To Find a Voice

Abstract

This article will present a compilation of case studies that will document the art therapy process utilized to assist incarcerated women with histories of severe trauma in expressing their feelings in an appropriate manner. These case studies will show how art images produced within this therapeutic milieu enabled the women described to reconnect with disowned thoughts, feelings and fantasies in a safe way.     

Trauma-related versus positive involuntary thoughts with and without meta-awareness

In earlier work, we asked subjects to report involuntary thoughts relating to a trauma film and also probed subjects periodically. Subjects often reported involuntary thoughts in response to probes, suggesting they lacked meta-awareness of those thoughts. But it is possible that some or all probe-detected thoughts were continuations of thoughts subjects had spontaneously reported, leading us to overestimate involuntary thoughts lacking meta-awareness. It is also unclear whether failures in meta-awareness occur for other emotional events. We exposed subjects to a negative or positive film. Subsequently, they reported involuntary film-related thoughts and responded to probes that distinguished new from continuing thoughts. Many (54%) but not all probe-caught thoughts were thought continuations. This result supports our earlier finding that people can lack meta-awareness for trauma-related thoughts, but suggests caution in how meta-awareness is assessed. We also found that self-caught negative and positive involuntary thoughts occurred at a similar frequency, with different characteristics.     

Emotion-Focused Therapy for Autism Spectrum Disorder: A Case Conceptualization Model for Trauma-Related Experiences

People with autism spectrum disorder (ASD) report painful experiences through emotional misunderstandings with typically developing peers. There are limited intervention methodologies for ASD on the impact of emotional injuries and how to work with resulting trauma. This paper presents a rational-empirical model of trauma-related experiences with the first presentation of a new case conceptualization model for emotion-focused therapy for ASD. It describes the transformation of problematic emotion schemes through a sequence of emotional processing steps illustrated with a case example. These steps include: overcoming differentiation of core painful feelings (such as loneliness, shame, and fear); autobiographical memory recall of distanced trauma, using a novel method of video Interpersonal Process Recall; and articulation of the unmet needs contained in core painful feelings. This is followed by the expression of an emotional response to those feelings/needs; typically, self-soothing, protective anger and compassion responses offered interpersonally by group members. These emerging adaptive emotions facilitate mentalization of self and other that strengthens intrapersonal and interpersonal agency. This rational-empirical case conceptualization acts as a hypothesis for testing in subsequent trials.     

Internalization of the therapeutic process: differences between borderline and neurotic patients

Intersession process in psychotherapy refers to the thoughts, memories, and feelings about each other and about their therapy sessions that participants experience during the intervals between sessions. This study compared the intersession process experienced by patients who had been diagnosed with severe borderline personality disorders (BPD) with others who had not. A total of 76 patients with neurotic disturbances and 20 patients with BPD were treated in a therapeutic day clinic and completed the Intersession Experience Questionnaire (IEQ) before sessions of individual psychotherapy and the Session Questionnaire (Stundenbogen) after those sessions. Comparison of the two groups on these measures of intersession process and postsession outcome showed markedly different patterns in patients' evaluations and internalizations of in-session therapeutic experiences: most prominently, that BPD patients internalize therapy sessions with much more negative and contradictory emotions.     

Ten Principles for Interpreting Neuroscientific Pronouncements Regarding Human Nature

As the field of brain research continues to advance, much is being discovered about the various aspects of the brain that are associated with certain feelings, thoughts, and behaviors. However, certain studies, or popularized accounts thereof, overreach in their pronouncements, drawing unwarranted conclusions regarding human nature. There are ten principles that will assist the non‐specialist in critically assessing both now and future discoveries reported from the neurosciences, with a focus on helping theologians using neuroscientific data in multidisciplinary work regarding human nature.     

Rebound effects following deliberate thought suppression: does PTSD make a difference?

