The integrative attitude–a personal journey

The origins of clinical psychotherapy date from the beginning of last century and the development of broadly four foundational schools–psychoanalytic, cognitive-behavioural, humanistic and transpersonal psychologies. The imperative to integrate these schools, however, is relatively recent and in the last 25 years a professional integration movement has developed, exemplified by the formation of SEPI and the UKAPI, and ‘integrative psychotherapist’ is now the most popular nomenclature used in the profession. This article gives a brief history of the integration movement, reviews some issues raised by developments so far, and discusses the personal dilemma that integration evokes in the would-be integrative practitioner. Using my own journey I espouse an integrative attitude that is based on the nature of integration as an evolving personal process rather than an ideal, fixed, profession-wide position. I describe three interweaving modalities of integration I call constructive, complicit and contiguous integration, which form a developmental framework that aims to encourage the individual activity of questioning, inventing, researching and interrogating the discipline within its philosophical, professional and social context. In concluding, this article exhorts the profession to see integration as a personal journey, as a way of being that is constantly becoming and unfolding in relation with the therapist's training, experience and interaction with peers and clients. The result is indefinable and unnameable, and perhaps represents the soul of integrative psychotherapy.     

A quality assurance programme for psychotherapy — The finnish experience

In many respects the status of psychotherapy in public health-care systems is similar to that of alternative medicine. The roots of training are outside universities. Legitimation and public funding have been non-existent or insufficient as compared with other fields of health care. Also a great deal of mysticism is attached to both. It is therefore relevant to study the role of psychotherapy from the frame of reference given by research into alternative health care.

Formal health care is characterised by (1) legalised status, (2) access to public funding and (3) integration in the formal medical curriculum. On the other hand there are several treatment philosophies which remain as outsiders from the point of view of formal health care. Informal health care approaches are characterised by (1) lack of legalised status, (2) no access to public funding and (3) no integration in the medical curriculum. Alternative medicine is a term usually attached to forms of informal health care like acupuncture, Spa-culture etc.

Psychotherapy in the public health sector lies somewhere between formal and informal health care. While it has no legalised status, anyone may call himself ‘psychotherapist’. Its definition remains obscure and its public accountability poor.

In this paper I have tried to show how one country — Finland — has tried to grapple with this problem as it attempted to set up psychotherapy services whose quality could be properly monitored — ‘Quality Assurance’ — allowing for public accountability. Now that psychotherapy is well established as a valuable treatment in the field of mental health it is possible to consider future expansion as a cost-effective way to improve the general mental health of the country.     

At the border: reflections on psychoanalytically oriented counselling in an Italian university setting

This paper analyses the ‘border’ position of counselling services in Italian universities. The concept of ‘border’ has great relevance in the work of psychoanalytically oriented university students’ counsellors. Counselling is part of a continuum of interventions, from befriending to psychotherapy. This closeness encompasses the need for identifying specificities and differences among interventions. Moreover, a university counselling service occupies a ‘marginal’ position, continuously confronted with the risks of rejection and/or assimilation. The concept of ‘border’ is also useful to define the developmental phase of university students, crossing the border between late adolescence and young adulthood, as represented by Conrad's novel The shadow line (1917/1999), recently analysed by Green (2008) as the metaphoric demarcation line between youth and adulthood. Finally, most of the students referring to our counselling service come from families that for the first time crossed the border of university education.     

Challenges of patient‐led mental health services to psychoanalytic clinicians

This paper considers implications to psychoanalytic psychotherapy of the British Government's decision to implement a patient choice agenda for state‐funded mental health services in England and Wales. It places the patient choice agenda in the context of consumerist society and argues that the complex nature of psychoanalytic psychotherapy leaves it more vulnerable than other psychological therapy modalities to compete in the current reality of ‘consumer’‐led public mental health, which, in turn reflects a profoundly changed social context from that to which psychoanalysis traces its roots. Unless psychoanalytic clinicians recognize and find ways to adjust to this context they will jeopardize the survival of psychoanalytic psychotherapy in an increasingly market‐orientated model of mental healthcare provision in the public sector, eager to promote more ‘consumer friendly’ psychological therapy models.     

