Use of a reference group in researching children’s views of psychotherapy in Malta

This paper explores the process and outcomes of a children’s reference group within the context of child psychotherapy research in residential care. The reference group was set up to consult children about the design of a research project which seeks to evoke, represent and understand children’s views of psychotherapy. No work to date has explored the experience of reference groups in the context of child psychotherapy in residential care in Malta. The paper contextualises the research within the literature on reference groups in child research, which identifies the potential of reference groups as a participative and co-reflexive activity which can inform research design. The paper critically examines the nature and conduct of the reference group by acknowledging the specific context of this work rather than assuming this is necessarily positive. It does so by specifying and evaluating the outcomes of the reference group in line with its aims. The paper draws on the recordings of the reference group meetings and reference group field notes taken by the researcher as key data which were thematically analysed. The main outcomes of the reference group include children’s contribution to the design of data collection methods especially in terms of not relying only on words during data collection. Children also identified key ethical issues from the point of view of young psychotherapy service users, especially in relation to issues of trust within a residential care context. Children also reviewed and appraised research information material. The reference group process drew from the researcher’s and participants’ contexts and contributed significantly to the researcher’s reflexive process especially in terms of acknowledging his power and positioning as an adult and his dual role as a practitioner/researcher.     

Group psychotherapy as taught by the polsters and the gouldings

Psychotherapy has been viewed by many as a subtle form of interpersonal persuasion. However, persuasion, or the lack of it, in a psychotherapy relationship is not always clearly definable. Most agree that persuasion is influenced by a number of important factors, of which the personal characteristics of the therapist are generally recognized as the most significant. Experience, credibility, training, dedication, values and enthusiasm are attributes usually agreed upon as being important contributors to the therapist's power to persuade. Understandably, psychotherapy conceptualized in this manner raises significant issues of values, ethics and responsibility in treatment. While not all agree or recognize persuasive influences existing in psychotherapy, it is suggested that persuasion is a salient feature of psychotherapy, whether or not it is identified as such. It is important to remember that in all psychotherapy, trouble is apt to follow the ignorant applications of important forces. Further, it is suggested that these persuasive influences cross doctrinal differences and can be augmented by applying them with a group psychotherapy setting. In the hands of a skilled and ethical psychotherapist, these persuasive influences can be enhanced and the group can become a powerful tool in the therapeutic process. These issues are explored in this paper in relation to two different group psychotherapy training experiences with Bob and Mary Goulding and Erv and Miriam Polster.     

Integrating Spirituality and Religion Into Psychotherapy: Persistent Dilemmas,Ethical Issues,and a Proposed Decision-Making Process

Religion and spirituality are important aspects of the lives of most psychotherapy clients. Unfortunately, many psychotherapists lack the training to effectively and ethically address these issues with their clients. At times, religious or spiritual concerns may be relevant to the reasons clients seek treatment, either as areas of conflict or distress for clients or as sources of strength and support that the psychotherapist may access to enhance the benefit of psychotherapy. This article reviews persistent ethical issues and dilemmas relevant to providing psychotherapy to clients for whom issues of religion and spirituality are clinically relevant. Ethical considerations include assessment, advertising and public statements, informed consent, competence, boundary issues and multiple relationships, cooperation with other professionals, and how to effectively integrate religious and spiritual interventions into ongoing psychotherapy. A decision-making process is presented to guide psychotherapists in their clinical work with clients for whom religious and spiritual issues are salient or clearly linked to their presenting problems.     

Narrative and discursive approaches to the analysis of subjectivity in psychotherapy

This paper reviews research that utilises language-based analyses (narrative analysis, discourse analysis and conversation analysis) to examine aspects of subjectivity in the context of psychotherapy. The studies reviewed fall broadly into two main groups. On the one hand, studies which share a view of subjectivity as the sum of internal 'voices' in dialogue adopt a narrative approach, examine subjectivity in terms of organisation, coherence and self-reflection, and consider psychotherapy a process of restoring an organised polyphony. On the other hand, studies which conceptualise subjectivity in terms of 'subject positions' adopt a discursive approach, emphasise the availability of subject positions and flexibility in adopting them and examine psychotherapy as a process of facilitating the flexible adoption by the client of a variety of subject positions. Theoretical, epistemological and methodological issues regarding each of the two approaches are discussed, along with representative studies. We finally examine the implications of these two approaches for understanding psychotherapeutic practice and for theorising and researching subjectivity.     

Linking social history and the therapeutic process in research and practice on black issues

This paper shares a first time experience of presenting a workshop at the 2002 BACP Research Conference. It highlights issues arising from the beginnings of research into the process of therapy in relation to black issues. The findings of two studies are reported in brief. Questions raised by workshop participants, and the low participation in the workshop session, are used as a means of illustrating the ambivalence that exists in the counselling and psychotherapy world in respect of this topic. It is argued that a historical perspective may assist the development of clinical responses to black issues, and that the effective exploration of black issues can be used as a vehicle to explore issues pertaining to all minority groups and their experiences.     

