Previews of a Paradigm Shift in Psychotherapy: An Interview with Alvin Mahrer

The main purpose of the interview was to explore Alvin Mahrer’s views on an uncommon issue, namely the possibility of a paradigm shift in the field of psychotherapy. The interview covers (a) a way to help bring about a revolutionary paradigm shift, and (b) preview possibilities for an across-the-board, comprehensive paradigm shift in the field of psychotherapy. Grateful appreciation is extended to the reviewers whose comments were helpful and constructive in enabling a substantial improvement in the earlier draft of the interview.     

文化心理学视域下的心理治疗

近年来,心理治疗的文化取向日益为心理学界所关注。在概要分析文化心理学理论取向和传统心理治疗特点的基础上,重点对文化心理学取向下的心理病因观、医患关系、心理治疗方法、心理治疗效果评价观做了相应分析,并对未来文化取向下的心理治疗理论进行了展望,希望对我国心理治疗理论和实践有所帮助。     

Psychotherapy: Definitions, Mechanisms of Action, and Relationship to Etiological Models

In this paper, we define psychotherapy as a modality of treatment in which the therapist and patient(s) work together to ameliorate psychopathologic conditions and functional impairment through focus on the therapeutic relationship; the patient's attitudes, thoughts, affect, and behavior; and social context and development. The possible mechanisms of action and active ingredients of psychotherapy in children and adolescents are discussed, with an emphasis on the above-noted domains. The adult psychotherapy literature strongly supports the central roles of the therapeutic relationship and therapeutic empathy; this has been much less intensively explored in the child and adolescent psychotherapy literature. Similarly, there have been few studies examining the mediation of treatment effects by impact on specific domains. Ideally, treatment studies should gather data that can be informative about the impact of putative mediating and moderating psychosocial and biological variables on outcome and course. The results of such studies can aid further refinements in both theories of etiology and improvement in treatments for children and adolescents.     

The Understanding and Treatment of Immigrant Trauma Survivors: Finding the Right Mix

This paper reviews attempts by three authors to describe psychoanalytic conceptualizations and treatment of torture victims. It argues that because the transference-countertransference configuration with immigrants who have not suffered torture is very similar to that of torture survivors, that no special diagnostic categories, theories, or treatment methods are needed to work with torture survivors. Second, the paper contends that newer psychoanalytic paradigms such as Hoffman's Social Constructivism may assist clinicians to capture the richness and complexity of clinical work with torture survivors better than do traditional analytic conceptions such as neutrality. Via an analysis of the three papers in this volume, I conclude with a consideration of the strengths and the weaknesses of the field of cross-cultural psychotherapy in general.     

An Overview of Directions in Psychotherapy Integration Research

In general, empirical research in psychotherapy integration has lagged behind the growing theoretical and clinical interest in the field. Even though many of the theoretically integrative treatment models currently available are based on empirical findings and clinical observations, the models themselves remain, for the most part, untested. Rigorous examination of integrative psychological theories and therapeutic programs is a necessary and useful way to increase our understanding of the process of psychotherapy and establish the efficacy and effectiveness of integrative therapies. The present article explores five different research areas in the field of psychotherapy integration, discussing several published studies in each area. The utility of this research for practicing clinicians is also discussed. Additional investigations in these areas and others are encouraged, with the goals of greater understanding of psychotherapy, as well as the further development and acceptance of integrative approaches.     

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。     

Therapist orientation,supervisor match,and therapeutic interventions: Implications for session quality in a psychotherapy training PRN

Background: Theoretical orientation is a multifaceted construct that is integral to the process of psychotherapy and psychotherapy training. While some research has been conducted on personal identification with particular schools of psychotherapy, techniques used in psychotherapy sessions, and match between trainees and supervisors in training, there is insufficient information regarding how these may interact with one another. Aim: This study, conducted in a practice research network of trainee therapists, was designed to test whether these variables may be related to one another in predicting session quality. Method: The sample comprised 328 sessions from 26 clients and 11 therapists, with the clients completing session quality measures and therapists completing measures of technique immediately post‐session. Results: Using multilevel linear modelling, the data showed varied results. For behavioural therapy and person‐centred therapy, techniques and orientation were unrelated to session quality in the sample. However, process‐experiential, psychodynamic, and cognitive therapy techniques were all involved in interactions with therapist and/or supervisor orientations. Conclusions: These results suggest that the impact of specific psychotherapy techniques sometimes depends on the orientation of the therapist and/or supervisor. For instance, sessions high in cognitive therapy techniques were only associated with positive outcome when both the therapist and supervisor were highly cognitively oriented. Though preliminary, these results suggest that orientation may be an important variable to consider in training and supervision, especially in the context of other variables.     

