Homework Use in Cognitive Therapy for Psychosis: A Case Formulation Approach

Based upon empirically supported cognitive-behavioral treatment approaches, this paper aims to outline the use of homework to enhance the therapeutic relationship, patient motivation, and skills for managing delusions, hallucinations, and negative symptoms. The nature and timing of homework is outlined for the different phases of treatment. Frequent barriers that emerge during the setting and reviewing of homework are described, followed by strategies to enhance motivation and homework compliance. The paper concludes with a demonstration of how homework is optimized within a case formulation approach for persistent symptoms of psychosis.     

Using Explicit Case Formulation to Improve Cognitive Processing Therapy for PTSD

We investigated the utility of explicit case formulation (CF) within Cognitive Processing Therapy (CPT) for individuals with posttraumatic stress disorder (PTSD). An uncontrolled pre-posttreatment design was used. Participants attended 12–16 weekly sessions of CPT with explicit CF, where CF guided treatment length and treatment components. Treatment was completed by 19 of the 23 participants who started therapy. Results revealed significant reductions in PTSD and depression severity as well as unhelpful PTSD-related beliefs from pre- to posttreatment (ds between 1.10 – 1.92) and treatment gains were maintained at 3-month follow-up. Of the participants available at posttreatment for assessment, 69% (n = 11/16) met good end-state functioning for PTSD and 62% (n = 8/13) did so at follow-up. Finally, 72% (n = 13/18) of those interviewed at posttreatment no longer met criteria for PTSD and this was found for 93% of those assessed at follow-up (n = 14/15). Treatment, and CF in particular, was found to be acceptable by participants. Explicit case formulation did not interfere with positive outcomes of Cognitive Processing Therapy for PTSD. Further clinical implications and future directions for research are discussed.     

Narrative Sexual Identity Therapy

Sexual identity therapy is an alternative to the two polarized positions of sexual reorientation therapy and gay-integrative therapy for clients who present with sexual identity concerns. This alternative model focuses on sexual identity—the private and public acts of identifying and communicating one's sexual preferences—and how the decision to do so is informed by dominant stories about what sexual attractions mean to a client. As one expression of sexual identity therapy, this paper presents narrative sexual identity therapy, an approach that utilizes a narrative therapeutic approach and techniques to facilitate exploration of dominant narratives and counter-narratives that speak to sexual identity with the goal of achieving a synthesis that reflects felt congruence of clients' beliefs/values and behavior/identity.     

Narrative Child Family Therapy

In this article, child family therapy is presented as a hermeneutic activity shaped by an interest in the evolving narrative. Over brief, analytic play interviews, the therapist documents a child's narrative understanding of the presenting family problem. This allows psychological meaning to be jointly constructed in therapeutic conversation with the child and family. The idea of play as narrative integrates child psychotherapy into recent social constructionist thinking in family therapy. The article also discusses how narrative therapists can use prior theory and training.     

Integrating Narrative Family Therapy in an Outdoor Behavioral Healthcare Program: A Case Study

Adolescent mental health is a significant societal concern in the United States. Diagnosable mental health disorders have been reported at rates of 10–20 % among children and adolescents and this does not include adolescents experiencing personal and interpersonal distress not meeting diagnostic criteria. Adolescents who do not respond to traditional mental health services are often placed in residential treatment centers or other out-of-home treatment programs. Outdoor Behavioral Healthcare (OBH) is growing as a viable treatment option for adolescents who struggle with emotional, behavioral or substance related problems; however, questions have been raised about how to integrate the family into an OBH treatment setting. This article describes a case study illustrating how techniques from Narrative Family Therapy can be used to accomplish this integration, and offers a view of using Narrative Family Therapy to further involve families in the treatment and post-treatment process in an OBH program.     

A Family Therapy Narrative

The evolution of the field of family therapy since its inception in the 1950s is traced in this article. Major contributory forces as well as key pioneers in the first generation and leaders in successive generations are highlighted. This is followed by an elucidation of the conceptual foundations and basic principles undergirding almost all of the main theoretical schools. Expansion in this now vast field is underscored through attention to the proliferation of the number of books and journals addressing family therapy/psychology topics as well as mention of the internationalization of the field. A typology of extant theoretical models is also presented. The article closes with a discussion of contemporary issues and trends.     

叙事疗法的生命伦理学关怀

简要回顾了叙事疗法的诞生和在中国的传播过程,探讨了叙事疗法在三个方面的生命伦理学关怀:以生命权力的平等为前提、以人文生态的和谐为途径、以生命意义的丰富为旨归.最后探讨分析了叙事疗法的发展潜力,并指出叙事疗法所蕴含的生命伦理学关怀是一个重要的推动因素.     

