Terapia y Tratamiento

8/20/2019 Terapia y Tratamiento

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Chapter 16

Therapy and Treatment

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Chapter Outline

16.1 BKQ>I B>IQE OB>QJBKQ: >PQ >KA OBPBKQ

16.2 VMBP LC OB>QJBKQ

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16.5 EB L@FL@RIQRO>I LABI >KA EBO>MV QFIFW>QFLK

Introduction

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16.1 Mental Health Treatment: Past and Present

Learning Objectives

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LINK TO LEARNING



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OBRKFCF@>QFLK. LO LQEBO @EFIAOBK TELPB M>OBKQP >OB RK>IB QL @E>KDBoCLO BU>JMIB, QEB M>OBKQ LO M>OBKQPTEL >OB EB>SFIV >AAF@QBA QL AORDP >KA OBCRPB QL BKQBO QOB>QJBKQoQEB DL>I LC QEBO>MV JFDEQ B QL EBIM QEB@EFIAOBK >AGRPQ QL CLPQBO @>OB >KA/LO >ALMQFLK (Figure 16.8).

Figure 16.8 EBO>MV TFQE @EFIAOBK J>V FKSLISB MI>V. (@OBAFQ: iFW>OFB=!+j/IF@H4)

LJB MBLMIB PBBH QEBO>MV B@>RPB QEB @OFJFK>I GRPQF@B PVPQBJ OBCBOOBA QEBJ LO OBNRFOBA QEBJ QL DL. LOPLJB FKAFSFAR>IP, CLO BU>JMIB, >QQBKAFKD TBBHIV @LRKPBIFKD PBPPFLKP JFDEQ B > @LKAFQFLK LC M>OLIB. C >K FKAFSFAR>I FP J>KA>QBA QL >QQBKA QEBO>MV, PEB FP PBBHFKD PBOSF@BP FKSLIRKQ>OFIV. Involuntary treatmentOBCBOP QL QEBO>MV QE>Q FP KLQ QEB FKAFSFAR>IsP @ELF@B. QEBO FKAFSFAR>IP JFDEQ SLIRKQ>OFIV PBBH QOB>QJBKQ.Voluntary treatment JB>KP QEB MBOPLK @ELLPBP QL >QQBKA QEBO>MV QL LQ>FK OBIFBC COLJ PVJMQLJP.

PV@ELILDF@>I QOB>QJBKQ @>K L@@RO FK > S>OFBQV LC MI>@BP. K FKAFSFAR>I JFDEQ DL QL > @LJJRKFQV JBKQ>IEB>IQE @BKQBO LO > MO>@QFQFLKBO FK MOFS>QB LO @LJJRKFQV MO>@QF@B. @EFIA JFDEQ PBB > P@ELLI @LRKPBILO,P@ELLI MPV@ELILDFPQ, LO P@ELLI PL@F>I TLOHBO. K FK@>O@BO>QBA MBOPLK JFDEQ OB@BFSB DOLRM QEBO>MV FKMOFPLK. EBOB >OB J>KV AFCCBOBKQ QVMBP LC QOB>QJBKQ MOLSFABOP, >KA IF@BKPFKD OBNRFOBJBKQP S>OV COLJ PQ>QBQL PQ>QB. BPFABP MPV@ELILDFPQP >KA MPV@EF>QOFPQP, QEBOB >OB @IFKF@>I PL@F>I TLOHBOP, J>OOF>DB >KA C>JFIVQEBO>MFPQP, >KA QO>FKBA OBIFDFLRP MBOPLKKBI TEL >IPL MBOCLOJ @LRKPBIFKD >KA QEBO>MV.

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

FKAFKD QOB>QJBKQ PLRO@BP FP >IPL KLQ >IT>VP B>PV: QEBOB J>V B IFJFQBA LMQFLKP, BPMB@F>IIV FK ORO>I >OB>P>KA ILT-FK@LJB RO>K >OB>P; T>FQFKD IFPQP; MLLO NR>IFQV LC @>OB >S>FI>IB CLO FKAFDBKQ M>QFBKQP; >KA CFK>K@F>ILPQ>@IBP PR@E >P @L-M>VP, ABAR@QFIBP, >KA QFJB LCC COLJ TLOH. SBO 85% LC QEB I,669 CBABO>IIV ABPFDK>QBAJBKQ>I EB>IQE MOLCBPPFLK>I PELOQ>DB >OB>P >OB ORO>I; LCQBK MOFJ>OV @>OB MEVPF@F>KP >KA I>T BKCLO@BJBKQ>OB QEB CFOPQ-IFKB JBKQ>I EB>IQE MOLSFABOP (SBV, @EBCCIBO, & >WW>IF, 1998), >IQELRDE QEBV AL KLQ E>SB QEBPMB@F>IFWBA QO>FKFKD LC > JBKQ>I EB>IQE MOLCBPPFLK>I, TEL LCQBK TLRIA B BQQBO BNRFMMBA QL MOLSFAB @>OB.S>FI>FIFQV, >@@BPPFFIFQV, >KA >@@BMQ>FIFQV (QEB PQFDJ> >QQ>@EBA QL JBKQ>I FIIKBPP) >OB >II MOLIBJP FK ORO>I>OB>P. MMOLUFJ>QBIV QTL-QEFOAP LC QELPB TFQE PVJMQLJP OB@BFSB KL @>OB >Q >II (.. BM>OQJBKQ LC B>IQE

>KA RJ>K BOSF@BP, 2005; >DBKCBIA, ROO>V, LE>QQ, & BORFVK, 1994). Q QEB BKA LC 2013, QEB ..BM>OQJBKQ LC DOF@RIQROB >KKLRK@BA >K FKSBPQJBKQ LC $50 JFIIFLK QL EBIM FJMOLSB >@@BPP >KA QOB>QJBKQCLO JBKQ>I EB>IQE MOLIBJP >P M>OQ LC QEB >J> >AJFKFPQO>QFLKsP BCCLOQ QL PQOBKDQEBK ORO>I @LJJRKFQFBP.



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16.2 Types of Treatment

Learning Objectives

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PMB@FCF@ MPV@ELILDF@>I AFPLOABOP

KB LC QEB DL>IP LC QEBO>MV FP QL EBIM > MBOPLK PQLM OBMB>QFKD >KA OBBK>@QFKD ABPQOR@QFSB M>QQBOKP >KA QLPQ>OQ ILLHFKD CLO BQQBO PLIRQFLKP QL AFCCF@RIQ PFQR>QFLKP. EFP DL>I FP OBCIB@QBA FK QEB CLIILTFKD MLBJ:

Autobiography in Five Short Chapters V LOQF> BIPLK (1993)

E>MQBO KB T>IH ALTK QEB PQOBBQ.EBOB FP > ABBM ELIB FK QEB PFABT>IH. C>II FK.

>J ILPQ. . . . >J EBIMIBPP.Q FPK'Q JV C>RIQ.Q Q>HBP CLOBSBO QL CFKA > T>V LRQ.

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E>MQBO LRO T>IH ALTK QEB P>JB PQOBBQ.

EBOB FP > ABBM ELIB FK QEB PFABT>IH. T>IH >OLRKA FQ.

E>MQBO FSB T>IH ALTK >KLQEBO PQOBBQ.

TL QVMBP LC QEBO>MV >OB MPV@ELQEBO>MV >KA FLJBAF@>I QEBO>MV. LQE QVMBP LC QOB>QJBKQ EBIM MBLMIB TFQEMPV@ELILDF@>I AFPLOABOP, PR@E >P ABMOBPPFLK, >KUFBQV, >KA P@EFWLMEOBKF>. Psychotherapy FP > MPV@ELILDF@>IQOB>QJBKQ QE>Q BJMILVP S>OFLRP JBQELAP QL EBIM PLJBLKB LSBO@LJB MBOPLK>I MOLIBJP, LO QL >QQ>FKMBOPLK>I DOLTQE. K JLABOK MO>@QF@B, FQ E>P BSLISBA FKL TE>Q FP HKLTK >P MPV@ELAVK>JF@ QEBO>MV,TEF@E TFII B AFP@RPPBA I>QBO. Biomedical therapy FKSLISBP JBAF@>QFLK >KA/LO JBAF@>I MOL@BAROBP QL




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QOB>Q MPV@ELILDF@>I AFPLOABOP. FOPQ, TB TFII BUMILOB QEB S>OFLRP MPV@ELQEBO>MBRQF@ LOFBKQ>QFLKP LRQIFKBA FKTable 16.1 (J>KV LC QEBPB LOFBKQ>QFLKP TBOB AFP@RPPBA FK QEB KQOLAR@QFLK @E>MQBO).

