PSYCHOTHERAPIES

INTRODUCTION:-
Psychotherapy is a typically interpersonal treatment based on psychological principles.
Specific therapies are often individualized to patients or groups with a psychiatric disorder,
problem, or adverse circumstance. There are many types of psychotherapy with varying
methods and levels of empirical support. The choice of the most appropriate type of
psychotherapy is in part based upon the patient’s specific problem or diagnosis. Although
there are many named psychotherapies, most are derivations of a few basic types.
Psychotherapies within each of these categories broadly share a similar explanatory model
and set of techniques.

DEFINITION:-
A process which attempts to help the patient relieve symptoms, resolve problems or seek
personal growth through a structured relation (i.e. specified goals and methods) with attained
professional therapist. The therapist may be a psychiatrist, a psychologist, a nurse, etc...

TYPES OF THERAPIES:-

1- INDIVIDUAL THERAPY-
Definition-
Psychotherapy can be defined as, the treatment by psychological means, of problems of an
emotional nature, in which a trained person (therapist) deliberately establishes a professional
relationship with the patient to,
-remove, modify or retard existing
-mediate disturbed patterns of behaviour and/ or
-promote positive personality growth and development.

Uses-
 To treat an emotional disorder.
 To treat chronic disorder.
 To gain insight and self knowledge.
 To train people in the helping profession.
 To promote positive personality.
 To modify the maladaptive behaviour.
 To improve interpersonal relationship.
 To make personal change.

Types-
a) Depth of probing in the unconscious mind
 Superficial or short term psychotherapies
 Deep or long term psychotherapies
 Educative psychotherapies

b) Number of patients treated in any therapeutic session

 Individual psychotherapy
  Group therapy
 Family psychotherapy
c) The purpose for which psychotherapy is given and the theoretical formulation
used in psychotherapy
 Supportive psychotherapy
 Re-educative psychotherapy
 Reconstructive psychotherapy

Techniques-
1) Ventilation: The process of allowing the release of bottled up emotions is called
ventilation. This technique helps to express the suppressed emotions outwardly.

2) Abreaction: It is process of exploring the repressed emotions in a high degree. They

should encourage the continuation by asking ‘ok’ then what happened.

3) Reassurance: It is a supportive approach that anyone can give. Our daily life itself
indicates the effectiveness of one’s reassurance in a critical situation.

4) Explanation: Explanation should be provided to remove misconceptions and to

provide a proper understanding of the problem.

5) Suggestion: It is a process by which symptoms relief is achieved through positive

statement made with a degree of firmness and authority.

6) Persuasion: It is a procedure by which the therapist urges the patient repeatedly to

change his behaviour or to try new methods of dealing with his problem.

7) Reinforcement: A potent method to enhance the desired behaviour. They can be

verbal or material in nature.

8) Recreation: It helps to break monotony of work. It is especially required foe subjects

who have developed emotional problems as a result of having to perform monotonous
and hard work.

9) Relaxation: It is a technique especially useful for anxious individuals.

Indication-
 Neurotic disorder
 Stress related disorder
 Alcohol & drug dependence
 Sexual disorder
 Marital disharmony

Contraindication-
 Psychotic patients with severe behaviour disturbances like excitement
 Organic psychosis
 Group psychotherapies
 Patients who are unlikely to respond. E.g. personality disorders.
Stages of psychotherapies-
1. Introductory stage: In this stage, the client and the therapist meet and begin to work
together. This stage usually involves taking a history of the client’s life, including any
medical problems and current medications.

2. Working stage: In the working stage, the client is able to become more trusting, to
disclose and to begin exploring with the therapist the thoughts, feelings and behaviour
to problems.

3. Termination stage: For this stage, client’s behaviour modified or removes the
maladaptive symptoms. It is not changed allow the next session for the treatment.

Method-
1. Classical psycho analysis:- It needs 3-5 visits/week by the patient for a period 3-5
years (even longer) . No history taking, examination or diagnosis making is
attempted. The patient is allowed to communicate unguided by using “free
association”. The therapist remains passive and his approach is non-directive.

