The Initial Interview with Asian American Clients

When grouped with Pacific Islanders, Asian Americans constitute the fastest growing ethnic group in the United States. In this article, the authors provide background information for understanding the diversity and commonalities within Asian American populations and discuss the challenges of initial assessment with clients who identify as Asian Americans. We conclude this article with guidelines for conducting an effective initial interview with Asian American clients.     

Group Counseling and Group Psychotherapy with Rehabilitation Clients

An instrument designed to measure components of two distinct alcoholism aftercare treatments was developed and evaluated for reliability and validity. Trained judges reliably rated audiotaped samples of coping skills and interactional group therapy sessions. Coping skills groups engaged in significantly more education and skill training, problem solving, and role playing. Interactional groups showed more interpersonal learning, expression/exploration of feelings, and here-and-now focus. Groups that employed more education and skill training, less expression and exploration of feelings, and less her e-and-now focus were associated with fewer members reporting subsequent drinking-related problems. None of the ratings of group activities was related to abstinence.     

Treating Depression During a Recession: Psychotherapy with Indigent Clients

During the last few years, the global economy has struggled and many clients have experienced significant financial hardship. It can be difficult to confront emotional problems when there are multiple life stressors impinging on clients and disrupting their daily functioning. Several recommendations are provided for helping clients to oppose their depressive tendencies when financial problems are real, significant, and lasting. First, therapists can provide a stable and supportive relationship that helps to ease the client’s emotional distress and lays the foundation for other aspects of treatment. Second, therapy can help to protect an optimistic attitude and instill hope for a better future. Third, behavioral activities can be used to encourage productive activity each day. Fourth, problem-solving skills can help many clients deal with stressors in a direct, constructive, and proactive manner. Fifth, therapy can examine ways to expand and improve the client’s social relationships. Finally, psychotherapists should collaborate with other health care professionals in order to ensure the optimal, integrated care for the client. It is hoped that these recommendations will be helpful for therapists who work with financially impoverished clients.     

Adolescent Focused Psychotherapy for Adolescents with Anorexia Nervosa

The paper describes a manualized specific form on individually based developmentally oriented therapy for Anorexia Nervosa (AN) in adolescents. Adolescent focused psychotherapy for AN is derived from a self-psychology model and is designed to address key deficits in development associated with AN. Adolescents with AN are viewed as using food and weight to avoid negative affective states associated with adolescent developmental issues that they perceive as intolerable. To develop a more constructive coping style and improve self-efficacy, adolescent patients need to first learn to identify and define their emotions, and later, to tolerate emotions, particularly negative ones. In withdrawing from the environment and situations which provoke distress through self-starvation and preoccupations with food and weight, emotional and psychological development is arrested. Learning to identify and cope adaptively with emotions and developmental challenges presented by the environment form the key therapeutic targets of treatment. Specific therapeutic procedures, a case illustration and discussion of therapeutic rationale are also provided.     

Modes of Interaction in Psychodynamic Psychotherapy with Borderline and Non-Borderline Clients

Abstract

Individual variation in the use of symbolic aspects of the treatment situation has been theorized across client groups of varying developmental profiles. In particular, the use of metaphor is thought to be different in the therapies with Borderline clients. The present study involved an intensive qualitative analysis of metaphor-ic expressions from Borderline and non-Borderline psychotherapy sessions. Open-ended interviews were conducted with 2 therapists and 4 clients (2 Borderline; 2 non-Borderline) following single sessions from psychoanalyticaily oriented long term psychotherapies. The analysis of data found significant differences in the therapeutic interaction which led to the major core categories of (a) Literal Mode of Interaction and (b) Representational Mode of Interaction, representing the Borderline and non-Borderline sessions respectively. The characteristics of these two modes underscored the differences found in the use of metaphor between the two client groups. Implications for clinical practice are discussed.     

Effective Psychotherapy With Low-income Clients: The Importance of Attending to Social Class

The purpose of this article is to explore some of the issues associated with conducting psychotherapy with low-income clients. Throughout the article, we draw from our specific clinical experiences working with low-income Latina mothers in a depression prevention program. The themes that we address regarding class and psychotherapy are in the areas of assessment of social class, integration of class issues into the therapy process, and managing differences in social class between therapists and clients. As we discuss these themes, we provide concrete recommendations in order to advance awareness and effectiveness in working with economically disadvantaged populations.     