Table 16.1 Various Psychotherapy Techniques

Type Description Example

PV@ELAVK>JF@MPV@ELQEBO>MV >IH QEBO>MV >PBA LK BIFBC QE>Q QEBRK@LKP@FLRP >KA @EFIAELLA @LKCIF@QPFJM>@Q BE>SFLO

>QFBKQ Q>IHP >LRQ EFP M>PQ

I>V QEBO>MV PV@EL>K>IVQF@>I QEBO>MV TEBOBFKFKQBO>@QFLK TFQE QLVP FP RPBA FKPQB>A LC Q>IH; RPBA FK @EFIA QEBO>MV

>QFBKQ (@EFIA) >@QP LRQ C>JFIV P@BKBPTFQE ALIIP

BE>SFLOQEBO>MV

OFK@FMIBP LC IB>OKFKD >MMIFBA QL @E>KDBRKABPFO>IB BE>SFLOP

>QFBKQ IB>OKP QL LSBO@LJB CB>O LC BIBS>QLOP QEOLRDE PBSBO>I PQ>DBP LC OBI>U>QFLK QB@EKFNRBP

LDKFQFSBQEBO>MV T>OBKBPP LC @LDKFQFSB MOL@BPP EBIMPM>QFBKQP BIFJFK>QB QELRDEQ M>QQBOKP QE>QIB>A QL AFPQOBPP

>QFBKQ IB>OKP KLQ QL LSBODBKBO>IFWBC>FIROB >PBA LK PFKDIB C>FIROB

LDKFQFSB- BE>SFLO>IQEBO>MV

LOH QL @E>KDB @LDKFQFSB AFPQLOQFLKP >KAPBIC-ABCB>QFKD BE>SFLOP

>QFBKQ IB>OKP QL FABKQFCV PBIC-ABCB>QFKD BE>SFLOP QL LSBO@LJB >KB>QFKD AFPLOABO

RJ>KFPQF@QEBO>MV

K@OB>PB PBIC->T>OBKBPP >KA >@@BMQ>K@BQEOLRDE CL@RP LK @LKP@FLRP QELRDEQP

>QFBKQ IB>OKP QL >OQF@RI>QB QELRDEQPQE>Q HBBM EBO COLJ >@EFBSFKD EBODL>IP

PSYCHOTHERAPY TECHNIQUES: PSYCHOANALYSIS

PV@EL>K>IVPFP T>P ABSBILMBA V FDJRKA OBRA >KA T>P QEB CFOPQ CLOJ LC MPV@ELQEBO>MV. Q T>PQEB ALJFK>KQ QEBO>MBRQF@ QB@EKFNRB FK QEB B>OIV 20QE @BKQROV, RQ FQ E>P PFK@B T>KBA PFDKFCF@>KQIV FKMLMRI>OFQV. OBRA BIFBSBA JLPQ LC LRO MPV@ELILDF@>I MOLIBJP >OB QEB OBPRIQ LC OBMOBPPBA FJMRIPBP>KA QO>RJ> BUMBOFBK@BA FK @EFIAELLA, >KA EB BIFBSBA MPV@EL>K>IVPFP TLRIA EBIM RK@LSBO ILKD-ROFBACBBIFKDP. K > MPV@EL>K>IVPQsP LCCF@B, VLR JFDEQ PBB > M>QFBKQ IVFKD LK > @LR@E PMB>HFKD LC AOB>JP LO@EFIAELLA JBJLOFBP, >KA QEB QEBO>MFPQ RPFKD S>OFLRP OBRAF>K JBQELAP PR@E >P COBB >PPL@F>QFLK >KA AOB>J>K>IVPFP (Figure 16.9). K free association, QEB M>QFBKQ OBI>UBP >KA QEBK P>VP TE>QBSBO @LJBP QL JFKA >Q QEBJLJBKQ. LTBSBO, OBRA CBIQ QE>Q QEB BDL TLRIA >Q QFJBP QOV QL IL@H, LO OBMOBPP, RK>@@BMQ>IB RODBP LOM>FKCRI @LKCIF@QP AROFKD COBB >PPL@F>QFLK. LKPBNRBKQIV, > M>QFBKQ TLRIA ABJLKPQO>QB OBPFPQ>K@B QL OB@>IIFKDQEBPB QELRDEQP LO PFQR>QFLKP. K dream analysis, > QEBO>MFPQ FKQBOMOBQP QEB RKABOIVFKD JB>KFKD LC AOB>JP.

PV@EL>K>IVPFP FP > QEBO>MV >MMOL>@E QE>Q QVMF@>IIV Q>HBP VB>OP. SBO QEB @LROPB LC QFJB, QEB M>QFBKQOBSB>IP > DOB>Q AB>I >LRQ EFJPBIC QL QEB QEBO>MFPQ. OBRA PRDDBPQBA QE>Q AROFKD QEFP M>QFBKQ-QEBO>MFPQOBI>QFLKPEFM, QEB M>QFBKQ @LJBP QL ABSBILM PQOLKD CBBIFKDP CLO QEB QEBO>MFPQoJ>VB MLPFQFSB CBBIFKDP,J>VB KBD>QFSB CBBIFKDP. OBRA @>IIBA QEFP transference: QEB M>QFBKQ QO>KPCBOP >II QEB MLPFQFSB LO KBD>QFSBBJLQFLKP >PPL@F>QBA TFQE QEB M>QFBKQsP LQEBO OBI>QFLKPEFMP QL QEB MPV@EL>K>IVPQ. LO BU>JMIB, OVPQ>I FPPBBFKD > MPV@EL>K>IVPQ. ROFKD QEB VB>OP LC QEBO>MV, PEB @LJBP QL PBB EBO QEBO>MFPQ >P > C>QEBO CFDROB. EBQO>KPCBOP EBO CBBIFKDP >LRQ EBO C>QEBO LKQL EBO QEBO>MFPQ, MBOE>MP FK >K BCCLOQ QL D>FK QEB ILSB >KA >QQBKQFLKPEB AFA KLQ OB@BFSB COLJ EBO LTK C>QEBO.



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Figure 16.9 EFP FP QEB C>JLRP @LR@E FK OBRAhP @LKPRIQFKD OLLJ. >QFBKQP TBOB FKPQOR@QBA QL IFB @LJCLOQ>IV LK QEB

@LR@E >KA QL C>@B >T>V COLJ OBRA FK LOABO QL CBBI IBPP FKEFFQBA >KA QL EBIM QEBJ CL@RP. LA>V, > MPV@ELQEBO>MV

M>QFBKQ FP KLQ IFHBIV QL IFB LK > @LR@E; FKPQB>A EB FP JLOB IFHBIV QL PFQ C>@FKD QEB QEBO>MFPQ (OL@E>PH> & LO@OLPP,

2010). (@OBAFQ: LBOQ RCCPQRQQBO)

LA>V, OBRAsP MPV@EL>K>IVQF@>I MBOPMB@QFSB E>P BBK BUM>KABA RMLK V QEB ABSBILMJBKQP LC PRPBNRBKQQEBLOFBP >KA JBQELALILDFBP: QEB MPV@ELAVK>JF@ MBOPMB@QFSB. EFP >MMOL>@E QL QEBO>MV OBJ>FKP @BKQBOBALK QEB OLIB LC MBLMIBsP FKQBOK>I AOFSBP >KA CLO@BP, RQ QOB>QJBKQ FP IBPP FKQBKPFSB QE>K OBRAsP LOFDFK>IJLABI.

FBT > brief video (http://openstaxcollege.org/l/psycanalysis) QE>Q MOBPBKQP >K

LSBOSFBT LC MPV@EL>K>IVPFP QEBLOV, OBPB>O@E, >KA MO>@QF@B.

