Introduction to Rabindrik Psychotherapy

Introduction to Rabindrik Psychotherapy
Dr. D. Dutta Roy, Ph.D.
Psychology Research Unit
Indian Statistical Institute
Kolkata - 700108
Lecture given at the certificate course students of Performing Art Therapy Centre, RBU dated 7.12.2012.

Reader is requested to make comment on the article.


Q1. What is psychotherapy ?
The term psychotherapy refers to the treatment of psychological disorders through the use of psychological methods rather than physical means like drugs or surgery.
Verbal communication between therapist and client is the most significant element of psychotherapy. It can be carried out individually or in groups. It is concerned with the evaluation of problems and possible solutions as well as with the encouragement of more adaptive ways of thinking and behaving.

Q2. What are the main models of psychotherapy?
Psychodynamic
Behaviour therapy
Existential
Gestalt
Rational emotive therapy
Transactional analysis
Rabindrik psychotherapy

Q3. What is Rabindrik Psychotherapy ? How does it differ from other therapies ?

Rabindrik psychotherapy refers to the way of self-awakening through the use of therapeautic postulates extracted from the literary works of Rabindranath Tagore. It can be used for treatment of psychological disorders. Postulate refers to theoretical assumption. Theory is composed of postulate.
Here, therapist acts as facilitator. Therapist creates the environment through performing arts of Tagore that leads client to understand own conflict and its management. Both verbal and non-verbal communication between therapist and the client are followed. Therapist must have adequate knowledge about therapeautic postulates extracted from the literary works of Rabindranath Tagore.

Q4. What are the similarities and dissimilarities between Rabindrik psychotherapy and other therapies?

All psychotherapies aim at treatment of psychological disorders. But Rabindrik psychotherapy does not accept labeling one as suffering from psychological disorders.
In other therapy, like psychoanalysis, mind is divided into three layers as unconscious, pre and conscious. Rabindrik psychotherpy is concerned with consciousness experience only. Consciousness is classified into three layers as murta, raaga and saraswat.
Verbal communication between therapist and client is the most significant element of psychotherapy.This is followed in Rabindrik psychothrapy. In Rabindrik approach, performing art or non-verabal communication can be used.
Like other therapies, Rabindrik psychotherapy can be administered indiviually or in group.
Other therapies are concerned with the evaluation of problems and possible solutions as well as with the encouragement of more adaptive ways of thinking and behaving. On the other hand, Rabindrik psychotherapy is concerned with self-evaluation and possible solutions to overcome the conflict of layer dynamics.

Q5.What is postulate? Write about few postulates of Rabidrik psychotherpapy.

Postulate is the basic assumption of theory. Any theory is composed of several postulates. Few postulates of Rabidrik psychotherpapy are:

1. Do not label rather understand other’s consciousness.
   
2. Consciousness is free floating. Look at it as detached being.
   
3. Make the consciousness unbounded and experience it.
   Experience of consciousness is like a journey from incomplete to complete across its layers– Murta, Raaga and Saraswat.
   
4. Man is the pursuer of completeness and newness.
   
5. Searching newness makes man incomplete that acts as the drive to find out completeness. Incomplete to complete is a cycling process.
   

Here are few songs in Bengali and in English (translated by me)related to postulates
Do not label rather understand other’s consciousness.

"Je tore pagol bole tare tui bolis ne kichu.
Ajke tore kemon vebe ange je tor dhulo debe
Kal se prate mala hate asbe re tor pichu pichu.
Ajke apan maner vare thak se bose gadir pare
Kalke preme asbe neme, karbe se tar matha nichu."

English:
Do not say anything when one calls on you mad
Assuming you as abnormal, one can throw dust on you today.
Tomorrow he will come to you with garland
Today, due to self-pride, he sits on high chair.
Tomorrow, he will get down and bow his head.

Consciousness is free floating. Look at it as detached being.
"Je ami bhese chale kaler dheue akash tale ori pane dekhchi ami cheye. …… o je sachal chabir mato ami nirab kabir mato- ori pane dekhchi ami cheye. Ei je ami oi ami noi, apan-majhe apni je roi,
Jai na bhese marandhara beye-
Mukto ami, tripto ami, shanto ami, dipto ami, ori pane dekhchi ami cheye.”

English
The ‘I’ that floats on the waves of time under the sky, I am watching at it. …..That ‘I’ moves like moving picture and I am watching at it as silent poet. This ‘I’ is not that ‘I’. I am within me. I am not floating like dead. I am free, satisfied, peaceful and lighted. I am watching at it.

Ei akashe amar mukti aloy aloy


Q6.Is therapeautic assessment important in Rabindrik psychotherapy?

In Rabindrik psychotherapy, therapeutic assessment is important to find out one’s mental state's position across three layers of consciousness. This helps the therapist in comprehending individual’s characteristics, reasons for present behaviour and in predicting one’s future psychological functioning or behaviour.

Q7.What is consciousness? Why is it imporant to study?

Consciousness is the immediate awareness of thoughts, sensations, memories, and the world around us. Experience of consciousness varies from moment to moment. Just like a river, it is changing. Individual’s behaviour is guided by his or her mental state position and its flow at the different layers of consciousness. Understanding about one’s state at the different layers of consciousness and its flowing pattern is prelude of Rabindrik psychotherapy.

Q8. What are changes taken place across three layers of consciousness ?

Consciousness experience varies with mental state position across layers of consciousness. These three layers are Murta, Raaga and Saraswat. When our mental state lies at the layer of murta, we are aware of morphology or the structural properties of the object in our surroundings. When our mental state lies at the layer of raaga, we associate morphology of the object with feeling of pleasantness or unpleasantness. This provides some meaning about object. And finally, when our mental state is in the saraswat layer, we experience harmony between the object and the environment. In this layer, our own existence is mixed with the surroundings. But such experience does not happen in murta and raaga layer.


Q9. What are the characteristics of three layers ?
Characteristics of three layers are given below:
Murta (The outer layer) : What we sense through our five sensory organs.
Raaga (The inner layer) : The meaning carried by the sensory stimuli. It is attached with affect or feeling of pleasant or unpleasantness. When perception is attached with affect, it is called apperception.
Saraswat layer (The inner core) : The feeling of harmony, the existence of truth, the feeling of white.

Q10. How does performing art help in assessment?
By using performing art, one can diagnose extent of malfunctions in the consciousness, locate one’s mental state across layers of consciousness, estimate possible flow of mental functions across layers. After taking case history and mental state examination, therapist will explore modes of performing arts to assess consciousness layers.

Q11. What are the approaches of therapy?
There are different approaches to administer performing art for assessing layers of consciousness.

a) Altered state of consciousness: It differs from normal waking consciousness. In this state, consciousness is split into two simultaneous streams of mental activity. One stream of mental activity remains conscious. But a second stream of mental activity-the one responding to the performing art is dissociated from awareness. This state is almost similar to hypnotic state. In hypnosis, suggestion is given by therapist. But in using performing art, client gets suggestion from the art itself.

b) Projecttion : In projection, individual projects own desires, feelings, needs etc. on the works of Rabindranath Tagore.

c) Self-report: Analysis of one's self-report about matching between own feeling and feeling of different characters of works of Rabindranath Tagore.

