Biomedical subjects

L H Rockland

Publications and source records attributed to L H Rockland.

9 recordsLinked to original sources

PubMed1994

Supportive psychotherapy of the schizophrenic patient.

The unimpressive results, in several classic studies, of expressive psychotherapy for schizophrenic patients have led to a neglect of all dynamic psychotherapy for these patients. However, there have been significant advances in psychodynamic supportive therapy over the past two decades and currently it is both well grounded in psychodynamic theory and has an accepted set of strategies and techniques. In this paper, we apply the general principles of psychodynamically oriented supportive therapy to the outpatient treatment of the schizophrenic patient. Outpatient treatment is divided into stabilization and maintenance phases. During stabilization, treatment focuses on building a therapeutic alliance, psychoeducation (including the family where appropriate) and establishing a bilaterally acceptable, clinically effective, pharmacological regimen. In the maintenance phase, the therapist becomes more therapeutically ambitious, particularly in undermining maladaptive, and supporting adaptive, defenses. Handling of the alliance, transference, countertransference, resistance, working through and attenuation (instead of termination) are addressed and illustrated with clinical material. The role of the supportive therapist also includes overall executive responsibility for the entire treatment, management of psychopharmacology, and clinically appropriate referrals for family work, social skills training and vocational rehabilitation. Studies are needed to determine the effectiveness of this treatment approach; further, whether it is applicable to all schizophrenic patients or only to a particular subgroup.

Adult↗

PubMed1993

A review of supportive psychotherapy, 1986-1992.

OBJECTIVE: In 1986 a review of literature on individual supportive therapy concluded that although many clinicians had a low regard for this treatment approach, it should be taken more seriously. In this paper the author reviews the literature on supportive therapy from 1986 to 1992 to determine whether it has received increased attention. METHODS: MEDLINE and PsycINFO data bases were used. Studies were chosen based on their relevance to supportive psychotherapy and quality of scholarship. RESULTS AND CONCLUSIONS: The quantity and quality of writing reflect heightened interest in supportive psychotherapy during the past six years. It is now securely ensconced in psychodynamic theory, and many clinicians have agreed on strategies and techniques. They include strengthening the therapeutic alliance, environmental interventions, education, advice and suggestion, encouragement and praise, limit setting and prohibitions, undermining maladaptive defenses while strengthening adaptive defenses, and emphasis on strengths and talents. Training programs have not kept pace with advances in knowledge and techniques. Further study of the use of supportive therapy with patients in specific diagnostic groups is recommended, as is more attention to this approach in clinical training and supervision.

Humans↗

PubMed1989

Psychoanalytically oriented supportive therapy: literature review and techniques.

Although there is increasing interest in supportive psychotherapy, it remains relatively unappreciated, unsystematized, and underrepresented in training programs. Its literature is sparse, and there is no generally accepted list of appropriate interventions. This paper reviews the psychoanalytic literature relevant to supportive psychotherapy. It then offers a list of 15 general and six specific techniques culled from the literature. The former are appropriate for the training of, and use by, nonpsychoanalytically trained clinicians, for example, family physicians. The latter require psychodynamic expertise and make sophisticated supportive psychotherapy and intellectually challenging enterprise for the practicing psychoanalyst or dynamic psychotherapist.

Humans↗

PubMed1986

Neuroleptic blood levels and clinical response.

Gas chromatography and radioreceptor assay technologies made possible the measurement of nanogram quantities of neuroleptic in the blood. They revealed large differences in blood concentrations among patients receiving the same oral dose. This led to the hope that measuring neuroleptic concentrations would allow more effective oral dosing for individual psychotic patients. Early attempts to study neuroleptic concentration/clinical response patterns, using chlorpromazine, produced confusing results. Many of the studies had serious design flaws, and were complicated by the many active metabolites of chlorpromazine. Adequate blood level/response studies should use fixed drug dosage schedules, drug-responsive patients, and neuroleptics without active metabolites. Brain concentration of drug is probably better reflected by erythrocyte than by plasma concentration. Therefore, recent investigators have usually used erythrocyte haloperidol or butaperazine concentrations to study level/response relationships. These recent studies strongly suggest an "optimal concentration" level/response pattern for haloperidol and butaperazine. Patients tend to respond best to moderate concentrations of neuroleptic, and nonresponse can be due to either too low or too high concentrations. In the latter case, decreasing the oral dose should be seriously considered. Blood level findings remain preliminary. The clinician should continue to fine-tune his clinical skills, using neuroleptic blood concentrations to complement his clinical judgment, in the attempt to determine the lowest effective dose for the individual patient.

Antipsychotic Agents↗

PubMed1985