Time-limited psychotherapy with adolescents

Short-term dynamic therapies, characterized by abbreviated lengths (10-40 sessions) and, in many cases, preset termination dates, have become more widespread in the past three decades. Short-term therapies are based on rapid psychodynamic diagnosis, a therapeutic focus, a rapidly formed therapeutic alliance, awareness of termination and separation processes, and the directive stance of the therapist. The emotional storm of adolescence, stemming from both developmental and psychopathological sources, leaves many adolescents in need of psychotherapy. Many adolescents in need of therapy resist long-term attachment and involvement in an ambiguous relationship, which they experience as a threat to their emerging sense of independence and separateness. Short-term dynamic therapy can be the treatment of choice for many adolescents because it minimizes these threats and is more responsive to their developmental needs. The article presents treatment and follow-up of a 17-year-old youth, using James Mann's time-limited psychotherapy method.     

Adverse outcomes in group psychotherapy: risk factors, prevention, and research directions

Group forms of therapy have been growing at a rapid rate, in part because of their documented effectiveness and economic considerations such as managed care. It is therefore becoming increasingly important to assess the psychological risks of these interventions. The author provides an overview of the published literature and conference presentations on negative effects in adult outpatient groups. Although much of the literature on adverse outcomes in group therapy focuses on single risk factors (e.g., negative leader, group process, or patient characteristics), the author argues that an interactional model should be encouraged. Means of reducing casualties are also discussed, as well as methodological issues and research directions.     

Inadequacy and indebtedness: no-fee psychotherapy in county training programs

The nature of the fee arrangement has significant influence on the psychotherapeutic process even when there is no fee. Given the large number of psychiatrists who receive at least some part of their training in the public system, understanding the no-fee arrangement is vital to the psychodynamic training of future psychiatrists. Following a brief overview of the meaning of money and the fee arrangement, various scenarios are considered under the headings of "inadequacy" and "indebtedness. "Although similar dynamics may be present in other public and private settings, attention is given to the county training program, with the intent to assist psychiatry residents and supervisors in their awareness and understanding of the psychodynamics of psychotherapy without fee.     

Role behavior expectancies and alliance change in short-term individual psychotherapy

Patients and therapists participating in a clinical trial of short-term, time-limited individual (STI) psychotherapy were asked to rate expectancies regarding their own and their counterpart's role behaviors during sessions. Significant relationships differed according to the index of alliance used (patient, therapist) and as a function of scores on a global patient personality measure known as Quality of Object Relations (QOR). Among high-QOR (or mature) cases, the patient's expectancy of being able to contribute to the treatment process was inversely associated with change in the patient-rated alliance. For those with low QOR (more primitive object relations), congruence of expectancies regarding a supportive therapist role was directly associated with change in the therapist-rated alliance. Results are discussed in terms of evaluating and preparing patients for psychotherapy and the appropriate therapeutic strategies for patients of different QOR.     

幻肢痛

幻肢现象不仅局限于四肢,身体其他部位被切除时也会发生,其中幻肢痛的发生率约占60%～70%。最近,其发病机制中大脑皮层功能重组和幻肢感、幻肢痛的相关性受到重视,认为很可能是幻肢痛产生的中枢性机制之一。幻肢痛的治疗极为困难,治疗方式多种多样,被证明行之有效的包括药物治疗、神经阻滞治疗、外科治疗、心理疗法等。治疗方案仍然没有统一和定论。     

药物治疗与心理康复疗法治疗脑卒中临床观察

目的：通过随机分组，临床对照研究，对脑卒中患者的心理康复与药物的综合治疗效果进行客观评价。方法：将80例脑卒中患者随机分为研究组和对照组。对照组给予常规药物治疗并配合一个疗程的针灸理疗，研究组则在常规药物治疗及相同疗程理疗之外给予有步骤的心理康复治疗。以6周为评定疗效的时间界限。结果：研究组总有效率为95．0％，显效率为57．5％，对照组总有效率为92．5％，显效率为30．0％，显效率相比较具有统计学意义（P〈0．05）。结论：心理康复治疗与药物综合治疗脑卒中疗效显著，与传统针灸理疗加药物治疗脑卒中在显效率上差异有显著性。     

Ericksonian hypnosis in tinnitus therapy: effects of a 28-day inpatient multimodal treatment concept measured by Tinnitus-Questionnaire and Health Survey SF-36

