kjhklj,mlm

1. Introduction :
Psychotherapy has been referred to as a systemic treatment primarily
employing verbal communication as the means of treatment aimed at relieving
the patient’s symptoms and helping him to understand and modify his conduct
so as to lead a well adjusted life.
Definition of Family therapy :
Family therapy is the branch of psychiatry. Family therapy has both a specific
meaning and a broader meaning. Family therapy is used to refer to both
specific family interventions and a broader conceptual frame work for
intervention that include family centered treatment, family / couples
psychotherapy, family skills building, multiple family groups and in home
support.
Principles of Family therapy :
i) The family is conceptualized as a behavior system with unique properties
rather than as the sum of the characteristics of its individual members.
ii) It is assumed that a close relationship exists between the way a family
functions as a group and the emotional adaptation of this individual members.
Purpose of family therapy :
The improve interpersonal skills, communication, behavior and functioning.
Indication of Family therapy :
 The presenting problem appears in system terms, such as marital
conflicts, severe sibling conflicts or cross generational conflict (parent
versus grandpare).
 Various types of difficulty and conflict arise between the identified
patient and other family members.
 Industrial therapy with one family member has resulted in symptoms
developing in another family member.

2.  No improvement occurs with adequate individual psychotherapy.
 The person in treatment seems unable to use individual psychotherapy
for personal understanding and change.
 Psychoses, Anxiety disorders, substance abuse and various childhood
psychiatric problems.
Component of therapy :
 Assessment of family structure, roles, boundaries, resources,
communication pattern and problem solving skills.
 Teaching communication skill
 Teaching problem solving skills.
 Writing a behavioral marital contact
 Homework assignments.
Patient Selection
 Families may be referred for treatment by private physician and
agencies. Such as the school system, welfare board, parole officers
and judges.
 Some families are referred for therapy from emergency room
psychiatric services after a visit caused by a crisis in the family, such
as a drug overdose.
 On discharge from a psychiatric hospital, a patient and his family may
be referred family therapy, as part of follow up services.
 Family therapy is the treatment of choice when there is a marital
problem or sibling conflict.
 Situational cirses such as the sudden death of a family member.

3. Types of family therapy :
1. Individual Family Therapy : In Individual family therapy each family
member has a single therapist. The whole family meet occasionally
with one or two of the therapist to see how the members are relating to
one another and work out specific issues that have been defined by
individual members.
2. Conjoint Family Therapy : The most common type of family therapy is
the single family group. The nuclear family is seen and the issues and
problems raised by the family are the ones addressed by the therapist.
The therapist helps the family deal more effectively with problems as
they arise and are defined.
3. Couples Therapy : Couples are often seen by the therapist together.
The couple may be experiencing difficulties in their marriage, and in
therapy they are helped to work together to seek a resolution for their
problems. Family patterns, interaction and communication styles and
each partners goals, hopes and expectations are examined in therapy.
4. Multiple Family Group Therapy :
In multiple group therapy, four or five families meet weekly to confront
and deal with problems they have in common. Ability or inability to
function well in the home and community, fear to talking, abuse, anger,
neglect, the develop of social skills, and responsibility for oneself are
some of the issues on which these groups focus.
5. Multiple Impact Therapy :
In multiple impact therapy, several therapists come together with the
families in a community setting. They live together and deal with
pertinent issues for each family member within the context of the
group. Multiple impact therapy is similar to multiple. Family group
therapy except that it is more intense and time limited.

4. 6. Network Therapy :
Network therapy is conducted in people’s homes. Individuals interested
or invested in a problem or crisis that a particular persons or persons in
a family are experiencing take part. People who form the network
generally know each other and interact on a regular basis in each
other’s lives. Thus a network may include as many as 40 to 60 people.
The answers to each problems come from the network and how people
in the network decide to manage each issue as it arises. The rewards
are great when all the people involved mobilize energy for
management of the problem.
Occupational Therapy
Definition – Occupational therapy is the application of goal oriented,
purposeful activity in the assessment and treatment of individuals with
psychological, physical or development disabilities.
Goal
 To enable the patient to achieve a therapy balance of occupations
through the development of skills that will allow them to function at a
level satisfactory to himself & others.
Settings:
Occupational therapy provided to children, adolescents, adults and elderly
patients. These programmes are offered in psychiatric hospitals, nursing
homes, rehabilitation centres, community mental health centres, de-addiction
centers.
Advantages :
 Helps to develop social skills and provide an outlet for self expression.
 Strengthens ego defenses.
 Develops a more realistic view of the self in relation to others.

5. Points to be kept in mind
 The patient should be involved as much as possible in selecting the
activity.
 Select an activity that interest or has the potential to interest him.
 The activity should utilize the patients strengths and abilities.
 The activity should be of short duration to foster a feeling of
accomplishment.
 If possible, the selected activity should provide some new experience
for the patient.
Process of intervention :
It consists of six stages :
1. Initial evaluation of what patient can do and cannot do in a variety of
situations over a period of time.
2. Development of immediate and long term goals by the patient and
therapist together. Goal should be concrete and measurable so that it
is easy to see when they have been attained.
3. Development of therapy plan with planned intervention.
4. Implementation of the plan and monitoring the progress. The plan is
followed until the first evaluation. It found satisfactory it is continued
and altered, if not.
5. Review meetings with patient and all the staff involved in treatment.
6. Setting further goals when immediate goals have been achieved,
modifying the treatment program as relevant.
Types of Activities :
 Diversonal activities :- These activities are used to divert one’s
thoughts from life stresses or to fill time. For example, organized
games.

