Narrative in psychotherapy theory,practice, and research: A critical review

This paper offers a critical review of narrative approaches to therapy, in terms of theory, practice and research. It proposes that narrative approaches currently lack a theory that explains adequately how the reworking of narratives brings about changes and how a client's various narratives are integrated. Research approaches to the study of narrative in therapy are at an early stage. A review of current research into narrative approaches to therapy is presented, and suggestions are offered for further research.     

Combining group psychotherapy and pharmacotherapy: a survey

Group psychotherapists, primarily members of the American Group Psychotherapy Association, were surveyed to determine their practice and attitude toward inclusion of patients receiving psychotropic medication in their "typical" outpatient psychotherapy groups. One hundred forty-three questionnaire responses were received from 258 contacted practitioners (55.4% return rate). More than two-thirds of the physicians, social workers, and psychologists reported including medicated members, and the professions did not significantly differ. Mood disordered patients were most frequently and schizophrenic and manic patients were least frequently reported to receive medication. Overall, clinicians' attitudes favored including medicated patients in the group. Indeed, therapists did not view inclusion of drugs as a detriment to the treatment process. Clinicians having only one medicated patient in their group felt more strongly that such individuals did not interfere with the treatment process when compared with those having none or more than one medicated patient. The one difference by discipline was that social workers and psychologists did not endorse the idea that medicated patients needed to be in groups led by psychiatrists.     

Use of mental imagery in psychotherapy: a critical review.

The paper presents arguments in favor of the use of mental imagery for therapeutic purposes. Several existing imagery approaches to psychotherapy are critically examined and suggestions for future inquiry are offered. The intimate relation between imagery and the affective-somatic processes is stressed.     

Qualitative meta-analysis of insight events in psychotherapy

Purpose: This study reports on a qualitative meta-analysis examining the phenomenon of insight into psychotherapy. Method: Studies (n?=?7, covering 15 insight events of 15 clients) were selected that examined significant events in psychotherapy leading to insight using session recordings and Interpersonal Process Recall interviews with clients and therapists. A conceptual organization of the data using a matrix grid consisting of three domains according to data origin (client process, therapist process, and their interaction) and three domains according to events’ sequence (context, event and key intervention, and impact) was established. Results: Key processes were identified that lead to insight events in psychotherapy. Two distinct types of events according to their main impacts as reported by the clients were identified: Painful/Poignant Insight where clients realized something that was painful, often evoking feelings of sadness or undifferentiated upset containing sadness and hurt; and Self-Asserting/Empowering Insight that led to an impact characterized by a sense of self-assertion and empowerment on the client’s part. A reasonably good alliance and vulnerability on the client’s part represent the context for insight events as does the client’s quest for self-understanding. The therapists’ key interventions in the event leading to poignant/painful insight contain either empathic reflection or collaborative interpretation. In empowerment/self-assertive insight events the therapists offer supportive, validating reframing promoting positive experience. In both types of events the therapist and the client work on consolidating insight. In some events, therapists emphasized cognitive or problem solution focused impacts, while clients emphasized emotional impacts. Some events contained emotional avoidance on the part of the client or therapist thus not realizing the full potential of the event.     

Significant events in a psychodynamic psychotherapy group for eating disorders

This qualitative pilot study was designed to identify and explain significant events for patients participating in a psychodynamic psychotherapy group for eating disorders. Specifically, seven members of a mixed (i.e., anorectic, bulimic, obese) eating disorders group recorded what they perceived as the three most significant events in group meetings for 14 weeks. In addition, group members were instructed to record why each event was significant. Manifest and latent content analyses of the data revealed that members found feedback and observing others the two most common types of significant events, and emotional experience, insight, and relationship the reasons these events had such impact. The implications of these results for working with the eating-disordered patient in group, as well as their implication for general group theory and practice, are discussed.An earlier vesion of this paper was presented at the 1991 meeting of the American Group Psychotherapy Association, New York. This paper was funded, in part, by a California State Faculty Support Grant and a Santa Barbara Cottage Hospital Research Grant awarded to the first author. The authors would like to thank Sean T. Casey, Sally Barton, Dr. Allison Wollitzer, Tom Knowlton, Craig Park, and Beth Buxton for their assistance in the preparation and execution of this study.     

Spiritual needs: Gender differences among professional spiritual care providers

The current study explored gender differences regarding spirituality by comparing the relative frequency with which male (n = 85) and female (n = 103) professional chaplains experience various facets of the spiritual experience. The women in the sample reported experiencing five of the seven spiritual constructs examined significantly more often than men, including the need for (1) belonging, (2) meaning, (3) hope, (4) beauty, and (5) acceptance of death. No significant gender differences were found for spiritual needs related to morality concerns or religious practices.     

