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Psychotherapy: An Overview

Author: mugilakil, Posted on Tuesday, November 22 @ 15:35:33 IST by RxPG  

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Psychiatry

This article will give a brief overview of psychotherapeutic techniques, their classification and how it is used.

Psychotherapy: Defined by Wolberg. It is the treatment by physiological means, of problems of an emotional nature, in which trained person (therapist) deliberately establishes a professional relationship with the patient to
1. Remove, Modify or Retard Existing Symptoms
2. Mediate disturbed patterns of Behaviour
3. Promote Positive personality Growth and Development.

---------------------------
Psychotherapy
---------------------------
- Basically it is a treatment by listening to what the patient says and taking with him.
- It involves communication between two individuals, the patient and therapist.
- The patient encourage to express freely his fears, emotion and experiences.
- The therapist may be a Psychiatrist, Psychologist, Psychiatric Social Worker or a trained Psychiatric Nurse.
- Development of therapeutic Relationship
- Understand the Patient’s Family & Cultural Background
- Good Listener
- Be Patient, Sympathetic, Understanding & Tactful
- Interest & Concern for Patient’s Problems
- Should not be upset with Patient’s selfish and irresponsible Behaviour
- Not to emotionally involved with the patient and his Problems

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Counseling Vs Psychotherapy
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- Counseling professional assistance given to a variety of problems by discussion and advice.
- Counseling can be given to healthy individuals also.
- Counseling will not go into the depth of the problem or about the unconscious Mental Processes.
- Psychotherapy – many techniques Ventilation, Abreaction, - Reassurance, Explanation, Suggestion, Persuation, Relaxation

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Types
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1. Individual Psychotherapy
2. Group Psychotherapy
3. Family Psychotherapy
4. Psychoanalytic Psychotherapy
5. Hypnotherapy
6. Cognitive Therapy
7. Crisis Intervention
8. Behaviour Therapy
9. Relaxation Therapy

---------------------------
Individual Psychotherapy
---------------------------
- Encouraging him to discover for himself the reasons for his behaviour.
- Listens to the patient and offers explanation and advise when necessary.
- Problem Solving
- Usually take place at regular intervals – Time – Weeks – Months
- Neurotic Disorders, Stress Related Disorders, Alcohol, Drug Dependence, Sexual Disorders and Marital Disharmony.

---------------------------
Group Therapy
---------------------------
- Several people meet as a group with a therapist for the treatment of emotional and behavioural problems.
- Patients usually 8 – 12 in number.
- The individual feels more comfortable and confident in a group and will begin to talk about his problems & find other patient are willing to listen & give him advice.
- Useful for persons with similar problem [Alcoholic, Dry Dependent]
- Traditional group therapy – Psychodrama

Role in group Therapy
1. Catalyst
2. Transference Object
3. Clarifier
4. Interpreter
5. Role Model & Resource Person
6. Supporter

---------------------------
Family Therapy
---------------------------
- Treating the family as a unit.

Aim
1. To Change the Way – Family Interact
2. Helping the family members clarify & express their feeling,
3. Developing Mutual Understanding
4. Workout effective way to relating to one another

Two Methods
1. Resolving Family Conflicts
2. Modifying Maladaptive Behaviour

Indication
1. Marital Problem
2. Child – School Phobia, Mental Retardation
3. Adjustment Disorder
4. Alcoholism & Drug Dependence
5. Attempt Suicide

---------------------------
Psychoanalytic Psychotherapy
---------------------------
- Sigmund Freud

Aim
– Uncovering Conflicting, Unconscious Impulses through special techniques that include
- Free Association
- Dream Analysis
- Transference
- Hysteria, Neurotic Disorders & Personality Disorder

---------------------------
Hypnotherapy
---------------------------
Hypnosis is a psychophysiological, Altered state of consciousness induced by conditioning and skilled use of suggestions.

