Integrating couples and family therapy into a community alcohol service: a pantheoretical approach

This paper discusses the contribution of family systems theory and therapy to mainstream alcohol treatment programmes. Systemic psychotherapy is integrated with group analytic psychotherapy in a couples and family therapy service within a community alcohol service (CAS) which uses the Prochaska and Diclemente model of stages of change. Problems and solutions in putting these complex ideas into practice are discussed, with specific reference to issues of engagement. An example of our work with a couple is offered to illustrate our weave of theory and practice.     

The River Model: A Metaphor and Tool for Training New Psychotherapists

A conceptual frame of reference called The River is presented for training of beginning psychotherapists. Using metaphors, trainees are taught specific tools (Equipment) and to identify salient features of the therapy process (Topography) by means of a series of metaphors for the process elements of timing and of level of intervention. Student therapist feedback indicated that this model facilitated learning of how much or little to do at given points in the therapeutic process, and that these metaphors appeared to transcend specific theoretical orientations.     

多重模型疗法简介

多重模型疗法(Multimodal Therapy)是由美国临床心理学家阿诺德     

Family therapy and incomplete families

Much of the literature in family therapy refers to the clinically orientated work with well-motivated families using specific techniques. This article briefly outlines the two main theoretical stances within family therapy as a whole, and describes three categories of incompleteness in families with particular reference to the idea of 'masked' incompleteness. This is illustrated by five case examples which show some of the common difficulties of working with families whose disturbance includes a masked incompleteness. The inadequacies of a singular treatment approach with such families are outlined, and it is suggested that the 'systems' approach in particular has limitations and possible contra-indications in such circumstances. It is argued that the more eclectic and pragmatic approach described, whilst remaining within the boundaries of family therapy as a whole, is likely to offer a more effective consideration of the long term needs of such families.     

Learning and teaching (briefly)

This paper was given as the Annual Ellen Noonan Counselling Lecture on July 2012 and retains some of the spoken style of the lecture. It uses examples of Ellen Noonan’s work to examine aspects of the process of teaching and learning psychodynamic practice. The difficulties of how to embed theoretical knowledge with its clinical application are discussed and the question of what are the key skills of the self-reflective practitioner is raised with reference to whether, and how, they can be taught or learnt. It is suggested that part of this process consists in helping students, and their teachers, to be more comfortable with not knowing, a concept that is both counter intuitive and counter cultural. From this aspects of contemporary therapeutic practice, with specific reference to psychodynamic short-term therapy, are addressed. The paper looks at the ambivalence felt by many psychodynamic clinicians towards working within a short-term paradigm in current workplace settings and how this might be addressed. The paper discusses the intrinsic qualities of a psychodynamic short-term approach and its relation to contemporary therapeutic modalities. It is suggested that the increasing managerial culture, leading to the ascendance of protocol driven, manualised and structured therapies, represents an attack on the relational and must be challenged.     

Family therapy and psychosomatic illness

The author suggests that clinical experience has developed to the point where the question can be asked, “Is a specific psychosomatic illness responsive to a specific type of family therapy?” Examples such as structural family therapy in childhood diabetes, asthma, pain, and anorexia nervosa; cognitive family therapy in adult chronic pain; and marital group behaviour modification in adult obesity, chronic pain, and myocardial infarction, are critically reviewed. The evidence suggests, but does not yet prove, that specific types of marital and family therapy may be effective in a few specific psychosomatic problems, a useful adjunctive therapy in some psychosomatic problems, and that family assessment is helpful in the management of all psychosomatic problems.     

A theoretical frame of reference for family systems therapy? An introduction to Luhmann's theory of social systems

The starting point for this paper is that family therapy lacks a theoretical frame of reference of its own; thus a stepwise search for such a frame of reference is described. First, social systems are defined as communication systems. Second, it is shown in what way a family can be seen as a social system. With the help of the theory of social systems of the sociologist Luhmann, a theoretical frame of reference for systems therapy is drafted. Finally, we hint at the implications such a theoretical framework could have for clinical practice.     

Cognitive therapy and social power

This paper addresses the capacity of cognitive therapy to engage with issues of social power. Some indicators of ‘power‐sensitised counselling’ are proposed and these are discussed with reference to cognitive therapy. ‘Power‐sensitised counselling’ for the purposes of this paper is described as counselling that takes account of power differentials, both across society and within the counselling room. The paper opens a discussion about the potential developments of cognitive therapy that could facilitate an engagement with issues of social power. The significance of these issues for research into cognitive therapy is discussed.     