The search for evidence: Psychoanalytic practice and the male imaginary

In this paper, I will attempt to discuss the future of psychoanalytic practice in the wake of the National Institute of Health and Clinical Excellence’s (NICE) embrace of ‘evidence’-based practice. In 2005, NICE, whose task is to regulate the provision of health care across the National Health Service, adopted positivistic evidence-based protocols as the sole proof of the effectiveness of psychotherapy. Despite the success over the past 40?years of psychoanalytic and humanistic therapies in primary care and psychotherapy departments of psychiatric hospitals, NICE insists on restricting therapy, to those who can claim effectiveness as a result of using the data from client questionnaires commonly described as ‘outcome measures’ and it has gone on to promoting new modalities many of which have been imported from the States. As a consequence, most of the provision of psychotherapy in the public sector currently, whether as part of the National Health Service or the voluntary sector, has embraced evidence-based practice’ and many training organisations are promoting it, which will, in time, have an effect on private practice. I use some of the threads of the work of the feminist psychoanalyst Irigaray and others to understand this turn to positivistic science and how it can be understood as an instance of the retrenchment of the ‘male imaginary’ and a re-installation of the values of detachment and mastery. I query whether there are some problems within current theory, practice and institutionalisation which interfere with the emergence of a more progressive psychoanalytic practice.     

Current Treatment Strategies for Sexually Abused Children

SUMMARY

Given the disturbingly high prevalence of child sexual abuse, the expertise of medical and mental health professionals in treating child sexual abuse victims is essential. Relevant issues in treating these children include the mindfulness of developmental considerations, incorporation of a multi-modal therapeutic evaluation approach, clarification of treatment goals, appropriate use of and integration of various treatment modalities, and effective treatment termination. This article provides an introduction aid overview of treatment of sexually abused children of all ages, from preschoolers to adolescents, with special emphasis on the importance of developmentally linked evaluation and treatment strategies. Treatment is discussed in terms of goals, stages from evaluation to termination, and formats and modalities including individual psychotherapy, family psychotherapy, group psychotherapy and hypnotherapy, to provide a comprehensive overview of current treatment strategies for sexually abused children.     

The validity of psychotherapy 1

How good is psychotherapy as a tool of research into human nature? There is an orthodox defence of it as a research tool, which relies on showing that interpretations are true of the patient when they satisfy certain criteria. This defence is examined and rejected. The reply is considered that an interpretation which ‘keeps things moving’ is true, or an approximation to the truth. This reply is rejected by comparing and contrasting an interpretation in psychotherapy with one from brainwashing sessions. Two suppositions about psychotherapy (which weaken its discovery powers) are deliberately adopted — the suppositions that the material produced is ‘perspective’ and ‘method’ dependent. An unorthodox defence of psychotherapy is then offered — by means of a watery sense of ‘discover’. This enables us to outline a weak sense in which psychotherapy is a valid enterprise, but one which is still strong enough for research purposes.     

Psychotherapy process and research: Missing persons and missing values

The task of ‘understanding’ in psychotherapy is compared with the mundance basis of interpersonal understanding. This implicates a discussion of three ‘principles’ which are put forward as distinguishing features of psychotherapy: ‘empathy’ (as a process, not a technique); ‘interpretation’ (particularly with regard to its relation to values); and the ‘faded person of the psychotherapist’ (related to empathy and interpretation, but particularly the power and remoteness of therapist). This allows a critical evaluation of psychotherapy research. Process research, particularly the innovative work of Robert Elliott, which seems best able to meet criticisms related to the sensitivity of research methodologies, is given particular attention. However, epistemological limitations are identified which are likely to unnecessarily distort the meaningfulness of the ‘events’ of psychotherapy.     

Integrative counselling and psychotherapy: A relational approach,by Ariana Faris and Els van Ooijen

The movement towards registration of psychotherapists, especially towards statutory registration is under way across Europe. This is seen as a way of ‘protecting the public’ against abusive and/or incompetent psychotherapists. In what follows I argue that the dominant ethos of contemporary psychotherapy is based upon a metaphysics of subjectivism and that registration will reinforce this coercively through the law. My concern is that this subjectivistic notion of psychotherapy compounds the estrangement of soul (psyche) and world; that it continues, by way of rationalization and bureaucratization, the process of the ‘disenchantment of the world’. Psychology and psychotherapy are then ‘logically’ constituted out of this rupture between the psyche and nature. This closes our psychological consciousness off from a deeper ecological awareness and from a critical self-reflection on the way this rupture is maintained in psychological and psychotherapeutic theory and practice.     

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.     

