The document provides an overview of individual psychotherapies. It discusses several approaches to psychotherapy including cognitive behavioral therapy, psychodynamic therapy, and psychoanalytic therapy. Cognitive behavioral therapy aims to change problematic behaviors, feelings, and thoughts by identifying and modifying dysfunctional beliefs and cognitive distortions. It involves 12-20 sessions over several months. Psychodynamic and psychoanalytic therapies focus more on unconscious motivations and aims to bring repressed content into conscious awareness through techniques like free association and dream analysis in order to gain insight.

1. INDIVIDUAL
PSYCHOTHERAPIES
(OVERVIEW)
PRESENTER – DR.SRAVANTHI.P
CHAIRPERSON – DR.SABARI SRIDHAR.OT
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2. INTRODUCTION
In general, Psychotherapy is the mode of treating mental disorders by psychological
rather than pharmacology.
Therapists apply scientifically validated procedures to help people develop healthier,
more effective habits.
There are several approaches to psychotherapy — including cognitive behavioral,
interpersonal and other kinds of talk therapy — that help individuals work through
their problems
It can also be a supportive process when going through a difficult period or under
increased stress, such as starting a new career or going through a divorce
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3. HISTORY OF PSYCHOTHERAPY
Ancient
Philosophers
Spiritual
practitioners
1. 19th century
PINEL
MORAL
TREATMENT
1853
WALTER COOPER
DENDY
PSYCHO-
THERAPEIA
LATE 1800s
SIGMUND FREUD
FATHER OF
PSYCHOTHERAPY
PSYCHOANALYSIS
2. 1920
Behaviorism and
Behavior therapies
3. 1950
Humanistic ,
existential
approaches
4. 1970s
Family – centered
approaches
IPT
2000s
Need for HOLISTIC
approaches
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4. DEFINITIONS
“Psychotherapy” was defined as every means and every possible agency
which primarily affects the psychical rather than the physical organization
of the patient in a curative direction.
Client is a person who is receiving services from a mental health
professional or a therapist. (term – Carl Rogers)
Therapist is a professional who is trained and often licensed to provide a
necessary psychotherapy and rehabilitation for their clients.
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5.  Rapport is the spontaneous, conscious feeling of harmonious responsiveness that promotes the development
of a constructive therapeutic alliance.
 Empathy is the capacity of a person to put himself into the psychological frame of reference of another and
thereby understand his thinking, feeling, orbehavior
 Active Listening is listening to a person and responding to them using techniques like paraphrases.
1. Bylooking at the patient and adopting anappropriate posture
2. Byindicating that you understand what is happening to him.
3. Being able to laugh in response to a humorous content.
4. Responsive to a patient’s initiatives.
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6. Psychotherapies provide..
A working alliance between patient and therapist
An emotionally safe setting where the patient can feel accepted, supported,
uncriticized.
A therapeutic approach that may either be strictly adhered to or modified
according to patient needs
Confidentiality as integral to therapeutic relationship except with safety
issues
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7. SCHOOLS OF
PSYCHOTHERAPY
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8. • Focuses on changing problematic behaviors, feelings, and
thoughts by discovering their unconscious meanings and
motivations
• Sigmund Freud
PSYCHOANALYTIC
• Modification of psychoanalytic school
PSYCHODYNAMIC
• Its dysfunctional thinking that leads to dysfunctional emotions or
behaviors.
• By changing their thoughts, people can change how they feel and what
they do.
• Albert Ellis and Aaron Beck.
COGNITIVE
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9. • Based on learning theories
• CLASSICAL CONDITIONING , REINFORCEMENT AND
PUNISHMENT
• Ivan Pavlov , E.L Thorndike, B.F. Skinner
BEHAVIOR
• Emphasizes people's capacity to make rational choices and
develop to their maximum potential.
