Implications of the Empirically Supported Treatment Movement for Psychoanalysis

In this article, I critique the empirically supported treatment (EST) movement and discuss the limitations of traditional psychotherapy research from a psychoanalytic perspective. The EST movement is based on a medical model that assumes that a psychotherapeutic treatment can be conceptualized independent of the human relationship in which it takes place. Psychotherapy and psychoanalysis are, however, treatments only in a metaphorical sense and are more akin to educational processes than medical treatments. Every therapeutic dyad is unique, and research that treats therapy as a standardized, disembodied entity will not contribute to our understanding. Nevertheless, there is a real need for psychoanalysts to become more actively involved in psychotherapy research both for political and scientific reasons. Although I do not believe that “empirical validation” in the form envisaged by the American Psychological Association task force is a realistic goal, I do believe in the value of microscopic studies of therapeutic process, particularly in the context of research-informed case histories.     

Rules Versus Principles in Psychotherapy: Implications of the Quest for Universal Guidelines in the Movement for Empirically Supported Treatments

In this article we briefly review the mission and criteria of the EST movement and several of its criticisms. We question an often-unacknowledged feature of the EST initiative—its foundation in a rule-governed approach to the regulation of psychotherapy—and argue that this approach encounters significant problems that are better resolved through an alternative, principle-based approach. The contrast between these perspectives is illustrated by presenting results of a qualitative research project identifying the implicit principles actually used by expert therapists across psychotherapy orientations to regulate values and interventions within their practice.     

The Meaning of Empirically Supported Treatment Research for Psychoanalytic and Other Long-Term Therapies

Two ways of evaluating the implications of empirically supported treatment research for psychoanalysis and other long-term therapies are considered. The first involves the comparison of the relative benefits of various psychotherapies; the second involves the comparison of short-term and long-term psychotherapies. The major findings are that (a) each of the different types of psychological treatments shows benefits, (b) the amount of benefits from each type of therapy shows mainly nonsignificant differences, (c) these nonsignificant differences are especially evident when the researcher's therapeutic allegiance is taken into account, (d) both short-term and long-term treatments show some positive benefits for some patients, and (e) there is a tendency for longer treatments to show more lasting benefits. The main gap in research studies consists of a lack of comparative studies of psychoanalysis versus other treatments. This review highlights the virtue of “methodological pluralism,” which means here applying to the same data a variety of methods for comparing psychotherapies with one another and for comparing long-term and short-term psychotherapies.     

Translating Empirically Supported Strategies Into Accessible Interventions: The Potential Utility of Exercise for the Treatment of Panic Disorder

Many patients suffering from panic disorder do not receive adequate care. Advances in the conceptualization and treatment of panic disorder encourage innovative strategies for targeting core fears (fears of anxiety sensations) that underlie this disorder. In this article, we discuss the use of exercise as a potential strategy for therapeutic exposure to these feared sensations, and the role that exercise may play as an acceptable intervention to aid the dissemination of exposure-based approaches to the treatment of panic disorder. Evidence for the efficacy of exercise for the treatment of anxiety and panic is presented; along with strategies to enhance the role exercise can play as an interoceptive (internal sensation) exposure procedure. Finally, issues of comorbidity and exercise acceptability are discussed. Our conclusion is that exercise-based interventions are promising strategies for improving the utilization of exposure-based interventions for panic disorder. Clinical guidelines and future research directions are discussed.     

On the Dissemination of Clinical Experiences in Using Empirically Supported Treatments

This article addresses the long-standing gap that has existed between psychotherapy research and practice and the efforts that have been made to bridge it. It also introduces one such effort, which has consisted of 3 clinical surveys on the experiences of practitioners in using empirically supported treatments for panic disorder, social anxiety, and OCD. In contrast to attempts to close the gap by disseminating research findings to the clinician, the clinical surveys are intended to allow for practitioners to disseminate their clinical experiences to the researcher—and also to other clinicians. What we view as a “two-way bridge” initiative is a collaboration between the Society of Clinical Psychology, Division 12 of the APA, and the Psychotherapy Division of the APA—Division 29. The mechanism that has been established provides a way for clinicians to be a part of the research process, which we hope will provide evidence that can help to enhance our clinical effectiveness.     

The Meaning vs. The Medical Model in the Empirically Supported Treatment Program: A Consideration of The Empirical Evidence

A review of the debate on the Empirically Supported Treatment Program is presented. It is argued that underlying the specifics of the debate are fundamentally incompatible paradigms: a meaning vs. a medical model. The findings from two gold standard multi-site studies are reviewed to conclude that the control condition meets requirements for an empirically supported treatment. The empirical finding of the failure of clinical training to improve treatment outcomes is explained by the focus on rational factors in training. It is recommended that training of therapists focus on enhancing experiential capacity rather than mastery of manualized treatment approaches.     

