Therapy techniques have grown to be increasingly important methods in the treatment of men and women with various forms of substance abuse ("SA") issues. Particularly in a day and age of managed treatment 1, the pressure to provide quick but extensive solutions to them is intense. Fortunately, there are several colleges of counselling whose techniques are amenable to these requirements. As the details of interventions and remedies will rely upon conditions like the substance(s) used, the severe nature of the condition(s) being tackled, and the desired short and long term effects, the techniques can be utilized independently or in a more eclectic combo.
Studies which is examined here show quick treatment can succeed for a range of problems. One of their primary advantages is that being that they are less costly, more people can be come to with resolved governmental financial resources. In addition, the techniques can be customized to the precise needs of a person client.
The term "brief remedy" as reviewed herein contains several treatment solutions derived from a number of theoretical institutions. They have been selected for use in the procedure world for a variety of reasons. This paper does not plan to be an exhaustive cataloging of these. In fact it'll look at only the three mostly used of the eight found out in a search of the primary U. S. databases of drug abuse treatment methodologies (SAMHSA, 2010) that the writer has personal experience with. The three are recognized by significant research, while others, such as Existential Therapy, havent been, and in truth some academic institutions of treatment may by their nature not be subject to such scrutiny.
The counselling methods found are:
Strategic Therapy
Interactional Therapy
Humanistic Therapy
Existential Therapy
Brief Family Therapy
Time-Limited Group Therapy
Brief Remedy Defined
Brief therapy is a process that uses rapid assessment (sometimes as little as five minutes; more generally an hour or two), immediate customer engagement (sometimes compelled by courts and other police agencies however in all cases based mostly upon the skill of the clinician (CSAT, 1998) and the proper assessment of client eligibility to begin with), and laser-like focused training in means of utilizing change. The length of time of brief solutions found ranges from one to more than three dozen classes, with typical amounts of trips of between six and twelve (Heather, 1994).
Research concerning comparative effectiveness of short versus long run therapies for a number of presenting problems is blended. However, there is certainly evidence recommending that brief remedies are often as effectual as lengthier treatments for properly-selected groups of clients.
Cognitive-Behavioral Therapy
Cognitive-behavioral therapy (CBT) derives, in part, from both behavioral and cognitive theories. While sharing a number of principles and methods in common, CBT is also unique in many ways from these other therapies (Carroll, 1998).
CBT uses the teaching of new learning procedures to help individuals reduce their medication use. It works by helping clients understand risky situations in which they are likely to use, find means of steering clear of those situations, and manage more effectively with them if indeed they cannot avoid them. It also instructs these to addresses their internal feelings and outward manners related to their substance abuse (Carroll, 1998).
To achieve these goals, cognitive-behavioral SA therapists use three basic methods: (1) functional evaluation, (2) coping skills training, and (3) relapse protection (Rotgers, 1996).
Functional Analysis
This analysis attempts to identify the precursors and results of substance abuse which provide as triggers. Precursors can come from emotional, communal, cognitive, situational, environmental, and physiological domains (Miller, 1980). The efficient analysis also needs to focus on the number, breadth and performance of the client's coping skills. While a significant weight in CBT is on spotting and fixing deficiencies in coping skills, the therapist also analyzes the client's advantages and adaptive skills (DeNelsky and Vessel, 1986).
Coping Skills Training
A major part in cognitive-behavioral remedy is the introduction of appropriate coping skills. Deficits in coping skills among material abusers may be the consequence of lots of possible factors (Carroll, 1998). They could have never developed these skills, possibly because the early onset of drug abuse and/or early family dysfunction impaired the introduction of age-appropriate skills. Or, previously developed healthy coping skills might have been diminished by the actual use of chemicals as the client's main method of dealing with life. Also, some clients continue to use skills which were suitable to a youthful time but are no more apt or useful. Others clients may involve some good coping skills but also for some reason are clogged from with them. However these flaws originated, one of the key goals of CBT is to help the individual cultivate and use coping skills that are designed for high-risk situations and never have to go back to their learned coping skill: more medication use.
