Fetal supraventricular tachycardia complicated by hydrops fetalis: a role for direct fetal intramuscular therapy

Maternally administered digoxin for the treatment of fetal supraventricular tachycardia (SVT) complicated by hydrops fetalis may be ineffective secondary to poor transplacental drug transfer. We present our experience with eight pregnancies treated with transplacental therapy or combined maternal and direct fetal intramuscular therapy. Response to treatment following maternal intravenous administration (MIV) of digoxin or a combination of fetal intramuscular (FIM) digoxin and MIV is described for eight hydropic fetuses during nine successful pharmacologic conversions. The MIV digoxin was administered using standard loading and maintenance protocols. FIM was administered at a dose of 88 micrograms/kg q 12-24 hours, to a maximum of three injections in the fetal buttock. Time to onset of the first two hours of sinus rhythm (TO2 degrees), time to onset > 90% sinus rhythm (TO > 90%), and time to resolution of hydrops fetalis (HF) were noted. The mean heart rate was 257 +/- 36 beats/minute and the mean gestational age was 29 +/- 4.8 weeks. Fetal SVT was due to a reentrant mechanism in all cases. For the three fetuses that underwent successful cardioversion following MIV digoxin (all required additional maternal antiarrhythmic drugs), TO2 degrees was 145 +/- 114 hours, TO > 90% was 176 +/- 55 hours, and HF resolved in 41 +/- 37 days. Initial combined FIM and MIV therapy in four fetuses resulted in a TO2 degrees of 5.5 +/- 4 hours, TO > 90% of 22 +/- 14 hours, and resolution of HF in 25 +/- 21 days. For the two failed cardioversions with transplacental treatment alone (one fetus had recurrent SVT with hydrops after initial successful cardioversion with MIV), TO2 degrees was 203 +/- 180 hours and TO > 90% was 313 +/- 270 hours. Once FIM was begun in these fetuses, TO2 degrees was 17 +/- 7 hours and TO > 90% was 60 +/- 13 hours; HF resolved in 45 days in one fetus, whereas the other fetus never had resolution of hydrops despite 100 days of antiarrhythmic therapy. Direct fetal intramuscular injection of digoxin combined with transplacental therapy appears to shorten the time to initial conversion of SVT and to sustain sinus rhythm in the fetus with SVT complicated by hydrops fetalis.     

Cognitive-Behavioral Therapy for Insomnia: Comparison of Individual Therapy, Group Therapy, and Telephone Consultations.

Forty-five adults with primary insomnia received cognitive-behavioral therapy (CBT) implemented in a group therapy format, in individual face-to-face therapy or through brief individual telephone consultations. The results indicate that CBT was effective in improving sleep parameters with all 3 methods of treatment implementation, and there was no significant difference across methods of implementation. All 3 treatment modalities produced improvements in sleep that were maintained for 6 months after treatment completion. These results suggest that group therapy and telephone consultations represent cost-effective alternatives to individual therapy for the management of insomnia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reflective-functioning during the process in brief psychotherapies.

Reflective-functioning (RF) is the ability to recognize the existence and nature of mental processes taking place in the self and in others (e.g., intentions and wishes). RF was investigated here as a patient variable during the process in two studies of brief psychotherapy. The first study investigated cognitive-behavioral therapy (CBT) and interpersonal psychotherapy (IPT) in the TDCRP sample. The second study investigated psychodynamic psychotherapy (BPDT). The Psychotherapy Process Q-set (PQS) was implemented to identify process correlates associated with high and low RF in order to distinguish which specific components in the psychotherapeutic process are related to RF. Process correlates defining high RF had good outcome, and process correlates defining low RF had poor outcome. RF remained stable or decreased during treatments and was linked with personality characteristics in the patients. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Dialogical Encounters: Contemporary Perspectives on "Chairwork" in Psychotherapy.

This article looks at the use of "chairwork" (2-chair and "empty" chair) dialogues through the lens of 5 psychotherapies: Gestalt, process-experiential therapy, redecision therapy, cognitive-behavioral therapy, and schema therapy. Many clinical examples are provided, and they are organized into 4 overlapping groups: (a) internal in focus; (b) external in focus; (c) conflictual, that is, whether they involve the replaying of difficult or traumatic scenes from the past; or (d) corrective, which means that the emphasis is on replacing maladaptive cognitions or schemas with ones that are healthier. A potential foundation for Gestalt and cognitive-behavioral integration is proposed on the basis of the idea that gestalts are schemas (I. G. Fodor, 1996) and that chairwork is actually a form of cognitive restructuring (D. J. A. Edwards, 1989). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Infidelity and Behavioral Couple Therapy: Optimism in the Face of Betrayal.