PSYCHOTHERAPY: PLAY THERAPY

Play therapy FP LCQBK RPBA TFQE @EFIAOBK PFK@B QEBV >OB KLQ IFHBIV QL PFQ LK > @LR@E >KA OB@>II QEBFO AOB>JPLO BKD>DB FK QO>AFQFLK>I Q>IH QEBO>MV. EFP QB@EKFNRB RPBP > QEBO>MBRQF@ MOL@BPP LC MI>V QL pEBIM @IFBKQPMOBSBKQ LO OBPLISB MPV@ELPL@F>I AFCCF@RIQFBP >KA >@EFBSB LMQFJ>I DOLTQEq (sLKKLO, 2000, M. 7). EBFAB> FP QE>Q @EFIAOBK MI>V LRQ QEBFO ELMBP, C>KQ>PFBP, >KA QO>RJ>P TEFIB RPFKD ALIIP, PQRCCBA >KFJ>IP, >KAP>KALU CFDROFKBP (Figure 16.10). I>V QEBO>MV @>K >IPL B RPBA QL EBIM > QEBO>MFPQ J>HB > AF>DKLPFP. EBQEBO>MFPQ LPBOSBP ELT QEB @EFIA FKQBO>@QP TFQE QLVP (B.D., ALIIP, >KFJ>IP, >KA ELJB PBQQFKDP) FK >K BCCLOQQL RKABOPQ>KA QEB OLLQP LC QEB @EFIAsP AFPQROBA BE>SFLO. I>V QEBO>MV @>K B KLKAFOB@QFSB LO [email protected] KLKAFOB@QFSB MI>V QEBO>MV, @EFIAOBK >OB BK@LRO>DBA QL TLOH QEOLRDE QEBFO MOLIBJP V MI>VFKD COBBIVTEFIB QEB QEBO>MFPQ LPBOSBP (BI>K@ & FQ@EFB, 2001). K AFOB@QFSB MI>V QEBO>MV, QEB QEBO>MFPQ MOLSFABPJLOB PQOR@QROB >KA DRFA>K@B FK QEB MI>V PBPPFLK V PRDDBPQFKD QLMF@P, >PHFKD NRBPQFLKP, >KA BSBK MI>VFKDTFQE QEB @EFIA (>OQBO, 1977).

LINK TO LEARNING



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Figure 16.10 EFP QVMB LC MI>V QEBO>MV FP HKLTK >P P>KAMI>V LO P>KAQO>V QEBO>MV. #EFIAOBK @>K PBQ RM > QEOBB-

AFJBKPFLK>I TLOIA RPFKD S>OFLRP CFDROBP >KA LGB@QP QE>Q @LOOBPMLKA QL QEBFO FKKBO PQ>QB (+>ICC, 1991). (@OBAFQ: +OFPQFK>

>IQBO)

PSYCHOTHERAPY: BEHAVIOR THERAPY

K psychoanalysis, QEBO>MFPQP EBIM QEBFO M>QFBKQP ILLH FKQL QEBFO M>PQ QL RK@LSBO OBMOBPPBA CBBIFKDP. Kbehavior therapy, > QEBO>MFPQ BJMILVP MOFK@FMIBP LC IB>OKFKD QL EBIM @IFBKQP @E>KDB RKABPFO>IB BE>SFLOPoO>QEBO QE>K AFDDFKD ABBMIV FKQL LKBsP RK@LKP@FLRP. EBO>MFPQP TFQE QEFP LOFBKQ>QFLK BIFBSBQE>Q AVPCRK@QFLK>I BE>SFLOP, IFHB MELF>P >KA BATBQQFKD, @>K B @E>KDBA V QB>@EFKD @IFBKQP KBT, JLOB

@LKPQOR@QFSB BE>SFLOP. BE>SFLO QEBO>MV BJMILVP LQE @I>PPF@>I >KA LMBO>KQ @LKAFQFLKFKD QB@EKFNRBP QL@E>KDB BE>SFLO.

KB QVMB LC BE>SFLO QEBO>MV RQFIFWBP @I>PPF@>I @LKAFQFLKFKD QB@EKFNRBP. EBO>MFPQP RPFKD QEBPB QB@EKFNRBP BIFBSB QE>Q AVPCRK@QFLK>I BE>SFLOP >OB @LKAFQFLKBA OBPMLKPBP. MMIVFKD QEB @LKAFQFLKFKD MOFK@FMIBPABSBILMBA V S>K >SILS, QEBPB QEBO>MFPQP PBBH QL OB@LKAFQFLK QEBFO @IFBKQP >KA QERP @E>KDB QEBFO BE>SFLO.JJFB FP BFDEQ VB>OP LIA, >KA COBNRBKQIV TBQP EBO BA >Q KFDEQ. EBsP BBK FKSFQBA QL PBSBO>I PIBBMLSBOP, RQ PEB TLKsQ DL B@>RPB LC EBO MOLIBJ. PFKD > QVMB LC @LKAFQFLKFKD QEBO>MV, JJFB BDFKP QL PIBBMLK > IFNRFA-PBKPFQFSB BA M>A QE>Q FP ELLHBA QL >K >I>OJ. EBK JLFPQROB QLR@EBP QEB M>A, FQ PBQP LCC QEB>I>OJ, T>HFKD RM JJFB. EBK QEFP MOL@BPP FP OBMB>QBA BKLRDE QFJBP, JJFB ABSBILMP >K >PPL@F>QFLK BQTBBK ROFK>OV OBI>U>QFLK >KA T>HFKD RM, >KA QEFP PQLMP QEB BATBQQFKD. JJFB E>P KLT DLKB QEOBBTBBHP TFQELRQ TBQQFKD EBO BA >KA FP ILLHFKD CLOT>OA QL EBO CFOPQ PIBBMLSBO QEFP TBBHBKA.

KB @LJJLKIV RPBA @I>PPF@>I @LKAFQFLKFKD QEBO>MBRQF@ QB@EKFNRB FP counterconditioning: > @IFBKQ IB>OKP >KBT OBPMLKPB QL > PQFJRIRP QE>Q E>P MOBSFLRPIV BIF@FQBA >K RKABPFO>IB BE>SFLO. TL @LRKQBO@LKAFQFLKFKDQB@EKFNRBP >OB >SBOPFSB @LKAFQFLKFKD >KA BUMLPROB QEBO>MV. Aversive conditioning RPBP >K RKMIB>P>KQPQFJRIRP QL PQLM >K RKABPFO>IB BE>SFLO. EBO>MFPQP >MMIV QEFP QB@EKFNRB QL BIFJFK>QB >AAF@QFSB BE>SFLOP,PR@E >P PJLHFKD, K>FI FQFKD, >KA AOFKHFKD. K >SBOPFLK QEBO>MV, @IFBKQP TFII QVMF@>IIV BKD>DB FK > PMB@FCF@ BE>SFLO (PR@E >P K>FI FQFKD) >KA >Q QEB P>JB QFJB >OB BUMLPBA QL PLJBQEFKD RKMIB>P>KQ, PR@E >P >JFIA BIB@QOF@ PEL@H LO > >A Q>PQB. CQBO OBMB>QBA >PPL@F>QFLKP BQTBBK QEB RKMIB>P>KQ PQFJRIRP >KA QEB BE>SFLO, QEB @IFBKQ @>K IB>OK QL PQLM QEB RKT>KQBA BE>SFLO.

SBOPFLK QEBO>MV E>P BBK RPBA BCCB@QFSBIV CLO VB>OP FK QEB QOB>QJBKQ LC >I@LELIFPJ (>SFAPLK, 1974;IHFKP, 1991; QOBBQLK & EBI>K, 2001). KB @LJJLK T>V QEFP L@@ROP FP QEOLRDE > @EBJF@>IIV >PBAPRPQ>K@B HKLTK >P KQ>RPB. EBK > MBOPLK Q>HBP KQ>RPB >KA QEBK @LKPRJBP >I@LELI, RK@LJCLOQ>IB

PFAB BCCB@QP OBPRIQ FK@IRAFKD K>RPB>, SLJFQFKD, FK@OB>PBA EB>OQ O>QB, EB>OQ M>IMFQ>QFLKP, PBSBOB EB>A>@EB,>KA PELOQKBPP LC OB>QE. KQ>RPB FP OBMB>QBAIV M>FOBA TFQE >I@LELI RKQFI QEB @IFBKQ >PPL@F>QBP >I@LELITFQE RKMIB>P>KQ CBBIFKDP, TEF@E AB@OB>PBP QEB @IFBKQsP ABPFOB QL @LKPRJB >I@LELI. KQ>RPB @OB>QBP >@LKAFQFLKBA >SBOPFLK QL >I@LELI B@>RPB FQ OBMI>@BP QEB LOFDFK>I MIB>PROB OBPMLKPB TFQE >K RKMIB>P>KQ LKB.

