Constructing bridges and systemic connections: In brief dynamic therapy

The author outlines how the conceptual framework which underpins cyclical psychodynamics, a branch of relational psychoanalysis, provides an opportunity for a coherent integration of constructivist CBT principles and techniques and family systems theory within a model of brief dynamic therapy. Drawing upon Wachtel’s articulation of a more flexible notion of the internal world and one in which current interpersonal patterns are seen to shape the psyche and internal conflicts, the author goes on to identify ways in which attending to a client’s behaviour and the ways in which affective experience is expressed interpersonally can open the way to an integration of therapeutic features from constructivist CBT and family systems theory. The contribution that coaching a client in the ways in which they behave interpersonally in the context of both family and workplace relationships can make to therapeutic effectiveness is explored. These themes are illustrated with a case study.     

Liberating narratives and the play of unforbidden pleasures: In brief dynamic therapy

Drawing upon the work of Adam Phillips and Ronald Britton the author highlights the intimidating and fear-inducing nature of the super-ego and the role of the therapist in supporting the judgements of the ego and liberating it from the domination of the super-ego. He goes on to explore the proposition that moral principles do not need to be oppressive in nature and that they can emanate from objects that are more akin to sexual or aesthetic objects. These themes are linked to Woodmansey’s conceptualistion of the punitive and humiliating super-ego, and the origin of the super-ego as an internalisation of an external conflict is outlined. The role of identifying a Cyclical Maladaptive Pattern as a focus and its contribution in identifying the super-ego and how it manifests in the client’s narrative are explored, as well as the crucial contribution of a playful stance on the part of therapist in subverting and undermining the intimidating strictures of the super-ego.     

Training service providers working with traumatized children in South Africa: The navigations of a trainer

In South Africa, counselling training poses two related difficulties: working in a situation of ubiquitous, ongoing violence, and offering training to people who have minimal or no qualifications and are often overwhelmed by enormous workload. In this context, there is a temptation either to give up hope in the face of the enormity of the task, or defensively to package counselling as a set of techniques which can be taught without much self-reflection. In this article we discuss, by contrast, an intervention which used psychodynamic principles to develop learner-centred training drawing on trainees' own experiences. We consider the benefits of this approach even in a context of violence and meagre resources.     

学校心理学专业化

本文扼要介绍由联合国教科文组织和国际教育局于1948年召开的第一次有关学校心理学的会议,此作为学校心理学始倡,以及会议分发给世界各国政府的问卷节要,讨论了学校心理学的不同任务,特别是普通教育系统中特殊教育的随班就读的各项任务。本文还概述了学校心理学在智力甑别、社会适应、教学咨询和职业指导方面的作用;尝试性地提出了以前忽略学校心理学的问题,指出它在我国将来发展的前景。     

Creative restorations: Holding a mirror to the self in brief dynamic therapy

The author outlines the conceptual framework that underpins psychoanalytic self-psychology, describing the function of the selfobject in meeting the need of the child and later the adult for mirroring, idealisation and essential alikeness, and thereby sustaining the coherence of the self within a structure that takes the form of a tension arc. Drawing from more recent elaborations of the need for optimal responsiveness by the selfobject in mirroring the expansiveness of the self, the author proceeds to compare this conceptual framework with that of Winnicott and Wright, who posited the role of mirroring in the development and realisation of the self. The contribution of mirroring to the facilitation of creativity as well as the relationship between the arts and the realisation of the self are explored in the particular context of the counselling of students in the field of the performing arts. The implications of these concepts are further explored in relation to short-term counselling and this is illustrated with a case example.     

Saboteur and superego: The judgement of the ego in brief dynamic therapy

Drawing principally upon the work of Woodmansey the author describes the development of the punitive or humiliating superego as arising from the internalisation of an external conflict, which the child experiences with adult carers, and from whom the child fears retaliatory punishment or scornful reproach. The superego serves the function of extricating the child from the external conflict. Woodmansey’s view of the natural instincts and the development of a moral sense are compared to those of Winnicott, Fairbairn and Guntrip. The notion of a pristine unitary ego and the development of an internal saboteur arising from the frustration of needs for relatedness are outlined and linked conceptually to the development of the punitive superego. The role and judgement of the ego and its emancipation from the superego in accordance with Britton’s formulation are highlighted and related to clinical practice and the alternating transference. These clinical themes are discussed in relation to eliciting affects and narrative construction and deconstruction in brief dynamic work and illustrated by a case example.     

