In Session: Psychotherapy in Practice最新文献

Attention to the self can take place even within the context of a brief or time-limited psychodynamically oriented therapy. The case presented here demonstrates how one can, and why one should, treat the whole person and not solely the symptoms of depression following a significant loss. The aspect of the client's sense of self that was most prominent was her need to depend excessively on her boyfriend rather than being more autonomous within a mature give-and-take relationship. She was treated in a 12-session time-limited therapy developed by James Mann that deals with the human inevitability of experiencing significant interpersonal separations and losses. In line with this model, the therapy focused on the client's chronically endured emotional pain, employing an empathic, exploratory, and interpretive style. The termination stage of therapy allowed the client to reexperience feelings of loss and separation with the opportunity to come to terms with them in a new, more constructive way. © 1997 John Wiley & Sons, Inc.

In this article, a conceptual framework for the evaluation and treatment of trauma survivors, the stage by dimension model, is summarized and applied to the formulation and treatment planning of a clinical case. The stage by dimension model outlines three stages along which trauma recovery proceeds, and describes eight dimensions of psychological functioning most relevant to the process of recovery. The complexities of clinical evaluation and treatment with multiply traumatized individuals are described. A case presentation of a woman with a complex trauma history illustrates the way in which this model highlights clients' strengths, and focuses clinical interventions in an individualized manner. © 1997 John Wiley & Sons, Inc.

This article presents a discussion and case illustration of using harm reduction as a model for treatment design for individuals presenting with multiple problems. Initial difficulties with engagement into treatment are discussed, as well as early strategies based on easing intake requirements and responding quickly to clients' stated needs. Some of these strategies include developing a needs hierarchy that clients participate in, not setting fixed rules for their behavior regarding their drug use, and a willingness to work with them on other pressing problems, such as housing despite active drug use. This strategy results in a working alliance based on mutual, honest exploration of clients' problems and creative solutions to them. In the case presented, shifting symptoms were addressed often without a diagnosis that could clarify whether the cause of the symptom was psychiatric, substance abuse, or medical in origin. Treatment team recommendations are given. © 1998 John Wiley & Sons, Inc.

Working with anxious children and their families presents a number of challenges to the clinician and researcher. Issues related to diagnosis, assessment, and treatment abound. Many of these children present with co-occurring problems of depression, attention, and oppositionality. Furthermore, for many of these children, anxiety is embedded in familial and social contexts and varies across development. As a result, anxiety does not exist solely in the child. Rather, important developmental and contextual factors must be considered both in the assessment and treatment of these children and their families. Toward this end, a wide array of assessment strategies may prove useful, including diagnostic interviews, self-report questionnaires, parent and teacher behavior checklists, and behavioral observation of the child and his or her family in various contexts. Empirically supported treatments have been developed to address these problems, including behavioral and cognitive-behavioral procedures. Diagnosis, assessment, and treatment are illustrated in a case study that illustrates several issues in working with these children and their families. © 1997 John Wiley & Sons, Inc.

This article describes a relational conception of the self grounded in cognitive theory. The self is considered in terms of several relationships, including (a) the interplay between its various processes and contents, (b) the implicit relation between self and other in its representational content, (c) the transitions among the various states of mind that an individual experiences (referred to as self-states), and (d) the reciprocity between the various states of two individuals in a therapeutic interaction. Depression is understood from this perspective as involving an avoidance of an emotional experience. Clinical vignettes are presented to illustrate the emergence of depressive states in psychotherapy sessions and the process toward effecting change by increasing awareness of these states and what they avoid in the context of the therapeutic relationship. © 1997 John Wiley & Sons, Inc.

In this article I discuss what I think is a major obstacle to doing what works in clinical practice. Namely, many times prior, foundational assumptions get in the way of our choosing and using the most effective treatment methods. I thus offer a way to think about things—a pragmatic perspective—that challenges this notion of foundational assumptions. I discuss the two main characteristics of a pragmatic perspective: its problem solving and contextualistic orientation. I also show how the articles contained in this issue of In Session can be viewed within this pragmatic perspective. My conclusion is that a pragmatic perspective provides a useful framework for incorporating procedures that work in one's clinical practice. © 1997 John Wiley & Sons, Inc.

Bridging the diverse viewpoints presented on the nature of the self in short-term treatment of depression, this concluding article identifies some common themes that run through each of the individual contributions. The concepts of an expanded self or a greater coherence of self-attributes is viewed as an important outcome, regardless of the modality through which it is achieved. Furthermore, individuals' capacity to observe and accept their own experiences and increases in their capacity for perspective taking were found to be especially important in enabling persons suffering from depression to develop a more functional sense of self. © 1997 John Wiley & Sons, Inc.

Although individual therapy involving imaginal experiencing of the traumatic event has been found to be effective in treating PTSD, there is evidence that few trauma therapists actually use the technique. Moreover, symptom improvement has been found to favor intrusive symptoms, whereas avoidance and hyperarousal have been less affected. Additionally, there are several published reports documenting difficulties in implementing the treatment, ranging from client refusal, adverse reactions, and therapist inexperience. In this article we outline an alternative group form of exposure therapy, manualized trauma focus group therapy (TFGT), designed to overcome some of these implementation obstacles and to enhance the effects of imaginal exposure to include those chronic PTSD symptoms of avoidance and social isolation. We describe the cognitive behavioral and developmental models from which the approach was derived, present clinical guidelines and an illustrative session, discuss complications we have encountered in TFGT pilot studies, and offer suggestions for improving future implementation. © 1997 John Wiley & Sons, Inc.

A model of cognitive-behavioral treatment for posttraumatic stress disorder (PTSD) in rape survivors is presented. Emotional processing theory, which proposes mechanisms that underlie the development of disturbances following rape, is reviewed. A combination therapy that includes education about common reactions to trauma, relaxation training, imaginal reliving of the rape memory, exposure to trauma reminders, and cognitive restructuring is presented. The case example of a young female rape survivor is described in detail, including her assessments before and after therapy. In this case, issues of prior substance dependence and intense shame and guilt are highlighted. The therapy was successful in reducing the client's symptoms of PTSD as well as her depressive symptoms, and these gains were maintained at a 1-year follow-up assessment. © 1997 John Wiley & Sons, Inc.