Psychotherapy

1. DR.VYJAYANTHI.S

3.  For patients with psychoneurotic disorders who
refuse medication and demand therapy.
 Some neurotic disorders such as Dissociative
disorders , Somatoform disorders respond exclusively
to dynamic psychotherapy.
 Cognitive Behavior therapeutic techniques of
Exposure response prevention in Obsessive
compulsive disorders, systematic desensitization in
panic disorders may uncover dynamic conflicts .

6. Crucial Emotional Insight with in few sessions
Complete and immediate relief of symptoms that
brought them to therapy

7.  Interpretation of the defense
 Link between the patient’s pattern of relation to
current people and people in the past
 Highly selective criteria while choosing the client to
avoid major resistance.

9.  High motivation for insight
 Responsiveness to interpretation
 Circumscribed problem
 Single psychotherapeutic focus
 Healthy relations with both parents
 Absence of deprivation
 Recent onset of the problem

10.  Tavistock system of Brief therapy
 David Malan’s Brief Psychotherapy
 Peter Sifneos Short term Anxiety –Provoking therapy
 James-Mann’s Time limited Psychotherapy
 Mc Gill Short –Term Psychotherapy Program
 Habib Davanloo’s Intensive Brief dynamic
psychotherapy

11.  Resistance of repression
 Super-ego resistance
 Transference resistance

12.  By -passing the resistance through selecting those
with least resistance.
 Mobilization of unconscious therapeutic alliance
against the major resistance ( super ego resistance ) it
is termed as
“Unlocking the Unconscious”

13.  Patient was Mr.H , 57 years old , married man with an
adopted daughter , senior manager of a multinational
company with past occupation history of being a senior
official of Indian Railway Service taken voluntary
retirement a year ago with complaints of 2 months
duration of recurrent fears of circulation of a duplicate CD
of one his presentations in an international conference ,
also recurrent thoughts that the years of winning medals
during his tenure in Indian Railway service were
misrepresented in the records as early years. He
recognized these fears as irrational, ego dystonic and
causing irritation and anxiety.

14.  Patient was diagnosed with Obsessive compulsive
disorder.
 He refused pharmacotherapy , requested for
psychotherapy.
 “My mind is playing tricks on me , I want to know why ?”
 He said Thought stopping, Replacing automatic irrational
thoughts with rational thoughts , distraction had been
employed by him and were unsuccessful.
 He had easy temperament , was open to interpretations,
healthy and strong ego functions, stable heterosexual
relations, no conflicts with parents.

15.  Enquiry and diagnostic formulation required two
sessions.
 Therapeutic focus was on the symptoms of obsessions.
 As the content was professional anxiety, his professional
history was explored both for performance anxiety and
social anxiety.
 First of this exploratory session patient recalled his steady
climb in the bureaucracy and winning medals, accolades
for his work and his hobby as a mountaineer and
connoisseur of music and literature.

16. Therapeutic alliance was established.
In 4th session in response to competition, rivalry,
internal politics with in his department , pt denied
hostility or rivalry said he felt unchallenged until the
entry of a junior woman to his sector, one and half
years before he took retirement.
He said she was extremely efficient, focused, ambitious,
had all his qualities. She also shared his hobbies.
They had undertaken several projects together and he
experienced a very stimulating companionship in
their working partnership.

17.  5th session - Patient accepted feelings of attraction
towards this colleague ( Unlocking unconscious )
 He also expressed the anxiety he felt about the social
impropriety in his feelings and intense guilt towards his
wife and also fear of trespassing the boundaries with the
colleague .
 He was willing to accept that he may have taken voluntary
retirement due to this anxiety .( Avoidance )
 6th session – patient was gently pointed out the
displacement and isolation of affect that could be
achieved by duplicate CD. He said “ Duplicate ? Yes , that
was her !”

18.  Reaction formation and undoing were the defenses as interpreted for the
symptom of dating his awards as later , to coincide with her tenure , to match
her age ( It was another social factor that upset patient , as she was more than
a decade younger to the patient )
 These interpretations were accepted, patient re-experienced the ambivalence,
magical thinking of feeling attracted as synonymous with adultery.
 Super ego resistance was dispelled.
 8th session pt reported feeling free to love his family again. Said he was glad he
understood passion. And such terrific compatibility.
 “ Perhaps I am young at heart and ahead of my times , my awards show that …
?” a smile …..
 He accepted transference.
 “Discovering my self through your help was just as much interesting as
working with her , thank you……!”
 He had no obsessions.
 Terminated the therapy in 9th session with a box of Swiss chocolates given to
the therapist…

20.  Brief Dynamic Therapy is useful when there is a
circumscribed problem, and when it is possible to
establish therapeutic alliance so as to unlock the
unconscious and remove major resistance.
 It humanizes psychiatry, emphasizing the uniqueness
of every individual.