DR RUPESH RANJAN CLINICAL PSYCHOLOGIST INDIA: What is Psychotherapy?

DR RUPESH RANJAN CLINICAL PSYCHOLOGIST INDIA: What is Psychotherapy?:                Wolberg, beautifully define the Psychotherapy       Psychotherapy is the treatment, by Psychological means of problems of an...

What is Psychotherapy?

              Wolberg, beautifully define the Psychotherapy

     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

•  Removing, modifying or retarding existing symptoms
• Mediating disturbed patterns of behavior
• Promoting positive personality growth and development

Child Counselling 

                                                           RUPESH RANJAN
                                                       

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Child Counselling 

It can be divided into two areas

             1.  Management for General problems

             2.  Management for Specific problems

         1.  Management for general problems    

·        Enhancement of self esteem

·        Anger management

·        Anxiety management

·        Stress management

·        Tension

·        Time- management

·        Examination related problem

·        Memory related problem

·        Problem solving

·        Decision making

·        Learning problems

·        Performance anxiety

·        Communication problem including problem related to expression.

·        Disciplinary problem

·        Substance dependence

·        Internet dependence

      2. Management for Specific problem              

·        Depression, learning disability, conducts disorder, attention deficit hyperactive disorder, emotional disorders, behavioural disorders etc.

           Procedure for Management                   

 a.To Elicit or diagnose the problem area

•  Source of information

1.  Academic report, class teacher, student, parents, home environment and peer groups

2.  Individual interview

b. Behavior analysis

c. Psychological testing

d. Case formulation

  Plan for Management
1.  Supportive psychotherapy

v Reassurance

v Ventilation

v Externalizing of Interests

2. Behaviour therapy

v Relaxation JPMR

v Breathing exercise

v Autogenic training

v Social skills Training

v Systematic Desensitization

v Exposure and Response prevention

v Home work assignments

3. Cognitive Therapy

BHU Kulgeet

BEHAVIOUR ANALYSIS

Behaviour Analysis

Seven part analysis

                The first model originates from the work of Kanfer and saslow (1969), and it considers assessment in a seven- part plan, and focuses on the behavioural components of cognitive behaviour assessment.

1.  Initial Analysis of the problem situation.

In this step the behaviour an excess, a deficit or an assets is considered and its frequency, intensity, duration and stimulus conditions.

a.        Behaviour excess:  A class of related behaviours occurs and is described as problematic by the client or an informant because of excess in - frequency, intensity, duration and occurrence under conditions when its socially sanctioned frequency approaches zero.

b.        Behaviour deficit:  A class of responses is described as problematic by someone because it fails to occur: with sufficient frequency; with adequate intensity; in appropriate form; under socially expected conditions.

c. Behaviour assets:  Behavioural asset are non- problematic behaviour.

·         What does the client do well?

·         What are his/her adequate social behaviour?

·         What are his/her special talents or assets?

·         His/her natural work and play activities provide a better starting point for behaviour change than can ever be provided in a synthetic activity or relationship.

2. Clarification of the problem situation

a. Assign the classes of problematic responses to Group A behavioural excess or Group B behavioural deficit.

b. Which persons or groups object to these behaviours? Which persons or group support them? Who persuaded the

 client to come to the clinician?

c. what consequences does the problem have for the client and for the significant others?  What are the consequences

 would removal of the problem have for the client or other?

d. Under what conditions do the problematic behaviour occurs.

e. What satisfaction would continue for the client if/ her problematic behaviour were sustained? What satisfaction

 would client gain after psychological interventions?

f. What new problems in living would successful therapy pose for the client? What reinforcers are there?

g. To w extent is the client as a sole informant capable of helping in the development of a therapy programme?

3. Motivational analysis

 How does the client rank various incentives in their importance to him/ her? Basing judgement on the client’s probable expenditure of time, energy or physical discomfort, which of the following reinforcing events are relatively most effective in initiating or maintaining his/her behaviour achievement of recognition sympathy.

a.         How frequent and regular have been his/her success with these reinforces?

b.       What specific conditions do each of these reinforcer arouse goal-directed behaviour.

c.        Do his /her actions in relation to these goals correspond with verbal statements?

d.       Which person or groups have the most effective and widespread control over his/her current behaviour.

e.        Can the client relate reinforcement contingencies to his/ her own behaviour?

f.         What are the major aversive stimuli for this client (1) in immediate day-to-day life;

g.        Would a treatment programme require that the client give up current satisfactions associated with his/her problem?

h.       Which events of know reinforcing value can be utilised for learning new interpersonal skills?

4. Developmental analysis

a. Biological changes

1.   What are the limitations in the client’s biological equipment that may affect current behaviour, e.g. defective vision and hearing; residuals of illness such as stroke, poliomyelitis, mononucleosis, glandular imbalances?

