Pub Date : 2020-10-12DOI: 10.14713/PCSP.V16I2.2074
P. Wachtel
This discussion of Michael Garrett's (2020) case study, "Portrait of a Man Imprisoned in an Altered State of Consciousness: The Case of 'Sean,'" examines the integrative conceptualization and practice that is evident in the presentation. Among the themes explored are the particular way that Garrett approaches issues often conceived in the psychoanalytic literature as 'Oedipal' and 'preoedipal;' the role of corrective emotional experiences; the boundaries of self and other in subjective experience; the cyclical nature of the dynamics that maintain Sean’s guilt and his problematic life patterns; and the creative tactics through which Garrett integrates psychodynamic and cognitive-behavioral perspectives in his efforts to help Sean escape from the repetitive pattern in which he is caught.
{"title":"The Keys to the Prison: Michael Garrett's Integrative Approach to the Treatment of Psychosis","authors":"P. Wachtel","doi":"10.14713/PCSP.V16I2.2074","DOIUrl":"https://doi.org/10.14713/PCSP.V16I2.2074","url":null,"abstract":"This discussion of Michael Garrett's (2020) case study, \"Portrait of a Man Imprisoned in an Altered State of Consciousness: The Case of 'Sean,'\" examines the integrative conceptualization and practice that is evident in the presentation. Among the themes explored are the particular way that Garrett approaches issues often conceived in the psychoanalytic literature as 'Oedipal' and 'preoedipal;' the role of corrective emotional experiences; the boundaries of self and other in subjective experience; the cyclical nature of the dynamics that maintain Sean’s guilt and his problematic life patterns; and the creative tactics through which Garrett integrates psychodynamic and cognitive-behavioral perspectives in his efforts to help Sean escape from the repetitive pattern in which he is caught.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"16 1","pages":"206-214"},"PeriodicalIF":0.0,"publicationDate":"2020-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43867366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-12DOI: 10.14713/PCSP.V16I2.2072
M. Garrett
This case study describes the first 18 months of weekly psychotherapy with a man suffering from a debilitating chronic psychosis that centers around his conviction that a group of four older men that he refers to as the Council of Four (CoF) operate a machine that can monitor his thoughts to determine if he is having disrespectful thoughts toward them. The patient lives in an altered state of consciousness in which the privacy of mind that people generally take for granted has dissolved. Every Monday the CoF sends him a Morse-code-like message conveyed by automobile horns. It is his belief that if he can meet the standards of the CoF they will reward him with a lucrative book deal and movie contract, which will allow him to approach a female movie star of whom he is much enamored. This case study describes a treatment approach that integrates cognitive-behavioral therapy (CBT) and psychodynamic technique, where CBT techniques are used to consider the literal falsity of the CoF idea while a psychodynamic approach is used to examine the figurative truth of the delusion by exploring the meaning of his subjugation to the CoF.
{"title":"Portrait of a Man Imprisoned in an Altered State of Consciousness: The Case of \"Sean\"","authors":"M. Garrett","doi":"10.14713/PCSP.V16I2.2072","DOIUrl":"https://doi.org/10.14713/PCSP.V16I2.2072","url":null,"abstract":"This case study describes the first 18 months of weekly psychotherapy with a man suffering from a debilitating chronic psychosis that centers around his conviction that a group of four older men that he refers to as the Council of Four (CoF) operate a machine that can monitor his thoughts to determine if he is having disrespectful thoughts toward them. The patient lives in an altered state of consciousness in which the privacy of mind that people generally take for granted has dissolved. Every Monday the CoF sends him a Morse-code-like message conveyed by automobile horns. It is his belief that if he can meet the standards of the CoF they will reward him with a lucrative book deal and movie contract, which will allow him to approach a female movie star of whom he is much enamored. This case study describes a treatment approach that integrates cognitive-behavioral therapy (CBT) and psychodynamic technique, where CBT techniques are used to consider the literal falsity of the CoF idea while a psychodynamic approach is used to examine the figurative truth of the delusion by exploring the meaning of his subjugation to the CoF.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"16 1","pages":"132-194"},"PeriodicalIF":0.0,"publicationDate":"2020-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48552948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-26DOI: 10.14713/pcsp.v16i1.2069
S. Mann, Rachael B. Miller, L. S. Hill, R. Dobkin
Providing evidence-based treatment always requires responding in the moment to apparent gaps between the protocol and the patient’s presenting needs and preferences. In the treatment of depression in Parkinson’s disease (PD), research has shown that providing PD-specialized, empirically supported interventions is paramount. However, given PD’s highly heterogeneous symptom presentations, adapting and individualizing treatment to address each patient’s unique constellation of neuropsychiatric symptoms and PD-related physical challenges is equally important. This Commentary on the article by Dr. Logan Durland (2020) focuses on the importance of attending to process-based factors to inform protocol adaptations in the treatment of Parkinson’s depression, guided by the framework of functional analytic psychotherapy (FAP). The FAP approach applies behavioral principles to in-session processes as a means of highlighting and therapeutically targeting clinically relevant behaviors in real time. Seeking such opportunities to foster within-session change may be especially important when providing evidence-based treatment to individuals with co-occurring mental health issues and chronic, functionally limiting medical problems like PD. As these patients manage the interactions between the complex demands of illness self-management and the burden of mental health symptoms, they must respond adaptively to unpredictable daily challenges. Harnessing moments of clinically relevant struggle during sessions in order to support and reinforce new responses—including new ways of approaching the learning process itself—can help patients consolidate both the coping skills themselves and flexibility and confidence to apply them.
