psychiatrists, psychologists or neither.
They specialize in psychoanalysis as practiced by Freud and its
followers .

7. Where does therapy happen? Trend
over recent decades

8. Who gets therapy? Money matters
and YAVISes versus QUOIDs
❑Money as a factor: Public facilities have more
applicants for their services than they can handle.
Private therapists can be expensive. Thus, money
matters a lot! Those who are financially unstable
finds more difficulty in availing mental health
services in the mental health centres.
❑YASVISes (young, attractive, verbal, intelligent and
successful) : these personalities are more
appealing to the therapist.
❑QUOIDs (quiet, ugly, old, institutionalized and
culturally different): they are less likely to receive
intense therapy.

9. Biomedical therapies
❑ Electroconvulsive / electroshock therapy-
➢ Electroconvulsive therapy (ECT) is also known as electroshock therapy
(EST) . It is widely used in mental hospitals- especially for the treatment of
severe depression and psychosis.
➢ In the electroconvulsive therapy a full- body seizure or convulsion is
triggered by a quick jolt of electric current. Electrodes are attached to one
or both temples and electricity (70-160 volts for 0.1-0.5 seconds ) is
passed directly through the brain.
➢ Sedatives or skeletal muscle relaxants are given before the
electroconvulsive therapy. With convulsion, patient immediately loses
consciousness, there is rigidity in the body and violent twitching of the
muscles take place.
❑ Psychosurgery-
➢ Prefrontal lobectomy: the removal of brain tissue from the prefrontal
cortex.
➢ Prefrontal lobotomy: severing of the connections between the prefrontal
cortex and the rest of the brain.
➢ After surgery individuals become dull apathetic, drained of emotion and
motivation. They are also described as ‘human vegetables’ or ‘zombies’.

10. Biomedical therapies
❑ Chemotherapy-
➢ Chemotherapy is defined as the treatment with chemical substances or drugs. It is
widely used than all other therapeutic methods.
➢ Tranquilizers : these are those drugs which lower anxiety and irritability like
Valium.
➢ Phenothiazines: these are those drugs which are helpful in psychological disorders
that have distinct biochemical abnormality such as neurotransmitter abnormality
(Schizophrenia). They reduce agitation, tension and combativeness; decrease and
eliminate delusions and hallucinations ; and improve social behavior and sleep
patterns.
➢ Tricyclics :it is the family of drugs which are used in the treatment of depression.
These drug increase the availability of the neurotransmitter norepinephrine.
Depression can also be treated with MAO (mooamine oxidase) inhibitors. These
drugs prevent the breakdown of norepinephrine and thus increase its availability.
➢ Lithium carbonate: it is a compound which reduces extreme mood elevations .
➢ Chemotherapy help to relieve several kinds of behavior related problems.
Disadvantages of chemotherapy includes side effects like tardive dyskinesia
(physical disorder in which there is uncontrollable facial movements(grimacing or
lipsmacking), limb movements like finger twitching and jerking of the arm or leg,
contractions of the neck and back muscles. It is seen in individuals who have
consumed heavy doses of antipsychotic drugs.

11. Psychodynamic therapies
Psychodynamic therapies are the methods aimed at unraveling the dynamics of
problem behavior and helping the client achieve insight into those dynamics.
❑ Freud’s traditional psychoanalysis:
✓ Probing the unconscious: Free association and dream analysis- in free association
techniques patients are asked to let their thoughts run free, without censorship,
reporting them as they occur. To facilitate their free association , patients are
asked to relax on a couch and look away from the analyst. Unexpected trains of
thought, sudden memory lapses and unusual statements give the analyst clues to
the patient’s expressed thoughts, feelings and conflicts. Dream analysis is the
another pathway to the unconscious. Id urges and unconscious conflicts push from
expression even if the individual is asleep and their defense mechanism relax a bit
during sleep. In analyzing dreams, a psychoanalyst tries to understand the
particular urges that a patient has repressed and the conflicts that are hidden from
view.
✓ Coping with resistance, transference and countertransference: resistance is
defined as the efforts to avoid, evade by rejecting the analyst’s interpretations ,
holding back crucial information or failing to remember. Transference is the ability
of psychoanalysts to analyze the patient’s attitudes and feelings towards people
outside analysis, for example parent- child relationships. Positive transference
occurs when emotions such as affection and dependence are involved; and when
emotions of hostility are involved it is called negative transference.
Countertransference reactions are the transference of analyst’s relationship with
the patient certain attitudes and feelings that originated in the analyst’s
relationships outside the analysis.

