Talking About Treatment

Clear and accessible, this book is the first qualitative analysis of the complex conversations that occur between breast cancer patients and their oncologists. Roberts focuses on discussions about possible avenues of treatment, and shows them to be an active and mutual collaboration of information on the one hand, and a subtle delineation of the roles of "expert" and "novice" on the other. Her work highlights how doctors achieve a delicate balance between promoting one particular treatment option while not guaranteeing a cure.

Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received. In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients' and providers' attitudes, expectations, and behavior are analyzed. How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve provider-patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.

Selective Mutism (SM) is an impairing behavioral condition in which a child fails to speak in certain social situations despite speaking regularly and normally in other situations. SM presents a significant mental and public health problem due to impact on the social, emotional, and academic functioning of young children at a critical point in their development. SM is closely related to childhood social phobia, but it cannot be treated in the same way because of the young age of the children affected, their lack of speech in the treatment setting, and the need for significant school involvement in treatment. Treatment for Children with Selective Mutism outlines the sequence and essential elements to guide clinicians through a comprehensive, integrated program for young children who display symptoms of SM. This approach utilizes behavioral interventions targeting gradual increases in speaking across settings in which the child initially has difficulty. The integrated nature of the therapy refers to the goal of incorporating input from the clinician with that from the parents and teacher, as well as others impacted by the lack of speech. Exposure exercises are based on behavioral techniques such as stimulus fading, shaping, and systematic desensitization that also allow for a less intense or gradual exposure to the speaking situation. These techniques are combined and used flexibly with a behavioral reward system for participation in treatment. The approach was developed by Dr. R. Lindsey Bergman as part of the UCLA Childhood OCD, Anxiety, and Tic Disorders Program. The treatment protocol consists of 20 sessions, 60 minutes each, delivered over the course of 24 weeks. Treatment for Children with Selective Mutism is an invaluable guide for mental health professionals who deliver CBT-based treatment to children and want to help those with SM.

Empirical evidence shows that treatment failure is a significant problem and one that practitioners routinely overlook. A substantial minority of patients either fail to gain a benefit from the treatments offered to them, or they outright worsen by the time they leave treatment. Intervening in a timely fashion with such individuals cannot occur if practitioners are unaware of which cases are likely to have this outcome. Prevention of Treatment Failure describes procedures and techniques that can be used by clinical practitioners and administrators to identify patients who are at risk for treatment failure. The book summarizes evidence that convincingly shows that a shift in routine care is needed, and that such a shift can be accomplished easily through integrating specific methods of monitoring patient treatment response on a frequent basis in routine care. Treatment response is placed in the context of historical views of healthy functioning and operationalized through the use of brief self-report scales. Providing alert-signals to therapists, along with problem-solving tools, is suggested as an evidence-based practice that substantially reduces patient deterioration and increases the chances of the return to normal functioning. The book also provides illustrations on how accumulated data resulting from monitoring patient treatment response can be used to improve systems of care.

An in-depth look at a much misunderstood practice, offering a fresh viewpoint on how this science can be a universally effective route to our better selves.

Motivation is key to substance use behavior change. Counselors can support clients' movement toward positive changes in their substance use by identifying and enhancing motivation that already exists. Motivational approaches are based on the principles of person-centered counseling. Counselors' use of empathy, not authority and power, is key to enhancing clients' motivation to change. Clients are experts in their own recovery from SUDs. Counselors should engage them in collaborative partnerships. Ambivalence about change is normal. Resistance to change is an expression of ambivalence about change, not a client trait or characteristic. Confrontational approaches increase client resistance and discord in the counseling relationship. Motivational approaches explore ambivalence in a nonjudgmental and compassionate way.

In a straightforward and easy–to–understand manner, Dr. Carroll describes what a new patient likely will experience when entering a comprehensive inpatient or outpatient Substance Use Disorder treatment program and what services s/he ideally should receive. Dr. Carroll also provides his perspective on how addiction develops, what addiction treatment should entail, the causes of relapses, and his approach to helping his patients achieve a meaningful recovery and enhanced quality of life. His perspective is based on forty–seven years of experience working in the field of addiction – as a service provider, administrator, program developer, executive, researcher, trainer, and consultant.

If you feel that a friend or loved one has a problem and needs professional help, this step-by-step guide will give you the tools to approach, engage, and support him or her. Just about everyone knows a relative, friend, or coworker who is exhibiting signs of emotional or behavioral turmoil. Yet figuring out how to reach out to that person can feel insurmountable. We know it is the right thing to do, yet many of us hesitate to take action out of fear of conflict, hurt feelings, or damaging the relationship. Through a rich combination of user-friendly tools and real-life stories, Mark S. Komrad, MD, offers step-by-step guidance and support as you take the courageous step of helping a friend who might not even recognize that he or she is in need. He guides you in developing a strong course of action, starting by determining when professional help is needed, then moves you through the steps of picking the right time, making the first approach, gathering allies, selecting the right professional, and supporting friends or relatives as they go through the necessary therapeutic process to resolve their problems. Included are scripts based on Komrad’s work with his own patients, designed to help you anticipate next steps and arm you with the tools to respond constructively and compassionately. You will also find the guidance and information needed to understand mental illness and get past the stigma still associated with it, so you can engage and support your loved one with insight and compassion in his or her journey toward emotional stability and health.