The New Occupational Therapy Paradigm: Implications for Integration of the Psychosocial Core of Occupational Therapy in All Clinical Specialties

In this paper, it is argued that the new occupational therapy paradigm includes a core of psychosocial skills, consistent with the profession's historical roots in mental health. It is proposed that contrary to the declining presence of occupational therapy in mental health, psychosocial interventions should be explicitly integrated in all professional practice, such that occupational therapy will become the profession of choice in addressing psychosocial issues of all clients irrespective of clinical specialty. A case study is presented as an example to demonstrate how this explicit integration may be achieved in physical rehabilitation.     

Values education in a democratic society

A democratic society requires a degree of consensus on values. But it is argued that the model of values education as the transmission of certain predetermined values is inadequate in a democracy, since for several reasons the transmission of predetermined values can itself be undemocratic. Education for individual autonomy in matters of values is also, by itself, inadequate. Each generation needs the resources by which it can work out its own interpretation of democratic values. What is also needed, then, is an education in a common language of discourse — which can be drawn primarily from philosophy — which will facilitate public debate.     

The real as illusion: deconstructing power in family therapy

This paper examines the current issue of power and intervention in family therapy from the perspective of Jacques Derrida's philosophy. In a deconstructive reading which presents power as both real and socially constructed, it negotiates the border between such dualities as knowing/ not-knowing, intervention/non-intervention, and power/non-power. The paper tracks Goolishian and Anderson's approach to therapy as deconstructive in practice, but not in theory, and discusses a double view of power in relation to both Bateson and Foucault. It suggests that power is both endemic to the context of family therapy and an illusion of epistemology. The paper concludes with a discussion of the wider question of ethics in relation to technology.     

The Cruelest Cure? Ethical Issues in the Implementation of Exposure-Based Treatments

Numerous studies have provided supportive evidence for the efficacy of exposure-based treatments for many psychological disorders. However, surprisingly few therapists use exposure therapy in the clinical setting. Although the limited use of exposure-based treatments may be partially attributable to a shortage of suitably trained therapists, exposure therapy also suffers from a “public relations problem” predicated upon concerns that it is cruel and at odds with some ethical considerations (e.g., first do no harm). This article provides an overview of ethical issues and considerations relevant to the use of exposure therapy. It is argued that the degree to which ethical issues become problematic in implementing exposure-based treatments is largely dependent upon the therapist's ability to create an adequately safe and professional context. Specific strategies that may be employed for avoiding potential ethical conflicts in the use of exposure-based treatments are discussed.     

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。     

Reclaiming the Idea of Truth: Some Thoughts on Theory in Response to Practice

This paper examines the idea of truth, its place in therapy and in the history of systemic theory. Beginning with some practice fragments, the theory exploration considers the idea of truth in the modernist frame, the paradox of the modernist metaphor in describing the activity of therapy, and the peculiarities of the idea of truth in the earlier systemic therapies. Postmodernist and social constructionist ideas are then explored, and meaning is identified as the concept which currently occupies the place of an idea of truth in systemic discourse. It is argued that meaning as a concept is insufficiently attached to an idea of (external) reality or to an understanding of the relationship of the individual to knowledge of her/his experience of the world. Reclaiming the idea of truth as an emotional and social process has more potential to meet the complexities of human experience in thinking about the process of therapeutic change.     

On evading analysis by becoming an analyst

This paper considers what implications Bion's famous anecdote about 'some patients getting better and others going on to become psycho-analysts' might have in clinical practice. It explores key stages in the post-qualification analyses of three practitioners whose training analyses had left them qualified but restless and dissatisfied with their ongoing work. It suggests that a significant common factor in these unsatisfactory outcomes was the weakness of these analysands' egos, understood as their inability to enjoy coniunctios, and their profound fear of accessing the source of the problem. This had led to an unwitting investment in spurious super-ego driven alternatives such as professional qualification rather than face the initially bleak realization (of 'nameless dread') that could initiate analysis and individuation. Because of the containment and reward implicit in the training environment it is argued that training analysts--despite their experience and expertise--remain vulnerable to being recruited into an ameliorative fantasy that blocks the transference and inhibits development.     

