INDIVIDUAL THERAPY

INTRODUCTION-
Individual psychotherapy 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 that is the therapist treats one patient at a
time.
Individual therapy is a psychotherapy implemented by a trained professional,
usually a therapist or psychologist, to help a client work through a problem. The
ways that individual therapy is implemented varies widely depending upon the
psychological problem experienced by the client the personal beliefs and
practices of the therapist, and the individual needs of the client

DEFINITION –
Individual therapy is a process through which clients work one-on-one with a
trained therapist in a safe, caring, and confidential environment to explore their
feelings, beliefs, or behaviours, identify aspects of their lives that they would like
to change, better understand themselves and others, & set personal goals of
their life

PURPOSE OF INDIVIDUAL THERAPY

Therapy is conducted on one-to-one basis, ie the therapist treats one patient at a
time
Such therapy helps to
 Understand themselves and their behavior.
 Make personal changes
 Improve interpersonal relationships.
 Get relief from emotional pain or unhappiness.
INDICATIONS-
Stress related disorders.
ADHD (Attention deficit hyperactivity disorder)
Alcohol and drug dependency
Sexual Disorders
Marital disharmony
Mild to moderate major depression
Mild to moderate anxiety disorder
Crisis, acute distress or acute adjustment disorder
Eating disorders.

TYPES OF INDIVIDUAL PSYCHOTHERAPY

1.Psychoanalysis-Psychoanalytical therapy was developed by Sigmund
Freud. It focus on unconscious forces such as repressed emotions &
memories, internal conflicts & childhood trauma on mental life &
adjustment of the individual
The aim of therapy is to bring all repressed emotions and experiences to
conscious awareness, so that the patient can work towards a healthy
resolution of his problems, which are causing the symptoms.
Psychotherapy is used primarily in bringing about basic modification in the
personality. This is done by establishing a constructive therapeutic
relationship.
2.Hypnosis The induction of a state of consciousness in which a person
apparently loses the power of voluntary action and is highly responsive to
suggestion or direction. Its use in therapy, typically to recover suppressed
memories or to allow modification of behaviour. It induced in a patient by
suggestions of relaxation & concentrating attention on a single object. The
client becomes highly suggestible, submissive & response to therapist
influence. He can be induced to recall forgotten events, becomes
insensitive to pain, gain relief from tension, anxiety & other psychological
symptoms. It affects behavioural change & control of attitude. Changes
that occur during hypnosis: The person becomes highly suggestible to the
commands of the therapist. There is an ability to produce or remove
symptoms or perceptions. Amnesia for the events that occurred during the
hypnotic state.
3.Abreaction- Abreaction is a process by which repressed material,
particularly a painful experience or conflict is brought back to
consciousness. Abreaction, the dramatic reliving of traumatic events
under hypnosis, is a powerful therapeutic intervention useful in the
treatment of victims of trauma. It is most useful in acute neurotic
conditions caused by extreme stress (Posttraumatic Stress Disorder
(PTSD) like terrorist incidents, serious accidents, or physical or sexual
assault in adult or childhood, etc).
METHODS:- Abreaction can be brought about by strong encouragement to
relieve the stressful events. The procedure is begun with neutral topics at
first, & gradually approaches are a of conflict. Abreaction can be done with
or without the use of medication
.4. Reality therapy-Reality therapy (RT) is an approach to psychotherapy
and counselling, Developed by William Glasser in the 1960s. This is a
psycho therapeutic technique which focuses on the present behaviour &
development of patient’s ability to cope with the stress of reality & take a
greater responsibility for the fulfilment of his needs. To achieve these
purposes the therapist becomes involved in an active relationship with
patient, rejects his unrealistic behaviour & teaches better ways to meet
his need in the real world. The patient need to be stressed on that the
past. cannot be changed, so he must take responsibility of right or wrong
actions of present.
5.Supportive Psychotherapy (Surface Psychotherapy) - The therapist helps
the patient to relieve emotional distress. It is a form of “surface therapy”.
The therapist reinforces the existing defences used by the client
symptoms without probing in to past or attempting to change or alter the
basic personality of the individual. APPROACH OR TECHNIQUES: There are
four main approaches to individual therapy which include psychodynamics
therapy, humanistic therapy, behavioral therapy and cognitive therapy.
A. PSYCHODYNAMICS THERAPY:- 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.