When Theory and Research Collide: Examining Correlates of Signature Strengths Use at Work

Signature strengths are individuals’ highest-ranked strengths, those that they own, celebrate, and frequently exercise. Their use has been theorized to elicit positive affect, and contribute significantly to individuals’ functioning and well-being. The present study examined two elements of these ideas in the work arena: (a) Associations of strengths use at work with work outcomes (work meaningfulness, engagement, job satisfaction, performance, organizational citizenship behavior, and counterproductive work behaviors), focusing on differences in the associations of signature-strengths use, lowest-strengths use, and happiness strengths-use at work; (b) The role of positive affect in mediating these associations. The results, based on self-reports of an international sample of 1031 working individuals, generally indicated that the use of all kinds of strengths had positive correlates. As expected, using signature strengths had the highest, robust unique contribution to behavioral outcomes (performance, organizational citizenship behavior, and lower counterproductive work behavior). But unexpectedly, using happiness strengths (and not signature strengths) had the highest, robust unique contribution to psycho-emotional work-related outcomes (work meaningfulness, engagement, and job satisfaction). Positive affect mediated the association between strengths use and all work-related outcomes for the three kinds of strengths, when each was examined separately. However, when uses of the three kinds of strengths were examined together, positive affect mediated the effects of lowest strengths use and those of happiness strengths use, but not the effects of signature strengths use. These findings highlight the differential benefits of using different kinds of strengths, and suggest that additional (and different) mechanisms may underlie these effects.     

Islamic Trauma Healing: Integrating Faith and Empirically Supported Principles in a Community-Based Program

Access to adequate, much less state-of-the-art, mental health care is a global problem. Natural disasters, civil war, and terrorist conflict have forcibly displaced millions of Muslims and have resulted in a remarkable level of individual and communitywide trauma exposure. As a result, many are at risk for posttraumatic stress and other trauma-related disorders. Many religiously oriented Muslims traditionally rely on Islamic principles and teachings, as well as their community, to cope with and address trauma-related distress. Islamic Trauma Healing is a six-session, lay-led group intervention developed within a Somali Muslim community that integrates evidence-based trauma-focused cognitive-behavioral therapy principles with cultural and religious practices aimed to enhance uptake and create an easily up-scalable intervention for a wide range of trauma. In sessions, narratives of prophets who have undergone trauma (e.g., Prophet Ayyub, faith during hard times) present Islamic principles and facilitate cognitive shifts. Group members spend individual time turning to Allah in dua (i.e., informal prayer), focused on exposure to trauma memories. Program themes arc across suffering to healing to growth following trauma. This paper describes the core theoretical principles and methods in the Islamic Trauma Healing program. We also describe leader perspectives and the program’s train-the-trainer model, in which lay leaders are trained to further disseminate the program and allow Islamic Trauma Healing to be owned and sustained by the Muslim community.     

A Model of Therapist Competencies for the Empirically Supported Cognitive Behavioral Treatment of Child and Adolescent Anxiety and Depressive Disorders

While a plethora of cognitive behavioral empirically supported treatments (ESTs) are available for treating child and adolescent anxiety and depressive disorders, research has shown that these are not as effective when implemented in routine practice settings. Research is now indicating that is partly due to ineffective EST training methods, resulting in a lack of therapist competence. However, at present, the specific competencies that are required for the effective implementation of ESTs for this population are unknown, making the development of more effective EST training difficult. This study therefore aimed to develop a model of therapist competencies for the empirically supported cognitive behavioral treatment of child and adolescent anxiety and depressive disorders using a version of the well-established Delphi technique. In doing so, the authors: (1) identified and reviewed cognitive behavioral ESTs for child and adolescent anxiety and depressive disorders, (2) extracted therapist competencies required to implement each treatment effectively, (3) validated these competency lists with EST authors, (4) consulted with a panel of relevant local experts to generate an overall model of therapist competence for the empirically supported cognitive behavioral treatment of child and adolescent anxiety and depressive disorders, and (5) validated the overall model with EST manual authors and relevant international experts. The resultant model offers an empirically derived set of competencies necessary for effectively treating children and adolescents with anxiety and depressive disorders and has wide implications for the development of therapist training, competence assessment measures, and evidence-based practice guidelines for working with this population. This model thus brings us one step closer to bridging the gap between science and practice when treating child and adolescent anxiety and depression.     

