This document provides an overview of psychological therapies used at a mental health institution. It discusses the history and profile of the institution's director, which has been providing mental health services for 43 years. It then describes various psychological therapies used there, including behavioral therapies like relaxation therapy, systematic desensitization, exposure therapy, response prevention, and modeling. Other therapies covered are thought stopping, biofeedback, and aversion therapy. The document provides details on how each therapy works and which psychiatric conditions it can be used for.

1. TABLE OF CONTENTS
Contents
Contents......................................................................................................................................................1
ACKNOWLEDGEMENT.................................................................................................................................2
INTRODUCTION...........................................................................................................................................3
HISTORY OF THE INSTITUTION.....................................................................................................................8
PSYCHOLOGICAL THERAPIES......................................................................................................................12
Features ................................................................................................................................................22
CASE STUDY – I..........................................................................................................................................24
CASE STUDY – II.........................................................................................................................................29
CASE STUDY – III........................................................................................................................................33
CASE STUDY –IV.........................................................................................................................................38
CASE STUDY – V.........................................................................................................................................42
REFERENCES..............................................................................................................................................46
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2. ACKNOWLEDGEMENT
With grateful heart I would like to remember the persons who have helped me
during the course of my internship program. I wish to place on record my words of
gratitude to Dr.S.Kadhiravan, Associate Professor and Head of the Department of
Psychology for being the enzyme and master mind behind my internship program.
I owe warm-hearted acknowledgement of gratitude to Dr Vedagiri Ganesan, Ph.D.
(PSY.), HONORARY DIRECTOR of Global Institute of Behaviour Technology &
Former Syndicate Member & The Ex-Professor & Head, Dept. of Psychology,
Bharathiyar University, Coimbatore. I sincerely thank him for his guidance and
information.
I express my sentiment of gratitude to my guide Mr. D. V. Nithyanandan, Assistant
Professor, for his guidance and support.
G. Saravanan
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3. INTRODUCTION
An internship is a trained and supervised experience in a professional setting
in which the student is learning and gaining essential experience and expertise.
Internship is meant for introducing candidates either full-time or part-time to a real
world experience related to their career goals and interests. It may, but does not
have to be related connected to one’s academic major or minor. Internships can be
done during the academic semester and or summer depending upon the spaced out
curriculum. There are several varieties of internship: some are paid some are not
and some offer credit towards graduation.
Internship is an excellent way to build those all important connections that
are invaluable in developing and maintaining a strong professional network for the
future. Internships provide real world experience to those looking to explore or
gain the relevant knowledge and skill required to enter into a particular career
field. Internship is relatively short term in nature with the primary focus on getting
some on the job training and taking what’s learning in the classroom and applying
it to the real world. Interns generally have a supervisor who assigns specific tasks
and evaluates their overall work. For internship for credit, usually a faculty sponsor
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4. will work along with the site supervisor to ensure that the necessary learning is
taking place. Internship can be done by high school or college students to gain
relevant experience in a particular career field as well as to get exposure to
determine if they have a genuine interest in the field.
An internship is an excellent way to determine if the industry and the
profession is the best career option to pursue. Interns not gain practical work
experience in a field that students intend to pursue but also build experience in
local, national and international platforms.
Internship helps individual to combine theory with practical work
experience. Internship helps develop professional work habits; provides an
understanding of professional cultures, gives an opportunity to analyze workplace
setting, and offers platforms to compare difference in work styles. Internships,
taken internationally, offer the privilege to observe differences in businesses, and
see how projects are handled in different cultures, which might be conducted
differently in the intern’s home country.
Internships may present a potential for an offer of full time employment.
Professional work experience is the most beneficial advantage that can be acquired
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5. by completing an internship for students or fresh graduates, having this work
experience on their resume can be the best way to get the foot in the door. This can
result in more job offers as compared to individuals who lack such work
experience.
OBJECTIVES OF INTERNSHIP
The main objective of the internship course is to facilitate reflection on
experiences obtained in the internship and to enhance understanding of academic
material by application in the internship setting. Internships will provide students
the opportunity to test their interest in a particular career before permanent
commitments are made. Apart from it is more important because:
1. Internship will help the trainees to develop skills and techniques directly
applicable to their careers.
2. Internship will provide students the opportunity to develop attitudes conducive
to effective interpersonal relationship.
3. Internship will provide students with an in-depth knowledge of the formal
functional activities of a participating organization.
4. Internship programs will enhance advancement possibilities of graduates.
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6. 5. Internship students will develop employment records or reference that will
enhance employment opportunities.
6. Internship will provide students the opportunity to develop attitudes conducive
to effective interpersonal relationships.
PURPOSE OF INTERSHIP IN PSYCHOLOGY
1. To develop facility with a range of diagnostic skills, including: interviews, case
history-taking, risk assessment, child protective issues, diagnostic formulation,
triage, disposition, and referral.
2. To develop further skills in psychological intervention, including: environmental
interventions, crisis intervention, short-term, goal-oriented individual, group, and
family psychotherapy, exposure to long-term individual psychotherapy, behavioral
medicine technique, and exposure to psychopharmacology, case management, and
advocacy.
3. To develop facility with a range of assessment techniques, including:
developmental testing (elective), cognitive testing, achievement testing, assessment
of behavior, emotional functioning, assessment of parent-child relationship and
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7. family systems, and neuropsychological evaluation (elective). Assessment training
across will include both current functioning and changes in functioning.
4. To develop facility with psychological consultation, through individual cases
and participation in multidisciplinary teams, including consultation to: parents,
mental health staff (e.g., psychiatrists, social workers) medical staff (e.g.,
physicians, nurses, PT, OT, etc.), school systems, and the legal system.
Consultation training occurs in both the inpatient and outpatient setting, both
downtown and in the suburbs, and ranges.
5. To learn the clinical, legal, and ethical involved in documentation of mental
health services within a medical setting.
6. To learn to promote the integration of science and practice, related to theories
and practice of assessment, intervention, and consultation. Interns are trained in
empirically-supported treatments (e.g., parent training groups, inpatient treatment
