- What psychotherapy actually is, and why the therapeutic relationship is itself one of the main agents of change
- How behaviour therapy, cognitive therapy and humanistic-existential therapy each explain and treat distress differently
- The named techniques inside each therapy: systematic desensitisation, RET, cognitive restructuring, client-centred reflection, and more
- Ethical rules every psychotherapist must follow, and how alternative therapies like yoga and meditation help
- How a mentally ill patient is rehabilitated after symptoms reduce
unconditional positive regardsystematic desensitisationtoken economy
RETcognitive restructuringself-actualisationlogotherapy
catharsisrehabilitation
This NCERT chapter classifies psychotherapies into three historical families: psychodynamic,
behaviour, and existential. The CBSE 2026-27 curriculum lists these topics for Unit V, Therapeutic
Approaches: nature and process of psychotherapy (therapeutic relationship); types of therapies
(behaviour, cognitive, humanistic-existential and alternative therapies,
factors contributing to healing, ethics); and rehabilitation of the mentally ill. Psychodynamic therapy
is not named in that list. The book gives psychodynamic therapy no taught section of its own, but it
does compare it with the other two families on six parameters, so its column in that table below is
part of the chapter. The chapter has no section on biomedical or drug therapy; it mentions
conventional drug treatment only as the contrast for alternative therapies.
In the CBSE 2026-27 curriculum, Unit V (this chapter) carries 9 marks of the 70-mark
theory paper. The 30-mark practical (practical file and case profile 10, viva voce 5, two
psychological tests 15) is assessed separately and is not part of these notes.
1Nature and Process of Psychotherapy
Psychotherapy is a voluntary relationship between the person seeking treatment (the client)
and the person who treats (the therapist), aimed at helping the client solve the psychological
problems they face.
The relationship builds the client’s trust so problems can be discussed freely. Psychotherapy
aims at changing maladaptive behaviours, decreasing personal distress, and helping the client adapt
better to their environment: including their marital, occupational and social adjustment.
1.1 Four defining characteristics
Systematic application
Every therapy applies principles from a theory of therapy in an organised way: it is not random advice.
Trained practitioners only
Only a person with practical training under expert supervision may practise psychotherapy. An
untrained person can unintentionally cause more harm than good.
Therapist and client
The client is the one seeking and receiving help: the focus of attention throughout.
A confidential, dynamic relationship
The interaction of therapist and client forms and consolidates the therapeutic relationship:
confidential, interpersonal, and the actual vehicle for change.
“Describe the nature and scope of psychotherapy” is Review Question 1 in the NCERT book.
Write the definition, then all 4 characteristics above, each as a separate point.
1.2 The ten goals of psychotherapy
The book lists these as one set: learn them as a list, not as separate ideas:
2Therapeutic Relationship
The special relationship between client and therapist is called the therapeutic relationship
(or therapeutic alliance): neither a passing acquaintance nor a permanent relationship.
2.1 Two components of the therapeutic alliance
Component 1: Contractual
- Two willing individuals
- Enter a partnership
- Aim: help the client overcome their problems
Component 2: Limited duration
- Lasts only until the client can
handle their problems - And take control of their own life
The alliance is a trusting and confiding relationship. High trust lets the client unburden
themselves. The therapist builds this by being accepting, empathic, genuine and warm: never judging
the client, whatever the client confides.
Unconditional positive regard is the therapist’s continuing positive feeling for the client,
regardless of what the client says or has done: the therapist does not withdraw warmth even if the
client is rude or confides “wrong” things.
2.2 Empathy, sympathy and intellectual understanding
Students confuse empathy with sympathy. Sympathy = compassion and pity towards another’s suffering,
without being able to feel like that person. Empathy = understanding AND feeling the client’s
situation “as if it were one’s own.” Intellectual understanding is cold: the person cannot feel like
the other and feels no sympathy either.
The alliance also requires strict confidentiality of everything the client discloses, and the
therapist must never exploit the client’s trust. It is, finally, a professional relationship.
3Classification of Psychotherapies
Though every psychotherapy aims at removing distress and building effective behaviour, they differ
greatly in concepts, methods and techniques. NCERT classifies psychotherapies into three broad groups:
learn the chronological order they emerged in:
The book has no separate section on psychodynamic therapy’s techniques. It appears in two places
only: the chronological order above, and the six-parameter comparison below.
