Notes from Along the Way

This article looks at the theme of "Intimate Autonomy" as it relates to the Gestalt therapy concept of the I-Thou relationship. The delicate balance between use of self and counter-transference is explored within the context of conjoint therapy with a specific couple. The clients' processes, and the therapist's, are interwoven as the level of awareness increases. Context is utilized in the service of developing the relationship between the three persons involved in the sessions.     

"Detoxification" of Vietnam War Trauma: A Combined Family-Individual Approach

Treatment with families of veterans suffering from the aftereffects of combat trauma in the Vietnam War often requires a preliminary phase of disjoint treatment, in which family members are seen separately, before conjoint treatment can proceed. In this disjoint phase of treatment, wives and children are introduced to the brutal realities of Vietnam combat experience and to an understanding of its sequelae. This disjoint phase of family therapy detoxifies combat experience so that it can be approached in subsequent conjoint sessions along with more traditional family therapy issues.     

班级集体效能对初中生学业自我效能与学习倦怠的调节作用

采用学习倦怠、学业自我效能、班级集体效能问卷,选取26个班级的1125名初中生作为被试,运用多层线性模型探讨班级集体效能对学业自我效能与学习倦怠的影响。在控制性别和年级的影响后,结果发现:(1)班级集体效能与学习倦怠具有直接的关联:班级正向联合力越高,则学生的学习成就感越高;班级负向联合力越高,则学生的情绪与生理的消耗越严重;班级优秀成员的效能越高,则其他学生学习的成就感越低,师生关系越疏远、生理消耗越严重;而班级成员的自我效能越高,学生的学习成就感越高、情绪的损耗越小;(2)班级集体效能对学业自我效能与学习倦怠之间的关系具有显著的调节作用:班级的正向和负向联合力越强,则学业自我效能对师生疏离的负向影响就越弱;班级的负向联合力越强,则学业自我效能对情绪耗竭的负向影响就越小;优秀成员效能越高,则学业自我效能对学习低成就感的负向影响就越大;而成员自我效能强,则学业自我效能对师生疏离的负向影响也强。     

Psychoanalytisch-orientierte Fokaltherapie der sozialen Phobie

Although psychodynamic therapy is one of the most frequently applied forms of psychotherapy to treat anxiety disorders in clinical practice, evidence for the efficacy of psychodynamic therapy in anxiety disorders is unsatisfactory. This is especially true with regard to randomized controlled trials of psychodynamic psychotherapy in anxiety disorders. Psychodynamically oriented treatment manuals for anxiety disorders presently exist for generalized anxiety disorder and panic disorder. For social phobia (or social anxiety disorder), however, no manual for psychodynamic treatment has yet been published. Social phobia is a very frequent mental disorder characterized by an early onset, a chronic course, severe psychosocial impairments and high socio-economic costs and at the same time in spite of these facts one of the mental disorders which are scarcely diagnosed and treated. In this article, a manual for a 30-session (5 exploratory and 25 therapy sessions) short-term psychodynamic treatment of social phobia is presented. The treatment is based on Luborsky’s supportive-expressive (SE) therapy. In the first part, the general principles of SE therapy are presented. In the second part, a manual specifically adapted to the treatment of social phobia is described. This manual includes specific additional treatment elements that have clinically proved to be useful in the therapy of social phobia. The treatment manual is presently used in a large-scale randomized controlled multi-center study comparing short-term psychodynamic psychotherapy and cognitive-behavioral therapy in the treatment of social phobia.     

The Role of the Occupational Therapist as a Community Consultant

Concern for health development has been in the forefront of occupational therapy practice and training for many years. However, consultation in this area to community agencies and grass roots programs is a relatively new endeavor for occupational therapists. This article describes community consultation in a demonstration project emphasizing the concept of preventive mental health. Steps in establishing the consultation role are discussed using the theoretical constructs of systems consultation. Discussion of the educational objectives for field training in community mental health, community experience during the field training, and the supervisory and communication networks essential to such a program are presented as a model in developing the role of the occupational therapist as a community consultant.     

Psychodynamische Kurzzeittherapie bei dependenter und vermeidender Persönlichkeitsstörung

Although dependent and avoidant personality disorders are frequent in patient populations, there are only few studies in which the efficacy of psychotherapeutic interventions for these two personality disorders was reviewed. The purpose of this study was to examine whether psychodynamic short-term therapy based on the model of the cyclic maladaptive pattern (CMP) is effective for reducing the mental impairment of patients diagnosed with a dependent or an avoidant personality disorder. Data were collected via a self-report scale (Symptom-Checklist, SCL) and expert ratings by therapists [Global Assessment of Functioning (GAF) Scale and Severity of Impairment-Score (Beeinträchtigungsschwere-Score, BSS)]. In the study 20 patients received 25 sessions of outpatient therapy. Mental impairment decreased significantly from the beginning to the end of the therapy; moreover this decrease remained stable over a 2-year period following completion of the therapy. The findings show that psychodynamic short-term therapy can lead to an enduring improvement in the mental health of patients with a dependent or an avoidant personality disorder.     