protocols for school avoidance, eating disorders), and behavioral medicine
protocols (e.g., medical noncompliance, pain management, headache treatment,
toilet training).
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8. HISTORY OF THE INSTITUTION
Global Institute of Behaviour Technology is situated at Vellingiri Nagar
(South) Navavoor in Coimbatore. It offers solution for most health problems,
which have emotional causes by the use of appropriate Behaviour Tehchnology,
without the use of drugs, within a specified period of time and with a guarantee. It
creates safe, lovely, homely and enabling environment for patients. It is a mental
health care and de-addiction centre. It is in service of people for around 43 years. It
is owned and operated by Rtn. PP. PHF. Prof. Dr. Vedagiri Ganesan, PhD.
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9. It is a well established institution for treating and caring for patients who are
suffering from different psychiatric disorders. It also functions as a De-addiction
centre for different substance abused or dependent people. It is the only institute in
India which treats the patients by physiological manipulation to bring
neurobiological changes in the patients and recondition their Mind-Body
relationship. People from all over the country visit the institution.
Internship in this institution
Over the last 43 years, students of psychology, psychiatric social work,
nursing students and psychiatric nursing students from across the country come to
this institution for their internship and training programs. The management of this
institution provides all facilities for these students. When I approached this
institution for my one month internship, they happily received my request. The
Director encouraged us to interview the patients and asked us to come with new
ideas to provide new exercises creatively. It was both Work experience internship
as well as Research internship. He taught us various ancient techniques taken from
scriptures and urged us to explore the hidden knowledge in our culture and apply it
innovatively according to the need of the hour. It was a kind of Guru-Shishya
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10. experience and he cared about our spiritual life in addition to the transferring his
knowledge and expertise.
Profile of the Director
Dr. Vedagiri Ganesan, Ph. D., is a renowned counseling/ clinical/ Business/
Organizational/ Environmental Psychologist with over four decades of experience
in Training and Consultancy at National and International levels. He has served in
various capacities in number of Professional Bodies of Psychology, Industrial
Psychiatry, Management, and Andrology as President, Vice - President, Secretary,
Executive Committee Member, etc.
Prof. Ganesan was awarded the Young Scientist Award by the Indian
Science Congress Association, Calcutta in 1982 at Mysore, the Visiting
Associateship Award (Yoga Techniques and Behaviour Modification Techniques),
and Source Material Collection Award for his research on Organizational Climate
for Knowledge Workers and Creativity.
He had presented research papers in over two hundred National and
International Conferences, Seminars and Workshops, and published papers over
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11. two hundred papers in National and International Journals and Magazines and
Dailies.
Prof. Ganesan has been serving as Expert / Consultant for various Public and
Private Sector Organizations. He holds patent right for Sea Shrink Technology.
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12. PSYCHOLOGICAL THERAPIES
1. BEHAVIOURAL THERAPY
Behaviour therapy refers to psychological treatments, which are based on
experimental psychology and intended to change symptoms and behaviour. It
assumes the role of learning in the aetiology, maintenance and treatment of some
psychiatric disorders. Some of these disorders are due to a lack of learning, e.g.
enuresis; some to over-learning, e.g. obsessional rituals; and others to loss of
previous learning, e.g. institutionalisation. Behavioural therapy has beneficial
change in behaviour as the goal. The methods used may be based on Pavlovian
classical conditioning (1927), Skinnerian operant conditioning (1938), learning
principles, experimental psychology, or behavioural sciences in general. Whereas
psychoanalysis is concerned with understanding how the individual's past
experiences (e.g. childhood trauma or conflicts) influence behaviour, The
behaviour therapy focuses on the behaviour of the here-and-now.
Criteria for behavioural treatment:
1. The problem can be defined in terms of observable and measurable
behaviour.
2. The problem is current and generally predictable.
3. Therapist and patient can agree on already defined behavioural goals.
4. Patient understands the treatment offered and accepts it.
CONDITIONS SUITABLE FOR BEHAVIOUR THERAPY
1. Phobic disorders
2. Obsessive compulsive disorders
3. Generalised anxiety disorder
4. Panic disorders
5. Habit disorders
6. Sexual deviations/dysfunctions
7. Social skills deficits
8. Enuresis
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13. CONDITIONS WHERE BEHAVIOUR THERAPY MAY BE USEFUL
1. Eating disorders
2. Alcohol dependence
3. Post-traumatic stress disorder
4. Marital disharmony
5. Rehabilitation of chronic psychiatric patients
6. Behaviour modification in the mentally retarded
Behavioural approaches may be categorised into:
1. Anxiety reduction techniques
a) relaxation therapy
b) autogenic training
c) guided imagery
d) systematic desensitization
e) exposure therapy
f) response prevention
g) modelling
h) thought stopping
i) biofeedback
2. "Appetite" reduction techniques
a) aversion therapy
b) habit reversal
c) mass practice
d) response cost
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14. 3. Addition (development) of new behaviour
a) social skills training
b) modelling
c) shaping
d) token economy
Relaxation Therapy
The simplest form of relaxation therapy involves regular deep breathing
exercises. The patient chooses a quiet spot e.g. a dimly lit room, rests on a
comfortable armchair, and closes his/her eyes. He/ She thinks about nothing, and
just focuses on his/her breathing. As he/she does that, he/she takes in a slow and
deep breath, holds it for a few seconds, then gradually breaths out. By breathing
slowly and regularly at a respiratory rate of 10 to 12 breaths per minute, he/she will
begin to feel the relaxation coming upon his/her body.
Another form of relaxation exercise is muscle relaxation. First described by
Jacobson (1938), it was an elaborate procedure intended to bring about reduction
of individual groups of skeletal muscle tone. It involves alternate contraction
followed by relaxation of different muscle groups e.g. the arms, shoulders, neck,
jaw, face, etc. This can be taught individually or in groups using a video or an
audiotape with recorded instructions and demonstration. It should be practised
regularly, especially in anticipation of any imminent stressor. Relaxation therapy is
effective for the management of generalised anxiety disorder, mild hypertension
and migraine. It can also aid in the dose reduction of benzodiazepines for the
treatment of anxiety and sleep disorders.
Autogenic Training
Developed by Schultz (1905) from the work of Oskar Vogt, this involves a
series of standard relaxation exercises followed by meditative ones to induce
feelings of heaviness, warmth or cooling in parts of the body and to slow
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15. respiration. Autogenic training can be used to treat generalised anxiety disorders
and stress related disorders.
Guided Imagery
Here the patient is presented with a series of mental images depicting peace
and rest. Sceneries such as the tranquillity of a clear blue lake, the morning break
by the golden beach, or the cool and refreshing dew in the woods, are used to
induce relaxation. Often soothing music or sounds of chirping birds or waves in the
background help enhance the relaxed state further. The purpose is to involve as
many sensory modalities as possible in the imagery in order to achieve optimal
relaxation. The indications are similar to those prescribed with relaxation therapy.
Systematic Desensitization
Developed by Wolpe (1958), it begins with the construction of a list of
anxiety-evoking situations in an ascending order (hierarchy). Relaxation is taught,
and the patient is presented with the hierarchy of feared situations (either live or by
imagination), beginning with the least feared one. Mild anxiety is experienced
initially, and this is paired with relaxation exercise. Once the anxiety diminishes,
the next level of feared stimulus is presented. In this way, while never experiencing
intolerable anxiety, the patient proceeds from mildly anxious situations to
progressively more terrifying ones. Gradually he will be able to cope with the most
anxiety evoking situations. Systematic desensitization is commonly used for the
treatment of phobic disorders.
Exposure Therapy
This is similar to systematic desensitization except that no attempt is made
to relieve the anxiety during the period of exposure. Instead, with time, the anxiety
will subside or disappear through a psychological process of habituation. This
