Psychotherapy -Individual & Group

Psychotherapy

1. PSYCHOTHERAPY PREPARED BY Mrs. Divya Pancholi M.Sc. (Psychiatric Nursing) Assistant Professor SSRCN, Vapi

2. DEFINITION Psychotherapy has been referred to as a systemic treatment primarily employing verbal communication as the means of treatment aimed at relieving the patient’s symptoms and helping him to understand and modify his conduct so as to lead a well adjusted life.

3. GOALS To achieve remission of symptoms (modify or retard existing symptoms) To mediate disturbed patterns of behaviour To strengthen ego To improve growth and development of the client To protect self-esteem of the client To produce deeper insight To modify deviated personality, thereby develops positive personality To develop positive attitude To correct psycho-pathology

4. TYPES OF PSYCHOTHERAPY SR NO DIMENSIONS TYPES 1 Depending on the number of patients taking part Individual psychotherapy Group psychotherapy 2 Depending on the duration of treatment Long term psychotherapy Short term psychotherapy 3 Depending on the depth of exploration Supportive psychotherapy Deep psychotherapy 4 Depending on the amount of responsibility given to the patient Directive Non-directive 5 Depending on the nature of the group Family therapy Marital therapy Group therapy Therapy with children and adolescents

5. INDIVIDUAL PSYCHOTHERAPY

6. DEFINITION It is a method of bringing about change in a person by exploring his or her feelings, attitudes, thinking and behaviour. Therapy is conducted on a one-to-one basis, i.e. the therapist treats one patient at a time. Patients generally seek this kind of therapy based on their desire.

7. AIMS The therapist has to make the client to understand his/her needs, feelings To modify the maladaptive behaviour To improve interpersonal relationship To get relief from stress or unhappiness To make personal changes

8. TECHNIQUE When the client comes for OPD, therapist observes the behaviour and assess whether client is indicated for psychotherapy, if indicated fix the therapeutic schedule, venue, time, etc. therapist provides conducive environment with comfortable sitting arrangement to enhance relaxation to the client Physician assess the physical status and exclude any physical illness of the client Therapist establish psychotherapeutic professional relationship with the client to extract the inner feelings, conflicts of the client After gaining confidence, the therapist explains theoretical information about principles of treatment, structure of mind, body-mind relationship, role of unconscious mind in determining the behaviour of normal person, influence of emotions over the body functions

9. CONTI…. Encourage the client to ventilate his ideas, feelings, painful/traumatic experiences without any inhibitions, embarrassment Therapist plays an active listener and nods the head, record essential information and makes an occasional remarks During interaction, the therapist analyses the situation and gives valuable suggestions whenever necessary The client is encourages to discover the reasons for his odd behaviour , thereby therapist allows the client for in depth understanding of himself and helps to find a solution to a problematic situation

10. CONTI… The process is continued until there is satisfactory improvement in the client’s condition and the extent of the nature of handling the psychological conflicts by the client himself The therapeutic procedures and ways of handling the problems are modified according to the client’s needs Frequency of the therapeutic sessions are decided upon client needs e.g. in superficial psychotherapy 40-60 sessions spread over 4-6 months in deep psychotherapy 200-300 sessions spread over 2-3 years

11. APPROACHES

12. PSYCHODYNAMIC THERAPY: It is primarily based on psychoanalytic theory, the assumption that when a patient has insight into early relationships and experiences as the source of his or her problems they can be resolved.    

13. HUMANISTIC THERAPY: It centres on the patient view of the world and his or her problems. The goal is to help patients realize their full potential through the therapist’s genuineness, unconditional positive regard, which fosters the patient’s sense of self-worth and empathetic understanding of the patient’s point of view. This therapy is nondirective but focuses on helping the patient to explore and clarify his or her own feelings and choices.

14. BEHAVIOUR THERAPY: It does not foster awareness but emphasis the principles of learning with positive or negative reinforcement and observational modelling.  

15. COGNITIVE THERAPY: It focuses on identifying and correcting distorted thinking patterns that can lead to emotional distress and problem behaviours. Cognitive therapists believe that patients change their behaviours by changing their maladaptive thinking about themselves and their experiences. Patients are taught problem-solving skills and stress reducing methods. They learn that their psychological difficulties or problems can be solves through cognitive processing.

