Psychology In Psychiatry Research Articles

The Therapeutic Relationship in Cognitive-Behavioral Therapy

Judith S. Beck, PhD, is President of the Beck Institute for Cognitive Behavior Therapy and Clinical Professor of Psychology in Psychiatry, University of Pennsylvania, Philadelphia, PA Marcia L. Verduin, MD, Book Editor Dr Beck wrote the foreward for this book.

Play Therapy: A Premier Treatment for Young Children

Back to table of contents Previous article Next article From the ExpertsFull AccessPlay Therapy: A Premier Treatment for Young ChildrenPamela Meersand,Ph.D.Pamela Meersand,Search for more papers by this authorPh.D.Published Online:21 Sep 2018https://doi.org/10.1176/appi.pn.2018.9b8Pamela Meersand, Ph.D., is an associate clinical professor of medical psychology in psychiatry and director of the Child Division of the Columbia University Psychoanalytic Center. She is the co-author of Play Therapy: A Psychodynamic Primer for the Treatment of Young Children from APA Publishing. APA members can purchase the book at a discount.For children between the ages of 3 and 8 years, imaginary play represents an ideal modality for communication, relationship building, and therapeutic action, offering unparalleled access to youngsters’ inner world. In play therapy, the clinician seeks to restore developmental progression through joining in the playing state, a natural habitat for young children that involves a temporary suspension of reality and a deep immersion in the fantasy and action of pretending. From within this shared intermediary zone, the therapist functions as a participant-observer who facilitates emotional expression, elaborates affects, and co-creates meaningful scenarios that elucidate the child’s developmental struggles, perceptions of reality-based events, wishes and worries, relational modes, and self-protective mechanisms. Imaginary play emerges at around the age of 3 years, in tandem with evolving ego capacities for complex fantasy, narrative language, and theory of mind. The Oedipal period of development, roughly from ages 3 to 6, represents high season for pretend play. Indeed, access to imaginary roles and stories vastly expands the child’s mental resourcefulness during a phase marked by heightened conflictual feelings toward important attachment figures. Pretend play provides an enormously flexible and creative medium for modulating aggressive urges, coping with small daily mortifications, and assuaging unsatisfied longings as the child grapples with augmented social expectations (sharing, waiting is or her turn), jealousy of others’ relationships (and particularly the intimacy between parents), a sense of exclusion from adults’ private lives, intense sexual curiosities, and inevitable feelings of powerlessness. While in the playing state, the child benefits from the transformation of passive into active experience, mastery of emotionally laden events, the temporary fulfillment of wished-for states, respite from reality-based pressures, organization and modulation of intense affects into coherent narratives, identification and experimentation with desired roles and storylines, and trying out creative solutions to interpersonal dilemmas. When clinicians use play as a therapeutic modality, they allow themselves to be enlivened by the child’s imaginary fantasies; inevitably, the therapist contributes unconscious elements to the unfolding narratives, but the child’s subtle cues and more overt directions (“You play the ugly stepsister, and I’ll be the beautiful princess!”) guide the evolving themes. For most children, the passion for play is powerful: often, little is needed to initiate pretense beyond inviting a young child into a room that contains usable objects that lend themselves to symbolic transformation. Through displacement onto play characters and scenarios, children reveal repudiated affects, painful experiences, and conflict-laden wishes. Disowned aspects of the self are often assigned to the therapist who is called upon to animate a jealous sibling, a stumbling reader, or an angry monster. From within these characters, the therapist labels hard-to-tolerate urges, elaborates unwanted self-states, and embellishes affect-laden events, helping the child to grasp, tolerate, reclaim, and reintegrate previously rejected aspects of self-experience. The developmentally normative and organic mode of play facilitates young children’s self-expression without undue self-consciousness or sense of exposure. Accordingly, the therapist’s questions, comments, and interpretive remarks are often made within the play itself, as one play character to another, rather than directly to the child. Playing with children is exhilarating and engrossing but also uniquely demanding, pushing the therapist beyond the usual comfort zone to tolerate action-filled sessions, contain overwhelming affects, and keep constantly abreast of shifting cultural modes that youngsters use for play and self-expression (for example, media-based references, images, and expressions). Moreover, imaginary play often teeters on the precarious brink of overstimulation as frankly aggressive and sexual material inevitably makes its way into the child’s narratives; such themes are prevalent in children’s fantasies and in their play, as they are in the classic beloved fairytales that have been adored for generations. Developmentally normative hostile urges and fears of punishment contribute to the ubiquity of common play representations such as sadistic, monstrous, and devouring characters.A clinician’s capacity to accept such roles when assigned by the child, tolerate uncomfortable affects, and make meaning of chaotic and scary scenarios is key to the use of play for therapeutic benefit. ■ ISSUES NewArchived

