PSYCHOTHERAPY.pptx

The treatment of emotional or related bodily problems by psychological means.

1. PSYCHOTHERAPY

2. DEFINITION The treatment of emotional or related bodily problems by psychological means. It is a process of helping a distressed person, which aims at facilitating a change in his feelings, attitudes and behaviour by means of verbal and emotional communication.

3. DEFINITION A method of treatment based on the development of intimate (therapeutic) relationship between client & therapist for the purpose of exploring & modifying the client behaviour in a satisfying direction.” …By lego “A process in which a person who wishes to relieve symptoms or resolve problems in living or seeking personal growth enters in implicit or explicit contract to interact in a prescribed way with a psychotherapist.” …By – psychiatric glossary (1980)

4. GOALS OF PSYCHOSOCIAL THERAPY Changing maladaptive behaviour pattern. Reducing of elimination environmental conditions that may be causing such a behaviour. Improving interpersonal & other competencies i.e. communication skill Helping the patient to resolve inner conflict & overcome feelings of handicap Modifying an individual’s accurate assessment of himself & the world around him Helping him to develop a sense of self-identity.

5. CONTRAINDICATION OF PSYCHOTHERAPY Psychotic patient with severe behaviour disturbance like excitement. Organic psychosis (in acute phase) Patient’s who are unmotivated & unwilling to accept it. Group psychotherapy in hysteria, hypochondriasis etc. Patient’s who are unlikely to respond, e.g.; personality disorder , specially antisocial personality.

6. UNWANTED EFFECT OF PSYCHOTHERAPY Patient may become excessively dependent on therapy or therapist. Intensive psychotherapy may be distressing to the patient & result in exacerbation of symptoms & deterioration in relationship.• Disorder s for which physical treatment would be more appropriate may be missed Ineffective psychotherapy waste time & money & changes in patient’s morale.

7. DIFFERENCES COUNSELLING Goal: Preventive Focus: Problems/Issue oriented. (Pre Marital. Marital and Disaster Counseling ). Techniques: Emotional Support Re Assurance Explanation Education PSYCHOTHERAPY Goal: Curative Focus: Treatment Oriented. Techniques: Abreaction Interpretation Analysis Behavior Modification Free Association Dream Analysis

8. TYPES OF PSYCHOTHERAPY Depth of exploration/ probing into the unconscious mind. Superficial / short term / supportive Deep / long term / analysis No of patients treated Individual Group Family Purpose of which it is given, Supportive or guidance Re – constructive Re build Duration of treatment Short term psychotherapy Long term psychotherapy Depending on the amount of responsibility Directive psychotherapy Non directive psychotherapy Nature of group Marital therapy Family therapy Therapy with children and adolescents

9. PSYCHOANALYTICAL THERAPY

10. Psychoanalytical therapy was developed by freud . It focus on unconscious forces such as repressed impulses & memories, internal conflicts & childhood trauma on mental life & adjustment of the individual. The most important indication for psychoanalytical therapy is the presence of longstanding mental conflicts, which may be unconscious but produce symptoms.

11. The aim of therapy is to bring all repressed material to conscious awareness so that the patient can work towards a healthy resolution of his problems, which are causing the symptoms. Psychotherapy as a form of therapy is used primarily in psychoneuroses by bringing about basic modification in the personality. This is done by establishing a constructive therapeutic relationship.

12. THERAPY PROCESS Lengthy therapies Aim – uncovering and resolving conflicts and unconscious impulses Goals – to discover relationships between unconscious motivations and present behaviour Therapy starts off --- client’s talking (catharsis) --- client gains insight into the problem --- working through the unconscious material https://youtu.be/7xE9ozhls3s

13. TECHNIQUE

14. FREE ASSOCIATION Therapist ask the patients to relate anything which came into their mind, regardless of how apparently unimportant or potentially embarrassing the memory threatened to be. This technique assumed that all memories are arranged in a single associative network, and that sooner or later the subject would stumble across the crucial memory

15. Client reports immediately without censoring any feelings or thoughts One of the ways to have access to unconscious wishes, fantasies, conflicts and motivations While the free association goes on, the therapist identifies the repressed material that is hidden in the unconscious Interpretation: analyst identifies , clarifies, and translates the materials of the client and proceed from the surface to the deeper level

16. DREAM ANALYSIS While one is asleep – defenses are lowered – repressed materials erupt into the surface Manifestations – so.. Unacceptable and painful – expressed in disguised or symbolic form Manifest content : what a person remembers and consciously considers - only a partial representation ( real dream ) Latent content : hidden, symbolic and unconscious motives, wishes and fears Process of converting the latent content into manifest content – dream work “Royal road to the unconscious”

