A Cognitive-Behavioural Treatment Programme for Conduct Disorder: The Case of Tumeleng

This article presents a case study of a teenager with conduct disorder (CD) using a cognitive-behavioural treatment programme for anger and aggression. Unique features of the case included comorbid expressive language disorder and a history of multiple traumatic brain injuries, and a Tswana (Botswana) ethnic/cultural background. Indications for successful treatment were the participant's intrinsic motivation to change and be accepted by his peers, and his good memory. Factors that contraindicated successful treatment were the absence of his parents, due to his attending boarding school and comorbidity. The case provides evidence for the efficacy of cognitive behavioral therapy (CBT) for CD in an adolescent of a Tswana background with comorbid expressive language disorder and history of multiple head injuries.     

Family Secrets: The Case of the Patient Kept in the Dark

The author examines the position of a child from whom important matters in his or her own life or key events in the family have been kept secret, outlines criteria by which the decision whether or not to unveil the secret should be made, and urges colleagues to gather more data and examine further family secrets.     

Öst's (2008) methodological comparison of clinical trials of acceptance and commitment therapy versus cognitive behavior therapy: Matching Apples with Oranges?

Öst (2008) recently compared the methodological rigor of studies of acceptance and commitment therapy (ACT) and traditional cognitive behavior therapy (CBT). He concluded that the ACT studies had more methodological deficiencies, and thus the treatment did not qualify as an “empirically supported treatment.” Although Öst noted several important limitations that should be carefully considered when evaluating early ACT research, his attempt to devise an empirical matching strategy by creating a comparison sample of CBT studies to bolster his conclusions was itself problematic. The samples were clearly mismatched in terms of the populations being treated, leading to differences in study design and methodology. Furthermore, reanalysis showed clear differences in grant support favoring CBT compared with ACT studies that were not reported in the original article. Given the actual mismatch between the samples, Öst's methodological ratings are difficult to interpret and provide little useful information beyond what could already be gathered by a qualitative review of ACT study limitations. Such limitations are characteristic of the earlier randomized controlled trials of any emerging psychotherapeutic approach.     

The driver whose heart was full of sand: Leigh's story - a play therapy case study of a bereaved child

This paper describes the therapeutic journey of Leigh (not his real name), a nine-year-old boy who was referred for play therapy due to the death of his 15-year-old brother. The play therapy was offered through a joint project called 'Playing through Loss' and run jointly between a UK university and the local branch of a national bereavement organisation. The project was set up to offer play therapy to bereaved children in the local area. Leigh had eight sessions of therapy and this paper describes the major themes of his play and makes some preliminary explorations of the meaning the play may have had for him. Interestingly some of his play focused on a computer game called 'Zelda' and an exploration of the powerfulness of this as a therapeutic tool is also explored. The therapist's theoretic orientation is described along with her perceived role as 'loyal companion'. Finally, the process by which Leigh worked with his loss is discussed.     

Fostering a safe atmosphere: A first step in discussing gender in family therapy training programs

Several important aspects of raising gender issues in family therapy training programs have been identified in the last few years. However, an important first step has often not been made explicit: the need to establish an open and safe environment in which these issues can be discussed. Such a safe environment can be developed by using theoretical perspectives with which family therapy students and faculty are already familiar. This paper offers three theoretical perspectives as examples and makes suggestions for facilitating an atmosphere that is conducive to discussing gender issues.The author wishes to thank Dr. Fred P. Piercy for his helpful comments and contributions to this paper.     

Balint's Influence on Contemporary Psychoanalytic Theory and Practice

Invited by the Psychoanalytic Psychotherapy Study Center in New York to lecture on my book Michael Balint: Le renouveau de l'Ecole de Budapest, Toulouse, Erès 2000, I first gave my personal and analytic motivations for writing this book. Then I stressed Balint's original contributions to analytical theory and practice: the object relation combined with the theory of instinct, the development of the infant, adolescent and even of old age, the basic fault, archaic defenses (such as ocnophilia and philobatism), as well as his idea about analytic treatment with its phases of regression and "new beginning". His style and his discretion in treatment and mainly the responsibility he recommended to the analysts seem to me very important not to forget. I have shown him as Ferenczi's heir and how he continued his work. His clinical approach and his style are evoked to alert contemporary analysts--who sometimes just know his method to train general practitioners through the Balint group--that they have been influenced unbeknown to them.     

Introduction to the Beck Commemorative Special Feature

My father, Aaron Beck (“Tim” to those closest to him), would have been proud of this special issue of Cognitive and Behavioral Practice, and so honored. Anyone who knew my father, knew he was a scientist at heart. His curiosity, intelligence, and humility made him a great scientist and a productive researcher. This introduction shares a personal perspective and context for his contributions, including his lifelong commitment to enhancing the evidence for cognitive and behavioral practice.     

