The therapeutic relationship as a paradoxical experience

The therapeutic relationship exists within multiple levels of reality—including that of ordinary life and that of the therapeutic frame. This interplay between these two levels of reality gives rise to paradoxical experiences for both participants. Certain “principles”; or “rules”; of technique can be understood as a means of enabling the therapist to cope with what is usually referred to as “boundary”; issues. It is essential that the analyst or therapist demonstrate capacity to shift playfully from one level of reality to another. The “rule”; of abstinence and the asymmetry of desire that exists between the two participants are discussed. Gratification within the therapeutic frame is paradoxical in that gratification at one level of reality leads to privation at another level of reality. These paradoxical experiences for both patient and analyst are examined in relation to projective identification and to the analyst's countertransference.     

The Crossroads of Countertransference and Attribution Theory: Reinventing Clinical Training within an Evidence-Based Treatment World

Social Psychological research on Person Perception/Attribution Theory has concluded that an individual responds to interpersonal situations based upon their interpretation of the “nature” of that situation. For example, physically attractive people are often attributed niceness and capableness even without any basis in reality. The observer, guided by percepts cum attributions, may treat the attractive participant “as though” these qualities are about them rather than about the observer's internal bias. In psychoanalysis, this social phenomenon takes on individual meaning as countertransference. Therapists seem to experience irrational feelings during the psychotherapy exchange, which remain, whether or not the therapist is conscious of these responses or whether their technical objective includes or ignores their own transference. The attributional tendency to act upon these feelings “as though” they were wholly about the patient may lead to therapeutic disasters. Therefore, clinical training of psychotherapists needs the early inclusion of this concept to prevent subsequent dogmatic and untherapeutic attitudes. This paper will discuss the possibility of disarming the damage rendered by medicalized parsimonious “healing” and the latest fashion, Evidence-Based Treatment, via a translation of assumedly unmeasurable psychoanalytic tenets into multiply measured, investigated areas of social research.     

“I Will Fear no Evil,for I Am with Me”: Mentalization-Oriented Intervention with PTSD Patients. A Case Study

Post traumatic stress disorder (PTSD) patients are described as suffering from a collapse of mentalization—the inability to understand and interpret their own behavior and that of others as emanating from intentional mental states. The present paper proposes an integrative focused intervention, called “traumatic mentalization change”, to improve and strengthen the mentalization abilities of PTSD patients. With the assistance of the therapist, patients learn how to embed their present self-states within their retrieved memories of the traumatic event and thus to change their traumatic narrative. These present selfstate images enrich the patients’ narratives with the emotional needs that were missing during the traumatic event by addressing mistaken attributions regarding these memories. In this way, the traumatic narrative changes, and the devastating selffeelings experienced during the original traumatic event are reduced. We demonstrate this intervention with a case study of a veteran PTSD patient who suffered from PTSD for 10 years after being involved in a terrorist attack. The neuro-clinical and clinical implications are discussed.     

Therapeutic popularity and personality: Association between peer therapist nominations and the “Big Five” personality factors

The “Big Five” personality factors of three groups of psychology students differing in popularity as therapist among their peers were compared (n=33). In agreement with earlier research, popular therapists are “agreeable”, “conscientious” and “stable”. However, popular therapists are not “surgent/extravert” and especially not “dominant” and “talkative”. No support was found for the hypothesis that similarity in “agreeableness” or dissimilarity in “surgency” (the complementarily hypothesis derived from interpersonal theory) predicts therapist popularity. However, similarity between client and therapist in “stability” was predictive of nominations for therapist. On the assumption that therapist popularity predisposes good therapeutic alliances, the results indicate that therapists agreeableness, conscientiousness and emotional stability are relative to success in therapeutic interventions.     

