Exploring In-Session Process with Qualitative and Quantitative Methods in Psychotherapy with an Adolescent

ABSTRACT

There is emerging evidence for the effect of psychotherapy in adolescents with depression. Research indicates that therapists often use techniques from different theoretical models when working with adults. Research on the therapy process in adolescents is scarce. We explore the therapist’s interventions in a time-limited psychodynamic adolescent therapy with Susanna suffering from major depression. Susanna quite suddenly became worse at mid-treatment, with self-harming and suicidal ideations. Rating scales for analyzing in-session relational processes included the Structural Analysis of Social Behavior (SASB), the Adolescent Psychotherapy Q-set (APQ), and the Transference Work Scale (TWS). Self-reports on symptoms, interpersonal problems, and working alliance were obtained before, during, and at the end of and one year after treatment. Different tools seemed to expose different aspects of the process and the patient’s development. Only patient-rated questionnaires revealed the mid-treatment crises. Combining different and pan-theoretical rating scales on here-and-now interventions (TWS and SASB) and whole sessions (APQ), as well as clinician-rated measures and a variety of self-reports, indicated that different psychotherapeutic techniques were integrated in the therapy and seemed beneficial to patient’s outcome. The therapist adhered to the treatment manual. This way of exploring the therapy process may be used for different treatment modalities.     

Psychological science treatment

New discoveries in psychological science have changed our understanding of some basic psychological processes. The new science, however, has not of yet been properly incorporated into the practice of psychotherapy. This has created a confusing state of affairs, lacking clear distinctions between therapy interventions rooted in lore and personal insight and those based on systematic scientific inquiry. In this paper, I discuss the problems caused by the current situation and propose a new distinction by which the psychological (science) treatment of psychological disorders is differentiated from psychotherapy. The implications of the proposed distinction for clinical research and training are discussed.     

Client self-image,therapist acting,and the establishment of the therapeutic alliance in a training context

This study examined how clients’ self-image and perception of therapist’s behavior are related to the therapeutic alliance, as well as how these variables change in the psychotherapy process in trainee-led psychotherapy. A total of 164 participants (M = 28.9 years) who attended two semesters of treatment at the Psychology Clinic of Umeå University completed the Working Alliance Inventory (WAI) to evaluate their perception of their alliance with the therapist. They also completed two questionnaires based on the Structural Analysis of Social Behavior (SASB) model to give insight into their self-image patterns and to analyze their perceptions of the therapist’s behavior. The results show that a positive self-image and positive perceptions of the therapist’s actions increased significantly over the course of the therapy, with a corresponding decrease in negative patterns. The alliance scores show that the therapeutic alliance gains significance over time and that it is influenced more by the perception of the therapist’s behavior than by the self-image. The self-image becomes relevant after the mid part of therapy, underlining the role of the therapist in co-creating the treatment relationship. The implications of these results are discussed, and so are directions for future research in other trainee-led settings and samples.     

Introject and identity: structural-interpersonal analysis and psychological assessment of multiple personality disorder.

Revisions of the diagnostic nomenclature have contributed to renewed interest in multiple personality disorder (MPD). Identity and self-organization in MPD are assessed using a sophisticated structural-interpersonal measurement system, Structural Analysis of Social Behavior (SASB). Two important features of the SASB model applied to MPD are the assessments of interpersonal perceptions of childhood initiators of abuse and of the introject or self-organization of host and secondary personalities. SASB findings from a clinical series of six cases of MPD are analyzed to illustrate the use of this assessment technique. Host personalities and abused secondary personalities differed in their identity and self-organization. Host personalities evidenced internalization of abuse dynamics related to self-destructive trends. Secondary personalities, despite having experienced abuse, did not manifest such dynamics. Implications for understanding personality processes in MPD and for further research are discussed.     

