Ce diaporama a bien été signalé.
Le téléchargement de votre SlideShare est en cours. ×

Cbt, milieu therapy, psychoanalytic theory

Chargement dans…3

Consultez-les par la suite

1 sur 53 Publicité

Plus De Contenu Connexe

Diaporamas pour vous (20)

Similaire à Cbt, milieu therapy, psychoanalytic theory (20)


Cbt, milieu therapy, psychoanalytic theory

  1. 1. SPECIFIC OBJECTIVE At the end of seminar student will be able to:- 1. Introduction of therapies 2. Explain about the technique and process of psychoanalytic therapy. 3. Discuss about the milieu therapy 4. Discuss the role of nurse in milieu therapy 5. Define the cognitive behaviour therapy 6. Discuss about the techniques and method of cognitive behaviour therapy
  2. 2. INTRODUCTION OF PSYCHOANALYTIC THERAPY Psychoanalysis was first developed by Sigmund Freud at the end of the 19th century. The most important indication for psychoanalytic therapy is the presence of long standing mental conflict, which may unconscious but produce symptoms. In psychoanalysis the focus is on the cause of the problem.
  3. 3. THERAPY PROCESS It is typical for the psychoanalyst to be positioned at the head of the patient and slightly behind, so that the patient can not see the therapist. This decrease any kind of non-verbal communication between the two people. The patient is typically on the couch, relaxed, and ready to focus on the therapist instruction, which facilitates free association.
  4. 4. The patient is active participant, freely revealing all thoughts exactly as they occur and describing all dreams. He reveals nothing personal, and he dosen’t give any directions to the patient. The major goal of is for the client to gain insight and understanding about current relationship and behavior pattern. This therapy is a lengthy and costly type treatment.
  5. 5. Techniques used in Psychoanalysis Free association  Dream analysis Hypnosis Catharsis Abreaction therapy
  6. 6. FREE ASSOCIATION The patient is allowed to say whatever comes to his mind, in response to a word that is given by the therapist.
  7. 7. DREAM ANALYSIS Freud believed that behavior is rooted in the unconscious and that dreams are a manifestation of the troubles people repress. Psychoanalysts believe that dreams truly are the mirror to the unconscious. Monitoring and interpreting dreams is an important techniques of psychoanalysis.
  8. 8. The client is asked to keep a “dream log” by writing in a notebook as much as he or she can remember of both pleasant and particularly disturbing dreams. the dreams are then interpreted in much the same way as free association. Significant people or situation in the dream are explored with the client , and possible meaning are offered by the therapist.
  9. 9. HYPNOSIS Altered state of consciousness in which people become deeply relaxed and highly suggestible to changes in experiences & behaviors.
  10. 10. Characteristics of Hypnotic State  Suggestibility  Do, think, say things as told  Dissociation Separate self from external reality “Hypnotic Analgesia”(Medication that acts to relieve pain)  Subject told to conduct Subject told to conduct orchestra orchestra  Problems that are Enhanced by Memory or Hypermnesia (unusual power of memory) Recall remote events in great detail Age regression False recollections
  11. 11. CATHARSIS “The expression of ideas, thoughts, and suppressed materials that is accompanied by an emotional response that produces a state of relief in the patient.”
  12. 12. Maladaptive symptoms may be resolved by bring unconscious thoughts and feeling into consciousness. Sometime the individual not only may recall the painful experience but also actually relives it, accompanied by the feeling and emotions associated with the event. The process is called abreaction.
  13. 13. Abreaction therapy Abreaction Therapy focuses on reliving a traumatic event and going through the emotions associated with them to heal and move forward. Originally created by Sigmund Freud the method gives patients a way to release their unconscious pain and escape from the memories and feelings that have kept them from moving forward.
  14. 14. Method Abreaction can be brought about by strong encouragement to relive the stressful events. The procedure is begun with neutral topics at first, and gradually approaches areas of conflict. Although abreaction can be done with or without the use of medication, the procedure can be facilitated by giving a sedative drug intravenously.
  15. 15.  A Safe method is the use of thiopentone sodium i.e. 500mg dissolved in 10cc of normal saline. It is infused at a rate no faster than 1 cc/minute to prevent sleep as well as respiratory depression.