This study was designed to examine the effects of deliberate suppression of trauma-related thoughts in 44 individuals who were PTSD+ and 26 individuals who were PTSD- following a motor vehicle accident (MVA). In an effort to resolve discrepancies in the literature, the PTSD- group was selected from the same help-seeking population as the patient group. Measures included the percentage of MVA-related thoughts, mood, perceived controllability of thoughts, and physiological arousal (heart rate, skin conductance, and two measures of facial EMG). Contrary to hypothesis, both PTSD+ and PTSD- groups showed a rebound in trauma-related thoughts following deliberate thought suppression. This rebound was associated with increases in negative affect, anxiety, and distress and diminished perceptions of controllability over thoughts. Examination of the physiological measures did not mirror the pattern noted for trauma-related thoughts, although the data suggest that suppression was associated with higher levels of frontalis EMG and possibly, reduced heart rate. The current study indicates that help-seeking individuals who are distressed about their psychological state following a serious MVA will show a rebound in MVA-related thoughts, irrespective of PTSD diagnosis. Implications for the study of thought suppression as a potential maintaining factor for trauma-related problems are discussed, with suggestions for future research.     

Text and Tune,Speaking and Listening: Musical Resources in Pastoral Care

This article examines the power of music to help transform suffering. It draws on insights from the work of music theorist David Schwarz (1997) that bridges psychoanalysis, music, and culture; and from Daniel Levitin’s (2008) work on music and human nature, especially as it pertains to religion, ritual and songs. Schwarz describes listening to music as a process of retrospective fantasy and as a type of transference experience. If how we listen to music is shaped by traces of past experiences, then music as a resource in pastoral care has the potential to assist ministers in the process of guiding their parishioners to re-trace painful experiences in ways that “re-sound” with thoughts and feelings which have become an impediment to healing. A “case study” in which the author was a “player” (or more accurately performer) is briefly examined, and the role of music in the lives of Steve Lopez and Nathaniel Ayers (Lopez 2008) is explored to demonstrate how music—specifically religious music or song associated with religious ritual—is an overlooked resource for pastoral care. The article concludes with an illustration of how individuals’ personal associations with a hymn may have implications for pastoral care.     

Acceptance and Commitment Therapy for Treatment-Resistant Posttraumatic Stress Disorder: A Case Study

An adult woman with chronic posttraumatic stress disorder (PTSD) and major depressive disorder who was nonresponsive to 20 sessions of cognitive behavior therapy (CBT) is presented in this case study. Two months after her CBT trial, she was treated with 21 sessions of Acceptance and Commitment Therapy (ACT) for PTSD. Measurements of PTSD severity, depression, anxiety, psychological flexibility and trauma-related thoughts and beliefs were taken at pretreatment, after Sessions 8 and 16, and at posttreatment. Results showed significant reduction on all measures throughout treatment, except for trauma-related thoughts and beliefs, which did not decrease until near the end of treatment. Strengths, limitations, and future directions are discussed.     

When accuracy hurts, and when it helps: a test of the empathic accuracy model in marital interactions

This study tested predictions from W. Ickes and J. A. Simpson's (1997, 2001) empathic accuracy model. Married couples were videotaped as they tried to resolve a problem in their marriage. Both spouses then viewed a videotape of the interaction, recorded the thoughts and feelings they had at specific time points, and tried to infer their partner's thoughts and feelings. Consistent with the model, when the partner's thoughts and feelings were relationship-threatening (as rated by both the partners and by trained observers), greater empathic accuracy on the part of the perceiver was associated with pre-to-posttest declines in the perceiver's feelings of subjective closeness. The reverse was true when the partner's thoughts and feelings were nonthreatening. Exploratory analyses revealed that these effects were partially mediated through observer ratings of the degree to which partners tried to avoid the discussion issue.     

Resensitizing Men: A Male Perspective

Most of us accept that men are conditioned to behave as though they are always dominant, achieving, tough, and unsentimental and that, as a consequence, they erect elaborate defenses against feelings or thoughts that threaten to negate this self-concept. As therapists we often experience how difficult it is to move men off the cognitive level and info more effective places where they can experience their self-division and alienation. This article encourages counselors to appreciate the threats involved for men in becoming more intimate with themselves. In addition, it suggests some ways to facilitate this process, and pinpoints specific concerns and thoughts that male clients may have as they become more deeply involved in therapy.     