The Impact of Specific Psychotherapist Beliefs Regarding Managed Care on Prospective Psychotherapy Clients

The purpose of this study was to investigate the separate impact of each of thirteen therapist beliefs that, presented collectively, were previously found to have a significantly negative impact on prospective clients' attitudes toward managed care psychotherapy (Pomerantz, 2000). Participants in this study initially completed a brief questionnaire measuring their willingness to enter psychotherapy and their expectations regarding psychotherapy under managed care. Participants subsequently completed the same brief questionnaire again after being instructed to imagine seeing a hypothetical psychologist and being presented with the psychologist's supposed beliefs regarding managed care (which were actually derived from survey data by Murphy et al., 1998). Results suggest that almost every discrete therapist belief had a significantly negative impact on participants' attitudes toward managed care psychotherapy. Several specific therapist beliefs produced particularly salient negative effects. Implications regarding ethics and informed consent are discussed.     

Integrated Group Psychotherapy Program [IGGP] for Multi-Diagnosed Clients

This article describes a group therapy–centered program geared toward the treatment of individuals with co-occurring disorders, including addictive disorders, borderline personality disorder and other mental health issues which involve difficulties with emotion regulation. Group therapy plays a vital role in their recovery. Over 18 years, the author has developed a treatment model that offers an integrative approach to group therapy and individual treatment encompassing psychodynamic and other empirically based therapies, especially dialectical behavior therapy (DBT). Its value lies in its therapeutic effectiveness with hard to reach clients, in its practice-based evidence, its team-building and management approach, its training component and its capacity for replication.     

青少年抑郁症患者的团体人际心理治疗

青少年抑郁症患者的团体人际心理治疗是建立在人际心理理论基础之上,具有循证医学理论依据的心理治疗方法.它是将原本应用于治疗成人抑郁症的人际心理治疗理论和程序经过修正后应用于青少年抑郁症的治疗.实践表明,青少年抑郁症的团体治疗目标明确,实施领城广泛,具有校为明显的疗效和多方面的积极作用.但是该疗法仍然有许多未解决的问题,需要更进一步的理论突破和实务研究.     

The Adolescent Psychotherapy Q-Set (APQ): A Validation Study

This article reports the validation of the Adolescent Psychotherapy Q-set (APQ), a newly developed instrument, adapted from the well-established Psychotherapy Q-Set (PQS) and the Child Psychotherapy Q-set (CPQ). The APQ aims to describe the psychotherapy process in the treatment of adolescents in a form suitable for quantitative comparison and analysis. The validation was conducted with the ratings of 70 audio-recorded youth psychotherapy sessions from a range of therapists, patients, and treatment stages, using two therapeutic approaches (Short-Term Psychoanalytic Psychotherapy and Cognitive Behavioral Therapy). Data analysis included intraclass correlation coefficients, Q-factor analysis, nonparametric mean differences, and Pearson correlations. Results suggest that the APQ has good levels of interrater reliability, is able to identify differences and similarities of two therapeutic approaches, and good convergent and discriminant validity with a widely-used measure of therapist behaviors (the Comparative Psychotherapy Process Scale). The APQ reported good levels of validity and reliability. It is hoped that it will contribute to new ways of investigating the mechanisms of therapeutic change for those working with adolescents.     

Limited Goals in Short-Term Group Psychotherapy with Institutionalized Delinquent Adolescent Boys

This paper applies a specific view of familylike dynamics to psychoanalytic group psychotherapy. Pathological forms of protectiveness and scapegoating are both involved in which the symptomatic individuals maintain an enmeshment with the group which saves them from anxieties associated with change. As the scapegoat, the problem patient becomes the spokesperson for a group transference involving the therapist(s), group members, and a developmentally internalized family. The primary technical error is the tendency for the therapist, in the guise of appropriate technique, to unconsciously collude with a scapegoating process thereby discouraging differentiation and growth. Viewing the group from the perspective of pathological versus healthy forms of family interaction helps to highlight certain problems in the therapist's interventions.     

Group Psychotherapy and Existential Concerns: An Interview with Irvin Yalom

Group psychotherapy can be used to help clients deal with most forms of emotional distress or problems with interpersonal functioning. Also, group therapy can be useful when helping clients to confront existential concerns such as isolation or meaning in ones life. During a recent interview, Irvin Yalom discussed a variety of issues related to group processes and existential matters that are involved in effective psychotherapy.     

