Relational Psychoanalytic Perspective on Couples Psychotherapy

ABSTRACT

This places Relational Psychoanalysis within the pantheon of models of couples psychotherapy in psychoanalysis including those from Freudian, Object Relational, Self Psychology, and Intersubjective Systems Theory. Following a brief overview of key ideas pertinent to Relational Psychoanalysis, the article discusses the author’s Six-Step version of a relational psychoanalytic approach to couples psychotherapy.     

苏丹心理治疗效能和常用疗法的调查研究

在苏丹,直到二十世纪90年代,人们对什么是心理障碍和心理治疗还普遍存在误解和混淆。他们常常从传统文化的角度来理解有关概念。大多社会成员都喜欢治疗师用传统方法来解决他们的心理问题,而对科学的治疗方法缺乏了解。在这种状况下,该国的专业临床实践很难得到支持。要解决这个问题．必须通过研究和评价来证实科学的心理治疗服务在该国确实产生了理想效果,这正是本研究的根本目的。为了详细描述苏丹目前的心理治疗实践,使治疗师们较     

The Effectiveness of Brief Versus Intermediate Duration Psychodynamic Psychotherapy in the Treatment of Adjustment Disorder

Treatment studies and particularly psychotherapeutic treatment studies of patients suffering from an adjustment disorder are very scarce, leading to insufficient evidence regarding the efficacy of treatment in this population. Whereas timely psychotherapy is known to be of benefit in the treatment of adjustment disorders, the ideal duration of psychotherapeutic interventions is not known. This study examined whether a brief 12-session focused psychodynamic psychotherapy may be as efficient as a longer intermediate-term (1?year) psychodynamic psychotherapy in treating patients suffering from an adjustment disorder. Subjects (n?=?66) were randomly assigned to either brief or intermediate psychotherapy. They were assessed by self-report measures and clinician’s evaluation at baseline, end of therapy, and 9?months after therapy was terminated. The results showed a good overall improvement in the whole group. Furthermore, brief psychotherapy was found to be as good as intermediate psychotherapy both at the end of treatment and at follow-up. Although our study was not designed to confirm the efficacy of dynamic psychotherapy in the treatment of adjustment disorders, our results suggest that brief interventions may be good enough in adjustment disorder, thus allowing treatment of a greater number of patients without compromising for the quality and suitability of treatment.     

Patient Personality and Relational Patterns in Psychotherapy: Factor Structure,Reliability, and Validity of the Psychotherapy Relationship Questionnaire

The aim of this study was to examine the factor structure and the psychometric properties of the Psychotherapy Relationship Questionnaire (PRQ; Bradley, Heim, &; Westen, 2005 Bradley, R., Heim, A. K., &; Westen, D. (2005). Transference patterns in the psychotherapy of personality disorders: Empirical investigation. The British Journal of Psychiatry, 186, 342–349. doi:10.1192/bjp.186.4.342[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]), a clinician report instrument that measures a wide spectrum of thoughts, feelings, motives, conflicts, and behaviors expressed by patients toward their therapists in psychotherapy. A national sample of psychiatrists and clinical psychologists (N = 314) of different theoretical orientations completed the PRQ, as well as the Shedler–Westen Assessment Procedure–200 (SWAP–200; Westen &; Shedler, 1999a Westen, D., &; Shedler, J. (1999a). Revising and assessing Axis II, Part I: Developing a clinically and empirically valid assessment method. The American Journal of Psychiatry, 156, 258–272.[PubMed], [Web of Science ®] , [Google Scholar], 1999b Westen, D., &; Shedler, J. (1999a). Revising and assessing Axis II, Part I: Developing a clinically and empirically valid assessment method. The American Journal of Psychiatry, 156, 258–272.[PubMed], [Web of Science ®] , [Google Scholar]) to assess the personality of a patient in their care. Factor-analytic procedures identified 6 transference dimensions that showed excellent internal consistencies: (a) hostile, (b) positive/working alliance, (c) special/entitled, (d) anxious/preoccupied, (e) avoidant/dismissing attachment, and (f) sexualized. Factor scores were significantly related to patients’ personality characteristics and psychological functioning, regardless of the clinicians’ orientations. The findings support that the PRQ is a valid and reliable tool for evaluating the patients’ relational patterns emerging in clinical practice in a clinically coherent and psychometrically robust way. Clinicians’ careful understanding of these patterns can be very useful for making accurate diagnostic formulations, as well as for providing a roadmap for effective therapeutic intervention.     

