Exam-useful questions from this chapter, grouped by marks, each with a full model answer. Try writing the answer yourself first, then check it against this one.
1 1-Mark Questions
Q. Define psychotherapy.
Answer: A voluntary relationship between the client seeking treatment and the therapist, aimed at helping the client solve their psychological problems.
Q. What is a therapeutic alliance?
Answer: The special, confidential relationship between client and therapist, neither a passing acquaintance nor a permanent one.
Q. Define unconditional positive regard.
Answer: The therapist’s continuing positive feeling for the client, regardless of what the client reveals or has done.
Q. What is clinical formulation?
Answer: Fitting the client’s problem into the therapeutic model being used for treatment.
Q. Who introduced systematic desensitisation?
Answer: Wolpe.
Q. What does RET stand for, and who formulated it?
Answer: Rational Emotive Therapy, formulated by Albert Ellis.
Q. Define self-actualisation.
Answer: An innate force that moves a person to become more complex, balanced and integrated.
Q. What is catharsis?
Answer: The process of emotional unburdening during the initial therapy sessions, which has healing properties.
Q. Name the therapy given by Fritz and Laura Perls, and what does its name mean?
Answer: Gestalt Therapy; ‘gestalt’ is German for ‘whole’.
Q. What is a core schema?
Answer: A belief-and-action-pattern system formed in childhood from family and societal experiences.
2 2-Mark Questions
Q. State the two components of a therapeutic alliance.
Answer: (i) Contractual nature: two willing individuals, client and therapist, enter a partnership to help the client overcome their problems. (ii) Limited duration: the alliance lasts only until the client can handle their problems and take control of their own life.
Q. Distinguish empathy from sympathy.
Answer: Sympathy is compassion and pity toward another’s suffering, but one cannot actually feel as the other person does. Empathy goes further: the therapist both understands AND feels the client’s situation, ‘putting themselves in the client’s shoes’.
Q. What are antecedent and consequent operations in behaviour therapy?
Answer: Antecedent operations change something that comes before the behaviour to alter its reinforcing value (an ‘establishing operation’). Consequent operations change something that comes after the behaviour, such as praising a wanted response.
Q. Explain aversive conditioning with an example.
Answer: Aversive conditioning repeatedly pairs an undesired response with an aversive consequence. Example: an alcoholic is given a mild electric shock while smelling alcohol; with repeated pairing, the smell of alcohol itself becomes aversive, and the person gives up alcohol.
Q. What is the principle of reciprocal inhibition?
Answer: When two mutually opposing forces are present at the same time, the weaker force is inhibited. In systematic desensitisation, the built-up relaxation response (stronger) inhibits the anxiety (weaker) as the client imagines increasingly frightening scenes.
Q. What is the ABC analysis in RET?
Answer: The first step of Rational Emotive Therapy: noting the Antecedent event that caused distress, identifying the irrational Belief distorting the client’s view of it, and the Consequence, i.e. the negative emotions and behaviours that result.
Q. State two of the six ethical standards a psychotherapist must follow.
Answer: Any two of: informed consent must be taken; confidentiality of the client must be maintained; alleviating personal distress must be the goal of every attempt; integrity of the practitioner-client relationship is important; respect for human rights and dignity; professional competence and skills are essential.
Q. Why may symptom reduction not improve quality of life in a severe disorder like schizophrenia?
Answer: Many patients with severe disorders suffer from negative symptoms, such as disinterest and lack of motivation to work or interact with people, which persist even after active symptoms reduce, so rehabilitation is separately needed to help them become self-sufficient.
3 4-Mark Questions
Q. Explain the process of behavioural analysis with the help of the smoking example given in the chapter.
Answer: Behavioural analysis interviews the client (and often family) to find: (i) the malfunctioning behaviour causing distress, (ii) antecedent factors that predisposed the person toward it, and (iii) maintaining factors keeping it going. In the book’s example, a young man’s malfunctioning behaviour is smoking; the antecedent factor is that he started while preparing for his annual exam (an anxiety-provoking situation); the maintaining factor is the relief from anxiety that smoking gives him, which keeps the operant response of smoking going.
Q. Describe how Aaron Beck’s cognitive therapy explains the development of psychological distress, with an example.
Answer: Childhood experiences from family and society develop a core schema (beliefs + action patterns). Example: a child neglected by parents develops the core schema ‘I am not wanted’. Later, a critical incident (being publicly ridiculed by a teacher) triggers this schema, producing negative automatic thoughts (‘nobody loves me’, ‘I am stupid’), which are characterised by cognitive distortions. Repeated occurrence of these thoughts leads to anxiety and depression.
