Psychotherapeutic Methods for IGNOU students

IGNOU MAPC material© 2016, M S Ahluwalia Psychology Learners
MPCE-013/ASST/TMA/2015-16
IGNOU Assignment

Psychotherapeutic Methods
Solved Assignment - MAPC

1000 words
Section A
3

Discuss the basic tenets of
psychoanalytic therapy. How do neo-
psychoanalytic models differ from
Freud’s psychoanalysis?
Q1.

Basic tenets of Psychoanalytic Therapy
5
A1
Psychoanalytic or psychodynamic psychotherapy draws on theories and practices of analytical psychology and
psychoanalysis. It is a therapeutic process which helps patients understand and resolve their problems by increasing
awareness of their inner world and its influence over relationships both past and present. It differs from most other
therapies in aiming for deep seated change in personality and emotional development.
Basic Tenets of Psychoanalytic Therapy
Psychoanalytic psychotherapy is based on a number of tenets. These include:
1. The Unconscious: The idea that some mental processes, such as motives, desires, and memories are not
available to awareness or conscious introspection. It is often referred to as unconscious mental functioning or
unconscious processing.
Unconscious forms the largest part of the human psyche. It is not within our awareness, but can be explored
indirectly through psychoanalysis. The two key drives are Eros (Libido or Life drive) and Thanatos (Aggression or
Death drive).
2. Defense mechanism: While some mental processes are out of our awareness, this is a process in which people
are also motivated to push threatening thoughts or feelings from awareness. Intrapsychic conflict between Id and
SuperEgo leads to anxiety.
Ego defence mechanisms are normal and healthy methods to mediate this conflict by denying or distorting
reality to protect the fragile balance of the psyche. Includes repression, denial, projection, displacement,
sublimation, reaction formation and compensation.
3. Developmental Perspective: Childhood relationships with caregivers are seen as playing a role in shaping current
relationships. The theory is probabilistic in regards to this relationship.
The developmental perspective is covered in the psychosexual and psychosocial stages of development laid out
in psychoanalysis.

Basic tenets of Psychoanalytic Therapy contd.
6
A1
4. Individual or Personal meaning of events: Psychodynamic clinicians are interested in the patient’s
phenomenological experience – how the patient experiences himself, important others, the world in general.
In this way the psychodynamic clinicians are focused on what is called schema or schemata in CBT terminology.
They are seen as having explicit, conscious and implicit unconscious aspects.
5. Transference: The tendency to unwittingly construct and create, through an active but unconscious process, the
pattern of imagined and real past relationships with an important person.
The creation of the transference derives from the patient. Most often, the patient “creates” the transference out
of an active, though unconscious, aspect of repeating a past experience.
6. Counter-transference: The experience of transference by analysts and therapists. The analyst’s awareness and
attention to countertransference permits the analyst/therapist to have a fuller appreciation of the drama of the
patient’s life.
The analyst does not act on the countertransference but rather uses her awareness of these feelings as further
information to inform the understanding of the patient’s world.
7. Resistance: It has two aspects, viz.
a. Neutrality: The stance which the analyst/therapist takes in which he or she does not express personal
preferences to the patient and does not ally himself or herself with important dimensions of the patient’s
conflict.
b. Abstinence: the analyst avoids gratifying the patient’s wishes, whatever those might be—praise or
punishment—direction or to be left alone.

Difference with Neo-Psychoanalytic Models
7
A1
Neo-Freudian psychologists were thinkers who agreed with many of the fundamental tenets of Freud's
psychoanalytic theory but changed and adapted the approach to incorporate their own beliefs, ideas, and opinions.
There are a few different reasons why these neo-Freudian thinkers disagreed with Freud. For example, Erik Erikson
believed that Freud was incorrect to think that personality was shaped almost entirely by childhood events. Other
issues that motivated neo-Freudian thinkers included:
• Freud's emphasis on sexual urges as a primary motivator.
• Freud's negative view of human nature.
• Freud's belief that personality was shaped entirely by early childhood experiences.
• Freud's lack of emphasis on social and cultural influences on behavior and personality.
There were a number of neo-Freudian thinkers who broke with the Freudian psychoanalytic tradition to develop their
own psychodynamic theories. Some of these individuals were initially part of Freud's inner circle.
Carl Jung
Freud and Jung once had a close friendship, but Jung broke away to form his own ideas. Jung referred to his theory of
personality as analytical psychology, and he introduced the concept of the collective unconscious. He described this
as a universal structure shared by all members of the same species containing all of the instincts and archetypes that
influence human behavior.
Jung still placed great emphasis on the unconscious, but his theory placed a higher emphasis on his concept of the
collective unconscious rather than the personal unconscious. Like many of the other neo-Freudian's, Jung also
focused less on sex than did Freud.

Difference with Neo-Psychoanalytic Models contd.
8
A1
Alfred Adler
Adler believed that Freud's theories focused too heavily on sex as the primary motivator for human behavior. Instead,
Adler placed a lesser emphasis on the role of the unconscious and a greater focus on interpersonal and social
influences.
His approach, known as individual psychology, was centered on the drive that all people have to compensate for their
feelings of inferiority. The inferiority complex, he suggested, was a person's feelings and doubts that they do not
measure up to other people or to society's expectations.
Erik Erikson
While Freud believed that personality was mostly set in stone during early childhood, Erikson felt that development
continued throughout life. He also believed that not all conflicts were unconscious.
Many were conscious and the result, he thought, from the developmental process itself. Erikson de-emphasized the
role of sex as a motivator for behavior and instead placed a much stronger focus on the role of social relationships.
Karen Horney
Horney was one of the first women trained in psychoanalysis, and she was also one of the first to criticize Freud's
depictions of women as inferior to men. Horney objected to Freud's portrayal of women as suffering from "penis
envy."
Instead, she suggested that men experience "womb envy" because they are unable to bear children. Her theory
focuses on how behavior was influenced by a number of different neurotic needs.

