不只是“谈话疗法”：精神分析治疗中的非言语维度

精神分析治疗在很长一段时间里被视为“谈话疗法”,其治愈机制是将潜意识的内容意识化,语言解释在其中发挥关键作用。自20世纪末开始,越来越多分析师强调非言语交流在治疗中的作用。非言语交流不仅能够为咨访双方提供更丰富的交流形式,还能通过互动中的“相遇时刻”,实现对患者过去经验的重组,改变其有缺陷的内隐关系知晓。非言语交流和语言交流能够在治疗中发挥互补作用,未来的精神分析心理学要继续加强对非言语领域的研究。     

不只是“谈话疗法”：精神分析治疗中的非言语维度

精神分析治疗在很长一段时间里被视为“谈话疗法”,其治愈机制是将潜意识的内容意识化,语言解释在其中发挥关键作用。自20世纪末开始,越来越多分析师强调非言语交流在治疗中的作用。非言语交流不仅能够为咨访双方提供更丰富的交流形式,还能通过互动中的“相遇时刻”,实现对患者过去经验的重组,改变其有缺陷的内隐关系知晓。非言语交流和语言交流能够在治疗中发挥互补作用,未来的精神分析心理学要继续加强对非言语领域的研究。     

Die Therapeutenrotation

For seven years, the so-called “rotation of therapists”, has been a central part of OLITA, the outpatient longterm intensive therapy for alcoholics. Thus far, the participation of several equally responsible therapists in the treatment of a patient has rarely been seen as a defined therapeutic approach. The present work discusses whether the “rotation of therapists” has any essential influence on the success of OLITA. It considers both, potential advantages and disadvantages for patients and therapists and tries to identify conditions under which this approach appears to promote therapeutic interactions. Following an overview of the present knowledge regarding the therapeutic interaction in addiction therapy, a method is described which may be seen as the precedent of the “rotation of therapists”, the multiple psychotherapy. Finally, the practical procedure in OLITA is outlined as well as its theoretical background. New areas of application for the “rotation of therapists” are discussed.     

A psycho-analytical approach to the assessment of a psychotic patient

SUMMARY

When approached from a psycho-analytic point of view, psychotic states reveal a wide variety of patterns. Some of these are so complex and so rigid in their organisation as to render the patient quite unsuitable for formal psychotherapy. Others are more benign and accessible to a psycho-analytic approach.

The attempt to assess whether a psychotic patient might benefit from psycho-analytic psychotherapy can be facilitated by the use of certain psycho-analytic concepts which provide “ground rules” for decoding psychotic communication, for understanding the psychotic patient's experience and how it has come about.

This paper represents an attempt to show how the psychoanalytic approach to such understanding can help in the management of the case and open the way for psycho-analytic psychotherapy within the N.H.S. Although extremely limited in its provision of skilled psychotherapy, the N.H.S. provides an extremely rich potential for effective understanding, care and treatment of the psychotic patient if the psycho-analytic approach is sufficiently well understood and implemented.     

SUICIDALITY IN MEN IN PSYCHODYNAMIC PSYCHOTHERAPY

Based on the evidence of empirical gender differences in attempted suicide and suicide, this paper develops psychodynamic hypotheses on gender‐specific biographic, intra‐psychic and treatment aspects of suicidality among men. ‘Forming Types by Understanding’ is a qualitative method, based on a systematic analysis of similarity and differential reference points to develop ideal types of suicidal men. A random sample of 20 suicidal men who were receiving out‐patient psychodynamic psychotherapy was studied.

Four ideal types of suicidal men were identified: (1) ideal type ‘disconnected’: a predominance of disconnected feelings that is associated with rejection experiences; (2) ideal type ‘hurt’: aggressive conflicts and the realization of disillusioned life reality combined with experiences of real loss and real trauma; (3) ideal type ‘stormy’: an attached‐symbiotic transference offer mobilizes unrealistic wishes to help against a background of unresolved dependency conflicts; and (4) ideal type ‘object dependent’: concrete facts are important in relationships; in case of separation, real repossession of the woman must occur, a lack of emotional experience is compensated. The danger of suicidality, especially in the early stage of psychotherapy, is particularly acute for patients who cannot reach their therapists emotionally and vice versa. Disturbance of the early experience of inseparability from the mother, gender‐specific conflicts in the development of separation and individuation, and failed triangulation are of central psychodynamic importance.     

Twenty-First Annual AGPA Conference January 23–25, 1964 Barbizon-Plaza Hotel

The experience of being in individual and group psychotherapy concurrently with different therapists is discussed. A semi-structured interview protocol was used to explore a variety of dimensions of “conjoint” treatment. The potential benefits and difficulties associated with receiving different perspectives about the same issues are delineated. The necessity of working with the inevitable comparisons of therapists and treatments is underscored. A number of aspects of the transference phenomena that emerge are discussed, including “splitting,” which is construed as a process that may be destructive, but that may also be valuable if handled well. Countertransference dangers are explored, as is the question of whether, and under what circumstances, communication between the treating therapists is necessary or desirable.     

