Psychoanalytic therapy used for psychiatric patient

1. PSYCHOANALYTICAL
THERAPY
PREPARED BY
Mrs. Divya Pancholi
M.Sc. (Psychiatric Nursing)
Assistant Professor
SSRCN, Vapi

2. INTRODUCTION
•Developed by Sigmund Freud at the end of the
19thcentury.
INDICATION:
•The presence of longstanding mental conflicts, which
may be unconscious but produce symptoms.
•The aim of the therapy is to bring all repressed
material to conscious awareness so that the patient
can work towards a healthy resolution of his problems,
which are causing the symptoms.

3. THERAPY PROCESS
• Typical for the psychoanalyst to be
positioned at the head of the
patient and slightly behind, so that
the patient cannot see the
therapist.
• This decreases 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’s instruction,
which facilitates free association.

4. Conti….
• The role of the patient as a active participant, freely
revealing all thoughts exactly as they occur and
describing all dreams.
• The psychoanalyst is a shadow person. He reveals
nothing personal, nor does he give any directions to
the patient.
• His verbal responses are for the most part brief and
noncommittal, so as not to interfere with the
associative flow.

5. TECHNIQUES
FREE ASSOCIATION
DREAM ANALYSIS
HYPNOSIS
CATHARSIS
ABREACTION THERAPY

6. FREE ASSOCIATION
• In this, patient is allowed to say whatever comes to his mind, in
response to a word that is given by the therapist.
E.g. The therapist might say ‘mother’ or ‘blue’ and the patient would
give a response, also typically one word, to each of the words the
therapist says.
• The therapist then looks for a theme or pattern to the patient’s
responses.
• So if the patient responds ‘evil’ to the word ‘mother’ or ‘dead’ to the
word ‘blue’ the therapist might pick up one potential theme, but if the
patient responds ‘kind’ and ‘true’ to the words ‘ mother’ and ‘blue’
respectively, the therapist might hear a completely different theme.

7. DREAM ANALYSIS
• Freud believed that behavior is rooted in the unconscious and that dreams
are a manifestation of the trouble people repress, the better way to get an
idea of the problem is to monitor and interpret dreams.
• The patient is asked to keep a dream lag.
• Analysis of the patient’s dreams helps to gain additional insight into his
problem and the resistances. The dreams symbolically communicate areas of
intrapsychic conflict. The therapist then attempts to assist the patient to
recognize his intrapsychic conflicts through the use of interpretation.
• The process is complicated by the occurrence of transference reactions. This
refers to the patient’s development of strong positive or negative feelings
towards the analyst, and they represent the patient’s past response to a
significant other, usually a parent.

8. CONTI…
• The therapist’s reciprocal response to the patient is called
countertransference.
• Such reactions must be handled appropriately before progress
can be made. By termination therapy, the patient is able to
conduct his life according to an accurate assessment of external
reality and is so also able to relate to others uninhibited by
neurotic conflicts.
• Psychoanalytical therapy is a long-term proposition. The patient is
seen frequently, usually five times a week. It is therefore time-
consuming and expensive.

9. HYPNOSIS
•The word 'hypnotism' was first used by James
Braid in the 19th century.
•Hypnosis is an artificially induced state in which
the person is relaxed and unusually suggestible.
•Hypnosis can be induced in many ways, such as
by using a fixed point for attention, rhythmic
monotonous instructions, etc.

10. CONTI…
Changes that occur during Hypnosis
•The person becomes highly suggestible to the
commands of the hypnotist.
•There is an ability to produce or remove
symptoms or perceptions.
• Dissociation of a part of body or emotions.
• Amnesia for the events that occurred during the
hypnotic state.

11. Techniques
• Patient is either made to lie down on a bed or sit in a chair.
• He is asked to gaze fixedly on a spot.
• Therapist makes monotonous suggestions of relaxation and sleep. The
patient however is not asleep and can hear what is being said, answer
questions and obey instructions.
This therapy is useful in:
• Abreaction of past experiences.
• Psychosomatic disorders.
• Conversion and dissociative disorders.
• Eating disorders.
• Habit disorders and anxiety disorders

12. CATHARSIS
•Act of purging or purification or elimination of a complex
by bringing it to consciousness and affording to expression.
•In this therapist helps the person see the root of the
problem and then, by talking or some other means, allows
the patient to learn to evacuate this problem form the
psyche.
•Nurse can be helpful in the treatment process by allowing
the patient to talk about the experiences in therapy and by
carefully documenting the responses of the patient.

13. ABREACTION THERAPY
•Abreaction is a process by which repressed material,
particularly a painful experience or conflict is brought
back to consciousness.
•The person not only recalls but also relives the
material, which is accompanied by the appropriate
emotional response. It is most useful in acute
neurotic conditions caused by extreme stress (Post-
traumatic stress disorder, hysteria etc). Although
abreaction is an integral part of psychoanalysis and
hypnosis, it can also be used independently.

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.
• A safe method is the use of Thiopentone sodium 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.