atlas of bipolar disorder

Podstrony

[ Pobierz całość w formacie PDF ]
.Patientsgenerally report that both cognitive and interpersonal psychotherapy models provide helpand support17.However, only supportive therapy is provided until a complete assessmentand diagnosis has been completed and the person is introduced to medication.Anillustrated review of symptoms that often cluster with bipolar disorder has been provided.In all models of therapy, one of the most important elements is the relationshipbetween patient and therapist.The therapeutic alliance is strengthened when therapistsdemonstrate an extensive knowledge of bipolar disorder, an ability to explain basic brainfunctioning and the role of medication, and honest compassion1.Therapist flexibility is akey requirement for managing psychotherapy with individuals who have bipolardisorders.The very nature of the illness forces shifts in treatment focus, changes inemphasis, and the need to redefine goals.As an example, psychoeducation is oftenfocused on as a first step in therapy.However, it may suddenly regain importance when apatient who is doing well starts thinking about stopping the use of medications.Furthermore, during acute episodes, psychotherapy shifts into a concrete supportive andmonitoring role.Particularly during periods of severe bipolar depression, patients needtrusted reassurance and constant monitoring for signs of suicidal thoughts and behaviors.To navigate the waters of psychotherapy in patients who have bipolar disorders, thisauthor has for years used a modular eclectic framework for guiding talk therapy.Thestructure is largely founded on neuroscience theory, and employs behavioralcognitivemethods along with elements of problemsolving, self-understanding, and existentialinterventions.Before therapy is initiated, clients are assured that bipolar illness is a truebrain disorder that cannot be cured by psychotherapy.The role of Modular EclecticPsychotherapy (MEP) is to help patients cope better with symptoms, remain onmedication regimens, improve interpersonal relationships, better understand and acceptthemselves, and improve or further develop personal strengths.A central theme in themodel is the inclusion of family and significant others in the therapy and in the flow ofinformation.There will be patients who do not want their family to participate, or haveno family in the immediate area.Requests not to invite and work with family membersmust be ethically and legally honored.However, inclusion of family members orsignificant others within the MEP model is not dropped.Periodically the therapist isexpected to explore with the client how and on what terms family members can beinvited to participate.Furthermore, with the patient s permission, phone conferencesusing speaker phones and email can allow distant family members to join selectedtherapy sessions.Resistance to family participation is sometimes bridged as the therapeutic relationshipgrows, and the patient learns that the therapist respects and protects the person sconfidentiality and privacy needs.Some patients, however, cannot include their familyuntil a written contract is hammered out, guaranteeing that certain issues and boundarieswill be protected.Bipolar disorders disrupt and make interpersonal relationships difficultfor the patient and significant others.Therefore, psychotherapy must work towardnormalizing, healing, and enhancing long-term family and support systems.Toaccomplish this, the MEP system incorporates numerous treatment theories and methodsinto the following 11 modules:Atlas of bipolar disorders 130(1) Education;(2) Symptom monitoring;(3) General support;(4) Specific support;(5) Focused psychotherapy;(6) Cognitive restructuring and clarification;(7) Behavior awareness, reinforcement, and modification;(8) Personal insight and understanding;(9) Existential psychotherapy;(10) Termination;(11) Booster sessions.This approach has grown out of over 25 years of the author s clinical practice,observations, and conversa-tions with patients and their families.Each of the modulesincorporates and borrows from a host of psychotherapy methods and helping skills thathave been researched and perfected over the years by countless master therapists.MEP isa framework designed to help the therapist plan a comprehensive therapeutic approachfor addressing the multifaceted problems and strengths of people whose lives have beencomplicated by serious psychiatric illnesses.The efficacy of using psychotherapy as anadd-on to medication treatment for patients with bipolar disorders is well documentedand accepted1,17,18.A list of references supporting the importance, role and effectivenessof, and major methods used in psychotherapy is provided below.However, the followingrules, beliefs, values, and concepts capture the philosophy and spirit of the MEPframework:(1) The therapist must continuously reassess the person for mania, depression, psychosis,substance abuse, suicide, and anxiety.(2) The order in which the modules and methods are applied depends on the client sneeds and the environmental context.The therapist is responsible for transitioning tothe most appropriate module as changes occur in the patient s illness, personal andfamily needs, and environment.(3) The therapist needs to know more about bipolar disorders, medication, andpsychotherapy than the patient.(4) Psychotherapy stops or shifts to a concrete supportive role during periods of mania,severe depression, or psychosis.(5) The therapist must always be ready to shift from therapy to support.(6) The involvement of family and significant others in treatment planning, informationsharing, education, support, and problemsolving is a constant treatment goal.(7) Family members are periodically included in therapy sessions, and an attempt is madealways to include family members during periods of crises and when major treatment,life, time, or economic decisions are to be made.(8) Treatment should never isolate the patient from the family and significant others, andtreatment as often as possible should include the family and significant others.(9) The perceptions, observations, beliefs, concerns, and culture of the patient and familyare not only listened to, but also validated and respected, and, when not in conflictwith sound treatment, incorporated into the psychotherapy process [ Pobierz całość w formacie PDF ]

zanotowane.pl

doc.pisz.pl

pdf.pisz.pl

bezglutenowo.pev.pl