deliberate exposure aims at confronting the fear instead of avoiding, and can be
graduated (graded-exposure) or else "flooding" the patient with the most feared
situations all at once. Exposure therapy is now the mainstay of behavioural
treatment for obsessive-compulsive disorder and phobias.
Response Prevention
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16. Often used in combination with exposure therapy, response prevention aims
at prolonging exposure to ritual-evoking cues by refraining from carrying out the
rituals that would normally follow e.g. hand washing. With time, the urge to
perform the rituals will subside. Response prevention can be used for obsessivecompulsive disorder and eating disorders.
Modelling
Modelling refers to the acquisition of new behaviours by the process of
imitation. The patient observes someone else carry out an action, which he has
problem with. It is often used in conjunction with other techniques like exposure
therapy and role-playing for the treatment of obsessive-compulsive disorder and
phobias, as well as in social skills training. In the phobic child, modelling is
especially useful e.g. the phobic child watches other children play with dogs and is
then encouraged to join in subsequently.
Thought Stopping
Here chains of repetitive thoughts or obsessional ruminations are suddenly
interrupted overtly e.g. by a sudden loud noise or by shouting the word "STOP!"
The snapping of elastic bands worn over the wrist can also act to interrupt these
thoughts. Alternatively, the patient could say the word "STOP" subvocally, which
is probably socially more acceptable.
Biofeedback
Biofeedback involves the use of electronic instruments to monitor small and
otherwise undetectable changes in the biological state of the patient. These are then
fed back to him (visually e.g. colours or by auditory means e.g. low or high pitched
sounds), so that he can in turn gradually learn to alter and control them.
Biofeedback has been used to train individuals to gain control over heart rate,
blood pressure, skin temperature, EEG activity and muscle tension. It has been
used in the treatment of cardiac arrhythmias, hypertension, tension headache,
migraine, tics, generalised anxiety and stress related disorders.
Aversion Therapy
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17. In aversion therapy, the undesirable behaviour is paired with an unpleasant
consequence. It may take the form of imaginable aversion (also called covert
sensitization) or physical aversion e.g. electric shock. A paedophile when
imagining touching a naked child shocks himself or imagines himself being
arrested and publicly humiliated. Besides deviant sexual behaviour, aversion
therapy has also been used in the treatment of alcohol dependence and pathological
gambling. The ethanol-alcohol reaction following alcohol ingestion with disulfiram
is an example of chemical aversion.
Mass Practice
In mass practice, the patient is asked to deliberately practise the undesirable
behaviour e.g. motor tics. This will lead to boredom and eventually extinction of
the behaviour.
Habit Reversal
As its name suggests, habit reversal attempts to extinguish undesirable
habits like tics, trichotillomania, stammering and stuttering. Described by Azrin
and Nunn (1977), it involves the use of a competing action, which is incompatible
with the habit. A nail biter can grasp an object while a person with motor tics may
be taught to contract the muscle of his upper limb isometrically.
Response Cost
This is a form of aversion in which the patient agrees to pay a forfeit, not
necessarily monetary, for every exhibition of an undesirable behaviour. Widely
practised as the form of fines for offending the law for instance, the person could
prearrange to make a donation to his least liked charitable organisation for every
stick of cigarette he smokes.
Social Skills Training
Social skills consist of verbal and non-verbal behaviours, which a person
needs in order to form and/or maintain social relationships with other people. It can
be taught to those who are deficient in such skills. The training involves a step-bystep programme including the breaking down of a social interaction into different
stages like initiating, maintaining and terminating social contact, personal
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18. grooming, modelling, rehearsal and role-plays, and finally video feedback.
Attention is drawn to details like eye contact, voice volume, body language,
posture and social distance. It has been employed successfully to institutionalised
chronic schizophrenics, depressives, psychopaths and the mentally retarded.
Although it may not play a direct therapeutic role like drugs in terms of cure for
the illness, it has an important role in the overall management of the patient in
enhancing a better quality of life during rehabilitation.
Shaping
It is a form of operant conditioning in which rewards are given for
successive approximations towards the desired new behaviour e.g. a mentally
retarded child dressing himself. The desired behaviour is broken into many steps,
and often the therapist also acts as a model for the child to follow. It is a laborious
process, and used only if a new behaviour is totally absent from the patient's
repertoire.
Token Economy
Also based on operant conditioning as in shaping, desired behaviours
necessary for day-to-day functioning are specified. A unit of exchange (the token)
is presented to the patient contingent upon the occurrence of the desired
behaviours. The tokens accumulated can then be exchanged for other objects or
privileges. Token economy is often used to avoid institutionalisation of long stay
psychotic patients and the mentally retarded.
2. PSYCHOTHERAPY
Psychotherapy is a form of treatment based on the systematic use of a
relationship between therapist and patient (as distinct from pharmacological or
social methods) to produce change in feelings, thinking and behaviour. The
advantage of this definition is that it highlights how the quality of the interpersonal
relationship forms the basis for therapeutic efficacy, whatever techniques are
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19. employed to this end. As with all interpersonal relationships, communication is an
intrinsic aspect of psychotherapy. The predominant medium of communication
involves the use of spoken language. However, non-verbal means (e.g. body
sculpting, drama, music, art and play) have been employed for psychotherapeutic
purposes as well.
The Goals of Psychotherapy
In general, the goals of psychotherapy are as follows:
(1) removal of distressing symptoms;
(2) altering disturbed patterns of behaviour;
(3) improved interpersonal relationships;
(4) better coping with stresses of life;
(5) personal growth and maturation.
Types of Psychotherapy
Broadly, there are 4 different theoretical approaches adopted in
psychotherapy. They have their basis in:
(1) psychoanalytic tradition;
(2) cognitive-behavioural theory;
(3) interpersonal or systemic theory;
(4) existential or gestalt philosophy.
Psychotherapy can be carried out in 4 modes, namely with:
(1) individuals
(2) couples
(3) families
(4) groups
By convention and for historical reasons, individual psychotherapy is often
identified by its theoretical orientation. Thus, we have 4 main types of individual
psychotherapy, namely psychodynamic psychotherapy, cognitive-behavioural
psychotherapy, interpersonal psychotherapy and existential/experiential
psychotherapy for individuals. When the mode of delivery involves more than one
person, the theoretical orientation is often left out in the reference (i.e. couple or
marital therapy, family therapy and group therapy).
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20. Despite the diversity of techniques employed in psychotherapy, the
following are beneficial functions that most, if not all effective psychotherapies
have in common:
(1) Developing a therapeutic relationship
(2) Generating positive expectations
(3) Facilitating cognitive and experiential learning
(4) Facilitating emotional arousal and catharsis
(5) Engendering a sense of mastery
(6) Application of new skills developed
3. COGNITIVE THERAPY
Cognitive therapy (CT) is a brief structured form of psychotherapy, which
deals with the identification of maladaptive cognitions (thoughts, attitudes, images
and dreams) and its substitution with more adaptive ones. Cognitions, emotions,
behaviours, bodily symptoms and environmental factors are intricately linked.
Change in any one of these may lead to changes in the other four. As emotions are
less directly amenable to change, changes of cognitions, behaviour and the
environment are more practical means of effecting emotional changes. CT is
concerned primarily with current problems the sufferer is faced with and possible
solutions. The therapist is active and interactive, seeking to secure a collaborative
relationship with the client. The therapy is based on empirical data and is education
and skills oriented with the aim of guiding the client to “discover“ solutions. There
is a myth that CT is not interested in emotions or the client’s past. Contrary to
