Infant-parent psychotherapy with an autistic toddler

This paper describes the 3½ -year treatment of an autistic toddler, who by age 5 showed normal social relationships and only minor residual cognitive features of the disorder. The treatment approach integrated infant-parent psychotherapy with techniques of special education and involved a two-person team that worked simultaneously in the family's home. The early work focused on discovering ways to mediate environmental stimulation so as to enhance the child's availability for social interaction. The treatment helped the parents understand this and explored and interpreted misconceptions about their son that interfered with parental feelings and functions. Multiple issues in the parent-child relationship and in the child's social and cognitive development eventually were addressed. This case illustrates one scenario in the development of relationships when an infant lacks the biological fittedness for social interaction. It demonstrates the possibility of ameliorating the autistic condition through a modification of infant-parent psychotherapy. The successful outcome of the case seems to be the result of several factors: The child's age at the beginning of treatment, his areas of cognitive strength, and his parents' exceptional ability to use and extend the therapy.     

试论后现代视野下社会治疗的二重属性

社会治疗兴起于上个世纪70年代的美国,它有别于传统心理学领域内的各种心理治疗。社会治疗的后现代属性主要源于后现代人本主义与建构主义在心理治疗领域内的应用,要准确把握社会治疗的后现代属性必然离不开对其后现代人本主义与建构主义二重性的研究。     

Cultural landscapes in counselling and psychotherapy: Introduction to the Theme Section

The concept of ‘culture’ is gaining in significance within the discourse of counselling and psychotherapy, as a means of making sense of the ways in which shared identities and behaviours are constructed and maintained. The selection of papers included within this Theme Section explore different aspects of the use of the idea of culture within counselling and psychotherapy. In this introductory piece, we seek to place this work in a social and professional context.     

The challenge of professional identity for Chinese clinicians in the process of learning and practicing psychoanalytic psychotherapy: the discussion on the frame of Chinese culture

One important element in psychoanalysis, which is derived from Western culture, is individualization: the independency and autonomy of an individual are highly valued. However, one of the significant essences in Chinese culture is that the collective interests transcend the individual interests and the interests of social groups are more important than those of families. Therefore, when learning and practicing psychoanalytic psychotherapy, Chinese clinicians inevitably experience conflicts derived from this difference of cultural values. This article attempts to use a historical perspective to discuss the current challenges of professional identity for Chinese clinicians learning and practicing psychoanalytic psychotherapy and psychoanalysis.     

An administratively created reality: Some problems with the use of self‐report questionnaire measures of adjustment in counselling/psychotherapy outcome research

Outcome research in counselling and psychotherapy has come to rely heavily on the use of self‐report questionnaire measures of anxiety, depression and general symptomatology. The validity of these measures in the context of psychotherapy research has, in general, been taken for granted. This paper proposes that, despite the success of self‐report questionnaires in personality research and personnel selection, there are significant problems involved in the use of these methods in research into therapeutic change. Specifically, three areas of difficulty are reviewed. First, questionnaires are completed in a social setting that itself changes as a result of therapy. Second, the experience of psychotherapy changes the way that clients make sense of questionnaire items (the ‘response shift’ phenomenon). Third, the conceptualisation of the person implicit in questionnaire design is not compatible with the conceptualisation of persons espoused by most contemporary therapeutic approaches. It is argued that the continuing popularity of self‐report questionnaires can be understood in terms of Kurt Danziger's model of the social construction of psychological knowledge.     

A Social Constructionist Model of Therapeutic Factors

Evidentiary support for the efficacy of therapeutic models has been a contentious issue since the professionalization of psychology. Despite advances in evidence-based practices in psychology and common factors research, discontent still exists among postmodern psychotherapists in that evidence is mainly defined in modernist/positivistic terms, thereby excluding therapeutic models based on alternative nonpositivistic epistemologies. I proposes a model, which is based on social constructionist theories, for investigating the therapeutic efficacy of various approaches. This article evaluates and differentiates between two models for viewing the efficacy of psychotherapy, namely outcome versus process efficacy. A social constructionist model of therapeutic factors is proposed as a means to incorporate therapeutic factors into psychotherapy processes that are consistent with a social constructionist theory of change. Three main therapeutic elements, which are identified as central to an effective psychotherapy process, are outlined in the model. The proposed model may be useful as a guide to efficacious psychotherapy and as a means for investigating the efficacy of social constructionist therapies.     

Social reinforcement in psychotherapy

Conditioning operates importantly in psychotherapy through a number of major mechanisms, one of the least recognized of which is direct behavioral shaping through social reinforcement and punishment. The case presented illustrates the operation of this mechanism in rather pure culture. The case was ideally suited to the use of behavioral shaping as a therapeutic technique. The patient, who had been unable to work or comfortably leave home for 17 years, was treated successfully in a total of approximately ten hours of patient-therapist contact. A four-year follow-up is presented, together with discussion of the importance of this behavioral dimension as it operates generally in psychotherapy.     