K exposure therapy, > QEBO>MFPQ PBBHP QL QOB>Q @IFBKQPs CB>OP LO >KUFBQV V MOBPBKQFKD QEBJ TFQE QEB LGB@QLO PFQR>QFLK QE>Q @>RPBP QEBFO MOLIBJ, TFQE QEB FAB> QE>Q QEBV TFII BSBKQR>IIV DBQ RPBA QL FQ. EFP @>K BALKB SF> OB>IFQV, FJ>DFK>QFLK, LO SFOQR>I OB>IFQV. UMLPROB QEBO>MV T>P CFOPQ OBMLOQBA FK 1924 V >OV LSBO *LKBP, TEL FP @LKPFABOBA QEB JLQEBO LC BE>SFLO QEBO>MV. *LKBP TLOHBA TFQE > LV K>JBA BQBO TEL T>P>CO>FA LC O>FQP. BO DL>I T>P QL OBMI>@B BQBOsP CB>O LC O>FQP TFQE > @LKAFQFLKBA OBPMLKPB LC OBI>U>QFLK,



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LT BCCB@QFSB FP ? KB @IFBKQ P>FA QEFP >LRQ EFP @LDKFQFSB-BE>SFLO>I QEBO>MV:

E>SB E>A J>KV M>FKCRI BMFPLABP LC ABMOBPPFLK FK JV IFCB, >KA QEFP E>P E>A > KBD>QFSB BCCB@QLK JV @>OBBO >KA E>P MRQ @LKPFABO>IB PQO>FK LK JV COFBKAP >KA C>JFIV. EB QOB>QJBKQP E>SB

OB@BFSBA, PR@E >P Q>HFKD >KQFABMOBPP>KQP >KA MPV@ELAVK>JF@ @LRKPBIFKD, E>SB EBIMBA JB< QL@LMB TFQE QEB PVJMQLJP >KA QL DBQ PLJB FKPFDEQP FKQL QEB OLLQP LC JV MOLIBJP. E>P BBK V C>O QEB JLPQ RPBCRI >MMOL>@E E>SB CLRKA FK Q>@HIFKD QEBPB JLLA MOLIBJP. Q E>P O>FPBAJV >T>OBKBPP LC ELT JV QELRDEQP FJM>@Q LK JV JLLAP. LT QEB T>V QEFKH >LRQ JVPBIC,>LRQ LQEBOP >KA >LRQ QEB TLOIA @>K IB>A JB FKQL ABMOBPPFLK. Q FP > MO>@QF@>I >MMOL>@E, TEF@EALBP KLQ ATBII PL JR@E LK @EFIAELLA BUMBOFBK@BP, TEFIPQ >@HKLTIBADFKD QE>Q FQ T>P QEBK QE>QQEBPB M>QQBOKP TBOB IB>OKBA. Q ILLHP >Q TE>Q FP E>MMBKFKD KLT, >KA DFSBP QLLIP QL J>K>DB QEBPBJLLAP LK > A>FIV >PFP. (>OQFK, 2007, K.M.)

PSYCHOTHERAPY: HUMANISTIC THERAPY

RJ>KFPQF@ MPV@ELILDV CL@RPBP LK EBIMFKD MBLMIB >@EFBSB QEBFO MLQBKQF>I. L FQ J>HBP PBKPB QE>Q QEB DL>ILC humanistic therapy FP QL EBIM MBLMIB B@LJB JLOB PBIC->T>OB >KA >@@BMQFKD LC QEBJPBISBP. K @LKQO>PQQL MPV@EL>K>IVPFP, ERJ>KFPQF@ QEBO>MFPQP CL@RP LK @LKP@FLRP O>QEBO QE>K RK@LKP@FLRP QELRDEQP. EBV >IPLBJME>PFWB QEB M>QFBKQsP MOBPBKQ >KA CRQROB, >P LMMLPBA QL BUMILOFKD QEB M>QFBKQsP M>PQ.

PV@ELILDFPQ >OI LDBOP ABSBILMBA > QEBO>MBRQF@ LOFBKQ>QFLK HKLTK >P Rogerian, LO client-centeredtherapy. LQB QEB @E>KDB COLJ patients QL clients. LDBOP (1951) CBIQ QE>Q QEB QBOJ M>QFBKQ PRDDBPQBA QEBMBOPLK PBBHFKD EBIM T>P PF@H >KA ILLHFKD CLO > @ROB. FK@B QEFP FP > CLOJ LC nondirective therapy, >QEBO>MBRQF@ >MMOL>@E FK TEF@E QEB QEBO>MFPQ ALBP KLQ DFSB >ASF@B LO MOLSFAB FKQBOMOBQ>QFLKP RQ EBIMPQEB MBOPLK QL FABKQFCV @LKCIF@QP >KA RKABOPQ>KA CBBIFKDP, LDBOP (1951) BJME>PFWBA QEB FJMLOQ>K@B LC QEBMBOPLK Q>HFKD @LKQOLI LC EFP LTK IFCB QL LSBO@LJB IFCBsP @E>IIBKDBP.




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K @IFBKQ-@BKQBOBA QEBO>MV, QEB QEBO>MFPQ RPBP QEB QB@EKFNRB LC >@QFSB IFPQBKFKD. K >@QFSB IFPQBKFKD, QEBQEBO>MFPQ >@HKLTIBADBP, OBPQ>QBP, >KA @I>OFCFBP TE>Q QEB @IFBKQ BUMOBPPBP. EBO>MFPQP >IPL MO>@QF@B TE>QLDBOP @>IIBA unconditional positive regard, TEF@E FKSLISBP KLQ GRADFKD @IFBKQP >KA PFJMIV >@@BMQFKDQEBJ CLO TEL QEBV >OB. LDBOP (1951) >IPL CBIQ QE>Q QEBO>MFPQP PELRIA ABJLKPQO>QB DBKRFKBKBPP, BJM>QEV,>KA >@@BMQ>K@B QLT>OA QEBFO @IFBKQP B@>RPB QEFP EBIMP MBLMIB B@LJB JLOB >@@BMQFKD LC QEBJPBISBP, TEF@EOBPRIQP FK MBOPLK>I DOLTQE.

EVALUATING VARIOUS FORMS OF PSYCHOTHERAPY

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sP >KUFBQV, ABMOBPPFLK, >KA J>I>A>MQFSB BE>SFLOP. EOLRDEMPV@ELQEBO>MV, FKAFSFAR>IP @>K IB>OK QL BKD>DB FK EB>IQEV BE>SFLOP ABPFDKBA QL EBIM QEBJ BQQBO BUMOBPPBJLQFLKP, FJMOLSB OBI>QFLKPEFMP, QEFKH JLOB MLPFQFSBIV, >KA MBOCLOJ JLOB BCCB@QFSBIV >Q TLOH LO P@ELLI.

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sP QOB>QJBKQ LRQ@LJB >KA QEB IBSBILC QEB @IFKF@F>KsP QO>FKFKD LO BUMBOFBK@B (>JMLIA, 2007). BD>OAIBPP LC TEF@E QVMB LC MPV@ELQEBO>MV >KFKAFSFAR>I @ELLPBP, LKB @OFQF@>I C>@QLO QE>Q ABQBOJFKBP QEB PR@@BPP LC QOB>QJBKQ FP QEB MBOPLKsP OBI>QFLKPEFM

TFQE QEB MPV@ELILDFPQ LO QEBO>MFPQ.