Trajectories and Processes of Symptom Change Over Time in Dialectical Behavior Therapy for Borderline Personality Disorder

Despite ample evidence for Dialectical Behavior Therapy (DBT) as an effective treatment for borderline personality disorder (BPD), close examination of the trajectory of change in BPD symptoms over the course of DBT is lacking. There also remain questions regarding the directionality of changes in different domains of BPD symptoms, such as improvements in dysfunctional behaviors and thoughts/feelings. In order to provide more fine-grained information about the treatment process in DBT, the current study aimed to (a) examine the trajectories of change of BPD-associated negative thoughts/feelings and behaviors, and positive behaviors, and (b) test the temporal relationship between changes in negative behaviors and thoughts/feelings. The study involved 55 adult clients attending a 6-month outpatient DBT program for BPD who completed assessments of BPD symptoms every four sessions. Growth curve models suggested that clients experienced a faster rate of decrease in negative behaviors during the initial phase of treatment, whereas steady rates of improvement were found for negative thoughts/feelings and positive behaviors, respectively, throughout treatment. Further, a random-intercept cross-lagged panel model found that the within-person fluctuations in negative behaviors preceded the within-person changes in negative thoughts/feelings at a subsequent time point during the later phase of treatment, whereas within-person fluctuations in thoughts/feelings were followed by changes in negative behaviors at the beginning and end of the treatment. These results highlighted the complexity of patterns and processes of change in BPD symptomatology during the course of DBT.     

How talking therapists experience working with adult clients who have autism

This research aims to gain new insight by exploring the thoughts, feelings and experiences of therapists working with clients who have autism. Three professional talking therapists participated in the study. Unstructured interviews were conducted and analysed using interpretive phenomenological analysis. Six main themes and 13 sub-themes were found which include therapists’ validation of autism, how therapists integrated autism when addressing mental health problems, how their personal experiences of autism impacted on their work and how they experienced the situation in which autism emerges during the therapy. Helpful suggestions are made for clinicians, namely, to zoom-in and zoom-out of autism, hold the knowledge that people with autism process information differently, incorporate working with trauma, consider disclosing a personal connection to autism and consider carefully whether, or not, to tell a client that they may have autism.     

Healing traumatized children: creating illustrated storybooks in family therapy

In this article we describe the therapeutic practice of creating illustrated storybooks in family therapy with traumatized children. Illustrated stories offer a predictable structure to sessions and facilitate engagement and participation of children in therapy. The therapeutic emphasis of storybooks can be adjusted to take into account a child's life story, verbal capacity, level of anxiety, and traumatic hyperarousal. The creation of storybooks is an active process that embraces important aspects of trauma-specific interventions, including expression of trauma-related feelings; clarification of erroneous beliefs about the self, others, or the traumatic event; and externalization of traumatic stimuli into artwork, allowing for exposure and habituation of the arousal response. A focus on visual images together with narrative takes advantage of children's developmental capacities and spontaneous pleasure in the creation of art, thus minimizing anxiety and enhancing feelings of mastery, competence, and hope. The creation of storybooks is compatible with family interventions that foster a safe family context, strengthen attachment relationships, insure appropriate structure and boundaries, and enhance parenting capacity as well as those interactions that facilitate understanding and dialogue between family members.     

Incorporating Principles from Acceptance and Commitment Therapy into Cognitive-Behavioral Therapy for Insomnia: A Case Example

Although traditional cognitive behavioral treatments for insomnia have demonstrated efficacy for many individuals with primary and comorbid insomnia, not all individuals benefit from treatment and some experience a subsequent relapse of insomnia. Furthermore, many individuals experience difficulty in implementing the sleep restriction and stimulus control strategies, especially over the long-term. The current article describes ways in which principles from a newer type of behavior therapy, Acceptance and Commitment Therapy (ACT), can be integrated with traditional behavioral treatment strategies for insomnia. A major goal of ACT is to increase willingness to experience unpleasant thoughts, feelings, and physical sensations, and to promote engagement in personally-valued behaviors while non-judgmentally observing these unpleasant experiences. ACT has the potential to enhance the behavioral treatment of insomnia by fostering willingness to experience short-term discomfort (e.g., fatigue) that occurs while implementing sleep restriction and stimulus control strategies. A case example is presented to illustrate how these principles from ACT can be integrated with behavioral techniques in the treatment of insomnia.     

Group rational-emotive and cognitive-behavioral therapy.

