诠释学：心理治疗理论的构建路径与展望

从自然科学和人文精神科学的区别开始,回顾了诠释学的源始与发展过程,尤其与心理科学的相互关系,指出诠释学是心理学的自然科学与精神科学特征之间沟通的桥梁。从心理现象和病理心理现象出发,探讨了西方心理治疗理论构建路径的诠释学特征,结合心理学质性研究方法的解释性,提出诠释学是西方心理治疗理论的构建路径,并从诠释学视角讨论了构建具有中国传统文化特征的心理治疗方法的可能性和可行性。指出心理诠释学的研究可作为心理治疗本土化的哲学基础,同时对诠释学在心理治疗本土化方面的作用进行了展望。

     

Complexity science: A framework for psychotherapy integration

The paradigm of complexity science provides a new way to address the problem of psychotherapy integration and allows us to bypass the various shortcomings of the linear-interventionist perspective. Nine criteria are outlined, which should be satisfied by any integrative approach to psychotherapy: (a) the use of complexity science to provide a meta-theoretical and generic understanding of change processes (from neuronal to social system levels); (b) a comprehensive and formalised modelling of change processes and personality development; (c) an integrative method of case formulation; (d) the ability to understand a variety of techniques in terms of basic change principles; (e) criteria to guide microdecisions; (f) the application of data-driven feedback and real-time monitoring of change dynamics; (g) standardised assessment of outcomes in naturalistic settings; (h) guidelines for training; and (i) strategies that are well-suited to science–practice integration. Using these criteria as a framework for evaluation, one may grasp the potential of complexity science to drive innovation in the pursuit of psychotherapy integration.     

Internal cohesion psychotherapy: The nature,principles and application

Psychotherapy is widely used to treat different mental health disorders and emotional difficulties. The main objective of psychotherapy is to help clients become aware of and have control over their thoughts, moods, feelings and behaviours, as well as create healthy strategies to respond to challenging situations. Since the existing psychotherapy approaches and other methods of treatment are not always effective in treating mental health disorders, there is still space for new approaches to fill this gap. In this paper, we provide information about internal cohesion psychotherapy, which is a new integrative approach. This paper presents a new approach to eclectic psychotherapy, focussing on four detrimental aspects of human functioning through different time perspectives.     

Single session and walk‐in psychotherapy: A descriptive account of the literature

Over the last several decades single session psychotherapy has become a mainstream psychotherapeutic approach. A steadily increasing demand for psychotherapeutic services and a continuous reduction in mental health care resources worldwide are both largely responsible for this development. This paper describes single session psychotherapy and provides a brief review of the relevant literature. Single session psychotherapy delivered in walk‐in settings is also discussed. Therapists who are unfamiliar with single session psychotherapy will find that this paper provides a concise introduction to the essential processes and outcomes of this psychotherapeutic approach.     

Psychosynthesis of the brain and mind: Comments on a new intellectual framework in psychiatry and psychotherapy

Abstract

Eric R. Kandel, the Nobel Prize winner of 2000 in physiology and medicine, emphasises five scientific principles of which psychiatrists must be aware and which are presented and critically analysed in this article. Kandel states that professional requirements for future psychiatrists will impose a greater knowledge of the structure and functioning of the brain, and that the rationale for the unique domain that psychiatry occupies within academic medicine is the analysis and understanding of the interaction between the social and biological determinants of behaviour. The work of a psychotherapist is based both on scientific knowledge and, to a large extent, on an empathic understanding of the patient's history as well as his or her verbal and non-verbal expressions – as a consequence, the orientation of hermeneutic philosophy and semiotics should also be included in the intellectual framework. The aim of this paper is to update the channels of communication between modern neurobiology, psychoanalysis, semiotics and philosophy to the best advantage for their multidisciplinary, holistic cooperation.     

Negotiating ending: A qualitative study of the process of ending psychotherapy

Objectives: When psychotherapy is open-ended, the question of termination is a matter for negotiation. A model based on both content and the process of ending may explain how ‘good enough’ psychotherapies can be brought to ‘good enough’ endings.

Design: Twelve processes of ending were explored through a combination of audio recordings made during therapy sessions and post-therapy interviews with clients and therapists. Therapies had been tailored to the needs of the clients and were based on a broad spectrum of theoretical affiliations.

