Psychotherapy Training Process as a Group Experience: A Hermeneutic-Constructivist Perspective

This article focuses on the training of hermeneutic constructivist psychotherapists and aims to point out those aspects that make the group such a privileged place for the construction of the professional role. It hypothesized that the group, as a closed and transitory context, can promote an openness to the exploration of different alternatives and the experimentation of the professional role. The article concentrates especially on applying the psychotherapy group theory of G. A. Kelly to the group training of hermeneutic constructivist psychotherapists, describing this process through the experience cycle (Kelly, 1995) in the perspective of a transformative experience. Starting from the basic theories behind the therapeutic process, illustration will follow of the training procedure formulated to allow working with the group within a context of relationships that favor learning and experimentation of new roles. The various phases of group therapeutic training will then be illustrated. These have been formulated to enable working within the group in a relational context that favors the role of therapist construction, coming from the elaboration of certain areas of the personal system and from experimentation and the elaboration of this new role itself.     

Psychotherapy as a skilled practice

While psychotherapy is related to both science and art, it is primarily a craft activity requiring the development of skilful practice, epitomized by the discipline of the analytic attitude. In terms of the forms of knowledge outlined by Aristotle, this places psychotherapy in the realm of ‘technê’ (arts and craft) rather than epistêmê (science). In particular, the technê of psychotherapy is concerned with the development of phronesis (practical wisdom) in both patient and analyst and its ultimate aim is concerned with the promotion of eudaimonia, a state of well-being considered by Aristotle to be definitive of ‘the good life’. It is therefore fundamentally an ethical endeavour. The nature of psychotherapeutic skill is illustrated by analogy with three other forms of technê – music, meditation and pottery. Clinical examples illustrate the crafting of interpretations and the art of patient holding.     

Psychotherapy as a moral enterprise

This article addresses the phenomenon of psychotherapy as a moral enterprise by discussing the notion of morality as it relates to the therapeutic task, enumerating ways in which the practices of psychotherapy can confuse a moral sense of things and by offering suggestions as to how psychotherapy can be undertaken as a moral enterprise.     

Psychotherapy as a rite of passage

Some psychotherapies may work because they resemble rites of passage. To explore this idea, this article describes an "individual" case of depression in which drug, cognitive, and narrative approaches fell short of effectiveness, and change occurred in a series of experiences that resemble a rite of passage. This resemblance is illuminated by examining two apparently quite different healing processes--Alcoholics Anonymous and multifamily group therapy in schizophrenia--to explore the elements they have in common with the case described: the acceptance of what Victor Turner called a liminal experience, and the importance of witnesses to the ritual support for that acceptance. The discussion contributes to a loosening of the distinctions between the processes of individual, family, group, and other social therapies and leads to questions about the expert knowledge the therapist provides.     

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。     

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.     

Morality and Adult Attachment Style as Predictors of Psychotherapy Process and Outcome Expectations

This study examined whether moral foundations and adult attachment style predict expectations for counseling. Hierarchical regression models were used to analyze self‐report questionnaires of 963 participants. Moral foundations related to harm–care, fairness–reciprocity, and authority–respect were significantly positively related to both process and outcome counseling expectations. Adult attachment anxiety was positively related to outcome expectations, whereas adult attachment avoidance was negatively related to process and outcome expectations. Moral foundations and adult attachment style are important predictors of therapy process and outcome expectations. Implications for practitioners and future research are discussed.     

Changes in Primary Process Thinking of a Prepsychotic Adolescent in Psychotherapy

The main goal of this study was to measure longitudinally change in thought processes and reality testing of a prepsychotic adolescent undergoing psychotherapy. The Holt scoring system for measuring primary process from Rorschach responses was the main measuring instrument. Four Rorschachs were administered over a period of three years. The results of the latter were compared with the clinical ratings of two psychiatrists. While clinical change in response to treatment was slight, there did appear to be a shift from primary to more secondary forms of formal thought processes as determined by the Rorschach.     

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.     

Acceptance and Commitment Therapy as a Spiritually Integrated Psychotherapy

This article presents acceptance and commitment therapy (ACT) as a spiritually integrated therapeutic modality. ACT is a value‐driven therapy that involves facilitating transcendence of physical, mental, and emotional experience to alleviate human suffering; as such, ACT shares common ground with the domain of spirituality. Approached as a spiritually integrated therapy, ACT can help clients to access spiritual resources and create life meaning as well as aid in the resolution or transformation of spiritual struggles. Given that spiritual struggles, in particular, can have a significant impact on mental health and well‐being, this article provides guidance in how ACT can address such struggles.     

Gadamer: Psychotherapy as conversation

Outcome research into psychotherapy shows that therapeutic approaches may all be equally valid forms of therapy despite the mutually exclusive theories on which they are based. Reviews of what therapists do in practice suggest a largely atheoretical and eclectic approach in which non-specific factors such as empathy, clinical management and persuasion are prominent. This paper proposes that a hermeneutic approach based on the work of the German philosopher Hans-Georg Gadamer can be useful in providing a non-dogmatic basis for therapy which makes room for these non-specific qualities. It outlines a hermeneutic mode of therapy and shows how this can allow for the rhetorical, interpretative and poetic dimensions of therapy-in-action.     

Time-Limited Dynamic Psychotherapy as a Model for Short-Term Inpatient Groups

The present article proposes a method, practiced by the author, to adapt time-limited dynamic psychotherapy (TLDP), a short-term individual psychodynamic therapy, for use with inpatient psychotherapy groups. Characteristics of TLDP which suggest the usefulness of such an adaptation, including short-term duration, specific treatment focus, rapid conceptualizations and broad selection of patients, and emphasis on the here-and-now in therapy, are discussed. The general approach to treatment, a supportive stance that involves an identification of maladaptive interpersonal issues, and then working on these issues without directly confronting the patients, is described. Specific therapeutic techniques for common inpatient group situations are also discussed.     

Group Psychotherapy as the Century Turns: Toward a Philosophy of Care

A futuristic essay should be written by two persons so as to invoke Bion's basic assumption pairing (Bion, 1964) with its connotations of hope, no matter how irrational. Accordingly, I split my self in two parts, one, the hard-headed realist, and the other, the prophetic visionary. As idealized identities, neither comes easily to me. But, perhaps heeding the two has permitted the articulation of some presentable notions about group psychotherapy and its evolving fate.