“I’ve got you under my skin”: Relational therapists’ experiences of patients who occupy their inner world

The aim of this study was to conduct an in-depth exploration of therapists’ experiences of patients who affect them more than others and occupy their inner world beyond the context of therapy sessions. A phenomenological analysis was performed on semi-structured interviews with five relational therapists. All the therapists had a strong experience of a particular patient getting “under their skin.” In all these cases, the patient was a traumatized woman. The distinctive characteristic of the phenomenon was a sense of blurred or too permeable boundaries between the therapist and the patient. This was associated with fear and anxiety, but also with feelings of love. The therapists’ reactions to having a patient “under their skin” varied from resistance to symbiotic relatedness. The therapists’ ideas of their professional role influenced how the experience of carrying the patient’s suffering was interpreted. The phenomenon of the patient’s presence in the therapist’s representational world might be interpreted as a distinct countertransference phenomenon when working in a more “thin boundary” manner with particular cases. The therapists’ ability to effectively manage their vulnerabilities, activated in the countertransference, seems to be crucial for therapeutic progress. Implications for research, clinical practice, and training are discussed.     

A Family Therapist for Life: Observations and Options

“Life” is used here in the chronological sense of years spent as a family therapist and in the existential sense of experiencing “life” in terms of satisfaction, meaning, and vitality in one’s living. In the 1950s, there were few guidelines for professionals recognizing the need for working therapeutically with families. Becoming and being a family therapist are discussed, along with lifetime learning about family and tolerance for ambiguity in understanding family and marital relationships and dynamics; flexibility in implementing therapeutic interventions; functioning in ways that fit with one’s personality, beliefs, and principles; working where one functions best; and what works at what stage for the family therapist and relating these to establishing and maintaining “life” in one’s living.     

Filling in the Gaps: False Memories and Partisan Bias

While cognitive psychologists have learned a great deal about people's propensity for constructing and acting on false memories, the connection between false memories and politics remains understudied. If partisan bias guides the adoption of beliefs and colors one's interpretation of new events and information, so too might it prove powerful enough to fabricate memories of political circumstances. Across two studies, we first distinguish false memories from false beliefs and expressive responses; false political memories appear to be genuine and subject to partisan bias. We also examine the political and psychological correlates of false memories. Nearly a third of respondents reported remembering a fabricated or factually altered political event, with many going so far as to convey the circumstances under which they “heard about” the event. False-memory recall is correlated with the strength of partisan attachments, interest in politics, and participation, as well as narcissism, conspiratorial thinking, and cognitive ability.     

Therapie und Theater

Theatre experience serve in drama therapies only as a background for a better understanding of the patients problems, whereas the dialogue between therapy and theatre contributes to the understanding of the process of therapy itself and the secrets of it’s effect. As the actor creates an “empty space” to express himself, so tries a therapist to eliminate all obstructions of understanding. Both dedicate their whole personality to the author respectively to the patient, which requires an enormous amount of humility and responsibility and can be achieved only by a continuous argument with himself. The closeness of profession and personal life is therefore unavoidable, which means various possibilities and impulses but great dangers as well. Therapy and theatre are not to compare with any other interpersonal relationship, for they are trying to achieve changes in the way of feeling, thinking and acting. Whether, on this way, the therapist’s and actor’s real emotional expression is more important than the rational analysis of all emotions or not, is a question often discussed controversially. Just like in a child’s play, it is always about the argument between fantasy and reality and, therefore, about the stimulation and development of the audience’s and the patient’s creativity. Therefore it is of greatest importance for the therapy as for the theatre that the process is immediate, vivid and unforeseen. They are paths towards life, experiencing their purpose and limits through this task.     

Politicizing Survivors of Incest and Sexual Abuse

Abstract

As both a feminist therapist and a survivor of incest, moving myself beyond therapeutic issues into an area of public education has been crucial to my own healing process. Receiving positive responses to my workshops and discussion groups, it became apparent that using a similar approach with clients who were survivors might be beneficial to their healing. As a member of The Counseling Center for Women, a feminist therapy collective in Israel, I suggested we sponsor a public exhibition and a series of programs of the topic of incest and abuse. The Municipality of Tel Aviv was approached to be its governmental sponsor. Entitled “Silent No More,” the program moved therapists and clients from working in the privacy of therapy to a public forum. What began as an uncomplicated educational program became an emotional process and a politicizing of individuals to help others as well as themselves. Moving from a feeling of shame to a sense of empowerment, the exhibition gave us a new sense of self-esteem and strength in our own abilities and our recovery process.     

