The power of rituals in dealing with traumatic stress symptoms: cleansing rituals for former child soldiers in Northern Uganda

International guidelines for emergency response note the importance of cultural adaptions and facilitation of local spiritual and religious healing practices when appropriate. Deciding whether traditional medicine is safe, effective and appropriate is a complex matter. This study explores the therapeutic factors of a local cleansing ritual in Northern Uganda aimed at healing former child soldiers. The components of the ritual are analysed and compared with research-based therapy for post-traumatic stress disorder. Participant observation was used during the ritual, followed by qualitative in-depth interviews and follow-up interviews over three years. The key informant is a former child soldier participating in the ritual. He was abducted and forced to commit several killings during a three-year period. The collective mobilisation of social support, the collective forgiveness and the strength of the psycho-education appear central for the effect of the ritual. In addition, the ritual draws on common therapeutic factors. The findings indicate that such a ritual involves elements that safely and effectively deal with symptoms in accordance with modern research on trauma therapy, perhaps more powerfully than Western-style therapy. Implications for collaboration with local healers in emergency settings are indicated.     

An outline explanation of how therapy heals

Therapists are unable to provide a comprehensive account of therapy as an intelligible activity. This is at least partly due to the unresolved problem of explaining how phenomenology is even possible. An alternative to providing a comprehensive account of therapy is to take the fact of phenomenology for granted and provide just an outline account of how therapy heals. One way this can be achieved is to set therapy in the context of medical anthropology which will facilitate a view of therapy as just another healing ritual. Insight into how healing rituals heal is provided in this paper by a long and in-depth look at the so-called ‘paradox’ of the placebo effect. This will reveal the so-called ‘placebo effect’ as a misunderstood, modern example of healing ritual self-healing. In fact, the single term ‘placebo effect’ will be abandoned and replaced by the two concepts of ‘SMCH’ (‘specifically modified consultation and health care’) and ‘RMH’ (‘response to modified health care’). These two concepts provide an outline explanation of how all healing rituals heal and so provide an outline explanation of how the healing ritual of therapy heals, also. At least one problem arises out of explaining therapy as healing ritual self-healing, namely that this conception conflicts with the idea in therapy circles that, in therapy, it is the relationship that counts. Nonetheless, it will be maintained that the purpose of therapy is healing, that the healing that is achieved is self-healing and that its fulfilment is not dependent upon one-to-one relationships. Finally, it will be argued that the further development of therapy requires a better understanding of what aids and obstructs psycho-emotional self-healing.     

Mapping Good Therapy Sessions: A Pilot Study of Within-Session Client Affect

The purpose of the present study was to measure client affect over small timescales within therapy sessions, in order to identify affective patterns that might distinguish good versus poor sessions. Toward this end, patterns of affect were observed across 15-s intervals throughout one therapy session for each of four different clients being treated for generalized anxiety disorder using cognitive-behavioral therapy. The primary hypothesis was that during “good” therapy sessions (as defined by high session alliance scores and good therapy outcomes), clients would exhibit a pattern of positive–negative–positive (PNP) affect during the course of the session, reflecting prolonged periods of negative affect consistent with productive therapeutic work, situated between periods of positive feeling. Clients in “poor” sessions were not expected to show this pattern. The findings were consistent with predictions. There was also a non-significant trend suggesting that clients in good sessions demonstrated a greater frequency of very small PNPs—as brief as 45 s—suggesting a potentially greater number of “micro-episodes” of therapeutic work. Implications of the findings are discussed.     

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.     

Predictors and consequences of sudden gains in transdiagnostic cognitive-behavioural therapy for anxiety disorders

Sudden gains—substantial stable symptom improvements between consecutive therapy sessions—are a common phenomenon. As condensed points of change, examination of sudden gains can provide insight into mechanisms of therapeutic change. This study investigated the association between sudden gains and cognitive change, therapeutic alliance, and/or client engagement in transdiagnostic group cognitive-behavioural therapy for anxiety disorders. Of 58 treatment initiators, 21% (n = 12) exhibited a sudden gain. Consistent with previous research, sudden gainers demonstrated significantly greater pre- to post-treatment symptom improvement than non-sudden gainers. Observational coding of therapy sessions found that sudden gains were associated with elevated levels of cognitive change and client engagement in the pre-gain session, and elevated levels of cognitive change and therapeutic alliance in the post-gain session. However, these results varied by use of within- and between-subject control comparisons, highlighting the value using a dual control methodology. In context of previous research, the results on cognitive change replicate previous findings in depressive populations, and clarify mixed findings in anxiety populations. The results on therapeutic alliance replicate previous findings for the first time in an anxiety sample, although the between-subject control comparisons revealed complexity previously undetected. This study was also the first to investigate and thus establish the relation between client engagement and sudden gains.     