17. What is important in dreams is the infantile wish fulfillment represented in them Freud assumed every dream has a meaning that can be interpreted by decoding representations of the unconscious material D ream symbol = represents some person, thing, or activity involved in the unconscious process Dream interpretations Knife, umbrella, snake = penis Room, table with food = women Water = birth, mother Children playing = masturbation Fire = bedwetting  falling = anxiety

18. HYPNOSIS Hypnosis is a superficial or deep trance (a somnolent state/sleep like) resembling sleep. It induced in a patient by suggestions of relaxation & concentrating attention on a single object. The client becomes highly suggestible, submissive & abandons control & response to therapist influence. He can be induced to recall forgotten events, becomes insensitive to pain, gain relief from tension, anxiety & other psychological symptoms. It affects behavioral change & control of attitude

19. Changes that occur during hypnosis: The person becomes highly suggestible to the commands of the therapist. There is an ability to produce or remove symptoms or perceptions. Dissociation of a part of the body or emotions. Amnesia for the events that occurred during the hypnotic state. This therapy is used in; obesity, hypertension, asthma, smoking, peptic ulcer, overeating, abreaction of past experiences, psychosomatic disorders, conversion & dissociative disorders, habit disorder & anxiety disorder or other addiction disorder.

20. 3. ABREACTION THERAPY Abreaction is a process by which repressed material, particularly a painful experience or conflict is brought back to consciousness. The person not only recalls but also relieves the material, which is accompanied by the appropriate emotional response. It is most useful in acute neurotic conditions caused by extreme stress (PTSD, hysteria etc).

21. Methods: Abreaction can be brought about by strong encouragement to relieve the stressful events. The procedure is begun with neutral topics at first, & gradually approaches area of conflict. Abreaction can be done with or without the use of medication.

22. CATHARASIS Catharsis is the act of purging or purification or elimination of a complex by bringing in to consciousness and affording to expression Patient learn to e vacuate this problem from the psyche These therapies are undertaken in one - one basis The nurses role is encouraging the patient to talk about the experience and documenting the response carefully Pity, fear, terror, horror and other negative emotions as the tragic suffering of the patients are safely exercised and exorcised.

23. INDIVIDUAL PSYCHOTHERAPY

24. INDIVIDUAL PSYCHOTHERAPY Individual psychotherapy is a method of bringing about change in a person by exploring his or her feelings, attitude, thinking and behaviour It is conducted on a one to one basis i.e. The therapist treat on client at a time By this therapist helps the patient to come to a greater understanding of himself & to find a way of dealing with his problem. Make personal changes Improve interpersonal relationship Get relief from emotional pain or unhappiness Indication: stress-related disorder, alcohol & drug dependence, sexual disorder & marital disharmony.

25. Therapy process: The patient is encouraged to discover for himself the reason for his behavior The therapist listen to the patient and offers explanation and advise when necessary By this the therapist helps the patient to understand himself and find the way of solution to his problem The relationship between the therapist and the patient passes through the stages of nurse patient relationship i.e introduction , working and termination

26. APPROACHES Psychodynamic Therapy:  which focus on increasing your awareness of unconscious thoughts and behaviors, developing new insights into your motivations, and resolving conflicts Cognitive behavioral therapy (CBT),:  which helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones

27. Humanistic therapy  : is a mental health approach that emphasizes the importance of being your true self in order to lead the most fulfilling life. It's based on the principle that everyone has their own unique way of looking at the world. This view can impact your choices and actions. Behavioral therapy:  is an umbrella term for types of  therapy  that treat mental health disorders. This form of  therapy  seeks to identify and help change potentially self-destructive or unhealthy  behaviors . It functions on the idea that all  behaviors  are learned and that unhealthy  behaviors  can be changed.

28. SUPPORTIVE PSYCHOTHERAPY

29. It is a form of “surface therapy”. The therapist helps the patient to relieve emotional distress & symptoms without probing in to past or attempting to change or alter the basic personality of the individual. The therapist reinforce the existing defenses used by the client & utilizes various techniques such as: a. Ventilation b. Environmental modification or manipulation c. Persuasion d. Reeducation e. Reassurance f. Abreaction g. Explanation h. Suggestion i . Reinforcement j. Recreation k. Work as therapy l. Relaxation

30. TECHNIQUES Ventilation It is the process of allowing the release of bottled emotions. It helps to express the suppressed emotions. Patient is allowed to talk whatever comes into his mind. Abreaction It is a process of exploring a repressed emotions. Example: ‘ok’, than what happened?