B. BEHAVIOUR THERAPY does not foster awareness but emphasizes the principles of
learning with positive and negative reinforcement and observational modelling. Behavior
Techniques – Systematic desensitization-It is developed by Joseph Wolpe. Relaxation
training: Relaxation produces physiological effects opposite to those of anxiety Hierarchy
construction: 10 - 12 condition in order or increasing anxiety Desensitization to stimulus;
Gradually exposure of individual from least to most anxiety provoking situation in a deeply
relaxed state
It is suitable for –
Anxiety disorder
Phobic anxiety disorder
Obsessive Compulsive disorder
Certain sexual disorder

Flooding
Exposing the individual directly with the Situation Based on the principles that escaping from
anxiety reinforces the anxiety through conditioning Prematurely withdrawing from the
situation may reinforce the phobia. Not suitable for the client with the heart diseases and
fragile psychological adaptation.
Aversion Therapy
When a noxious stimulus (punishment) is presented immediately after a specific behavioral
response. theoretically, the response is eventually, the response is eventually inhibited and
extinguished. Time out-Time put is a aversion stimulus or punishment during which the
client is removed from the environment where the unacceptable behaviour is being
exhibited. The client is usually isolated so that reinforcement from attention of others is
absent.

D. COGNITIVE THERAPY 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 solved
through cognitive processing.

Milieu Therapy
Milieu theory is a form of psychotherapy that involves the use of therapeutic communities.
Patients join a group of around 30, for between 9 and 18months. During their stay, patients
are encouraged to take responsibility for themselves and the others within the unit. Milieu
therapy is thought to be of value intreating personality disorders and behavioral problems.

MUSIC THERAPY
Music therapy is an allied health profession and one of the expressive therapies, consisting
of an interpersonal process in which a trained music therapist uses music and all of its facets
—physical, emotional, mental, social, aesthetic, and spiritual—to help clients to improve or
maintain their health. Music the rapists primarily help clients improve their health across
various domains (e.g., cognitive functioning, motor skills, emotional and affective
development, behavior and social skills, and quality of life) by using music experiences (e.g.,
free improvisation, singing, songwriting, listening to and discussing music, moving to music)
to achieve treatment goals.

GROUP THERAPY
Group therapy can form part of the therapeutic milieu of a psychiatric in-patient unitor
ambulatory psychiatric partial hospitalization .
 In addition to classical "talking" therapy, group therapy in an institutional setting can also
include group-based expressive the rapies such as drama therapy, psychodrama, art therapy,
and non-verbal types of therapy such as music therapy and dance/movement therapy.
PLAY THERAPY
Play is a natural mode of growth and develop- ement in children. Through play a child learns
=to express his emotions and it serves as a tool in the development of the child.
Curative Functions
 It releases tension and pent-up emotions
 It allows compensation for loss and failures
 It improves emotional growth through his relationship with other children
 It provides an opportunity to the child to act out his fantasies and conflicts, to get rid
of aggression and to learn positive qualities from other children.

Diagnostic Functions
 Play therapy gives the therapist a chance to explore family relationships of the child
and discover what difficulties are contributing to the child's problems
 Play therapy allows studying hidden aspects of the child's personality It is possible to
obtain a good idea of the intelligence level of the child
Through play inter-sibling relationships can be adequately studied. Types of Play Therapy
Individual vs group play therapy: In individual therapy, the child is allowed to play by himself
and the therapist's attention is M focused on this one child alone. In group play therapy,
other children are involved.
Free play vs controlled play therapy: In free play, the child is given freedom in deciding with
what toys he wants to play. In controlled play therapy, the child is introduced into a scene
where the situation or setting is already established.

Structured vs unstructured play therapy: Structured play therapy involves organizing

the situation in such a way so as to obtain more information. In unstructured play therapy
no situation is set and no plans are followed.

Directive vs non-directive play therapy: In directive play therapy, the therapist totally
sets the directions, whereas in non-directive play therapy, the child receives no directions.
Play therapy is generally conducted in a playroom. The playroom should be suitably stocked
with adequate play material, depending upon the problems of the child.

OCCUPATIONAL THERAPY
Occupational therapy is the application of goal-oriented, purposeful activity in the
assessment and treatment of individuals with psychological, physical or developmental
disabilities.