  16. 16. MILIEU THERAPY  it is defined as “a scientific structuring of the environment in order to effect behavioural changes and improve the psychological health and functioning of the individual.”
  17. 17. The goal of milieu therapy is to manipulate the environment so that all aspects of the clients hospital experience are considered therapeutic. Within this therapeutic community setting, the client is expected to learn adaptive coping, interaction, and relationship skills that can be generalized to other aspects of his or her life.
  18. 18. BASIC ASSUMPTION  The health in each individual is to be realized and encouraged to grow.  Every interaction is an opportunity for therapeutic intervention.  The client owns his or her own environment.  Each client owns his or her behaviour.
  19. 19. Peer pressure is a useful and powerful tool. Inappropriate behaviour are dealt with as they occur. Restriction and punishment are to be avoided.
  20. 20. CONDITIONS THAT PROMOTE A THERAPEUTIC COMMUNITY  Therapeutic community setting, everything that happens to the client, or within the clients environment, is considered part of the treatment program. The community setting is the foundation for the program of treatment. Community factors- such as social interaction, the physical structure of the unit, and schedule of activities- may generate negative response from some client. These stressful experiences are used as examples to help the client learn how to manage stress more adaptively in real life situation.
  21. 21.  Basic physiological needs are fulfilled.  The physical facilities are conducive to achievement of the goal of therapy.  A democratic form of self- government.  Responsibilities are assigned according to client capabilities.  A structured program of social and work related activities is schedule as part of the treatment program.  Community and family are included in the program of therapy in an effort to facilitate discharge from treatment.
  22. 22. THE ROLE OF NURSE  Through use of the nursing process, nursing manage the therapeutic environment on a 24 hours.  Nurse have the responsibility for ensuring that the clients psychological needs are meet.
  23. 23. Nursing are also responsible for medication of administration. Develop of one to one relationship. Setting limits on unacceptable behaviour. Client education.
  24. 24. Team member
  25. 25. COGNITIVE BEHAVIOUR THERAPY Cognitive behavior therapy is a talking therapy that can help you manage your problems by changing the way you think and behave. Its most commonly used to treat anxiety and depression, but can be useful for other mental and physical health problems.
  26. 26. DEFINITION Cognitive behavior therapy is a process of teaching, coaching, and reinforcing positive behaviors. That helps to identify cognitive patterns or thoughts and emotions that are linked with behaviors”.
  27. 27. Thinking Different people can think differently about the same event. The way in which we think about an event influences how we feel and how we act. Example- a classic example is that when looking at a glass of water filled with halfway, one person will see it half empty and feel discouraged and the other sees it half full and feel optimistic.
  28. 28. BEHAVIOR What we do affects how we feel and think. The individual, who deals with an upcoming exam by putting off his studies until the last minute, is likely to experience more distress on the day of the exam than an individual who has studied well in advance. Cognitive behavior therapy helps people to learn new behaviors and new way of coping with events, often involving the learning of particular skills.
  29. 29. Therapy In this special focus on the relationships between how we think, feel and behave, the following are the fundamental to the practice of cognitive behavior therapy.
  30. 30. ELEMENTS OF CBT ACTIVE:-the client must be involved in the therapeutic process not as an occasional visitors, but as a core and key participant.
  31. 31. MOTIVATIONAL:- The therapist needs to take responsibility for helping to motivate the client toward a change in behavior, affect, or thinking. The therapist must be able to set up the format and rational for the client to consider change of value
  32. 32. DIRECTIVE:- The therapist must be able to develop a treatment plan and then to help the client to understand, contribute to, and see the treatment plan as a template for change.
  33. 33. STRUCTURE CBT is structure in two ways. First, the overall therapy follow structure that approximates the treatment plan. Sessions have identifiable beginning, middle and end.