Sexual Morality: The Cultures and Emotions of Conservatives and Liberals1

Political conservatives and liberals were interviewed about 3 kinds of sexual acts: homosexual sex, unusual forms of masturbation, and consensual incest between an adult brother and sister. Conservatives were more likely to moralize and to condemn these acts, but the differences were concentrated in the homosexual scenarios and were minimal in the incest scenarios. Content analyses reveal that liberals had a narrow moral domain, largely limited to the “ethics of autonomy” (Shweder, Much, Mahapatra, & Park, 1997) while conservatives had a broader and more multifaceted moral domain. Regression analyses show that, for both groups, moral judgments were best predicted by affective reactions, and were not predicted by perceptions of harmfulness. Suggestions for calming the culture wars over homosexuality are discussed.     

Introduction to Group-Analytic Psychotherapy by S. H. Foulkes

This article will explore special leader issues that emerge in psychodynamically oriented therapy groups with adult children of alcoholics. Particular focus will be on countertransference feelings that get stirred up in group leaders and techniques for dealing with some of these special dilemmas. Specific issues include (a) assumption of sameness between the therapist and the patient (the therapist assuming that he or she “understands” because of having also grown up in an alcoholic family); (b) the “will to restore,” which may be destructive when the therapist, whose own self-esteem is dependent on the patient's progress in therapy, forces a “rush to recovery” on the patient; (c) other personal issues in the life of the therapist that may also resonate with experiences of the patient; (d) “countertransference goodness and availability” as it affects therapists' abilities to set reasonable limits on their patients, as well as reasonable expectations for themselves; and (e) special issues regarding therapist transparency and self-disclosure.     

The Powerless Therapist and the Helpless Borderline: Acceptance,Aloneness, and Dyadic Joining

The encounter between therapist and borderline patient brings with it a humbling experience of powerlessness. The therapist or helping agent must confront her or his own feelings of inability to change anything in the patient's mental or material life. With this comes a corresponding reality that the locus of therapeutic action remains very circumscribed indeed. Many therapists, particularly new ones to the field, may feel overwhelmed by anxiety, grief, guilt, and fear, tempting them to jump precipitously into interpretations or thinly veiled advice-giving—or, alternatively, to deflect emotion with hollow “empathic” mirroring. By actively getting in touch with and using his or her experience of powerlessness, however, the therapist can find a way forward that relies on dyadic joining and a more useful conception of the therapist/patient system (whose dynamics, as we will see, are also increasingly clarified thanks to emergent neuroscience findings). Central aspects of this approach have been present since borderline first appeared in the literature, continuing through more recent contributions, notably those of Marsha Linehan and the Dialectical Behavior Therapy (DBT) school.     

Reality Testing and Testing Reality in Group Treatment

This two-part contribution addresses concepts of “reality,” “reality testing,” and “testing reality,” as they apply to group treatment. Part I provided topic overview and focused on reality testing. Part II focuses on testing reality and how it promotes emergence of new or previously inhibited forms of engagement.

Whereas reality testing centers on a particular theme or object, with a goal to define and solve problems, testing reality involves approaching targets of interest without necessarily looking for or coming to definition or clarity. It is wide open, spontaneous, and unbounded, and may take the individual and group into realms that are uncomfortable and even unwanted. Engaging the group and supporting individuals in these two approaches to learning requires a well-defined therapeutic focus on process and purpose; at times, different tactics and techniques are called for.     

Effects of the Gulf War: Identifying dangers to integrity of the psychoanalytic process

This paper deals with aspects of psychoanalytically-oriented psychotherapy taking place during a period of political and dangerous military events in the Gulf War. The situatiOn threatened the physical existence of the civilian population, including the therapist and the patient. Presented are number of potential dangers to the integrity of the therapeutic process. These military-oriented dangers produce in therapists an occasional inability to contain their own feelings. This may lead to therapists' unconscious use of patients for their own intrapsychic needs, and harm their patients. Another source of danger is the vagueness and ambiguity of the objective reality of the outside world. This may disrupt the ability to help the patient differentiate between inner and outer reality. Moreover, discussed are the ways in which therapy may facilitate personal growth in both the therapist and the patient. These external events may also serve to accelerate the course of therapy, as patients identify with their therapist' coping ability. Similarly, therapists may also gain and benefit by perceiving their patients' healthy growth and development.