The role of internal reference prices in consumers' willingness to pay judgments: Thaler's Beer Pricing Task revisited

Alternative reference prices, either displayed in the environment (external) or recalled from memory (internal) are known to influence consumer judgments and decisions. In one line of previous research, internal reference prices have been defined in terms of general price expectations. However, Thaler (Marketing Science 4 (1985) 199; Journal of Behavioral Decision Making 12 (1999) 183) defined them as fair prices expected from specific types of seller. Using a Beer Pricing Task, he found that seller context had a substantial effect on willingness to pay, and concluded that this was due to specific internal reference prices evoked by specific contexts. In a think aloud study using the same task (N = 48), we found only a marginal effect of seller context. In a second study using the Beer Pricing Task and seven analogous ones (N = 144), general internal reference prices were estimated by asking people what they normally paid for various commodities. Both general internal reference prices and seller context influenced willingness to pay, although the effect of the latter was again rather small. We conclude that general internal reference prices have a greater impact in these scenarios than specific ones, because of the lower cognitive load involved in their storage and retrieval.     

Situation-evoking stimuli,domain of reference,and the incremental interpretation of lexical ambiguity

In two experiments, we examined the influence of situation-evoking stimuli on the resolution of lexical ambiguity. In Experiment 1, we examined situation-evoking stimuli at an early NP position. Readers were asked to establish whether specific entities were likely to participate as agents in contextually defined situations. Naming latencies demonstrated that defined situations headed by likely agents evoked a domain of reference that included only the situation-appropriate meaning of a targeted lexical ambiguity. In contrast, defined situations headed by unlikely agents evoked a domain of reference that did not include either meaning of the intended ambiguous word. In Experiment 2, we examined situation-evoking stimuli at a later direct object position. The specificity of the theme/patient role filler was manipulated, where the linguistic expressions were either specific or general with respect to a given contextual situation. The results showed that contexts with specific situation-evoking stimuli were rated as strongly biased and provided a domain of reference for the immediate resolution of lexical ambiguity, whereas contexts with nonspecific role fillers were rated as ambiguous and provided a domain of reference that was supportive of both meanings of an ambiguous word. The results were discussed within a contextual-feature-sensitive model of language processing.     

The effectiveness of counselling with older people: Results of a systematic review

In 2003 the British Association for Counselling and Psychotherapy (BACP) commissioned a systematic review of the research evidence relating to counselling older people. This paper reports on some of the findings of this review, particularly those which address the effectiveness of counselling with this population. Electronic searches of the research literature spanned six databases and were supplemented by hand‐searches of reference lists and key journals, along with an extensive search of the “grey” literature. The location of papers testing interventions which fall within a definition of counselling set out by the BACP, with samples aged 50 years of age or above resulted in the inclusion of 47 relevant studies. Studies investigated a variety of mental health problems in older people, particularly depression, anxiety, dementia and the psychological impact of physical conditions such as chronic obstructive pulmonary disease. Of the 47 studies, eight tested counselling as a generic treatment, 15 tested cognitive behavioural therapy, 13 tested reminiscence therapy, and 11 tested various other specific approaches. The review concluded that counselling is efficacious with older people, particularly in the treatment of anxiety and depression and outcomes are consistent with those found in younger populations. Evidence as to the efficacy of counselling interventions in the treatment of dementia is weak.     

A Comparison of General and Work‐specific Personality Measures as Predictors of Organizational Citizenship Behavior

The current study compared general and work‐specific measures of personality as predictors of organizational citizenship behavior (OCB). Consistent with the literature on frame‐of‐reference effects in personality assessment, two of the Five Factor Model dimensions – agreeableness and conscientiousness – were significantly related to OCB. Use of a frame of reference that is conceptually relevant to the criterion led to increased validity as a result of the decrement in between‐subject variability and within‐subject inconsistency. Results indicated that work‐specific personality yielded significant incremental relationships with OCB even after general personality is controlled. Finally, regression analyses found that the incremental variance predicted by work‐specific personality decreased as the degree of between‐subject variability and within‐subject inconsistency increased. Overall, the results suggest that there are benefits to considering the work‐specific measure of personality in the prediction of OCB.     

Confrontation and support in group therapy in the residential treatment of severely disturbed adolescents

This paper focuses on the use of various forms of group therapy for severely emotionally and behaviorally disturbed adolescents. Group therapy is considered to be subordinate to a total systemic approach which includes individual, family, group, and milieu therapy. The author uses an eclectic theoretical frame of reference which includes some elements of psychodynamic, object relations, and structural and strategic family therapy theory. Precedents for the confrontational-supportive approach include encounter group and residential drug addiction programs, psychodynamic short-term individual therapy, and dynamic group therapy.     