SPONTANEOUS “CURES”: NORMAN REIDER'S FORGOTTEN PAPER,PART II

Part I of this paper combined an introduction to Norman Reider's original 1955 paper with a republication of the paper itself. Part II is a discussion of the complexities of a comparison of past and present psychoanalytic literature. The concept of enactment is proposed as one of many possible alternative views in considering Reider's notion of spontaneous “cures.” A careful consideration of these spontaneous cures within the ordinary ups and downs of any psychoanalytic treatment sheds important light on our continuing confusion about how we define the term cure, and therefore about the nature of change during psychoanalytic treatment. This alternative perspective is only one of many plausible ones for present‐day readers. The purpose of this republication is not to propose an explanation for “what really happened” with Reider and his patients; rather, it is to reconsider the fallacy of evaluating his paper outside its historical context and thereby failing to appreciate his courage in presenting what at the time were radical views. Questions about the complexity and confusion regarding cure and change require reexamination of the neglect of epistemology on the part of psychoanalysis in prolonging the confusion about distinguishing psychotherapy and psychoanalysis.     

Phenomenology and Fiction in Dennett

In Consciousness Explained and other works, Daniel Dennett uses the concept of phenomenology (along with his variant, called heterophenomenology) in almost complete disregard of the work of Husserl and his successors in German and French philosophy. Yet it can be argued that many of the most important ideas of Husserl, Merleau-Ponty and others (and not just the idea of intentionality) reappear in Dennett's work in only slightly altered form. In this article I try to show this in two ways, first by talking in a general way about Dennett's phenomenology, and second by examining his treatment of the concept of the self. In both cases I argue that Dennett should have read his Husserl and Merleau-Ponty more carefully, since in the end his (hetero-) phenomenology is methodologically incoherent and suffers from something like a weakness of will. This emerges especially in his use of the notion of fiction.     

SPONTANEOUS REMISSIONS: NORMAN REIDER'S FORGOTTEN PAPER,PART I

Almost sixty years ago, Norman Reider published a paper about spontaneous “remissions” he had observed. He discussed the manner in which psychoanalytic theory provided a way to partially explain these otherwise mysterious remissions or improvements in symptoms, some without benefit of either psychoanalysis or psychotherapy. Especially important were his comments about the negligible role of interpretation or insight in these examples. His conjectures reflected controversies that were current at the time and that remain unsettled. Of special interest is his introduction of some highly original ways to think of applying psychoanalytic ideas to supportive psychotherapy. But few analysts today have heard of this paper. A reconsideration of his paper allows us to be vividly reminded about our enduring and profound confusion about exactly what constitutes a “cure” at all. Spontaneous shifts in the severity of symptoms may be viewed as experiments of nature that we have neglected to investigate as valuable restraints on our immodest therapeutic claims.     

Shepherd Ivory Franz: His contributions to neuropsychology and rehabilitation

Shepherd I. Franz was an important figure in psychology of the last century, and historians of psychology have given recognition to much of his work. However, his experimental work with animals and his pioneer investigations in experimental and clinical neuropsychology have been largely ignored. This article reviews his conceptual, assessment, and treatment contributions, including (1) his pioneering work on the use of learned behavior as a baseline for the study of cerebral ablations, (2) his interest in brain plasticity, (3) his development of comprehensive psychological assessment methods, and (4) his work on the rehabilitation of neurological patients with techniques derived from his animal experiments. His work predated much of what is now part of the conceptual substance of the experimental and clinical neurosciences.     

Relationship Between Homework Completion and Outcome in Cognitive Behaviour Therapy

Homework or between‐session learning has long been considered an essential aspect of effective cognitive behaviour therapy. However, it has received relatively less empirical attention than other components of cognitive behaviour therapy. In general, studies have found that homework completion is predictive of outcome in psychotherapy. However, the amount of homework completed by a patient represents only one aspect of this important therapeutic component. This study investigated both the quantity and the quality of homework completed during a 10‐week group cognitive and behavioural treatment program for anxious and depressed patients. It explored the relationship between various aspects of homework completion and outcomes on several different variables. A total of 94 patients were included in the analysis. It was found that both quantity and quality of homework completed predicted outcome on measures of depression, anxiety and quality of life at post‐treatment and at 1‐month follow‐up. The results were strongest for the amount of homework completed, suggesting that clinicians should encourage patients to complete homework even if the homework content is not entirely accurate. The results of this study highlight the importance of homework as a central part of effective cognitive and behavioural treatment.     

Exposure-based cognitive behavior therapy for anxiety related to asthma: A feasibility study with multivariate baseline design

In the presence of asthma, the risk of having an anxiety disorder is increased twofold. The few trials conducted on cognitive behavior therapy (CBT) for anxiety and asthma have mainly targeted panic disorder, and with mixed results. Experimental laboratory research indicates that increased anxiety may lead to hypervigilance toward asthma. Hence, fear and avoidance associated with increased anxiety due to asthma may be an important treatment target. A treatment that learn participants to differentiate between anxiety and asthma through gradual exposure to situations that risk triggering anxiety for asthma may be a possible avenue. As a first step to investigate this issue further, we developed a 10-week exposure-based CBT protocol for anxiety related to asthma and tested it in six participants using multivariate baseline design with repeated assessments throughout treatment. All participants reported satisfaction with treatment, as well as subjective overall improvement after treatment. Visual analysis, using graphs over each individual's trajectory, as well as potential efficacy on group level analyzing standardized mean change, indicated improvements in important outcomes. We conclude that exposure-based CBT is feasible and may improve anxiety related to asthma. Further investigation under randomized controlled trial conditions is warranted.     