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Performing Art Therapy in Mental retardation

In the modification of behaviour of Mentally retarded children, performing art therapist should pay specific attention to deficits and deformities in the Murta layer of consciousness through performing art improvisation. Performing art includes specifically music, songs, dance, drama, painting etc having taal, lay, chanda. The last three are important as changes in murta layer of consciousness may affect Raag layer of consciousness that results intrinsic motivation to new or modified behaviour. Intrinsic motivation results sustainable change in the behaviour of children.

Before introducing intervention, case history taking and mental status examination are important. Case history may be collected from the parents or other informants. During taking the history, therapist should check extent of reliability of the statement of informants as there is a scope for hello error. Second, beginning and variation of each complaint must be recorded. If variation is needed, therapist should record the duration of behaviour constancy, possible antecedents or reasons, possible facilitators and inhibitors of the behavior.

Performing art therapist by improvisation of activity can assess child's sensory thresholds, pattern of perception, short, long term memory, working memory, psychomotor co-ordination etc. It must be remembered that aim of performing art therapist is not to teach singing, playing music, drama etc but to facilitate performing arts in order to improve adaptive and to control maladaptive behaviour.

Therapist should identify which adaptive behaviour requires minimum support and which one requires maximum support. For the same, one can prepare behaviour checklist using rating scale. The scale categories will be:

Assign 5 if the behaviour requires least support of others
Assign 4 if the behaviour requires less support of others
Assign 3 if the behaviour requires moderate support of others
Assign 2 if the behaviour requires much support of others
Assign 1 if the behaviour requires maximum support of others

The scaling will help therapist to plot graph of changes and association among different adaptive skills.

ADAPTIVE BEHAVIOUR

Adaptive behaviors are everyday living skills such as walking, talking, getting dressed, going to school, going to work, preparing a meal, cleaning the house, etc. They are skills that a person learns in the process of adapting to his/her surroundings. Since adaptive behaviors are for the most part developmental, it is possible to describe a person's adaptive behavior as an age-equivalent score. An average five-year-old, for example, would be expected to have adaptive behavior similar to that of other five-year-olds.

Performing art therapist will prepare adaptive and mal adaptive behaviour checklist before intervention. Below are the some adaptive and maladaptive behaviour.

MOTOR SKILL

1. Motor Skills
   
2. Gross Motor
   
3. Fine Motor
   
   SOCIAL SKILL
   
4. Social & Communication Skills
   
5. Social Interaction
   
6. Language Comprehension
   
7. Language Expression
   
8. Personal Living Skills
   
   SELF-HELP SKILLS
   
9. Eating & Meal Preparation
   
10. Toileting
    
11. Dressing
    
12. Personal Self-Care
    
13. Domestic Skills
    
14. Community Living Skills
    
    OCCUPATION
    
15. Time & Punctuality
    
16. Money & Value
    
17. Work Skills
    
18. Home/Community Orientation
    

Maladaptive Behavior - General
INTERNALIZED

1. Hurts Self
   
2. Repetitive Habits
   
3. Withdrawn or Inattentive
   
4. Asocial
   
5. Socially Offensive
   
6. Uncooperative
   
   EXTERNALIZED
   
7. Hurts Others
   
8. Destructive to property
   
9. Disruptive
   

Bengali version checklist
Below is the Bengali version checklist to assess abilities to detect source of sound, to pronounce sound and to vary the sound in the ascending and descending orders.

BEHAVIOUR CHECKLIST IN BENGALI LANGUAGE (Click it to make it big)



ACTIVITY ANALYSIS: Activity analysis is most important in modification of one's behaviour.

Activity: First play one rattle lightly and rhythmically in front of the child. Second, observe movement of eye ball, change in facial expression (smile, muscular changes in face), and tertiary activity. Third change the source of sound, observe and score the behaviour. (Click below to make the figure big)

INTERVENTION
Identify deficit > Set target behaviour > Set systematic steps to achieve target behaviour > Activity > Observe > Intervention by activity > Is target behaviour achieved? > yes > Is it sustainable? > Yes > Stop

Here Intervention includes
1. Segmenting behaviour: Target behaviour should be segmented in interlinked parts of behaviour. Each part should be linked with antecedents and consequences so that facilitating and inhibiting factors can be identified.
2. Associating behaviour: Now, arrange the behaviour in such a fashion so that facilitating factors are incorporated
3. Disassociating Behaviour : The inhibitors should be disassociated from each segment of behaviour
4. Shaping behaviour: The existing behaviour can be shaped using reinforcement schedule principles
5. Modeling behaviour: The new behaviour can be modeled using reinforcement schedule principles

MENTAL RETARDATION
Mental retardation (MR) is a generalized disorder appearing before adulthood, characterized by significantly impaired cognitive functioning and deficits inhttp://www.blogger.com/img/blank.gif two or more adaptive behaviors.


MR possesses less than 70 IQ and SQ level. According to the definition by the American Association on Mental Retardation (AAMR), an individual is considered to have mental retardation based on the following three criteria: intellectual functioning level (IQ) is below 70-75; significant limitations exist in two or more adaptive skill areas; and the condition manifests before the age of 18. Adaptive skill areas are those daily living skills needed to live, work, and play in the community. The new definition includes ten adaptive skills: communication, self-care, home living, social skills, leisure, health and safety, self-direction, functional academics, community use, and work.

Cognitive functioning: Any mental process that involves symbolic operations–eg, perception, memory, creation of imagery, and thinking; Cognitive functioning encompasses awareness and capacity for judgment.

Individual fails to put the blocks in the hole according to the size and shape. This suggests impairment in perception.
Adaptive behaviors: It is the individual’s everyday behavior that he/she emits to respond to the demands of his/her cultural, social, and physical environment. Adaptive behaviour includes self-help eating (taking food without other's help), dressing (to wear cloth him/her self, to button the wearing), socialization (to play with others, to visit the neighbour's house), occupational activities (to string the bead, to clean the utensils etc).

Physical demand: "Open the door", "Close the door"
Social demand: "Hello","Go to toilet"

STATISTICS

According to the World Health Organization (1994); approximately 156 million people, or 3 percent of the world's population have mental retardation. Prevalence by continent:

Africa 20,310,000
Australia 5,25,000
Asia 97,710,000
Europe 15,390,000
Latin America 13,800,000
North America 8,610,000

Mental retardation knows no boundaries. It cuts across the lines of racial, ethnic, educational, social and economic backgrounds. It can occur in any family. One out of ten American families is directly affected by mental retardation.

Ref: http://www.disabilityindia.org/MentalRetardation.html

CAUSES:
Problems at birth:Although any birth condition of unusual stress may injure the infant's brain, premature birth, and low birth weight predict serious problems more often than any other conditions.

Problems after birth: Childhood diseases such as whooping cough, chicken pox, and measles can damage the brain, as can accidents such as a blow to the head or near drowning. Mercury and lead poisoning can cause irreparable damage to the brain and nervous system.

