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Madam Maryam Noor Chapter 1 Psychotherapy Definition It attempts to bring behavioral change through psychological method most frequently

ly process of communication between patient and another person called psychotherapist. The term psychotherapy embraces a wide variety of techniques whose goal is to help the emotionally disturb individual to modify his behavior so that he could adjust satisfactorily to his environment. Psychotherapy is the formal treatment of patients using psychological rather than physical or chemical agents, principally verbal communication. Psychotherapy may be defined as the treatment of emotional or personality problems and disordered by psychological means. Psychotherapy is the treatment, by psychological means, of problem of an emotional nature in which a trained person deliberately establishes a professional relationship with the patient with the objective of (1) removing, modifying, or retarding the existing symptoms, (2) mediating disturbed pattern of behavior, and (3) promoting positive personality growth and development. MAJOR CATEGORIES OF PSYCHOTHERAPY Three major categories SUPPORTIVE THERAPY Aims at correction of symptoms/problems without producing deeper changes.(guidance, catharsis) REEDUCATIVE THERAPY Helps the person to relearn and correct certain pattern behavior. (CCT, CBT) RECONSTRUCTIVE THERAPY Involves some modification of behavior. (psychoanalysis, Play therapy) NEEDS OF THE PATIENT The need to be dependent The client while entering in the therapy process come with the feeling of dependency as he is unable to solve his problem and feel helpless, so he needs some one who could help him in his disturbance. The need for unqualified (non judgmental) understanding Client is in need of such attitude in which his mistakes are not taking as the part of his personality. And that therapist not considers him as a bad person, but take him a person with mistakes. The need to relieve one self of painful ideas and feelings He is in need of such guide ness that can help him in his disturbance so that he could live his life peacefully. The need for factual understanding (why me?) 1

The client is always confused in his mind about question that why he suffers too much in life and others are satisfied with their life. The need for transference relationship The client is in search of such person by which he can project his past relationship and the conflict with them as he felt burdensome by keeping them in his unconscious. The need for cooperative relationship As the client feel dependant on others, he wants therapist to be actively involve in the solution of his problems. MULTIPLE ROLES OF THE THERAPIST Therapist is a person who heals, a friend who console, authority who guides, teacher who educate, catalyst who accelerate personality growth. Therapist as a healing authority Therapist as an idealized parental image Therapist as an actual parental representative Therapist as a representative of important past person (transference) Therapist as a cooperative partner. ETHICAL CONSIDERATION IN PSYCHOTHERAPY EHTICS is the study and evaluation of human conduct with respect to standards of behaviors which can either individual or social. INFORMED CONSENT Inform the client about the Nature Anticipated course of time Fees And involvement of third party and most important the limits of confidentiality and provide opportunity for the client to ask question and receive answers. Discuss that in need the assessment of supervisor will be seeked. Below age 18 we take inform consent from parents and care givers. ISUES IN INFORMED CONSENT; Inform consent before registering a client for assessment. To clarify the nature of psychological tests, purpose of the tests and whether the result should be shared with him or not. Inform consent for discussing information with the supervisor. LENGTH OF THERAPEUTIC SESSION AND THERAPUTIS RELATIONSHOP Exact time will be given to the client not extra time without fees. But in some important cases therapist has to give extra time but dont make it routine. Continue therapeutic relationship as long as it is reasonably clear that clients are benefiting from relationship. FINANCIAL ARRANGEMENTS By entering into therapeutic relationship explain financial arrangements and fees related to professional services. 2

CLOSING OF PRACTICE The therapist should handover the case to some one else if he is no more providing professional services in the area. Arrangements should be made to maintain confidentiality and safeguard the welfare of client. CONFIDENTIALITY; Confidentiality is important for maintaining trust. The identity of the client must be protected. Psychologist is accountable to their clients and to their profession for the management of confidentiality. Psychologist should ensure the protection of sensitive information from unauthorized disclosure. BREAKING OF CONFIDENTIALITY There are certain conditions in which confidentiality can be break. With minors/children Severe psychotic individual who can be a threat to themselves or others. Highly aggressive individual that can do harm to others/therapist. Suicidal clients. DISCUSSION OF CASES WITH OTHER COLLEGUES Cases can only be discussed with supervisor for the purpose of consultation but keeping the limits of confidentiality. EXCHANGE OF GIFTS BETWEEN CLIENT AND THERAPIST. Any such act is not permitted in the therapy. SEXUAL RELATIONSHIP WITH CLIENT Therapist should avoid such kind of relationship but if faced with such condition clinical psychologist should carefully consider ethics before entering into personal relationship with the client. He can establish marital relationship with client after 2 years of termination of therapy. TERMINATION Terminate the client when it is Reasonably clear that the client no longer need the services. If he is not likely to benefit from the therapy Being harmed by continued services. RECORD KEEPING
a) Mental health counselors create, maintain, store, transfer, and dispose of client records in ways that protect confidentiality and are in accordance with applicable regulations or laws.

b) Mental health counselors establish a plan for the transfer, storage, and disposal of client records in the event of withdrawal from practice or death of the counselor that maintains confidentiality and protects the welfare of the client. DUAL RELATIONSHIP

