Integrating clients' moment‐to‐moment ratings into psychotherapy research: A novel approach

Counselling and psychotherapy researchers have considerably advanced the field's understanding of psychotherapy processes and how they relate to treatment outcomes. Despite these advances, little is known about the client's perspective of changes in psychotherapy processes that occur throughout a given session (i.e. micro‐processes). To address this gap, this article describes the novel application of methods that assess participants' moment‐to‐moment ratings to psychotherapy research. This method entails recording psychotherapy session content that clients and other potential raters (e.g. therapists, researchers) later review while simultaneously providing continuous ratings of psychotherapy processes (e.g. helpfulness, alliance). In addition, moment‐to‐moment ratings can facilitate significant events research by prompting researchers to elicit client feedback about the moments that are rated the most and least positively. However, few studies have used these methods in the context of psychotherapy research. Studies incorporating these methods may yield findings that advance psychotherapy research, training efforts and clinical practice. For example, studies may examine how the magnitude and timing of clients' moment‐to‐moment ratings of psychotherapy processes are associated with treatment outcomes, therapist ratings and physiological processes (e.g. heart rate variability). Trainee therapists and their supervisors may also use clients' moment‐to‐moment ratings to facilitate attunement to verbal and non‐verbal indicators of moments perceived more positively and negatively. Last, these methods can produce findings that are highly relevant to clinical practice, where therapists routinely navigate fluctuations in psychotherapy processes (e.g. alliance ruptures) that can be assessed using moment‐to‐moment ratings.     

Student essay competition prize winner basket weaving: Sharing stories in a group setting

Abstract

Participating in a self-awareness group (in this case for counsellors in training) is an exercise in give and take - an interweaving of stories - through which we share ourselves with our peers. This paper explores some personal discoveries about the processes at work in (a) listening to others, (b) relating my own story - and assessing thereby the extent of my belonging, role and investment in the group. A dream alerted me to our shifting to another dimension of story-sharing by the end of forty sessions. The imagery I use is of basket weaving and creating a mandala.     

The Mutual Development of Intersubjectivity and Metacognitive Capacity in the Psychotherapy for Persons with Schizophrenia

While cognitive behavioral approaches have been shown to help some individuals with schizophrenia, these approaches may be limited when working with patients with impairments in the metacognitive abilities required to form complex and integrated representations of themselves and others. In response, this paper explores the possibility that a key to working with patients with relatively impaired self-reflectivity lies in explicitly focusing on a patient’s intersubjective experience within psychotherapy. We offer theoretical and empirical support for the assertion that the tolerance and capacity for intersubjectivity is a basis for the development of self-reflectivity in general. We also explore how the fostering of intersubjective processes in psychotherapy might enable some patients to form more complex ideas about themselves and so better ward off delusions in the face of the challenges of daily life. To illustrate these principles we present the case of a patient with tenaciously held delusions and limited capacity for self-reflection. We discuss when and how the therapist’s awareness and verbalization of intersubjective processes within session allowed her and the patient to develop more complex and consensually valid ideas about him as a being in the world, which then assisted the patient to achieve improvements in a number of domains in his life.     

Truth and Consequences: What We Lose and Gain in Psychoanalytic Postmodernism

In this article, I use the psychoanalytic concept of truth as a lens through which to explore how psychoanalysis has changed and not changed under the influence of postmodernism. I suggest that the seeking after truth remains in current psychoanalytic practice even though under different guises or conceptual umbrellas, for instance in the high value placed today on authenticity (or trueness) to self and of relationship. Although, admittedly, the search for truth in the sense of compiling historical facts has receded, our current interest in the construction of narratives still comes with the requirement that the stories we co-create with our patients at least have the ring of truth if they are to facilitate psychic growth and psychological intimacy. Additionally, I offer an overview of some of the salient characteristics of postmodern psychoanalysis, with suggestions as to how each of these might relate to the concept of truth. In closing, I borrow a brief clinical vignette from the unpublished notebooks of Melanie Klein for the purpose of making a brief comparison between earlier and current ways of interacting in the treatment relationship.     

Phenomenal experience and the measure of information

This paper defends the hypothesis that phenomenal experiences may be very complex information states. This can explain some of our most perplexing anti-physicalist intuitions about phenomenal experience. The approach is to describe some basic facts about information in such a way as to make clear the essential oversight involved, by way illustrating how various intuitive arguments against physicalism (such as Frank Jackson’s Knowledge Argument, and Thomas Nagel’s Bat Argument) can be interpreted to show that phenomenal information is not different in kind from physical information, but rather is just more information than we typically attribute to our understanding of a physical theory. I clarify how this hypothesis is distinct from Nagel’s claim that the theory of consciousness may be inconceivable, and then in conclusion briefly describe how these results might suggest a positive and conservative physicalist account of phenomenal experience.     

