Six approaches: one table
CTEVT PSC curriculumCTEVT PSC curriculum: on the official Psychosocial Counselor syllabus, can appear in the exam. Beyond curriculum: added for completeness, not examinable. A chip like 296.2x · F32 is the diagnosis code: the DSM-5's older ICD-9-CM number, then the ICD-10 "F-code" used in hospital records. Non-students can ignore all of these.
| Approach | Problem is… | Counselor does… | Best for · watch out |
|---|---|---|---|
| Psychodynamic | Unconscious conflict rooted in early relationships | Listens for patterns, explores childhood, works with the relationship itself | Long-standing relational patterns · slow, needs training |
| Behavioural | Learned behaviour kept alive by reinforcement | Exposure, activity scheduling, reinforcement of new behaviour | Phobia, avoidance, habits · ignores meaning if used alone |
| Humanistic (Rogers) | Growth blocked by lack of acceptance | Empathy, genuineness, unconditional positive regard; client leads | The foundation of ALL counselling · not enough alone in severe illness |
| Cognitive-behavioural (CBT) | Unhelpful thoughts drive feelings and behaviour | Identify → test → reframe distortions; homework; behavioural experiments | Depression, anxiety · needs literacy-adapted tools in Nepal |
| Exposure technique | Avoidance keeps fear alive (the loop of Fear: the foundation) | Graded ladder; stay long enough to learn that the feared outcome is less likely or more bearable than predicted (anxiety may or may not fall); repeat | Phobia, OCD; PTSD only as trauma-focused therapy by a trained provider · never force; consent and pacing are everything |
| Socio-cultural | Distress produced by context: poverty, discrimination, family, culture | Works with family/community, healers, resources, advocacy | Almost every Nepali case · don't let it excuse skipping the individual |
The table is the map a first reader needs. The four sections below open one approach at a time, at the depth the curriculum expects for the exam.
Go deeper: the psychodynamic approachCTEVT PSC curriculum
Three assumptions carry the whole approach:
- Psychic determinism: thoughts, feelings and slips have causes, often out of awareness
- Unconscious motivation: drives we do not see steer us
- Childhood primacy: early relationships shape adult patterns
The counselor listens for repeating patterns, especially in how the client treats the counselor.
Psychosexual stages, as the curriculum expects them. Freud held that pleasure-seeking energy settles on one body zone per stage, and that an unresolved stage leaves a "fixation" in the adult. Learn the table for the exam; then hold it lightly: neither the stages nor the popular "id-dominant / superego-dominant personality" typology is diagnostic, and neither has held up as evidence. What survives is the wider idea that early relationships and defences matter.
| Stage · age | Zone · task | "Fixation" traits Freud proposed |
|---|---|---|
| Oral · birth to 18 months | Mouth · weaning | Dependence, overeating, smoking; or sarcasm and verbal hostility |
| Anal · 18 months to 3 years | Bowel and bladder · toilet training | Over-neat, stingy, perfectionist; or messy, careless, rebellious |
| Phallic · 3 to 6 years | Genitals · the Oedipus conflict (the girl's version was named the Electra complex by Jung, not Freud) | Vanity, recklessness, difficulty in close relationships |
| Latency · 6 years to puberty | Dormant · school, friends, skills | Energy goes into learning and play |
| Genital · puberty onward | Mature relationships · "to love and to work" | The balanced adult, if earlier stages resolved |
Go deeper: the behavioural approachCTEVT PSC curriculum
Behaviourism (Pavlov, Watson, Skinner) keeps only what can be seen and counted. Its wager: a troubling behaviour was learned, so it can be unlearned. Two kinds of learning do the work.
Classical conditioning is learning by association: a neutral thing gets paired with something that already triggers a response, until it triggers the response alone.
| Phase | What happens | Pavlov's dogs |
|---|---|---|
| Before | Unconditioned stimulus gives an unconditioned response; the neutral stimulus gives nothing | Food makes the dog salivate; a bell does not |
| During | Neutral and unconditioned stimuli arrive together, again and again | Bell, then food, many times |
| After | The once-neutral stimulus alone now gives the response | Bell alone: salivation |
Four words go with it:
- Extinction: the bell without food, until the response fades
- Spontaneous recovery: it returns after a rest
- Generalisation: similar things trigger it too
- Discrimination: only the exact cue does
Watson's "Little Albert" (1920), an infant taught to fear a white rat paired with a loud noise, the fear spreading to rabbits and fur coats, is history, not a model: no ethics board would allow it today, and Albert was never deconditioned. A clinical example: after chemotherapy, the hospital waiting room alone can bring on nausea.