• Client-centered therapy - therapists help clients change by
emphasizing their concern, care and interest. (Carl Roger)
• Gestalt therapy - the importance of being aware of the here
and now and accepting responsibility for yourself. (Frederick
S. Perls)
• Existential therapy - focuses on free will, self-determination
and the search for meaning.(Victor Frankyl)
HUMANISTIC
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10. CHRI,2019 10

11. As per CARL ROGERS,
Therapist must have four basic conditions
◦ Unconditional Positive Regard: Unshakable acceptance of another person, regardless of
what they tell the therapist or how they feel
◦ Empathy: Ability to feel what another person is feeling; capacity to take another person’s
point of view
◦ Authenticity: Ability of a therapist to be genuine and honest about his or her feelings
◦ Reflection: Rephrasing or repeating thoughts and feelings of the clients’; helps clients
become aware of what they are saying
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12. TYPES OF
PSYCHOTHERAPIES
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13. TYPES
Psychoanalytic
Psychodynamic
MBCT
DBT
IPT
Behavioral
Therapy
CBT
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14. PSYCHOANALYTIC AND
PSYCHODYNAMIC
PSYCHOTHERAPY
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15. PSYCHOANALYTIC PSYCHOTHERAPY
As given by Freud , Psychoanalysis has different types
of meanings
1. Method of investigating the mind.
2. Explains both normal and abnormal human behavior.
3. Specific treatment method designed initially to treat
neuroses, such as hysteria and obsessive-compulsive
symptoms, but later used for many other disorders.
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16. BASIC ASSUMPTIONS
Intra-psychic determinism
Childhood sets the stage for lifelong adjustment
Assessment, treatment and research focused on intra-psychic
factors, often not directly accessible
Psychoanalysis is based on overcoming the desires and negative
influences of the unconscious mind. It encourages patients to use free
association as a way to come to insights about unresolved issues from
the past that are resulting in emotional or behavioral problems in the
present.
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17. CHRI,2019 17

18. Specific terms used in Psychoanalysis
Transference: Unconscious redirection of feelings for one person to another
(including the therapist)
Counter Transference: Redirection of therapist’s feelings for the patient
Resistance: Ideas unacceptable to conscious; prevents therapy from
proceeding
Free Association: Allow the patient to express even the most irrelevant,
unpleasant, or trivial material - Clues to unconscious
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19. CHRI,2019 19

20. TECHNIQUES USED IN PSYCHOANALYSIS
a. Maintaining an analytic framework
b. Free association
c. Interpretation
d. Dream analysis
e. Analysis of resistance
f. Analysis of transference
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21. ANALYTICAL FRAMEWORK
Analyst’s relative anonymity
The regularity and consistency of meetings
Starting and ending the sessions on time
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22. FREE ASSOCIATION
The clients are encouraged to say whatever comes to their mind, regardless of how
painful, silly, trivial, illogical, or irrelevant it may be.
It is used to open the doors to unconscious wishes, fantasies, conflicts and
motivations.
Recollection of past experiences and also a release of intense feelings (catharsis).
The therapist interprets the material to the clients guiding them toward increased
insight into the underlying dynamics.
Not only the surface content is listened to, but also the hidden meaning.
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23. INTERPRETATION
Includes identifying, clarifying and translating the client’s material.
1. The analyst should interpret material that the client has not seen yet; but is
capable of tolerating it and incorporating it.
2. Always start from surface and should only go as deep as the client can go.
3. Best to point out a defense/ resistance before interpreting the emotion/
conflict behind it
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24. DREAM ANALYSIS
Royal roads to the unconscious’ (Freud).
Latent content: hidden, symbolic, unconscious motives,
wishes, fears.
Manifest content: the dream as it appears to the dreamer.
Dream Symbols: Images in dreams that have personal or
emotional meanings
Dreams help clients to understand repressed material and
also to see the present functioning.
During session, therapist may ask clients to free associate to
some aspect of the manifest content of a dream for the
purpose of uncovering the latent meanings.
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25. ANALYSIS OF RESISTANCE
During free association or association to dreams, client may show an
unwillingness to relate to thoughts, feelings and experiences.
