Diabetes Education and Counseling Using Solution-Oriented Questions

Solution-focused brief therapy (SFBT) utilizes the client’s strengths and resources to the fullest to achieve what the client wants, rather than looking at the client’s problem pathologically and digging deeper into analysis. Therefore, in this article, we would like to introduce a SFBT that can be usefully applied to the education and counseling of diabetic patients in the clinical field. Pre-session change questions, rewarding questions, miracle questions, exception-finding questions, scaling questions, relationship questions, and coping questions used in SFBT consist of the questions that allow the client to answer positively. In this process, a medical social worker pays full attention to remarks that suggest clues to the client’s potential for change, the change the client wants, past experiences that have been successful, and what has already been attempted to make the situation better. Also, when setting goals, it’s important to target positive behaviors rather than eliminate the problem and what’s important to the patient and small, specific, clear, and actionable things. SFBT no longer focuses on or talks about the client’s problem. The client has the resources and strengths to solve the problem. Rather than exploring the cause of the problem, it is important to find a clue to the solution and connect it to actual action, so you can use the solution question techniques to get the client to practice using their strengths. In the treatment field, we recommend that the client remember and ask a few questions with the belief that they can solve them on their own.

Session-by-Session Improvements in Subjective Wellbeing and Satisfaction with Life Prospectively Predicts Session-by-Session Improvements in Bulimia Nervosa Symptoms.

PurposeBehavioral treatments (BT) have been credited for improving both subjective wellbeing (SWB) and satisfaction with life (SWL) among those with bulimia nervosa (BN); However, researchers have yet to examine whether the improvements in SWB and SWL during BTs occur prior to or after BN symptom reduction. The current study examines session-by-session change in SWB and SWL and BN symptoms.MethodsThe sample was comprised of 35 patients with BN-spectrum disorders. Participants received 20 sessions of BT and completed weekly pre-session surveys assessing their symptom frequency, SWB, and SWL. Data was analysed using linear mixed effect modelling.ResultsBN symptom reduction during preceding sessions prospectively predicted improvements in SWB and SWL during succeeding sessions. In addition, improvements in SWB and SWL during preceding sessions prospectively predicted reductions in BN symptoms in succeeding sessions.ConclusionThis study provides preliminary evidence of a bidirectional relationship between SWB and SWL and BN symptoms. Future research should test whether incorporating content focused on improving SWB and SWL into BT models could optimize treatment outcomes for BN.Level I, randomized controlled trials

Individualizing Evidence-Based Treatment of Neuropsychiatrically Complex Patients: Process-Based Targets for Change in Parkinson’s Depression

Providing evidence-based treatment always requires responding in the moment to apparent gaps between the protocol and the patient’s presenting needs and preferences. In the treatment of depression in Parkinson’s disease (PD), research has shown that providing PD-specialized, empirically supported interventions is paramount. However, given PD’s highly heterogeneous symptom presentations, adapting and individualizing treatment to address each patient’s unique constellation of neuropsychiatric symptoms and PD-related physical challenges is equally important. This Commentary on the article by Dr. Logan Durland (2020) focuses on the importance of attending to process-based factors to inform protocol adaptations in the treatment of Parkinson’s depression, guided by the framework of functional analytic psychotherapy (FAP). The FAP approach applies behavioral principles to in-session processes as a means of highlighting and therapeutically targeting clinically relevant behaviors in real time. Seeking such opportunities to foster within-session change may be especially important when providing evidence-based treatment to individuals with co-occurring mental health issues and chronic, functionally limiting medical problems like PD. As these patients manage the interactions between the complex demands of illness self-management and the burden of mental health symptoms, they must respond adaptively to unpredictable daily challenges. Harnessing moments of clinically relevant struggle during sessions in order to support and reinforce new responses—including new ways of approaching the learning process itself—can help patients consolidate both the coping skills themselves and flexibility and confidence to apply them.