NCERT classifies the three families on six parameters. Learn the table as the book prints it:
| Parameter | Psychodynamic therapy | Behaviour therapy | Existential therapy |
|---|---|---|---|
| Cause of the problem | Intrapsychic conflicts: conflicts present within the psyche of the person | Faulty learning of behaviours and cognitions | Questions about the meaning of one’s life and existence |
| How the cause arose | Unfulfilled desires of childhood and unresolved childhood fears lead to intrapsychic conflicts | Faulty conditioning (mislearned associations between a situation and a response), learning, thinking and beliefs → maladaptive behaviour | Present feelings of loneliness, alienation (feeling cut off from others and one’s own true self), and a sense of futility |
| Chief treatment method | Free association and reporting of dreams elicit the client’s thoughts and feelings; these are interpreted to the client to help confront and resolve the conflicts | Identify faulty conditioning; set up alternate behavioural contingencies (new if-then links between a behaviour and its consequence) | Provide a positive, accepting, non-judgmental environment; client talks, arrives at solutions through personal growth |
| Nature of therapeutic relationship | Therapist understands the client’s intrapsychic conflicts better than the client, so the therapist interprets the client’s thoughts and feelings to her/him | Therapist discerns the faulty pattern and finds the correct/adaptive one for the client | Therapist merely provides a warm, empathic relationship; client explores by themselves |
| Chief benefit to client | Emotional insight: understanding the conflicts intellectually, accepting them emotionally and changing one’s emotions towards them; symptoms and distress reduce | Changing faulty behaviour/thought patterns to adaptive ones | Personal growth: increasing understanding of self, aspirations, emotions and motives |
| Duration of treatment | Classical psychoanalysis may continue for several years; several recent versions are completed in 10-15 sessions | Shorter; completed in a few months | Shorter; completed in a few months |
4Clinical Formulation: Steps in Understanding a Client’s Problem
Clinical formulation means formulating the client’s problem in the therapeutic model being used
for treatment. It is not advisable to start psychotherapy without one.
A client seeks help because they cannot hold a job and cannot face superiors.
Behaviour therapy’s clinical formulation states this as: lack of assertiveness
skills + anxiety. The target areas are now identified precisely: teaching assertiveness, and
reducing anxiety: not “the client has a work problem” in general.
Formulation is an ongoing process: it may need to be reformulated as clinical insight is gained
during therapy. Usually the first one or two sessions give enough material for an initial formulation.
5Behaviour Therapy
Behaviour therapy holds that psychological distress arises from faulty behaviour or thought
patterns. It focuses on the client’s behaviour and thoughts in the present: the past
matters only to understand how the faulty pattern began, it is never relived. Only the faulty pattern
in the present is corrected.
Its foundation is the clinical application of learning theory: the study of how behaviour is
shaped and changed through conditioning, the process by which a stimulus or a consequence comes
to control a response. It is not one unified theory: it is a large set of specific techniques, chosen
according to the client’s actual symptoms and diagnosis: a phobia needs different techniques from an
anger outburst, which needs different techniques from depression or anxiety.
5.1 Behavioural analysis: finding what to treat
A young man smokes and wants to quit. Malfunctioning behaviour: smoking. Antecedent
factor: he started while preparing for his annual exam: the anxiety-provoking situation.
Maintaining factor: he felt relief from anxiety on smoking, so the relief keeps the operant
response (a behaviour that acts on the environment to produce a consequence, here smoking) going.
5.2 The treatment package: antecedent and consequent operations
The aim: extinguish the faulty behaviour and substitute an adaptive one, through two kinds of
operation:
Antecedent operation
- Changes something that comes before
the behaviour - Called an establishing operation when it changes a consequence’s
reinforcing value, meaning how strongly that consequence motivates the behaviour that earns
it (reinforcement itself is detailed in the techniques below)
Consequent operation
- Changes something that comes after the
behaviour - E.g. praising a child for a wanted behaviour
A child gives trouble eating dinner. Antecedent operation: decrease food at tea time → this
raises hunger and the reinforcing value of food at dinner. Consequent operation: praise the
child for eating dinner properly. Together, they establish the response of eating dinner.
5.3 Behavioural techniques
Principles: reduce the client’s arousal level; alter behaviour through classical or operant
conditioning with different contingencies of reinforcement; and use vicarious learning procedures, if
necessary. Negative reinforcement and aversive conditioning are the two major techniques of
behaviour modification. These notes group the book’s named techniques as: negative reinforcement,
aversive conditioning, positive reinforcement, token economy and differential reinforcement (below),
then relaxation procedures, systematic desensitisation and modelling (each in its own subsection
next):
An alcoholic is given a mild electric shock while smelling alcohol. With repeated pairing, the
smell of alcohol itself becomes aversive (associated with the shock’s pain), and the person gives up
alcohol.
