Quelle place pour les médiations thérapeutiques dans la « psychothérapie par l'institution » ?

Therapeutic mediations are an essential part of the communautary treatment offered by our Clinic (Clinique Dupre de Sceaux). They contribute to the adaptation of our therapeutic program to the psychopathological characteristics of our adolescents and young adults patients. We see this therapeutic mediations as a tool to allow a bounding between the treating team and patients whose central psychopathological feature is the fear of bounding and relationship with significative others seen as potential threat of dependency and/or seduction. Through therapeutic mediations, the treating staff is able to deal with repetitive symptomatic situations, using the empathic capacity of each member of the team included in the “psychic enlarged space” of the patient. Therapeutic mediations are the contributing to regulate the bounding process in this type of patient. Through a clinical presentation this paper will present the use of therapeutic mediations in our Clinic. We will then discuss more widely the concept of “psychotherapy through the institution” we use in this type of therapeutic setting.     

Emotion in psychotherapy

The therapeutic process involves many different types of affective phenomena. No single therapeutic perspective has been able to encompass within its own theoretical framework all the ways in which emotion plays a role in therapeutic change. A comprehensive, constructive theory of emotion helps transcend the differences in the therapeutic schools by viewing emotion as a complex synthesis of expressive motor, schematic, and conceptual information that provides organisms with information about their responses to situations that helps them orient adaptively in the environment. In addition to improved theory, increased precision in the assessment of affective functioning in therapy, as well as greater specification of different emotional change processes and means of facilitating these, will allow the role of emotion in change to be studied more effectively. A number of different change processes involving emotion are discussed, as well as principles of emotionally focused intervention that help access emotion and promote emotional restructuring.     

Re-Membering Spirituality

Ritual has been used as a therapeutic tool within family therapy for nearly two decades. Our understanding of ritual has been drawn from studies of cultures in which all life was viewed as sacred. However, common use of ritual in therapy lifts ritual out of its sacred context and secularizes it. Blending some of the key thinking in feminist theology with feminist psychology can help women reconnect with a perspective on the sacred that is empowering. Reimbuing ritual with the sacred and expanding its use in therapy make it a powerful healing process for women.     

Resolving therapeutic deadlocks using a contrived team conflict

The author describes a way that a therapy team can intervene to break through a therapeutic deadlock with highly resistant families, which involves the acting out by the team of a nodal family struggle. The pragmatics of using the technique will be discussed.The authoer wishes to acknowledge the assistance of Phil Kingston, Philippa Seligman and Bebe Speed-colleagues on his research team     

Beneficial factors in family discussion groups of a psychiatric day clinic: perceptions by the therapeutic team and the families of the therapeutic process

This paper reports a pilot investigation of the perception of helpful events by the therapeutic team and the families in two family discussion groups (FDGs) of a psychiatric day clinic. All participants of the FDG, including therapists and observers, filled in questionnaires measuring events helpful for the individual, for the family and for the group after each FDG session. The results showed that the therapeutic team and the families diverged in their overall perception of which factors were important in family discussion group therapy. The therapeutic team saw the relational climate and the structural aspects of the group (including group involvement and support from the group), and specific therapeutic interventions as more helpful than the families. The process aspects in the group members (including the experiencing of communality and gaining insight) were, on the other hand, more frequently mentioned by the families than by the therapeutic team. The clinical implications of these findings and suggestions for future research are discussed.     

How the Marvel Cinematic Universe Represents Our Quality World: An Integration of Reality Therapy/Choice Theory and Cinema Therapy

This article presents the integration of cinematherapy with William Glasser’s reality therapy/choice theory. This article also addresses the need to integrate reality therapy/choice theory and the therapeutic intervention known as “cinematherapy” to help students conceptualize the constructs of Glasser’s choice theory and to help novice cinema therapists address Glasser’s themes in their clients’ lives (i.e., fun, survival, power, freedom, love, and belonging). This integration will be helpful to not only students and clients, but also to the community of therapists who will intend to use cinematherapy as a therapeutic and creative intervention.     

“The Gift of an Apple or the Twist of an Arm”: Negotiation in Couples and Couple Therapy

This paper explores the role of negotiation in couples and couple therapy from a relational perspective, situated at the interface of psychoanalytic and systems theories, that emphasizes intersubjectivity. We consider the clinical processes through which members of a couple may be helped to develop competence in basic elements of intimate communication and negotiation, including reflective listening, mentalization, and recognition. Clinical examples illustrate therapeutic movement from projective-introjective “transference” repetitions within a couple's relationship toward a growing ability to transcend the intrapsychic “demons” that haunt the couple. Specific technical measures are described, including the use of communication “exercises” and “homework” in the context of analytic couple therapy—what we term working from the outside-in and the inside-out—as well as the potential functions of a cotherapist team for particular couples.     