{"title":"Individualizing Evidence-Based Treatment of Neuropsychiatrically Complex Patients: Process-Based Targets for Change in Parkinson’s Depression","authors":"S. Mann, Rachael B. Miller, L. S. Hill, R. Dobkin","doi":"10.14713/pcsp.v16i1.2069","DOIUrl":"https://doi.org/10.14713/pcsp.v16i1.2069","url":null,"abstract":"Providing evidence-based treatment always requires responding in the moment to apparent gaps between the protocol and the patient’s presenting needs and preferences. In the treatment of depression in Parkinson’s disease (PD), research has shown that providing PD-specialized, empirically supported interventions is paramount. However, given PD’s highly heterogeneous symptom presentations, adapting and individualizing treatment to address each patient’s unique constellation of neuropsychiatric symptoms and PD-related physical challenges is equally important. This Commentary on the article by Dr. Logan Durland (2020) focuses on the importance of attending to process-based factors to inform protocol adaptations in the treatment of Parkinson’s depression, guided by the framework of functional analytic psychotherapy (FAP). The FAP approach applies behavioral principles to in-session processes as a means of highlighting and therapeutically targeting clinically relevant behaviors in real time. Seeking such opportunities to foster within-session change may be especially important when providing evidence-based treatment to individuals with co-occurring mental health issues and chronic, functionally limiting medical problems like PD. As these patients manage the interactions between the complex demands of illness self-management and the burden of mental health symptoms, they must respond adaptively to unpredictable daily challenges. Harnessing moments of clinically relevant struggle during sessions in order to support and reinforce new responses—including new ways of approaching the learning process itself—can help patients consolidate both the coping skills themselves and flexibility and confidence to apply them.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41419569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-26DOI: 10.14713/pcsp.v16i1.2068
L. Durland
Roseanne Dobkin and her colleagues (e.g., Dobkin, Interian, Durland, Gara, & Menza, 2018) have developed a 10-session, individual cognitive-behavioral treatment (CBT) program for treating depression in individuals with Parkinson’s disease (dPD). The program has been found to yield statistically and clinically significant success in both uncontrolled group trial designs and randomized clinical trials—originally in a face-to-face version, and then in a telehealth version, using telephone therapy sessions and guided self-help materials for patients. This latter version is herein called "Teleheath Guided Self-Help for dPD," or "TH-GSH-dPD," for short. Applying Fishman, Messer, Edwards, and Dattilio’s (2017) "case studies within psychotherapy trials" methodological model, the present research was designed to complement the group research findings by my conducting systematic, pragmatic case studies (Fishman, 2013) with four patients representative of those in the telehealth studies, given the names of "Alice" (and her caregiver husband "Bob"); "Carl" (and his caregiver wife "Doris"); "Ethan" (and his caregiver wife, "Fay"); and "Gary" (and his caregiver mother, not named). Specifically, Alice and Carl were representative of those patients in the group studies with positive, responsive outcomes; and Ethan and Gary were representative of those patients in the group studies with negative, nonresponsive outcomes. Each case combines (a) quantitative data, comprised of demographic information, psychiatric diagnostic data, neurocognitive data, caregiver distress, and treatment outcome measures; and (b) qualitative data, consisting of recordings of the telephone therapy sessions, my treatment notes, my observations as the therapist, and systematic, post-treatment "Exit Interviews" I conducted with each of the patients and their caregivers about their therapy experience. Each of the four case studies aims (a) to provide a detailed, thickly described portrait of the TH-GSH-dPD treatment process; and (b) to explore the presence and influence of barriers and facilitators of treatment in an idiographic context. Regarding point (b), the following variables that cut across the case studies are explored as appearing to be particularly impactful: patients’ worldviews, patients’ cognitive functioning, caregiver involvement, and homework adherence.
