In Session: Psychotherapy in Practice最新文献

In this article we review current knowledge about the nature of posttraumatic stress disorder (PTSD) in order to assist clinicians in the diagnosis and treatment of reactions to traumatic life events. The review is limited to information about PTSD in adults, although some of the material may generalize to child and adolescent populations. Information presented includes prevalence, course, and comorbidity. We also briefly summarize findings on information processing and psychobiology. After presenting research findings, we then discuss the assessment of trauma and PTSD. © 1997 John Wiley & Sons, Inc.

Most people suffering from major depressive disorder experience chronic symptoms, recurrence, or both. We speculate on how the process of diagnosis and cognitive therapy may produce changes that, over time, can affect the view of the self. In clinical practice and research, some of the most challenging questions involve how best to identify and design strategies to help patients and clinicians reduce the chance that depressions recur. Related and equally challenging questions involve how best to increase the time between episodes and how to decrease the length of depressive episodes when prophylactic treatment does not prevent a relapse or recurrence. In this article we describe how we have used the continuation/maintenance phase of cognitive therapy for depression to achieve these goals. We illustrate these concepts and processes with one case history. © 1997 John Wiley & Sons, Inc.

Psychotherapy and pharmacotherapy are each effective in treating borderline personality disorder. In severely symptomatic patients, psychotherapy reduces suicidality and the utilization of inpatient psychiatric care within the first year of treatment, but drop-out rates are high. Pharmacotherapy reduces impulsivity, hostility, suicidality, and psychoticism over five to twelve week periods after which it may not be effective. The combination of both modalities surmounts the limitations of each, but is difficult to achieve because characteristic features of borderline pathology can undermine efforts at integrating the treatments. The meaning of being given medication, the effect of medication on the therapeutic relationship, issues of control, seduction and dependency, the all-or-nothing tendency to “biologize” or “psychologize,” and the therapist's counter-reactions to the patient must all be addressed for combined treatment to be possible. Several clinical vignettes illustrate these issues. © 1997 John Wiley & Sons, Inc.

Depression is a common, often incapacitating, disorder characterized by emotional, cognitive, behavioral, and physiological symptoms. Psychotherapy and pharmacotherapy are both effective, but limited, treatments for depression. Integration of these modalities has the potential to combine the benefits and compensate for the limitations of each approach, thereby significantly enhancing positive therapeutic outcomes. Integrated treatment for depression may be conducted by a single therapist or by two therapists, one providing psychotherapy and one pharmacotherapy. In either form of integration, it is essential for the therapist or therapists to be mindful of potential complications and to deal with them in constructive ways. © 1997 John Wiley & Sons, Inc.

Harm reduction psychotherapy gives a name to a practice many therapists have quietly been conducting for years. Some of us have been doing psychotherapy with clients who present with both psychological and addictive behavior problems, despite the ideological barriers that have promulgated total separation of these two sets of problems in terms of treatment philosophies, interventions, and providers. This article chronicles the author's evolution from viewing addictions as distinct from psychological problems to understanding and treating them as a subset of human behaviors causing suffering that can and should be integrated into a more comprehensive psychotherapeutic framework. © 1998 John Wiley & Sons, Inc.

Substance abuse occurs in approximately half of adults who have childhood-onset attention-deficit/hyperactivity disorder (ADHD), and in many individuals who exhibit symptoms of posttraumatic stress disorder (PTSD). This article provides clinical guidelines for working with this population. The case presented illustrates how a harm reduction approach to substance use and a “come-as-you-are” stance regarding both occasional use and characteristic ADHD symptoms may better serve the ADHD adult, and individuals with PTSD, than the traditional insistence on complete abstinence from substance use as a prerequisite to psychotherapy. © 1998 John Wiley & Sons, Inc.

In this article we discuss some of the relevant theoretical, technical, and clinical issues in the treatment of depression with short-term psychoanalytic psychotherapy. When successful, we suggest that such psychotherapy results in changes involving aspects of the self. We believe that this is particularly likely to occur when the technique emphasizes the interpretation of the nature of the client's relationship to the therapist. To illustrate this approach, we present the case of a clinically depressed woman treated in time-limited, short-term psychoanalytic psychotherapy. We demonstrate the nature of the therapeutic work typical of this treatment using verbatim vignettes from two sessions. © 1997 John Wiley & Sons, Inc.

Children who are seen in clinical settings frequently experience interpersonal difficulties with peers. Because of this, efforts to help children improve their friendships should be an essential aspect of the child treatment process. Accordingly, this article first reviews developmental findings on children's peer acceptance and friendships to provide a framework for understanding children's social functioning. Next, the article describes current approaches to assessing and intervening with children's peer relationship problems. Specific interventions include social skills training, strategies for enhancing peer friendships, and ways to reduce competing behavior problems. Finally, two case examples are provided that illustrate several of the main intervention themes. In general, the purpose of the article is to assist practicing therapists in integrating information on children's social functioning into their everyday clinical practice. © 1997 John Wiley & Sons, Inc.

Eating disorders are complex psychiatric illnesses that often require the integration of multiple therapeutic modalities. Psychotherapy, pharmacotherapy, and nutritional therapy have each proven to be independently helpful but limited interventions for these disorders. In this article, we describe two different ways of integrating these three modalities: (1) Integration within a multidisciplinary treatment team; and (2) Integration by a single therapist. The benefits and drawbacks of each approach are discussed. © 1997 John Wiley & Sons, Inc.

A review of the psychosocial treatment research literature indicates that several forms of therapy appear to be useful in reducing the symptoms of posttraumatic stress disorder (PTSD). Strongest support is found for the treatments that combine cognitive and behavioral techniques. Hypnosis, psychodynamic, anxiety management, and group therapies may also produce short-term symptom reduction. Still unknown is whether any approach produces lasting effects. Imaginal exposure to trauma memories and hypnosis are techniques most likely to affect the intrusive symptoms of PTSD, whereas cognitive and psychodynamic approaches may better address the numbing and avoidance symptom cluster. Treatment should be tailored to the severity and type of presenting PTSD symptoms, to the type of trauma experience, and to the many likely comorbid diagnoses and adjustment problems. © 1997 John Wiley & Sons, Inc.