Summary and Sources
9
A1
Freud is considered the father of Psychoanalysis. And his technique forms the base of the psychoanalytic therapy,
also known as the talking cure. The psychoanalytic psychotherapy is based on a number of tenets viz. The
Unconscious, Defense Mechanisms, Developmental Perspective, Individual or Personal meaning of events,
Transference, Counter-transference and Resistance.
Several psychologists close to Freud branched out to conceptualise their own models with psychoanalytic
underpinnings. Most of them had reservations about the importance to sex and lack of social focus. These included
Jung, Adler, Horney and Erikson amongst others.
* * *
Sources:
http://psychology.about.com/od/psychoanalytictheories/f/neo-freudian.htm
Core Approaches in Counselling and Psychotherapy by Fay Short and Phil Thomas (free preview)
Clinical Psychology: Assessment, Treatment, and Research edited by David C.S. Richard, Steven K. Huprich (free
preview)

Discuss the concept and applications of
behaviour modification. What are the various
methods used in behaviour modification?
Explain with suitable examples.
Q2.
10

Concept of Behavior Modification
11
A2
Behavior modification is the use of empirically demonstrated behavior change techniques to increase or decrease the
frequency of behaviors, such as altering an individual's behaviors and reactions to stimuli through positive and
negative reinforcement of adaptive behavior and/or the reduction of behavior through its extinction, punishment
and/or satiation.
Concept of Behavior Modification
Behavior modification is based on methodological behaviorism, which refers to limiting behavior-change procedures
to behaviors that are observable—in particular, superimposing consequences, such as increasing or decreasing the
frequency of behaviors and altering an individual's behaviors through positive and negative reinforcement to increase
desirable behavior and/or the reduction of behavior through extinction and punishment.
Behavior modification uses the principles of operant conditioning, which were developed by American behaviorist B.
F. Skinner (1904-1990). Skinner formulated the concept of operant conditioning, through which behavior could be
shaped by reinforcement or lack of it. Skinner considered his concept applicable to a wide range of both human and
animal behaviors and introduced operant conditioning to the general public in his 1938 book, The Behavior of
Organisms .
Martin and Pear indicate that there are seven characteristics to behavior modification, namely:
- strong emphasis on defining problems in terms of behavior that can be measured in some way
- treatment techniques are ways of altering an individual's current environment to help him/her function more fully
- methods and rationales can be described precisely
- techniques are often applied in everyday life
- techniques are based largely on principles of learning specifically operant conditioning and respondent conditioning
- There is a strong emphasis on scientific demonstration that a particular technique was responsible for a particular
behavior change
- There is a strong emphasis on accountability for everyone involved in a behavior modification program.

Applications of Behavior Modification and Methods used
12
A2
Applications of Behavior Modification
Behavior modification can be useful in a variety of situations:
1. Treatment of problems:
a. Clinical Psychology: Behavior modification has been successfully used to treat obsessive-compulsive
disorder (OCD), attention-deficit/hyperactivity disorder (ADHD), phobias, enuresis (bed-wetting),
generalized anxiety disorder , and separation anxiety disorder , among others.
b. Health Psychology: to increase compliance with medical regimens
c. Issues with children: helps treat problems such as bedwetting, noncompliance etc.
d. Mental Illnesses: Used to modify behaviors of patients with chronic mental illness
e. Developmental Disabilities: To reduce self-injurious behaviors, aggressive and destructive behaviors in such
patients
f. Rehabilitation: Used to improve the efficacy of rehabilitation routines and decrease problem behaviors
2. To increase desired behaviors in various settings:
a. Sports: increasing healthy lifestyle behaviors
b. Foster homes and prisons: helps in reducing recidivism for adolescents with conduct problems and adult
offenders
c. Community: to increase desired behaviors in the community. Ex: compliance with law
d. Industry: to enhance productivity and sales by influencing employee and consumer behavior
e. Schools and Colleges: to improve the pedagogy to ensure maximum learning by students
Methods used in Behavior Modification
Behavior modification methods can be divided into five categories:
1. Developing a new behavior:
a. Successive Approximation Principle: To teach a person to act in a manner in which he has seldom or never
before behaved, reward successive steps to the final behavior (also called shaping)

Methods used in Behavior Modification
13
A2
b. Continuous Reinforcement Principle: To develop a new behavior that the person has not previously
exhibited, arrange for an immediate reward after each correct performance.
c. Negative Reinforcement Principle: To increase a person’s performance in a particular way, arrange for him
to avoid or escape a mild aversive situation by improving his behavior or by allowing him to avoid the
aversive situation by behaving appropriately.
d. Cueing Principle: To teach a person to remember to act at a specific time, arrange for him to receive a cue
for the correct performance just before the action is expected rather than after he has performed it
incorrectly.
2. Strengthening a behavior:
a. Decreasing Reinforcement Principle: To encourage a person to continue performing an established
behavior with few or no rewards, gradually require a longer time period or more correct responses before
a correct behavior is rewarded.
b. Variable Reinforcement Principle: To improve or increase a person’s performance of a certain activity,
provide the child with an intermittent reward.
3. Maintaining an established behavior:
a. Substitution Principle: To change reinforcers when a previously effective reward is no longer controlling
behavior, present it just before (or as soon as possible to) the time you present the new, hopefully more
effective reward.
4. Stopping inappropriate behavior
a. Satiation Principle: allow the person to continue (or insist that he continue) performing the undesired act
until he tires of it.
b. Extinction Principle: To stop a person from acting in a particular way, you may arrange conditions so that
he receives no rewards following the undesired act.

