Recognizing the infant as subject in infant-parent psychotherapy

Drawing on Winnicott's view of infants as subjects entitled to an intervention in their own right, infants as the referred patient have been seen in infant-parent psychotherapy for 20 years at the Royal Children's Hospital, Melbourne, Australia. This is a radically different view of infant symptomatology than viewing it as only expressing an aspect of the mother's unconscious. The clinical pathway differentiates the therapy from much parent-infant psychotherapy. The author describes the theoretical model of a twofold approach to understanding the infant's experience through interactive dialogue between therapist and infant, and sharing this understanding with the parents, and illustrates it with cases of failure-to-thrive infants. She discusses two criticisms: first, that infant-parent psychotherapy may undermine the parents and, second, that brief parent-infant psychotherapy does not alter parents' insecure attachment status. Videotaped sessions often show rapid improvement; parents generally feel relieved. This approach potentially shapes not only parents' and infants' representations, but also their implicit knowledge of relationships-partly, it is suggested, through activating the mirror neuron system to bring about implicit memory change. Change may therefore be longer lasting than psychoanalytic theory presently conceives. The approach is relevant in an outpatient setting: gains were maintained long term in 90% of out-patient cases.     

BROKEN NARRATIVES: TRAUMA,METACONSTRUCTIVE GAPS,AND THE AUDIENCE OF PSYCHOTHERAPY

A constructivist model of posttraumatic psychotherapy is presented with particular attention to the metaphors of "narrative" and "audience." Metaconstruction, implicit construing, and narrative continuity are explored to conceptualize how persons story their experiences, and how some experiences (e.g., traumas) disrupt the storying process. Then the elements of posttraumatic psychotherapy are discussed with case examples illustrating how the therapist, as audience member and conarrator, facilitates the reconstruction and renarration of the client's life story.     

The present moment and implicit communication in group psychotherapy

The importance of the concepts of present moment and implicit communication to group psychotherapy is discussed in relation to the articles by Gans and by Counselman and Abernethy and to the life work of Anne Alonso. Clinical examples are used to illustrate the discussion.     

A Patient Who Does Not Look: A Collaborative Treatment with Video Feedback

We describe a collaborative treatment of a woman in face-to-face psychoanalytic psychotherapy (with Larry Sandberg), whose persistent gaze aversion was a symptom immune to interpretive efforts. After many years of treatment, the patient agreed to engage in video feedback sessions (with Beatrice Beebe), which have occurred for the past decade. The face of Dr. Beebe, but not the face of the patient, was videotaped during psychotherapy sessions. Dr. Beebe and the patient then reviewed segments of the videotaped session, collaboratively observing and thinking together, translating between the verbal dialogue and the therapist’s implicit action dialogue. We examine the impact of this intervention on the psychotherapy process.     

Experiential personal construct therapeutic artistry: The therapy relationship and the timing of interventions

Abstract

Experiential personal construct psychotherapy focuses on the intimate, interconnected, and evolving relationship between the therapist and the client as vital to therapeutic growth. Great creativity is demanded of the therapist who aspires to connect with clients in life‐changing psychotherapy. This article first describes the essential nature of the therapy relationship with its implicit and explicit demands for therapist creativity. These principles then are illustrated through a discussion of the critical issue of timing therapeutic interventions.     

Ethically Problematic Value Change as an Outcome of Psychotherapeutic Interventions

Values nonpaternalism—the ethical imperative to avoid imposing values onto clients—is implicit in most widely used ethical frameworks employed by psychotherapists. Although changes in client values may represent desired psychotherapeutic outcomes, some such changes may be ethically problematic. Interventions are characterized by values paternalism when they are intended to promote client welfare but are accompanied by impositions against client values. Providers and consumers of psychotherapy may routinely lack awareness of this consideration. Psychotherapists may have a duty to be informed about ethically problematic value change accompanying psychotherapy and to inform clients about this phenomenon.     

'Dialectical process' and 'constructive method': micro-analysis of relational process in an example from parent-infant psychotherapy

Jung defined experience that takes place between therapist and patient as 'dialectical process', achieved through 'constructive method'. Perspectives from attachment theory, neurobiology, cognitive science, systems thinking and infancy research confirm and extend his view of the centrality of relational process in the development of self. Interactional experiences are embedded within the history of the primary parent-infant relationship and structure within the mind implicit patterns of relating. These patterns influence capacities for managing a whole lifetime of affective relational experience within the self and with others. This paper shows how parent-infant psychotherapy seeks to intervene during the formation of disturbed relational patterns. I offer detailed micro-analysis of the moment-to-moment 'dialectical process' that a mother, her four-month-old infant and myself 'constructed' together.     