these beliefs, in CT, emotions and shifts of emotions are important to the therapy.
Strong emotions are often the best time to explore cognitions (“hot cognitions”).
Although CT is primarily focused on current problems the client faces, the past is
extremely important in helping both client and therapist understand and
conceptualize the current problem(s).
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21. Fig. 1 The interplay of environment, behaviour, emotions, thoughts and
bodily symptoms. The environment, behaviour and thoughts are more
amenable to change than emotions and bodily symptoms.
Cognitive therapy has its roots in the empirical method much espoused by
the early Greek philosophers. Indeed, “Socratic” questioning (inductive
questioning which seeks to lead the client to answers based on knowledge already
available to the patient) is held to be a key therapeutic tool in CT. Until the end of
the Second World War, analytical psychotherapy was the primary form of
psychotherapy practiced in much of the Western world. In the fifties, behaviour
therapy became popular. In the sixties, both Aaron Beck and Albert Ellis
independently introduced cognitive models mental distress and its accompanying
therapy - cognitive therapy. They hypothesized that thinking mistakes were behind
much of the emotional distress in people and that people would be able to change
the way they feel if they first changed the way they think. Today, cognitivebehaviour therapy stands alongside analytical psychotherapy as the most
commonly prescribed form of psychotherapy in the Western world. Efforts by
Anthony Ryle and his team have focused on merging psychoanalytical and
cognitive-behavioural principles (cognitive-analytical therapy).
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22. CT is an empirical method, driven by cognitive models derived from social
psychology, cognitive psychology, psychiatry, behaviour therapy and dynamic
psychotherapy. Its efficacy is supported by empirical scientific studies. The nature
of CT has lent itself well to the manualisation of therapy, aiding standardization of
research and its availability to the lay-person in the form of “self-help manuals”.
Features
As with other forms of psychotherapy, a good therapeutic relationship is
critical for the successful outcome of psychotherapy. Factors that are responsible
for patient improvement in psychotherapy or counseling are no less important in
CT. These include: the instillation of hope; the provision of an alternative view to
the problem; confidence in the therapist and the therapy; acceptance of the
therapeutic model; warmth, genuineness and concern; the development of patient
skills; and patient co-operation and openness.
CT is indicated for the following conditions: Anxiety disorders, Depressive
disorders; Marital Problems; Personality disorders; Eating disorders; Additive
disorders and Somatoform disorders. It is a useful adjunct in bipolar and psychotic
conditions, where it can be used to improve the detection of early signs of relapse
and improve medication compliance. Modifications may have to be made when CT
is used in children, those with psychotic conditions and those with personality
disorders.
Clients should be assessed on their ability to be collaborative, to develop a good
rapport and to accept the cognitive model. If both therapist and patient agree on
cognitive therapy, a fixed number of sessions (usually 8-12) are decided upon, as is
the focus of therapy (based on the patient’s problem list and the priority of each
problem). Ideally sessions should be weekly or fortnightly and lasting for 45
minutes to an hour.
Assessment should include the following:
• What are the patient’s problem(s)?
• What is the diagnosis? (use of the DSM-IV pentaxial classification is
recommended)
• What are the negative automatic thoughts and schemas operating
• What are the cognitive models available
• How do the patient’s cognitions, behaviours, emotions, bodily symptoms and
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23. environmental factors interact?
• At what stage of readiness for change is the client?
• Can the client form a collaborative working relationship?
• What is the client’s perception and beliefs of his or her “problem”?
• What are the client’s strengths and weaknesses?
• How can the case be best conceptualized? (predisposing, precipitating,
perpetuating
factors)
• What interventions are most suited for the case?
• What scales and questionnaires may be useful in this case?
• What is the client’s view about the cognitive model and cognitive therapy?
• Should cognitive techniques or therapy be used
• What are the therapist’s own negative thoughts and schemas which may affect
therapy?
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24. CASE STUDY – I
Client Profile
Name
:K
Age
: 66
Gender
: Male
Marital Status
: Married
Religion
: Hindu
Socio Economic
Status
: Middle Class
Occupation
: Nil
Domicile
: Urban
Informant
: Son
Reliability
: Reliable
Chief Complaints
1. Fear of Death
2. Heart palpitation
3. Excessive burning sensation all over the body
4. Constipation
5. Throat irritation
6. Sense of vomiting
7. Lack of appetite and sleeplessness
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25. 8. Diabetics
9. Erectile Dysfunction
Complaints by Family
1. Does not allow the family members to sleep
2. Does not speak with family members
3. Complaints about family members and doctors
4. Unnecessary physical touch on his daughter-in-law
History of Present Illness
The above symptoms has been reported by the client since last 7 months and
visited around 11 doctors. Doctors certified that there was underlying physical
cause and referred him to a psychotherapy.
History of Past Illness
Nil
Medical History
Under the treatment for Diabetics since a year
Personal History
He was born as 8th child in his family. He got married to his niece by force
after having coital relationship as a result his wife never enjoyed sex till date and
does not cooperate for it. Both are excessively religious.
Sexual History
He had extra-marital affairs and now suffers from erectile dysfunction.
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26. Mental Status Examination
General Appearance
• Dressed Neatly
• Proper Eye contact is maintained.
• Psychomotor activity was not normal
Speech
• Slurred and incoherent
Attention and Concentration
• Normal
Diagnosis
The client has been diagnosed to be suffering from Psychosomatization with
Phobic Anxiety and Fear of Death.
Treatment
1. Paradoxical Intensive Technique
The client was asked to bring out the burning sensation and increase it
to the highest level and face the death for an hour. The harder he tried,
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27. the harder it was to feel his burning sensation and he lost the fear of
death and never reported the burning sensation again.
2. Enema
Enema was administered to clean the stomach for constipation. Once
it was given, the client had good appetite and peaceful sleep.
3. Genital Muscle Relaxation Technique
It involved the contraction of genital muscle and withholding it for a
specified period and releasing it. Hence, the genital muscles become under
the voluntary control of the client and enhance sexual behavior.
4. Wall pushing
Wall pushing makes the client realize that the effort on certain things
does not bring any change and therefore redirect the energy on more fruitful
away. This also makes the person physically active.
5. Incremental Walking
The client is asked to count each step there by bringing presence of
mind in him and productive physical activity.
6. Rate of Breathing
Rate of Breathing is the counting of inhale and exhale of a person in a
minute. In this process, the client is aware of each and every part of his body
and mind and he is able control it on his own will. This enables the client to
manage his stress and keep him calm and composed in any anxiety
provoking situation.
7. Imagery Guidance (“Om” Khar)
The client was asked to imagine his favorite God and chant “OM” in
order to remove his guilt feelings and fear of death.
8. Mirror Gazing
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28. Looking at the mirror increases liking for the person and develops
positive image and self concept of the person
9. Boxing
This makes the client active and provides a sense of achievement.
10.Laughter Therapy
The client was asked to laugh for 30mins. This released neurochemical in the brain and made him feel happy.
11.Sex Therapy to his wife was administered
Sexual therapy involves various exercises involving both husband and
wife. The wife is given hip movement to remove her sexual inhibition and
proper sexual positions are demonstrated.
12.Varma Therapy
Varma points were pressed in order to alert her and bring her back to
conscious and overcome the effect of the tranquilizer.
PHARMACOLOGICAL
White Leninment was applied for burning sensation and salt gaggling was
administered for vomiting sensation.
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29. CASE STUDY – II
Client Profile
Name
:V
Age
: 20
Gender
: Male
Marital Status
: Unmarried
Religion
: Hindu
Socio Economic
Status
: Middle Class
Occupation
: Student
Domicile
: Urban
Informant
: Sister
1

