A behavioral consultation program for parents and teachers of children with conduct problems.
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Therapists working in lesbian, gay, bisexual, and transgender (LGBT) communities are likely to experience the potential to engage in multiple relationships with their clients. Currently, the American Psychological Association's (2002) ethics code and the related literature base offer minimal direct guidance to therapists practicing in LGBT communities. In this article, the authors review current literature regarding multiple relationships in psychotherapy, considering how this literature addresses issues specific to practitioners working within LGBT communities, present a case study highlighting the negotiation of a multiple relationship between a client and therapist who both identify as lesbian, and offer recommendations for practitioners working within LGBT communities.
This article examines the prevalence and complexity of multiple personality disorder as well as the contributions that psychiatry and occupational therapy make in its treatment. The value of activity is that it serves as a nonverbal mediator of communication. Activities are also useful in helping the therapist to obtain a patient's history, which is necessary for abreaction (i.e., the patient's reliving and recalling of the original abuse). Abreaction is a precursor to the integration of the abusive memories into the patient's current life.
Based on the transcripts of video-recorded, semi-structured interviews with 41 offspring (aged 6-18 years) of parents with multiple sclerosis, we evaluated the indication for psychotherapy. These results were then compared with the previously determined coping ability of each child/adolescent. Psychotherapy was indicated for 22 out of the 41 children/adolescents. There was a significant relation between the indication for psychotherapy and the children's inability to cope with the parental disease. The present findings confirm the risk of mental health problems in children of somatically ill parents. In our sample, half of the children and adolescents were estimated to benefit from individual psychotherapy, which might enhance their ability to cope with the parental illness.
The findings concerning the basic psychic condition preceding the onset of a so-called multiple sclerosis seem to correspond to the basic structure and disorders of a narcissistic neurosis, especially that of the phobic type of this illness. The same psychic structure may also be referred to as faulty identify establishment or, in terms of depression, described as a somatically masked depression. Because of the deep-rooted psychic damage lasting results can only be obtained by long-term uncovering analytic psychotherapy. In general patients afflicted with a neurosis of this type violently oppose to psychic training and reorientation.
Premature termination of inpatient psychotherapy can have multiple, mostly negative, effects for patients, therapists, clinics, insurance companies, and employers, but research regarding inpatient settings is still deficient. The analysis of two sets of data of four different rehabilitation clinics from two different hospital companies (2699 and 2215 patients, respectively), aimed at possible predictors and outcomes of premature termination. We found ratios of premature termination of 8.3% and 14.7%, respectively. Especially young patients under 30 years of age and patients with eating and personality disorders were more likely to terminate inpatient treatment prematurely. Treatment outcome as rated by therapists was in significantly fewer cases among premature terminators than among successful terminators improved. The results seem to indicate, that assignment to inpatient psychotherapy can be optimized. For a better understanding of the process of premature termination more theory guided prospective and followup studies are necessary.
The author cites significant changes in the conduct of the psychiatric profession between the fourth and ninth decades of this century. Determinants of the changes included the impact of World War II, the National Mental Health Act of 1946, the evolution of multiple modes of psychotherapy, the move from a system of involuntary incarceration and treatment in public institutions to a voluntaristic and pluralistic system, the provision of public and private insurance support for office, outpatient, and inpatient psychiatric care, the resurgence of psychopharmacology, and the pursuit of research in biological and psychosocial fields. The social goals of the profession are also discussed.
The author cites significant changes in the conduct of the psychiatric profession between the fourth and ninth decades of this century. Determinants of the changes included the impact of World War II, the National Mental Health Act of 1946, the evolution of multiple modes of psychotherapy, the move from a system of involuntary incarceration and treatment in public institutions to a voluntaristic and pluralistic system, the provision of public and private insurance support for office, outpatient, and inpatient psychiatric care, the resurgence of psychopharmacology, and the pursuit of research in biological and psychosocial fields. The social goals of the profession are also discussed.
Comprehensive treatment, including pharmacotherapy, rehabilitation, psychotherapy and ultrasound stimulation of the lymphatic system by the method of Seltzer is given to multiple sclerosis patients at the hospital department for these patients. In the first year of treatment three courses of ultrasound sessions are given with 24 sessions in each course, in the second year two such courses are given, and in the following years one course is given yearly. The present material comprised 45 patients after 7 or 8 courses of treatment in the hospital. The neurological status of each patient was evaluated before the first course and after the last one using a score scale containing the most important clinical parameters. Is was found that these therapeutic methods had only a negligible effect on paresis of the extremities, but it seems that they influenced favourably eye signs, particularly nystagmus, and cerebellar tremor. The greatest improvement was obtained in sphincter disturbances, especially in pollakiuria and urinary incontinence. The effect of ultrasound alone on the obtained results could not have been assessed. Investigations would be necessary for this purpose which are not done in this hospital.
