A tripartite learning conceptualization of psychotherapy: the therapeutic alliance, technical interventions, and relearning.

One problem in conceptualizing the various explanatory factors in psychotherapy has been the lack of a common theoretical language by which to construe these various aspects of treatment. This article integrates a broad range of theoretical contributions within the wider context of a learning theory perspective of essential psychotherapeutic processes. A tripartite model of psychotherapy is outlined that incorporates the contributions of the emotional learning that takes place in the therapeutic alliance, the cognitive aspects of the therapist's technical interventions that are intended to accelerate change, and the behavioral elements of relearning that take place in the patient's world beyond the consulting room.

Collaborative academic training of psychiatrists and psychologists in VA and medical school settings.

OBJECTIVE: The authors review the background and contemporary strengths of Dean's Committee Veterans Affairs Medical Centers in the collaborative academic training of psychiatrists and psychologists. METHODS: The authors discuss the problems and prospects of the current health care environment as it impacts the behavioral health treatment of returning veterans from the wars in Iraq and Afghanistan and the educational agenda for psychiatry and psychology. The medical education program in psychiatry and the internship program in psychology at the Syracuse Veterans Affairs Medical Center and the SUNY Upstate Medical University provide an exemplar of academic collaboration in clinical training. RESULTS: Within this combined educational environment, opportunities and challenges abound for interns and residents to receive advanced training in the state-of-the-art assessment and treatment of disorders related to psychological trauma, posttraumatic stress disorder, sexual trauma, traumatic brain injury, polytrauma, behavioral health in primary care, and telepsychiatry. CONCLUSION: There is tremendous mutual benefit from academic collaboration for both institutions as they grapple with their respective treatment and educational missions.

Family Support, Self-Rated Health, and Psychological Distress.

BACKGROUND: Comprehensive health care is becoming an important issue; however, little is known about the complex relationships between perceived family support, self-rated health, and psychological distress in mixed middle-aged/older primary care patient samples. METHOD: In this cross-sectional and predominantly male sample of 137 patients attending their appointments at a primary care clinic in a Department of Veterans Affairs Medical Center, participants completed several questionnaires including the Family Adaptation, Partnership, Growth, Affection, and Resolve; the General Health Questionnaire-12; the Symptom Checklist-10; and the Primary Care Evaluation of Mental Disorders (PRIME-MD) screening questionnaire and interview. Data were collected in 1998. Eighteen percent of the participants were diagnosed with a mood disorder, and 15% were diagnosed with an anxiety disorder (PRIME-MD diagnoses). RESULTS: Perceived family support and self-rated health were negatively associated with psychological symptoms and certain psychological disorders, while perceived family support and self-rated health were positively rated. In addition, the interaction between perceived family support and self-rated health was significant (p <.01) in relating to psychological symptoms such that psychological symptoms were most elevated in participants reporting dissatisfying family support combined with poor self-rated health. However, the cross-sectional nature of the study prevents causal conclusions from being made. CONCLUSIONS: Physicians and other health care professionals are encouraged to assess both the perceived family support and self-rated health in an effort to conceptualize their patients' problems in a more comprehensive manner.

Fundamental dilemmas in contemporary psychotherapy: a transtheoretical concept.

The transtheoretical nature of fundamental dilemmas in contemporary psychotherapy is explored. The basic distinction between technical and ethical dilemmas in clinical practice is discussed, as well as the ramifications for the psychotherapist. Clinical dilemmas identified by survey research studies and interviews with master psychotherapists are reviewed. In addition to dilemmas relevant to circumscribed areas of psychotherapy, such as brief therapy, managed mental health care, sexual questions, feminist therapy, dilemmas fundamental to the psychotherapeutic process as a whole are examined. Finally, clinical examples are provided that include such issues as hospitalization of the suicidal patient, dealing with known contraindications, treating the intractable patient, and self-care of the psychotherapist.

Mental Health Screening in Primary Care: A Comparison of 3 Brief Measures of Psychological Distress.

BACKGROUND: The current study compared 3 brief mental health screening measures in a sample of older patients in a primary care outpatient setting. Previous mental health screening research has been conducted primarily with younger patients, often with only 1 screening measure, thereby limiting the generalizability of findings. In addition, measures have not yet been compared in terms of their ability to discriminate between cases and noncases of psychiatric disorder. METHOD: One hundred thirty-four male patients attending their appointments at a primary care clinic in a Department of Veterans Affairs Medical Center participated in this study. Participants completed the General Health Questionnaire-12 (GHQ-12), the Symptom Checklist-10 (SCL-10), and the Primary Care Evaluation of Mental Disorders screening questionnaire and interview. RESULTS: Receiver operating characteristic analysis yielded the optimum cutoff scores on each brief mental health screening measure and showed that all 3 measures discriminated well between cases and noncases of psychiatric disorders. The 3 measures performed slightly better in terms of discriminating between cases and noncases of mood or anxiety disorders than between cases and noncases of any psychiatric disorder. There were no significant differences between the measures' abilities to accurately identify cases and noncases of disorder. CONCLUSION: Primary care physicians are encouraged to use brief mental health screening measures with their patients, since many report symptoms of psychological distress and disorder. It is recommended that the SCL-10 and GHQ-12 be used to detect mood or anxiety disorders in patients such as these because of the accuracy and brevity of these measures.