BIOMEDICAL THERAPIES

KAFSFAR>IP @>K B MOBP@OFBA FLILDF@>IIV >PBA QOB>QJBKQP LO MPV@ELQOLMF@ JBAF@>QFLKP QE>Q >OB RPBAQL QOB>Q JBKQ>I AFPLOABOP. EFIB QEBPB >OB LCQBK RPBA FK @LJFK>QFLK TFQE MPV@ELQEBO>MV, QEBV >IPL>OB Q>HBK V FKAFSFAR>IP KLQ FK QEBO>MV. EFP FP HKLTK >P biomedical therapy. BAF@>QFLKP RPBA QLQOB>Q MPV@ELILDF@>I AFPLOABOP >OB @>IIBA MPV@ELQOLMF@ JBAF@>QFLKP >KA >OB MOBP@OFBA V JBAF@>I AL@QLOP,FK@IRAFKD MPV@EF>QOFPQP. K LRFPF>K> >KA BT BUF@L, MPV@ELILDFPQP >OB >IB QL MOBP@OFB PLJB QVMBP LC QEBPB JBAF@>QFLKP (JBOF@>K PV@ELILDF@>I PPL@F>QFLK, 2014).

FCCBOBKQ QVMBP >KA @I>PPBP LC JBAF@>QFLKP >OB MOBP@OFBA CLO AFCCBOBKQ AFPLOABOP. ABMOBPPBA MBOPLK JFDEQ B DFSBK >K >KQFABMOBPP>KQ, > FMLI>O FKAFSFAR>I JFDEQ B DFSBK > JLLA PQ>FIFWBO, >KA > P@EFWLMEOBKF@

FKAFSFAR>I JFDEQ B DFSBK >K >KQFMPV@ELQF@. EBPB JBAF@>QFLKP QOB>Q QEB PVJMQLJP LC > MPV@ELILDF@>IAFPLOABO. EBV @>K EBIM MBLMIB CBBI BQQBO PL QE>Q QEBV @>K CRK@QFLK LK > A>FIV >PFP, RQ QEBV AL KLQ @ROB QEBAFPLOABO. LJB MBLMIB J>V LKIV KBBA QL Q>HB > MPV@ELQOLMF@ JBAF@>QFLK CLO > PELOQ MBOFLA LC QFJB. QEBOPTFQE PBSBOB AFPLOABOP IFHB FMLI>O AFPLOABO LO P@EFWLMEOBKF> J>V KBBA QL Q>HB MPV@ELQOLMF@ JBAF@>QFLK CLO> ILKD QFJB. Table 16.2 PELTP QEB QVMBP LC JBAF@>QFLK >KA ELT QEBV >OB RPBA.



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Table 16.2 Commonly Prescribed Psychotropic Medications

Type of

Medication

Used to

Treat

Brand

Names of

Commonly

Prescribed

Medications

How They Work Side Effects

KQFMPV@ELQF@P(ABSBILMBA FKQEB 1950P)

@EFWLMEOBKF>>KA LQEBOQVMBP LC PBSBOBQELRDEQAFPLOABOP

>IALI,BII>OFI,OLIFUFK,ELO>WFKB

OB>Q MLPFQFSB MPV@ELQF@PVJMQLJP PR@E >P>RAFQLOV >KA SFPR>IE>IIR@FK>QFLKP, ABIRPFLKP,>KA M>O>KLF> V IL@HFKDQEB KBROLQO>KPJFQQBOALM>JFKB

LKD-QBOJ RPB @>KIB>A QL Q>OAFSBAVPHFKBPF>,FKSLIRKQ>OVJLSBJBKQP LC QEB>OJP, IBDP, QLKDRB>KA C>@F>I JRP@IBP,OBPRIQFKD FK>OHFKPLKsP-IFHBQOBJLOP

QVMF@>IKQFMPV@ELQF@P(ABSBILMBA FKQEB I>QB 1980P)

@EFWLMEOBKF>>KA LQEBOQVMBP LC PBSBOBQELRDEQAFPLOABOP

FIFCV,FPMBOA>I,ILW>OFI

OB>Q QEB KBD>QFSBPVJMQLJP LC P@EFWLMEOBKF>, PR@E >PTFQEAO>T>I >KA >M>QEV, V Q>ODBQFKD LQEALM>JFKB >KA PBOLQLKFKOB@BMQLOP; KBTBOJBAF@>QFLKP J>V QOB>Q LQE MLPFQFSB >KAKBD>QFSB PVJMQLJP

>K FK@OB>PB QEBOFPH LC LBPFQV >KAAF>BQBP >P TBII >PBIBS>QB @ELIBPQBOLIIBSBIP;@LKPQFM>QFLK, AOVJLRQE, IROOBASFPFLK, AOLTPFKBPP,>KA AFWWFKBPP

KQF-ABMOBPP>KQP

BMOBPPFLK>KAFK@OB>PFKDIVCLO >KUFBQV

>UFI,OLW>@,LILCQ(PBIB@QFSBPBOLQLKFKOBRMQ>HBFKEFFQLOP,PKFI >KAI>SFI(QOF@V@IF@P)

IQBO IBSBIP LC KBROLQO>KPJFQQBOP PR@E >PPBOLQLKFK >KAKLOBMFKBMEOFKB

P: EB>A>@EB,K>RPB>, TBFDEQD>FK, AOLTPFKBPP,OBAR@BA PBU AOFSBOF@V@IF@P: AOVJLRQE,@LKPQFM>QFLK, IROOBA SFPFLK,AOLTPFKBPP,OBAR@BA PBU AOFSB,FK@OB>PBA OFPH LC

PRF@FAB




19/134

Table 16.2 Commonly Prescribed Psychotropic Medications

Type of

Medication

Used to

Treat

Brand

Names of

Commonly

Prescribed

Medications

How They Work Side Effects

KQF->KUFBQV>DBKQP

KUFBQV >KA>DFQ>QFLK QE>QL@@RO FK, ,M>KF@AFPLOABO, >KAPL@F>I MELF>

>K>U,>IFRJ,QFS>K

BMOBPP @BKQO>I KBOSLRPPVPQBJ >@QFSFQV

OLTPFKBPP,AFWWFKBPP,EB>A>@EB, C>QFDRB,IFDEQEB>ABAKBPP

LLAQ>FIFWBOP

FMLI>OAFPLOABO

FQEFRJ,BM>HLQB,

>JF@Q>I,BDOBQLI

OB>Q BMFPLABP LC J>KF>>P TBII >P ABMOBPPFLK

U@BPPFSB QEFOPQ,FOOBDRI>O

EB>OQB>Q, FQ@EFKD/O>PE, PTBIIFKD(C>@B, JLRQE, >KABUQOBJFQFBP),K>RPB>, ILPP LC >MMBQFQB

QFJRI>KQP AABO>II,FQ>IFK

JMOLSB >FIFQV QL CL@RPLK > Q>PH >KA J>FKQ>FK>QQBKQFLK

B@OB>PBA>MMBQFQB, AFCCF@RIQVPIBBMFKD,PQLJ>@E>@EB,EB>A>@EB

KLQEBO FLILDF@>IIV >PBA QOB>QJBKQ QE>Q @LKQFKRBP QL B RPBA, >IQELRDE FKCOBNRBKQIV, FPelectroconvulsive therapy (ECT) (CLOJBOIV HKLTK V FQP RKP@FBKQFCF@ K>JB >P BIB@QOLPEL@H QEBO>MV). QFKSLISBP RPFKD >K BIB@QOF@>I @ROOBKQ QL FKAR@B PBFWROBP QL EBIM >IIBSF>QB QEB BCCB@QP LC PBSBOB ABMOBPPFLK. EBBU>@Q JB@E>KFPJ FP RKHKLTK, >IQELRDE FQ ALBP EBIM >IIBSF>QB PVJMQLJP CLO MBLMIB TFQE PBSBOB ABMOBPPFLKTEL E>SB KLQ OBPMLKABA QL QO>AFQFLK>I AORD QEBO>MV (>DKFK, AB RBFOLW, FKF, & >PP>KL, 2004). LRQ85% LC MBLMIB QOB>QBA TFQE FJMOLSB (BQF, K.A.). LTBSBO, QEB JBJLOV ILPP >PPL@F>QBA TFQE OBMB>QBA>AJFKFPQO>QFLKP E>P IBA QL FQ BFKD FJMIBJBKQBA >P > I>PQ OBPLOQ (LK>ERB, 2000; ORAF@, BVPBO, & >@HBFJ,2000). JLOB OB@BKQ >IQBOK>QFSB FP QO>KP@O>KF>I J>DKBQF@ PQFJRI>QFLK (), > MOL@BAROB >MMOLSBA VQEB FK 2008 QE>Q RPBP J>DKBQF@ CFBIAP QL PQFJRI>QB KBOSB @BIIP FK QEB O>FK QL FJMOLSB ABMOBPPFLKPVJMQLJP; FQ FP RPBA TEBK LQEBO QOB>QJBKQP E>SB KLQ TLOHBA (>VL IFKF@, 2012).