2. Psychoanalytically oriented psychotherapy:- It is a much more direct form of

psychoanalysis. The duration of therapy is much briefer and advice is given to the
patient occasionally. The patient and therapist sit face to face. The rest of the method
is nearly same.

Goal-
Resolution of symptoms and major reworking of personality structures related to childhood
conflicts

2- GROUP THERAPY-
Definition-
1- Group psychotherapy is a treatment of psychological problems in which two or more
patients interact with each other on both an emotional and cognitive levels in the
presence of one or more therapist who serves as catalyst facilitators or interpreters
___Kapoor Bimla
2- It is a treatment method in which clients meet at planned times with a qualified
therapist to focus on becoming self aware and self understanding, improving IPR,
making behavioural changes or all three.___Haber

Goals-
 Alleviating intrapsychic stress.
 Reducing anxiety.
 Providing clients with opportunities to modify and test new behaviours in controlled
setting.
 Helping him to develop a sense of self-identity.
Types-
 Group therapy-
It is a treatment method in which clients meet at planned times with a qualified
therapist to focus on becoming self aware and understanding.
 Therapeutic therapy-
It deals with emotional stress from physical illness, normal growth and developmental
crisis or social maladjustment to prevent health problems, to educate / develop group
member’s potentials, to enhance quality of life.
 Adjunctive groups-
It deals with the selected need of individuals, such as cognitive stimulation, sensory
stimulation, orientation to reality and socialization.

3- FAMILY THERAPY-
Introduction-
Family therapy was started by Bateson in 1956 and was well developed by Nathan
Ackerman group in 1958. Family therapy is an essential intervention in a family
system to change the family. The family is the unit which is being treated for better
interaction among each other.

Aims-
 Helping the family members clarify and express their feelings towards one
another.
 To remove transitional- generational gap.
 To establish good communication pattern.
 To develop greater mutual understanding.

Types-
1. Structural family therapy: In a structural family therapy, change the origin of the
family in such a way that the family members behave more positive and supportively
towards each other.

2. Systemic family therapy: It is based in the concept of the families are systems where
-Individual are not independent.
-In the pursuit of homeostasis changes are often focused on one individual when
presents as the problems.

3. Strategic family therapy: Strategic family therapy is a problem based therapy, where
although understanding the meaning of the problem is important. It is not the basis for
interventions.
-To promote group and social interaction, every member of group will be aware of
their roles, limitations and responsibilities.

Purpose-
Improving communication.
Facilitating autonomy and individualization of member
Increasing empathy.
 Fasting flexible leadership.
Improving role agreement and enactment.
Reducing conflicts.
Facilitating symptomatic improvement.
Enhancing individual task performance.

Indications-
 Problems in the relationship
 Interdependence of symptoms
 Symptomatology In one individual reflecting a dysfunctional family background
 Development of street in other family members when one family member improves
 Family of individual therapy.

Contraindication-
A. Family factors-
 Family in the process of breaking up
 Families having major psychopathology in more than one family
member unrelated to family interactions.
 Families in which tense, dysfunctional equilibrium is present.
 Families staying apart.
 Non availability of the key therapy.
B. Therapist factors-
 Lack of commitment
 Inflexibility
 Poor psychological mindedness, judgemental attitude, cultural biases.
 Therapist having problems similar to the client’s
 Lack of empathy and adequate training.
 Therapist having social relations with the client.

Techniques-
 Family systems approach: What affects one family member will affect the
others. Effective family therapy techniques are based on the family systems
approach. The family systems approach sees the individual as an extension of
the family unit and that one cannot be treated to the exclusion of the others.
 Observation: I t is an effective family therapy technique because it offers the
psychologist the first real window into the family dynamic. He/she must get a
base measurement of the family’s interaction, emotional balance and initial
dysfunction.
 Effective communication: It is an important lessons that family systems
psychologist incorporate into group and individual family therapy sessions. To
 create an effective solution to any dysfunction or problems in the group
dynamic requires effective communication.
 Problem solving: Problem solving is an effective therapy technique not
because it teaches the family how to resolve the issue that brought.
 Reality: It is an approach to psychotherapy and counselling. It is a considered
a cognitive-behavioural approach to treatment.

