ABSTRACT
This article introduces the therapeutic contracting program as a comprehensive treatment system for persons with serious mental illness. Therapeutic contracting offers a promising framework for integrating medical, psychological, and social therapies in a manner that fosters clients' active involvement in treatment. This article outlines a multistage therapy program that mobilizes clients' adaptational resources through experimental interventions, structured goal-setting exercises, and skills-building experiences. Data illustrate the effectiveness of therapeutic contracting for (a) securing clients' treatment compliance, (b) promoting positive clinical outcomes, (c) reducing overall treatment costs. The therapeutic contracting model is discussed as a potential vehicle for expanding the professional role of psychologists in psychiatric settings, particularly in areas of clinical and administrative decision making.
Subject(s)
Professional-Patient Relations , Chronic Disease , Decision Making , Humans , Mental Disorders/rehabilitation , Patient Compliance , Treatment OutcomeABSTRACT
Agoraphobia is a complex disorder characterized by substantial personal, social, and occupational disability. This paper presents a cognitive-behavioral model of group psychotherapy for agoraphobia treatment wherein group members are taught active coping skills to reduce anxiety and behavioral avoidance. Therapy occurs in the context of a supportive group, which aids in reducing the social isolation and alienation attendant on this severe anxiety disorder. The model of treatment is amenable to both time-limited and open-ended group therapy formats.
Subject(s)
Agoraphobia/therapy , Cognitive Behavioral Therapy/methods , Panic Disorder/therapy , Psychotherapy, Group/methods , Agoraphobia/psychology , Desensitization, Psychologic/methods , Group Processes , Humans , Panic Disorder/psychology , Patient Compliance/psychology , Social SupportSubject(s)
Continuity of Patient Care/organization & administration , Mental Health Services/organization & administration , Cognitive Behavioral Therapy , Hospitals, Psychiatric/organization & administration , Humans , Massachusetts , Mental Disorders/prevention & control , Mental Disorders/therapy , Models, Organizational , Patient Compliance , Social AdjustmentABSTRACT
The cases of three self-injurious patients suffering with borderline personality disorder are briefly presented. From this clinical base, the consultant describes a cognitive-behavioral psychotherapeutic model and how it might be applied to the treatment of these and similar patients. A dialectical behavioral approach is used to describe three major dichotomies and their application. The consultant also illustrates how cognitive-behavioral therapy may be integrated with more dynamic-analytic approaches, and proposes a strategy and methodology that establish and reinforce the treatment alliance in developing a treatment plan.
Subject(s)
Borderline Personality Disorder/therapy , Cognitive Behavioral Therapy/methods , Self Mutilation/therapy , Adult , Borderline Personality Disorder/psychology , Female , Humans , Middle Aged , Self Mutilation/psychologySubject(s)
Behavior Therapy/methods , Goals , Mental Disorders/therapy , Adolescent , Adult , Aged , Cognition , Humans , Inpatients , Middle Aged , Token EconomyABSTRACT
The performance of 60 elderly volunteers (mean age = 74.5 years) on two cancellation tasks was examined under one of three experimental conditions: social praise, social reproof, or no comment. When compared with the no-comment group, subjects in the reproof condition showed response increments over baseline performance (p less than .05). Praise, when compared with no comment, failed to reach statistical significance. Results are interpreted in terms of the possible negative reinforcement, challenge, or informational properties of reproof. The clear implications from these data are that social incentives may well facilitate behavioral change in the aged and that there is a need for further examination of the effects of this variable.