Freud viewed resistance as an unconscious dynamic that people use to defend
against the intolerable anxiety and pain that would arise if they were to become
aware of their repressed impulses and feelings.
Therapists must point out resistance to the clients and they should confront it if
they hope to deal with conflicts realistically.
Therapists should respect the resistances of the clients and assist them to work
therapeutically with their defenses.
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26. ANALYSIS OF TRANSFERENCE
Through the relationship with therapist, the clients express feelings,
beliefs, and desires that they have buried in their unconscious.
Through appropriate interpretations and working through of these
current expressions of early feelings, clients are able to become
aware of and gradually change some of their long-standing patterns
of Behaviour.
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27. PSYCHOANALYTIC SCHOOLS WHICH
INFLUENCED PSYCHODYNAMIC APPROACH
Models
Drive theory
Object relation
Theory
Ego Psychology
Self Psychology
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28. INSTINCT OR DRIVE THEORY
Essence of Freud’s theory is that sexual and aggressive energies originating in the id (or unconscious)
are modulated by the ego, which is a set of functions that moderates between the id and external reality.
Defense mechanisms are constructions
of the ego that operate to minimize pain
and to maintain psychic equilibrium.
INSTINCT
Source: The part of the body from which the instinct arises.
Impetus : Amount of force or intensity associated with the instinct.
Aim : Any action directed toward tension discharge or satisfaction.
Object: The target (person) for this action
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29. VARIOUS INSTINCTS
Libido:
The force by which the sexual instinct is represented in
the mind.
Ego :
Remaining nonsexual components are called ego instincts.
Aggression :
Part of sexual instinct
Narcissism:
An individual’s libido invested in the ego itself rather than
in other persons
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30. OBJECT RELATIONS THEORY
Melanie Klein & D.W Winnicott
Humans are primarily motivated by the need for contact with others—the
need to form relationships
“Objects” - significant others with whom an individual relates, sometimes part
of an individual or mental representations as well (External / Internal)
Importance of early family interactions – Mother-Child relationship
1. "My mother is good because she feeds me when I am hungry" (representation of the object).
2. "The fact that she takes care of me must mean that I am good" (representation of the self in
relation to the object).
3. "I love my mother" (representation of the relationship).
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31. OBJECT RELATIONS THEORY
Object relation involves mental representations of:
◦ Object as perceived by the self
◦ The self in relation to the object
◦ The relationship between self and object
To help an individual in therapy uncover early mental images that may
contribute to any present difficulties in one’s relationships with others
and adjust them in ways that may improve interpersonal functioning.
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32. EGO PSYCHOLOGY
Anna Freud focused her attention on the ego's unconscious, defensive operations
and introduced many important theoretical and clinical considerations.
Ego was predisposed to supervise, regulate, and oppose the id through a variety of
defenses.
Psychoanalyst's attention should always be on the defensive functions of the ego,
which could be observed in the manifest presentation of the patient's associations.
Stresses the individual’s capacity for defense, adaptation, and reality testing.
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33. SELF PSYCHOLOGY
Heinz Kohut believed that a parent's failure to
empathize with child was the root of nearly every
psychological problem.
The therapist makes the effort to understand the
client from within the client’s own subjective
experience and viewpoint.
The self forms the central focus of this theory,
and is understood as the vital, cohesive, feeling of
ongoingness and self-worth.
Developed Self Psychology which consisted of
four main components
◦ Nuclear Self(what babies are born with)
◦ Virtual Self(image of baby retained by parents)
◦ Cohesive self(combination of nuclear and virtual)
◦ Grandiose self(egocentric form of self)
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34. PSYCHODYNAMIC PSYCHOTHERAPY
(EXPRESSIVE / INSIGHT- ORIENTED)
First introduced by Ernst Wilhelm von Brücke (suggested all living organisms are
energy systems and operate on energy conservation )
Form of psychoanalysis which relies on the interpersonal relationship between
client and therapist
Less focus on transference and dynamics
Interpretation, encouragement to elaborate, affirmation and empathy important
1 – 2 sessions/week; open-ended duration
Limited goals
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35. THERPISTS ROLE ?