Evidence-based Practice

! RWWTLOA FK QEBO>MV QLA>V FP BSFABK@B->PBA MO>@QF@B. LTBSBO, FQhP KLQ > KLSBI @LK@BMQ RQ LKB QE>Q

E>P BBK RPBA FK JBAF@FKB CLO >Q IB>PQ QTL AB@>ABP. SFABK@B->PBA MO>@QF@B FP RPBA QL OBAR@B BOOLOP FK

QOB>QJBKQ PBIB@QFLK V J>HFKD @IFKF@>I AB@FPFLKP >PBA LK OBPB>O@E (>@HBQQ & LPBKBOD, 1995). K >KV @>PB,

DIG DEEPER



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BSFABK@B->PBA QOB>QJBKQ FP LK QEB OFPB FK QEB CFBIA LC MPV@ELILDV. L TE>Q FP FQ, >KA TEV ALBP FQ J>QQBO? K

>K BCCLOQ QL ABQBOJFKB TEF@E QOB>QJBKQ JBQELALILDFBP >OB BSFABK@BA->PBA, MOLCBPPFLK>I LOD>KFW>QFLKP PR@E

>P QEB !JBOF@>K PV@ELILDF@>I !PPL@F>QFLK (!!) E>SB OB@LJJBKABA QE>Q PMB@FCF@ MPV@ELILDF@>I QOB>QJBKQP

B RPBA QL QOB>Q @BOQ>FK MPV@ELILDF@>I AFPLOABOP (#E>JIBPP & IIBKAF@H, 2001). !@@LOAFKD QL QEB !! (2005),

iSFABK@B->PBA MO>@QF@B FK MPV@ELILDV () FP QEB FKQBDO>QFLK LC QEB BPQ >S>FI>IB OBPB>O@E TFQE @IFKF@>I

BUMBOQFPB FK QEB @LKQBUQ LC M>QFBKQ @E>O>@QBOFPQF@P, @RIQROB, >KA MOBCBOBK@BPj (M. 1).

EB CLRKA>QFLK>I FAB> BEFKA BSFABK@B >PBA QOB>QJBKQ FP QE>Q BPQ MO>@QF@BP >OB ABQBOJFKBA V OBPB>O@E

BSFABK@B QE>Q E>P BBK @LJMFIBA V @LJM>OFKD S>OFLRP CLOJP LC QOB>QJBKQ (#E>OJ>K & >OHE>J, 2005).

EBPB QOB>QJBKQP >OB QEBK LMBO>QFLK>IFWBA >KA MI>@BA FK QOB>QJBKQ J>KR>IPfQO>FKBA QEBO>MFPQP CLIILT QEBPB

J>KR>IP. EB BKBCFQP >OB QE>Q BSFABK@B->PBA QOB>QJBKQ @>K OBAR@B S>OF>FIFQV BQTBBK QEBO>MFPQP QL BKPROB

QE>Q > PMB@FCF@ >MMOL>@E FP ABIFSBOBA TFQE FKQBDOFQV (#E>OJ>K & >OHE>J, 2005). EBOBCLOB, @IFBKQP E>SB >

EFDEBO @E>K@B LC OB@BFSFKD QEBO>MBRQF@ FKQBOSBKQFLKP QE>Q >OB BCCB@QFSB >Q QOB>QFKD QEBFO PMB@FCF@ AFPLOABO. EFIB

FP >PBA LK O>KALJFWBA @LKQOLI QOF>IP, @OFQF@P LC OBGB@Q FQ PQ>QFKD QE>Q QEB OBPRIQP LC QOF>IP @>KKLQ

B >MMIFBA QL FKAFSFAR>IP >KA FKPQB>A ABQBOJFK>QFLKP OBD>OAFKD QOB>QJBKQ PELRIA B >PBA LK > QEBO>MFPQhP

GRADJBKQ (RIIBK & QOBFKBO, 2004).

16.3 Treatment Modalities

Learning Objectives

V QEB BKA LC QEFP PB@QFLK, VLR TFII B >IB QL:k FPQFKDRFPE BQTBBK QEB S>OFLRP JLA>IFQFBP LC QOB>QJBKQk FP@RPP BKBCFQP LC DOLRM QEBO>MV

K@B > MBOPLK PBBHP QOB>QJBKQ, TEBQEBO SLIRKQ>OFIV LO FKSLIRKQ>OFIV, EB E>P >K intake ALKB QL >PPBPPEFP @IFKF@>I KBBAP. K FKQ>HB FP QEB QEBO>MFPQsP CFOPQ JBBQFKD TFQE QEB @IFBKQ. EB QEBO>MFPQ D>QEBOP PMB@FCF@FKCLOJ>QFLK QL >AAOBPP QEB @IFBKQsP FJJBAF>QB KBBAP, PR@E >P QEB MOBPBKQFKD MOLIBJ, QEB @IFBKQsP PRMMLOQ

PVPQBJ, >KA FKPRO>K@B PQ>QRP. EB QEBO>MFPQ FKCLOJP QEB @IFBKQ >LRQ @LKCFABKQF>IFQV, CBBP, >KA TE>Q QLBUMB@Q FK QOB>QJBKQ. Confidentiality JB>KP QEB QEBO>MFPQ @>KKLQ AFP@ILPB @LKCFABKQF>I @LJJRKF@>QFLKPQL >KV QEFOA M>OQV RKIBPP J>KA>QBA LO MBOJFQQBA V I>T QL AL PL. ROFKD QEB FKQ>HB, QEB QEBO>MFPQ >KA@IFBKQ TFII TLOH QLDBQEBO QL AFP@RPP QOB>QJBKQ DL>IP. EBK > QOB>QJBKQ MI>K TFII B CLOJRI>QBA, RPR>IIVTFQE PMB@FCF@ JB>PRO>IB LGB@QFSBP. IPL, QEB QEBO>MFPQ >KA @IFBKQ TFII AFP@RPP ELT QOB>QJBKQ PR@@BPP TFII B JB>PROBA >KA QEB BPQFJ>QBA IBKDQE LC QOB>QJBKQ. EBOB >OB PBSBO>I AFCCBOBKQ JLA>IFQFBP LC QOB>QJBKQ(Figure 16.14): KAFSFAR>I QEBO>MV, C>JFIV QEBO>MV, @LRMIBP QEBO>MV, >KA DOLRM QEBO>MV >OB QEB JLPQ@LJJLK.

Figure 16.14 EBO>MV J>V L@@RO (>) LKB-LK-LKB BQTBBK > QEBO>MFPQ >KA @IFBKQ, LO () FK > DOLRM PBQQFKD. (@OBAFQ >:

JLAFCF@>QFLK LC TLOH V #LKKLO !PEIBFDE, !RP!/BM>OQJBKQ LC LOBFDK !CC>FOP >KA O>AB)




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INDIVIDUAL THERAPY

K individual therapy, >IPL HKLTK >P FKAFSFAR>I MPV@ELQEBO>MV LO FKAFSFAR>I @LRKPBIFKD, QEB @IFBKQ >KA@IFKF@F>K JBBQ LKB-LK-LKB (RPR>IIV COLJ 45 JFKRQBP QL 1 ELRO). EBPB JBBQFKDP QVMF@>IIV L@@RO TBBHIV LOBSBOV LQEBO TBBH, >KA PBPPFLKP >OB @LKAR@QBA FK > @LKCFABKQF>I >KA @>OFKD BKSFOLKJBKQ (Figure 16.15).EB @IFKF@F>K TFII TLOH TFQE @IFBKQP QL EBIM QEBJ BUMILOB QEBFO CBBIFKDP, TLOH QEOLRDE IFCB @E>IIBKDBP,FABKQFCV >PMB@QP LC QEBJPBISBP >KA QEBFO IFSBP QE>Q QEBV TFPE QL @E>KDB, >KA PBQ DL>IP QL EBIM QEBJ TLOH

QLT>OAP QEBPB @E>KDBP. @IFBKQ JFDEQ PBB > @IFKF@F>K CLO LKIV > CBT PBPPFLKP, LO QEB @IFBKQ J>V >QQBKAFKAFSFAR>I QEBO>MV PBPPFLKP CLO > VB>O LO ILKDBO. EB >JLRKQ LC QFJB PMBKQ FK QEBO>MV ABMBKAP LK QEB KBBAPLC QEB @IFBKQ >P TBII >P EBO MBOPLK>I DL>IP.

