Intensive psychotherapy of former anorexic individuals

The intensive psychotherapy of six recovered anorexic females revealed consistent information regarding premorbid parental and familial interaction as well as particular difficulties surrounding the onset of the anorexic illness. Persistent personality problems, difficulties in relationships, and characteristic transference reactions in these adult individuals are described.     

The biology of family psychotherapy.

This article has presented a view of biologic psychiatry consistent with that described by Bowlby, discussed hypotheses concerning the biologic purpose of the primate brain and the human brain, and challenged standard beliefs about the identity of the patient entity in a true biologically based psychiatry. Ideas developed by Whitaker, Malone, and their colleagues almost 50 years ago are consistent with a modern biologic basis of family psychotherapy. The treatment of an anorexic family was used to illustrate possible mechanisms of psychotherapeutic treatment requiring the presence of the whole family. The role of the psychiatrist who treats a family is to understand the biologic or medical importance of treating the family as a whole, communicate this to the family, continually work toward that level of participation, suggest relevant topics for discussion, and catalyze interactions within the family. Psychotherapy with families as a whole is effective because of the power of kin selection and inclusive fitness, biologic processes not usually considered in the practice of medicine or psychiatry.     

Intensive short-term dynamic psychotherapy for DSM-IV personality disorders: a randomized controlled trial

This study evaluated the efficacy and long-term effectiveness of intensive short-term dynamic psychotherapy (ISTDP) in the treatment of patients with DSM-IV personality disorders (PD). Twenty-seven patients with PD were randomized to treatment with ISTDP or a minimal-contact, delayed-treatment control condition. ISTDP-treated patients improved significantly more than controls on all primary outcome indices, reaching the normal ranges on both the brief symptom inventory (1.51-0.51, p < 0.001) and inventory of interpersonal problems (1.56-0.67, p < 0.001). When control patients were treated, they experienced benefits similar to the initial treatment group. In long-term follow-up, the whole group maintained their gains and had an 83.3% reduction of personality disorder diagnoses. Treatment costs were thrice offset by reductions in medication and disability payments. This preliminary study of ISTDP suggests it is efficacious and cost-effective in the treatment of PD. Limitations of this study and suggestions for future research are discussed.     

The integrated use of individual and family psychotherapy

For almost thirty years after the development of family therapy, the concurrent use of family and individual psychotherapy was seen as incompatible by leading proponents of each modality. Although recently the literature has revealed an increased willingness to utilize family and individual therapies concurrently, the decision for or against any such combination has been left largely to the intuition or bias of the individual clinician. This paper suggests the concurrent use of family and individual psychotherapies when disturbances of family structure and interaction co-exist with, reinforce, and are maintained by largely ego- syntonic internalized psychopathology (that is, the character defences of individual family members). It provides a rationale for integrating the concurrent therapies, and uses clinical examples to illustrate how each can potentiate the other. There is a discussion of indications and contraindications for the integrated use of concurrent family and individual therapy. From their attempts to apply these principles, the authors conclude that the experience for the family, the individual and the therapists is that the selective and integrated use of concurrent family and individual therapies can achieve more than can either therapy alone--the whole is greater than the sum of the parts.     

Meeting families' treatment needs through a family psychotherapy center

A small group of mental health professionals in St. Louis established a private-practice family therapy center staffed by therapists of various disciplines and theoretical orientations. Families receive a comprehensive, five-phase evaluation at the end of which the panel of evaluators recommends the type of family therapy and the therapist most suited to deal with the central problem. During the center's first two years of operation, 42 families received a complete evaluation and 36 began treatment, most of them in marital therapy. Of the 21 who completed treatment, 16 were rated as improved and five as unchanged. Thirty members within those 21 families manifested serious psychopathology, but none had to be hospitalized during treatment.     

Somatization: A psychiatrist's perspective

Psychiatrists are referred only a small and unrepresentative proportion of patients who somatize. To a large extent this is due to the fact that patients consider themselves physically ill and regard psychiatric referral as inappropriate. Although somatization has several social advantages it obscures underlying psychopathology and leads to unnecessary physical investigations with a risk of iatrogenic disease. It is important to establish a psychiatric diagnosis as early as possible so that treatment can be started before a chronic pattern of illness behaviour is established.     

A religious psychiatrist's ethnographic self-report

The religious identity of psychiatric patients is deemed important as it may impact upon the understanding of patients' problems and the quality of the therapeutic relationship. It would seem important that the psychiatrist should also be sensitive to the role of his/her own religious identity and its effect on clinical work. Nevertheless, even in studies by and about psychiatrists who have religious roles within a community, this component has tended to be ignored. A series of self-observations are offered by a religious Jewish psychiatrist to describe the effect of religious identity on himself and his patients during clinical work in Israel. Three types of situations were apparent: when he was unsure about his religious identity, when he was unsure about his professional identity, and when he was dealing with essentially religious rather than psychiatric issues and having to differentiate between his own role and that of a rabbi. These observations support the need to be sensitive to the effect of one's religious identity on clinical work, while appreciating that, as Andrew Sims has stated, the psychiatrist's "attitude towards the patient who shares his faith is as a fellow believer and not as a priest".