UNDERSTANDING
EXPLAINING
ACCEPTING
A: pts past has something to do with
present experiences
U: affirming that the conscious and
unconscious
E: expressing to client that he understood/
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36. PSYCHOANALYTIC PSYCHOTHERAPY PSYCHODYNAMIC PSYCHOTHERAPY
Requires daily visits Once a week (twice/thrice for unstable or
highly motivated clients)
Analysand lies on a couch with the analyst
sitting out of sight and behind
Client and therapist sit face to face
Silent Analyst and FREE ASSOCIATION by
analysand
The psychotherapist usually talks quite a
lot
Not a very interactive process Highly interactive process
Takes several years to be effective Generally 1-12/20 sessions (Brief) to more
than 50 sessions/several years (Long-term)
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37. CONTRAINDICATIONS
According to Wallerstein , 1978 Psychoanalysis should be avoided in these
individuals
1. Active psychosis
2. Perversion
3. Psychopathy (Narcissistic and anti-social personality disorders)
Others include those with limited intelligence
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38. COGNITIVE BEHAVIORAL
THERAPY
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40. • Developed by Aaron T Beck
• Initially for Depression
• 12 - 20 sessions , 1 -2 sessions
per week initially, later 1 session
/ week
Goals:
1. Reduce the symptomatology
by breaking the vicious cycle
mentioned .
2. To reduce vulnerability and
decrease the frequency (or at
least the intensity) of future
episodes.
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41. COGNITIVE DISTORTIONS
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42. Core beliefs
Most fundamental
level of belief
Global, rigid, and
overgeneralized
Absolute truths—just
the way things “are”-
often unarticulated
Helplessness /
Unlovability /
worthlessness
Intermediate beliefs
Attitudes, Rules, and
Assumptions
Developed from core
beliefs
Often unarticulated
Attitude: “It’s terrible to
fail.”
Rule: “Give up if a
challenge seems too
great.”
Assumptions: “If I try to
do something difficult, I’ll
fail. If I avoid doing it, I’ll
be okay.”
Negative Automatic
Thoughts
Automatic [i.e. not arising
from reasoning]
Autonomous/Involuntary
Situation-specific
Habitual ,Plausible,
Distorted
Subjective Idiosyncratic
Rapid/Fleeting
Closest to Consciousness
and modified first
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43. Typical session in CBT
Check in
Set agenda
Review home work
 Work the agenda
Periodic summaries
Set Home work
Feed back
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44. In BPAD, preferred as treatment modality in continuation or maintenance
phase. Mansell et al. (2007) emphasize the role of interpretations of internal
events and beliefs about affect regulation as factors that contribute to the
triggering of depressive, manic, or mixed episodes.
Individuals with GAD hold both positive and negative beliefs about the
worry process.
◦ Positive beliefs : worry is helpful, prepares one for danger, and shows that one is being
conscientious.. Because most worries do not come true, the belief that worry is helpful
and can prevent catastrophe is maintained.
◦ Negative beliefs : preoccupation with worry and reduces their capacity to think
positively.
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45. In OCD , intrusive thoughts, images, or urges develop into obsessions when they
are given excessive negative importance. When beliefs about intrusions are
activated, individuals experience intense negative emotion and their beliefs
about rituals or compulsions become activated as well
Allen and associates (2001) showed that CBT helped patients with somatization
disorder (SD) significantly reduce their physical discomfort, anxiety, and
depression, as well as increase their physical functioning.
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46. Others:
• Eating Disorders
• Schizophrenia
• Substance use disorders
• Personality disorders
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47. BEHAVIORAL THERAPY
Basis: Maladaptive behaviors are acquired through learning, according to the
same principles that govern the learning of adaptive behavior
Help clients to understand how changes in behavior can lead to changes in how
they feel.