4- OCCUPATIONAL THERAPY-
Definition-
“It is defined as a profession concerned with promoting health and well being through
occupation.”
“It is defined as an active method of treatment with a profound psychological
justification __Clark (1963)

Goal-
 Increasing functioning and independence
 Maintaining or increasing skills
 Adapting environment to meet the unique needs of an individuals
 To provide intervention.

Indication-
 Traumatic injuries (brain or spinal cord)
 Learning problem
 Autism
 Pervasive development disorder
 Mental health or behavioural problems
 Developmental delays.

Types-
 Pottery therapy
 Carpentry therapy
 Candle making
 Basketting
 Mat weaving
 Crafts
 Tailoring

Therapeutic activities-
 Develop or maintain strength, endurance and range of motion
 Provide use of voluntary, automatic movements in goal direction
 Exercise effected parts of the body
 Improve sensation, perception and cognition
 Develop social skills

Types of activities: 1.diversional activities- These activities are used to divert ones
thoughts from life stresses or to fill time.
E. g.-organized games
 2.Therapeutic activities- These activities are used to attain a specific
care plan or goal.
E. g.- basket making, carpentry
Suggested occupational activities for psychiatric disorders:
 Anxiety disorder
 Depressive disorder
 Manic disorder
 Schizophrenia (paranoid)
 Schizophrenia (catatonic)
 Antisocial personality
 Dementia
 Substance abuse
 Mental retardation

5- MILIEU THERAPY-
Introduction-
Milieu therapy is the treatment of maladjustment by making substantial changes in a
patient’s immediate life circumstances and environment in a way that will enhance the
effectiveness of other forms of therapy.

Meaning-
‘Milieu’ is a French word, means ‘middle’ and ‘surrounding or environment’. The therapy
which involves the ‘milieu’ or ‘environment’ is called milieu therapy or therapeutic
community or therapeutic environments.

Definition-
“the total resources of the staff, the resident, their relatives and the institutions are pooled for
the purpose of treatment __MAXWELL, 1959

Goals-
 Changes maladaptive behaviour into adaptive behaviour.
 Provide conductive environment in which the client can talk and be aware about his
feelings, impulses behaviour.
 Minimize prolongation of hospital stay.
 Promotes early recovery.
 To make the clients to understand how their behaviour will be affected, with the
behaviour of others.
 To re-socialize the client.

Features of milieu therapy-

 An informal and communal atmosphere: The environment in home like rather than
institutional.
 A mutual therapeutic role of resident: Residents will understand their role and tries to
understand, how their behaviour will be influencing peer group or their surroundings.
 Sharing decision-making: Health professionals and residents will share their
experience and involve actively in decision making.
 Staff meeting therapy session can be conducted in each meeting
 Feedback is the fundamental concept in therapeutic community practice.
  Minimize environmental stresses, develops abilities and strength, and identifies
alternate solutions to problems.

Principles of milieu therapy-

 Democratization
 Permissiveness
 Every member of the community has to share equally in decision-making related to
community affairs.
 The client should have easy approach to interact with the hospital staff members
without any inhibition.
 It tries to develop one-one contact
 Every member has to tolerate from one another a wide degree of behaviour that may
be distressing or deviant from ordinary standards.

Characteristics-
Distribution of power
Open communication
Structured interactions
Work-related activities
Community and family involvement in the treatment process.
Adaptation of the environment to meet development needs.

6- RECREATIONAL THERAPY-
Definition-
“It is a form of activity therapy, where an individual enjoys pleasurably the leisure
time through recreational and renewing the body and mind by relieving emotional tensions or
internal conflicts and thereby releases monotonous life of mentally sick or ill persons.”

“It is a planned therapeutic activity that enables people with limitations to engage in
recreational experiences.

