Intervening with depressed women during their childbearing years, especially with those on low incomes, is critically important. Not only do mothers and expectant mothers suffer unnecessarily, but their untreated depression has critical negative consequences for their families. Despite this, these women have proven especially difficult to engage in psychotherapy. In this paper we describe several adaptations and additions we have made to a brief form of Interpersonal Psychotherapy (IPT) to meet the needs of mothers and expectant mothers living on low incomes in the community who suffer from depression, but face significant practical, psychological, and cultural barriers to engaging in and staying in treatment. In addition, we present some preliminary data on the extent to which our enhanced, brief IPT approach promotes improvements in treatment engagement and retention relative to usual care for expectant mothers on low incomes.
Medicating ADHD is a controversial subject that was acutely inflamed in 1995 when high rates of ADHD diagnosis and treatment were documented in southeastern Virginia. Psychologists in southeastern Virginia formed a regional school health coalition to implement and evaluate interventions to address the problem. Other professionals with strong ties to the pharmaceutical industry launched ad hominem attacks on the coalition's research and work. These attacks contributed to the work being terminated in 2005. In the ensuing years, ADHD drug treatment continued to escalate. Today, the national rate of ADHD diagnosis exceeds all reasonable estimates of the disorder's true prevalence, with 14 % of American children being diagnosed before reaching young adulthood. Notable key opinion leaders continue to claim that there is no cause for concern, but with a message shift from "the prevalence is not too high" to "high prevalence is not too concerning." This paper provides an object lesson about how innovative research can be derailed to the detriment of sound medical and mental health care of children when industry interests are threatened. Tenure may be the only option for protecting innovative research from specious attacks. The authors offer a summary of the data on ADHD drug treatments, suggest judicious use of such treatments, and add their voices to others who are once again sounding a cautionary alarm.
The purpose of this article is to explore some of the issues associated with conducting psychotherapy with low-income clients. Throughout the article, we draw from our specific clinical experiences working with low-income Latina mothers in a depression prevention program. The themes that we address regarding class and psychotherapy are in the areas of assessment of social class, integration of class issues into the therapy process, and managing differences in social class between therapists and clients. As we discuss these themes, we provide concrete recommendations in order to advance awareness and effectiveness in working with economically disadvantaged populations.
Now a century old, psychotherapy supervision occupies a place of increasing prominence across all mental health disciplines
and appears to generally be regarded as a (if not the) sine qua non for the teaching and learning of psychotherapy. Psychotherapy
supervision has emerged as our “signature pedagogy.” In this paper, I take a look back at supervision’s last century and consider
some (but by no means all) of the salient issues and themes that have defined its science and practice. The reviewed supervision
issues and themes include the following: (1) the beginnings and evolution of supervision and supervision theory; (2) our evolving
perspective about the supervision matrix; (3) methodological pluralism and diversity; (4) “good” and “bad” supervisor behaviors
and the working alliance; (5) measurement; (6) effectiveness; (7) diversity; and (8) education. I use this “look back” to
(1) give voice to where we have been and where we are now in psychotherapy supervision and (2) shine a light on some of what
seems to lie ahead for supervision’s second century.
KeywordsPsychotherapy supervision–Clinical supervision–Psychotherapy–Training–Psychotherapy education–Supervision
Managed care has challenged mental health professionals to develop more efficient ways of addressing patient care needs. Psychoeducational
programs, for patients and their families, have emerged as a medium by which relevant education and mutual support can be
provided to participants. A review of the literature, a comprehensive model of psychoeducation, and the advantages of such
models within the managed care program are offered. Also addressed are issues and import, treatment and research considerations.