Dynamic Relational Group Psychotherapy: A Neurobiologically Informed Model of Change

In this article, we introduce a preliminary, neurobiologically informed model of group therapy that links the timing and nature of specific group interventions with hypothesized changing neurobiological needs of the group. We suggest that the observed phases of group development reflect an underlying reorganization of neuronal circuitry that occurs as members progress through a hierarchically organized treatment, and that this reorganization involves the integration and homeostatic rebalancing of subcortical and neural networks. Our preliminary Dynamic Relational Model suggests that an understanding of the neurobiological processes involved in group development may help inform and direct effective group-based psychotherapy interventions.     

Cost Effective Assessment Models in Providing Patient-Matched Psychotherapy

Examined are various models of assessing cost-effectiveness in the use of psychological measures employed for screening patient pathology through psychological testing as a precursor to providing psychotherapy. Actual and simulated quality assurance studies are provided. The authors caution that cost-containment limited to financial incentives may have negative consequences for patient care. Systems analysis and program restructuring designed to better balance the service system through levels of care may be more clinically sound, and less costly. Clinical algorithms and critical pathways are discussed, as are recommendations that incorporate psychological testing services as an ingredient in providing contemporary psychotherapy.     

Relational Diagnosis: A Retrospective Synopsis

This article highlights and summarizes efforts that have been made primarily during the past 20 years to bring the significance of relational diagnosis to the attention of the entire mental health community, and either (1) to have dysfunctional relational interactive patterns classified and codified and accepted for inclusion in the Diagnostic and Statistical Manual of Mental Disorders, or (2) if this is not feasible, to have a nosology of relational diagnoses, which have been clearly defined with accompanying risks specified for mental illnesses that might develop, and criteria sets delineated and adequately field tested to warrant and lead to publication of a separate but equal Diagnostic Manual of Relational Disorders and Dysfunctional Interactional Patterns.     

心理治疗与普通医疗的平等性

心理治疗与普通医疗的平等性是美国心理健康服务系统面临的一个主要政策问题,强调健康保险应为心理健康和物质滥用障碍提供与普通医疗相同的承保范围。近20年来,平等性立法在美国得到了较快发展,并取得了一定效果。但由于立法本身存在的局限性及心理健康服务需求与提供双方的多重因素影响,平等性立法的实施及对其效果的评估仍存在一定困难。借鉴平等性立法的经验,得出了一些关于我国心理健康服务发展的启示。     

心理疗法在针灸治疗中的应用

随着疾病谱和死亡谱的改变,生物医学模式逐渐地不能满足医学发展的需要,取而代之的是生物心理社会医学模式。现代医学模式全方位探求影响人类健康与疾病的因果关系,认为生物学、心理学及社会学因素是人类致病共同的重要因素。针灸是中国传统医学同时也是西方辅助与替代医学的重要内容。针灸医护人员应大力宣传针灸知识,应用生物心理社会医学模式去对待每一位患者。本文试述心理疗法如支持性心理治疗、认知行为疗法、放松疗法在针灸临床的应用,展现针灸心身同治的诊疗特点。     

The Dialectics of Relational Psychoanalysis and Group Psychotherapy: Commentary on Paper by Robert Grossmark

In this commentary, I address the question of why so few psychoanalysts become group therapists as I respond to the thoughtful and impressive paper written by Robert Grossmark on his work with a psychotherapy group, now in its 10th year of meeting. Prior to discussing the clinical material, and to set the stage for a discussion of Grossmark's work, I comment on my sense of the prevailing attitudes on group affiliations and group therapy within our culture and field as they have progressed over time. I then discuss my reactions to Grossmark's handling of his group session. Many of his conceptualizations of group treatment are in accordance with my own beliefs. There are some differences, however, in how I view my role as a leader and some ideas I have about group treatment that Grossmark did not address.