Poverty: Children in poor families may suffer mental retardation because of malnutrition, disease-producing conditions, inadequate medical care, and environmental health hazards. Also, children in disadvantaged areas may be deprived of many common cultural and day-to-day experiences provided to other young children. Research suggests that such under-stimulation can result in irreversible damage and can serve as a cause of mental retardation.

CLASSIFICATION:
In ICD-10, there are 6 classifications as

1. (F70–F79) Mental retardation
   
2. (F70.) Mild mental retardation
   
3. (F71.) Moderate mental retardation
   
4. (F72.) Severe mental retardation
   
5. (F73.) Profound mental retardation
   
6. (F78.) Other [[mental retardation
   
7. (F79.) Unspecified mental retardation
   

Mild mental retardation: Approximately 85% of the mentally retarded population is in the mildly retarded category. Their IQ score ranges from 50-75, and they can often acquire academic skills up to the 6th grade level. They can become fairly self-sufficient and in some cases live independently, with community and social support.

Moderate mental retardation: About 10% of the mentally retarded population is considered moderately retarded. Moderately retarded individuals have IQ scores ranging from 35-55. They can carry out work and self-care tasks with moderate supervision. They typically acquire communication skills in childhood and are able to live and function successfully within the community in a supervised environment such as a group home.

Severe mental retardation: About 3-4% of the mentally retarded population is severely retarded. Severely retarded individuals have IQ scores of 20-40. They may master very basic self-care skills and some communication skills. Many severely retarded individuals are able to live in a group home.

Profound mental retardation: Only 1-2% of the mentally retarded population is classified as profoundly retarded. Profoundly retarded individuals have IQ scores under 20-25. They may be able to develop basic self-care and communication skills with appropriate support and training. Their retardation is often caused by an accompanying neurological disorder. The profoundly retarded need a high level of structure and supervision.

The American Association on Mental Retardation (AAMR) has developed another widely accepted diagnostic classification system for mental retardation. The AAMR classification system focuses on the capabilities of the retarded individual rather than on the limitations. The categories describe the level of support required. They are: intermittent support, limited support, extensive support, and pervasive support. To some extent, the AAMR classification mirrors the DSM-IV classification. Intermittent support, for example, is support needed only occasionally, perhaps during times of stress or crisis. It is the type of support typically required for most mildly retarded individuals. At the other end of the spectrum, pervasive support, or life-long, daily support for most adaptive areas, would be required for profoundly retarded individuals.

medical-dictionary

MENTAL STATUS EXAMINATION
Psychiatric mental status examination

1. Observations of Examiner (not in response to questions):
2. Patient's own subjective evaluation of his emotional reaction and mood
3. Content of thought
4. Examination of the Cognitive Functions

THERAPY

Applied Behavior Analysis (ABA):Applied behavior analysis is the process of systematically applying interventions based upon the principles of learning theory to improve socially significant behaviors to a meaningful degree, and to demonstrate that the interventions employed are responsible for the improvement in behavior. Learning principles include classical, operant conditioning and trial and error theory.

Socially significant behaviors" include reading, academics, social skills, communication, and adaptive living skills. Adaptive living skills include gross and fine motor skills, eating and food preparation, toileting, dressing, personal self-care, domestic skills, time and punctuality, money and value, home and community orientation, and work skills.

Components of ABA

1. selection of interfering behavior or behavioral skill deficit;
   


2. identification of goals and objectives;
   


3. establishment of a method of measuring target behaviors;
   


4. evaluation of the current levels of performance (baseline);
   


5. design and implementation of the interventions that teach new skills and/or reduce interfering behaviors;
   


6. continuous measurement of target behaviors to determine the effectiveness of the intervention, and
   


7. ongoing evaluation of the effectiveness of the intervention, with modifications made as necessary to maintain and/or increase both the effectiveness and the efficiency of the intervention.
   

PERFORMING ART THERAPY
Performing art therapist will prepare one case history records and behaviour check list based on possible limitations of children or based on observation of child's behaviour. The check list of behaviour will be graded in such a fashion so that one can measure change in behaviour across periods. Measurement is important as this will give therapist regular feedback about therapy. Therapist should be aware of different developmental stages from birth to childhood and its different principles. I am suggesting Hurlock or Mussen's book on child development. Knowledge about the developmental stages gives idea about extent of development with age. Development includes physical, intellectual, social, moral, emotional and personalty development.To develop adaptive behaviour, it is important to know about gross (total-body movements as playing football) and fine motor skills (delicate movement where in eye-hand coordination is involved as beading string).


DANCE THERAPY: Dance is useful therapy to improve psycho-motor skills. Dance therapy is not movement therapy where in movement is important for adaptive skill development. Dance therapy helps to integrate sensory organs of the children. Physical complaints can be reduced by the dance. Besides, it develops socialization skills. Dance helps therapist to examine the extent of physical and cognitive deficits of the children.Therapist can design the training need oriented dance in order to develop specific adaptive skills. But in this technique, client's consciousness will not be free floating. Therefore, therapist can act as facilitator rather trainer. Therapist can demonstrate phule phule dhole dhole dance of Tagore sangeet. It facilitates both eye-coordination and coordination among different parts of body.



DRAMA THERAPY: To perform drama, therapist can use mask of pet animals, toys, flash cards, sands etc. to develop adaptive behaviour skills.

MUSIC THERAPY: Therapist can improvise theme using instrumental music. Some of the instruments are given below:




The theme should be directed to develop adaptive behaviour of the children.

Sample question for 1st Sem Cert course

SAMPLE QUESTIONS
Performing Arts Therapy Centre
Rabindra bharati University

Paper: Psychology (First Semester) for Certificate course

Full marks: 100 Time: 3 hours

A. Answer any five (1st question is compulsory) (5 X 16)
1. Psychology is important to learn performing art therapy. – Do you agree with this statement? Give reasons.
2. Make difference between sensation and perception. Describe principles of Perception.
3. What is classical conditioning? Write the experiment of Pavlov.
4. What is forgetting? Why do people forget ?
5. Does conflict occur in our consciousness ? Illustrate with example.
6. What is stress ? Make difference between eustress and distress.
7. What is conflict ? Discuss types of conflict with examples.
8. Performing art is useful instrument to assess mental status examination – Give reasons

B. Write short notes ( any 2 only) (2 X10)
1. Double Approach conflict
2. Distortion in outer layer of consciousness
3. Digit span
4. Attention
5. Individual psychotherapy

Sample questions for 1st sem 1st year diploma

SAMPLE QUESTIONS
Performing Arts Therapy Centre
Rabindra bharati University
Paper: Psychology (First Semester) for 1st Year Diploma group

Full marks: 100 Time: 3 hours

A. Answer any four (1st question is compulsory) (4 X 20)

1. Sukanya, 10 years old, grade IV, came to the clinic with complaint of poor academic performance. Initial case history and psychological testing reveal that she is average in intellectual functions. She is good in performing arts like painting, singing and drama. She does not find any interest in study. Her note book is filled with different forms of human figures, some are crossed and some are overlapped. As a performing art therapist, what will be your improvisation to use her innate potentialities for developing interest in study ?