The Gift of Therapyis Irvin Yalom’s attempt to distill his forty-five years of psychiatric practice into a guidebook for therapists and their patients. The book, presented in short, succinct chapters, is full of tips presented as reminders, obstacles to avoid, and lessons learned from the author’s wealth of knowledge regarding the psychotherapeutic milieu. Yalom describes the text as a resource for beginning therapists and their patients; however, it seems more useful a guide for novice and possibly more seasoned psychotherapists. The 85 ideas and techniques discussed in this book are organized loosely into sections. The first and largest (Chapters 1‐40) section of the book explores the relationship between therapist and patient, here-and-now process issues, and therapist self-disclosure. While written from an interpersonal and existential theoretical framework, the lessons in this section focus on the importance of those “nonspecific” factors which catalyze the work of all therapists. Examples of chapter titles from this section include: “Be Supportive,” “Therapist and Patient as ‘Fellow Travellers,’” and “Use Your Own Feelings as Data.” Yalom is refreshingly unapologetic in the weight he places on the therapeutic relationship. In the second section (Chapters 41‐51), Yalom addresses existential themes in therapy, such as death anxiety, search for meaning in life, and the paradoxes of personal freedom. While today’s mental health care environment may not be supportive of existential exploration for its own sake, this section offers nuggets of wisdom that many therapists will find of use, especially those working with populations for whom end-of-life issues are less distal realities. The author’s sage treatment of freedom and patients’ responsibility for their behaviors has applicability to a variety of clinical contexts. In the third section (Chapters 52‐76) ofThe Gift of Therapy, Yalom discusses pragmatic issues germane to the day-to-day practice of therapy. With simple, yet effective reminders, such as the importance of taking a clinical history, inquiring
Steven Taylor’s Clinician’s Guide to PTSD: A CognitiveBehavioral Approach is a comprehensive, accessible text that will likely appeal to a wide range of clinicians with varying levels of experience. The body of the book is divided into two major sections. Part I begins with an overview of posttraumatic stress disorder (PTSD), including symptoms, prevalence of, and risk factors for the development of PTSD. The author critically evaluates four of the primary cognitive-behavioral conceptualizations of the development and maintenance of PTSD, and summarizes the strengths and limitations of each theoretical approach. Taylor has included a review of the neurobiological literature relevant to PTSD that will bring clinicians up-to-date with this growing body of research. Importantly, Taylor provides a strong rationale regarding why this information is important for clinicians and how a thorough understanding of the biological mechanisms underlying PTSD can influence and improve clinical practice. The first section concludes with a general overview of the data that supports the use of cognitive-behavioral therapy (CBT) in the treatment of PTSD, and the applicability of CBT for PTSD with special populations including children, the elderly, veterans, and adult survivors of childhood sexual abuse. The second section builds upon this important theoretical and empirical basis with a presentation of cognitivebehavioral treatment methods for PTSD. The author begins Part II with the assessment of PTSD, including ways to expand a standard clinical interview to gather necessary information regarding trauma history, trauma-related distress, and impairment in functioning. Several specific cognitive
Supervisors and teachers who are interested in advancing integrative psychotherapy in the 21st century have the dual task
of surveying the range of treatment approaches that have been developed and distilling these approaches down to a manageable number of influences that have been found to have the greatest impact on clinical practice
over time. It has been proposed that there are four bona fide schools of psychotherapy that would be most useful for comprehensive training and supervision that would contribute to either
(a) case conceptualization or (b) the process of clinical interviewing: psychodynamic psychotherapy; cognitive-behavioral
psychotherapy; family systems therapy; and, humanistic/client-centered therapy. The goal for such broadly based clinical instruction
would be for students, trainees, and interns to have an ability to provide a multi-level case conceptualization for any of
the psychotherapy cases for which they are providing treatment. Thorough instruction in clinical reasoning and decision-making
in this type of multi-level case formulation can provide some of the most valuable tools for novice and experienced clinicians
alike.