说谎的非言语视觉线索

说谎是一种非常普遍的社会现象。及时有效地识别说谎, 在人际交往和司法安防领域都具有十分重要的意义。根据说谎的自主性, 将说谎研究的实验范式分为被动说谎范式、主动说谎范式和混合说谎范式三大类。个体说谎时具有较高的认知负荷、较强的情绪唤醒和刻意的自我控制等心理活动特点, 这些心理活动会导致眼睛运动、面部表情、姿态动作等非言语视觉线索的变化, 且非言语视觉线索存在个体差异。未来研究应深入考察说谎的内在心理机制以及非言语视觉线索的心理意义, 加强真实情境下说谎行为的研究, 并借助新技术实现对非言语视觉线索的精准测量和分析。     

Communication Formats and Their Impact on Patient Perception and Working Mechanisms: A Mixed-Methods Study of Chat-Based vs. Face-to-Face Psychotherapy for Insomnia

The application of Internet-based interventions within stepped-care models raises the question of when patients should receive Internet-based treatment and when patients should receive face-to-face (FtF) treatment. To address this question, the patient perception and effects of working mechanisms were evaluated after brief psychotherapy for insomnia applying a mixed-methods approach. Treatment was either delivered through a text-based chat or it was delivered FtF. Almost half of the patients who received the chat-based treatment indicated that chat-based communication was appropriate for them when dealing with sleep difficulties, but that they would prefer FtF communication for more sensitive topics. Results from the therapists’ evaluations of working mechanisms yielded that these working mechanisms were more strongly associated with treatment outcome in the FtF condition than they were in the chat-based condition. To understand and to interpret the results, media richness theory may be a useful tool: More severely impaired patients and patients with more complex concerns may need more complex (richer) communication formats for treatment delivery. Such heuristics may help to better justify treatment recommendations and optimize media choice in Internet-based interventions, e.g., by defining moments when human interaction is needed and moments when communication could be conducted by nonhuman chatbots.     

The Art of Living in Otto Rank’s Will Therapy

Otto Rank's approach to psychotherapy, developed after his separation from Freud, encourages living life fully in spite of death and limitation. In his emphasis on the here and now, new experience in the therapeutic relationship, and collaboration and creativity in the therapy process, Rank was ahead of his time. As a theorist of personality and of creativity, his work is well known, but his influence on the practices of humanistic, existential, and post-psychoanalytic relational therapists is largely unacknowledged. Rank's creative legacy is an approach to psychotherapy that calls forth artistry and collaboration between therapist and client.     

Physical therapists' nonverbal communication predicts geriatric patients' health outcomes

Two studies explored the link between health care providers' patterns of nonverbal communication and therapeutic efficacy. In Study 1, physical therapists were videotaped during a session with a client. Brief samples of therapists' nonverbal behavior were rated by naive judges. Judges' ratings were then correlated with clients' physical, cognitive, and psychological functioning at admission, at discharge, and at 3 months following discharge. Therapists' distancing behavior was strongly correlated with short- and long-term decreases in their clients' physical and cognitive functioning. Distancing was expressed through a pattern of not smiling and looking away from the client. In contrast, facial expressiveness, as revealed through smiling, nodding, and frowning, was associated with short- and long-term improvements in functioning. In Study 2, elderly subjects perceived distancing behaviors of therapists more negatively than positive behaviors.     

Weighing up the evidence: A qualitative analysis of how person‐centred counsellors evaluate the effectiveness of their practice

Research into the effectiveness of counselling and psychotherapy has great practical significance, as a means of collecting evidence that may potentially enhance the quality of services delivered to users. In recent years, the evidence base for counselling and psychotherapy has increasingly relied on data derived from self‐report questionnaires completed by clients, with relatively little attention being paid to therapists’ evaluations of outcomes. To make full use of therapist estimates of outcome, it is important to develop an understanding of the processes and criteria that therapists employ when making such judgements. However, little is known about the evaluation strategies used by therapists in their everyday practice. The aim of the present study was to explore the implicit and informal construction of outcome evaluation by experienced practitioners. Person‐centred therapists were interviewed about their approach to evaluation. The interview data were analysed using a grounded theory approach. These practitioners reported that they engaged in a process of evaluation based on a range of different sources of evidence, which was then “weighed up”. Evaluation was a continuous activity that was embedded in the counselling process itself rather than arising from discrete measurements carried out at particular times. The findings of this study suggest that practitioners may possess a sensitivity to the complexity of outcome that is missing in much current research. Implications for training, research and practice are discussed.     

Recognizing and responding to a suicide crisis.

Data from therapists who were treating 26 patients when they committed suicide were utilized to identify signs that warned of a suicide crisis. Three factors were identified as markers of the suicide crisis: a precipitating event; one or more intense affective states other than depression; and at least one of three behavioral patterns: speech or actions suggesting suicide, deterioration in social or occupational functioning, and increased substance abuse. Problems in communication between patient and therapist were identified as factors interfering with crisis recognition. Evaluation of the identified affects and behaviors may help therapists recognize a suicide crisis.     

