Amelioration of transference resistance: substitute therapists in milieu group psychotherapy

Building upon Wolf's (1949) notion of the use of an alternate session in group psychotherapy, this paper suggests that an alternate therapist substituting for an absent regular therapist in milieu group psychotherapy can facilitate similar therapeutic benefits. The mechanism of this process of overcoming transference resistance is seen as twofold: (1) sessions with a substitute therapist allow patients to confront the infantilization often present in a milieu setting and experiment with more autonomous ego functioning. (2) Sessions with a substitute therapist create conditions which are apart from the ongoing process of the therapy group, thereby allowing for a therapeutic splitting process to develop wherein transference feelings about the regular therapist can be expressed to his or her "alter ego." Several case vignettes are presented in order to illustrate the clinical utility of a substitute therapist.     

Race, culture, and psychotherapy: transference to minority therapists

We present observations on the use of racial and cultural stereotypes in psychoanalytic psychotherapy with patients from the majority culture and with those from minority backgrounds. Earlier work has centered on black/white patient dyads and has not taken other possible combinations into account. "Race" and "culture" have sometimes been used synonymously. Our clinical experience indicates that there is some overlap in the themes of transferences to us as members of different racial minorities. We note, however, that for the African-American therapist, projections are more often based on racial stereotypes, whereas for the Chinese-American therapist, projections are based more on cultural assumptions. When careful attention is paid to the manifestations of racial and cultural stereotyping, much can be learned about the patient's inner life, to the benefit of the analytic work.     

Training Soviet immigrant therapists in the field of group psychotherapy

Between 1970 and 1990 about one-half million Jews immigrated to Israel, most of them from the former Soviet Union, including many mental health therapists who had trained and worked in the Soviet Union. This article addresses the special characteristics of this population, in general, and of the mental health therapists, in particular. It relates these characteristics to training for group psychotherapy. Key issues include their unique experience of the inner world as a source of danger, the specific defensive modes connected with this experience, their perception of authority as an agent of ideology, and their representation of the group as a persecutory entity and as a vehicle of indoctrination.     

Beliefs and practices of therapists who practice sexual reorientation psychotherapy

There is currently controversy regarding whether sexual reorientation or conversion therapies are ethical and effective forms of treatment for dissatisfied homosexually oriented people. We present the results of a survey of 206 psychotherapists who practice sexual conversion therapy. 187 therapists said they believed homosexuality is a developmental disorder and that the 1973 decision by the American Psychiatric Association to "depathologize" homosexuality was politically motivated and unscientific. The therapists believe that the majority of dissatisfied homosexually oriented clients who seek conversion therapy benefit from it, experiencing both changes in their sexual orientation and improved psychological functioning. We conclude that therapists who persist in providing reorientation therapy do so because they believe it is an effective and ethical treatment option for their clients.     

Generic planning: Research results and applications

Older approaches to planning lack the capacity to be responsive to complexity. A new philosophy supporting a new mode of practice could improve significantly the capacity of society to cope with complexity in design, planning, and policy making. The new philosophy and practice must be generic; in other words, it must be divorced in its philosophy and approach from any particular kind of planning activity. It must emphasize the capacity to enhance the work of groups in designing new conceptual structures whether they be plans, policies, or tangible products. John N. Warfield is University Professor and director of the Institute for Advanced Study in the Integrative Sciences at George Mason University, Fairfax, Virginia, 22030. He is a Fellow of the Institute of Electrical and Electronics Engineers (IEEE) and a recipient of the IEEE Centennial Medal in 1984. His booksSocietal Systems andA Science of Generic Design present theoretical and empirical results relevant to issues of coping with complexity.     

Developmental issues in psychotherapy research

Research on psychosocial interventions with children requires attention to developmental principles such as age-specific competence, maturational shifts, increasing cone of relevant contacts, and socioeconomic context of biological stages. Research strategies that include such variables should lead to ecologically sound investigations and the correct selection of outcome variables. A consideration of the specificity of treatment and controlled design alone are not sufficient to guide the study of the psychological treatment of developing organisms and persons.     

Maternal styles in infant psychotherapy: Treatment and research implications

Infant psychotherapy, in which the mother is requested to follow the baby's activities without initiating or directing, is described. Mothers demonstrate different styles of involvement with their infants: a protective mode, a prohibitive mode, a competitive mode, and other ways of interfering with their infants' tendency to explore the environment. Attempts to analyze such factors as position, distance and movement are discussed. Research for recording and analyzing the movement of infant and mother dyads is proposed.     

