Collaborative Empiricism in Cognitive Therapy for Psychosis: A Practice Guide

We outline our understanding of collaborative empiricism (CE) as used in cognitive therapy (CT) for psychosis. We discuss how CE can be thought of as a technique for facilitating cognitive change in the service of a client's goals, but also as an expression of respect for client autonomy, recognizing the ethical imperative to empower clients by involving them in decisions about their care. Taking a CE approach is therefore consistent with user-led conceptualizations of recovery, and the related movements of “shared decision-making” and “evidence-based patient choice.” We discuss how CE can aid with engagement, assessment, formulation, and intervention in CT, illustrating this with case material. We focus on how CE can help with distressing intrusive experiences and beliefs, and also consider its role in helping clients achieve wider life goals. Adaptations to CE for working with people with problems with learning, attention, and memory are discussed, as are considerations for working with high conviction and conceptual disorganization.     

Re‐framing systemic paradigms for the art of learning

Thoughtful people are increasingly concerned that the current paradigms for social, corporate, and educational activities are in disgraceful disarray. The “problem‐solving” or analytical model, the competitive or game model, the commercial or consumer model, the bureaucratic or institutional model, and the disease or illness model which prevail in public discourse are proving to be especially unwholesome. We cannot, however, educate ourselves without paradigms. A credible educational paradigm must be generally accessible without being simplistic, informative without being monothematic, and accommodating as well as discriminating. Given our disquiet with the current cognitive situation, a renewing paradigm must be somehow novel; given the character of human nature, a sustaining paradigm must be somehow familiar.

For a very long time now, professional Sciences have committed themselves to paradigms about “reality out there,” while professional Arts have devoted themselves to expressing “imagination from within here.” The more these two worldviews polarize in opposition to one another, the more room there is—and the more human heed there becomes—for mediation by an applied philosophy which accommodates the “real” as well as the “imaginary” in a complementary way. Such a philosophy would address not only “what do you know?” and “how do you do?” but also “how do you know?” and “why do you do?” In earlier times, people would have been considered neither educated nor wise unless they appreciated the Sciences and the Arts whole. In our time, we may not survive unless we can re‐integrate our fractured perceptions. How might we proceed to do so? There may be a systemological way.     

基于眼动数据的一例角色书信疗法临床案例的分析与启示

采用眼动法,探究来访者阅读去信与回信时认知信息的变化,以及新手型咨询师与来访者在阅读角色书信时认知信息的差异。结果表明,来访者阅读回信时,对去信中诱发不良情绪的部分认知因素予以回应;新手型咨询师的注视时间显著短于来访者,注视次数多于来访者,热点区域不同于来访者。结果说明,往复的角色书信可以促进来访者转变不良认知;新手型咨询师对角色书信的理解与来访者存在不同。     

Behind the (Virtual) Mirror: Online Live Supervision in Couple and Family Therapy

Online therapy and supervision, a rapidly rising practice in couple and family therapy, has been the subject of a growing body of literature. From its early days, family therapy training has included live supervision, which has typically been conducted by a supervisor and a team of trainees situated on the other side of a one-way mirror. With the outbreak of the COVID-19 global pandemic, we—the staff of supervisors at the Barcai Institute in Tel Aviv, Israel—were compelled to find solutions to continue meeting with clients and to provide supervision for family therapy trainees. To this end, we have shifted our live supervision courses (“practicums”) to the virtual arena, adapting the popular application “Zoom” into what we call “PractiZoom.” Based on over 100 PractiZoom sessions conducted between March and May 2020, involving 14 supervisors and 28 therapists-in-training and their clients, the article reflects on this pioneering online practicum for the online live supervision of therapists with geographically distributed participants. In this article, we outline our operational methods and adaptations for conducting live behind-the-mirror supervision online. Following a short theoretical background, we outline the process of online live supervision, discuss our reflections and those of our trainees on the challenges and possibilities it poses, and offer a number of preliminary conclusions and recommendations.     