Dissatisfied psychotherapy patients: A tentative conceptual model grounded in the participants' view

Usually, between 5% and 20% of psychotherapy patients are dissatisfied with their treatments. This naturalistic study explores seven clearly dissatisfied patients' view of the therapeutic process and outcome. Interviews at termination of psychoanalytic psychotherapy and at a 1.5-year follow-up were analysed to create a tentative conceptual model of patient dissatisfaction using grounded theory approach. At the core of the model is an experience of abandonment by a therapist felt to be insufficiently flexible, a therapy lacking intensity, and links missing between therapy and everyday life. Dissatisfied patients lacked confidence in their relationship with the therapist, described their therapists in negative terms and concluded that their therapies lacked direction. They wanted more response from the therapist. Paying greater attention to the patient's emerging dissatisfaction may prevent lasting disappointment, unnecessary continuation of fruitless treatment, and probably increase efficiency.     

交流手势认知理论

手势是交流互动中一种重要的非语言媒介, 手势不仅可以辅助语言交流而且具有独立的交流性; 作为和语言共同发生的非语言媒介, 手势交流有助于降低交流认知负荷。文章重点归纳和述评了基于手势和语言表达关系的交流手势理论、交流手势激活理论、交流手势的认知节省理论。未来研究需要进一步考虑交流手势实验研究情境自然性和控制严格性间的平衡, 交流手势和其他非语言因素间的关系, 交流手势认知研究的现实意义。     

Selbsthilfegruppen im Rahmen stationärer psychotherapeutischer Behandlungen

Psychosomatic in-patient treatment applies a combination of various methods in order to facilitate learning by insight and corrective emotional experiences in a therapeutic community. The establishment of a self-help group on the ward can be a useful complementary element in such a comprehensive approach. However, empirical research on this specific topic does not yet exist. Based on clinical experience, necessary preconditions as well as the pros and cons of integrating self-help into professional treatment are described. The assessment of 850 patients in a clinic for psychosomatic medicine and psychotherapy concerning a self-help group on the ward are presented. Relationships between patients’ evaluation of the self-help group and various other variables as well as the overall treatment effect were studied. Empirical data provide evidence of a differential effect of the self-help group on the ward: the majority of the patients experienced the self-help group as useful. Whether the patient is able to benefit from group therapy seems to be an intermediate variable and the therapists’ attitude towards self-help groups also seems to play an important role.     

Therapists' Use of DBT: A Survey Study of Clinical Practice

The purpose of this study was to examine how therapists conduct Dialectical Behavior Therapy (DBT) individual psychotherapy with clients, focusing on clinical factors that could account for decisions regarding modifications of DBT (e.g., client diagnosis, therapist theoretical orientation, and intensity of DBT training). Additionally, the study investigated how therapists integrate DBT into their primary approach to therapy. Greater adherence to the DBT protocol was reported by therapists who described using DBT with a client with a diagnosis of borderline personality disorder. More frequent use of DBT components (i.e., group skills training, consultation teams, and telephone consultation) was reported by therapists who viewed their therapy as being guided by an applied behavior analysis/radical behavioral theoretical orientation and by therapists who had received intensive DBT training. Most therapists reported using DBT skills in their non-DBT work, with non-cognitive-behavioral therapists more likely to introduce mindfulness skills.     

Small Groups: Studies in Social Interactions Edited by A. Paul Hare,F. Borgatta,and Robert F. Bales

Abstract

A large body of literature has supported the application of attachment theory to the understanding of psychotherapy. In addition, a more recent social psychological literature is exploring the application of attachment theory to the area of group dynamics and group process. The current study is designed to integrate these two distinct bodies of literature. In a preliminary fashion, we examined the relationship between group therapists’ group attachment styles and their assumptions and expectations of their patients’ attitudes about group psychotherapy. Seventy–six therapists completed the Smith, Murphy &; Coats (1999) measure of group attachment style. They also completed the Revised Group Therapy Survey (Carter, Mitchell, &; Krautheim, 2001) from the viewpoint of a typical patient they treat. As hypothesized, therapists with more group attachment anxiety assumed that patients would hold more negative myths and misconceptions about group treatment than therapists with less group attachment anxiety. The utility of a group attachment construct in future research and practice is discussed.     

When transference isn't transference: Iatrogenesis of multiple role relations between practicing therapists

Charismatic, grandiose and authoritarian senior therapists often develop complicated relationships not only with practicing therapists who are their colleagues, but also their friends, supervisees, as well as patients. The patient/therapist in a multiple role relationship with such a senior person may be extremely vulnerable and very unaware of the true nature of the problem Under certain conditions, some of these patient/therapists have suffered ego dysfunction and decompensation which appeared to be iatrogenic in origin rather than due to the patient's transference resistance. The implications of these issues for the field of psychotherapy, and underlying dynamics in vulnerable patient/therapist's, and in grandiose, narcissistic group leaders, are highlighted, along with ways of identifying the intrapsychic, interpersonal, and institutional roots of this problem An earlier draft of this paper was presented at the 1990 Meeting of the American Group Psychotherapy Association in Boston.