15.0. Brief overview of Psychotherapies - Final- Siluwe Yambayamba.pptx

Psychotherapies overview

1. Brief overview of Psychotherapies Presenter: Siluwe Yambayamba (001-165) Cavendish University. Moderator: Dr Ravi P aul

2. Contents Introduction Definition of psychotherapy Purpose of psychotherapy Psychoanalysis & related therapies: Freud’s theories of the mind. Defense mechanisms Types of the Psychotherapies MCQs. 12/21/2021 SILUWE YAMBAYAMBA - CUZ 2

3. Introduction Because psychiatrists deal with disorders that involve thoughts , feelings, and relationships, it is essential that they maintain an empathic and caring attitude toward their patients and become skilled in using therapies directed at the mind in addition to the brain . Psychotherapy may be used in combination with medication or other therapies . 12/21/2021 SILUWE YAMBAYAMBA - CUZ 3

4. Definition Psychotherapy is a therapeutic process to treat psychological problems by way of establishing a relationship between a trained professional and an individual . This treatment modality is established through therapeutic communication, both verbal and nonverbal, attempts to alleviate the emotional disturbance, reverse or change maladaptive patterns of behavior, and encourage personality growth and development. 12/21/2021 SILUWE YAMBAYAMBA - CUZ 4

5. Purpose of Psychotherapy The following are the main goals or purposes of Psychotherapy: 1 . Remove, modify or retard existing symptoms. 2. Mediate disturbed patterns of behavior, and/or 3. Promote positive personality growth and development 12/21/2021 SILUWE YAMBAYAMBA - CUZ 5

6. Psychoanalysis and Related Therapies 12/21/2021 SILUWE YAMBAYAMBA - CUZ 6

7. Psychoanalysis and Related Therapies Psychoanalysis and its related therapies are derived from Sigmund Freud’s psychoanalytic theories of the mind. Freud proposed that behaviors, or symptoms , result from unconscious mental processes, including defense mechanisms and conflicts between one’s ego, id , superego , and external reality . 12/21/2021 SILUWE YAMBAYAMBA - CUZ 7

8. Freud’s Theories of the Mind (Topographic Theory) In the topographic theory, the mind contains three levels : The unconscious, preconscious, and conscious. Unconscious: Includes repressed thoughts that are out of one’s awareness - involves primary process thinking (A type of thinking associated with primitive, pleasure-seeking urges with no regard to logic or time, prominent in children and psychosis). Thoughts and ideas may be repressed into the unconscious because they are embarrassing, shameful, or otherwise too painful. Preconscious: Contains memories that are easy to bring into awareness, but not unless consciously retrieved. Conscious: Involves current thoughts and secondary process thinking (logical, organized, mature, and can delay gratification). 12/21/2021 SILUWE YAMBAYAMBA - CUZ 8

9. Freud’s Theories of the Mind (Structural Theory) In the structural theory, the mind contains three parts: the id , the ego , and the superego. Id : Unconscious ; involves instinctual sexual/aggressive urges and primary process thinking . Superego : Moral conscience and ego ideal (inner image of oneself that one wants to become ). Superego is the aspect of one’s psyche that represents “morality , society, and parental teaching .” Ego : Serves as a mediator between the id, superego, and external environment and seeks to develop satisfying interpersonal relationships. Uses defense mechanisms to control instinctual urges and distinguishes fantasy from reality using reality testing. Problems with reality testing occur in psychotic individuals. 12/21/2021 SILUWE YAMBAYAMBA - CUZ 9

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11. Defense Mechanisms Defense mechanisms are defined as unconscious mental techniques used by the ego to keep conflicts out of the conscious mind, thus decreasing anxiety and maintaining a person’s sense of sa f ety , equilibrium, and sel f -esteem . They can be useful in helping people deal with difficult life situations such as medical illness , but, when used in excess, can become a barrier to seeking care or adhering to treatment recommendations . They are (mostly) unconscious processes that are normal and healthy if mature and when used in moderation (i.e ., adaptive ), but may be unhealthy and seen in some psychiatric disorders when used excessively (i.e., maladaptive ). 12/21/2021 SILUWE YAMBAYAMBA - CUZ 11

12. Defense Mechanisms – con’t Defense mechanisms are often classified hierarchically: Mature defense mechanisms are healthy and adaptive, and they are seen in normal adults . Neurotic defenses are encountered in obsessive-compulsive patients, patients with other anxiety disorders, and adults under stress . Immature defenses are seen in children, adolescents, psychotic patients, and some nonpsychotic patients , such as patients with severe personality disorders. They are the most primitive defense mechanisms. 12/21/2021 SILUWE YAMBAYAMBA - CUZ 12