{"title":"Telephone-Based, Clinician-Guided Self-Help Cognitive Behavioral Therapy for Depression in Parkinson's Disease (dPD): The Responder Cases of \"Alice\" and \"Carl,\" and the Nonresponder Cases of \"Ethan\" and \"Gary\"","authors":"L. Durland","doi":"10.14713/pcsp.v16i1.2068","DOIUrl":"https://doi.org/10.14713/pcsp.v16i1.2068","url":null,"abstract":"Roseanne Dobkin and her colleagues (e.g., Dobkin, Interian, Durland, Gara, & Menza, 2018) have developed a 10-session, individual cognitive-behavioral treatment (CBT) program for treating depression in individuals with Parkinson’s disease (dPD). The program has been found to yield statistically and clinically significant success in both uncontrolled group trial designs and randomized clinical trials—originally in a face-to-face version, and then in a telehealth version, using telephone therapy sessions and guided self-help materials for patients. This latter version is herein called \"Teleheath Guided Self-Help for dPD,\" or \"TH-GSH-dPD,\" for short. Applying Fishman, Messer, Edwards, and Dattilio’s (2017) \"case studies within psychotherapy trials\" methodological model, the present research was designed to complement the group research findings by my conducting systematic, pragmatic case studies (Fishman, 2013) with four patients representative of those in the telehealth studies, given the names of \"Alice\" (and her caregiver husband \"Bob\"); \"Carl\" (and his caregiver wife \"Doris\"); \"Ethan\" (and his caregiver wife, \"Fay\"); and \"Gary\" (and his caregiver mother, not named). Specifically, Alice and Carl were representative of those patients in the group studies with positive, responsive outcomes; and Ethan and Gary were representative of those patients in the group studies with negative, nonresponsive outcomes. Each case combines (a) quantitative data, comprised of demographic information, psychiatric diagnostic data, neurocognitive data, caregiver distress, and treatment outcome measures; and (b) qualitative data, consisting of recordings of the telephone therapy sessions, my treatment notes, my observations as the therapist, and systematic, post-treatment \"Exit Interviews\" I conducted with each of the patients and their caregivers about their therapy experience. Each of the four case studies aims (a) to provide a detailed, thickly described portrait of the TH-GSH-dPD treatment process; and (b) to explore the presence and influence of barriers and facilitators of treatment in an idiographic context. Regarding point (b), the following variables that cut across the case studies are explored as appearing to be particularly impactful: patients’ worldviews, patients’ cognitive functioning, caregiver involvement, and homework adherence.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"16 1","pages":"1-103"},"PeriodicalIF":0.0,"publicationDate":"2020-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49170523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-26DOI: 10.14713/pcsp.v16i1.2070
Liza E. Pincus
I am a fourth year clinical psychology doctoral student at the Graduate School of Applied and Professional Psychology (GSAPP) at Rutgers University. I have devoted much of my graduate training to exploring effective tools for the dissemination and implementation of mental health services, with telehealth chief among them. However, until the COVID-19 pandemic hit, I had had no personal experience delivering psychotherapy treatment via virtual platforms. Reviewing Dr. Logan Durland’s (2020) lessons from treating Parkinson’s disease patients via telephone therapy has served as an excellent guide for navigating treatment, both during the pandemic and in the future.