31. Reassurance Supportive approach. Example: “you do not have a serious problem. I am confident that you will get well”. Suggestion Suggestion is a process by which symptoms relief is achieved through positive statements made with a degree of firmness and authority. Persuasion Persuasion is a procedure in which therapist urges the patient repeatedly to change his behavior or to try new methods of dealing with his problem.

32. Reinforcement Reinforcement or rewards are potent methods to enhance the desired behavior . They can be verbal or material in nature. Recreation It helps to break the monotony of work. It is essentially required for the patients who have developed emotional problems as a result of having to perform monotonous and hard work.

33. Explanation Explanations are provided to remove misconceptions and to provide proper understanding of a problem. Work as therapy When a person engages in work his preoccupation with emotional problems decreases.. It enhances self – esteem, and helps to resolve conflicts in many circumstances. Relaxation It is especially useful for the anxious individual. It is an effective intervention for many psychosomatic problems like, ht , pud , ba and migraine. Example: yoga and asanas.

34. COGNITIVE THERAPY

35. cognitive therapy is a relatively new mode of short-term psychotherapy. It is developed for treatment of depression and anxiety is now widely applied to a broad Range of mental disorders. It is based on the premise that our moods and feelings are influenced by our thoughts.

36. To improve patient’s abilities to function in the world by correcting the distorted ways of thinking the cognitive therapist restructures patients views of themselves, the world, and future. More realistic thoughts are substituted to reduce painful feelings such as anxiety, guilt, and hopelessness.  

37. DEFINITION Cognitive therapy is a psychotherapy approach based on the idea that behaviour is secondary to thinking. It focuses on how patients think about themselves and their world, make changes in the current ways of thinking and behaviour.

38. FUNDAMENTAL ASSUMPTIONS It is based on the premise that the way a person perceives an event rather than the event itself, determines its relevance and the response to it. It is time limited, attempting to cause change rapidly and often within an established time frame. Therapeutic change can be effected through an alteration of idiopathic, dysfunctional modes of thinking, leading to cognitive change.

39. These therapies are based on the belief that patient’s are the architects of their own misfortune and have control over their thoughts and actions. They also help the patient learn something about the process of therapy and develop therapeutic skills applicable to other problems. It aims at altering the cognitions for effecting a change in behaviour. It implies that all psychiatric disorders have some amount of cognition and an improvement in this enhances the patient’s recovery

40. Duration of cognitive therapy atypical cognitive therapy schedule consist of about 15 visits over a three month period. Indications Depression Anxiety disorder Panic disorder Phobias Anticipatory anxiety For teaching problem solving methods some centres also use cognitive behaviour therapy (CBT) for management of psychotic symptoms such as delusions and hallucination.

41. TECHNIQUES OF COGNITIVE BEHAVIOUR THERAPY There are four main groups of cognitive techniques. They are the following: Techniques for stopping intrusive cognitions Techniques to counterbalance faulty cognitions Techniques for altering cognitions Techniques to resolve problem directly

42. Techniques for stopping intrusive cognitions : these methods aims at stopping intruding thoughts through distraction. Alteration is directed to another mental act like doing mental arithmetic or copying a figure. II) Techniques to Counterbalance Faulty Cognitions : these involves counterbalancing intruding cognitions and the emotions provoked by them with another thought. Eg. When an anxious patient with chest pain becomes apprehensive thinking that he has a heart problem; he may be trained to think it is only muscular pain and does not relate to the heart

43. III) Techniques For Altering Cognitions: T hese are aimed at changing the nature of cognitions. The patient is helped to identify “maladaptive cognitions” and their “logical errors”. Some errors which are not mutually exclusive and which occur in depression are given below: F aulty inference overgeneralization magnification or minimization unrealistic assumptions IV) Techniques to resolve problems directly : These involves several steps and consist of: Defining the problem more clearly. Dividing it into small sub-problem which can be better managed. Finding out alternate methods of solving each problems Considering the merits and demerits of each method and Selecting one method which is the most advantageous at their instance

44. THERAPY PROCESS Therapy is result oriented and defines goals so that progress towards them can be monitored. The therapist is a coach and teacher for the patients learning new skills. Therapist may help the patient identify situations in which thoughts and actions occur and then assist with the development of alternatives. Its overall goal is to increase self-efficacy or proficiency and sense of control over the patient must participate actively and be committed to the decision for change. The patient-therapist interaction is a goal oriented collaborative partnership with a beginning middle and on end.