13. Mature defenses Mature ego defenses are commonly found in healthy, high-functioning adults . These defenses often help people integrate conflicting emotions and thoughts. These are: 1. Altruism 2 . Humor 3. Sublimation 4 . Suppression 12/21/2021 SILUWE YAMBAYAMBA - CUZ 13

14. cont. 1 . Altruism: Performing acts that benefit others in order to vicariously experience pleasure e.g A child dies of ovarian cancer and as part of the grieving process, the parent donates money to help raise community awareness about the symptoms of ovarian cancer so other patients could potentially benefit from early intervention.) 2. Humor: Expressing (usually) unpleasant or uncomfortable feelings without causing discomfort to self or others . 3. Sublimation: Satisfying socially objectionable impulses in an acceptable manner (thus channeling them rather than preventing them) e.g a person with unconscious urges to physically control others becomes a prison guard. 4. Suppression: Purposely ignoring an unacceptable impulse or emotion in order to diminish discomfort and accomplish a task. E.g. A Nurse who feels nauseated by an infected wound puts aside feelings of disgust to clean wound and provide necessary patient care.) 12/21/2021 SILUWE YAMBAYAMBA - CUZ 14

15. N eurotic defenses 1. Controlling 2 . Displacement 3 . Intellectualization 4. Isolation of affect 5. Rationalization 6 . Reaction formation 7 . Repression 12/21/2021 SILUWE YAMBAYAMBA - CUZ 15

16. N eurotic defenses 1. Controlling: Regulating situations and events of external environment to relieve anxiety. 2. Displacement: Shifting emotions from an undesirable situation to one that is personally tolerable. 3. Intellectualization: Avoiding negative feelings by excessive use of intellectual functions and by focusing on irrelevant details. E.g A Physician dying from colon cancer describes the pathophysiology of his disease in detail to his 12-year-old son . 4. Isolation of affect: Unconsciously limiting the experience of feelings or emotions associated with a stressful life event in order to avoid anxiety. E.g. Woman describes the recent death of her beloved husband without emotion . 12/21/2021 SILUWE YAMBAYAMBA - CUZ 16

17. Neurotic defenses – con’t . 5. Rationalization: Explanations of an event in order to justify outcomes or behaviors and to make them acceptable. 6 . Reaction formation: Doing the opposite of an unacceptable impulse e.g. Man who is in love with his married coworker insults her . 7. Repression: Preventing a thought or feeling from entering consciousness- Repression is unconscious, whereas suppression is a conscious act . 12/21/2021 SILUWE YAMBAYAMBA - CUZ 17

18. Immature defenses 1 . Acting out 2 . Denial 3 . Regression 4 . Projection 12/21/2021 SILUWE YAMBAYAMBA - CUZ 18

19. Immature defenses 1 . Acting out: Giving in to an impulse, even if socially inappropriate, in order to avoid the anxiety of suppressing that impulse. 2 . Denial: Not accepting reality that is too painful. E.g. Woman who has been scheduled for a breast mass biopsy cancels her appointment because she believes she is healthy . 3. Regression: Performing behaviors from an earlier stage of development in order to avoid tension associated with current phase of development . E.g. A Woman brings her childhood teddy bear to the hospital when she has to spend the night . 4. Projection: Attributing objectionable thoughts or emotions to others. E.g. Husband who is attracted to other women believes his wife is having an affair . 12/21/2021 SILUWE YAMBAYAMBA - CUZ 19

20. Other defense mechanisms 1 . Splitting: Labeling people as all good or all bad (often seen in borderline personality disorder). E.g. A Woman who tells her doctor , “ You and the nurses are the only people who understand me; all the other doctors are mean and impatient .” 2. Undoing: Attempting to reverse a situation by adopting a new behavior. E.g. Man who has had a brief fantasy of killing his wife by sabotaging her car takes the car in for a complete checkup . 12/21/2021 SILUWE YAMBAYAMBA - CUZ 20

21. Types of psychotherapy Behavior therapy Individual therapy Classical psychoanalysis Psychodynamic psychotherapy Insight-oriented psychotherapy Relationship psychotherapy Interpersonal therapy (IPT) Supportive psychotherapy 3 . Cognitive-behavioral therapy (CBT) 4. Group therapy 5. Couples therapy 6 . Family therapy 7 . Social skills training 12/21/2021 SILUWE YAMBAYAMBA - CUZ 21