It focuses on increasing the person's engagement in positive or socially
reinforcing activities.
Goal - To replace undesirable behaviors with desirable ones
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48. CHRI,2019 48

49. PIONEERS IN BEHAVIORISM
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50. VARIOUS TYPES
OPERANT CONDITIONING
SYSTEMATIC DESENSITIZATION Anxiety spectrum disorders , Sexual aversion
AVERSION THERAPY Substance use disorders , Impulse control disorders
TOKEN ECONOMY ADHD , Autism
ROLE PLAY Depression
ACTIVITY SCHEDULING Depression , Anxiety
EXPOSURE AND RESPONSE
PREVENTION
OCD
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51. OTHERS
•Social skill Training
•Problem solving techniques
•Time out
•Modelling
•Shaping
•Assertiveness training
Eye contact with others during conversation
Smiling when greeting people
Shaking hands when meeting someone
Using the right tone and volume of voice
Expressing opinions to others
Perceiving how others are feeling and showing
empathy
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52. Areas
Addressed
Interpersonal
Deficits
Role
Transition
Interpersonal
Disputes
Grief
Structured , individual time limited Psychotherapy.
12-20 sessions lasting for 5 months.
It is based on the work of Harry Stack Sullivan
(1953) who considered that “ Psychiatry includes
the scientific study of people and processes
between them rather than focusing exclusively on
mind , brain and society .”
Unlike other therapies , it mainly focuses on the
patients interpersonal relationship issues at present
INTERPERSONAL PSYCHOTHERAPY
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53. First phase
• 1-3 sessions
• Diagnostic evaluation and Psychiatric history
• Sets frame work for the treatment
Middle
phase
• Strategies specific to the chosen interpersonal area
Final phase
• last few weeks of treatment.
• supports the patient's newly regained sense of independence and competence by recognizing and
consolidating therapeutic gains.
• helps the patient to anticipate and develop ways to identify and counter depressive symptoms if they arise
in the future.
PHASES :
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54. INDICATIONS
A systematic review by Madelon L et al (2013) on the effectiveness of individual
IPT as treatment modality for Depression concluded that Psychotherapeutic
treatments such as IPT and CBT, and/or pharmacotherapy are recommended as
first-line treatments for depressed adult outpatients.
A review on outcome of IPT for anxiety disorders found that IPT lowered
anxiety symptoms, was well tolerated than CBT ( non-significant) .
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55. Bipolar Disorder : IPSRT was found superior to the comparison condition in
delaying recurrence of depressive and manic episodes for acutely ill bipolar
patients (Frank et al., 2005)
Bulimia Nervosa: IPT(18 weeks) has benefits comparable to those of CBT and
superior to those of the psychoeducation or supportive counselling alone (Agras
et al. 2000)
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56. OTHER CONDITIONS
Recurrent depression
Postpartum depression
Dysthymia
Binge-eating disorder
Affective disorders in special population (as combination therapy)
Comorbid medical conditions
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57. DIALECTICAL BEHAVIOR THERAPY
Designed by Marsha Linehan and her colleagues (1993)
It was originally applied for borderline personality disorder patients to
reduce the suicidality and self-harm behavior.
Dialectical means working with the opposite (self-acceptance and
change in order to bring about positive changes in the patient)
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59. CHRI,2019 59

60. INDICATIONS
Borderline Personality Disorder
Eating Disorders (emotional dysregulation)
Comorbid substance use disorder in BPD
ADHD
Forensic settings ( to reduce life threatening behavior and
impulsivity)
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61. MINDFULNESS is defined as “the awareness that emerges through paying
attention on purpose, in the present moment, and nonjudgmentally to the
unfolding of experiences, moment by moment.”
Mindfulness therapy was developed by Dr. Jon Kabat Zin
MBCT integrates elements of cognitive therapy and mindfulness-based
meditative practices.
