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Here is a compilation of essays on the ‘Reconstructive Psychotherapies’ for class 11 and 12. Find paragraphs, long and short essays on the ‘Reconstructive Psychotherapies’ especially written for school and college students.
Essay on Reconstructive Psychotherapies
Essay Contents:
- Essay on Freudian Type Reconstructive Psychotherapy
- Essay on Jung’s Therapy
- Essay on Adlerian Therapy
- Essay on Klein’s Theory
- Essay on Intensive Psychoanalytically Oriented Psychotherapy
- Essay on Brief Psychodynamic Psychotherapy
- Essay on Marital Therapy
- Essay on Family Therapy
- Essay on Group Psychotherapy
- Essay on Combined Therapy
Essay # 1. Freudian Type Reconstructive Psychotherapy:
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The key concepts of the form of psychological treatment elaborated by Freud in 1890s are:
a. Free association:
It is the spontaneous, uncensored verbalization by the patient of whatever comes to mind. It has replaced “hypnosis”.
b. Interpretation:
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The process by which the therapist brings the patient to an understanding of a particular aspect of his problems or behaviour.
c. Transference:
The unconscious assignment to others of feelings and attitudes that were originally associated with important figures (parents, siblings etc.) in one’s early life. In patient-physician relationship, the transference may be negative (hostile) or positive (affectionate). Absence of transference, positive or negative can be a serious obstacle to therapist.
d. Counter transference:
The psychiatrist’s partly unconscious or conscious emotional reaction to the patient.
e. Unconscious:
The part of the mind or mental functioning of which the content is only rarely subject to awareness. It is a repository for data that have never been conscious (primary repression) or that may have become conscious briefly and later repressed (secondary repression).
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f. Resistance:
One’s conscious or unconscious psychologic defense against bringing repressed (unconscious) thoughts to light. (There are also “preconscious” accessible to recall and “conscious” components of mind).
g. Repression:
A defense mechanism operating unconsciously, that banishes unacceptable ideas, fantasies, affects or impulses from consciousness or that keeps out of consciousness what has never been conscious. It is often confused with the conscious mechanism of suppression.
The components of repression are:
Dissociation from the self of the unconscious idea leads to failure of comprehension of the enacted idea, so there is then unresponsiveness to feedback, and acts are not regulated (leading to repetition compulsion).
Repression also has abnormal motivational state (since unconscious motivation still drives the acts) and repression of memory (the data are preserved in the unconscious).
i. Therapeutic or working alliance:
The normal, adult relationship between therapist and patient. The therapeutic alliance leads to the transference neurosis which leads to the counter-transference neurosis. The transference neurosis is interpreted to the patient; the counter transference may or may not be resolved.
ii. Transference neurosis:
It is the term for the neurotic and other inappropriate attitudes towards the analyst and as these include later patterns of neurotic behaviour, it helps the analyst to gain some insight into the patient’s character structure.
iii. Manifest dream content during analysis:
Manifest dream content acts as an aid to communication during analysis. It has specific uses e.g., direct exposure on the less-discussed affect laden content; a vocabulary of a unique and specific character with its catalogue of rerence points; facilitation of memory for significant achievements in the analysis; resolution of conflict and sequestration of neurotic problems expressed in manifest dream content and a reference point for analysis of counter-transference.
Working through:
Repeatedly experiencing a conflict, in the transference situation, so that it may be resolved. This is the constant repetition of interpretation which had sufficed to give the patient insight into his neurotic conflicts. Gottesman (1975) stressed the four ‘R’s in working through- Recollection, Repetition, Restitution and Recall.
Psychic apparatus:
Freud postulated the three components of psychic apparatus:
Id:
It contains unorganized, unconscious instinctual impulses.
Ego:
The part of the id which has been modified by the direct influence of the outside world and represents rationality. It has many functions (e.g., maintaining relationships with reality; regulation and control of drives (libido theory); relationships with other people (object relations theory); cognitive’ defensive; synthetic (the ability to hold together as a person and autonomous).
Superego:
The part of the ego from which self- criticism, self-control, self-hatred and self-recrimination arise. It is mainly unconscious (ego-ideal) and partly conscious (the ‘conscience’). Freudian theory envisages the ego using various defence mechanisms to control the impulses of the id unacceptable to the superego.
Essay # 2. Jung’s Therapy:
Jung’s divergence from Freud was due in part of to the former’s idea of neurosis as a one-sided development of the individual and to the Jungian concept that the unconscious compensated for this imbalance. For Jung, neurotic symptoms were not always residues of childhood experience as Freud insisted but could be understood on the part of the mind to correct its own lack of balance. Jungian therapy emphasizes the value of patients pursuing the products of unconscious fantasy through dreams, reveries and artistic creativity.
