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Professional Betrayal
Published in Paul Ian Steinberg, Psychoanalysis in Medicine, 2020
One needs to determine which psychotherapeutic approach is most effective in treating abused patients. This will depend partly on variables specific to the individual patient. Although specific clinics and symptom-oriented treatments are available for survivors of abuse, physicians are probably less well acquainted with psychoanalytic treatments for abused patients. These treatments address not only symptoms related to the abuse, but the personality of the patient who experienced the abuse. That is important in not only helping a patient to recover from trauma-related symptoms, but also to understand what the trauma has meant to her, and to relate it, when appropriate, to earlier traumatic experiences of trauma and neglect predisposing her to becoming involved in a traumatic situation with her physician (Gartner, 2017).
Health Care in Prisons *
Published in Andrew Stevens, James Raftery, Jonathan Mant, Sue Simpson, Health Care Needs Assessment, 2018
Tom Marshall, Sue Simpson, Andrew Stevens
In a minority of cases, patients are referred for specialist assessment by a clinical psychologist or psychiatrist. In the former case this may result in a psychotherapeutic intervention such as cognitive therapy or psychodynamic psychotherapy. In the latter case this usually results in prescription of medication (such as an antidepressant), but this may be combined with a psychotherapeutic approach.
What are we talking about?
Published in Derek Steinberg, Complexity in Healthcare and the Language of Consultation, 2018
Characteristically, many individual and group therapists are prepared to sit silently and non-committally as the minutes tick by until, with rising tension and dissipating defences, the patient feels moved to say what matters. The caricature of the psychotherapeutic approach has the patient sitting in silence with the therapist perhaps gazing out of the window or, if trying to help, possibly raising his or her eyebrows in a friendly and enquiring way from time to time. The patient finally asks, ‘what do you want to know?’, to which the reply is: ‘what do you want to tell me?’ (Lest the reader unfamiliar with the ways of psychotherapy thinks this can only be a caricature, it is worth mentioning there have been studies looking at the pros and cons of explaining to patients in advance about how the sessions might be conducted, and that sometimes describing how psychotherapy proceeds is positively helpful; but many disagree.) It also needs to be said that systems consultation, or training in systems consultation, is conducted by some trainers and practitioners on the basis of generating group feelings which the consultant feels should be worked with. My own view is that this tips the balance of the work away from using the consultee’s own understanding and towards that which the consultant wants or needs to use. However, it will be found in some areas of consultative work and training.
Psilocybin and MDMA for the treatment of trauma-related psychopathology
Published in International Review of Psychiatry, 2021
Catherine I. V. Bird, Nadav L. Modlin, James J. H. Rucker
Treatment models of psilocybin- and MDMA-assisted psychotherapy overlap (Krediet et al., 2020), with both drugs used to facilitate salutary psychological change within a safe, comfortable, trusting and non-judgmental set and setting. Dosing sessions with MDMA and psilocybin take place in a comfortable, quiet, neutrally furnished room, with relaxing music and a supportive relationship with at least one therapist, which is thought to ‘deepen’ the therapeutic process (Krediet et al., 2020; Mithoefer et al., 2016). The psychotherapeutic approach to dosing is supportive but non-directive. ‘Preparation’ sessions are given before and ‘integration’ sessions are given after drug-dosing sessions. In MDMA-assisted sessions, both inner focus and dialogue occur under the drug effect (Mithoefer et al., 2016). Inner focus and psychological support are crucial to both approaches, but treatment with psilocybin encourages sustained attention on internal processes with the aim to discuss the experience with the therapist after the drug session.
Psychotherapy in recurrent depression: efficacy, pitfalls, and recommendations
Published in Expert Review of Neurotherapeutics, 2020
Fiammetta Cosci, Jenny Guidi, Giovanni Mansueto, Giovanni A. Fava
The clinician could then refer the patient for a short-term (10–20 sessions) course of cognitive-behavioral therapy. This would be the psychotherapeutic approach of choice, since it has been specifically studied for its preventive effects. We would be inclined to taper antidepressant drugs during the course of psychotherapeutic treatment. Tapering should be performed at the slowest possible pace, to minimize the risk of antidepressant medication discontinuation syndromes. Slow tapering, however, may allow the detection of emerging symptoms in their prodromal phases, which may become the target of psychotherapeutic strategy, and especially withdrawal symptomatology. Interventions that bring the person out of a negative functioning are one form of success but facilitating progression toward psychological well-being is quite another. This is an emerging area for psychotherapeutic research and practice [64]. As a result, we feel that a sequential combination of CBT and WBT is the optimal choice.
Feasibility and Patient Experiences of Method of Levels Therapy in an Acute Mental Health Inpatient Setting
Published in Issues in Mental Health Nursing, 2020
Hannah Jenkins, Jordan Reid, Claire Williams, Sara Tai, Vyv Huddy
The foregoing discussion indicates a need for a psychotherapeutic approach that can focus on a variety of problems, potentially concurrently, that is not of fixed duration, and has no pre-determined session content or phases of application (i.e. assessment, formulation to intervention). Method of Levels (MOL) therapy has potential to address these requirements within an inpatient setting (MOL; Carey, 2008). MOL is an application of Perceptual Control Theory (PCT; Powers, 1973), which states that psychological distress results from an individual having reduced control over experiences important to them. The task of a therapist delivering MOL is to 1) help the patient talk about what is distressing them by asking questions to sustain the client’s attention on the problem. The second step is 2) to notice and explore background thoughts about the problem being discussed. Background thoughts are usually detectable when the client experiences ‘disruptions’—for example, moments when the client emphasises certain words, pauses, laughs, looks away, or otherwise indicates they are thinking about something else. In MOL, the therapist’s task is to ensure the patient generates the focus of conversation, rather than the therapist being directive. Evaluations of MOL in primary care (Carey & Mullen, 2008, Carey, Carey, Mullan, Spratt, & Spratt, 2009) and secondary care services (Carey, Tai, & Stiles, 2013) report positive outcomes with effect sizes at least as positive as other interventions such as CBT. Qualitative evaluation of patients’ experiences of MOL across different service contexts indicated that the approach is acceptable (Carey et al., 2009; Griffiths et al., 2019).