Prepared phobias and obsessions: Therapeutic outcome

Sixty-nine phobic and eighty-two obsessional patients, treated at the Maudsley Hospital, were rated for ‘preparedness’, the evolutionary significance of the content and behaviour of the disorder. Reliable ratings (r = 0.78 and 0.90) of the dangerousness of the object or situation to pretechnological man indicated that the content of the large majority of the phobias and obsessions are judged as evolutionarily significant. Degree of preparedness, however, did not predict outcome of therapy, suddenness of onset of the disorder, severity of impairment, intensiveness of the treatment received, or age of onset. Nor was there any significant relationship between preparedness and certain other variables in the obsessional sample: stimulus generalization, effect on life style, impaired reproductive capacity and abnormal personality. The implications of these findings for the hypothesis that human phobias and obsessions are prepared, and for the clinical usefulness of the concept of preparedness, are discussed.     

Therapeutic alliance and cohesion variables as predictors of outcome in short-term group psychotherapy

The current study explored the relative ability of aggregate therapeutic alliance and cohesion variables to predict short-term group therapy outcome. Data were collected from a comparative trial of two forms of time-limited group psychotherapy for complicated grief (Piper, McCallum, Joyce, Rosie, & Ogrodniczuk, 2001). The therapeutic alliance and elements of the cohesion construct were measured from the perspectives of each patient and the group therapist at intervals during the groups; scores were aggregated across assessments. Hierarchical multiple regression analyses, adjusting for the effects of treatment approach (interpretive vs. supportive) and specific group membership, demonstrated that the patient-rated alliance was a consistent predictor of outcome. Two cohesion measures, reflecting other participants' (therapist, other members) views of the patient's "fit" with the group, also accounted for variation in outcome. Implications of the findings for research and clinical practice, and the limitations of the measurement approach taken in this study, are considered.     

Therapeutic relationship and outcome seen by clients in first and third session of individual therapy

Rogers' assertion that therapeutic improvement results from clients seeing their therapist as genuinely empathic and unconditionally accepting was explored in the first and third session of individual therapy with 24 clients. This proposition was partly supported in that higher combined levels of these therapist qualities as seen by clients after session one was associated with higher self-esteem and lower need for approval after session three, when these two variables after session one were respectively controlled. However, no support for this assumption was found for depression and anxiety, in that lower depression and greater anxiety after session one was associated with higher levels of these therapist qualities after session three. These latter two findings imply that the subsequent therapist qualities may have resulted from earlier anxiety and depression.     

太极拳是道教适应社会的产物

太极拳 ,作为运用我国传统道家哲理、阴阳学说和五行八卦演变之法 ,结合人体内外运行规律 ,形成刚柔相济、动静相间的健身防卫的优秀武术拳种 ,现已形成一种东方特色的太极文化浪潮 ,波及漫衍当今世界各个角落。蔚为大观的太极拳文化 ,既含有事物本质规律 ,又富有为人哲理、处世原则 ,更有优美的人体拳术造型 ;其丰富的文化内涵 ,让人解读不尽。现代生活节奏和工业文明的生存方式 ,需要太极拳这种调节剂来滋润人们的身心 ;无论是现代生活造成的各种慢性病、职业病 ,还是人们心灵上的自危感、信仰危机 ,都可以从太极拳的锻炼中得到很好的预防…     

The Therapeutic Alliance: Implications for Therapeutic Process and Therapeutic Goals

Interest in the importance of the therapeutic alliance to the psychotherapeutic process has recently grown across theoretical domains. Through a case example the author demonstrates that in some cases a familiar pattern of relating with the therapist may be more important for the client in terms of treatment success than positive regard early in treatment. Also, charting shifts in the quality of the relationship rather than quantitative changes in the alliance may help the therapist navigate the recursive emergent properties of relationship, goals of treatment and choice and timing of interventions. Finally, the author suggests that the therapist’s internalization of the client may represent a significant leap in the relationship, and help reduce some of the “sloppiness” that is inherent in the therapeutic process.     

