unit 1: Psychotherapy

 The word psychotherapy is derived from two Greek word psyche

meaning “soul” or “being” and therapeutikos meaning “caring for
another”.
 Therefore, according to this old definition psychotherapy implies caring
for another person’s soul or being
 But the current definition of psychotherapy is board . i.e
 it is a unilateral professional relationship that is circumscribed by :
 limits on time
 frequency of contact
 content of discussions, and
 level of intimacy in which a person may talk over problems with a
specialist in human behavior.
• Confidentiality is assured in a professional relationship, so that a
client or patient can express whatever is on his or her mind without
concern that the information will be disclosed to others.

• psychotherapy involves consulting with a mental health

professional to obtain assistance in changing:

 feelings

 thoughts, or

 behaviors that one experiences as problematic and distressing.

Goals of psychotherapy
• The list of possible goals of psychotherapy is
endless.
• Goals may include:
behavioral change
enhanced interpersonal relationships
Insight
support, or concrete outcomes such as finding a
job or a partner,
staying out of the hospital, or
staying alive.
 There are six fundamental therapeutic goals common to almost all
psychotherapies:
1. Overcoming demoralization and gaining hope: Psychotherapy usually
seeks to return or develop a sense of hope or optimism.
2. Enhancing mastery and self-efficacy: increasing one’s sense of mastery,
efficacy, and control can also heighten one’s sense of hope.
3. Overcoming avoidance: avoidance of issues can lead to more serious
problems. Denying, avoiding, and minimizing problems prevent a person
from dealing directly with them
4. Becoming aware of one’s misconceptions,
5. Accepting life’s realities, and
6. Achieving insight
Common denominators in psychotherapy:

 the common denominators in all psychotherapy include:

1. a professional person or “expert,” :

• Almost all psychotherapies involve working with a licensed mental

health professional who have learned the principles of human
behavior and apply them to the individual needs and concerns
expressed by those who seek their services.

• These include; psychologist, psychiatrist, social worker, psychiatric

nurse, marriage and family counselor.
2. Professional Manner:
 Almost all psychologists maintain a professional manner. This
entails;
• Observing appropriate professional boundaries (e.g., not discussing
one’s own problems)
• Behaving in an attentive, caring, and helpful manner.
• Being physically and psychologically available to the patient
during sessions.
• Psychologists should not, for example, take telephone calls, fall
asleep, eat, be late for appointments, act impulsively, or allow
themselves to be distracted from their patients during the session.
3. Professional Setting

• Most psychotherapy occurs in the professional office of the

service provider. The office is usually equipped with comfortable
seating and space and also allows for private conversation

4. Fees

• Almost all psychotherapy involves fees. Patients and/or their

insurance companies are required to pay for the psychotherapy
sessions.

• Fees range from about $30 per hour in low-fee training or

community clinics to $150 or more per hour.
5. Duration of Sessions

• Psychotherapy usually involves about an hour of service per

session (e.g., 50 minutes).

• Longer sessions (e.g., 80 minutes) are often scheduled for family

or group psychotherapy.

6. Frequency of Sessions

• Most outpatient psychotherapy is conducted on a once-per-week

basis, whereas inpatient or hospital-based psychotherapy is usually
conducted daily.
Stages of psychotherapy
• Most psychotherapy is carried out in several stages:
Stage 1: Initial Consultation
• An initial consultation generally involves a discussion of why the patient
has decided to seek help and what the patient hopes to gain from the
psychotherapy experience.
• The consultation provides an opportunity to determine whether there is a
good fit between the needs, goals, and interests of the patient and the
skills of the psychologist.
• Stage 2: Assessment
• The psychologist must perform an assessment of the patient. This may
involve formal psychological testing or extended interviews.
Stage 3: Development of Treatment Goals
• Once a reasonable level of understanding about the nature of the problem(s) is
established, treatment goals and objectives can be developed.
• It is important, for both patient and psychologist to have some understanding of
the goals that each has in mind so that both parties can work toward the same
ends.
• Once treatment goals are developed, a treatment plan should be outlined to
reach them.
Stage 4: Implementation of Treatment
• The actual treatment is provided with the hope of reaching the treatment goals.
• The treatment might include homework, self-help readings, or consultation with
other professionals
Stage 5: Evaluation of Treatment
• During the course of treatment, an evaluation of the treatment should be
regularly conducted to determine whether the treatment plan is working
effectively or needs to be altered to be more useful to the patient.
Stage 6: Termination
• Once psychotherapy has successfully reached the treatment goals,
psychotherapy is usually terminated
• Sometimes treatment is terminated prematurely due to a variety of
factors such as;
 the patient’s financial or time constraints or resistance to change
 a job change or move on the part of the patient or psychologist
 Changes in insurance coverage; and so forth.
Stage 7: Follow-Up

• Often, follow-up sessions are scheduled or at least offered to the

patient to ensure that the changes achieved during the course of
therapy are maintained after treatment is terminated.