Infidelity is a common issue with which distressed couples and their therapists grapple. However, there are no data on the efficacy of commonly used therapies to treat couples in which there has been an affair. In the present exploratory study, the authors examined the therapy outcomes of a sample of infidelity couples (n=19) who had participated in a randomized clinical trial of marital therapy (N=134). Results show that infidelity couples began treatment more distressed than noninfidelity couples; however, evidence suggests that couples who had an affair and who revealed this affair prior to or during therapy showed greater improvement in satisfaction than noninfidelity couples. Implications for therapy with infidelity couples are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to play therapy research theme issue.

Play therapy is at a point in its history where outside forces are demanding that we look at ourselves and demonstrate that what we do has empirical value. Many of these outside forces have either ignored play therapy or have questioned, even denied, the capacity of play therapy to produce positive outcomes in therapy and counseling of children. It is from this perspective that the need for a special research theme issue was born. Detractors and supporters of play therapy need to know what the state of the art is in play therapy research, along with ways we can help move play therapy research exposure and credibility forward. Sandra Frick-Helms was invited to guest edit this first in a series of theme issues for the International Journal of Play Therapy. She in turn asked Athena Drewes to join her in coediting this issue because of her wide range of knowledge, skill, and contacts in the therapy and counseling fields. Together, they have compiled an impressive grouping of authors and researchers who offer the reader food for thought and practical tips for research application. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is time-out from positive reinforcement an aversive event? A review of the experimental evidence.

Experiments concerning the aversive properties of time-out (TO) from positive reinforcement are reviewed. A discussion of experimental designs employed and problems encountered in defining aversive stimuli precedes the review. The major topics covered are: avoidance of TO, escape from TO, escape from stimuli which previously signalled TO, punishment with TO, effects on ongoing behavior of pre-TO stimuli, escape from conditions of positive reinforcement into TO. In general, TO satisfied sufficient criteria to conclude that it belongs to the class of stimuli called "aversive." However, this conclusion is only tentative. (2 p. ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

From the editor...

Introduces the articles appearing in this issue of the International Journal of Play Therapy. Of the five articles in this issue, three provide a quantitative analysis of the outcomes of play therapy/filial therapy and two present a qualitative approach through case study and model building. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Child-centered play therapy with a seven-year-old boy diagnosed with intermittent explosive disorder.

Child-centered play therapy (CCPT) has been supported as an effective method for working with children. A case study is presented that describes treatment using CCPT with a 7-year-old boy diagnosed with intermittent explosive disorder (IED). This case study delineates 16 sessions of play therapy with a registered play therapist. The behavioral problems the child exhibited at the onset of therapy were greatly improved at the conclusion of the sessions. The outcome of this case study supported the use of play therapy for children with IED. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effectiveness of play therapy: Responding to the critics.

Notes that play therapy has long been criticized for a lack of adequate research base to prove its efficacy. For 6 decades, while play therapists conducted small research studies, critics challenged the utility and efficacy of play therapy as a viable psychotherapy intervention. The purpose of this study was to conduct a meta-analysis of 94 research studies focusing on the efficacy of play therapy, filial therapy, and combined play therapy and filial therapy. The following electronic databases were used in the authors 3-yr search for studies on play therapy: PsycLit, PsycINFO, ERIC, FirstSearch, and Dissertation Abstracts. Meta-analysis revealed a large positive effect on treatment outcomes with children. Play therapy appeared effective across modality, age, gender, clinical vs nonclinical populations, setting, and theoretical schools of thought. Additionally, positive play therapy effects were found to be greatest when there was parent involvement in treatment and an optimal number of sessions provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief psychodynamic and cognitive therapy regarding acute treatment.

Cognitive–behavioral therapy (CBT) and psychodynamic psychotherapy either in their pure forms or possibly synthesized as a form of eclectic therapy appear to be the 2 most commonly utilized forms of psychotherapy, both having levels of empirical support. As the majority of outpatient therapy in America appears to be very brief, 1 reasonable assumption is that treatment is often sought for resolution of acute episodes. A relevant question for practice and clinical training is what are the potential implications with brief psychodynamic and cognitive therapy for this type of treatment? This brief commentary will address the following: (a) the current general differential empirical status of each approach; (b) distinctions between acute treatment and traditional brief therapy and current common treatment patterns; and (c) the general clinical mechanisms for change for each approach and their potential implications regarding acute treatment and clinical supervision. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A reflection on the blending of person-centered therapy and solution-focused therapy.

This article provides a commentary on the article by Cepeda and Davenport (2006; see record 2006-05485-001) that proposes an integration of solution-focused and person-centered therapy. The commonalities of each approach are highlighted as well as the differences. The primary argument of the article is that the process orientation of person-centered therapy may conflict with the goals of solution-focused therapy. Markers for identifying when each approach might be appropriate are identified and the implications for the therapeutic alliance of combining the two approaches are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Clients’ experiences giving gifts to therapists.

