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PubMed1982

The role of the psychoanalytically oriented psychotherapist within a therapeutic community.

This paper presents a theoretical model for the psychoanalytically oriented psychotherapist working in a therapeutic milieu in which the standard psychoanalytic situation is altered in three respects: (1) the patient is borderline or psychotic and has difficulty participating in a verbal, insight-oriented approach, (2) the therapist is part of a treatment team, and (3) the patient is treated while in a community setting. These three factors can create difficulties in treatment, which will be reviewed with the goal of delineating a model to guide the therapist as he or she responds to the multiple stimuli of a therapeutic community. The role of the therapist will be examined from two broad points of view: the nature of psychotherapy with borderline and psychotic patients within the milieu, and the interaction between therapist, treatment team, and therapeutic community and its effect on the patient. Certain aspects of transference and countertransference in milieu treatment will also be discussed.

Countertransference↗
PubMed2006

The impact of parity on major depression treatment quality in the Federal Employees' Health Benefits Program after parity implementation.

BACKGROUND: Since the 1990s, parity laws have been implemented to reduce inequities in mental health coverage compared with that for general medical conditions. It is unclear if parity under managed care is associated with improvements in mental health treatment quality. Major depressive disorder (MDD) is a prevalent but often undetected and undertreated and thus could potentially benefit from parity implementation. OBJECTIVE: The objective of this study was to examine the association between parity implementation and changes in MDD treatment quality in the Federal Employees' Health Benefits (FEHB) Program. METHODS: We conducted retrospective analyses of insurance claims data. Logistic regression models estimated quality changes for MDD-diagnosed enrollees from pre- to postparity. SUBJECTS: Subjects included MDD-diagnosed FEHB insured enrollees, aged 18-64, across multiple states and 6 FEHB plans before (1999-2000) and after (2001-2002) parity implementation. MEASURES: Measures included receipt of any antidepressant or psychotherapy within a given calendar year of diagnosis; receipt of appropriate psychotherapy frequency/intensity and duration; and pharmacotherapy duration during acute-phase treatment episodes. RESULTS: Postparity, several plans improved significantly in the likelihood of receiving antidepressant medication. In the acute-phase episodes, the greatest improvement was seen in the likelihood of follow up >or=4 months. Few or no other changes were observed in the acute-phase treatment intensity or duration quality measures. CONCLUSIONS: Parity under managed care was associated with modest improvements. The observed improvements were consistent with secular trends in MDD treatment. Whereas mental health parity is an important policy goal, these results highlight its limitations: improving the financing of care may not be sufficient to improve quality.

Adolescent↗
PubMed1979

Tourette's syndrome symptom onset at age thirty-five.

It is apparent to the authors that the primary factors influencing this particular case of Tourette's Syndrome are psychological. The condition appeared to result from threatening environmental conditions causing repression. The repressed material manifested itself in multiple tics, echolalia and coprolalia. Because of this patients's extreme resistance to accept the true conditions of his situation, individual and group psychotherapy have been difficult modes of treatment.

Adult↗
PubMed2001

Narcotic withdrawal syndrome following gastric bypass--a difficult diagnosis.

BACKGROUND: It is common for bariatric patients to experience postoperative nausea, depression and remorse for several months following surgery. Difficulty exists for the surgeon in delineating the physical from the psychological in treating these patients. Preoperative education, evaluation and preparation, although essential, will not identify nor eliminate all potential problems. METHODS: We report the case history of a patient who ultimately underwent reversal of her gastric bypass. Her symptoms required multiple procedures and hospital admissions for what appeared to be anatomical problems. All procedures were done laparoscopically. RESULTS: The patient's main complaints of persistent nausea and abdominal pain combined with radiographic evidence of sub-optimal anatomic construct led to multiple operative procedures. Psychological intervention relative to the persistent nausea and abdominal pain was ineffectual, although the supportive and consistent nature of the psychotherapy relationship was useful in overall patient stability and emotional well being. Complete reversal of the bypass did not effect improvement. Ultimately, the diagnosis of narcotic withdrawal prompted the institution of methadone treatment with complete cessation of the symptoms of nausea and pain. CONCLUSIONS: The diagnosis of narcotic withdrawal syndrome can be difficult in the postoperative bariatric patient. Psychological evaluation and support are essential elements of the program throughout the entire course of a patient's treatment experience. Laparoscopic techniques simplified the surgical care of this patient.

