[ Pobierz całość w formacie PDF ]
.As an example, a Treating bipolar disorders 131belief that depression is a choice cannot go unchallenged or be validated and turnedinto a treatment method or goal.(10) Psychotherapy techniques may be presented alone, or in parallel with otherstrategically planned psychotherapeutic methods.(11) The patient s treatment compliance and the effectiveness of treatment is reviewedduring each session.The therapist, patient, and family must determine whether:(a) Compliance is helping to stabilize or increase the client s functioning;(b) Lack of compliance is an indicator of increased symptoms or an indicator of a needfor changes in the treatment plan.(12) Each session surveys not only the patient s and family s problems, but also thesuccesses and strengths experienced during the week.(13) Assessments for suicide and hazardous behaviors are conducted in each session.Within the framework s neurosciencific theory, humanistic philosophy, and value system,therapy sessions move purposefully across the 11 modules.The key emphasis of thesemodules is briefly outlined below.It is beyond the scope of this book to provide or evenlist all of the elements that can be contained in the independent modules.Nonetheless, theprimary purpose of each module is provided.It becomes the therapist, patient, andfamily s responsibility to develop individualized and meaningful treatment goals withineach module and across the framework.Education module Patients, families, and significant others are helped to understandwhy bipolar disorders are brain illnesses, the cause of illness, why medication is needed,and rules for taking medications.This module also includes information on methods forcoping with symptoms, changing energy levels and motivation, changing personal andfamily requirements, and how to address work and school problems better.An importantpart of the module is helping patients and families to accept the illness better and planhow to care for each other more effectively.Within this module therapists may want touse numerous handouts.Questionnaires and medication/illness educational forms areincluded with this section.The medication and illness illustrations (Algorithms 3 and 4)are reprinted with permission from the Texas Medication Algorithm Project.Symptom monitoring module The primary purposeof this module is to teach patientsand families how to keep records of symptoms and important strengths.Systematicallyillustrating how symptoms and strengths change can greatly help to improve bothmedication and psychotherapy interventions.Tracking behaviors provides a concretepicture of the patient s progress or increasing problems.There are numerous publishedrating scales available for helping patients and therapists to quantify and track howsymptoms and strengths change over time.Readers will find a series of questionnaires inAppendix 2 of this book that also serve this purpose.Questionnaires, unlike scales, do notprovide a total score.Each question is independent and is not considered in relation toother items.Because of the unique nature and circumstances of severe mental illness,scales often lack true psychometric reliability and validity.The use of questionnaires thatdo not have summative scores partially overcomes this problem.The main purpose of thequestionnaires is to serve as a concrete communication tool between the therapist, patient,and family.General support module Patients and families need ongoing general support.Thismodule is used to provide case management, advocacy, support, and a concrete focus on Atlas of bipolar disorders 132the patient s and family s strengths.In order to overcome the stresses caused by illnessand everyday life, people need to be reminded that they are important and rewardedconcretely and verbally for succeeding.The concrete support may be a simple cup ofcoffee that was not expected, or a willingness by the therapist to change an appointmentor help resolve a clinic-related problem.Therapy for chronic problems is enhanced andmore meaningful when general support is consistently provided.Patients and familyshould not have to wait for a crisis before therapists offer concrete and verbal support.The patient and family should leave therapy sessions feeling validated, important, andreassured.Specific support module There are times when every patient and family needs anadvocate and specific help.The therapist must be prepared either to provide the requiredsupport, or to link the individual and family to an agency or professional person who canresolve the difficulty and stress.In addition, during depressive and manic episodes thetherapist:(1) Helps the patient and family to identify tasks that must be completed;(2) Jointly develops a plan and means for completing the tasks;(3) Gives the family and patient permission not to perform or to delay work and dailymaintenance tasks that can be delayed;(4) Reminds the patient and family of strengths and validates skills that continue tofunction even though the patient s illness is not improving or increasing.During a crisis or severe episode, it may be more productive to direct the family andpatient s focus toward recalling that strengths and skills during past episodes disappearedand returned.That is, to overcome despair, individuals are reminded that past severeepisodes have been survived, and lost skills regained.Furthermore, the fact that difficultsituations and crises caused by illness have been over and again survived is cognitivelyreframed and reinforced as a current and admirable strength.Focused psychotherapy module Modified realityoriented therapy methods areempathetically applied to help the patient and family cope during periods of hypomanicepisodes and dangerous periods of depression.The therapist, as an example, becomes thevoice of reality and provides specific directives and suggestions for organizing thefamily, and establishing needed rules.Directives may include specific instructions suchas to remove the patient s car keys or to lock up all items that could easily be used for asuicide attempt.During this period it is helpful to increase therapy and home visits [ Pobierz całość w formacie PDF ]