1. Lessening the subject inhibitions & Reasoning
2. Heightening the ability to relax & his susceptibility to suggestion.

Hypnosis is super concentration of the mind

Steps of Hypnosis
1. Relaxation
2. Realisation of the cause of the problem
3. Removal of the cause of the problem
4. Rehabilitation
5. Reinforcement

Application of Hypnosis
1. The problem & conflict, which deeply placed inside the mind
2. Neurotic Disorder – Hysteria, Phobia & Obsessive Compulsive Disorders
3. Induction of Labour & Dental surgery without Anaesthesia
4. Alter Unwanted Behaviour
5. Self – Hypnosis & Attain Relaxation
6. Psychosomatic Disorder

---------------------------
Cognitive Therapy
---------------------------
- Theory that Behaviour is Secondary to Thinking
- Short – Term Psychotherapy
- Mood & Feeling are influenced by our thoughts
- Self Defeating & thinking ΰ Depressed Mood
- Self Deprecating
- Correcting the distorted way of thinking
- Mood Disturbances & Behaviour Change Corrected.
- What we Think – Cognitive Content
- How we Think – Cognitive Process

Cognitive Triad
1. Negative View about Self
2. Negative View about the Environment
3. Negative View about the future.

- Depression & Anxiety
- Drug Abusers

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Crisis Intervention
---------------------------
- Type of brief Psychological method of treatment for the persons who is in emotional crisis.

Crisis – Sudden event in one’s life that disturbs the mental equilibrium during which the usual coping mechanisms fail.

Criteria for Selection
1. Recent Traumatic situation produces Anxiety
2. Precipitating event that Intensified the Anxiety
3. Clear cut Evidence that Patient in Psychological Crisis
4. High Motivation to overcome the Crisis

Technique
- The Action Required is Rapid one.

Focus on the Crisis & Precipitating Factors
1. Reassurance
2. Suggestion
3. Environmental Manipulation
4. Psychotropic Medication

- One or two sessions may be sufficient
- If needed brief Hospitalisation

Most suitable for
1. Attempted Suicide
2. Post Traumatic Stress Disorder

---------------------------
Behaviour Therapy
---------------------------
- Based on Learning Theory
- Learned to be unlearned
- Unlearned to be learn

Used in
- Phobia
- Obsessional Thought
- Compulsive Behaviour
- Schizophrenic Mannerisms
- Eating Disorder
- Smoking
- Drinking
- Sexual perversion

Phobia
1. Systematic Desensitisation - Exposed slowly to a gradual hierarchy of Phobic objects or Situations.
2. Flooding - Forced to remain in the Phobic Situation until his Anxiety is exhausted
3. Implosion - Instructed to Imagine the Phobic Situation & remain in it until his Anxiety is exhausted

Compulsive Acts
4. Modeling - Therapist carried out the act which patient is afraid of and require the patient to imitate.
5. Response Prevention - Therapist prevents the patient from avoiding unpleasant act or situation.
6. Thought Stopping - Prevent the patient from continuing to ruminate his obsessive thought by shouting “STOP” or inflicting mild pain on his arm with a rubber band.

Schizophrenia or Mental Retardation
7. Operant Conditioning - Reward for desired behaviour – token economy punished for undesirable behaviour
8. Social Skills Training - Eye contact, Speaking Appropriately, Observing Simple Etiquette & Relating to People.

Alcoholism & Sexual Deviations
9. Aversion Therapy
- Drinking Alcohol
– Electric Shock Disulfram Treatment
- HCR - Aversion Treatment

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Relaxation Therapy
---------------------------
- Anxiety & Stress Related Problems
1. Progressive Muscle Relaxation Technique (Jacobson)
2. Transcendental Meditations
3. Yoga

Four Elements Needed
1. Quiet Environment
2. Mental Devices
3. Passive Attitude
4. Comfortable Position

Relaxation Effect
O2 Consumption
Respiratory Rate
Heart Rate
Alpha Brainwaves
Blood Pressure
Blood Lactate Level

©2005 DR.M.RAJARAM



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