一例人际关系敏感的心理咨询案例报告

一位女大学生在由于人际关系敏感,不能与同学正常交往,出现焦虑情绪、睡眠障碍、学习效率下降等症状。咨询师通过摄入性会谈收集了资料,发现来访者之所以陷入困境与复杂的家庭关系有关。咨询师主要运用认知行为疗法,帮助来访者进行认知重建,通过5次咨询,来访者情绪趋于平稳,睡眠得到了改善,学习效率得以提高,社会适应能力及心理承受能力都得到了提高,人格进一步完善。     

Cognitive Behavioural Therapy and Applied Relaxation for Generalized Anxiety Disorder: A Time Series Analysis of Change in Worry and Somatic Anxiety

The present study examined symptom change profiles in patients with generalized anxiety disorder (GAD) receiving either cognitive behavioural therapy (CBT) or applied relaxation (AR). It was hypothesized that (a) changes in worry would uniquely predict changes in somatic anxiety for most participants receiving CBT and (b) changes in somatic anxiety would uniquely predict changes in worry for most participants in the AR condition. Twenty participants (CBT n = 10; AR n = 10) completed daily ratings of worry and somatic anxiety during therapy, and multivariate time series analysis was used to assess the causal impact of each variable on the other. The hypotheses were not supported because we found no evidence of a match between individual symptom change profiles and treatment condition. Rather, a bidirectional relationship between worry and somatic anxiety was observed in 80% of participants receiving CBT and 70% of participants receiving AR. When only treatment responders were considered, 83% of participants receiving CBT and 86% of those receiving AR had such a bidirectional effect. The findings are discussed in terms of models of psychopathology that posit dynamic interactions between symptom clusters and in terms of the value of examining treatment mechanisms at the individual level.     

复杂哀伤丧亲女孩的箱庭疗法个案研究

通过19次个体箱庭和2次家庭箱庭治疗,对一名12岁复杂哀伤的丧亲女孩W进行了个案研究。发现:(1)箱庭治疗能提高丧亲青少年的个体和家庭功能,促进青少年个体和家庭哀伤任务的完成;(2)W的个体箱庭经历了在混乱重复中寻找秩序、重建自我、转化与整合、自我治愈力展现四个阶段;(3)W的哀伤经验经历了在治疗者促进下分享—象征性表达—主动地象征性表达—直接而主动地表达哀伤经验最终获得哀伤任务完成的变化过程。     

Treating Symptoms of Borderline Personality Disorder Through Narrative Therapy and Naltrexone

Abstract

Borderline Personality Disorder (BPD) is characterized by instability in interpersonal relationships, volatile perceptions of self-image and affects, and marked impulsivity, presenting in various contexts. Current BPD treatments are individual-centered, coping skills based, with a reduced emphasis on identifying etiology and systemic components. Narrative therapy focuses on deconstructing and reauthoring personal stories. A clinical case study shows narrative therapy to be efficacious, however, sometimes psychotherapeutic interventions alone are inadequate in managing these symptoms. Medication can serve as a useful adjunct in addressing self-injurious behaviors, suicidal ideation, and dissociation. Researchers further discuss the integration of naltrexone into treatment of BPD symptoms.     

From stratospheric ozone to climate change: Historical perspective on precaution and scientific responsibility

The issue of the impact of human activities on the stratospheric ozone layer emerged in the early 1970s. But international regulations to mitigate the most serious effects were not adopted until the mid-1980s. This case holds lessons for addressing more complex environmental problems. Concepts that should inform discussion include “latency,’ ‘counter-factual scenario based on the Precautionary Principle,’ ‘inter-generational burden sharing,’ and ‘estimating global costs under factual and counter-factual regulatory scenarios.’ Stringent regulations were adopted when large scientific uncertainty existed, and the environmental problem would have been prevented or more rapidly mitigated, at relatively modest incremental price, but for a time delay before more rigorous Precautionary measures were implemented. Will history repeat itself in the case of climate change?     