Q. Explain systematic desensitisation as a technique for treating phobias.
Answer: Introduced by Wolpe. The therapist interviews the client to find fear-provoking situations, and together they build a hierarchy of anxiety-provoking stimuli from least to most frightening. The therapist relaxes the client, who then imagines the least anxiety-provoking situation, stopping if any tension is felt. Over sessions, the client imagines progressively more severe situations while remaining relaxed, becoming systematically desensitised. This works through the principle of reciprocal inhibition: relaxation, the stronger response, inhibits the weaker anxiety response.
Q. Describe Carl Rogers’s Client-centred Therapy.
Answer: Rogers combined scientific rigour with an individualised practice, introducing the concept of self, with freedom and choice as its core. The therapy provides a warm relationship in which the client reconnects with disintegrated feelings. The therapist shows empathy (understanding the client’s experience as their own), unconditional positive regard (total acceptance regardless of what is revealed), and reflection (rephrasing the client’s own statements to seek clarification). These set up an emotional resonance so the client feels secure enough to explore their feelings, become integrated, and become their real self, with the therapist merely facilitating.
Q. What is Cognitive Behaviour Therapy (CBT), and why is it described as comprehensive?
Answer: CBT is presently the most popular psychotherapy, conclusively shown to be a short and efficacious treatment for anxiety, depression, panic attacks, borderline personality, and more. It adopts a bio-psychosocial approach: biological aspects are addressed through relaxation procedures, psychological aspects through behaviour and cognitive therapy techniques, and social aspects through environmental manipulation. This makes it comprehensive, easy to use, applicable to a variety of disorders, and of proven efficacy.
Q. Explain Victor Frankl’s Logotherapy.
Answer: Frankl, a psychiatrist and neurologist, propounded Logotherapy (‘logos’ is Greek for soul, so Logotherapy means treatment for the soul). Its basis is ‘meaning making’ – a person’s quest for the spiritual truth of their existence, arising from a proposed ‘spiritual unconscious’ (a storehouse of love, aesthetic awareness and values, parallel to the ordinary unconscious). Existential anxiety is neurotic anxiety of spiritual origin. The goal is to help the client find meaning and responsibility in life regardless of circumstances; the therapist is open, emphasises the here-and-now, and actively discourages transference.
Q. List and briefly explain the four factors contributing to healing in psychotherapy.
Answer: (i) The techniques adopted by the therapist and their implementation, e.g. relaxation and cognitive restructuring in CBT. (ii) The therapeutic alliance itself, which has healing properties due to the therapist’s regular availability, warmth and empathy. (iii) Catharsis, the emotional unburdening in the initial interview sessions. (iv) Non-specific factors, occurring across all systems/clients/therapists: patient variables (motivation for change, expectation of improvement) and therapist variables (positive nature, absence of unresolved conflicts, good mental health).
Q. Describe the components of rehabilitating a mentally ill patient.
Answer: Rehabilitation aims to empower the patient to become a productive member of society. Its components are: occupational therapy (skills like candle making, paper bag making, weaving, building work discipline); social skills training (role play, imitation, instruction, developing interpersonal skills to function in a social group); cognitive retraining (improving attention, memory and executive functions); and vocational training, given after sufficient improvement, to gain skills for productive employment.
4 6-Mark Questions
Q. Discuss the various techniques used in behaviour therapy.
Answer: Behaviour therapy holds that distress arises from faulty behaviour/thought patterns, and focuses on the present. Its foundation is the clinical application of learning theory. Negative reinforcement and aversive conditioning are the two major techniques of behaviour modification. Key techniques: (i) Negative reinforcement – escaping/avoiding a painful stimulus (e.g. wearing woollens to avoid cold). (ii) Aversive conditioning – repeatedly pairing an undesired response with an aversive consequence (e.g. shock + alcohol smell). (iii) Positive reinforcement – rewarding a rare adaptive behaviour to increase it (e.g. favourite dish for homework done on time). (iv) Token economy – tokens given for wanted behaviour, collected and exchanged for a reward. (v) Differential reinforcement – reducing unwanted and increasing wanted behaviour simultaneously: positive reinforcement for the wanted plus negative reinforcement for the unwanted behaviour together, or positive reinforcement for the wanted behaviour while ignoring the unwanted one (less painful and equally effective), e.g. the cinema/sulking-girl example. (vi) Relaxation procedures, such as progressive muscular relaxation and meditation, to reduce the anxiety that acts as an antecedent factor for faulty behaviour. (vii) Systematic desensitisation (Wolpe) for phobias, using a hierarchy of feared situations and the principle of reciprocal inhibition. (viii) Modelling – learning a behaviour by observing a role model or the therapist, through vicarious learning.