DBT Principles in Action: Acceptance, Change and Dialectics

Dr Beth Brodsky, PhD, is Associate Clinical Professor of Medical Psychology in Psychiatry at Columbia University, and a Research Scientist in the Silvio O. Conte Center for the Neurobiology of Mental Disorders, at the New York State Psychiatric Institute, Department of Molecular Imaging and Neuropathology, New York, NY Marcia L. Verduin, MD, Book Editor

Henrik Sjöbring and the concept of individual psychology in psychiatry

In 1913 Henrik Sjobring presented his thesis, ‘Den individualpsykologiska fragestallningen inom psykiatrien’ [‘The question of individual psychology in psychiatry’] in Upsala Lakareforenings Forhandlingar (1), the principal aim of which was to construct a system for characterizing the various dimensions of personality. The system presupposed that it is possible to distinguish different fundamental characteristics, or factors, in our innate psychic constitution and that combinations in different degrees of these fundamental characteristics could produce an infinite number of personality variations. Extreme positions, above and below the median, could result in mental illness. At that time this stance was new, but it corresponds well with contemporary beliefs. A person’s personality and its importance for illness, particularly mental illness, has always been interesting, both generally and in medicine. For a long time, a barrier to meaningful typology was the inadequate knowledge about the ‘site of the soul’ and later, when the brain’s role in this connection was established, the functioning of the brain. At the start of the last century this issue was beginning to be dealt with in a more modern way, and Kraepelin’s classification in 1899 of two categories of ‘madness’, dementia praecox (schizophrenia) and manic-depressive psychosis, was crucial (2-4). The importance of the personality in relation to mental illness is, however, probably most apparent in the case of less severe forms of illness, where a psychotic condition has not been able to eradicate to any great extent the personality’s fundamental characteristics. The development of psychology in the twentieth century has led to many different typologies, of which Henrik Sjobring’s ‘individual psychology’ was the first with its systematic and modern approach that foresaw later developments. Sjobring is generally acknowledged as Sweden’s most influential twentieth-century psychiatrist and a leading professor in psychiatry. Torsten Frey wrote in 1964: If asked today to nominate a group of medical scientists, who more than others have made important contributions to man’s global reactions in health and illness, I would propose from Britain John Hughlings Jackson, from France Pierre Janet, from Germany Emil Kraepelin, from Austria Sigmund Freud, and from Russia Ivan Petrovitch Pavlov. For a Swedish name in this company I would not hesitate to propose Henrik Sjobring (5). However, Sjobring is not particularly well-known internationally, which is probably due to several factors. He usually wrote in Swedish and published his important, early articles in less widely spread fora (his thesis, in 1913, was published in Upsala Lakareforenings Forhandlingar (1). In the same journal in 1920 he published ‘Forstamningar and forstamningspsykoser’ [‘Melancholy and melancholic psychoses’] (6), in 1922 ‘Psykologi och biologi’ [‘Psychology and biology’] (7), and in 1922 ‘Psychic energy and mental insufficiency’ (8); in 1919 ‘Psykisk konstitution och psykos’ [‘Psychic constitution and psychosis’] was published in Svenska Lakarsallskapets Handlingar (9). In addition, as has been pointed out in several of his biographies, his texts are somewhat difficult and written in a very abstract way, often without the facilitation of explanatory examples and concretization. It is also said that he was not prepared to compromise and had difficulty in accepting opinions that did not coincide with his own (10-13). This could create problems not least during the time when Freud’s ideas from around 1910 had begun to attract many adherents. Sjobring’s brief dismissal of the psychodynamic school is dealt with later in this article in connection with the review of his thesis. A citation from one of his opponents, Carl-Henry Alstrom in his book from 1945, Ytpsykologi Kontra Djuppsykologi [Superficial psychology versus profound psychology] (14) reflects their differences on this issue: The thoroughly dynamic perception of the development of the psychic phenomenon and the whole approach of his [Freud’s] comprehensive empirical investigations exposes a neurologist who, given the nature of his work, is forced to think in a distinctly dynamic and logical way. This is undoubtedly also the reason why Freud does not use a statistical approach which involves classifying people into predefined constitutional types, and which is always doomed to end in so called ‘buttonology’. Hence it is immaterial whether we choose to classify buttons according to qualitative factors, for instance shape (Kretschmer), or quantifiable factors such as size (Adler) or several quantitative factors, for instance not only size but also the number of holes (Sjobring) (14).