16. SOME ISSUES FOR WHICH INDIVIDUAL PSYCHOTHERAPY MAY HELP Personal growth and exploration Peak performance enhancement Spiritual issues Life adjustment issues Coping with changes Grief or loss Work-life balance Self-esteem/confidence issues Chronic pain & pain disorders Past trauma Relationship issues

17. CONTI.. Adolescent issues Eating disorders Weight issues Depression Anxiety problems Sexuality issues Stress related problems Stress management Coping with health problems Excessive fears

18. GROUP PSYCHOTHERAPY

19. DEFINITION Group psychotherapy is a treatment in which carefully selected people who are emotionally ill meet in a group guided by a trained therapist, and help on another effect personally change.

20. SELECTION Homogenous groups Adolescents and patients with personality disorders Families and couples where the system needs change

21. INDICATIONS When individual therapy fails When drugs alone do not help When patient needs socialization

22. CONTRAINDICATIONS Antisocial patients Actively suicidal or severely depressed patients Patients who are delusional

23. CONTI….. GROUP SIZE Optimal size for group therapy is 8 to 10 members. FREQUENCY AND LENGTH OF SESSIONS Most group psychotherapists conduct group sessions once a week, each session may last for 45 minutes to 1 hour.

24. CHARACTERISTICS OF GROUP Group is an identifiable system composed of 3 or more members, who engage in certain tasks to achieve common goal. Goals can be single or multiple. The content of a group is to overt verbal exchange. Group follows values, norms m rules that govern the operation. Group involvement is based upon strength and weakness of the group members. Group should have scheduled program.

25. APPROACHES TO GROUP THERAPY The therapist’s role is primarily that of a facilitator, he should provide a safe, comfortable atmosphere for self-disclosure. Focus on the “here and now.” Use any transference situations to develop insight into their problems. Protect members from verbal abuse. Whenever appropriate, provide positive reinforcement, this gives ego support and encourage future growth.

26. CONTI… Handle circumstantial patients, hallucinating and delusional patients in a manner that protects the self-esteem of the individual and also sets limits on the behavior so as to protect other group members. Develop ability to recognize when a group member is “fragile”, he should be approached in a gentle, supportive and non- threatening manner. Use silence effectively to encourage introspection and facilitate insight. Laughter and a moderate amount of joking can act as a safety valve and at times can contribute to group cohesiveness. Role-playing may help a member develop insight into the ways in which he relates to others

27. THERAPUTIC FACTORS INVOLVED IN GROUP THERAPY

28. SHARING EXPERIENCE: This helps the patients to realize that they are not isolated and that others also have similar experiences and problems. Hearing from other patients that they have shared experiences is often more convincing and helpful than reassurance from the therapist.

29. SUPPORT TO AND FROM GROUP MEMBERS: Receiving help from other group members can be supportive to the person helped. The sharing action of being mutually supportive is an aspect of the group cohesiveness that can provide a sense of belonging for patients who feel isolated in their everyday lives.

30. SOCIALIZATION: It is acquisition of social skills (e.g. maintaining eye contact) within a group through comments that members provide about one another’s deficiencies in social skills. This process can be helped by trying out new ways of interacting within the safety of the group.

31. IMITATION: It is learning from observing and adopting the behaviors of other group memb ers. If the group is run well, patients imitate the adaptive behaviors of other group members.

32. INTERPERSONAL LEARNING: It refers to learning about difficulties in relationships by examining the interaction of individuals with the other members of group.

33. TECHNIQUES USEFUL IN GROUP THERAPY: Reflecting or rewarding comments of group members Asking for group reaction to one member’s statement Asking for individual reaction to one member’s statement Pointing out any shared feelings within the group Summarizing various points at the end of session

34. TYPES OF GROUP THERAPY: REEDUCATIVE GROUP THERPAY: Provides information, socialisations, support and strengthening of defences PSYCHO-DRAMA GROUP THERAPY: Provides more depth and breadth of experience utilizing psychoanalytical principles. EXISTENTIAL GROUP THERAPY: Giving importance to immediate feelings rather than the exploration of those feelings. GROUP DYNAMIC GROUP THERPAY: importance is given to exploration of group themes, relationship, interactions and reactions. PSYCHO-ANALYTICAL GROUP THERPAY: Based on the psychoanalytical technique such as dream analysis and free association etc.

35. GROUP DEVELOPMENT

36. ROLE OF NURSE As a co-therapist and leader by possessing high degree of therapeutic empathy. She should have creativity and opportunism while dealing with the group members. She should introduce her to the team in to the group members. Assertive communication helps to convey the message among the members. The nurse nurtures the group members act genuinely to deal the problem of the group members.