2. Psychology is important to learn performing art therapy. – Do you agree with this statement? Give reasons.

3. What is learning? Can it be conditioned ?

4. Delineate the statement – “Stress is a non specific response of the body”

5. What is conflict ? Discuss types of conflict with examples.

6. Stars are twinkling in the sky. They are separated from each other. But people perceive different figures like human being, animal etc. by grouping them. Why do people group them and how ?

7. Performing art is useful instrument to assess mental status examination – Give reasons

B. Write short notes ( any 2 only) (2 X10)
1. Approach avoidance conflict
2. Inner layer of consciousness
3. Memory span
4. Fluctuation of attention
5. Psychotherapy

Sample questions for 1st sem 2nd year diploma

SAMPLE QUESTIONS
Performing Arts Therapy Centre
Rabindra bharati University
Paper: Psychology (First Semester) for 2nd Year Diploma group

Full marks: 100 Time: 3 hours

A. Answer any four (1st question is compulsory) (4 X 20)

1. Ramal, 20 years old, has complained of tingling sensation on his left thigh. Through clinical interview, therapist has noted that he regularly keeps his cell-phone in the left side pocket of his pant. His habit is to send short messages to the friends. His friends also reciprocate. Recently, due to loss of cell phone, he is not in touch with friends. How do you explain Ramal’s complaints in terms of conditioning theory of learning ? What will be your improvisation of performing art to relieve Ramal from such typical complain?

2. Psychology is important to learn performing art therapy. – Do you agree with this statement? Give reasons.

3. What is learning? Can it be conditioned ?

4. Delineate the statement – “Stress is a non specific response of the body”

5. What is conflict ? Discuss types of conflict.

6. Stars are twinkling in the sky. They are separated from each other. But people perceive different figures like human being, animal etc. by grouping them. Why do the people group them and how ?

7. Psychology touches almost every facet of our life – Give reasons

B. Write short notes ( any 2 only) (2 X10)

1. Role stress
2. GAS
3. Layers of Consciousness
4. Fluctuation of attention
5. Working memory

FORMAT TO WRITE DISSERTATION IN PATC COURSE

FORMAT TO WRITE DISSERTATION IN PAT COURSE

General comment:

Your dissertation should not exceed 10,000 word limits.

• Dissertation should include 11 sections

• State the purpose of the each chapter before writing it.

1. TITLE PAGE:

a. Title: It is brief and related to basic problems of dissertation. It should be different from others

b. By author: Author’s name

c. Research supervisor’s name

d. University emblem

e. Name and address of the university

f. Foot note: A dissertation submitted for the post graduate diploma in Performing Art Therapy to Performing Art Therapy Center, Rabindra Bharati University, Kolkata

g. Date of submission :

2. CONTENTS

a. Topics: Title of each chapter and subheadings with page no

b. Tables: Caption of table and page no

c. Figures: Caption of Figures and page no

3. PREFACE

Introduce very briefly the objectives of study, methods followed, results obtained and organization of chapters.

4. ACKNOWLEDGEMENT

Acknowledge assistance from various sources.

5. INTRODUCTION

a. General problem : For example ON STRESS/ON CONSCIOUSNESS/ ON PERCEPTION/ ON LEARNING/ ON CONFLICT . Select the problem which has been studied in the class. This will help you to write the introduction about the problem.

b. Specific problem: Effect of performing art on changes in level of stress/ Analysis of stress. Specific problem should be related to general problem. Select the specific problem in such a manner so that you can present it in your dissertation within specific time limit.

c. Introduction: Introduce general and specific problem, idea formulation, Importance of ideas to study. For example, your general problem is ON STRESS. Define and describe it. Write about specific problem and its importance to study in this dissertation.

b. Objectives : It comprises questions that will be answered in the dissertation. There will be justification in setting objectives. A literature survey would help seeking the useful questions that can be used as objectives.

c. Hypothetical models: Any cause effect models

d. Operational definitions of technical terms: All the variables measured in this study should be operationally defined so that they can be understood by the examiners.

6. LITERATURE REVIEW:

a. Past researches and results and its classification in different angles. Critical comparison of the past literature

b. Summary of literature review - narrow down to give outline of future research. It should cover all the study variables under study.

7. METHODS:

a. Participants: Sources and techniques followed in getting participants, single case or multiple. No. of participants. Description of participants- age, education, specific disorders, suffering time (in frequency Table form), inclusion and exclusion criteria. (Add case history in the APPENDIX with code).

b. Instruments:

v Schedule: One introductory schedule was used to know about age, educational level, specific interest and aptitudes in performing art. Schedule format will be given in the appendix with code. For example APPENDIX- A

v Musical instruments: If any musical instrument is used, describe the characteristics of instrument, purpose to use it in this study, procedure to administration to the subject including instruction to the subject or client. (Picture can be given in the Appendix -B).

v Performing art: Describe the performing art used in the study, its purpose in this study, procedure of administration (Picture can be given in the Appendix -C)

v Questionnaire: If any standardized questionnaire is used, describe its characteristics (no of items, what it measures, response categories), usefulness in your study, scoring procedure, reliability and validity of the questionnaire. If student him/herself constructed questionnaire or checklist, give justification and describe the methods followed to design instrument.

v Recording instrument: Describe the recording instrument, its purpose for collection of data, procedure to retrieve the data etc.

c. Design of research : If observation method is followed, describe time and event sampling, precautions maintained to control extraneous variables. If experimental design is followed, describe pre-post design, control and experimental groups, precautions maintained to control extraneous variables.

d. Collection of data : Collection of consent, Establishing rapport, specific procedures followed in collection of data.

e. Analysis of data : Brief description about measurement tools used for data analysis

8. RESULTS :

a. Descriptive : Analysis of data to describe frequency or percentage or average of each study variable. Results will be presented in Table form and graphs.

b. Model: Analysis of data to relate study objectives. For example, study objective is to examine effect of performing art therapy on change in stress perception, analysis should reflect changes in stress level before and after intervention or therapy. Results will be presented in Table form.

9. DISCUSSION:

a. Summarize major findings

b. Relate major findings of study with past researches

c. Implications

d. Limitations ( in time, in availability of instrument, and others)

e. Future research

10. REFERENCES

a. Books:

i. Author/s, Year, Title, Place, Publisher, page no.

ii. Author/s, Year, Title, in Editor’s name, (Ed./s), Book name, Place, Publisher, Page no.

b. Journals: Paterson, P. (2008). How well do young offenders with Asperger Syndrome cope in custody?: Two prison case studies British Journal of Learning Disabilities, 36(1), 54-58.

c. Webs: Topics, Source, URL

d. Video Blog: Title, Video posted to http://www.youtube.com/watch?v=lqM90eQi5-M

11. APPENDIX

a. Brief description about institution from which data were collected

b. The primary or secondary data in original form

c. The questionnaires, observation checklists, or other tools used in study

d. Any other

ANECDOTAL RECORDS

1. Basic information:
Name of client:                             Age:                            Educational level:
Date:                         Day:
Time of observation : Starting time and Ending time
Place and surroundings:
Address:

2. Specific events :

3. Events and observation:
    Singing :  How client sings

4. Analysis of observation: Specific facilitators and inhibitors

5. Impression about client's cognitive, emotional and psycho-motor coordination

6. Therapeautic suggestions:

7. Limitations:

8. Bibliography:

9. Annextures

Links:

Psychiatric Case history writing format

Conflict in consciousness by Shyama Gitinatya

13. 4. 2011

Tagore composed Shyama Gitinatya. It includes approach avoidance conflict across three layers of consciousness - murta, raaga and saraswat layers. When elements are passing to each layer, conflict occurs. I have noted three different styles of conflict occurrence - Shyama style, Uttiya style and Bajrasen style.
Shyama's conflict lies at the boundary of inner and innercore layer. But Uttiya and Bajrasen have noted conflict in saraswat layer. It appears to me that this is most stressful.