Figure 16.15 K >K FKAFSFAR>I QEBO>MV PBPPFLK, > @IFBKQ TLOHP LKB-LK-LKB TFQE > QO>FKBA QEBO>MFPQ. (@OBAFQ: !I>K

#IB>SBO)

GROUP THERAPY

K group therapy, > @IFKF@F>K JBBQP QLDBQEBO TFQE PBSBO>I @IFBKQP TFQE PFJFI>O MOLIBJP (Figure 16.16).EBK @EFIAOBK >OB MI>@BA FK DOLRM QEBO>MV, FQ FP M>OQF@RI>OIV FJMLOQ>KQ QL J>Q@E @IFBKQP CLO >DB >KAMOLIBJP. KB BKBCFQ LC DOLRM QEBO>MV FP QE>Q FQ @>K EBIM AB@OB>PB > @IFBKQs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

DRFIQV >KA JLOB PRMMLOQBA V BFKD FK > DOLRM TFQE PFJFI>O TLJBK.OLRM QEBO>MV >IPL E>P PLJB PMB@FCF@ IFJFQ>QFLKP. BJBOP LC QEB DOLRM J>V B >CO>FA QL PMB>H FKCOLKQ LC LQEBO MBLMIB B@>RPB PE>OFKD PB@OBQP >KA MOLIBJP TFQE @LJMIBQB PQO>KDBOP @>K B PQOBPPCRI >KALSBOTEBIJFKD. EBOB J>V B MBOPLK>IFQV @I>PEBP >KA >ODRJBKQP >JLKD DOLRM JBJBOP. EBOB @LRIA >IPL B @LK@BOKP >LRQ @LKCFABKQF>IFQV: LJBLKB COLJ QEB DOLRM JFDEQ PE>OB TE>Q >KLQEBO M>OQF@FM>KQ P>FA QLMBLMIB LRQPFAB LC QEB DOLRM.



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>P AFSLO@B, DOFBC, >K B>QFKD AFPLOABO, PRPQ>K@B >RPB, LO >KDBO J>K>DBJBKQ. (@OBAFQ: #LOV >KHBO)

KLQEBO BKBCFQ LC DOLRM QEBO>MV FP QE>Q JBJBOP @>K @LKCOLKQ B>@E LQEBO >LRQ QEBFO M>QQBOKP. LO QELPBTFQE PLJB QVMBP LC MOLIBJP, PR@E >P PBUR>I >RPBOP, DOLRM QEBO>MV FP QEB OB@LJJBKABA QOB>QJBKQ. OLRM

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

OLRMP QE>Q E>SB > PQOLKD BAR@>QFLK>I @LJMLKBKQ >OB @>IIBA MPV@EL-BAR@>QFLK>I DOLRMP. LO BU>JMIB, >DOLRM CLO @EFIAOBK TELPB M>OBKQP E>SB @>K@BO JFDEQ AFP@RPP FK ABMQE TE>Q @>K@BO FP, QVMBP LC QOB>QJBKQCLO @>K@BO, >KA QEB PFAB BCCB@QP LC QOB>QJBKQP, PR@E >P E>FO ILPP. CQBK, DOLRM QEBO>MV PBPPFLKP TFQE @EFIAOBKQ>HB MI>@B FK P@ELLI. EBV >OB IBA V > P@ELLI @LRKPBILO, > P@ELLI MPV@ELILDFPQ, LO > P@ELLI PL@F>I TLOHBO.OLRMP JFDEQ CL@RP LK QBPQ >KUFBQV, PL@F>I FPLI>QFLK, PBIC-BPQBBJ, RIIVFKD, LO P@ELLI C>FIROB (EB@EQJ>K,

2002). EBQEBO QEB DOLRM FP EBIA FK P@ELLI LO FK > @IFKF@F>KsP LCCF@B, DOLRM QEBO>MV E>P BBK CLRKA QL BBCCB@QFSB TFQE @EFIAOBK C>@FKD KRJBOLRP HFKAP LC @E>IIBKDBP (EB@EQJ>K, 2002).

ROFKD > DOLRM PBPPFLK, QEB BKQFOB DOLRM @LRIA OBCIB@Q LK >K FKAFSFAR>Is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

COUPLES THERAPY

Couples therapy FKSLISBP QTL MBLMIB FK >K FKQFJ>QB OBI>QFLKPEFM TEL >OB E>SFKD AFCCF@RIQFBP >KA >OB QOVFKDQL OBPLISB QEBJ (Figure 16.17). EB @LRMIB J>V B A>QFKD, M>OQKBOBA, BKD>DBA, LO J>OOFBA. EB MOFJ>OVQEBO>MBRQF@ LOFBKQ>QFLK RPBA FK @LRMIBP @LRKPBIFKD FP @LDKFQFSB-BE>SFLO>I QEBO>MV (>QERP & >KABOPLK,1999). LRMIBP JBBQ TFQE > QEBO>MFPQ QL AFP@RPP @LKCIF@QP >KA/LO >PMB@QP LC QEBFO OBI>QFLKPEFM QE>Q QEBVT>KQ QL @E>KDB. EB QEBO>MFPQ EBIMP QEBJ PBB ELT QEBFO FKAFSFAR>I >@HDOLRKAP, BIFBCP, >KA >@QFLKP >OB>CCB@QFKD QEBFO OBI>QFLKPEFM. CQBK, > QEBO>MFPQ QOFBP QL EBIM QEB @LRMIB OBPLISB QEBPB MOLIBJP, >P TBII >PFJMIBJBKQ PQO>QBDFBP QE>Q TFII IB>A QL > EB>IQEFBO >KA E>MMFBO OBI>QFLKPEFM, PR@E >P ELT QL IFPQBK, ELT QL




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s QEBO>MV QL B IFHB pMFILQFKD > EBIF@LMQBO FK > EROOF@>KBq (BFI, 2012,M>O>. 7).

Figure 16.17 K @LRMIBP @LRKPBIFKD, > QEBO>MFPQ EBIMP MBLMIB TLOH LK QEBFO OBI>QFLKPEFM. (@OBAFQ: #LOV >KHBO)

FAMILY THERAPY

Family therapy FP > PMB@F>I CLOJ LC DOLRM QEBO>MV, @LKPFPQFKD LC LKB LO JLOB C>JFIFBP. IQELRDE QEBOB >OBJ>KV QEBLOBQF@>I LOFBKQ>QFLKP FK C>JFIV QEBO>MV, LKB LC QEB JLPQ MOBALJFK>KQ FP QEB PVPQBJP >MMOL>@E.

EB C>JFIV FP SFBTBA >P >K LOD>KFWBA PVPQBJ, >KA B>@E FKAFSFAR>I TFQEFK QEB C>JFIV FP > @LKQOFRQFKDJBJBO TEL @OB>QBP >KA J>FKQ>FKP MOL@BPPBP TFQEFK QEB PVPQBJ QE>Q PE>MB BE>SFLO (FKR@EFK, 1985).>@E JBJBO LC QEB C>JFIV FKCIRBK@BP >KA FP FKCIRBK@BA V QEB LQEBOP. EB DL>I LC QEFP >MMOL>@E FP QLBKE>K@B QEB DOLTQE LC B>@E C>JFIV JBJBO >P TBII >P QE>Q LC QEB C>JFIV >P > TELIB.

CQBK, AVPCRK@QFLK>I M>QQBOKP LC @LJJRKF@>QFLK QE>Q ABSBILM BQTBBK C>JFIV JBJBOP @>K IB>A QL @LKCIF@Q. C>JFIV TFQE QEFP AVK>JF@ JFDEQ TFPE QL >QQBKA QEBO>MV QLDBQEBO O>QEBO QE>K FKAFSFAR>IIV. K J>KV@>PBP, LKB JBJBO LC QEB C>JFIV E>P MOLIBJP QE>Q ABQOFJBKQ>IIV >CCB@Q BSBOVLKB. LO BU>JMIB, > JLQEBOsPABMOBPPFLK, QBBK A>RDEQBOsP B>QFKD AFPLOABO, LO C>QEBOsP >I@LELI ABMBKABK@B @LRIA >CCB@Q >II JBJBOP LC QEBC>JFIV. EB QEBO>MFPQ TLRIA TLOH TFQE >II JBJBOP LC QEB C>JFIV QL EBIM QEBJ @LMB TFQE QEB FPPRB, >KA QLBK@LRO>DB OBPLIRQFLK >KA DOLTQE FK QEB @>PB LC QEB FKAFSFAR>I C>JFIV JBJBO TFQE QEB MOLIBJ.