12. Psychodynamic therapies
✓Insight, “working through”, and termination-
The last stages of analysis are reached when
the patient achieves insight into the sources of
his or her anxiety and neurotic behavior.
Working through is the process of repeatedly
bringing repressed material into the surface,
after interpretation. By working through
conflicts, the patient lessens the need to
repress them. As anxiety is reduced and
repression weakened, the neurotic behavior
that brought the patient into treatment is
gradually diminished.

13. Psychodynamic therapies
❑Traditional versus contemporary
psychoanalysis:
➢Traditional analysis make patients too
dependent on their analyst.
➢Most of the psychiatrist utilize the
psychoanalytic methods but most commonly
used approach was Freud’s original approach.

14. Psychodynamic therapies
❑ Dissident theorists and their techniques: Jung, Alder and Horney:
➢ Jung, Alder and Horney’s approaches were psychodynamic i.e. they focus on the
underlying causes of a disorder and strive for insight development .
➢ Jung’s approach : it was also known as analytical therapy . His theory putted more
emphasis on the each person’sneed for individuation (becoming a single,
homogeneous).individuation involves putting the parts of one’s psychological self
together into a unified whole. He believed that so long as the feeling parts of
oneself are hidden away in the unconscious , those part cannot be integrated with
the more rational , practical parts of the self to form a fully functional balanced
person. He utilized the association technique or dream analysis in which he
observed for the messages from the unconscious that had been converted into
symbols.
➢ Alfred Alder approach: it is also known as individual therapy. The main focus is on
the social and interpersonal factors. They concentrate less on the unconscious
process and biological drives than on the patient’s need for meaning, personal
freedom, and a fulfilling style of life.
➢ Horney’s approach: Horney’s form of analysis emphasized more on the social
factors. Basic anxiety is social rather than a biological experience. It is an
experience that grows out of childhood feelings of isolation and helplessness.
Basic anxiety can lead to various ineffective interpersonal coping strategies. The
patients are advised to identify their maladaptive interpersonal strategies and
their reasons for using these strategies ; then they try to lead their patients toward
more constructive interpersonal styles and greater self- reliance.

15. Humanistic and existential therapies
❑ Client- centered therapy
➢ This theory was developed by Carl Rogers.
➢ The main aim of the client- centered therapy is to reduce the
discrepencies and pain which are caused by the maladjustment occurring
in individuals who are unable to perceive reality and the way the world
actually is.
➢ Client- centered process: in this therapy the patient are considered as
clients and client itself shapes the process. the therapist tries to help by
facilitating self- awareness in the client and by nurturing a humane client-
therapist relationship.
➢ Qualities of relationship between client and therapist:
✓ The therapist must have empathy for the client (i.e. an ability to
understand the client’s views and feelings).
✓ The therapist must give sensitive, unconditional positive regard, never
criticizing, always accepting. Therapist should not judge, probe or
disapprove.
✓ The therapist must be genuine (open, spontaneous and caring).
➢ Reflection of feeling: the therapist facilitates clients awareness by
reflecting the essence of the feelings they are expressing. The
interchanges can be productive and thoughtfull if therapists succeed at
seeing the world as their clients do.