'We are the stuff that dreams are made on': the use of dreams in systemic therapy

This paper considers the place that dream material has occupied in therapy, and particularly family therapy. A rationale will be given for the inclusion of this source of information by systemic therapists. The use of dreams in systemic therapy with individuals, couples and families is described. Dreams are divided into five main categories: those that precipitate therapy, provide hypotheses, as memories, relationship dreams, and those that reflect the process of change. Each category is described and illustrated with relevant clinical material. The paper concludes with a method for working with dreams that is congruent with a systemic perspective applicable to individual, conjoint or family therapy sessions.     

How do therapists ally with adolescents in family therapy? An examination of relational control communication in early sessions

Sequential analyses examined associations between the working alliance and therapist-adolescent communication patterns in 10 Spanish cases of brief conjoint family therapy. Early sessions with strong versus problematic alliances, rated by observers, were selected for coding of relational control communication patterns. No differences were found in the frequency of exchanges, but competitive responding by the therapists (reflecting an interpersonal struggle for control) was significantly more likely in problematic alliance sessions than in strong alliance sessions. Cases in which the adolescent's alliance with the therapist remained positive from Session 1 as compared with Session 3 showed a decrease in the likelihood of competitive symmetry. Notably, when the quality of the alliance deteriorated over time, the therapists were increasingly more likely to respond to the adolescents' domineering messages in a competitive manner. Results underscore the need to avoid competitive responding in order to ally with adolescents in conjoint family treatment.     

Better versus worse family therapy sessions as reflected in clients' alliance-related behavior

To be responsive to clients' evaluations of the unfolding therapy process, therapists must first accurately "read" client behavior, a particularly challenging task in conjoint family therapy. In this study, the authors compared client behavior in 28 sessions that one family member and the therapist concurred, on the Session Evaluation Questionnaire (W. B. Stiles & J. S. Snow, 1984), were relatively better or worse than their other sessions. Client behavior was rated from videotapes using the System for Observing Family Therapy Alliances (SOFTA-o; M. L. Friedlander et al., 2006). In contrast to the worse sessions, the better sessions were characterized by significantly greater client Engagement in the Therapeutic Process and Safety within the Therapeutic System. Notably, whereas only the worse sessions had exceptionally poor within-family collaboration, 40% of the better sessions were characterized by mild family conflict. Implications are discussed for building theory on therapist responsiveness and for future research that may benefit practice, training, and supervision.     

Couples Therapy

The authors propose a more comprehensive definition of couples therapy since parenting and individual issues can impact so forcefully on spousal relationships. Couples therapy, is redefined as a therapy with both spouses concerning their individual, parenting, and marital functioning which is conducted in conjoint marital/family sessions and individual meetings with each spouse. A case example illustrates this approach which is called Comprehensive Family Therapy.     

Group-Schematherapy for Adolescents: Results from a Naturalistic Multiple Case Study

Personality disorders are complex mental health problems, associated with chronic dysfunction in several life domains. Adolescents suffer from these disorders as well. The present study is a naturalistic case study, investigating whether group schematherapy (GST) can be applied to adolescents with personality disorders or personality disorder traits. Four clinically referred patients were included and completed questionnaires on quality of life, symptoms of psychopathology, schema modes, early maladaptive schemas, and schema coping styles. Patients participated in weekly GST sessions complemented by weekly or 2-weekly individual sessions. The parents of the adolescents participated in a separate parent group. From pre- to post-treatment, results demonstrated improvements for some patients in quality of life and symptoms of psychopathology. Changes in a number of modes and schemas were observed in all patients from pre- to post-therapy. In addition to assessing changes from pre- to post-treatment, the current study investigated the temporal changes in modes during therapy as well. Results demonstrated that maladaptive modes decreased, whereas healthy modes increased for all patients across the course of therapy. The present study provides preliminary support for the applicability of GST for adolescents as well as the effectiveness of GST. It is a starting point for further research on this intervention.     

Transference reactions in conjoint therapy: A view from an observation group

Summary This paper reports on conjoint therapy conducted with the individual therapists of two of the group's members observing the group sessions. The development of the transference reactions of all group members are highlighted and suggestions are made regarding the most useful methods of handling these transference reactions to help create a mutative experience for the members of the group.The author wishes to thank Dr. Judith Isaac for her comments and editorial assistance throughout the preparation of this paper.     

The Practices of Apostolic Faith Healers in Mental Health Care in Zimbabwe

This study aimed to understand and interpret faith healers' explanations of the aetiology and treatment of diseases and to canvass their views regarding collaboration between Western trained health care professionals and faith healers. Fifteen female and six male faith healers from Apostolic churches in Marondera (Zimbabwe) were selected and interviewed (mean age = 42.38 years; age range = 20–69 years). All the faith healers interviewed had been practising from two to fifty years. Content analysis of the data indicated that faith healers use a variety of procedures like prayer, holy water, counselling and sacred stones during their healing sessions. Common ailments brought to the faith healers included mental disorders, infertility, substance abuse, sleep disorders, childhood problems and physical problems. Witchcraft and avenging spirits were cited as the most common causes for illness. Closer cooperation between Western trained health practitioners and traditional (faith) healers is needed in the treatment of both physical and mental illnesses.     