The theory of rational-emotive therapy (RET) and of cognitive-behavioral therapy (CBT) is briefly explained and is applied to group therapy. It is shown how RET and CBT therapy groups deal with transference, countertransference, levels of group intervention, process versus content orientation, identifying underlying group process themes, here-and-now activation, working with difficult group members, activity levels of therapist and group members, and other group problems. Although they particularly concentrate on people's tendencies to construct and create their own "emotional" difficulties, RET and CBT group procedures fully acknowledge the interactions of human thoughts, feelings, and actions and active-directively employ a variety of cognitive, emotive, and behavioral group therapy techniques.     

Edith Stein’s phenomenology of sensual and emotional empathy

This paper presents and explicates the theory of empathy found in Edith Stein’s early philosophy, notably in the book On the Problem of Empathy, published in 1917, but also by proceeding from complementary thoughts on bodily intentionality and intersubjectivity found in Philosophy of Psychology and the Humanities published in 1922. In these works Stein puts forward an innovative and detailed theory of empathy, which is developed in the framework of a philosophical anthropology involving questions of psychophysical causality, social ontology and moral philosophy. Empathy, according to Stein, is a feeling-based experience of another person’s feeling that develops throughout three successive steps on two interrelated levels. The key to understanding the empathy process á la Stein is to explicate how the steps of empathy are attuned in nature, since the affective qualities provide the energy and logic by way of which the empathy process is not only inaugurated but also proceeds through the three steps and carries meaning on two different levels corresponding to two different types of empathy: sensual and emotional empathy. Stein’s theory has great potential for better understanding and moving beyond some major disagreements found in the contemporary empathy debate regarding, for instance, the relation between perception and simulation, the distinction between what is called low-level and high-level empathy, and the issue of how and in what sense it may be possible to share feelings in the empathy process.     

Belief systems in administration and training

Belief systems are instruments for observing events, classifying information, communicating with others, and doing therapy. A belief system is a combination of feelings, thoughts, actions, and expectations. Belief systems operating in the training environment affect how therapists are able to deal with transference and countertransference. Belief systems must be evaluated in terms of whether they are comprehensive, delusional, absent, sinelusional, and the extent to which they are structuring us. The use of belief systems provides us with an appreciation of our own activities, an instrument for conveying our feelings, and, most importantly, a means for understanding the views of others.     

Racial healthcare disparities: A social psychological analysis

Around the world, members of racial/ethnic minority groups typically experience poorer health than members of racial/ethnic majority groups. The core premise of this chapter is that thoughts, feelings, and behaviours related to race and ethnicity play a critical role in healthcare disparities. Social psychological theories of the origins and consequences of these thoughts, feelings, and behaviours offer critical insights into the processes responsible for these disparities and suggest interventions to address them. We present a multilevel model that explains how societal, intrapersonal, and interpersonal factors can influence ethnic/racial health disparities. We focus our literature review, including our own research, and conceptual analysis at the intrapersonal (the race-related thoughts and feelings of minority patients and non-minority physicians) and interpersonal levels (intergroup processes that affect medical interactions between minority patients and non-minority physicians). At both levels of analysis, we use theories of social categorisation, social identity, contemporary forms of racial bias, stereotype activation, stigma, and other social psychological processes to identify and understand potential causes and processes of health and healthcare disparities. In the final section, we identify theory-based interventions that might reduce ethnic/racial disparities in health and healthcare.     

The manageability of empathic (in)accuracy during couples’ conflict: Relationship-protection or self-protection?

The current study sought to expand upon research on motivated empathic (in)accuracy by testing assumptions underlying the empathic accuracy model, namely if a perceiver’s level of empathic accuracy is variable and might be associated with different outcomes depending the situation. More specifically, the model assumes that (a) the perception of threat in the thoughts/feelings of an interaction partner can result in a lower level of empathic accuracy, and (b) empathic accuracy can both improve and harm situational well-being on the personal and relationship level. These assumptions were tested in a laboratory-based study in which couples participated in a conflict interaction task and reported on their thought processes during a video-review task. All participants also completed a similar standard-stimulus task. A shift in participants’ motivation to be accurate to a motivation to be inaccurate in response to perceived threat could not be detected. Men’s higher levels of empathic accuracy for non-threatening feelings of their female partner were predictive of an increased feeling of closeness in men. Women’s higher levels of empathic accuracy for non-threatening feelings of the male partner were predictive for a better mood in women. A harmful effect of empathic accuracy for threatening thoughts/feelings on situational well-being was not found.