22. 1. Psychoanalysis 12/21/2021 SILUWE YAMBAYAMBA - CUZ 22

23. Psychoanalysis The goal of psychoanalysis is to resolve unconscious conflicts by bringing repressed experiences and feelings into awareness and integrating them into the patient’s conscious experience. Psychoanalysis is therefore considered insight oriented. Patients best suited for psychoanalysis have the following characteristics : Not psychotic I ntelligent , and Stable in relationships and daily living . Psychoanalysis is not indicated for people who have problems with reality testing , such as actively psychotic or manic patients. 12/21/2021 SILUWE YAMBAYAMBA - CUZ 23

24. Psychoanalysis – con’t Treatment is usually 3–5 days per week for many years . During therapy sessions , the patient usually lies on a couch with the therapist seated out of view. Psychoanalysis can be useful in the treatment of : Clusters B and C personality disorders Anxiety disorders Problems coping with life events. Sexual disorders Persistent depressive disorder 12/21/2021 SILUWE YAMBAYAMBA - CUZ 24

25. Important concepts & Techniques u sed in Psychoanalysis Free association: The patient is asked to say whatever comes into his or her mind during therapy sessions. The purpose is to bring forth thoughts and feelings from the unconscious so that the therapist may interpret them. Dream interpretation: Dreams are seen to represent conflict between urges and fears. Interpretation of dreams by the psychoanalyst is used to help achieve therapeutic goals. Therapeutic alliance: This is the bond between the therapist and the patient, who work together toward a therapeutic goal . 12/21/2021 SILUWE YAMBAYAMBA - CUZ 25

26. Con’t 4. Transference: This is projection of unconscious feelings regarding important figures in the patient’s life onto the therapist. Interpretation of transference is used to help the patient gain insight and resolve unconscious conflict. E xample of transference: when a patient who has repressed feelings of abandonment by her father becomes angry when her therapist is late for the appointment. 5. Countertransference: Projection of unconscious feelings about important figures in the therapist’s life onto the patient. The therapist must remain aware of countertransference issues, as they may interfere with his or her objectivity . 12/21/2021 SILUWE YAMBAYAMBA - CUZ 26

27. Psychoanalysis-related Therapies Examples of psychoanalysis-related therapies include : 1. Psychoanalytically oriented psychotherapy and brief dynamic psychotherapy: These employ similar techniques and theories as psychoanalysis, but they are less frequent, less intense, usually briefer (weekly sessions for 6 months to several years), and involve face-to-face sessions between the therapist and patient (no couch). 2. Interpersonal therapy: Focuses on development of social skills to help treat certain psychiatric disorders. Treatment is short (once-weekly sessions for several months). Aimed at improving interpersonal relations. Sessions focus on reassurance, clarification of emotions, improving interpersonal communication , and testing perceptions . 12/21/2021 SILUWE YAMBAYAMBA - CUZ 27

28. con’t . 3 . Supportive psychotherapy: Purpose is to help patient feel safe during a difficult time and help to build up the patient’s healthy defenses. Treatment is not insight oriented but instead focuses on empathy, understanding, and education. Supportive therapy is commonly used as adjunctive treatment in even the most severe mental disorders. 12/21/2021 SILUWE YAMBAYAMBA - CUZ 28

29. 2. Psychodynamic psychotherapy 12/21/2021 SILUWE YAMBAYAMBA - CUZ 29

30. Psychodynamic psychotherapy Psychodynamic psychotherapy is typically conducted face to face. A short-term treatment, generally consisting of 10 to 40 sessions during a period of less than 1 year . The goal, based on psychodynamic theory, is to develop insight into underlying conflicts; such insight leads to psychological and behavioral changes. . This therapy is more confrontational than the other insight-oriented therapies in that the therapist is very active in repeatedly directing the patient’s associations and thoughts to conflictual areas. U sed to treat patients with a variety of problems, including personality disorders, sexual dysfunctions, anxiety disorders, and mild depression . N ot suitable for those with fragile ego structures (e.g., suicidal or psychotic patients) and those with poor impulse control (e.g., borderline patients , substance abusers, and antisocial personalities). 12/21/2021 SILUWE YAMBAYAMBA - CUZ 30

