14 - Combination of treatment methods

Summary

Combining several therapeutic techniques

Combination treatment is the simultaneous use of several therapeutic methods in psychotherapy, or a concomitant use of psychotherapy with non-psychotherapeutic treatments, e.g. medication or physical therapy.

Much like psychotherapy, three basic prinicples need to be considered when undertaking combined treatment: the psychotherapeutic method, the setting in which treatment is undertaken, and the disorder which is to be treated (Remschmidt and Schmidt, 1986). The three dimensions of this approach are explained in Chapter 1 and shown in Fig. 1.1.

Usually several methods, e.g. behaviour therapy, relaxation training, psychodynamic therapy, behaviour therapy, family therapy can be used together, as can several different settings, e.g. individual and group therapy or day-patient treatment followed by outpatient treatment.

However, treatment methods should never pursue incompatible goals and should work towards similar treatment aims. Thus, a very structured approach, e.g. operant conditioning techniques is considered incompatible with a laissezfaire approach, in which behaviour is left entirely up to the patient, e.g. non-directive play therapy. The aims of the two approaches are contradictory: on the one hand, strict behavioural rules are drawn up with the aim of modifying behaviour, whilst on the other hand, treatment is based on the idea that the patient can expand his behavioural repertoire through his own creativity, resulting in improvement of symptoms.