A child does not do homework regularly. The mother prepares the child’s favourite dish whenever the
child does homework at the appointed time. The positive reinforcement of the favourite dish increases
the behaviour of doing homework on time.
A patient with behavioural problems is given a token every time a wanted behaviour occurs. The
tokens are collected and exchanged for a reward, such as an outing for the patient or a
treat for a child.
Differential reinforcement reduces unwanted behaviour and increases wanted behaviour
simultaneously, by either of two methods: (a) positive reinforcement for the wanted behaviour and
negative reinforcement for the unwanted behaviour, attempted together; or (b) positive reinforcement
for the wanted behaviour while the unwanted behaviour is ignored. The second method is less painful
and equally effective.
A girl sulks and cries to be taken to the cinema. The parent takes her only if she does not
cry/sulk, and ignores her when she does. Result: the wanted behaviour (asking politely)
increases; the unwanted behaviour (crying, sulking) decreases.
5.4 Relaxation procedures
Anxiety raises the client’s arousal level and acts as an antecedent factor for faulty behaviour
(smoking, overeating, poor concentration): so reducing anxiety reduces these behaviours.
Progressive muscular relaxation: the client learns to contract an individual muscle group
(e.g. the forearm) to become aware of tension, then release it: with repeated practice, the client
learns to relax all the muscles of the body.
5.5 Systematic desensitisation: for phobias and irrational fears
Introduced by Wolpe. The client and therapist build a hierarchy of anxiety-provoking
situations, least → most frightening.
The therapist relaxes the client, who imagines the least anxiety-provoking situation first,
stopping immediately if any tension is felt. Over sessions, the client tolerates progressively more
severe imagined situations while remaining relaxed, and becomes systematically desensitised.
The principle of reciprocal inhibition: when two mutually opposing forces are present at the
same time, the weaker force is inhibited. Relaxation (the stronger, built-up response) inhibits
anxiety (the weaker force) as the client imagines progressively more frightening scenes.
Modelling: the client learns to behave a certain way by observing a role model or the
therapist (who first acts as the model), through vicarious learning (learning by watching
someone else’s behaviour and its consequences, without personally experiencing them); small behaviour
changes are rewarded progressively until the model’s behaviour is fully acquired.
6Cognitive Therapy
Cognitive therapies locate the cause of psychological distress in irrational thoughts and
beliefs.
6.1 Albert Ellis: Rational Emotive Therapy (RET)
Central thesis: irrational beliefs mediate between antecedent events and their consequences.
Irrational beliefs carry “musts” and “shoulds” that may not be supported by real evidence: e.g. “One should be
loved by everybody all the time,” or “Human misery is caused by external events one cannot control.”
These beliefs are assessed through questionnaires and interviews.
The therapist refutes irrational beliefs through gentle, non-directive questioning: never
probing or directive. Example questions the book gives: “Why should everyone love you?”, “What does
it mean to you to succeed?” The client gradually replaces the irrational belief system with a rational
one, reducing distress.
6.2 Aaron Beck’s cognitive therapy
A child neglected by their parents develops the core schema “I am not wanted.” Later in life, being
publicly ridiculed by a teacher (the critical incident) triggers this schema, producing negative
automatic thoughts like “I am stupid” or “I will not succeed.”
The therapist uses gentle, non-threatening questioning to reverse the negative automatic thoughts,
achieving cognitive restructuring: which reduces anxiety and depression.
Similar to behaviour therapy, cognitive therapy also focuses on solving a specific problem of the
client. Unlike psychodynamic therapy, behaviour therapy is open (the therapist shares
the method with the client) and short: lasting 10 to 20 sessions.
6.3 Cognitive Behaviour Therapy (CBT)
The most popular therapy presently. Research has conclusively shown CBT to be a short,
efficacious (effective) treatment for anxiety, depression, panic attacks, borderline
personality (a personality disorder marked by unstable emotions, self-image and relationships),
and more.
Biological aspects
Addressed through relaxation procedures
Psychological aspects
Addressed through behaviour therapy + cognitive therapy techniques
Social aspects
Addressed through environmental manipulation (changing the client’s surroundings or social situation itself, not just their behaviour or thoughts)
This bio-psychosocial approach is what makes CBT comprehensive, easy to use, applicable to
many disorders, and proven effective.
