Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

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Psychotherapies

One of the major goals of a family therapist is to determine what homeostatic role, however pathologic, the identified patient is serving in the particular family system. A family therapist’s goal is to help a family understand that the identified patient’s symptoms in fact serve the crucial function of maintaining the family’s homeostasis. One example is the triangulated child—the child who is identified by the family as the patient is actually serving to maintain the family system by becoming involved in a marital conflict as a scapegoat, referee, or even surrogate spouse. The therapist’s job is to help the family understand the triangulation pro cess and address the deeper conflict that underlies the child’s apparent disruptive behavior. Techniques include reframing and positive connotation (a relabeling of all negatively expressed feelings or behaviors as positive); for example, “This child is impossible” becomes “This child is desperately trying to distract and protect you from what he or she perceives is an unhappy marriage.” Other goals of family therapy include changing maladaptive rules that gov ern a family, increasing awareness of cross-generational dynamics, balancing individuation and cohesiveness, increasing one-on-one direct communication, and decreasing blaming and scapegoating. Table 29-4 summarizes the principles in which the history of the family is examined in an effort to understand how that history informs the current familial interactions. Interpersonal Therapy Interpersonal therapy is a short-term psychotherapy, lasting 12 to 16 weeks, that was developed specifically for the treatment of nonbipolar, nonpsychotic depression. Sessions 1 to 5 are the initial phase, sessions 6 to 15 intermediate, and sessions 16 to 20 are the termination phase. Intrapsychic conflicts are not addressed. Emphasis is on current interpersonal relationships and on strategies to improve the patient’s interpersonal life. Antidepressant medication is often used as an adjunct to interpersonal therapy. The therapist is very active in helping to formulate the patient’s predominant interpersonal problem areas, which define the treatment focus. TABLE 29-3. General Assumptions of Cognitive Therapy Perception and experiencing in general are active processes that involve both inspective and introspec tive data. The patient’s cognitions represent a synthesis of internal and external stimuli. How persons appraise a situation is generally evident in their cognitions (thoughts and visual images). Those cognitions constitute their stream of consciousness or phenomenal field, which reflects their configuration of themselves, their world, their past, and future. Alterations in the content of their underlying cognitive structures affect their affective state and behav ioral pattern. Through psychological therapy, patients can become aware of their cognitive distortions. Correction of those faulty dysfunctional constructs can lead to clinical improvement. Adapted with permission of Guilford Publications, Inc. from Beck AT, Rush AJ, Shaw BF, Emery G. Cognitive Therapy of Depression . Guilford; 1979:8; permission conveyed through Copyright Clearance Center, Inc.

Psychotherapies

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