The Linguistic Therapy of Evaluation: A Treatment Plan for Silvia

This paper describes the treatment of a depressed woman, Silvia (I. Caro, 2001), treated with the linguistic therapy of evaluation. The linguistic therapy of evaluation is a type of cognitive psychotherapy developed from the theory of general semantics. The theory and the treatment are based on the use of language and the role this plays in the development of emotional problems such as anxiety and depression. We briefly describe the main conceptual and assessment issues of the therapy and the procedure followed in the case of Silvia. The aim of the therapy is to change patients' evaluations, that is, to help them to develop an extensional orientation instead of an intensional orientation, which is assumed to be at the core of emotional problems. The paper ends with a brief review of the process and outcome research that has demonstrated the efficacy and the clinical process of the linguistic therapy of evaluation.     

Is the Impact of Psychotherapy Processes on Outcomes Already Quacking and Waddling? Comment “A Primer on Psychotherapy Process Research (Pfeifer & Strunk, 2015)”

The article by Pfeifer and Strunk on psychotherapy process research offers a highly thoughtful review on the state of psychotherapy process research in cognitive therapy for depression, and the inherent challenges in establishing causal relationships between process and outcomes. In this commentary, I argue that the goal of internal validity in psychotherapy process research may be unattainable, and possibly unnecessary. Finally, I suggest that psychotherapy process research should shift from “does it affect change?” to “how does it affect change?”, “when does it affect change?”, and “for whom does it affect change?”     

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.     

The Relation of Psychotherapy Integration to the Established Systems of Psychotherapy

That individuals (and groups) have vested interests is part of the nature of the human condition and is captured in the cognitive theoretical concept “personal domain” (Beck, 1976, p. 56). Of relevance to psychotherapy integration (and consistent with this concept), there are some apparent philosophical differences between advocates of psychotherapy integration and those of the major systems of psychotherapy. In the same manner that the various schools of integrative and eclectic psychotherapy compete with one another (Lazarus & Messer, 1991, p. 144), so too do they contend with the established systems. In this article, we present several issues about which the systems of psychotherapy and the integration movement may differ, and we respond to criticisms of cognitive therapy that have been the focus of previous articles in this journal. Finally, we give examples of how those who research and apply the contemporary systems of psychotherapy can, within those systems, explore possibilities for psychotherapy integration. We conclude that there is probably much that the integration movement and the established systems of psychotherapy can offer each other.     

A Primer on Psychotherapy Process Research: A Review of Cognitive Therapy of Depression

Researchers conducting psychotherapy process research aim to understand the process by which efficacious psychotherapies achieve therapeutic benefits. A key challenge in this research is how to maximise what can be learned from naturalistic longitudinal data. We provide a selective overview of research examining the process of change in cognitive therapy of depression. While the efficacy of this treatment is widely recognised, a consensus regarding how the treatment reduces depressive symptoms and provides protection from relapse and recurrence has yet to be reached. We review the current state of the research addressing the process of change in cognitive therapy, highlighting how specific methodological features can be used to better understand the process by which this treatment achieves its effects. We highlight the importance of two key challenges to making causal inferences from a process–outcome relation: (a) establishing the temporal precedence of predictors to outcome variables, and (b) evaluating whether any relations identified could be spurious. We argue that methodologically rigorous studies tend to support key claims of the model underlying cognitive therapy of depression. We conclude by considering future directions. For example, we highlight the importance of efforts to understand patient characteristics that may moderate process–outcome relations and could ultimately prove useful in tailoring treatment to best suit individual patients.     

Why using “consciousness” in psychotherapy? Insight,metacognition and self-consciousness

Since its early development, clinical psychology has questioned the impact of “consciousness” on the determination of human responsibility across psychiatric disorders. In recent years, specific clinical approaches have focused on “consciousness” work that could play a key role in psychotherapy. We focused our research on clinical psychology's consciousness-related concepts of insight, self-consciousness, and metacognition. Insight and metacognition, for example, have prompted increased interest in schizophrenia (SZ), bipolar disorder (BD), and, more recently, borderline personality disorder (BPD) treatments as representative of the latest advances in the cognitive and behavioral therapy field. Here we review cognitive, social, and clinical psychology research measuring “consciousness” in BPD, SZ, and BD, exploring the implications of different conceptualizations of consciousness-like concepts for treatment adherence, symptom evolution, and related aspects of psychotherapy. Our results show the overall relevance of using measures of clinical and cognitive insight, emphasizing the more central role of cognitive insight and metacognition in psychotherapy, as it appears that consciousness can remain useful if understood as a cognitive skill. The inclusion of a conceptualization of self-consciousness is important in order to address the social component of psychotherapy, as it does in biopsychosocial approaches. We discuss the implications of such results for global efficacy, for the relevance of the “consciousness” concept to clinical psychology, and for the potential need to keep operationalizing different conceptualizations of it in psychotherapy. We open the debate on the definition of consciousness to motivational aspects of change and to general considerations of both legal and ethical aspects.     