Adult↗
PubMed1988

Comprehensive assessment of change in patients treated with short-term dynamic psychotherapy: an overview. A 2-year follow-up study of 34 cases.

Change was assessed in 34 patients at the end of short-term dynamic psychotherapy (STDP), and at 2 follow-ups (1 year and 2 years subsequent to treatment). The assessment was made from different perspectives and according to multiple criteria and methods of measurement. The results indicate that, when a particular form of STDP is selected according to each patient's ego resources, motivation for therapy, and motivation for change, approximately 90% of the patients will attain substantial symptom relief. The majority of the patients in this study also gave evidence of positive change in adaptive functioning, while one-third attained some dynamic/structural change as well. Clinically rated improvement was confirmed by changes in the patients' self-reported distress level (SCL-90), and from psychological test findings (MMPI). Improvement observed at the end of therapy was sustained throughout the 2-year follow-up period.

Adaptation, Psychological↗
PubMedDate not supplied

The role of psychotherapy in the treatment of substance-use disorders.

Psychotherapies for substance-use disorders are reviewed, with particular attention to modifications of standard treatments necessary to make them effective for patients with disorders. Treatments reviewed include cognitive-behavioral therapies (Relapse Prevention, Cognitive Therapy, Contingency Contracting, Behavioral Treatment, Cue Exposure, Network Therapy, and Aversion Therapy) and psychodynamic/interpersonal methods (Supportive-Expressive Therapy, Interpersonal Therapy, Motivational Interviewing, and Modified Psychoanalytic Therapy). The psychotherapies selected are individual, verbally based treatments for substance-use disorders; except for modified psychoanalytic therapy, all have been presented in treatment manuals and empirically studied. Research shows that these forms of psychotherapy can be effective, with some treatments providing more benefit than others for specific subpopulations, but no one treatment is consistently more effective than any other. General guidelines consistent across psychotherapies for substance-use disorders are discussed, with emphasis on phases of treatment, the importance of a compassionate stance by the therapist, the difficulty of engaging substance abusers in treatment, the need for urine and breath-alcohol testing, assessment of comorbid disorders, countertransference problems, the need for multiple treatment modalities, evaluation of the therapist's effectiveness, adjusting the amount of treatment, and appropriate termination. Directions for future research are also discussed.

Humans↗
PubMed2001

Psychosocial treatments for schizophrenia.

As indicated in recent treatment guidelines, psychosocial treatments play a critical role in the rehabilitation of schizophrenia patients. During the past few years, novel psychosocial treatments have emerged expanding the scope of successful outcomes and designed to address the specific deficits inherent in schizophrenia. This paper provides a brief description and evaluate the efficacy of five new emerging psychosocial treatments for schizophrenia. There is strong evidence for the efficacy of supported employment programs and family therapy, especially those involving multiple family interactions. Although schizophrenia patients appear to derive benefit from cognitive behavioral therapy, no evidence supports it superiority over that of other individual psychotherapies. The trials of cognitive remediation to date have been largely unsuccessful, although new innovative approaches continue to be tested. Finally, substance use treatment specifically designed to address the deficits in schizophrenia patients have been formulated, which are supported by optimistic pilot data and awaiting the completion of on-going clinical trials.

Cognitive Behavioral Therapy↗
PubMed1981

Reversal of Urinary tract diversion after recovery from hysterical conversion reaction.

We have described a case in which the diagnosis of multiple sclerosis with findings of progressive paraplegia and a neurogenic bladder led to supravesical urinary diversion. Pyocystis led to creation of a urethrovesicovaginal fistula. Psychotherapy later uncovered hysterical conversion reaction. Which was cured with hypnotherapy. The urinary tract diversion was subsequently reversed after reconstruction of the bladder and urethra.

Adult↗
PubMedDate not supplied

Effects of treatment for depression on fatigue in multiple sclerosis.

OBJECTIVE: There has long been a belief that depression contributes to fatigue in multiple sclerosis (MS) although supporting data are minimal at best. Clinical guidelines for the treatment of fatigue include recommendations for the treatment of depression in the absence of clear empirical support. The goal of this study was to examine the effects of treatment for depression on fatigue in MS. METHODS: Sixty patients with a relapsing form of MS and moderate to severe depression were randomly assigned to one of three validated 16-week treatments for depression: individual cognitive behavioral therapy, group psychotherapy, or sertraline. Assessments at baseline and treatment cessation included the primary outcome measure, fatigue assessment instrument (FAI), and Beck depression inventory (BDI). RESULTS: The total FAI and the global fatigue severity subscale were significantly reduced over the course of treatment (p values <.02). Other subscales did not change significantly. Secondary analyses showed change in global fatigue severity was associated with change in BDI (p =.03) but change in total FAI was only marginally related to change in BDI (p =.05). These relationships were due entirely to change in mood (p values <.02) and not to change in cognitive or vegetative symptoms (p values >.17). CONCLUSIONS: These findings suggest that treatment for depression is associated with reductions in the severity of fatigue symptoms, and that this relationship is due primarily to treatment related changes in mood.

