to know about the psychoanalytic theory, cognitive behavior therapy and milieu therapy.

2. SPECIFIC OBJECTIVE
At the end of seminar student will be able to:-
1. Introduction of therapies
2. Explain about the technique and process of
psychoanalytic therapy.
3. Discuss about the milieu therapy
4. Discuss the role of nurse in milieu therapy
5. Define the cognitive behaviour therapy
6. Discuss about the techniques and method of
cognitive behaviour therapy

3. INTRODUCTION OF
PSYCHOANALYTIC THERAPY
Psychoanalysis was first developed by Sigmund
Freud at the end of the 19th century. The most
important indication for psychoanalytic therapy is the
presence of long standing mental conflict, which may
unconscious but produce symptoms. In
psychoanalysis the focus is on the cause of the
problem.

4. THERAPY PROCESS
It is typical for the psychoanalyst to be positioned at
the head of the patient and slightly behind, so that the
patient can not see the therapist. This decrease any
kind of non-verbal communication between the two
people. The patient is typically on the couch, relaxed,
and ready to focus on the therapist instruction, which
facilitates free association.

5. The patient is active participant, freely revealing all
thoughts exactly as they occur and describing all
dreams.
He reveals nothing personal, and he dosen’t give
any directions to the patient. The major goal of is
for the client to gain insight and understanding
about current relationship and behavior pattern.
This therapy is a lengthy and costly type treatment.

6. Techniques used in
Psychoanalysis
Free association
 Dream analysis
Hypnosis
Catharsis
Abreaction therapy

7. FREE ASSOCIATION
The patient is allowed to say whatever comes
to his mind, in response to a word that is
given by the therapist.

8. DREAM ANALYSIS
Freud believed that behavior is rooted in the
unconscious and that dreams are a manifestation
of the troubles people repress. Psychoanalysts
believe that dreams truly are the mirror to the
unconscious. Monitoring and interpreting
dreams is an important techniques of
psychoanalysis.

9. The client is asked to keep a “dream log” by
writing in a notebook as much as he or she can
remember of both pleasant and particularly
disturbing dreams. the dreams are then
interpreted in much the same way as free
association. Significant people or situation in
the dream are explored with the client , and
possible meaning are offered by the therapist.

10. HYPNOSIS
Altered state of consciousness in which people
become deeply relaxed and highly suggestible
to changes in experiences & behaviors.

11. Characteristics of Hypnotic State
 Suggestibility
 Do, think, say things as told
 Dissociation Separate self from external reality
“Hypnotic Analgesia”(Medication that acts
to relieve pain)
 Subject told to conduct Subject told to conduct orchestra
orchestra
 Problems that are Enhanced by Memory or Hypermnesia
(unusual power of memory) Recall remote events in great
detail Age regression False recollections

12. CATHARSIS
“The expression of ideas, thoughts, and suppressed
materials that is accompanied by an emotional
response that produces a state of relief in the patient.”

13. Maladaptive symptoms may be resolved by
bring unconscious thoughts and feeling into
consciousness.
Sometime the individual not only may recall
the painful experience but also actually relives
it, accompanied by the feeling and emotions
associated with the event. The process is called
abreaction.

14. Abreaction therapy
Abreaction Therapy focuses on reliving a traumatic
event and going through the emotions associated
with them to heal and move forward. Originally
created by Sigmund Freud the method gives patients
a way to release their unconscious pain and escape
from the memories and feelings that have kept them
from moving forward.

15. Method
Abreaction can be brought about by strong
encouragement to relive the stressful events. The
procedure is begun with neutral topics at first, and
gradually approaches areas of conflict. Although
abreaction can be done with or without the use of
medication, the procedure can be facilitated by giving
a sedative drug intravenously.

16.  A Safe method is the use of thiopentone
sodium i.e. 500mg dissolved in 10cc of normal
saline. It is infused at a rate no faster than 1
cc/minute to prevent sleep as well as
respiratory depression.