Erotic Transfer in Borderline Personality Patients

Erotic Transfer in Borderline Personality Patients

Cognitive Impairment in Schizophrenia: Characteristics, Assessment, and Treatmentedited by HarveyPhilip D.. New York, Cambridge University Press, 2013, 328 pp., $95.00.

Cognitive Impairment in Schizophrenia: Characteristics, Assessment, and Treatmentedited by HarveyPhilip D.. New York, Cambridge University Press, 2013, 328 pp., $95.00.

The Becks Recount CBT’s History and Promise

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessThe Becks Recount CBT’s History and PromiseAaron LevinAaron LevinSearch for more papers by this authorPublished Online:18 Dec 2013https://doi.org/10.1176/appi.pn.2013.12b10AbstractCognitive-behavior therapy was a pragmatic response by one young psychiatrist to his patients’ emotional states.Cognitive-behavior therapy (CBT) reshaped the field of psychotherapy over the last several decades, and in November in Philadelphia, Aaron Beck, M.D., who developed the therapy, discussed its origins and growth in a dual interview with his daughter and colleague, Judith Beck, Ph.D.Beck developed CBT in the 1960s at the University of Pennsylvania at least partly in reaction to the then-reigning psychoanalytic paradigm.“We changed therapy by emphasizing current problems, as opposed to childhood experiences,” said Aaron Beck before a large audience in the studios of public radio station WHYY. “Therapy today is more structured, with more activity by the therapist compared to analysis, and more emphasis on coping by the patient.”Beck graduated from Yale Medical School in 1946. Today, at age 92, he is professor emeritus of psychiatry at the University of Pennsylvania and president emeritus of the Beck Institute for Cognitive Behavior Therapy.Like most of his generation, Beck began his career as a psychoanalyst. In analytic theory, dreams were said to reveal the patient’s inner state, yet Beck’s clinical experience convinced him that the dreams of depressed patients were quite benign.“But their self-image affected the way they viewed the world,” he said. “A negative self-image screened out the positive things in their lives.”When sitting opposite his patients, he observed the expression of emotions on their faces and thus could ask what they were thinking about at that moment. “I saw their expressions as automatic thoughts, a form of internal communication not usually said out loud,” he recalled. At that moment, he asked his patients to pin down the negative thoughts they had just before sensing the emotion. He then began actively challenging the patients’ statements, asking them for the facts behind their words.“CBT is about the problems connected to the reactions to an event, not to the event itself,” said Judith Beck, a clinical associate professor of psychology in psychiatry at the University of Pennsylvania and president of the Beck Institute.“People in psychological distress often have a distorted view of their situation,” she said. “To make lasting changes, you have to work at deeper levels of core beliefs.”Despite the name, cognitive-behavior therapy is not defined solely by cognitive techniques, she pointed out. Therapists can also use psychodynamic techniques, gestalt therapy, supportive methods, medication, or environmental change.Judith Beck, Ph.D., and her father, Aaron Beck, M.D., talk about the origins and growth of cognitive-behavior therapy.Aaron LevinFidelity to the CBT model is important, though, she said. The Becks have long conducted research to validate CBT, and in 1994 they created the Beck Institute as a center for training clinicians in this modality. Aaron Beck still takes part in training programs there. “Cognitive-behavior therapy is practiced more outside the United States than here,” he said. In Britain, for instance, the institute has trained more than 8,000 clinicians who have helped more than 1 million patients, he noted.Trainees anywhere in the world can now upload tapes of patient sessions and get an hour of consultation and supervision.However clinicians learn CBT, the essence of the process remains the structure of the patient-therapist interaction, said Judith Beck.Ideally, a session begins with a preparatory discussion with the patient, choosing and prioritizing one or two problems. After discussing those points the therapist asks the patient to summarize the session and then agree to some action or homework before the next session. Finally, the therapist asks the patient for feedback, making therapy a collaborative enterprise.“Our goal is to teach patients to be their own therapists,” she said.■Information about the Beck Institute for Cognitive- Behavior Therapy is posted at http://www.beckinstitute.org. ISSUES NewArchived

CBT Gets Citywide Rollout In Philadelphia’s MH System

CBT Gets Citywide Rollout In Philadelphia’s MH System

JoAnn Difede: emotional engagement with victims of trauma

“I didn't have the stomach for politics”, says JoAnn Difede, Director of the Program for Anxiety and Traumatic Stress Studies and Professor of Psychology in Psychiatry at Weill Cornell Medical College. We're talking about her career, and how she chose to specialise in psychology. I am surprised by this revelation: looking at her CV—which includes work with victims of the 9/11 attacks and veterans of the wars in Iraq and Afghanistan—I imagine that she must have a strong core of resilience. I ask her to explain further.

