Therapy can take various forms—cognitive behavioral therapy, mindfulness-based

cognitive therapy, psychodynamic therapy, or a combination of these—but at the center of each

is the caring relationship between a mental health professional and a patient.

Psychotherapy is a general term for treating mental health problems by talking with a
psychiatrist, psychologist or other mental health provider. During psychotherapy, you learn
about your condition and your moods, feelings, thoughts and behaviors.

Psychotherapy helps people with a mental disorder to:

 Understand the behaviors, emotions, and ideas that contribute to his or her illness and learning
how to modify them.
 Understand and identify the life problems or events -- like a major illness, a death in the family, a
loss of a job, or a divorce -- that contribute to their illness and help them understand which
aspects of those problems they may be able to solve or improve.
 Regain a sense of control and pleasure in life.
 Learn coping techniques and problem-solving skills.

Types of Therapy

Therapy can be given in a variety of formats, including:

 Individual: This therapy involves only the patient and the therapist.
 Group: Two or more patients may participate in therapy at the same time. Patients are able to
share experiences and learn that others feel the same way and have had the same experiences.
 Marital/couples: This type of therapy helps spouses and partners understand why their loved
one has a mental disorder, what changes in communication and behaviors can help, and what
they can do to cope.
 Family: Because family is a key part of the team that helps people with mental illness get better,
it is sometimes helpful for family members to understand what their loved one is going through,
how they themselves can cope, and what they can do to help.
 Different approaches to therapy include:

A) Psychodynamic Therapy:

 Psychodynamic therapy is based on the assumption that a person is having emotional

problems because of unresolved, generally unconscious conflicts, often stemming from
 childhood. The goal of this type of therapy is for the patient to understand and cope better
with these feelings by talking about the experiences. Psychodynamic therapy is
administered over a period of at least several months, although it can last longer, even
years.

B) Interpersonal Therapy

Interpersonal therapy focuses on the behaviors and interactions a patient has with family and
friends. The primary goal of this therapy is to improve communication skills and increase self-
esteem during a short period of time. It usually lasts three to four months and works well
for depression caused by mourning, relationship conflicts, major life events, and social isolation.

Psychodynamic and interpersonal therapies help patients resolve mental illness caused by:

 Loss (grief)
 Relationship conflicts
 Role transitions (such as becoming a mother, or a caregiver)

C) Cognitive-Behavioral Therapy

Cognitive-behavioral therapy helps people with mental illness to identify and change inaccurate
perceptions that they may have of themselves and the world around them. The therapist helps the
patient establish new ways of thinking by directing attention to both the "wrong" and "right"
assumptions they make about themselves and others.

Cognitive-behavioral therapy is recommended for patients:

 Who think and behave in ways that trigger and perpetuate mental illness.
 Who suffer from depression and/or anxiety disorders as the only treatment or, depending on the
severity, in addition to treatment with antidepressant medication.
 Who refuse or are unable to take antidepressant medication.
 Of all ages who have mental illness that causes suffering, disability, or interpersonal problems.

a) Cognitive Techniques
i) Rational analysis Focussing on specific incidents from CTs’ lives and demonstrating the art of
disputing the irrational beliefs underlying their distress.
ii) Double-standard dispute If CTs are holding a ‘should’ or are self-downing about their
behaviour, ask them whether they would recommend that their best friend hold this same
‘should’ or would they assess theirfriend in the same way. When Client say no then help them to
see that this action indicates the presence of a double standard.

Devil’s Advocate
Therapist argues vigorously for irrational belief of Client while Client tries to convince therapist
that belief is irrational. Good to use for consolidation purposes.

Reframing
Re-evaluate bad events as ‘disappointing’, ‘concerning’, or ‘uncomfortable’, rather than as
‘awful’ or ‘unbearable’. A variation of this procedure is to list the positives of a negative event.

Rational-emotive imagery
A form of mental practice, that allows a person to imagine himself thinking, feeling and
behaving exactly the way he would like to in actual life. First, the Client imagines a situation that
would normally upset a great deal, to feel the inappropriately intense feelings about that event
and then change them to more appropriate feelings. The Client keeps practicing such a procedure
‘several times a week for a few weeks’ then the Client will reach a point where he is no longer
troubled by the event.
Shame-attacking exercises
Aim of these exercises is for Client to feel unashamed even when others disapprove of their
actions.

Exposure
lonely people go out and talk to a dozen people in their shopping centre or at their next party,
thereby showing them that meeting people is not so unpleasant as they had previously thought.

Stepping out of character

This technique is the use of a paradoxical behavior. A perfectionist may be asked to deliberately
do something that is not up to her normal standard; a person who doesn’t care for himself
because he believes that to be selfish would be invited to indulge in a personal treat each day for
a week.

