Holism in Psychotherapy and Spiritual Direction: A Course Correction

The authors offer a course correction for understanding the term holism as used in spiritually oriented psychotherapy literature. This is done to allow the relationship between psychotherapy and spirituality to expand beyond limited dualistic conceptualizations. They first address numerous sources from which spiritually oriented psychotherapy arose and then explore the ill‐defined relationship between the psychological and the spiritual dimensions of human existence. Next, holism is distinguished from 2 common forms of dualistic “elementism” that are frequently misrepresented as holism. The authors conclude by presenting a holistic conceptualization of the relationship between the dimensions of psychotherapy and spirituality.     

Psychoanalytic Psychotherapy with People in Abusive Relationships

Summary

Psychoanalytic perspectives on violence between partners is describedand forms a foundation for an approach to group and individual psychotherapy of men and women in relationships in which there is physical violence between partners. The empirical results of a study of the outcome of psychoanalytically oriented psychotherapy are described. Nineteen men and 16 women completed research measures before beginning psychotherapy and after completing 16 sessions of group psychotherapy. Twelve people who completed group psychotherapy continued in individual psychotherapy and completed measures again after 16 sessions of individual psychotherapy, and nine people completed measures again after the 16 sessions of group and 32 sessions of individual psychotherapy. Statistical analyses addressed outcomes in terms of verbal and physical aggression and dysphoric affects and anger. Both research and clinical outcomes are discussed.     

Ethics,metaphysics, and psychoanalysis∗

An attempt is made to point out some of the moral presuppositions and implications of psychotherapy in theory and in practice. In the various forms of dynamically oriented psychotherapy, the setting of goals and decisions concerning maturation and health have value components. Even in psychoanalysis in its strict sense, decisions made in accepting or rejecting contracts and determination of the terminating point of analysis are value laden.

Finally, in the theorizing of Freud and others about psychotherapy moral positions are assumed.     

Expanding the single-case study: a proposed psychoanalytic research program

This paper offers a proposed program of research using single-case time-series methods that can be used by practicing clinicians. The paper is written for psychodynamically oriented clinicians who want to get involved in psychotherapy research and make contributions to the scientific literature. How to measure treatment outcomes and psychodynamic constructs are discussed. With few exceptions, conducting single-case time-series research using psychodynamic psychotherapy has far more advantages than disadvantages.     

Three modes of psychotherapy and their requisite core skills

The field of psychotherapy suffers from the lack of an integrative meta‐perspective on the large variety of existing psychotherapies and on the therapeutic skills involved. In the present paper, it is suggested that the development of a more comprehensive view of this field may be facilitated if we differentiate between three modes of psychotherapy, which require different therapeutic core skills: (a) an educational mode, which requires teaching skills; (b) a reparative mode, which requires analytic‐conceptualising skills to identify some kind of disordered functioning, in combination with specific relational‐technical skills to repair this dysfunction; and (c) a developmental mode, which involves engaging in a therapeutic relationship with patients to facilitate their personal growth, and which requires non‐directivity skills. In addition, some therapeutic skills (e.g., awareness and communication skills) may be more or less important in all modes of treatment. Concrete manifestations of the three different modes of psychotherapy are discussed in terms of five different theoretical perspectives on psychotherapy: the common factors, the humanistic‐experiential mindfulness cognitive‐behavioural (CBT) and psychodynamic perspective. The common factors model is criticised as being insufficient in several respects. Finally, it is argued that if personal therapeutic skills are essential to the effects of psychotherapy, then empirical research on psychotherapy needs to be re‐oriented towards a person‐oriented study of therapist skills in action, in the context of a study of the interaction between therapist and patient.     

Indikation zu Psychoanalyse und analytischer Psychotherapie

Based on the diagnostic process in the initial interview, which is an intersubjective encounter, the various developmental steps for establishment of the indications for psychoanalysis are presented. Freud and his followers, who were initially oriented to the psychiatric diagnosis, were later oriented to the criteria of approachability, analysability and in particular on the aptitude for psychoanalysis. The criterion of aptitude was not only elaborated from the perspective of Ego psychology but was also relevant for all high frequency non-terminated psychoanalyses which followed the basic psychoanalytical principles of “afocality”. This has so far characterized the standard procedure of all psychoanalytic schools. Due to the experiences of psychoanalysts with early disturbed, structurally Ego-disturbed neuroses and personality disorders, the extent of lability of the mental structure and by turning to countertransference analysis, the person of the psychoanalyst become more important for the assessment of the indications. In Germany the integration of psychotherapy, which is financially supported by healthcare insurance, ultimately leads to differential indication assessments between high frequency psychoanalysis or analytical psychotherapy, modified psychoanalytical psychotherapy and less frequent psychodynamic procedures.     

