Cotherapy is often used in groups treating substance abuse. There are many problems that involve the family of substance abusers and require attention on the part of the group leader. Extragroup issues, including legal problems, debt, housing, and employment, are all factors that affect conducting a group composed of substance abusers. Staff burnout is high among those who work exclusively with the problems of substance abuse. Team leadership is advantageous in allowing for the sharing of leadership tasks in the group. Having more than one leader increases options for identification, interaction, and the exploration of intragroup relationships. The leader’s therapeutic load is then lightened as a result, and the pace of the group can be accelerated.

A strain gauge is a device for measuring nocturnal penile tumescence that is used to determine whether erections occur during sleep. It has no biofeedback applications. In electromyography, muscle fibers generate electrical potentials that can be measured on an electromyograph. Electrodes placed in or on a specific muscle group can be monitored for relaxation training. In electroencephalography (EEG), the evoked potential of the EEG is monitored to determine relaxation. In galvanic skin response, skin conductance of electricity is measured as an indicator of autonomic nervous system activity.

Flooding works best with specific phobias, such as a social fear of eating in public. It is sometimes called “implosion” and is similar to graded exposure in that it involves exposing the patient to the feared object in vivo; however, there is no hierarchy. It is based on the premise that escaping from an anxiety-provoking experience reinforces the anxiety through conditioning. Thus, clinicians can extinguish the anxiety and prevent the conditioned avoidance behavior by not allowing the patient to escape the situation. Patients are exposed to the feared situation with no buildup, and no relaxation techniques are used. Patients experience fear, which gradually subsides over time. Many patients refuse it because of the psychological discomfort involved, and it is contraindicated when intense anxiety would be hazardous to a patient, such as those who are psychologically fragile.

Dialectical behavior therapy is a cognitive behavioral treatment program that also draws on methods from supportive therapies, as well as some Eastern philosophical schools, such as Zen Buddhism. It does not focus on insight. It has been developed to treat suicidal patients who meet criteria for borderline personality disorder and has been evaluated empirically. A recent study has demonstrated that it directly targets suicidal behavior. An important strategy of dialectical behavior therapy is to encourage outpatient use of behavioral skills over inpatient treatment even when self-destructive or suicidal risk is high.

The initial phase is dedicated to identifying the problem area that will be the target for treatment. The intermediate phase is devoted to working on the target problem area(s). The termination phase is focused on consolidating gains made during treatment and preparing the patient for future work on his or her own (Table 34.1).

Supportive psychotherapy aims at the creation of a therapeutic relationship as a temporary bridge for the deficient patient. Techniques are designed to focus on conscious external events and on the therapist as a largely nontransferential figure. As such, therapeutic neutrality is judiciously suspended with much greater direction, disclosure, and gratification offered than would be appropriate in other approaches. The global perspective of supportive psychotherapy places major etiological emphasis on external rather than intrapsychic events, particularly on stressful environmental and interpersonal influences on a damaged self. It is indicated generally for those whose potential for decompensation is high (not low). It focuses on the here and now of the patient’s problems; genetic interpretations relating to the patient’s past may cause decompensation and are generally contraindicated in this treatment. The therapist works to diminish the breakthrough of regressive transferences.