17. MILIEU THERAPY
 it is defined as “a scientific structuring of the
environment in order to effect behavioural changes
and improve the psychological health and functioning
of the individual.”

18. The goal of milieu therapy is to manipulate
the environment so that all aspects of the
clients hospital experience are considered
therapeutic. Within this therapeutic
community setting, the client is expected to
learn adaptive coping, interaction, and
relationship skills that can be generalized to
other aspects of his or her life.

19. BASIC ASSUMPTION
 The health in each individual is to be realized
and encouraged to grow.
 Every interaction is an opportunity for
therapeutic intervention.
 The client owns his or her own environment.
 Each client owns his or her behaviour.

20. Peer pressure is a useful and powerful tool.
Inappropriate behaviour are dealt with as they
occur.
Restriction and punishment are to be avoided.

21. CONDITIONS THAT PROMOTE A
THERAPEUTIC COMMUNITY
 Therapeutic community setting, everything that
happens to the client, or within the clients
environment, is considered part of the treatment
program. The community setting is the foundation
for the program of treatment. Community factors-
such as social interaction, the physical structure of
the unit, and schedule of activities- may generate
negative response from some client. These stressful
experiences are used as examples to help the client
learn how to manage stress more adaptively in real
life situation.

22.  Basic physiological needs are fulfilled.
 The physical facilities are conducive to achievement of
the goal of therapy.
 A democratic form of self- government.
 Responsibilities are assigned according to client
capabilities.
 A structured program of social and work related activities
is schedule as part of the treatment program.
 Community and family are included in the program of
therapy in an effort to facilitate discharge from treatment.

23. THE ROLE OF NURSE
 Through use of the nursing process, nursing manage
the therapeutic environment on a 24 hours.
 Nurse have the responsibility for ensuring that the
clients psychological needs are meet.

24. Nursing are also responsible for medication of
administration.
Develop of one to one relationship.
Setting limits on unacceptable behaviour.
Client education.

25. Team member

26. COGNITIVE BEHAVIOUR
THERAPY
Cognitive behavior therapy is a talking therapy that
can help you manage your problems by changing the
way you think and behave. Its most commonly used
to treat anxiety and depression, but can be useful for
other mental and physical health problems.

27. DEFINITION
Cognitive behavior therapy is a process of
teaching, coaching, and reinforcing positive
behaviors. That helps to identify cognitive
patterns or thoughts and emotions that are
linked with behaviors”.

28. Thinking
Different people can think differently about the
same event. The way in which we think about an
event influences how we feel and how we act.
Example- a classic example is that when looking at
a glass of water filled with halfway, one person
will see it half empty and feel discouraged and the
other sees it half full and feel optimistic.

29. BEHAVIOR
What we do affects how we feel and think. The
individual, who deals with an upcoming exam by
putting off his studies until the last minute, is likely
to experience more distress on the day of the exam
than an individual who has studied well in advance.
Cognitive behavior therapy helps people to learn
new behaviors and new way of coping with events,
often involving the learning of particular skills.

30. Therapy
In this special focus on the relationships
between how we think, feel and behave, the
following are the fundamental to the
practice of cognitive behavior therapy.

31. ELEMENTS OF CBT
ACTIVE:-the client must be involved in the
therapeutic process not as an occasional
visitors, but as a core and key participant.

32. MOTIVATIONAL:-
The therapist needs to take responsibility for
helping to motivate the client toward a
change in behavior, affect, or thinking. The
therapist must be able to set up the format
and rational for the client to consider change
of value

33. DIRECTIVE:-
The therapist must be able to develop a
treatment plan and then to help the client
to understand, contribute to, and see the
treatment plan as a template for change.

34. STRUCTURE
CBT is structure in two ways. First, the overall
therapy follow structure that approximates the
treatment plan. Sessions have identifiable beginning,
middle and end.

35. COLLABORATIVE:- the therapist must evaluate
the client ability and motivation for the therapy.
PROBLEM ORIENTED:- CBT focuses on
discrete problems rather than vague and amorphous
goals of feeling good, getting better, or increasing
self- esteem.

