Incest and the multiple personality.
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Adult↗
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Results for “Psychotherapy, Multiple”
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[Multiple sclerosis].
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Adrenal Cortex Hormones↗
[Group psychotherapy in the treatment of post-traumatic stress disorder].
Working with psychotraumatized war veterans we perceived their extremely regressive position, which is accompanied by several destructive and autodestructive compulsions. Facing the multiple traumatic experiences which they lived through, a certain degree of regression has been appearing, since even a satisfying "nourishing-indulgence of their needs" cannot completely make up for their pre-war position. In this way occurred the splitting between ideal (introjected) object and real object, in which were projected all bad experiences, and which is still persecuting and wants to destroy. Through interactions between all group members of traumatized patients we analyzed the phenomena and the specificities of these groups-particularly their regressive position. The aim of the group psychotherapy was to enable progressive overcoming of regressive position and transition into a more mature stage of development, thus creating a favorable climate for growing up and independence.
Combat Disorders↗
Rehabilitation of patients with multiple sclerosis.
There are inherent difficulites in the rehabilitation of patients with multiple sclerosis (MS). The clinical manifestations of the disease vary tremendously, as does its natural course. The many theories on the etiology, pathogenesis and treatment of MS are presented. However, at the current time, the patient with MS may be treated with the realistic goal of minimizing the effects of the disease. This is accomplished best in a rehabilitation setting. Diagnosis, prognosis, and factors associated with precipitaiton or exaggeration of symptoms, are discussed. Specific techniques of rehabilitation of decreased motor power, spasticity, ataxia and intention tremor, speech and optic defects, and impaired sensation are presented. Decubiti and ulcerations, bladder and bowel problems, and sexual dysfunction are recognized as common problems and attention must be directed to these. The importance and wide array of emotional difficulties in patients with MS is emphasized, and those patients who may benefit from psychotherapy are discussed.
Ataxia↗
[Configural methods of assessment in psychotherapy research].
The particularity of psychotherapy research implies the application of configural techniques, with respect to the developmental state of theory generation in psychotherapy especially inductive configurational approaches like GUHA or HYPAG/Search. Each variant of HYPAG (i. e. Search for non-disjunctive types, explanations of multiple relationships, elaboration of theory-related optimal suggestions for operationalization) are presented in detail and demonstrated with secondary analyses. The main problem of this approach is the requirement of large numbers of subjects. The application of this approach can hardly be recommended with less than 250 subjects.
Follow-Up Studies↗
A trial of neuropsychologic rehabilitation in mild-spectrum traumatic brain injury.
OBJECTIVE: To test the effectiveness of a neuropsychologic rehabilitation program consisting of psychotherapy and cognitive remediation in the treatment of the affective and neuropsychologic sequelae of mild-spectrum traumatic brain injury (TBI). DESIGN: Single-blind randomized, wait-listed controlled trial, with repeated measures and multiple baselines. SETTING: Outpatient clinic in northern New Jersey. PARTICIPANTS: Twenty persons with persisting complaints after mild and moderate TBI (11 in treatment group, 9 controls). INTERVENTIONS: The experimental group received both 50 minutes of individual cognitive-behavioral psychotherapy and 50 minutes of individual cognitive remediation, 3 times a week for 11 weeks. The control group was wait-listed and received treatment after conclusion of follow-up. MAIN OUTCOME MEASURES: Symptom Check List-90R General Symptom Index, plus scales of depression, anxiety, coping, attention, and neuropsychologic functioning. RESULTS: Compared with the control group, the treatment group showed significantly improved emotional functioning, including lessened anxiety and depression. Most significant improvements in emotional distress were noted at 1 month and 3 months posttreatment. Performance on a measure of divided auditory attention also improved, but no changes were noted in community integration scores. CONCLUSIONS: Cognitive behavioral psychotherapy and cognitive remediation appear to diminish psychologic distress and improve cognitive functioning among community-living persons with mild and moderate TBI.
Adult↗
The supervisory needs of neophyte psychotherapy trainees.
This article focuses on the difficulties facing the neophyte trainee in the field of psychotherapy. Three areas of such difficulties are identified, defined, and discussed: feelings of inadequacy and incompetence, anxieties concerning supervisors, and confusion concerning multiple theoretical views of clinical work. Two vignettes from the early training of the paper's junior authors illustrate and discuss these problems and their resolution in applied contexts. A conclusion is offered which emphasizes the value of supervisory recognition of these dimensions of trainees' experience, as well as their potential for modeling processes of growth that are likely to help supervisees' patients as well.
Clinical Competence↗
Multiple sclerosis, disease modifying treatments and depression: a critical methodological review.