Pragmatism, Pluralism, and Psychotherapy Relationships: An Interview with John C. Norcross, Ph.D.

John C. Norcross has made significant contributions in the areas of the transtheoretical model of change, psychotherapy integration, and empirically supported psychotherapy relationships. This interview explores the contributions of pragmatic philosophy and his personal upbringing to his work as a psychotherapy researcher and practitioner. Dr. Norcross discusses the status of the psychotherapy integration movement, the work of the Task Force on Empirically Supported Psychotherapy Relationships, and future trends in psychotherapy over the next 25 years. He emphasizes the importance of a methodological rigor that recognizes the unique characteristics of the psychotherapy relationship. He describes his current interest in the psychotherapy of psychotherapists, illustrating it with his personal challenges in balancing work and home.     

What’s it all about? A qualitative study of meaning in life for counseling psychology doctoral students

The interviews of 10 female counseling psychology doctoral students regarding their views about meaning in life (MIL) were analyzed using consensual qualitative research. The participants defined MIL as goals or purposes, were actively involved in searching for meaning, and believed that MIL had been stimulated by life-changing experiences and culture. On a personal level, they gained meaning from relationships, personal growth, and religion/spirituality. On a professional level, they gained meaning from providing therapy, conducting research, and teaching. As therapists, participants approached MIL indirectly by asking about client goals/motivations or by focusing on other clinical problems that if resolved would enhance MIL. Implications for doctoral training and for psychotherapy are offered.     

The psychotherapy of parenthood: towards a formulation and valuation of concurrent work with parents

This paper explores the process and value of concurrent work with parents when their child is being treated in individual psychotherapy. The position taken is that psychoanalytic understanding generally and the specific formulations presented in this paper have a broader applicability in other aspects and approaches in child and adolescent mental health practice. The central issues are the interweaving of knowledge of family processes, child development and psychopathology, and the uses that can be made of an understanding of transference and countertransference. A particular formulation is presented in relation to aspects of the work that constitute ‘child guidance’ and those that may be considered as ‘psychotherapeutic’ in relation to parental psychopathology. We have coined the term ‘the psychotherapy of parenthood’ to give this work the status it deserves and to define a boundary within which to explore the areas and levels of this complex work. Some practice and training implications are considered.     

Review article

A training need to help core trainees prepare for the psychotherapy long case was identified. We prepared and showed a training DVD to all core psychiatric trainees at South West London and St Georges Mental Health NHS trust. A questionnaire was designed to receive feedback from trainees. A total of 26 trainees participated. All trainees found the DVD informative. Most trainees found the DVD helpful in reducing their anxieties prior to taking on a long case. All trainees found the DVD accurately reflected their experience of psychotherapy and supervision. Using simulated and technology-aided learning material is a useful and economical way of introducing psychotherapy skills to core psychiatry trainees before the clinical supervised experience of a long case.     

A Phonological Existential Analysis to the Book of Job

This current article “A Phonological Existential Analysis to the Book of Job” explores the various ways that Job’s friends attempted to help him deal with his grief. Dr. Johnson is able to identify the various stages of grief that Job goes through and correlate each stage and the response from the friends in current psychological terms. It becomes clear that various practices of modern psychotherapy can be seen in each response from Job’s friends. It is reasonable to conclude that the responses from Job’s friends were part of the therapeutic process that moved Job to a state of rationality and wholeness. While the article approaches the Book of Job from a psychotherapeutic standpoint, it does not distract for the spiritual teachings found in the document. Fred Johnson is licensed as a counseling psychologist and is certified as a school psychologist. Dr. Johnson has worked many over 15 years as a private practicing family therapist and behavior specialist. Dr. Johnson completed his doctorate in counseling psychologist at the University of Louisville and attended Southern Baptist Theological Seminary obtaining a degree in pastoral psychology. He currently owns Educational Resource Services, a company that is dedicated to providing seminars in classroom behavior management throughout the United States and Canada. Dr. Johnson has published two books, Effective Discipline for the Difficult Child and From Chaos to Control: Managing Disruptive Classroom Behavior. He has also published several research studies, including ones dealing with the role of the ministers and a pastoral approach to divorce.     