In Memoriam: Saul Scheildlinger, MS, PhD 1918-2010

GROUP, Vol. 35, No.i,March 2011 In Memoriam: Saul Scheildlinger, MS, PhD 1918-2010 Howard D. Kibel1,2and Seth Aronson3 On August21,Saul Scheidlinger, husbandofRosalynTauberScheidlinger, died peacefully atMountSinaiHospital inNewYork City. Saulwasthe18th president of theAmerican GroupPsychotherapy Association (AGPA;1982-1984) andthethird editor oftheInternational Journal ofGroup Psychotherapy (1970-1980). In1985, he became thesixth person tobeelected toDistinguished Fellowship inAGPA.In1988, a testimonial dinner-dance washeldattheannualconference tohonorhis40-year history ofoutstanding contributions tothefield. A Festschrift inhishonor, edited bySaulTuttman, MD, PhD,waspublished in1991. Saulwasa Professor Emeritus ofPsychiatry attheAlbert Einstein Collegeof Medicine andanadjunct professor ofclinical psychology inpsychiatry attheWeill MedicalCollegeofCornellUniversity. He wasa LifeFellowofboththeAmerican Psychological Association andtheAmerican Orthopsychiatric Association. Saulwasbornina small town inwestern Poland. Early on,helearned anadaptive technique toavoidphysical andmental abusebyhisanti-Semitic schoolmates. He helpedsomeofthebullieswiththeir studies togainprotection from theabusehe would haveotherwise received (Fenchel, 1983). In1938, attheageof20,Saulemigrated from Polandandarrived inBrooklyn tostay with relatives whomhehadnever met andwhowere shocked tolearn that heintended togotocollege, particularly sincehe didnotspeaka wordofEnglish. Yet, twoyears later, heentered CityCollege, from which hegraduated magnacumlaudeandPhiBetaKappawith four tophonors in 1 The authors would like tothank Gloria Batkin Kahn, EdD, ABPP, CGP, for her help inthe preparation of this manuscript. 2 Clinical Professor ofPsychiatry, New York Medical College, Valhalla, andAdjunct Clinical Professor ofPsychiatry, Weill Medical College ofCornell University, White Plains, New York. Correspondence should beaddressed toHoward D.Kibel, MD,CGP, DFAGPA, 503 Grasslands Road, Suite 104, Valhalla, NY10595-1503. E-mail: hkibel@pol.net. 3 Fellow, Training and Supervising Analyst, William Alanson White Institute, New York. ISSN 0362-4021©2011 Eastern Group Psychotherapy Society 59 6o KIBELANDARONSON Saul Scheidlinger hisclass.Hewent ontoobtain a master sdegree attheColumbiaUniversity School ofSocialWork in1944anda doctorate atNewYork University in1951. Saul'sfamily oforigin perished intheHolocaust. Asthesolesurvivor, hecarried with hima tradition fostered byhistwooldersisters. They hadbeenvery active in theZionist youth movement inPolandandfrequently tookhimtotheir meetings. Helookeduptohissisters, whobecamehisrolemodels. Whenhewasoldenough, hejoinedtheZionist youth movement andeventually becametheleaderofa group ofover100members, ranging inagefrom 8 to18years. He later recalled hisadolescence as amongthehappiest times ofhislife. Thus,early on,Saulwasdrawn to groups, wasa member ofa group, andeventually becamea leadertowhomothers lookedwithadmiration. Hisprofessional life paralleled theseearly experiences. Whileworking onhismaster sdegree attheColumbia SchoolofSocialWork, he metSamuelR.Slavsonduring a field placement attheJewish BoardofGuardians (JBG), which, atthetime, wasa famous childguidance clinic. Slavson, thefounder ofAGPAand,bysomeaccounts, thefather ofAmerican group psychotherapy, took Saulunderhiswing.In September 1944,underSlavsonssupervision, Saulstarted hisfirst group oflatency-aged