Systematic Treatment Selection: Toward Targeted Therapeutic Interventions

385 Pages·1990·5.971 MB·English

by  Larry E. Beutler, John F. Clarkin

SYSTEMATIC
TREATMENT
SELECTION
Toward Targeted
Therapeutic Interventions
BRUNNER/MAZEL INTEGRATIVE PSYCHOTHERAPY SERIES
JOHN C. NORCROSS, PH.D., SERIES EDITOR
1. HANDBOOK OF ECLECTIC PSYCHOTHERAPY
Edited by John C. Norcross (1986)
2. CASEBOOK OF ECLECTIC PSYCHOTHERAPY
Edited by John C. Norcross (1987)
3. SYSTEMATIC TREATMENT SELECTION:
TOWARD TARGETED THERAPEUTIC INTERVENTIONS
by Larry E. Beutler & John F. Clarkin (1990)
REVIEW BOARD
Bernard D. Beitman, M.D. Toksoz B. Karasu, M.D.
Larry E. Beutler, Ph.D Arnold A. Lazarus, Ph.D
John F. Clarkin, Ph.D Jeanne S. Phillips, Ph.D.
Windy Dryden, Ph.D. James O. Prochaska, Ph.D.
Joel Fischer, D.S.W. PaulL. Wachtel, Ph.D.
Allen Frances, M.D. Esther Wald, M.S.W., Ph.D.
Marvin R. Goldfried, Ph.D.
BRUNNERIMAZEL INTEGRATIVE PSYCHOTHERAPY SERIES, NO.3
SYSTEMATIC
TREATMENT
SELECTION
Toward Targeted
Therapeutic Interventions
by LARRY E. BEUTLER, Ph.D.
and JOHN F. CLARKIN, Ph.D.
gl
Routledge
i
~
Taylor & Francis Group
New York London
First published by BRUNNER/MAZEL, INC.
This edition published 2013 by Routledge
Routledge Routledge
Taylor & Francis Group Taylor & Francis Group
711 Third Avenue 27 Church Road, Hove
New York, NY 10017 East Sussex BN3 2F A
Copyright © 1990 by Larry E. Beutler and John F. Clarkin
All rights reserved. No part of this book may be reproduced
by any process whatsoever without the written permission
of the copyright holder.
Library of Congress Cataloging-in-Publication Data
Beutler, Larry E.
Systematic treatment selection: toward targeted therapeutic
interventions/by Larry E. Beutler and John F. Clarkin.
p. cm.-(Brunner/Mazel integrative psychotherapy series:
3)
Includes bibliographical references.
ISBN 0-87630-576-1
1. Psychiatry-Differential therapeutics. I. Clarkin, John F.
II. Title. III. Series.
{DNLM: 1. Decision Making. 2. Mental Disorders-therapy.
3. Psychotherapy. WI BR917I v. 3/ WM 400 B569s}
RC480.52.B48 1990
616.89'14-dc20
DNLM/DLC
for Library of Congress 89-71203
CIP
To our wives Elena and Audrey,
and to our children
lana, Kelly, Ian, Gail, Kevin, and Brian.
We love you.
This page intentionally left blank
Contents
Preface ......................................................................................... xi
A Note on Case Examples .......................................................... xv
PART I. BACKGROUND AND INTRODUCTION
1. INTRODUCTION ......................................................................... 3
A History of Eclectic Psychotherapy ............................................... 6
Contemporary Eclectic Theories ................................................... 10
Summary and Comment ............................................................... 12
Suggested Readings ....................................................................... 13
2. A MODEL OF DIFFERENTIAL TREATMENT SELECTION .... 14
Contributing Viewpoints .............................................................. 14
An Integrative Model ................................................................... 20
Summary and Comment ............................................................... 27
Suggested Readings ....................................................................... 27
PART II. PATIENT PREDISPOSING VARIABLES
3. DIAGNOSTIC CONSIDERATIONS ........................................... 31
Critique of Diagnostic Concepts ................................................... 32
A Practical Critique ..................................................................... 36
Seeking a Role for Diagnosis in Treatment Planning .................. .40
Summary and Comment ............................................................... 55
Suggested Readings ....................................................................... 55
4. PATIENT PERSONAL CHARACTERISTICS .............................. 57
Patient Expectations ..................................................................... 58
Coping Ability .............................................................................. 63
Patient Personality ........................................................................ 66
Summary and Comment ............................................................... 80
Suggested Readings ....................................................................... 82
5. ENVIRONMENTS AND CIRCUMSTANCES ............................. 83
Environmental Stressors ............................................................... 84
Environmental Resources .............................................................. 86
VII
VIII SYSTEMATIC TREATMENT SELECTION
Summary and Comment ............................................................. 96