心理治疗结果的临床显著性分析方法

心理治疗结果研究中,如何对结果测量数据进行统计分析,是非常重要的环节之一。研究者发现,不能简单使用统计显著性来考察心理治疗的结果,因而引入了临床显著性的概念以便更准确地从临床角度考察治疗的情况。在验证临床显著性改变中,西方学者提出了JT法、GLN法、EN法和HA法等统计分析方法,这些方法都试图更准确地分析临床显著性,但在心理治疗结果研究中,这些方法仍然存在概念明确性、标准和数据收集完善性等方面的问题。因此今后的研究应该关注方法的创新或修订,还是关注数据解释是目前西方关于临床显著性分析方法的两大争论。国内也应在心理治疗结果的研究中引入临床显著性分析方法,同时还应考虑效果评价指标的设立和有效测量工具编制的问题,为正确评价心理治疗结果服务,并最终为提高心理治疗效果服务。     

Levels of change in parent–infant psychotherapy

This paper offers a way of thinking about the process of parent–infant psychotherapy. I start by outlining some ideas as to what can go awry in troubled parent–infant relationships, and then a way of working with parents with pre-verbal babies. I suggest a model for understanding three interlaced levels at which change might occur if a psychodynamic, systemically sensitive, therapeutic intervention is offered. I describe a particularly challenging clinical case in which a mother and I also worked with video material of her and her son.     

Hidden in Plain Sight: The Active Ingredients of Executive Coaching

We propose that I/O psychologists who coach executives have overlooked psychotherapy outcome research as a source of information and ideas that can be used to improve our executive coaching practices. This research, based on thousands of studies and many meta-analyses, has converged on the conclusion that four "active ingredients" account for most of the variance in psychotherapy outcomes. We describe how this literature has identified four primary "active ingredients" that account for most of the variance in psychotherapy outcomes: 1) Client/extratherapeutic factors (40%), 2) The relationship or alliance (30%), 3) Placebo or hope (15%), and 4) Theory and technique (15%). Working on the assumption that psychotherapy and executive coaching are sufficiently similar to justify generalization from one domain to the other, we describe these four active ingredients at length and explore how they may be at work in the executive coaching process. We also suggest that I/O psychologists have training and experience that allows us to leverage some of these active ingredients in our executive coaching (e.g., understanding of client individual differences related to coaching outcomes). But we also have areas of weakness (e.g., building a strong working relationship with an individual client) that may need to be bolstered with additional training and development experiences.     

Making Pacifism Plausible

The ethics of war is a minefield. It is a morass of conceptual unclarity, contentious assumptions, impassioned arguments, unexploded myths, and the injured defenders of indistinct positions. My aim is to help to make the minefield (conceptually) safe, and to assist that most vulnerable party to the dispute, the pacifist. In this paper I explore the possibility that, farfrom being naïve or outlandish, pacifism might follow from a widely-held and fundamental intuition about the moral status of persons [hereafter MSP]. In Section 1 I describe MSP, and suggest how we might draw implications from it about the ethics of war. In Section 2, I argue that a ‘presumption of war-ism’ has distorted debate in the ethics of war: to arrive at a balanced view, we need distinguish two sets of moral questions. First, can the development and maintenance of the means to make war be justified? Second, can the use of those means ever be justified? I sketch some strategies which might be developed in addressing the first question, concentrating on what MSP suggests might be wrong with setting up a war-machine, and with being or employing a soldier. In Section 3 I argue that even if considerations from Section 2 are insufficient to establish that we must dismantle our war-machines, facts about war which conflict with MSP do establish that we must never use them.     

The Dialectics of Relational Psychoanalysis and Group Psychotherapy: Commentary on Paper by Robert Grossmark

In this commentary, I address the question of why so few psychoanalysts become group therapists as I respond to the thoughtful and impressive paper written by Robert Grossmark on his work with a psychotherapy group, now in its 10th year of meeting. Prior to discussing the clinical material, and to set the stage for a discussion of Grossmark's work, I comment on my sense of the prevailing attitudes on group affiliations and group therapy within our culture and field as they have progressed over time. I then discuss my reactions to Grossmark's handling of his group session. Many of his conceptualizations of group treatment are in accordance with my own beliefs. There are some differences, however, in how I view my role as a leader and some ideas I have about group treatment that Grossmark did not address.     

Between Realism and Relativism: Moral Certainty as a Third Option

This paper is an attempt to lay out a meta-ethical position that is inspired by the framework of Wittgenstein's later philosophy. To achieve this goal, this paper is divided into two parts. First, I explore recent attempts to tie Wittgenstein's epistemology in On Certainty to moral epistemology. I argue that there can be a meaningful parallel drawn between the epistemic certainties discussed in On Certainty and what I consider to be moral certainties. These moral certainties are unjustified fundamental moral attitudes that underlie our moral practices. Then, I show how the debate over moral certainty has branched into two directions. One direction presents the concept of moral certainty as a naturalistic concept. On this reading, moral certainties transcend time and place since they are rooted in our natural tendencies to act or not act in certain ways. The other direction presents moral certainty as a distinctly relativistic concept. On this reading, we have our moral certainties because we belong to communities that agree on these certainties. In the second section, I argue that we have both natural, universal certainties and localized, relative certainties. I also argue that our localized certainties are constrained by non-moral facts about ourselves and about the world. To make this argument, I rely on Wittgenstein's concept of “general facts of nature.” The result of the paper is a meta-ethical position that can be located in between moral relativism and moral realism.     

