This is an introductory set of slides about things which one should know before entering into the arena of psychotherapy

1. PSYCHOTHERAPY
Dr. S. Krishnan MBBS, MD, DPM, DIP.NB,MNAMS
Associate Professor of Psychiatry
Mo-IN-Charge, Holistic and Stress Research Clinic
Department of Psychiatry
Medical College, Thiruvananthapuram

2. Definition…
• "Psychotherapy is the treatment, by psychological
means,
• Of problems of an emotional nature in which a trained
person deliberately establishes a professional
relationship with the patient
• With the object of
• (1) Removing, modifying, or retarding existing symptoms
• (2) Mediating disturbed patterns of behavior, and
• (3) Promoting positive personality growth and
development."
Woolberg L, The Technique of Psychotherapy, 1977.

4. Psychotherapy
• Should be a regular part of Psychiatrist’s
treatment schedule
• Very few budding psychiatrists get training
• Most training programs end up as dramas or
theoretical sessions

5. Misconceptions
• Psychotherapy is THE treatment
• Psychotherapy is not a treatment at all
• Psychotherapy does not need training
• With the understanding of the neurobiology of
psychotherapy, psychotherapy has become a
valid treatment
• Psychotherapy produces the same changes in the
brain as pharmacotherapy
• And many more…

6. Psychotherapy
• Have a diagnosis
• Is there an indication for psychotherapy
• Does the patient fits well into the paradigm?

7. Following steps
• General introduction to psychotherapy
• Guideline to initiate practice
• Guideline to what you should be prepared to
face and do
To open or to close
the door?

8. Seating

9. Time

10. Place

11. Qualities of a Psychotherapist

12. Who can really be a psychotherapist?
Adequately trained and certified
• Psychiatrist
• Psychologist
• Social worker
• Nurse practitioner
• Physician assistant
• Minister, priest
Untrained persons not tested for competence!
• Anyone can call themselves a “therapist!”

13. Being Monitored

14. Psychotherapy
• Fellow travelers
• Engage in personal therapy
• Be supportive
• Have and teach empathy (Hyperempathy!!!)
• Let the patient matter to you
• Acknowledge your limitations and errors
• Have a new therapy for each patient

15. The therapist has many patients.
The patient, one therapist

16. Which Therapy is the Best

17. The present – use it, use it, use it
• Hear with eyes and see with ears
• Working through issues in present
• Frame ‘present’ comments carefully
• What lies have you exchanged
• Be real

18. Therapist disclosures – 3 kinds
• Be transparent
• Use discretion
• Use caution

19. Revealing your personal life
Why
What
How

20. Do patients want to hear your life
story

21. On being helped by your patient

22. Encourage patient self disclosure

23. Feedback – Johari Window

24. How to talk about
God Death
Sex
Meaning
of life

25. Helping patients to assume
responsibility

26. Never make decisions for the patient

27. Blocks in therapy
Forms of
transference
Types of
resistance

28. Facilitate awareness
• Encourage self monitoring

29. Should advices be given?

30. Notes on each session

31. What to do if patient…
• Weeps
• Gets irritated

32. Taking care of yourself

33. Express your dilemmas openly

34. Home visits therapy?

35. Should everything have a psychological
explanation

36. Should you touch the patient?
• Where
• When
• How

37. Your feelings for the patient…
Sexual
Love
Compassion
Involvement

38. Promises given to patients

39. Interview with significant others

40. Previous therapist

41. Freud was not always Right
Freud was not always Wrong

42. CBT is not everything

43. Dreams – Use them
First
Last
Recurring
Distressing

44. Dreams about therapist

45. Thanks…