In the course of analysis, patients encounter various typical ‘primordial’ images or archetypes, which are familiar in myth, fable and fairy stories. In order to attain balance and integration, the individual must recognize and differentiate himself from the immensely powerful influence of such archetypal images which are, in many instances, projected upon actual people in the external world.
The key concepts in Carl Jung’s (1875-1961) school of Analytic Psychology include:
i. Psychic apparatus:
There are three levels of psyche:
a) Conscious includes the persona.
b) Personal unconscious.
c) Collective unconscious (racial, universal).
ii. Persona:
The outer crust of the personality which is opposite of the personal unconscious on the dimensions of:
a) Thinking/feeling,
b) Sensuousness/intuition.
c) Extrovert/introvert (related to direction of flow of mental energy).
iii. Archetypes:
The generalized symbols and images within the collective unconscious.
They include:
a. Animus:
The unconscious, masculine side of the woman’s female persona.
b. Anima:
The unconscious feminine side of the man’s persona.
c. Complex:
A group of interconnected ideas which arouse associated feelings and effect behaviour.
Essay # 3. Adlerian Therapy:
Adlerian psychology reflects its founder’s view that aggression, in the sense of self-assertion and the will to power, takes precedence over sex as the prime mover of human behaviour. Adler conceived the infant and child as feeling weak and inferior and driven to achieve in order to overcome such feelings. Adler popularized the concept of striving and modified it into something akin to self-actualizing, a goal of completion aspired but never attained.
His view of ‘organ inferiority’ whereby infantile weakness could be expressed through deficiencies and dysfunctions in particular organs of the body provided a psychological foundation for the development of psychosomatic medicine.
Alfred Adler (1870-1937) founded the school of Individual Psychology and the theories of organ inferiority, concept of psychic compensation, fictive goals and drive for superiority (importance of power and social significance and psycho- dynamic) to overcome inferiority complex. (For differences with Freudian type See Table 34.8).
Essay # 4. Klein’s Theory:
Melanie Klein focuses on the relationships of the developing infant with other couple. Klein emphasizes the importance of fantasy in the first two years of life. The infant’s love and hate are initially directed towards the mother who represents the child’s whole world.
The lack of cohesion of the infantile ego results in the splitting of impulses into good and bad and one consequence is that the infant views the mother as split into good and bad parts, hereby adopting the so-called paranoid schizoid position.
As the ego matures and becomes more integrated, this splitting decreases and the mother’s good and bad parts and the baby’s internalized image of her can be synthesized. Now the child fears that his mother may be damaging to her, a realization which leads to sadness, guilt and concern, the depressive position.
This is slowly worked through as the child grows but these depressive and persecutory anxieties can return when internal and external pressures become intense. The essential difference of Kleinian from Freudian theory is that, in contrast to the Freudian emphasis on the satisfaction of instincts, the object-relations theorists focus on early object seeking and relating.
These forms of psychoanalytic therapy are time-consuming, involving the subject in two years or more therapy, conducted on a five-days-a-week, one-hour- a-day basis and demanding in terms of money and commitment.
The important features of psychoanalysis are given in Table 34.9:
Indications:
Psychoanalysis has been useful in the treatment of obsessional disorders, anxiety disorders, dysthymic disorders and moderately severe personality disorders.
Essay # 5. Intensive (long term) Psychoanalytically Oriented Psychotherapy:
Intensive (long term) Psychoanalytically Oriented Psychotherapy (also known as psychoanalytic psychotherapy, psychodynamic psychotherapy, explorative psychotherapy). It is a psychotherapeutic procedure which recognizes the development of transference and resistance in the psychotherapy setting. The same patients who are treated with psychoanalysis can be treated in psychoanalytic psychotherapy.
The important characteristics of this type of psychotherapy are given in Table 34.10:
Essay # 6. Brief Psychodynamic Psychotherapy:
It requires the therapist to confront his or her own ambitiousness and perfectionism as well as only exaggerated ideal of personality structure and function. Brief psychotherapy is distinguished from more long-term treatments by the time limits placed upon this endeavour. Over 200 brief psychotherapy types have been described.
Some of the important types of brief psychodynamic psychotherapy are given in Table 34.11:
Essay # 7. Marital Therapy:
In marital therapy, treatment is given to both partners in a marriage. The term ‘couple therapy” is sometimes used to include people living in common law cohabitation (Family therapy, which is discussed later, differs in including one or more other family members, usually children).
Definition:
Marital therapy, the treatment of marital relationship, refers to a broad range of treatment modalities that attempts to modify the marital relationship with the goal of enhancing marital satisfaction or correcting marital dysfunction. In marital therapy, the marital relationship is considered to be the “patient”, rather than the individual spouses.
