The Initial Psychotherapy Interview with Adolescent Clients

Initial psychotherapy sessions with adolescents can be very challenging due to the need to balance assessment, relationship building, caretaker/parent management, and case formulation with a client population that sometimes has little motivation for psychotherapy. This article combines empirical evidence, theoretical knowledge, and clinical experience to describe strategies for how psychotherapists can prepare themselves for initial psychotherapy sessions and manage tasks associated with five stages of the clinical interview: (a) the introduction, (b) the opening, (c) the body, (d) the closing, and (e) termination. Using case vignettes and short examples, there is an emphasis on how psychotherapists can develop and maintain a strong therapeutic alliance while simultaneously helping adolescent clients focus on psychotherapy tasks and goals. The overall goal of this article is to help psychotherapists smoothly navigate the potentially stormy stages of the initial clinical interview with adolescents.     

Pragmatism, Pluralism, and Psychotherapy Relationships: An Interview with John C. Norcross, Ph.D.

John C. Norcross has made significant contributions in the areas of the transtheoretical model of change, psychotherapy integration, and empirically supported psychotherapy relationships. This interview explores the contributions of pragmatic philosophy and his personal upbringing to his work as a psychotherapy researcher and practitioner. Dr. Norcross discusses the status of the psychotherapy integration movement, the work of the Task Force on Empirically Supported Psychotherapy Relationships, and future trends in psychotherapy over the next 25 years. He emphasizes the importance of a methodological rigor that recognizes the unique characteristics of the psychotherapy relationship. He describes his current interest in the psychotherapy of psychotherapists, illustrating it with his personal challenges in balancing work and home.     

Cultural Psychotherapy: A Consideration of Psychosocial Class and Cultural Differences in Group Treatment

Most psychotherapists are aware of the many social issues and cultural factors that influence development throughout each individual life. Human nature, being a social nature, exists within relationships to others, the community, and a culture, sometimes a mixture of cultures. One social parameter, social class, redefined here as psychosocial class, has not received the same attention from psychotherapists as gender issues or ethnicity, two other important sociocultural spheres of influence on everyday life. It is suggested that group therapists are in a unique position to develop a cultural psychotherapy that addresses psychosocial class and cultural aspects of mental health. This paper includes a preliminary model of cultural psychotherapy that highlights the psychology of social class and culture for psychodynamic group psychotherapy.     

Indikation zu Psychoanalyse und analytischer Psychotherapie

Based on the diagnostic process in the initial interview, which is an intersubjective encounter, the various developmental steps for establishment of the indications for psychoanalysis are presented. Freud and his followers, who were initially oriented to the psychiatric diagnosis, were later oriented to the criteria of approachability, analysability and in particular on the aptitude for psychoanalysis. The criterion of aptitude was not only elaborated from the perspective of Ego psychology but was also relevant for all high frequency non-terminated psychoanalyses which followed the basic psychoanalytical principles of “afocality”. This has so far characterized the standard procedure of all psychoanalytic schools. Due to the experiences of psychoanalysts with early disturbed, structurally Ego-disturbed neuroses and personality disorders, the extent of lability of the mental structure and by turning to countertransference analysis, the person of the psychoanalyst become more important for the assessment of the indications. In Germany the integration of psychotherapy, which is financially supported by healthcare insurance, ultimately leads to differential indication assessments between high frequency psychoanalysis or analytical psychotherapy, modified psychoanalytical psychotherapy and less frequent psychodynamic procedures.     

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.     

PASTORAL PSYCHOTHERAPY: IS IT UNIQUE?

Proponents and practitioners of pastoral psychotherapy hold to the idea that it is a unique form of psychotherapy. Little empirical or procedural evidence seems to exist to substantiate that viewpoint. Indeed, the data suggest that pastoral psychotherapy is a close kin to secular psychotherapy, not only in practice, but in the opinion of those who seek it out for help. This article takes the viewpoint that pastoral psychotherapy should be unique and attempts to show how it can be. The author stresses that it is ordination that makes pastoral psychotherapy unique, because the ordained pastor is both a theologian and a representative of the church. These two elements provide unique “lenses” for doing psychotherapy. To the extent that these lenses are not being used, the author issues a challenge to pastoral psychotherapists to bring this uniqueness to the forefront.     