{"title":"Telemental Health During a Global Pandemic: Clinical Lessons from Guided Self-Help, Telephone Therapy Case Studies","authors":"Liza E. Pincus","doi":"10.14713/pcsp.v16i1.2070","DOIUrl":"https://doi.org/10.14713/pcsp.v16i1.2070","url":null,"abstract":"I am a fourth year clinical psychology doctoral student at the Graduate School of Applied and Professional Psychology (GSAPP) at Rutgers University. I have devoted much of my graduate training to exploring effective tools for the dissemination and implementation of mental health services, with telehealth chief among them. However, until the COVID-19 pandemic hit, I had had no personal experience delivering psychotherapy treatment via virtual platforms. Reviewing Dr. Logan Durland’s (2020) lessons from treating Parkinson’s disease patients via telephone therapy has served as an excellent guide for navigating treatment, both during the pandemic and in the future.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"16 1","pages":"118-123"},"PeriodicalIF":0.0,"publicationDate":"2020-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49461988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-26DOI: 10.14713/pcsp.v16i1.2071
L. Durland
My current clinical practice has been shifted to a telehealth format for the last three months due to the COVID-19 pandemic, and it seems an apt moment to reexamine my participation in Dr. Roseanne Dobkin’s research on manualized telehealth therapy for depression in Parkinson’s disease patients (dPD), using a protocol titled "Teleheath Guided Self-Help for dPD," or "TH-GSH-dPD," for short (Dobkin et al., 2020). My participation involved, in part, being the therapist in four case studies I have written about with "Alice," "Carl," "Ethan," and "Gary" (Durland, 2020). In these case studies, a subset of those in Dr. Dobkin’s group studies, I explored my clinical decision-making, seeking insight into how best to flexibly apply the dPD protocol to meet the needs of a heterogeneous clinical population. Here, my aim is to recontextualize and expand on the conclusions of my four case studies, based on my dissertation and conducted over three years ago (Durland, 2017), in light of both my recent experience providing mental health services and the Commentaries on the four case studies so perceptively contributed by Dr. Dobkin and her colleagues (Mann, Miller, St. Hill, & Dobkin, 2020) and by Liza Pincus (2020). In particular, I will focus first on (a) continuing the analysis of clinical decision-making involved in the case studies described in my earlier article (Duland, 2020); and then on (b) general issues related to the delivery of telehealth treatment.
由于COVID-19大流行，我目前的临床实践在过去三个月里已经转移到远程医疗形式，现在似乎是重新审视我参与Roseanne Dobkin博士关于帕金森病患者(dPD)抑郁症手动远程医疗治疗的研究的恰当时机，使用名为“dPD远程医疗指导自助”或简称“TH-GSH-dPD”的协议(Dobkin et al.， 2020)。在某种程度上，我参与了四个案例研究，其中包括“爱丽丝”、“卡尔”、“伊森”和“加里”(Durland, 2020)。在这些案例研究中(Dobkin博士小组研究的一部分)，我探索了我的临床决策，寻求如何最好地灵活应用dPD方案以满足异质临床人群的需求。在这里，我的目标是重新背景化和扩展我的四个案例研究的结论，基于我的论文，并进行了超过三年前(Durland, 2017)，鉴于我最近的经验提供心理健康服务和四个案例研究的评论如此敏锐地贡献了博士多布金和她的同事(曼，米勒，圣希尔，&多布金，2020)和丽莎平克斯(2020)。特别是，我将首先关注(a)继续分析我之前文章中描述的案例研究中涉及的临床决策(Duland, 2020);然后是(b)与提供远程保健治疗有关的一般问题。
{"title":"Lessons Learned: Conducting Cases of Manualized, Telephone-Based, Cognitive Behavioral Treatment for Depression in Parkinson’s Disease (dPD)","authors":"L. Durland","doi":"10.14713/pcsp.v16i1.2071","DOIUrl":"https://doi.org/10.14713/pcsp.v16i1.2071","url":null,"abstract":"My current clinical practice has been shifted to a telehealth format for the last three months due to the COVID-19 pandemic, and it seems an apt moment to reexamine my participation in Dr. Roseanne Dobkin’s research on manualized telehealth therapy for depression in Parkinson’s disease patients (dPD), using a protocol titled \"Teleheath Guided Self-Help for dPD,\" or \"TH-GSH-dPD,\" for short (Dobkin et al., 2020). My participation involved, in part, being the therapist in four case studies I have written about with \"Alice,\" \"Carl,\" \"Ethan,\" and \"Gary\" (Durland, 2020). In these case studies, a subset of those in Dr. Dobkin’s group studies, I explored my clinical decision-making, seeking insight into how best to flexibly apply the dPD protocol to meet the needs of a heterogeneous clinical population. Here, my aim is to recontextualize and expand on the conclusions of my four case studies, based on my dissertation and conducted over three years ago (Durland, 2017), in light of both my recent experience providing mental health services and the Commentaries on the four case studies so perceptively contributed by Dr. Dobkin and her colleagues (Mann, Miller, St. Hill, & Dobkin, 2020) and by Liza Pincus (2020). In particular, I will focus first on (a) continuing the analysis of clinical decision-making involved in the case studies described in my earlier article (Duland, 2020); and then on (b) general issues related to the delivery of telehealth treatment.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"16 1","pages":"124-131"},"PeriodicalIF":0.0,"publicationDate":"2020-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47170392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-10DOI: 10.14713/pcsp.v15i3.2059