Bridging worlds: participatory thinking in Jungian context

Introducing the ‘participatory’ paradigm associated with the work of transpersonalists Richard Tarnas and Jorge Ferrer, the author outlines an approach to Jung's archetypal thinking that might offer a more adequate basis in which to ground a non‐reductive approach to practice. In order to demonstrate the relevance of this outlook at the present time, the author begins by examining recent debates concerning the nature of ‘truth’ in the clinical setting. Reflecting on the difficulties analysts face in attempting to maintain professional authority without falling into an implicit authoritarianism, it is argued that any approach to therapy seeking to orient itself towards ‘the unconscious’ must posit the challenges of pluralism as a central concern for practice. With reference to the relationship between analytical psychology and the psychoanalytic mainstream, attention is drawn to the theoretical problems raised by the relational commitment to constructivist epistemologies, and a consequent tendency towards biological reductionism. Turning to the Jungian literature, similar tensions are observed at play in the present state of analytical psychology. Drawing attention to the process‐oriented qualities of Jung's work, it is suggested that the speculative nature of Jung's psychology offers a more adequate basis for contemporary practice than might be assumed.     

The place of psychotherapy and counselling in a healthy European social order: A commentary on Tantam and Van Deurzen

This commentary on Tantam and van Deurzen's vision for psychotherapy in Europe (this issue, pp. 228-235) interrogates their seeming modernity-driven, rights-obsessed convictions. Specifically, their uncritical advocacy of control-fixated political intrusions into the cultural-spiritual sphere is challenged; and critical reflections are offered on institutional professionalization; the authors' profession-centred, grandiose discourse; and therapy's alleged scientificity. Some dangers associated with individualised therapy's becoming a fetishized, institutionally sanctioned ‘regime of truth’ are voiced — one practicable antidote to which is the deliberate cultivation of an ongoingly deconstructive, ‘New Paradigm’ approach to therapy which, not least, mistrusts therapy's tendency towards delusory, self-interested exaggeration of its own cultural indispensability.     

Psychiatry in the labyrinth: Deconstructing deviancy

Abstract

Deviancy is a key concept in psychiatry and other therapeutic disciplines, because it dramatizes the way in which they depend on the establishment of norms, in order to justify their theory and practice. The writings of Derrida as well as Goethe provide a different view: that “deviation” from a “norm” can be fundamentally important to the well‐being of the norm. Thus deviancy can be viewed not as something to be “corrected” but rather as a creative possibility to be encouraged and shaped in productive ways. As a case of “deviancy” we have selected the writings of John Perceval, whose Narrative provides a critique of the mental‐health establishment of his day, particularly the asylum, and offers an alternative to 19th‐century views of “lunacy.” We see his “schizophrenic” commentary on his “psychosis” and its treatment as analogous to the deconstructive, “schizophrenic” discourse of postmodernity which is similarly critical of the reigning, modernist psychiatric order.     

Free-associating with the bodymind

Abstract

The history of attitudes toward Freud's adoption of free-associative discourse, as well as toward the significance of the clinical significance of the free-associative method, is critically reviewed. It is argued that, if one takes the re-inviting of repressed contents back into self-consciousness to be the defining process of psychoanalysis as a discipline (distinguishing it even from those psychotherapies that are based on psychoanalytic models of the mind), then free-associating is indeed the sine qua non of the psychoanalysis process. It is further suggested that whereas Freud's notion of libidinality radically subverts Cartesian dualism, our thinking about the significance of free-associative discourse has too frequently lapsed into the mistaken assumption that free-associating should only be about what “comes to mind.” In this context, a way of free-associating with the “bodymind” is described as an addendum to customary psychoanalytic practices. This augmented method remains faithful to Freud's practice of allowing the voice of sensuality to “join the conversation,” at the same time that its clinical implementation incorporates some of the wisdom concerning “breathwork” that comes from the yogic procedures for cultivating awareness.     

Respect as Esteem: The Case of Counselling

To claim that respect is one of the cornerstones of professional ethics is uncontroversial. However, it has become commonplace in the philosophical literature to distinguish between different kinds of respect. This paper considers the distinction between ‘recognition respect,’ said to be owed to persons as such, and ‘appraisal respect,’ said to be owed to those persons whom merit it, in the context of the professional–client relationship. Using the practice of counselling as an example, it is argued that both kinds of respect have a place in the professional–client relationship, which is in turn articulated as a relationship between equally fallible moral agents.     

Policy Responses to Honor-Based Violence: A Cultural or National Problem?