Methods: A procedure for systematic text condensation was used on a case-by-case basis. Issues surrounding the initiation and negotiation of ending were pointed out in each case and were then compared across cases.

Results: The initiation of ending and exchanges concerned with when and how to end therapy unfolded as a concerted process because both parties seemed to be aware that the theme of ending contained a potential challenge to the alliance. Dual affect regulation, implicit communication and a future-oriented perspective were important features. Structural elements such as schedule changes and temporary breaks served several psychological functions. Therapies seemed to reach ‘good enough’ endings when the client and therapist joined in their efforts to resolve basic ambivalences embedded in the decision to terminate contact with the affirmation of a continuing emotional bond.     

Cultural landscapes in counselling and psychotherapy: Introduction to the Theme Section

The concept of ‘culture’ is gaining in significance within the discourse of counselling and psychotherapy, as a means of making sense of the ways in which shared identities and behaviours are constructed and maintained. The selection of papers included within this Theme Section explore different aspects of the use of the idea of culture within counselling and psychotherapy. In this introductory piece, we seek to place this work in a social and professional context.     

Renunciation of the self in psychotherapy

Self-renunciation or self-denial, although often misunderstood, is a foundational concept in several major religions and is frequently associated with spiritual maturity. In spite of this, the action of self-renunciation has been viewed with suspicion by the psychological community and criticized as repressive. This article argues that the concept of self-denial found in the Sufi tradition of rebirth and the salvation paradox found in the synoptic Gospels can bring a valuable perspective to psychotherapy. First, a brief summary of the history of psychotherapy and its contributions to the understanding of the self are provided. Next, a cursory overview of the Sufi tradition of rebirth is given. Third, the salvation paradox found in the synoptic Gospels is reviewed. It is argued that these two traditions offer valuable insight into ideas surrounding the self. Finally, the clinical implications of self-denial are discussed, and conclusions are drawn related to how psychotherapy can benefit self-renunciation.     

Introduction to the Special Section ‘Innovative counselling and psychotherapy research methods’: Defining the future of counselling and psychotherapy research

In the call for papers for this Special Issue, we sought submissions that would introduce innovative methods with the potential to shape counselling and psychotherapy research into the future. We believe that we accomplished this goal and that this issue introduces a range of valuable examples of current innovations in counselling and psychotherapy research methods. Through the review process, we encouraged authors to offer practical guidelines on how to innovatively assess and analyse change and other relevant aspects of therapy. We also guided authors to not only provide the field with an update on cutting‐edge methodology, but also describe these methods in a practice‐friendly way. As such, the Special Issue aims at becoming a building block for future practice‐friendly research in counselling and psychotherapy.     

Attitudes about psychotherapy: A qualitative study of introductory psychology students who have never been in psychotherapy and the influence of attachment style

Design: Interviews about attitudes about psychotherapy with 12 undergraduate students who had never been in psychotherapy were analysed using consensual qualitative research. Results: Participants believed that the client role is to disclose, be receptive, and be motivated; that the therapist role is to listen, support, and give advice; and that the therapeutic relationship should be close and personal. Participants had ideas about the benefits (a healing therapeutic relationship, personal and interpersonal changes) and the barriers (self‐stigma and public stigma, difficulty revealing, need to solve problems on own, cost) associated with seeking therapy, and they disliked the idea of being diagnosed. In contrast with participants who were securely attached, those who were insecurely attached more often wanted a professional therapeutic relationship, wanted the therapist to ask questions, mentioned fewer benefits to therapy, and thought that they would have difficulty disclosing to a therapist. Discussion: Implications for changing attitudes about psychotherapy and improving training programs for practitioners are discussed.     

Trainee psychotherapy effectiveness at a psychodynamic training clinic: a practice-based study

The degree to which clinical experience is a significant factor in predicting positive psychotherapeutic outcomes is an open question. Empirical studies comparing experienced and beginning practitioners on differences in client outcomes have yielded mixed results. While multiple sources have indicated that trainees are generally effective therapists, few of these studies have examined the effectiveness of graduate-level therapists in a psychodynamic training program. In this study, conducted in the United States, we use a practice-based research approach to examine the outcomes of clients working with trainees at a community mental health clinic in the northeast United States. The theoretical orientation identified by the clinic and training program is psychodynamic with an interpersonal and/or relational emphasis. Results indicated that clients working with trainees at this clinic demonstrated improvement across several indicators of symptoms and psychosocial functioning over the time they received treatment. Implications for training and service reimbursement are discussed.     