For the first time, the therapeutic effects on subacute and chronic tinnitus of an inpatient multimodal treatment concept based on principles of Ericksonian hypnosis (EH) were examined by standardized criteria of the Tinnitus Questionnaire (TQ) and Health Survey (SF-36) within a controlled prospective, longitudinal study. A total of 393 patients were treated within an inpatient closed-group 28-day-setting based on a resource-oriented, hypnotherapeutic concept. The severity of tinnitus was assessed by TQ at times of admission, discharge and also at a 6- and 12-month follow-up. Health-related quality of life was evaluated before and after therapy using the SF-36. After therapy, a decrease in TQ score was seen in 90.5% of the patients with subacute tinnitus and in 88,3% of those with chronic tinnitus. Assessment of the TQ score at the end of therapy revealed highly significant improvements of 15.9/14.1 points in mean. Effect sizes in the treatment groups (0.94/0.80) were superior to those in the waiting-list controls (0.14/0.23). The TQ score remained stable in the follow-up controls. Significant improvement in health-related quality of life has been observed within the treatment groups depending on initial level of tinnitus serverity I–IV according to TQ. Using a multimodal treatment concept with emphasis on resource-activating approaches of EH the annoyance of tinnitus can be significantly reduced while health-related quality of life is enhanced within a comparatively short treatment period of 28 days.     

心理干预疗法对围术期食管癌患者康复的影响

目的 评价心理干预对围术期食管癌患者康复的影响。方法选择中山大学附属肿瘤防治中心2008年1月至10月胸外科收治的60例食管癌患者，随机分为干预组（31例）、对照组（29例），采用症状自评量表SCL-90（symptomcheck list-90，SCL-90）对食管癌患者做心理状况评价，同时由经过培训并掌握一定肿瘤相关知识的医学生对于预组患者进行针对性心理干预，包括健康教育、心理支持、应激处理、应对技术与行为训练，分术前、术后第一疗程、术后第二疗程三个阶段进行，同时进行阶段性评价、分析。结果与1986年金华等发表的全国常模比较，手术前干预组和对照组的躯体化、强迫、抑郁、焦虑、偏执、敌对、恐怖7个因子分均较常模高（P〈0．05），两组间差异无统计学意义（P=0．31）。术后第4、24周，干预组的因子积分及其平均分逐渐下降，与对照组比较差异有统计学意义（t4=4．71，P4=0．002；t24=3．82，P24=0．005）。结论心理治疗对患者的心理状态产生积极作用，有利于患者术后康复。     

学习障碍儿童心理问题及心理辅导效果评价

目的 探讨学习障碍（LD）儿童心理问题及心理辅导对改善LD儿童心理行为的效果评价。方法 分设干预组，LD对照组，学业一般组，学业优秀组。对各组儿童进行厌学情绪，心理健康和生活质量测定，并对干预组儿童进行2年心理辅导干预。结果 LD儿童和学业一般，学业优秀儿童在厌学情绪，对人焦虑，孤独倾向，自责倾向，过敏倾向和心理健康测量总分的差异有显意义（P＜0．05），均分结果显示LD组＞学业一般组＞学业优秀组。心理辅导后，干预组儿童在大学套学情绪，孤独倾向，自责倾向，过敏倾向和心理健康测量的总分均明显下降，亲子关系，同伴关系，师生关系，居住环境，活动机会性，社会心理状况，社会环境状况，生活质量总分则显提高，且心理辅导前后差异有显意义（P＜0．01）；干预组与LD对照组比较，在厌学情绪，心理健康状况，生活质量方面的上述各项指标，两组间差异有显意义（P＜0．05）。结论 LD组儿童存在一定的心理问题，心理辅导有助于改善LD儿童的心理健康状况，提高其生活质量。     

心理干预对干扰素-α治疗慢性乙型病毒性肝炎病人疗效及复发的影响

目的 分析心理干预对慢性乙型病毒性肝炎（CHB）病人重组干扰素-α 2b（rIFN-α 2b）疗效的影响.方法 CHB病人60例随机分为2组,观察组和对照组各30例,观察组除用rIFN-α 2b治疗外加心理干预治疗,对照组单用rIFN-α 2b治疗.rIFN-α 2b治疗前、结束时用症状自评量表（SCL-90）分别进行心理测试,并相互比较.结果 抗病毒前两组病人均存在严重的心身症状,差异无显著性（P＞0.05）;抗病毒结束时观察组阳性总分低于对照组（P＜0.05）;随访期末观察组完全应答率高于对照组（P＜0.05）,而复发率低于对照组（P＜0.05）.结论 CHB病人抗病毒前心理负担大,存在负性情绪;心理干预能减轻心理负担,且能提高干扰素-α治疗的远期疗效,降低复发率.