Early assessment of implementing evidence-based brief therapy interventions among secondary service psychiatric therapists

This implementation study was part of the Ostrobothnia Depression Study, in Finland, which covered implementation of motivational interviewing (MI) and behavioral activation (BA) within regional public psychiatric secondary care. It aimed to evaluate the mid-term progress of implementation and related factors. Altogether, 80 therapists had been educated through the implementation program by the point of the mid-term evaluation. Eligible information for evaluation was gathered using two questionnaires (q1, q2) with a one-year interval.A total of 45 of the 80 therapists completed q1, 30 completed q2, and 24 completed both questionnaires. Professional education was the only background factor associated with adopting the interventions (q1: p = 0.059, q2: p = 0.023), with higher education indicating greater activity. On the basis of trends such as changes in overall usefulness score from q1 to q2, the most involved therapists were slightly more likely to adopt MI/BA. Our experience so far suggests that encouraging staff to begin using new interventions during education is very important. The Consolidated Framework for Implementation Research was found to be a useful tool for constructing the evaluation.     

积极认知行为治疗的基本方法

积极认知行为治疗以调动患者的积极性和主动性为核心,在治疗师的积极引导下,指导患者自主完成思维记录和自我探索负性情绪对抗行为,并进行认知重建和行为矫正,以达到心理治疗的效果。积极认知行为治疗的操作程序包括四个阶段:首次会谈与诊断评估阶段、自我探索阶段、强化巩固阶段、效果评估和回归社会阶段。而自我探索阶段是整个治疗过程中的核心阶段,主要通过建立在患者问题概念化基础之上的"积极认知行为治疗记录"来分步完成。而六个核心治疗环节依次是:临床访谈、躯体和心理检查、对患者关于积极认知行为治疗表格记录和表中关系要素说明、对抗负性情绪行为模式的自我探索、非理性信念的批判及理性信念的建立、有效对抗负性情绪行为模式的确定和强化巩固。     

EMDR、适应性信息加工与个案概念化(下)

EMDR是一个整合性的、以咨客为中心的心理治疗方法。该方法用于治疗那些不是由器质性损伤为病理学基础的心理问题,它的治疗重点是处理大脑的信息加工系统中的痛苦记忆。EMDR既能处理那些引起困扰的经历和体验,也能帮助咨客获得达到更健康的心理状态所需要的经历和体验。综览EMDR的历史、发展和研究,它是一个主要以经验为支持的治疗方法。本文在阐述适应性信息加工模型之后,用一个延续的个案实例,来说明EMDR的个案概念化和8个阶段的治疗。EMDR技术主要是加工那些有病理学基础的早期记忆和引发不良功能的当前情境,并为未来适应性的行为提供模板,包括克服技能不足和(或)发展性的不足所需的知识与行为。整合的EMDR与家庭系统观点的好处是可以提供最综合的治疗效果。     

The story of Lucy: lessons learned,lessons taught

ABSTRACT

This article provides an extended case example highlighting the value of a supportive approach to practice, in addition to the importance of holding a psychodynamic developmental frame of reference. Concepts of repetition compulsion, the holding environment, and object constancy are applied to the clinical material. The case is underscored for its value as a teaching tool.     

Special Considerations in the Treatment of College Students With Bipolar Disorder

Abstract

Bipolar disorder is a relatively common mental disorder that often has its onset during the college years. This means that students simultaneously face both the challenge of late adolescent development and the challenge of adapting to a major mental illness. As a further complication, the college environment is not well suited to the kinds of lifestyle changes that add stability to the lives of people with bipolar disorder. Treatment involves establishing an alliance, education about lifestyle changes, aiding adaptation to the illness, careful medication to minimize side effects, and loosening the affective constriction that can result from fear of relapse. Both the health care provider and student can use the culture of learning and self-discovery in the college setting to the treatment's benefit. As well, the provider can use the time-limited nature of college to lessen ambivalence about making long-term changes.     

Treating Juveniles in a Sex Offender Program Using Adventure-Based Programming: A Matched Group Design

ABSTRACT

This case describes bodily experiences that appeared to cue child sexual abuse memories during psychotherapy by a woman who was amnesic for her childhood and suffered from chronic dissociative states. Though corroboration was unavailable, she became increasingly confident about her returning memories. Special efforts were made to avoid making suggestions. The article proposes the theory that integrates the construct of the self with the relationship between bodily experiences and memory narratives. It suggests that: (1) amnesia and recovering memories involve normal and abnormal memory mechanisms; (2) remembering during psychotherapy is complex; (3) psychotherapy need not be suggestive; (4) inaccessible memories may act as constraints on suggestibility; and (5) narrative recall may depend on the connection of bodily experiences with self-reflection.     

Training Mental Health Professionals in Child Sexual Abuse: Curricular Guidelines

This study explored whether counseling practices with women survivors of child sexual abuse reflect the belief that women do not sexually abuse children. Canadian therapists (n?=?164) who work with women survivors of child sexual abuse were surveyed about their beliefs about what constitutes child sexual abuse, who commits child sexual abuse, and their practices regarding inquiries about abusive behavior. A majority self-reported that they ask women and think it is important to ask but most believe that clients will not spontaneously self-disclose inappropriate sexual thoughts or behaviors. How broadly or narrowly therapists defined child sexual abuse was not related to self-reported therapeutic discussion. Therapists demonstrated differential gender beliefs about child sexual abuse perpetration, but this did not relate to self-reported counseling practices. Implications for therapist education are discussed.     

Psychotherapy with Lesbian,Gay, Bisexual,and Transgender Older Adults

A small literature has addressed psychotherapy with lesbian, gay, bisexual, and transgender (LGBT) samples over the past two decades. Older adults have also been investigated in a growing number of psychotherapy research studies. However, psychotherapy specifically with LGBT older adults has not received adequate investigation. This review relies on converging lines of research to provide an integrated discussion of evidence-based psychological treatments (EBTs) with current research and clinical observations in the field of gerontology and suggests ways in which these topics can inform psychotherapy practice with LGBT older adults. We summarize current research on aging in several areas of practical interest to psychotherapists seeking to apply EBTs in their work with LGBT older adults. These areas include: adult development, coping, stigmatization, social context, and the effects of cohort membership. The results of these studies belie stereotypes regarding both the aging process, in general, and more specifically LGBT older adulthood, with significant implications for the practice of psychotherapy. EBTs are adaptable to a variety of issues encountered in later life by LGBT older adults, and these modifications to therapeutic technique are addressed throughout.     

Clinical and Practical Considerations in Private Practice with Lesbians and Gay Men of Color

Abstract

The clinical and practical needs of people of color who come to private practitioners are diverse. Issues of coming out, spirituality, multiple identity, and gender role take on unique characteristics with persons of different racial and ethnic backgrounds. This chapter covers practical considerations clinicians are encouraged to stay mindful of when working with clients of different racial and cultural backgrounds, including social class, race, and boundary issues.