Group Psychotherapy in the Context of Cultural Diversity

The authors review the salient issues involved in therapy with culturally diverse populations. They present a framework where group therapy addresses those issues. Clinical vignettes from each of the authors serve to illustrate the power of group therapy with ethnocultural populations.     

文化心理学视域下的心理治疗

近年来,心理治疗的文化取向日益为心理学界所关注。在概要分析文化心理学理论取向和传统心理治疗特点的基础上,重点对文化心理学取向下的心理病因观、医患关系、心理治疗方法、心理治疗效果评价观做了相应分析,并对未来文化取向下的心理治疗理论进行了展望,希望对我国心理治疗理论和实践有所帮助。     

Psychoanalytic Psychotherapy for Severely Disturbed Borderline Patients: Observations on the Supervision Group of Psychotherapists

The authors describe the role of a supervision group of psychotherapists within a wider therapeutic field for severely disturbed borderline patients. The group concentrates on the transference and countertransference, seen according to Racker’s distinction between concordant and complementary identifications. The implications of the prevalence of the complementary identifications over the concordant identifications of the therapists to their patients and the resulting regression to primitive defense mechanisms can be counterbalanced by the group’s integrative functioning as receiver (1) of a variety of information about the patient, (2) of the therapist’s attempt to understand and synthesize, and (3) of the therapist’s countertransference reactions to his patient. The major discrepancies between the various conceptions of the borderline patients’ psychic world and the appropriate therapeutic technique to be applied are also discussed, as well as the way the group filters the information and integrates the therapeutic thought. It might be said, therefore, that, in the “inpatient” phase of the individual psychotherapy, the group of psychotherapists functions, for the patient and the treatment, in a synthesizing context, as it provides the therapist with a space of integration for his split-off part of self and object representations, which the therapist makes use of for his patient.*Members of the Athens University Project for Borderline Patients’ research team consisting of psychoanalysts and psychotherapists, Eginition Hospital, 74 Vas Sophias Avenue, Athens 11528, Greece.Maria Chatziandreou, M.D., is a member of the Hellenic Psychoanalytical Society.Haris Tsani, M.D., is a candidate of the Hellenic Psychoanalytical Society.Nikos Lamnidis, M.D., is a candidate of the Hellenic Psychoanalytical Society.Claire Synodinou, Ph.D., is a member of the Paris Psychoanalytical Society and an associate professor at Panteion University, Athens.Grigoris Vaslamatzis, M.D., is a training analyst of the Hellenic Society of Psychoanalytic Psychotherapy and an associate professor of psychiatry at Athens University.Address correspondence to: Maria Chatziandreou, M.D., 1-3, Skippi Street, 11525 Athens, Greece.     

Challenges in Developing a Cultural Evidence‐Based Psychotherapy in the USA: Suggestions for International Studies

In this article, we underscore some of the cultural challenges and limitations of the evidence‐based psychotherapy (EBP) utilised within the USA with the hope that these problems will be avoided or ameliorated in Australia and other countries. Although the EBP research is very diverse and complex, we categorise this fast‐growing literature using a threefold classification system that underscores culture. This classification system is proposed to examine the influence of culture on EBPs. The three categories used are (a) universal evidence‐based psychotherapies or universal psychotherapies, (b) race and ethnic minority evidence‐based psychotherapies or racial/ethnic psychotherapies, and (c) cultural evidence‐based psychotherapies or cultural psychotherapies. After each category is described, its benefits and limitations are discussed, emphasising implications for culturally diverse and international studies. We conclude with suggestions to promote the advancement of a more effective and inclusive cultural EBP in which researchers from different countries can collaborate and learn from each other.     

Psyche and System: On Progress in the Integration of Individual Psychotherapy and Family Psychotherapy

This article addresses the frequency with which the same group of patients utilizes individual and family therapies, and at the same time do not constitute actual integration. The conditions under which such serial or concurrent utilization of the two forms of psychotherapy may be considered to be integrative are discussed.     

Factors That Predict Premature Termination Among Mexican-American Children in Outpatient Psychotherapy

The role of demographic variables, acculturation, and therapy attitudes and expectations in predicting treatment dropout for Mexican-American families who presented for mental health treatment for a young child at a community mental health center was examined. Univariate analyses indicated that less educated parents who felt that they should be able to overcome their child's mental health problems on their own, and who felt that emotional and behavioral problems should be handled by increasing discipline were more likely to terminate prematurely. In addition, parents who perceived more barriers to treatment and expected their child to recover quickly were more likely to drop out of treatment after attending just one session. Measures of household income, acculturation, therapist–client ethnic match, perceptions of stigma, and expectations of therapist directiveness were not related to treatment dropout. When multivariate analyses were examined, parental education, perceived barriers to treatment, and belief in increased discipline remained significant predictors of treatment dropout, and client–therapist ethnic match became a significant predictor of dropout. Results are discussed in terms of implications for culturally-sensitive interventions.     

