AMERICAN JOURNAL OF PSYCHOTHERAPY最新文献

Ruptures to the therapeutic alliance are an inevitable part of therapy. The ability to repair these ruptures is an essential therapist skill. Racial, ethnic, and cultural differences between therapists and patients can increase the likelihood of rupture to the therapeutic alliance, potentially leading to unilateral treatment termination by patients. Therapists therefore need skills to work effectively with patients who have diverse, intersectional identities. In this article, the authors give therapists tools to help protect against ruptures and to repair ruptures when they occur by integrating three complementary models: taking a stance of cultural humility to decrease assumptions, identifying and directly broaching cultural topics, and implementing a six-stage cultural repair model. A case example is used to illustrate these tools and techniques in practice. These skills can improve collaboration and decrease the inherent power imbalance in the therapeutic relationship.

The broad acceptance of evidence-based psychosocial interventions as adjuncts to pharmacotherapy for bipolar disorder has been inhibited by the extensive training, supervision, and fidelity requirements of these approaches. Interventions that emphasize evidence-based strategies drawn from these modalities-rather than the full manualized protocols-may broaden the availability of psychotherapy for patients with bipolar disorder. In this article, psychosocial risk factors relevant to the course of bipolar disorder (stressful life events that disrupt social rhythms, lack of social support, family criticism and conflict, and lack of illness awareness or literacy) are reviewed, along with evidence-based psychosocial interventions (e.g., interpersonal and social rhythm therapy, cognitive-behavioral therapy, family-focused therapy, and group psychoeducation) to address these risk factors. The results of a component network meta-analysis of randomized psychotherapy trials in bipolar disorder are discussed. Manualized psychoeducation protocols-especially those that encourage active skill practice and mood monitoring in a family or group format-were found to be more effective, compared with individual psychoeducation or routine care, in reducing 1-year recurrence rates. Cognitive restructuring, regulation of daily and nightly routines, and communication skills training were core components associated with stabilization of depressive symptoms. The authors describe a novel psychoeducational approach-practical psychosocial management (PPM)-that integrates these core strategies into the personalized care of patients with bipolar disorder to reduce recurrences and enhance mood stability. PPM is designed to be implemented, without time-intensive training and oversight, by physician or nonphysician clinicians. Evaluating the efficacy and coverage of PPM will require implementation trials in community settings.

Objective: Dialectical behavior therapy for adolescents (DBT-A) is an evidence-based treatment for adolescents with multiple emotional and behavioral problems. Research has demonstrated the posttreatment acceptability of DBT-A by parents and adolescents. However, no study has systematically explored the expectations and preferences of adolescents before beginning DBT-A treatment. The goals of this study were to investigate adolescents' pretreatment expectations for DBT-A by developing the Adolescent Expectancies for Therapy Scale (AETS), adapted from the Parent Expectancies for Therapy Scale, and to explore their preferences regarding treatment delivery format.

Methods: Participants were 21 adolescents (ages 13-18) with varying race-ethnicities who were referred for DBT-A in either a group private practice or a community mental health clinic. Participants completed the AETS and the Preferences Rating Form, which examined the extent to which participants preferred each of seven treatment modifications or preferred to keep DBT-A as is.

Results: Findings indicated that, before beginning DBT-A, adolescents had moderate expectations for the outcome and process of the therapy, and approximately half reported that they preferred to be separate from their parents during multifamily skills group sessions (for at least part of the time) and to add weekly teen-only support groups to DBT-A. The AETS had adequate internal consistency (Cronbach's α=0.88).

Conclusions: Understanding adolescents' pretreatment expectations and preferences for the format in which DBT-A is delivered can help clinicians better engage adolescents during the intake and orientation process.

Objective: The first substantive article to address cultural humility in psychotherapy supervision appeared in a 2016 issue of this journal. The aim of this review is to update that 2016 article, providing a conceptual-practical and empirical status report about cultural humility's increasing integration into psychotherapy supervision.

Methods: A hybrid database-snowballing search process was used. Database searches were conducted by using PubMed and PsycInfo with the words "cultural humility" and "supervision." Backward and forward snowballing were also used to identify possible missed articles for inclusion.

Results: Twenty-nine articles on cultural humility and supervision, all appearing since the original 2016 article, were identified. Seventeen articles were conceptual-practical, whereas 12 articles were empirical research studies. The conceptual-practical articles provided support for a cultural humility-supervision nexus via proposed models, supervision interventions, and case examples (e.g., demonstrating the facilitation of culturally informed work with minoritized supervisees). The research articles were similarly supportive, providing empirical data that indicated cultural humility's beneficial impact on supervision (e.g., making rupture repair more likely).

Conclusions: Since 2016, the host of supervisors who conceptualize about, practice, and research cultural humility in supervision have seemingly converged on one point: cultural humility is a supervision enhancer, contributing to both positive supervision processes and outcomes. It indeed appears that, where supervisor cultural humility goes, so too goes a strengthened supervisory alliance, heightened supervisee satisfaction, and increased supervisee self-disclosure. Based on this status report, the authors contend that supervisors could greatly benefit from learning about cultural humility and incorporating it into their supervisory practice.

Objective: Pharmacotherapy outcomes may be influenced as much by psychosocial factors as by medication. Comprehensive discussion of such factors may contribute to better patient outcomes and may counter aspects of a curriculum that prioritizes efficiency and that has the potential to undermine clinician empathy. This pilot study aimed to explore the benefits of teaching psychosocial aspects of prescribing and student acceptance of such teaching.

Methods: First-year medical students (N=22) at Quinnipiac University were surveyed after completing an online module explaining psychosocial principles of pharmacology and participating in role-plays.

Results: Nineteen participants (86%) strongly agreed that how they prescribe was as important as what they prescribe, and 17 participants (77%) strongly agreed that they would benefit from additional education.

Conclusions: An interactive activity can enhance first-year medical students' interest in and knowledge of the impact of integrating psychosocial factors into medical education on treatment adherence.

Considering the escalating gap between the population-level need for substance use services and the availability of board-certified addiction specialty physicians, all psychiatrists must be equipped to treat substance use disorders. Residency training programs must therefore ensure that graduates are equipped with a sufficient knowledge base and skill set to treat substance use disorders, including an understanding of medications for addiction treatment and appropriate selection and utilization of psychotherapy for substance use disorders. Resources for teaching psychiatric residents about psychotherapeutic approaches to substance use disorders are often limited, and many programs may struggle to include this content in their curricula. The authors highlight the core evidence-based psychotherapeutic approaches relevant to the care of patients with substance use disorders and identify supervised experiential learning opportunities for psychiatric residents to practice psychotherapy for substance use disorders during existing clinical rotations within their general psychiatry residency programs.