Knowledge and assertion in “Gettier” cases

Assertion is fundamental to our lives as social and cognitive beings. By asserting, we share knowledge, coordinate behavior, and advance collective inquiry. Accordingly, assertion is of considerable interest to cognitive scientists, social scientists, and philosophers. This paper advances our understanding of the norm of assertion. Prior evidence suggests that knowledge is the norm of assertion, a view known as “the knowledge account.” In its strongest form, the knowledge account says that knowledge is both necessary and sufficient for assertability: you should make an assertion if and only if you know that it is true. The knowledge account has been rejected on the grounds that it conflicts with our ordinary practice of evaluating assertions. This paper reports four experiments that address an important objection of this sort, which focuses on a class of examples known as “Gettier cases.” The results undermine the objection and, in the process, provide further evidence for the knowledge account. The findings also teach some important general lessons about intuitional methodology and the curation of genres of thought experiment.     

The “Activist Client”: Social Responsibility,the Political Self,and Clinical Practice in Psychotherapy and Psychoanalysis

The idea of the “activist client” is intended to be taken both literally and metaphorically—applying to some extent to a wider range of clients than actual activists. The paper develops a set of ideas about a “political turn” in psychotherapy and psychoanalysis, using the tag “the inner politician.” There is a focus on working directly with political material in the session, and the pros and cos of this practice are reviewed. Wider issues such as social responsibility and social spirituality are discussed, as well as an exploration of the limits of individual responsibility. Some specific topics covered in the paper include the political roots of depression, difficulties with the concept of the therapeutic alliance from the point of view of democratic perspectives on clinical work, and a challenge to the unquestioned valuing of empathy (based on a reading of therapy though a Brechtian lens). There are numerous clinical examples.     

Why Husserl’s Universal Empiricism is a Moderate Rationalism

Husserl claims that his phenomenological–epistemological system amounts to a “universal” form of empiricism. The present paper shows that this universal moment of Husserl’s empiricism is why his empiricism qualifies as a rationalism. What is empiricist about Husserl’s phenomenological–epistemological system is that he takes experiences to be an autonomous source of immediate justification. On top of that, Husserl takes experiences to be the ultimate source of justification. For Husserl, every justified belief ultimately depends epistemically on the subject’s experiences. These are paradigms of empiricist claims and thus Husserl seems to subscribe to empiricism. However, what is universal about Husserl’s “empiricism” is that he does not limit the concept of (justification-conferring) experiences to sensory experiences or sensory experiences plus introspective intuitions but broadens the concept of experience such that also a priori intuitions are included. Husserl insists that logical, mathematical, and phenomenological intuitions such as?~?(p ∧ ?~?p), 2?+?2?=?4, and “Experiences necessarily bear the mark of intentionality” provide non-inferential justification analogous to how sensory experiences can non-inferentially justify beliefs such as “There is a table in front of me.” Importantly, Husserl makes clear that such a priori intuitions are not about our concepts but about reality. This is why Husserl’s universal empiricism is a rationalism. Husserl differs from traditional rationalism as he allows that a priori intuitions can be fallible and empirically underminable. This distinguishes Husserl’s rationalism from Descartes’ and makes him a proponent of moderate rationalism as currently championed by Laurence BonJour.     

Can Multimodal and Rational Emotive Behavior Therapy be Reconciled?

The purpose of this article is to determine whether two distinct modes of cognitive-behaviour therapy—Rational Emotive Behaviour Therapy (REBT) and Multimodal Therapy (MMT)—can be reconciled. This quest in the spirit of integrationism is pursued along three lines of inquiry: Do we talk about schools, approaches, or techniques? A reconciliation between MMT and REBT as systems seems not to be feasible, just because of the simple fact that MMT is not a new school with an idiosyncratic theory, whereas REBT is. However, REBT is also a congenial approach consisting of various eclectic techniques, as is MMT. It is explained how the A-B-C format and firing orders of the BASICI.D. modalities stem from an S-O-R model. Furthermore, the circular character of the various modalities (thinking, feeling, and behaving) is recognised both in MMT and in REBT. The techniques used in REBT and MMT overlap for 65–80%, according to a comparative perusal of Ellis's and Lazarus's presentations of preferred techniques. This means that MMT and REBT, as an approach with distinct techniques, “must” be very similar in practice. The conclusion is that philosophically Ellis and Lazarus see eye-to-eye and that MMT and REBT overlap a great deal. But a fusion is not yet at hand. At best the two can be described as two sides of one coin. “When you wake up in the morning, Pooh,” said Piglet at last, “what's the first thing you say to yourself?” “What's for breakfast?” said Pooh. “What do you say, Piglet?” “I say, I wonder what's going to happen exciting today?” said Piglet. Pooh nodded thoughtfully. “It's the same thing,” he said. “What's that?” the Unbeliever asked. “Wisdom from a Western Taoist,” I said. “It sounds like something from Winnie-the Pooh,” he said. “It is,” I said. From The Tao of Pooh Benjamin Hoff (1982)     