boys.Within twoyears, hebecamea supervisor, had administrative responsibilities, accompanied Slavson tohisfrequent on-site seminars atlocalagencies, andbecameassistant director ofgrouptherapy attheJBG. Duringsummer 1944, Saulworked with hislatewife, LucyPrince,2 alsoa social worker, asa counselor ata therapeutic campfor emotionally disturbed boys. Together they wrote what proved tobehisfirst paperongroup therapy, drawn from that experience . Hissecondpaperfocused ontheinternational BoyScoutmovement, drawn from hisexperiences as a leaderofthat Zionistscoutorganization inPoland. Saulleft theJBG in1948topursue hisdoctorate inpsychology. Hisdissertation 2 Their son David J. Scheidlinger, MD,of SanDiego, isapsychiatrist. InMemoriam: SaulScheidlinger 6i for thedegree becamethebasisfor hisfirst book,Psychoanalysis andGroup Behavior ; published in1952. Upuntil then, thedominant thinking inAmerican group psychotherapy , ledbySlavson andAlexander Wolf, wasthat group psychotherapy consisted ofthetreatment ofindividuals in a groupsetting, eschewing theimportance of groupdynamics. Despitecriticism from manyquarters, Saulcontinued tolecture andwrite abouttheimportance ofthegroup-as-a-whole intreatment. Thiswasa radical departure from conventional thinking intheUnited States and,particularly, from thethinking ofhismentor, Slavson. However, Saulreceived theoretical support from aneminent British colleague, S.H. Foulkes. SoonsomeAmerican colleagues stoodinhiscamp, notably HelenDurkin andLeonard Horwitz (Kibel, 2004).From theperspective oftoday, thiswouldnotseemrevolutionary, butatthat timeitwas. In1952, Saulbecamedirector oftheCommunity Service Society inupperManhattan , where heremained for 23years. Working there with severely ego-disturbed youngsters, Saulrealized that thenondirective, nonverbal approach hehadlearned from Slavsonwasnotapplicable tothisclientele. He developed structured groups andlearned howtouseverbal interventions effectively. Fromthisexperience with markedly impaired personalities, he developedhistheoretical concepts, notably that ofthemother-group. In 1962, hewasinvited tojointheDivisionofSocialand Community Psychiatry attheAlbert Einstein CollegeofMedicineintheBronx. He alsotaught attheColumbiaUniversity SchoolofSocialWork andtheSchoolof Education oftheCity CollegeofNewYork. Forfour years, hebecamea commuting consultant totheJudge BakerChildGuidanceCenter inBoston, where hetrained clinicians andsupervisors wholater becameleadersinthefield ofgroupwork. In themid-1960s, as partofhisworkattheEinstein CollegeofMedicine, he joinedtheso-calledLincolnBrigade attheCommunity MentalHealthCenter of LincolnHospital(1963-1977)» whichconsisted ofa groupofdedicated, liberalthinking clinicians, suchas HarrisPeck,MelvinRoman,and Seymour Kaplan, whobrought community psychiatry tothesouthBronx. There heproduced three educational films, twoforadolescents andonefor humanservice workers, which demonstrated theapplication ofgroupprocessin a nonclinical setting. In these films, heexpanded hisviewthat clinically informed group theory couldbeapplied ina variety ofwaystomyriad settings. In 1970,he assumedtheeditorship oftheInternational Journal ofGroup Psychotherapy . Duringhis10years atthehelm, hetookthejournalfrom a provincial, clinically oriented onewith a smallreadership toa preeminent international journal inthefield witha readership of5,000andexpandeditsscopetoincluderesearch. In1975, Saulbecamea full-time faculty member...

