Three modes of psychotherapy and their requisite core skills

The field of psychotherapy suffers from the lack of an integrative meta‐perspective on the large variety of existing psychotherapies and on the therapeutic skills involved. In the present paper, it is suggested that the development of a more comprehensive view of this field may be facilitated if we differentiate between three modes of psychotherapy, which require different therapeutic core skills: (a) an educational mode, which requires teaching skills; (b) a reparative mode, which requires analytic‐conceptualising skills to identify some kind of disordered functioning, in combination with specific relational‐technical skills to repair this dysfunction; and (c) a developmental mode, which involves engaging in a therapeutic relationship with patients to facilitate their personal growth, and which requires non‐directivity skills. In addition, some therapeutic skills (e.g., awareness and communication skills) may be more or less important in all modes of treatment. Concrete manifestations of the three different modes of psychotherapy are discussed in terms of five different theoretical perspectives on psychotherapy: the common factors, the humanistic‐experiential mindfulness cognitive‐behavioural (CBT) and psychodynamic perspective. The common factors model is criticised as being insufficient in several respects. Finally, it is argued that if personal therapeutic skills are essential to the effects of psychotherapy, then empirical research on psychotherapy needs to be re‐oriented towards a person‐oriented study of therapist skills in action, in the context of a study of the interaction between therapist and patient.     

Towards an Italian model of therapeutic community

In this paper the author reflects on research undertaken by the Association Myth and Reality in the context of the psychiatric reforms in Italy which resulted in the closure of the asylums and the organisation, over the last 20?years, of a network of services in the community. These include thousands of residential units operating on a rehabilitative model. The focus of this paper is on the concept of the therapeutic community as a dynamic evolutionary path, individually tailored to people with different diagnoses and different ages – e.g. psychosis; borderline; adolescents and children. The therapeutic – and more specifically the environmental – factors are presented here. This includes the aesthetics of living and the sensory/emotional climate in relation to the care of the self and protection, regulation and safety, transitional playful climate, everyday life and the sharing implicit in relationships. The emotional climate is a fundamental component that transverses and intersects all the other factors. Treatment is central to the group with its potential for containment and dynamism in relation to relationships, cohesion, belonging, integration of the self in the community and connections with social networks outside the group aimed at reintegration into society of the resident as a citizen. A system of evaluation through peer reviews between therapeutic communities in Italy is being built in order to continuously improve the quality of service delivery.     

The therapeutic alliance: Adolescent perspectives

This paper presents a conceptualisation of the therapeutic alliance from the adolescent perspective and discusses implications for practitioners. The main aim of the study was to focus on the factors that participants identified as important in relationship formation and maintenance. Eighteen individuals were interviewed using a semi‐structured format. Three major themes were identified: therapeutic environment, uniqueness of the therapeutic relationship, and therapist characteristics. Participants identified both positive and negative aspects of the therapeutic relationship. A strong alliance was found to be necessary in that the perception of the therapist as accepting, supportive and trustworthy influenced the adolescent's evaluation of the appropriateness of therapeutic tasks and goals. Participants stressed the importance of the supportive nature of the relationship in their willingness to collaborate in therapeutic interventions.     

The Value of Research Methods in Psychotherapy Research: A Reply to the Commentary of Dr Norton

Norton's commentary on our article has prompted us to think further about the purpose of psychotherapy research. We agree with his suggestion that researchers have much work to do to understand when and for whom interventions are most efficacious. We hope that our field will make progress in this regard. In this reply, we further describe why we believe careful attention to research methods, such as those highlighted in our article, is key to making progress in psychotherapy research.     

“The Parallel Dialogue”: Parental experience of their role in the relationship with their child's counsellor/psychotherapist

The parent–therapist relationship is a central consideration in child counselling and psychotherapy, particularly in private practice where parents are typically financially, emotionally and practically invested in the process. The relationship, which can be ambiguous and anxiety-laden on both sides, has historically received scant attention in therapeutic discourse, leading to gaps in practitioner confidence and training. In this context, and seeking to centre parent voices, this study provides an interpretative phenomenological analysis of four mothers' experiences of their role in the relationship with their child's therapist. Key identified themes encompass parental expectation of involvement; the destabilising, disorienting nature of the relationship; the centrality of trust; and critical evaluations of value. Findings are discussed in relation to attachment theory and cultural expectations of parental responsibility. The study concludes that the relationship is a live and potent property with potential to impact the course of the intervention, and recommends that practitioners thoughtfully consider the potential benefits and drawbacks of meeting or frustrating parental involvement expectations.     