Taught students of performing art therapy centre of Rabindra Bharati University the followings:

1. What is consciousness ?
2. Why do we study consciousness in performing art therapy course ?
3. What are the layers of consciousness ?
4. What are their characteristics ?
5. How does stimulus change its characteristics when it passes across layers ?
6. What is the difference between perception and apperception ?
7. What is conflict ?
8. What are the types of conflict ?
9. What are the styles of conflict management ?

Students sang songs of Shyama and other songs of Tagore, danced and were highly delighted.

Co-ordinator said that to Tagore, Shyama is the best gitinatya. This word enchanted me very much as I first presented one lecture on consciousness using Shyama Gitinatya to the students who are the experts in Rabindra Natya, literature and songs. One student asked me ' Sir, how do you feel now ? " I can't express my feeling of completeness. She said " if you know, you can not enjoy" . I have understood learning through freedom of thinking.

With students of Performing Art Therapy Centre, RBU

Application of Multivariate statistics in questionnaire design

LECTURE NOTES FOR M.STAT STUDENTS OF ISI
TOPIC: Application of Multivariate statistics in questionnaire design
Dr. D. Dutta Roy
Psychology Research Unit
INDIAN STATISTICAL INSTITUTE
203, B.T. ROAD., Kolkata
Date: 11.3.2011

While recognizing the powerful position occupied by the scientific sample survey in social research, it is worth noting to the reliability and validity of the data. Modern research based on schedule technique sometimes fails to establish the data quality (reliability and validity) resulting conflict in use of these data for social policy and social research movement. Besides, this technique fails to provide integrated information about social cognitions related to social issues. In
implementation of any policy, social cognition like attitudes, beliefs, prejudice, stereotype ideas, social motivation, happiness with specific social policy etc of people play critical roles. Questionnaire overcomes this limitation as it provides more integrated reliable and valid information. It is less expensive, requires less skill to administer, and instills confidence because of its anonymity. It
helps in developing objective reliable and valid database in short time based on large number of people. This database is useful to determine distribution of variables across diverse groups of larger society. Questionnaires can be used to examine the general characteristics of a population, to compare attitudes of different groups, and to test theories. Due to these reasons, questionnaire is most widely used data collection instrument now-a-days. Good questionnaire construction is critical to the success of a survey. Inappropriate questions, incorrect ordering of questions, incorrect scaling, or bad questionnaire format can make the survey valueless. Sir Francis Galton in 1870 invented questionnaire and conducted survey for the study of human differences and heredity. Questionnaire is a comprehensive measure to assess individual differences in human faculty. Therefore, questionnaire is embedded in a well-established theory of individual differences.

CHARACTERISTICS OF QUESTIONNAIRE

Questionnaire possesses few characteristics as
1. Objectivity: It should be free from any subjectivity (personal judgment
regarding ability, skill, traits, knowledge to be measured and evaluated).;
2. Standardization: There should be uniformity in instruction, questions,
administration of questionnaire, and scoring procedures.
3. Reliability: There should be consistency in responses over the time and across the questions.
4. Validity: It shows the degree to which a questionnaire measures what it
purports to measure. Questionnaire should be related with the internal and external criteria.
5. Norm: A norm is the average or typical score (mean or median) on a
particular questionnaire made by a specified population. This is important to determine individual differences in responses across age, educational level etc.

APPLICATION


Questionnaire has wide application in exploring and testing hypotheses in the areas of different disciplines as Psychology, Education, Sociology, Human resource management, Personnel management, Labour welfare, Marketing management, Consumer behaviour research, Financial management etc.

APPLICATION OF MULTIVARIATE STATISTICS


Questionnaire includes sets of questions which are often to be linearly related. Therefore, to assess their underlying latent relationship, to estimate reliability and validity, several multivariate statistics are used.
MVS refers to the set of statistical tools that simultaneously analyze multiple measurements on each individual or object under investigation.

It is the linear combination of variables with empirically determined weights.
Variate value= w1X1+ w2X2+ w3X3 + wnXn
W=weight determined by the multivariate technique; X=observed variable

Common statistics are principal component, cluster analysis, multiple regression analysis, discriminant function analysis, correspondence analysis.
Analysis depends on specific objectives, pattern of relations among the measures and measurement scales used in the questionnaire.
When responding to the questions, individual is affected by several random variables. Multivariate statistics partials out random variation effect and accounts only fixed effect.


References:

1. Dutta Roy, D. (2009). Principles of Questionnaire development with empirical studies. Prasad Psycho Corporation. New Delhi.
   
2. Dutta Roy,D. - Construct validity of writing motivation questionnaire. International Journal of Psychological Research
   
3. Dutta Roy,D.(2010).Cluster Analysis for Test-Retest Reliability. International Journal of Psychological Research ,(published from USA). 3,1,132-140.
   
4. Dutta Roy,D.(2010).Construct validity of Reading motivation. Journal of the Indian Academy of Applied Psychology, (to be published in January 2011, vol.37,No.1).
   
5. Dutta Roy, D. (2005).Clustering state anxiety scores across twelve months in the Antarctic expedition,Journal of Psychometry,Vol.XIX,1,January,pp 14-20.
   
6. Dutta Roy, D. (2003).Cluster analysis of GHQ-12 items using Indian Antarctica Expeditioners' Responses,,Journal of Psychometry ,Vol.17, No.1&2,pp 38-44.
   
7. Dutta Roy,D. (2002). Correspondence between item and rating on the checklist of relative importance of computer programming tasks., Journal of Psychometry, 16,2,67-76.
   

Rabindrasangeet as projective technique

A girl of 14 years old came with complaints of inattentiveness, lack of concentration and unexpected marks in the school examination. By examining her mental status, I noted that she was intrinsically motivated to read and problem came when she read the chapters. As her parents asked many questions out of it resulting inhibition to read. The girl knew Rabindra sangeet as she learnt from her mother. So, I asked her to sing a song. She started-

" Pran chay chakkhu na chay, mori e ki tor dustara lajja, sundara ese phire jay, kar lagi mithya e sajya ". The song actually carries her personal feeling. She wants to read but with anticipation of questions from mother, she can not enjoy it. She is not in favour of developing extrinsic reading motivation as suggested by the parents. And Tagore song is used here as understanding personal feeling of the girl.

songs in Youtube: http://www.youtube.com/results?search_query=pran+chay+chokkhu+na+chai&aq=2

Therapeautic Relationship

Dr. D. Dutta Roy, Ph.D.(Psy.)
LECTURE NOTES ON THERAPEUTIC RELATION
PERFORMING ART THERAPY CENTRE
RABINDRABHARATI UNIVERSITY
KOLKATA
To be presented


INTERVIEW
A skillful interviewer is able to gather the data necessary to understand and treat the patient and in the process to increase the patient's understanding of and compliance with the patient's advice.