B. Philips
This commentary on the article by Frankl, Wennberg, Berggraf and Philips (2020) focuses on methodological aspects of case studies versus group designs in psychotherapy research. Experimental case study designs such as ABAB design and multiple baseline design have a long tradition within behavior therapy. These research designs are especially useful for testing newly developed therapy methods and investigating the effectiveness for treatment of rare disorders. However, experimental case study design is most appropriate for single-component treatments for patients with one circumscribed problem. Randomized controlled trials (RCTs) are considered as the gold standard for testing and establishing the efficacy of a particular therapy method for a particular problem. However, the RCT design also bears some methodological shortcomings, such as low external and construct validity, simplistic epistemological assumptions, and only being able to establish average causal effect (thus not giving the clinician clear guidelines on how to work with individual patients). Rigorous process research is useful for identifying change mechanisms in psychotherapy. Finally, pragmatic case studies have a great potential of increasing our knowledge about psychotherapy and its effectivess. This potential could be increased even further if pragmatic case studies integrated some methods from process research and if the results from multiple case studies were analyzed together in meta-syntheses.
{"title":"The Quest for Causality in Psychotherapy Research","authors":"B. Philips","doi":"10.14713/pcsp.v15i3.2059","DOIUrl":"https://doi.org/10.14713/pcsp.v15i3.2059","url":null,"abstract":"This commentary on the article by Frankl, Wennberg, Berggraf and Philips (2020) focuses on methodological aspects of case studies versus group designs in psychotherapy research. Experimental case study designs such as ABAB design and multiple baseline design have a long tradition within behavior therapy. These research designs are especially useful for testing newly developed therapy methods and investigating the effectiveness for treatment of rare disorders. However, experimental case study design is most appropriate for single-component treatments for patients with one circumscribed problem. Randomized controlled trials (RCTs) are considered as the gold standard for testing and establishing the efficacy of a particular therapy method for a particular problem. However, the RCT design also bears some methodological shortcomings, such as low external and construct validity, simplistic epistemological assumptions, and only being able to establish average causal effect (thus not giving the clinician clear guidelines on how to work with individual patients). Rigorous process research is useful for identifying change mechanisms in psychotherapy. Finally, pragmatic case studies have a great potential of increasing our knowledge about psychotherapy and its effectivess. This potential could be increased even further if pragmatic case studies integrated some methods from process research and if the results from multiple case studies were analyzed together in meta-syntheses.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"15 1","pages":"271-280"},"PeriodicalIF":0.0,"publicationDate":"2020-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45342700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-10DOI: 10.14713/pcsp.v15i3.2058
Kristin Osborn
In this commentary on the important cases of "Carey," "Michelle," and "Mary" conducted by Dr. My Frankl (Frankl, Wennberg, Berggraf, & Philips, 2020), I begin with some general considerations on the importance of assessment and case formulation in Affect Phobia Therapy (APT) and how these considerations impact on the experiential interventions of APT. Next I specifically review Frankl’s three case studies, with a focus on: how Alcohol Use Disorder (AUD) is embedded in close family relationships; the connection between AUD and affect regulation; the role of feelings of shame in AUD; individualizing and adjusting APT treatment based on feedback from ongoing therapy; Frankl’s activation of transference feelings; the issue of sobriety before treatment; activating inhibitory affects and maladaptive defenses; Frankl’s missing some moments of connection; and an example of Frankl’s conducting the two-chair technique skillfully and successfully. I end with a proposal for enhancing Frankl’s narrative analysis with two methodologies from APT: the "Ten-Session Summary Form," and the micro-analytic coding approach of the "Achievement of Therapeutic Objectives Scales" (ATOS).