Interpersonal Psychotherapy: Effectiveness Trials in Rural Uganda and New York City

<P>During the past 2 decades, attention in psychotherapy research has shifted to transporting controlled studies of efficacious interventions into studies of these interventions in real world settings. Typically, these effectiveness studies include patients who do not need to meet extensive exclusion criteria, are treated by community clinicians, and are assessed with clinical as well as functional and consumer-based outcome measures. With rates of depression throughout the world on the rise, the need to find effective and feasible psychotherapy approaches for its treatment is imperative. While interpersonal psychotherapy (IPT) has been proven efficacious in many research protocols conducted in academic settings, there is a dearth of clinical trials in community settings. </P> <H4>ABOUT THE AUTHORS</H4> <P>Ms. Clougherty is senior consulting trainer and supervisor, New York State Psychiatric Institute, New York, NY 10032. Dr. Verdeli is assistant professor, Clinical Psychology, Teachers College, Columbia University, and adjunct assistant professor, Clinical Psychology in Psychiatry, Columbia University College of Physicians and Surgeons, New York. Dr. Mufson is associate professor, Clinical Psychology in Psychiatry, Columbia University College of Physicians and Surgeons, and research scientist, New York State Psychiatric Institute. Dr. Young is assistant professor, Clinical Psychology in Psychiatry, Columbia University College of Physicians and Surgeons.</P> <P>Address reprint requests to: Kathleen F. Clougherty, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032; or e-mail <a href="mailto:kfcipt88@aol.com">kfcipt88@aol.com</a>.</P> <P>The authors disclosed no relevant financial relationships.</P>

Edith Silverglied Lisansky Gomberg, PhD 1920–2005

DITHSILVERGLIEDLISANSKYGomberg,PhD,Professor of Psychology in Psychiatry, emerita at theUniversity of Michigan, died peacefully in her sleep onSunday January 9, just 5 days short of her 85th birthday.Described by Sharon Wilsnack, an international authorityon alcohol problems in women, as ‘‘truly the ‘grandmoth-er’ of gender and alcohol research,’’ she was schooled at atime when women were neither expected, nor sometimespermitted, to achieve academic status. Born and raised inNew York City, she earned a BA in Psychology fromBrooklyn College at 18 and an MA in social psychologyfrom Columbia at 20. When she was told by her advisor,the eminent social psychologist Otto Kleinberg, thatwomen did not need a PhD, she headed north to NewHaven.HerdoctoralworkatYalewasaprecursortowhatlater became the clinical psychology degree and involvedwork in clinical, social, and experimental psychology. Shefinished at 29 and in the midst of raising a family began along association with the Yale Center of Alcohol Studies,at that time the only academic/research center on alcoholin the United States.This was a time when the alcohol field was just develop-ing as an area of scientific respectability. E. M. Jellinekwas a major presence at the Center but his writing on thedisease concept of alcoholism was still more than a decadeaway, and the then Quarterly (sic) Journal of Studies onAlcohol had been published for less than a decade. Gomb-erg’s early publications were more clinically focused, andnot all were related to alcoholism (e.g., Lisansky, 1948;1950),butbythemid-1950s,shehadmovedtotheground-breaking work she was known for thereafter, describingthe characteristics of women alcoholics, their psychosocialadaptations, their problems, and their lives as women(Gomberg, 1989a; Lisansky, 1957; 1958). This workremained a major theme throughout her career. Edithmoved from this to the more general topic of problemdrinking among women (e.g., Gomberg, 1988; 1989b) notapopularsubjectin thoseyearssince women were thoughtnot to suffer from such problems at all. She took it uponherself to ask questions, provide data, and inform the sci-entificandclinicalcommunitiesabouttheseissues,andsheremained a leader in research on women’s drinking andalcoholism in women until the end of her career (Gombergand Nerenberg, 1993). Her continuing support andencouragement of women who entered the alcoholresearch field, along with a vigorous program of lecturing,made her an icon to many who did not know her person-ally. She also was a vigorous spokeswoman and advocatefor more focused treatment that would speak to women’sspecial needs.Gomberg’s academic career spanned five institutions:Yale, then Rutgers, where she sustained collaborationswith old colleagues and friends at the Alcohol StudiesCenterafterithadmovedfromNewHaventoNewBruns-wick, the University of Puerto Rico, the Ann Arbor VAMedical Center, and for the last three decades of hercareer, the University of Michigan. There she heldappointmentsin theInstituteofGerontology, theInstituteof Social Research, the School of Social Work, and theAddiction Research Center/Department of Psychiatry. AtMichigan, Edith’s work broadened to focus on anotherneglectedarea, understandingtheproblems of alcoholandprescription drug abuse among older people (e.g., Gomb-erg, 1990, 1992). She also began a program of work tounderstand drinking behavior among African Americansand to describe the ways that treatment process needed totake account of cultural differences (Nelson et al., 1997).In the late 1980s she was part of the core faculty groupinvolved in bringing the first national NIAAA Center onAlcohol and Aging to Michigan, and that center, the Uni-versity of Michigan Alcohol Research Center, is the fore-runner of what is today’s University of MichiganAddiction Research Center. During those years she alsocoedited two of the major works on alcohol involvementand aging (Alcohol and Aging, with Beresford; Oxford,1995) and the NIAAA Research Monograph on AlcoholProblems and Aging (with Zucker and Hegedus, 1998).Gomberg remained a presence both nationally andinternationally on the effects of alcohol on women andalcohol and aging until her retirement, and she continuedto write and correspond with others about their work untilthe end of her life. Those who knew her will rememberEdith’s spark, her sense of humor, her broad span ofinterests, her ability to ‘‘tell it like it is,’’ and her specialknack to stay down-to-earth and connected with so manypeople from diverse backgrounds. She will be missed