  34. 34. COLLABORATIVE:- the therapist must evaluate the client ability and motivation for the therapy. PROBLEM ORIENTED:- CBT focuses on discrete problems rather than vague and amorphous goals of feeling good, getting better, or increasing self- esteem.
  35. 35. METHOD OF ACCESS Therapist Computerized or internet delivered Reading self help materials Group educational course
  36. 36. THERAPIST  A typical CBT programme would consist of face to face sessions between patient and therapist, made up of 6-18 sessions of around an hour each with a gap of a 1-3 weeks between sessions.
  37. 37. Computerized or Internet Delivered CBT via an interactive computer interface delivered by personal computer, internet, or interactive voice response system. Instead of face to face with a human therapist. It is also know as internet delivered cognitive behavioral therapy.
  38. 38. READING SELF HELP MATERIALS Enabling patients to read self help CBT guides has been shown to be effective by some studies. However one study found a negative effect in patients who tended to ruminate and another meta- analysis found that the benefit was only significant when the self help was guided.
  39. 39. GROUP EDUCATIONAL COURSE Patient participation in group courses has been shown to be effective.
  40. 40. BASIC PRINCIPLES OF CBT Cognitive effect behavior and emotion. Cognitions may be made aware, monitored and altered. Desired emotional and behavioral change may be achieved through cognitive change.
  41. 41. Change mood states by using cognitive and behavioral strategies. Identifying/modifying automatic thoughts and core beliefs. Regulating routine. Minimizing avoidance.
  42. 42. TECHNIQUES OF CBT Cognitive rehearsal. Validity testing. Writing in a journal.
  43. 43. Modeling. Homework Aversive conditioning Systematic positive reinforcement
  44. 44. COGNITIVE REHEAESAL:- In this technique, the patient asked to recall a problematic situation of the past. The therapist and patient both work together to find out a solution for the problem or a way in which the difficult situation, if it occurs in the future can be sorted out.
  45. 45. The therapist asks the patient to rehearse positive thoughts cognitively in order to make appropriate change to the latter’s thoughts processes. Power of imagination proves to be great use in such exercises.
  46. 46. VALIDITY TESTING In this techniques the therapist tests validity of belief/thoughts of the patient. The patient is allowed to defined his view point by means of objective evidence. The faulty nature or invalidity of the belief of the patient is exposed if he/she is unable to produce any kind of objective evidence.
  47. 47. WRITING IN A JOURNAL It is the practice of maintaining a diary to keep an account of situations that arise in day to day life. Thoughts that are associated with these situation and the behavior exhibited in response to them are also mentioned in the diary.
  48. 48. The therapist and patient together review the matter written in the journal and find out maladaptive thought pattern. The discussion that takes place between them proves to be useful in finding different ways in which behavior of the patient gets affected.
  49. 49. MODELING It is one of the cognitive therapy technique in which therapist perform role playing exercise aimed at responding in a way that is helpful to overcome difficult situations. The patient makes use of this behavior of the therapist as a model in order to solve problem he/she come across.
  50. 50. AVERSIVE CONDITIONING Amongst the different CBT techniques used by therapist, aversive conditioning technique makes use of discussion so as to lessen the appeal of a maladaptive behavior. The patient while being engaged in a particular behavior or thought for which he has to be treated, is exposed to an unpleasant stimulus. Thus, the unpleasant stimulus gets associated with these thought/behavior and then the patient exhibits an aversive behavior towards them.
  51. 51. SYSTEMATIC POSITIVE REINFORCEMENT The systematic positive reinforcement is one of the techniques of CBT therapy in which certain (positive) behavior of a person are rewarded with positive reinforcement. A reinforcement system is established for the of a certain positive behavior. Just like positive reinforcement proves to be helpful in encouraging a particular behavior, with-holding the reinforcement deliberately also is instrumental in eradicating a maladaptive behavior.
  52. 52. BIBILIOGRAPHY:- 1. Mary C. Townsend psychiatric mental health nursing 5th edition concepts of care in evidenced based practice page no. 184- 190 2. R. Sreevanvi mental health nursing 3rd edition page no. 140 3. Niraj Ahuja a short textbook of psychiatry 6th edition