Lecture 1: Notes

Introduction to the Course

-Welcome Message This course will have 15 weekly classes. Students will be able to submit their final projects and any leftover work during the 16th week.

-A quick overview of the course outline including the topics, the online environment, assessment and evaluation will be

To Label or not to Label

The controversy around DSM and the medical model has been around since the very beginning. I will introduce the biopsychosocial model as a more effective framework to formulate emotional difficulties.

Here are some questions for you to ponder upon?

Is depression a disease?

What does it mean when we call depression a disorder?

Is sadness a disease?

What about grief when someone dies?

Should we be jumping about with joy when someone close to us passes away? Would that be normal behavior?

Is anxiety a disease?

Will we ever prepare for an examination if there were no anxiety?

The Biopsychosocial Model proposes that emotional difficulties are probably rooted in biological predisposition. These genetically acquired traits then interact with the psychosocial environment of the person: personality factors as well as social environment along with these inherited predispositions create complex patterns of thought, emotion and behavior which in any given society at any given time might be perceived as “abnormal.”

How does one decide whether these patterns are really “abnormal”?

For one, we talk about maladaptive behavior. It is simply defined as not appropriately adjusting to the environment and the situation. Many psychologists look at abnormal behavior as irrational or behavior that interferes with achievement of our own goals.

Ethical Issues in Psychotherapy


Setting limits around our conduct in the physical, emotional, social and cultural domains within therapeutic settings is extremely important.

Physical Boundaries

You have to think about the physical location (hospital, clinic, therapist’s home, clients home, seating arrangements for therapists and clients, decoration, paintings, safety considerations etc.).

Psychological Boundaries


          Respecting the client’s privacy means that we not intrude on the client’s life beyond what is necessary. This may vary from one therapeutic approach to another. For example a client with odontophobia hadn’t been to the dentist for 30 years. At the age of 47, his teeth were badly decaying. He came to me to overcome his phobia. Using CBT, I helped him with his odontophobia, which was successfully cured in 6 sessions and some supportive work outside of therapy, such as calling up the dentist and preparing them for the client. There was no discussion of the client’s married life, which might have taken Center stage in psychoanalytic therapy.


          Keeping all the client’s information as absolutely secret is extremely important. This includes any clinical notes, conversation records, any video or audio recordings made for future use and/ or supervision purposes (for these one must obtain written permission of the client).

          Multiple Relationships

          Anytime we enter into a transaction with the client which is outside of the therapeutic frame, we are said to be in multiple relationships. These multiple relationships may be ethical, such as conducting some kind of barter instead of fees, for instance, a car mechanic fixes your car instead of paying your fees, which he otherwise couldn’t afford. Some multiple relationships are clearly unethical such as having a romantic relationship with your client while they are undergoing therapy with you.


Practicing beyond one’s competence level is considered highly unethical. An example of this would be a fresh graduate trying to independently manage a complex case of substance misuse without having had any experience or specialized training.

Culture and Psychotherapy

Pakistan has different cultures and within its ethnic and religious groups, class and caste distinctions lead to a plethora of subcultures. It is important to be aware of these differences so that we don’t not inadvertently impose our values on our clients.

Critical Thinking Exercise

A Muslim Jatt boy wants to marry their maid who belongs to Chamaar caste. Parents’ opposition to this marriage seems to have precipitated a breakdown and the parents bring him to you for management of his depression. How do you view the situation?

Essential Reading: https://www.zurinstitute.com/boundaries-dual-relationships/

Assignment 1

This post-class assignment carries 5 percent of the overall marks.

How can caste differences of therapist and clients interfere with therapy?  Imagine such a situation and briefly express its implications for psychotherapy. (200 words)