16. Humanistic and existential therapies
❑Gestalt therapy-
➢ This approach encourages people to shed their
defenses, unlock their potential , accepting
responsibility the way they are and focusing on the
here and now.
➢ Gestalt therapy main emphasis is on staying in touch
with one’s feelings right now and expressing those
feelings to others.
❑Existential therapy-
➢ Existential therapies make their clients aware that they
always have choices and thus some control over their
fate.
➢ It is an intriguing blend of philosophy and psychology.
It also comprises of specific set of techniques like
paradoxical intention.

17. Behavioral therapies
❑ Instrumental or operant conditioning techniques-
➢ Functional analysis of Behavior:
✓ Antecedents: these are discriminative stimuli that acts as cues to the
individual , signaling when rewards are available and what particular
behavior is likely to be reinforced.
✓ Behavior: these are in response to the antecedents.
✓ Consequences : these are the reaction of the individual towards the
antecedents.
➢ Identifying positive and negative reinforcers:
✓ Positive reinforcers: events which increase the likelihood that the
response will be repeated by the individual.
✓ Negative reinforcers: events that increase the likelihood of a response
when their termination is imposed on the response.
➢ Extinction: it takes place when the reinforcement for a particular response
is withdrawn.
✓ Time-out from reinforcement or time- out: it is also called omission
training . In this a place is which have minimum positive reinforcements.

18. Behavioral therapies
❑ Differential reinforcement: this consists of giving positive
reinforcement for desired behaviors and with- holding it in
their absence.
❑ Shaping: there is use of prompts and successive
approximations. It is a sort of gradual nurturing of correct
responses.
❑ Token economies: people earn objects (tokens) , which they
can exchange for desirable items, services or previlages.
Token economies are used in institutions, classrooms,
sheltered workshops.
❑ Punishment: punishment can interfere with effective
learning. Punishment should not be used according to
most of the operant therspists.
❑ Covert sensitization: in this technique, the unwanted
behaviour is imagined together with its imaginary
punishing consequences. Covert- sensitization treatments
are used to treat obesity, smoking, compulsive behaviors.

19. Behavioral therapies
❑Classical conditioning techniques
• Systematic desensitization : In this technique
relaxation and pleasant feelings are learned as
conditioned responses to stimuli that once
acted as fear producers. It utilizes the principle
of reciprocal inhibition.
• Flooding : direct presentation of a high-
strength conditioned stimulus , either in
imagination or reality.
• Aversion therapy: the aim is to condition
unpleasant feelings in response to a stimulus.

20. Behavioral therapies
❑Modelling techniques
Obervational learning:
✓ Principle: cognitive learning (observational learning)
e.g. can be used in phobias
✓ There are two ways that observational learning helps
people to acquire new behavior.
(i) Information is provided regarding the steps by which
others are able to perform it.
(ii) It gives evidence for the possibility of that behavior . It
encourages the belief that “I can do it”.

21. Cognitive approaches
• Ellis’s rational – emotive theory:
it is designed to reveal and breakdown irrational beliefs that lead to
distress. Find the irrational belief and change it cognitively. For
example: avoiding some vegetables can be treated by knowing the
benefits of consuming that vegetable.
• Beck’s cognitive theory:
✓ It is used for depression.
✓ In this, the therapist uses pointed , but friendly questioning to root
out the depressed people’s faulty depressogenic cognitions. Then,
the therapist should work on altering these cognitions.
✓ Homeworks (scheduled home activities) and engaging patients to
enjoyable activities.
• Meichenbaum’s self- instructional training:
it helps clients to replace their maladaptive cognitions with rational,
positive thoughts, particularly when they are in stressful conditions.
It uses self- talk and relaxation . Problems like social anxiety, por
self- cotrol and achievement deficits can be treated with the help of
this training.

22. The emerging field of behavioral
medicine
Behavioral medicine or health psychology : it involves
the application of behavioral – science knowledge and
techniques to problems involving health and physical
illness. It is more focused on medical problems like
hypertension, chronic headache, heart ailments,
diabetes, obesity, cancer.
❑Relaxation training: it can be supplemented by guided
imagery, with the therapist directing the client to focus
on pleasant , relaxing scenes.
❑Hypnosis: it is defined as the state of deep sleep or
drowsiness. Therapists use this techinque to uncover
the psychological causes of a problem.
❑Biofeedback: it is a procedure in which people learn to
modify internal responses like heart rate and body
temperature. It is helpful in Raynaud’s syndrome.

