Panic Disorder and Self States: Clinical and Research Illustrations

Patients who suffer from panic attacks are often deeply distressed by the symptoms of panic and their aftermath. Alarming physiological symptoms (i.e., dizziness, shakiness, and abdominal distress) are typically accompanied by a sense of imminent doom. This article presents a formulation of panic disorder that assumes that panic results from selfobject failures, leading to fragmentation and disorganizing experiences. Early selfobject responses to panic set the stage for the meanings of panic in subsequent development. A single clinical case, along with examples from research, illustrates the benefit of focusing on developmental processes and unconscious and preconscious fantasies.     

Implementing Single Session Therapy

In recent decades, discussion about clinical practice has been dominated by a focus on evidence‐based treatments, whilst the translation of evidence‐based treatments into practice has been neglected or avoided. The single session therapy (SST) field reflects this general trend. As a result, the community has not benefited from available service improvements simply because they have not found their way into core practice or been translated across state‐wide services. This article draws on a range of implementation projects managed by The Bouverie Centre, in particular a successful state‐wide SST implementation project conducted in collaboration with Victorian community health counselling services, to raise implementation dilemmas and suggest practical ideas about the translation of SST ideas into mainstream clinical practice. It is hoped this discussion will be of interest to those wanting to translate any new idea into practice.     

Existential social work and the quest for existential meaning and well-being: A conceptual framework

ABSTRACT

The aim of this article is to conceptualize “existential social work.” A greater understanding of what existential social work means may enable social workers and those studying social work to see how its practice can reveal “the truth” about human existence and how they, as professionals, can enhance existential meaning and existential well-being among their clients. In such work, existential social workers have at their disposal tools such as the Frankl therapeutic approach to existential analysis (i.e., logotherapy) as well as spiritual-sensitive modalities (prayer and mindfulness). To interpret and understand apparent phenomena in the therapy is the ultimate goal with existential social work practices, thus providing clients with the opportunity to discover the meaning that exists in themselves. In addition, these practices pave the way for existential well-being.     

A Mixed Methods Exploration of Single Session Family Therapy in a Child and Adolescent Mental Health Service in Tasmania,Australia

Single session therapy (SST) is grounded in the belief that clients and families can effect change after one therapeutic encounter, using their own resources, with brief support and assistance from therapists. SST has been found to be an effective intervention for children, young people, and their families presenting with a wide range of difficulties. Research in child and adolescent mental health has shown that over 50% of families find one SST encounter is enough with no need for further specialist input. This study aims to explore family member experiences of SST (undertaken as single session family therapy and termed hereafter SSFT) as an initial intervention in a regional child and adolescent mental health service (CAMHS), specifically in terms of worry, confidence, and satisfaction outcomes. An exploratory, mixed methods convergent design was utilised using a combination of open questions and Thurstone scales. All eligible family members were invited to complete questionnaires before and after the SSFT, asking about level of worry, confidence, and overall satisfaction with SSFT. Quantitative and qualitative findings indicated most family members had a positive experience of SSFT, although differences were found between young people, parents, and siblings. Overall, family members’ level of worry decreased, while only parental confidence in managing the presenting issue(s) increased. Over half of the families did not require further contact with CAMHS following the SSFT. Our findings support previous research that SSFT is an effective, family-inclusive, and well received intervention for a variety of mental health issues facing children and young people. SSFT could be considered a beneficial and well received first response for the majority of CAMHS clients, which prioritises a family-inclusive approach. Future research could focus on attaining a more in-depth understanding of individual family member experiences with a view to improving SST delivery.     

Career Counseling With Black Men: Applying Principles of Existential Psychotherapy

Counselors may benefit from applying principles of existential psychotherapy to career counseling with Black men. Existential psychotherapy asserts that there are 4 issues that all people experience: death, freedom, isolation, and meaning. The life experiences of Black men, including difficulty with their careers, suggest that they may struggle with these existential concerns, particularly finding meaning in their lives. Because work and issues in other domains of life (e.g., family, community) often intersect, an existentially based career counseling approach may prove useful. An overview of existential psychotherapy is presented, followed by a discussion of its applicability to career counseling with Black men. In addition to suggestions for career counselors, recommendations for training and professional development are offered.     

Becoming Each Other: A Single Case Exploration of Relational Consciousness in Couple Therapy

The concept of “relational consciousness” has gained increasing attention in the last decades in the fields of philosophy, sociology, and psychotherapy. Yet human consciousness with its concomitant awareness of self and other as distinct is linguistically and culturally situated in the individual mind. This article explores the lived experience of shared consciousness in the practice of “becoming the other” with a focus on therapy with one couple. The historical development of our understanding of consciousness as a relational phenomenon is addressed with particular attention to the observations, insights, and practices of Lev Vygotsky, George Herbert Mead, and Gregory Bateson, who have each contributed substantially to our understanding of mind as relationally experienced and constructed. The article explores implications for practice and future directions this methodology might take.