Recognizing group cognition

In this paper, we approach the idea of group cognition from the perspective of the “extended mind” thesis, as a special case of the more general claim that systems larger than the individual human, but containing that human, are capable of cognition (Clark, 2008, Clark and Chalmers, 1998). Instead of deliberating about “the mark of the cognitive” (Adams & Aizawa, 2008), our discussion of group cognition is tied to particular cognitive capacities. We review recent studies of group problem solving and group memory which reveal that specific cognitive capacities that are commonly ascribed to individuals are also aptly ascribed at the level of groups. These case studies show how dense interactions among people within a group lead to both similarity-inducing and differentiating dynamics that affect the group’s ability to solve problems. This supports our claim that groups have organization-dependent cognitive capacities that go beyond the simple aggregation of the cognitive capacities of individuals. Group cognition is thus an emergent phenomenon in the sense of Wimsatt (1986). We further argue that anybody who rejects our strategy for showing that cognitive properties can be instantiated at multiple levels in the organizational hierarchy on a priori grounds is a “demergentist,” and thus incurs the burden of proof for explaining why cognitive properties are “stuck” at a certain level of organizational structure. Finally, we show that our analysis of group cognition escapes the “coupling-constitution” charge that has been leveled against the extended mind thesis (Adams & Aizawa, 2008).     

Embracing the other: Revisiting the epistemological foundations of family systems therapy

Family systems therapy originated in the 1960s, 1970s, and 1980s through the work of innovative thinkers and clinicians. However, despite the creative contributions of the mentioned colleagues and of later innovations in family therapy theory and practice, it seems as though the dominant culture of establishment psychiatry in the United States (and in most Western countries) to this day has not seriously incorporated relationships, social context, or community connectedness into the treatment of individuals with psychiatric diagnoses. For the “psychiatric” patients diagnosed according to the DSM-5, the dominant underlying epistemological perspective is the medical “scientific” paradigm. Within this approach there is a dearth of reflections about the truthfulness of so-called “empirical facts” and a lack of skepticism about the techniques of “measurement” of the psychiatric illness. The alternative, relationship-oriented, context-sensitive, and community-connected thinking paradigm is highlighted here in contrast to the “psychiatric” foundation. This paradigm consists of (a) the awareness that all human Subjects (including “psychiatric” clients) are constituted as such by their relational connection to others; (b) the awareness of our sensitivity to and embeddedness in a socio-economic, cultural, and racial context; and (c) the awareness of our involvement in and connectedness with many kinds of communities.     

The issue of force and energy in behavioral change

The issue of force and energy in behavioral change involves the following question. Assuming that certain ideas or cognitions help individuals to change their basic personality structure, is it important that these ideas be conveyed by the therapists, or by the clients, to themselves, in a vigorous, forceful and dramatic manner? This question, along with the concomitant one of “intellectual” versus “emotional” insight, has been neglected and avoided in much of the recent literature. This article considers these questions, tries to formulate an operational definition of force and energy in behavioral change, and suggests some specific things that clients may do to achieve “emotional” insight or elegant philosophic reconstruction.     

