[An approach with multiple effects: reflection].
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Community Mental Health Services↗
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Results for “Psychotherapy, Multiple”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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[Neuropsychiatric disorders in multiple sclerosis].
A comprehensive randomized study involved 138 patients with multiple sclerosis (MS). Clinical follow-up of the patients was supplemented by computer-aided tomography in 40 cases and electroencephalo-, rheoencephalo- and echoencephalography in 25 cases. Twenty-five patients were subjected to experimental and psychological examination. Follow-up for as long as 4 years was conducted in 56 patients. The main syndromes of psychic disorders in MS patients were as follows: neurosis-like disturbances (asthenic, hysteriform and obsessive syndromes), affective disturbances (apathic and anxiety depression, euphoria without decreased intellect), as well as organic oligophrenia, psychotic states and epileptiform syndrome in the initial status. Structural changes in the brain were found to be the principal factor in the genesis of the described disorders. The authors propose a differential approach to the treatment of the identified disorders including the use of tranquilizers, antidepressants, neuroleptics and nootropic drugs, as well as methods of rational psychotherapy.
Adult↗
Counselling gay men with multiple loss and survival problems: the bereavement group as a transitional object.
When AIDS is becoming a chronic disease, gay men with multiple loss experiences can easily turn into a forgotten group of widowers. Due to new medical treatment HIV-infected gay men are living longer and also have to deal with loss and surviving. This paper argues in favour of group grief therapy for multiple loss and survival problems, within the scope of peer support in the gay community during the AIDS era. In this group psychotherapy special attention is given to the influence of a low gay self-esteem on the grief process and surviving strategies.
Acquired Immunodeficiency Syndrome↗
The fear of reducing medication, and where have all the patients gone?
In spite of the enormous effort made by the Boston group, the findings were few. The high rate of dropouts and refusals to be assessed raise serious questions. One significant point that should be raised is that there was no difference in the use of medication between the treatments, and there should have been to foster underlying change with expressive psychotherapy. Also, treatment was not attempted without medication. Did patients drop out to avoid medication? Would a more flexible technique such as multiple crisis intervention have reduced dropout? Did selecting subjects with normal Wechsler Adult Intelligence Scale scores eliminate severe thought disorders, making differential improvement impossible? Was eliminating the sickest third of patients a mistake?
Antipsychotic Agents↗
Spiraling out of control: one case of pathologic anxiety as a response to a genetic risk of cancer.
The threat of cancer can result in an existential crisis characterized by feelings of uncertainty and fear. Anxiety, the most common response to the threat of cancer, may be expressed in ways as varied as individual personalities and circumstances. It is a normal response to the threat of cancer, but in some it may deteriorate to pathologic anxiety and manifest somatic or avoidant patterns. Members of families diagnosed with genetic mutations that predispose to cancer are unique in that they experience a complex chain of life events. People affected with genetic mutations that increase the risk for the development of cancer may be at greater risk of manifesting abnormal anxiety. Little research exists that can guide the health professional in meeting the needs of these individuals, which leads health practitioners to approach their needs on the basis of combined theoretical assumptions about the needs of people with cancer, people who have family members with cancer, and people with recurrent cancer. Some factors may be assessed by the health professional as an aid in identifying an individual at increased risk of developing a psychopathology. These factors include age and developmental level, existence of a previous psychologic disorder, and family integrity. Advanced practice nurses may effectively intervene in the care of these patients by (a) accurately assessing the risk for and extent of the anxiety reaction in individuals and family members; (b) developing management plans that include ongoing support, education, psychotherapy, and pharmacotherapeutics for the individual; and (c) support and psychotherapy for the family. In this article, the pathologic anxiety experienced by one adolescent girl diagnosed with a genetic mutation that caused multiple endocrine neoplasia 2a is addressed, along with the treatment of her avoidant anxiety disorder--trichotillomania.
Adaptation, Psychological↗
Long-term neuroleptic therapy in chronic anorexia nervosa complicated by tardive dyskinesia. A case report.
A patient is described with a 25-year history of disabling, and at times life-threatening, anorexia nervosa alternating with major depression associated with suicidal ideation. Repeated relapse occurred despite a variety of treatments until the institution of high-dose neuroleptic therapy. On this regime, together with supportive psychotherapy, she experienced a sense of emotional well-being, exhibited a good level of functioning and maintained a safe body weight. Multiple attempts to withdraw the medication resulted in relapse. Recently, the patient has exhibited signs of tardive dyskinesia. Possible mechanisms underlying her response to this form of treatment are discussed. The characteristics of the small subgroup of chronic anorexics, in whom the risk/benefit ratio may justify such a regime, are tentatively outlined.
