Transparency and self-disclosure in family therapy: dangers and possibilities

Therapy is a paid intimate relationship that thrusts clients and therapists into navigating personal and professional boundaries. When, where, why, and how is it appropriate and ethical for family therapists to be transparent, and when is it damaging? Theorists take varied stances from Haley's position of tight boundaries around therapist disclosure—whether in treatment or training—to the narrative viewpoint that therapists should be transparent about models of therapy, personal values, and life experiences that inform their practice and beliefs. However, these positions are not research based, and theorists who support disclosure offer few guidelines other than general statements. This article examines the history of ideas about disclosure in six major family therapy models, and the dangers and possibilities of transparency. It looks at the research on self‐disclosure in individual therapy and whether and how it could apply to family therapy. Guidelines are proposed that take into account the multiple social identities of therapists and clients, and issues of safety and transparency.     

The use of imagery in cognitive therapy for psychosis: A case example

There has been a long tradition of studying imagery in relation to psychotic symptoms. Recent studies have suggested that imagery may be involved in the development and maintenance of psychotic symptoms (hallucinations and delusions in particular). Following a review of this literature, including work conducted by the author and colleagues, a case study is used to illustrate the clinical applications of this work. Working with images that were associated with persecutory delusions appeared to contribute to a reduction in distress, preoccupation, and conviction in relation to these beliefs, which were assessed using a standardised measure (PSYRATS). The implications for theory, practice, and future research are considered.     

The use of imagery in cognitive therapy for psychosis: a case example

There has been a long tradition of studying imagery in relation to psychotic symptoms. Recent studies have suggested that imagery may be involved in the development and maintenance of psychotic symptoms (hallucinations and delusions in particular). Following a review of this literature, including work conducted by the author and colleagues, a case study is used to illustrate the clinical applications of this work. Working with images that were associated with persecutory delusions appeared to contribute to a reduction in distress, preoccupation, and conviction in relation to these beliefs, which were assessed using a standardised measure (PSYRATS). The implications for theory, practice, and future research are considered.     

Branching in the landscape of possibilities

The metaphor of a branching tree of future possibilities has a number of important philosophical and logical uses. In this paper we trace this metaphor through some of its uses and argue that the metaphor works the same way in physics as in philosophy. We then give an overview of formal systems for branching possibilities, viz., branching time and (briefly) branching space-times. In a next step we describe a number of different notions of possibility, thereby sketching a landscape of possibilities. In the final section of the paper we look at the place of branching-based possibilities in that larger landscape of possibilities. Our main message is that far from being an outlandish metaphysical extravagancy, branching-based possibilities are epistemically as well as metaphysically basic.     

EEG performance spectral mapping during drug therapy in a patient with schizophrenic psychosis

In a paranoid-hallucinatoric patient with chronic course and acute exacerbation a EEG mapping study during neuroleptic treatment was carried out. The typical changes of the alpha power spectra in schizophrenic psychoses as well the normalization after neuroleptic treatment could be found in the alpha map. The changes were in correlation to the clinical state.     

Social anxiety and the shame of psychosis: a study in first episode psychosis

Social anxiety disorder (SaD) or social phobia is a co-morbid affective disorder in schizophrenia, present in up to one in three individuals. We employ 'social rank' theory to predict that one pathway to social anxiety in schizophrenia is triggered by the anticipation of a catastrophic loss of social status that the stigma of schizophrenia can entail. A group of 79 people with a first episode of psychosis were assessed for social anxiety: hypotheses were tested comparing 23 socially anxious and 56 non-anxious patients on measures of cognitive appraisals of shame/stigma of psychosis and perceived social status, controlling for depression, psychotic symptoms and general psychopathology. Participants with social anxiety experienced greater shame attached to their diagnosis and felt that the diagnosis placed them apart from others, i.e., socially marginalised them and incurred low social status. We propose a stigma model of social anxiety that makes testable predictions about how the shame beliefs may contaminate social interaction and thereby exacerbate and maintain social phobia.     

Social identity and psychosis: Explaining elevated rates of psychosis in migrant populations

A substantial body of literature suggests that migrants are at greater risk of developing psychotic symptoms, such as paranoia, compared to non‐migrants. To date, researchers have been unable to identify the primary cause of this effect, finding scarce support for biological, diagnostic, and economic explanations. Social determinants have received little empirical attention in this domain, which we assert is a critical gap in the literature. Here, we propose that the social identity approach offers a framework to help explain the elevated rates of psychosis among migrants, and in turn inform policies and interventions to address this important mental health issue. We propose that cultural identities play a central role in mitigating the psychological precursors of psychosis and that disidentification and social disconnection subsequent to migration could initiate or exacerbate psychosis for multiple generations. We draw together research from social and clinical psychology to detail a social identity approach to psychosis in migrant populations, and make recommendations for future research.