1. PSYCHOTHERAPY
PREPARED BY
Mrs. Divya Pancholi
M.Sc. (Psychiatric Nursing)
Assistant Professor
SSRCN, Vapi

2. DEFINITION
Psychotherapy has been referred to as a systemic
treatment primarily employing verbal
communication as the means of treatment aimed
at relieving the patient’s symptoms and helping
him to understand and modify his conduct so as
to lead a well adjusted life.

3. GOALS
To achieve remission of symptoms (modify or retard existing symptoms)
To mediate disturbed patterns of behaviour
To strengthen ego
To improve growth and development of the client
To protect self-esteem of the client
To produce deeper insight
To modify deviated personality, thereby develops positive personality
To develop positive attitude
To correct psycho-pathology

4. TYPES OF PSYCHOTHERAPY
SR
NO
DIMENSIONS TYPES
1 Depending on the number of patients taking
part
 Individual psychotherapy
 Group psychotherapy
2 Depending on the duration of treatment  Long term psychotherapy
 Short term psychotherapy
3 Depending on the depth of exploration  Supportive psychotherapy
 Deep psychotherapy
4 Depending on the amount of responsibility
given to the patient
 Directive
 Non-directive
5 Depending on the nature of the group  Family therapy
 Marital therapy
 Group therapy
 Therapy with children and adolescents

5. INDIVIDUAL PSYCHOTHERAPY

6. DEFINITION
•It is a method of bringing about change in a person by
exploring his or her feelings, attitudes, thinking and
behaviour.
• Therapy is conducted on a one-to-one basis, i.e.
the therapist treats one patient at a time. Patients
generally seek this kind of therapy based on their desire.

7. AIMS
The therapist has to make the client to understand
his/her needs, feelings
To modify the maladaptive behaviour
To improve interpersonal relationship
To get relief from stress or unhappiness
To make personal changes

8. TECHNIQUE
When the client comes for OPD, therapist observes the behaviour and assess
whether client is indicated for psychotherapy, if indicated fix the therapeutic
schedule, venue, time, etc. therapist provides conducive environment with
comfortable sitting arrangement to enhance relaxation to the client
Physician assess the physical status and exclude any physical illness of the client
Therapist establish psychotherapeutic professional relationship with the client to
extract the inner feelings, conflicts of the client
After gaining confidence, the therapist explains theoretical information about
principles of treatment, structure of mind, body-mind relationship, role of
unconscious mind in determining the behaviour of normal person, influence of
emotions over the body functions

9. CONTI….
Encourage the client to ventilate his ideas, feelings, painful/traumatic
experiences without any inhibitions, embarrassment
Therapist plays an active listener and nods the head, record essential
information and makes an occasional remarks
During interaction, the therapist analyses the situation and gives valuable
suggestions whenever necessary
The client is encourages to discover the reasons for his odd behaviour,
thereby therapist allows the client for in depth understanding of himself
and helps to find a solution to a problematic situation

10. CONTI…
The process is continued until there is satisfactory improvement in the
client’s condition and the extent of the nature of handling the
psychological conflicts by the client himself
The therapeutic procedures and ways of handling the problems are
modified according to the client’s needs
Frequency of the therapeutic sessions are decided upon client needs
e.g. in superficial psychotherapy 40-60 sessions spread over 4-6
months
 in deep psychotherapy 200-300 sessions spread over 2-3 years

11. APPROACHES
Psychodynamic
therapy
Humanistic
therapy
Behavior
therapy
Cognitive
therapy

12. PSYCHODYNAMIC THERAPY:
It is primarily based on psychoanalytic theory,
the assumption that when a patient has
insight into early relationships and
experiences as the source of his or her
problems they can be resolved.

13. HUMANISTIC THERAPY:
It centres on the patient view of the world and his or her
problems.
The goal is to help patients realize their full potential through the
therapist’s genuineness, unconditional positive regard, which
fosters the patient’s sense of self-worth and empathetic
understanding of the patient’s point of view.
This therapy is nondirective but focuses on helping the patient to
explore and clarify his or her own feelings and choices.

14. BEHAVIOUR THERAPY:
It does not foster awareness but
emphasis the principles of learning with
positive or negative reinforcement and
observational modelling.

15. COGNITIVE THERAPY:
It focuses on identifying and correcting distorted thinking patterns
that can lead to emotional distress and problem behaviours.
Cognitive therapists believe that patients change their behaviours by
changing their maladaptive thinking about themselves and their
experiences.
Patients are taught problem-solving skills and stress reducing
methods.
They learn that their psychological difficulties or problems can be
solves through cognitive processing.