Reflections and Learning From an Agency‐Wide Implementation of Single Session Work in Family Therapy

In November 2009, the Bouverie Centre, a centre for training, research, and clinical family therapy in Melbourne, Australia, embarked on a 12‐month trial involving the implementation of single session work as our main model of service provision for all new family appointments. We were interested in evaluating clients' and therapists' experiences of this change in our clinical service delivery. This article discusses some clinical dilemmas that arose for staff in this process, and how they were addressed. Clients' responses to single session work are outlined, followed by a discussion of outcomes of the implementation for our organisation.     

Functional Neurological Symptom Disorder (Conversion Disorder) from an Interactional Approach: A Composite Case Study

Functional neurological symptom disorder, alternatively termed conversion disorder (FNSD-CD) (Although the DSM-5 utilises the term 'conversion disorder', practitioners and consumers consider this to be an outdated, unsubstantiated and often stigmatising term. In accordance with this, the current terminology used in the field is 'functional neurological symptom disorder'), involves symptoms of altered voluntary motor or sensory functions without identifiable nervous system disease or pathology. It is considered a psychiatric disorder and is, thus, listed in the Diagnostic and Statistical Manual of Mental Disorders (5th Ed.; DSM-5). As per the nosology of the DSM-5, the discrete behavioural or psychological syndrome or pattern observed in FNSD-CD is assumed to be a function of a problem of, or a disorder within, the individual. Accordingly, the psychiatric approach to FNSD-CD, as set out in the DSM-5, invokes an assumption common to the medical model which is that of lineal (i.e., straight-line) causality, namely, causal events are arranged in a lineal sequence. The interactional approach, however, which is a development of general system theory in the field of family therapy, offers an alternative approach to understanding psychiatric disorders. Specifically, this approach places the emphasis on the relationships between individuals and their reciprocal influences on – including their psychological and emotional wellbeing with – one another. It draws on the assumption of nonlineal (i.e., circular) causality, namely, causal events are arranged in a circular sequence. From an interactional approach, therefore, FNSD-CD is thought to be a function of a problem of, or a deficit within, the individuals’ relationship/s, rather than within an individual, per se. This article utilises a composite case study to investigate FNSD-CD from an interactional approach.     

Interactive Family Music Therapy: Untangling the System

Interactive Family Music Therapy can have a unique role to play when working as part of a multidisciplinary team by demonstrating a capacity to ‘surprise’ a client/patient when they least expect it. It provides a positive shared experience that can add to multidisciplinary assessment and treatment planning. This article will illustrate the role Interactive Family Music Therapy has at Redbank House and includes case material.     

A Network Therapy Clinic for Clients with Intellectual Disability

Over the past 30 years a systemic approach has been applied to complex cases involving intellectual disability and behaviours of concern. This paper describes a model that draws on systemic family therapy and network therapy as well as the use of a reflective team. A single session intervention was provided for families of people with intellectual disability. A systemic consultation was used as a pre‐session meeting for professionals working with the family. The systemic consultation and single session therapy allowed the family and the professional network to gain insight. Involving the professionals in the therapy session also enhanced the alliance between professionals and family. This approach assists everyone involved in the case to find a way to progress.     

Fiscal Mapping Autism Spectrum Disorder Funds: A Case Study of Ohio

Individuals with autism spectrum disorders (ASDs) have complex needs requiring regular service utilization. Policymakers, administrators, and community leaders are looking for ways to finance ASD services and systems. Understanding the fiscal resources that support ASD services is essential. This article uses fiscal mapping to explore ASD funding streams in Ohio. Fiscal mapping steps are overviewed to assist ASD stakeholders in identifying and examining ASD-related funding. Implications are drawn related to how fiscal mapping could be used to identify and leverage funding for ASD services. The resulting information is critical to utilizing existing resources, advocating for resources, and leveraging available funds.     

Single‐Session Approaches to Therapy: Time to Review

In 2001 Bloom produced a comprehensive review of single‐session approaches to therapy (SST). In his paper he outlined the concept of single session therapy and considered the evidence that could be used to support implementation of single session approaches. At the time, Bloom's was probably the most comprehensive review of research on single session therapy available: he considered papers that provided overviews of approaches to developing and delivering single‐session treatment, as well as papers that used controlled and uncontrolled methods to evaluate outcomes. What I will do in this paper is to informally review the literature on single session therapy that has been published since Bloom's 2001 paper. The paper is not intended as a formal review or meta‐analysis of research data, partly because the field still does not have such methodological rigour.     