Nine therapy clients were interviewed regarding their experiences of giving gifts to therapists. Data were analyzed using consensual qualitative research. In describing a specific event when they gave a gift that was accepted, participants described having a good relationship with the therapist and usually identified their therapy concerns as relationship or family struggles or both. Most bought a relatively inexpensive gift they thought their therapist would like and gave it during a nontermination session to express appreciation or mark an important life event. Most participants acknowledged mixed emotions when giving the gift and noted that any discussion of the gift was brief and did not explore its deeper meaning. Nevertheless, most participants perceived that gift events positively affected them and their therapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Saying goodbye: A casebook of termination in child and adolescent analysis and therapy.

Reviews the book, Saying goodbye: A casebook of termination in child and adolescent analysis and therapy edited by Anita G. Schmukler (see record 1991-98015-000). Anita Schmukler's new book is comprised of 10 clinical and 6 theoretical papers. Schmukler and her colleagues set themselves the task of exploring and illustrating the theoretical and technical issues involved in ending child analyses. The primary theoretical question under review is, of course, the selection of criteria for terminability. The theoretical articles in this book try to tease out with some specificity the changes in the child and in the sessions themselves that indicate termination is on the horizon. Several articles outline criteria for termination, as indicated both in symptomatic improvement in the outside world and in the evolution of the transference neurosis in the analyst's office. The life and times of children and analysts at work around termination are richly illustrated. All practicing child analysts will recognize the pains and pleasures inherent in their line of work. And all will feel helped by the clarity of conceptualization offered as they think through with their own child patients and their parents the question of when it is time to say goodbye. However, the most important criterion for terminability, the child's expanded capacity to integrate disparate parts of himself or herself and metabolize his or her own experience, is inadequately explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contrasting exposure and experiential therapies for complex posttraumatic stress disorder.

In this paper, the authors compare and contrast two psychotherapy paradigms for the treatment of complex posttraumatic stress disorder (PTSD): a behavioral therapy (prolonged exposure; PE) and an experiential therapy (Accelerated Experiential Dynamic Psychotherapy; AEDP). PE has received strong research support as an effective treatment for PTSD. The scientific evidence for experiential therapy is sparser, but also positive. In addition, clinical and research evidence suggest that (a) experiential processes are inherently embedded in PE, and may influence PE outcomes; and that (b) AEDP addresses several clinical and relational factors that are negative prognostic factors for PE (e.g., affect dysregulation, disorganized attachment, sense of alienation and mental defeat, dissociation, and disorders of the self). Suggestions are provided for further empirical exploration of the process and efficacy of AEDP and experientially informed PE for complex cases of PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Blending psychotherapies.

Reviews the book, Psychoanalytic therapy and behavior therapy: Is integration possible? edited by Hal Arkowitz and Stanley B. Messer (see record 1985-97016-000). In this book, 13 scholars engage in a heady debate about whether a clinician can slip comfortably into a loose fitting suit with component pieces crafted independently by psychoanalytic and behavior thinkers. Some of the authors view alterations in their traditional dress as progressive whereas others tend to see amalgamation, consolidation, or synthesis as akin to castration. The 13 contributors to this volume represent a nice range of behavioral and psychoanalytic viewpoints on the subject of integration, and all of them write very well. Stylistically, each chapter, representing a specific viewpoint, is followed by both a commentary (written from a different perspective) and a rejoinder to the commentary. This book presents a great deal that is intellectually exciting, but there are some trends that are disquieting. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The development of an advanced filial therapy model.

This article presents an advanced filial therapy model. This model was developed and implemented by the author in an effort to provide parents with ongoing support and skill development after the completion of a standardized filial model called Child–Parent Relationship Therapy. The advanced filial therapy model is described, including an exploration of how it was developed and how it compares with basic filial therapy models. Examples from the author's clinical experience are provided to illustrate various components of this approach. Finally, implications for research and practice are considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Universal session-level change processes in an early session of psychotherapy: Path models.

The authors used structural equation modeling to investigate universal change processes identified in the generic model of psychotherapy (GMP). Three path models of increasing complexity were examined in Study 1 in dynamic therapy. The best fitting model from Study 1 was replicated in Study 2 for participants receiving either cognitive or interpersonal therapy. Findings provided support for the universality of the GMP constructs in different types of therapy. Positive influences for therapeutic bond, openness, and realizations were observed, as was a surprising negative impact for one aspect of bond. Discussion highlights a complex conception of the therapy relationship that underscores the importance of investigating the multiple functions that the therapy relationship might serve in different psychotherapies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapeutic and other hospital treatment criteria: The dilemma.

Inconsistent findings with regard to the result of treatment was assumed to be, at least in part, a function of different criteria for improvement utilized. Data regarding 66 items involving test material, demographic, clinical history, and follow-up information were intercorrelated and the matrix factor-analyzed. 7 relatively unrelated factors were found, but of all the items, only one seemed to be related to good post-hospital adjustment: a group therapy rating. It was concluded that a universal criterion for evaluating therapy was not found, but that personal interaction within the hospital was worthy of further investigation. From Psyc Abstracts 36:04:4IE98F. (PsycINFO Database Record (c) 2010 APA, all rights reserved)