Collaborative Practice and Support Systems

Qualitative inspection of the studies reviewed reveals certain themes and consistencies that appear in multiple interventions. First, and by definition, psychotherapy presupposes a collaborative practice approach to managing manic-depressive disorder. This collaboration includes the individual being treated, provider, and, where possible, partner or family members. Rather expect the individual and, where possible, significant others to bccome educated regarding the illness and to become partners in managing it. Although the specific methods and priorities may differ somewhat (e.g., work with couples vs. group work only with those in treatment vs. individual cognitive interventions), this theme is perhaps most evident across all modalities. The care organization interventions of Bauer, Williford, and coworkers (2001) and Simon and coworkers (2001) also build upon this basic collaborative approach. Second, few interventions manage the individual in isolation. Family or couples interventions have been tested in those whose social network has not unraveled. In those interventions that work with a less select group, the individual is often seen as part of a group to enhance social support, reinforce


: the most cost-effective interventions are likely to be the most widely This is one of the major reasons that the Life Goals Program is delivered in group format. In addition, one needs to recognize that fits from psychosocial interventions may not be evident until some in into treatment (Bauer et al, 1998; Miklowitz et al, 2000).

fholld take* this long-lead time imoLcount.

A further challenge will be to develop interventions that not only are able to be widely disseminated but that are sustainable in j , This will require that interventions be

• applicable to the majority of individuals encountered in such :

• implementable by clinical staff likely to be available in those settings, and

• acceptable cost-wise from the perspective of the payor, who will:

ceptabie o the decision regarding whether or not to implement a specific type of

These issues of sustainability are not specific to psychosocial treatments, but they have been a focus of debate around increasingly expensive medications for other psychiatric and medical disorders as well. However, the payoff for manic-depressive disorder is potentially great in terms of reduced morbidity if researchers can develop psychosocial interventions that are indeed able to be disseminated and sustained in general clinical practice. We will now turn in detail to the conceptual background and structure of the Life Goals Program, which was designed with such issues as dissemination and sustainability in mind.

Ch apter 6

The Conceptual Framework for the Life Goals Program


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