Psychotherapies

According to Approaches
– Behavioural Therapy
– Psychoanalytic
– Cognitive therapy
– Humanistic Therapy
According to Client Involvement
– Individual therapy
– Group Therapy
Others
– Interpersonal psychotherapy (family, marital)
– Occupational therapy
– Milieu therapy/ therapeutic community
– Recreational Therapy
– Supportive Therapy
• Counselling (Review)
Behavioural Therapy
Behaviour
• Adaptive
• Maladaptive- when it is age inappropriate, interferes with adaptive functioning or others
misunderstand it in terms of cultural inappropriateness.
• Behaviorism see psychological disorders as the result of maladaptive learning, as people are
born tabula rasa (a blank slate).
• Basic assumption is that the maladaptive behaviour can be corrected through the provision of
adequate learning experiences.
Behavioral therapy
Definitions
A form of psychotherapy, the goal of which is to modify maladaptive behaviour patterns by
reinforcing more adaptive behaviors.

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“Behaviour therapy is a form of treatment for problems in which a trained person deliberately
establishes a professional relationship with the client, with the objective of removing or
modifying existing symptoms and promoting positive personality, growth and development.”
“Behaviour therapy is the systematic application of scientific principles of learning and a form of
psychotherapy, aims at changing maladaptive behaviour by substituting it with adaptive
behaviour.”
Principles of Behavioral Therapies
 Theory of Classical conditioning: involves learning by association and is usually the
cause of most phobias.
 Theory of Operant conditioning: involves learning by reinforcement (e.g. rewards) and
punishment, and can explain abnormal behavior should as eating disorders.
 Social Learning Theory
 Cognitive Behavioral Approach
Assumptions of Behavioral therapy
1. Based on principles & procedures of scientific method
2. Deals with client’s current problems (as opposed to analysis of historical determinants) &
factors influencing them & factors that can be used to modify performance 3. Clients expected to
assume an active role by engaging specific actions to deal with their problems
4. Emphasizes teaching clients skills of self-management, with expectation they’re responsible
for transferring what’s learned in office to everyday lives
5. Focus on assessing overt & covert behaviors directly, identifying problem, & evaluating
change 6. Emphasizes a self-control approach in which clients learn self-management strategies
7. Interventions individually tailored to specific problems “What treatment, by whom, is the
most effective for this individual with that specific problem & under which set of
circumstances?”
8. Based on collaborative partnership between therapist & client (clients informed about nature
& course of Rx)
9. Emphasis on practical application Interventions applied to ALL facets of daily life in which
maladaptive behaviors are to be deceased & adaptive behaviors are to be increased
10. Therapists strive to develop culture-specific procedures & obtain clients’ adherence &
cooperation
Indications of Behavioral therapy
 obsessive-compulsive disorder (OCD)
 post-traumatic stress disorder (PTSD)
 depression
 social phobia
 bipolar disorder

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  schizophrenia
 autism
 personality disorders
 substance abuse
 eating disorders
Behavioral Therapy Techniques

 Systemic Desensitization
 Flooding
 Therapeutic Graded Exposure
 Participant Modeling
 Assertiveness Training
 Social Skill Training
 Aversion Therapy
 Shaping
 Premack principle
 Extinction
 Token Economy
 Contingency Contracting
 Overt Sensitization
 Covert Sensitization
 Time out
Systemic Desensitization
• Developed by Joseph Wolpe
• Steps –Relaxation Training: Relaxation produces physiological effects opposite to those of
anxiety.
–Hierarchy Construction: 10-12 conditions in order of increasing anxiety
–Desensitization of Stimulus: gradual exposure of individual from least to most anxiety
provoking situation in a deeply relaxed state.
• Suitable for
– Anxiety disorder
– Phobic anxiety disorder
– Obsessive compulsive disorder
– Certain sexual disorder
Flooding/Implosion
• No relaxation

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• No Grading
• Exposing the individual directly with the situation
• Based on the principle that escaping from anxiety reinforces the anxiety through conditioning
• Prematurely withdrawing from the situation may reinforce the phobia.
• Not suitable for client with heart disease and fragile psychological adaptation.
Therapeutic Graded Exposure
Therapeutic grade exposure is similar to the systemic desensitization except that relaxation
training is not involved and treatment is usually carried out in real life context.
Participant Modeling
In participant modeling, patients learn a new behaviour by imitation, primarily by observation,
without having to perform the behaviour until they feel ready.
Types of model
 Live model
Watching a model perform a specific behavior
symbolic model E.g: flim tape , video e.t.c.
Self modeling Videotape target behavior in desired way
Participant modeling Someone models the behavior for the client
Covert modeling
Therapist describes a situation for client to imagine
Useful in phobic children
• Children with problem are placed with children of own age and sex, who approach the feared
situation together.
Assertiveness Training
Assertiveness is a response that seeks to maintain an appropriate balance between passivity and
aggression. Assertive responses promote fairness and equality in human interactions, based on a
positive sense of respect for self and others.
Assertiveness training is a form of behavior therapy designed to help people stand up for
themselves—to empower themselves, in more contemporary terms.
Social Skill Training