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.     

Efficacy of the third wave of behavioral therapies: a systematic review and meta-analysis

During the last two decades a number of therapies, under the name of the third wave of cognitive behavior therapy (CBT), have been developed: acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), cognitive behavioral analysis system of psychotherapy (CBASP), functional analytic psychotherapy (FAP), and integrative behavioral couple therapy (IBCT). The purposes of this review article of third wave treatment RCTs were: (1) to describe and review them methodologically, (2) to meta-analytically assess their efficacy, and (3) to evaluate if they currently fulfil the criteria for empirically supported treatments. There are 13 RCTs both in ACT and DBT, 1 in CBASP, 2 in IBCT, and none in FAP. The conclusions that can be drawn are that the third wave treatment RCTs used a research methodology that was significantly less stringent than CBT studies; that the mean effect size was moderate for both ACT and DBT, and that none of the third wave therapies fulfilled the criteria for empirically supported treatments. The article ends with suggestions on how to improve future RCTs to increase the possibility of them becoming empirically supported treatments.     

Innovative Moments in Humanistic Therapy II: Analysis of Change Processes Across the Course of Three Cases of Grief Therapy

The current study is an extension of a complementary investigation examining links between process and outcome within six-session psychotherapies in which three eminent psychotherapists each worked with a bereaved client, using person-centered, existential, and constructivist approaches, respectively. The Innovative Moments Coding System (IMCS) was used in both studies to examine processes of change in the moment-by-moment unfolding of grief therapy. The initial study's findings help inform theory regarding the relevance of humanistic interventions when working with bereaved clients, particularly those that help promote meaning making in the wake of loss. The current investigation extends the original by offering a fine-grained analysis of the progression of innovative moments (IMs) in the context of good-outcome grief therapy, liking specific therapy procedures with positive indicators of client functioning, while providing case illustrations of each therapy dyad. Findings highlight the promise of humanistic approaches in grief therapy, and suggest directions for further research in this area. Implications for future use of the IMCS in psychotherapy process and outcome research are also discussed.     

An exploration of the therapeutic process while using computerised cognitive behaviour therapy

Background: Modern technologies that offer an alternative to face‐to‐face therapy have gained ground in the NHS. Critics have argued that some of the important elements of the therapeutic change process necessarily require a human therapist. Yet, the traditional understanding of the change process in psychotherapy is challenged by evidence that some computerised cognitive behaviour therapy (cCBT) programs may be as effective as face‐to‐face therapy, suggesting that in certain cases the interaction between user and a cCBT product satisfies sufficient criteria for personal change without the need for actual human contact. Aim: This study used the cCBT package Blues Begone as a means of investigating the process by which a computer‐mediated program helped adults with mild depression help themselves. Method: Seven qualitative interviews were conducted with mildly depressed users who had completed Blues Begone in their own homes without any additional human help or support. Findings: Interpretive phenomenological analysis (IPA) was performed with four main themes emerging. These were: the meaningful relationship; shape from confusion; stimulation and empowerment. This study illustrates some of the ways that some depressed users make use of cCBT self help.     

A Cross-Contextual Construction of Clients' Therapeutic Practice

This study demonstrates how gathering data from a different context can significantly change how an object of study may be viewed. Data from a qualitative diary study of psychotherapeutic practice were used to construct a cross-contextual view of psychotherapy. Data about clients’ everyday lives as well as psychotherapy sessions were analyzed. Examples of how extra-therapeutic factors are significant to client change are presented. Six types of extra-therapeutic information sources that clients use to develop their personal stances while in therapy were identified. The case of one client's abundant use of extra-therapeutic sources of information offers a different construction of how psychotherapy works, emphasizing client activities outside sessions. The implications of the study for psychotherapy research are addressed.     

