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1/32. A multiple group psychotherapy approach to adolescents with psychiatric and substance abuse comorbidity.

    Multiple group psychotherapy was employed as the primary treatment modality in a day-treatment program as an innovative multifaceted approach to treating adolescents comorbid for psychiatric and substance abuse diagnoses. The concurrent educational program included a high school on site. The groups included Substance Abuse Group, which promoted the 12-step model; Health Group; psychotherapy Group; Leisure time Group; Self-awareness Group; and Multiple family Group. The effect of the multiple groups was to provide a variety of experiences focusing on varied aspects of normal and dysfunctional adolescent development. Together the combination of groups served to strengthen the participants' cohesiveness, communicating skills, and hopefulness.
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ranking = 1
keywords = psychotherapy
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2/32. Integrating group psychotherapy and 12-step work: a collaborative approach.

    Group therapists can expect to treat an increasing number of patients who are active in a 12-step program or other addiction-related self-help groups. The value of simultaneous participation in these two modalities has been recognized; 12-step work supports abstinence necessary for the focus on emotional growth in psychotherapy. However, mere simultaneous participation in the two modalities fails to incorporate the benefits of a collaborative relationship where both modalities are used to support both abstinence and emotional growth. The conjoint approach to group and individual treatment is used to (a) argue for the possibility of a collaborative relationship between psychotherapy and a patient's 12-step work, (b) understand the benefits and challenges to collaboration, and (c) provide guidelines for how to work collaboratively with a 12-step program. Illustrations are provided of typical issues raised by this type of collaborative relationship.
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ranking = 1.2
keywords = psychotherapy
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3/32. The whisper of death: psychotherapy with a dying vietnam veteran.

    psychotherapy with a dying vietnam veteran is described. In spite of a severe heart condition and hiv-positive diagnosis, the outspoken and provocative patient reverts to heroin and cocaine use early in the treatment. This causes a heart attack and interruption of treatment. The therapist maintains empathy, a solid bond is forged, and the patient returns, but under constrained circumstances. A turning point is reached, both in the treatment and in this final phase of the patient's life, with major life improvement ensuing. At death the patient leaves word to thank the therapist. This case exemplifies how the approach of death lends urgency to positive forces appropriate to life's final developmental stage, and how end-of-life therapy bolsters those forces.
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ranking = 0.8
keywords = psychotherapy
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4/32. Leader dilemmas and countertransference considerations in group psychotherapy with substance abusers.

    Leader issues and countertransference dilemmas that emerge in psychotherapy groups for substance abusers will be examined along with strategies to extricate the therapist from the impasses that emerge. Specific issues include feelings of helplessness and inadequacy when a patient relapses and resumes substance use, countertransference reactions emanating from an overlapping personal or family history of substance abuse, countertransference helplessness when the therapist is more invested in the treatment than the patient, feelings of incompetence related to partial familiarity with 12-step culture and lingo, and countertransference devaluation fostered by systemic issues in substance abuse settings.
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ranking = 1
keywords = psychotherapy
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5/32. Drug dreams: a neuropsychoanalytic hypothesis.

    Recent studies have shown that the ventral tegmental pathway stimulates both dreaming and drug craving. To investigate a possible clinical link between these two psychic phenomena, psychotherapy notes from the first six months of an addicted patient's treatment were reviewed, together with verbatim notes from the four years of psychoanalysis that followed. Of 240 dreams reported by the patient,58 had manifest content involving the seeking or using of drugs. There was no particular temporal or emotional thematic pattern to these "drug dreams,"which persisted through four and a half years of sobriety. Drug dreams are observable phenomena that reflect both the innate structure of the brain and neural changes produced by exposure to addictive drugs. In some addicted persons, exposure to drugs produces a fixed change in neurological functioning with which they must contend for years, possibly the rest of their lives. Drug craving meets Freud's defining characteristics for a drive: it is a constant pressure, originating from within the organism, to do work, and it constantly demands satisfaction. Because ego and libidinal drives share a common neural pathway, they should not be separated conceptually. Solms's finding (in press) that the activating systems for dreaming and for craving are identical, a finding based on observations of tumor- or stroke-provoked brain lesions, is confirmed by observation of the dreams of a patient whose brain changes were created by drug exposure. This study provides further evidence that the origin of the dream is a wish.
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ranking = 0.2
keywords = psychotherapy
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6/32. Treatment of dual diagnosis patients: a relapse prevention group approach.

