Guest Editor's Note

Abstract

When Mike Plaut and I first began to discuss ideas for this special issue, we thought about several things: the various issues facing clinicians today, the growing complexity of problems that people bring to therapy, and the multitude of theories and techniques that are now at therapists' disposal. As our discussion continued, and the list of possible topics grew, we eventually decided that having readers submit cases that either had been challenging to them, different from the more typical cases coming through the door, or represented a new way of looking at and doing therapy than what is typically the norm for a particular disorder, would be most interesting. So often we read about how to conceptualize a problem, or how to apply a new technique or approach-more seldom do we read about how this actually works in the therapy process. Additionally, there seems to be less and less time available these days to discuss cases with colleagues. The changes in the mental health field due to managed care have led many clinicians to increase their caseloads and see more patients. Consequently, there is less time for the busy therapist to discuss cases with colleagues. Yet we think that most clinicians are still interested in hearing how others work with patients and how they handle certain challenges and issues. We thought that focusing this special issue on case studies was one way this could be accomplished. The case studies selected for this special issue are comprehensive and, as most clinical cases are, complex. The authors have done an admirable job making the material come to life in a way that enables the reader to understand the patient and the therapist. These cases are typical of most clinical caseloads; previous treatment failures, family-of-origin issues, concurrent psychological distress or psychopathology, or physical symptomatology. In many of these cases success was achieved by asking certain questions not previously asked, through willingness on the therapist's part to be creative in approach (e.g., acquiring knowledge of the culture and religious beliefs of the patient), and through close collaboration with other health care professionals. It is my hope you will gain, as I did, some helpful ideas or insights that might benefit you in your work with patients. Let me give you an overview of this special issue. There are three papers that focus on vaginismus (we received several abstracts on this topic). It is clear that therapists feel quite challenged by this particular dis-