Acta psychiatrica Belgica最新文献

Three areas of psychotherapy research can be delimited of which differential efficiency research promises to be the most fruitful, because it will eventually inform us which interventions with what kind of patient and what kind of problem will be the most constructive. One problem it can solve is the so-called equivalence paradox. This epitheton designates the fact, that in spite of the enormous differences in theory and interventions between the different kinds of psychotherapies, their results are not remarkably divergent. One quite popular hypothesis is that this is due to common factors, commun to any and every kind of psychotherapy. Our results indicate that this explanation is too simplistic because it uses a monosubstance-doses-effect-relationship model and disregards interaction. One other avenue is the relevant events approach. Our examples yield equivocal results. Nevertheless this remains a promising field of investigation. Finally there are time series analyses which are probably most germane to the field of psychotherapies. One illustration with a case of negative psychotherapy outcome is presented. Time series analysis is able to show that the patient changed to a negativistic attitude in the middle of session, whereas the psychoanalyst only changed at the beginning of session 10 respectively in its middle.

Psychotherapy training is experiencing conflicting messages: escalating criticism of conventional training at a time of unprecedented success in training competent practitioners. This paradox sets the context for this overview of psychotherapy training. In the first part of the paper, I summarize eight lessons learned in the past two decades on improving training: demonstrate and illustrate psychotherapy; furnish ample and diverse experiences; coordinate the training process; impart technical and interpersonal skills; establish competence; account for individual differences; cultivate respect for empirical research; and evaluate training outcomes. These serve as both sobering lessons from past deficiencies and as continuing challenges for the future of psychotherapy training. In the second part of the paper, I briefly advance several models for training in psychotherapy integration, the mental health zeitgeist of the 1990's and beyond. The net result is not necessarily self-identified eclectic or integrative practitioners, but knowledgeable graduates who will approach patients with an open mind, an insatiable curiosity, and a relentless commitment to confront the complexities of human behavior.

In psychotherapy, the crucial question of indication-and more particularly, the question of differential indication-has, for a long time, not received the attention it deserves. This has been the case both in research and in the training of psychotherapists, and the decisions made by psychotherapists when choosing a type of intervention for a patient (or the patient for an intervention), have scarcely been informed by research results. This state of things is changing due to a series of factors, and the scientific, the clinical, the socio-political, and the legal aspects of the problem gain more and more attention. The fact that a psychoanalysis during five years with four sessions a week (the therapeutic effects of which are not established) takes almost the same therapeutic effort as the treatment of fourty patients receiving a short-term therapy of twenty six sessions during a half year, or of eighty patients having thirteen sessions (these twenty six or thirteen sessions likely to yield quite satisfying therapeutic effects) is something of which everybody begins to be strikingly aware. But differential indication-globally the question: what therapy for what patient?- continues to pose problems. Do we have valuable criteria for choosing, and why don't we use those we have? In this paper we distinguish two types of problems: those at the conceptual and technical level and the problems pertaining to the ethical and professional domain. Their description will be followed by some conclusions and recommendations that might be useful for treatment selection.

A methodology has been set up for evaluating the effects of psychotherapeutic treatment by surveying psychiatric French-speaking institutions. Our approach consisted in modeling the questions of the clinicians and to develop multi-dimensional questions, covering the different aspects of the care, the different points of view from which one can consider a patient: symptomatic, psychodynamic, or from the point of view of his quality of life. In the following text we present descriptive or explanatory results obtained in different contexts.

Child and adolescent psychotherapy form a large proportion of the total amount of psychotherapeutic efforts. Because of the age of the patients, the positive or negative impact is considerable. From the literature we learn that the efforts made to evaluate psychotherapy effects are not in balance with the amount of executed therapies. Meta-analyses of the available controlled therapy-evaluation studies offer a limited but rather encouraging view on the effectiveness of child and adolescent psychotherapy. Also on the differences in effectiveness according to the therapeutic orientation or the treated disturbance some interesting conclusions can be drawn. Unfortunately, these conclusions are based on a limited number of studies, because few clinicians conduct systematic research on therapy effectiveness. Systematic therapy evaluation requires some explicit decisions. The clinician has to decide on the description of the disturbance and the use of a diagnostic system, on the choice of standardized assessment procedures, on the operationalization of his therapeutic techniques and on the availability of norm groups and/or appropriate control conditions. In our psychology and psychotherapy training programs, attention for therapy evaluation is rather limited. Only a small number of students or trainees is explicitly trained in this aspect of therapeutic work. The available literature offers some interesting suggestions to enhance the quantity and the quality of the research in this area.

Cost-benefit analyses to translate treatment costs and effects into monetary units. For a cost-benefit analyses of psychotherapy data, direct costs can be most easily and reliably estimated; but indirect costs of treatment and the effects of treatment are difficult to estimate. Among these are such considerations as lost pay, disruption of relationships, embarrassment and anxiety. There are also costs associated with not having treatment--e.g., compromise of personal and familial immunologic systems, lost productivity. But, for the sake of simplicity, we focus on the direct monetary costs of treatment. We have developed theoretical frameworks--the dosage and phase models--within which to approach a cost-benefit analysis of psychotherapy. The dosage model specifies a lawful relationship between number of sessions and therapeutic benefit. The phase model utilizes a three-component conception of psychotherapy--remoralization, remediation, and rehabilitation--and allows for differential cost-benefit analyses for specific therapeutic benefits.

The mind-brain barrier is being challenged by clinicians using both medications and psychotherapy for the major psychiatric disorders. In this paper, six categories of study are outlined: 1) Diagnosis specific questions, 2) psychotherapy during randomized controlled mediation trials, 3) psychotherapeutic aspects of pharmacotherapy, 4) pharmaco-therapist and the non-medical psychotherapist, 5) meaning of medications during psychotherapy, and 6) neurology of psychotherapy. Three of these are elaborated upon: 1) diagnostic questions as they relate to panic disorder, 2) pharmacotherapy during the stages of psychotherapy, and 3) the neurology of psychotherapy.

The diagnostic of "borderline" relies on the study of the Ego the refers to the prevalence of imaginary mechanisms, like object splitting. However, it doesn't allow to distinguish neurotic from psychotic structure. In the case of the Wolf-Man, the investigation of childhood's material (hallucination of the cut finger) allows to overpass this difficulty.

After an extensive survey of MAOI diets prescribed in different Belgian training institutes, there appears to be a confused situation which can cause obstacle for prescription. Of the diets received, we note that 211 foodstuffs and type of foodstuffs have been recommended for restrictive use. However, a most recent literature overviews shows restrictive recommendations for only 40 foodstuffs and types of foodstuffs. Its systematic analysis allows us to propose to the patient a personalized diet with little restrictions which is explained on an understandable rather than a descriptive basis. The adoption of this kind of diet should facilitate easier access to MAOI's, in case more simple therapy strategies have failed, especially in the atypical depressive disorders and tricyclic's refractory depressive disorders.