Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

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Psychotherapies

in heterogeneous, insight-oriented groups. In general, patients who are acutely psychotic or suicidal do not do well in groups. Alcoholics Anonymous An example of a large, highly structured, peer-run group that is organized around persons with a similar central problem, Alcoholics Anonymous (AA) emphasizes sharing experiences, role models, ventilation of feelings, and a strong sense of community and mutual support. Similar groups include Narcotics Anonymous (NA) and Sex Addicts Anonymous (SAA). Milieu therapy Milieu therapy is the multidisciplinary therapeutic approach used in inpatient psychiatric wards. The term milieu therapy reflects the idea that all activities on a ward are oriented toward increasing a patient’s ability to cope in the world and relate appropriately to others. The treatment emphasizes appropriate socioenvi ronmental manipulation for the benefit of the patient. Multiple family groups Multiple family groups are composed of families of patients with schizophre nia. The groups discuss issues and problems related to having a person with schizophrenia in the family and share suggestions and means of coping. Multi ple family groups are an important factor in decreasing relapse rates among the patients with schizophrenia whose families participate in the groups. Psychodrama Originated by psychiatrist Jacob Moreno, psychodrama therapy allows individ ual patients to play out conflicts or trauma in the hope of working through emo tions, resolving trauma, or gaining insight within a group setting. Typically, the therapist plays the role of the director, the patient plays the role of protagonist and acts out a personal problem or conflict, and members from the group fill secondary roles that help the patient play out the drama. Couple and Marital Therapy As many as 50% of patients are estimated to enter psychotherapy primarily because of marital problems. Another 25% experience marital problems along with their other presenting problems. Couple or marital therapy is designed to psychologically modify the interaction of two people who are in conflict with one another over one parameter or a variety of parameters—social, emotional, sexual, or economic. As in family therapy, the relationship rather than either of the individuals is viewed as the patient. Individual therapy Partners may consult different therapists, who do not necessarily communicate with each other. The goal of treatment is to strengthen each partner’s adaptive capacities.

Psychotherapies

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