INTRODUCTION

It is the treatment of psychological means , of the problems of an emotional nature, in which the therapist deliberately establishes a professional relationship with the patient to: Remove, modify or retard existing symptoms.  Mediate disturbed patterns, and/or  Promote positive personality growth and development [psychotherapy can be conducted by either verbal or non -verbal means].

DEFINITION
Certain psychological processes used for the treatment of emotional problems in which professionally trained person ( psychiatrist, clinical psychologists, psychiatric nurse, social worker) deliberately establishes therapeutic relationship. It is a method of treatment based on the development of an intimate( therapeutic) relationship between client or patient and therapist for the purpose of exploring or modifying the patients behaviour in a satisfying direction.

GOALS
     Changing maladaptive behaviour. Modifying environment causing m aladaptive behaviour. Improving IPR skills. Helping a patient to overcome a feeling of handicap. Helping him to make an accurate assessment of himself and develop self identity.

INDIVIDUAL PSYCHOTHERAPY

INTRODUCTION
It is conducted on one to one basis as the therapist treats one person at a time. Its aim is to produce limited but worthwhile changes within in a short time seldom more than six months and often considerably less.

As therapist may vary in their formal credentials, experiences and mode of practice, the client must self select a therapist whose theoretical believes and style of therapy are congruent with the clients needs and expectations.

DEFINITION
It can be defined as the method of bringing about changesin a person by exploring his/her feelings, attitudes, thinking and behaviour.

PURPOSES
     The therapists has to make the client to understand his/her needs, feelings. To modify the maladaptive behaviour. Ti improve interpersonal relationship. To get relief from stress and unhappiness . To make personal changes.

INDICATION
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Patients who have difficulties in personal relationships but are free from serious disorder of personality. Those who are interested in gaining psychological understanding of their own behaviour, reasonably intelligent, a nd well motivated to change by their own efforts.

TECHNIQUES
 The therapist observes the behaviour and assess whether the client is indicated for psychotherapy, if indicated fix the therapeutic schedule , venue, time, etc.  Therapists provides conducive environment with comfortable seating arrangement to enhance relaxation to the client.  Physical assessment and exclusion of any physical illness of the client.  Therapist establish psychotherapeutic professional relationship with the client to extract the inner feelings, conflicts of the client.  The therapist then 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 emot ions over the body functions.  Encourage the client to ventilate his ideas, feelings, painful/ traumatic experiences without inhibitions, embarrassment.

 Therapists acts as an active listener and nods the head, record essential information and makes an occasional remark.  During interaction the therapists analyse the situation and gives valuable suggestions whenever necessary .  The client is encouraged 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/procedure to a problematic situation.  The process is continued until ther e is satisfactory improvement in the clients condition and the extend of the nature of handling the psychological conflicts by tha client himself.  The therapeutic procedures and ways of handling the problems are modified according to the clients needs.  Frequency of the therape utic session decided upon clients needs.

TYPES

PSYCHOANALYSIS:
the therapeutic technique focuses primarily on the influence of unconscious forces such as repressed impulses and memories, internal conflicts and childhood traumas on the mental life and the adjustment of the individual. Its foundation is based upon problem s in early psychosexual development. The Oedipus complex; the pleasure and reality principles, the systems of personality, i.e. Id, Ego ,Super Ego and the central importance of anxiety and neurotic reaction. It is used primarily in psycho -neuroses by bringing about basic modification in the personality. This is done by establishing a constructive therapeutic relationship.

HYPNOSIS AND HYPNOTHERAPY

Hypnosis is a superficial or deep trance( a somnolent state/sleep like) resembling sleep.it is induced in a patient by suggestions of relaxation and concentrating attention on a single object. The patient /client become highly suggestible , submissive and abandons control and response to therapists influence. He/she can be induced to recall forg otten events, becomes insensitive

to pain, gains relief from tension, anxiety and other psychological symptoms. It affects behavioural change and control of attitudes.

ABREACTION

It is the therapeutic technique in which the patients talks about repressed emotions by reviving and relieving painful experiences tha t have been buried in the unconscious. When the psychiatrist considers that it could be helpful, he may use an intravenous injection of a drug such as pentothal.

REALITY THERAPY
A psychotherapeutic technique which focuses on the present behaviour and development of a patients ability to cope with the stresses of reality and take a greater responsibility for the fulfilment of his needs. To achieve these purposes the therapists becomes involved in an active relationship with the patient, rejects his unrealistic behaviour and teaches better ways to meet his needs in the real world. The patient needs to be stressed on, that the past cannot be changed; so he must take responsibility of right or wrong actions of the present.

UNCOVERING OR INSIGHT PSYCHOTHERAPY:

The technique is used to break through the patients repressed conflicts and traumatic experience to the surface. It helps the patients in gaining an insight. The patient explores different met hods to cope with the problem, once he gains an insight to his conflict or problem.

SUPPORTIVE PSYCHOTHERAPY :

It is a form of surface therapy. The therapist helps the client to relieve emotional distress and symptoms without probing in to the past or attempting to change or

alter the basic the basic personality of the individual. The therapist reinforces the existing defences used by the client and utilizes various techniques such as: 1. VENTILLATION: It is a free expression of feelings or emotions. 2. ENVIRONMENTAL MODIFICATION AND MANIPULATION: A method of improving the wellbeing of mental patients by changing the living conditions. 3. PERSUASION: The therapists attempts to induce the patient to modify his faulty behaviour by using his power of reasoning, will and self criticism. 4. RE- EDUCATION: the patient learns more effective ways of dealing with problem relationship through therapists - patients relations or group therapy. 5. REASSURANCE: It is a supportive approach that encourages the patient to believe that there are possibilities of improvement.