KeywordsPsychotherapy–Integrative psychotherapy–Psychotherapy supervision–Case–Formulation
Cognitive therapy has become a well established and widely used treatment for depression. However, most treatment guidelines
describe a session-by-session focus that may not adequately conform with the individualized nature of individual psychotherapy
used in most clinical settings. The present manuscript describes strategies for helping clients to reduce their cognitive
biases by: (1) identifying their cognitive biases, (2) appreciating the relationship between cognitions, emotions, and behavior,
(3) distancing themselves from their perspective, (4) developing realistic positive self-statements, (5) altering maladaptive
thought processes, (6) shortening the temporal delay required to challenge their thoughts, and (7) learning to find positive
elements in predominantly negative situations. These strategies for reducing cognitive biases can be incorporated into a comprehensive
treatment plan that includes modules for the assessment of depression severity and suicide risk, enhancing social performance,
and improving problem-solving skills. The modules are meant to be used in a flexible manner, allowing the therapist to address
a variety of treatment goals while still responding to the unique needs of each client.
Suicide risk has been found to be associated with particular attachment styles. The purpose of this paper is to discuss suicide risk in terms of family dynamics, and the development of attachments with others. Theories of suicide and development, including those by Freud, Erikson, Bowlby, Richman, and Kaplan, and their clinical implications, are discussed. Literary works by Kafka and Plath are also discussed in the context of suicide and attachment. It is concluded that families characterized by excessive enmeshment and/or detachment often produce an atmosphere of isolation and intolerance which increases suicide risk.
This article advances a proposal for a newly identified type of personality disorder. While, like some of the other major
personality disorders, the abrasive personality disorder (AbPD) shares some features with other Axis II disorders, it may
however be considered as possessing sufficient idiosyncratic features as to warrant a separate classification. There are few
documented discussions of this disorder within the historical confines of scientific psychology, however a good deal of attention
is being focused currently in the popular press, under the rubric of “difficult people,” “control freaks,” and the like. The
disorder is defined, its distinguishing characteristics delineated, with theoretical discussion provided. Some rudimentary
assessment approaches are noted, with a call for research in this virgin territory.
Father absence in American families is a recent, widespread phenomenon. Empirical research comparing single-parent, usually mother-headed families, with two-parent families has demonstrated various negative outcomes for children in single-parent homes. Many of these symptoms, such as deficits in cognitive and social competence, as well as internalizing and externalizing behavioral problems, have underlying psychodynamic bases in disturbances in object relations, separation-individuation, aggression, and sexual identity, all of which influence personal identity and self cohesion. These disturbances stem from the lack of certain functions performed by a dependable, nurturing father-figure, as well as the reaction of the mother to this absence. If the mother's reacts to this loss with over-investment and over-valuation of the child for her own narcissistic needs, the child may feel special, but also, paradoxically, deprived. These experiences result in shame and suffering for the child, prompting resentment and anger, in having been deprived of father support. In some individuals this may lead to a sense of entitlement, that is, the attitude of having unjustly endured special suffering and thus deserving special consideration.
Traditional psychoanalytic literature describes the father as occupying a critical role in child development. The father’s
loss or absence is seen as hindering development from early infancy throughout childhood and even into adulthood. Father absence
is defined as any situation where the father is psychologically disconnected from his children, whether or not he is currently
living in the same home. Dramatic shifts have occurred in the American family over the past several decades, which have resulted
in changes for both the father and mother’s role in child development. With the increasing divorce rate and rise in single
parenthood, father-absence has become common, and a multiplicity of family forms has emerged. However, psychoanalytic ideas
regarding maternal and paternal roles have not been modified to encompass these changing family forms. Research is beginning
to show that children can develop in families that are not the traditional mother-father unit. Two case examples are provided
to examine various factors related to unresolved separation-individuation issues, and how psychoanalytic ideas regarding the
paternal and maternal functions can be used in either a modified or unmodified manner in organizing the clinical material.
An analog design was used to investigate the mediating effects of client locus of control (i.e., an internal focus or external focus) on perceptions of counselor style of interpreting events (i.e., absolute or tentative interpretations) on measures of perceived session depth and smoothness, and perceived counselor expertness, attractiveness, and trustworthiness. One hundred and thirty-four undergraduate college students, crossed on level of locus of control, were randomly assigned to one of two treatment conditions, and then completed measures of perceived session depth and smoothness, as well as perceived counselor expertness, attractiveness, and trustworthiness. Results indicated a significant interaction effect on perceived counselor trustworthiness. Implications for college counselors are provided.