Parent Satisfaction with Case Managed Systems of Care for Children and Youth with Severe Emotional Disturbance

Case management has emerged as an integral component of current efforts to reform the delivery of mental health services to children and youth with Severe Emotional Disturbance (SED). We examined parental satisfaction with one program's case management system for SED children. In order to validly address parental satisfaction, the program first turned to a group of its parents to develop a satisfaction measure, the Family Satisfaction Survey (FSS). Of the 51 parents who returned an FSS, 74% of the parents were generally satisfied while 26% indicated that they were dissatisfied with their families' case management services. Multivariate regression analyses were employed to examine the role played by client, service, and outcome variables in predicting parental satisfaction. After controlling for child diagnoses, severity of impairment, and levels of psychosocial stress, parent satisfaction with case management services was best predicted by the frequency of monthly contact and fewer days is a psychiatric hospital proportional to length of service. Our results suggest that parent satisfaction is based not only on what case managers do but on how this service impacts SED children's ability to remain at home and in their communities.     

Extending the temporal range of psychometric prediction by optimal linear filtering of mental test scores

Incorporating temporal decline in predictive validity into mental testing theory is outlined. Starting from multivariate regression of criterion on repeated measurements, an analytic extension results in a weighting function for repeated measurements, replacing the beta weights. Besides optimizing, the procedure permits an evaluation of any particular prognosis setting: In cases of exponentially declining predictive validity, prognostic range can be extended if concurrent validity is nonperfect by optimal weighting (predictive filtering) of repeated measurements. Considerable gain in prognostic range over the traditional approach can be achieved if predictive validity declines concavely downwards.This work was supported by grant Dr 58/3 from Deutsche Forschungsgemeinschaft.     

Adapting Strauss and Corbin's grounded theory in clinical case study research in the field of counselling

Case study can be adopted when aiming to understand an individual's lived experience. Such experience produces rich and complex qualitative data for analysis, conducive to counselling and psychotherapy research. Furthermore, grounded theory (GT) can be adopted to produce a theory from qualitative data, fitting well with case study research that explores complex experiences regarding social, psychological and phenomenological processes. This paper aims to guide the counselling researcher to incorporate Strauss and Corbin's model into the main arena of qualitative counselling research. In addition, this paper draws on a multiple case study that adopted Strauss and Corbin's method and identified various phases in the GT process. The aim is to inform the reader how to put the iterative process and pragmatic theoretical sampling into practice to produce a robust theory from clinical case study data.     

Cyclical Maladaptive Patterns: Interpersonal Case Formulation for Psychotherapy with Children

This paper proposes the use of Hans Strupp's case formulation method, Cyclical Maladaptive Patterns, with child clinical cases. While Strupp's case formulation method was developed for use with adults in Time-Limited Dynamic Psychotherapy, this interpersonally-based model is viewed as consistent with recent literature in child development and psychopathology which emphasizes the centrality of peer relationships, interpersonal schema, and social attribution biases in the development of maladaptive interpersonal behavior. Application of this method underscores the interpersonal nature and context of childhood problems as well as their cyclical and self-perpetuating quality. Use of this case formulation method with children is proposed as a basis for individually tailoring treatment plans with children who have problems with aggression, rejection, and other maladaptive interpersonal patterns.     

Intensive Transactional Analysis Psychotherapy (ITAP): A case series study

Intensive Transactional Analysis Psychotherapy (ITAP) is a new therapeutic approach based on the integration of Transactional Analysis and brief psychodynamic approaches. ITAP is based on two key therapeutic tools—the intrapsychic triangle and the interpersonal triangle—which the therapist uses to focus patients’ attention on moment‐by‐moment therapy processes. The aim of the present study was to provide early empirical documentation of ITAP effectiveness. To this aim, six patients (four females, two males) were longitudinally evaluated using an A‐B‐A mixed quantitative and qualitative design, with evaluations at Baseline, Treatment and Follow‐up phases. Each patient received 16 50‐min weekly sessions of ITAP therapy over 4 months. For quantitative evaluations, patients filled out the Clinical Outcome in Routine Evaluation‐Outcome Measure (CORE‐OM) at each evaluation. Effects size values were estimated to evaluate quantitative changes comparing mean scores of Baseline, Treatment and Follow‐up phases. At the first follow‐up, the Change Interview was used to qualitatively evaluate patients’ perceived changes. In the quantitative data, four of the six patients reported a very good outcome, with large to very large effect sizes in Baseline versus Treatment and/or Baseline versus Follow‐up scores comparisons, whereas two patients reported variable fluctuations within the non‐clinical range of outcome scores. In the qualitative evaluations, all patients reported several moderately to extremely important perceived changes attributed to psychotherapy.