后现代叙事心理治疗探幽

近15年来国际心理治疗界出现一种由科学隐喻向叙事隐喻转变的潮流.它突出了心理问题的多维性和生活方式的多样性,强调整体联系的视角,与中国文化中的"大人"思想相契合.对叙事心理治疗做探讨,分为三个部分:什么是叙事心理治疗,介绍对叙事心理治疗的整体理解;叙事心理治疗的哲学渊源,介绍叙事心理治疗的理论基础;伦理问题,探讨叙事心理治疗在组织实施过程中权力关系与责任分布.     

后现代叙事心理治疗探幽

近15年来国际心理治疗界出现一种由科学隐喻向叙事隐喻转变的潮流。它突出了心理问题的多维性和生活方式的多样性,强调整体联系的视角,与中国文化中的“大人”思想相契合。对叙事心理治疗做探讨,分为三个部分:什么是叙事心理治疗,介绍对叙事心理治疗的整体理解;叙事心理治疗的哲学渊源,介绍叙事心理治疗的理论基础;伦理问题,探讨叙事心理治疗在组织实施过程中权力关系与责任分布。     

Toward a Developmentally Informed Narrative Therapy

Narrative approaches to psychotherapy emphasize the impact of the stories or narratives we construct on our reality and behavior. However, little effort has been made to elucidate how individuals' differential capacities for meaning-making influence the process of re-storying lives. The present article introduces to family therapy a model of the changing nature of individuals' ability to create meaning. The model, referred to as developmental-constructivism ( 10 ), suggests that, in addition to contextual factors, individual differences in the capacity for organizing experience will influence therapeutic efforts to generate new and more adaptive narratives. The model is also presented as a heuristic for comparing and integrating two influential approaches to narrative therapy: the externalizing approach of Michael White and the solution-focused approach of Steve de Shazer.     

Assessment-Driven Case Formulation and Treatment Planning in Dialectical Behavior Therapy: Using Principles to Guide Effective Treatment

Dialectical Behavior Therapy (DBT) is a complex cognitive-behavioral treatment designed for a population with multiple problematic and high-risk behaviors. As with any behavioral treatment, the role of assessment in DBT is critical. Although there is a significant body of research supporting the efficacy of DBT, there is a relative dearth of practical and principle-based information that help therapists formulate cases and treatment from a DBT perspective. In this article, we provide a step-by-step guide for creating an assessment-driven DBT case formulation and treatment plan. We focus on identifying stage of treatment, determining goals, developing the target hierarchy, assessing and treating the primary target behavior, and tracking outcomes. We highlight the few rules that inform DBT assesssment and practice, note and correct several common misconceptions, and demonstrate how the use of thorough assessment can result in a more nuanced case formulation and treatment plan.     

Embodied Disbelief: Poststructural Feminist Atheism

“I quite rightly pass for an atheist,” Jacques Derrida announces in Circumfession. Grace Jantzen's suggestion that the poststructuralist critique of modernity can also be trained on atheism helps us make sense of this playfully cryptic statement: although Derrida sympathizes with the “idea” of atheism, he is wary of the modern brand of atheism, with its insistence on rationally arranging—straightening out—religion. In this paper, I will argue that poststructural feminism, with its focus on embodied epistemology, offers a way to re‐explain Derrida's “I rightly pass,” and also to carry it forward. Poststructural feminist atheism leads us through Derrida to an embodied disbelief drawing on three dimensions of poststructural feminism: feminist epistemology and material feminism, relationality, and affect theory.     

Testing Case Formulation Hypotheses in Psychotherapy: Two Case Examples

We describe two cases that illustrate and demonstrate the effectiveness of a case formulation–driven approach to psychotherapy in which the therapist, in collaboration with the patient, develops a hypothesis (formulation) about the psychological mechanisms that cause and maintain the patient’s difficulties, uses the formulation to guide intervention, and collects data to test the formulation and evaluate the effectiveness of the intervention plan. As shown by the cases reported here, a key strength of this collaborative empirical process is that it enables the patient and therapist to quickly determine when a treatment is failing and take action to rescue it.     

End-of-Life Case Study: The Use of Narrative Therapy on a Holocaust Survivor with Lifelong Depression

Journal of Contemporary Psychotherapy - End-of-life is associated with several physical and existential challenges that may necessitate and yet limit intervention. However, there is limited...