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Psychotherapy is a voluntary relationship between two people, one who seeks help and the other who is ready to provide the help, i.e., the therapist. It is given under therapeutic conditions. 

Various psychotherapeutic approaches have the following characteristics: 

1. All psychotherapies are systematic application of some theory or principle of different therapies. 

2. Only trained professionals can practise psychotherapy. 

3. Therapeutic situation is a two-way process in which therapist as well as client actively interact. 

4. Psychotherapy functions under formation of therapeutic relationship which is confidential, interpersonal and dynamic in nature. Psychotherapy has very broad scope to deal with disorders which are as follows: 

• Reinforcing client’s resolve for betterment. 

• Lessening emotional pressure. 

• Unfolding the potential for positive growth. 

• Modifying habits. 

• Changing thinking patterns. 

• Increasing self-awareness. 

• Improved interpersonal relations and communication. 

• Facilitating decision-making. 

• Becoming aware of ones preferences in life. 

• Development of adaptive behaviour. 

Therapeutic Relationship: 

The special professional relationship between the client and the therapist is known as therapeutic relationship or alliance. 

There are two major components of this relationship: 

1. The Contractual Nature of the Relationship in which two willing individuals, the client and the therapist, enter into a partnership which aims at helping the client overcome his problems. 

2.  Limited Duration of the Therapy: This alliance lasts until the client becomes able to deal with his problems and take control of his life. 

Through therapeutic relationship the therapist wins the trust of the client. The quality of this relationship/alliance determines early healing in psychotherapy.

Following are the main psychotherapies:

• Psychodynamic Therapy

• Behaviour Therapy

• Humanistic Therapy or 

Existential Therapy Parameters of classification are as follows :

1. What is the cause of the problem?

(a) Psychodynamic therapy-Intrapsychic conflicts (id, ego and super ego) causes problems.

(b) Behaviour therapy-Faulty learning of behaviours and unrealistic cognition , (thinking process) cause problems.

(c) Existential therapy-Ansviev about the meaning of one’s life and existence is not available.

2. How did the cause come into existence?

(а) Psychodynamic therapy-Intrapsychic conflicts are caused due to unfulfilled desires of childhood or unresolved fears which cause fixation and repression during psycho-sexual stages of life.

(b) Behaviour therapy-Faulty conditioning patterns, faulty learning through improper rewards, faulty thinking and beliefs.

(c) Existential therapy-Current feelings of loneliness, aimless life or meaningless existence.

3. What is the chief method of treatment?

(a) Psychodynamic therapy-Free association and reporting of dream to make the person confront and resolve the conflict.

(b) Behaviour therapy-To identify faulty conditioning patterns and faulty learning and to challenge the faulty thinking patterns.

(c) Existential therapy-Providing positive, non-judgmental and accepting therapeutic environment. Therapist acts as a facilitator helping client solve his own problems and arrive at solution through personal growth.

4.  What is the nature of the therapeutic relationship?

(a) Psychodynamic therapy-Therapist understands the client and is more capable in interpreting his thoughts and feelings.

(b) Behaviour therapy-Therapist is able to identify faulty behaviour and thought patterns and is capable of finding out correct behaviour and realistic thought patterns.

(c) Existential therapy-Therapist provides warm and emphatic relationship helping the client feel secured to explore the causes of his problems himself and herself.

5.  What is the chief benefit to the client?

(a) Psychodynamic therapy-Emotional insight to resolve problems.

(b) Behaviour therapy-Adaptive and healthy behaviour and thought pattern to reduce stress.

(c) Existential therapy-Personal growth by increasing understanding of one’s aspirations, emotions and motives.

6. What is the duration of treatment?

(a) Psychodynamic therapy-Classical psychoanalysis lasts for several years. New version? 10- 15 sessions.

(b) Behaviour therapy-Short and completed within few months.

(c) Existential therapy-Short and completed within few months.

The techniques used in behaviour therapy are not based on any unified theory. These are developed on the basis of various principles particularly on classical conditioning, operant conditioning and modelling. The main objective of the techniques are to modify maladaptive behaviour. Negative reinforcement and aversive conditioning are the two major techniques of behaviour modification. 

1. Reinforcement Techniques: 

(а) Negative Reinforcement: It refers to following an undesired response with an outcome that is painful or not liked. For example, a mother may cover her son’s thumb with a bitter NEEM paste so that he should not develop habit of thumb sucking. Due to the bitterness, the child tries to avoid or withdraw the bitterness of thumb and will leave the habit of thumb-sucking. 