Relapse Prevention
The third part of CBT is relapse avoidance. While one will discover many theories of relapse (Donovan and Marlatt, 1993), the most common one cited is that of Annis and Davis (1989). Relapse prevention relies an intensive initial efficient analyses, recognition of causes (people, places and things), and coping skills, but offers more training in which the therapist deals directly with the thinking involved in relapse process and works on getting the given individual to be more effective in dealing with that thinking.
The two main features of CBT are a) that it's generally brief in length and b) adaptable in implementation. CBT is usually done in 12 classes over 12 weeks (Carroll, 1998). Lessons include basic ones that package with substance-related issues (urges, declaring "no" to offered chemicals, crisis planning) and standard problem-resolution skills as well as more particular topics that are definitely more general (usually cultural and communication skills) predicated on the individual diagnosis. For instance, a 12-session CBT for cocaine use shows that this amount of treatment is enough to develop and keep maintaining cocaine abstinence, (Carroll, 1998). Alas, however, not absolutely all clients will significantly improve for the reason that number of trainings. If occurring, the original CBT experience can still form the building blocks of a far more thorough treatment plan.
Brief Psychodynamic Therapy
Psychodynamic remedy ("PT") attempts to treat the unconscious thoughts that bring about the behavior the client presents at analysis. The goals of psychodynamic therapy are self-awareness and experiencing the impact of the past on the present. In its quick form, this process teaches the client to view unresolved conflicts and behaviors which have grown up out of previous dysfunctional interactions and behaviors and that arrive in the need and prefer to use chemicals.
Many different methodologies of brief psychodynamic psychotherapy have developed from psychoanalytic theory and also have been used clinically to treat many disorders. An acceptable body of research supports the use of the methodologies (Crits-Christoph and Barber, 1991).
Short-term PT generally has been seen to be the very best when used within a more extensive treatment program that includes such aversive tools as urine verification, psycho-education and some of the newer psychopharmacological treatments.
Brief PT also seems to be more effective over time of abstinence has been achieved. It may also be more useful with people of only moderate severeness in their abuse. Irrespective, the therapist must be well-versed in SA pharmacology, the subcultures of substance abuse, and 12-Step programs.
Ten major methods to short-term psychodynamic psychotherapy were learned in a search of the SAMHSA database (SAMHSA, 2010; Crits-Christoph and Barber, 1991). They are really:
Mann's Time-Limited Psychotherapy (TLP)
Sifneos' Short-Term Anxiety-Provoking Psychotherapy (STAPP)
Davanloo's Intensive Short-Term Active Psychotherapy (ISTDP)
SE Psychoanalytic Psychotherapy
The Vanderbilt Method of Time-Limited Dynamic Psychotherapy (TLDP)
Short-Term Dynamic Remedy of Stress Response Syndromes
Brief Adaptive Psychotherapy (BAP)
Dynamic Supportive Psychotherapy
A Self-Psychological Approach
Interpersonal Psychotherapy (IPT)
While these strategies differ in some or many ways with regards to the extent to that they use supportive versus challenging techniques, focus on short-term or long-term problems, have an objective of managing symptoms or undertaking more important personality change, or are inward or outward directed, they all comply with some of the essential tenets of psychotherapy: the value of the therapeutic alliance, working with body's defence mechanism and resistance, and transference,
This list is not exhaustive; numerous others, perhaps less well known, or alterations to them aren't considered here. Several approaches have developed from scientific experience and are thus based on more anecdotal data, plus some have been explored minimally, if.
The number one factor that appears to determine a successful end result of PT is the healing alliance that builds up (Luborsky et al. , 1985). This seems to be true in addition to the specific school of remedy. Psychodynamic remedy has always looked at the partnership as critical and the means where change occurs. Of all the brief techniques talked about, PT places the greatest emphasis on the therapeutic romance and the most specific and thorough information of developing and maintain this romantic relationship.
Another critical root concept of psychodynamic theory -- and the one which can be of great benefit to all therapists -- is the concept of insight. Psychodynamic strategies regard insight as a most effective kind of self-knowledge, particularly with respect to past issues and present world-views and the information into repressed thoughts. Insight can appear quickly or slowly but surely, however the goal of quick PT is to streamline the procedure. Luborsky et al. give an example of a client who feels stressed out and furious and then drinks who then realizes that his anger toward his daddy that he considers lead him to utilize is stimulated by another abusive person in his life, perhaps at the job. This learned understanding then provides client the chance to interrupt the patterns.
