The Value of Integration: Psychoanalytic Psychotherapy Meets Ego Psychology in a Psychotherapy Group for Children

ABSTRACT

Psychotherapy integration requires us to look beyond the confines of a particular theoretical or technical approach towards other perspectives. Integrative work with children, in particular, meets the socio-emotional needs of the child while simultaneously modeling behaviors and skills. This paper presents an explicitly integrative approach to child group psychotherapy: Relationships. Individuals. Skills. Engagement (RISE) Group. We begin with an in-depth discussion of the RISE group structure illustrated by clinical examples (the “what”) followed by a review of the theory and treatment modalities that inform the approach (the “why” and “how”). The RISE group is grounded in two theoretical perspectives (psychoanalytic principles and ego psychology) and draws upon clinical techniques from multiple treatment modalities (including cognitive behavior therapy, psychodynamic play therapy and dialectical behavior therapy). Combined, the merger of these perspectives results in a multilevel intervention that forges pathways to mastery and competence within the child. Finally, we discuss the value and limitations of integration as applied to group psychotherapy for children.     

Dyadic Influence of Adverse Childhood Experiences: Counseling Implications for Mental and Relational Health

Adverse childhood experiences (ACEs) predict physical and mental health. We examined dyadic differences in intimate partner relationship health by ACE score among couples with low to moderate income enrolled in a relationship education program. Overall, we found a high prevalence of ACEs, disproportionate representation in the highest risk ACE group, and a significant effect between ACEs and indicators of mental and relational health. Implications for counselors include support for an ACE‐informed approach to couples counseling services, as well as a holistic and systemic view of mental and relational health.     

Family-Focused Relational Psychotherapy: An Integrative Approach and Its Application to Adult Children of Divorce

This paper presents an integrative model of treatment—family focused relational psychotherapy—and applies it to work with adult children of divorce (ACDs). Three areas of assessment are identified—(a) assessment of individual ego development, (b) assessment of family of origin functioning, and (c) assessment of the nature of the parents' divorce (e.g., level of conflict). Based on this assessment, the treatment model is presented, which integrates strategies from relational/psychodynamic therapy, family of origin work, and experiential techniques. Case examples are presented to demonstrate the appropriate integration of these techniques with clients at different levels in the assessment schema. In addition, a review of the literature on the long-term effects of divorce on children suggests several specific issues that may arise in treatment. These include low self-esteem, emotional distress, externalizing problems, and interpersonal problems such as fear of commitment, difficulty trusting, a high rate of divorce, and strained relationships with parents.     

Child and Caregiver Dropout in Child Psychotherapy for Trauma

This study focused on the identification of variables collected at baseline assessments that predict children and caregivers who are at risk for dropout from treatment. A sample of 115 children and their caregivers who received evidence-based treatment for traumatic stress was utilized for this study. Multinomial logistic regression analyses indicated that caregiver and child age, the child's externalizing behaviors, and the child and caregiver's acknowledgment of posttraumatic stress symptoms significantly predicted premature dropout from treatment. Clarification of child and caregiver characteristics that increase the risk of dropout allows for the identification of families in need of additional support to stay in treatment.     

Relational Aggression in Mothers and Children: Links with Psychological Control and Child Adjustment

This study assesses associations between mothers’ use of relational aggression with their peers and psychological control with their children, and child adjustment in a sample of fifty U.S. mothers of elementary and middle school children. Mothers completed surveys assessing their relational aggression and psychological control. Teachers completed surveys assessing children’s externalizing behavior, internalizing symptoms, and relational aggression. Results suggest that mothers who are relationally aggressive with their peers are more likely to be psychologically controlling with their children. Results also showed that relational aggression predicted adjustment problems in youth. Relational aggression was associated with externalizing problems among boys and girls, and with internalizing problems among boys. Few gender differences in mean levels of maternal or child behaviors emerged.     

A Relational Psychoanalytic Model for Case Management: A Literature Review

Abstract

Relationship building is critical in case management with the seriously mentally ill. A theoretical framework, such as relational psychoanalytic theory, with a strong integrative emphasis provides a structure for the complex interplay of internal and external factors/forces in case management. The purpose of this paper is to provide a literature review in the area of case management: relational psychoanalytic theory, relationship building and psychodynamic theory. The review concludes outlining the appropriateness of this theoretical framework for case management.     

The Process of Personal Change Through Reading Fictional Narratives: Implications for Psychotherapy Practice and Theory

This qualitative study provides an understanding of how and when individuals experience transformational change as a consequence of reading narratives. Six participants who attributed significant personal changes to reading were recruited and interviewed. The investigators used grounded theory method to analyze these interviews and identify processes through which change unfolded. The core category of the analysis was identification with characters' experiences created a safe venue to consider threat and experiment with new possibilities and perspectives. Empathizing with protagonists enabled readers to integrate new modes of responding to personally difficult situations. Implications for bibliotherapy and narrative therapy are discussed.     

