The Closing of a Ward: A Group Experience

The potential for psychotherapy in a large-group format has been discussed since the 1960s. Day treatment programs provide optimal support for such groups. One program type, which has maintained large-group psychotherapy as a central feature for over twenty years, is described. Essential features include an integrated therapeutic team, with clearly defined leadership, that is open to examination of its own process. Such groups may not only provide effective therapy, but are also readily amenable for teaching and research in psychotherapy.     

Activity/nonactivity and the group therapist: “Don't just do something,sit there”

The abstinent stance of psychoanalytically-oriented clinicians is often confused with passivity or coldness toward the patient or the group. Given the current move toward more active, shorter-term treatment, this paper offers a reaffirmation of the value of the abstinent analytic stance. The theoretical rationale for the technique is reviewed, and some specific arguments are made to illustrate the continuing importance of the method in the treatment of patients in psychodynamic group psychotherapy.Reputed to be Adlai Stevenson's advice to President John F. Kennedy during the Cuban Missile Crisis.     

Using the prospective approach as an adjunct to established models of group psychotherapy

Four models of group therapy-psychoanalytic, psychodynamic, cognitive-behavioral, and existential-are discussed. Three features of these models are compared: the therapist's role, the establishment of a therapeutic alliance, and the working through of conflict. Despite their advantages, each of these models has certain limitations. Techniques derived from the prospective principles of caregiver-infant interaction may help overcome these limitations, resulting in additional insight about the relational patterns of the group members. This prospective approach supplements established models by facilitating a more rapid identification of latent conflict, as well as easing the working-through phase and the transition from conflict to a conflict-free state. In addition, the prospective approach promotes the integration of diverse models of group psychotherapy.     

Mentalization-Based Interventions in Child Psychiatry and Youth Protection Services I: Objectives,Setting, General Principles and Strategies

ABSTRACT

Many of the children who receive services in child psychiatry or are in the care of Youth Protection Services present with complex, multiple and often severe problems. Classic psychodynamic psychotherapy seems to be of little benefit to them. The majority of these children tend to not use symbolic play as a means of expressing their intrapsychic conflicts or relational difficulties and they do not verbally communicate much with clinicians. They are more likely to display an imaginative poverty that translates into boredom, motor discharge, and an inability to use the material put at their disposal for therapeutic purposes. The systematic and rigorous observations of these children in Quebec revealed that the majority of them present with severe mentalizing difficulties. They often show attitudes and behaviors linked to the prementalizing modes of psychic functioning. This article presents a mentalization-based intervention adapted to these children’s difficulties. The objectives, adaptation of the work setting, and general principles underlying this intervention are discussed. In addition, general intervention strategies are also covered. These interventions are considered as preparatory work whose principal purpose is to enable children to benefit later on from psychodynamic psychotherapy. The authors also recommend specific intervention strategies adapted to children’s predominant mode of psychic functioning. The details of these strategies will be shared in a separate article.     

A Psychodynamic Treatment for Severe Personality Disorders: Issues in Treatment Development

We describe a psychodynamic treatment modified for patients with severe personality disorders identified as borderline personality disorder in DSM-IV, Axis II, and understood as borderline personality organization from a psychoanalytic perspective. This treatment is labeled transference-focused psychotherapy (TFP) in order to highlight the centrality of working with these patients in the here-and-now treatment interaction. The empirical development of TFP is described, including the generation of a treatment manual, the utility of various methods to teach the treatment, and preliminary data on efficacy. The latest step in the development of this treatment is an ongoing randomized clinical trial comparing the efficacy of TFP to a cognitive-behavioral and a supportive treatment.     

Integration of problem-oriented and mystery-centered approaches in existential psychotherapy

Existential psychotherapy can be understood as a treatment orientation directed towards helping the client discover, actualize and honor the meanings and meaning potentials in life. In this article, the authors outline the problem-oriented and the mystery-centered elements of existential treatment and how these two components of existential treatment are both poles of a relationship of tension and complimentary to each other. The article further explores treatment activities, treatment goals, assessment activities and the treatment relationship as these notions are understood in both the problem-oriented and the mystery-centered aspects of existential psychotherapy.     