Changing views of emotion regulation and neurobiological models of the mechanism of action of psychotherapy

Influential neurobiological models of the mechanism of action of psychotherapy attribute its success to increases of activity in prefrontal areas and decreases in limbic areas, interpreted as the successful and adaptive recruitment of controlled processes to achieve emotion regulation. In this article, we review the behavioral and neuroscientific evidence in support of this model and its applicability to explain the mechanism of action of psychotherapy. Neuroimaging studies of explicit emotion regulation, evidence on the neurobiological substrates of implicit emotion regulation, and meta-analyses of neuroimaging studies of the effect of psychotherapy consistently suggest that areas implicated in coding semantic representations play an important role in emotion regulation not covered by existing models based on controlled processes. We discuss the findings that implicate these same areas in supporting working memory, in encoding preferences and the prospective outcome of actions taken in rewarding or aversive contingencies, and show how these functions may be integrated into process models of emotion regulation that depend on elaborate semantic representations for their effectiveness. These alternative models also appear to be more consistent with internal accounts in the psychotherapeutic literature of how psychotherapy works.     

How does evidence-based practice in psychology work? – As an ethical demarcation

Evidence-based practice in psychology (EBPP) is ordinarily understood to demarcate between legitimate and illegitimate psychotherapy practice, based upon the epistemic demarcation distinguishing scientific from non-scientific knowledge. EBPP emphasizes the value of effective and efficient interventions identified through randomized controlled trials and cost-benefit analyses. Basing the template for choice of action or strategy on randomized controlled trials and cost-benefit analyses create a deceptive appearance of ethical neutrality. However, there is an implicit ethical demarcation at work in EBPP, which favors a non-articulated specific position in normative ethics. More particularly, evidence-based practice in psychology is structured according to a utilitarian framework, severely limiting the kinds of ethical perspectives available to assess psychotherapy practice. The latter point is illustrated through a new mode of delivering psychotherapy services called “Internet-based guided self-help” (IBGSH). In EBPP the only relevant ethical question is to what extent any intervention, such as IBGSH, is effective and efficient. Some of the limiting effects of the ethical, utilitarian, demarcation are showcased by presenting three alternative ethical perspectives by which psychotherapy practice in general and IBGSH in particular can be analyzed. The analysis concludes that EBPP is not suited to ethically regulate the practice of psychotherapy.     

Reflections on the process of psychotherapeutic change as applied to medical situations

This article takes the basic ideas on the process of changing implicit knowledge put forward in this special issue, and extends them beyond psychotherapy to include other therapeutic relationships that occur in medicine. One vignette, from an encounter between a medical student and a dying patient, illustrates how a “moment of meeting” changes the student as well as the patient. The second shows how therapeutic interventions for new mothers with their newborn infants involve “moments of meeting” that alter the mother's implicit knowledge of her baby and of herself as a mother. © 1998 Michigan Association for Infant Mental Health     

Consulting with gargoyles: applying narrative ideas and practices in counselling supervision

This article explores waysin which narrative ideas and practices might influence supervisory relationships in counselling and psychotherapy,and questions some of the taken-for-granted assumptions implicit within counselling supervision. This paper, which represents ‘work in progress’ towards further conversations, rather than an exhaustive study,is illustrated with stories from the author'sown practice as a supervisor and trainer and educator of supervisors.     

Tracking the implicit self using event-related potentials

Negative biases in implicit self-evaluation are thought to be detrimental to subjective well-being and have been linked to various psychological disorders, including depression. An understanding of the neural processes underlying implicit self-evaluation in healthy subjects could provide a basis for the investigation of negative biases in depressed patients, the development of differential psychotherapeutic interventions, and the estimation of relapse risk in remitted patients. We thus studied the brain processes linked to implicit self-evaluation in 25 healthy subjects using event-related potential (ERP) recording during a self-relevant Implicit Association Test (sIAT). Consistent with a positive implicit self-evaluation in healthy subjects, they responded significantly faster to the congruent (self–positive mapping) than to the incongruent sIAT condition (self–negative mapping). Our main finding was a topographical ERP difference in a time window between 600 and 700 ms, whereas no significant differences between congruent and incongruent conditions were observed in earlier time windows. This suggests that biases in implicit self-evaluation are reflected only indirectly, in the additional recruitment of control processes needed to override the positive implicit self-evaluation of healthy subjects in the incongruent sIAT condition. Brain activations linked to these control processes can thus serve as an indirect measure for estimating biases in implicit self-evaluation. The sIAT paradigm, combined with ERP, could therefore permit the tracking of the neural processes underlying implicit self-evaluation in depressed patients during psychotherapy.     

