Competency in Combining Pharmacotherapy and Psychotherapy: Integrated and Split Treatment (Core Competencies in Psychotherapy) (Core Competencies in Psychotherapy) PDF
Preview Competency in Combining Pharmacotherapy and Psychotherapy: Integrated and Split Treatment (Core Competencies in Psychotherapy) (Core Competencies in Psychotherapy)
Competency in Combining Pharmacotherapy and Psychotherapy Integrated and Split Treatment Competency in Combining Pharmacotherapy and Psychotherapy Integrated and Split Treatment By Michelle B. Riba, M.D., M.S. Clinical Professor of Psychiatry, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan Richard Balon, M.D. Professor of Psychiatry, Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan Washington, DC London, England Note: The authors have worked to ensure that all information in this book is ac- curate at the time of publication and consistent with general psychiatric and med- ical standards, and that information concerning drug dosages, schedules, and routes of administration is accurate at the time of publication and consistent with standards set by the U.S. Food and Drug Administration and the general medical community. As medical research and practice continue to advance, however, therapeutic standards may change. Moreover, specific situations may require a specific therapeutic response not included in this book. For these reasons and be- cause human and mechanical errors sometimes occur, we recommend that read- ers follow the advice of physicians directly involved in their care or the care of a member of their family. Books published by American Psychiatric Publishing, Inc., represent the views and opinions of the individual authors and do not necessarily represent the poli- cies and opinions of APPI or the American Psychiatric Association. Copyright © 2005 American Psychiatric Publishing, Inc. ALL RIGHTS RESERVED Manufactured in the United States of America on acid-free paper 09 08 07 06 05 5 4 3 2 1 First Edition Typeset in Adobe’s Berling Roman and Frutiger. American Psychiatric Publishing, Inc. 1000 Wilson Boulevard Arlington, VA 22209-3901 www.appi.org Library of Congress Cataloging-in-Publication Data Riba, Michelle B. Competency in combining pharmacotherapy and psychotherapy: integrated and split treatment / by Michelle B. Riba, Richard Balon. — 1st ed. p. ; cm. Includes bibliographical references and index. ISBN 1-58562-143-9 (alk. paper) 1. Mental illness—Chemotherapy. 2. Combined modality therapy. 3. Psycho- therapy. [DNLM: 1. Mental Disorders—therapy. 2. Clinical Competence. 3. Combined Modality Therapy—methods. 4. Drug Therapy—methods. 5. Psychotherapy— methods. WM 140 R482c 2005] I. Balon, Richard. II. Title. RC483.R465 2005 616.89'18—dc22 2004026974 British Library Cataloguing in Publication Data A CIP record is available from the British Library. Contents Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Introduction to the CoreCompetencies in Psychotherapy Series. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix 1 Introduction to Integrated and Split Treatment. . . . . . . . . . . 1 Part I Integrated Treatment 2 Selection of Medication and Psychotherapy in Integrated Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 3 Evaluation and Opening in Integrated Treatment . . . . . . . . 31 4 Sequencing in Integrated Treatment. . . . . . . . . . . . . . . . . . . 49 5 Termination in Integrated Treatment . . . . . . . . . . . . . . . . . . 61 Part II Split Treatment 6 Selection of Medication, Psychotherapy, and Clinicians in Split Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . 75 7 Evaluation and Opening in Split Treatment. . . . . . . . . . . . . .83 8 Sequencing and Maintenance in Split Treatment . . . . . . . .109 9 Termination in Split Treatment. . . . . . . . . . . . . . . . . . . . . . .123 Part III Evaluation, Monitoring, and Supervision 10 Evaluation, Monitoring, and Supervision of Integrated and Split Treatment . . . . . . . . . . . . . . . . . . . . . .139 Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .153 Preface T he practice of combining pharmacotherapy and psychotherapy for mental disorders has become the most frequently used approach to the treatment of these disorders. Most clinicians would agree that the com- bination of these two modalities is more efficacious and beneficial than each modality alone for a wide range of disorders. Combining pharmacotherapy with psychotherapy may seem like a simple affair. However, it is a fairly complex process with many variations and permutations. Pharmacotherapy could be combined with brief psy- chotherapy, cognitive-behavioral therapy, psychodynamic psychother- apy, supportive therapy, interpersonal therapy, and many others. The combination of pharmacotherapy and psychotherapy could be delivered by one person (integrated treatment) or by two or more persons (collab- orative or split treatment). The combination of these two modalities could begin with either pharmacotherapy or psychotherapy, with the second modality starting later. All these issues need to be factored in when considering combining pharmacotherapy and psychotherapy. The Residency Review Committee for Psychiatry appropriately decided that psychiatry residents must be able to demonstrate competency in combin- ing psychotherapy with pharmacotherapy. This book is intended to be a basic text for residents and teaching fac- ulty in addressing competency in combining psychotherapy and pharma- We thank Linda Gacioch for her invaluable help with the preparation of this book. vii viii Combining Pharmacotherapy and Psychotherapy cotherapy. It is meant to be simple, straightforward, clinically oriented, and easy to read. We feel that each psychiatry resident should become competent in and master both major approaches to combining psychotherapy and pharmacotherapy—integrated and split treatment—because these are common clinical practices. Therefore, this book is divided into two major parts, the first dealing with integrated treatment and the second focused on split treatment. Some parts of the text in these two sections could, in fact, be similar if not identical, because they deal with similar problems. The resident, however, should read both sections of the book separately to familiarize and educate himself or herself with each particular treatment modality (i.e., integrated and split treatment). Each section is a separate unit stand- ing on its own, and therefore should be read as such. We hope that this book will help all residents in psychiatry to master and become competent in combining pharmacotherapy and psychother- apy. Ultimately, their mastery of and competency in this crucial thera- peutic area will help to improve the lives of patients. Richard Balon, M.D. Michelle B. Riba, M.D., M.S. Introduction to the Core Competencies in Psychotherapy Series W ith the extraordinary progress in the neurosciences and psychophar- macology in recent years, some psychiatric training programs have de- emphasized psychotherapy education. Many residents and educators have decried the loss of the “mind” in the increasing emphasis on the bio- logical basis of mental illness and the shift toward somatic treatments as the central therapeutic strategy in psychiatry. This shift in emphasis has been compounded by the common practice in our managed care era of “split treatment,” meaning that psychiatrists are often relegated to seeing the patient for a brief medication management session, while the psychother- apy is conducted by a mental health professional from another discipline. This shift in emphasis has created considerable concern among both psy- chiatric educators and the consumers of psychiatric education—the resi- dents themselves. The importance of psychotherapy in the training of psychiatrists has re- cently been reaffirmed, however, as a result of the widespread movement toward the establishment of core competencies throughout all medical specialties. In 1999 both the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS) recognized that a set of organizing principles was necessary to measure competence in medical education. These six principles—patient ix
The list of books you might like