Suggested Readings ..................................................................... 97
PART III. THE TREATMENT CONTEXT
6. THE TREATMENT SETTING ................................................ 101
Least Restrictive Treatment Settings ......................................... 102
The Psychiatric Hospital .......................................................... 104
Restrictive Settings for the Acute Patient. ................................. 105
Restrictive Settings for the Chronic Patient.. ............................ 107
Alternatives to Hospitalization ................................................. 108
Treatment Settings vs. Treatment Programs ............................. 109
Summary and Comment. .......................................................... 111
Suggested Readings ................................................................... 112
7. TREATMENT MODE AND FORMAT ................................... 113
Psychosocial Modes and Formats ............................................. 114
The Treatment Mode of Medical Management ......................... 133
Summary and Comment ........................................................... 139
Suggested Readings ................................................................... 140
8. TREATMENT FREQUENCY AND DURATION ................... 141
Treatment Duration ................................................................. 141
Interrelationships of Frequency and Duration .......................... 152
The Decision Not To Treat ...................................................... 155
Summary and Comment ........................................................... 161
Suggested Readings ................................................................... 162
PART IV. RELATIONSHIP VARIABLES
9. THERAPIST-PATIENT PERSONAL COMPATIBILITY ......... l69
Persuasion and the Therapeutic Alliance .................................. 171
Dimensions of Compatibility .................................................... 174
Summary and Comment ........................................................... 184
Suggested Readings ................................................................... 185
10. ENHANCING AND MAINTAINING THE THERAPEUTIC
ALLIANCE ............................................................................. 186
Role Induction ........................................................................ 187
In-Therapy Environmental Management ................................. 196
Summary and Comment ......................................................... 205
Suggested Readings ................................................................. 206
CONTENTS IX
PART V. TAILORING STRATEGIES AND TECHNIQUES
11. SELECTING FOCAL TARGETS OF CHANGE ...................... 211
Differences Among Psychotherapy Methods ............................. 212
A Model for Matching Therapy to Patient ............................... 222
Formulating Focal Treatment Goals ......................................... 224
Summary and Comment ........................................................... 234
Suggested Readings ................................................................... 237
12. SELECTING THE LEVEL OF INTERVENTION AND
THE MEDIATING GOALS OF PSYCHOTHERAPY ............. 238
Types of Psychotherapy Experiences ......................................... 2 39
Mediating Goals and Phases of Psychotherapy ......................... 253
Summary and Comment ........................................................... 263
Suggested Readings ................................................................... 264
13. CONDUCTING THERAPEUTIC WORK .............................. 265
The Dimensions of Specific Procedures .................................... 266
Treatment Manuals and the Four Steps .................................... 279
Summary and Comment ........................................................... 283
Suggested Readings ................................................................... 284
PART VI. TRAINING DIRECTIONS
14. TRAINING IN DIFFERENTIAL TREATMENT
SELECTION ............................................................................. 289
with John C. Norcross, Ph.D.
Critique of Conventional Training .......................................... 290
Ideal Training Models .............................................................. 293
Recurrent Obstacles in Integrative Training ............................ 297
Clinical Supervision ......................................... , ...................... 300
Conclusions and Recommendations ........................................ 304
Suggested Readings ................................................................. 307
References ................................................................................ 308
Index ........................................................................................ 352