7Humanistic-Existential Therapy
Humans are motivated by a need for personal growth and self-actualisation, and an innate
need to grow emotionally. When society and family curb these needs, psychological distress results.
Self-actualisation is an innate force that moves a person to become more complex, balanced
and integrated: a whole, complete person despite a variety of experiences.
Healing happens when the client perceives and removes obstacles to self-actualisation, through free
emotional expression, in a permissive, non-judgmental, accepting therapeutic atmosphere. The client
has the freedom AND the responsibility to control their own behaviour; the therapist is merely a
facilitator/guide.
7.1 Existential Therapy: Victor Frankl’s Logotherapy
Victor Frankl, a psychiatrist and neurologist, propounded Logotherapy (“Logos” is
Greek for “soul”: Logotherapy = “treatment for the soul”). He called finding meaning even in
life-threatening circumstances meaning making: a person’s quest for the spiritual truth of
their own existence.
Just as the unconscious (the part of the mind holding instincts and experiences a person is
not aware of) is a repository of instincts, Frankl proposed a spiritual unconscious: the
storehouse of love, aesthetic awareness and life’s values. Neurotic anxieties arise when
life’s problems attach to the physical, psychological or spiritual aspects of one’s existence. Frankl
stressed spiritual anxieties, which lead to meaninglessness; this is called existential
anxiety, i.e. neurotic anxiety of spiritual origin.
The goal of logotherapy: help the client find meaning and responsibility in life, irrespective of
their circumstances. The therapist is open, shares their own feelings/values, emphasises “here and
now”, and actively discourages transference (a client unconsciously redirecting feelings about
someone else, often a parent, onto the therapist).
7.2 Client-centred Therapy: Carl Rogers
Carl Rogers combined scientific rigour with an individualised practice, and introduced the
concept of self: freedom and choice as the core of one’s being.
Empathy
Understanding the client’s experience as if it were one’s own
Unconditional positive regard
Total acceptance of the client as they are, regardless of what is revealed
Reflection
Rephrasing the client’s own statements to seek simple clarification, helping them become integrated
Empathy sets up an emotional resonance between therapist and client. Unconditional positive
regard, warmth that does not depend on what the client reveals, lets the client feel secure enough to
explore their own feelings. The therapist merely
facilitates: it is the client who becomes their real self.
7.3 Gestalt Therapy: Fritz and Laura Perls
German gestalt = “whole”. Given by Freiderick (Fritz) Perls with his wife
Laura Perls. Goal: increase the client’s self-awareness and self-acceptance. The client
is taught to recognise bodily processes and emotions being blocked from awareness, by acting out
fantasies about feelings and conflicts: this can also be used in group settings.
8Factors Contributing to Healing in Psychotherapy
Catharsis is the process of emotional unburdening while the client’s problem is first being
understood in the initial sessions: it has healing properties of its own.
Example for factor 1 (the book’s): if the behavioural system and the CBT school are adopted to
heal an anxious client, the relaxation procedures and the cognitive restructuring largely contribute
to the healing.
8.1 Non-specific factors: patient and therapist variables
Patient variables
- Motivation for change
- Expectation of improvement from treatment
Therapist variables
- Positive nature
- Absence of unresolved emotional conflicts
- Good mental health
9Ethics in Psychotherapy
9.1 The six standards every therapist must follow
✓ Every therapist must
- Take informed consent
- Maintain the client’s confidentiality
- Make alleviating personal distress the goal of every attempt
- Preserve the integrity of the practitioner-client relationship
- Respect human rights and dignity
- Have professional competence and skills
✗ The book’s warnings, in short
- Practise without professional training
- Break the client’s confidentiality
- Exploit the trust and the confidence of the client
10Alternative Therapies
Alternative treatment possibilities to conventional drug treatment or psychotherapy: yoga,
meditation, acupuncture, herbal remedies. In the past 25 years, yoga and meditation have gained
popularity as treatment programmes.