Acceptability of Psychotherapy, Pharmacotherapy, and Self-Directed Therapies in Australians Living with Chronic Hepatitis C

Despite the prevalence of psychiatric co-morbidity in chronic hepatitis C (CHC), treatment is under-researched. Patient preferences are likely to affect treatment uptake, adherence, and success. Thus, the acceptability of psychological supports was explored. A postal survey of Australian CHC outpatients of the Royal Adelaide Hospital and online survey of Australians living with CHC was conducted, assessing demographic and disease-related variables, psychosocial characteristics, past experience with psychological support, and psychological support acceptability. The final sample of 156 patients (58 % male) had significantly worse depression, anxiety, stress, and social support than norms. The most acceptable support type was individual psychotherapy (83 %), followed by bibliotherapy (61 %), pharmacotherapy (56 %), online therapy (45 %), and group psychotherapy (37 %). The most prominent predictor of support acceptability was satisfaction with past use. While individual psychotherapy acceptability was encouragingly high, potentially less costly modalities including group psychotherapy or online therapy may be hampered by low acceptability, the reasons for which need to be further explored.     

Social justice and remembering “the personal is political” in counselling and psychotherapy: So,what can therapists do?

This brief contribution argues for the importance of a social justice perspective in counselling and psychotherapy, particularly within the current international socio‐political context. Much has been said about social justice over recent years in the fields of psychology, psychotherapy and counselling. Professionals and academics have expressed some concerns about what it might actually mean, or how difficult it might be in practice to engage with this perspective. In this paper, the activist phrase “the personal is political” (Hanisch, 1970) is used to illustrate the way in which a social justice approach to counselling and psychotherapy does not need to be complicated, but rather a foregrounding of a particular understanding of well‐being and the people we work with. Following this, some concrete and straightforward suggestions for how therapists might begin to act on their social justice values are made.     

Counting black sheep: Contextualizing therapeutic relations

In this paper we draw on feminist and post-colonial theory to situate an account of a six-month therapy between a black, Asian woman therapist and a woman patient of mixed parentage, within contemporary Britain. We draw on this analysis to further the debates between psychotherapeutics and social theory, challenging each in three ways. First, in relation to the literature on culture, class, gender and sexuality in psychotherapy, we indicate how these enter into the therapeutic relation in distinct and intersecting ways, which, second, challenge the separation between inner and outer worlds frequently maintained within psychotherapy circles. Third, in terms of the correlative challenge psychotherapeutic perspectives pose for social theorists and activists, we highlight how the therapist's constructive and explicit use of her power and socio-cultural position was central to the progress of this client's therapy. Finally, we reflect on the broader questions around the theorizing of culture and gender within psychotherapy, including the available positions and representations of black therapists as well as black patients.     

Responding to unemployment and inequalities in income and health

This paper discusses the social and economic context in which counselling and psychotherapy are practised. The use of ‘outplacement counselling’ and personal skills training programmes for dealing with unemployment and redundancy is criticized. It is argued that they involve a form of psychological reductionism which fails to acknowledge socio-economic realities. Research showing a strong link between inequalities of income and physical and mental health is reviewed. It is suggested that counsellors and psychotherapists have a professional obligation to acknowledge the social and economic circumstances likely to contribute to clients' mental distress and avoid the dangers of reductionism.     

Developing a research tradition consistent with the practices and values of counselling and psychotherapy: Why Counselling and Psychotherapy Research is necessary

Despite the general acknowledgement that it is important for counselling and psychotherapy practice to be informed by research, it is clear that in recent years a widening gap has emerged between research and practice. This paper briefly reviews some of the factors responsible for the current crisis in therapy research and offers a number of reasons why a healthy relationship between research and practice is necessary. It is suggested that, at present, there exists within psychology and social science a level of acceptance of pluralistic and innovative approaches to research, which may facilitate the emergence of a new genre of practitioner‐oriented inquiry in the field of counselling and psychotherapy. Some of the ways in which Counselling and Psychotherapy Research intends to contribute to this movement are described, for example the promotion of new forms of writing, use of information technology, and the creation of knowledge communities. Readers are invited to participate in this endeavour.     

Siblings as Selfobjects in Childhood: An Interview Study of Factors and Consequences

This study explores the factors psychotherapists working with adult clients identify as contributing to their clients' use in childhood of relationships with siblings to meet selfobject needs or the use of clients by their siblings for selfobject purposes in childhood, and the consequences of this to the children's intrapsychic development as evidenced in their adult psychotherapy. Using interviews with six psychotherapists practicing within the framework of self psychology, this research determines that the emotional and physical unavailability of parents was a common factor causing children to use their siblings for selfobject purposes. The research also explores the lasting impact of these selfobject ties on the psychological development of both the child using a sibling for selfobject purposes and the child who serves this function for another, as well as the role of psychotherapy in understanding these relationships. These findings give psychotherapists from a variety of disciplines, including social work, an enhanced conceptual framework from which to consider the role of siblings in psychological development.     