The UK government has consistently sidelined honor-based violence from mainstream political discourse and has chosen to present the issue as a problem that is embedded in the culture of minority communities. This inevitably leads to a sense of heightened cultural sensitivity and the pressure to be viewed as culturally competent. It is argued that for honor-based violence to be managed effectively, it must first be dissociated from culture and from mainstream domestic violence discourse and recognized as a national problem that requires serious and specific policy intervention. Although it is acknowledged that all policy responses to complex social problems should reflect multicultural sensitivity, we argue in this critical review that this should not become an excuse for nonintervention.     

Psychology as a discipline of discourse

This paper begins with a discussion of various layers of meaning now associated with the term ‘discourse’. Particular attention is paid to one aspect of discourse, namely the notion of ‘dialogue’. Some of Mikhail Bakhtin's ideas on dialogue are outlined, leading towards his emphasis on life, itself, being dialogical by its very nature. The author then articulates some of his own activities in psychotherapy,identifying various ways in which aspects of discourse are involved in his daily practice as a ‘professional conversationalist’. He then spells out an agenda for developing a psychology viewed and approached as a ‘discipline of discourse’. He finishes by indicating some of the implications of this perspective.     

Transference and countertransference in an applied setting — education

This paper offers an overview of current clinical approaches to psychoanalytically informed work with parents by child psychotherapists. The analysis is based on practice at the Tavistock Clinic and on broader knowledge of trends in work with children and families within the National Health Service. A brief history sets the scene. Four varieties of approach are described, with clinical examples. The particular sensitivity of child psychotherapists to infantile features in the personality is highlighted, and it is argued that this, together with their broad clinical experience, provides a proper basis for psychoanalytic psychotherapy with parents. Such work significantly extends and enriches the clinical contribution of child psychotherapists and has involved a shift in professional identity. It also raises ethical issues which are discussed.     

The words we work with that work on us: clinical paradigm and cumulative relational trauma

This paper addresses a gap between analytic clinical theory and practice which emerges when examining the words we work with via textual and narrative research of case histories. Both subject matter and methodology fit with the remit of conceptual research in psychoanalysis, currently ranging from inductive to nomothetical approaches. Research of clinical language reveals an implicit account of human nature and the world which undergirds clinical practice. Based in the critical philosophy of the previous century, this is termed clinical paradigm. Such implicit views are induced rather than explicitly taught during analytic training, and need to be spelled out in order to become available to discourse and difference of opinion. Textual research shows these implicit pre‐clinical attitudes to be inherently pessimistic and thus too similar to the views of self and others found in cumulative relational trauma. Moreover, clinical accounts tend to normalize subtly antagonistic forms of relating, recently recognised as micro‐trauma. Importantly, this contravenes the agapic orientation of our theories and ethics. Paradigmatic reflection as a form of professional individuation addresses this gap. This includes a more optimistic outlook which can be traced through the philosophical implications of quantum theory.     

The Small and the Ordinary: The Daily Practice of a Postmodern Narrative Therapy

In this article, I contrast assumptions of a modernist worldview and a postmodern worldview as they relate to clinical practice. Two exercises are described that help therapists develop insight into and practice with the kind of thinking that is consistent with a postmodern narrative clinical practice. Particular attention is paid to the ways that even the small and the ordinary — single words, single gestures, minor asides, trivial actions — can provide opportunities for generating new meanings. Five concepts that I routinely use in my professional and personal life and that are consistent with a postmodern narrative practice — discourse, externalizing the internalized discourse, exceptions, power as the means to produce a consensus, and characteristics of narrative — are illustrated.     

Avoiding Colonizer Positions in the Therapy Room: Some Ideas About the Challenges of Dealing with the Dialectic of Misery and Resources in Families

Some authors have argued that certain acts of family therapists—despite their best intentions—may represent a form of colonizing the family. When acting as a colonizer, a therapist is understood as becoming overly responsible for the family and focusing too strongly on change. In so doing, the therapist disrespects the family's pace, and neglects their own resources for change. This paper aims to highlight the need for therapists to be hypersensitive both to the resources of families entering therapy as well as to the impact of prevailing ideologies on their own positioning in the session. The kind of sensitivity advocated here is dialectical in the sense that every family is understood as having potentials promoting dynamism, happiness, and well-being as well as potentials contributing to stagnation, unhappiness, and misery. In this article, using illustrations from clinical practice, we present some ideas for resisting the tendency by the therapist to assume a colonizing position as a professional solver of problems for families. Our main aim here is to redirect the therapist toward connecting with the family's suffering, as well as with the resource repertoire it has developed for navigating and negotiating its way through life.