Anorexia Nervosa↗
Depression. A case of anger and alienation.
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Anger↗
Motivation for brief dynamic psychotherapy.
BACKGROUND: Preliminary research indicates that motivation may be a key predictor of success in brief dynamic psychotherapy, but different aspects of motivation have not been studied as predictors. METHODS: In this study 48 out-patients were clinically evaluated before therapy with regard to different aspects of motivation. Seven motivation items modified after Sifneos were rated by several experienced judges. Forty-three patients were treated and followed up 2 and 4 years after brief dynamic psychotherapy. The predictive validity of each of the motivation items was tested by their direct correlations with long-term outcome, and their collective predictive validity was tested by use of multiple regression analyses. RESULTS: The interrater reliability was problematic for single items, but when the average scores of 4 judges were used, adequate reliabilities on 4 items were achieved. Two items, Motivation for change and Realistic expectations, showed the best predictive validity of long-term outcome. CONCLUSIONS: An Active engagement aspect of motivation may predict both successful and unsuccessful cases. Our data indicate that patients should be instructed about the principles and procedures of dynamic psychotherapy and they should be told why it is important for them to actively test alternative problem-solving strategies during and after therapy.
Adult↗
What are the prerequisites and indications of the therapeutic community proper? A comparative study.
Is the therapeutic community model appropriate for short term psychiatric wards with catchment area responsibility and emergency obligations? A comparative study of group dynamics, measured by Group Emotionality Rating System and Group Focal Conflict Analysis within three different therapeutic community wards, revealed that the short term ward contained extreme fight/flight groups and pseudo-groups unable to deal with the delegated responsibility presupposed by the therapeutic community model. The intermediate ward functioned fairly well, while the long term ward for psychotherapy of schizophrenia and personality disorders also functioned badly from a therapeutic community proper point of view. The author discusses these findings in light of previous literature and concludes that the therapeutic community proper is predominantly a treatment model relevant for personality disorders and severe neuroses, and not adequate for the multiplicity of emergency tasks facing a short term psychiatric ward.
Group Processes↗
Patient predictors of process and outcome in short-term individual psychotherapy.
Twenty-one psychiatric outpatients were treated with short-term, psychoanalytically oriented, individual psychotherapy. Outcome ratings were provided by the patient, the therapist, and an independent assessor. Process ratings were provided by the patient and the therapist at the end of therapy. From a series of multiple regression analyses two pretherapy predictor scores (defensive style of the patient, object choice of the patient) emerged as good predictors of several of the process and outcome ratings. The two predictor scores were statistically independent of one another and were not significantly related to initial severity of disturbance. Attention to these two concepts in future research and in clinical assessment of patients for short-term individual psychotherapy is recommended.
Adult↗
Understanding the relationship between transference interpretation and outcome in the context of other variables.
Transference interpretation has traditionally been regarded as a powerful distinguishing feature of dynamically oriented psychotherapy. The failure of early studies to demonstrate its impact on outcome may, in part, have been due to limitations in methodology and conceptual models. A recently completed clinical trial of short-term individual psychotherapy has provided evidence of associations between two aspects of transference interpretation and outcome. The two aspects were concentration (frequency expressed as a proportion of interventions) and correspondence (congruence with a patient formulation). The nature of the associations varied as a function of the patient characteristic known as quality of object relations. Also important was the therapeutic alliance. When the variables were considered together in a multivariate model and their relationships examined by means of multiple regression, substantial amounts of outcome variance were accounted for. The evidence from previous and recent studies suggests that technique can have an important impact on outcome in short-term individual psychotherapy. It also indicates that the impact of technique should be viewed in relation to patient and relationship variables.
Humans↗
The place of the unconscious in mental health nursing.
This paper acknowledges the concept of the unconscious in psychiatric discourse and explores the importance of this for mental health nursing practice. Mental health nursing practice has always been strongly influenced by psychiatric discourse because of its dominance in the clinical setting. The most recent edition of the American Psychiatry Association's Diagnostic and Statistical Manual has signalled that the concept of the unconscious is re-emerging in psychiatric discourse. This re-emergence provides the opportunity for mental health nurses to re-affirm or develop their psychotherapeutic skills in the nurse-patient relationship. The psychotherapeutic relationship could focus on ways for the patient to find meaning in their lives that recognize and value difference and multiple ways of being.