A healing relationship: Clients’ experiences of the long-term relational significance of the horse in horse assisted psychotherapy

Horse assisted psychotherapy is a type of treatment for mental ill-health in which the client forms a relationship with a horse. Research suggests that the relationship to a horse is very helpful to clients, but how the horse is experienced many years after the end of treatment has not been investigated. The aim of the present study was thus to investigate how former clients from horse assisted psychotherapy experienced the horse several years after treatment was completed. Former clients (n = 5; all females) from one and the same treatment center were interviewed and the data was analyzed with an inductive thematic approach. The analysis showed that many years after completion of treatment, the horses were still remembered as the most important individuals in the informants’ lives during the time of treatment. This was captured by the core category ‘A healing relationship’. These findings are in line with previous research that found that patients in horse assisted psychotherapy and their family members attributed improvements from treatment to the patients’ relationship to the horses, but adds that the clients also keep these views at follow-up several years after termination of treatment.     

心理治疗中共同要素理论的历史发展

从共同要素的角度,分理论模式化与研究实证化两条线索,追溯了心理治疗中共同要素理论的思想渊源,并自Saul Rosenzweig开始,综述了Carl Rogers、Jerome Frank、Marvin Goldfried、Michael Lambert、Bruce Wampold等学者的观点,探讨了共同要素理论的历史演进、内涵结构、理论模式及当代研究进展。认为它在不久的未来,将与特殊技术说逐步走向整合,加深对心理治疗过程与改变机制的认识,共同提升心理治疗的效果。     

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.     

The construction of emotional experience: State‐related emotional awareness and its application to psychotherapy research and practice

The cognitive–developmental theory of ‘levels of emotional awareness’ (LEA) addresses an individual's capacity to experience and express emotion, a capacity highly relevant to psychotherapy. Previous papers on LEA and psychotherapy addressed the aspect of LEA theory pertaining to the ‘trait’ (i.e. enduring) aspects of an individual's emotional functioning over time. LEA theory also applies to the construction of emotional experience at any given moment, in which levels emerge or disappear in a process of microgenetic construction as a function of arousal and other variables. This state‐related perspective is supported by recent research showing that people vary in their LEA from moment to moment. Momentary changes in LEA correspond to the variations in lived experience that occur in relationships, including the therapy relationship, and provide the context for corrective emotional experiences that promote change. In this paper, the construction of emotional experience at different levels of organisation is discussed separately in relation to clients and therapists. Key phenomena relevant to psychotherapy include the transition from bodily sensations to specific differentiated emotional feelings, the ability to be aware of multiple feelings that may be contradictory or counter‐intuitive, and the appreciation of how complex combinations of feelings may differ in self and other. This perspective adds to the literature on how the integration of emotion and cognition contributes to change in psychotherapy. The clinical and research implications of this perspective are discussed.     

‘Critical psychotherapy,’ ‘postpsychotherapy,’ and the cult of technicism

This paper about the terms ‘critical psychotherapy’ and ‘postpsychotherapy’ argues that the terms ‘critical psychology,’ ‘critical psychiatry,’ and ‘postpsychiatry’ are already in use, and we can see the new terms – ‘critical psychotherapy’ and ‘postpsychotherapy’ – as additions to this already existing family of terms. However, this paper also argues that what is of most importance is not the case for using these new terms, but the tendencies and features these terms might be taken to refer to. The paper begins with an experience the author had while working as a counsellor some years ago. The terms listed above are explored, as are the roots of ‘critical psychotherapy’ in psychoanalysis, before providing an example of how a philosopher’s work might be relevant to psychotherapists.     

Transcultural histories of psychotherapy

Abstract

Both proponents of and critics tend to assume psychotherapy’s origin and status as a ‘Western’ practice. The history of the emergence of psychoanalysis and psychotherapy are far more complex than this picture allows for. Today as we enter a more multipolar era of world history, the easy identification of psychotherapy with ‘the West’ will become increasingly difficult to sustain, as Bangalore and Shanghai are likely to rival Hampstead and Manhattan as centres of influence for the development of therapeutic practice and theory in the coming decades. Adapting to this new world will necessitate a different conception of the role of ‘culture’ than we have been used to in recent discussions in psychotherapy. Rather than simply seeing ‘culture’ as a factor that needs to be added to discussions to counteract the alleged ethnocentrism of ‘Western’ psychotherapy, we will need to begin to pay more careful attention to the work that is done by appeals to the ‘culture concept’ in different contexts. In particular ‘culture’ can be constructed as an object of evaluation that makes it part of the ‘check-list’ of skills that characterise the reconception of psychotherapy in an era of neoliberal instrumental manualised therapy training and practice.     