叙事心理治疗的后现代视角

叙事心理治疗,作为一种本体存在一伦理实践的总体取向,隐含着某些基本的后现代主义视角,尤其是语言观的根本转变。现代主义的观点把语言看作是对现实的表征,而后现代主义关注语言的本体论地位,关注我们如何使用叙事和文本来建构和解构我们的生活世界,强调话语实践的自我反思性。该文探讨了后现代语境中心理治疗的几个关键问题,并讨论了叙事观在心理治疗的临床实践中的应用含义。     

Humour as a tool in counselling and psychotherapy: A reversal-theory perspective

Humour has occasionally been regarded as a valuable tool in counselling and psychotherapy. The specific uses of humour and its potential as a coping tactic are rarely described. The therapeutic use of humour is accordingly examined in the light of reversal theory (Apter, 1982a). It is suggested that the use of humour needs to be related to the motivational task implicit in the therapeutic interaction.     

An administratively created reality: Some problems with the use of self‐report questionnaire measures of adjustment in counselling/psychotherapy outcome research

Outcome research in counselling and psychotherapy has come to rely heavily on the use of self‐report questionnaire measures of anxiety, depression and general symptomatology. The validity of these measures in the context of psychotherapy research has, in general, been taken for granted. This paper proposes that, despite the success of self‐report questionnaires in personality research and personnel selection, there are significant problems involved in the use of these methods in research into therapeutic change. Specifically, three areas of difficulty are reviewed. First, questionnaires are completed in a social setting that itself changes as a result of therapy. Second, the experience of psychotherapy changes the way that clients make sense of questionnaire items (the ‘response shift’ phenomenon). Third, the conceptualisation of the person implicit in questionnaire design is not compatible with the conceptualisation of persons espoused by most contemporary therapeutic approaches. It is argued that the continuing popularity of self‐report questionnaires can be understood in terms of Kurt Danziger's model of the social construction of psychological knowledge.     

后现代视野中的心理治疗及其思考

现代心理治疗与后现代心理治疗在关于认识论、知识的性质、标准、构造以及语言的作用等方面存在诸多差异。前者是对客观与理性的探寻．后者是对主观建构的追求。尽管人们对后现代心理治疗尚有诸多争论,但却能引发人们在扩展对心理治疗性质之认识、推进心理治疗本土化、克服心理治疗中的非人格化倾向等方面的有益思考。     

Reflections on an Anti-discriminatory Stance in Psychotherapy

Challenges and opportunities for psychologists and psychotherapists in respect to explicit and implicit discrimination issues in therapy are explored, both from the side of the therapist and the client. Furthermore, personal reflections on such issues are discussed drawing on examples of indirect discrimination on the basis of race and sexual orientation. It is suggested that a combination of professional anti-discriminatory guidelines, a willingness to understand deeply the client’s frame of reference and self-reflection can guard against such phenomena that can harm ethical and constructive psychotherapy.     

Creative Group Living in a Children's Institution Edited by Susanne Schulze

Psychoanalytic psychotherapy is not well developed in Japan (Kotani, 1996). Until recently, group psychotherapy in particular has not been well received by patients or clinicians. Cultural difficulties in using group psychotherapy with Japanese patients have now been overcome and a theory of systematic intervention techniques has been developed. The basic dynamic factors of group psychotherapy such as culturally embedded aspects of social and personality structure are analyzed in this article. Culture-bound psychodynamic characteristics of Japanese patients as activated and worked through in the group process are first described with case illustrations. A systemic hypothesis linking cultural and psychodynamic structure is then delineated and the focal points of interventions are explained in terms of the field dynamics of social structure and boundary dynamics of personality structure.     

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.     

Clinical Aspects of Adolescent Issues Contributions from Neuro-Psychoanalysis

ABSTRACT

Clinical aspects of adolescent issues are reviewed, particularly the importance of emotions. The work of Jaak Panksepp, with regard to core affects, is highlighted as a potential for the elaboration of an overarching theoretical frame of reference for psychoanalysis and psychotherapy. The paper highlights the importance of understanding the power of defeqnses against painful emotions, implicit emotion regulation, and the cortical/subcortical imbalance in adolescence. A case example is provided to illustrate these ideas.