Eine Therapiestunde mit einem Mörder

Although psychodynamic concepts may be helpful in identifying the complex interpersonal and manipulative processes that occur between inmates and therapists and to transform them into the therapeutic process they are hardly ever applied in a correctional setting. The author provides an insight into the psychotherapeutic work conducted in prison. The first part of the paper outlines the special conditions in which psychodynamic psychotherapy occurs in a social therapeutic intervention institution within the German prison service. Characteristic transference and countertransference constellations are described. Based on a verbatim report an account is provided of a therapy session with a serious violent offender. In his reflections on the session the author focuses on the effects on the transference process of, in the offender’s eyes, being both therapist and assessor at the same time.     

Therapeutic relationship and outcome seen by clients in first and third session of individual therapy

Rogers' assertion that therapeutic improvement results from clients seeing their therapist as genuinely empathic and unconditionally accepting was explored in the first and third session of individual therapy with 24 clients. This proposition was partly supported in that higher combined levels of these therapist qualities as seen by clients after session one was associated with higher self-esteem and lower need for approval after session three, when these two variables after session one were respectively controlled. However, no support for this assumption was found for depression and anxiety, in that lower depression and greater anxiety after session one was associated with higher levels of these therapist qualities after session three. These latter two findings imply that the subsequent therapist qualities may have resulted from earlier anxiety and depression.     

‘The essay method’ a qualitative method for studying therapeutic dialogues

ABSTRACT

This paper presents a qualitative research method for analysing therapeutic dialogues called ‘the essay method’. A central part of the method uses the format of the literary essay as a model. The method consists of a close monitoring of clinical material guided by an overall psychoanalytic/psychodynamic theoretical frame. It combines both clinical details and global patterns of clinical material and is especially fitted for studying relational qualities of psychotherapeutic dialogues. In this paper, the background for qualitative analysis in studying psychoanalytic material is discussed, and the procedures for using the method are demonstrated. A study of therapeutic competence in a group of student therapists is used as an example of the method in practice, demonstrating that the essay method may have potential for revising theory and establishing new concepts based on empirical findings. The essay method is compared with other qualitative methods, and it is argued that it is suitable for psychoanalytic research.     

Scientific empathy,American buddhism,and the ethnography of religion

This paper examines some of the current ideas and methods that have problematised the study of religion within a globalised community. Religion and culture cannot be considered bounded entities, to be described as unchangeable. However, their constant process of change is not something new. It becomes new due to writing patterns and contemporary ideas on the relevance of religion or the creativity of culture. By analysing some discussions on possession cults, the paper suggests that ritual and performance constitute the moments when culture and religion are mediated. It is through ritual that religious practices are adapted, and it is in a ritual performance where culture is contested and challenged. Religion becomes ‘confused culture’, that once again is re‐organised and made orderly by reflection on ritual practices. Finally, the paper suggests that the agenda for an anthropology of religion for this new century is two‐fold. Firstly, to try to become more conversant with ever changing localised practices of ritual, and secondly, to try to converse about those practices with other practitioners and scholars from different fields and in different fields.     

Family Rituals

Family rituals, consisting of celebrations, traditions, and patterned family interactions, are defined and illustrated in this paper. The power of ritual practice in families is explained by three underlying processes — transformation, communication, and stabilization — concepts whose roots lie in anthropology and ethology. We propose that all families struggle with finding a suitable role for rituals in their collective lives but their actual achievement varies greatly. Commitment to ritual and adaptability of ritual practice throughout the family life cycle are important considerations. The utility of these concepts in the assessment and treatment of families is discussed.     

Parting gifts: termination rituals in group therapy

A patient's termination from group therapy is a powerful experience for the departing patient, the therapist, and all group members. Unless the feelings evoked are channeled into constructive expression, they may undermine this potentially valuable phase of both the departing patient's group treatment and the life of the group as a whole. A termination ritual, styled by a particular patient according to his or her own need, therapy goals, and personality may help the patient achieve a more clearly defined sense of self. The authors suggest that the group therapist's careful attunement to and thorough exploration of the significance of any termination ritual or gift will help to extract maximum therapeutic benefit for the departing member and the group as a whole.     

