Therapeutic Multiple Family Groups

The therapeutic effects of interpretations by both therapists and other clients were recorded by observers in three cognitive–behavioral and three psychodynamic groups over a period of thirty one-and-one-half-hour group therapy sessions. There was no significant difference in the overall frequency of interpretations made in the two different therapy modalities; however, there was the expected difference in the types of interpretations made. Cognitive–behavior therapists and group members tended to interpret patterns of behavior or impact on others more frequently than did psychodynamic therapists and group members; while psychodynamic therapists and group members made more historical cause interpretations. However, contrary to expectations, both therapy modalities made more interpretations of patterns of present behavior than any other type. When these interpretations were converted into problem statements that were sent to outside raters after the termination of the groups, the outside raters judged that clients improved most when interpretations of a pattern of behavior were made; next most when interpretations of impact on others were made; and did not improve when interpretations of motive were employed in either modality.     

The effects of different types of interpretation on outcome in group psychotherapy

Interpretations in three psychodynamic therapy groups were rated according to Yalom's typology. Results indicated that here-and-now interpretations were employed over four times as often as historical ones. Outcome results, as measured by the DSM-III-R, indicated that interpretations of a client's present patterns of behavior were most effective in changing pathology, followed by interpretations of the impact of the client's behavior on others, then by historical interpretations. Interpretations of motivation tended to make clients worse. Client session satisfaction ratings demonstrated the same pattern as the outcome results.     

Chapter 4 Interpretation in Short-Term Therapy

Abstract

There is much theoretical and clinical literature on the role of interpretation in psychoanalysis, psychoanalytic psychotherapy, and brief dynamic psychotherapy, but little supporting research data. Using 112 audiotaped sessions from 38 patients in supportive-expressive time-limited treatment, the present study hypothesized that therapists would modify the object and temporal content and frequency of their interpretations in relation to the level of patient functioning. The results did not support this hypothesis. Therapists were not less active with more interpretations for higher functioning patients, nor were they more active with fewer interpretations for lower functioning patients. Therapists were more active and made more genetic interpretations with married patients, regardless of level of patient functioning. The findings are discussed in terms of their implications for supportive-expressive psychodynamic therapy.     

“Bridging the Gap”: A reflexive thematic analysis of the experiences of therapy trainees transitioning from psychodynamic counselling to cognitive behavioural therapy

There is limited empirical research and insight into the experiences of therapy trainees who are being taught more than one psychotherapeutic approach during their training. Further understanding is warranted to ensure that a dual modality approach to training (that is, where therapists are trained in two paradigmatically distinct modalities) is experienced as worthwhile and acceptable to trainees and to better understand any challenges faced when transitioning between approaches. The aim of this study was to investigate trainees' experiences of transitioning from psychodynamic counselling to cognitive behavioural therapy (CBT) on a two-year master's degree that offers a dual modality approach to training. Data were collected from a sample of 8 trainees using an online semistructured questionnaire. These data were analysed using Braun and Clarke's (2020) reflexive thematic analysis. Four main themes were identified: (1) perceived competence; (2) preparedness; (3) professional advantages; and (4) external challenges. The findings suggested considerable individual variation in the ease with which participants navigated the transition between therapeutic modalities. Those who found the transition easier used the structure of CBT to provide a framework and point of difference that allowed them to temporarily suspend their psychodynamic learning in order to embrace a new therapeutic approach. Others experienced the move to CBT as posing a threat to their developing identities as counsellors. Recommendations are made on how to prepare trainees for the transition including exploring the psychological impact of transitions, increasing opportunities for reflective practice and facilitating exploration of what it means to be a therapist trained in two distinct therapeutic modalities.     

Group Work with Aggressive Men: Group Within a Group Within a Group

Psychodynamic group therapy offers many opportunities for members to identify, understand, and change the underlying problems, which lead to their aggressive behavior. In addition, group therapy can help to improve the members’ interpersonal relationships. The “Coping with Aggression” is comprised of three groups. A psychodynamic group of assaultive men made up the first group. The second group consisted of two leaders and a consultant whom the group members knew about but never actually met. The observers who sat outside the group made up the third group. Therapy contracts, boundaries, and leadership, and group process are discussed.     