Therapeutic turn

This paper offers a systematic and critical exploration of contemporary theology of pastoral care in the Evangelical Lutheran Church of Finland in light of the history of the practice of care-giving and Western cultural change. Currently, pastoral care is characterized by a therapeutic approach that aims to offer sincere help for earthly suffering and to promote the good things that the individual chooses to reach for. This has been drastically different than historical models from Luther to the early twentieth century that were spiritual and paternalistic in nature. The therapeutic turn connects to the therapeutic culture that has set self-actualization as a central idea determining Western cultural ethos. The therapeutic approach calls into question how the spiritual task of the church is carried out. The prevailing pastoral-psychological theology of pastoral care proves to be problematic. The spiritual task of pastoral care should be based on the basic Lutheran theology of God as objective and not conditioned upon the human mind. Yet, the therapeutic aim should still be maintained as the basic approach of care.     

Therapeutic Relationship

This article addresses the important role of the therapeutic relationship in cognitive-behavioral therapy (CBT). As has been noted from the inception of CBT, there are critical features of both the therapist and the relationship that optimize the likelihood of therapeutic success, and this article briefly describes these features. It is further argued that a successful therapeutic relationship in CBT is not static but is flexible and adaptive both across and within clients, as their needs and concerns vary. A positive therapeutic relationship is viewed within CBT as a necessary but insufficient condition for change, as the relationship serves as a foundation upon which interventions are scaffolded, but that the client’s response to various interventions itself shapes the interactions between therapist and client. Finally, it is argued that the key therapeutic ingredients of CBT are largely teachable, and the article provides several suggestions to promote an effective therapeutic relationship in CBT.     

Therapeutic Interventions

This article has two aims. One is addressed to practitioners, to say to them that too big a distinction is being drawn between interpretations and other interventions, and in particular that the term directive is being wrongly used. This militates against important moves toward the integration of different therapies. The other is addressed to researchers, to say to them that their research will be inadequate to the extent that they ignore many of the interventions used in therapy. Both of these aims are eventually served by the provision of a list of interventions running the whole continuum from non-directive to more directive. By looking at this list, we can become more aware of the range of what is possible in psychotherapy, and also of where the standard types of interpretations come in the scheme of things. It seems as though the wide range of interventions available in psychotherapy represents one of the ways in which it differs from counseling.     

Therapeutic strategy and psychoanalytic technique

The role of therapeutic strategy within psychoanalytic technique is described. An antistrategic bias inherent in certain aspects of the "classical" technique is explored in relation to the historical development of psychoanalysis. Clinical expertise, which includes the making of strategic or tactical choices, is relegated to the "unofficial," due in part to this negative bias impeding the study of technical differences in favor of general agreement about a theory of technique that may differ considerably from actual clinical work. A case is presented that illustrates strategic choices in the management of a severe character resistance in a supervised analysis. Some consequences of a negative bias against therapeutic strategy as it relates to psychoanalytic training is described.     

Free Will and Therapeutic Change

Much of psychology has minimized, or disregarded, the notion of free will. However, it remains a critical construct in most theories of behavioral and religious change. This paper briefly examines the free will/determinism debate and the construct of free will from the perspective of postmodern/narrative psychology, as well as integrating recent developments in the field of cognitive neuroscience. Finally, the implications of this analysis on personal responsibility in pastoral psychology are discussed.     

Self-esteem and outcome fairness: differential importance of procedural and outcome considerations

Results of a survey of 222 detainees in Dutch jails and police stations showed that outcome-fairness judgments of individuals with high self-esteem were more strongly related to outcome considerations than to procedural considerations, whereas outcome-fairness judgments of individuals with low self-esteem were more strongly related to procedural considerations than to outcome considerations. It was proposed that these differences were due to the fact that (a) procedures more strongly express a social evaluation than outcomes and (b) individuals with low self-esteem are more concerned with social evaluations than individuals with high self-esteem. The implications of the results for other individual-differences factors and other populations than detainees are discussed.     

Anxiety and outcome predictions

Research shows that people display a downward shift in their predictions in anticipation of performance and feedback. The authors used a misattribution paradigm to explore whether anxiety serves as a signal for predictions. Participants (N = 108) anticipating results from an important test either immediately or in a few days were or were not encouraged to attribute any arousal they experienced to coffee they consumed earlier. Consistent with predictions, participants encouraged to attribute their arousal to the coffee were optimistic in their predictions even when anticipating immediate test feedback. In addition, the more participants attributed their arousal to the coffee, the more optimistic they were in their predictions. Ancillary analyses suggest that anxiety can be a cause rather than a consequence of less optimistic predictions.