We all have strategies aimed at making our work with patients more productive. What strategies have you used with patients between sessions--such as giving them handouts to read or tapes to listen to--that have enriched the therapeutic experience? Have you found that certain strategies are effective for certain types of patients?
Speeding the Recovery
It's been known for quite some time that there's a correlation between doing psychotherapy homework between sessions and the speed of recovery or degree of improvement from major depression. A colleague and I published some research recently on the topic of psychotherapy homework in the treatment of depression. We looked for the first time at the causal effect of homework compliance and recovery from depression and saw that the data were consistent with the idea that there's a fairly strong causal effect of these homework assignments. The patients who consistently did at least some psychotherapy homework between sessions were the ones who improved the most, while patients who refused to do psychotherapy homework did not improve and sometimes even deteriorated (J. Consult. Clin. Psychol. 68:46-56, 2000). It's a vitally important area. Not only do the homework assignments speed recovery, they help you identify patients who are motivated versus those who are committed to their symptoms for whatever reason.
When I wrote "Feeling Good: The New Mood Therapy," I intended the book as homework that patients could read between sessions. I originally conceptualized it as a series of handouts I could give patients to read so that they could learn to do certain things on their own and learn about the ideas of cognitive therapy. Then I could focus more on individualizing it to their problems during the actual sessions.
The book is probably still a very good type of homework assignment for patients. A psychologist at the University of Alabama, Forrest Scogin, has published six or seven controlled outcome studies that examined the antidepressant effects of "Feeling Good" alone, without drugs or psychotherapy. He and his colleagues have shown that two-thirds of patients with major depression have recovered or improved substantially within 4 weeks without any other treatment. That type of bibliotherapy is one of the best types of homework that patients can do.
David D. Burns, M.D.
Los Altos Hills, Calif.
Activities Are Important
I've been in practice for 35 years, and I'm now mainly doing geriatric psychiatry. Treatment for most psychiatric illnesses--especially depression, schizophrenia, psychosis--in my opinion consists of psychotherapy, medication, and activities. I encourage activities more than anything. Most of the psychotherapy that we do is in relation to activities that we encourage. These are things such as reading newspapers, writing poems, or taking trips or even walks to various places. I always encourage my patients to write down their feelings and thoughts. If they bring a log of irrational thoughts, we can discuss what would be a more rational response to those thoughts during a session. Just thinking about themselves and writing things down is more important than spending 45 minutes with me.
Jack Dang, M.D.
Families Can Help
I do a lot a work with patients who have schizophrenia and bipolar illness. The most significant thing I've done is to establish a free group for families with a member who is severely mentally ill. I spend 2 hours a week with that group. By educating the families and helping them deal with their emotions, the family member with the severe mental illness does much better, and I receive many fewer calls. The family becomes an extension of me, because they understand the illness, they keep the patient on medication, they help to provide structure for the patient, and their own emotional responses are more reasonable when crises come up so that they can diffuse a situation. …