BACKGROUND: Major depression affects one in two patients with multiple sclerosis (MS) during the course of their lifetime. This adds to the morbidity associated with the disorder and may contribute to an increased mortality rate because of suicide. Over the past few years, with the advent of disease modifying treatments for MS, a new concern with respect to mood has arisen, namely the possibility that some of these drugs may have depression as a clinically significant side effect. OBJECTIVE: To ascertain whether disease modifying treatments in MS are associated with the development of depression or the worsening of a depressive illness. METHODOLOGY: A MEDLINE and PSYCHLIT search focusing on depression and disease modifying treatments going back to 1993 (the publication date of the results of the first randomised, placebo controlled trial). The methodology pertaining to the assessment of depression is critically reviewed. Furthermore, a critical summary is provided of treatment modalities for the depressed MS patient. RESULTS: There are conflicting data that depression may occur with some disease modifying drugs, particularly interferon beta-1b. However, all studies reveal limitations with respect to the assessment of mood. Some reports, despite omitting details of how mentation was assessed, still comment on the presence or absence of depression. Others suffer from one or more of the following shortcomings: a failure to assess premorbid risk factors for mood disorder; a reliance on one question to assess depression; the utilisation of self report mood rating scales of questionable validity; neglecting to distinguish depression as a symptom from depression as a syndrome (i.e. major depression as defined by the DMS-1V). CONCLUSIONS: Given the many methodological pitfalls inherent in all studies to date, it is premature to conclude that disease modifying drugs are associated with depression. Evidence suggests that treatment of depression, irrespective of a putative association with a disease modifying agent, is frequently effective. This applies to pharmacotherapy or psychotherapy, although the former may be preferred should depression arise during a course of treatment with a disease modifying agent. Multiple Sclerosis (2000) 6 343 - 348
Major Depressive Disorder↗
The multistory self: why the self is more than the sum of its autoparts.
A summary is presented of both the theoretical and clinical points made by the contributors to this issue of Journal of Clinical Psychology: In Session on the multiplicity of self. It is argued that there are many theoretical and clinical commonalities in the diverse range of psychotherapies that have been developed and that have been used in work with problems in the self-concept. Core problems encountered in clinical practice include an apparent self-integration that is attained through the exclusion of important parts of the self. The key to opening up clients who present such problems is through the use of experienced emotions and the therapeutic relationship. More extreme problems in the self-concept can be seen in the personality and psychotic disorders, in which the self may be chaotic or disintegrated. Such clients may need help with the development of a reflective self that can integrate and regulate the separate parts of the self-concept.
Humans↗
The sociocognitive model of dissociative identity disorder: a reexamination of the evidence.
According to the sociocognitive model of dissociative identity disorder (DID; formerly, multiple personality disorder), DID is not a valid psychiatric disorder of posttraumatic origin; rather, it is a creation of psychotherapy and the media. Support for the model was recently presented by N.P. Spanos (1994). In this article, the author reexamines the evidence for the model and concludes that it is based on numerous false assumptions about the psychopathology, assessment, and treatment of DID. Most recent research on the dissociative disorders does not support (and in fact disconfirms) the sociocognitive model, and many inferences drawn from previous research appear unwarranted. No reason exists to doubt the connection between DID and childhood trauma. Treatment recommendations that follow from the sociocognitive model may be harmful because they involve ignoring the posttraumatic symptomatology of persons with DID.
Adult↗
The genetics of schizophrenia: a review.
The evidence suggesting that genetic factors are involved in the etiology of schizophrenia is reviewed. Despite methodological and other difficulties, independent lines of research--family, twin, and adoption studies--point in a common direction: Persons genetically at risk for schizophrenia are more likely to become affected than those who are not. Current attempts to understand the mode of inheritance of the gene or genes involved have become increasingly sophisticated and, consequently, less accessible (and possibly useful) to clinicians and nongeneticist researchers. Guidelines are provided for the provision of genetic counseling to affected persons and their relatives. Such counseling is frequently enmeshed with multiple psychosocial (rather than strictly medical) issues and should be provided by professionals with appropriate training and experience in psychotherapy.
Adoption↗
Cost-effectiveness of ADHD treatments: findings from the multimodal treatment study of children with ADHD.