• Follow-up can provide a sense of continuity for patients, and

alleviate the abruptness of termination after an intensive therapy.
Modes of psychotherapy

• Psychotherapy can be provided in:

• individual

• couple

• group, or

• family ,

 Each mode has advantages and disadvantages as well as different

potential goals and objectives.
Essential questions about psychotherapy( home work 10%)
• following are the frequently asked 10 questions by students,
psychotherapy clients, and others. So what is your reflection
(evidence based)for each of these questions? 10 pts.
1. Does Psychotherapy Work?
2. Is Long-Term Therapy Better Than Short-Term Treatment?
3. Who Stays In and Who Drops Out of Psychotherapy?
4. Is One Type of Therapy Better Than Another?
5. Do the Effects of Psychotherapy Last after Therapy Ends?
6. What Common Factors Are Associated with Positive
Psychotherapy Outcome?
7. Why Is Change Difficult?
8. Must Someone Be a Professional to Be an Effective Therapist?
9. Does Psychotherapy Help Reduce Medical Costs?
10. Can Psychotherapy Be Harmful?
Group and Family Therapy
Definition and Historical Overview of Group Therapy

• Group: A group is a collection of individuals whose association is

founded on commonalities of interest, norms, and values.

• Membership in the groups may be by chance, by choice, or by

circumstances.

Group psychotherapy:

• It is a treatment in which carefully selected persons who are

emotionally ill meet in a group guided by a trained therapist and help
one another effect personality change.

• it is also widely used by those who are not mental health

professionals in the adjuvant treatment of physical disorders
Historical Overview of Group Therapy
1900 – 1909
 Joseph Henry , TB patients, focus, support and inspiration.

1920 to 1929
(1922) Alfred Adler. Counselling with prison and child guidance
populations

1940 to 1949
1940’s and World War II seen as beginning of modern work group
Characteristics of Group Therapy and types of
therapy groups
 Yalom Identified the following Characteristics that make
Effective Group Therapy

• Universality:

 Nothing is truly outside the experience of other people (“I’m not

alone nor have unique problems”)

• Group Cohesiveness:

Is the attractiveness of a group for its members

• Is the feelings of trust, belonging and togetherness experienced
by the group members
• Altruism (unselfish giving)

 Group therapy allows individuals to be of benefit to other people

• Instillation of Hope:

 Member recognizes that other members’ success can be helpful

and they develop optimism for their own improvement

 group members gain inspiration through contact with individuals

who have been in their place and made it through

• Imparting Information(educational):
 Implies education or advice provided by the therapist or group
members
• interpersonal learning- input

 Members gain personal insight about their interpersonal impact

through feedback provided from other members

• Interpersonal learning- output

 Members provide an environment that allows members to interact in

a more adaptive manner
• Development of Socializing Techniques

 Members can develop more sophisticated social skills

 The group provides members with an environment that fosters

adaptive and effective communication

• Imitative Behaviour

 Is the process of members discovering who they are by imitating

the psychotherapist and other group members

• The Corrective Recapitulation of the Primary Family Group

 Group members can work through early familial conflicts

correctively
• Catharsis:

 it is the ability to reflect on one’s emotional experience

 Members release of strong feelings about past or present

experiences

 Is an essential component of the change process valued later in

group

• Existential factors

 Members accept responsibility for life decisions

Types of group therapy ( open book exam 20 % ) 40 Minutes

1. Transactional group therapy( was devised by Eric Berne)

2. behavioral group therapy: relies on conditioning techniques based on learning

theory

3. Gestalt group therapy: was devised by Frederick Perls)

4. client-centered group psychotherapy( developed by Carl Rogers)

NB: Issues to be covered

I. View of Human Nature

II. The Therapeutic Process
• Therapeutic Goals
• Therapist’s Function and Role
• Client’s Experience in Therapy
• Relationship Between Therapist and Client
III. Application: Therapeutic Techniques and Procedures
The Role of the Nurse in Group Therapy

• Nurses who work in psychiatry may lead various types of therapeutic

groups, such as:

 client education groups

 assertiveness training

 support groups for clients with similar problems

 parent groups

 transition to discharge groups, and others.