Theoretical Orientation and Therapists' Attitudes to Important Components of Therapy: A Study Based on the Valuable Elements in Psychotherapy Questionnaire

The authors describe the inception and subsequent testing of a questionnaire on attitudes regarding how psychotherapy ought to be pursued: the Valuable Elements in Psychotherapy Questionnaire (VEP-Q). A sample of 416 Swedish therapists (161 psychodynamic, 93 cognitive, 95 cognitive behavioral, and 67 integrative/eclectic) responded to the 17-item VEP-Q. A factor analysis of these items resulted in three subscales: PDT, CBT, and Common Factor, as validated by analyses of covariance. The internal consistency and test–retest reliability of the scales were excellent. In addition to theoretical orientation, variables such as gender and basic professional training influenced how respondents answered the VEP-Q. The authors conclude that the VEP-Q seems to be an appropriate instrument for describing similarities as well as differences among practitioners of various schools of psychotherapy.     

Toward Holistic,Compassionate, Professional Care: Using a Cultural Lens to Examine the Practice of Contemporary Psychotherapy in the West*

The author describes work undertaken in New Delhi with two young Indian women and their families from 1995 to 1999. Both presented with depression and suicidal ideation. One was severely cerebral palsied, the other was diagnosed with endogenous depression. As an integrative therapist, the author looks at her work from several perspectives. The debates highlighted here focus on the optimal usefulness of each of these perspectives in different situations, both the benefits and the limits and the very limits of contemporary psychotherapy itself. The author uses a cultural lens to explore the use of the self of the therapist and issues around boundaries, continuity, ethics, and compassion in psychotherapy.*Part of this work has been published in N. Hutnik (1999). An unusual intervention: Disability and abuse. Psychological Foundations - The Journa1, 1, 81–84, and is reproduced here with the permission of Psychological Foundations, New Delhi.**My heartfelt thanks are offered to Reenee Singh, friend of many years and very competent family therapist, who offered me her comments on an earlier draft of this paper.     

悟践疗法与中国心理治疗本土化

中国心理学家在心理治疗本土化方面进行了许多尝试,其中开本土化之先河的是悟践疗法。从悟践疗法的发展可以了解在不同社会历史背景下中国心理治疗本土化的早期特征。悟践疗法的人性主义理论是中国心理治疗本土化的理论产物,强调人性是由生物性、心理性和社会性三方面融合的全方位、全息的整体。悟践疗法的认知与行为的有机结合是中国心理治疗本土化的实践特色。理论和实践证明:悟践疗法具有承前启后、与时俱进的历史和现实意义。     

Psychotherapy among children and teenagers in the republic of Georgia

Psychotherapy was conducted with 103 children and teenagers. Medical checkups and physiological evaluations were performed along with analyses of family relations and social environments. Problems discovered were multifarious and can be classified as those owing to age, those resulting from the Georgian lifestyle (the traditional Georgian family consists of several generations living together and provides the basic structure for the development and maturation of youth), and those that had emerged in the previous 3 years as a result of a hostile social environment. Perinatal pathology (pathological pregnancy, complicated delivery, asphyxia, and prematurity) was revealed in 30% of the cases. Psychotherapy resulted in stable psychological balance in 42% of the cases.     

神经美学视角的审美愉悦加工机制

审美对象特有的刺激属性会唤起观赏者特定的情绪或情感反应。个体在欣赏自然、艺术品和其他人类作品时会产生审美愉悦体验。审美愉悦-兴趣模型(PIA)认为, 审美愉悦体验包含审美过程中自动化加工阶段的审美愉悦和控制加工阶段的审美兴趣。近年来, 神经美学研究表明, 负责愉悦和奖赏的眶额叶皮层在审美过程中广泛激活, 是自动化加工阶段初级审美愉悦奖赏的神经基础, 而审美过程中纹状体亚回路中不同的连接和功能作用与两个阶段中审美愉悦的产生都有关联; 上述结果支持了审美愉悦-兴趣模型。但审美高峰体验时默认模式网络(DMN)相关脑区的激活和负责控制与理性思维的外侧前额叶皮层等脑区的失活, 提示在PIA模型强调的自动化加工阶段审美愉悦和控制加工阶段审美兴趣之上, 还有整合升华阶段的审美沉浸愉悦, PIA模型需得到进一步的扩展。未来研究应进一步检验审美愉悦认知加工模型及神经机制, 探索审美对创造力的影响机制和神经基础, 探讨不同审美经验愉悦机制的异同。     

The Role of the Therapist's Subjectivity: Using Countertransference in Psychotherapy

No abstract available for this article.     

