Concise Guide to Brief Dynamic and Interpersonal Therapy

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American Psychiatric Pub, Aug 13, 2008 - Medical - 232 pages
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In today's world of managed care -- characterized by limited mental health resources, emphasis on accountability, concerns of third-party payers, and consumer need -- the demand for mental health professionals to use briefer therapeutic approaches is on the rise. Fully 84% of all clinicians are doing some form of planned brief therapy (6-20 sessions per year per patient).

Yet despite clinical advances and outcome data that demonstrate the effectiveness of short-term therapy, many therapists -- in fact, 90% of those whose theoretical orientation is psychodynamic rather than cognitive-behavioral -- are reluctant to learn briefer interventions, seeing value only in long-term, depth-oriented work. The second edition of this Concise Guide is intended to help educate both beginning and experienced clinicians in the strategies and techniques of time-attentive models and to foster more positive and optimistic attitudes toward using these important therapies. The seven therapeutic models presented here -- including an entirely new chapter on time-limited group therapy -- highlight the importance of the interpersonal perspective.

The seven models, one per chapter, represent well-established short-term approaches to clinical issues that therapists commonly encounter in their clinical practices. These models also have clearly defined intervention techniques and formulation strategies and can be used within the 10- to 20-session time frame of most managed care settings.

The first part of each chapter dealing with a therapeutic model lists the various presenting problems the authors deem most suitable for treatment by that particular approach. The authors discuss the overall framework of each model, selection criteria, goals, therapeutic tasks and strategies, empirical support, and relevance for managed care, with clinical cases to illustrate the application of each model.

The authors include updated chapters on supportive, time-limited, and interpersonal therapies; time-limited dynamic psychotherapy; short-term dynamic therapy for patients with posttraumatic stress disorder; brief dynamic therapy for patients with substance abuse disorders; an entirely new chapter on time-limited group therapy; and a final chapter on the reciprocal relationship between pharmacotherapy and psychotherapy.

Meant to complement the more detailed information found in lengthier psychiatric texts, this Concise Guide (it is designed to fit into a jacket or lab coat pocket) is a practical and convenient reference for psychiatrists, psychiatric residents, and medical students working in a variety of treatment settings, such as inpatient psychiatry units, outpatient clinics, consultation-liaison services, and private offices.

 

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Contents

Introduction
1
Interpersonal Focus
2
Brief Psychotherapy
3
Brief Dynamic Approaches
4
Qualities That Define Brief Dynamic Therapy
6
Specific Models Presented
9
Supportive Therapy Treatment for LowerFunctioning Patients and Others?
15
Definition of Supportive Psychotherapy
18
Treatment
84
Clinical Illustration
87
Empirical Findings
93
ShortTerm Dynamic Therapy for Patients With Posttraumatic Stress Disorder
97
Patient Selection
99
Goals of Treatment
101
Acknowledging and Accepting the Traumatized Self
102
Viewing Trauma as a Challenge
103

Goals of Treatment
19
The Therapeutic Alliance
20
Techniques of Supportive Therapy
21
Enhancing SelfEsteem
22
Respecting Defenses
23
Clarification Confrontation and Interpretation
24
Rationalization
25
Refraining
26
Advising
27
Rehearsal or Anticipation
28
Attention to Not Interpretation of Transference
29
Conclusion
30
Clinical Illustration
31
Empirical Findings
32
Relevance for Managed Care
34
TimeLimited Therapy
37
Theory and Technique
38
Phases of Treatment IntakeSelection
40
Honeymoon Phase
41
Negative Transference Phase
42
Termination Phase
43
Reverberations for the Therapist
44
Clinical Illustration
45
Empirical Findings
52
Interpersonal Psychotherapy for Patients with Depression
55
Basic Principles
56
Selection Criteria
58
Strategies and Phases of Treatment
59
Intermediate Phase
62
Termination Phase
65
Clinical Illustration
67
Psychoeducation About the Sick Role
68
Exploring Options
69
Therapist Confidence
71
Termination
72
Relevance for Managed Care
74
TimeLimited Dynamic Psychotherapy
77
Conceptual Framework Assumptions
78
Goals
80
The Cyclical Maladaptive Pattern
81
Inclusion and Exclusion Criteria
83
Techniques of Therapy for Patients With Stress Response Syndromes
104
Content Themes
110
Personality Styles
111
Clinical Illustration
113
Empirical Findings
117
Relevance for Managed Care
118
Brief Dynamic Psychotherapy for Patients With Substance Abuse Disorders
121
Conceptualizing Substance Abuse as a Psychiatric Disorder
122
Patient Selection
126
TwelveStep Programs and Group Counseling
127
Role of Various Psychoactive Substances
129
SupportiveExpressive Therapy for Cocaine Abuse
132
Treatment Goals Beginning Phase
134
Transference and Countertransference
138
Clinical Illustration
140
Mr Hs Core Conflictual Relationship Theme
141
Empirical Findings
143
Relevance for Managed Care
145
TimeLimited Group Therapy
149
Why Groups?
150
Why TimeLimited Groups?
152
Group Dynamics and Group Therapy
153
An Illustrative Model of TimeLimited Group Psychotherapy
156
Focus
157
Screening and Pregroup Preparation
158
Technical Considerations
163
Stages of Group Development
164
Empirical Findings
170
Relevance for Managed Care
172
The Reciprocal Relationship Between Pharmacotherapy and Psychotherapy
177
ObsessiveCompulsive Disorder and the Worry Circuit
179
Psychopharmacology During the Stages of Psychotherapy
180
Pharmacotherapy Highlights Key Dysfunctional Patterns
181
AsNeeded Ingestion Illustrates a Key Interpersonal Pattern
184
Transference and Countertransference
185
Pharamcothereapy Alters Marital and Family Dynamics
187
Medications as Markers for Marital Difficulties
188
Catalysts for Change
189
Combined Treatment in the Era of Managed Care
190
Index
195
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About the author (2008)

Hanna Levenson, Ph.D., is the Founder of the Levenson Institute for Training (LIFT) and Director of the Brief Psychotherapy Program at California Pacific Medical Center in San Francisco. She also maintains a private practice in San Francisco and Oakland, California. For 20 years she was Clinical Professor in the Department of Psychiatry at the University of California School of Medicine. Past positions include Director of Brief Therapy Training at the Veterans Administration Medical Centers in San Francisco and Palo Alto, California.

Stephen F. Butler, Ph.D., is Senior Vice President and Chief Science Officer at Inflexxion (formerly Innovative Training Systems), a research and consulting firm based in Massachusetts that develops scientifically based solutions in the areas of health education, prevention, and disease management. Before serving in this position, he held faculty appointments in the Vanderbilt University Psychology Department and the Psychiatry Department of the Medical College of Virginia. He was also Director of Psychology at Nashua Brookside Hospital, Nashua, New Hampshire.

Theodore A. Powers, Ph.D., is an Assistant Professor in the Department of Psychology at the University of Massachusetts Dartmouth. Previously, he was Clinical Director of the Short-Term Therapies Unit at Massachusetts General Hospital and an Instructor at Harvard Medical School.

Bernard D. Beitman, M.D., is Professor and Chairman in the Department of Psychiatry and Neurology at the University of Missouri--Columbia School of Medicine.

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