Therapist orientation,supervisor match,and therapeutic interventions: Implications for session quality in a psychotherapy training PRN

Background: Theoretical orientation is a multifaceted construct that is integral to the process of psychotherapy and psychotherapy training. While some research has been conducted on personal identification with particular schools of psychotherapy, techniques used in psychotherapy sessions, and match between trainees and supervisors in training, there is insufficient information regarding how these may interact with one another. Aim: This study, conducted in a practice research network of trainee therapists, was designed to test whether these variables may be related to one another in predicting session quality. Method: The sample comprised 328 sessions from 26 clients and 11 therapists, with the clients completing session quality measures and therapists completing measures of technique immediately post‐session. Results: Using multilevel linear modelling, the data showed varied results. For behavioural therapy and person‐centred therapy, techniques and orientation were unrelated to session quality in the sample. However, process‐experiential, psychodynamic, and cognitive therapy techniques were all involved in interactions with therapist and/or supervisor orientations. Conclusions: These results suggest that the impact of specific psychotherapy techniques sometimes depends on the orientation of the therapist and/or supervisor. For instance, sessions high in cognitive therapy techniques were only associated with positive outcome when both the therapist and supervisor were highly cognitively oriented. Though preliminary, these results suggest that orientation may be an important variable to consider in training and supervision, especially in the context of other variables.     

Psychodynamic psychotherapy for children and adolescents: a critical review of the evidence base

For many years psychoanalytic and psychodynamic therapies have been considered to lack a credible evidence-base and have consistently failed to appear in lists of ‘empirically supported treatments’. This study systematically reviews the research evaluating the efficacy and effectiveness of psychodynamic psychotherapy for children and young people. The researchers identified 34 separate studies that met criteria for inclusion, including nine randomised controlled trials. While many of the studies reported are limited by sample size and lack of control groups, the review indicates that there is increasing evidence to suggest the effectiveness of psychoanalytic psychotherapy for children and adolescents. The article aims to provide as complete a picture as possible of the existing evidence base, thereby enabling more refined questions to be asked regarding the nature of the current evidence and gaps requiring further exploration.     

Psychodynamic psychotherapy for children and adolescents: an updated narrative review of the evidence base

While the evidence base for psychodynamic therapy with adults is now quite substantial, there is still a lack of research evaluating the effectiveness of psychodynamic therapies with children and young people. Those studies that have been carried out are also not widely known in the field. To help address the second point, in 2011, we carried out a review of the evidence base for psychodynamic psychotherapy for children and adolescents, which identified 35 studies which together provided some preliminary evidence for this treatment for a range of childhood disorders. The present study is an updated review, focusing on research published between March 2011 and November 2016. During this period, 23 additional studies were published, of which 5 were reports on randomised controlled trials, 3 were quasi-experimental controlled studies and 15 were observational studies. Although most studies covered children with mixed diagnoses, there were a number of studies examining specific diagnostic groups, including children with depression, anxiety and disruptive disorders. whilst the quality of studies was mixed, some were well-designed and reported, and overall indicated promising findings. Nevertheless, further high-quality research is needed in order to better understand the effectiveness of psychodynamic psychotherapy across a range of different disorders, and to ensure that services can provide a range of evidence-based treatments for children and young people.     

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.     

Brief psychodynamic psychotherapy in adolescent depression: Two case studies

In this paper the authors outline the basic principles of a manualized, brief psychodynamic approach that was evaluated as part of an outcome study within the National Health Service researching the effectiveness of two different forms of psychotherapy for major depression in childhood/adolescence: Focused Individual Psychodynamic Psychotherapy and Systems Integrative Family Therapy. As well as describing some of the difficulties encountered in short-term dynamic psychotherapy with adolescents, the authors present therapeutic work with two adolescents with major depressive disorder who were both seen as part of the research study. The authors depict some of the challenges and unavoidable difficulties which emerged during the therapy, arising from the needs of the research programme.