Resistance as a Problem for Practice and Theory

Resistance is one of the most problematic and potentially counterproductive concepts in the entire field of psychotherapy. It is at the same time one of the most crucial, pointing toward perhaps the single most important factor—or, more accurately, set of factors—in determining the success or failure of the therapeutic enterprise. Drawing on the articles by Davis and Hollon, Prochaska and Prochaska, Reid, and Eagle in this issue, as well as on the author's own perspective, this paper explores this seeming contradiction in order to point toward an integrative resolution of the differing perspectives on resistance and related phenomena.     

Psychotherapy Process Measure Research and the Evaluation of Psychotherapy Orientation: A Narrative Analysis

This article discusses the need for a systematic method that enables researchers to evaluate integrative therapy approaches using a range of therapy process measures. The Narrative System Process Coding (NPCS; Angus, Hardtke, & Levitt, 1996) is proposed as such a method, and is applied with the Experiencing Scale (Klein, Mathieu, Gendlin, & Keisler, 1970) and the Levels of Client Perceptual Processing (LCPP; Toukmanian, 1986) to three brief good outcome integrative therapy modalities to illustrate this need. The study found higher Experiencing Scale scores to be most strongly related to an experiential approach to therapy and to the NPCS internal narrative processes. Higher LCPP scores were most strongly related to the NPCS reflexive narrative process and to a perceptual-processing approach. The discussion initiates a discourse on the importance of explicating process measures' origins when comparing different therapy approaches in order to allow for the meaningful consolidation of process research findings.     

What is the End Point of Psychotherapy Integration? A Commentary

This commentary on six papers about assimilative integration considers the place assimilative integration, as defined by Messer, ought to have in the discussion on psychotherapy integration. After briefly summarizing the contribution of each paper, with particular attention to whether the paper takes a position on the end point of psychotherapy integration, the author compares the relative benefits of assimilative integration to those of a unified grand theory. He argues that assimilative integration, as an end point, is preferable to a unified grand theory because it has a more generative influence on both theory evolution and clinical practice.     

Understanding Islamic Perspective of Mental Health and Psychotherapy

This paper is an attempt to provide foundational information about Islamic perspective of mental health and psychotherapy. It further highlights the historical contribution of Muslim philosophers and physicians to the field of psychotherapy. In the aftermath of the 9/11 and 7/7 tragedies, there has been a growing need to understand the Islamic perspective of mental health and gain insight into the followers of this faith otherwise perceived as ‘mysterious and Far Eastern’. A case example illustrates how counselors/therapists can effectively incorporate religious-cultural aspects of Islam in their work with Muslim clients so that they could work more effectively with their Muslim clients in the post 9/11 climate. Health care professionals must be sensitive to and fully aware of the unique religious traditions, cultural norms and gender sensitive values of their Islamic psychiatric patients so that they could introduce modern therapeutic interventions with less resistance from their clients.     

The Therapeutic Relationship as Viewed by Existential Psychotherapy: Re-Embracing the World

Existential psychotherapy places pivotal significance upon the interrelational aspects of human experience. By so doing, the therapeutic relationship itself becomes the principal means through which the client's presenting symptoms and disorders are disclosed as direct expressions and outcomes of the client's overall way of being rather than as isolated and disruptive impediments. This paper examines the therapeutic relationship as viewed from four primary interrelational dimensions. Further, it focuses upon psychotherapy's tendency to exclude the world from the therapeutic relationship and provides two novel and challenging alternatives whose principal aim is to bring the world back into the therapeutic relationship.     

Absolute Versus Tentative Interpretations: Mediating Effects of Client Locus of Control

An analog design was used to investigate the mediating effects of client locus of control (i.e., an internal focus or external focus) on perceptions of counselor style of interpreting events (i.e., absolute or tentative interpretations) on measures of perceived session depth and smoothness, and perceived counselor expertness, attractiveness, and trustworthiness. One hundred and thirty-four undergraduate college students, crossed on level of locus of control, were randomly assigned to one of two treatment conditions, and then completed measures of perceived session depth and smoothness, as well as perceived counselor expertness, attractiveness, and trustworthiness. Results indicated a significant interaction effect on perceived counselor trustworthiness. Implications for college counselors are provided.