Conflictual relational demands of anaclitic and introjective depressive women

The depression is associated with typical ways of relating to and handling conflict with others. This study empirically examined the most frequent relational demands of female depressive patients, depending on their personality configuration and the characteristics of relevant segments within the session: change and stuck episodes. Ten psychotherapies (n = 230 sessions) were observed in order to identify, delimit and code relevant episodes within session (24 change episodes and 26 stuck episodes) using the CCRT-LU-S Category System (Albani et al., 2002), to determine patients’ relational demands. The results showed that introjective patients verbalized more relational demands on themselves as a relational object, and therefore more demands with a subject-subject direction. These patients expressed their needs and wishes centered on questioning themselves, to the detriment of generating significant interpersonal relationships. Furthermore, it was possible to predict a greater presence of relational demands referred to contents about “loving” during the change episodes, confirming that the most frequent themes in patients’ discourse were a strong wish to feel happy, despite their experiences of helplessness. These findings highlight the need for a more dimensional view of depression that takes into account patients’ personality configurations and their association with little and big outcomes.

The Origins of Social Anxiety

The primary purpose of this chapter is to finish presentation of the cognitive–behavioral therapy (CBT) model with a discussion of the etiology and maintenance of social anxiety. Clients vary on how much they want to know about some of the details. However, nearly everyone asks about etiology at some point in treatment. Possible causes of social anxiety include a genetic component, family environment, and important experiences. However, most psychologists agree that social anxiety disorder, like most other psychological disorders, is not caused by just one thing and results from a combination of factors. This chapter includes the beginning of monitoring progress using the SASCI (Social Anxiety Session Change Index). From this point in therapy forward, at the beginning of each session, clients complete the SASCI.

Cognitive Restructuring

This chapter builds on the first two steps of cognitive restructuring that were developed in chapter 5: (a) the identification of automatic thoughts (ATs) and the emotions they cause and (b) the identification of thinking errors. This chapter presents the remaining steps in cognitive restructuring: (c) challenging ATs by using disputing questions and (d) generating rational responses. The session opens with a review of the Social Anxiety Session Change Index and homework, and then each concept is covered. There is also a brief discussion in anticipation of the first exposure in the next session. The first in-session exposure is a key moment in treatment.

Psychoeducation

The primary purpose this chapter is to finish presentation to the client of the cognitive–behavioral therapy (CBT) model, with a discussion of the etiology and maintenance of social anxiety. Clients vary on how much they want to know about some of the details; however, nearly everyone asks about etiology at some point in treatment. This chapter includes the beginning of monitoring progress using the Social Anxiety Session Change Index (SASCI). From this point in therapy forward, at the beginning of each session, clients complete the SASCI. The chapter is an opportunity to reinforce the basics of the CBT model.

Alliance challenges in the treatment of a narcissistic patient: the case of Alex

People with pathological narcisism, with their conflicted sense of grandiosity and vulnerability, often pose a variety of therapeutic challenges, which may impede these patients’ ability to benefit from psychotherapy. To offer a case illustration and provide insight into the intrinsic difficulties of working with this patient group, we examined the treatment of a fictional character, Alex, from the TV series In Treatment. Based on the Shedler-Westen Assessment Procedure-200 we diagnosed Alex with pathological narcissism, and evaluated the treatment process (seven sessions) by reporting on measurements of session-by-session change in explicit working alliance, implicit language alliance, and ruptures and repairs. Over the course of treatment, the working alliance (Working Alliance Inventory-Observer scale) fluctuated with a particularly low bond at session five, identified as a rupture (Rupture Resolution Rating System). Language analysis (Linguistic Inquiry and Word Count) showed that the unconscious aspects of the alliance started to deteriorate just before the rupture occurred. The results illustrate how therapists might be pulled to collude with narcissistic patients’ grandiosity, with the risk of neglecting their vulnerability. This fictional portrayal of a treatment with a narcissistic patient may be widely shared with researchers, students and therapists alike, offering a common locus of scholarly attention, and an innovative tool for teaching. Given the lack of empirical treatments for pathological narcissism and the great therapeutic challenges narcissistic patients present, further research and development of clinical guidelines are warranted.