30. Reliability
: Reliable
Chief Complaints
1. Unrealistic goals
2. Anger
3. Abusing family members
4. Poor social skills
5. Breathing problem
6. Poor memory
Complaints by Family
1. Does not respect anybody in the family
2. Demands bulk of amount for unrealistic goals
3. Cries when he is alone
History of Present Illness
The above symptoms have been reported by the client since last 4 years and
consulted 6 doctors for counseling.
History of Past Illness
Nil
Medical History
1

31. Under the treatment for stomach problem such as poor digestion and lack of
appetite due to acidity.
Personal History
He was born as 2nd child in his family. He lost his father when he was 5
years old and he is under the control of his grandparents. He is forced to get
married soon by his grandmother to get his ancestral property. And his mother is
being neglected by his grandparents leading to conflicts in him.
Educational History
He started schooling at the age of 5. He excelled in his studies and joined BE
in Sathyabama University, Chennai. He was forced to discontinue the course by his
mother due to family issue and join BCA in AVS college, Salem. This created
trouble in him
Sexual History
Failed intercourse with his ex-lover due to anxiety.
Mental Status Examination
General Appearance
• Dressed Neatly
• Proper Eye contact is maintained.
• Psychomotor activity was normal
Speech
• Slurred
Attention and Concentration
• Distracted
Diagnosis
1