OBJECTIVE: The authors examine national patterns in psychotherapy for older adults with a diagnosis of depression and analyze correlates of psychotherapy use that is consistent with Agency for Health Care Policy and Research guidelines for duration of treatment. METHOD: Linked Medicare claims and survey data from the 1992-1999 Medicare Current Beneficiary Survey were used. The data were merged with the Area Resource File to assess the effect of provider-supply influences on psychotherapy treatment. An episode-of-care framework approach was used to analyze psychotherapy use and treatment duration. Multiple logistic regression analysis was used to predict psychotherapy use and its consistency. RESULTS: The authors identified 2,025 episodes of depression treatment between 1992 and 1999. Overall, psychotherapy was used in 25% (N=474) of the episodes, with 68% of episodes with psychotherapy involving services received only from psychiatrists. (Percentages were weighted for the complex design of the Medicare Current Beneficiary Survey.) Use of psychotherapy was correlated with younger patient age, higher patient educational attainment, and availability of local psychotherapy providers. Among episodes in which psychotherapy was used, only a minority (33%, N=141) involved patients who remained in consistent treatment, defined as extending for at least two-thirds of the episode of depression. Availability of local providers was positively correlated with consistent psychotherapy use. In analyses with adjustment for provider-related factors, patients' socioeconomic and demographic characteristics did not affect the odds of receiving consistent psychotherapy. CONCLUSIONS: Use of psychotherapy remains uncommon among depressed older adults despite its widely acknowledged efficacy. Some of the disparities in psychotherapy utilization suggest supply-side barriers. Increasing the geographic availability of mental health care providers may be one way of increasing access to psychotherapy for depressed older adults.
This article describes a systematic and integral method of incorporating self-help books into psychotherapy as a collaborative function. We address the distinctions between self-help and bibliotherapy, consider bibliotherapy as adjunctive or integrative to psychotherapy, and outline the multiple uses of bibliotherapy for clinical purposes. How to apply self-help books in psychotherapy and ways to select books are illustrated by a case example. Indications and contraindications for bibliotherapy in therapy are outlined.
The patient described is a 33-year -old woman, L.,who developed a transient dual personality while undergoing desensitization for contact phobia, the alternate personality, Toni, manifesting overtly aggressive behaviour. L. was taught how to behave angrily using role-playing techniques within 48 hours of Toni's first appearance and the alternate personality did not reappear after this treatment was commenced. It is suggested that behavioural psychotherapy may, in some instances of multiple personality, have advantages over psychodynamically oriented psychotherapy, which has frequently been advocated as the treatment of choice for this condition.
The relationship among therapeutic alliance, psychotherapy outcomes, and interpersonal problems was examined. The present study hypothesized therapeutic alliance would mediate the relationship between interpersonal functioning and outcome among patients with multiple sclerosis entering psychotherapy for depression. Nineteen clients received 16 weeks of individual cognitive-behavioral therapy (CBT) for depression as described by D. C. Mohr, A. C. Boudewyn, D. E. Goodkin, A. Bostrom, and L. Epstein (2001). Participants completed the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961), the Inventory of Interpersonal Problems-Circumplex (IIP-C; Alden, Wiggins, & Pincus, 1990), and the Working Alliance Inventory-Client Form (WAI-C; Horvath & Greenberg, 1989). The IIP-C significantly predicted Week 16 BDI and the WAI-C at 4 weeks. When controlling for the WAI-C, the relationship between the IIP-C and BDI was no longer significant, supporting the mediational hypothesis.
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Videotaped treatment sessions in conjunction with 1-month, 1-year, and 8-year follow-up allow a unique level of analysis in a case study of hypnotic treatment for pain and neuromuscular rehabilitation with multiple sclerosis (MS). Preparatory psychotherapy was necessary to reduce the patient's massive denial before she could actively participate in hypnosis. Subsequent hypnotic imagery and posthypnotic suggestion were accompanied by significantly improved control of pain, sitting balance, and diplopia (double vision), and a return to ambulatory capacity within 2 weeks of beginning treatment with hypnosis. Evidence regarding efficacy of hypnotic strategies included (a) direct temporal correlations between varying levels of pain relief and ambulatory capacity and the use versus nonuse of hypnotic strategies, (b) the absence of pharmacological explanations, and (c) the ongoing presence of other MS-related symptoms that remained unaltered. In conjunction with existing literature on hypnosis and neuromuscular conditions, results of this case study strongly suggest the need for more detailed and more physiologically based studies of the phenomena involved.
OBJECTIVE: Reported cases of multiple personality disorder have increased dramatically in the last decade. Few data are available on the treatment of multiple personality disorder. Current recommendations are based on the experience of individual clinicians rather than on systematic research. METHOD: A questionnaire study of 305 clinicians representing a spectrum of mental health professionals was conducted to survey the types and relative efficacy of treatment modalities currently used with cases of multiple personality disorder. RESULTS: Individual psychotherapy facilitated by hypnosis was uniformly endorsed as the primary treatment by all practitioner groups. The average patient was in twice-weekly psychotherapy facilitated by hypnosis for 3.8 years. Antidepressant and anxiolytic medications were reported to be moderately useful adjunctive treatments. CONCLUSIONS: These findings support current impressionistic treatment recommendations for multiple personality disorder regarding the primacy of psychotherapy and the moderate benefits of psychopharmacology with antidepressant and antianxiety agents.