Factors influencing interview:

1. The patient's personality and characteristics significantly influence transference reactions and the emotional context in which the interview unfolds.

2. Different clinical situations - hospital ward, psychiatric ward, emergency room, or as an outpatient-shape the types of questions asked and recommendations offered.

3. Technical factors - telephone interruptions, use of interpreter, note taking, physical space and room comfort.

4. The timing of interview in the patient's illness, be it in the most acute stage or during remission influences content and the process of interview.

5. The interviewer's style, orientation and experience have a significant influence on interview.

6. The interjections like " uh-buh" can influence what a patient will or will not say and when, as individual tries unconsciously to follow the cues provided by the therapist.

FUNCTIONS OF INTERVIEW

1. Determining nature of the problem
Objective: To establish diagnosis and course of treatment and predict nature of illness.

2. Developing and maintaining a therapeutic relationship
Objective:a) The patient's willingness to provide diagnostic information.
b) Relief of physical and psychological distress.
c) Willingness to accept a treatment plan or a process of negotiation.
d) Patient's satisfaction
e) Physician's satisfaction


3. Communicating information and implementing a treatment plan
Objective:a)Patient's understanding of the nature of illness.
b)Patient's understanding of suggested diagnostic procedure.
c)Patient's understanding of the treatment possibilities.
d)Achievement of consensus between physician and patient over the above items 1-3.
e)Achievement of informed consent.
f)Improved coping mechanisms.
g)Lifestyle changes.



SKILLS:

1. Knowledge base of diseases, disorders, problems, and clinical hypothesis from multiple conceptual domains like biomedical, socio-cultural, psycho-dynamic and behavioral.

2. Ability to encourage the patient to tell his or her story, organizing the flow of interview, the form of questions, the characterization of symptoms and the mental status examination.

3. Ability to perceive data from multiple sources (history, mental status exam, physician's subjective response to patient, non-verbal cues, listening at multiple levels.

4. Hypothesis generation and testing.

5. Developing a therapeutic relationship (Function 1)

6. Hearing, bearing, and tolerating the patient's expression of painful feelings.

7. Appropriate and genuine interest, empathy, support and cognitive understanding.

8. Attending to common patient concerns over embarrassment, shame and humiliation.

9. Elicitation of the patient's perspective.

10. Determining the nature of the problem.

11. Communicating information and recommending treatment.

12. Establishing the differences in perspective between therapist and patient.

13. Educational strategies.

14. Clinical negotiations for conflict resolution.



SPECIFIC INTERVIEW TECHNIQUES:


1. Open-ended vs. Close-ended questions:-

Open ended : Physicians allow the patient to speak as much as possible in his or her own words.For e.g. "Can you tell me more about it?"

Close-ended:Here more directive question is asked or specific information and that does not allow the patient many questions in answering.For e.g. "Tell me more about what your feeling and what you think may be causing it?"


2. Reflection:-

The purpose of reflection is two fold: to assure the therapist that he or she has correctly understood what the patient is trying to say and to let the patient know that the doctor is perceiving what is being said. It is empathic respond meant to allow the patient to know that the therapist is both listening to and understanding the patient's concerns.

3. Facilitations:-

The therapist helps the patient continue in the interview by providing both verbal and non-verbal cues that encourage the patient to keep talking. For e.g. nodding one's head, leaning forward in one's seat, saying "yes, and then....?"

4. Silence:-

Silence may be constructive to allow the patient to cry or just to sit in an accepting, supportive environment where it is made clear that not every moment must be filled with talk.

5. Confrontation:-

Confrontation must be done in a skillful way so that the patient is not forced to become hostile and defensive.

6. Clarifications:-

Here the therapist attempts to get more details from the patient about what the patient has already said: " You are feeling depressed, when is it that you most depressed?"

7. Interpretations:-

This technique is used when the therapist states something about the patient's behavior or thought that the patient may not be aware of.

8. Summation:-

Periodically during the interview, the therapist can take a moment and briefly summarize what the patient has said thus far .

9. Exclamation:-

Therapist explain the treatment plan to the patient in easily understandable language and allows the patient to respond and ask questions.

10. Transition:-

This technique allows the therapist to explore other related information besides already explored information.

11. Self-revelations:

If the physician feels that some piece of information will help the patient be more comfortable, the therapist can decide self-revealing.

12. Positive reinforcement:

This technique allows the patient to feel comfortable telling the doctor anything, even about such things as non-compliance with treatment. For e.g. " I appreciate your telling me that you have stopped taking your medication. Can you tell me wht the problem was with the medication? The more I know, the better I will be able to treat you in way that you will feel comfortable with.

13. Reassurance:

Truthful reassurance can lead to increased trust. False reassurance can badly impair trust and compliance. False reassurance is given to make a patient feel better tactfully.For e.g. "Am I going to be alright doctor?" The doctor response "I am going to do everything I can to make you feel as comfortable as possible".

14. Advice:

Giving advice too quickly can lead the patient to feel that the doctor is not really listening. Therefore, advice is to be given at that time when the patient is ready to accept.

Study format

1. General problem: On Consciousness

1.1 Basic problem: Effect of performing art on Consciousness

2. Introduction: Consciousness is a cognitive state in which one is aware of his sensations, perceptions, feelings, emotions, thoughts and memories and the surroundings. Following the model of Integral psychology, it has three layers - outer (Murta), inner (bimurta) and inner core (saraswat). Outer layer is composed of attention, sensations and perceptions. It is everything in man that is visible on the surface for others. It is tangible. It includes all the actions and interactions. For example, Just listening to the words of song is the expression of outer nature. This comes through development of sensory capabilities and control over the different organs. For example, child differentiates objects by developing his capability on shape, size, distance or depth, color discrimination and on the figure ground relations. Inner layer is composed of imaginations, memories, feelings etc. Experience of feeling by listening to songs is the inner layer. Inner core or Saraswat is expression of inner harmony between the living entity and the surroundings. Performing art is the journey across the layers of consciousness. The journey causes changes in each layer and provides different experiences to the individual. This study aims at examining changes across layers due to performing art.

Layer analysis: Though these three layers are overlapped with each other, for the purpose of study, they can be differentiated using different parameters. Any abnormality in outer layer leads to missing and anomalies in expressing the object. Inner layer can be differentiated in terms of vividness, orderliness and complexity. The inner core layer can be differentiated in terms of cleanliness, aesthetic and harmony with environment.

3. Method

3.1 Participants: Six participants (children =2, middle aged=2, senior=2) participated into this study. Average age and interest in their performing art are given below:

Children/middle aged/senior : Mean age= , SD= , Interest: High/Moderate/Low (description)

Following inclusion and exclusion criteria were followed in selection of participants.

Inclusion: Able to follow performing art as administered and able to report the feelings in verbal and in written expression.

Exclusion: Diagnosed as mentally challenged or psychiatric disorders.

