抽动症儿童的箱庭治疗个案研究

探讨箱庭治疗对抽动症儿童的有效性和作用机制。对一名抽动症儿童进行15次箱庭治疗,综合使用作品分析、访谈法和问卷法对治疗的过程及效果进行评估,结果发现个案的变化经过问题呈现、转变和自性三个阶段,箱庭治疗所提供的自由受保护的空间、矫正性的情绪体验以及良好的咨访关系等能够帮助个案减少抽动症状,提高情绪调节能力和人际交往能力。     

Combined cognitive-behavioral therapy for fibromyalgia: Effects on polysomnographic parameters and perceived sleep quality

Background/Objective: Cognitive-behavioral therapy (CBT) is one of the first-line treatments in the management of fibromyalgia (FM) and it has been applied with considerable success to treat the psychological processes associated with pain and insomnia. We hypothesized that treating sleep and pain jointly with new combined modalities of CBT may offer greater sleep-related benefits to patients. Method: Thirty-nine female patients with FM and insomnia were randomly allocated to receive CBT centered on pain (CBT-P) or combined CBT focused on pain and insomnia (CBT-C). Participants were assessed at baseline and post-treatment with the Pittsburgh Sleep Quality Index and an ambulatory polysomnography.Results: Participants who received CBT-P showed increases in time in bed and total sleep time and decreases in light sleep, but there was no improvement in perceived sleep quality. Participants who received combined CBT-C showed more meaningful improvements related to refreshing sleep (i.e., higher sleep efficiency and less time awake and longer time in Stage 4 sleep), and these changes were concordant with a significant improvement in self-perceived sleep quality. Conclusions: This study suggests that new CBT-C approaches can improve insomnia-related clinical aspects.     

家庭功能对青少年早期外化问题行为的影响：心理韧性的中介作用和性别的调节作用

为探讨家庭功能对青少年早期外化问题行为的影响,以及心理韧性和性别在二者关系中的作用机制,采用家庭功能量表、心理韧性量表和青少年外化问题行为量表对1284名初一学生进行测查。结果显示：（1）家庭功能显著负向预测青少年外化问题行为。（2）心理韧性在家庭功能和青少年外化问题行为中起部分中介作用,即家庭功能可以通过心理韧性间接影响青少年外化问题行为。（3）家庭功能对青少年外化问题行为中介过程的前半条路径和直接路径受到性别调节,具体而言,相比于男生,在女生群体中,家庭功能对心理韧性的影响更大;相比于女生,在男生群体中,家庭功能对外化问题行为的影响更大。     

Cognitive behavior therapy in treatment-naive children and adolescents with obsessive-compulsive disorder: an open trial

This work aims is to evaluate the therapeutic efficacy of cognitive behavior therapy (CBT) in pediatric patients with obsessive-compulsive disorder (OCD) who had not previously been treated with either pharmacotherapy or psychotherapy and who remained medication-free during CBT. Sixteen OCD outpatients, 8-17 years of age, were treated in a 12-week open trial with manualized CBT. Target symptoms were rated at two-week intervals with the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), the National Institute of Mental Health Global Obsessive-Compulsive Scale (NIMH Global), the Clinical Global Impression Scale (CGI), and the Hamilton Anxiety Rating Scale (Ham-A). Statistical analyses showed a significant benefit for treatment. Ten patients experienced at least a 50% reduction in symptoms on the CY-BOCS; seven were asymptomatic on the NIMH Global. These results build on previous reports that CBT may be effective in the acute treatment of pediatric OCD. Further, the results of this study suggest that CBT can be efficacious in alleviating OCD symptoms in the absence of pharmacotherapy. These results must be considered preliminary, given the small sample size and open administration of treatment.     