Client-Therapist Intimacy: Responses of Psychotherapy Clients to a Consumer-Oriented Brochure

Psychotherapy clients read two consumer-oriented brochures: a general brochure on psychology and a brochure on the topic of client-therapist intimacy. Half of the participants read the general brochure first and the brochure on client-therapist intimacy second, and half the participants did the reverse. Participants reported favorable reactions to the brochures, indicating they thought both should be made available to psychotherapy clients; that neither were too long, too sensitive, or too difficult to read; and that the brochures should be made available early during the therapeutic process. After reading the client-therapist intimacy brochure, participants also showed some changes in Likert-type scores measuring attitudes regarding intimate contact between clients and therapists. Although participants were more negative about issues of sexual misconduct after reading the client-therapist intimacy brochure, they did not indicate a decrease in trust of therapists, nor did they indicate a greater likelihood of filing a false complaint. We concluded that therapists' reservations about presenting clients with factual information regarding therapist sexual exploitation of clients are not empirically founded.     

Child and Adolescent Psychotherapy Research: Developmental Issues

Describes developmental issues that pose current challenges to the design of treatment outcome investigation with children and adolescents. Normal childhood development and the development of childhood disorders are discussed using the transactional model of development. Challenges in diagnostic decision making, the selection of the most appropriate treatment regimen, and the measurement methods are highlighted. Recognition of the need to study child treatments through long-term follow-up periods underscores the need for resolution of these developmental issues.     

Exploring In-Session Process with Qualitative and Quantitative Methods in Psychotherapy with an Adolescent

ABSTRACT

There is emerging evidence for the effect of psychotherapy in adolescents with depression. Research indicates that therapists often use techniques from different theoretical models when working with adults. Research on the therapy process in adolescents is scarce. We explore the therapist’s interventions in a time-limited psychodynamic adolescent therapy with Susanna suffering from major depression. Susanna quite suddenly became worse at mid-treatment, with self-harming and suicidal ideations. Rating scales for analyzing in-session relational processes included the Structural Analysis of Social Behavior (SASB), the Adolescent Psychotherapy Q-set (APQ), and the Transference Work Scale (TWS). Self-reports on symptoms, interpersonal problems, and working alliance were obtained before, during, and at the end of and one year after treatment. Different tools seemed to expose different aspects of the process and the patient’s development. Only patient-rated questionnaires revealed the mid-treatment crises. Combining different and pan-theoretical rating scales on here-and-now interventions (TWS and SASB) and whole sessions (APQ), as well as clinician-rated measures and a variety of self-reports, indicated that different psychotherapeutic techniques were integrated in the therapy and seemed beneficial to patient’s outcome. The therapist adhered to the treatment manual. This way of exploring the therapy process may be used for different treatment modalities.     

The Initial Interview with Diverse Populations: An Introduction to the Special Issue

Every initial clinical interview is a unique encounter between psychotherapist and client. This unique encounter typically includes interactions designed to build the therapeutic relationship, collect assessment data, develop a case formulation, and initiate psychotherapy. As the United States population has become more diverse, conducting an effective initial interview has become more complex and challenging. To meet this challenge, it is recommended that psychotherapists make cultural adaptations by seeking self-awareness, acquiring knowledge, and learning culture-specific techniques. This special issue includes six articles designed to stretch the way psychotherapists think about the initial interview and infuse greater multicultural sensitivity and humility into psychotherapy practice.     

When Words are not Enough: Psychotherapy with Clients Who are Living Below the Poverty Level

The present article describes six strategies found useful when working with depressed clients who are struggling with severe financial limitations. First, it is important to help clients maintain an attitude of hope for a better future, so they remain as positive yet realistic about their current options and future goals. Second, empathy is considered to be a central component in all psychotherapy sessions, helping therapists to understand their clients’ life experiences and ongoing struggles. Third, clients can learn to develop more adaptive perspectives about life, family, and friends, trying to focus on the positive events they have experienced and the supportive bonds they have developed. Fourth, clients can develop new specific coping skills that may help them to manage the problems they encounter. Fifth, many clients can better utilize the social support that is often available, starting to ask family members and friends for assistance and support when help is needed. Sixth, an interdisciplinary treatment team is often optimal when the treatment plan integrates the potential benefits derived from psychotherapy, medications, and social service agencies. An effective psychotherapist respects the limits of psychology while consulting with colleagues from other health care professions. These six strategies can help guide therapists when working with clients who are struggling with persistent depression in the face of adversity.