Containment,curiosity and consultation: an exploration of theory and process in individual systemic psychotherapy with an adult survivor of trauma

This paper describes an individual therapy from the author's private practice. On referral, the client came to therapy requesting help with her 8‐year‐old daughter. Within the assessment, a single episode of trauma was revealed. Further therapeutic conversations told of multiple memories of trauma. The main therapeutic work has now ended, the contract being left that the client can continue to request appointments if she wishes. I show how systemic therapy from Post Milan and Narrative models, including practices from other orientations, has been useful and name three key practices as being crucial to the work, containment, curiosity and consultation. I suggest parallel processes operating between myself and my client as well as between the therapy and consultation. Distinct phases in the therapy recovery are identified. The discussion will consider themes of containment, curiosity and consultation.     

Using Drawings to Elicit Nonverbal Constructs in Experiential Personal Construct Psychotherapy

Clients who have experienced psychological wounds prior to the use of language frequently struggle to articulate and make sense of their core constructs around self and others. These early wounds can have a significant influence on future relational interactions, even though they may be experienced at a nonverbal level. While eliciting these preverbal constructs may be essential to the healing process, without verbal representation the therapeutic task can be difficult. In this article, we will discuss the use of symbolism within personal construct psychology as well as the use of drawings as representations of nonverbal constructs. We will then discuss experiential personal construct psychotherapy and its focus on the ways we both connect and disconnect from others. Finally, we will present Kristen, a therapy client who experienced early relational wounds and increasingly dissociated in response to relational stress as she matured. Kristen's work in therapy around her fragmented sense of self included drawing her internal self-parts. Only then was she able to wrap words around that which she previously experienced nonverbally. In this case study, Kristen's drawings and her core constructs as elicited during four years of therapy will be presented and discussed.     

Working through: in-session processes that promote between-session thoughts and activities

This study examined whether clients' ratings of the working alliance as well as their perception of cognitive-behavioral (CB) and psychodynamic-interpersonal (PI) techniques (delivered by therapists who used both) were associated with clients' intersession processes (i.e., their thoughts about therapy and therapeutic activity between sessions). Seventy-five clients who were currently in therapy at a large university counseling center participated in the current study. Multilevel regression analyses demonstrated that alliance and clients' perceptions of their therapists' use of PI techniques were positively associated with clients' general thoughts about therapy between sessions. Also, stronger alliances were associated with more therapeutic activities between sessions and more positive (and less negative) thoughts about therapy between sessions. In addition, clients at later sessions who described their therapists as using more PI techniques also reported engaging in more therapeutic activities between sessions (after controlling for the variance in the other variables, such as use of CB techniques). Clients' perceptions of their therapists' use of CB techniques in the most recent session were not related to thinking about therapy or therapeutic activities after controlling for the variance in the other variables.     

Team adaptation: A fifteen-year synthesis (1998–2013) and framework for how this literature needs to “adapt” going forward

Organizations increasingly operate within dynamic environments that require them to adapt. To respond quickly and effectively to acute or on-going change, many organizations use teams to help them remain competitive. Accordingly, the topic of team adaptation has become more prominent within the broader organizational team literature. Given the wealth of knowledge that has been accumulated, we consider what has been learned to date. However, even with the increased attention to team adaptation within the literature, not all teams are created equal in terms of their capacity for adaptability. Thus, we review factors that serve as antecedents of team adaptation, the process of adaptation, and the resulting adaptive outcomes. Finally, we suggest future directions for research and practice as we introduce a conceptual framework, whereby the focus of a team’s adaptation process is impacted by the type and severity of the disruption or trigger that gives rise to the need for adaptation.     

Narrative Therapy Using a Reflecting Team: An Ethnographic Study of Therapists' Experiences

Narrative therapy in the last 15 years has been utilized by many clinicians and yet there is a lack of research on therapists' experience of this approach. This ethnographic research explores the views and perceptions of eight narrative therapists who belonged to a narrative team in an outpatient clinic. These therapists were observed and interviewed. Five themes emerge from the data. The themes include a sense of success in reducing the clients' problems as well as some limitations of narrative therapy. Two recommendations for research and practice involve the use of narrative therapy without a team and the use of narrative therapy in addressing issues of family violence.     

Catathymic image experience as a psychotherapeutic imagination procedure--principles and practical approach

The catathyme image experience conceived by Leuner is introduced as a psychotherapeutic imagination method structured into many standard motives. The general basic principles, the so-called direction principles as well as the special therapeutic techniques of the day dream technique mainly recommended as a short time therapy are explained. Further information on the use of the symbol drama in groups and the indication finding is given. Modification and combination opportunities with other psycho therapeutic methods is referred to.     