3.2 Instruments:

a) Schedule: One introductory schedule was used to know about age, educational level, specific interest and aptitudes in performing art

b) Questionnaire: One questionnaire was used to understand the changes in layers of consciousness due to performing art.

3.3 Procedure to collect data: Initially rapport was established with subject. Rapport included present condition of the subject, the purpose of the study and willingness of the subject to participate in the study. Next, the introductory schedule was administered. Next performing art in terms of song, music, dance or drama was presented. Please see the appendix A (performing art).

Precautions: Following precautions were followed to control intervening variables as noise, distractors of attention etc.

Analysis of data:

Results : Interpreting Table and Figures

Discussion: Summarize results and relate to existing theories

References : Journal, Book and Web

Appendix

A : Performing Art

B: Original data

c: Any picture

Schedule:

1. Name: 2. Age: 3. Sex:

4. Address

5. Latest educational qualifications (Degree and Diploma if available) :

6. Which performing art do you enjoy frequently ? (Rating: Most frequently-5/more frequently-4/ sometimes -3/ less frequently -2/ least frequently -1)

a) Dance

b) Drama

c) Song

d) Music

7. Please write below your favorite songs, music, dance, drama (at least 5 in each)

Questionnaire:

Please recall the song :

Please recall some sentences:

Please perform it:

Analysis of performance:

1. Can he recall correct words? : yes/no ( Score 1 for each correct word)

2. Can he recall the words orderly ? :

3. Can he maintain rhythm ? :

assigned per category is usually consistent:

Category	Possible points	Description
Orientation to time	5	From broadest to most narrow. Orientation to time has been correlated with future decline.[4]
Orientation to place	5	From broadest to most narrow. This is sometimes narrowed down to streets,[5] and sometimes to floor.[6]
Registration	3	Repeating named prompts
Attention and calculation	5	Serial sevens, or spelling "world" backwards[7] It has been suggested that serial sevens may be more appropriate in a population where English is not the first language.[8]
Recall	3	Registration recall
Language	2	Name a pencil and a watch
Repetition	1	Speaking back a phrase
Complex commands	6	Varies. Can involve drawing figure shown.

The abbreviated mental test score (AMTS) was introduced by Hodkinson in 1972^[1] to rapidly assess elderly patients for the possibility ofdementia. Its uses in medicine have become somewhat wider, e.g. to assess for confusion and other cognitive impairment, although it has mainly been validated in the elderly.

The following questions are put to the patient. Each question correctly answered scores one point. A score of 6 or less suggests delirium or dementia, although further and more formal tests are necessary to confirm the diagnosis.

Question [1]	Score
What is your age? (1 point)
What is the time to the nearest hour? (1 point)
Give the patient an address, and ask him or her to repeat it at the end of the test. (1 point) e.g. 42 West Street
What is the year? (1 point)
What is the name of the hospital or number of the residence where the patient is situated? (1 point)
Can the patient recognize two persons (the doctor, nurse, home help, etc.)? (1 point)
What is your date of birth? (day and month sufficient) (1 point)
In what year did World War 1 begin? (1 point) (other dates can be used, with a preference for dates some time in the past.)
eName the present monarch/dictator/prime minister/president. (1 point) (Alternatively, the question "When did you come to [this country]? " has been suggested)
Count backwards from 20 down to 1. (1 point)

Sensation, Attention and Perception

Dr. D. Dutta Roy, Ph.D.(Psy.)
LECTURE NOTES ON SENSATION,ATTENTION AND PERCEPTION :PROBLEMS OF CONSCIOUSNESS
PERFORMING ART THERAPY CENTRE
RABINDRABHARATI UNIVERSITY
KOLKATA
12.1.2011

SENSATION

Sensation refers to awareness of stimulus. Stimulus refers to any thing that elicits response. This may be internal(changes in organ system) or external changes (changes in surroundings). There are five sensory organs excited by different types of stimuli.

1. Visual organ (Eye): Light
2. Auditory organ (Ear): Sound
3. Gustatory organ (Tongue):Chemical
4. Olfactory organ (Nose): Chemical
5. Cutaneous organ (Skin): Temperature,pressure

There is another organ named as kinesthetic organ excited by movement sensation. There are different attributes of sensation as
1. Quality: Generic quality (light and sound), specific quality (red, blue)
2. Quantity: Low and high frequency of sound
3. Localization: sensing pressure across different areas over skin

It will be misnomer to assume that any change in physical stimulus on physical scale causes same amount of change in the response scale. This is illustrated in problems of psychophysics. Psychophysics is a study to understand relation between changes in physical stimulus on physical scale and changes in response pattern on response scale. It discusses three types of thresholds of sensation as absolute, differential and terminal threshold.

Attention
When individual focuses awareness to something, attention takes place. Attention is focus of awareness. It has few functions like:

1. alerting: It is physical and mental preparedness to focus on specific stimulus.
2. selective function: Selectivity refers to a process by which attention is focused on stimulus or stimuli of ongoing interest and other stimuli are ignored.
3. limited capacity channel:limited capacity to carry out the task. We can process one task at a time. This causes serial processing.
4. vigilance: maintaining attention on a task continuously, for some
time, is called vigilance or sustained attention. It has been found that attending to a task for long is taxing, particularly if the task is monotonous and it leads to decrease in performance.

PERCEPTION
Perception occurs when sensation carries certain meaning. This can be explained in this formula:

Perception = sensation+meaning

Sensation = perception - meaning

visual perception must be viewed as an active process by which the visual information is interpreted and grouped according to a large number of rules. These Gestalt laws allow a phenomenological interpretation of the interactions between visual features that lead to the perception of composite objects. These laws are given below:

Laws of Perceptual Organization

(i) Good Form (Law of Pragnanz): This law states that perceptual organization will always be as “good” as the prevailing conditions allow. The simplest organization requiring the least cognitive effort will always emerge. Pragnanz means that we perceive the simplest organization that fits the stimulus pattern.

(ii) Proximity: All the stimuli that occur together in space or time will be organized together.

(iii) Similarity: Other things being equal, elements which are similar in structure or have common characteristics will be grouped together.

(iv) Closure: An incomplete figure will be seen as a complete one. a figure consisting of incomplete lines, that have gap in them. It is perceived as a triangle despite the fact that its sides are incomplete. A closure like phenomenon yields subjective contours.

AS ELEMENTS OF OUTER LAYER OF CONSCIOUSNESS

Success in performing art therapy depends upon its act on outer, inner and innercore layer of consciousness. The three layers of consciousness is given in Figure 1.

Figure 1 Layers of consciousness

Through performing art, one can start journey from outer to innercore layer through inner layer. Figure 2 shows the journey by Rabindrasangeet.

Faulty or poor development of outer layer inhibits this journey.

Figure 2 Rabindrasangeet is a journey across layers of consciousness.

Outer layer of consciousness concerns attention, sensation and perception. Any abnormality in these three causes serious problem in formation of inner and inner core layers of consciousness as these three play critical role in information processing model (Figure 3) specially in relation to filtering stimuli, retaining in memory stores and in developing imagery processes.