FQE C>JFIV QEBO>MV, QEB KR@IB>O C>JFIV (F.B., M>OBKQP >KA @EFIAOBK) LO QEB KR@IB>O C>JFIV MIRP TELBSBO IFSBP

FK QEB ELRPBELIA (B.D., DO>KAM>OBKQ) @LJB FKQL QOB>QJBKQ. >JFIV QEBO>MFPQP TLOH TFQE QEB TELIB C>JFIVRKFQ QL EB>I QEB C>JFIV. EBOB >OB PBSBO>I AFCCBOBKQ QVMBP LC C>JFIV QEBO>MV. K structural family therapy,QEB QEBO>MFPQ BU>JFKBP >KA AFP@RPPBP QEB LRKA>OFBP >KA PQOR@QROB LC QEB C>JFIV: TEL J>HBP QEB ORIBP, TELPIBBMP FK QEB BA TFQE TELJ, ELT AB@FPFLKP >OB J>AB, >KA TE>Q >OB QEB LRKA>OFBP TFQEFK QEB C>JFIV. KPLJB C>JFIFBP, QEB M>OBKQP AL KLQ TLOH QLDBQEBO QL J>HB ORIBP, LO LKB M>OBKQ J>V RKABOJFKB QEB LQEBO,IB>AFKD QEB @EFIAOBK QL >@Q LRQ. EB QEBO>MFPQ EBIMP QEBJ OBPLISB QEBPB FPPRBP >KA IB>OK QL @LJJRKF@>QBJLOB BCCB@QFSBIV.



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PBPPFLK.

K strategic family therapy, QEB DL>I FP QL >AAOBPP PMB@FCF@ MOLIBJP TFQEFK QEB C>JFIV QE>Q @>K B AB>IQ TFQEFK > OBI>QFSBIV PELOQ >JLRKQ LC QFJB. VMF@>IIV, QEB QEBO>MFPQ TLRIA DRFAB TE>Q E>MMBKP FK QEB QEBO>MVPBPPFLK >KA ABPFDK > ABQ>FIBA >MMOL>@E QL OBPLISFKD B>@E JBJBOsP MOLIBJ (>A>KBP, 1991).

16.4 Substance-Related and Addictive Disorders: A Special Case

Learning Objectives

V QEB BKA LC QEFP PB@QFLK, VLR TFII B >IB QL:k B@LDKFWB QEB DL>I LC PRPQ>K@B-OBI>QBA >KA >AAF@QFSB AFPLOABOP QOB>QJBKQ

k FP@RPP TE>Q J>HBP CLO BCCB@QFSB QOB>QJBKQk BP@OFB ELT @LJLOFA AFPLOABOP >OB QOB>QBA

AAF@QFLK FP LCQBK SFBTBA >P > @EOLKF@ AFPB>PB (Figure 16.18). EB @ELF@B QL RPB > PRPQ>K@B FP FKFQF>IIVSLIRKQ>OV; ELTBSBO, B@>RPB @EOLKF@ PRPQ>K@B RPB @>K MBOJ>KBKQIV >IQBO QEB KBRO>I PQOR@QROB FK QEBMOBCOLKQ>I @LOQBU, >K >OB> LC QEB O>FK >PPL@F>QBA TFQE AB@FPFLK-J>HFKD >KA GRADJBKQ, > MBOPLK B@LJBPAOFSBK QL RPB AORDP >KA/LO >I@LELI (RgLW-RBS>P, QEFIFKD>J, FP@LML, & FIOB@EQ, 2013). EFP EBIMPBUMI>FK TEV OBI>MPB O>QBP QBKA QL B EFDE. LRQ 40%n60% LC FKAFSFAR>IP relapse, TEF@E JB>KP QEBV OBQROKQL >RPFKD AORDP >KA/LO >I@LELI >CQBO > MBOFLA LC FJMOLSBJBKQ (>QFLK>I KPQFQRQB LK ORD RPB MQBO 16 EBO>MV >KA OB>QJBKQ


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Figure 16.18 EB >QFLK>I ROSBV LK ORD PB >KA B>IQE PELTP QOBKAP FK MOBS>IBK@B LC S>OFLRP AORDP CLO >DBP

12e17, 18e25, >KA 26 LO LIABO.

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igure 16.19).

Figure 16.19 RPQ>K@B RPB >KA >RPB @LPQP QEB KFQBA Q>QBP LSBO $600 FIIFLK > VB>O (!, 2012). EFP >AAF@Q FP

RPFKD EBOLFK. (@OBAFQ: "GBIIVJ@ - RO>KPK>MP"/IF@HO)



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WHAT MAKES TREATMENT EFFECTIVE?

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QEB QOB>QJBKQ MOLDO>J >KA QB>@E PQO>QBDFBP CLO AB>IFKD TFQE @O>SFKDP >KA ELT QL MOBSBKQ OBI>MPB. IPL,QOB>QJBKQ KBBAP QL B ELIFPQF@ >KA >AAOBPP JRIQFMIB KBBAP, KLQ GRPQ QEB AORD >AAF@QFLK. EFP JB>KP QE>QQOB>QJBKQ TFII >AAOBPP C>@QLOP PR@E >P @LJJRKF@>QFLK, PQOBPP J>K>DBJBKQ, OBI>QFLKPEFM FPPRBP, M>OBKQFKD,SL@>QFLK>I @LK@BOKP, >KA IBD>I @LK@BOKP (@LSBOK & >OOLII, 2003; , 2012).

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

V QBBK PRPQ>K@B >RPBOP. IPL, JLQEBOP TEL M>OQF@FM>QBA FK QOB>QJBKQ AFPMI>VBA BQQBO JBKQ>I EB>IQE>KA DOB>QBO T>OJQE QLT>OA QEBFO @EFIAOBK (BOQO>KA BQ >I., 2013). LTBSBO, KBFQEBO FKAFSFAR>I KLO DOLRMQEBO>MV E>P BBK CLRKA QL B JLOB BCCB@QFSB (BFPP BQ >I., 2004). BD>OAIBPP LC QEB QVMB LC QOB>QJBKQ PBOSF@B,QEB MOFJ>OV CL@RP FP LK >PQFKBK@B LO >Q QEB SBOV IB>PQ > PFDKFCF@>KQ OBAR@QFLK FK RPB (@LSBOK & >OOLII,2003).

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COMORBID DISORDERS

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K @>PBP LC @LJLOFAFQV, QEB BPQ QOB>QJBKQ FP QELRDEQ QL >AAOBPP LQE (LO JRIQFMIB) AFPLOABOPPFJRIQ>KBLRPIV (, 2012). BE>SFLO QEBO>MFBP >OB RPBA QL QOB>Q @LJLOFA @LKAFQFLKP, >KA FK J>KV@>PBP, MPV@ELQOLMF@ JBAF@>QFLKP >OB RPBA >ILKD TFQE MPV@ELQEBO>MV. LO BU>JMIB, BSFABK@B PRDDBPQP

LINK TO LEARNING



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QE>Q RMOLMFLK (QO>AB K>JBP: BIIRQOFK >KA V>K), >MMOLSBA CLO QOB>QFKD ABMOBPPFLK >KA KF@LQFKBABMBKABK@B, JFDEQ >IPL EBIM OBAR@B @O>SFKD >KA RPB LC QEB AORD JBQE>JMEBQ>JFKB (, 2011).LTBSBO, JLOB OBPB>O@E FP KBBABA QL BQQBO RKABOPQ>KA ELT QEBPB JBAF@>QFLKP TLOHoM>OQF@RI>OIV TEBK@LJFKBA FK M>QFBKQP TFQE @LJLOFAFQFBP.

16.5 The Sociocultural Model and Therapy Utilization

Learning Objectives

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