Antidepressants, CBT Help Night Eating Syndrome

Antidepressants, CBT Help Night Eating Syndrome

Invited Discussion: Comparison of Preoperative Anxiety in Reconstructive and Cosmetic Surgery Patients

Received October 13, 2004. Accepted for publication October 13, 2004. Reprints: David B. Sarwer, PhD, Associate Professor of Psychology in Psychiatry and Surgery, University of Pennsylvania School of Medicine, Center for Human Appearance, 10 Penn Tower, 3400 Spruce Street, Philadelphia, PA 19104. (Tel): 215-662-7589; (fax): 215-349-5895; E-mail: [email protected].

IPT Effective for Depressed Teens In School-Based Setting

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessIPT Effective for Depressed Teens In School-Based SettingEve BenderEve BenderSearch for more papers by this authorPublished Online:6 Aug 2004https://doi.org/10.1176/pn.39.15.0390037aWhen compared with adolescents receiving routine treatment for depression in school-based health clinics, those who received interpersonal psychotherapy for depressed adolescents (IPT-A) experienced greater reduction in depression symptoms and improved overall functioning.This was the major finding of a study examining the effectiveness of IPT in urban schools published in the June Archives of General Psychiatry.Researchers at the New York State Psychiatric Institute conducted the study in five school-based health clinics in impoverished communities in New York City. They gathered data on the mental health outcomes of 63 adolescents referred for treatment to their school's health clinic.The lead investigator was Laura Mufson, Ph.D., an associate professor of clinical psychology in psychiatry at Columbia University College of Physicians and Surgeons and director of the department of psychology at New York State Psychiatric Institute. She adapted the therapy—which was developed in the 1980s to target depressive symptoms in adults—for use in adolescents.IPT is a time-limited form of psychotherapy “based on the premise that depression occurs in the context of interpersonal relationships,” Mufson told Psychiatric News.While problems in a person's relationships with others may not be the cause of the depression, she noted, they can “exacerbate and prolong depressive episodes.”IPT, she added, focuses on one or two problems within a patient's interpersonal relationships and helps the patient develop better ways of communicating and problem solving within that area of his or her life.To be eligible for the study, adolescents had to meet DSM-IV criteria for major depression, dysthymia, adjustment disorder with depressed mood, or depressive disorder NOS. They also had to have a score of 10 or higher on the Hamilton Depression Rating Scale (HAM-D) and 65 or lower on the Children's Global Assessment Scale.A child psychologist determined whether students met eligibility criteria after independent evaluators, who were master's-level social workers, assessed children using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children and conducted a clinical interview with the students.The students were between the ages of 12 and 18, with an average age of 15 years; 84 percent were female, and 71 percent were Hispanic.If at any time during the study, an adolescent's symptoms or functioning appeared to be worsening—for example, if their HAM-D score was greater than 25—he or she was referred for an evaluation by a child psychologist or psychiatrist and offered an additional treatment such as medication.Between spring 1999 and summer 2002, 34 students were randomly assigned to receive 12 sessions of IPT-A over 16 weeks, and 29 were randomly assigned to treatment as usual, which typically included supportive counseling on an individual basis.The mean number of sessions for the treatment-as-usual condition was about eight sessions, according to the report. Eight adolescents received one to three additional family/parent therapy sessions, and five students also participated in group therapy.Mufson measured depressive symptoms of students in both groups using the HAM-D and Beck Depression Inventory (BDI), global functioning with the Clinical Global Impressions scale and the Children's Global Assessment Scale, and social functioning with the Social Adjustment Scale Self-Report.At the end of the clinical trial, 17 students, or 50 percent, of those who received IPT-A met the criterion for improvement of depression as measured by the HAM-D as compared with 10 students, or 34 percent, of those who received treatment as usual.On the BDI, 25, or 74 percent, of those receiving IPT-A met recovery criteria as compared with 15, or 52 percent, who received treatment as usual.Adolescents who received IPT also fared significantly better on measures of global and social functioning than had those who received treatment as usual.Mufson said she would like to see the results of the study replicated in a larger sample, and noted that IPT-A is the type of treatment clinicians can learn and conduct easily within a number of school health clinic settings.“We were able to train the clinicians from the schools that participated in the study to conduct IPT-A with a brief training program and supervision, and they were able to implement the study with good fidelity,” she said.The study was funded by the Substance Abuse and Mental Health Services Administration and the National Institute of Mental Health Child Psychiatry Intervention Research Center.An abstract of the article, “A Randomized Effectiveness Trial of Interpersonal Psychotherapy for Depressed Adolescents,” is posted online at<www.archgenpsychiatry.com>.▪ ISSUES NewArchived