Dual relationship arises when the clinical psychologists has two or more kind of relationships concurrently with the client, e.g., client and trainee, family relationship, colleague and supervisor, friend etc. This dual relationship is seldom natural so it is better to avoid it but in cases where it is unavoidable great care should be taken. MORAL VALUES OF THE THERAPIST; RESILIENCE The competency to work with client concerns without personally diminished. HUMILITY Is the ability to assess accurately and acknowledge ones strengths and weaknesses. COMPETENCE Is the ability to work skillfully in ones profession. FAIRNESS Consistent application of appropriate criteria to take decision and action. WISDOM Possession of sound judgment. COURAGE The capacity to work or to act in risk, fear and uncertainty. SINCERITY A person commitment to consistency between what is professed. INDIGNITY Commitment to being moral in dealings with others i.e., personal straight forwardness. ETICAL ISUES WHILE DEALING WITH MINORS; INFORMED CONSENT Professionally from parents/guardian but ask client who is in age that can understand psychological assistance. Issues in confidentiality Where to break Knowledge and experience to deal with minors High level of tolerance and effective control is important Awareness of childs rights and protection services Ability to deal with cases of abuse. Skills and competency in parental counseling. Knowledge of effective treatment approaches. Unbiaseness. Understanding of developmental stages and normal development. DONTS OF PSYCHOTHERAPY DO NOT ARGUE WITH THE CLIENT Do not argue with, minimize or challenge the patient. If the patient presents a point of view that is obviously prejudiced or distorted, one should avoid argue or challenged the patient.

DO NOT PRAISE THE PATIENT; Do not praise or give false reassurance to the patient. Because the patient self esteem is so damaged, he or she will probably be unable to accept any praise even though it is sincerely offered and realistically justified. DO NOT MAKE FALSE PROMISES This can be greatly damaging to the patients trust in the therapist. DO NOT INTERPRET THE DYNAMICS OF THE PATIENT; Never interpret or speculate on the dynamics of the patient as at times these were not clear and this will lead to inappropriate dealing on the part of the therapist. DO NOT OFFER A DIAGNOSIS Do not offer a diagnosis even if the client insist on it because the patient will use it as a masochistic torture weapon and it is impossible to make a complete diagnosis without studying a patient over a period of time. DO NOT QUESTION THE PATIENT ON SENSITIVE AREARS OF LIFE It is important not to interrogate the patient on sensitive points, particularly appearance, status, sexual difficulties, and failure in life. An opening may be given the patient to talk about these, but if blocking occurs, it should be respected until some later date when the relationship is sufficiently firm. DO NOT PUT THE PATIENT ON COUCH; The establishing of rapport and the eliciting of important data are best accomplished in face to face interviewing. DO NOT TRY TO SELL THE PATIENT ON ACCEPTING TREATMENT; Once the facts are presented to the patient, the choice of whether therapy is pursued must be the patients. DO NOT JOIN IN ATTACK THE PATIENT LAUNCHES ON PARENTS, MATE, FRIEND, OR ASSOCIATES; Because the patient feels ambivalent about people he or she attacks, the therapist criticism of these people may be resented. The therapist best response is sympathetic listening, not defending, condemning, or condoning the person attacked. DO NOT PARTICIPATE IN CRITICISM OF ANOTHER THERAPIST; Even if the patient presents accounts of unprofessional behavior, it is bad practice to criticize another therapist.

Counselor or Psychotherapist?
The Difference Between Counseling and Psychotherapy
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By Nancy Schimelpfening, About.com Guide "Psychotherapy" and "counseling" are terms that are often used interchangeably. Although they are very similar, there are some subtle differences as well. Technically speaking, "counselor" means "advisor". It involves two people working together to solve a problem. It is a term that is used in conjunction with many types of advice giving. For example, financial planning and spiritual guidance are both types of counseling. Just about anyone at all may claim to be a counselor if they are in the role of giving advice. The term counseling may also properly be used to refer to what occurs in a relationship with a psychotherapist. In the context of mental health, "counseling" is generally used to denote a relatively brief treatment that is focused most upon behavior. It often targets a particular symptom or problematic situation and offers suggestions and advice for dealing with it. "Psychotherapy" on the other hand is generally a longer term treatment which focuses more on gaining insight into chronic physical and emotional problems. It's focus is on the patient's thought processes and way of being in the world rather than specific problems. In actual practice there may be quite a bit of overlap between the two. A therapist may provide counseling with specific situations and a counselor may function in a psychotherapeutic manner. Generally speaking, however, psychotherapy requires more skill than simple counseling. It is conducted by professionals trained to practice psychotherapy such as a psychiatrist, a trained counselor, social worker or psychologist. While a psychotherapist is qualified to provide counseling, a counselor may or may not possess the necessary training and skills to provide psychotherapy. Some common issues for which psychotherapy is helpful are as follows:

Relationships marriage, parenting or work Trauma and loss death, divorce, illness, violence or abuse Identity personal, career or sexuality Psychological Pain depression, anxiety, grief or stress Personal Development love, intimacy, creativity or spirituality Sports psychology performance, teamwork or motivation Physical illness particularly chronic and life-threatening

The length of psychotherapy varies greatly depending on the issues being dealt with and the goals of the client. Frequently people are able to make substantial changes and feel better in a relatively short period of time. Deeper, long-standing issues, particularly when there has been much loss or trauma, or a serious commitment to a personal growth process, may take months and even years. A skilled psychotherapist will guide you in setting realistic goals for therapy and respect your own judgment in determining when to end therapy.

When choosing a psychotherapist, it is helpful to find a therapist whom you feel comfortable with and respected by. Most therapists will offer you an opportunity to interview them by phone or in person. Psychotherapists come from many different backgrounds in training and theory but generally have a master's or doctorate degree in psychology, counseling, pastoral counseling or social work. In Colorado, all psychotherapists are required to be registered in a state-wide database.