Aversive Conditioning: 

• It is establishing relationship between undesirable behaviour and aversive consequences. 

• Aversive therapy is a therapeutic technique which uses an unpleasant stimulus to change a deviant behaviour. 

• It works by pairing together the stimulus that normally invites the deviant behaviour (such as an alcoholic drink or sexual image) with an unpleasant (aversive) stimulus such as an electric shock or a nausea-inducing drug, with repeated presentations. 

• The two stimuli become associated and the person develops an aversion toward the stimulus that formerly gave rise to the deviant behaviour. 

(b) Positive Reinforcement: If an adaptive behaviour occurs, positive reinforcement may be used by the therapist. For example, the child’s mother may prepare child’s favourite dish on the day when most of the time child was being observed not keeping his thumb in the mouth. 

Token Economy: A behaviour therapy is based on positive reinforcement. 

• A package or deal is being established between the therapist and the client. 

• Persons with behavioural problems can be given a token as a reward every time a wanted behaviour occurs. 

• The tokens are collected and exchanged with for a predetermined reward such as outing for the patient or a treat for the child. 

• The technique is widely used in hospitals, schools and reformatory. 

(c) Differential Reinforcement: In differential reinforcement, both positive and negative reinforcements are used together. By using this method, unwanted behaviour can be reduced and wanted behaviour can be increased simultaneously. 

(d) Method of ignoring Unwanted Behaviour: In this method, the therapist positively reinforces the wanted behaviour and ignores the unwanted behaviour. For example, the parents are instructed to praise the child or give chocolate to him or to take him to cinema if the child does not suck the thumb, : but ignore the unwanted behaviour that is sucking the thumb. Thismethod is less painful and equally effective for modifying the unwanted behaviour. 

2. Systematic Desensitisation: It is a technique introduced by Wolpe, for treating phobias or irrational fears. This technique is based on the principle of reciprocal inhibition. This principle states that the presence of two mutually opposing forces forces at the same time, inhibits the weaker force, e.g., distress, at the same time, relaxation, can not occur. The technique follows four steps: 

(i) Initial interview. 

(ii) Training in relaxation exercises.  

(iii) Preparation of hierarchy of anxiety-provoking situation. This is a subjective process and changes from problem to problem.  

(iv) Desensitization: When the client becomes relaxed, he/she is exposed to least anxietyprovoking situation. Over sessions, the client is able to unique more severe fear-provoking situations while maintaining with relaxation. The client gets systematically desensitized to the fear.

3. Modelling: It is the procedure wherein the client learns to behave in a certain way by observing the behaviour of a role model or the therapist. 

• It is role playing. 

• Vicarious learning (learning by observing others) is used and through a process of rewarding small changes in the behaviour, the client gradually learns to acquire the behaviour of the model.

Rehabilitation of the mentally ill is necessary to improve their quality of life once their active symptoms are reduced. 

• In the case of milder disorders, such as generalized anxiety disorder, reduction of symptoms improves their quality of life and such patients need not to help rehabilitation. 

• However in severe mental disorders, such as schizophrenic disorders, reduction of symptoms does not mean that patient is cured. Such patients develop negative symptoms like apathy or lack of motivation and their cognitive social and occupational skills get impaired. So they need rehabilitation. 

• Rehabilitation provides:

1. Social Skill Training: It helps the patients to develop interpersonal skills through role play, imitation and instruction. 

2. Cognitive Retraining: It helps the patients to improve the basic cognitive functions of attention, memory and executive functions.  

3. Occupational Therapy: The patients are taught skills such as candle¬making, paper bag making and weaving to develop work discipline. 

4. Vocational Training: When the patient becomes self-sufficient, vocational training is given wherein the patient is helped to gain skills necessary to undertake productive employment.

Social learning theories work on the principle that our experience—be it positive or negative—such as phobia of lizards/cockroaches are the result of learning process which start early in life. Small children can play with snakes, they sire not aware of the danger involved. For them it is just another play object, as they grow up the fear of these things are instilled by their parents and society which is reinforced and accounts for reactions like phobia. 

A psychoanalytical account for the same could involve attribution to some unconscious or/and repressed experiences. For example, suppose in your childhood you watched a group of roudy boys brutally torturing a cockroach/snake, which eventually died, although you going about the incidence after some days, but it might remain in back of your mind forever, which might explain your phobia to cockroaches which might remind you of the incidence and disturbs you emotionally.