A Preliminary Investigation of the Effectiveness of Attachment Therapy for Adopted Children with Reactive Attachment Disorder

The purpose of this preliminary investigation was to examine the effectiveness of attachment therapy for adopted children diagnosed with Reactive Attachment Disorder (RAD). Although attachment therapy is widely utilized in the practice community, outcomes of such therapy have not been well documented. In this study a pretest–posttest one-group design was used with a sample of 24 adopted children who received attachment therapy from trained, licensed therapists. Therapy was funded by the Georgia Office of Adoptions under a contract with a non-profit adoptive parent advocacy group which provided training of therapists and direct services to families. RAD was measured with the Randolph Attachment Disorder Questionnaire (RADQ), Third Edition; functional impairment was measured with the Child and Adolescent Functional Assessment Scale (CAFAS). Statistically significant decreases in scores on the RADQ and CAFAS from pretests to posttests indicate improvement for the children who received therapy. In spite of methodological limitations, the current study adds to the limited knowledge about effective treatment for RAD.     

After the Assault: Cognitive Trauma Therapy with a Single Event Trauma Survivor

This article explores the specific context of a single event criminal assault, (i.e., a stranger non-sexual assault that occurred during a robbery) and shares the theoretical framework that successfully guided the clinician’s assessment, treatment planning, and interventions. Based on a literature review and employing a case study, this article presents the potential norms of trauma aftermath following a single event non-sexual criminal assault. It provides an overview of those theoretical frameworks that have consistently proven effective with this population; this article shares the rationale for selecting cognitive trauma therapy and illustrates its application to an assault survivor.

Multidimensional Family Therapy: A Science‐Based Treatment System

MDFT is a family‐based intervention for adolescent substance abuse and associated mental health and behavioural problems (Liddle, 2010). Integrative in several ways, MDFT uses an ecological or contextual conceptual framework to understand the developmental tasks of teens and their families. Research‐derived knowledge about risk and protective factors, and proximal causes, correlates and contributors to adolescent drug and related problems inform clinical thinking and interventions with every case. A multisystems approach, MDFT assesses and intervenes in four areas: (1) the adolescent as an individual and a member of a family and peer network; (2) the parent(s), both as individual adults and in his or her role as mother; father or caregiver; (3) the family environment and family relationships, as manifested in day‐to‐day family transactional patterns; and (4) extrafamilial sources of influence such as peers, school and juvenile justice. Interventions are made within and coordinated across domains. Progress in one area or with one person has implications for and use in others. Individual meetings with parent(s) and teen set the stage for family sessions, and family meetings may offer content and new outcomes that need to be brought to extrafamily meetings with juvenile justice or school personnel. MDFT was developed and tested as a treatment system rather than a one‐size‐fits‐all approach. A treatment system offers different versions of a clinical model that vary according to factors such as clinical sample characteristics (older versus younger adolescents, juvenile justice involved versus no involvement in juvenile justice systems), and treatment parameters (type of clinical setting and treatment dose).     

Reactive Attachment Disorder: A Biopsychosocial Disturbance of Attachment

The etiology, differential diagnosis, and treatment of Reactive Attachment Disorder (RAD) are discussed utilizing a psychodynamically-informed biopsychosocial approach. Early trauma in childhood attachment experiences alters the structures, neuro-chemicals, and connectivity of the brain. The neurobiological effects of childhood neglect equal and even surpass the impact of abuse and related trauma. This paper discusses structures in the brain involved in early emotional and attachment experiences and how they are affected by pathogenic caregiving, the absence of caregivers, or the disruption of the early caregiving environment. All three types of neglect affect the ability of the Hypothalamic-Pituitary-Adrenal (HPA) axis to regulate the body and brain’s response to stress in a significant and enduring way.     

Cognitive-Behavioral Family Therapy with a Family in High-Conflict Divorce: A Case Study

Children who live in families with high-conflict divorce situations are increasingly coming to the attention of clinicians. This paper explains the nature of the impasse of high-conflict divorce. It presents a brief theoretical overview of cognitive-behavioral family therapy as an effective approach to treatment for high-conflict divorce families. A case study that successfully utilized a cognitive-behavioral approach to family therapy is presented. Specific techniques such as parent training, communication and empathy skills, problem-solving skills, assertiveness training, role-modeling on the part of the therapist and application of the concept of reciprocal inhibition were included in the cognitive-behavioral family treatment. An N=1 research design is graphically illustrated for evaluation purposes.