10.1 Yoga and meditation
Yoga
- Ancient Indian technique, detailed in the Ashtanga Yoga of
Patanjali’s Yoga Sutras - Today: asanas (postures), pranayama (breathing), or both
Meditation
- Focusing attention on breath, an object, thought or mantra
- Vipasana (mindfulness-based): no fixed object; passively observing bodily sensations and thoughts
Sudarshana Kriya Yoga (SKY): rapid breathing causing hyperventilation; low-risk, low-cost;
helps stress, anxiety, PTSD (Post-Traumatic Stress Disorder), depression, stress-related medical
illnesses, substance abuse, and
rehabilitation of offenders; used as a public-health intervention for PTSD in mass-disaster survivors.
NIMHANS, India research showed
SKY reduces depression, including in alcoholic patients. Insomnia is treated with yoga: it reduces
the time taken to fall asleep and improves the quality of sleep. Proper training by a skilled teacher
and a 30-minute practice every day will maximise the benefits.
Kundalini Yoga (taught in the USA): combines pranayama with chanting of mantras. The
Institute for Non-linear Science, University of California, San Diego, USA found it effective
for obsessive-compulsive disorder. Mindfulness-based/Vipasana meditation may help prevent
repeated depressive episodes by improving how emotional stimuli are processed.
11Rehabilitation of the Mentally Ill
Treating a psychological disorder has two components:
11.1 Milder vs severe disorders
Milder disorders
- Generalised anxiety, reactive depression, phobia
- Symptom reduction is associated with better quality of life
Severe disorders
- E.g. schizophrenia
- Symptom reduction may not improve quality of life
- Many patients have negative symptoms: disinterest, lack of motivation to work or interact
Rehabilitation aims to empower the patient to become a productive member of society, to the extent
possible.
Occupational therapy
Skills like candle making, paper bag making, weaving: builds work discipline.
Social skills training
Role play, imitation, instruction: develops interpersonal skills and the ability to function
in a social group.
Cognitive retraining
Improves basic cognitive functions: attention, memory, and executive functions (higher mental
skills such as planning, organising and self-control).
Vocational training
Given after sufficient improvement: skills for productive employment.
Psychotherapy is not one treatment: NCERT itself notes there are about 400 different types of
psychotherapy, but every one of them shares the therapist, the therapeutic relationship, and the
process of therapy as the actual agents of change.
Summary, NCERT Psychology Chapter 5
- Can I state the 4 characteristics of psychotherapy and the therapeutic alliance’s 2 components?
- Can I explain empathy vs sympathy vs intellectual understanding, in my own words?
- Can I name and briefly describe the behavioural techniques with an example each?
- Can I trace Beck’s schema → critical incident → negative automatic thoughts → distortion chain?
- Can I name the therapist behind RET, Logotherapy, Client-centred therapy and Gestalt therapy?
- Can I list all 6 ethical standards in psychotherapy?
- Can I explain why symptom reduction may not bring better quality of life in schizophrenia?
- Psychotherapy = voluntary, confidential relationship aimed at solving the client’s psychological problems
- The predominant mode of psychotherapy for adults with psychological distress is individual psychotherapy; the therapist must be professionally trained
- Therapeutic alliance = contractual + limited duration; needs trust, empathy, unconditional positive regard, confidentiality
- 3 families, chronological order: psychodynamic → behaviour → existential (compared on six parameters: cause, how it arose, method, relationship, benefit, duration)
- Behaviour therapy: behavioural analysis (malfunctioning/antecedent/maintaining factors) → treatment package (antecedent + consequent operations); techniques = negative reinforcement, aversive conditioning, positive reinforcement, token economy, differential reinforcement, relaxation, systematic desensitisation (Wolpe, reciprocal inhibition), modelling
- Cognitive therapy: Ellis’s RET (ABC analysis, non-directive questioning) and Beck’s cognitive therapy (core schema → negative automatic thoughts → cognitive restructuring); CBT = bio-psychosocial, most popular today
- Humanistic-existential: self-actualisation is the core idea; Frankl’s Logotherapy (meaning making, spiritual unconscious), Rogers’s Client-centred therapy (empathy, unconditional positive regard, reflection), Perls’s Gestalt therapy (self-awareness)
- Healing factors: techniques, the alliance, catharsis, non-specific patient/therapist variables
- 6 ethical standards; alternative therapies = yoga, meditation (Vipasana), SKY (NIMHANS), Kundalini yoga (UCSD, OCD)
- Rehabilitation: occupational therapy, social skills training, cognitive retraining, vocational training
Resistance is one of the book’s own Key Terms for this chapter, though the chapter body
does not explain it. Its general meaning (not given in the book) is a client’s unconscious opposition
to confronting painful material, a concept from psychodynamic therapy.