2. When and how did biological deviations or limitations develop?

3.  How do these biological conditions limit response to treatment or resolution of his/her problem?

     b. Sociological changes

1. What are the most characteristic features of the client’s present socio-logical milieu?

2. Have there been changed in this milieu which are pertinent to his/her current behaviour?

3. Does the client view these changes as brought about by him/her by significant persons?

4. Are the client’s roles in various social setting?

5. How can identified sociological factors in the problematic behaviour be brought into relation with a treatment programme?

c. Behavioural changes

           a.  Prior to the time of referral, did the client’s behaviour show deviations in behaviour patterns compared with

               developmental and social norms?

           b. Do identified biological, social or sociological events in the client’s life seem relevant to these behavioural 

               changes?

5.   Analysis of self- control

How can the client’s self-controlling behaviour be used in the treatment programme?

   In what situations can the client control those behaviours that are problematic?

6.   Analysis of relevant social relationships

      Who are the most significant people in the client’s current environment?

   To which or persons or groups is he most responsive? Who provokes antagonistic or problematic behaviours?

7. Assessment of the socio cultural and physical environment

            a. What are the norms in the client’s social milieu for the behaviours about which there is a complaint?

          b. Are these norms similar in the various environments in which the client   interacts, e.g. home and school, friends and

              parents, work and social milieu, etc.?

Efficacy of Cognitive Behavior Therapy in Obsessive Compulsive Disorder

Efficacy of Cognitive Behavior Therapy in Obsessive Compulsive Disorder

* Rupesh  Ranjan et al

                   

Abstract

  Cognitive behavior therapy is probably the most well known and most practiced form of modern psychotherapy in treatment of Obsessive compulsive disorder. The present study was intended to see the efficacy of Cognitive Behavior Therapy in Obsessive compulsive Disorder. This is a three month follow up study based on pre and post test design. Based on purposive sampling a sample consisting of ten obsessive compulsive disorder patients selected and age range of 20-45 year  either sex, on the basis of ICD-10 DCR criteria. The patient was treated by cognitive behavior techniques. After 20 sessions of therapeutic intervention programme significant improvement was seen. He was under follow up of 3 month and reached to level of social functioning. Appropriate descriptive statistics Mean, SD, and t-ratio was calculated for analysis of data.

Key words: Cognitive Behavior Therapy (CBT), OCD

Spirituality and Religious Practices and Executive Function

Impact of Spirituality and Religious Practices on Executive Function in Paranoid and Undifferentiated Schizophrenia

*Rupesh Ranjan et al 

Objective: Spirituality and religiousness have been shown to be highly prevalent among patients with schizophrenia .However, clinicians are rarely aware of the importance of spirituality and religiousness. Executive function refers to host neuro cognitive activities that are associated the prefrontal cortex such as planning, problem solving, shifting, cognitive set and alteration between two or more tasks (Green 1998). This study examined the spirituality and religious practices and executive function in paranoid and undifferentiated schizophrenia.

 Method : The sample included 75 right handed male subjects .who were divided in three groups- normal control, paranoid and undifferentiated schizophrenia. After initial screening using GHQ-12 for normal control and BPRS for schizophrenia were selected. Self made semi structure interview about spirituality religious practices conducted on among schizophrenia group. After that WCST were administered to all of them, according to standard procedure.

Results: The findings were as follows: all groups were well matched except for marital status & occupation. Paranoid schizophrenia shows more spirituality and religious practice compare to undifferentiated schizophrenia. The performance of normal control on WCST better than schizophrenia and within schizophrenia paranoid had less deficits in executive function compare to undifferentiated schizophrenia.

Conclusion: Thus, it can be concluded that executive functioning  of schizophrenics, are impaired in comparison to normal subjects. Within the schizophrenics subgroups the greatest impairment exists in undifferentiated schizophrenics patients and spirituality and religious practice is an important issue for patient with schizophrenia and importance in executive function.    

Key words: Spirituality, Executive Function, Schizophrenia, WCST

Critical evaluation of Freud’s theory

Critical evaluation of Freud’s theory

Status of Freud’s theory as a scientific one

·        Question of reliability and validity

·        Question of generaliability and representativeness

·        Quantifiability

Status of coherence of Freud’s theory

·        System of interpretation

·        Delineation of cause and effect relationship

·        Deemphasizing important influence on personality

Freudian psychotherapy

Strength of Freud work

Status of Freud’s theory as a scientific one

 ·        Question of reliability and validity

 An often made criticism of Freudian theory is that, many of the Freudian hypotheses are not testable, since one criterion for valuable scientific theory is its ability to generate testable hypothesis.

eg, if Freudian theorist conclude that , patient has a strong unconscious hatred  for  his sister what sort of evidence would demonstrate that  the conclusion is correct or incorrect.

If the patient says she cannot remember any negative feeling towards sister –according to Freud she is repressing them.