Family Sculpting: I. Some doubts and some possibilities

Family sculpting is reviewed within the context of general doubts that confront family therapy, in particular the need for a certain act of faith in therapy, and the search for some sort of underlying theory. Family sculpting is most often used in reference to the psychoanalytic tradition of family therapy, but here the case is made for more serious attention to structural approaches. The potential of family sculpting is further explored in a number of other respects: its concreteness, its portrayal of ambiguity and its use with students, workers and other groups.     

General principles for treating personality disorder with a prominent inhibitedness trait: towards an operationalizing integrated technique

Psychotherapists need to perform tasks such as being empathetic, performing an ongoing assessment of cases, self-disclosing, making explicit treatment contracts, validating patients' experiences and promoting awareness of psychological experience, if they are to be effective in treating personality disorder (PD). Successful therapy also requires a systematic accurate PD model. We suggest here that it is still unclear how, when, and according to what session markers therapists need to perform specific operations to maximize therapeutic gains. This article describes and operationalizes a step-by-step procedure for organizing and delivering the interventions necessary for effective outcomes, such as maintaining a good therapeutic relationship, increasing understanding of mental states, reducing symptoms and improving social adaptation. The procedure is illustrated by reference to the treatment of cases of emotionally overly-constricted PDs. We include a theoretical proposal to facilitate the development of measures for evaluating the efficacy of therapist actions.     

Anticruelty care: commentary

The anticruelty policy is a best-interests test for treatment plans including decisions to forgo life-sustaining therapy for certain incompetent patients. In connection with specific proposed therapy, the policy requires no reference to the patient's unknowable values, subjective experiences, or quality of life. The decision to undertake a treatment plan derives from the caregiver's knowledge of burdens and benefits of that treatment when used in caring for the competent or for those incompetents capable of growth or repair. The caregiver should weigh the potentially cruel effects of treatment against the likelihood of reducing suffering or encumbrance with the treatment. The terms "burden" and "benefit," in fact, are replaced by the terms "cruelty" and "beneficence," as the relevant opposing outcomes that must be weighed. Thus, the anticruelty policy shifts our scrutiny from experiences of the patient that we cannot evaluate to the proposed actions of the competent decision makers and caregivers. Notably, it is a protreatment policy when the goals of medicine are attainable; and it is an anticruelty policy when they are not. The policy does evaluate the world of the patient to the extent that it requires a judgment based upon external appearances about patient pleasure or happiness in living. It presumes to universalize larger societal values about cruelty, beneficence, compassionate concern for the helpless, and certain rights of individuals. And it presumes to universalize on the patient's behalf specific medical values about hopeless injury, timely death, the goals of medicine, and cruelty, which should remain open to societal discussion and revision. The presented definition of hopeless injury does not require brain death, coma, or persistent vegetative state. Specifically, the policy holds that death is timely for a patient with hopeless injury, and that prevention of death for such patients is not a goal of medicine but a cruelty.     

Exposition und Psychoedukation in der psychodynamischen Therapie

Psychotherapy is a complex process of understanding and action. In order to adequately realize this, reference to only a single therapy school or monotheoretical reference framework would be insufficient, but an appropriate reduction in complexity cannot be dispensed with. A psychotherapy process is composed of a large number of multifaceted elements: image of humanity and value orientation, personality variables of patients and therapists, relationship parameters, diagnostic categories with a spectrum of disorders and disorder symptoms, indications, approach or disorder-specific techniques and therapeutic competence. Other factors including context of life, time windows and frequency also determine the individual therapy process. The logic of the therapeutic understanding and action should be governed a far as possible by a process and patient-related and/or disorder-specific theory and should bind both together in a meaningful way.     

Life review therapy using autobiographical retrieval practice for older adults with clinical depression

The aim of this experiment was to examine the efficacy of life review based on autobiographical retrieval practice for treating depression in older adults. Thirty-seven clinically depressed older adults aged 64-83, who were also receiving pharmacological treatment, were randomly assigned to life review therapy or to a placebo condition with supportive therapy. Results indicated decreased depression for both conditions, with no significant differences between the two therapies. There was some indication of greater gain in production of specific memories among those in life review therapy. Patients who produced higher numbers of specific memories decreased their depression scores at a faster rate.