    The authors describe the successful use of an adjunctive group psychotherapy for substance-abusing patients with major psychiatric disorders (bipolar, schizophrenia, schizoaffective, psychotic depression, and atypical psychosis). The group utilizes a psychoeducational approach that focuses on substance abuse causes and consequences, principles of recovery, and relapse prevention strategies. Eight patients with prolonged histories of abuse of cocaine, alcohol, marijuana, or other drugs were enrolled in this weekly group treatment at a community mental health center drug treatment program, while continuing in treatment with their current case manager or primary therapist. Six of the eight patients achieved periods of stable abstinence, documented by self-report, urine toxicology screens, continued group attendance, and improved social functioning. Case examples are utilized to illustrate the group process.
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ranking = 0.2
keywords = psychotherapy
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7/32. Headlock: psychotherapy of a patient with multiple neurological and psychiatric problems.

    Psychodynamic psychiatrists seldom engage in psychotherapy with brain-injured patients because psychodynamic treatment typically depends on the patient's highly developed verbal skills, reflectiveness, tolerance of frustration, and capacity for abstract thinking and generalization--characteristics impaired by brain injury. The author describes the difficult but successful extended treatment of a young adult patient with preexisting attention-deficit hyperactivity disorder and personality disorders who had also abused alcohol and drugs and had suffered severe brain trauma. Treatment was characterized by a lengthy developmental process, the success of which depended on several factors, particularly the maintenance of the therapeutic alliance.
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ranking = 1
keywords = psychotherapy
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8/32. Methylenedioxymethamphetamine (ecstasy)-related hyperthermia.

    MDMA (or 3, 4 methylenedioxymethamphetamine) was first manufactured in the 1920s and found to have structural similarities to both mescaline and amphetamines. Used briefly by some therapists in the 1970s and early 1980s as an adjunct to psychotherapy, it is now primarily abused by teenagers and young adults as an illicit recreational drug known as "ecstasy." As its popularity has increased, so have the number of fatalities and adverse events related to its use. We report six patients suffering fatal or life-threatening hyperthermia after MDMA use. These cases illustrate that hyperthermia associated with MDMA use cannot be solely attributed to rave parties (high ambient temperatures, excessive dancing, dehydration, and overcrowded conditions), drug contaminants, or co-ingestants. A better understanding of the etiology of hyperthermia after MDMA use is needed so that appropriate harm-reduction measures can be developed and instituted.
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ranking = 0.2
keywords = psychotherapy
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9/32. To surrender drugs: a grief process in its own right.

    The basic thesis of this article is that addictive substances, because of their need-grafifying and self-medication value, become so central to the life of the addicted person that their absence is associated with a grief reaction. Painful feelings of loss and helplessness accompany drug surrender. This view contrasts with formulations that indicate that mourning experiences observed in recovering persons are specific to and determined by unresolved past losses of loved ones. The author discusses the theoretical underpinnings of the drug-loss grief reaction. Also presented are case vignettes that demonstrate the grief aspects of drug surrender. Finally, the role of brief psychotherapy as a vehicle for helping clients cope with their grief reactions is discussed.
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ranking = 0.2
keywords = psychotherapy
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10/32. Inpatient care of the substance-abusing patient with a concomitant eating disorder.

    Substance abuse rehabilitation programs have been increasingly faced with the difficult task of treating patients with both an eating disorder and a chemical dependency disorder. The authors discuss screening patients with substance abuse for eating disorder and describe a strategy for care that integrates an eating disorder treatment protocol with a standard chemical abuse rehabilitation program. elements of the treatment protocol include a thorough medical evaluation, nutritional stabilization, strategies to stop the patient's aberrant eating behavior, psychotherapy, medication, and discharge planning that actively addresses both the substance abuse and the eating disorder.
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ranking = 0.2
keywords = psychotherapy
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