Control-Mastery

Abstract

This paper will introduce the theory of Control-Mastery, an empirically supported, cognitively oriented interpersonal theory of psychotherapy. Control-Mastery theory offers a distinctive approach to counter-transference in particular and suggests a unique way to understand unconscious functioning. The theory also provides specific guidelines for conducting psychotherapy as well as a useful framework for understanding the impact of familial as well as cultural context on individual psychological struggles.     

Interpersonal problems and outcome in outpatient psychotherapy: findings from a long-term longitudinal study in Germany

We used a comprehensive longitudinal data set from Germany to examine trajectories of symptom distress depending on interpersonal problems at study intake measured via the Inventory of Interpersonal Problems-64 (IIP-64; Horowitz, Strau, & Kordy, 1994). Participants (N=622) underwent mid- or long-term outpatient psychotherapy (either psychodynamically oriented psychotherapy, cognitive behavioral therapy, or analytic psychotherapy). Data comprises up to 5 assessments during a 2-year period and was analyzed via hierarchical linear modeling. In the analytic psychotherapy subgroup, initial symptom level was higher in submissive patients. Initial interpersonal problems were not predictive of the rate of symptom change during therapy. Only in psychodynamic treatments, low affiliation positively affected treatment outcome. Interpersonal problems at intake were not related to the number of utilized sessions and utilization rate across treatment subgroups. We discuss the findings and outline future research topics.     

In Defense of Child Therapy

Traditional child dyadic psychotherapy can be viewed from a family systems point of view. Seen in this light it shows itself to have powerful family systems effects. These are often therapeutically effective, although unintended. The deliberate identification of the child as "sick" and the choice of an intervention format that avoids direct dealing with the rest of the family may make change possible where it might otherwise not have occurred. Child psychotherapy is shown to have important elements in common with recently developed symptom oriented treatment methods.     

阿德勒心理治疗方法与当代心理治疗整合精神的契合

阿德勒为心理治疗提供了一个经得起时间考验的综合理论。他对人类行为做了务实的概念化处理,并改变了程序使其可能整合当代心理治疗理论中众多有价值的见解。阿德勒心理治疗与当代实践之间存在很多相似之处,因为阿德勒治疗是一种现在与未来定向的、限时性的（即短程的）、整合性和折衷性的方法。     

Direktausbildung Psychotherapie an der medizinischen Fakultät

Background

There is ongoing political discussion at the Federal Ministry of Health that a university entrance diploma should allow psychotherapy to be studied directly: Graduation leads to a licensure that qualifies for further specialization, e.g. in cognitive behavioral therapy (CBT) or psychodynamic psychotherapy analog to medical specialization. As psychotherapy has its roots in both psychology and in medicine, the question is raised which faculty should be the future home of direct psychotherapy schools.

Material and methods

A theoretical model curriculum of psychosomatic psychotherapy is proposed. Its structure which is oriented to the established structure of medical training and its contents are described. It is argued that the proposed model in the tradition of psychosomatic medicine is suitable to meet ongoing changes in the structure of psychotherapeutic care due to new challenges in the field of public health.

Conclusion

The study of psychotherapy should be associated with chairs in clinical psychology and psychosomatic medicine in order to maintain and further develop the variety and quality which psychotherapy has gained in Germany.     

Rorschach Changes in Long-Term Short-Term Psychotherapy

Over a period of several years, repeat Korschach testing was done with two groups of patients receiving outpatient psychotherapy, a long-term group (n = 88) engaged in intensive, dynamically oriented psychotherapy and a short-term group (n = 88) involved in behavioral or gestalt therapy. Rorschach protocols were obtained at the beginning of the treatment and on three subsequent occasions, 1 year, 21/2 years, and 4 years later, when most of the long-term and all of the short-term patients had completed their therapy. The findings demonstrate generally beneficial effects of psychotherapy, greater change in long-term than in short-term therapy, and the validity of the Rorschach for measuring these effects and changes.     

