In the ABC analysis of Ellis's rational emotive therapy, "B" stands for:

Beliefs about the antecedent events

Behaviour shown after the events

Assertion (A): Cognitive behaviour therapy combines cognitive therapy with behavioural techniques. Reason (R): Cognitive behaviour therapy holds that psychological distress arises only from unconscious conflicts in early childhood.

Both A and R are true, and R is the correct explanation of A

Both A and R are true, but R is not the correct explanation of A

Therapeutic Approaches — Psychotherapy, Its Kinds, and Rehabilitation

If the last two chapters described what goes wrong, this one describes how people are helped. Psychotherapy is a voluntary relationship between a person seeking help and a trained therapist, and the major therapies differ in what they think causes distress and so in what they do about it — uncovering unconscious conflict, changing learned behaviour, disputing irrational beliefs, or helping a person find meaning and grow. The chapter also covers medical and alternative treatments, what all therapies seem to share that helps people heal, the ethics a therapist must follow, and the rehabilitation that helps people return to productive lives.

The Nature and Process of Psychotherapy

Psychotherapy is a voluntary relationship between the one seeking treatment, the client, and the one who treats, the therapist. Its purpose is to help the client solve psychological problems. All psychotherapies share some characteristics: the systematic application of principles from theories of therapy; practice only by people with practical training under supervision; a therapeutic situation involving a therapist and a client who seeks help; and, most important, the interaction between the two that forms the therapeutic relationship. The goals include reinforcing the client's resolve for betterment, lessening emotional pressure, unfolding the potential for positive growth, modifying habits, changing thinking patterns, increasing self-awareness, improving interpersonal relations and communication, facilitating decision-making, becoming aware of one's choices in life, and relating to one's social environment more creatively.

The therapeutic relationship, or therapeutic alliance, has two major components. It is contractual in nature — two willing individuals enter into a partnership aimed at helping the client overcome problems — and it is of limited duration, lasting until the client becomes able to deal with problems independently. Within it the therapist shows unconditional positive regard, warmth and acceptance whatever the client says; empathy, understanding the client's experience from the client's point of view; and genuineness. The relationship is professional, and everything the client says is kept confidential.

How Therapies Differ

Psychotherapies are classified by asking six questions: what caused the problem; how that cause came into existence; what the chief method of treatment is; what the therapeutic relationship is like; what the chief benefit to the client is; and how long treatment lasts. On these the book groups therapies into three broad kinds — psychodynamic, behaviour and existential (humanistic-existential) — and treats cognitive therapies as a fourth family close to behaviour therapy.

Three kinds of psychotherapy compared
Question	Psychodynamic	Behaviour	Humanistic-existential
Cause	Intrapsychic conflicts	Faulty learned patterns of behaviour and cognition	Loss of meaning, loneliness, lack of personal growth
Chief method	Free association and reporting of dreams	Conditioning procedures to change behaviour	A non-judgemental, accepting atmosphere; unconditional positive regard and empathy
Chief benefit	Emotional insight	Improved functioning, adaptive behaviour	Personal growth
Duration	Several years	A few months	Relatively short

Psychodynamic Therapy and Behaviour Therapy

Psychodynamic therapy, pioneered by Freud, seeks to bring unconscious conflicts into awareness. In free association the client, lying relaxed on a couch, says whatever comes to mind without censoring it; in dream interpretation the therapist analyses the symbols in dreams. As therapy proceeds the client attaches to the therapist and treats him or her as an authority figure from childhood — transference. In positive transference the client idolises or falls in love with the therapist and seeks approval; in negative transference the client feels hostility, anger and resentment towards the therapist. The client may also show resistance, conscious or unconscious, to bringing painful material into awareness. The therapist uses interpretation: confrontation, pointing out an aspect of the psyche the client must face, and clarification, bringing a vague or confusing event into sharp focus. Repeating this process to overcome resistance is working through, and it leads to insight — intellectual insight first, then emotional insight, the understanding of one's feelings about the conflict.

Behaviour therapy holds that psychological distress arises from faulty behaviour patterns or thought patterns, and it works on the present rather than the past. It begins with a functional analysis of behaviour — how the faulty behaviour is learned, what sets it off and what maintains it. Its techniques include aversive conditioning, the repeated association of an undesired response with an aversive consequence, as when a person with alcohol dependence is given a mild electric shock while smelling alcohol; positive reinforcement of a wanted behaviour; the token economy, in which a person earns a token for each wanted behaviour and exchanges tokens for a reward; and differential reinforcement, which increases wanted and decreases unwanted behaviour together. Systematic desensitisation, introduced by Joseph Wolpe for phobias, has the client build a hierarchy of anxiety-provoking situations and then, while deeply relaxed, imagine them from the least to the most frightening. It rests on reciprocal inhibition: the presence of two mutually opposing forces at the same time inhibits the weaker one, so relaxation overcomes the mild anxiety at each step. In modelling the client learns by observing a role model, and gains through vicarious reinforcement.