Ripples in the pond: A qualitative study of graduates' perceptions of the impact of counselling training upon their work within the core professions

A small-scale qualitative study was conducted in order to examine the value of counselling training when incorporated into a person's established professional role. Questionnaires were sent to graduates from an MA/diploma in counselling course in order to identify those who had continued working within their core profession. This was followed by in-depth exploration of the issues through a focus group and interviews. Twelve respondents, from a variety of work settings, took part in this second stage. Results indicated that counselling training had impacted on all aspects of their work role and that there can be a benefit of such training in the workplace. Participants developed a tripartite understanding with regard to the self, clients and the organization, and change was experienced in each of these three dimensions. A larger-scale study, among graduates from a number of courses and also among employers, is indicated.     

Worlds within worlds: a strategy for using interpretative phenomenological analysis with focus groups

There is increasing interest in applying interpretative phenomenological analysis (IPA) to focus group data and in developing appropriate strategies for doing so. These strategies should exploit the unique features of focus groups, which provide a rich canvas of experiences not seen in individual interviews, while remaining true to the personal, phenomenological perspective of IPA. We present a four-stage approach with specific group focused analytical strategies: looking for “groupness,” clustering reoccurring group interactions, identifying interactional relationships, and incorporating group elements into an analysis. These stages are illustrated with worked examples developed while working with data from focus groups of women with gynaecological cancer discussing a yoga intervention, and explain how these can enrich our understanding of participants’ lived experiences. This approach demonstrates a suggested framework for developing IPA themes from focus group data by analysing and interpreting the group setting. We discuss links to psychological concepts, potential applications and limitations. This empirically based methodology is presented as a practical guide for other researchers grappling with this type of data.     

Researching a client's experience of preconceptions of therapy - A discourse analysis

This paper uses discourse analysis to look at clients' preconceptions of therapy, through the presentation of a case study. Further findings suggest that discourse analysis may be a useful approach to helping psychotherapists and counsellors as part of their practice.     

Owning evaluation: Revaluing clinical work in a university context

This paper draws on the experience of a year-long evaluation project in a university counselling service. The author considers some reasons for practitioners' reluctance to undertake formal evaluation, but suggests their confidence in clinical work may be enhanced if ambivalence can be explored. The paper discusses the impact of organizational culture on such ventures and considers what conditions might promote their success.     

Personal responsibility,empowerment and medical utilization: a theoretical framework for considering counselling and offset costs

The problem of effectively managing patients with functional somatic symptoms remains huge in both primary and hospital care, although the potential benefits of mental health interventions such as counselling or psychotherapy are still not widely accepted. Unfortunately, the cost-effective evaluation of counselling has been beset by methodological problems, which stem from attempting to make comparisons between counsellors with different types of training, therapeutic approach and case mix. Since these real-world variations in counselling practice are likely to remain, it is proposed that a different approach to the evaluation of cost-effectiveness should be adopted in the hope of accelerating acceptance of the value of psychological interventions for the army of patients who are currently labelled as ‘difficult’ or ‘heartsink’ and who do not receive the treatment they deserve from the health-care services. It is proposed that, since the common aim of almost all mental health interventions is to engender or enhance a sense of ‘personal responsibility’ in patients/clients, this core objective should form an agreed ‘yardstick’ against which to evaluate the impact of various mental health interventions. Furthermore, since personal responsibility and future health-care utilization (and associated costs) can be assumed to be directly causally related, it is proposed that offset costs should form the basis for future cost-effectiveness evaluations.     