32. The client has been diagnosed to be suffering from Anxiety about Future and
Social Anxiety
Treatment
1. Rate of Breathing
Rate of Breathing is the counting of inhale and exhale of a person in a
minute. In this process, the client is aware of each and every part of his body
and mind and he is able control it on his own will. This enables the client to
manage his stress and keep him calm and composed in any anxiety
provoking situation.
2. Anger Reversal Technique
The clients sat in front of a mirror and exhibited anger on start and
relax on stop. This brings anger under the voluntary control of the client
3. Wall pushing
Wall pushing makes the client realize that the effort on certain things
does not bring any change and therefore redirect the energy on more fruitful
away. This also makes the person physically active.
4. Incremental Walking
The client is asked to count each step there by bringing presence of
mind in him and productive physical activity.
5. Genital Muscle Relaxation Technique
1

33. It involved the contraction of genital muscle and withholding it for a
specified period and releasing it. Hence, the genital muscles become under
the voluntary control of the client and enhance sexual behavior.
6. Imagery Guidance (“Om” Khar)
The client was asked to imagine his favorite God and chant “OM” in
order to remove his guilt feelings and fear of death.
7. Candle Gazing
It increases the concentration of the client and able to focus on the
task at hand. This also increases assertiveness of the client
8. Laughter Therapy
The client was asked to laugh for 30mins. This released neurochemical in the brain and made him feel happy.
9. Tossing the Coin
Tossing a coin and guessing the result makes the client realize that the
outcome of an event is beyond our control and therefore accept the life
events as it comes and go ahead with the life irrespective of the past.
10.Skipping
Skipping brings coordination between mind and body. It increases
concentration and provides a sense of achievement.
CASE STUDY – III
Client Profile
Name
: KN
1