Building Alliances with (In)Voluntary Clients: A Study Focused on Therapists’ Observable Behaviors

This study aimed to compare therapists’ observable behaviors to promote alliances with involuntary and voluntary clients during brief family therapy. The therapists’ contributions to fostering alliances were rated in sessions 1 and 4 using videotapes of 29 families who were observed in brief therapy. Using the System for Observing Family Therapy Alliances, trained raters searched for specific therapist behaviors that contributed to or detracted from the four alliance dimensions: engagement in the therapeutic process, an emotional connection with the therapist, safety within the therapeutic system, and a shared sense of purpose within the family. The results showed that when working with involuntary clients, therapists presented more behaviors to foster the clients’ engagement and to promote a shared sense of purpose within the family. However, in the fourth session, the therapists in both groups contributed to the alliance in similar ways. The results are discussed in terms of (a) the therapists’ alliance‐building behaviors, (b) the specificities of each client group, and (c) the implications for clinical practice, training, and research.     

No ownership of common factors

Comments on the original article, "The efficacy of psychodynamic psychotherapy," by J. Shedler (see record 2010-02208-012). Shedler's informative article raised several issues worthy of comment. His choice of the word distinctive (p. 98) in describing aspects of psychodynamic technique is open to at least two interpretations. On the one hand, distinctive can have a qualitative meaning and indicate the presence of a characteristic that is not shared. For example, a sign in the Bronx Zoo distinguishes birds from all other creatures as follows: "If it has feathers it's a bird, if it doesn't, it isn't." On the other hand, distinctive can have a quantitative meaning and indicate that one practice has more of a common element than another practice. Careful reading of Shedler's article and the article by Blagys and Hilsenroth (2000) that forms the basis of the "seven features [that] reliably distinguished psychodynamic therapies from other therapies" (Shedler, 2010, p. 98) shows that Shedler subscribes to the latter, quantitative, definition of distinctive. In other words, the seven features he presented are present in both psychodynamic therapies and the cognitive-behavioral therapies to which he compares them. For example, although Shedler did not mention it, dialectical behavior therapy explicitly focuses on six of the seven features, namely, "focus on affect and expression of emotion," "exploration of attempts to avoid distressing thoughts and feelings," "identification of recurring themes and patterns," "discussion of past experience," "focus on interpersonal relations," and "focus on the therapy relationship" (Shedler, 2010, p. 99). However, in the articles that Blagys and Hilsenroth reviewed, psychodyamic therapists engaged in more of these behaviors than did cognitive-behavioral therapists.     

Using Genograms Creatively to Promote Healthy Lifestyles

ABSTRACT

Family therapists have used Genograms as an assessment tool for years to examine the interactions and relationships of family members across generations. This article discusses how a therapist can use a genogram creatively to help clients examine the impact of family relationships on healthy and unhealthy lifestyle patterns and how those relationships may be influencing the manner in which clients are currently managing their lives. The integration of a creative genogram can assist clients in recognizing inherited health-disease risks, learned lifestyle patterns, and parental behavior modeling. This technique can assist clients in developing a healthier lifestyle.     

The Influence of Individual Attachment Styles on Group Members’ Experience of Therapist Transitions

Abstract

Attachment theory has recently been applied to clinical practice in an effort to improve understanding and treatment of the maladaptive relational patterns clients bring to therapy. While most of this research has focused on individual therapy, interest in the application of attachment theory to group psychotherapy is growing. This paper will explore the impact of clients’ attachment styles on their experiences of co-therapist transition in an ongoing psychodynamic therapy group. This discussion will elucidate how knowledge of attachment theory and an understanding of clients’ individual attachment styles can be useful in predicting responses to therapist-initiated terminations and transitions.     

An experimental inquiry into transference roles and age

In this psychotherapy analogue investigation, the effects of client age and therapist age on transference-like projections onto therapists were examined. Young (25-35) and older (60-70) pseudoclients compared paraprofessional therapists to significant figures in their own lives after a dyadic "helping" interview. The results provide empirical support for the phenomenon of reverse transference in therapy with older patients. Older clients were more inclined than young clients to view therapists, particularly younger therapists, as similar to their children. Young clients more willingly attributed parental qualities to older therapists. Both old and young clients may see therapists more as peers or friends than as family members.     