Premature termination: A risk in eating disorder groups

This study examines the influence of combined vs. conjoint psychotherapy on the phenomenon of premature termination in eating disorder groups. Thirty-eight women with a diagnosis of anorexia nervosa or bulimia enrolled in group psychotherapy were designated as group completers or premature terminators using individually defined treatment objectives. Those eating disorder patients in combined group and individual psychotherapy showed a lower frequency of premature termination than patients in conjoint group and individual psychotherapy.     

Pete the diesel: Psychotherapy with a severely disturbed five-year-old boy

The psychic significance of the figure of the grandmother in psychodynamic psychotherapy has received scant attention. This paper develops the concept of the ‘grandmaternal transference’ in parent–infant psychotherapy and explores its identification, its possible functions and its therapeutic significance. The grandmaternal transference has special relevance to parent–infant psychotherapy since the grandmother often represents both the mother’s mother and the child’s grandmother and offers a unique third position between mother and child. Three clinical vignettes illustrate how the grandmaternal transference may operate in this third position. In the first vignette, the therapist becomes in the transference a containing grandmother thereby facilitating maternal containment. In the second case, the therapist may be experienced as a differentiating grandmother able to help mother and infant with separation and individuation. In the third one, the therapist is transferentially experienced as a paternal grandmother who acts as a pseudo-father able to embody the paternal function. In each of these positions, the transference and countertransference – whether positive or negative – require that the therapist responds to rather than enacts the grandmaternal role. The three configurations of the grandmaternal transference have different clinical manifestations and offer different therapeutic ports of entry.     

Expression and interpretation of emotions in multilingual psychotherapy: A literature review

This review aimed at presenting the findings of 19 original studies that were published in the period from 2000 to 2022 in order to outline the current state of the art in the field of emotion communication (i.e., expressing and interpreting emotions) in multilingual psychotherapy. This analysis involves in particular the studies that investigate multilingual phenomena (e.g., code-switching and language-mixing) that occur during psychotherapeutic sessions when client and therapist can speak more than one language, as well as the articles that research emotion communication in this multilingual setting. With this in mind, the articles selected for this review are divided into two main categories: linguistic phenomena in multilingual psychotherapy and emotion communication in multilingual psychotherapy. Results of the studies in the current analysis reveal that code-switching remains one of the main linguistic phenomena that arises in the area of multilingual psychotherapy. Switching languages in therapy tends to be considered as beneficial for both client and therapist. Besides, findings suggest a connection between speaking L1/LX and one's identity (e.g., feeling different depending on the language). Additionally, studies that investigate emotion communication in multilingual psychotherapy show that an individual's first language (L1) is predominantly viewed as more emotionally charged than their language(s) learned later in life (LX). However, some studies also demonstrate that the relationship between L1 and LX is more fluid and context-dependent than it has traditionally been regarded. Propositions are given for future research in the field of emotion communication in multilingual psychotherapy.     

A systematic review of the effectiveness of psychoanalysis,psychoanalytic and psychodynamic psychotherapy with adults with intellectual and developmental disabilities: progress and challenges

Objectives: This systematic review aimed to critically appraise the literature on the efficacy and effectiveness of psychoanalysis, psychoanalytic and psychodynamic psychotherapy in adults with intellectual and developmental disabilities (IDD). Method: A systematic search of electronic databases was carried out. The methodological quality of the studies was assessed using a quality assessment tool and comparisons were made with a review of the quality of research on the effectiveness of cognitive behavioural therapy (CBT) for people with IDD. Results: The search yielded 13 papers which provided evidence for the effectiveness but not efficacy of psychoanalytic and psychodynamic psychotherapy; but none were found for psychoanalysis. The quality of the research was generally poor compared to the current research on the effectiveness of CBT. Conclusions: Positive outcomes have been indicated for psychoanalytic and psychodynamic psychotherapy with people with IDD. Larger scale, more controlled research is necessary to advance the evidence base.     