Invited Discussion: Causes of Death Among Finnish Women With Cosmetic Breast Implants, 1971–2001

From the University of Pennsylvania School of Medicine, Center for Human Appearance, Philadelphia, PA. Reprints: Dr. David B. Sarwer, Assistant Professor of Psychology in Psychiatry and Surgery, University of Pennsylvania School of Medicine, Center for Human Appearance, 10 Penn Tower, 3400 Spruce Street, Philadelphia, PA. Email: [email protected]

Professionalism and Ethics in Complementary and Alternative Medicine

Professionalism and Ethics in Complementary and Alternative Medicine

Experts Study Consequences Of Sleep Deprivation

Experts Study Consequences Of Sleep Deprivation

The Future of Psychology in Medical Specialities: Introduction to the Special Issue

The continuing evolution of the health care delivery system in the United States presents threats and opportunities to psychologists in medical settings. This special issue explores the future of psychology in psychiatry, family medicine, rehabilitation, geriatric medicine, and pediatric medicine. The challenges facing neuropsychology and pain management are explored also. Finally, the professional issues of ethics in managed care, psychology in the public sector, and training future psychologists are addressed. Each paper summarizes concerns and provides recommendations for clinical practice, research, and training.

Training in empirically validated treatments: What are clinical psychology students learning?

Directors of clinical training (83%) and directors of internships with American Psychological Asso-ciation approval (55%) responded to a survey concerning empirically validated psychological treat-ments in which their students received training. Most programs provided supervised clinical experi-ence in a number of these treatments. However, over 20% of doctoral training programs failed toprovide minimal coverage of empirically validated treatments in didactic courses, and internshipprograms typically did not require that students be competent in any of these treatments beforecompletion of the program. The absence of didactic and clinical training in empirically validatedpsychodynamic therapies and interpersonal therapy was most marked. These findings suggest thatprograms need to be more attentive to teaching data-based treatments.PAUL CRITS-CHRISTOPH received his PhD in clinical psychology fromYale University in 1984. He is currently associate professor of psychol-ogy in psychiatry and director of the Center for Psychotherapy Researchat the University of Pennsylvania. At present he is studying the effects ofbrief dynamic psychotherapy and cognitive therapy for cocaine addic-tion and for generalized anxiety disorder and is examining the processof interpersonal psychotherapy and cognitive therapy for depression.ELLEN FRANK received her PhD from the University of Pittsburgh in1979. She is professor of psychiatry and psychology in the Departmentof Psychiatry at the University of Pittsburgh School of Medicine. Shedirects the Depression and Manic-Depression Prevention Program atWestern Psychiatric Institute and Clinic. Her treatment research hasfocused on the prophylaxis of recurrent mood disorders using interper-sonal psychotherapy, pharmacotherapy, and their combination.DIANNE L. CHAMBLESS received her PhD in clinical psychology fromTemple University in 1979. She is currently professor of psychology atThe American University. She conducts research on the psychopathol-ogy and cognitive-behavioral treatment of anxiety disorders and is par-ticularly interested in psychotherapy integration and the impact of in-terpersonal relationships on anxiety.CINDY BRODY received her BA in psychology from the University ofPennsylvania in 1991 and for 3 years was a research assistant at theCenter for Psychotherapy Research. She is currently a doctoral studentin clinical psychology at The American University. Her major researchinterests are in coping, interpersonal problems, and psychotherapy pro-cess and outcome.JORDAN F. KARP received his BA in psychology from Emory University in1992. He completed 2 years as a research associate in the Depression andManic-Depression Prevention Program at Western Psychiatric Instituteand Clinic. He is currently a medical student at the University ofPittsburgh.WE THANK David Barlow, Barry Wolfe, and Division 12 for assistance