The Development and Role of the Therapeutic Alliance in Supportive Psychotherapy with Adolescents

The formation of a therapeutic alliance is considered a central issue in therapy, and particularly crucial and challenging in work with adolescents. The relational and technical components of the therapeutic alliance were examined from the perspective of the adolescent client. 40 emotionally disturbed adolescent girls, aged 13 to 16 years, received brief supportive psychotherapy in the school setting. The alliance was assessed at sessions 3, 6 and 9, and outcome was evaluated on measures of internalizing problems, self-esteem, adjustment and client satisfaction. The results indicated the stability of the alliance between sessions 3 and 6, followed by significant linear increases between sessions 6 and 9. The strength of the alliance was most consistently related to reductions in internalising problems and client estimates of change. The implications for training and clinical practice with adolescent clients are discussed and future research avenues outlined.     

Transference in Psychotherapy with Schizophrenic Patients

Three current approaches to the group therapy of the cognitively intact, depressed elderly are reviewed. Examination of the strengths and limitations of these three models—self psychology, developmental considerations such as reminiscing and life review, and cognitive—behavioral therapies—points in the direction of the usefulness of an integrated model. The main objectives of an integrated approach include: stabilization of the individual's sense of self, establishment of interpersonal competence, and enhanced mastery over the affects of depression and demoralization. Clinical illustrations are provided to demonstrate the practical considerations in this model of group therapy.     

重视终末期肾病患者的心理治疗

心理治疗在终末期肾病(ESRD)治疗中的作用非常重要,不但可缓解患者的心理压力,还可改善患者的生理障碍、减少并发症,因此重视对ESRD患者的心理治疗,可使患者保持良好的生理、心理状态,并能提高患者的生活质量,改善预后。     

重视终末期肾病患者的心理治疗

心理治疗在终末期肾病(ESRD)治疗中的作用非常重要,不但可缓解患者的心理压力,还可改善患者的生理障碍、减少并发症,因此重视对ESRD患者的心理治疗,可使患者保持良好的生理、心理状态,并能提高患者的生活质量,改善预后.     

Treating Depression in Older Medical Patients with Psychotherapy

This purpose of this paper is to discuss the effectiveness of psychotherapy for treating depression in older, primary care patients. This paper highlights the feasibility of implementing psychotherapy in primary care settings, patient preference for psychotherapy, and the utility of primary care versions of therapy in treating depression in older adults. The discussion is supported with examples from three ongoing research projects, specifically the San Francisco General Hospital Depression in Late Life Study, the Hartford Foundation/California Healthcare Foundation IMPACT study, and the NIMH PROSPECT study. The findings presented here support the value of offering psychotherapy as a treatment alternative in primary care medicine.     

Doing Psychotherapy with Patients with Genital Herpes: Issues and Interventions

Abstract

This article presents issues that the psychotherapist is likely to have to deal with in treating patients with genital herpes. A review of medical issues, clinical manifestations and pharmacotherapy of herpes infections is presented. Common psychological reactions and psychopathology related to herpes simplex virus infection, a discussion of the patient's dilemma of disclosing his or her herpes simplex positive status to others and a list of cognitive-logical distortions often encountered in, and negatively affecting, patients with genital herpes are presented in detailed examples. A practical model (SANE) conceptualizing psychotherapy for patients with genital herpes in 4 intervention stages (Stabilization-crisis intervention, Acceptance, Normalization and social-personal Empowerment-evolution) is suggested for use. The use of cognitive-behavioral therapeutic strategies in facilitating the patient's assumption of a healthier psychosocial perspective in each stage is comprehensively detailed. Ethical and legal concerns in working with herpes simplex positive patients are also discussed.     

Group Psychotherapy and Rehabilitation of Long-Stay Patients

Abstract

Bulimia is a complex disorder that can significantly interfere with psychosocial functioning. It is a particularly significant problem among adolescents and young women in college and university settings. The preponderance of literature on group therapeutic approaches for this disorder is from a cognitive–behavioral perspective. In this paper, we present a psychodynamic group therapy approach for female university students, informed specifically by self psychological and relational frameworks. Through clinical illustrations, we demonstrate how the group provides selfobject experiences, including mirroring, idealizing, twinship, and adversarial experiences, and how the group becomes the arena through which group members can experience, express, and understand emotions. The interpersonal context of the group uniquely provides opportunities for members to examine their bulimic symptoms in relation to interactions that take place outside of or within the group.     

Selection of Patients for Group Psychotherapy

The concept of projective identification is reviewed, and its application to family and group systems is noted. Projective identification is then applied as a construct central to couples' groups, particularly useful in sorting out dynamics within couples, between couples, and toward the group-as-a-whole and its leader(s). Clinical examples are provided from a couples group co-led by the author, with indications of how this perspective on disavowal, interaction, and containment can be utilized therapeutically to provide a stimulus for intrapsychic and interpersonal change. The couples group offers a unique forum for working with projective identification, where this process presents a challenge to the therapist regarding the multiple levels from which to select appropriately and to “contain” skillfully.     

Strategic Issues in the Psychotherapy of Patients with Narcissistic Pathology

Narcissistic personality disorder is a relatively uncommon diagnosis in clinical settings; however, these patients are frequently in need of and referred for long-term psychotherapy. Such patients may not seek therapy willingly but do so at a time when they experience sufficient vulnerability to accept therapy. Given these and other characteristics, the narcissistic patient can be challenging for therapists. This paper suggests some strategic approaches that may be employed with patients with narcissistic pathology. Partly, these approaches incorporate more contemporary understandings of narcissistic pathology such as appreciating that these patients can present both the grandiose and vulnerable elements of narcissistic pathology and that a gender focus using theories of masculinity may enlighten our approach to these patients. Specifically the strategies reviewed are: starting therapy by assessing for the patient’s vulnerable characteristics and offering some gratification for their need for acknowledgement; monitoring and managing the risk of suicide and comorbid disorder in patients with narcissistic pathology and in the working through phase of therapy, recognizing the need for patients to developed increased self-cohesion and the importance of supervision/consultation in the working through process of therapy.     

Psychotherapy with Low-Income Patients: Lessons Learned from Treatment Studies

Psychotherapy with low-income patients presents a variety of challenges for the clinician. This paper discusses some of those challenges, including the barriers that poor individuals face in obtaining treatment, as well as issues of stigma, mistrust of authority, and potential cultural differences and differing expectations between mental health providers from higher socioeconomic backgrounds and lower-income individuals in need of care. We review some of the findings reported in treatment studies with low-income, frequently minority, samples that shed light on the types of adaptations to treatment that have proven successful. Finally, we discuss some of the clinical research that has been conducted with low-income, predominantly minority women through the department of psychiatry at Georgetown University over the past several years, concluding with some of the lessons we have learned in developing and conducting psychotherapeutic treatments with this population.