Adult↗
PubMed1996

Reasons for depression and the process and outcome of cognitive-behavioral psychotherapies.

This study examined the relationships between clients' reasons for depression and the process and outcome of a cognitive therapy (CT) and a behavioral activation (BA) treatment for major depression. Reason giving was conceptualized as the tendency to offer multiple explanations for a problem. Different reasons for depression were also thought to match or mismatch the theoretical model underlying each treatment. Reasons for depression were assessed pretreatment with a previously developed questionnaire. Process variables including homework compliance and perceived treatment helpfulness were measured early in treatment. Results demonstrated that perceived helpfulness of the treatment was associated with positive outcomes in BA. Reason giving was associated with worse outcomes in BA. Specific reasons also predicted differential outcome in the 2 treatments. Clients who endorsed existential reasons for depression had better outcomes in CT and worse outcomes in BA. Relationship-oriented reasons were consistently associated with negative process and outcome in CT. Results are discussed in terms of the function of reason giving and the role of specific explanations for depression in treatment process and outcome.

Adult↗
PubMed2005

[The therapist in group psychotherapy].

Nowadays, group psychotherapy designates a broad range of procedures based on different theoretical frameworks, applied to several contexts. The purpose of this study is to understand the group therapist's role, delineating some strategies and necessary abilities for group psychotherapy practice. The authors emphasize the technical-scientific level in which the work with groups is developed and the influence of the therapist's personality on the participants. They conclude that, in order to preserve their role without loosing the specificity of his function due to his involvement in multiple patients' experiences, therapists must have a stable professional identity. Therefore, the therapists' preparation, based on a process of continuing formation, is a necessary condition to enable them to face peculiar situations that occur in the group context and also to assure the singular therapeutic potential of group psychotherapy.

Humans↗
PubMedDate not supplied

Psychogenic erectile dysfunction: comparative study of three therapeutic approaches.

We administered the International Index of Erectile Function (IIEF; Rosen et al., 1997) questionnaire to 30 patients with psychogenic erectile dysfunction (ED) at baseline, immediately after treatment, and 3 months after treatment. We randomized patients into three groups: group I, who had weekly sessions of time-limited theme-based group psychotherapy for 6 months and 50 mg sildenafil citrate orally on demand; group II, who had an intake of 50 mg sildenafil citrate orally on demand for 6 months only; and group III, who had weekly sessions of time-limited theme-based group psychotherapy for 6 months. We analyzed data (15-item IIEF) for each group at three times during the study and compared by the data using analysis of variance (ANOVA), followed by the Bonferroni multiple comparison test. We used Cochran's Q-test for analysis between baseline and posttreatment stages of patients with remission of symptoms (EF equal to or higher than 26 points). Group III had a mean score higher than group II, with the difference being statistically significant (immediately after treatment, p = 0.033; at 3 months after treatment, p = 0.049; p < 0.05). All three therapeutic alternatives resulted in an improvement of erectile function domain score. However, significant differences from baseline were observed in groups I (p = 0.0009) and III (p = 0.0002) but not in group II (p = 0.135). The psychotherapy groups, I and III, had significantly higher scores compared with group II, in which patients were exclusively treated with sildenafil citrate. These findings suggest that time-limited theme-based group psychotherapy is an effective treatment for psychogenic ED.

Adult↗
PubMed1999

Integrating psychological therapies: processes of meaning transformation.

We review the role played by meaning in different schools of psychotherapy, and propose that the systematic study of meaning transformation has the potential to unify understanding of the scientific basis of psychotherapy. We describe some of the most important innate and social origins of meaning, and identify seven major themes that characterize the thinking of people with psychological disorders. We also describe how these themes are processed cognitively on multiple levels, and propose common change processes that are consistent with research in cognitive psychology. These core sets of themes and processes are offered as a first step toward a systematic study of meaning and psychotherapeutic change.

Attitude to Health↗