Dynamic Psychotherapy and the Problem of Time

This paper examines the dilemmas psychodynamic clinicians face in dealing with the challenges of the current clinical climate. We look to our theories, to the evolution of psychodynamic technique and to the collaborative nature of the therapeutic endeavor as they relate to the goals of psychotherapy. A case illustration is provided, and guidelines are offered for current professional practice.     

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.     

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.     

从心理学杂志相关文献看我国心理咨询与治疗方法的现状

对我国近年来已在实践中应用,并在心理学学术刊物上发表的心理咨询与治疗的方法进行了梳理,目的是探寻我国心理咨询与治疗方法的现状及存在问题.结果表明:我国心理咨询与治疗从业者所采用的方法绝大多数来源于国外;也有极少数本土化和本土的方法,但其研究及推广有限;从业者所采用的折衷方法多于单一方法,多数折衷方法是认知疗法和行为疗法的结合,或是将这二种方法结合其他疗法使用.     

From Interpretation to Commentary: Truth and Meaning in Psychotherapy

Some of the epistemological consequences of adopting the narrative point of view in psychotherapy are explored. Attempts to apply principles and norms from the philosophy of science to psychotherapy are criticized, since psychotherapy is not a science, but a technique. In addition, those models, related to the acquisition of knowledge, that consider that knowledge could increase by apposition without transforming the subject who is knowing are discussed. Natural science and hermeneutic metaphors are not suitable for understanding the practice of psychotherapy. Traditionally, the interpretation of symptoms or problems to solve has been the main instrument in therapy. In other words, the therapist tries to look for the truth hidden under the symptom, which then becomes a sign. Our proposition is to substitute these metaphors for the paradigm of text commentary. Text commentary, instead of providing a unique truth, provides a set of meanings suggested by a commentary. Characteristics that allow one to distinguish a good and a bad commentary, and implications of the paradigm described for the training of psychotherapists, are discussed.     

心理治疗的过程研究

心理治疗的过程研究是辨识心理治疗的活性成分和改变机制,是心理治疗效果研究的重要领域。心理治疗过程研究的最新进展体现在研究内容的扩展,研究方法的改进及研究结果的新发现等方面。对未来研究的几点建议：活性成分的层次性观点,改变机制的双线研究及与治疗过程模型的结合,借鉴邻近学科的研究成果,改善RCTs时间设计,关注质化研究,临床工作者与研究者的合作,以及开展本土化研究。     

Definitional and Research Issues in the Common Factors Approach to Psychotherapy Integration: Misconceptions, Clarifications, and Proposals

This paper focuses on two common misconceptions of common factors in therapy. The first misconception entails the confusion between common factors and therapeutic factors, and thus the inappropriate and misleading use of the term therapeutic common factors in various situations. The second misconception is the mixing of commonalities of different kinds and levels in proposed lists and studies of common factors. These areas are discussed and clarified, and recommendations designed to facilitate conceptual and methodological improvements relative to each misconception are offered. The selection of best levels and kinds of common factors to be studied are further explored (i.e., the study of client change events and antecedent therapist behaviors across different therapies), and specific proposals for their research are outlined.     

Research priorities in the psychological therapies: View from the British Association for Counselling and Psychotherapy

This paper seeks to summarise recent discussions within the British Association for Counselling and Psychotherapy (BACP) about the strategic direction and priorities for the organisation, the profession as a whole and, ultimately, the service users. The standing research policy commitment to a pluralist approach to research is affirmed and a number of competing approaches are briefly considered. The direction of general policy and specific aims are noted. The paper does not seek to define a BACP position, as such, and is intended to stimulate further debate and discussion which will feed directly into the development of the BACP research policies and activities during this crucial development period.     