Co-morbidity of alcohol and substance with the spectrum of other psychiatric diagnoses is examined with specific emphasis
on diagnostic indicators for anxiety and mood disorders. Diagnostic issues for the chemically dependent person are examined
with the context of borderline personality disorder, schizophrenia and other psychiatric disorders. Clinical research related
to the dually-diagnosed patient is explored
There has been a growing awareness of Post-Traumatic Stress Disorder (PTSD) as a consequence of childhood sexual trauma. Central to this diagnosis is the flashback experience. Flashbacks are essentially memories which have not been integrated into everyday consciousness and return as intrusive symptoms, usually accompanied by dread and panic. This article presents a treatment strategy based on a four-stage model. The model includes (1) education; (2) assisting clients in identifying their flashback patterns; (3) designing coping strategies; and (4) processing the flashback. The goal is to assist the client with the management and integration of traumatic memory.
Relapse prevention is influenced by a number of variables including stress and negative mood states, motivation and commitment to abstinence, social support, physiological factors, withdrawal symptoms, and a repertoire of cognitive and behavioral strategies utilized in responding to the relapse process. Diverse theoretical approaches have emphasized conditioning models as well as information processing, cognitive and affective components of treatment, cognitive and behavioral coping responses, and a variety of other procedures. Outcome studies related to treatment have failed to consistently support the effectiveness of several of these components. To overcomes this, the authors advocate a single subject design in the study of these approaches. This article emphasizes the role of relapse prevention, and training and education in facilitating long-term abstinence, particularly with those intervention methods that are based on social learning theory and cognitive-behavioral models.
As an alternative to the sado-masochistic interpretation of violent spouse abuse, a quasi-romantic perspective sees abuse as a consequence of intensive intimacy—even love. In this study, abuse is explained as a form of punishment of the partner who is experienced as the spoiler of the expectations, hopes and plans for a fulfilling long term, committed and attuned communion. He/she, who is perceived as the breaker of that intimate context has to be penalized, with the death-penalty being the extreme form of expression of outrage at the offense. Both husbands who killed their wives, and wives who killed their husbands, in their interviews with the author displayed a deep commitment to their marriages. This explains why their leave-takings were so violent and their exits so final. By killing the spoiler they could bury and let go of their romantic dreams! Less lethal forms of spouse abuse-battering, enslavement, etc., often have the same element of punishment of the spoiler.
This paper examines the phenomenon of False Memory Syndrome (FMS). In the last decade there has been an increase in the number
of adult individuals who report childhood sexual abuse only to recant their allegations. Recanters and the falsely accused
are specifying that therapeutic interventions by trusted and, at times, well intentioned therapists facilitated their false
memories. The theory of repression, reliability of memory, recovery techniques, and characteristics of therapist and clients
are explored. This paper also discusses a number of cases that have been filed, and some guidelines for therapists who work
or plan to work in the recovery of repressed memories.
Dual diagnosis within the context of alcohol and substance abuse has become the focus of considerable interest, particularly when related to anxiety and depression. Depressive symptomatology is frequently associated with substance abuse and chemical dependency and numerous studies report a high concordance with these diagnostic entities and major affective disorder (Galanter,Casteneda, & Ferman, 1988). Depressive symptoms are also related to post treatment of alcohol and substance abuse with reported occurrences of 75 percent occurring with patients who have experienced relapse (Biedermann, Newcome, & Sprich, 1991).
Vietnam veterans have had a high incidence of substance abuse, resulting from attempts to control posttraumatic symptoms. Their recovery from drug and alcohol dependency has meant involvement in treatment for resolution of posttraumatic symptoms. The author found that the addition of a short-term educational-therapeutic group experience, focusing on the symptoms of posttraumatic stress disorder, was helpful for the participants. They worked-through important war-related experiences via the following phases: (1) Breaking through detachment and establishing control over disruptive symptoms, (2) Revealing experiences of death and dehumanization (3) Describing the internal death of self experience, and (4) Beginning the grief response.