Clinical Experiences in Conducting Cognitive-Behavioral Therapy for Social Phobia

Several authors have identified a disconnect between psychotherapy research, including research on cognitive behavioral therapy (CBT), and real-world psychotherapy practice. This disconnect has several negative consequences, potentially including less-than-optimal practice standards as well as a lack of input from practicing psychotherapists on how research can be improved and made more relevant in their day-to-day clinical work. As part of an ongoing effort to engage practicing psychotherapists in a feedback loop with psychotherapy researchers, this study reports the results of a survey of CBT therapists who have used CBT in the treatment of social phobia (SP). The survey was designed primarily to document how often certain potential problems, identified by expert researchers and CBT manuals, actually act as barriers to successful treatment when CBT is employed in nonresearch environments. The participants were 276 psychotherapists responding to email, online, and print advertisements completing the online survey. Participants varied considerably in psychotherapy experience, work environment, experience in using CBT for SP, and in some ways varied in their usual CBT techniques when treating SP. Among the most prominent barriers identified by many of the participants were patient motivation, comorbidity, logistical problems (especially with exposures), patient resistance, and severity and chronicity of SP symptoms. These findings may be useful for psychotherapy researchers as areas for potential study. The results may also suggest topics requiring clinical guidelines, innovations within CBT, and dissemination of successful techniques to address the barriers identified here.     

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.     

后现代心理治疗及其伦理问题思考

文章通过论述后现代对现代认识论和思维模式的质疑与超越,分析了后现代语境下心理治疗与现代心理治疗的差异,并关注在后现代这一新的思维模式下,心理治疗领域可能产生的伦理问题。作者指出,后现代心理治疗的不确定性、价值干预和文化介入,使心理治疗的伦理挑战被进一步复杂化,对治疗师也提出了更高要求。     

Psychotherapie auf Palliativstationen

Exemplary for psychotherapeutic activity in the ??sphere of death?? the article focuses on the present situation of psychotherapists working on palliative care units in Germany. For that a questionnaire has been developed which includes 17 items dealing with fields of concrete psychotherapeutic work, psychotherapy training, relations with teams and institutions, subjectively felt burden and contentment etc. The questionnaire was sent to most of the German palliative care infirmaries. There is a high presence of psychotherapists in these units who are well trained in different therapeutic methods, numerically led by behavior therapy and non-directive therapy. In addition most colleagues are qualified in psychooncology and specialized pain management. Surprisingly topics, such as death or spirituality are not so often found in therapeutic contacts as would be expected. Furthermore there is a rather negative outlook on the preparation for the palliative working field during psychotherapy training. This requires extensions and supplementary curricula concerning existential themes in psychotherapy. The psychotherapists feel well integrated in their therapeutic teams but many of them have a feeling of at best a mediocre appreciation in their institutions. In spite of the difficult and stressful work the general job satisfaction is stated as high to very high.     

Exploring the bio-psycho-social

The United Kingdom Council for Psychotherapy (UKCP) was formed to provide a professional body for all psychotherapists in the UK. It maintains a register of trained practitioners who abide by the ethical standards ratified by UKCP, which includes psychotherapists working in all the modalities recognized by UKCP irrespective of their primary professional training. In the absence of statutory registration, there is no fully representative list of UK psychotherapists, but the UKCP register is probably the nearest thing to it. The UKCP board recognized that a survey of registrants would provide a snapshot of the state of UK psychotherapy, which would be valuable in understanding the contribution of psychotherapists to health services in the UK.

A questionnaire was designed, and sent out to all 4005 practitioners registered by UKCP in December 1997. One thousand three hundred and thirty-one questionnaires were returned, a response rate of 34 per cent. The respondents were representative of all registered psychotherapists in 1998 in those characteristics that are published in the paper register, or that can be inferred from it. The respondents were aged 51 years on average, predominantly white (97 per cent described themselves this way) women (69 per cent) practising in London and the South East of England (55 per cent). All the respondents described themselves as being influenced by psychotherapeutic approaches rooted in psycho-analysis. Ninety-five per cent of respondents had another profession previous to psychotherapy. This was most commonly teaching (27 per cent), social work (22 per cent) or counselling (21 per cent). Only 11 per cent of respondents were psychologists.

The contribution of UKCP registrants to the National Health Service has never previously been estimated. A breakdown of the diaries provided by respondents in this survey suggests that UKCP registrants may contribute as many as 44,760 hours of psychotherapy per week to the British National Health Service and other health sectors. Assuming that a whole-time-equivalent psychotherapist works 37 hours per week, this means that UKCP registrants may provide the equivalent work to health service organizations, both public and private, of more than 1,311 full-time psychotherapists.     

A Positive and Proactive Approach to the Ethics of the First Interview

Some may view the initial interview as a mechanistic procedure complete with a list of tasks to accomplish. The primary purpose of this article is to deconstruct this perspective and encourage psychotherapists to explore the initial interview through an ethical acculturation lens. Using a case scenario, we demonstrate the need for purposeful reflection to better understand important judgments and choices psychotherapists make while conducting initial interviews. Employing a proactive approach to ethics using a “wide-angle” lens, we organize the discussion around personal, professional, and global themes. We offer practical tips to facilitate ethical excellence as psychotherapists engage in their first client contacts.     