OBJECTIVE: Attention deficit hyperactivity disorder (ADHD) is a costly public health problem. To the authors' knowledge, this is the first study on the cost-effectiveness of the major forms of ADHD treatments used in NIMH's Multimodal Treatment Study of Children With ADHD (MTA Study). METHOD: Five hundred seventy-nine children with ADHD, combined type, ages 7 to 9.9, were assigned to 14 months of medication management, behavioral treatment, both combined, or community care. Services were tallied throughout the study, including medication, health care visits, behavioral treatments, and rental costs. Provider specialty, total time, and number of visits with providers were used to calculate costs, adjusted to FY 2000 dollars with the consumer price index. RESULTS: Treatment costs varied fourfold, with medication management being the least expensive, followed by behavioral treatment, and then combined treatment. Lower costs of medication treatment were found in the community care group, reflecting the less intensive (and less effective) nature of community-delivered treatment. Medical management was more effective but more costly than community care and more cost-effective than combination treatment and behavioral treatment alone. Under some conditions, combination treatment (medical management and psychotherapy) were somewhat more cost-effective, as demonstrated by lower costs per additional child "normalized" among children with multiple comorbid disorders. CONCLUSIONS: Medical management treatment, although not as effective as combined medical management and behavioral treatment, is likely to be more cost-effective in routine treatment for children with ADHD, particularly those without comorbid disorders. For some children with comorbid disorders, it may be cost-effective to provide combination treatment.
Attention Deficit Disorder with Hyperactivity↗
[Relationship experiences and therapeutic outcome in inpatient psychotherapy].
OBJECTIVES: Inpatient psychotherapy includes the patient's manifold contacts with different therapists, nurses and fellow patients. The present study investigated the association between these multiple relationships and therapy outcome. METHODS: Pre-post measures of symptom load (Brief Symptom Inventory), interpersonal problems (IIP) and self-efficacy (SEB) were used to define three groups with positive (N=129), unchanged (N=44) or negative (N=40) outcome. These groups were compared 1) by their alliance with an individual therapist, their relationship to the therapeutic team, their experience of cohesion and climate concerning fellow patients in the ward (measured weekly by the "Stationserfahrungsbogen" SEB), and 2) by their differences in mean correlations between the courses of relationship experiences and symptom load. RESULTS AND CONCLUSIONS: Cohesion and relationship to the therapeutic team were not associated with therapy outcome. Therapeutic alliance with the individual therapist and climate among fellow patients turned out to be moderate indicators of the therapeutic outcome. It is recommended to include these process parameters systematically into the process diagnostics of inpatient psychotherapy.
Adult↗
The multiple personality debate.
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Child↗
Hypnosis, nonvolitional responding, and multiple personality: a social psychological perspective.
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Dissociative Identity Disorder↗
Treatment for multiple personality disorder: at what cost?
The material presented in this paper suggests that before mental health practitioners ask of society the resources to treat those thousands of patients diagnosed with MPD in the past few years, a critical attempt should be made to evaluate the efficacy of the type of treatment currently recommended for the condition. Proponents of the disorder claim its treatment is cost-effective, but this article's analysis indicates that it is simply premature to make claims about the treatability or prognosis of multiple personality disorder.
Cost-Benefit Analysis↗
An intermediate psychiatric facility: the usefulness of a place for treatment between hospital and home.
A new kind of psychiatric facility to deal with patients returning to their community from a state hospital or with patients newly ill and treatable locally, combines a number of features in the interests of economy and enhanced effectiveness. Its economy arises from: (1) The exclusion of bed-patient and security-ward care for patients not in need of them; (2) a shortened hospital stay resulting from rapid treatment procedures (electroconvulsion, brief psychotherapy and drug therapy); (3) a flexible shifting to outpatient or day care as soon as practicable. Enhanced effectiveness of therapy arises from earlier discharge from state hospitals, earlier treatment of patients from the community, as well as comprehensive utilization of multiple therapeutic modalities.
Day Care, Medical↗
Clinician perspective on achieving and maintaining remission in depression.
The majority of large-scale clinical trials of depression focus on response, typically defined as a 50% reduction in symptoms, as the endpoint. Response in the absence of remission places patients at greater risk for relapse, decreases their level of functioning, and erodes quality of life. Most importantly, both research and our clinical experience suggest that remission, or "getting well," is an attainable goal for patients with major depressive disorders. Pharmacotherapy, psychotherapy, and combination regimens are all treatment options. Recent studies across a range of patient populations have demonstrated the benefit of affecting multiple transmitter systems over a single antidepressant mechanism. Pooled data from more than 2000 patients comparing venlafaxine, a serotonin-norepinephrine reuptake inhibitor, and selective serotonin reuptake inhibitors suggest that the dual mechanism of action of venlafaxine provides significantly greater efficacy in achieving remission. Ultimately, achieving a good clinical outcome is desirable, but sustaining the mood state is, perhaps, more important. Studies of venlafaxine show it is possible to prevent more relapses and recurrences of depression with dual-mechanism treatment than with placebo. These data highlight the need for setting appropriately aggressive goals and working closely with our patients to achieve them. By doing so, we create the best opportunity for restoring patients to "wellness" and, ultimately, a normal and fulfilling life.
Antidepressive Agents↗