Multi(ple) cultural voices speaking “Outside the Sentence” of counselling and psychotherapy

This paper examines the notion that marginalized clients through their socio-cultural and geo-political histories are positioned “outside” the masculine cultural metaphors and conventional theoretical epistemologies of counselling, psychology and psychotherapy. In other words, these minoritized clients are “outside the sentence” of the texts and contexts of therapy. The discursive practice of therapeutic reconstitution and restoration produces a particular set of vocabularies and sentences that facilitate transformation and psychic equilibrium consistent with the process of individuation and self actualization. However, for marginalized groups, such as black and other visible minority, women, deaf, gay and lesbian clients the hegemonic masculine narratives of counselling psychology and psychotherapy only make it possible for these clients to be “outside the sentence”, not just grammatically and metaphorically of the therapeutic project, but in the external reality of how the practice is clinically governed. In other words, the social and cultural marginalization outside the clinic room is in a dialectical relationship with the therapy dyad. For the minoritized client being “outside the sentence” produces the effect of being “inside” another process, i.e., the history of subjugation, domination, diaspora, and displacement. This paper explores this issue and argues that the only way for counselling, psychology and psychotherapy to bring the diversity client “within the sentence” of therapy is to assign and re-inscribe the history, memory and pain of “the Other” voices to the “inside” of the therapeutic space, to interrupt and disrupt the hegemonic masculine narratives, thus transforming “non-sentences” into sentences and paragraphs, and eventually into essays of the discursive subject.     

Nothing Matters in Survival

Do I have a special reason to care about my future, as opposed to yours? We reject the common belief that I do. Putting our thesis paradoxically, we say that nothing matters in survival: nothing in our continued existence justifies any special self-concern. Such an “extreme” view is standardly tied to ideas about the metaphysics of persons, but not by us. After rejecting various arguments against our thesis, we conclude that simplicity decides in its favor. Throughout the essay we honor Jim Rachels, whose final days exemplified his own unselfish morality as well as the “neutralist” ideal we espouse. As an appendix, we include the last original work to be published by James Rachels, in which he criticizes Sidgwick’s most famous defense of egoism.     

A problem for rationalist responses to skepticism

Rationalism, my target, says that in order to have perceptual knowledge, such as that your hand is making a fist, you must “antecedently” (or “independently”) know that skeptical scenarios don’t obtain, such as the skeptical scenario that you are in the Matrix. I motivate the specific form of Rationalism shared by, among others, White (Philos Stud 131:525–557, 2006) and Wright (Proc Aristot Soc Suppl Vol 78:167–212, 2004), which credits us with warrant to believe (or “accept”, in Wright’s terms) that our senses are reliably veridical, where that warrant is one we enjoy by default, that is, without relying on any evidence or engaging in any positive argument. The problem with this form of Rationalism is that, even if you have default knowledge that your senses are reliable, this is not adequate to rule out every kind of skeptical scenario. The problem is created by one-off skeptical scenarios, scenarios that involve a highly reliable perceiver who, by a pure fluke, has a one-off, non-veridical experience. I claim you cannot infer that your present perceptual experience is veridical just on the basis of knowledge of your general reliability. More generally, if you infer that the present F is G, just on the basis of your knowledge that most Fs are Gs, this is what I call statistical inference, and, as I argue, statistical inference by itself does not generate knowledge. I defend this view of statistical inference against objections, including the objection that radical skepticism about our ordinary inductive knowledge will follow unless statistical inference generates knowledge.     

On Studying the Cognitive Value of Literature

The debate on the cognitive value of literature is undergoing a change. On the one hand, several philosophers recommend an epistemological move from “knowledge” to “understanding” in describing the cognitive benefits of literature. On the other hand, skeptics call for methodological discussion and demand evidence for the claim that readers actually learn from literature. These two ideas, the notion of understanding and the demand for evidence, seem initially inconsistent, for the notion of understanding implies that the cognitive benefits of literature are ultimately nonverbal and thus inarticulate. In this article, I defend both the move from knowledge to understanding and the demand for evidence. After proposing that the cognitive value of literature is best construed in terms of enhancing the reader's understanding, I argue that the place to look for evidence for the cognitive benefits of literature is not the laboratory but the practice of literature.     

Where “culture wars” and therapy meet: Exploring the intersection between political issues and therapeutic practice

In the era of “culture wars,” instances where client and practitioner discuss political issues in therapy may become more frequent. This paper introduces the way in which “culture wars” manifest in today's societies and highlights the importance of therapeutic practitioners to engage with and explore their own views in relation to these polarising political debates. In doing so, this paper reflects upon the existing research focussing on the way in which “culture wars” enter the therapeutic encounter and highlights the feelings of anxiety and conflict that arise when practitioners are tasked with “talking politics” with clients. It considers the implications for practice and policy and concludes with recommendations for future scholarship, arguing for more culturally specific studies that examine how “culture wars” issues impact therapeutic work in a variety of international settings.     

