In Session: Psychotherapy in Practice最新文献

Research on expressed emotion (EE) has shown that clients with depression, like those with schizophrenia, are more likely to relapse if they live with a partner or family members who express critical attitudes toward the client. This article describes a new treatment for major depression, based on systemic therapy we have called Partner Assisted Therapy. Specific interventions are discussed and illustrated with case material. Results at one and two years show partner-assisted therapy to be superior to pharmacological treatment. © 1998 John Wiley & Sons, Inc.

This article reviews and integrates the previous articles under central concerns facing the field about the treatment of patients with borderline personality disorder. Since borderline is a heterogenous category, various authors have isolated treatment-relevant subgroups. One approach to structuring treatment with these impulsive and chaotic patients is to begin with an explicit treatment contract. The choice of treatment tactics and techniques is related to the types of outcomes conceptualized by the various orientations. Finally, the therapist training needed to work with this patient population is examined. © 1998 John Wiley & Sons, Inc.

This article describes a group-treatment program that was developed and tested in a treatment-comparison study with clients who met criteria for the diagnosis of borderline personality disorder. The etiologic and diagnostic factors that were selected for emphasis in the development of the treatment model are outlined; the specific structure, techniques, and therapeutic focus of the group method are described; and four phases of group development and focus are illustrated with the use of material from one of the groups. Therapist training and the use of subjective reactions for understanding and treating clients with borderline personality disorder are central features of this method. The process of change within the context of group interaction is illustrated. Recommendations for selecting clients and guidelines for implementation of the treatment method are provided. © 1998 John Wiley & Sons, Inc.

Dialectical Behavior Therapy (DBT) has been shown to be effective for adult, female borderline personality disordered patients and shows promise to be the treatment of choice for emotionally unstable patients in general. In this article we present an overview of the application of the DBT treatment to adolescent borderline clients, and illustrate the intervention in a 13-year-old male who presented for treatment with symptoms of identity disturbance, role confusion, frequent suicide ideation, and impulsive self-damaging behavior. Our intention is to illustrate the use of DBT with this population, and to explain by example some of the modifications we think are useful in using DBT with inner-city minority youth. © 1998 John Wiley & Sons, Inc.

Expressed emotion (EE) is discussed in relation to bipolar affective disorder, a major psychiatric illness involving fluctuating periods of mania and depression. High levels of EE among relatives of bipolar clients are conceptualized as reactions to the stress of adjusting to the acute illness period and the post-episode aftercare period. EE has an associated cognitive component involving certain styles of attribution about illness in the client, and a behavioral component involving aversive interaction patterns between the bipolar client and his or her relatives. Family-focused psychoeducational treatment—consisting of psychoeducation about bipolar disorder, communication enhancement training, and problem-solving skills training—addresses high EE on the cognitive, affective, and behavioral levels. A case study illustrates the approach. © 1998 John Wiley & Sons, Inc.

Obsessive compulsive disorder (OCD) often has burdensome and debilitating effects on families. Family responses range from support and empathy to excessive accommodation and overinvolvement to hostility and rejection. Assessment of individual family members' responses in these arenas help determine psychoeducational content for family members and whether relatives should participate in behavioral treatment sessions and homework assignments. Research evidence indicates that families may be helpful in assisting with treatment, especially in a multifamily behavioral treatment (MFBT) format. Strategies for addressing problematic family behaviors and attitudes are illustrated with case examples. © 1998 John Wiley & Sons, Inc.

A brief overview of transference-focused psychotherapy (TFP), developed by Otto F. Kernberg for the treatment of clients with severe personality disorders, is presented. The therapy begins with the development of a treatment contract, which consists of general guidelines that apply for all clients and with specific items developed from problem areas from the individual client's history that could interfere with the therapy process. The contract also contains therapist responsibilities. The client and therapist must agree to the content of the treatment contract for therapy to proceed. The client's affectively charged internal representations of previous relationships are consistently interpreted as the therapist becomes aware of them in the therapeutic relationship, that is, the transference. There are specific strategies and techniques used in TFP; however, more important are the guiding principles used throughout the treatment. A case is presented to illustrate aspects of this therapy as applied to a client with borderline personality disorder (BPD). © 1998 John Wiley & Sons, Inc.

This article describes a form of behavior therapy called Dialectical Behavior Therapy (DBT), developed by Linehan for treatment of the seriously and chronically suicidal patient. The author describes the following characteristics of DBT: 1 theoretical perspective (dialectics, biosocial/behavior), 2 treatment stages and targets, and 3 treatment strategies, including dialectical strategies, core strategies (validation and problem-solving), change procedures (use of operant learning principles, skills training, and exposure/response prevention techniques from behavior therapy and cognitive modification techniques taken primarily from rational-emotive therapy), communication strategies (irreverent and reciprocal communication), and case-management strategies (consultation to the patient, environmental intervention, supervision/consultation with therapists). Some aspects of DBT are represented in a case presentation together with transcripts of several sessions. © 1998 John Wiley & Sons, Inc.

The article describes the authors' approach to working with families of schizophrenic clients and attempts to give the reader an understanding of why it is important to take account of expressed emotion (EE) in planning and executing family interventions. To this end we include descriptions of the EE dimensions in the context of schizophrenia in a way that may be meaningful to clinicians (i.e., criticism, emotional overinvolvement, and hostility). Assessment techniques directed at general clinical use are outlined, and we describe methods of harnessing aspects of our understanding of EE to generate and guide family intervention goals. This is followed by a case example used to illustrate the assessments, before we examine the intervention framework and techniques with the help of further clinical material. We employ a case formulation framework to produce an individualized view of each family's problems (Barrowclough & Tarrier, 1992). © 1998 John Wiley & Sons, Inc.

This article provides an introduction to the construct of expressed emotion (EE), which comprises criticism, hostility, and emotional overinvolvement. The importance of EE as a predictor of treatment outcome and relapse in a number of psychiatric disorders is noted, as are the possible mechanisms of EE's impact on the patient and potential causes of EE. © 1998 John Wiley & Sons, Inc.