Harmful dysfunction and the search for value neutrality in the definition of mental disorder: response to Wakefield, part 2

Wakefield's claims to have identified and objective scientific component of mental disorders in the concept of dysfunction are examined in light of previous attempts to state a value free concept of mental disorders. The harmful dysfunction concept of dysfunction is not value free because it confounds cause and purpose in a specious use of evolutionary theory and because evolutionary theory cannot reliably supply standards for when a function is broken. Harmful dysfunction analysis collapses into a value-laden concept of mental disorders and serves the untoward goal of promoting the status quo in the modern DSMs. If the concept of dysfunction were taken seriously and rigorously defined, then it might be possible to separate what is medical from what is not in the domain of mental disorders.     

The Role of Structure in Couples Therapy

ABSTRACT

The universal thread of the therapist'S use of structure in the beginning, middle and termination phases of couples therapy is explored across different theoretical models. The uses of history, intensity, skill building, and unconscious material are among the topics considered. Also briefly raised are such issues as decisions about individual and/or conjoint sessions, use of explicit goal setting, and when to focus on extramarital affairs.     

Schematherapie

Schema therapy is a cognitive behavioral therapy (CBT) development mainly for the treatment of personality disorders and other chronic mental disorders. It is characterized by an integration of cognitive, emotional and behavioral intervention methods derived from different therapeutic approaches with an emphasis on a specifically supportive therapeutic relationship. The original approach focused mainly on early maladaptive schemas. Current developments, however, concentrate on the concept of schema modes, describing different schema-associated emotional states. The schema mode approach is also used for specific case concepts for personality disorders. Effectiveness of schema therapy has been shown for borderline personality disorder. Current studies investigate the effectiveness of schema therapy for patients with other chronic mental conditions and as a group therapy approach. This paper provides an overview about case conceptualization and treatment, presents main research findings and discusses open questions and problems.     

On the nature of mental disorder: towards an objectivist account

According to the predominant view within contemporary philosophy of psychiatry, mental disorders involve essentially personal and societal values, and thus, the concept of mental disorder cannot, even in principle, be elucidated in a thoroughly objective manner. Several arguments have been adduced in support of this impossibility thesis. My critical examination of two master arguments advanced to this effect by Derek Bolton and Jerome Wakefield, respectively, raises serious doubts about their soundness. Furthermore, I articulate an alternative, thoroughly objective, though in part normative, framework for the elucidation of the concept of mental disorder. The concepts of mental dysfunction and impairment of basic psychological capacities to satisfy one??s basic needs are the building blocks of this framework. I provide an argument for the objective harmfulness of genuine mental disorders as patterns of mental dysfunctions with objectively negative biotic values, as well as a formally correct definition of the concept of mental disorder. Contrary to the received view, this objective framework allows for the possibility of genuine mental disorders due to adverse social conditions, as well as for quasi-universal mental disorders. I conclude that overall, the project of providing an objective account of the concept of mental disorder is far from impossible, and moreover, that it is, at least in principle, feasible.     

Relational Diagnosis and Psychotherapy Treatment Cost Effectiveness

Despite a call by researchers for estimates of the treatment effectiveness and cost effectiveness for relational problems, very little has been done to answer this call. The present study is an examination of actual treatment costs and recidivism rates for patients treated for a relational problem (either in individual or conjoint therapy sessions) in the Cigna network. Policymakers and third-party payers may use such clinical-effectiveness and cost effectiveness data to make decisions regarding treatment of relational problems and funding allocation. The present study is also the first to compare the costs of couples therapy versus family therapy for relational problems.     

Rational emotive behaviour therapy in high schools to educate in mental health and empower youth health. A randomized controlled study of a brief intervention

Rational emotive behaviour therapy (REBT) is effective in reducing distress in several target groups. No other study has tested the mental health effects on adolescents in a high school setting while expanding a Cognitive Behaviour-based therapy, REBT, into the concept of mental health literacy. The format of the ABC model, which is an important element of REBT, functioned as a working manual in and between three sessions. This study tested whether knowledge and practical use of the ABC model increased self-esteem and hope, and reduced symptoms of anxiety and depression, and dysfunctional thinking. Sixty-two high school students with subclinical levels of anxiety and depression were randomly allocated into three groups; three individual REBT sessions, or three individual attentional placebo (ATP) sessions or no sessions (control). However, dysfunctional thinking, self-esteem and hope were not measured in the control group. Repeated measures with ANOVA and t-tests were conducted. Both REBT and ATP significantly reduced symptoms of anxiety and depression, but only REBT was significantly different from the control group at the six-month follow-up. Only REBT significantly reduced dysfunctional thinking, and both REBT and ATP significantly increased self-esteem and hope. REBT had both an immediate and a long-term effect. The findings show the potential positive effects of educating well-documented psychological techniques as ordinary education in school. Further research might contribute to decide whether or not to change the school system by enclosing mental health literacy classes for all students.