Marital therapy differs from marital counselling on theoretical and technical basis i.e., marital therapy employ varied, extensive assessment techniques and utilize the systematic knowledge of personality, learning and communicational systems theory to achieve the goal whereas marriage counselling includes a very broad range of disharmony. This ranges from giving advice on concrete problems such as division of household chores, to intervening to change maladaptive behaviours.
Indications:
Marital therapy is indicated in a wide range of situations where marital dysfunction symptomatology or disability in a married person in present.
a) Presence of overt marital conflicts that result in recognizable suffering of both spouses.
b) Presence of covert marital disorder in form of symptomatology or dysfunction in one of the spouses or the children.
c) Poor communication problem.
d) Extramarital relationships.
e) When individual therapy has failed or is unlikely to succeed due to poor motivation or limited ability to communicate with the therapist.
f) Eruption of symptoms in a family member coincides with the outbreak of marital conflicts or when gross distortions of reality are held jointly by the couple increasing the risk of marital instability.
g) When there is danger of marital instability due to improvement of a mentally ill patient or when the healthy “spouse” develops symptoms.
Contraindications:
These are relative and few and include:
a) Premature exposure of the spouses to marital secrets such as homosexuality, criminal involvement of a spouse, or an extramarital affair. This may lead to abrupt interruption of treatment or termination of marriage.
b) If the spouses use the sessions consistently to attack each other and seek therapist’s assistance with their destructive efforts, conjoint marital therapy is contraindicated.
c) Lack of commitment of continuation of the marriage.
Essay # 8. Family Therapy:
History:
Nathan Ackerman, psychoanalyst and group therapist, developed the idea of family therapy as a result of his experience in the psychotherapy of children; he observed parents developing neurotic symptoms or marital dysfunction as their child improved. He pioneered the use of confrontation, interpretation and manipulation of metaphor to cut through the characterological defenses of the family members.
Don Jackson, Jay Halley, Virgin Stair and Gregory Bateson are associated with the study of communication between schizophrenics and their families. Murray Bowen evolved the idea of the ‘undifferentiated ego mass’ family, the related concept of personal individuation as essential to mental health.
General principles:
The essential features of family therapy are the following concepts:
i. The parts of the family are interrelated.
ii. One part of the family cannot be fully understood in isolation from the rest of the system.
iii. Family functioning cannot be fully understood by simply understanding each of the parts.
iv. A family’s structure and organization are important factors determining the behaviour of family members.
v. Transactional pattern of the family system shapes the behaviour of family members.
Resistance:
Typical fears underlying resistance to a family approach are:
a) Fear felt by parents that they will be blamed for their child’s difficulties.
b) Fear that the entire family will be pronounced ‘sick’.
c) Fear that a spouse will object.
d) Suspicion that open discussion of one child’s misbehaviour will have a negative influence on younger siblings.
Family:
Usually all members of the nuclear household are included in the evaluation. In some circumstances, even young children or members of extended families or others (friends, colleagues etc.) may be included.
The interview is always directed and controlled by the therapist. Transference to the therapist is only rarely a tool of family treatment. Family therapy is given in sessions of 11/2 to 2 hours sessions (sometimes longer with intermission). Length of treatment depends not only on the nature of the problem but also on the therapeutic model.
Sequence of treatment:
It consists of joining (the therapist makes contact with each family member in such a way that each feels heard, understood and respected), contracting (mutual understanding between therapist and family), data collection (using different models discussed below),introduction of change (problem-solving with focus on outward and inward reverberations) and long-term contracts (once the original complaint has improved).
Different models:
They are described in Table 34.12:
Indications:
Family therapy has been used in all types of psychiatric problems including the psychoses, reactive depression, anxiety neurosis, psychosomatic illness, substance abuse and various childhood psychiatric problems.
Contraindications:
These are same as those for psychotherapy and include:
a) Lack of adequately trained therapist (only true contraindication).
b) Poor motivation.
c) Fixed character pathology e.g., lying, physical violence.
d) Extreme secrecy.
Essay # 9. Group Psychotherapy:
Group therapy is effective and appeals to both patients and therapists. It is relatively easy to teach and can be combined with individual therapy and the same number of therapists can treat more patients.
History:
Joseph H. Pratt (not a psychiatrist but an internist) began the practice of group therapy. His first group composed of tuberculosis patients. In 1919, L. Cody Marsh applied the group methods of treatment to institutionalized mental patients. The other scientists who pioneered different methods of group-therapy were E.W. Lazell (Didactic lectures to schizophrenic patients), Trigant Burrow (group analysis), Paul Schilder (free association in group therapy), Slavson (activity group therapy), Alexander Wolf (Psychoanalysis in groups), J.L. Moremno (Psychodrama, has been discussed in this article), Freud (Group Psychology; leaderless and leader- centred group); Alfred Adler (Relationship of group to the individual and vice versa).