Defense Mechanisms↗
Sally Beauchamp's career: a psychoarchaeological key to Morton Prince's classic case of multiple personality.
By the methods of psychoarchaeology, the identity of Sally Beauchamp, Morton Prince's classic case of multiple personality, has been established. The reconstructed life history has for the first time revealed the roots of the dissociative process. This goal was actually obscured by the tangled web of Prince's rambling 1906 book and his other publications on the case. The determinative events included two instances of sudden infant death during the childhood period of the patient, the earlier of which was apparently never even known to Dr. Prince. Though not mentioned in the patient's autobiography, it probably induced the initial dissociation to defend the integration of the personality. The relevance of the new concept of SIDS (since 1969) is considered. Other disturbing influences were the constant rejection of the patient by her mother, who died at an early age, and probable severe abuse by the widowed father which led her to run away from home (permanently) at age 16. Nine years afterward, therapy with Dr. Prince began and lasted seven years. It is suggested that this case and the parallel one of Breuer and Freud (Anna O.) be comparatively reexamined from the standpoint of modern feminism. The role of the conventional 19th-century woman was not acceptable to either of them, and both probably had an unusually large innate, bisexual endowment. Endogenous conflict, intensified by social demands, produced dissociation as a pseudo-solution until, through opportune therapy and other environmental opportunities, each was able to achieve a productive modus vivendi. The relation of bisexuality to the etiology of personality dissociation in general is considered. An incidental but instructive discovery made in the course of the Prince research was an unknown letter from William James to Morton Prince about The Dissociation of a Personality. This find points up the fact that James's final metaphysic was a form of pluralistic panpsychism derived from both psychical research and the contemporary knowledge about dissociated personality. James postulated a cosmic multiple personality.
Dissociative Identity Disorder↗
Was ist eine erfolgreiche Psychotherapie? Was ist erfolgreich in der Psychotherapie?
What Is Successful Treatment? What Is Success in Therapy? - Observations on Psychotherapy ResearchThe author raises the following questions: What are the criteria for the evaluation of successful psychotherapeutic treatment? Which are the suitable research methods for the assessment of psychotherapeutic success? He proposes a research paradigm based on multiple criteria and multiple methods. Psychotherapeutic treatment success must be assessed on different levels: aetiology of disease, disease as nosologic category (e. g. depression), symptomatology, consequences (psychic, physical, social, economical) of disease. He further develops a research logic that is multimethodical: Results from different research methods must be aggregated on the basis of convergent findings. The three 'key research methods' in psychotherapy research are: single-case studies, controlled trials, naturalistic catamnestic research. Statements about any psychotherapeutic method or intervention strategy are only valid when results from these different study types converge. It may be a very severe bias when findings from only one study type (e. g. controlled trials) are generalised as a final verdict on certain psychotherapeutic methods.
Journal Article↗
Patients' reactions to humorous interventions in psychotherapy.
This study explores the preference of patients for humorous or nonhumorous therapist interventions. Hysterical, obsessive, and depressive patients were presented with three functional kinds of humorous interventions: emotional confrontation, anxiety reduction and perspective development. The data indicate that the patients consistently favored the nonhumorous interventions, but the degree of this preference varied according to personality style. Obsessive patients stood out in their ardent repudiation of humorous interventions. The results suggest that the desirability of utilizing humor in therapy depends on a multiplicity of parameters.
Adult↗
Client issues in drug abuse treatment: addressing multiple drug abuse.
Multiple drug abuse may involve the whole range of abused drugs, but the most critical problems exist with cocaine, alcohol, opioids, and benzodiazepines. The medical and psychosocial consequences of abusing these drugs in various combinations are often more severe than abusing each drug alone, and specific combinations of treatment options may be needed for many of these drugs. These combination treatments may include relapse prevention psychotherapies targeted toward drug-related cues that are specific to each type of drug as well as pharmacotherapies targeted toward specific drugs of abuse, such as naltrexone for opioid abuse and disulfiram for alcohol abuse. Few controlled clinical trials are available with multiple drug abusers, but successful treatments using pharmacological adjuncts such as disulfiram and amantadine have been described with cocaine-abusing or alcoholic methadone-maintained patients.
Humans↗
Multiple therapy in the treatment program of a mental hospital.
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Hospitals, Psychiatric↗