Methods used in Behavior Modification contd.
14
A2
c. Incompatible Alternative Principle: To stop a person from acting in a particular way, you may reward an
alternative action that is inconsistent with or cannot be performed at the same time as the undesired act.
d. Response Cost Principle: To stop a person from acting in a certain way, remove a pleasant stimulus
immediately after the action occurs. Since response cost results in increased hostility and aggression, it
should only be used infrequently and in conjunction with reinforcement.
e. Punishment:
i. Positive Punishment: adding a negative consequence after an undesired behavior is emitted to
decrease future responses. Disapproval, criticism, pain and fines are common forms.
ii. Negative Punishment: taking away a certain desired item after the undesired behavior happens in
order to decrease future responses.
iii. Overcorrection: Can involve practicing correct behaviors after making mistakes (positive practice) or
correcting a mistake (restitution)
5. Modifying emotional behavior:
a. Avoidance Principle: To teach a person to avoid a certain type of situation, simultaneously present to the
child the situation to be avoided (or some representation of it) and some aversive condition (or its
representation).
b. Fear Reduction Principle: To help a person overcome his fear of a particular situation, gradually increase
his exposure to the feared situation while he is otherwise comfortable, relaxed, secure or rewarded.

Summary and Sources
15
A2
Behavior modification is an effective technique used to treat many problems related to clinical psychology, health
psychology, mental illnesses, rehabilitation etc. and to increase desired behaviors in various settings such as sports,
business, prisons etc.
It draws heavily on the concepts of respondent conditioning and operant conditioning. The methods used in Behavior
modification can be categorized into five sets – developing a new behavior, strengthening a behavior, maintaining an
established behavior, stopping inappropriate behavior and modifying emotional behavior.
* * *
Sources:
http://www.minddisorders.com/knowledge/Behavior_modification.html
https://en.wikipedia.org/wiki/Behavior_modification
http://www.minddisorders.com/A-Br/Behavior-modification.html
http://www.livestrong.com/article/105661-behavior-modification/
http://nspt4kids.com/parenting/the-difference-between-positive-and-negative-punishment/

What are the goals of client centered
therapy? Discuss the process adopted
in client centered therapy.
Q3.
16

Goals of client-centered therapy
17
A3
Client-centered therapy differs from other forms of therapy because client-centered therapy does not focus on
therapeutic techniques. What's most important in client-centered therapy is the quality of the relationship between
the therapist and the client.
Client-centered therapy was not intended for a specific age group or subpopulation, but has been used to treat a
broad range of people. It has been applied for use with people suffering from depression, anxiety, alcohol disorders,
cognitive dysfunction, schizophrenia, and personality disorders.
Goals of Client-centered therapy
Basic goals for the client: Considering this is a non-directive technique the therapist does not prescribe the goals.
Instead the client chooses his own goals, and also bears the responsibility of the treatment process. However there
are some basic goals that are there – the four basic goals a person will achieve in successful person-centered therapy.
They will become:
1. open to experience - more positive and comfortable relationships with others; and an increased capacity to
experience and express feelings at the moment they occur.
2. learn to trust themselves and have increased self-esteem: thus, have lower levels of defensiveness, guilt, and
insecurity.
3. develop an internal evaluation of themselves: include closer agreement between the client's idealized and actual
selves; better self-understanding
4. have a willingness to continue growing.
Goal for the therapist: A major goal is to provide a climate of safety and trust in the therapeutic setting so that the
client, by using the therapeutic relationship for self-exploration, can become aware of blocks to growth. The client
tends to move toward more openness, greater self-trust, more willingness to evolve as opposed to being a fixed
product, and a tendency to live by internal standards as opposed to taking external cues for what he or she should
become.

Process of client-centered therapy
18
A3
The aim of therapy is not merely to solve problems but to assist in the growth process, which will enable the client to
better cope with present and future problems. Person-centered therapists are in agreement on the matter of not
setting goals for what clients need to change, yet they differ on the matter of how to best help clients achieve their
own goals.
Process of client-centered therapy
The three phases are:
1. Catharsis: Catharsis involves a gradual and more complete expression of emotionalized attitudes. The
conversation goes from superficial problems and attitudes to deeper problems and attitudes. This process of
exploration gradually unearths relevant attitudes which have been denied to consciousness.
2. Insight: involves more adequate facing of reality as it exists within the self, as well as external reality; that it
involves the relating of problems to each other, the perception of patterns of behavior; that it involves the
acceptance of hitherto denied elements of the self, and a reformulating of the self-concept; and that it involves
the making of new plans.
3. Positive choice and action: In the final phase, the choice of new ways of behaving will be in conformity with the
newly organized concept of the self; that first steps in putting these plans into action will be small but symbolic;
that the individual will feel only a minimum degree of confidence that he can put his plans into effect, that later
steps implement more and more completely the new concept of self, and that this process continues beyond the
conclusion of the therapeutic interviews.
Roger further described the continua of change in a client comprising of the following seven stages:
1. Loosening of feelings
2. Change in the manner of experiencing: therapists have a modest amount of success working with clients at this
stage
3. Shift from incongruence to Congruence: Therapy typically begins at this stage

