It is the time consumed with the patient by the practioner not for diagnosis or prescribing medication.

It is a misnomer as psyche refers to all therapies but we mean the language or talk.

Behavioral = maladaptive behavior =

A rational, conceptual scheme. For explanation of symptoms and management

A procedure with active participation for patient and therapist to maintain patient ‘s health.

Shared therapeutic functions of the rational and procedures of psychotherapy

1. They strengthen the therapeutic relationship
2. All therapies maintain patient’s hope for help, which is a strong healing, force.
3. Provide the patient cognitive and experimental learning by new information about his suffering
4. Experimental learning implies emotional arousal; which supplies the motive to change.
5. Enhance patient’s sense of mastery and self-control, competence and effectiveness.
6. Encourage the patient to work through what he has leant.

Be alert to the patient’s non verbal behavioral:

• Tone of voice
• Hesitancy of speech
• Facial expression
• Gestures of body postures
• Autonomic activity.  Put no comments on that u see

Focus on the present:  here and now

Take a history, present then go to the past

Reflect what you see and that you have heard.

Interpret but shortly

Ending the interview

Individual long- term psychotherapy

Starting psychotherapy:

Preparation:  encourage the patient explain set goal

Therapeutic contract: arrange general and specific agreements [time, length and frequency]

Goals of therapy: symptom alleviation and personality change to discard the negatives and enhance the positives

Trial of therapy: for a couple so sessions if no benefit stop

Significant others: if are influential consider them.

Any questions at the end.

Reflecting: be as a mirror

Interpretation: to make the unconscious motives, feelings and attitudes to conscious ones. This enhances insight and modifies behavior.

Confrontation: with consequences of his behavior, it is basically a challenge. Should be used after interpretation.

Managing the unsuitable patient: by reduction of the number sessions and emphasize the present reality

Finishing the therapy:

There are positive and negative reasons for termination. If symptom relief

Further assessment: may be re-contracting is required

Socializing with patients: should be tried towards the end.

Assume a focus for management and maintain on it for brevity.

Problems: the problem can be operationally defined, i.e. it affects the patient and his relationship.  Agreement about the nature of the problem and that it has a concept for both therapist and patient. It can be solved by time and allocated for treatment. Focusing on the problem is the goal.

Therapeutic techniques:

It is a range of models and not a unitary approach with common feature of brevity.

The therapeutic relationship: create a rapid trusting safe therapeutic environment. This could be by active listening and not to deviate from focus.

Transference:

Intervention: best initiated by here and now level and this is used to maintain optimum level of arousal. Illuminate the patient difficulties with success in his day-to-day life.

Type of the problem: avoid intervention in problems as unemployment, poverty as these can hardly be solved through therapist.  But focus on problems due to physical illness and

Patient sense of self esteem

Patient’s style of thinking

Preparation:

By role induction interview, prepare the patient for what will follow.

The therapeutic contract:

By time of preparation, agreement for hypothesis used, method number of sessions frequency of time.

The activity phase: generally it consists of further exploration and reworking of the problem and its ramifications, particularly involving the therapeutic relationship itself.

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1. Problem solving: the matures and most adaptive
2. Regression: to earliest stage of development. Transfer problem to others.
3. Denial: with distorted reality and may be effective if the problem is spontaneously. Solved
4. Inertia:  reactive convenience that one is helpless regarding the problem with consequent depressive state.

Normally we use combinations of these but failure could result from, the problem is too great, too numerous, too unfamiliar. Also coping may be impaired due to physical or mental ill health, lacking support from family or from friends.  If coping attempted and failed the patient passes through 4 phases:

1)     Arousal: attempts at problem solving increases at first.

2)     Tension: due to impairment and delay with continuous distress→ too angry and too anxious

3)     Novel methods for coping: are tried as emergency.

4)     Continuous failure: state of deterioration, and exhaustion.

1. Facilitate affect expression: as in case of grief where cultural factors or personality factors may inhibit its expression.  Listen, encourage talking about his feelings, accepting their expressions and understanding reaction to crisis.
2. Facilitate communication: observe during interview how communication is with spouse or family members and suggest how can be improved.
3. Facilitate patient’s understanding to his problem: to relieve distress and identify the problems with possible solutions.
4. Facilitate problems solving skills. [See ART of problem solving]
5. Prescribe medications in cases of insomnia, high arousal, any features of depression, which can halt the ability for problem solving.

• Joseph Pratt was a physician in Boston used to treat the tuberculus patients in groups [didactic] and use the group climate for support. His idea was used later on for psychotic patients, first educational, which faded then psychoanalytical approach, which welcomed by Adler.
• Then after war II several methods in group dynamics and T- groups proved to be of great benefit.

• Motivated for change
• Convinced by the way of therapy
• Able to express verbally
• Psychotherapy minded

• Severely depressed: hopeless, too pessimistic, and withdrawn.
• Acute schizophrenia: disturbed reality testing.
• Paranoid personality: becomes suspicious in the group.
• Extreme schizoid: can’t survive in the group.
• Drug dependent alcohol sigma type: intolerable.
• Sociopath: irresponsible
• Hypochondriac: continue to focus on somatic symptoms
• Narccestic: doesn’t pay attention to others

• Group cohesion: sense of belonging and acceptance → security and safety. “ You won’t be judged, rejected or demolished  “ even opposition is true friendship”

• Insight and learning from interpersonal actions:  behaves in the group as being in the society.

• Universality: before the group “ I am unique!!” but after the group “ we are all in the same boat”

• Hope: as his fellow patient show improvement.

• Altruism:  patient will be helpful for others” I can be useful and I am of value”

• Guidance:  didactic as in classroom situation and it can be offered by the therapist or the patient.

• Vicarious learning: from others around.

• Catharsis and self-disclosure:  ventilation of feelings, like anger, depression, guilt and shame.

Could be closed same group of patients. Or

Open: changeable group of patients.

• In –out: the therapist is responsible to continue
• Top – bottom: The therapist frustrates the patients and they continue themselves.
• Near far: the intimacy and they should be close together.

Problems arising with the most experienced therapists:

Dropouts, absentism, missed meetings and lateness.

• It is an active directive, time limited, structured approach used to treat Varity of psychiatric disorders depression, anxiety, phobias, pain problems as well as eating disorders.
• It is based on underlying theoretical rational that an individual’s affect and behavior is largely determined by the way in which he structure the world i.e. his cognitions.

To substitute more reality oriented interpretations.

To learn to identify and counterbalance the dysfunctional beliefs.