Zukunft der Psychotherapie in der Psychiatrie

The conceptual development of the German mental health system can only be understood against the background of the specific historical development process; therefore, the emigration of psychodynamic psychotherapists during the Third Reich as well as the complicated reintegration of psychotherapy into psychiatry during the postwar period are of particular relevance. The current discussion concerning the relationship of psychiatry and psychotherapy is characterized by the development of new techniques and methods and the concept of modular psychiatry, whereas the traditional complex psychotherapeutic procedures are becoming less important. In the future, the development of clinical and scientific research should focus on psychotherapy in old age as well as adolescence psychotherapy, the combination of psychopharmacological and psychotherapeutic treatment and issues concerning chronic courses as well as resistance to therapy.     

Group psychotherapy as a technique for assisting ego-impaired children and adolescents

This paper describes an approach to working with egoimpaired children and adolescents. The structure and process of psychotherapy groups within a residential program are discussed. We describe how insight-oriented groups act as a collective superego, thereby encouraging maturation. Functions of the group relating to socialization, milieu issues, peer issues, family relationships, personal issues, selfesteem, empowerment, and special issues are discussed. The focus of the discussion is on the structure and process of the groups. Brief clinical vignettes are utilized to illustrate components of the approach.     

The Development,Process, and Evaluation of Group Psychotherapy With Sexually Abused Preschool Girls

The development, process, and evolution of group psychotherapy specifically designed for sexually abused preschool aged females is presented. Utilization of male and female cotherapists, group structure, individual and family dynamics, the role of children's mothers in treatment, and process of treatment are examined. Issues regarding countertransference phenomena, cotherapy relations, in-depth involvement of the children's mothers, and specifics related to structuring of a time-limited group are beyond the initial intent and scope of this paper, and are not discussed here.

The cotherapists conclude that group psychotherapy for children of this age group is both clearly valuable and highly indicated as an adjunct treatment modality. In future group psychotherapy with sexually abused preschool aged children, based upon clinical experience and evaluation, the cotherapists advocate a time-limited approach whereby each session would focus upon specific issues as illustrated in Table 1, and include structured and purposeful involvement of the girls' caretakers.     

Attending to diversity in group psychotherapy: an ethical imperative

Ethical issues can arise in dealing with diversity when practicing group psychotherapy. In this paper, a case is presented of a therapist-in-training who is attempting to determine whether a particular psychotherapy group composed exclusively of heterosexual males would be an appropriate and effective treatment venue for a gay male; the clinical vignette is designed to illustrate a process of ethical and culturally competent decision making. The discussion of this vignette articulates the multiple steps through which the group psychotherapist must proceed to successfully resolve ethical dilemmas that are related to diversity.     

Martin Mayman's early memories technique: bridging the gap between personality assessment and psychotherapy

In this article, we describe Martin Mayman's approach to early childhood memories as a projective technique, beginning with his scientific interest in learning theory, coupled with his interest in ego psychology and object relations theory. We describe Mayman's contributions to the use of the early memories technique to inform the psychotherapy process, tying assessment closely to psychotherapy and making assessment more useful in treatment. In this article, we describe a representative sample of research studies that demonstrate the reliability and validity of early memories, followed by case examples in which the early memories informed the therapy process, including issues of transference and countertransference.     

The Use of Mindfulness Practice in the Treatment of a Case of Obsessive Compulsive Disorder in Sri Lanka

For over 20 centuries, Buddhism has been the spiritual practice of the majority of Sri Lankans. Though Buddhist practices have been increasingly influencing psychotherapy in the West, the use of such practices in psychotherapy in Sri Lanka is not common. This paper attempts to bridge this gap by presenting a case study where Buddhist mindfulness practice was used successfully in the treatment of a case of obsessive compulsive disorder. This paper also presents an outline of the association between Buddhist mindfulness practice and mindfulness practices used in modern-day psychotherapy and discusses issues in the use of mindfulness practice in psychotherapy.     

Psychotherapy Research Needs Theory. Outline for an Epistemology of the Clinical Exchange

This paper provides an analysis of a basic assumption grounding the clinical research: the ontological autonomy of psychotherapy—based on the idea that the clinical exchange is sufficiently distinguished from other social objects (i.e. exchange between teacher and pupils, or between buyer and seller, or interaction during dinner, and so forth). A criticism of such an assumption is discussed together with the proposal of a different epistemological interpretation, based on the distinction between communicative dynamics and the process of psychotherapy—psychotherapy is a goal-oriented process based on the general dynamics of human communication. Theoretical and methodological implications are drawn from such a view: It allows further sources of knowledge to be integrated within clinical research (i.e. those coming from other domains of analysis of human communication); it also enables a more abstract definition of the psychotherapy process to be developed, leading to innovative views of classical critical issues, like the specific-nonspecific debate. The final part of the paper is devoted to presenting a model of human communication—the Semiotic Dialogical Dialectic Theory–which is meant as the framework for the analysis of psychotherapy.     