Indications-
 Clients who have difficulty in relating to others e. g. Withdrawn
 Schizophrenia
 Excitement
 Depression
 Anxiety disorder
 Organic brain syndrome
 Obsessive compulsive disorder
 Substance abuse
Purpose-
 To relieve from stress, anxiety, boredom, tension, emotional internal conflicts,
loneliness.
 To assist the client for self expression of their thoughts, feelings freely and
openly.
 Identifies own creative ability.
 Provides socially acceptable outlet for fantasy and wish fulfilment
 Increase self esteem.
 To develop and enhance social skill.
  To promote the client to engage in healthy and competitive interaction.
 To divert the mind from stressful situations.
 To decrease withdrawal tendencies.
Types-
1. Indoor activities: Ludo, crafts, Chinese checker, puppet shows, carom board, singing
2. Outdoor activities: Picnic trips, visits to interested place e.g. zoo, garden swimming
3. Activities for intellectual expression: Reading books, painting, drawing, writing
4. Activities for psychosocial expression: Singing, dancing, painting, drawing etc.
5. Activities for expression of love and tenderness: taking care of kids with play
materials, pets, gardening etc.
6. Activities for expression of muscular strength: sports and games.
7. Activities increasing sensory power: visual-e.g. watching pictures, movies
Auditory-e.g. listening to music, radio
Kinaesthetic-e.g. painting, art, drawing

Benefits with psychiatric disabilities-

Symptom reduction: -reduction in depression
-reduction in anxiety
-reduction in tension
-reduction in sleep disturbance
-reduction in negative thinking
Social skill benefits: -decreased social anxiety
-Improved social skill competence and retention of skills
-increased socialization
-improved cooperation
-improved communication skill
Community skill benefits: -increased tolerance for change
-increased trust and cooperation
-increased parenting skill
-increased activity skill competency
-improved family relation
Self management skill benefits: increased coping skill for anxiety
-increased sense of personal responsibility
-increased self concept and self confidence
-increased self mastery
-increased quality of discretionary time use

7- BEHAVIOURAL THERAPY-
Introduction-
Behaviour is considered to be maladaptive when it is age inappropriate, when it
interferes with adaptive functioning or when others misunderstand in terms of cultural
inappropriateness. The behavioural approach to therapy is that people have become what they
are through learning processes or more correctly, through the interaction of the environment
with the genetic endowment.

Goals of therapy-
 Increase adaptive behaviors
 Decrease maladaptive behaviors
Four Aspects of Behaviour Therapy
1. Classical Conditioning: It is a process of learning that was introduced by Russian
psychologist Pavlov. In his experiments with dogs, during which he hoped to learn
more about the digestive process, he inadvertently discovered that organisms can
learn to respond in specific ways if they are conditioned to do so. In hi trials he found
that, as expected that the dog salivated when they began to eat the food that was
offered to them. This was the reflective response that Pavlov called as unconditioned
response.
Unconditioned stimulus (anxiety)
Unconditioned response (sweating & shaking)
Conditioned stimulus (snake)
Conditioned response (sweating & shaking)

2. Operant Conditioning:
Re-enforcement, Punishment and Extinction: these are the core tools of operant
conditioning, are either positive or negative. It is the response that is reinforced,
punished or extinguished.
 Reinforcement- It is a consequence that causes behaviour to occur with
greater frequency.
a. Positive reinforcement: It occurs when behaviour is followed
by a favourable stimulus that increases the frequency of that
behaviour.
b. Negative reinforcement: It occurs when a behaviour is
followed by the removal of an aversive increasing that
behaviours frequency.

 Punishment- It is a consequence that causes behaviour to occur with less

frequency.
a. Positive punishment: It occurs when behaviour is followed by
an aversive stimulus, such as introducing a shock or loud noise,
resulting in a decrease in that behaviour.
b. Negative punishment: It occurs when behaviour is followed
by the removal of a favourable stimulus, such as taking away a
child’s toy following an undesired behaviour, resulting in a
decrease in that behaviour.