Cognitive Therapies

Cognitive therapies locate the cause of psychological distress in irrational thoughts and beliefs. Albert Ellis developed rational emotive therapy (RET), later called rational emotive behaviour therapy. Its central thesis is that irrational beliefs mediate between antecedent events and their consequences, and it begins with an ABC analysis: A, the antecedent events that cause distress; B, the beliefs about those events; C, the emotional and behavioural consequences. Irrational beliefs are marked by "musts" and "shoulds" — "one must be loved by everyone all the time" — and by catastrophising. The therapist disputes them through non-directive questioning, gentle rather than probing or argumentative, so that the client replaces them with rational beliefs. Aaron Beck's cognitive therapy holds that childhood experiences give rise to core schemas, systems of beliefs and cognitive patterns; when a critical incident activates them, they produce negative automatic thoughts that are persistent and that carry cognitive distortions. Through non-confrontational yet challenging questioning the therapist helps the client test and reorganise these thoughts. Cognitive behaviour therapy (CBT), the most widely used today, combines cognitive therapy with behavioural techniques in a short, efficient treatment that takes a biopsychosocial view.

🧠 Ellis is ABC; Beck is schemas

Antecedent → Belief → Consequence: change the B and the C changes. That is Ellis. Childhood → core schemas → negative automatic thoughts: that is Beck. Both are cognitive; the paper tests which name goes with which vocabulary.

Humanistic-Existential Therapies

These therapies hold that psychological distress arises from feelings of loneliness, alienation and an inability to find meaning and genuine fulfilment in life; people are motivated by a desire for personal growth and self-actualisation. Viktor Frankl, a psychiatrist and neurologist who survived Nazi concentration camps, developed logotherapy — from "logos", meaning soul — the treatment of the soul. It helps clients find meaning in their lives even in suffering, and confront the existential anxiety that comes from feeling that life lacks meaning; one of its techniques is paradoxical intention, in which the client is encouraged to intend the very thing he or she fears. Carl Rogers developed client-centred therapy, which combines scientific rigour with an individual-centred approach: the therapist provides a warm, accepting relationship of empathy, unconditional positive regard and authenticity, and reflects the client's feelings back without directing, so that the client comes to accept himself or herself. Gestalt therapy, developed by Fritz (Frederick) Perls with his wife Laura Perls — "gestalt" means whole — aims to increase self-awareness and self-acceptance, using techniques such as fantasy and role play to bring unacknowledged feelings into the present.

Biomedical and Alternative Therapies, Healing, Ethics and Rehabilitation

Biomedical therapy treats disorders with medication, prescribed only by a qualified psychiatrist, and in some severe cases with electro-convulsive therapy (ECT), in which a mild electric current is passed through the brain by electrodes to induce convulsions; it is given only by a psychiatrist when judged necessary. Alternative therapies are alternatives to conventional treatment: yoga, meditation, acupuncture and herbal remedies among them. Yoga includes asanas and breathing practices, and meditation the focusing of attention on breath or an object; Indian research has reported benefits of practices such as Sudarshan Kriya Yoga (SKY), a rapid-breathing technique, for depression and stress-related conditions.

Across therapies, several factors contribute to healing: the techniques adopted and their implementation; the therapeutic alliance; the release of pent-up emotions, or catharsis, early in therapy; and a number of non-specific factors — patient variables, such as motivation for change and the expectation of improvement, and therapist variables, such as good nature, the absence of unresolved emotional conflicts and expertise. Therapy is also bound by ethics: informed consent; confidentiality; alleviating personal distress; the integrity of the practitioner–client relationship; respect for human rights and dignity; and professional competence and skills.

Rehabilitation of people with severe mental disorders
Component	What it involves
Occupational therapy	Teaching skills such as candle-making, paper-bag making and weaving to build a work discipline
Social skills training	Developing interpersonal skills through role play, imitation and instruction
Cognitive retraining	Improving basic cognitive functions — attention, memory and executive functions
Vocational training	Gaining the skills needed to undertake productive employment

Key takeaways

Psychotherapy is a voluntary relationship between client and therapist; the therapeutic alliance is contractual and of limited duration, built on empathy, unconditional positive regard and confidentiality.
Psychodynamic therapy: free association, dream interpretation, transference (positive and negative), resistance, interpretation, working through, insight.
Behaviour therapy: functional analysis, aversive conditioning, token economy, differential reinforcement, Wolpe's systematic desensitisation (reciprocal inhibition), modelling.
Cognitive: Ellis's RET with ABC analysis and non-directive questioning; Beck's core schemas and negative automatic thoughts; CBT combines both with behavioural methods.
Humanistic-existential: Frankl's logotherapy, Rogers' client-centred therapy, the Perlses' Gestalt therapy.
Rehabilitation uses occupational therapy, social skills training, cognitive retraining and vocational training; ethics require informed consent and confidentiality.