36. METHOD OF ACCESS
Therapist
Computerized or internet delivered
Reading self help materials
Group educational course

37. THERAPIST
 A typical CBT programme would consist
of face to face sessions between patient
and therapist, made up of 6-18 sessions of
around an hour each with a gap of a 1-3
weeks between sessions.

38. Computerized or Internet Delivered
CBT via an interactive computer interface
delivered by personal computer, internet, or
interactive voice response system. Instead of face
to face with a human therapist. It is also know as
internet delivered cognitive behavioral therapy.

39. READING SELF HELP MATERIALS
Enabling patients to read self help CBT guides has
been shown to be effective by some studies.
However one study found a negative effect in
patients who tended to ruminate and another meta-
analysis found that the benefit was only significant
when the self help was guided.

40. GROUP EDUCATIONAL COURSE
Patient participation in group courses has
been shown to be effective.

41. BASIC PRINCIPLES OF CBT
Cognitive effect behavior and emotion.
Cognitions may be made aware, monitored and
altered.
Desired emotional and behavioral change may be
achieved through cognitive change.

42. Change mood states by using cognitive and
behavioral strategies.
Identifying/modifying automatic thoughts
and core beliefs.
Regulating routine.
Minimizing avoidance.

43. TECHNIQUES OF CBT
Cognitive rehearsal.
Validity testing.
Writing in a journal.

44. Modeling.
Homework
Aversive conditioning
Systematic positive reinforcement

45. COGNITIVE REHEAESAL:-
In this technique, the patient asked to recall
a problematic situation of the past.
The therapist and patient both work
together to find out a solution for the
problem or a way in which the difficult
situation, if it occurs in the future can be
sorted out.

46. The therapist asks the patient to rehearse
positive thoughts cognitively in order to
make appropriate change to the latter’s
thoughts processes.
Power of imagination proves to be great use
in such exercises.

47. VALIDITY TESTING
In this techniques the therapist tests validity
of belief/thoughts of the patient.
The patient is allowed to defined his view
point by means of objective evidence.
The faulty nature or invalidity of the belief of
the patient is exposed if he/she is unable to
produce any kind of objective evidence.

48. WRITING IN A JOURNAL
It is the practice of maintaining a diary to keep
an account of situations that arise in day to day
life.
Thoughts that are associated with these
situation and the behavior exhibited in
response to them are also mentioned in the
diary.

49. The therapist and patient together
review the matter written in the journal
and find out maladaptive thought
pattern.
The discussion that takes place between
them proves to be useful in finding
different ways in which behavior of the
patient gets affected.

50. MODELING
It is one of the cognitive therapy technique in
which therapist perform role playing exercise
aimed at responding in a way that is helpful
to overcome difficult situations.
The patient makes use of this behavior of the
therapist as a model in order to solve problem
he/she come across.

51. AVERSIVE CONDITIONING
Amongst the different CBT techniques used by
therapist, aversive conditioning technique makes use
of discussion so as to lessen the appeal of a
maladaptive behavior.
The patient while being engaged in a particular
behavior or thought for which he has to be treated, is
exposed to an unpleasant stimulus.
Thus, the unpleasant stimulus gets associated with
these thought/behavior and then the patient exhibits
an aversive behavior towards them.

52. SYSTEMATIC POSITIVE
REINFORCEMENT
The systematic positive reinforcement is one of
the techniques of CBT therapy in which certain
(positive) behavior of a person are rewarded with
positive reinforcement.
A reinforcement system is established for the of a
certain positive behavior. Just like positive
reinforcement proves to be helpful in encouraging
a particular behavior, with-holding the
reinforcement deliberately also is instrumental in
eradicating a maladaptive behavior.

53. BIBILIOGRAPHY:-
1. Mary C. Townsend psychiatric mental
health nursing 5th edition concepts of care in
evidenced based practice page no. 184- 190
2. R. Sreevanvi mental health nursing 3rd
edition page no. 140
3. Niraj Ahuja a short textbook of psychiatry
6th edition