16. SOME ISSUES FOR WHICH INDIVIDUAL
PSYCHOTHERAPY MAY HELP
•Personal growth and
exploration
•Peak performance
enhancement
•Spiritual issues
•Life adjustment issues
•Coping with changes
•Grief or loss
•Work-life balance
•Self-esteem/confidence
issues
•Chronic pain & pain
disorders
•Past trauma
•Relationship issues

17. CONTI..
•Adolescent issues
•Eating disorders
•Weight issues
•Depression
•Anxiety problems
•Sexuality issues
•Stress related problems
•Stress management
•Coping with health
problems
•Excessive fears

18. GROUP PSYCHOTHERAPY

19. DEFINITION
Group psychotherapy is a treatment in
which carefully selected people who are
emotionally ill meet in a group guided by a
trained therapist, and help on another
effect personally change.

20. SELECTION
Homogenous groups
Adolescents and patients with personality
disorders
Families and couples where the system
needs change

21. INDICATIONS
When individual therapy fails
When drugs alone do not help
When patient needs socialization

22. CONTRAINDICATIONS
Antisocial patients
Actively suicidal or severely depressed
patients
Patients who are delusional

23. CONTI…..
GROUP SIZE
Optimal size for group therapy is 8 to 10 members.
FREQUENCY AND LENGTH OF SESSIONS
Most group psychotherapists conduct group sessions
once a week, each session may last for 45 minutes to
1 hour.

24. CHARACTERISTICS OF GROUP
Group is an identifiable system composed of 3 or more members, who
engage in certain tasks to achieve common goal.
Goals can be single or multiple.
The content of a group is to overt verbal exchange.
Group follows values, norms m rules that govern the operation.
Group involvement is based upon strength and weakness of the group
members.
Group should have scheduled program.

25. APPROACHES TO GROUP THERAPY
The therapist’s role is primarily that of a facilitator, he should
provide a safe, comfortable atmosphere for self-disclosure.
Focus on the “here and now.”
Use any transference situations to develop insight into their
problems.
Protect members from verbal abuse.
Whenever appropriate, provide positive reinforcement, this
gives ego support and encourage future growth.

26. CONTI…
Handle circumstantial patients, hallucinating and delusional patients in a
manner that protects the self-esteem of the individual and also sets limits on
the behavior so as to protect other group members.
Develop ability to recognize when a group member is “fragile”, he should be
approached in a gentle, supportive and non- threatening manner.
Use silence effectively to encourage introspection and facilitate insight.
Laughter and a moderate amount of joking can act as a safety valve and at
times can contribute to group cohesiveness.
Role-playing may help a member develop insight into the ways in which he
relates to others

27. THERAPUTIC FACTORS INVOLVED IN GROUP
THERAPY
Sharing experience
Support to and from group members
Socialization
Imitation
Interpersonal learning

28. SHARING EXPERIENCE:
•This helps the patients to realize that they are not
isolated and that others also have similar
experiences and problems.
•Hearing from other patients that they have shared
experiences is often more convincing and helpful
than reassurance from the therapist.

29. SUPPORT TO AND FROM GROUP
MEMBERS:
•Receiving help from other group members can be
supportive to the person helped.
•The sharing action of being mutually supportive is an
aspect of the group cohesiveness that can provide a sense
of belonging for patients who feel isolated in their everyday
lives.

30. SOCIALIZATION:
It is acquisition of social skills (e.g. maintaining eye
contact) within a group through comments that
members provide about one another’s deficiencies in
social skills.
This process can be helped by trying out new ways of
interacting within the safety of the group.

31. IMITATION:
It is learning from observing and adopting the
behaviors of other group members.
If the group is run well, patients imitate the
adaptive behaviors of other group members.

32. INTERPERSONAL LEARNING:
It refers to learning about difficulties in
relationships by examining the interaction
of individuals with the other members of
group.

33. TECHNIQUES USEFUL IN GROUP THERAPY:
Reflecting or rewarding comments of group members
Asking for group reaction to one member’s statement
Asking for individual reaction to one member’s
statement
Pointing out any shared feelings within the group
Summarizing various points at the end of session

34. TYPES OF GROUP THERAPY:
REEDUCATIVE GROUP THERPAY: Provides information, socialisations, support
and strengthening of defences
PSYCHO-DRAMA GROUP THERAPY: Provides more depth and breadth of
experience utilizing psychoanalytical principles.
EXISTENTIAL GROUP THERAPY: Giving importance to immediate feelings
rather than the exploration of those feelings.
GROUP DYNAMIC GROUP THERPAY: importance is given to exploration of
group themes, relationship, interactions and reactions.
PSYCHO-ANALYTICAL GROUP THERPAY: Based on the psychoanalytical
technique such as dream analysis and free association etc.

35. GROUP DEVELOPMENT
PRE-AFFILIATION
PHASE
INITIAL OR
ORINTATION PHASE
WORKING PHAAE
TERMINATION PHASE

36. ROLE OF NURSE
As a co-therapist and leader by possessing high degree of therapeutic
empathy.
She should have creativity and opportunism while dealing with the group
members.
She should introduce her to the team in to the group members.
Assertive communication helps to convey the message among the members.
The nurse nurtures the group members act genuinely to deal the problem of
the group members.