• Guidelines set forth by the American Nurses Association specify that

nurses who serve as group psychotherapists should have a minimum
of a master’s degree in psychiatric nursing.
 Advantages of Group therapy
• Clients motivate each other.

• Clients/families recognize that others have problems similar to

their own.

• Provides opportunities for socialization, peer interaction, and

carryover.

• There are increased opportunities to learn by observing others.

• Self-monitoring is encouraged to reduce the client’s dependence on

clinician cues.
 Disadvantages of Group therapy

• Group members receive less individual attention

• Fewer opportunities to address individual client weaknesses

• Clients who are shy may be reluctant to participate in a group

• Group members’ progress will vary within the group

Some of the critical tasks that a Nurse must face in
group therapy are:

1. Size of group
• Group therapy has been successful with as few as 3 members and as
many as 15, but most therapists consider 8 to 10 members the optimal
size.

• Interaction may be insufficient with fewer members unless they are

especially verbal, and with more than 10 members, the interaction
may be too great for the members or the therapist to follow.
• Recommended group size for children is 2 to 6 members

• Recommended group size for adults is 5 to 7 (e.g. conversation

groups)

2. Frequency and Length of Sessions

• Most group psychotherapists conduct group sessions once a

week.

• When there are alternate sessions, the group meets twice a week,
once with and once without the therapist.

• Group sessions generally last anywhere from 1 to 2 hours, but

the time limit should be constant.
3. Patients composition

• Most therapists believe that groups should be as heterogeneous as

possible to ensure maximal interaction.

• Members with different diagnostic categories and varied

behavioral patterns; from all races, social levels, and educational
backgrounds; and of varying ages and both sexes should be
brought together.

• Patients between the ages of 20 and 65 years can be included

effectively in the same group.

• Both children and adolescents are best treated in groups

comprising mostly persons in their own age groups.
4. preparation of patients

• Patients prepared by a therapist for a group experience tend to

continue in treatment longer and report less initial anxiety than
those who are not prepared.

• The preparation consists of having a therapist explain the

procedure in as much detail as possible and answer the patient’s
questions before the first session.

5. determining group process

• group process generally refers to what happens in the group,

particularly in terms of the development and evolution of patterns
of relationships between and amongst group participants
 These processes occur at both observable and inferred levels.

 Observable processes consist of verbal (e.g. speech content;

expressed affects) and nonverbal behaviors that have been
conceptualized, operationalized and assessed from fine-grained to
very abstract levels of analysis

 Inferred or covert group processes refer to conscious and

unconscious intentions, motivations, wishes, and needs enacted by
individual participants, dyads, subgroups or the group-as-a-whole.

 These processes can serve both adaptive, work-oriented, therapeutic

ends or defensive, work-avoidant or resistive purposes
6. Therapist’s interventions

 Treatment begins with a clear statement about diagnosis,

recommended treatment and the rationale for treatment

 The therapist’s interventions consist of a range of integrated but

distinct actions that are most effective when they are well balanced
with one another such as :

 coordination of the group and regulation of the boundaries of the

group

 activating and emoting the group

7. Confidentiality and Informed Consent

 Therapists should keep specific treatment notes for individual

members; individual notes for members should never refer to other
members by name.

 Informed consent for group members can include having members

sign a group confidentiality
8. Termination of group psychotherapy

• The three key points that termination should address in group

therapy.

1. The ending phase includes a review and reinforcement of

individual change which has occurred in the therapy;

2. The therapist guides the departing client to a resolution of the

relationships with the therapist and group members; and

3. The individual is helped to face future life demands with the

tools provided in the therapy (Joyce et al., 2007).

Tea Break!
1.4. Introduction and Duvall’s theory of the Family Life Cycle
• Family is the basic unit in which we all grow up, so whether we want
it or not, it leaves a very profound impression.

• The family life cycle is a series of stages through which a family may pass over
time.