Experiential Activities in Family Therapy: Perceptions of Caregivers and Youth

Novel and creative therapeutic modalities have been developed in an effort to increase motivation in family therapy for adolescents and families. Many of these approaches incorporate experiential activities or “family play”, which provides a supplemental approach to traditional talk therapy. Incorporating experiential activities into family therapy sessions has been shown to increase engagement and enhance participation in therapy. Therefore, to understand how families view experiential activities within family therapy, we interviewed nineteen adolescents (age 12–17) and their parents/caregivers who were receiving family therapy augmented with experiential activities. We asked a series of open-ended questions to understand the families’ experiences concerning how they initially felt about participating in family therapy and their perceptions of the experiential activities. The activities involved experiential interactions and skill-building exercises that elicited active participation from all family members and encouraged further discussions. Topics of these activities focused on problem areas the family had identified, such as anger management, problem-solving, improving communication, substance use, expressing feelings, coping, etc. Results showed that most caregivers and youth found the experiential activities helpful in creating positive family interactions and developing communication skills. Caregivers and adolescents noted that the activities increased their desire to participate in family therapy sessions and they were more motivated to engage in the treatment process. Clinicians using the methods discussed in this intervention should be aware of the study’s limitations. Implications for clinical practice and research are discussed.     

Relapse prevention treatment for liver transplant patients

This paper explores the utility of relapse prevention therapy (RPT) for transplant candidates with substance use disorders. Similarities and differences between this population and the general substance abuse patient population are discussed and suggestions are made for modifying the RPT treatment protocol. Major issues include the source and intensity of motivation for treatment, the nature of the therapeutic relationship, the type and severity of psychosocial consequences that may have been experienced as a result of substance use, and the patient's perception of the problem (addiction versus liver disease). Recommendations are made to provide empathy and support around medical concerns, motivate them for sobriety, and work to build collaborative relationships between team members and patients. Patients need to see the RP therapists as working to help them maintain sobriety and obtain a transplant, not as policing their drug use.     

Conceptual issues in network therapy

This paper presents three concepts developed within the context of a project to study and conduct network therapy. The concepts discussed are: (1) the need for balance in participant composition, specifically in terms of support systems for core members, and the participant levels of affective involvement; (2) the therapeutic use of polarization of the network members against the therapist; and (3) the shared leadership role within the team of therapists. Case illustrations are included to demonstrate the concepts presented; and other areas for future study are suggested.     

Self psychology and group therapy

This paper illustrates how the theories of Heinz Kohut elucidate the curative aspects of group treatment. Group therapy is an ideal milieu in which mirroring, idealizing and alterego transferences can be experienced and worked through. Transmuting internalizations, or psychic structure building, occur when optimal frustration of these needs can be provided by available selfobjects. In group therapy a patient can use the group-as-a-whole, the individual members as well as the leader as potential selfobjects. With the help of individual sessions to reflect on group encounters, a patient can gain a more fully integrated therapeutic experience.The author wishes to acknowledge Susan Sands, Ph.D., Jane Jordan, M.S.W., and Ruth White, Ph.D., for their help.     

L’alliance thérapeutique triadique dans une psychothérapie avec un interprète : un concept en quête de validation

The relevance of the use of an interpreter when receiving an allophone patient seems to be more and more accepted among clinicians. However, the influence of this third person on the therapeutic process, and particularly on the establishment of the therapeutic alliance, has received scarce attention so far. The presence of an interpreter inevitably modifies the therapeutic process and makes it more complex. It requires some adjustments of the physical and material setting. It also influences practical arrangements and the very nature of interactions, as well as their content. General concepts about the intercultural approach will first be presented. Subsequently, the issue of the establishment of a triadic therapeutic alliance during a couple and family therapy or mother infant consultations will be discussed from an interactionnist and systemic perspective. The application of these models to a better understanding of patient-therapist-interpreter alliance and its specific components and dimensions will be discussed. Finally, research directions and some clinical considerations to optimize the conduct of a consultation or a psychotherapy with an interpreter will be stressed.     

Family therapy for childhood depression: researching significant moments

This paper is a qualitative family therapy process study which is part of a larger European-based outcome study comparing family therapy to child psychotherapy plus parent support for depressed children and their families. The family therapists and two clinical supervisors from the original study formed themselves into a research team to study the process of therapy with twelve families. Therapists selected the significant moments from fifty-nine sessions, and were then interviewed by the research team using a standard protocol to investigate the therapists' own thinking about the significant moments. Applying a thematic analysis, the significant moments were clustered into eleven themes. The paper discusses the rationale for this model of research, which is well suited for clinical teams, and the application of the themes to therapeutic work with depressed children and their families.