Ways to independence

Much research attests to the beneficial effects of equine interventions on physical development and ability. However, less is known about the possible psychological benefits of horse activities, such as therapeutic riding or interactions with horses. Although there is public consensus that horses can have psychological benefits, it is an under-researched area and conclusions are largely based on anecdotal data. The little empirical evidence that is available about the efficacy of equine-assisted interventions on psychological outcomes tends to be mixed and is often difficult to interpret due to the lack of rigorous research designs. The purpose of this review was to examine the current state of the literature regarding the psychological effects of equine-assisted interventions, and to make recommendations for future research. Findings from this review suggest that equine-assisted interventions hold much promise, particularly in terms of child/adolescent social and behavioural issues, and perhaps adult affective disorders. However, the current state of the literature does not allow us to definitively conclude that equine-assisted interventions are efficacious. Well-designed randomised controlled trials are greatly needed in this area, as it is an appreciation of the need to standardise and document equine-assisted interventions and outcomes in future research.     

对一名受虐男孩的箱庭治疗

本研究采用个案研究法,对一名13岁受虐男孩（小N）实施了25次的箱庭治疗,研究了该儿童箱庭治疗过程的特点及箱庭疗法的治疗效果。结果发现：个案的箱庭治疗经历了问题呈现、自我调适、对抗斗争和问题解决四个阶段;箱庭治疗过程中,个案所使用的玩具数量及种类从贫乏单一转向丰富多样;经过箱庭治疗,个案的抑郁、焦虑情绪得以较大缓解,自我意识得到提高,同伴关系显著改善,学业成绩也得到较大提高。     

The Therapeutic Community Sing: Music Therapy Inpatient Group Process

Early psychoanalytic authors and music educators in both Europe and the United States pointed to the contemporary use of music therapy as a powerful modality in an inpatient psychiatric unit. The inpatient community sing is discussed in its capacity to address both individual and group goals. A clinical vignette from such a group is presented and discussed.     

Exploring the meaning in meaningful coincidences: An interpretative phenomenological analysis of synchronicity in therapy

Synchronicity experiences (SEs) are defined as psychologically meaningful connections between inner events (e.g. thought, dream or vision) and one or more external events occurring simultaneously or at a future point in time. There has been limited systematic research that has investigated the phenomenology of SEs in therapy. This study aimed to redress this by exploring the process and nature of such experiences from the perspective of the practitioner. Semi-structured face-to-face interviews were conducted with a purposive sample of nine practitioners who reported SEs in their therapeutic sessions (three counsellors, three psychologists and three psychotherapists), and focused on how participants make sense of their experiences of synchronicity in therapy. Interpretative phenomenological analysis was used to identify three superordinate themes: sense of connectedness, therapeutic process, and professional issues. Findings suggest that SEs can serve to strengthen the therapeutic relationship and are perceived as useful harbingers of information about the therapeutic process, as well as being a means of overcoming communication difficulties, as they are seen to provide insights into the client’s experiencing of themselves and others, regardless of whether or not the SE is acknowledged by the client or disclosed by the therapist.     

促进当事人的改变：基于治疗性最近发展区的视角

作为心理治疗的有效区域,治疗性最近发展区是指当事人当前适应问题经验的能力和通过治疗师的协助能够达成的潜在能力之间的距离。早期的同化模型理论更注重对心理治疗改变过程的描述,治疗性最近发展区理论则能够进一步解释治疗师在不同阶段的帮助策略。在研究上,治疗性最近发展区理论建立在非传统的方法论基础上,通过不断累积个案的质性研究,帮助治疗师理解和解释不同咨询效果的互动过程,并使理论得到持续发展;在临床上,治疗性最近发展区为理解心理治疗过程中倒退现象提供了新视角,并能够有效指导在治疗过程中采取挑战性还是支持性策略。未来研究可从临床上探索经验丰富的治疗师的实践智慧,也可选取较大跨度的治疗对话序列,对不同流派的特点,从不同参与者的视角出发进行研究,进而深化对心理治疗过程机制的理解。     