Operant conditioning is learning by consequence. Skinner's ABC: an antecedent sets the scene, a behaviour happens, a consequence decides whether it happens again. Reinforcement always increases a behaviour; punishment always decreases it; "positive" means something is added, "negative" means something is taken away.
| Consequence | Mechanism | Example |
|---|---|---|
| Positive reinforcement | Add something wanted; behaviour increases | Praise for a child who sat through the session |
| Negative reinforcement | Remove something unpleasant; behaviour increases | Skipping the party removes the dread, so skipping grows: the avoidance loop of Fear: the foundation |
| Positive punishment | Add something unpleasant; behaviour decreases | A scolding for running into the road |
| Negative punishment | Remove something valued; behaviour decreases | Losing phone time for missing curfew |
Schedules decide how fast a habit forms and how long it stays.
- Continuous: every time. Learned fast, lost fast.
- Fixed ratio: every fifth sale earns commission.
- Variable ratio: the slot machine, hardest of all to extinguish.
- Fixed interval: checking the post as delivery time comes near.
- Variable interval: checking for messages.
In the counselling room: systematic desensitisation pairs relaxation with a graded ladder of feared cues; behavioural activation schedules rewarding activity for a depressed client (worked step by step on Techniques step by step); a token economy rewards target behaviours with tokens exchanged later for privileges, useful in wards and classrooms, and only as fair as the adults running it. Aversion therapy, pairing a drink with a nausea-inducing drug, belongs to the history of the approach; it is not taught here as a technique.
Go deeper: the humanistic approachCTEVT PSC curriculum
The "third force" answered both Freud and the behaviourists: people are not driven by hidden urges or shaped only by rewards; given the right conditions they grow toward their own potential. Reality is what the person experiences, choice is real, and a person is a whole, not a bundle of symptoms.
Rogers' map of the self. The self-concept is the picture we hold of ourselves. Distress grows in the gap between the real self (who I am) and the ideal self (who I feel I should be). The gap is widened by conditions of worth: rules absorbed from parents and society such as "I am lovable only if I bring top marks", which teach a person to hide what they actually feel in order to stay accepted.
Three core conditions. Rogers argued the relationship heals, and technique is secondary. He listed six necessary and sufficient conditions in 1957; three of them are what every counsellor is trained in:
- Congruence: genuine, no professional mask
- Unconditional positive regard: warm acceptance without terms
- Empathic understanding: feeling with, not for, and showing it
The client sets the pace and the topic. The counselor listens actively, reflects feeling, and clarifies rather than advises. This is why the six-approach table above calls it the foundation of all counselling.
Maslow's hierarchy studied healthy, thriving people rather than patients and named five families of need:
- Physiological: food, water, sleep, shelter
- Safety: from danger, from want, a predictable world
- Love and belonging
- Esteem: competence, respect, standing
- Self-actualisation: becoming what one can be
Read it as a heuristic, not a staircase: needs overlap, a hungry person still loves, and which need comes first shifts with culture and circumstance. In Nepal after a flood, it is a reminder that counselling sits beside food, shelter and safety, not above them.
Go deeper: the cognitive-behavioural approachCTEVT PSC curriculum
CBT (Aaron Beck; Albert Ellis reached similar ground with his REBT) starts from one observation: it is rarely the event alone that hurts, it is the event as we read it. Change the reading and the feeling and the behaviour shift with it. It is active, structured, time-limited and full of homework.
Beck's cognitive triad in depression: bleak automatic thoughts about the self ("I am useless"), the world ("everyone expects too much of me"), and the future ("nothing will change"). Three levels of cognition sit under them: automatic thoughts, the fast commentary that pops up in a situation; intermediate beliefs, the rules and if-thens ("if I work twice as hard, nobody will notice my mistakes"); and core beliefs, the absolute verdicts laid down early ("I am fundamentally broken").
| Distortion | What it does | Sounds like |
|---|---|---|
| All-or-nothing thinking | Two boxes, no middle | "If I don't get an A, I'm a complete failure." |
| Catastrophising | Jumps to the worst outcome | "If I stumble in the presentation, my career is over." |
| Mind reading | Assumes what others think | "She didn't wave back because she hates me." |
| Emotional reasoning | A feeling taken as proof | "I feel terrified, so this must be dangerous." |
| Should and must statements | Rigid rules, then guilt or anger when they break | "I should never need help." |
Cognitive restructuring in six steps (the fuller version of the three-question check on Mental health basics):
- Name the situation and rate the feeling, 0 to 100.
- Catch the automatic thought that ran through just before the peak.
- Examine the evidence with Socratic questions: what supports this, what contradicts it, am I treating a thought as a fact.
- Label the distortion, which puts a little distance between you and the thought.
- Write a fairer alternative that admits the real difficulty without inflating it.
- Re-rate the feeling.
The aim is a truer thought, not a positive one. Thoughts are only one corner: body, behaviour and circumstances pull on feelings too, which is why CBT pairs thought-work with breath, activity and problem-solving.