The Medieval Octagon of Opposition for Sentences with Quantified Predicates

The traditional Square of Opposition consists of four sentence types. Two are universal and two particular; two are affirmative and two negative. Examples, where ‘S’ and ‘P’ designate the subject and the predicate, are: ‘every S is P’, ‘no S is P’, ‘some S is P’ and ‘some S is not P’. Taking the usual sentences of the square of opposition, quantifying over their predicates exhibits non-standard sentence forms. These sentences may be combined into non-standard Squares of Opposition (an Octagon in this case), and they reveal a new relationship not found in the usual Square. Medieval logicians termed ‘disparatae’ pairs of sentences like ‘every S is some P’ and ‘some S is every P’, which are neither subaltern nor contrary, neither contradictory nor subcontrary. Walter Redmond has designed a special language L to express the logical form of these sentences in a precise way. I will use this language to show how Squares of Opposition, standard and non-standard, form a complex network of relations which bring to light the subtleties contained in this traditional doctrine.     

Phenomenological research on supervision: Supervisors reflect on ‘being a supervisor’

A study using a phenomenological research method was performed to reveal the meanings of the concept ‘supervision’, from the supervisor's perspective. Eleven supervisors of counselling and psychotherapy from a humanistic/existential framework answered the open question: “What does being a supervisor mean?”. Content analysis and frequency measuring were performed, revealing six groups of statements; six facets describing the experience of supervision: ‘structuring’, ‘teaching’, ‘nurturing’, the ‘supervisor as person’, ‘supervisor as colleague’, and the ‘triangle, client-therapist-supervisor’. Structuring was the largest category, and the first three categories together represented more than 75% of the statements. The results showed that ‘teaching’ and ‘nurturing’ were very similar in their importance, as represented by the number of statements in each. Further research should address the possible relation between supervisors' perception and experience of their role and the theoretical framework of counselling and psychotherapy in which they are based, The phenomenological research method in this study has shown the possibility of doing research on processes without ‘betraying’ the subjective perspective.     

SUICIDALITY IN MEN IN PSYCHODYNAMIC PSYCHOTHERAPY

Based on the evidence of empirical gender differences in attempted suicide and suicide, this paper develops psychodynamic hypotheses on gender‐specific biographic, intra‐psychic and treatment aspects of suicidality among men. ‘Forming Types by Understanding’ is a qualitative method, based on a systematic analysis of similarity and differential reference points to develop ideal types of suicidal men. A random sample of 20 suicidal men who were receiving out‐patient psychodynamic psychotherapy was studied.

Four ideal types of suicidal men were identified: (1) ideal type ‘disconnected’: a predominance of disconnected feelings that is associated with rejection experiences; (2) ideal type ‘hurt’: aggressive conflicts and the realization of disillusioned life reality combined with experiences of real loss and real trauma; (3) ideal type ‘stormy’: an attached‐symbiotic transference offer mobilizes unrealistic wishes to help against a background of unresolved dependency conflicts; and (4) ideal type ‘object dependent’: concrete facts are important in relationships; in case of separation, real repossession of the woman must occur, a lack of emotional experience is compensated. The danger of suicidality, especially in the early stage of psychotherapy, is particularly acute for patients who cannot reach their therapists emotionally and vice versa. Disturbance of the early experience of inseparability from the mother, gender‐specific conflicts in the development of separation and individuation, and failed triangulation are of central psychodynamic importance.     

分离水平和空间位置对三维物体识别的影响

物体识别的两大理论一直存在争议。以物体为中心理论认为不管物体出现在什么位置,识别均与空间位置无关,而以观察者为中心理论认为识别与空间位置有关。研究参照物体识别的“小几何体”思想自制实验材料,采用启动范式下的分类任务,通过操纵物体自身的结构信息和相对的结构信息,考察了三维物体识别的影响机制。结果发现：（1）物体自身组成部分之间的分离水平和物体之间的相对空间位置对物体识别的影响均呈层级式。支持以观察者为中心理论的整体表征观;（2）不分离水平和相同位置上,整体启动快于部分启动;全分离水平和远距离位置上,部分启动快于整体启动。支持以物体为中心理论的小几何体优先加工观。实现两大理论的融合需要进一步厘清“What + Where”两通路联合表征的二级子层级。