Managing Chronic Illness Using the Four-Phase Treatment Approach: A Mental Health Professional's Guide to Helping Chronically Ill People

Preface xi

Part I Conceptual Overview

1 A New Model for Treating the Chronically Ill 3

Necessary Paradigm Shifts 4

The Four-Phase Model and Other Phase Theories 5

Underlying Assumptions of the Model 13

Conceptual Dichotomies 16

The Phenomenon of Chronicity 23

Traumatization of the Chronically Ill 28

The Integration Assumption 35

Palliation 35

Patient and Clinician Together 36

2 The Cultural Context of Chronic Illness 39

The Primary Cultural Context: The Health Care System 39

Levels of Discourse 47

Sociocultural Inf luences in Chronic Illness and Their Traumagenic Effects 59

Potentially Traumagenic Sociocultural Factors 60

3 Introduction to the Four Phases: Betty’s Story 73

A Note on Developmental Life Processes 73

Betty’s Story 74

Part II The Four Phases

4 Phase 1: Crisis 97

Identifying Phase 1 Patients 99

Assessment: Physical/Behavioral Domain 105

Assessment: Psychological Domain 113

Assessment: Social/Interactive Domain 118

Clinical Goal and Treatment Issues in Phase 1 121

Treatment: Physical/Behavioral Domain 122

Treatment: Psychological Domain 130

Treatment: Social/Interactive Domain 149

Countertransference 160

Transformative Steps over the Four Phases 162

Countertransference in Phase 1 164

Clinical Stance in Phase 1 170

Spiritual/Philosophical Perspective in Phase 1 174

5 Phase 2: Stabilization 181

Personal Energy Process and Activity Categories 181

Identifying Phase 2 Patients 186

Assessment: Physical/Behavioral Domain 192

Assessment: Psychological Domain 196

Assessment: Social/Interactive Domain 199

Clinical Goal and Treatment Issues in Phase 2 206

Treatment: Physical/Behavioral Domain 207

Treatment: Psychological Domain 216

Treatment: Social/Interactive Domain 229

Countertransference in Phase 2 239

Transformation Steps in Phase 2 243

Clinical Stance in Phase 2 244

Spiritual/Philosophical Perspective in Phase 2 247

6 Phase 3: Resolution 253

Development of Meaning 253

Identifying Phase 3 Patients 256

Assessment: Physical/Behavioral Domain 263

Assessment: Psychological Domain 268

Assessment: Social/Interactive Domain 269

Clinical Goal and Treatment Issues in Phase 3 273

Treatment: Physical/Behavioral Domain 274

Treatment: Psychological Domain 276

Treatment: Social/Interactive Domain 294

Countertransference in Phase 3 298

Transformation Steps in Phase 3 301

Clinical Stance in Phase 3 303

Spiritual/Philosophical Perspective in Phase 3 304

7 Phase 4: Integration 315

Identifying Phase 4 Patients 316

Assessment: Physical/Behavioral Domain 322

Assessment: Psychological Domain 323

Assessment: Social/Interactive Domain 325

Clinical Goal and Treatment Issues in Phase 4 329

Treatment: Physical/Behavioral Domain 329

Treatment: Psychological Domain 331

Treatment: Social/Interactive Domain 335

Countertransference in Phase 4 337

Transformation Steps in Phase 4 338

Clinical Stance in Phase 4 340

Spiritual/Philosophical Perspective in Phase 4 341

Part III Future Directions

8 A Paradigm Shift 347

Chronicity and Ambiguity 347

Systems Inclusiveness 347

Distinctive Features of the Four-Phase Model 348

Umbrella Paradigm 351

Cyclic Pattern of Chronic Illness 353

Conceptual Dichotomies 354

Ongoing Trauma 357

Countertransference 358

Necessity for Teamwork 361

Meaning Development 362

Public Policy and Chronic Illness 363

Research Considerations 364

Bibliography 379

Author Index 415

Subject Index 425