Process of client-centered therapy contd.
19
A3
4. Change in the manner and extent of communication
5. Loosening of the cognitive maps of experience
6. Change in the individual’s relationship to his problems: the moments of immediate, full accepted experiencing
are in some sense almost irreversible
7. Change in the manner of relating
There is a stage beyond therapy in which the client is not much in need of the therapist’s help – ‘transference cure’.
Rogers believed that the most important factor in successful therapy was not the therapist's skill or training, but
rather his or her attitude. Three interrelated attitudes on the part of the therapist are central to the success of
person-centered therapy:
1. Congruence refers to the therapist's openness and genuineness—the willingness to relate to clients without
hiding behind a professional facade. Therapists who function in this way have all their feelings available to them
in therapy sessions and may share significant emotional reactions with their clients.
2. Unconditional positive regard means that the therapist accepts the client totally for who he or she is without
evaluating or censoring, and without disapproving of particular feelings, actions, or characteristics. The therapist
communicates this attitude to the client by a willingness to listen without interrupting, judging, or giving advice.
3. The third necessary component of a therapist's attitude is empathy ("accurate empathetic understanding"). The
therapist tries to appreciate the client's situation from the client's point of view, showing an emotional
understanding of and sensitivity to the client's feelings throughout the therapy session.
According to Rogers, when these three attitudes (congruence, unconditional positive regard, and empathy) are
conveyed by a therapist, clients can freely express themselves without having to worry about what the therapist
thinks of them. The therapist merely facilitates self-actualization by providing a climate in which clients can freely
engage in focused, in-depth self-exploration.

Process of client-centered therapy contd., Summary and
Sources
20
A3
This list has since been expanded to:
- Unconditional positive regard (discussed above)
- Empathetic understanding (discussed above)
- Genuineness and congruence (discussed above)
- Transparency: All feelings about the client are expressed, even if negative.
- Self-disclosure: Degree to which therapists may express and disclose themselves
- Concreteness: Focusing discussion on specific, events, thoughts and feelings that matter
- Cultural awareness: therapist should be cognizant of cultural differences and their impact
* * *
Person-centered therapy is based on an organismic psychology which describes the innate and unforced tendency of
human beings, given a conducive environment, to actualize their potential. The major goal for the therapist is to
provide a climate of safety and trust so that the client is able to achieve the four basic goals of becoming – open to
experience, learning to trust themselves and have increased self-esteem, develop an internal evaluation of
themselves, and have a willingness to continue growing. The process of therapy involves three phases of catharsis,
insight and positive choice and action.
Sources:
http://www.minddisorders.com/Ob-Ps/Person-centered-therapy.html
http://study.com/academy/lesson/client-centered-therapy-by-rogers-techniques-definition-quiz.html
Theory and Practice of Counseling and Psychotherapy By Gerald Corey (free preview)
Person Centred Therapy 100 Key points By Paul Wilkins (free preview)
Significant Aspects of Client-Centered Therapy By Carl R. Rogers (free)
Person-Centred Therapy: A Clinical Philosophy By Keith Tudor, Mike Worrall (free preview)

400 words
Section B
21

Discuss the techniques used in
interpersonal therapy.
Q4.
22

Techniques used in interpersonal therapy
23
A4
It is the focus on extra-therapeutic interpersonal relationships rather than any particular intervention which
characterizes IPT. Not surprisingly, given its psychodynamic roots, IPT incorporates a number of “traditional”
psychotherapeutic methods, such as exploration, clarification, and even some directive techniques.
The techniques used in interpersonal therapy are discussed below:
Nonspecific Techniques
Nonspecific techniques are generally understood as those that are held in common across most psychotherapies.
Examples would be the use of Directive and Non-Directive techniques such as open-ended questions, clarifications,
and the expression of empathy by the therapist.
These techniques play a crucial role in IPT, as they serve to help the therapist understand the patient’s experience,
convey that understanding to the patient, and to provide information regarding the genesis of the patient’s problems
and potential solutions to them.
Techniques such as problem solving with the patient, giving directives, and assigning homework can also be used
judiciously in the service of facilitating interpersonal change.
Communication Analysis and Interpersonal Incidents
Communication analysis requires that the therapist elicit information from the patient about important interpersonal
incidents. Interpersonal incidents are descriptions by the patient of specific interactions with a significant other.
The goal in working through an interpersonal incident is to examine the patient’s communication so that maladaptive
patterns of communication can be identified. The patient can then begin to modify his or her communication so that
his or her attachment needs are better met.

Techniques used in interpersonal therapy, Summary and
Sources
24
A4
Use of Affect
The more the patient is affectively involved in the issues
being discussed, the greater the motivation to change
behavior or communication style. Consequently, one of
the most important tasks for the IPT therapist is to attend
to the patient’s affective state.
Of particular importance are those moments in therapy in
which the patient’s observed affective state, and his or
her subjectively reported affect, are incongruent.
Examining this inconsistency in affect can often lead to
breakthroughs in therapy.
Use of Transference
By observing the developing transference, the therapist
can begin to draw hypotheses about the way that the
patient interacts with others outside of the therapeutic
relationship. Sullivan coined the term “parataxic
distortion” to describe this phenomena: The way in which
a patient relates to the therapist in session is a reflection
of the way in which he or she relates to others as well.
Using these data, the therapist can then begin to draw
conclusions about the patient’s attachment style and
problems in communicating to others. The therapist
should ask questions to confirm or disprove these
hypotheses.
* * *
IPT is a time-limited, dynamically informed psychotherapy
that aims to alleviate patients’ suffering and improve
their interpersonal functioning. To achieve these
objectives it makes use of several techniques viz.
Directive and non-directive exploration, Clarifications,
Communication Analysis and Interpersonal incidents, Use
of Affect and Use of Transference.
Sources:
Comprehensive Handbook of Psychological Assessment:
Intellectual and Neuropsychological Assessment edited by
Michel Hersen (free preview)