Context and Culture: The Initial Clinical Interview with the Latina/o Client

Changing social demographics require that psychotherapists and mental health delivery systems become accountable for developing attitudes and skills for working multiculturally. This article immerses the reader in contextual and cultural principles for establishing an initial therapeutic relationship with Latinas/os. These contextual and cultural principles also can be implemented across any theoretical orientation or clinical interview structure psychotherapists employ. This article also reports on data from a subset of participants (n = 27) that self-identified as bilingual, bicultural, and highly culturally competent from a larger mixed-methods study of 89 Latina/o therapists. The results support the utility of personalismo, respeto, charlar (small talk), language and education, and self-disclosure in building respectful relationships with, and in conducting the initial interview with Latina/o clients. These findings are highly consistent with the common factors literature and lend further support to the proposition that the therapeutic relationship serves as the base for therapeutic interventions across all cultures.     

Announcement

Abstract

Empathy has consistently been identified as an important quality of psychotherapists. Understanding unique ways that empathy emerges in group therapy may assist group therapists in fostering empathy. Rogerian and selected psychodynamic and interpersonal perspectives on empathy are discussed. Group psychotherapy poses a challenge for empathic responding, but also a rich opportunity for utilizing a more varied embodied approach to empathy.     

Language as power in the therapy room: A study of bilingual (Arabic–English) therapists' experiences

The topic of language as power (LaP) in individual therapeutic encounters has thus far been overlooked, and as bilingual therapists have the ability to use more than one language in the therapy room, their experience of LaP is a compelling research area that this paper attempts to explore. This qualitative, inductive, phenomenological study used interviews and interpretative phenomenological analysis to explore five bilingual Arabic–English-speaking therapists' experiences of LaP in the therapeutic encounter. The study identifies two overarching themes: (a) the emergence of identity and power from language and (b) comparisons of power in the English and Arabic languages. Within these themes, the study finds that therapists experience LaP through multiple avenues: self-disclosure, intersectionality, being transported to different identities and expressions of power and power of expression in Arabic–English. These multiple avenues illustrate the complexity of LaP in the therapeutic encounter. The study sheds light on an underexplored area in psychotherapy, illuminating an important area for psychotherapists and training institutions to consider when working with clients.     

Sind Psychotherapeuten heimliche Evaluatoren?

Evaluation and psychotherapy share a variety of common features. Both concepts embrace a wide variety of models and applications and are frequently met with opposition and scepticism. A more detailed comparison indicates the close relation between evaluation and psychotherapy and gives authority to the stance that psychotherapists’ resistance to evaluation is futile. The rising demands on psychotherapists for accountability and evidence of what works have increased the practical, academic, and political importance of developing appropriate evaluation approaches. This paper argues that psychotherapists, in their own interest, need to play an increasingly active role in developing useful methods, objectives, and indicators with respect to the evaluation of psychotherapeutic processes.     

Humanizing Psychotherapy

The essence of the humanistic and existential approaches to psychotherapy is a commitment to conceptualizing, and engaging with people in a deeply valuing and respectful way. Hence, within these approaches, there is an emphasis on viewing clients’ behaviors as meaningful and freely chosen; and there is also a belief that clients have the capacity to become aware of the reasons for their thoughts, feelings and behaviors. Phenomenological exploration is thus a central element of many existential and humanistic psychotherapies, and this requires psychotherapists to put to one side their therapeutic techniques and interpretative assumptions and to listen to clients in an in-depth, non-analytical way. From an existential and humanistic standpoint, however, this valuing of human beings also extends to the psychotherapist's own humanity. Hence, within these approaches, there is an emphasis on the psychotherapists themselves being genuine in the psychotherapeutic encounter, and being willing to meet their clients at a level of “relational depth.” Existential and humanistic practices may not be appropriate for all clients and all psychotherapists, but it is concluded that the principles underlying these approaches are of universal relevance to the practice of psychotherapy.

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Secular Psychotherapists and Religious Clients: Professional Considerations and Recommendations

Traditional psychotherapy has often failed to meet the needs of religiously committed clients. Because many potential clients have religious as well as secular concerns, secular psychotherapists must become more empathic and competent in treating religious individuals. In this article the author argues that efforts toward consciousness raising as well as fundamental changes in professional training programs are necessary to accomplish this goal. Recommendations are offered for counselor educators and mental health service providers.