疼痛治疗方法在晚期癌痛病人中的应用

癌症是当今严重威胁人类健康和生命的疾病之一。解除癌症疼痛对改善晚期癌症患者的生存质量、延长生存期都具有十分重要的意义。癌痛的诊断和合理的疼痛评估是治疗癌痛的基础。癌症疼痛的治疗方法虽有多种,但其目的就是使用最佳方法解除患者痛苦,消除疼痛,从而提高生存质量。因此本文从科学的角度对晚期癌痛的治疗方法进行评价和阐述。     

Self-criticism and the therapeutic relationship

The relationship between self-criticism and the therapeutic alliance was examined in 169 clients attending counselling in a community clinic. Self-criticism was associated with lower client ratings of the working alliance, suggesting that clients with higher self-criticism had greater difficulties establishing and maintaining a therapeutic alliance. These findings extend previous studies on the working alliance and self-criticism from highly controlled clinical studies to a more ecologically valid community mental health setting. Regression analyses were conducted to examine the mediating effect of additional factors on the relationship between self-criticism and the working alliance. Sensitivity to a perceived subordinate role in therapy did not impact the working alliance, although a general resistance to subordination was related to self-criticism. Implications for counselling self-critical clients are discussed.     

The morning (mourning) minyan: Group therapeutic aspects

Group therapeutic benefits may be provided by the performance of religiously prescribed ritualistic activities in an emotionally supportive group environment. This brief paper describes the author’s experience of group therapeutic benefit from an early morning prayer meeting, particularly from the ritualistic act of Kaddish recitation in a group setting, for his own mourning experience following the death of his mother.     

A Two-Systems Approach to the Treatment of a Disturbed Adolescent

Abstract

This article is based upon die rich conceptual and technical framework for understanding and treating sadomasochistic psycho-pathology presented by the Novicks (this volume). Specifically, the Novicks' “two-systems” approach to self-regulation is applied to the treatment of a disturbed adolescent boy. Examples of “open” and “closed” functioning are presented as well as the role of underlying defensive omnipotent beliefs and fantasies. The clinical utility of this model, the pivotal role of the therapeutic alliance, and the significance of clinical work with the family through all stages of the treatment process are illustrated.     

Conscious and Unconscious Use of Self: The Evolution of a Process

Recent emphasis has been placed on the central role of the therapeutic relationship in successful treatment. One aspect of the development of an effective relationship is the clinical social worker's use of self. We argue that the use of self happens both consciously and unconsciously and is a dynamic and evolving process in psychotherapy. This evolution can result in the clinical social worker shifting from a stance of doing to being. Drawing from a Japanese tradition of learning, three stages of learning provide a framework for understanding how therapists may transition from a state of doing to being in the therapy. Through this process, the conscious use of self may develop into unconscious use of self. Two case examples demonstrate how expanding and using one's self-awareness and the new knowledge through meaningful learning experiences can shift a clinical social worker's ability to develop and enhance his or her use of self, inviting therapeutic presence and depth.     

Factors Associated with Therapeutic Approaches Among Norwegian Occupational Therapists: An Exploratory Study

According to the Intentional Relationship Model, the use of therapeutic approaches tailored to individual clients’ needs is essential for building therapeutic relationships. This study investigated factors associated with occupational therapists’ preferred therapeutic approaches. One hundred eight occupational therapists were recruited as a convenience sample, and the data were analyzed with linear regressions. Mental health as the field of practice was associated with a stronger preference for use of empathy. More job satisfaction was associated with stronger preference for the instructing mode. Empathy appears to be more commonly used in mental health practice, whereas instructing may be linked with job satisfaction.     

The pregnant therapist and the psychotic client: A phenomenological understanding of the impact of the therapist’s pregnancy on the therapeutic process

This original paper examines the underresearched area of therapist pregnancy. It explores the impact of psychosis as an additional complicating factor to the therapeutic process and the experience of one British counselling psychologist working in the National Health Service whilst pregnant. Five brief client summaries/clinical examples are presented to explore the common themes of anger, rejection, abandonment and envy that often emerge following the disclosure of a therapist’s pregnancy or the opposite reactions of over-protectiveness and an unwillingness to engage in therapy for fear of harming the therapist. Recommendations are made for further research within this neglected area and the need to incorporate the themes within training for therapists and training for supervisors.