 8 session program with 50 minutes per session
a) attention
b) emotional regulation
c) thinking pattern
MINDFULNESS BASED COGNITIVE THERAPY
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62. EFFECT OF MINDFULNESS ON BRAIN
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63. CHRI,2019 63

64. INDICATIONS
Depression - 8 session program (each session for around 2-2.5 hr. with 45 min homework)
followed by 4 sessions (2 hr. each) per year Post MBCT sessions for maintenance .
Randomized trail by Fjorback LO .et al. (2013) had demonstrated significant positive
outcome and sustained symptomatic improvement in patients with Somatoform disorders
following Mindfulness techniques.
Sharma et.al (2016) found that mindfulness helps to predict and control dissociation by
improving awareness of dissociative processes
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65. EASTERN
VS
WESTERN
PERSPECTIVE
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66. WESTERN VIEW EASTERN VIEW
Aids “normal” individuals to reach their
maximum psychological potential
All are in need of “therapy” since few of us are
functioning free from the influence of
delusions, projections, or uncurbed desires.
Less related to religion Close relation between religion, Philosophy
Other modalities are not tried Other modalities are trusted (Yoga ;Meditation)
Tends to draw sharp contrast between
opposites
Tends to see harmony between opposites
Focused on individual self concept Focused on collectivistic self-concept
Needs to prove something Understands Polarities of the situation
EGO - Central to identity and personality EGO - Social fiction
Believes in nature
,
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67. TAKE HOME POINTS
Individual Psychotherapy is effective in treating a wide variety of psychiatric
diagnoses
There are many schools of thought in psychotherapy and there is no one
“right” approach
Multiple “patient factors” when recommending psychotherapy
Combination of psychotherapy and pharmacotherapy have better results .
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68. REFERENCES
 Corey, Gerald (2009). Theory and Practice of Counseling and Psychotheraphy. Brooks/Cole Cengage Learning
 Wallerstein, R. S. (1978). Perspectives on psychoanalytic training around the world. Int. J. Psycho-Anal., 59: 477-503
 Muñoz, R. F., and Miranda, J. (1986). Group Therapy Manual for Cognitive-behavioral Treatment of Depression.
 Markowitz JC, Svartberg M, Swartz HA. Is IPT time-limited psychodynamic psychotherapy? J Psychother Pract Res. 1998;7:185–195.
 Markowitz JC, Lipsitz J, Milrod BL. Critical review of outcome research on interpersonal psychotherapy for anxiety disorders. Depress Anxiety.
2014;31(4):316–325.
 van Hees, Madelon & Rotter, Thomas & Ellermann, Tim & Evers, Silvia. (2013). The effectiveness of individual interpersonal psychotherapy as a treatment
for major depressive disorder in adult outpatients: A systematic review. BMC psychiatry. 13. 22.
 Chapman AL. Dialectical behavior therapy: current indications and unique elements. Psychiatry (Edgmont). 2006;3(9):62–68.
 Piet, J., & Hougaard , E. (2011). The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: A
systematic review and meta-analysis. Clinical Psychology Review, 31, 1032–1040.
 Williams, MW.; Teasdale, JD.; Segal, Z., et al. Freeing yourself from chronic unhappiness. New York: Guilford Press; 2007. The mindful way through
depression.
 Fjorback LO, Carstensen T, Arendt M, Ornbol E, Walach H, et al. (2013) Mindfulness therapy for somatization disorder and functional somatic syndromes:
analysis of economic consequences alongside a randomized trial. J Psychosom Res 74: 41–48Sharma T, Sinha VK, Sayeed N. Role of mindfulness in
dissociative disorders among adolescents. Indian J Psychiatry 2016;58:326-8.
 Castonguay, L.G., & Beutler, L.E. (Eds.) (2006). Principles of therapeutic change that work. New York: Oxford Press
 Sadock, Benjamin J. Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 10th Edition. Wolters Kluwer Health
 Gabbard, G. O., Beck, J. S., & Holmes, J. (Eds.). (2005). Oxford textbook of psychotherapy. New York, NY, US: Oxford University Press.
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