PSYCHOTHERAPY

abnormal psychology

PUNE UNI SYBA

introduction 1. Psychotherapy is a process of interaction between the patient (the person seeking help for emotional and/or mental problems) and a trained professional (i.e. the psychotherapist). The psychotherapist helps the patient by creating a positive relationship based on trust. 2. The goal is to produce psychological change (i.e. improvements in personality and behavior) in a person by means of dialogues/discussions and interactions. 3. Psychotherapy is used to solve problems and to end crises; but it is also used in the case of healthy individuals to further promote growth. 4. Psychotherapy is based on the belief that people who have psychological problems can change, learn and adapt better and better (in the aspects of perception, evaluation and behavior). 5. However, it is not easy to achieve these changes many people prefer to tolerate problems rather than challenge themselves to creating a different life.

why do people need/seek therapy? 1. Stressful life circumstances: sudden and highly stressful situations such as death in the family, divorce or unemployment, often creates feelings of overwhelm. Such individuals feel vulnerable and become willing to be treated psychologically. 2. Longstanding/chronic problems: those who have long-term psychological distress or disorders and have histories of maladjustment. They may also have interpersonal problems, mood swings, persistent unhappiness and inability to feel confident.

professionals that provide therapy 1. Clinical psychologists: they have graduate degrees in clinical psychology and usually have past experience (internships of 1 year). They are trained in psychological principles, methods, identification and treatment of psychological disorders. 2. Psychiatrists: they have general medical degrees and upto 3 years of post-doctoral residency training in psychiatry. The emphasis is on treatment using drugs/medicine. 3. Psychiatric social workers: they have Masters degrees in social work and sometimes more advanced degrees. They have training focused on mental health problems and are skilled in interviewing, compiling family histories and assessing social factors involved in problematic behavior. 4. Psychiatric nurses: they are registered nurses, trained to help people with psychological disorders; they are specialists employed in institutions such as mental hospitals and psychiatric wards of general hospitals.

5. Psychoanalyst: they may be psychiatrists, psychologists or neither; they use particular psychotherapeutic techniques originated by Sigmund Freud and his followers. 6. Counselors/counseling psychologists: their work is similar to that of clinical psychologists. They work with milder problems and more frequently administer tests in order to make diagnoses.

therapeutic alliance/relations 1. The term therapeutic alliance emphasizes the collaboration between the therapist and the client. 2. This partnership takes into consideration the preferences and goals of the client. It is important to listen to the client without being judgmental or giving unnecessary advice. There may be little progress in treatment without trust and intimacy between the two. 3. The alliance is a framework within which effective helping occurs and the patient is encouraged. 4. Stages of therapeutic relation: i. Relationship development: it includes the initial meeting of the client and the therapist, rapport building, gathering of information, determination of goals and informing the client about the conditions under which counseling will take place (especially about confidentiality/privacy). ii. Extended exploration: using special techniques and theoretical approaches and strategies the therapist explores in-depth the emotional and cognitive make-up of the patient, his/her history (including treatments tried before), decisionmaking abilities (including critical thinking ability) and re-evaluation of goals determined in stage (i). iii. Problem resolution: there is increase in activity for both parties; the therapist facilitates, demonstrates and instructs; the client re-evaluates emotional and cognitive dynamics, trying out new behaviors, both inside and outside the session.
[it is not clear where to put the points that follow; see the handwritten notes for sequence; probably part of a section titled Qualities of a Psychotherapist]

5. Core conditioning: empathy, respect and unconditionally positive regard/outlook/attitude. 6. Genuineness: the therapist should be a real person; the client should be able to relate to the therapist. 7. Congruency: the therapist must show congruence (equivalence) in what he says and how he behaves. 8. Concreteness: it is the ability not only to see the incomplete picture that clients paint with their words but also to communicate to clients the figures, images and structures that will complete the picture; in this process of exploring problems/issues, clients often present somewhat distorted views of the actual situation. Concreteness enables the therapist to help the client identify the distortions in the situation and fir them together in such a way that clients are able to view the situation in a more realistic

fashion. It has also been defined as the role the psychologist plays to clarify and comprehend the vague or ambiguous ideas expressed by the client. 9. Reflection: The therapist makes the client more aware of what is happening, filling in the gaps for the client and figuring out the real meaning of the content. 10. Clarification: the therapist must clarify; he should be able to understand the meaning/context of what the client is reporting. 11. Warmth: it is the ability to demonstrate genuine caring and concern for clients; therapists convey acceptance of clients and their sincere interest in finding solutions to the problems; warmth is often communicated in non-verbal behaviors (smiles, touch, tone of voice etc.) 12. Immediacy: it is the ability to deal with the here-and-now factors involved in overt and covert interactions between the client and therapist (examples include: a client getting angry at the therapist, the therapist being frustrated, feelings for each other between the two etc.)

cultural awareness 1. The openness and motivation of the therapist to understand cultural diversity that clients bring is important. 2. Cultural awareness helps the therapist develop insight into the many variables that affect the client and should enable to them to place their clients issues, problems and concerns in the proper perspective.

measuring success in therapy 1. Some ways to assess the success of a therapy: a. A clients self-report of the changes is extremely beneficial; however, a client is not necessarily a reliable source of information. (Clients may report optimistically in order to please the therapist or to avoid the dissonant perception of their investment of time, energy and money being useless) b. Reports from the clients family or friends are usually a good source of information. However, sometimes the relatives of the client tend to see only the improvement they hoped for. c. Therapists impression of changes that have occurred: a therapist may not be the best judge of a clients progress because any therapist is likely to be biased in favor of seeing himself as competent/successful d. Comparison on pre-treatment and post-treatment scores on psychological tests; however, one drawback is regression to the mean, in which very high or very low scores tend to drift towards average after repeated measurement, thus giving a false impression that change has occurred.