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 Social skills training (SST) is a form of behavior therapy used by teachers, therapists, and
trainers to help persons who have difficulties relating to other people
A major goal of social skills training is teaching persons who may or may not have emotional
problems about the verbal as well as nonverbal behaviors involved in social interactions.
Some examples of social skills are
• Eye contact with others during conversation
• Smiling when greeting people
• Shaking hands when meeting someone
• Using the right tone and volume of voice
• Expressing opinions to others
• Perceiving how others are feeling and showing empathy
• Appropriate emotional responses (e.g. crying when something sad happens; laughing when
someone says something funny)
Aversion Therapy
When a noxious stimulus (punishment) is presented immediately after a specific behavioural
response, theoretically, the response is eventually, the response is eventually inhibited and
extinguished.
Types of noxious stimulus
– Electric shock
– Substance that induce vomiting
– Corporal punishment
– Social disapproval
Aversion therapy is suitable for
– Alcohol abuse
– Paraphilias
– Impulsive and obsessive behaviour
Shaping
a method of training by which successive approximations toward a target behavior are
reinforced

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 Shaping, or behavior-shaping, is a variant of operant conditioning. Instead of waiting for a
subject to exhibit a desired behavior, any behavior leading to the target behavior is rewarded.
• Speech therapy in Autistic Child- suitable
Premack Principle
• The Premack principle was derived from a study of Cebus monkeys by Professor David
Premack
• Premack's principle suggests that if a person wants to perform a given activity, the person will
perform a less desirable activity to get at the more desirable activity; that is, activities may
themselves be reinforcers.
• An individual will be more motivated to perform a particular activity if they know that they
will be able to partake of a more desirable activity as a consequence.
• R1- Frequently occurring response •
R2- Less frequently occurring response
• Allowing R1to occur only afterR1
• R1 – Telephone talking with friends
• R2- Completing homework
• Completion of homework may get incentive of telephone talking
Extinction
• Extinction is observed in both operantly conditioned and classically conditioned behavior.
• "Extinction as a procedure occurs when reinforcement of a previously reinforced behavior is
discontinued; as a result, the frequency of that behavior decreases in the future.“
Eg. Extinction in temper tantrum
Token Economy
An operant technique applied to groups, such as classrooms or mental hospital wards, involving
the distribution of "tokens" or other indicators of reinforcement on desired behaviors. The tokens
can later be exchanged for privileges, food, or other reinforcers.
Contingency Contracting
• A contract is drawn up among all parties involved.
• Desired behavioral change is expressed in writing
• Contract is made for the reinforcement of compliance and punishment for non compliance
Restitution/Over Correction
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• Restitution means restoring the disturbed situation to a state that is much better than what it
was before the ocuurrance of problem behaviour.
• For example, if a patient passes urine in the ward he would be required to clean the dirty area
but also mop the entire larger area of the floor of the ward.
Time Out
• Time out is an aversive stimulus or punishment during which the client is removed from the
environment where the unacceptable behaviour is being exhibited.
• The client is usually isolated so that reinforcement from attention of others is absent.
Reciprocal Inhibition
• Also called counter conditioning, it decreases or eliminates a behaviour by introducing a more
adaptive behaviour, but one that is incompatible with unacceptable behaviour.
• Eg. Relaxation exercise for the phobic patient.
Overt Sensitization
• A type of aversion therapy
• Eg. Disulfiram for the person who wish to quit the alcohol
Covert Sensitization
• Individual’s imagination to produce unpleasant symptoms rather than on medication
• The individual learns through mental imagery to visualize nauseating scenes and even to induce
mild feeling of nausea.
Exposure and Response Prevention
• Exposure and response prevention (ERP) is a treatment method available from behavioral
psychologists and cognitive- behavioral therapists for a variety of anxiety disorders, especially
obsessive–compulsive disorder and phobias.
Advantages of Behavioural Therapy
 Behavioral therapists use empirically tested techniques, assuring that clients are receiving
both effective and brief treatment
 Evidence-based therapies (EBT) are a hallmark of both behavior therapy and cognitive
behavior therapy
 Most studies show that behavior therapy methods are more effective than no treatment
 Emphasis on ethical accountability (does not dictate whose behavior or what behavior
should be changed)
 Address ethical issues by stating that therapy is basically an education process; an
essential feature of behavior therapy involves collaboration between therapist & client

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Disadvantages of Behavioral Therapy
 Behavior therapy may change behaviors, but it does not change feelings
 Behavior therapy ignores the important relational factors in therapy
 Behavior therapy does not provide insight
 Behavior therapy treats symptoms rather than causes
 Behavior therapy involves control & manipulation by therapist