23. The emerging field of behavioral
medicine
❑Therapy for groups:
❖Family therapy – the psychological problems
are interpreted and treated in systemic
manner entire family is being involved.
❖Group therapy- there is individual therapy.
Groups can be made of 5-15 peoples. There
are trainers and leaders (therapist).

24. Community psychology
❑Solving problem where they happen
❑Prevention (primary prevention- it involves
measures to stop serious psychological
problems before they happen , secondary
prevention- it involves identifying problems as
they begin to develop and stop them before
they becomesevere ,tertiary prevention – it
involves minimizing future difficulties in a
people identified with psychological disorders)
❑Social support : person- to- person helping: it
can help people cope with stressful life events

25. Cognitive Behavioural Therapy
Definition: it is defined as the psychotherapy technique which is based upon
the behavioral and cognitive principles. In this, the individual learns to
identify, question and change their thoughts , attitudes, beliefs and
assumptions related to their problematic emotional and behavioral
reactions to certain kinds of situations. CBT is “problem focused” and
“action- oriented”.
Fundamental concept of cognitive behavioral therapy:
➢ Identifying distortions in their thinking
➢ Seeing thoughts as ideas about what is going on rather than as facts
➢ Standing back from their thinking to consider situations from different
viewpoints.
changing maladaptive thinking leads to change in affect and behavior.
CBT : it is effective in the treatment of :
➢ Schizophrenia
➢ Depression
➢ Bipolar disorder
➢ Anxiety disorders
➢ Personality disorders
➢ Insomia

26. Cognitive Behavioural Therapy
characteristics of CBT:
➢ Structured
➢ Goal oriented and problem- focused
➢ Proven strategies and skills
➢ Emphasis on good relationship between therapist and client
phases of CBT:
➢ Psychological assessment
➢ Reconceptualization
➢ Skills acquisition
➢ Skills consolidation and application training
➢ Generalization and maintenance
➢ Post treatment assessment and follow-up
types of CBT:
❑ Brief CBT-
➢ it is used for situations in which there is time constraints
➢ It involves orientation, skill focus and relapse prevention
❑ Cognitive emotional behavioural therapy:
➢ It is used for eating disorders, post- traumati c stress disorder

27. Cognitive Behavioural Therapy
❑ SCBT( structured cognitive behavioral training):
➢ It is delivered in a highly regimented format
➢ It is a predetermined and finite training process that becomes
personalized by the input of the participant.
➢ It is used in substance abuse disorder, stress and anxiety.
❑ Moral reconation therapy:
➢ It is used for criminals.
➢ It decreases the risk of further crime.
❑ Stress inoculation training:
➢ It uses a blend of cognitive, behavioral and humanistic training
techniques.
➢ Conceptualization: it includes psychological testing,client self
monitoring. Clients learn how to categorize problems into emotion-
focused and problem- focused.
➢ Skills acquisition: it involves self regulation, problem solving
➢ Application: it includes role- playing, imagery, modelling.

28. Alternative cognitive behavioral
approaches
❑ Mindfulness therapy and mindfulness- based cognitive
therapy: mindfulness is a state of awareness, openness
and receptiveness that allows people to engage fully in
what they are doing at any given moment.
❑ Acceptance and commitment therapy: it is also known as
ACT helps individuals to notice and accept thoughts and
feelings in the present moment.
❑ Dialectical behavioural therapy: it is effective treatment for
the people with extensive mood swings , self- harming
behaviour.
❑ Metacognitive therapy: it was developed to treat
generalized anxiety disorder . Metacognition is the aspect
of cognition that controls mental processes

30. Thank you