Len Sperry

A double-blind controlled study of methylphenidate treatment in closed head injury

Closed head injuries (CHI) may produce permanent, disabling changes in cognitive functions and social behaviour. Recent clinical case reports have suggested that stimulant medications may improve neurobehavioural functioning in CHI patients. In the present study, we evaluated the effects of methylphenidate (0.3 mg/kg b.i.d.) in 12 chronic CHI patients (14 to 108 months post-injury) using a double-blind, placebo-controlled, randomized, crossover design. Outcome measures consisted of cognitive tests of attention, learning and cognitive processing speed. In addition, a rating scale was completed by a close friend or relative to assess social behaviour. No significant differences were found between drug and placebo conditions on any of the neurobehavioural measures. These data do not support the clinical use of methylphenidate in the treatment of CHI patients.

Adlerian marital therapy strategies with middle income couples facing financial stress

Abstract This article describes the impact of economic stressors and discusses how Adlerian marital therapy strategies can be tailored to help middle-income couples deal with such stressors.

Integrating Spiritual Direction Functions in the Practice of Psychotherapy

Recent research and clinical experience suggest that clients are increasingly expecting that psychotherapists will deal with their spiritual concerns that are traditionally addressed in spiritual direction. This expectation has already begun to impact the practice of psychotherapy by increasing interest in the “spiritually-oriented-psychotherapies.” This article proposes that psychotherapy can become more receptive and effective in dealing with spiritual concerns by appropriately incorporating some or many of the functions of spiritual direction. The practice of spiritual direction is first described and compared to pastoral counseling and spiritually-oriented psychotherapy. Then eight functions of spiritual direction are presented and compared to similar “functions” in psychotherapy. Finally, specific recommendations for incorporating these functions into the practice of psychotherapy are discussed.

Case Conceptualization: A Strategy for Incorporating Individual, Couple and Family Dynamics in the Treatment Process

While market and regulatory forces have made case conceptualizations essential in individual, couple and family therapy, therapists, trainees, and supervisors are increasingly recognizing the clinical value and utility of case conceptualizations in everyday practice. This article describes and critically analyzes three main types of case conceptualization and argues that the client-focused type is the most appropriate in addressing theoretical and clinical considerations. A client-focused type with a phenomenological and systematic emphasis, called pattern analysis, is described. A detailed case study illustrates pattern analysis.

Tailoring treatment with dual-career couples

Abstract Clinicians are increasingly consulted by couples whose conflicts arise from or are exacerbated by a dual-career relationship. Therapy with these couples can be greatly aided when treatment is tailored to the unique needs of their relational system. A protocol for tailoring treatment based on a comprehensive, multidimensional assessment is described and illustrated with case material.

Teaching the Biopsychosocial Perspective: A Comparison of Two Approaches

Two approaches to teaching the biopsychosocial approach were compared. Four outcome measures from 55 patients and 11 resident physicians support a skill-based consultative approach as a more effective teaching method than a traditional didactic method. Implications of this innovative method for the practice of medicine are briefly discussed.

Workplace mental health consultation: A primer of organizational and occupational psychiatry

Though there are only a few hundred psychiatrists who identify themselves as specialists in organizational and occupational issues, the need for psychiatric skills in the workplace has increased dramatically in recent years. Crucial issues include distressed employees, the effects of organizational structure and change, job stress, psychiatric disability, substance abuse, and violence in the workplace. It is important for general psychiatrists to become more conversant in work and workplace-related mental health issues. Use of an occupational history with all patients, and knowledge of organizational structures and function, are just two ways to become more aware of these matters. With business and government increasingly attentive to mental health benefits and systems, appropriate psychiatric focus on organizational and occupational concerns becomes ever more important.

Adlerian marital therapy with the passive-aggressive partner

Abstract This paper describes the passive-aggressive personality and provides an Adlerian formulation of the PAP in couples functioning. It points out the similarities of this formulation to DSM-III-R, cognitive therapy, and transactional analysis. A specific treatment plan incorporating several types of intervention for helping such couples lead more effective marital lives is presented.

The impact of biological factors on marital functioning

Abstract Biological correlates have been shown to affect marital functioning. Reviewed are findings from studies on longevity and health status; psychosomatic, medical, and surgical conditions; biological rhythms; medication side effects; and nutritional factors that may be clinically useful in the practice of marital therapy.

Enhancing Brief Marital Therapy with Psychoeducational Interventions

Concurrent with the trend toward briefer psychotherapies is an increasing interest in utilizing psychoeducational interventions in the course of marital therapy. This article overviews three different perspectives on incorporating psychoeducaion (PE) into marital therapy and emphasizes the values of a comprehensive biopsychosocial assessment. A case study illustrates the use of PE to enhance marital therapy.