Discuss the process of cognitive
behaviour therapies.
Q5.
25

Process of Cognitive Behaviour Therapy
26
A5
Cognitive-behavioral therapy is an action-oriented form of psychosocial therapy that assumes that maladaptive, or
faulty, thinking patterns cause maladaptive behavior and "negative" emotions. The treatment focuses on changing an
individual's thoughts (cognitive patterns) in order to change his or her behavior and emotional state.
The process of CBT is as follows:
1. Rapport formation and Client engagement: Build a relationship with the client by using the core human
elements of empathy, warmth and respect. Look out for any negative impacters such as interview related anxiety.
Thereafter, build confidence in them that change is possible using CBT. Knowing that CBT will help them will
engage them into the treatment.
2. Assessment: This step focuses on assessment of three things - the problem, the person, and the situation. Some
of the most common areas that are assessed include
a. Symptoms - Severity of the problem
b. Predisposing factors - Client’s personal and social history, Relevant personality factors
c. Precipitating factors - Non-psychological causative factors
d. Triggers - Presence of any related clinical disorders
e. Beliefs and assumptions - Client’s view of the problem
f. Maintenance processes - Secondary disturbances
3. Preparation: After the assessment, the client is prepared for the therapy. The preparation involves helping the
client understand the treatment goals, assessing client’s motivation levels for therapy and increasing client’s
knowledge about CBT. This is followed by discussing approaches to be used and the implications of treatment.
Once the discussion has happened a contract is developed.
4. Implementation: In this phase the treatment program that is found most suitable based on the above steps is
implemented. The treatment program involves using activities such as Socratic questioning, identifying cognitive
errors, experimentation, changing self-talk from negative to positive, homework tasks and thought
recording/rational analysis.

Process of Cognitive Behaviour Therapy, Summary and
Sources
27
A5
Supplementary strategies & techniques may include : relaxation training, interpersonal skills training, etc.
5. Evaluation: After the implementation phase an evaluation is conducted to assess whether improvement is due to
significant changes in the client’s thinking, or due to an improvement in their external circumstances.
6. Termination: Finally, the client is prepared for the termination of therapy, so that if they slip back and discover
their old problems are still present to some degree, they don’t despair and continue their self-help work. Clients
should be warned about possibility of relapse and apprised of appropriate next steps. They should also be
coached on seeking help again in case of relapse.
* * *
In Cognitive Behavior Therapy the more the client knows about how the problem works and about the techniques to
manage and overcome the problem, the more the client can become their own therapist. The CBT process is
designed to help achieve this goal and involves the following steps: rapport formation and client engagement,
assessment, preparation, implementation, evaluation, and termination.
Sources:
A Brief Introduction To Cognitive-Behaviour Therapy By Wayne Froggatt (free)
Core Approaches in Counseling and Psychotherapy by Fay Short and Phil Thomas (free preview)

What are the basic features of solution
focused therapy? Discuss the
treatment principles of solution focused
therapy.
Q6.
28

Solution focused therapy and its features
29
A6
Steve deShazer conceptualized therapy as a search for solutions rather than an exploration and analysis of problems.
This solution-focused approach, can be readily adapted to the single-session framework.
By focusing on client goals and quickly initiating a search for imagined or experienced exceptions to client patterns,
solution-focused therapists are able to quickly move treatment to an action phase, greatly abbreviating the change
process.
Features of solution focused therapy
1. Solution focus: A movement from problem-talk to solution-talk and a focus on keeping therapy simple and brief.
There are exceptions to every problem, and by talking about these exceptions, clients are able to conquer what
seem to be gigantic problems.
2. Client is competent: Solution-focused therapists make the assumption that clients are competent and that the
therapist’s role is to help clients recognize the competencies they already possess and apply them toward
solutions.
3. Focus on what is working: Thus, attention is paid to what is working, and clients are encouraged to do more of
this. Change is constant and inevitable, and a small change leads to other changes until the “solution
momentum” outweighs the problem momentum.
4. Pathology is not the focus: Little attention is paid to pathology or to giving clients a diagnostic label. A therapist’s
not-knowing stance creates an opportunity for the client to construct a solution.
5. Focus on client’s agenda: SFT attends to the problem presented by the client. The closer the counselor can keep
to the client’s agenda, the more likely the client will be motivated to change.

Treatment Principles, Summary and Sources
30
A6
Treatment principles of solution focused therapy
Working together in a collaborative relationship, both the therapist and client develop useful treatment goals. The
underlying treatment principles, applicable to both, are:
•Complex problems do not necessarily require complex solutions: It is possible that there is a simple solution for the
most complex of problems being faced by the client.
•Fix what is broken: People are not problems, they have problems. Don’t treat the clients as being sick or damaged.
Look for what is healthy and functioning in their lives.
•A small change can cause big changes: The therapist attempts to create an atmosphere of understanding and
acceptance that allows individuals to tap their resources for making constructive changes.
•Repeat what works: Encourage the clients to continue what they can do well. This will build their confidence. This
constructive behaviour may have started prior to the counseling.
•Stop what doesn’t work: Encourage the clients to do something different (almost anything) to break the failure
cycle.
•Simple counseling: Don’t begin a search for hidden explanations and unconscious factors. Focus on the problem and
finding its solution.
* * *
The solution-focused model emphasizes the role of clients establishing their own goals and preferences. This is done
when a climate of mutual respect, dialogue, inquiry, and affi rmation are a part of the therapeutic process. We also
discussed the various features and treatment principles of solution focused therapy.
Sources:
Comprehensive Handbook of Psychological Assessment: Intellectual and Neuropsychological Assessment edited by
Michel Hersen (free preview)