6.  Therapeutic activities – These activities are used to attain a specific
care plan or goal. For example basket making, carpentry etc.
Suggested occupational Activities for Psychiatric Disorders :
 Anxiety disorder – Simple concrete task with non more than 3 or 4
steps that can be learnt quickly. For example, kitchen tasks, washing,
sweeping, mopping.
 Depressive disorder – Simple concrete tasks which are achievable, it is
important for the patient to experience success. Provide positive
reinforcement after each achievement. For example crafts, moving
lawn, weeding gardens.
 Manic disorder – Non competitive activities that allow the use of energy
and expression of feelings. Activities should be limited and changed
frequently. For example raking grass, sweeping etc.
 Schizophrenia (Catatonia) :- simple concrete tasks in which patient is
actively involved patient needs continuous supervision, and at first
works best on a one-to-one basis for example, metal work, molding
clay etc.
 Schizophrenia (Paranoid) : - Non competitive solitary meaningful tasks
that require some degree of concentration so that less time is available
to focus on delusions. For example puzzles, scrabble.
Antisocial personality – Activities that enhance self-esteem and are
expressive and creative, but not too-complicated. Patient needs supervision to
make sure each task is completed. For example, leather work, painting etc.
Substance abuse : Group activities in which patient uses his talents. For
example involving patient in planning social activities, encouraging interaction
with others etc.

7. Childhood and Adolescent Disorder :
 Children : Playing, story telling, painting, poetry, music etc.
 Adoelescents : creative activities such as leather work, drawing,
printing.
 Mental retardation : Repetitive work assignments are ideal, provide,
positive reinforcement after each achievement. For example cover
making, candle making, packing goods etc.
Recreational Therapy : Recreation is a forms of activity. This therapy used
in most psychiatric settings. It is a planned therapetic activity that enables
people with limitations to engage in recreational experience.
Aims :
 To encourage social interactions.
 To decrease withdrawal tendencies.
 To provide outlet for feelings.
 To promote acceptable behavior
 To develop skills, talents and abilities.
 To increase physical confidence and a feeling of self worth.
Points to be kept in mind
 Provide a non-theatening and non-demanding environment.
 Provide activities that are relaxing and without rigid guidelines and time
frames.
 Provide activities that are enjoyable and self satisfying.
Types of Recreational Activities
 Motor forms : These can be further divided into fundamental and
accessory; among the fundamental forms are such games as hockey
and football, while the accessory farms are exemplified by play activity
and dancing.
 Sensory forms – These can be either visual for example, looking at
motion pictures, paly etc. or auditory such as listening to a concret.

8.  Intellectual forms – These include reading, debating and so on.
Suggested Recreational Activities for Psychiatric Disorder.
 Anxiety disorder – Aerobic activities like walking, jogging etc.
 Depressive disorder : Non-competitive sports, which provide outlet for
anges, like jogging, walking running etc.
 Manic disorders : One-to-one basis individual games like shuttle
badminton, ball badminton etc.
 Schizophrenia (Paranoid) : Activities requiring countration like chess,
puzzles.
 Schizophrenia (Catatonic) – Social activities to give patient contact with
reality like dancing, atheletics.
 Childhood and adolescent disorder –It is better to work with the child
on a one-to-one basis and give him feeling of importance. Employ
activities such as playing, story telling and painting. Adolesecents fare
better in groups, provide gross motor activities like sports and games to
use up excess energy.
 Mental retardation – Activities should be such as walking, dancing,
swimming, ball playing etc.
Role of a Nurse in Therapies :
The nurse has an important role in enhancing the theraputic effects of activity
therapies.
 Close co-ordination between the nursing staff and the activity therapy
department is essential.
 By engaging these activities, the nurse not only has an opportunity to
support the therapeutic efforts of the recreational therapist but also has
an invaluable opportunity to observe the patient in different settings.

9.  Through her observations of the patients behavior during these
activities, the nurse gains valuable information that she can
subsequently utilize to therapeutic advantage in the working phase of
the nurse-patient relationship.
Conclusion :-
Psychotherapy is a therapeutic relationship is established between the
patient and the therapist & modify the disturbed behavior, help the patient to
grow and develop coping mechanism to face the problems in future and
improve in social functioning.
Bibliography :
1. Sreevani R.A. Guide to Mental Health & Psychiatric Nursing, 3rd
Edition. New Delhi : Jaypee Brother’s, 2010 page 112 to 121 page.
2. Gail W. stuuart & Laria. Principles and practice of psychiatric nursing.
8th edition. New Delhi. ELSEVIER; 2007 Page 685 to page 690.
3. Dr. Bimla Kapoor. Text book of Psychiatric Nursing (Vo. 11). 2nd
Edition. New Delhi : Kumar Publishing House; 2010. Page 88-100
Page.