Why using “consciousness” in psychotherapy? Insight,metacognition and self-consciousness

Since its early development, clinical psychology has questioned the impact of “consciousness” on the determination of human responsibility across psychiatric disorders. In recent years, specific clinical approaches have focused on “consciousness” work that could play a key role in psychotherapy. We focused our research on clinical psychology's consciousness-related concepts of insight, self-consciousness, and metacognition. Insight and metacognition, for example, have prompted increased interest in schizophrenia (SZ), bipolar disorder (BD), and, more recently, borderline personality disorder (BPD) treatments as representative of the latest advances in the cognitive and behavioral therapy field. Here we review cognitive, social, and clinical psychology research measuring “consciousness” in BPD, SZ, and BD, exploring the implications of different conceptualizations of consciousness-like concepts for treatment adherence, symptom evolution, and related aspects of psychotherapy. Our results show the overall relevance of using measures of clinical and cognitive insight, emphasizing the more central role of cognitive insight and metacognition in psychotherapy, as it appears that consciousness can remain useful if understood as a cognitive skill. The inclusion of a conceptualization of self-consciousness is important in order to address the social component of psychotherapy, as it does in biopsychosocial approaches. We discuss the implications of such results for global efficacy, for the relevance of the “consciousness” concept to clinical psychology, and for the potential need to keep operationalizing different conceptualizations of it in psychotherapy. We open the debate on the definition of consciousness to motivational aspects of change and to general considerations of both legal and ethical aspects.     

A meditation on the nature of self‐healing and personality change in psychotherapy based on Gendlin's theory of experiencing

Abstract

From a humanistic point of view psychotherapy is a creative transformational process in which therapists assist clients’ intrinsic self‐healing tendencies. However the nature of the self‐healing process is poorly understood. I briefly consider two theories of self‐healing, Rogers’ self‐actualization theory and dialectical theory, but focus on Gendlin's theory of experiencing as providing a more complete explanation. I consider the fundamentally implicational nature of change and portray personal change as “paradigm evolution” rather than paradigm revolution. I conclude with an examination of the self‐healing process in therapies that provide minimal prosthetic assistance to the client: client‐centered therapy, eye movement desensitization and reprocessing, and focusing‐oriented therapy. I conclude that the self‐healing/self‐change process occurs when intellectual, “top‐down” cognitive and self‐critical activity is interrupted, and when clients adopt a receptive, listening attitude towards inner experience.     

Reclaiming Quine’s epistemology

Central elements of W. V. Quine’s epistemology are widely and deeply misunderstood, including the following. He held from first to last that our evidence consists of the stimulations of our sense organs, and of our observations, and of our sensory experiences; meeting the interpretive challenge this poses is a sine qua non of understanding his epistemology. He counted both “This is blue” and “This looks blue” as observation sentences. He took introspective reports to have a high degree of certainty. He endorsed outright Hume’s “skeptical” argument concerning induction. His naturalized epistemology is simply naturalistic, or scientific, epistemology stripped of the project of rational reconstruction, and is thoroughly normative. Quine was unconditionally a scientific philosopher who took our theories to be answerable ultimately to our perceptual experiences (sensations)—and conditionally an empiricist, empiricism being a scientific theory that has no competitors worthy of the name. I attempt to make all of this clear, and conclude by offering a concise formulation of his epistemology.     

How Do Our Values Inform Ethical Research? A Narrative of Recognizing Colonizing Practices

How do you reconcile tensions between ethical research practice, personal values, and disciplinary values? This article focuses on an ethical challenge involving the engagement of rural Indigenous community members that emerged during my PhD fieldwork. The narrative illustrates the necessity to engage in critical reflexive research practice, a process which saw me respond to my own feelings of “wrong” and “right,” contemplate a distinction between procedural ethics and virtue ethics in community‐based research, explore colonizing research practices, and endeavor to reconcile an instance where the values of community psychology appeared in contest. The “voice” in this narrative is that of the first author; the dual authorship reflects the ongoing collaboration between both authors. When this ethical issue came about, our relationship was one of “student” and “supervisor”; we are now colleagues and friends.