• The family life cycle emphasizes the effects of marriage, divorce, births, and deaths
on families, as well as changes in income, expenses, and assets.
The Duvall’S 8 Stages FAMILY LIFE CYCLE

Stage 1 Beginning family

• The couple establishes their home but do not yet have children.

• Developmental Tasks: Establishing a satisfying home and marriage/

relationship and preparing for children

Stage 2: Childbearing family

 Includes from the birth of the first child until that child is 2 1/2 years
old.

Developmental Tasks: Adjusting to increased family size; caring for

an infant; providing a positive developmental environment.
STAGE 3: FAMILY WITH PRESCHOOLERS

Includes When the oldest child is between the ages of 2 1/2 and 6.

Developmental Tasks: Satisfying the needs and interests of

preschool children; coping with demands on energy and attention with
less privacy at home.

Stage 4: family with school age children

Includes when the oldest child is between the ages of 6 and 13.

Developmental Tasks: Promoting educational achievement and fitting

in with the community of families with school-age children.
STAGE 5:FAMILY WITH TEENAGERS

 When the oldest child is between the ages of 13 and 20.

Developmental Tasks: Allowing and helping children to become

more independent; coping with their independence; developing new
interests beyond child care.

STAGE 6: LAUNCHING

Includes from the time the oldest child leaves the family for
independent adult life till the time the last child leaves.

Developmental Tasks: Releasing young adults and accepting new

ways of relating to them; maintaining a supportive home base; adapting
to new living circumstances.
STAGE 7: EMPTY NEST

Includes from the time the children are gone till the marital couple
retires from employment.

Developmental Tasks: Renewing and redefining the marriage

relationship; maintaining ties with children and their families;
preparing for retirement years.

STAGE 8: AGING FAMILY

Includes from retirement till the death of the surviving marriage

partner.

Developmental Tasks: Adjusting to retirement; coping with the

death of the marriage partner and life alone.
1.5. Healthy Functioning families and Dysfunctional Families

 Features of Healthy Functioning families

 Functional families carry out effectively their economic function,

which means that their members find the basic economic
security they need at home

 Apply a fair distribution of domestic activities so that each

member is responsible for its implementation and does not
overload a single person with all duties.
 Improve the sense of belonging to the family and at the same time
stimulate the personal identity and autonomy of each of its
members. There is a balance between family membership and
identification.

 Apply clear limits, psychological boundaries that other members

should not overcome and ensure good coexistence at home. But
even so, it leaves a good margin of tolerance, so that family
conflicts do not arise.

 Although there are well-defined rules and roles, when problems

surge, there is some flexibility that facilitates arrangements and
solutions based on family well being.
 There is an adequate distribution of hierarchy levels. The
hierarchy between the parents is horizontal so that both have the
same power at home, but exercise a vertical hierarchy on their
children, allowing them to set standards and apply them

 Clear communication where all members can express what they

think and feel assertively and without harming others.

 Each member feels accepted within the family, where he finds an

emotional security source.

 The family grows alongside its members, so the mistakes are

learning experiences that strengthen them.
• Characteristics of dysfunctional families
 Promote the over-dependence of some of its members, which
limits their growth and personal development.
 Establish a too open relationship so that family feelings are
canceled. Usually happens in families too permissive, which end
up generating a sense of uproar in their members
 It does not apply clear rules and limits, so that members do not
know what their duties and rights are.
 It does not respect the generational distance and reverses the
hierarchy of power, so that the parents subordinate themselves to
the child, who ends up becoming a little tyrant/dictator.
 At the base of dysfunctional families there are often
communication problems. Members do not want to express their
feelings or ideas, thus repressing them or expressing them
indirectly by triggering defensive behaviors.

 Its members are not empathic and sensitive to others, so that the
family does not meet the minimum requirements of acceptance
and affection.

 There is a low level of tolerance, so it ends up blaming one of the

members and treating him unfairly.
1.7.Culturally Diverse Families

 What is culture?