Problems and prospects in group psychotherapy research

The scientific basis of psychotherapeutic findings involves a number of difficulties which are above all connected with the insufficient state of basic research in this field. In this situation, significant advances can only be expected on the basis of a systematic long-term investigation and research programme. This applies in particular to the problems of personality and efficiency diagnostics and to group process research. On the basis of some intermediate results, it is shown that by the combined and systematic use of procedures a number of possibilities for the differentiated recording of the complex processes in therapeutic groups can be obtained.     

Developing clinical effectiveness in psychotherapy training: Action research

This study is an evaluation of a new approach to clinical training in Transactional Analysis using the methodology of action research. The evaluation focuses on the second year of training and placement‐based clinical practice at the Metanoia Institute, UK. The design of the training year was research‐based and used the concept of an ‘internship’ year. The design aimed to close the gaps between clinical practice, supervision and formal training; facilitate translation of theory into practice; and integrate findings from the ‘common factors’ research into effectiveness of psychotherapy. Training and supervision methods were linked and focused on emerging issues in clinical practice and the development of students’ capacity for critical reflection and a research attitude to practice. The evaluation was a naturalistic study which used quantitative and qualitative methodology within the action research framework to reflect on the impact of the training on the participants, the organisation and the clinical practice. The quantitative outcomes show that the project developed the effectiveness of students’ clinical practice and reflexivity. Qualitative analysis gives insight into the experiences of the participants and the emotional impact of the research process.     

Intraclass Correlation Associated with Therapists: Estimates and Applications in Planning Psychotherapy Research

It is essential that outcome research permit clear conclusions to be drawn about the efficacy of interventions. The common practice of nesting therapists within conditions can pose important methodological challenges that affect interpretation, particularly if the study is not powered to account for the nested design. An obstacle to the optimal design of these studies is the lack of data about the intraclass correlation coefficient (ICC), which measures the statistical dependencies introduced by nesting. To begin the development of a public database of ICC estimates, the authors investigated ICCs for a variety outcomes reported in 20 psychotherapy outcome studies. The magnitude of the 495 ICC estimates varied widely across measures and studies. The authors provide recommendations regarding how to select and aggregate ICC estimates for power calculations and show how researchers can use ICC estimates to choose the number of patients and therapists that will optimize power. Attention to these recommendations will strengthen the validity of inferences drawn from psychotherapy studies that nest therapists within conditions.     

Some variables associated with psychologists' appraisal of psychotherapy in Argentina

The purpose of this research is to provide information about the state of psychotherapy in Argentina, as well as to study some variables involved in psychologists' evaluation of psychotherapy. A survey of 14 items was elaborated ad-hoc for this purpose, and administered to 226 psychologists from all over the country by mail and, in some cases, personally. Results suggest that the predisposition to apply techniques from different frameworks is associated with the amount of experience and with the perception of a bias concerning other theoretical focuses, although it is not related to the evaluation of the state of psychotherapy. On the other hand, in the view of psychologists, personal aspects of the therapeutic relationship are believed to be the most important factor in patients' change and effective progress.     

Intraclass correlations: uses in assessing rater reliability

Reliability coefficients often take the form of intraclass correlation coefficients. In this article, guidelines are given for choosing among six different forms of the intraclass correlation for reliability studies in which n target are rated by k judges. Relevant to the choice of the coefficient are the appropriate statistical model for the reliability and the application to be made of the reliability results. Confidence intervals for each of the forms are reviewed.     

Feedback in dynamic psychotherapy: Notes on selected clinical issues and practical applications

Conclusion In this presentation of selected clinical issues and applications of feedback in dynamic psychotherapy, I have ranged from metaphor to paradox and the sharing of the therapist’s wisdom; from feedback of silence, empathy, and memories to working through alienation from self; from feedback of the therapist’s psychophysiologic reactions during a session to feedback of the fear of separation and mortality. Believing that all too often the therapeutic process is based on linear feedback, I have focused on the circularity of interactive, interpersonal systems, suprasystems, and subsystems as well as their simultaneous, mutually influencing perception through many equally important channels of communication and levels of awareness. These serve as the ground, frame, and context for constructive feedback between therapist and patient that can promote personality reconstruction and development of human potentials. Revised from a paper presented at a scientific meeting of the Association for the Advancement of Psychoanalysis of the Karen Horney Psychoanalytic Institute and Center on April 22, 1993. Immediate Past-President of the Association for the Advancement of Psychoanalysis; author of many publications on verbal and nonverbal communications.