Inductive systematization: Definition and a critical survey

In 1958, to refute the argument known as the theoretician's dilemma, Hempel suggested that theoretical terms might be logically indispensable for inductive systematization of observational statements. This thesis, in some form or another, has later been supported by Scheffler, Lehrer, and Tuomela, and opposed by Bohnert, Hooker, Stegmüller, and Cornman. In this paper, a critical survey of this discussion is given. Several different putative definitions of the crucial notion inductive systematization achieved by a theory are discussed by reference to the properties of inductive inference. The consequences of the following differences between deductive and inductive inference are emphasized: the lack of simple transitivity properties (even in a modified sense) of inductive inference, and the failure of the inductive analogue of the converse of The Deduction Theorem. The main conclusions are: (i) Hempel's original thesis may very well be right but his argument for it is unsatisfactory, (ii) theoretical terms can be logically indispensable for a non-Hempelian kind of inductive systematization, relative to both Craigian and Ramseyan elimination, (iii) Lehrer's attempt to prove the indispensability of theoretical terms for inductive-probabilistic systematization is, as a modification of Hempelian kind of inductive-deterministic systematization, unsatisfactory, and (iv) there does not seem to be much hope of escaping the conclusion (ii), if it is true, by extending the Craigian replacement programme along the lines suggested by Cornman.The work for this paper was initiated in a research group supported by The Emil Aaltonen Foundation (Emil Aaltosen Säätiö). I am greatly indebted to Professor Raimo Tuomela for many discussions concerning the subject-matter of this paper and earlier drafts of it.     

A survey of genetic counselors' strategies for addressing ethical and professional challenges in practice

There is limited research about ethical and professional dilemmas that genetic counselors encounter in their practice and their strategies for addressing them. In this study, 454 genetic counselors rated the frequency with which they encounter each of 16 ethical/professional challenges identified and categorized previously (McCarthy Veach P, Bartels DM, LeRoy BS (2001) J Genet Couns 10(2):97–119). Over 40% indicated these issues occurred frequently: patient emotions, diversity, financial constraints, uncertainty, and colleague error. Two hundred and fifty-five respondents provided personal anecdotes describing exceptionally challenging situations and recommended strategies for addressing them. Most of their anecdotes involved informed consent, value conflicts, confidentiality, colleague error, withholding information, and resource allocation. The most frequently recommended strategies were further discussion with patient, consultation with other professionals, and referral to other health sources. Thirty-five respondents were unable to/did not offer strategies. Respondent demographics were not related to frequency of issues, type of anecdote, or recommended strategies. Practice, policy, and research implications are discussed.     

The philosophy of economic modelling: a critical survey

Economic modelling, the heart of orthodox economics, has long been accused of neglecting the interpretation of its models needed to generate knowledge claims about the real world. It is argued that recent developments in the philosophy of model and theory can help us to evaluate the scientific and policy relevance of economic models. McCloskey's attempt to finesse this issue by reference to the rhetoric of economics is argued not to be congruent with economics' revealed explanatory and policy objectives. Blaug's adherence to a Popper-Lakatos mode of appraisal may be a little dated, but none of the more recent approaches to the metaphysical foundations of economics—such as scientific realism, constructive empiricism or 'causal holism'—seem able to rebuff the criticism explicit and implicit in the recent work of, for example, Hausman and Rosenberg. An example of 'modelling without theory' and Rapport's recent defence of economic modelling's practice suggest the need for further detailed evaluation by case-studies of the development and application of economic models.     

A statewide survey of audiologists regarding auditory processing disorders

This study surveyed all licensed Arkansas audiologists (N = 127) regarding auditory processing disorders in children and adults, with 16 items covering demographic information, knowledge, identification and diagnosis, service provision, and referral. Analysis indicated 40% and 35% of the 62 respondents were "very" or "somewhat comfortable" with diagnosing auditory processing disorders in adults and children, respectively. In the current work setting, 58% did not provide auditory processing testing, 44% had never performed such testing, and 40% did not answer a question related to referral sources. The lack of consistent testing or referral probably leaves community persons with auditory processing disorders at risk for being overlooked or misdiagnosed.     

Neurodynamics: A critical survey

Following a brief introduction to the functional complexity of an individual nerve cell, the current status of neural network dynamics is reviewed. This survey is then used as a basis for suggesting some fundamental difficulties in developing a science of the human mind.