Brief Group Therapy
Group psychotherapy is the most frequent method of treatment of drug abuse disorders. It really is different from other styles of group therapy, such as family therapy, in that categories tend to be a) open-ended and b) shaped with folks who are generally strangers to each other.
The lessons discovered in the group are then employed in the client's external social network. The client then returns to the group to describe his/her success/inability and the group functions this.
Group remedy is cited as standard SA treatment for a number of reasons. In actual practice, groups allow client see how their disease has advanced in themselves and in the associates of their interpersonal network. It lets them experience their own success and the successes of other group people within an environment of mutual support and hope. The curative factors associated with group psychotherapy, described by Irvin Yalom, the elder statesman of group remedy, specifically address the issues of hope, universality and insight seen through others, and a number of other issues specific to the SA clients (Yalom, 1995). Furthermore, Alcoholics Anonymous (AA) and many other 12-Step groups have long identified the value of the way the fellowship of an organization can end the profound and unpleasant isolation associated with substance abuse. At the same time, such groups foster a level of connectedness with those people who have a common purpose which is to drastically and permanently change their lives. Out of this angle, short psychotherapy teams offer significant opportunity to maximize the initiatives of your client and the therapist.
Research shows that most clients improve through group therapy in a brief amount of time - typically 8 to 12 weeks (Garvin et al. , 1976). Garvin's research suggests that brief group remedy can plan that of long run remedy in fostering change, if that remedy is more goal-oriented, more organized and more directive than long-term group remedy.
SAMHSA identifies seven ways of group remedy (SAMHSA, 2010):
Brief cognitive group therapy
Cognitive-behavioral group therapy
Strategic/interactional therapy
Brief group humanistic and existential therapies
Group psychodynamic therapy
Modified powerful group therapy (MDGT)
Modified interactional group process (MIGP)
The preferred time for short group remedy is no more than 2 sessions per week (except in home treatment where it usually occurs daily). Trainings are usually 1 to 2 hours long.
Given the much shorter domestic course of treatment that generally occurs under managed care, one can question the utilization of a process-intensive group and suggest that psycho-educational groups be used instead. However, even though today's client might not exactly spend more than 3 to 5 times in detox by using an inpatient device, much work can be done by the client in this short time. As stated before, directive educational teams are an additional necessity but aren't generally sufficient independently. Groupings with expert, productive facilitation, but which still abide by a formal, can easily build cohesion and become powerful tools for clients to move to their next level of treatment.
Group remedy is usually most effective if customers have had the opportunity to build up their assignments in the group, to perform in these jobs, and to learn from the reviews they receive. Categories usually need period to explain themselves, develop cohesion, and be a protected climate for the members. Naturally, with any treatment, associates have to have cleansed their bodies and minds of the most drastic serious ramifications of their recent use before gaining much benefit from the group. Because of this, the time shape of the member's participation in the group must addresses his or her own restorative goals as well as any externally-imposed limit.
Modified Interactional Group Process
Brief therapy based on the Modified Interactional Group Process ("MIGP") is a mixture of the work of several theorists, mostly Irvin Yalom (Yalom, 1995). MIGP differs significantly from psycho-educational groupings found in treatment. While both types of groups offer learning experience necessary for a newly-sober customer, combining one with the other has the most clinical result. The psycho-educational group is more directive, with the therapist as the primary figure. Despite having this, however, the dynamism of the procedure itself, even in a psycho-educational format, enables clients to make cable connections and build romantic relationships that will support their restoration.
The features that produce MIGP different other group processes are the better activity of the leader and his / her creation of a safe environment which allows group members to look at inter-personal romance issues without abnormal psychological reticence. This feeling of safe practices is greatly increased by the therapist's enforcement of adherence to group guidelines and norms during the period of the group's life. The critical importance of confidentiality, the group's performing in a dependable, mature fashion, and the need for self-disclosure must all be backed by the therapist. Beginning and ending on time, ensuring each member has a location in the group, and dealing with absences set examples of boundaries the members might not exactly have recently experienced in their chaotic, dysfunctional lives and contribute to the development of a safe healing environment.