Intensive Outpatient Program Using Prolonged Exposure for Combat-Related PTSD: A Case Study

Although prolonged exposure (PE) has been identified as a first-line treatment for posttraumatic stress disorder (PTSD), research has found that military service members and veterans have smaller reductions in symptom severity compared to civilians. The nature of trauma in a deployed combat setting and the unique complexities of military culture have been proposed as explanations for greater rates of PTSD and poorer treatment response to first-line psychotherapies in military and veteran populations. This paper presents a case study to highlight how a novel, intensive outpatient program utilizing prolonged exposure therapy (IOP-PE) may benefit military personnel with combat-related PTSD. The patient is a Caucasian man in his early 40s seeking treatment for PTSD after more than 10 years of enlisted, active duty military service across two branches and three combat deployments. The IOP-PE includes the standard PE components and eight, nonstandard treatment augmentations tailored for military personnel. In contrast to standard PE, which typically is delivered weekly over several months, IOP-PE consists of 15 daily, 90-minute PE sessions conducted over 3 weeks. The patient demonstrated large reductions on the Clinician-Administered PTSD Scale (28 points) and PTSD Checklist (48 points) by the 6-month posttreatment follow-up point. Findings provide support for conducting further research that determines whether IOP-PE is effective and tolerable in military and veteran populations.     

Psychotherapy with an adolescent boy who refused medical treatment

In this paper we describe psychotherapeutic work carried out in a paediatric hospital to illustrate the important contribution of a psychoanalytically-oriented approach in a hospital context. The work concerns an adolescent boy who had undergone several surgical operations with the result that some of his natural orifices were obstructed and artificial ones had to be created. He was referred to us because he refused pharmacological and rehabilitative treatment necessary prior to further surgery and his eventual recovery. The boy's experience of loss of control of his life and the more primitive anxieties of not feeling safely contained in his physical and psychic skin emerged and were worked through in the psychotherapeutic relationship. The parallel work with medical staff reduced the risk of splitting and acting out by the patient and professionals. The approach adopted enabled this boy to resume his medical treatment and his developmental process.     

HACKER'S COMPLAINT

My goal in writing 'Philosophical Analysis in the Twentieth Century' was to identify and explain the most important achievements of analytic philosophy which every student of the subject should be aware of, as well as those of its failures from which we have the most to learn. I attempted to do this by constructing a history that was itself apiece of analytic philosophy in its emphasis on analysis, reconstruction and criticism of arguments. In rebutting Hacker's critique of it, I explain how my goal shaped my selection of topics, with special reference to the ordinary language period. I correct his misrepresentations of my treatment of the philosophers of this period, I demonstrate his failure to grasp, or understand the significance of, the Kripkean necessary a posteriori, and I reveal the misconceptions in his criticism of my interpretation of the 'Tractatus'.     

Hutcheson on Natural Religion

Recent scholars have examined the important role of English Deism in the formation of a modern naturalistic approach to the study of human religiosity. Despite the volume of important studies of various aspects of his thought, the role of Francis Hutcheson (1694–1746) in this development has been overlooked. The aim of this paper is to show how Hutcheson develops his own account of the origins of religion, consonant with his more well-known theories in aesthetics and moral philosophy, that diverges sharply from the then-prevailing Deist views. Hutcheson pioneers a psychological account of religion that anticipates the work of nineteenth- and twentieth-century scholars in important ways. At the same time, Hutcheson incorporates his account of the origins of religion into an overall vision of human flourishing.     

So Suzie Wants to Become a Counselor

In this article, a father speaks to his college-bound daughter about the field of counseling, her intended major. The father, an experienced counselor, discusses significant others in his life who have had and continue to have a strong influence on his philosophy and practice of counseling. The love that exists between the father and daughter provides the reader with understanding of the most important ingredient in effective counseling.     

Adaptations for Youth

Aaron T. Beck exemplified the clinical scientist, willing to test his hypotheses, and willing to share his experiences and treatment features with others. Assessment and treatment of emotional disorders have been forever improved through the efforts of Aaron T. Beck. Using the psychological treatment of an emotional disorder in youth (i.e., anxiety), this commemorative reflects on how Aaron T. Beck’s clinical strategies have been impactful well beyond his initial focus. As a world-renowned clinical scientist, Beck’s work has influenced multiple fields addressing mental health. As a friend and colleague, Beck was a gentleman and a scholar.     

Otto Rank: beginnings, endings, and current experience

I have traced the theories of Otto Rank as they appeared in his major technical writings. Against this background, I have discussed references to Rank in past and contemporary psychoanalytic literature. This paper describes three important contributions of Rank--his birth trauma theory, leading to his theory of the birth of the self; his emphasis on present experience (forerunner of the current "here-and-now" theory); and his writings about the creative potential of the termination process.