DISADVANTAGES:
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Clients may not cooperate if therapist fails to establish a supportive relationship, during the therapy. Client may blame his/her relations for his short comings instead of focusing on his own failures. Client may show reluctance to reveal his/her secrets bothering about confidentiality. The therapy is quite experience.

GROUP THERAPY
It is a therapeutic procedure in which the therapists carefully selects the homogenous group (8-10) who are emotionally ill and suffering with similar type of problem. The therapist fixes the sessions and formulates group activities which are guided by skilled persons. The group members assist each other under guidance of therapists to bring expected behavioural changes.

DEFINITION:
It is a form of treatment in which carefully selected, emotionally ill persons are placed into groups, guided by a trained therapists for the purpose of changing the maladaptive behaviour of the individual member.

PURPOSES:
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To intervene in psychopathology. To reveal, examine and resolve distortions in the interpersonal relationships. To improve the skill of relatin g to others. To learn coping styles.

INDICATIONS:
    Personality disorder. Adjustment problems related to adolescents. Families or couples,. Where entire system is in need of change. The entire group suffering common problem.

TECHNIQUES
 Therapists carefully selects the clients and inform the group about the time, venue of session.  Therapist provides conducive environment with adequate seating, good ventilation, calm and quiet environment which acts as a therapeutic modality.  Therapist acts as a facilitator/coordinator/moderator for the group.  Therapists gives self introduction and make the client to gi ve brief self introduction and allows sometime where group members will interact

          

with each other and share the feelings, disclose inner conflicts, thoughts openly as they gain confidence among one another. Therapist briefly explains the purpose of group se ssion, emphasizes its importance, gain the confidentiality of members and explains the events which has to be tackled. Therapists encourage the clients to converse with one another and motivate them to ventilate their experience freely. The psychological p rocesses like transference (to develop deeper insights into their problems) and counter transference are used. Therapist encourages the members to be active listener during session. Ask the group member to react for individual statement and individual reaction for other members statement. Therapists provides positive reinforcement whenever required. Sets limits to protect group behaviour. Therapists handles the situation in a supportive and non threatening manner. Encourage moderate humour to have ease environment at times. Promotes group cohesiveness. If the group members are interested, encourage the activities like psychodrama, discussion among members. At the end arrange the reflex session where therapist starts the activity by summarizing the session and clients are at liberty to share their feelings. Therapists gets the feedback and informs next schedule of therapeutic session.

TYPES:
1) TRADITIONAL GROUP: It includes mainly the patient with mental illness and are from the hospital inpatient department. In the didactic group therapy, lecture is given to the patient along with some film show, like in case of excessive drinking or use of drugs. Psychodrama is a technique of psychotherapy in which a patient acts out his feelings in front of a group of patients. The therapist guides and directs the patients. This acting out provides an insight into the patient about his faulty patterns of learning which he can eliminate. 2) ENCOUNTER GROUP OR T- GROUP:

It is a form of small group in which an individual learns how his behaviour and feelings affect him and others. This is not necessarily a group with mental illness. The individual may have some coping difficulty which he would like to resolve at right time. These groups are based on sensitivity training or t - groups. 3) HOMOGENOUS OR HETEROGENEOUS: Homogenous group are composed of patients of the same age, race, sex, socioeconomic level and similar category of illness. Heterogeneous groups vary on all these aspects. 4) OPEN GROUPS AND CLOSED GROUPS: In open groups members may join and leave the group at any time. Closed group have a specific number of people, specific time to start and close the group sessions; the duration is 3 to 4 weeks. Inpatient and outpatient both are included in this group. Open and closed groups are used extensively in the hospital. 5) GROUP ACCORDING TO MENTAL ILLNESS: Neurotic group or patient suffering from psychotic illness comes under this category.

ADVANTAGES:
 Cost effective.  Members profit by hearing other members discuss their problems.  Opportunity to explore specific styles of communication in a safe atmosphere, where they can receive feedback and can undergo change.  Learns multiple ways of solving the problems from other group members, and group exploration helps them to discover new ways of solving problems.  Learn socialization skills  The group provides for its members understanding, confrontation and identification with more than one individual.

DISADVANTAGES:

 Individual privacy is destroyed.  Resistance and reluctance to change.  Therapist at times dominant or as if he is giving individual therapy.

CONCLUSION:
Individual psychotherapy is mainly focussing on the modification of the maladaptive behaviour of an individual by making some personal changes in his/her feelings, attitudes, behaviour, etc. where as group thera py involves a group of people who share similar emotional problems, and they are guided by a trained therapist for modifying their maladaptive behaviour and to learn coping styles.

BIBLIOGRAPHY

Neeraj Ahuja A Short Text Of Psychiatry Page:- 72, 227, 231. Jaypee Publications

Jn Vyas, Neeraj Ahuja Textbook Of Post Graduate Psychiatry Edition:- 2nd Page:- 126, 828-829. Jaypee Publications

Stuart Laraia Principles And Practice Of Psychiatric Nursing Edition :- 7th Page :- 683 Mosby Publications

Dr. (Mrs.) K. Lalitha Mental Health And Psychiatric Nursing. An Indian Perspective Page :- 194, 208, 190

Dr. Bimla Kapoor Textbook Of Psychiatric Nursing Vol-Il Page :-90-93, 99-101.

SUBMITTED BY:
VIBIN VARGHESE 1ST YEAR M.sc LAXMI COLLEGE OF NURSING.

SUBMITTED TO:
MRS. THERESA MATHIAS HOD - MENTAL HEALTH DEPARTMENT