 Extinction- It is the lack of any consequence following behaviour. When the

behaviour is inconsequential, producing neither favourable nor unfavourable
consequences.

3. Social Learning Approach:

Gives prominence to the reciprocal interactions between an individual’s
behaviour and the environment.

4. Cognitive Behaviour Therapy Emphasizes

cognitive processes and private events (such as clients self-talk) as mediators of
behaviour change
Limitations & Criticisms of Behaviour Therapy-
 Behaviour therapy may change behaviours, but it does not change feelings
 Behaviour therapy ignores the important relational factors in therapy
 Behaviour therapy does not provide insight
 Behaviour therapy treats symptoms rather than causes
 Behaviour therapy involves control & manipulation by therapist
Cognitive therapy-
Introduction-
Cognitive therapy has its roots in the early 1960s research on depression conducted by
Aaron Beck (1963-64). In his clinical research, he began to observe a common theme of
negative cognitive processing in thoughts and dreams of his depressed clients. Behavioural
techniques like expectancy of reinforcement and modelling are used within the domain of
cognitive therapy.
Definition-
“Cognitive therapy or cognitive behaviour therapy is a type of psychotherapy which aims at
correcting the maladaptive methods of thinking, thus providing relief from symptoms.”
Indications-
 Cognitive therapy was originally developed for use in the treatment of depression.
Today it is used for a broad range of emotional disorders.
 Cognitive therapy should be varied and individualized for clients according to their
specific diagnosis, symptoms and level functioning.
 In can be used in public disorders, generalized anxiety disorders, social phobias,
OCD, eating disorders, substance abuse, personality disorders etc.
Goals-

 Monitor his or her negative, automatic thoughts.

 Recognize the connections between cognition, affect, and behaviour.
 Examine the evidence for and against distorted automatic thoughts.
 Substitute more realistic interpretation for these biased situations.
 Learn to identify and alter the dysfunctional beliefs that predispose him or he
to distort experiences.
Principles-
 Cognitive therapy is based on an eve revolving formulation of the client and his or her
problems in cognitive terms.
 Cognitive therapy requires a sound therapeutic alliance.
 Cognitive therapy emphasizes collaboration and active participation.
 Cognitive therapy is goal oriented and problem focused.
 Cognitive therapy initially emphasizes the present.
 Cognitive therapy is educative, aims to teach the clients to be his or her own therapist,
and emphasizes relapse prevention.
 Cognitive therapy aims to be time limited.
 Cognitive therapy sessions are structured.
  Cognitive therapy teaches clients to identify, evaluate and respond to their
dysfunctional thoughts and beliefs.
 Cognitive therapy uses a variety of techniques to change thinking, mood and
behaviour.
Basic concepts-
1. Automatic thoughts: Automatic thoughts are those that occur rapidly in response to a
situation and without rational analysis. These thoughts are often negative. These thoughts are
also called as cognitive errors.

 Arbitrary inference: It is a type of thinking error, the individual automatically comes

to a conclusion about an incident without the facts to support it.
 Overgeneralization (absolutistic thinking): sweeping conclusions are
overgeneralizations made based on one incident- a type of “all or nothing” kind of
thinking.
 Dichotomous thinking: An individual who is using dichotomous thinking views
situations in terms of all of nothing, black or white, or good or bad.
 Selective

Therapeutic Techniques-
 Relaxation Training
 Flooding
 Simple Exposure and Response Prevention
 Systematic Desensitization
 Aversive Techniques
 Blow-up Technique
 Shaping
 Reinforcement
 Differential Reinforcement
 Extinction
 Punishment
 Assertiveness Training
  Stimulus Control
 Covert Conditioning
 Modeling
 Behavioral Self-Control

Process of Therapy-
Assessment: Counselor and client determine target behaviors to focus on Counselor forms
hypotheses about what is maintaining the client’s current problematic behavior.

Intervention:

 Goals of initial session

 Establishment of the working alliance
 Identify target behaviors
 Gather information about what maintains the target behaviors
 Teach the client about behavior therapy

8- PLAY THERAPY