Relational Turbulence Theory: Explaining Variation in Subjective Experiences and Communication Within Romantic Relationships

This essay extends the relational turbulence model as a framework for understanding communication in romantic relationships. Following the relational turbulence model, relational turbulence theory identifies relational uncertainty and interdependence as parameters that shape subjective experiences, but the theory clarifies the theoretical processes underlying their distinctive effects. In addition, relational turbulence theory articulates causal processes linking cognitive appraisals and emotions to communication. Relational turbulence theory also describes how episodes characterized by biased appraisals, intense emotions, and volatile communication coalesce into global evaluations of relationships as turbulent. In turn, the theory addresses the effect of relational turbulence on personal, relational, and social outcomes. Finally, the theory explains how communication can contribute to the development of both turbulence and resilience in romantic relationships.     

Constructive Metatheory: II. Implications for Psychotherapy

Abstract

The implications of constructive metatheory for the conceptualization and practice of psychotherapy are briefly outlined. It is argued that the constructivist therapist construes the client as an active and developing process, and that psychological problems are approached not as piecemeal flaws or deficiencies, but as expressions of current discrepancies between an individual's adaptive capacities and the challenges she or he faces. Likewise, the process of psychotherapy is portrayed as one of trial-and-error experimentation with different (novel) ways of “being in the world.” Ideally, the client and therapist create an intimate and emotionally charged alliance in and from which the client can explore and experiment with self and world relationships. These practical features dovetail with many assertions of the major me-tatheories of psychotherapy, and it is argued that constructive metatheory may be uniauely suited to facilitating attempts at conceptual integration     

Child and Adolescent Psychotherapy Research: Developmental Issues

Describes developmental issues that pose current challenges to the design of treatment outcome investigation with children and adolescents. Normal childhood development and the development of childhood disorders are discussed using the transactional model of development. Challenges in diagnostic decision making, the selection of the most appropriate treatment regimen, and the measurement methods are highlighted. Recognition of the need to study child treatments through long-term follow-up periods underscores the need for resolution of these developmental issues.     

Attachment and Affect between Mothers with Depression and their Children: Longitudinal Outcomes of Child Parent Psychotherapy

The present investigation examined the longitudinal effects of Child-Parent Psychotherapy (CPP) for toddlers and their mothers with depression on: a) maternal affective expression, b) child affective expression, and c) mother-child cohesion. Mothers with depression (M_age?=?31.7 years; 92.8% White, 3.5% Black, 2.1% Hispanic, 2.3% other) and their toddlers were randomized to receive CPP (DI; n?=?66) or to a control group (DC; n?=?64). Mothers without depression and their toddlers (NC; n?=?68) were recruited as an additional comparison group. Dyads were assessed at baseline (T1; 20 months old), post-intervention (T2; 36 months old), and follow-up (T3; 9 years old). Data from a mother-child conflict task was coded as a measure of observed outcome variables. Change in post-intervention attachment security assessed via the Strange Situation was evaluated as a mediator between intervention condition and maternal and child affective expression and dyadic cohesion at T3. Change to secure attachment post-intervention significantly mediated the association between intervention condition and T3 maternal warmth and child anger/problem behavior. Toddlers of mothers with depression who received CPP showed higher rates of change to secure attachment compared to those in both the DC and NC groups. Dyads who changed to secure attachment at T2 displayed higher levels of maternal warmth at T3 and lower levels of child anger and problem behavior at T3. Implications for the use of CPP as a preventive intervention and the importance of attachment as a mediator of long-term outcomes are discussed.

     

Expiation,Substitution and Surrender: Levinasian Implications for Psychotherapy

This essay will build on Emmanuel Levinas’s rejection of ontology as foundational and draw out the implications for psychotherapy. We will explore Levinas’s concept of substitution (in both his more Jewish writings and his philosophical treatises) and consider its meaning in relationship to the role of a psychotherapist. Levinas understands the Other as a calling for substitution of the self and of a taking on of responsibility. We explore the notion of surrender in the work of the psychoanalyst Emmanuel Ghent and argue that his position is ultimately lacking in ethical injunction; requiring nothing of the self in relationship to the Other. It remains within the confines of the conventional, self-reflexive models that Levinas critiques. Following Levinas, we suggest that the therapist bear the burden of ethical responsibility by being exposed to the client’s ethical call and by responding out of a kenotic self-emptying.