31. 3 . Behavioral Therapy 12/21/2021 SILUWE YAMBAYAMBA - CUZ 31

32. Behavioral Therapy Behavioral therapy, was pioneered by B. F. Skinner, seeks to treat psychiatric disorders by helping patients change behaviors that contribute to their symptoms. It can be used to extinguish maladaptive behaviors (such as phobic avoidance, compulsions , etc.) by replacing them with healthy alternatives. The time course is usually brief, and it is usually combined with cognitive therapy as Cognitive-Behavioral Therapy (CBT). Behavioral therapy is based on learning theory, which states that behaviors are learned by conditioning and can similarly be unlearned by deconditioning. 12/21/2021 SILUWE YAMBAYAMBA - CUZ 32

33. Conditioning Classical conditioning: A stimulus can evoke a conditioned response – e.g. Pavlov’s dog would salivate when hearing a bell because the dog had learned that bells were always followed by food. Operant conditioning: Behaviors can be learned when followed by positive or negative reinforcement - E.g. Skinner box—a rat presses a lever by accident and receives food; eventually, it learns to press the lever for food [trial-and-error learning]. 12/21/2021 SILUWE YAMBAYAMBA - CUZ 33

34. Behavioral Therapy Techniques (Deconditioning) Systematic desensitization. Flooding and implosion. Aversion therapy Token economy. Biofeedback. 12/21/2021 SILUWE YAMBAYAMBA - CUZ 34

35. Con’t 1. Systematic desensitization: The patient performs relaxation techniques while being exposed to increasing doses of an anxiety-provoking stimulus . Gradually , he or she learns to associate the stimulus with a state of relaxation. Commonly used to treat phobic disorders. E.g. A patient who has a fear of spiders is first shown a photograph of a spider, followed by exposure to a stuffed toy spider, then a videotape of a spider, and finally a live spider. At each step, the patient learns to relax while exposed to an increasing dose of the phobia . 12/21/2021 SILUWE YAMBAYAMBA - CUZ 35

36. con’t 2. Flooding and implosion: The patient is confronted with a real (flooding) or imagined (implosion) anxiety-provoking stimulus and not allowed to withdraw from it until he or she feels calm and in control. Relaxation exercises are used to help the patient tolerate the stimulus . Through the process of habituation , the person becomes accustomed to the stimulus and is no longer afraid Example: A patient who has a fear of flying is made to fly in an airplane [flooding] or imagine flying [implosion ]. 12/21/2021 SILUWE YAMBAYAMBA - CUZ 36

37. con’t 3. Aversion therapy: Classical conditioning is used to pair a maladaptive but pleasurable stimulus with an aversive or painful stimulus (e.g., a shock) so that the two become associated . The person ultimately stops engaging in the maladaptive behavior because it automatically provokes an unpleasant response Used to treat addictions ( e.g smoking) or paraphilias . ( e.g. pedophilia). Example : An alcoholic patient is prescribed Anti-abuse , which makes him ill every time he drinks alcohol. 12/21/2021 SILUWE YAMBAYAMBA - CUZ 37

38. con’t 4. Token economy: Through the process of operant conditioning, desirable behavior (e.g ., shaving, hair combing) is reinforced by a reward or positive reinforcement to reinforce them . The person increases the desirable behavior to gain the reward. Commonly used to encourage showering, shaving, and other positive behaviors in disorganized patients or individuals on addiction rehabilitation units . 12/21/2021 SILUWE YAMBAYAMBA - CUZ 38

39. con’t 5. Biofeedback : Through the process of operant conditioning, the person is given ongoing physiologic information (e.g., blood pressure measurement), which acts as reinforcement (e.g., when blood pressure drops ). The person uses this information along with relaxation techniques to mentally control visceral changes (e.g., heart rate, blood pressure, smooth muscle tone ) Can be used to treat anxiety disorders, migraines, hypertension, chronic pain, asthma, and incontinence. Example : A patient is given her heart rate and blood pressure measurements during a migraine while being instructed to mentally control visceral changes that affect her pain.) 12/21/2021 SILUWE YAMBAYAMBA - CUZ 39

40. 4 . Cognitive Therapy 12/21/2021 SILUWE YAMBAYAMBA - CUZ 40

41. Cognitive Therapy Cognitive therapy, is pioneered by Aaron T. Beck, seeks to correct faulty assumptions and negative feelings that exacerbate psychiatric symptoms. The patient is taught to identify maladaptive thoughts and replace them with positive ones. Most commonly used to treat depressive and anxiety disorders, and it is usually combined with behavioral therapy as CBT. May also be used for paranoid personality disorder , obsessive-compulsive disorder, somatic symptom disorders, and eating disorders. Cognitive therapy can be as effective as medication. 12/21/2021 SILUWE YAMBAYAMBA - CUZ 41