What do you understand by attachment
based interventions? Discuss the
technique used in attachment based
interventions.
Q7.
31

Attachment Based Interventions
32
A7
Attachment-based interventions are based on attachment theory, originated by John Bowlby. These range from
individual therapeutic approaches to public health programs to interventions specifically designed for foster cares.
Following are approaches used by mainstream attachment theorists and clinicians aimed at infants or children who
have developed or are at risk of developing less desirable, insecure attachment styles or an attachment disorder.
Dyadic developmental psychotherapy: For families that have children with symptoms of emotional disorders,
including complex trauma and disorders of attachment. The "dyad" referred to must eventually be the parent-child
dyad. It involves creating a "playful, accepting, curious, and empathic" environment in which the therapist attunes to
the child's "subjective experiences" and reflects this back to the child.
Child–parent psychotherapy (CPP): This approach to treating disturbed infant–parent relationships is based on the
theory that disturbances are manifestations of unresolved conflicts in the parent's past relationships. The "patient" is
the infant–parent relationship.
'Circle of Security': The aim is to present ideas to the parents in a user-friendly, common-sense fashion that they can
understand both cognitively and emotionally. This is done by a graphic representation of the child's needs and
attachment system in circle form, summarising the child's needs and the safe haven provided by the caregiver.
"Watch, wait and wonder", Cohen et al. (1999): It is based on the notion of the infant as initiator in infant–parent
psychotherapy. The idea is that it increases the mother's sensitivity and responsiveness by fostering an observational
reflective stance, whilst also being physically accessible. Also the infant has the experience of negotiating their
relationship with their mother.
"Manipulation of sensitive responsiveness", van den Boom (1994) (The Leiden Programs): This intervention was
based on Ainsworth's sensitive responsiveness components, namely perceiving a signal, interpreting it correctly,
selecting an appropriate response and implementing the response effectively.

Attachment Based Interventions, Summary and Sources
33
A7
"Modified interaction guidance", Benoit et al. (2001): This intervention aimed to reduce inappropriate caregiver
behaviours as measured on the AMBIANCE (atypical maternal behaviour instrument for assessment and
classification). Such inappropriate behaviours are thought to contribute to disorganized attachment.
Feedback methods such as VIPP, CAVES and VIG: Videofeedback intervention to promote positive parenting (VIPP)
aims to promote maternal sensitivity through the review of taped infant–parent interactions and written materials.
Clinician assisted videofeedback exposure sessions (CAVES)and VIG (video interaction guidance)are the other two
methods.
Attachment and biobehavioral catch-up (ABC): This an intervention programme aimed at infants who have
experienced early adverse care and disruptions in care. It aims to provide specialized help for foster carers, targetting
key issues: providing nurturance for infants when the carers are not comfortable providing nurturance, overriding
tendencies to respond in kind to infant behaviors and providing a predictable interpersonal environment.
* * *
According to attachment theory attachment behavior in adults towards the child includes responding sensitively and
appropriately to the child’s needs. Attachment based interventions are based on this premise.
The various techniques that leverage this include Dyadic Developmental Theory, CPP, Circle of Security, Wait, Watch
and Wonder, ABC etc.
Sources:
https://en.wikipedia.org/wiki/Attachment-based_therapy_(children)
https://en.wikipedia.org/wiki/Dyadic_developmental_psychotherapy
http://www.simplypsychology.org/attachment.html

Discuss the importance of
psychotherapies with reference to
cancer and AIDS patients.
Q8.
34

Importance of psychotherapies with reference to cancer
and AIDS patients
35
A8
As treatment for cancer has become more effective, it is better thought of as a chronic rather than a terminal illness.
However, it is a progressive disease, and approximately half of all people diagnosed with cancer will eventually die of
it. On the other hand, the treatment of AIDS is still being researched. The patients of both these and other terminally-
ill diseases need care. Care is “the process of helping ill people with cancer and AIDS live as well and as long as
possible.”
Importance of Psychotherapies
1. Social Support: Psychotherapy, especially in groups, can provide a new social network with the common bond of
facing similar problems. Members also find that the process of giving help to others enhances their own sense of
mastery of the role of cancer patient and their self-esteem, giving meaning to an otherwise meaningless tragedy.
2. Emotional Expression: The expression of emotion is important in reducing social isolation and improving coping.
When unbidden thoughts involving fears of dying and death intrude, they can be better managed by patients who
know that there is a time and a place during which such feelings will be expressed, acknowledged, and dealt with.
3. Processing Existential Concerns: Death anxiety in particular is intensified by isolation, in part because we often
conceptualize death in terms of separation from loved ones. Feeling alone, makes one feel already a little bit
dead, setting off a cycle of further anxiety. This can be addressed by psychotherapeutic techniques that directly
address such concerns.
4. Reorganizing Life Priorities and Living in the Present: The acceptance of the possibility of illness shortening life
carries with it an opportunity for reevaluating life priorities. When cure is not possible, a realistic evaluation of
the future can help those with life-threatening illness make the best use of remaining time.