Microphenomena research,intersubjectivity and client as self-healer

This article describes an approach to counselling and psychotherapy which complements dominant discourse approaches to clinical evaluation based on New Public Management systems which underpin the Improved Access to Psychological Therapies scheme within the field of therapy. It is based on an approach to research and practice development which I will call practitioner microphenomena research. In order to demonstrate the method, I will examine an extract from a single case study of a client with major depressive disorder from the point of view of intersubjective theory and a little-known approach to therapy called anthroposophic psychotherapy based on the work of Rudolf Steiner. I will show how the two clinical methods are well suited to examining the microphenomena of practice and can be integrated into a coherent whole. A central feature of the account will be the anthroposophical view about the central importance of our individuality or ‘I’ which has similarities with the Jungian self but is still distinct from it.     

Virtual reality in psychotherapy: review.

Virtual reality (VR) has recently emerged as a potentially effective way to provide general and specialty health care services, and appears poised to enter mainstream psychotherapy delivery. Because VR could be part of the future of clinical psychology, it is critical to all psychotherapists that it be defined broadly. To ensure appropriate development of VR applications, clinicians must have a clear understanding of the opportunities and challenges it will provide in professional practice. This review outlines the current state of clinical research relevant to the development of virtual environments for use in psychotherapy. In particular, the paper focuses its analysis on both actual applications of VR in clinical psychology and how different clinical perspectives can use this approach to improve the process of therapeutic change.     

The construction of emotional experience: State‐related emotional awareness and its application to psychotherapy research and practice

The cognitive–developmental theory of ‘levels of emotional awareness’ (LEA) addresses an individual's capacity to experience and express emotion, a capacity highly relevant to psychotherapy. Previous papers on LEA and psychotherapy addressed the aspect of LEA theory pertaining to the ‘trait’ (i.e. enduring) aspects of an individual's emotional functioning over time. LEA theory also applies to the construction of emotional experience at any given moment, in which levels emerge or disappear in a process of microgenetic construction as a function of arousal and other variables. This state‐related perspective is supported by recent research showing that people vary in their LEA from moment to moment. Momentary changes in LEA correspond to the variations in lived experience that occur in relationships, including the therapy relationship, and provide the context for corrective emotional experiences that promote change. In this paper, the construction of emotional experience at different levels of organisation is discussed separately in relation to clients and therapists. Key phenomena relevant to psychotherapy include the transition from bodily sensations to specific differentiated emotional feelings, the ability to be aware of multiple feelings that may be contradictory or counter‐intuitive, and the appreciation of how complex combinations of feelings may differ in self and other. This perspective adds to the literature on how the integration of emotion and cognition contributes to change in psychotherapy. The clinical and research implications of this perspective are discussed.     

The Nuances of Metaphor Theory for Constructivist Psychotherapy

Constructivist psychotherapy and contemporary metaphor theory, as part of the neighboring fields of psychology and linguistics, share fundamental assumptions rooted in constructivist philosophy. There has been much cross-disciplinary discussion of how our inclination toward metaphors translates into an important meaning-making resource in therapy and other domains of professional practice, such as education. Nevertheless, more reciprocal effort is needed to (a) show practitioners the relevance of nuanced aspects of metaphor theory and linguistic analysis that may evade their attention, and (b) sensitize linguists toward practice-driven factors in their analyses. This article attempts the first of these tasks by identifying and exemplifying four such aspects: (a) source domains at different experiential levels, (b) variable source-target relationships in discourse, (c) metaphorical processes at higher levels of analysis, and (d) discursive and communicative grounding of metaphor. I suggest how they might provide pertinent insights and future directions for interpreting, analyzing, and working with metaphors in psychotherapy.     

创伤性分离症状及其认知研究

创伤性分离是具有心理创伤经历的人常表现出来的典型症状,它包括记忆缺失、幻听、人格解体等,它主要表现在分离性障碍中,在其他精神疾病中也常见,如创伤后应激障碍、精神分裂症等。该文阐释了创伤性心理、创伤性分离的基本概念,介绍了创伤性分离症状的几种理论：人格结构性分离理论,背叛创伤性理论,回避加工假设与警戒-回避假说等。其中人格结构性分离理论主要是以临床治疗为取向,采用EMDR技术,侧重于研究创伤性分离对人格结构产生的影响;而背叛创伤性理论,回避编码假说以及警戒-回避假说是通过认知心理学的研究范式,探讨创伤性分离的症状与记忆。通过对几种理论的比较分析。发现后三种认知理论对创伤性分离症状的解释主要侧重于三个方面,一“是否存在回避警戒”,二“是否存在回避加工”,三“是否存在回避记忆”,而关于这几方面问题发生的条件,还有待于进一步的研究验证