Practice questions (8)

Attempt each one before opening the answer. Every explanation names the tempting wrong option as well as the right one, because that is where marks are lost.

Systematic desensitisation, in which a client imagines a hierarchy of anxiety-provoking situations while deeply relaxed, was introduced by:
1. B.F. Skinner
2. Albert Ellis
3. Joseph Wolpe
4. Aaron Beck
Show answer
Answer: C — Joseph Wolpe
Joseph Wolpe introduced systematic desensitisation for treating phobias, based on reciprocal inhibition. Skinner's operant conditioning lies behind techniques such as the token economy, but not this one; Ellis and Beck developed cognitive therapies.
Logotherapy, which helps clients find meaning in their lives even in suffering, was developed by:
1. Viktor Frankl
2. Carl Rogers
3. Fritz Perls
4. Albert Ellis
Show answer
Answer: A — Viktor Frankl
Viktor Frankl, a psychiatrist and neurologist who survived Nazi concentration camps, developed logotherapy, the "treatment of the soul" that seeks meaning in life. Rogers and Perls are also humanistic-existential therapists, which is why they tempt, but they developed client-centred and Gestalt therapy respectively.
Match the technique with the therapy it belongs to. A. Free association B. Token economy C. ABC analysis D. Unconditional positive regard — 1. Rational emotive therapy 2. Client-centred therapy 3. Psychodynamic therapy 4. Behaviour therapy
1. A-3, B-1, C-4, D-2
2. A-4, B-3, C-1, D-2
3. A-3, B-4, C-2, D-1
4. A-3, B-4, C-1, D-2
Show answer
Answer: D — A-3, B-4, C-1, D-2
Free association is Freud's psychodynamic method; the token economy is a behaviour-therapy technique built on reinforcement; ABC analysis is the starting point of Ellis's rational emotive therapy; and unconditional positive regard is the core of Rogers' client-centred therapy. Pairing the token economy with RET mistakes a reinforcement technique for a cognitive one.
Several months into psychodynamic therapy, a client begins to treat her therapist with the anger and resentment she once felt towards a strict parent. This is an instance of:
1. Positive transference
2. Negative transference
3. Working through
4. Catharsis
Show answer
Answer: B — Negative transference
Transference is the client treating the therapist as an authority figure from childhood; when the feelings are hostility, anger and resentment it is negative transference. Positive transference would show as idolising the therapist or seeking his or her approval, and working through is the therapist's repeated use of interpretation to overcome resistance.
In the ABC analysis of Ellis's rational emotive therapy, "B" stands for:
1. Beliefs about the antecedent events
2. Behaviour shown after the events
3. The body's level of arousal
4. A biological predisposition
Show answer
Answer: A — Beliefs about the antecedent events
A is the antecedent event, B the beliefs about it, and C the emotional and behavioural consequences; Ellis's central thesis is that irrational beliefs at B mediate between A and C. Behaviour is the tempting wrong answer, but behaviour belongs to C, the consequences.
Assertion (A): Cognitive behaviour therapy combines cognitive therapy with behavioural techniques. Reason (R): Cognitive behaviour therapy holds that psychological distress arises only from unconscious conflicts in early childhood.
1. Both A and R are true, and R is the correct explanation of A
2. Both A and R are true, but R is not the correct explanation of A
3. A is true, but R is false
4. A is false, but R is true
Show answer
Answer: C — A is true, but R is false
A describes CBT correctly: it joins cognitive and behavioural techniques in a short treatment with a biopsychosocial view. R is false because locating distress solely in unconscious childhood conflict is the psychodynamic position; CBT works on present thoughts and behaviours, not on uncovering the unconscious.
In the rehabilitation of people with severe mental disorders, teaching skills such as candle-making, paper-bag making and weaving to build a work discipline is called:
1. Social skills training
2. Cognitive retraining
3. Vocational training
4. Occupational therapy
Show answer
Answer: D — Occupational therapy
Occupational therapy teaches such skills to help the person develop a work discipline. Vocational training is the close distractor: it comes later and aims at the skills needed for productive employment. Social skills training works on interpersonal skills, and cognitive retraining on attention, memory and executive functions.
Consider the statements. I. Gestalt therapy was developed by Fritz Perls together with his wife Laura Perls. II. In client-centred therapy the therapist directs the client by interpreting his dreams. III. Ethical practice requires informed consent and confidentiality. IV. In Beck's cognitive therapy, childhood experiences give rise to core schemas that shape later thinking. Which are correct?
1. I and III only
2. I, III and IV only
3. II, III and IV only
4. I, II, III and IV
Show answer
Answer: B — I, III and IV only
I, III and IV are accurate: the Perlses developed Gestalt therapy, ethics demand informed consent and confidentiality, and Beck traced thinking to core schemas formed in childhood. II is false — client-centred therapy is non-directive, and dream interpretation is a psychodynamic technique, not Rogers'.