Definition:
Group psychotherapy is a form of treatment in which carefully selected emotionally ill persons are placed into group, guided by a trained therapist for the purpose of changing the maladaptive behaviour of the individual member.
Preparation:
The patient is prepared for the group therapy sessions by explaining the processes to which the patient will be exposed, emphasizing the need to be open and honest with co-patients, and finally, alerting the patients to the possibility that he may not like all the other members nor they the patient but by examination that evolves, self- knowledge will increase.
Patient selection:
The specific membership criteria for a given therapy group can vary widely from one type of group to another and are intimately linked to the goals of the group.
The general membership criteria for group therapy are:
Therapeutic Factors in Group Therapy:
Yalom has derived an atheoritical 11 -factor inventory of the therapeutic mechanisms operating in group therapy.
It includes:
i. Instillation and maintenance of hope:
Faith in the treatment mode.
ii. Universality:
Disconfirmation of a patient’s sense of uniqueness comes as powerful sense of relief.
iii. Impairing of information:
Didactic instruction about mental functioning, direct guidance about life problems.
iv. Altruism:
Patients offer each other support, reassurance, suggestions and insight.
v. Development of socializing techniques:
The development of basic social skills.
vi. Imitative behaviour:
Imitation of healthy behaviour.
vii. Catharsis:
Ventilation of emotions.
viii. Corrective rehabilitation of primary family group:
Reaction of family conflicts.
ix. Existential factors:
Acceptance of some existential issues e.g., death (bereavement), isolation, freedom and meaninglessness.
x. Group cohesiveness:
Attractiveness that members have for their group and for the other members.
xi. Interpersonal learning:
Encouragement of interpersonal exploration.
xii. Therapist’s basic roles:
The basic roles of a therapist are given in Table 34.13.
Special indications:
The main uses of group therapy include:
i. Schizophrenia
ii. Affective Disorders
iii. Neuroses (Anxiety Neurosis, Phobic Disorders)
iv. Personality Disorders (schizotypal, borderline, schizoid, passive-aggressive, dependent, avoidant, rarely antisocial type)
v. Disorders of Impulse Control
vi. Adolescent disorders
vii. Other disorders e.g., homosexual conflict disorder, transvestism, gender identity disorder, alcoholism and other substance abuse disorders, juvenile delinquency etc.
Types of group psychotherapy:
They are given in Table 34.14:
Therapeutic techniques:
The therapist’s task is to bring the necessary processes to bear on the problems of the various members in the group or on the group as a whole to achieve the desired therapeutic goals.
The main techniques used in group therapies are:
i. Dream analysis:
The technique outlined by Freud, useful in individual and group therapies).
ii. Free association:
Free Association one member’s thought or feeling is followed by another member’s thought or feeling.
iii. Go-round:
Each member respond in turn to a specific thought, feeling, behavioural pattern, topic or theme introduced by a patient or by the therapist.
iv. Co-therapy:
Greater authority or dominance is avoided and the co-therapist of different sexes stimulate the replication of parental surrogates.
v. New member:
A new member may be welcomed and quickly integrated into a group.
vi. Acting out:
Patient attempts to avoid tension through activity, usually sexual or aggressive.
vii. Alternative sessions and after sessions:
Alternate sessions without the therapist or after sessions just after a session with the therapist.
viii. Electronic recording:
Patients see themselves interacting with others.
ix. Movies and photographs:
Home movies or early childhood or current life to receive impressions from other members as to their content.
x. Termination:
Discharge of a patient after goals have been achieved.
Various models:
The various types of groups which have been used in group therapy include:
i. Impatient groups:
To improve consultation liaison services by improving communications between professionals of different specialities and also to improve the therapeutic experience of the patient.
ii. Encounter, sensitivity and training (T-) groups:
Encounter, sensitivity and training (T-) groups used in variety of mental disorders and in individuals with personality problems.
Essay # 10. Combined Therapy:
Combined individual and group therapies may be used with many advantages of both methods of therapy.
Definition:
In combined therapy, the patient is seen individually by the therapist and also takes part in group sessions on regular basis.
Indications:
The important indications of combined therapy include:
i. Patients with specific conflicts:
Patients with specific conflicts e.g., having incestuous manner of relating to others, show difficulty in pairing situations, problems dealing with isolation, tend to act out, very silent in dyadic treatment, orally frustrated and possesses paranoid trends etc.).
ii. Patients in certain diagnostic categories:
Patients in certain diagnostic categories e.g., personality disorder (borderline, narcissistic, schizoid, dependent, passive-aggressive), male homosexuality.
iii. Other indications:
Other indications e.g., patients acceptable to psychoanalysis but lack time, money or access to psychoanalyst; patients in termination phase of psychotherapy.