Brief therapy in adult psychiatry: results from fifteen years of practice

We report the outcomes from our solution-focused brief therapy outpatient clinic in adult mental health. A questionnaire was sent to clients and their family doctors one year after they ceased to attend. Seventy-five clients were referred, of whom fifty-three were seen and forty-one traced at follow-up. Thirty-one (76%) reported a good outcome, with an overall average of 5.02 sessions, 20% attending only one session. Combining these data with our previous studies, 170 referrals were received of whom 136 attended and 118 were traced. Good outcome was reported by eighty-three clients (70%) with a mean of 4.03 sessions per case. There was no significant difference between the groups in solving additional problems or seeking further professional help. New problems were significantly less common in the 'good outcome' group. Long-standing problems did less well. In all three studies there were no significant differences in outcome between socioeconomic groups.     

A two year audit of a family therapy clinic in adult psychiatry

This paper reports a 2 year audit of a family therapy clinic in a psychiatric department, focusing especially on the relationship between diagnosis and outcome. Patients with affective disorders–especially where anxiety predominated–and eating disorders had good outcome. Structural change occurred in families with psychotic members, even though psychotic symptoms were often unchanged. Difficulties with an acute onset were more responsive than long-term problems, but a substantial number of the latter did improve. Families receiving between four and 10 sessions had the best outcome, and improvement was generally maintained at 2 year follow-up.     

Clinical psychopathology, psychiatric diagnosis and therapy in psychiatry

Clinical psychopathology has a diagnostic and therapeutic purpose. On the level of phenomenology one has to deal with four paradoxes. 1. The paradox of gradual transition from normality towards pathology versus the occurrence of symptoms of a new quality, 2. the paradox of nosological nonspecificity of various symptoms versus typical constellations of special symptoms for certain diseases, 3. the paradox of pure and typical symptoms and diseases versus symptoms and diseases which are mixed and non typical. 4. The paradox of the prevalence of psychopathological phenomena versus prevalence of somatic phenomena in one and the same disease. On the level of etiology one must face the fact that there are not only typical endogenous, exogenous (organic) and psychogenic syndromes. Neurotic symptoms may have an endogenous cause. Therefore neuroses may be treated effectively with antidepressants.     

Brief therapy in the Israeli kibbutz

Analysis of results of therapy in an unselected sample of 211 kibbutz patients seen over a three year period by the author in his capacity as kibbutz member and psychiatrist indicated that over 70% of the identified patients responded very satisfactorily to brief therapy. About one-third of the clients did not need more than a single comprehensive therapy session to achieve continuous improvement. In a minority of the cases more than 10 sessions were required. The results were significantly better in cases treated by brief therapy than in the sample treated by long-term therapy, where the pre-treatment severity was determined to be greater. The paper describes the unique aspects of brief therapy in the kibbutz setting, giving an outline of the author's model of intervention, using all components of the individual, family, and community ecosystem.     

The extent and quality of intensive therapy measures in psychiatry

An epidemiological study considered all new admissions that were the subject of intensive therapy in three Leipzig clinics from October 1, 1983 to September 30, 1984, comparing them with a randomly selected control group. From a total of 1,928 admissions, 314 underwent intensive therapy, 46 of these under the intensive therapist (anesthetist, internist, surgeon). Indications arising out of intensive medicine resulted in the transfer of 1.2% of all admissions to other institutions. Extent and quality of the intensive measures was in general judged to be good.     

Brief family therapy during army service

A case of a brief family therapy is presented. It illustrates how problems of adjustment to army life can be viewed and treated within the family context. For many families in Israel, the draft is a period of developmental crisis when a new balance is created with respect to relationships, coalitions, activities and other aspects of family life. The success of the family coping with this task influences its ability to support and help the young draftee in separating from home and coping with army life.     

Reye-like syndrome following valproate therapy in an adult

Three months after anticonvulsive regulation by means of the spasmolytic agent Convulsofin, a 46-year-old man suffered severe hepatosis, and when the preparation was discontinued he suffered a severe cerebral dysfunction. The clinical picture is interpreted as being "similar to the Reye syndrome", and distinctions between this and previously reported cases are noted. There has been very little observation of such complications among adult patients.     

The effects of behavioral activation therapy with inpatient geriatric psychiatry patients

This study examined the effects of Behavioral Activation (BA) treatment on depressive symptoms and quality of life among older adult patients in a geriatric psychiatry facility. There were 50 participants with mild to moderate cognitive impairment, each being 65 years of age or older. A 2 (between) × 3 (time of measurement) design was used in this study comparing control (treatment-as-usual) and experimental (BA) conditions at pre-, mid-, and posttreatment. BA consisted of eight 30- to 60-minute sessions across 4 weeks. Intent-to-treat analyses indicated a significant Group × Time interaction on depressive symptoms, with this effect remaining when only completer data were included. Further analyses indicated that this effect was due to significant change early in treatment in both the full and completer samples. There was no evidence of a significant effect on the quality-of-life measure. Cognitive status was not related to change in depressive symptoms, suggesting that BA may be useful across a range of older adults.     

Brief family therapy for childhood tic syndrome.

This paper reports the success of brief analytically oriented outpatient family therapy exclusively in treating an eight-year old girl presenting with a short history of multiple tics involving facial, thoracic, and upper limb musculature, with associated hoarse coughing and grunting. Diagnostic features are reviewed. No medicines were used, and the patient remained asymptomatic nine months after ceasing family therapy. Tentative indications for family therapy for tiqueurs are proposed.     

Brief cognitive-behavioral internet therapy for irritable bowel syndrome

While cognitive-behavioral therapy for IBS is quite effective, the limited availability of competent therapists and lack of access to treatment remain problematic. This paper reports on a small, randomized, controlled trial of a five week internet based cognitive-behavioral intervention for IBS with limited therapist feedback via e-mail. Fifty-four IBS patients were recruited via the internet and randomly assigned to either immediate treatment or a wait-list control group. Thirty-one subjects completed the post-treatment assessment. 77% of treatment completers also completed a 3-month follow-up assessment. Treatment completers experienced statistically and clinically significant declines in IBS symptoms and improvements in quality of life. Those gains were substantially maintained at follow-up. Treatment efficacy was partially mediated by reductions in the tendency to catastrophize the social and occupational implications of symptoms, suggesting that catastrophizing may be an important target for treatment.     

Brief functional analysis and treatment of bizarre vocalizations in an adult with schizophrenia

Variables responsible for the maintenance of bizarre vocalizations emitted by an adult diagnosed with schizophrenia were examined via a brief functional analysis, and results suggested that the behavior was maintained by attention. A treatment consisting of extinction and differential reinforcement of appropriate vocalizations was effective in reducing bizarre vocalizations and increasing appropriate vocalizations. The use of functional analysis methodology to examine variables that maintain problem behavior in this population is discussed.