Coming to an end: A case study of an ambiguous process of ending psychotherapy

Aim: When the duration of therapy is not preset and the outcome is a matter for negotiation, the decision to end psychotherapy will be an experiential concern for the two participants. This case study draws attention to how ambiguities may be settled in a process where ending is initiated by the therapist and resisted by the client. Method and analysis: The actual case was strategically selected as exceptional owing to a combination of circumstances. The client and the therapist had developed a ‘good enough’ alliance (WAI) and reached a ‘good enough’ outcome (OQ‐45), and still the client felt she was far from finished. A close inspection of interactional data in sessions together with both clients' and therapists' reflections in post‐therapy interviews elicited information about both substantial content and structural aspects of this complicated process of ending. Findings and discussion: The discrepancy between therapist and client was not addressed, but rather postponed and revisited again later. Structural elements like preparations for a break for vacations and reducing the frequency of sessions were used to test experiential qualities, such as how the client managed life without therapy. Carefully preserving a ‘good enough’ emotional bond through the negotiations seemed important to both parties. Significantly, the client's autonomy was interpreted as the final proof of improvement and the client came to a point where she could affirm that she had got better only by accepting that treatment was coming to an end.     

Intraclass Correlation Associated with Therapists: Estimates and Applications in Planning Psychotherapy Research

It is essential that outcome research permit clear conclusions to be drawn about the efficacy of interventions. The common practice of nesting therapists within conditions can pose important methodological challenges that affect interpretation, particularly if the study is not powered to account for the nested design. An obstacle to the optimal design of these studies is the lack of data about the intraclass correlation coefficient (ICC), which measures the statistical dependencies introduced by nesting. To begin the development of a public database of ICC estimates, the authors investigated ICCs for a variety outcomes reported in 20 psychotherapy outcome studies. The magnitude of the 495 ICC estimates varied widely across measures and studies. The authors provide recommendations regarding how to select and aggregate ICC estimates for power calculations and show how researchers can use ICC estimates to choose the number of patients and therapists that will optimize power. Attention to these recommendations will strengthen the validity of inferences drawn from psychotherapy studies that nest therapists within conditions.     

A fertile matrix: the birth of the Forensic Psychotherapy Society

This paper traces some aspects of the fertile matrix within which, over many years, the application of a psychoanalytic perspective to clinical work with the most severely mentally ill, difficult and at times frightening patients in secure and community settings has evolved and now led to the recent inauguration of the Forensic Psychotherapy Society (FPS), a new Member Institution of the British Psychoanalytic Council. The Society provides both a framework for a national, multidisciplinary professional training in psychodynamic forensic psychotherapy and the potential launching pad for an active post-qualification organisation supporting CPD and all other forms of professional development. The particular contributions to the birth of the FPS of the Forensic Psychotherapy Department at West London Mental Health NHS Trust, partly because we know it best but also because it is part of the largest forensic psychiatric service in the United Kingdom, are described.     

Relational ecologies of psychotherapy: The influence of administrative attachment on therapeutic alliance

There is now vast and multi-faceted empirical literature on the impact of relational dynamics in psychotherapy, and relationality is a central theme within contemporary psychoanalytic theories. Yet, there is virtually no literature addressing the relational dynamics around outpatient psychotherapy that influence the wider therapeutic alliance, that is the relational dynamics that unfold between clients and administrative office staff in making initial contacts and appointments, completing paperwork, negotiating payment, discussing insurance coverage, working through crisis calls, and the myriad of other forms of interaction which serve to form the relational ecology of psychotherapy. Milieu therapy or the use of supportive and structured therapeutic environments has been given significant attention in inpatient settings; however, administrative relational factors or administrative staff characteristics have seemingly been ignored in outpatient psychotherapy and psychoanalysis literatures. Many outpatient clinical practice settings involve multiple levels and dimensions of relationality between clients, administrative personnel, and therapists which shape the potential for secure continuous containment and various forms of attachment to psychotherapeutic space. In this paper, we describe several clinical illustrations of relational dynamics between clients and office staff which influence therapeutic alliance and outline the contours of our emerging idea of administrative hospitality based on relational psychoanalysis, attachment theory, symbolic anthropology, and stigma research. In doing so, we draw on our collective experience working in several outpatient clinics and insights from our current context in an urban outpatient training clinic which emphasises psychodynamic practice. Our goal is not a comprehensive analysis of the relational ecology of psychotherapy but to offer an initial exploratory account of some of the administrative relational dynamics in and around outpatient psychotherapy which go beyond the therapist-client dyad. The anthropological concept of liminality is connected to relational psychoanalytic theories to describe the important dynamics of transitional space in an overall process of relational transformation.     