Time-Limited Dynamic Psychotherapy as a Model for Short-Term Inpatient Groups

The present article proposes a method, practiced by the author, to adapt time-limited dynamic psychotherapy (TLDP), a short-term individual psychodynamic therapy, for use with inpatient psychotherapy groups. Characteristics of TLDP which suggest the usefulness of such an adaptation, including short-term duration, specific treatment focus, rapid conceptualizations and broad selection of patients, and emphasis on the here-and-now in therapy, are discussed. The general approach to treatment, a supportive stance that involves an identification of maladaptive interpersonal issues, and then working on these issues without directly confronting the patients, is described. Specific therapeutic techniques for common inpatient group situations are also discussed.     

Special Aspects of Countertransference in Analytic Group Psychotherapy

The structure of health care delivery is in a period of rapid change. An understanding of psychotherapy service use patterns indicates the importance of time categories as well as the relevance of group techniques. Traditional interpersonal and psychodynamic group techniques may be modified for time-limited use without sacrificing basic values and with demonstrated effectiveness. Adapting to a more fiscally stringent practice environment requires the clinician to undertake a difficult process of transition. As professionals our task is to prepare ourselves for this challenge and to let the health care system know that proper practice guidelines are necessary to achieve effective treatment for our patients.     

Clients' Experiences of Obstructive Silence: Integrating Conscious Reports and Analytic Theories

The psychodynamic literature has associated clients' silences in psychotherapy sessions with a variety of processes. These processes include wishes to merge with the therapist, to gain control in session, to communicate the unsayable, to express helplessness and, most frequently, the intertwined processes of resistance and regression. Experiences of obstructive silence—that is, moments in which clients detached from the process of therapeutic inquiry—were examined in this study. A grounded theory analysis was used to explore clients' experiences of silences in psychotherapy across psychotherapeutic modalities. Two types of obstructive pausing processes, Disengaged pauses and Interactional pauses, were identified. The implications of delineating conscious aspects of these complex experiences are stressed and techniques are suggested for therapeutic intervention in moments of experienced threat.     

Behandlungskrisen ambulanter Psychotherapien aus der Sicht einer Krisenstation

The purpose of the following study is to identify characteristics of the clinical treatment of patients who came into a crisis during an out-patient psychotherapy and were admitted to a crisis intervention ward. Most of the patients particularly reacted to a disruption of the treatment process as a result of conflicts in their relationship with their therapists. By means of a psychodynamic short diagnostics these conflicts were elucidated although they were often hidden and had to be traced back to their origins in the therapeutic relationship. Moreover, the authors describe their therapeutic focus on the conflict-solution-oriented short-term psychotherapy of the disruption of the therapeutic bond between patient and therapist which leads to a fixation of the setting. The in-patient crisis intervention aims at preparing the patients to continue the out-patient psychotherapy.     

Post natal depression,the mother's conflict and parent – infant psychotherapy

This paper sets out to consider a psychodynamic approach to postnatal depression. In particular, it examines the advantages of psychodynamic parent?–?infant psychotherapy both as a treatment model, and also as a way of thinking that can help to formulate a theory of the postnatal period. An illustration is provided in the clinical account of the therapy of a couple and their nine-week-old infant. The author draws on this example, and on findings from psychoanalytic theory, infancy research, evolutionary biology and anthropology to suggest an integrated understanding of the postnatal state of mind and its challenges.     

Supervising Integrative Psychotherapy in the 21st Century: Pressing Needs,Impressing Possibilities

Supervisors and teachers who are interested in advancing integrative psychotherapy in the 21st century have the dual task of surveying the range of treatment approaches that have been developed and distilling these approaches down to a manageable number of influences that have been found to have the greatest impact on clinical practice over time. It has been proposed that there are four bona fide schools of psychotherapy that would be most useful for comprehensive training and supervision that would contribute to either (a) case conceptualization or (b) the process of clinical interviewing: psychodynamic psychotherapy; cognitive-behavioral psychotherapy; family systems therapy; and, humanistic/client-centered therapy. The goal for such broadly based clinical instruction would be for students, trainees, and interns to have an ability to provide a multi-level case conceptualization for any of the psychotherapy cases for which they are providing treatment. Thorough instruction in clinical reasoning and decision-making in this type of multi-level case formulation can provide some of the most valuable tools for novice and experienced clinicians alike.