Concept of Psychotherapy – This book covers the entire syllabus of “Psychiatric Nursing” prescribed by the Universities of Bangladesh- for Basic and diploma nursing students. We tried to accommodate the latest information and topics. This book is an examination-friendly setup according to the teachers’ lectures and examination questions.
At the end of the book previous university questions are given. We hope in touch with the book students’ knowledge will be upgraded and flourish. The unique way of presentation may make your reading of the book a pleasurable experience.
Concept of Psychotherapy
Certain psychological processes are used for the treatment of emotional problems in which professionally trained person (psychiatrist, clinical psychologist, psychiatric nurse, social worker) deliberately establishes therapeutic relationship’.
[Ref: KP Neeraja/I/Vol-1/230]
Or,
Psychotherapy has been defined in various ways. Briefly it can be defined as “the treatment of emotional and/or related bodily problems by psychotherapy means”.
[Ref-K.Lalitha/1/1301]
Or,
Psychotherapy is defined as the treatment of emotional disorders by psychological means. Its goal is to help people to cope better with life and achieve more emotionally satisfying lifestyles.
[Ref- S. Namb/1/1k]
Or,
Wolberg defined psychotherapy 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
1. Remove, modify or retard existing symptoms.
2. Mediate disturbed patterns of behaviour, and/or
3. Promote positive personality growth and development.
[Ref-K.Lalitha/1/1311]
Goals of psychotherapy:
1. To achieve remission of symptoms (modify or retard existing symptoms)
2. To mediate disturbed patterns of behaviour
3. To strengthen the ego
4. To improve growth and development of the client
5. To protect self-esteem of the client
6. To-produce deeper insight
7. To modify deviated personality, thereby developing positive personality
8. To develop positive attitude
9. To correct psycho-pathology.
[Ref: KP Neeraja/1/Vol-1/231]
Indications of psychotherapy:
1. Neurotic illness
➤ Anxiety neurosis
➤ Hysteria
➤ Phobia
➤ Obsessive compulsive neurosis
2. Psychosomatic illness
3. Schizophrenia
4. Depression
5. Mania
6. Psychotic states-after the remission of symptoms of acute attack to correct psychopathology
7. Alcoholism
8. Drug addiction
9. Sexual deviation
10. Personality and character disorder
11. Marital disharmony.
[Ref: KP Neeruja/I/Vol-1/231-232]
Contraindications of psychotherapy:
1. Severe psychotic illness
2. Excitement
3. Assaultive and destructive behaviour
4. Negativism
[Ref: KP Neeraja/I/Vol-1/232]
Side effects of psychotherapy:
1. Patients may become excessively dependent on therapy or therapist.
2. Intensive psychotherapy may be distressing to the patient and result in exacerbation of symptoms and deterioration in relationships.
3. Disorders for which physical treatments would be more appropriate may be missed.
4. Ineffective psychotherapy wastes time and money, and damages patient’s morale.
[Ref: K. Lalitha/1/137-138]
Common elements of psychotherapy:
1. Repression
Getting relief by pushing forcibly the painful traumatic events or situations in the unconscious mind.
2. Sublimation
Releasing the stressful situations which are stored deeply in the unconscious mind through socially permissible and acceptable manner.
3. Transference
The client displaces his feelings and experiences; likes and dislikes over to the therapist.
4. Counter Transference
The therapist will get certain feelings generated by the client. Therapist will counteract by the clients’ experiences and analyses the situation, diagnose the problem and gives valuable advices to overcome the situational difficulties.
5. Rapport
The therapist wins the confidence of the client by developing good rapport and establishes therapeutic relationship with the client to explore the information related to real and significant events and past experiences from the client; the client gains trust and comes forward to explain the inner feelings, thoughts openly.
6. Resistance
This is a process which interferes and prevents the repressed psychological conflicts from becoming conscious.
[Ref: KP Neeraja/1/Vol-1/231]
Aims of psychotherapy:
1. To relieve signs and symptoms
2. To promote recovery
3. To correct psychopathology
4. To rehabilitate the client in his own setting either in the community or in social group
5. To prevent relapse.
[Ref: KP Neeraja/1/Vol-1/223]
Methods of psychotherapy:
1. Physical therapy
- Convulsive therapy
Electroconvulsive therapy
Chemical convulsive therapy
- Abreative therapy
2. Insulin therapy
Insulin sub-coma therapy
Insulin coma therapy
3. Psychotherapy
- Based on Number of Clients
➤ Individual psychotherapy
➤ Group psychotherapy
➤ Family psychotherapy
- Based on Duration or Depth or Probing
➤ Short term of illness or superficial or supportive psychotherapy
➤ Deep or long term or analytical psychotherapy
- Based on Theoretical Formulations
4. Psychoanalysis.
5. Transactional therapy
- Family therapy
- Behaviour therapy
- Psycho-educative therapy
- Psycho-surgery
- Bio-feedback
- Cognitive therapy
- Relaxation therapies
- Marital therapy
- Social therapy
6. Occupation therapy
- Activity Therapy
- Recreational therapy
- Diversional therapy, e.g. Art, music, dance
- Play therapy
7. Drug therapy
8. Milieu therapy
9. Biblio therapy
10. Narco analysis and Narcosynthesis
11. Rehabilitation
- Physical rehabilitation
- Emotional rehabilitation
- Vocational rehabilitation
- Social rehabilitation
- Educational rehabilitation.
[Ref: KP Neeraja/1/Vel-1/223-224]
Psychosocial therapy:
Psychosocial therapy includes different types of psychotherapy and social and vocational training, and aim to provide support, education and guidance to people with mental illness and their families. Psychosocial therapies are an effective way to improve the quality of life for individuals with mental illness and their families. They can lead to fewer hospitalizations and less difficulties at home, at school and at work.
[Ref: Psychiatric-Mental Health Nursing-Sheila 1/5/255]
Qualities of a psychosocial therapy nurse:
1. Should understand the patients family and cultural background
2. Should be a good listener
3. Should have patience, sympathetic, understanding and tactful attitude
4. Should have an interest and concern for the patients
5. Should not be upset with patient’s selfish and irresponsible behavior
6. Should not be too emotionally involved with the patient and his problems
7. Should not take sides and should act as nonjudgmental attitude.
[Ref: S Nambi/2/194]
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