Goal
The main goal is to enable the patient to achieve a healthy balance of occupations through
the development of skills that will allow him to function at a level satisfactory to himself and
others.
Settings
Occupational therapy is provided to children, adolescents, adults and elderly patients. These
programs are offered in psychiatric hospitals, nursing homes, rehabilitation centers, special
schools, community group homes, community mental health centers, day care centers,
halfway homes and de-addiction centers.
Advantages
 Helps to develop social skills and provide an outlet for self-expression
 Strengthens ego defenses
 Develops a more realistic view of the self in relation to others.
Points to be kept in Mind
• The patient should be involved as much as possible in selecting the activity
• Select an activity that interests or has the potential to interest him
The activity should utilize the patient's strengths and abilities
• The activity should be of short duration to foster a feeling of accomplishment
• If possible, the selected activity should E provide some new experience for the patient.
Process of Intervention
It consists of six stages:
1.Initial evaluation of what patient can do and that cannot do in a variety of situations over
a period of time.
2. Development of immediate and long-term goals by the patient and therapist together.
Goals should be concrete and measurable so that it is easy to see when they have been
attained.
3. Development of therapy plan with planned intervention.
4. Implementation of the plan and monitoring the progress. The plan is followed until the
first evaluation. If found satisfactory it is continued and altered, if not.
5. Review meetings with patient and all the staff involved in treatment.
6. Setting further goals when immediate goals have been achieved; modifying the treatment
program as relevant.

LIGHT THERAPY
Light therapy, sometimes called photot- herapy, involves exposing the patient to an artificial
light source during winter months to relieve seasonal depression. The light source must be
very bright, full-spectrum light, usually 2,500 lux.
Indications
 Bulimia
 Sleep maintenance insomnia
 Seasonal depression.
Adverse Effects

 Nausea
 Eye irritation
 Headache.
 Contraindications
 Glaucoma
 Cataract
 Use of photosensitizing medications.

Nurse's Role
The patient is instructed to sit in front of the light at a distance of about 3 feet, engaging in a
variety of other activities, but glancing directly into the light every few minutes. The duration
of administration is 1-2 hours daily

RECREATIONAL THERAPY
Recreation is a form of activity therapy used in most psychiatric settings. It is a planned
therapeutic activity that enables people with limitations to engage in recreational
experiences.

Aims
To encourage social interaction
To decrease withdrawal tendencies
To provide outlet for feelings
To promote socially acceptable behavior
To develop skills, talents and abilities
To increase physical confidence and a feeling of self-worth.
Points to be kept in Mind
Provide a non-threatening and non- demanding environment
Provide activities that are relaxing and without rigid guidelines and time-frames
Provide activities that are enjoyable and self-satisfying.

Types of Recreational Activities

Motor forms: These can be further divided into fundamental and accessory; among
the fundamental forms are such games as hockey and football, while the accessory
forms are exemplified by play activity and dancing.
Sensory forms: These can be either visual, e.g. looking at motion pictures, play, etc.
or auditory such as listening to a concert.
Intellectual forms: These include reading, debating and so on.
Suggested Recreational Activities for Psychiatric Disorders
Anxiety disorders: Aerobic activities like walking, jogging, etc.
Depressive disorder: Non-competitive sports, which provide outlet for anger, like
jogging, walking, running, etc.
Manic disorder: One-to-one basis individual games like shuttle badminton, ball
badminton, etc.
Schizophrenia (paranoid): Activities requiring concentration like chess, puzzles.
Schizophrenia (catatonic): Social activities to give patient contact with reality like
dancing, athletics.
Dementia: Concrete, repetitious crafts and projects that breed familiarization and
comfort.
Childhood and adolescent disorders: It is better to work with the child on a one-to-
one basis and give him a feeling of importance.
Employ activities such as playing, story telling and painting. Adolescents fare better
in groups; provide gross motor activities like sports and games to use up excess
energy.
Mental retardation: Activities should be according to the patient's level of
functioning such as walking, dancing, swimming, ball playing, etc.

AROMATHERAPY

Aromatherapy is concerned with the psychological, physiological and

pharmacological effects of essential oils introduced by means of inhalation, olfaction
and dermal application. The essential oils that are used in aromatherapy are distilled
from flowers, roots, bark, leaves, wood resins and lemon or orange rinds. When
essential oils are inhaled, aromas are detected by the olfactory receptor cells in the
nares. The stimuli travel along the olfactory nerve to the brain where they are
thought to play a role in emotions, memory and a variety of body functions and
immune responses. Nurses should caution people who are considering
aromatherapy to be aware that aromatic oils vary in quality, their production is not
regulated and some may be toxic when inhaled. The skin should always be tested for
allergies by applying a very small amount of the diluted oil before a whole treatment
 is tried. Oils should not be used near the eyes and should always be diluted in a
suitable oil or water before application to skin. Oil should be stored in dark colored
glass bottles, and kept away from sunlight.

UNIT-9

PSYCHO SOCIAL AND PHYSICAL THERAPIES