Introject and Identity: Structural-Interpersonal Analysis and Psychological Assessment of Multiple Personality Disorder

Revisions of the diagnostic nomenclature have contributed to renewed interest in multiple personality disorder (MPD). Identity and self-organization in MPD are assessed using a sophisticated structural-interpersonal measurement system, Structural Analysis of Social Behavior (SASB). Two important features of the SASB model applied to MPD are the assessments of interpersonal perceptions of childhood initiators of abuse and of the introject or self-organization of host and secondary personalities. SASB findings from a clinical series of six cases of MPD are analyzed to illustrate the use of this assessment technique. Host personalities and abused secondary personalities differed in their identity and self-organization. Host personalities evidenced internalization of abuse dynamics related to selfdestructive trends. Secondary personalities, despite having experienced abuse, did not manifest such dynamics. Implications for understanding personality processes in MPD and for further research are discussed.     

NLP心理疗法——一种简单快速的心理咨询与治疗方法

NLP心理疗法是从完形疗法发展而来的一种,目前正被越来越多地应用于心理咨询与心理治疗的临床工作。本文主要介绍了NLP心理疗法的主要思想、基本原理和常用治疗技巧,以及把NLP疗法与精神分析进行了简要比较。     

Emotions,narrative and change

There is a wide agreement that emotions are central to the evaluation and understanding of change processes in psychotherapy. Unfortunately, most of the debate on the role of emotions has been influenced by the reductionist view of ‘psychophysiological symbolism’ (Averill 1996). We defend the position that, in order to understand their role in psychotherapy fully, we need to move in the direction of a more complex view of emotions. This paper presents a view of emotionsas social constructed phenomena operating via language and narrative. We present research suggesting that these narratives may be an essential process for understanding psychological disorders, how these disorders are developed and, finally, how they can be changed.     

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.     

The rehabilitation of the case-study method

The controversy surrounding the scientific nature of the case-study research method in psychotherapy is not new and can be traced to the time when Freud started publishing his works. Traditional, quantitative researchers have argued thatthe case-study method is anecdotal and non-scientific, dismissing the results and findings obtained by this method on the grounds that they lack validity and reliability.This article seeks to dispel the traditional misconceptions about case study.It conclusively argues that the case study,perceived from the postmodern perspective, is a completely legitimate research method and, moreover, better suited to a holistic, democratic psychotherapy as a discipline dealing with the understanding and change of interwoven complexities of intrapsychic and interpersonal processes that emerge and unfold within a wider socio-historical context.     

Eine Therapiestunde mit einem Mörder

Although psychodynamic concepts may be helpful in identifying the complex interpersonal and manipulative processes that occur between inmates and therapists and to transform them into the therapeutic process they are hardly ever applied in a correctional setting. The author provides an insight into the psychotherapeutic work conducted in prison. The first part of the paper outlines the special conditions in which psychodynamic psychotherapy occurs in a social therapeutic intervention institution within the German prison service. Characteristic transference and countertransference constellations are described. Based on a verbatim report an account is provided of a therapy session with a serious violent offender. In his reflections on the session the author focuses on the effects on the transference process of, in the offender’s eyes, being both therapist and assessor at the same time.     

Group Psychotherapy and Existential Concerns: An Interview with Irvin Yalom

Group psychotherapy can be used to help clients deal with most forms of emotional distress or problems with interpersonal functioning. Also, group therapy can be useful when helping clients to confront existential concerns such as isolation or meaning in ones life. During a recent interview, Irvin Yalom discussed a variety of issues related to group processes and existential matters that are involved in effective psychotherapy.     

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.     

Group-based interpersonal psychotherapy for posttraumatic stress disorder: theoretical and clinical aspects

Posttraumatic stress disorder (PTSD) is a condition that engenders both symptomatic distress and severe disruption in interpersonal and social functioning. Most of the empirical research on treatment has emphasized interventions that aim to alleviate the symptoms of PTSD, despite the persisting impairments in social, occupational, and interpersonal functioning. In clinical practice, achieving relief from symptoms such as irritability or phobic avoidance is a worthwhile goal, yet significant distress and disability derived from disruptions to interpersonal attachments, social networks, and confiding intimate relationships persist. Interpersonal psychotherapy (IPT) has been shown to be efficacious in research settings for depression and eating disorders, in both group and individual formats. Recent pilot data also suggests the potential usefulness of IPT in anxiety disorders. The aim of this paper is to provide a rationale for the use of group-based IPT as an intervention for PTSD as part of a management package, arguing from theoretical and clinical viewpoints. The integration of IPT therapeutic processes with the therapeutic group process is discussed, and a detailed case discussion is presented as an illustration.     