Q. Explain with the help of an example how cognitive distortions take place.
Answer: Cognitive therapies locate distress in irrational thoughts and beliefs. Aaron Beck’s theory: childhood experiences from family and society develop a core schema (belief and action-pattern system). Example: a child neglected by their parents develops the core schema ‘I am not wanted’. A later critical incident (being publicly ridiculed by a teacher at school) triggers this schema, producing negative automatic thoughts such as ‘nobody loves me’, ‘I am ugly’, ‘I am stupid’, ‘I will not succeed’. These negative automatic thoughts are characterised by cognitive distortions – general ways of thinking that distort reality in a negative manner, called dysfunctional cognitive structures, which lead to errors of cognition about social reality. Repeated occurrence of these thoughts develops feelings of anxiety and depression. The therapist uses gentle, non-threatening questioning to dispute the client’s beliefs and thoughts, aiming for cognitive restructuring, which reduces the anxiety and depression.
Q. Which therapy encourages the client to seek personal growth and actualise their potential? Discuss the therapies based on this principle.
Answer: Humanistic-existential therapy is based on the principle that human beings are motivated by a need for personal growth and self-actualisation – an innate force moving a person to become more complex, balanced and integrated. When society and family curb these needs, psychological distress results; healing happens through free emotional expression in a permissive, accepting atmosphere, with the client having the freedom and responsibility to control their own behaviour. Three named therapies follow this principle: (i) Existential Therapy – Victor Frankl’s Logotherapy, which helps the client find meaning through ‘meaning making’, addressing existential anxiety of spiritual origin. (ii) Client-centred Therapy – Carl Rogers’s therapy, using empathy, unconditional positive regard and reflection to help the client reconnect with their feelings and become their real self. (iii) Gestalt Therapy – Fritz and Laura Perls’s therapy, increasing the client’s self-awareness and self-acceptance by encouraging them to act out fantasies about their feelings and conflicts.
Q. What are the factors that contribute to healing in psychotherapy? Enumerate some of the alternative therapies.
Answer: Four factors contribute to healing: the techniques adopted by the therapist and their implementation; the therapeutic alliance itself (regular availability, warmth, empathy); catharsis (emotional unburdening in initial sessions); and non-specific factors (patient variables like motivation for change, and therapist variables like absence of unresolved emotional conflicts). Alternative therapies, offered as alternatives to conventional drug treatment or psychotherapy, include yoga, meditation, acupuncture and herbal remedies. Yoga, detailed in Patanjali’s Yoga Sutras (Ashtanga Yoga), today commonly means asanas and/or pranayama. Meditation focuses attention on breath, an object, thought or mantra; Vipasana (mindfulness-based) meditation has no fixed object, and the person passively observes bodily sensations and thoughts. Sudarshana Kriya Yoga (SKY), a rapid-breathing technique, is found to be a beneficial adjunct to the treatment of stress, anxiety, PTSD, depression, stress-related medical illnesses and substance abuse, and NIMHANS research shows it reduces depression. Kundalini Yoga, combining pranayama with chanting, was found by the Institute for Non-linear Science, UCSD, USA, to be effective for obsessive-compulsive disorder.
5 Case Studies
(A) 1 mark According to the chapter, with what step does the process of psychotherapy begin?
Answer: Formulating the client’s problem (clinical formulation, Box 5.1).
(B) 2 marks What three things does a behavioural analysis try to identify, as described in the chapter?
Answer: The malfunctioning behaviour causing distress, the antecedent factors that predisposed her toward it, and the maintaining factors that keep it going.
(C) 3 marks Priya’s fear of crowded places would likely be treated with which specific technique, and how does it work?
Answer: Systematic desensitisation. The therapist and Priya would build a hierarchy of crowd-related situations from least to most anxiety-provoking; after being relaxed, she would imagine the least anxiety-provoking situation first, and over sessions progress to more severe situations while staying relaxed, using the principle of reciprocal inhibition (the built-up relaxation response inhibits the weaker anxiety response).