D) BEHAVIOR THERAPY:

This approach focuses on learning's role in developing both normal and abnormal behaviors.
Behavior therapy is a broad term referring to psychotherapy, behavior analytical, or a
combination of the two therapies. In its broadest sense, the methods focus on either just
behaviors or in combination with thoughts and feelings that might be causing them. Those who
practice behavior therapy tend to look more at specific, learned behaviors and how the
environment has an impact on those behaviors.

METHODS:

 Behavior management
 Behaviour modification
 Operant conditioning
 Respondent conditioning
 Systematic desensitisation
 Flooding
 Modeling
 Covert conditioning
 Exposure and response prevention
 Observational learning
 Contingency management
 Matching law
 Habit reversal training
Habit reversal training (HRT) is a "multi component behavioral treatment package originally
developed to address a wide variety of repetitive behavior disorders".
Behavioral disorders treated with HRT include tics, trichotillomania, nail biting, thumb sucking,
and skin picking.
HRT consists of five components:

 awareness training,
 competing response training,
 contingency management,
 relaxation training, and
 Generalization training.
Behavior modification—quite similar to operant conditioning (except antecedents are either
absent or assumed)—relies on the following:

 Reinforcement (Positive and Negative)

 Punishment (Positive and Negative)
 Extinction
 Shaping
 Fading
 Chaining

E) Family therapy, also referred to as couple and family therapy, marriage and family
therapy, family systems therapy, and family counseling, is a branch of psychotherapy that
works with families and couples in intimate relationships to nurture change and
development. It tends to view change in terms of the systems of interaction between family
members. It emphasizes family relationships as an important factor in psychological health

Techniques
Family therapy uses a range of counseling and other techniques including:
Structural therapy - Identifies and Re-Orders the organization of the family system
Strategic therapy - Looks at patterns of interactions between family members
Systemic/Milan therapy - Focuses on belief systems
Narrative Therapy - Restoring of dominant problem-saturated narrative, emphasis on context,
separation of the problem from the person
Trans generational Therapy – Trans generational transmission of unhelpful patterns of belief
and behaviour.

F) Interpersonal psychotherapy (IPT) is a time-limited treatment that encourages the patient to

regain control of mood and functioning typically lasting 12–16 weeks. IPT is based on the
principle that there is a relationship between the way people communicate and interact with
others and their mental health
Techniques
• Clarification.
• Communication analysis
• Interpersonal incidents
• Use of affect
• Role playing
• Problem solving
• Homework
• Use of therapeutic relationship

Clarification
• Asking good questions so the therapist can understand the patient's experience
• Asking very good questions so that the patient can understand their own experiences better
• Asking extraordinary good questions so that the patient is motivated to change their behaviour.

Communication analysis:
• Help patient – identify their communication pattern – see the contribution they make to
difficulties in communication.
• Motivate patient to communicate more effective

Focus of therapy
• Interpersonal disputes.
• Role transitions
• Grief
G) Play therapy is generally employed with children aged 3 through 11 and provides a way for
them to express their experiences and feelings through a natural, self-guided, self-healing
process. As children’s experiences and knowledge are often communicated through play, it
becomes an important vehicle for them to know and accept themselves and others.

H) Person-centered therapy (PCT) is also known asperson-centered psychotherapy, person-

centered counseling, client-centered therapy andRogerian psychotherapy. PCT is a form of
talk-psychotherapy developed by psychologist Carl Rogers in the 1940s and 1950s. The goal of
PCT is to provide clients with an opportunity to develop a sense of self where they can realize
how their attitudes, feelings and behavior are being negatively affected.
Techniques

Client Centered counselors would not say they use techniques – rather they have an approach of
being empathetic, accepting and truly “there” for the client. Having said that the following skills
are central:

• Active and empathic listening

• Reflection of content and feelings

• Genuineness which may include appropriate self-disclosure by counselor

• Active Listening

• Encouraging Body Language

• Good Tone

• Open Ended and Closed Questions

• Paraphrasing

• Summarizing

According to Rogerian theory, the six factors necessary for growth are:

1. Therapist-Client Psychological Contact: This first condition simply states that a

relationship between therapist and client must exist in order for the client to achieve positive
personal change. The following five factors are characteristics of the therapist-client
relationship, and they may vary by degree.
2. Client Incongruence or Vulnerability: A discrepancy between the client’s self-image and
actual experience leaves him or her vulnerable to fears and anxieties. The client is often
unaware of the incongruence.
3. Therapist Congruence or Genuineness: The therapist should be self-aware, genuine, and
congruent. This does not imply that the therapist be a picture of perfection, but that he or she
be true to him- or herself within the therapeutic relationship.
4. Therapist Unconditional Positive Regard (UPR): The clients’ experiences, positive or
negative, should be accepted by the therapist without any conditions or judgment. In this
way, the client can share experiences without fear of being judged.
5. Therapist Empathy: The therapist demonstrates empathic understanding of the clients’
experiences and recognizes emotional experiences without getting emotionally involved.
6. Client Perception: To some degree, the client perceives the therapist’s unconditional
positive regard and empathic understanding. This is communicated through the words and
behaviors of the therapist.