A Model of Therapist Competencies for the Empirically Supported Interpersonal Psychotherapy for Adolescent Depression

In order to treat adolescent depression, a number of empirically supported treatments (ESTs) have been developed from both the cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT-A) frameworks. Research has shown that in order for these treatments to be implemented in routine clinical practice (RCP), effective therapist training must be generated and provided. However, before such training can be developed, a good understanding of the therapist competencies needed to implement these ESTs is required. Sburlati et al. (Clin Child Fam Psychol Rev 14:89–109, 2011) developed a model of therapist competencies for implementing CBT using the well-established Delphi technique. Given that IPT-A differs considerably to CBT, the current study aims to develop a model of therapist competencies for the implementation of IPT-A using a similar procedure as that applied in Sburlati et al. (Clin Child Fam Psychol Rev 14:89–109, 2011). This method involved: (1) identifying and reviewing an empirically supported IPT-A approach, (2) extracting therapist competencies required for the implementation of IPT-A, (3) consulting with a panel of IPT-A experts to generate an overall model of therapist competencies, and (4) validating the overall model with the IPT-A manual author. The resultant model offers an empirically derived set of competencies necessary for effectively treating adolescent depression using IPT-A and has wide implications for the development of therapist training, competence assessment measures, and evidence-based practice guidelines. This model, therefore, provides an empirical framework for the development of dissemination and implementation programs aimed at ensuring that adolescents with depression receive effective care in RCP settings. Key similarities and differences between CBT and IPT-A, and the therapist competencies required for implementing these treatments, are also highlighted throughout this article.     

When Faith,Race, and Hate Collide: Religious Ecology,Local Hate Cultures,and Church Burnings

This study explores the extent to which the spate of church burnings that occurred throughout the South during the 1990s may have been influenced by local religious ecologies, diverse forms of civic engagement, and broader community support for racial animus that we call local hate cultures (e.g., prior hate crime incidents, hate group presence). We use county-level data from a variety of sources to determine the degree to which church arsons were associated with relevant features of local communities. Various congregational factors measuring county-level religious ecology are significantly associated with the number of church burnings in Southern communities, as are several local hate culture indicators. Our study provides empirical confirmation of the linkages between church arsons, the public role of religious institutions, and local hate cultures. It also suggests a number of theoretical refinements for existing community-level approaches to the study of religion and hate crimes.     

Worlds within Worlds: Kabbalah and the New Scientific Paradigm

Beginning with relativity and quantum theory, the deterministic view that has dominated and shaped Western culture for more than 2,500 years has begun to unravel, leading to the emergence of a new paradigm. This new paradigm effectively reformulates the project of science, conceiving of existence as an interpenetrating web of coevolving, cocreative relationships. By exploring Kabbalah and the new scientific paradigm within the context of shared evolutionary principles, I seek to demonstrate a viable alternative to the prevailing deterministic worldview. By going beyond the limits of determinism and re–visioning existence as an evolutionary, emergent phenomenon, we can establish a new basis for an authentic dialogue between science and religion.     

Catharsis: Psychoanalysis and the theatre

The notion of catharsis, in relation to tragedy, was introduced by Aristotle in his work Poetics. Over the centuries, Aristotle's innovative and enigmatic reference to this process has been widely commented on and given rise to intense controversy. In 1895, Freud and Breuer reconsidered this notion in their Studies on Hysteria, where they present the so-called cathartic therapeutic method. It is not, however, this aspect of psychoanalytical theory that the author of this article seeks to elucidate: drawing on a detailed study of the references to tragic catharsis in the work of Freud and Lacan, the author proposes to examine their implications for psychoanalytic treatment.With specific reference to Freud's article Psychopathic characters on the stage (1905) and Lacan's commentary on Sophocles' Antigone (1960), the author argues that catharsis is to be understood not so much as a mechanism of discharge linked to abreaction, but rather as the actual analytic process itself during which the Subject is 'unveiled' and thus faced with the enigma of his own desire.     

Psychoanalysis: The Sacred and the Profane

Colleagues from a variety of perspectives have written about the propensity to enshrine psychoanalytic theory. The meaning of the word “enshrine” is to cherish as sacred an idea or philosophy and protect it from change. In other words, the way we view psychoanalysis, our theories of mind and technique, become holy writ and we have divided the world of theory into the sacred and the profane. This is the kiss of death for theory, which must constantly evolve and change, but comforting for the analyst who believes he is on the side of the right, the sacred. In this paper I will discuss how our propensity to enshrine theory has had a debilitating effect on the development of psychoanalysis and, in particular, as a treatment for the most vulnerable people who seek our help. I also address the idea that movement away from enshrined positions allows us to construct different versions of reality. In this context, the notion of “action at a distance” is presented along with the attendant idea of psychoanalytic entanglement.