The challenge of understanding process in clinical behavior analysis: the case of functional analytic psychotherapy

Whether explicitly acknowledged or not, behavior-analytic principles are at the heart of most, if not all, empirically supported therapies. However, the change process in psychotherapy is only now being rigorously studied. Functional analytic psychotherapy (FAP; Kohlenberg & Tsai, 1991; Tsai et al., 2009) explicitly identifies behavioral-change principles used to bring about therapeutic improvements in adult outpatients whose clinical problems stem from ineffective interpersonal repertoires. These principles include contingent responding to behavioral excesses and deficits by a therapist who has established him- or herself as a salient source of social reinforcement. Empirical support for FAP is emerging, but a variety of pragmatic and theoretical questions warrant investigation. Among the issues described in this paper are the training and dissemination of procedures for how to conduct a functional analysis, how to train therapists to identify functional stimulus classes, how to best address decreasing problem behavior without creating an aversive environment, how to enhance generalization, and how to account for the principle of equifinality when trying to specify therapeutic procedures. These and other issues stem largely from trying to disseminate a behavioral principle-based intervention rather than a topographically specified intervention. These issues present challenges and research opportunities for applied clinical behavior analysts if they wish to extend their science to address clinical issues important to the treatment of adult outpatients with normal intellectual functioning.     

Psychotherapie®

Psychotherapy has not escaped the societal changes of the last decades, which are labelled by sociologists as “reflexive modernization”. Nevertheless, psychotherapists occasionally are supposed to avoid a discussion of issues related to modern societies. This article discusses economization, connected with reflexive modernization, in relation to psychotherapy focussing on the question if psychotherapy has already become a “product” (or is imminent to that). This question is discussed in connection with three specific issues: parallels between psychotherapy and industrial production related to terms such as quality assurance and quality management, the question of a monopoly within psychotherapy, similar to monopolies of industrial companies, and, finally, some phenomena connected with a boom of specific psychotherapies of the recent years that indicate the product-character of psychotherapy.     

The psychotherapy of parenthood: towards a formulation and valuation of concurrent work with parents

This paper explores the process and value of concurrent work with parents when their child is being treated in individual psychotherapy. The position taken is that psychoanalytic understanding generally and the specific formulations presented in this paper have a broader applicability in other aspects and approaches in child and adolescent mental health practice. The central issues are the interweaving of knowledge of family processes, child development and psychopathology, and the uses that can be made of an understanding of transference and countertransference. A particular formulation is presented in relation to aspects of the work that constitute ‘child guidance’ and those that may be considered as ‘psychotherapeutic’ in relation to parental psychopathology. We have coined the term ‘the psychotherapy of parenthood’ to give this work the status it deserves and to define a boundary within which to explore the areas and levels of this complex work. Some practice and training implications are considered.     

Benefits and Challenges of Conducting Psychotherapy by Telephone

Telephone-delivered psychotherapy has increased utility as a method of service delivery in the current world, where a number of barriers, including economic hardships and limited access to care, may prevent people from receiving the treatment they need. This method of service provision is practical and has the potential to reach large numbers of underserved people in a cost-effective manner. The aim of this paper is to review the state-of-the-art of telephone-delivered psychotherapy and to identify improvements and possible solutions to challenges. Results of randomized controlled trials indicate high client acceptance and positive outcomes with this method of delivering psychotherapy. Nonetheless, psychotherapists wishing to deliver psychotherapy by telephone face a number of challenges, including a lack of control over the environment, potential compromises of privacy and confidentiality, developing therapeutic alliance without face-to-face contact, ethical and legal issues in providing psychotherapy by telephone, handling crisis situations at a distance, and psychotherapist adjustment to conducting psychotherapy in an alternative manner. There remains a need for further research, including direct comparisons of face-to-face psychotherapy with telephone-delivered psychotherapy and feasibility of telephone delivery of psychotherapies other than cognitive behavioral therapy.     

Assessment for psychotherapy

This paper explores some issues that might arise when one considers having a table hockey game in the therapy room, and describes how an autistic boy, aged four-and-a-half when starting treatment, used that game. The unfolding process from withdrawal to separateness, intersubjectivity and playfulness is illustrated by the progress of two years of twice-weekly psychoanalytic psychotherapy. Special attention is paid to how the play progressed through the intermediate area that the therapist provided.     

Ambulante Psychotherapie bei Kindern und Jugendlichen

This paper presents the results of a study of the state of outpatient psychotherapy of children and juveniles in Germany after the PTG came into force. A total of 180 psychotherapists were questioned on certain issues. One result was that patients have to wait 4.5 months for psychotherapy and that every second patient asking for a diagnostic interview and possible treatment was refused.Of those who were given a diagnostic interview 43% were not taken into treatment, although disturbances were diagnosed such as addiction, bodily disabilities with psychic complications, enuresis/encopresis, anorexia nervosa, psychosomatic illnesses, developmental arrests which would normally demand psychotherapeutic treatment. Furthermore only 25% of those children and juveniles who Löcherbach et al. (2000, S.59 f.) considered needing and wanting psychotherapeutic treatment were actually in a G IV psychotherapy.Apart from this the possibility of getting psychotherapy as well as the kind of psychotherapy proved to be dependent on the kind of medical insurance. Differing payments by the insurance companies caused longer waiting times for patients and determined the choice of psychotherapy by the psychotherapists.