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Psychotherapy Report Psychotherapy Treatment of emotional and personality problems and disorders by psychological means A process in which a person who wishes to relieve symptoms, resolve problems in living, or seek personal growth enters into a contract to interact in a prescribed way with the psychotherapist History o Sigmund Freud o Psychoanalysis (Original talking therapy) o o - Analyzing the root causes of behavior and feeling by exploring the unconscious mind and the conscious minds relation to it. o Psychotherapeutic process o Therapist and client establish boundaries of the relationship Clients problems are noted Present coping skills are identified Strengths and attributes are explored Open communication is established Purpose: TO GAIN CONTROL OF ONES LIFE Gender Age Race Culture Life experiences Three phases 1. Introductory

- As an interpersonal experience between client and therapist Harry Stack Sullivan o o A psychiatrist and psychoanalyst Research: Psychotherapy of SCHIZOPRENIA Parataxis

2. Working o Therapist and client focus on the clients problems and reach an understanding of why the problems have occurred.

- Presence of distorted perception or judgment exhibited by the client during therapy

3. Termination o Client has achieved maximum benefit of therapy

GOALS Individual Psychotherapy A confidential relationship between client and therapist may occur in the therapists office, outpatient clinic or mental hospital To alleviate the clients discomfort or pain To alter character structure and strengthen the clients ego

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To promote emotional and interpersonal maturation To improve clients ability to perform appropriately How to Achieve Establish a therapeutic relationship Provide an opportunity for the client to release tension Assist client in gaining insight Provide the opportunity to practice new skills Reinforce appropriate behavior Provide consistent emotional support MODES OF INDIVIDUAL PSYCHOTHERAPHY BRIEF COGNITIVE THERAPHY uses a time-limited, goal-oriented, problem solving, here and now approach. Psychiatric nurse uses counseling interventions to assist clients in improving or regaining their previous coping abilities, fostering mental health, preventing mental illness. Communication and interviewing techniques Problem solving skills Crisis intervention Stress management TYPES: Behavior therapy focuses on the modifying overt symptoms, without regard with the clients experience or inner conflicts. Cognitive-behavioral therapy combines the individual goals of cognitive therapy and behavioral therapy. The therapist works with the client to identify both the thoughts and behaviors causing distress, and to change those thoughts in order to readjust behavior. Relaxation techniques Assertiveness training Conflict resolution Behavior modification During counselling, the councillor will provide you... Reassurance Helps client to regain self-confidence and decreases feeling of guilt anxiety or fear Clarification Long standing interpersonal problem of loneliness and isolation COUNSELING Brief interpersonal psycho therapy Assessment focuses on an interpersonal inventory of the clients relationship with members of his family of origin Four problem areas: Grief related to loss by death or separation Ongoing interpersonal conflict Social role change requiring adaptation

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Helps client to gain clearer picture of reality by understanding feelings and behavior Group Therapy O O An identifiable system consisting of at least 3 people who share a common goal O O It began in the early 1900s O The awkward phase where there is minimal communication Goal: resolve these initial feelings and to achieve a sense of group identification For the leader: create a supportive and accepting environment to promote unification, and to encourage verbalization of feelings Every client must not be forced to participate. O Termination

Beginning or Orientation

Advantages: O O O Decreased isolation and dependence Opportunities for helping others Interpersonal learning and development of coping skills Decreased transference to the therapist while developing the ability to listen to other group members

Middle or Working O O Group becomes more cohesive Goal: develop a sense of reliance on each other and maintain trust and openness in the group For the leader: encourage members to explore their conflicts and goals, identify repetitive behaviors, and clarify group goals and tasks

Five Models of Group Therapy O O O O O Support groups Reeducation and remotivation groups Problem-solving therapy groups O

Termination Insight without reconstruction groups O Personality reconstruction groups O Group Establishment O O Participants are selected on the basis of personal treatment philosophies and individual client needs. Age and gender play a role in the selection In preparation to leave, clients share their insights and growth they have made Most members may both feel happy and sad It is recommended that the therapist conduct an exit interview with each member to review individuals progress and make accurate evaluation of the experience.

Stages O O Beginning or Orientation

For effective leadership, 3 qualifications must be met: O Theoretical preparation

Middle or Working

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O Supervised practice in the role of co-leader and leader Personal experience as a group therapy member. At times, a combination of different psychotherapy approaches may be helpful. In some cases a combination of medication with psychotherapy may be more effective. Child and adolescent psychiatrists are trained in different forms of psychotherapy and, if indicated, are able to combine these forms of treatment with medications to alleviate the child or adolescent's emotional and/or behavioral problems.

Child & Adolescent Psychotherapy Provides emotional support Helps client understand feelings and problems Assists client in trying out new solution to problems to old problems

Family Therapy Family therapy is a type of psychological counseling in which includes the family members with the goals of gaining insight into problems, improving communication, and improving the function of each members as well as the family as a whole It assumes the outside or external influence play a major role in personality development an regulation of members lives Approaches to Family Therapy: Integrative Psychoanalytic Bowen Accept the client but not necessarily the behavior. Do not criticize client. Avoid discussing symptoms with the client unless the client refers to them. Attempt to understand the clients feelings and point of view. Psychotherapy is not a quick fix or an easy answer. It is a complex and rich process that, over time, can reduce symptoms, provide insight, and improve a child or adolescent's functioning and quality of life. Structural Interactional or Strategic Social Network Behaviorist Integrative Approach Developed by Nathan Ackerman who was known as the grandfather of family therapy The family needs to share concern for each members welfare

