In Session: Psychotherapy in Practice最新文献

Schizophrenia can no longer be viewed as a chronic, inexorably deteriorating disorder with little chance for rehabilitation or recovery. Felicitous outcomes, however, are achieved only if treatment and rehabilitative services are continuously provided to individuals and their families. Clinicians can no longer be content to rely solely on a biomedical model of treatment that reduces the disorder to the biological correlates of psychotic symptoms. Instead, a biopsychosocial perspective, which emphasizes the interaction of the brain, behavior, and the environment, serves as the foundation for the integration of psychopharmacology and psychotherapy. This integration has arisen specifically to develop, evaluate, and disseminate those techniques that improve the social functioning of people with serious mental illnesses such as schizophrenia. Employing the biopsychosocial approach to comprehensive care—including training in social and independent living skills, family psychoeducation, self-management of medication and symptoms—can amplify the impact of medication in fostering better outcomes and higher levels of personal functioning. © 1997 John Wiley & Sons, Inc.

This article describes a brief, psychodynamic psychotherapy for adults who have PTSD following exposure to a single traumatic event, such as tragic bereavement, assault, or loss of a body part through surgery. It uses a supportive therapeutic relationship to uncover what the specific event and circumstances that follow mean to the individual, and the obstacles to normal psychological processing of these events. Using this 12-session treatment model, therapists pay particular attention to the individual's current phase of response and the typical ways that the individual avoids threatening information. Making links between the recent trauma, earlier developmental experiences that may have rendered the individual vulnerable to the development of PTSD, and ways that conflicts are reenacted in the therapeutic dyad, dynamic therapists seek to help traumatized individuals reestablish a sense of coherence and meaning in their lives. A case illustration is provided to demonstrate the phases and techniques in this approach. © 1997 John Wiley & Sons, Inc.

The traditional medical model of treatment for substance abuse has worked for some addicts. However, many have been unable to benefit from this paradigm because of comorbid psychiatric disorders that are not addressed, or due to individual characteristics or preferences that are not considered by the unitary approach of medical model treatment. A harm reduction approach, which combines principles of psychotherapy with substance use treatment, is described and illustrated with a case example of a woman treated for alcoholism and depression. This approach is nonauthoritarian, collaborative, and based on an integration of psychodynamic, cognitive-behavioral, and substance use treatment techniques. © 1998 John Wiley & Sons, Inc.

This article offers a brief selective review of basic research findings linking the self to clinical depression. Criteria used for identifying the most influential research trends included theoretical impact, extent of empirical support, and potential clinical utility. We discuss and summarize several of the most productive areas of research on the self: self-esteem, the self-schema, and self-inconsistency. Within each topic area, the most important findings and their applicability to psychotherapy for depression are presented. The article concludes with a discussion of issues raised by the review itself and a set of recommendations for applying basic research findings to treatment selection and psychotherapeutic intervention. © 1997 John Wiley & Sons, Inc.

Anxiety disorders are best viewed from the biopsychological model in terms of etiology as well as treatment. Leading psychological theories and treatments are reviewed, as well as biological theories and current pharmacotherapies of these disorders. Treatment using these modalities is discussed from several perspectives: the psychotherapist as primary therapist, consulting a pharmacotherapist for medication treatment; the pharmacotherapist as primary therapist, consulting a psychotherapist for addition of psychotherapy; and the solo practitioner, providing both psychotherapy and pharmacotherapy. Case illustrations of each approach are given, and advantages, disadvantages, and pitfalls of each method are explored, concluding that in many cases, whether one or two therapists are involved, the best treatment is likely to be an integration of psychotherapy and pharmacotherapy. © 1997 John Wiley & Sons, Inc.

Although drug and alcohol abuse continues to be widespread in our society, traditional approaches to treatment have had limited success at engaging and retaining clients, and have shown poor outcomes overall. Harm reduction is a new approach to treating substance abuse that may be more acceptable and effective for this large clinical population. This article describes the harm reduction paradigm and the author's use of harm reduction within a psychotherapeutic approach that integrates cognitive and behavioral interventions with a psychodynamic understanding of substance use as personally meaningful. The approach is illustrated by a case of a client who presented with alcohol abuse secondary to depression. © 1998 John Wiley & Sons, Inc.

Although many youngsters refuse to attend school at one time or another, school refusal is largely misunderstood by parents, educators, and therapists. Because youngsters who refuse school present with so many different behaviors, finding a treatment procedure that works well for all cases is difficult. As a result, many therapists have been forced to rely on their own makeshift approaches to address this problem. In this article, we present a way of viewing this population systematically from the perspective of two clinicians who are familiar with these clients. To illustrate this perspective, we rely on a description of school refusal, our clinic, assessment and treatment options, and three clinical cases. © 1997 John Wiley & Sons, Inc.

Certain thematic principles emerge when attempting to integrate psychotherapy and pharmacotherapy in the treatment of anxiety disorders, depression, borderline personality disorder, eating disorders, and schizophrenia. Indications for collaborative treatment, issues involved in making a referral, and the nature of the actual collaboration are described. Indications and guidelines for integrating psychotherapy and pharmacotherapy by the same clinician are also considered. © 1997 John Wiley & Sons, Inc.

Medical fears are common in children and can have long-term implications for future attitudes toward health care. Providing accurate information about an impending medical procedure can help the inexperienced child prepare for a painful or unpleasant medical experience and ultimately adapt to the experience more rapidly. The main strategies for providing developmentally appropriate medical information to children are reviewed, and common errors made by parents and medical staff are highlighted. However, anxious children who have already experienced difficult or painful medical procedures are unlikely to be helped by additional information. Distraction, relaxation, and imagery techniques specifically designed for such children who already have developed medical phobias are reviewed. The importance of parents and other adults as “coaches” for children during stressful medical procedures is addressed. © 1997 John Wiley & Sons, Inc.