42. 5 . Cognitive-Behavioral Therapy (CBT) 12/21/2021 SILUWE YAMBAYAMBA - CUZ 42

43. Cognitive-Behavioral Therapy (CBT) CBT combines theories and approaches from cognitive therapy and behavior therapy . CBT focuses on a patient’s current symptoms and problems by examining the connection between thoughts, feelings , and behaviors - The patients learn how their feelings and behavior are influenced by their thoughts . Treatment follows a protocol or manual with homework assignments between therapy sessions . 12/21/2021 SILUWE YAMBAYAMBA - CUZ 43

44. con’t During therapy sessions, the patient and therapist set an agenda, review homework, and challenge cognitive distortions. Treatment is usually brief and may last from 6 weeks to 6 months . C BT is effective for many psychiatric illnesses, including depression , anxiety disorders, schizophrenia, and substance use disorders . 12/21/2021 SILUWE YAMBAYAMBA - CUZ 44

45. 6 . Dialectical Behavioral Therapy (DBT) 12/21/2021 SILUWE YAMBAYAMBA - CUZ 45

46. Dialectical Behavioral Therapy (DBT) DBT was developed by Marsha Linehan . Patients are seen weekly, with the goal of improving interpersonal skills and decreasing self-destructive behavior by means of techniques involving advice, use of metaphor, storytelling, and confrontation , among many others. It incorporates cognitive and supportive techniques, along with the “mindfulness ” derived from traditional Buddhist practice. DBT has demonstrated effectiveness in patients with borderline personality disorders and Para-suicidal behavior. 12/21/2021 SILUWE YAMBAYAMBA - CUZ 46

47. 7 . Group Therapy 12/21/2021 SILUWE YAMBAYAMBA - CUZ 47

48. Group Therapy Three or more patients with a similar problem or pathology meet together with a therapist for group sessions . These groups meet to discuss problems, share feelings, and provide support to each other. It is especially useful in the treatment of substance use disorders, adjustment disorders, and personality disorders. Advantages of group therapy over individual therapy include: Patients get immediate feedback and support from their peers. Patients gain insight into their own condition by listening to others with similar problems. If a therapist is present, there is an opportunity to observe interactions between others who may be eliciting a variety of transferences. 12/21/2021 SILUWE YAMBAYAMBA - CUZ 48

49. 8 . Family Therapy 12/21/2021 SILUWE YAMBAYAMBA - CUZ 49

50. Family Therapy The goals of family therapy are to reduce conflict, help members understand each other’s needs (mutual accommodation), and help the family unit cope with internally destructive forces. Family therapy is especially useful in treating schizophrenia and anorexia in adolescents . Family therapy is useful as an adjunctive treatment in many psychiatric conditions because : 1. An individual’s problems usually affect the entire family. 2. Psychopathology may arise or worsen due to dysfunction within the family unit . These conditions are most effectively treated with the entire family present . 12/21/2021 SILUWE YAMBAYAMBA - CUZ 50

51. 9 . Couples Therapy 12/21/2021 SILUWE YAMBAYAMBA - CUZ 51

52. Couples Therapy Couples therapy is useful in the treatment of conflicts, sexual problems, and communication problems within the context of an intimate relationship . The therapist sees the couple together (conjoint therapy), but they may also be seen separately (concurrent therapy). In addition, each person may have a separate therapist and be seen individually ( collaborative therapy ). In the treatment of sexual problems, two therapists may see the couple together (four-way therapy). Relative contraindications include lack of motivation by one or both spouses and severe illness in one of the spouses (e.g ., schizophrenia). 12/21/2021 SILUWE YAMBAYAMBA - CUZ 52

53. MCQs 12/21/2021 SILUWE YAMBAYAMBA - CUZ 53

54. MCQs Q1. Which of the following is essential for psychotherapy to proceed? A. Acting out B. Therapeutic alliance C. Splitting D. Idealization E. Repression Answer: B. Psychotherapy cannot proceed without a therapeutic alliance between patient and therapist. Acting out is the direct expression of an unconscious impulse in order to avoid the accompanying effect. Freud wrote about acting out in transference as the patient’s acting toward the therapist as if the therapist were the patient’s father, mother, or other significant figure from the patient’s past life. Splitting is a primitive defense mechanism. The term refers to the division of an object into good and bad, “idealized” and “denigrated.” The patient first idealizes the therapist, perhaps telling the therapist that he or she is perfect and is the only person who ever understood the patient. After the therapist disappoints the patient on one occasion, the patient denigrates him, describing him as being useless, incompetent, and irrelevant. The process of idealization followed by denigration is called splitting. Repression is the most basic defense mechanism. Thoughts or feelings that the conscious mind finds unacceptable are repressed from consciousness. 12/21/2021 SILUWE YAMBAYAMBA - CUZ 54