Importance of psychotherapies with reference to cancer
and AIDS patients contd.
36
A8
5. Enhancing Family Support: Psychotherapeutic
interventions is quite helpful in improving
communication, identifying needs, increasing role
flexibility, and adjusting to new medical, social,
vocational, and financial realities.
6. Improving Communication with Physicians: Groups
provide mutual encouragement to get questions
answered, to participate actively in treatment
decisions, and to consider alternatives carefully.
7. Symptom Control: Treatment involves teaching
cognitive techniques to manage anxiety like learning
to identify emotions as they develop, analyze sources
of emotional response, and move from emotion-
focused to problem-focused coping.
Goals of the Therapy Process
•Personalization: Facilitating an examination of personal
and specific cancer-related issues.
•Affective expression: Facilitating the expression of here-
and-now feelings
•Supportive group interaction:
o Facilitating supportive interactions among
group members,
o Sharing group time and access to group
attention,
o Avoiding scapegoating
o Maintaining boundaries
•Active coping: Facilitating the use of active coping
strategies
* * *
Therapy for cancer and AIDS patients involves attention to
enhancing social support; encouraging emotional
expression and processing; confronting existential
concerns; improving relationships with family, friends,
and physicians; and enhancing coping skills. Such therapy
approaches have been shown to reduce distress, enhance
coping, and ameliorate symptoms.
Sources:
Encyclopedia of Psychotherapy_Michel Hersen, William
Sledge

50 words
Section C
37

Technical neutrality
38
A9
Neutrality was first formally defined by Anna Freud (1936, p. 28), who said that in doing his work the analyst "takes
his stand at a point equidistant from the id, the ego, and the superego."
Offering what is perhaps the most comprehensive formulation of neutrality that has appeared to date, Schafer lists
six characteristics of the neutral position:
1. The analyst allows all conflictual material to be represented, interpreted and worked through. He takes no sides
in the consideration of these conflicts.
2. The analyst avoids both the imposition of his own values on the patient and an unquestioning acceptance of the
patient's values.
3. The analyst is unpresumptuous as to the desirability of alternative courses of action which the patient is
considering. He does not unilaterally try to make anything happen and does not try to bring about a certain kind
of change because he believes in it in principle.
4. The analyst is non-judgmental not only with respect to the patient, but also with respect to others in the
patient's life.
5. The analyst subordinates his personality to the analytic task.
6. The analyst totally repudiates any adversarial conception of the analytic relationship.
* * *
Sources:
http://www.wawhite.org/uploads/PDF/E1f_10%20Greenberg_J_Analytic_Neutrality.pdf

Existential therapy
39
A10
Existential therapy reacts against the tendency to view therapy as a system of well-defined techniques; it affirms
looking at those unique characteristics that make us human and building therapy on them. It focuses on exploring
themes such as mortality, freedom, responsibility, self-determination, anxiety, and aloneness, as these relate to a
person’s current struggle.
Key propositions are:
1. We have the capacity for self-awareness.
2. Because we are basically free beings, we must accept the responsibility that accompanies our freedom.
3. We have a concern to preserve our uniqueness and identity; we come to know ourselves in relation to knowing
and interacting with others.
4. The significance of our existence and the meaning of our life are never fixed once and for all; instead, we re-
create ourselves through our projects.
5. Anxiety is part of the human condition.
6. Death is also a basic human condition, and awareness of it gives significance to living.
Clients are confronted with addressing ultimate concerns rather than coping with immediate problems. They are
expected to put into action in daily life what they learn about themselves in therapy.
* * *
Sources:

Defining features of short term therapies
40
A11
Short-term therapy, is a generic label for any form of therapy in which time is an explicit element in treatment
planning.
Defining features:
1. Time is a key element: Therapy is “time limited,” allocating a fixed number of sessions for clients.
2. Focus: Therapy targets specific patterns rather than attempt broader personality changes.
3. Activity level of the therapist: Therapists adopt active methods to maintain the focus of treatment and promote
self-understanding and change.
4. Activity level of the client: Clients are absorbed in change efforts between sessions, as well as during them.
5. Client selection: Therapy typically begins with an assessment to determine the appropriateness of brief
treatment for a particular client.
6. Enhanced experiencing: Methods, including hypnosis, relaxation techniques, introspection, confrontation,
exposure, and role playing, enable individuals to experience themselves and their problems in new ways.
7. Emphasis upon readiness for change: When clients are not aware of or not committed to changes, brief therapy
goals focus on advancing readiness for change
8. Emphasis on impact of intervention: Therapists emphasize promotion of corrective emotional experiences rather
than exhaustive insight into past conflicts.
* * *
Sources:
Encyclopedia of Psychotherapy_Michel Hersen, William Sledge

Negative Punishment
41
A12
Negative punishment occurs when the removal or prevention of delivery of a stimulus, termed a negative punisher,
weakens the behavior that produced this consequence. In contrast to positive punishment that occurs when the
presentation of a stimulus, termed a positive punisher, weakens the behavior that caused this consequence to occur.
As an everyday example of negative punishment, envision two friends who are sitting together having a friendly
conversation when one makes a highly critical comment about a presidential candidate. The other person likes the
candidate and is angered by the comment and abruptly gets up and walks away upon hearing it. If this results in
fewer negative comments about the politician in the future, then negative punishment has occurred. In this
hypothetical example, and in most cases, the response-weakening effect of punishment involves a decrease in the
frequency of responding.
* * *
Sources:

Counter conditioning
42
A13
A classical conditioning procedure in which a stimulus that formerly elicited one response (e.g., pleasure) is
conditioned to elicit a different response (e.g., nausea). Sometimes used in the treatment of paraphilias and
substance use disorders.
Basically, it involves weakening or eliminating an undesired response by introducing and strengthening a second
response that is incompatible with it.
The type of counter-conditioning most widely used for therapeutic purposes is systematic desensitization, to reduce
or eliminate fear of a particular object, situation, or activity. An early example of systematic desensitization was an
experiment in 1924, by Mary Cover Jones – the treatment of a three-year-old with a fear of rabbits. Jones countered
the child's negative response to rabbits with a positive one by exposing him to a caged rabbit while he sat some
distance away, eating one of his favorite foods. The boy slowly became more comfortable with the rabbit as the cage
was gradually moved closer, until he was finally able to pet it and play with it without experiencing any fear.
* * *
Sources:
http://psychology.jrank.org/pages/152/Counterconditioning.html