Three Aspects of the Therapeutic Conversation in Couples Therapy

Abstract

Feminist scholars have revealed the importance of examining the influence of gender on the therapeutic process. Gender differences in the treatment of clients may reveal inequitable or traditionally Stereotypie treatment of clients by therapists. This study examined gender differences in three conversational strategies widely used by therapists: expressions of empathy or understanding, compliments or praise, and challenges or requests for change. Fourteen tapes of live therapy sessions conducted by “master” therapists were examined using an exploratory, qualitative methodology based on Conversation Analysis. Results of this exploration revealed that therapists who are not self identified as “feminist challenged female clients more than male clients, and complimented male clients more than female clients. Feminist therapists challenged male clients more than female clients, and complimented female clients more than male clients. Feminist therapists used more challenges designed to facilitate non-stereo-typic gender behavior in both male and female clients. Only male therapists used disrespectful challenges of female clients, and were more often disrespectful to female clients than to male clients. Implications for the therapist-client relationship and the feminist critique are provided.     

Therapist orientation,supervisor match,and therapeutic interventions: Implications for session quality in a psychotherapy training PRN

Background: Theoretical orientation is a multifaceted construct that is integral to the process of psychotherapy and psychotherapy training. While some research has been conducted on personal identification with particular schools of psychotherapy, techniques used in psychotherapy sessions, and match between trainees and supervisors in training, there is insufficient information regarding how these may interact with one another. Aim: This study, conducted in a practice research network of trainee therapists, was designed to test whether these variables may be related to one another in predicting session quality. Method: The sample comprised 328 sessions from 26 clients and 11 therapists, with the clients completing session quality measures and therapists completing measures of technique immediately post‐session. Results: Using multilevel linear modelling, the data showed varied results. For behavioural therapy and person‐centred therapy, techniques and orientation were unrelated to session quality in the sample. However, process‐experiential, psychodynamic, and cognitive therapy techniques were all involved in interactions with therapist and/or supervisor orientations. Conclusions: These results suggest that the impact of specific psychotherapy techniques sometimes depends on the orientation of the therapist and/or supervisor. For instance, sessions high in cognitive therapy techniques were only associated with positive outcome when both the therapist and supervisor were highly cognitively oriented. Though preliminary, these results suggest that orientation may be an important variable to consider in training and supervision, especially in the context of other variables.     

Group-as-a-whole interpretations in short-term group psychotherapy

The usefulness of therapists making group-as-a-whole interpretations in long-term group therapy was actively debated in the 1960s and 1970s. Advantages and disadvantages were delineated. An often-cited survey study of therapy groups that had emphasized group-as-a-whole interpretations found that many patients were dissatisfied with the therapist’s technique and the outcome of therapy. Although group-as-a-whole concepts subsequently became a part of the theory of many orientations of group therapy, there has appeared to be reluctance among many therapists to make group-as-a-whole interpretations, especially in short-term group therapies. Contrary to this tendency, an argument is made and a case illustration presented, which advocate the use of group-as-a-whole interpretations in short-term group therapies.     

Die verbale Aktivit?t in therapeutischen Dialogen

The discourse in psychotherapeutic treatment is less specific than usually expected so the question arises whether different therapy methods are different in the style of communication. In this study the verbal activity and other characteristics of the discourse of therapist and patient for sessions from two psychoanalytic, two psychodynamic and two cognitive behavior therapies were compared. Psychoanalytic therapists were found to talk the least and behavior therapists the most. Patients talk nearly the same amount in all therapies. As therapists of psychoanalytic treatment talk less than behavior therapists the percentage of patient talking is highest in psychoanalytic therapy. Further formal characteristics: statements are the most frequent form of intervention in behavior therapy (51?%), followed by psychodynamic (36?%) and psychoanalytic therapy (27?%). The most frequent form of intervention in psychodynamic and psychoanalytic therapy is listening, whereas it is only a small part of communication in behavior therapy. Questions are asked most often in behavior therapy. Hence there are significant differences which correspond to the theory of treatment, between the three methods in discourse behavior on a single case level.     

