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
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.
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
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…
Psychotherapy 
• Have a diagnosis 
• Is there an indication for psychotherapy 
• Does the patient fits well into the paradigm?
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?
Seating
Time
Place
Qualities of a Psychotherapist
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!”
Being Monitored
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
The therapist has many patients. 
The patient, one therapist
Which Therapy is the Best
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
Therapist disclosures – 3 kinds 
• Be transparent 
• Use discretion 
• Use caution
Revealing your personal life 
Why 
What 
How
Do patients want to hear your life 
story
On being helped by your patient
Encourage patient self disclosure
Feedback – Johari Window
How to talk about 
God Death 
Sex 
Meaning 
of life
Helping patients to assume 
responsibility
Never make decisions for the patient
Blocks in therapy 
Forms of 
transference 
Types of 
resistance
Facilitate awareness 
• Encourage self monitoring
Should advices be given?
Notes on each session
What to do if patient… 
• Weeps 
• Gets irritated
Taking care of yourself
Express your dilemmas openly
Home visits therapy?
Should everything have a psychological 
explanation
Should you touch the patient? 
• Where 
• When 
• How
Your feelings for the patient… 
Sexual 
Love 
Compassion 
Involvement
Promises given to patients
Interview with significant others
Previous therapist
Freud was not always Right 
Freud was not always Wrong
CBT is not everything
Dreams – Use them 
First 
Last 
Recurring 
Distressing
Dreams about therapist
Thanks…

Psychotherapy