Biological Case

Much of these therapeutic gains can be attributed to their high degree of motivation and personal resources. Individuals who seem to have the best prognosis for personality change, according to repeated research outcomes, have been described in terms of the so called YAVIS pattern (Schofield, 1964)-they are Young, Attractive, Verbal, Intelligent, and Successful. Ironically, those who tend to do best in psychotherapy are those who seem objectively to need it least.

Psychotherapeutic interventions have been applied to a wide variety of chronic problems. Even a severely disturbed psychotic client may profit from a therapeutic relationship that takes into account his or her level of functioning and maintains therapeutic subgoals that are within the client's present capabilities. It should be clear from this brief description of individuals in psychological therapy that there is indeed no "typical" client, nor, as we will see, is there a "model" therapy.

Physicians, in addition to caring for their clients' physical problems, often become trusted advisers in emotional matters as well. In past eras, before the advent of health maintenance organizations and highly differentiated medical specialties, the family physician was called on for virtually all health questions. Even today, the medical practitioner-although he or she may have little psychological background and limited time to spend with individual clients-may be asked to give consultation in psychological matters. Many physicians are trained to recognize psychological problems that are beyond their expertise and to refer patients to psychological specialists. Another professional group that deals extensively with people's emotional problems is the clergy. Members of the clergy are usually in intimate contact with the emotional needs and problems of their congregations. A minister, priest, or rabbi may be the first professional to encounter a person experiencing an emotional crisis. Although some clergy are trained counselors, most limit their counseling to religious matters and spiritual support and do not attempt to provide psychotherapy. Rather, like general-practice physicians, they are trained to recognize problems that require professional management and refer troubled people to mental health specialists.

Most clinical psychologists receive broad clinical experience in assessment and psychotherapy in addition to their mental health research training. The psychiatrist is an M.D. who has had further training-minimally a three-year residency-in dealing with clients in a mental health setting. The medical training of psychiatrists qualifies them for administering somatic therapies, such as electroconvulsive therapy and psychotropic medication. In addition, during residency, psychiatric residents receive supervision in psychotherapy.