Figure 3. The Information Processing Model of Memory (Based on Atkinson and Shiffrin, 1968)
[Ref. Stevens Handbook of Experimental Psychology (2002) 3rd Edition, Volume 2: ‘Memory and Cognitive Processes’. John Wiley & Sons, Inc.; pp 10].

This multi store memory model is later expanded upon by Baddeley and other co-workers and has become the dominant view in the field of working memory (Figure 4).

Figure 4 Baddley's working memory model

The original model of Baddeley & Hitch was composed of three main components; thecentral executive which acts as supervisory system and controls the flow of information from and to its slave systems: the phonological loop and the visuo-spatial sketchpad. The slave systems are short-term storage systems dedicated to a content domain (verbal and visuo-spatial, respectively). In 2000 Baddeley added a third slave system to his model, the episodic buffer. This component is a third slave system, dedicated to linking information across domains to form integrated units of visual, spatial, and verbal information with time sequencing (or chronological ordering), such as the memory of a story or a movie scene. The episodic buffer is also assumed to have links to long-term memory and semantical meaning.

ABNORMALITIES & PERFORMING ART THERAPY

Faulty development of outer layer creates mental illness due to inability to learn. Therefore, attention should be paid to these three processes in order to understand functional efficacy of the outer layer. ADHD or AD, Mentally challenged or mentally retarded children, HIV and Schizophrenic patients suffer from poor organizing functions of outer layer of consciousness.

ADHD or AD: Attention deficit hyperactivity disorder (ADHD or AD/HD or ADD) is a neurobehavioral developmental disorder. It is primarily characterized by "the co-existence of attentional problems and hyperactivity, with each behavior occurring infrequently alone" and symptoms starting before seven years of age. Function and outcome of Autism spectrum disorders (ASD) are affected not only by core deficits but by frequently associated comorbid behaviors- such as irritability, sensory abnormalities, hyperactivity, affective disorders and others. Outcome is further affected by the presence or absence of language and by overall cognitive ability. Robert Sears, M.D., discussed top 7 therapies for autism in his recently published book. To him, “Every child with autism is unique, and so each therapy program should be individualized to meet his or her needs,”. The 7 therapies are (i) Applied Behaviour Analysis (ABA), (ii) Relationship based floor-time therapy, (iii) Functional communication training, (iv) Language therapy, (v) Picture exchange communication system, (vi) Occupational therapy (viii) Treatment and Education of Autistic and Related Communication-Handicapped Children or TEACCH. In another experiment, it is noted that by using Rabindrik dance to one child diagnosed as autistic by NIMHANS., Bangalore, attentive behaviour is controlled. One performing art therapist was asked to train the child Rabindrik dance " Phule phule dhole dhole". The autistic boy initially could not attend to eye movement but he gradually followed each eye and posture movement of the therapist and finally was able to coordinate eye and posture movement keeping in tune of the music. This suggests that one can control outer layer of consciousness by performing art with patience and hierarchical structuring of the dance movement. In this experiment, therapist had used classical conditioning and patting, hugging, verbal reinforcements were the reinforcements.

Mentally challenged or Mentally retarded: In case of mentally challenged or mental retardation, problem is related to impaired cognitive functioning and deficits in adaptive behaviour. Usually their IQ and SQ are below 70 using standard intelligence test and adaptive behaviour test like Vineland Social Maturity scale. Below are the ranges of IQ and corresponding classification of mentally disorder.

Profound mental retardation: Below 20
Severe mental retardation: 20–34
Moderate mental retardation: 35–49
Mild mental retardation: 50–69
Borderline intellectual functioning: 70–84

To provide performing art therapy to mentally retarded children, it is important to follow different principles of behaviour modification technique like shaping, token economy etc.

HIV: Human immunodeficiency virus (HIV) infection is associated with an increased risk for human herpes viruses (HHVs) and their related diseases and they frequently cause disease deterioration and therapeutic failures. Cognitive impairments are one of the major consequences of HIV infection in the human body – as the virus, once in the blood stream, can cause significant damage to the brain. Further, it makes the body vulnerable to a host of opportunistic infections – infections that would not normally affect a person with a healthy immune system (“AIDSmeds”, 2009). Many of these have significant impact on brain functioning.

1. In the early stages the disorder is characterized by minimal cognitive and motor impairments as shown by slowed information processing and slowed extremity movements. The patient can function on his own with minimal assistance such as reminders.

2. As the disease progresses, there is functional cognitive, affective and motor impairment. The patient misplaces things, faces difficulty in performing complex tasks and has problems with verbal memory and new learning. There may be motor dysfunctions like tremors, leg weakness and loss of balance. The patient may become ambulatory, but may be able to perform the basic activities of self-care.

3. With further neurodegeneration, the subcortical dementia begins to resemble global cortical dementia. At this point, there is deterioration of intellectual function, decision making capacity, delirium, hallucinations and loss of behavioural control. The patient cannot walk unassisted, there is considerable slowing of all cognitive faculties (including speech and reaction time), and there may be affective symptoms like apathy, irritability and social withdrawal.

4. The end stage, marking full progress of the syndrome, is characterized by a nearly vegetative state, with rudimentary levels of intellectual and social comprehension and bladder incontinence.

Schizophrenia: Schizophrenia affects approximately 1% of the population worldwide and is a chronic, severe psychiatric disorder. The onset of schizophrenia usually occurs around 18-25 years of age and is often preceded by premorbid behavioral deviations, such as social withdrawal and affective changes (Keshavan et al., 2005). Psychiatrist Emil Kraepelin, was the first to acknowledge psychiatric disorders from a biological perspective, and established the term dementia praecox. In 1911, the Swiss psychiatrist Paul Eugen Bleuler renamed dementia praecox as “the group of schizophrenias” and described it as a cluster of disorders rather than one coherent disease. With reference to prognosis, Crow (1980) classified two categories – type I and type II. Type I schizophrenia patients are those who present, often more acutely, with a predominantly positive symptom profile and who have a good response to neuroleptics or antipsychotics. In contrast, type II schizophrenia patients are those who have a more chronic illness, more frequent evidence of intellectual impairment and enlarged ventricular size and cortical atrophy as seen on CT or MRI scans, a poorer response to neuroleptics and predominantly negative symptoms. Type I category of patients possessed symptoms which are excess or distortion of normal mental functions like hearing voices, so these symptoms are called as positive symptoms. And Type II category patients possess symptoms which are loss or reduction of normal functioning like asocial behavior. These are called negative symptoms. Diagnostic Statistical Manual (DSM-IV-TR) accepts this classification. Of the two types, the negative symptoms are more difficult to evaluate because they may be influenced by a concurrent depression or a dull and un-stimulating environment, but they account for much of the morbidity (unhealthiness) associated with schizophrenia. The positive symptoms associated with better prognosis as compared to negative symptoms.

Positive Symptoms: The positive symptoms of schizophrenia include four "first-rank" or Schneiderian symptoms, named for a German psychiatrist who identified them in 1959 and other positive symptoms.

Ref: http://www.nios.ac.in/srsec328newE/328EL5.pdf

Dutta Roy,D.(2006). Development of picture drawing test to assess consciousness layers of tribal children of Tripura, Journal of the Indian Academy of Applied Psychology,Vol. 32, No. 1, 20-25