34. Age
: 24
Gender
: Male
Marital Status
: Unmarried
Religion
: Hindu
Socio Economic
Status
: Upper Class
Occupation
: Student
Domicile
: Urban
Informant
: Father
Reliability
: Reliable
Chief Complaints
1. Suicidal Thoughts
2. Obesity
3. Anger
4. Obsessive Thoughts
5. Poor social skills
6. Emotional Instability
7. Poor memory
Complaints by Family
1. Poor academic performance
2. Avoids social gatherings
1

35. 3. Gets annoyed soon for no reason
History of Present Illness
The above symptoms have been reported by the client since last 1 year after
a girl commented about his physical appearance in front of everyone in the class
and rejected his proposal
History of Past Illness
Nil
Medical History
Nil
Personal History
He is the only child in his family. He lost his mother when he was 4 years
old
Educational History
He started schooling at the age of 5. He excelled in his studies and joined
M.Tech in USA. He was forced to discontinue the course due to failed love affair
Sexual History
Nil
Mental Status Examination
General Appearance
1

36. • Dressed Neatly
• Proper Eye contact is not maintained
• Looks very shy
• Psychomotor activity was normal
Speech
• Slurred
Attention and Concentration
• Normal
Diagnosis
The client has been diagnosed to be suffering from poor Self Concept and
Social Anxiety
Treatment
1. Rate of Breathing
Rate of Breathing is the counting of inhale and exhale of a person in a
minute. In this process, the client is aware of each and every part of his body
and mind and he is able control it on his own will. This enables the client to
manage his stress and keep him calm and composed in any anxiety
provoking situation.
2. Anger Reversal Technique
1

37. The clients sat in front of a mirror and exhibited anger on start and
relax on stop. This brings anger under the voluntary control of the client.
3. Mirror Gazing
Looking at the mirror increases liking for the person and develops
positive image and self concept of the person
4. Wall pushing
Wall pushing makes the client realize that the effort on certain things
does not bring any change and therefore redirect the energy on more fruitful
away. This also makes the person physically active.
5. Incremental Walking
The client is asked to count each step there by bringing presence of
mind in him and productive physical activity.
6. Genital Muscle Relaxation Technique
It involved the contraction of genital muscle and withholding it for a
specified period and releasing it. Hence, the genital muscles become under
the voluntary control of the client and enhance sexual behavior.
7. Laughter Therapy
The client was asked to laugh for 30mins. This released neurochemical in the brain and made him feel happy.
8. Tossing the Coin
Tossing a coin and guessing the result makes the client realize that the
outcome of an event is beyond our control and therefore accept the life
events as it comes and go ahead with the life irrespective of the past.
1

