In Session: Psychotherapy in Practice最新文献

Coping with marital conflict, divorce, and/or parental remarriage can be stressful for children. In this article, I review some of the effects that these family stressors can have on children, describe therapeutic approaches to help children cope with these stressors, and present a case illustration. In order to help children cope with marital conflict, divorce, and/or remarriage, it is often necessary to work in a multifaceted way with a number of subsystems within the family. © 1997 John Wiley & Sons, Inc.

A model of cognitive—behavioral treatment for sexually abused children is presented. A brief review describes the definition, prevalence, and effects of child sexual abuse as well as the treatment outcome literature in this field. A treatment model is presented that includes the following therapeutic components: gradually encouraging the child to think and talk about the abuse; helping child and parent cope with emotions surrounding the abuse; helping parents better manage their child's behavior; and education regarding child sexual abuse, healthy sexuality, and personal safety skills. A case example is presented involving a 10-year-old girl who was sexually abused by a paternal uncle. The case depicts how the child's symptoms of posttraumatic stress, depression, and anxiety were successfully treated through individual sessions with the child and her mother as well as joint sessions that allowed the mother to serve as a therapeutic resource and support for her child. © 1997 John Wiley & Sons, Inc.

After a homicide, those surviving family members who fail to recover and present for therapy are unable to adjust to the trauma of the dying. They present with persistent reenactment images of the dying, which are frightening and nonconformable. This article suggests a strategy that specifically focuses on the encouragement of psychologic offenses to begin the mastery of the traumatic responses of avoidance and intrusion. Mastery of the trauma of the dying is a necessary first step in therapy before resolution of bereavement distress can begin. This article introduces some guiding principles that can be of pragmatic assistance during treatment. © 1996 John Wiley & Sons, Inc.

Depression is a frequent complication of grief. As for other depressions in nonbereaved populations, the treatment of choice for these depressions often involves a combination of psychotherapy and medication. The goal is ameliorating the acute episode as well as prevention of further episodes. Through case vignettes of four individuals with spousal bereavement, this article describes ways depression may be masked (and therefore inadequately treated) by grief, may require multiple interventions over time, and may require treatment of depression with psychotherapy alone. At times, optimal treatment may dictate that the therapist actively disregard grief as a therapeutic issue. Though potentially a serious and debilitating complication of bereavement, depression generally responds favorably to appropriate and timely treatment. © 1996 John Wiley & Sons, Inc.

A sudden, unanticipated death confronts the mourner not only with the loss of the loved one, but with personal traumatization resulting from the unexpected psychological assault brought by the event. Interventions necessarily must target the twin goals of trauma mastery and accommodation of the loss. This article delineates the specific issues inherent in sudden death that tend to complicate mourning and suggests treatment interventions to employ when working with a mourner confronting this type of loss. An in-depth case study is provided to illustrate the treatment process. © 1996 John Wiley & Sons, Inc.

Therapy for complicated grief is predicated on a thorough working knowledge of normal grief and its maladaptive complications. Knowledge of attachment theory, traumatic stress theory, and theoretical concepts of depression and anxiety disorders are also particularly useful. This background is used for psychoeducational purposes and integrated with therapeutic strategies from established psychotherapies. To illustrate this approach, the authors present a case of complicated grief in a woman whose mother and son died within 10 months. She was treated with brief, problem-focused, integrated psychotherapy aimed at alleviating symptoms or clarifying underlying psychological processes engendered by the losses. © 1996 John Wiley & Sons, Inc.

Clinicians who work with bereaved individuals around grief issues need a way to understand the process of mourning. Generally, the mourning process can be conceptualized as involving either stages, phases, or tasks. In this article the author selects the task model and outlines the tasks of mourning as well as identifying 6 mediators of mourning that influence both the grief experience and duration of the bereavement course. This model is useful for working with both complicated and uncomplicated bereavement. © 1996 John Wiley & Sons, Inc.

This article provides a broad overview of empirical research on bereavement. We draw on existing research to address three major clinical issues. First, how do people typically respond to major losses? We argue that many reactions assumed to be abnormal, such as the failure to exhibit intense distress following a loss, are more common than believed and are not necessarily indicative of pathology. We maintain that a broader definition of “normal grieving” would benefit the bereaved. It is true, however, that as many as 40% of the bereaved may develop full-blown clinical complications following a major loss. We offer clues for identifying and treating such clients. Second, we review those factors that have been shown to enhance vulnerability to the effects of loss. Special emphasis is placed on the unique symptomology of sudden, traumatic deaths, which are the leading cause of death of people under the age of 44. Third, we discuss the efficacy of various treatments. Available evidence suggests that individual psychotherapy is an effective intervention, particularly among those categorized as high risk. There is also evidence to suggest that antidepressant and antianxiety drugs can be very useful as an adjunct to therapy. This article concludes with a discussion of the unique difficulties in working with the bereaved, including the possibility of emotional numbing, demoralization, and ultimately, burnout. Fortunately, the work is also rich in rewards; sharing and helping to transform another's suffering is at the heart of what it means to be human. © 1996 John Wiley & Sons, Inc.