Self monitoring
43
A14
Self-monitoring requires clients to be mindful of the “what,” “where,” “when,” and “why” of the behavior they have
targeted for change and to keep a careful and detailed record of their thoughts, feelings, actions and their
environment at the moment that behavior occurred. Clients are also asked to keep track of the antecedents and
consequences of their behaviors.
It is useful when direct observation by another party is limited or not possible.
One should keep in mind that accuracy is questionable with self-monitoring. Without contingencies in place to
ensure reliability of data collection, there may be incentives for the participant to inaccurately report the presence of
a specific setting event. An example here might be a participant who just experienced a toileting accident and fails to
record it on her daily tracking sheet of self-initiated activities outside of the house because she is embarrassed.
* * *
Sources:

Multimodal therapy
44
A15
The most influential and important integrative approach that is representative of technical eclecticism is multimodal
therapy, described by Arnold Lazarus in 1992. It was derived from his experiences as a behavior therapist, and his
follow-up studies of patients who relapsed after seemingly successful behavioral treatment.
He found that most behavioral problems had extensive psychological and social causes and correlates. Seeking to
expand the range of his ability to work in a more “broad spectrum” way, Lazarus arrived at a multimodal, or broad-
based, eclectic therapy.
Multimodal therapy is organized around an extensive assessment of the patient’s strengths, excesses, liabilities, and
problem behaviors. Upon completion of this assessment, that patient’s clinically significant issues are organized within a
framework that follows the acronym of the BASIC ID: Behavior, Affect, Sensation, Imagery, Cognition, Interpersonal
relations, and Drugs (or biology).
As the firing order or causal sequence of variables in the BASIC ID is identified, interventions are selected and are
implemented. More microscopic BASIC ID profiles of discrete or difficult problems and of components of a firing order
can be attempted once the initial, global assessment and interventions are completed.
* * *
Sources:

Multiple family group therapy
45
A16
Multiple Family Group Therapy (MFGT), initially developed by Dr. H. Peter Laqueur in his work with hospitalized
schizophrenic patients in the 1950's, emerged as a form of intervention adjunct to the treatment of serious mental
disorders with biological basis.
It involves working with a collection of families in a group setting. MFGT combines the power of group process with
the systems focus of family therapy and is suited to work with families facing similar problems (schizophrenia,
chemical dependence, domestic violence, sexual abuse etc.)
Why Do It?
1. MFGT is more powerful, supportive and empowering than single family therapy due to following curative factors:
universality, hope, acceptance, imitation learning, experimentation, and increased commitment to change.
2. It offers a family more avenues for learning and growth, with less resistance, than they would get in therapy by
themselves.
3. Because of the shared experiences and boosted learning, it is also easier for the therapist as much of the
therapeutic work is done by group members.
4. More economical for therapist - can see more families in less time.
5. Participation in MFGT is good preparation for transition into ongoing self-help support groups like Parents
Without Partners, Alcoholics Anonymous, etc.
* * *
Sources:
https://en.wikipedia.org/wiki/Family_therapy
http://www.multiplefamilygrouptherapy.com/J%20Howe%20Model%20of%20MFGT.htm

Psychotherapy integration
46
A17
Psychotherapy integration can be defined as an attempt to look beyond the confines of single-school approaches to
see what can be learned from other perspectives (Stricker, 1994). It is characterized by an openness to various ways
of integrating diverse theories and techniques.
The term has been applied for:
1. Common factors refers to aspects of psychotherapy that are present in most, if not all, approaches to therapy
(Weinberger, 1995). This collection of common and effective techniques cuts across all theoretical lines and is
present in all psychotherapeutic endeavors.
2. Assimilative integration (Messer, 1992) is an approach in which a solid grounding in one theoretical approach is
accompanied by a willingness to incorporate techniques from other therapeutic approaches.
3. Theoretical integration is the most difficult level at which to achieve integration, for it requires bringing together
theoretical concepts from disparate approaches, some of which may differ in their fundamental worldview.
theoretical integration tries to bring together those approaches themselves and to develop a "Grand Unified
Theory.
* * *
Sources:
http://www.psychiatrictimes.com/articles/introduction-psychotherapy-integration

Narrative therapy
47
A18
Narrative therapy is a form of psychotherapy using narrative developed by Michael White and David Epston. It
includes a discussion of how a problem has been disrupting, dominating, or discouraging the person.
The therapist attempts to separate clients from their problems so that they do not adopt a fixed view of their
identities. Gaps, incompleteness, and incoherence in the client’s life story may indicate struggles in creating an
integrated experience of self-in the-world. Clients are invited to view their stories from different perspectives and
eventually to co-create an alternative life story. Clients are asked to find evidence to support a new view of
themselves as being competent enough to escape the dominance of a problem and are encouraged to consider what
kind of future could be expected from the competent person that is emerging.
Because people intimately create meanings to understand their experiences, the experience of reviewing the abuse
with an empathic therapist allows for new constructions to be created. These newer meanings, in turn, allow for
newer experiences as clients’ lives move into the future.
* * *
Sources:
https://en.wikipedia.org/wiki/Narrative_therapy

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