Psyche and System: On Progress in the Integration of Individual Psychotherapy and Family Psychotherapy

This article addresses the frequency with which the same group of patients utilizes individual and family therapies, and at the same time do not constitute actual integration. The conditions under which such serial or concurrent utilization of the two forms of psychotherapy may be considered to be integrative are discussed.     

Group Psychotherapy Research: Current Status and Future Trends on the Dawn of the New Millennium

For the past two decades, the group psychotherapy research literature has been dominated by the efficacy study. Over this period of time, this laboratory-based work has acquired a number of methodological requisites all aimed at maximizing its internal validity in order that causal inferences can be made with increasing confidence. These very refinements in methodology, however, have led to increasing criticisms regarding the meaningfulness and relevance of the findings to real-world settings. This paper briefly reviews these developments and offers predictions, gleaned from the current literature, about future directions of research. In particular, three areas are highlighted: (1) the development of effectiveness studies, (2) the greater sophistication of process research, and (3) a renewal of the very early interest in group therapy treatment of medical conditions.     

The Role of the Therapist's Subjectivity: Using Countertransference in Psychotherapy

No abstract available for this article.     

Pretreatment Correlates of the Therapeutic Alliance in the Chronically Depressed

We examined the relationship between patient characteristics and the working alliance in a multisite trial for chronic depression. Patients treated with the Cognitive Behavioral Analysis System of Psychotherapy (CBASP), alone (n = 169) or combined with nefazodone (n = 198), completed the Working Alliance Inventory during the 2nd week of treatment. Within the CBASP alone group, a history of drug abuse/dependence, lower peak social adjustment over the past five years, and lower current social adjustment predicted a significantly poorer alliance. Within the combination group, male gender and a distancing coping style predicted a significantly poorer alliance. Results should be interpreted with caution since they did not replicate across treatment groups, and the number of significant findings were not much greater than chance expectations.     

A Two-Systems Approach to the Treatment of a Disturbed Adolescent

Abstract

This article is based upon die rich conceptual and technical framework for understanding and treating sadomasochistic psycho-pathology presented by the Novicks (this volume). Specifically, the Novicks' “two-systems” approach to self-regulation is applied to the treatment of a disturbed adolescent boy. Examples of “open” and “closed” functioning are presented as well as the role of underlying defensive omnipotent beliefs and fantasies. The clinical utility of this model, the pivotal role of the therapeutic alliance, and the significance of clinical work with the family through all stages of the treatment process are illustrated.     

A Primer on Psychotherapy Process Research: A Review of Cognitive Therapy of Depression

Researchers conducting psychotherapy process research aim to understand the process by which efficacious psychotherapies achieve therapeutic benefits. A key challenge in this research is how to maximise what can be learned from naturalistic longitudinal data. We provide a selective overview of research examining the process of change in cognitive therapy of depression. While the efficacy of this treatment is widely recognised, a consensus regarding how the treatment reduces depressive symptoms and provides protection from relapse and recurrence has yet to be reached. We review the current state of the research addressing the process of change in cognitive therapy, highlighting how specific methodological features can be used to better understand the process by which this treatment achieves its effects. We highlight the importance of two key challenges to making causal inferences from a process–outcome relation: (a) establishing the temporal precedence of predictors to outcome variables, and (b) evaluating whether any relations identified could be spurious. We argue that methodologically rigorous studies tend to support key claims of the model underlying cognitive therapy of depression. We conclude by considering future directions. For example, we highlight the importance of efforts to understand patient characteristics that may moderate process–outcome relations and could ultimately prove useful in tailoring treatment to best suit individual patients.