Problem Definition in Marital and Family Therapy: A Qualitative Study

This paper describes findings from a grounded theory study on the process of constructing problem definitions by marital and family therapists. Coding of the observations and interviews resulted in two meta-problem definition processes. In the first meta-process clinicians kept their definitions internal to themselves during the therapy session. In contrast, the second meta-definition process involved clinicians bringing forth their internal problem definitions and incorporating them into the therapeutic conversation. Implications for existing conceptualizations and marital and family therapy practice and supervision are discussed, as well as suggestions for further consideration.     

With Onions and Tears: A Multidimensional Analysis of a Counter-Ritual

“Family rituals” and “family myths” are useful concepts for understanding some of the behavior of disturbed families and hence for planning therapeutic interventions. A case of a family of a schizophrenic patient is described in which a “counter-ritual” involving onion-peeling to induce tearing was invented. The intervention addressed the family's inappropriate laughter and denial of sadness and seemed to lead to therapeutic gains for the identified patient and the family. This counter-ritual, as an indirect affect-inducing experience, is analyzed from a variety of perspectives and a partial parallel is drawn to an Iranian cultural ritual. A suggestion is made that more light may be shed on the mechanisms and structures of myths and rituals in families by drawing on studies of myths and rituals in ethnography. “Counter-ritual” is offered as a general concept for a type of active family intervention that involves inventing and employing rituals antithetical to pathological ones engaged in by some families.     

Placement of responsibility and moral reasoning in couple therapy

Within the past two decades there has been a growing awareness of the importance of moral and ethical judgements in family and couple therapy. In this article we provide a detailed analysis of placements of responsibility related to blame in one couple therapy session. We suggest that it is important to study therapeutic interaction in situ , when searching for an understanding of moral reasoning in couple therapy and an ethical evaluation of the practice. A detailed analysis of discursive tools used by clients and therapists makes it possible to look at moral reasoning in action as it unfolds within the flow of therapeutic conversation. The findings are discussed in relation to two discourses of moral justification: autonomy and relationality. The principle guiding the therapists' actions in the studied conversation could be called 'relational autonomy'.     

Group Processes in Family Therapy: a Psychoanalytic Approach

This paper describes a model of family therapy that draws on experiences and theories of psychoanalysis as applied to individuals and groups. It suggests concepts that help to understand and work with the family as a system. A brief example is given to illustrate the effort to engage with the patients' immediate feelings in the session in relation to each other and the therapist.     

The Use of Homework in Cognitive Behavior Therapy: Working with Complex Anxiety and Insomnia

Homework, or self-help, is an essential and required part of cognitive behavioral treatment. It offers several opportunities for the therapist to extend and increase therapy contact by having the patient “live” the therapy outside of the consulting room. It can also serve as a measure of the patient’s motivation for therapy or for change. Homework offers the patient an opportunity to practice what has been developed and discussed in the therapy session. By trying out new behaviors, new ideas, or new emotional responses, the patient can make “real” what has been an abstraction in the therapeutic dialogue. The homework becomes an opportunity for gathering data. Inasmuch as the homework grows “organically” from the session content, it is relevant and timely. Homework provides continuity between sessions. Rather than sessions being discrete moments in time, they are chained together by the homework from the previous session being included in the agenda for the subsequent session. The homework can be structured to involve significant others. This is essential in many therapeutic situations, and having the significant others involved can substantially aid in relapse prevention. Finally, effective homework helps to build therapeutic collaboration and afford the patient the opportunity for building self-efficacy. Using several case examples, this paper describes the functions and impediments to using homework in CBT.     

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.     

Revisiting Bordin's Theory on the Therapeutic Alliance: Implications for Family Therapy

Because of the belief that relationships are a major contributor to problems as well as the avenue for bringing about change, the alliance between therapists and clients is important in family therapy. Writings and ideas on the therapeutic alliance from psychoanalytic theory were used by Edward Bordin to develop a working theory in 1979, and later adapted to the field of family therapy. However, the adaptation did not account for many variables unique and important to family therapy. This article describes the therapeutic alliance and the necessity of creating a theory of therapeutic alliance that accounts for family therapy concepts. Future ideas for scholarship are presented.