By carrying out this, the leader trains the clients to understand that they, not he or she, the primary brokers of change. The group becomes a safe spot to give and to receive support. And although customarily SA were once significantly confrontational, MIGP is less threatening and a lot more supportive. Yalom bases this on the belief that denial and other body's defence mechanism become more fixed whenever a person is attacked. Therefore, group members are encouraged to support one another and look for regions of commonality alternatively than use more shame-based interactive styles that attempt to "break through denial. "
Conclusion
There are many counseling techniques available for drug abuse treatment. Some have been rigorously researched and others count more on anecdotal information. Some are based on well-researched and time-established ideas of personality and habit and others are new. This paper has not been an effort to exhaustively catalog most of them but rather to assess some of the most popular and, in today of managed health care and limited governmental costs, most cost-effective method of providing some significant treatment to a more substantial society than can be offered by what continues to be the gold standard to element treatment: 30-90 days and nights of residential treatment followed by 3-6 weeks of regular aftercare organizations.
Brief Psychodynamic Therapy
(Crits-Christoph and Barber, 1991)
Therapy (Theorist)
Length of Treatment
Focus
Major Techniques
Time-Limited Psychotherapy (Mann)
12 sessions
Central issue related to discord about reduction (lifelong source of pain, attempts to understand it, and conclusions drawn from it about the client's self-image)
Formulation, presentation, and interpretations of the central issue
Interpretation around prior losses
Termination
Short-Term Anxiety-Provoking Psychotherapy (Nielsen and Barth)
Usually 12 to 15 sessions
Unresolved conflict described during the evaluation
Early transference interpretation
Confrontation/clarification/interpretations
Intensive Short-Term Active Psychotherapy (Laikin, Winston, and McCullough)
5 to 30 sessions; up to 40 trainings for severe personality disorders
Experiencing and linking social issues with impulses, feelings, defenses, and anxiety
Relentless confrontation of defenses
Early transference interpretation
Analysis of persona defenses
SE Therapy (Luborsky and Mark)
16 for major depression, 36 for cocaine dependence
Focus on the key conflictual relationship theme
Supportive: creating therapeutic alliance through sympathetic listening
Expressive: formulating and interpreting the CCRT; relating symptoms to the CCRT and describing them as coping attempts
Vanderbilt Time-Limited Active Psychotherapy (Binder and Strupp)
25 to 30 sessions
Change in social performing, especially change in cyclical maladaptive patterns
Transference analysis in a interpersonal framework
Recognition, interpretation of the cyclical maladaptive structure and fantasies associated with it
Brief Adaptive Psychotherapy (Pollack, Flegenheimer, and Winston)
Up to 40 sessions
Maladaptive and inflexible personality attributes and feelings and cognitive working, especially in the social domain
Maintenance of focus
Interpretation of the transference
Recognition, task, interpretations, and resolution of early resistance
High degree of therapist activity
Dynamic Supportive Psychotherapy (Pinsker, Rosenthal, and McCullough)
Up to 40 sessions
Increase self-esteem, adaptive skills, and ego functions
Self-esteem boosters: reassurance, compliment, encouragement
Reduction of anxiety
Respect adaptive defenses, problem maladaptive ones
Clarifications, reflections, interpretations
Rationalizations, reframing, advice
Modeling, expectation, and rehearsal
Self Mindset (Baker)
12 to 30 consultations, not rigidly adhered to
Change intra-psychic habits. Include more diverse representations of others and changes in information processing
Analysis of the mirroring, idealizing, and merger transferences
Supportive, empathic
Interpersonal Psychotherapy (Klerman)
Time limited; for drug abuse, the studies have been 3 and 6 months
Eliminating or reducing the primary indicator; improvement in handling current interpersonal problem areas, especially those associated with material abuse
Exploration, clarification, encouragement of affect, analysis of communication, use of the restorative romance and behavior-change techniques