 It is :

• the roles we play,

• what we value

• the ways we express ourselves,

• our goals for ourselves and our families, and

• our relationships with others

Family culture is the core of our beliefs and
interactions with others.
• Principles for working with culturally diverse families:

1. Become informed about the cultures of the families with whom

you work.
 Examine your own attitudes and dispositions.
 Acquire knowledge of child rearing practices, gender roles,
common beliefs, holidays, and traditions.
 Visit homes.
 Learn about verbal and non-verbal communication.
 Select appropriate multicultural books and materials.
2. Honor the language and literacy backgrounds of families.
• Show honest appreciation of language and speech patterns.
• Learn about home literacy experiences
3. Incorporate culturally diverse literature and experiences to help link
home and school.
 Considerations when parents are not able to read or write
• Communicate the importance of oral language
• Encourage families to share oral histories, folktales, and songs
• Model the use of wordless picture books for families to support
imagination and language
• Encourage language play and dialogue
•
 Family therapy

 It Is any psychotherapeutic treatment of the family to

improve psychological functioning among its
members.
It is an Intervention to alter interactions among
family members and improve function
• Many models treatment exist
 Family therapy as a whole
• Basic assumption
– An individual’s problematic behavior grows out of the
interactional unit of the family, community, and societal
systems
• Focus of family therapy
– Short term, solution-focused, action-oriented, and here-
and-now interaction.
– Focus on how current family relationships contribute to
the development and maintenance of symptoms.
 Family therapy as a whole
• Role of goals and values
– Specific goals are determined by family and
therapist
– Global goal is to reduce family’s distress
• How family change
– Cognitive, emotional, or behavioral changes
– Change needs to happen in relationships, not just
within the individual
 Family therapy as a whole
• Techniques of family therapy
– Techniques are tools for achieving therapeutic
goals
– Personal characteristics (respect, empathy,
sensitivity) are even more important
– Always consider what is in the best interests of the
family.
 The Family Systems Perspective
• Individuals – are best understood through assessing
the interactions within an entire family
• Symptoms – are viewed as an expression of a
dysfunction within a family
• Problematic behaviors –
– Serve a purpose for the family
– Are a function of the family’s inability to operate
productively
– Are symptomatic patterns handed down across
generations
• A family – is an inter-actional unit and a change in
one member effects all members
 Adlerian Family Therapy
• Alfred Adler
• Adlerians use an educational model to counsel
families
• Emphasis is on family atmosphere, birth order, and
family constellation
• Therapists function as collaborators who seek to join
the family
• Understand the purposes of underlying children’s
misbehavior
Adlerian Family Therapy Therapy Goals
• Unlock mistaken goals and interactional patterns
• Engage parents in a learning experience and a
collaborative assessment

• Emphasis is on the family’s motivational patterns

(e.g., a desire to belong)

• Main aim is to initiate a reorientation of the

family
• What is a Nursing Diagnosis?
 It is a clinical judgment concerning a human response to health
conditions/life processes, or vulnerability for that response, by
an individual, family, group, or community. A nursing diagnosis
 PURPOSES
 Contributes to the professional status of nursing as a discipline
 Provides a means for effective communication
 Facilitates holistic client, family
community-focused care
 components nursing diagnosis
 Label: It is important to state that merely having a label or a list
of labels is insufficient.
 Definition: It is critical that nurses know the definitions of the
diagnoses they most commonly use
 diagnostic indicators: are the data that are used to diagnose and
to differentiate one diagnosis from another
 These diagnostic indicators include:
1.Defining characteristics: are observable cues/inferences that
cluster as manifestations of a diagnosis (e.g., signs or symptoms)
2. Related factors

 are an integral component of all problem-focused nursing

diagnoses.

 They are etiologies, circumstances, facts, or influences that have

some type of relationship with the nursing diagnosis (e.g., cause,
contributing factor).

3. Risk factors : are influences that increase the vulnerability of an

individual, family, group, or community to an unhealthy event (e.g.,
environmental, psychological, genetic).
• Types of nursing diagnoses

 A nursing diagnosis can be:

1.Problem-focused diagnosis – a clinical judgment concerning an

undesirable human response to a health condition/life process that
exists in an individual, family, group, or community

2. Risk diagnosis – a clinical judgment concerning the vulnerability

of an individual, family, group or community for developing an
undesirable human response to health conditions/life processes
3. Health promotion diagnosis –
 a clinical judgment concerning motivation and desire to increase well-
being and to actualize human health potential.
 These responses are expressed by a readiness to enhance specific
health behaviors, and can be used in any heath state
 Health promotion responses may exist in an individual,
family, group, or community/
4. A syndrome: is a clinical judgment concerning a specific
cluster of nursing diagnoses that occur together, and are best addressed
together and through similar interventions.
 example chronic pain syndrome (00255).