The multi-level approach: a road map for couples therapy

This paper presents a multi-level framework and road map to guide the therapeutic process. Starting with the couple's reactive pattern, the multi-level approach first orients the therapist on how to create a "holding environment." It then suggests how the therapist, in collaboration with the couple, can proceed to explore interactional, sociocultural/ organizational, intrapsychic, and intergenerational processes that might be fueling the couple's dynamics. Central to this approach is the construct of the vulnerability cycle, a nexus of integration that helps the therapist stay anchored while moving through the many layers of therapeutic work. The overall goal is to help the partners move from reactivity to responsibility for their own feelings and behavior; from impasse to a greater ability to reflect, express feelings, listen, negotiate, and make choices about how to be in the relationship. This paper describes a range of concepts and interventions from basic to complex; it is intended as an organizational tool for practice and clinical training.     

Counselling asylum seekers and refugees: a study of Kurds in early and later stages of exile

This study explores the experience of asylum seekers and refugees in early and later phases of exile. Twenty-five Kurds (mainly asylum seekers) were interviewed in Greece in early phases of exile and twenty Kurds (mainly refugees) in later phases of exile in the UK. Refugee camps in Greece and community centres in London were the main locations for these interviews. Representatives from eight support organizations were also interviewed in each country. The multidimensional aspects of being a refugee are discussed, including models of formulating the experience, PTSD and the cross-cultural context. Key findings of the study include the desperate need among the asylum seekers and refugees, in the early phases, to have the story of their traumatic journey to Greece witnessed and validated by an outsider; the differing experiences of men and women; a change in identity over time; and considerable fear, which was evident in early and later phases. Moreover, all the support organizations expressed pronounced frustration but responded to it in different ways. Those organizations with supervision and support groups in place demonstrated more insight into their interactions with asylum seekers and refugees. Counselling approaches are evaluated with reference to the asylum seekers' and refugees' needs, and the desirability of adequate support for those with a counselling role is highlighted.     

The dynamic relationship between performance feedback, trust, and conflict in groups: A longitudinal study

Moderate task conflict has generally been associated with higher group performance, and relationship conflict associated with lower performance. Past studies have most often discussed their findings as though differences in level of intragroup conflict cause differences in group performance—rather than testing the additional possibility that reported group conflict is a reaction to feedback on past group performance. This paper explores the dynamic relationships between intragroup conflict and performance with a longitudinal design. Results from 67 groups suggest that initial performance feedback to groups can have significant consequences for future team interaction. We find evidence to suggest that, (a) negative initial group performance feedback results in later increases in both task and relationship conflict, but that (b) groups with high early intragroup trust are buffered from experiencing the worst of future relationship conflict.     

Solution-focused brief therapy: a review of the outcome research

Solution-focused brief therapy (SFBT) is a new and increasingly used therapeutic approach that focuses on helping clients construct solutions rather than solve problems. The approach evolved in a clinical context amid many anecdotal reports of success from both therapists and clients, but it has not been subjected to controlled empirical testing until very recently. In this article we critically review all of the controlled outcome studies of SFBT to date (N = 15) to assess the extent to which SFBT has received empirical support. Five studies were well-controlled and all showed positive outcomes--four found SFBT to be better than no treatment or standard institutional services, and one found SFBT to be comparable to a known intervention: Interpersonal Psychotherapy for Depression (IPT). Findings from the remaining 10 studies, which we consider moderately or poorly controlled, were consistent with a hypothesis of SFBT effectiveness. We conclude that the 15 studies provide preliminary support for the efficacy of SFBT but do not permit a definitive conclusion. Our critique highlights areas where methodology in future studies can be strengthened to provide more conclusive evidence of SFBT efficacy.     

In focus. Life after BioethicsLine: a reply to Joyce Plaza

The recent closure and removal of BioethicsLine led many researchers to wonder where to turn for their research needs. Joyce Plaza wrote that the closure is a mistake. In this essay I maintain, contra Plaza, that due to its cross-disciplinary nature researchers can find bioethics literature in other databases. In developing the search strategy the researcher needs to consider what the problem is about. If the researcher has a philosophical approach in mind, a wise choice would be to use Philosopher's Index; a legal approach suggests using Academic Universe, Westlaw, Lexis or legal databases freely available through state and federal websites. Further, in so far as the National Library of Medicine is integrating citations in BioethicsLine into the NLM Gateway databases (PubMed and LOCATORplus) I point out suggestions on using the latter databases effectively. There is a wealth of information readily available and researchers have much to learn by trying the alternatives.