The goal as process: music and the search for the Self

This paper explores and compares the processes of music and analysis from the author's experience as a musician, piano teacher and analyst. It explains how the use of music improvisation in analysis (with simple percussion instruments) can powerfully enhance the dialogue between the unconscious and conscious psyche, as well as deepen the relationship between analyst and analysand. This is connected theoretically to Jung's active imagination and Winnicott's concept of play within the analytic encounter. Finally, the question is raised whether analytic trainings could do more to expose trainees to the possibility of using music within the analytic encounter. This touches on the more basic and controversial issue (which often separates analytical psychology and psychoanalysis) of whether expressive therapy should be used in analysis at all.     

Might Relationship “Techniques” Extend the Reach, Efficacy, and Efficiency of the Psychotherapies? The Challenge of Treatment-Resistant Outpatients

Study-based clinical observations and two premises are presented as indications for a need to identify therapeutic relationship techniques or the like that can extend the reach and efficiency of the psychotherapies. The premises are: (1) advances in psychotherapy practice and research now highlight one of the field's most longstanding challenges, signified by terms like treatment resistance; and (2) some proportion of outpatients whose problems are resistant to the psychotherapies (and medications) have marked limitations in the capacity to relate positively and productively to others, including therapists. Thus, ironically, they cannot optimally utilize a treatment modality that largely has developed to ameliorate problems relating to others.     

Envy and Generosity Between Co-Therapists

This paper explores the dynamics of envy and generosity between co-therapists. Generally speaking, co-therapists can be drawn into the same social comparisons (overt and covert), competitiveness, and envy as their group members. The list of valued resources can include the group's affection, appreciation, and recognition, or, more generally, one's status, popularity, creativity, sensitivity, understanding, or parental functioning. The group in turn, will sometimes tend to divide the therapists into the good one and the bad one in order to serve its own developmental needs. This process can increase the tension between the therapists, and feed their envy. I present an argument for processing those feelings and assert that awareness of co-therapist envy can promote the expression of generosity and enhance the capacity of group members for similar experiences. Clinical material will be presented to demonstrate how this works.     

Family Unification with Reactive Attachment Disorder Children: A Brief Treatment

This is a case study of a family with a child (age eight) with reactive attachment disorder and the subsequent individual and family therapy. Treatment of choice for the child was Eye Movement Desensitization and Reprocessing (EMDR) and supportive educational counseling for the parents and family. Qualitative evaluation of the process demonstrated that the parents observed an instant change in the child's attitude. The child reported that she felt better about family, school, and truthfulness, and stated about the therapy: It opened a window for me. A 12-month evaluation demonstrated continued positive effects.     

Ethical dilemmas in testing for late onset conditions: reactions to testing and perceived impact on other family members

This paper examines some of the ethical dilemmas that arise when testing for the late onset, untreatable condition of Huntington disease (HD) specifically now that technology allows us to test younger generations of the family for the mutant gene. Drawing on interview data from families with Huntington disease, the reactions to testing and perceived impact on other family members are considered. These are discussed in the light of the possible lowering of the age of test applicants. This potentially raises problems for a younger generation as they are confronted with reproductive decisions that the older generation did not have to face. It also means that individuals have the prospect of living with knowledge of a future illness for much longer.     

Fabry disease in genetic counseling practice: recommendations of the National Society of Genetic Counselors

The objective of this document is to provide health care professionals with recommendations for genetic counseling and testing of individuals with a suspected or confirmed diagnosis of Fabry disease, with a family history of Fabry disease, and those identified as female carriers of Fabry disease. These recommendations are the opinions of a multicenter working group of genetic counselors, medical geneticists, and other health professionals with expertise in Fabry disease counseling, as well as an individual with Fabry disease who is a founder of a Fabry disease patient advocacy group in the United States. The recommendations are U.S. Preventive Task Force Class III, and they are based on clinical experience, a review of pertinent English-language articles, and reports of expert committees. This document reviews the genetics of Fabry disease, the indications for genetic testing and interpretation of results, psychosocial considerations, and references for professional and patient resources. These recommendations should not be construed as dictating an exclusive course of management, nor does use of such recommendations guarantee a particular outcome. The professional judgment of a healthcare provider, familiar with the facts and circumstances of a specific case, will always supersede these recommendations.