Operationalisierte Basisdokumentation von Gruppenpsychotherapien

It can be assumed that group psychotherapy will play an increasingly more important role for both inpatient and outpatient basic care not only due to health economic considerations. This means that new methods of documentation, quality management and optimization of group-specific therapy processes and results have to be developed. The present system for operationalized basic documentation of group psychotherapy (OBG) is not only meant to be a starting point for research on dynamics and efficacy of group psychotherapy but could also serve as an instrument for standardized documentation of clinical progress, quality assurance and, in combination with the accompanying manual, as an aid for education and further training for psychotherapists. The contents of the documentation system are based on the current state of scientific research and, as far as possible, were implemented irrespective of specific psychotherapeutic approaches referring to particular schools of thought. Particular consideration was given to the practice guidelines for group psychotherapy of the American Group Psychotherapy Association (AGPA) published in 2007. The system structure is based on a model of anatomy and physiology of a group according to Burlingame et al., which ascertains patterns and processes within groups. In addition to general thematic and methodological aspects, several items on group dynamics are included, such as distribution of roles, formation of subgroups, development of group norms, conflict management, interpersonal feedback, self-disclosure, cohesion and other so-called therapeutic factors. Clinical testing in different settings is currently being carried out. Results and further developmental possibilities of the OBG system will be reported soon.     

On the mechanisms and effects of feedback in group psychotherapy

Group psychotherapists commonly see feedback as one of the primary mechanism that furthers the goals of the group. This paper will summarize the research that has been done on the mechanisms leading members to produce feedback, the factors that induce members to accept feedback (for example, feedback valence and timing), and the effects of feedback on outcome and aspects of group process such as group cohesion. The article will address the practical implications of these findings for the interventions of the group psychotherapist. As will be discussed, the emphasis on the importance of feedback in the interpersonal group psychotherapy literature exceeds the programmatic research that has been done on basic questions. This paper will identify major lines of future investigation that could yield findings critical to the delivery of effective group psychotherapy such as the information processing sequences that underlie feedback delivery and reception.     

A Social Constructionist Model of Therapeutic Factors

Evidentiary support for the efficacy of therapeutic models has been a contentious issue since the professionalization of psychology. Despite advances in evidence-based practices in psychology and common factors research, discontent still exists among postmodern psychotherapists in that evidence is mainly defined in modernist/positivistic terms, thereby excluding therapeutic models based on alternative nonpositivistic epistemologies. I proposes a model, which is based on social constructionist theories, for investigating the therapeutic efficacy of various approaches. This article evaluates and differentiates between two models for viewing the efficacy of psychotherapy, namely outcome versus process efficacy. A social constructionist model of therapeutic factors is proposed as a means to incorporate therapeutic factors into psychotherapy processes that are consistent with a social constructionist theory of change. Three main therapeutic elements, which are identified as central to an effective psychotherapy process, are outlined in the model. The proposed model may be useful as a guide to efficacious psychotherapy and as a means for investigating the efficacy of social constructionist therapies.     

Hope,Wholeness, and Helping the Flat to Grow Round

Abstract

The purpose of this article is to bridge the gap between neuroscience and psychotherapy so that there is greater understanding of how the objective biological processes of the brain affect interpersonal relationships and how relationship therapy can affect that biology. The research on emotional systems, implicit and explicit learning and memory are reviewed. Suggestions for therapeutic interventions include focusing on the changing the brain of each partner, reattaching through the therapeutic relationship, increasing physical activity, using nonverbal techniques, understanding the role of emotions in rational thinking, activating the left prefrontal cortex, using mindfulness techniques, and creating new experiences.