38. CASE STUDY –IV
Client Profile
Name
: PD
Age
: 11
Gender
: Female
Marital Status
: Unmarried
Religion
: Hindu
Socio Economic
Status
: Upper Class
Occupation
: Student
Domicile
: Urban
Informant
: Father
Reliability
: Reliable
Chief Complaints
1. School Phobia
2. Excessive Sweating
3. Obsessive Thoughts
4. Anger
5. Emotional Instability
1

39. Complaints by Family
1. Breaks things and adamant
2. Refuses to go to school
3. The schooling is not challenging to her and it is of no use
4. Changes cloth three to four times before going to bed
5. Gets annoyed soon for no reason
History of Present Illness
The above symptoms have been reported by the client since last 1 month
after being shifted to new school due to professional transfer of her father. The new
school has a system of seating arrangement in which a boy and girl sits
alternatively. This creates anxiety in her.
History of Past Illness
Nil
Medical History
Nil
Personal History
He is the only child in her family. Her parents show excessive love. She got
annoyed when her mother threatened her that she would adopt another child. Her
mother reported similar problem when she was 11 years old before attaining
puberty.
Educational History
She started schooling at the age of 5. She excels in her studies.
Sexual History
1

40. Nil
Mental Status Examination
General Appearance
• Dressed Neatly
• Proper Eye contact is maintained
• Psychomotor activity is normal
Speech
• Normal
Attention and Concentration
• Normal
Diagnosis
The client has been diagnosed to be suffering from Aversion to Boys and
Anxiety
Treatment
1. Rate of Breathing
Rate of Breathing is the counting of inhale and exhale of a person in a
minute. In this process, the client is aware of each and every part of his body
1

41. and mind and he is able control it on his own will. This enables the client to
manage his stress and keep him calm and composed in any anxiety provoking
situation.
2. Candle Gazing
It increases the concentration of the client and able to focus on the task at
hand. This also increases assertiveness of the client
3. Behavioural Contract
Both the parents and the child have come to an agreement and listed out
the expectations from each other and abide by that. This reduces the conflict
and creates better understanding.
4. Training to Teachers
The therapist contacted the school management and arranged for a
workshop and train them on how to handle the teenage students.
1

42. CASE STUDY – V
Client Profile
Name
: VI
Age
: 17
Gender
: Male
Marital Status
: Unmarried
Religion
: Hindu
Socio Economic
Status
: Middle Class
Occupation
: Student
Domicile
: Urban
Informant
: Father
Reliability
: Reliable
Chief Complaints
1. Addicted to Gadgets and porn movies
1

43. 2. Obsessive Thoughts
3. Excessive Anger
4. Emotional Instability
Complaints by Family
1. Breaks things and adamant
2. Refuses to go to school
3. Does not concentrate on studies
4. Uses abusive words
5. Gets annoyed soon for no reason
History of Present Illness
The above symptoms have been reported by the client since last 2 year after
being criticized by a lady teacher in front of classmates. This created an emotional
trauma in him.
History of Past Illness
Nil
Medical History
Nil
Personal History
He is the only child in his family. His parents show excessive love. He got
annoyed when his class teacher slapped in cheek and scolded him in front of girls.
1

44. Educational History
He started schooling at the age of 5. He excelled in his studies up to 9th
standard and his performance decreased from SSLC onwards.
Sexual History
Nil
Mental Status Examination
General Appearance
• Dressed Neatly
• Proper Eye contact is maintained
• Psychomotor activity is normal
Speech
• Normal
Attention and Concentration
• Normal
Diagnosis
The client has been diagnosed to be suffering from Aversion to girls and
Poor Self Concept
Treatment
1. Developing Multiple Response to a threatening stimulus
1

45. The client was asked to image the teacher he hated most and morphine
her like a monkey, dog and various other funny creatures. This
reduces the anxiety in the client
2. Candle Gazing
It increases the concentration of the client and able to focus on the
task at hand. This also increases assertiveness of the client
3. Mirror Gazing
Looking at the mirror increases liking for the person and develops
positive image and self concept of the person
4. Skipping
Skipping brings coordination between mind and body. It increases
concentration and provides a sense of achievement.
5. Incremental Walking
The client is asked to count each step there by bringing presence of
mind in him and productive physical activity.
6. Wall pushing
Wall pushing makes the client realize that the effort on certain things
does not bring any change and therefore redirect the energy on more fruitful
away. This also makes the person physically active.
7. Rate of Breathing
Rate of Breathing is the counting of inhale and exhale of a person in a
minute. In this process, the client is aware of each and every part of his body
and mind and he is able control it on his own will. This enables the client to
1

46. manage his stress and keep him calm and composed in any anxiety provoking
situation.
8. Genital Muscle Relaxation Technique
It involved the contraction of genital muscle and withholding it for a
specified period and releasing it. Hence, the genital muscles become under
the voluntary control of the client and enhance sexual behavior.
REFERENCES
1. Theory and Practices of Behaviour Therapy, J. Wolpe. (1969), New York: Pergamon
1