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.As an example, a Treating bipolar disorders 131belief that depression is a choice cannot go unchallenged or be validated and turnedinto a treatment method or goal.(10) Psychotherapy techniques may be presented alone, or in parallel with otherstrategically planned psychotherapeutic methods.(11) The patient s treatment compliance and the effectiveness of treatment is reviewedduring each session.The therapist, patient, and family must determine whether:(a) Compliance is helping to stabilize or increase the client s functioning;(b) Lack of compliance is an indicator of increased symptoms or an indicator of a needfor changes in the treatment plan.(12) Each session surveys not only the patient s and family s problems, but also thesuccesses and strengths experienced during the week.(13) Assessments for suicide and hazardous behaviors are conducted in each session.Within the framework s neurosciencific theory, humanistic philosophy, and value system,therapy sessions move purposefully across the 11 modules.The key emphasis of thesemodules is briefly outlined below.It is beyond the scope of this book to provide or evenlist all of the elements that can be contained in the independent modules.Nonetheless, theprimary purpose of each module is provided.It becomes the therapist, patient, andfamily s responsibility to develop individualized and meaningful treatment goals withineach module and across the framework.Education module Patients, families, and significant others are helped to understandwhy bipolar disorders are brain illnesses, the cause of illness, why medication is needed,and rules for taking medications.This module also includes information on methods forcoping with symptoms, changing energy levels and motivation, changing personal andfamily requirements, and how to address work and school problems better.An importantpart of the module is helping patients and families to accept the illness better and planhow to care for each other more effectively.Within this module therapists may want touse numerous handouts.Questionnaires and medication/illness educational forms areincluded with this section.The medication and illness illustrations (Algorithms 3 and 4)are reprinted with permission from the Texas Medication Algorithm Project.Symptom monitoring module The primary purposeof this module is to teach patientsand families how to keep records of symptoms and important strengths.Systematicallyillustrating how symptoms and strengths change can greatly help to improve bothmedication and psychotherapy interventions.Tracking behaviors provides a concretepicture of the patient s progress or increasing problems.There are numerous publishedrating scales available for helping patients and therapists to quantify and track howsymptoms and strengths change over time.Readers will find a series of questionnaires inAppendix 2 of this book that also serve this purpose.Questionnaires, unlike scales, do notprovide a total score.Each question is independent and is not considered in relation toother items.Because of the unique nature and circumstances of severe mental illness,scales often lack true psychometric reliability and validity.The use of questionnaires thatdo not have summative scores partially overcomes this problem.The main purpose of thequestionnaires is to serve as a concrete communication tool between the therapist, patient,and family.General support module Patients and families need ongoing general support.Thismodule is used to provide case management, advocacy, support, and a concrete focus on Atlas of bipolar disorders 132the patient s and family s strengths.In order to overcome the stresses caused by illnessand everyday life, people need to be reminded that they are important and rewardedconcretely and verbally for succeeding.The concrete support may be a simple cup ofcoffee that was not expected, or a willingness by the therapist to change an appointmentor help resolve a clinic-related problem.Therapy for chronic problems is enhanced andmore meaningful when general support is consistently provided.Patients and familyshould not have to wait for a crisis before therapists offer concrete and verbal support.The patient and family should leave therapy sessions feeling validated, important, andreassured.Specific support module There are times when every patient and family needs anadvocate and specific help.The therapist must be prepared either to provide the requiredsupport, or to link the individual and family to an agency or professional person who canresolve the difficulty and stress.In addition, during depressive and manic episodes thetherapist:(1) Helps the patient and family to identify tasks that must be completed;(2) Jointly develops a plan and means for completing the tasks;(3) Gives the family and patient permission not to perform or to delay work and dailymaintenance tasks that can be delayed;(4) Reminds the patient and family of strengths and validates skills that continue tofunction even though the patient s illness is not improving or increasing.During a crisis or severe episode, it may be more productive to direct the family andpatient s focus toward recalling that strengths and skills during past episodes disappearedand returned.That is, to overcome despair, individuals are reminded that past severeepisodes have been survived, and lost skills regained.Furthermore, the fact that difficultsituations and crises caused by illness have been over and again survived is cognitivelyreframed and reinforced as a current and admirable strength.Focused psychotherapy module Modified realityoriented therapy methods areempathetically applied to help the patient and family cope during periods of hypomanicepisodes and dangerous periods of depression.The therapist, as an example, becomes thevoice of reality and provides specific directives and suggestions for organizing thefamily, and establishing needed rules.Directives may include specific instructions suchas to remove the patient s car keys or to lock up all items that could easily be used for asuicide attempt.During this period it is helpful to increase therapy and home visits [ Pobierz całość w formacie PDF ]