            

If the patient describes how much she loves her sister. Freud would infer it as reaction formation and if the patient she harbor some negative feeling towards her sister Freud would argue that the therapy has been successful in bringing the material into consciousness. Thus if the hypothesis generated by the theory cannot be unsupported them neither can it be truly supported. This makes the theory less scientific. Moreover, the theory does not lend itself for empirical validation for e.g. it is impossible to derive any empirical proposition from the postulation of death wishes.

Freud has also been criticized for accepting at face value whatever   a patient said, without attempting to corroborate it by some external evidence.

 ·        Question of generaliability and representativeness

 Freud based his theory on a very small number of observations.

E.g., question are being raised as to, in how many cases did he find an association between paranoid and homosexuality, hysteria and oral fixation etc.

Also Freud’s patients hardly representated typical adults. Not only did they come from relatively wealthy and educated European families they also were suffering from psychological disorders.  Thus it will be an illogical assumption to expect that the minds of the patients function the same as the mind of average psychological healthy adult. Thus, Freud’s  theory lacks the capacity to generalize its concepts to diverse social and cultural backgrounds.

 ·        Quantifiability

 Thirdly the theory stands silent on the problem of how to quantitatively measure certain concept for e.g. cathexis and anticathexis.

 Status of coherence of Freud’s theory

·        System of interpretation

Freud has never given any systematic account of his method of analysis and his inductive and deductive operations.

Consequently it is practically impossible to repeat any of the Freudian investigation in accordance with original design. Thus other investigators have often reached at different conclusion and interpretation of ostensibly by the same phenomena.

Moreover he is accused of drawing inference and reaching conclusion by a line of reasoning that was rarely made explicit.

 ·        Delineation of cause and effect relationship

 Secondly Freudian theory is markedly deficit in providing set of relational rules by which one can arrive at precise cause and effect relationship between traumatic experience, dreaming  , repression etc. what concepts the formation of superego with Oedipus complex?

 ·        Deemphasizing important influence on personality

 Freud Theory has also been attacked on the grounds that he ignored or deemphasized important influences on personality other than childhood. E.g. Freud failed to recognize how experiences beyond the first five years of life could affect the personality. Freud has also been criticized for over emphasis on an instinctual basis of personality at the expense of important social and cultural influences. Still other look issue with Freud’s tendency to concentrate on psychological disorders rather than on daily functioning and positive aspects of personality.

 Freudian psychotherapy

 Freud’s therapy has been criticized for being an extremely time consuming and costly process. Freud has also been unsystematic regarding the structure, frequency and duration of the therapy necessary to bring about change.

One of the most serious limitations of psychoanalytic therapy is that its use is restricted for a narrow section of the population educated, intelligent, and resourceful with good capacity for verbal expression. 

 Strength of Freud work

 Freud’s theory is said to be first comprehensive theory of human behavior and personality. The shape of more recent approaches to personality, even though far removed from Freud’s theory has probably been influenced by Freud.

Freud is also the pioneer who popularized and promoted psychological principles and their role in the development of personality as well pathology. Freud can be credited with developing the fist system of psychotherapy.

CLINICAL PSYCHOLOGIST

Introduction

The different approaches towards the treatment of behavioural problem are referred as psychotherapy and is been done by a trained professionals. It is a form of helping or help giving in which trained healer or therapist tries to relieve a sufferer’s distress by facilitating certain changes in his feelings, attitudes and behaviour. So the therapist does not force but console the patient. It may be defined by psychological means. It also defined in terms of special kind of relationship or interpersonal relationship in which unique types of social learning, emotion arousing interactions and growth experience takes place.

Concept of Clinical Psychologist

Clinical psychologist may be confused with psychiatrist, which generally has similar goals (e.g. the alleviation of mental distress), but is unique in that psychiatrists are physicians with medical degrees. As such, they tend to focus on medication-based solutions, although some also provide psychotherapeutic services as well. In practice, clinical psychologists often work in multidisciplinary teams with other professionals such as psychiatrists, occupational therapists, and social workers to bring a multi modal approach to complex patient problems.

a. Psychiatrist: The psychiatrist is a Doctor of Medicine who has specialized in the field of mental health, being a doctor; he can prescribe the patient medicines.
 Clinical Psychologist: The clinical psychologist is postgraduate in psychology and has specialized in clinical psychology. A professional specialty concerned with diagnosing and treating diseases of the brain, emotional disturbance, and behavior problems.

c Psychiatric Social Worker: The psychiatric social worker assists the psychiatrist in interviewing the family in their residence and helping the patient to cope up with the problems of daily living after discharge.

d. Psychiatric nurse: The psychiatric nurse is a graduate in nursing who has specialized in psychiatry. He/she play an important role in ward management of admitted patients, carrying out observation of patients, administering medicines as prescribed and helping in restraining violent and suicidal patients.

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