Report of the Psychotherapy Task Force of the American Academy of Child and Adolescent Psychiatry.
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In this task force report, the authors define the field of child and adolescent psychotherapy; review the state of the field with respect to advocacy, training, research, and clinical practice; and recommend steps to ensure that psychotherapy remains a core competence of child and adolescent psychiatrists. (+info)
Some neurobiological aspects of psychotherapy. A review.
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Ever since the idea was accepted that memory is associated with alterations in synaptic strength, studies on the cellular and molecular mechanisms responsible for the plastic changes in neurons have attracted wide interest in the scientific community. This article explores the process of memory consolidation leading to persistent modifications in synaptic plasticity as a mechanism by which psychotherapy facilitates changes in the permanent storage of information acquired throughout the individual's life. The psychobiological interrelationships of affect, attachment, and memory offer a perspective regarding the etiology and treatment of clinical disturbances of affect. Analogies between brain physiology and modes of psychotherapy provide the foundation for a review of psychiatric disorders involving the inability to control fear, obsessions, compulsions, and delusions, all of which respond to psychotherapeutic interventions. (+info)
Empirical comparison of two psychological therapies. Self psychology and cognitive orientation in the treatment of anorexia and bulimia.
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The authors investigated the applicability of self psychological treatment (SPT) and cognitive orientation treatment (COT) to the treatment of anorexia and bulimia. Thirty-three patients participated in this study. The bulimic patients (n = 25) were randomly assigned either to SPT, COT, or control/nutritional counseling only (C/NC). The anorexic patients (n = 8) were randomly assigned to either SPT or COT. Patients were administered a battery of outcome measures assessing eating disorders symptomatology, attitudes toward food, self structure, and general psychiatric symptoms. After SPT, significant improvement was observed. After COT, slight but nonsignificant improvement was observed. After C/NC, almost no changes could be detected. (+info)
Measuring therapist technique in psychodynamic psychotherapies. Development and use of a new scale.
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Treatment manuals are becoming a requirement for conducting quality psychotherapy research. What the field lacks, however, are reliable, valid, and cost-efficient instruments that can be used to measure a wide variety of prescribed therapeutic techniques. This article describes the development and use of a new instrument, the Interpretive and Supportive Technique Scale (ISTS). It is designed to measure interpretive and supportive features of technique for a broad range of dynamically oriented psychotherapies. Data concerning the psychometric properties of the ISTS are presented from two studies. The findings suggest that the ISTS is a potentially useful tool for measuring interventions for different forms of dynamically oriented psychotherapy. (+info)
Projective identification, countertransference, and the struggle for understanding over acting out.
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Projective identification is examined as an intrapsychic and interpersonal phenomenon that draws the analyst into various forms of acting out. The therapist struggles to use understanding and interpretation as the method of working through the mutual desire to act out the patient's core fantasies and feelings. Clinical material is used to illustrate the ways in which projective identification affects the analytic relationship. The focus is on methods of using interpretation to shift from mutual acting out to mutual understanding. (+info)
Alternative insurance arrangements and the treatment of depression: what are the facts?
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Using insurance claims data from nine large self-insured employers offering 26 alternative health benefit plans, we examine empirically how the composition and utilization for the treatment of depression vary under alternative organizational forms of insurance (indemnity, preferred provider organization networks, and mental health carve-outs), and variations in patient cost-sharing (copayments for psychotherapy and for prescription drugs). Although total outpatient mental health and substance abuse expenditures per treated individual do not vary significantly across insurance forms, the depressed outpatient is more likely to receive anti-depressant drug medications is preferred provider organizations and carve-outs than when covered by indemnity insurance. Those individuals facing higher copayments for psychotherapy are more likely to receive anti-depressant drug medications. For those receiving treatment, increases in prescription drug copayments tend to increase the share of anti-depressant drug medication costs accounted for by the newest (and more costly) generation of drugs, the selective serotonin reuptake inhibitors. (+info)
Postpartum major depression: detection and treatment.
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Postpartum major depression occurs in approximately one of 10 childbearing women and is considerably underdiagnosed. If left untreated, the disorder can have serious adverse effects on the mother and her relationship with significant others, and on the child's emotional and psychologic development. A simple screening instrument can be used to increase the detection of postpartum major depression. Although few well-controlled studies have been done to support the use of any one modality, the mainstay of treatment has been antidepressant therapy, alone or in combination with psychotherapy. Plasma concentrations of antidepressant drugs are usually low in the breast-fed infant, and most studies demonstrate that certain antidepressants can be used during lactation without any important adverse effects on the infant. (+info)
The Norwegian naturalistic treatment study of depression in general practice (NORDEP)-I: randomised double blind study.
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OBJECTIVE: To evaluate the efficacy of emotional support and counselling combined with placebo or antidepressants with single or dual mechanism of action in the treatment of depression in primary care. DESIGN: Randomised double blind study. SETTING: Several locations in Norway. SUBJECTS: 372 patients with depression. MAIN OUTCOME MEASURES: Improvement (clinical remission) reported both by the patient (Montgomery Asberg depression rating scale) and the physician (clinical global improvement and impression scales). RESULTS: Intention to treat analyses showed 47% remission in patients randomised to placebo compared with 61% remission in patients randomised to sertraline (odds ratio 0.56, 95% confidence interval 0.33 to 0.96) and 54% in patients randomised to mianserin (0.75, 0.44 to 1.27). Women responded better than men (1.86, 1.17 to 2.96). Subgroup analyses showed that subjects with recurrent depression (n=273) responded more frequently to sertraline than to placebo (0.43, 0.23 to 0.82) than those having their first episode of depression (1.18, 0.39 to 3.61). Statistically significant interactions between type of drug treatment and history of depression were not shown by logistic regression. CONCLUSION: The combination of active drug and simple psychological treatment (counselling, emotional support, and close follow up over a 24 week period) was more effective than simple psychological treatment alone, in particular for those with recurrent depression. Overall, women may benefit more than men. If confirmed in future studies, the findings should lead to more differentiated treatment guidelines for depression in primary care. (+info)