Important reminders: Therapist must have an understanding of the normal developmental stages of children and adolescents These clients do not voluntarily seek treatment. So let the client feel comfortable, safe, and understood for easier expression of thoughts and feelings. Involve parents, depending on age of client and nature of the identified conflict Guidelines for a Therapeutic nurse-client relationship:

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Problem arises when interpersonal conflict is internalized by the client and it becomes an intrapersonal conflict Goal: identify and remove the pathologenic or intrapersonal conflict, improve communication, and problem solving and promote a more healthy relationships in the family Psychoanalytic Approach Each family member is affected by each own psychological make up Focuses on cognitive, affective, and behavioral components of the family interaction Goal: guide the family who exhibit the pathology into clarifying old misunderstanding between themselves and parents and members of the family of origin and establish an adult-adult relationship (Jones,1980;Sadock&Sadock,2003) Family as system of individuals, set a hierarchy system Problems arise when family boundaries become disturbed The therapist observes the activities the family performs, gives guidance to develop clear boundaries for individual members and changing the familys structural pattern. To solve the problem in the family structure Self concept: when the person can distinguish his feeling process and his intellectual process I ones self Therapy focuses on guiding one or more family member to be solid , defined self in the face of emotional forces created by marriage, children or the family of origin so that the person can carry his/her own role Structural Approach

Interactional or Strategic Approach Developed by Virginia Satir and Jay Harley Bowen Approach Developed by Murray Bowen Family as both an emotional and relational system Individuals behavior is a response to the functioning of the family system as a whole The therapist studies the interaction between the family members and observe that a change in one of the members also triggers a change in the other member Therapy is about maintaining Balance or homeostasis

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As one gets better the other gets worst Social Network or Systemic Approach Healing come from the social relationship and problem occurs if there is a problem in the social network such as losing its ability to recover from illness or adapt from the changes Considers family as the answer to the problem Behaviorist Approach Behavior is learned through satisfaction or rewards from certain response of other individual Problem arises when maladaptive behavior is learned and reinforced by family members who respond positively or negatively and the overall effect of the behavior to each members Stages of Family Therapy I. Initial Interview - In this phase the client contacts the family therapist to express concern regarding the problem and setting up an appointment - During this phase some therapist gather data on the family history while the other has an option to focuses on the present functioning of the family - During this phase the therapist determines what problems of the family needs focus Sub-stages of Initial Interview Engagement: The family meat and put at ease by the therapist Assessment : Problems are identified Exploration: Exploring other factors that the family experience and tries to connect it on the present family problem Goal Setting : The therapist synthesize all information and the family members state what change they want to see Termination: Next appointment is set and determines which family members are needed to attend II. Intervention or Working Phase

Goals of Family Therapy: The family should provide the information for and determine the direction of change when goals are being set Facilitate positive change in the family Foster open communication Promote optimum function in interdependent roles Assess the roles that the family plays and evaluate them Act as a role model and show how to deal with conflicts Helps family members to take a realistic view of their relationship with one another

Goal: Help the family to accept and adjust to change The therapist identifies the strength of the family and reinforces it Soon family members would make interpretation as well as offer suggestions to fix the problem And they would later realized that role are note fixed but it is changing as personal growth occurs

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The 12 Criteria of Family Strength by Otto are the ff: Provide physical ,emotional, and spiritual needs of each family members Be sensitive to the family members Communicate feelings, emotion, beliefs and values effectively Provide support, security, and encouragement to enhance creativity and independence Initiate and maintain growth-producing relationship within and without family members Maintain and create constructive and responsible community relationships in the neighborhood, school, town, and local and state governments Grow with and through children Types Help oneself and accept help when appropriate Perform family roles flexibility Show mutual respect for the individualization and independence of each family member. Uses crisis as means of growth Have a concern for family unity and loyalty and for cooperation among family members III. Termination Phase Occurs in two event resolution of the problem or premature termination of the therapy If the family has achieved the goals and identified specific problems has been resolved By this phase the family should learned how to solve the problem in a healthy way, - Designed to modify the interactions of two individuals who are in conflict with each other * Contextual therapy * Marital-relations therapy (conjoint therapy) * A way of resolving tension or conflict in a relationship between two individuals Indications 1. Presence of a crisis 2. Medical or mental illness or death 3. Emotional tension 4. Lack of trust 5. Sexual dissatisfaction 6. Disagreement about parenting 7. Stress develop its own internal support system and has learned to communicate openly, honestly and directly COUPLE THERAPY

- Non directive; addresses changes or imbalances in giving or taking or entitlement and fulfillment that occur within the relationship overtime * Object-relations therapy

- A psychodynamic approach to resolve self destructive patterns of relationships with people or objects * * Combined therapy Brief couples therapy

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- Understanding each partners beliefs systems and how it interlock to govern their lives and relationships

Techniques * Understand what each person wants to changed and in what way Understand each persons perception of solution Look for the constraints Explore motivating force Identify hidden positive qualities or values and expand Ask future-oriented questions

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GOALS * Resolve problems and conflicts that couples are unable to handle themselves Establish trust and loyalty Enhancement of sexual intimacy Improvement in listening and expressive skills Establish empathy Nurse-Therapist Role * Assist clients in dealing constructively with thoughts, emotions and behaviors Persuade each partner to take responsibility Understanding the psychodynamic make up of the personality

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