55. Con’t . Q2. Which of the following best describes the id? A. Self-critical B. Rational C. Unorganized D. Modified by external influences E. Self-loathing Answer: C. The id is unorganized, unconscious, and instinctual. The ego is modified by direct external influences and is rational. The superego spawns self-hatred, self-criticism, self-control, and self-recrimination 12/21/2021 SILUWE YAMBAYAMBA - CUZ 55

56. Con’t . Q3. Which of the following is not a mature defense mechanism? A. Humor B. Sublimation C. Rationalization D. Anticipation E. Suppression Answer: C . Rationalization is a neurotic defense mechanism. The mature defense mechanisms include altruism, anticipation, ascetism , humor, sublimation, and suppression. 12/21/2021 SILUWE YAMBAYAMBA - CUZ 56

57. Con’t . Q4. How does the technique known as flooding expose patients to their phobic stimuli? A. Gradually B. In symbolic form C. Along with benzodiazepines to allay anxiety D. In massive amounts E. Along with an interpretation of conflicts Answer: D. Flooding is a behavior-therapy technique for phobias and other problems involving maladaptive anxiety. In this technique , situations or objects producing anxiety are presented to the patient in intense forms either in imagination or in real life. 12/21/2021 SILUWE YAMBAYAMBA - CUZ 57

58. Con’t . Q5. Behavior therapy has been shown to be useful in all of the following except? A. Panic disorder B. Psychotic depression C. Specific phobia D. OCD E. Bulimia nervosa Answer: B. Behavior therapy is useful in treating panic disorder, depression without psychotic features, specific phobias, OCD, and bulimia nervosa. However, psychotic depression needs treatment with antidepressants and antipsychotics or electroconvulsive therapy. 12/21/2021 SILUWE YAMBAYAMBA - CUZ 58

59. Con’t Q6. All of the following are true regarding cognitive-behavioral therapy ( CBT) except A. It can be employed by a therapist without full CBT training. B. It is useful in depression secondary to life problems. C. It can be used in patients with dementia. D. It includes the three-column technique. E. It may need to be modified in the elderly. Answer: C. Cognitive-behavioral therapy cannot be used in patients with dementia . “Triple-column therapy” is a cognitive technique developed by David Burns in which a sheet of paper is divided into three columns and labeled from left to right: “Automatic Thoughts,” “Cognitive Distortions ,” and “Rational Responses.”

60. Con’t Q7. According to cognitive-behavioral therapy, which of the following is true regarding depression ? A. Activity scheduling is discouraged. B. Thought diaries are not of much use. C. Cognitive content is a threat or danger. D. Depression can improve with correction of cognitive distortions. E. The therapy can be carried out by the passive therapist. Answer: D. Cognitive therapy has proven useful in the treatment of depression by correcting the cognitive distortions that lead to the development of depression.

61. Con’t Q8. Which of the following is true regarding interpretation in psychoanalysis? A. It should be done early in therapy. B. Its main function is to keep the patient happy. C. The analyst may interpret latent meanings. D. It should never be painful to the patient. E. The patient should agree with the analyst’s interpretation. Answer: C. The analyst may interpret latent meanings. There is no specific time for interpretations. The function of the analyst is not to keep the patient happy but to help the patient understand the dynamics of the patient’s present situation. Sometimes the interpretations might be painful to the patient, but that is necessary.

62. References Black D.W., Andreasen N. C., (2014), Introductory Textbook of Psychiatry, 6th Ed., American Psychiatric Publishing, Washington DC. Fadem Barbara (2017), Behavioral Science (7 th ed.) Wolters Kluwer: New jersey . Ganti Latha , Blitzstein Sean M. & Kaufman Matthew S. (2016 ), First Aid for the Psychiatry Clerkship (4 th ed.), McGraw-Hill Education: New York. Kaplan & Sadock (2019) Pocket handbook of clinical psychiatry ( 6 th ed .) Wolters Kluwer: New York. 12/21/2021 SILUWE YAMBAYAMBA - CUZ 62