Transference in Gerontologic Group Psychotherapy: Studies in Gerontologic Human Relations IV

For a number of reasons, we decided to bring three long-term, open-ended psychodynamic therapy groups to termination. We examine the process that began with the announcement of the change to a time-limited format, and concluded with the termination of the group. The transition had a powerful impact on the members and the group-as-a-whole. The therapists used supervision to deal with the intensity of the group process and the countertransference demands posed by the transition. Groups facing a similar change due to economic pressures may benefit from these observations.     

The use of self-disclosure among Swedish psychotherapists

Although self-disclosure, when handled with discretion, is often seen as an important intervention in many psychotherapy orientations, including psychodynamic as well as humanistic and cognitive-behavioral approaches, many psychotherapists seem reluctant to use it. The frequency and type of those interventions from psychotherapists of different orientations is less well known. In this study, a random sample of Swedish psychotherapists was asked about their use of different types of self-disclosing information. The results showed that therapists with CBT orientation told their clients more about their training and about their personal ways of handling affective-relational issues. It was apparent that the trend toward more use of self-disclosure in relational psychodynamic treatment has not been accepted among a large number of psychodynamic and psychoanalytic psychotherapists in Sweden. It is recommended that psychotherapists inform their clients more about their training and in appropriate ways share more with their clients about their own relational experiences. Doing so may help enhance clients’ hope and their ability to address their ongoing difficulties.     

Leaders' behavior and group members' interpersonal gains

Early and late in 18 2-day solo-led psychodynamic groups for mental health professionals, 185 participants rated their own behavior and each other's on composite measures of Acceptance versus Rejection of Self (ARS) and of Others (ARO). Only on ARO were leaders consistently rated more favorably than members. Considered by group units, members' mean ratings of peers made modest but significant early-to-late advances on both measures. About two-thirds of all intergroup differences in members' net shifts were separately predictable from ratings of leaders by self and also by pooled group members each time. Groups' ARO shifts were best predicted by members' ratings of leaders toward Warm versus Cold. Leader self-ratings toward Accepts others versus Rejects others best predicted groups' ARS shifts. Featuring interpersonal behavior's two principal dimensions and bridging the common split between studies of group outcome versus group processes, these findings generally support Roger's (1959) theory of personality change.     

Book review

Voluntary or involuntary migration and international work patterns have made it necessary for many people to adopt a new country and with it, a new language. Some of these latter-acquisition proficient bilinguals may seek therapy in this country. A small scale qualitative study was conducted, informed by a constructionist epistemology, in order to explore the meanings that participants gave to their experience of working in English with a client or patient who used English, proficiently, as a second language. Interviews were conducted with 10 therapists who had been contacted through counselling and psychotherapy organizations, and professional networks. Results indicated that participants experienced varying degrees of separation and distance from their bilingual clients. They found it necessary to pay extra attention to their clients' communications on all levels in order to make a good connection. An awareness of the underlying psychodynamic implications of bilingualism is helpful for the assessment of bilingual clients, in supervision and training, and in the ongoing work.     

Interpretation bias and depressive symptoms: The role of self-relevance

Cognitive theories of depression emphasize negatively biased interpretations as an important target of therapy. Much of the research on interpretation bias in depression has focused on selection, or deciding which of several interpretations is likely. However, depressive biases may also exist in the generation of possible interpretations, or the ability to think of positive alternatives. If biases exist for generation as well as selection, therapeutic techniques to encourage the generation of more positive interpretations would be warranted. Asking therapy clients to consider someone else in a similar situation is a commonly used therapy strategy but has not been sufficiently examined empirically. In the current studies, we examine interpretation generation and selection in dysphoric and nondysphoric individuals, and contrast interpretations made for the self to interpretations made for two types of “other.” Our studies reveal depressive biases in both interpretation generation and selection, and indicate that interpretation valence is highly sensitive to the type of other considered. All participants generated and selected significantly more positive interpretations for friends than for themselves, but generated significantly more negative interpretations for hypothetical others than for themselves. Our results suggest that encouraging dysphoric individuals to imagine others can be beneficial, but the type of “other” used is critically important, with instructions to consider a close friend most likely to be effective in decreasing negativity in interpretation.