Attitudes about psychotherapy: A qualitative study of introductory psychology students who have never been in psychotherapy and the influence of attachment style

Design: Interviews about attitudes about psychotherapy with 12 undergraduate students who had never been in psychotherapy were analysed using consensual qualitative research. Results: Participants believed that the client role is to disclose, be receptive, and be motivated; that the therapist role is to listen, support, and give advice; and that the therapeutic relationship should be close and personal. Participants had ideas about the benefits (a healing therapeutic relationship, personal and interpersonal changes) and the barriers (self‐stigma and public stigma, difficulty revealing, need to solve problems on own, cost) associated with seeking therapy, and they disliked the idea of being diagnosed. In contrast with participants who were securely attached, those who were insecurely attached more often wanted a professional therapeutic relationship, wanted the therapist to ask questions, mentioned fewer benefits to therapy, and thought that they would have difficulty disclosing to a therapist. Discussion: Implications for changing attitudes about psychotherapy and improving training programs for practitioners are discussed.     

Margolis Looks at the Arts

This paper examines the early aesthetic writings of Joseph Margolis from the late 1950s to the mid-1960s in order to argue for the relevance of these works in understanding Margolis’s later, more well-known views in the philosophy of art. Specifically, the paper addresses Margolis’s early essays on the definition and ontology of art and aesthetic perception. These essays not only show Margolis engaged in the most significant debates in mid-century analytic aesthetics but also provide important indications of the limitations of that approach to thinking about the arts that informs the development of Margolis’s later cultural realism.     

Self Psychology, Dreams and Group Psychotherapy: Working in the Playspace

This paper presents one leadership style within a self-psychological approach to working with dreams in group psychotherapy. It stresses an empathic attunement, the creation of safety, and an experience-near playful relationship. Playful is not used lightly here. It is used in the spirit of Winnicott's intermediate space where a mother suspends questions of what is real or not real and what is me and not me. Freud's analogy to a playspace forms a metaphor for the creation of a special atmosphere in a group, or for that matter in individual work as well, that encourages exploration, risk taking, and vulnerability. Working with dreams in this playspace deepens the curative process, not only for the dreamer, but for the entire group.     

Definitional and Research Issues in the Common Factors Approach to Psychotherapy Integration: Misconceptions, Clarifications, and Proposals

This paper focuses on two common misconceptions of common factors in therapy. The first misconception entails the confusion between common factors and therapeutic factors, and thus the inappropriate and misleading use of the term therapeutic common factors in various situations. The second misconception is the mixing of commonalities of different kinds and levels in proposed lists and studies of common factors. These areas are discussed and clarified, and recommendations designed to facilitate conceptual and methodological improvements relative to each misconception are offered. The selection of best levels and kinds of common factors to be studied are further explored (i.e., the study of client change events and antecedent therapist behaviors across different therapies), and specific proposals for their research are outlined.     

矛盾分析法在心血管疾病心理治疗中的应用

随着我国人口老龄化趋势的加快,心血管疾病患病率、病死率不断上升,并往往伴随异常的心理状态,在传统治疗基础上辅以心理干预,将会改善患者的生活质量和预后。矛盾分析法是运用对立统一规律,观察、分析社会现象,应贯穿于心血管疾病心理治疗的全部过程。     

试析后现代心理学影响下的心理治疗与咨询

后现代心理学强调心理现象的建构特性和心理学知识的文化相对性。后现代背景下的心理治疗和咨询接受社会建构主义的认识论主张,认为病理心理是语言的社会建构,并没有客观的意义。所有的治疗和咨询理论都是一种“建构”或“叙事”,而不是所谓的“真理”。承认这一点,将有助于在后现代多元化的基础上,实现各种治疗和咨询理论的整合。     

Too close for comfort: the challenges of engaging with sexuality in work with adolescents

This paper explores some of the ways in which sexuality can intrude into the psychotherapeutic relationship and present both opportunities and risks to our work with adolescents. It highlights some of the complexities of this area of the clinical encounter, exploring the particular difficulties encountered by both patient and therapist when sexuality emerges in the transference and countertransference. While we are well aware of the centrality of sexual development during adolescence, far less has been written about the way in which sexuality and the erotic transference emerges and impacts on both patient and therapist. Given the profoundly unsettling nature of this area of work and its capacity to disrupt our thinking and psychic equilibrium, it is easy to underestimate how much we are drawn to avoid, negate and defend ourselves against registering such experiences. Through the discussion of clinical material with two adolescent patients, this paper explores some of these dynamics, addressing some of the technical dilemmas that frequently challenge us in this area of work. These include questions about whether and when it is therapeutically important and effective to take up and interpret the emergence of sexuality more directly in the transference and some of the risks to our patients when we ‘play safe’ and fail to do so. Most importantly, this paper aims to facilitate further thinking and discussion about an important but uncomfortable and easily neglected area of our work.