{"title":"The Impact of Affect Phobia Therapy (APT) on Alcohol Use Disorders (AUD)—Evaluating Three Case Studies","authors":"Kristin Osborn","doi":"10.14713/pcsp.v15i3.2058","DOIUrl":"https://doi.org/10.14713/pcsp.v15i3.2058","url":null,"abstract":"In this commentary on the important cases of \"Carey,\" \"Michelle,\" and \"Mary\" conducted by Dr. My Frankl (Frankl, Wennberg, Berggraf, & Philips, 2020), I begin with some general considerations on the importance of assessment and case formulation in Affect Phobia Therapy (APT) and how these considerations impact on the experiential interventions of APT. Next I specifically review Frankl’s three case studies, with a focus on: how Alcohol Use Disorder (AUD) is embedded in close family relationships; the connection between AUD and affect regulation; the role of feelings of shame in AUD; individualizing and adjusting APT treatment based on feedback from ongoing therapy; Frankl’s activation of transference feelings; the issue of sobriety before treatment; activating inhibitory affects and maladaptive defenses; Frankl’s missing some moments of connection; and an example of Frankl’s conducting the two-chair technique skillfully and successfully. I end with a proposal for enhancing Frankl’s narrative analysis with two methodologies from APT: the \"Ten-Session Summary Form,\" and the micro-analytic coding approach of the \"Achievement of Therapeutic Objectives Scales\" (ATOS).","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"15 1","pages":"258-271"},"PeriodicalIF":0.0,"publicationDate":"2020-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42848831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-10DOI: 10.14713/pcsp.v15i3.2057
My Frankl, P. Wennberg, L. Berggraf, B. Philips
Affect Phobia Treatment (APT) is based on an integrative theory involving the use of psychodynamic principles for understanding a client’s psychological dynamics, experiential principles for engaging and working with the client’s affect, and behavioral principles of exposure and response prevention for desensitizing the client to the fear of affect. APT’s goal is "to help patients function better by resolving emotional conflict through reducing their avoidance of adaptive, activating emotions" (Osborn et al., 2014). APT has not yet been systematically employed and researched for patients with mild to moderate Alcohol Use Disorder (AUD) together with affect phobia. The present study was designed to begin this process by describing and comparing, both qualitatively and quantitatively, three illustrative, distinctive cases of APT in patients with AUD, assigned the names of "Carey," "Michelle," and "Mary." The focus was on exploring the process by which the different individual patients responded to the multifaceted APT therapy, and hence how the therapist had to adapt the therapy to each particular patient, as outlined in Stiles’ (2009) concept of "appropriate responsiveness." Following the manual for APT, therapy included 10 weekly sessions of individual psychotherapy. This short length for a therapy like APT, a treatment which usually has no determined session length (McCullough et al., 2003), was designed to make the therapy comparable in length to other therapies for AUD, like Motivational Interviewing. During the whole study period, patients gave weekly reports of their alcohol consumption and craving. In addition, at the beginning and at the end of the study, the patients answered questionnaires measuring affect phobia and psychiatric symptoms. Role expectations and experiences of psychotherapy were also measured. All three patients completed the treatment and the measurement period. No adverse events were reported. The patients had different trajectories of change regarding alcohol consumption, craving, and symptom change. The study showed that 10-session APT was a tolerable treatment for the patients with on-going mild-to-moderate alcohol dependence, who primarily used alcohol as a way of avoiding emotions, but that the therapy worked to different degrees and in different ways for the three patients due to their different presenting patterns of psychiatric symptoms and personality characteristics. Experience in the three cases suggests the advisability of (a) flexible treatment length in accordance to a patient's needs, and (b) complementary treatment strategies beyond APT focusing on reducing alcohol consumption per se for some patients.