Clients’ perceptions of personal psychotherapy or counselling for therapists

The purpose of this study was to examine clients’ opinions of therapists’ personal use of psychotherapy or counselling. Participants in this study, a nationwide sample of clients recruited through Amazon’s MTurk system, were asked to complete an online survey assessing their attitudes towards treatment use by therapists as well as their general attitudes towards psychological help-seeking and perceptions of stigma (social and self) with psychological treatments. In this study, we found that clients generally had positive views about therapists’ personal use of psychotherapy or counselling. Although overall positive attitudes were found, the results from repeated measures ANOVAs indicated that attitudes depended somewhat on whether the therapist had sought out treatment as part of a training requirement for self-enrichment, or for the treatment of a psychological problem. In addition, participating clients were less supportive of therapists disclosing a treatment use history with their clients. Regression analyses also indicated that attitudes towards treatment use by therapists were significantly predicted by general help-seeking attitudes and perceptions of stigma (social and self), but attitudes towards disclosure were not. The findings from this study have important implications regarding therapist treatment use and disclosure in practice.     

Using client feedback in training of future counseling psychologists: An evidence-based and social justice practice

Training in counseling psychology has evolved to emphasize both evidence-based practice (EBP) and social justice, though these two dimensions have often seemed disconnected, or even at odds in the practice of psychotherapy. The Partners for Change Outcome Management System (PCOMS), an EBP that monitors treatment outcomes and the therapeutic alliance across treatment (often called “client feedback”), may offer a means to connect evidence-based and socially just practices. The purpose of this article was to outline how the use of PCOMS in psychotherapy and supervision can serve as a useful training tool that is a form of EBP and also promotes a socially just paradigm in psychotherapy. We also offer an implementation example from a counseling psychology doctoral program to demonstrate how PCOMS can be used with clients in psychotherapy and included within the supervisory process.     

Group therapy of schizophrenia in the inital phase of the disease

The initial (prepsychotic) period of schizophrenia is characterized by different degrees of involvement of various levels of personality organization depending upon the basic tendencies of the disease process, and the going forward of unimpaired personality reactions, which are not related to processes of alteration (including inadequate forms of psychological defense), allows the states of patients and the characteristics of their adaptation to be determined. There is a need to differentiate the functions of group psychotherapy and its methods at the level of emotional stimulation, social activation and stimulation of communication, development of certain behavioral stereotypes and increasing the degree of social security, optimizing associations, partial changes of attitude and behavior, discussion of conflicts, finding adequate forms of psychological compensation, and development of a behavioral pattern. It is in this way that it is possible to work out a certain "hierarchy" of methods that may be used successively.     

Metacognitive Therapy Focused on Psychosocial Function in Psychosis

Metacognitive Insight and Reflection Therapy is a manual-based individual psychotherapy aimed at enhancing four metacognitive processes through patient’s personal narratives which may promote recovery by helping individuals suffering from schizophrenia to develop a richer and more integrated sense of self. This study is a single case analysis of the effects of a meta-cognitively oriented CBT on residual psychotic symptoms and functional targets. Outcome measures (PANNS, PDI 21, BAVQ-R, PSP, MAS-A) were collected at two different times: pre-CBT and 1-year. Results showed reductions in the distress, preoccupation and conviction associated with delusions and improvements in metacognitive abilities, social functioning, hopefulness and of the sense of self-confidence to cope with the psychotic symptoms. Adopting a metacognitive perspective during psychotherapy had several benefits: to foster the development of therapeutic alliance, to allow the patient to assess the efficacy and acknowledge the consequences of the different strategies he could use to cope with his symptoms and to question the predominance of his delusions in his life. To conclude, Metacognitive Reflection and Insight Therapy seem particularly adapted to address psychosocial issues, such as social or work functioning.     

How Psychoanalytic Thinking Lost its Way in the Hands of Men: The Case for Feminist Psychotherapy

A feminist stance is adopted to challenge the androcentric nature of many of the concepts which lie within the tradition of male psychoanalytical thinking. Such thinking steadfastly refused, and largely still refuses, to acknowledge the social reality and consequences of women's experience of living in a patriarchal society. It is argued that psychoanalytical theory has construed women as inferior and is wholly revealing of what men expect and want women to be. Any psychotherapy based solely within that tradition thus plays its part in the oppression of women. Two concepts from analytical psychotherapy, transference and counter-transference, are used as specific examples, and some contrasting researches advanced by feminist psychotherapy are outlined.