Rorschach changes in long-term and short-term psychotherapy

Over a period of several years, repeat Korschach testing was done with two groups of patients receiving outpatient psychotherapy, a long-term group (n = 88) engaged in intensive, dynamically oriented psychotherapy and a short-term group (n = 88) involved in behavioral or gestalt therapy. Rorschach protocols were obtained at the beginning of the treatment and on three subsequent occasions, 1 year, 2 1/2 years, and 4 years later, when most of the long-term and all of the short-term patients had completed their therapy. The findings demonstrate generally beneficial effects of psychotherapy, greater change in long-term than in short-term therapy, and the validity of the Rorschach for measuring these effects and changes.     

My Life as a Psychoanalyst in Spain

This article attempts to explain, in a necessarily brief way, the reasons underlying my choice of the psychiatry specialty: why I chose the psychoanalytically oriented psychotherapy, the authors and theories that have influenced me the most, and my current professional situation, making some allusion to my hobbies.     

A Theory of Change (-In-Relationship)

The relationship between the client and therapist is the central change factor in religiously oriented psychotherapy. The identification of the beloved and the value and use of that recognition to shed light on the unconscious motives in relationship are two central points in this theory.     

CHRISTIAN HUMANISM AND PSYCHOTHERAPY: A RESPONSE TO BERGIN'S ANTITHESES

Abstract. Secular and religious values of psychotherapists influence the process of psychotherapy. The psychologist Allen Bergin has pointed out several major antitheses between values of secular psychotherapists and their religiously oriented clients. The present essay is a response to Bergin's antitheses, on the one hand, and to humanistic psychology, on the other, from the point of view of a Christian humanism. Karl Rahner's theological anthropology is proposed as one possible foundation for an explicit articulation of the relationship between psychotherapy and religion, and as a means to address apparently divergent values of psychotherapists and religious believers.     

A Metaperspective for Counseling Practice: A Response to the Challenge of Contextualism

This article discusses the challenge of contextualism to developmental theory as articulated by Lewis (1997), as well as the challenge of current changes in life contexts for developmentally oriented counseling practice. Counseling practice refers to activities of psychologists and counselors in relation to theory, research, and intervention, and in relation to both career and psychotherapy domains of practice. It is hoped that a consideration of both career and psychotherapy practice will contribute to dialogue and integration across these domains. In the second part of the paper, a metaperspective for counseling practice, conceived as a response to this challenge, is presented. It consists of a conception of life contexts inclusive of work and relationships across both public and private domains of life and posits a generic developmental process goal of effective functioning as relevant to both career and psychotherapy domains of counseling practice.     

Inanspruchnahme, Verlauf und Ergebnis ambulanter Psychotherapie

This paper summarizes the major results of the study ?Optimizing psychotherapy service provision via transparency and outcome orientation: evaluating outpatient psychotherapy“ (TRANS-OP). Between September 1998 and February 2000, all insured persons of a major German health insurance company (?Deutsche Krankenversicherung“) who requested reimbursement of outpatient psychotherapy were asked to participate in the study. Comprehensive data concerning structural, process and outcome criteria of outpatient psychotherapy were collected from 714 participants and from the majority of their psychotherapists during a 2-year observation period. Participants applied for the following treatments eligible for reimbursement in the German health insurance system: psychodynamically oriented psychotherapy (52%), cognitive behavioral therapy (31%), and psychoanalytic psychotherapy (17%). The amounts of sessions claimed for reimbursement were approved almost without exception. Participants in the three treatment modalities did not differ in socio-demographic characteristics, or in initial symptom severity as assessed by standardized measures. Even though courses of improvement of the symptoms varied, therapy outcome after 2 years was similar in the three forms of treatment. In addition, a cost offset was found, i.e. medical costs, especially for hospital days, substantially decreased during the course of psychotherapy. These findings support the effectiveness as well as the economic significance of outpatient psychotherapy across different treatment modalities in routine care. However, allocation of psychotherapeutic resources should be more considerate of individual patient needs and treatment outcome.     

Évaluation des enjeux narcissiques à partir du test de Rorschach au terme d’une psychothérapie

The goal of this study is to evaluate, using the Rorschach, the evolution of one patient's narcissistic investments after two years of psychoanalytically oriented psychotherapy. Both quantitative and qualitative measures of narcissism on the Rorschach were studied in depth in this test-retest study. Results indicate that quantitative measures of narcissism and egocentrism were decreased after two years of psychotherapy. The patient also presented doubt concerning her self-worth, as well as new perceptions of her vulnerabilities and her need for shoring up. Increased flexibility concerning narcissistic investments was evident, which weakened the patient's Ego and containing capacity; this facilitated work on depressive issues.