{"title":"Affect Phobia Therapy for Mild to Moderate Alcohol Use Disorder: The Cases of \"Carey,\" \"Michelle,\" and \"Mary\"","authors":"My Frankl, P. Wennberg, L. Berggraf, B. Philips","doi":"10.14713/pcsp.v15i3.2057","DOIUrl":"https://doi.org/10.14713/pcsp.v15i3.2057","url":null,"abstract":"Affect Phobia Treatment (APT) is based on an integrative theory involving the use of psychodynamic principles for understanding a client’s psychological dynamics, experiential principles for engaging and working with the client’s affect, and behavioral principles of exposure and response prevention for desensitizing the client to the fear of affect. APT’s goal is \"to help patients function better by resolving emotional conflict through reducing their avoidance of adaptive, activating emotions\" (Osborn et al., 2014). APT has not yet been systematically employed and researched for patients with mild to moderate Alcohol Use Disorder (AUD) together with affect phobia. The present study was designed to begin this process by describing and comparing, both qualitatively and quantitatively, three illustrative, distinctive cases of APT in patients with AUD, assigned the names of \"Carey,\" \"Michelle,\" and \"Mary.\" The focus was on exploring the process by which the different individual patients responded to the multifaceted APT therapy, and hence how the therapist had to adapt the therapy to each particular patient, as outlined in Stiles’ (2009) concept of \"appropriate responsiveness.\" Following the manual for APT, therapy included 10 weekly sessions of individual psychotherapy. This short length for a therapy like APT, a treatment which usually has no determined session length (McCullough et al., 2003), was designed to make the therapy comparable in length to other therapies for AUD, like Motivational Interviewing. During the whole study period, patients gave weekly reports of their alcohol consumption and craving. In addition, at the beginning and at the end of the study, the patients answered questionnaires measuring affect phobia and psychiatric symptoms. Role expectations and experiences of psychotherapy were also measured. All three patients completed the treatment and the measurement period. No adverse events were reported. The patients had different trajectories of change regarding alcohol consumption, craving, and symptom change. The study showed that 10-session APT was a tolerable treatment for the patients with on-going mild-to-moderate alcohol dependence, who primarily used alcohol as a way of avoiding emotions, but that the therapy worked to different degrees and in different ways for the three patients due to their different presenting patterns of psychiatric symptoms and personality characteristics. Experience in the three cases suggests the advisability of (a) flexible treatment length in accordance to a patient's needs, and (b) complementary treatment strategies beyond APT focusing on reducing alcohol consumption per se for some patients.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"15 1","pages":"214-257"},"PeriodicalIF":0.0,"publicationDate":"2020-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46736412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-10DOI: 10.14713/pcsp.v15i3.2060
My Frankl
This article is a response to commentaries by Kristin Osborn (2020) and Bjorn Philips (2020) on three case studies I conducted (Frankl, Wennberg, Berggraf & Philips, 2020), which involved the use of a 10-session Affect Phobia Therapy (APT) with individuals diagnosed with mild to moderate Alcohol Use Disorder (AUD). The response focuses on four main areas: (a) the tension between the need for systematic assessment and core conflict formulation in each case versus the need for efficiency and accessibility in the design of a "first-line," 10-session version of APT, which is typically much longer in length; (b) specific considerations in applying APT to AUD; (c) research design considerations associated with the three case studies; and (d) my personal experience as the therapist in conducting the 10-session APT with these three AUD cases. I conclude with a proposal for incorporating the critical points from the commentaries into future studies.
{"title":"Wanting Too Much and Too Soon – The Therapist´s Clinical Perspective","authors":"My Frankl","doi":"10.14713/pcsp.v15i3.2060","DOIUrl":"https://doi.org/10.14713/pcsp.v15i3.2060","url":null,"abstract":"This article is a response to commentaries by Kristin Osborn (2020) and Bjorn Philips (2020) on three case studies I conducted (Frankl, Wennberg, Berggraf & Philips, 2020), which involved the use of a 10-session Affect Phobia Therapy (APT) with individuals diagnosed with mild to moderate Alcohol Use Disorder (AUD). The response focuses on four main areas: (a) the tension between the need for systematic assessment and core conflict formulation in each case versus the need for efficiency and accessibility in the design of a \"first-line,\" 10-session version of APT, which is typically much longer in length; (b) specific considerations in applying APT to AUD; (c) research design considerations associated with the three case studies; and (d) my personal experience as the therapist in conducting the 10-session APT with these three AUD cases. I conclude with a proposal for incorporating the critical points from the commentaries into future studies.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"15 1","pages":"281-289"},"PeriodicalIF":0.0,"publicationDate":"2020-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48550438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：