Broken Bounds: Contemporary reflections on the antisocial tendency

When embarking on research into the effectiveness of psychoanalytic psychotherapy in the NHS or the application of psychoanalytic principles, researchers come up against a number of hurdles: many clinicians still see empirical research as antithetical or disruptive to the practice of psychoanalytic psychotherapy; psychoanalytic psychotherapy has previously fared poorly in evidence-based policy guidelines and this can discourage ambition, and there are technical problems of research design, measurement and standardization. Nevertheless, in a political climate which stresses service evaluation, measurable outcomes and empirical evidence, psychoanalytic psychotherapy must participate to survive. There may be gains from conducting research beyond simply meeting the requirement to provide evidence of effectiveness. Research may be viewed by some clinicians as an unwelcome intruder but it may have the potential to offer triangulation, the perspective of the ‘third’, and so strengthen the foundations of clinical practice and the development of psychoanalytic thought.     

Manualizing psychotherapy: Aaron T. Beck and the origins of Cognitive Therapy of Depression

Abstract

This paper examines the origins of psychiatrist Aaron T. Beck’s 1979 Cognitive Therapy of Depression (CTOD). CTOD was the first psychotherapy manual designed to be used in a randomized controlled trial (RCT). Making psychotherapy amenable to the RCT design had been a ‘holy grail’ for leading American psychotherapy researchers since the late 1960s. Beck’s CTOD – which standardized his treatment so it could be compared with drug treatments in a clinical trial – delivered that holy grail, and ushered in the manualized treatment revolution. Manuals are now a sine qua non in psychotherapy research. In this paper, I explore some of the personal, political, and economic variables that made the idea of a manual irresistible to Beck and to those who first championed him.     

Self-Regulatory Dysfunctions in Personality Disorders: The Role of Poor Self-Monitoring and Mindreading

To understand how persons self-regulate, we need, as Cervone, Shadel, Smith, and Fiori (2006 ) assert, to refer to personality science, with which it is possible to identify the multifarious psychological elements and processes helping or hindering action programming, overcoming difficulties, and error correction. Personality disorder research and personality science itself demonstrate that dysfunctions in two skills—self-monitoring and mindreading—worsen self-regulation and lead individuals to fail chronically to achieve goals in the social domain. Here we describe how poor self-reflection and biased mindreading impair self-regulation in personality disorders and other clinical conditions and make some suggestions about how to tackle them in psychotherapy.     

Psychotherapy with compulsively striving professional women 1: Introducing the patient group

In this paper I develop a profile of compulsively striving professional women with whom I have found myself working in private psychotherapy practice. I put them into a developmental, systemic and cultural context, and suggest a theoretical perspective. In a subsequent article (‘Clinical issues’) I shall describe the challenge they present from a clinical point of view and how these difficulties might be addressed in individual psychotherapy.     

The challenges and future of applied Islamic ethics discourse: a radical reform?

In this paper, I explore the concept of applied Islamic ethics, the facts, its challenges, and its future. I aim to highlight some of the deep-rooted issues that Muslims have faced historically and continue to experience today as they apply religious guidance to their daily lives. I consider the causes and rationale behind the current situation and look beyond to suggest ways in which this may evolve, calling for a radical reform. Muslims throughout the world are experiencing a deepening crisis of identity and confusion about their faith's principles and practices. I suggest how improvements might be achieved, in order to gain more coherence and understanding. This approach recognizes the importance of inviting an in-depth, deliberate analysis of relevant dialogues between religious experts of the text (scholars) and practitioners, those working at the grassroots. This approach remains faithful to the fundamental principles of the Islamic sources but also considers our present context. I recommend a shift in authority from scholars alone to a more inclusive, critical engagement of practitioners. Through this more comprehensive methodology of applied Islamic ethics, I suggest that Muslim communities, organizations, and individuals can remain faithful to their religious principles while, at the same time, actively participating in and contributing to our evolving societies. While I recognize that this will be a long process, I am confident that with applied Islamic ethics, the current feelings of confusion, self-doubt, and even apathy, given the previous failed processes of adaptation and reform, will give way to a new confidence in knowing how to address contemporary challenges.     

Considering methodological integrity in counselling and psychotherapy research

Within the field of counselling and psychotherapy research, qualitative methods have been a longstanding tradition of inquiry due to the mutual interest of therapists and researchers in both internal experiences and intersubjective processes. Methodological integrity is a conceptual framework that has been advanced to increase the rigor of these methods. In this paper, we consider the value of this concept for counselling and psychotherapy researchers and reviewers. This framework guides investigators and reviewers to consider how procedures can be adapted to meet the goals of specific studies, given their characteristics and approach to inquiry. In this brief article, we exemplify the relevance and application of this concept to this field by describing the decision‐making process within the designing of a qualitative research project to investigate clients' needs within rape crisis counselling. Through this exemplar, we also provide guidance to counselling and psychotherapy researchers on considerations during the process of research review and reporting.