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Formulation as a Basis for Planning Psychotherapy Treatment utilizes a step-by-step structure and copious case illustrations to teach psychiatrists, residents in psychiatry and psychology, social workers, and marriage and family counselors how to plan treatment after the initial diagnosis. This new edition arrives two decades after the first, with revised content, updated case studies, and new insights gleaned over the author''s noteworthy career. Clinical formulation, also known as case formulation and problem formulation, is a theoretically-based explanation or conceptualization of the information obtained from a clinical assessment. Although formulation systems vary by different schools of psychotherapy, the author has adopted and here explores a systematic approach based on an integrative effort. This system of configurational analysis combines concepts derived from psychodynamic, interpersonal, cognitive-behavioral, and family system approaches.
After an overview of psychological change processes, each of the five steps of configurational analysis is covered systematically: Step one involves selecting and describing the patient''s currently most important symptoms, signs, problems, and topics of concern. For example, symptoms may consist of trouble sleeping or feelings of depression; signs may include discordant verbal and physical expression; problems may include reluctance to go to work or care for family members; and topics of concern might be unresolved grief the patient feels helpless to process without assistance. Since both patient and therapist want to know if these observable phenomena are changing, this list is modified as treatment progresses. Step two entails describing states in which the patterns of phenomena do and do not occur, with attention to patterns of shifts in states, especially maladaptive state cycles. The therapist is taught how to aggregate and organize this information by describing states of mind -- for example, undermodulated (e.g., unthinking rage) or overmodulated (e.g., numbness and lack of affect). Step three involves describing the challenging topics that patients may both approach and avoid because they are conflicted or unresolved, as well as the obstacles patients may create to divert attention from those topics. For example, patients may avoid a topic or shift attention from it by changing the subject and so forth. Step four entails describing the organizing roles, beliefs, and scripts of expression and action that seem to organize repetitions in each state, with an effort made to identify dysfunctional attitudes and how these may have evolved from past attachments and traumas. Finally, step five involves figuring out how to stabilize working states by enhancing the therapeutic alliance and helping the patient contain and master emotional attitudes. At this point, the clinician plans how to counteract avoidances by direction of attention and promotes adaptive social cognitive capacities.
From surface observation to deeper inferences, Formulation as a Basis for Planning Psychotherapy Treatment transcends DSM diagnoses, helping clinicians to use information gleaned in the immediacy of the moment to make sound, sensitive, and effective psychotherapeutic decisions.
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Stress is a universal condition. However, severe stress related to loss, trauma, and/or terror necessitates an integrated approach, one that was pioneered nearly 20 years ago with the publication of Treatment of Stress Response Syndromes. This classic text has been updated and revised for our times, reflecting changes in DSM-5, which introduced a new category of diagnoses called trauma- and stressor-related disorders. This new edition updates treatment recommendations for these disorders and emphasizes formulation for determining appropriate therapeutic strategies. The author''s method is assessment-based and does not compartmentalize its recommendations into treatment modalities such as cognitive-behavioral therapy, prolonged exposure, or cognitive processing therapy. Instead, the book takes an integrative and transtheoretical approach that emphasizes repeated assessments, resulting in treatment plans that are individualized, flexible, and more responsive to patient changes. Clinicians plan interventions based on the current state of mind of patients as they progress through the processing of traumatic events.
The new edition reflects evolution in the field, including the following: The cross-theoretical approach helps practitioners integrate previously acquired clinical concepts without limiting them to one treatment modality or school of thought, enhancing their ability to respond to patient needs. Assessment can be used throughout all phases of treatment, which leads to the possibility of enhancing emotional control, advancing attachment models, and consolidating identity. Because of the financial constraints of insurance coverage or military troop availability, many treatment guidelines for PTSD focus on brief therapy; however, this book stresses the need for therapies of the length required to provide full benefit to patients and to lead to personality growth.
In addition, the inclusion of illustrative cases anchors techniques to pragmatic actions, engaging readers and focusing them on the most critically important concepts. End-of-chapter summaries allow review of key principles, and pertinent tables and figures condense essential information for easy understanding and retrieval.
Of great practical value for psychotherapists and other mental health professionals working with patients experiencing the effects of serious life events, Treatment of Stress Response Syndromes is the definitive guide to the psychotherapy and management of acute stress and PTSD, combining clear and compelling case descriptions with the eloquent presentation of therapeutic technique.
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