Psychotherapy Supervision in the New Millennium: Competency-Based, Evidence-Based, Particularized, and Energized

Psychotherapy supervision has increasingly become or is on the fast track to becoming competency-based, evidence-based, particularized, and accountable. In this paper, I explore how that appears to be so by: (1) briefly considering the concepts of ??competencies?? and ??evidence-based practice?? as preeminent guides for psychotherapy supervision practice and training; and (2) briefly reviewing the current status, pressing needs, and future possibilities of psychoanalytic, cognitive-behavioral, humanistic-existential, and integrative psychotherapy supervision. Based on my examination, the following conclusions are proposed: (1) the supervision relationship, individualization, developmental differentiation, and self-reflection (for supervisee and supervisor) appear to be crucial cornerstones for the conceptualization and actuation of supervision process and practice across psychotherapy-based supervision approaches; (2) all indications suggest that three emphases??competency-based supervision, evidence-based practice, and accountability??will continue to substantially influence, affect, and inform psychotherapy supervision practice for its near and distant future; (3) psychotherapy-based supervision approaches will need to be and indeed appear to now be in the process of becoming increasingly particularized in how each of their respective approach-specific competencies are defined and explicated; and (4) psychotherapy supervision has come to be increasingly viewed as an educational process and practice that is best facilitated by: (a) a rich and enriching supervision training environment that vigorously addresses and attempts to meaningfully integrate declarative, procedural, and reflective knowledge bases throughout the supervisory endeavor; and (b) the considered and deliberate utilization of facilitative technology that has the potential to substantially enhance and expand the value of the supervisee??s training/supervision experiences. Some discussion is provided about those four conclusions, and a retrofitted psychotherapy supervision for the new millennium is considered.     

Opfer-überzeugungen

The public interest in ??new?? clinical symptoms is described exemplified by burnout, mobbing and trauma. In the background self-explanations by patients as well as interests of therapists can be recognized. Both can be understood as an expression of subconsciously reflected contemporary convictions. Post-traumatic stress syndrome and the sequelae of abuse, which are probably diagnosed too often in guideline correct psychotherapy, throw up questions on the appropriate therapy and possible injurious side effects. The social background to the psychotherapeutic fascination with trauma will be discussed.     

Theme centered group psychotherapy with psychiatrically hospitalized preadolescent boys

This paper describes how a particular content can be ascribed to verbal group work with psychiatrically hospitalized children. This focus can then provide the basis for psychotherapeutic intervention in which resistance and transference are interpreted while underlying conflicts are uncovered and worked on. The theme of the group, health issues and sexuality, was derived from the children's expressed needs on the unit. The use of psychotherapy as a basis for subsequent education about these health issues is discussed. Also described is the way in which the verbal medium was used in conjunction with other unit procedures.     

Brauchen wir eine ?Neuropsychotherapie“?

The somewhat crude question of whether we need neuropsychotherapy means more precisely whether its neuroscientific perspective can be useful for the psychotherapeutic practice. To answer this question the traditional scientific approaches do not completely suffice. The ??empirical-technical approach?? of quantitative psychotherapy research is of no service here as neuropsychotherapy is only its continuation. Within the framework of this methodology it is not possible to critically reflect on the relevance of neuroscientific research. Such a reflection is, however, the prerequisite for an evaluation of the benefits of neuropsychotherapy. The question about the meaning of neurobiological processes thus leads to the field of epistemology. This ??theoretical approach?? is nonetheless only helpful within limits. It provides an important background of reflection, however it needs to remain abstract compared to psychotherapeutic practice because it does not integrate the specific goals of such practice. What is presented here instead is an ??approach of pragmatic reflection??. This reflection departs from a general purpose of psychotherapy from which the value of neuropsychotherapy can be appropriately estimated. After this clarification the approach of pragmatic reflection can be preliminarily demonstrated with concrete applications of neuroscience in psychotherapy. What is shown hereby is that neuropsychotherapy represents a very specific practice of argumention and action, which implements a logic into psychotherapy that does not fit its contents and goals.     

Psychotherapie zwischen Narrativ und Qualit?tssicherung

Two important books and a psychotherapeutic quality study published in 2011 serve as background for the examination of the polar conditions that determine psychotherapeutic work: the laws of the narrative, i.e. of relating, which provides the contents of the psychotherapeutic work and quality assurance as the canon of the scientific, politically correct and governmental controls of psychotherapeutic practice. The narrative is a composition formally characterized by a course scheme and in terms of contents as an enactment of the first person narrator and a narrated first person. Different from daydreams it seeks public attention and the listener in order to evoke concern and identification. It transports wishes, anxiety, fulfillment and catastrophes. The narrative is the phenomenology of speech logic and interpersonal coherence and can be linked to different theories, above all psychoanalytical ones. For psychotherapy it opens the world of the ??I??, with its conflicts, assessments and stabilizing efforts in the interpersonal context. Quality control is also a scientifically based steering of practical work which is increasingly being manifested in psychotherapy as well as in medicine and other areas of life. A study of the Techniker Krankenkasse (Technical Health Insurance) concluded in May 2011, confirms the uselessness of time-consuming and costly control procedures in psychotherapy and emphasizes the importance of good training and further education, for which the study has attested a high quality for Germany.     

Tragedy and the art of questioning in depth psychotherapy

Abstract

This essay examines how the art of questioning is central to depth psychotherapy. Conceiving of depth psychotherapy as a tragic art suggests the kind of inquiry unique to psychotherapy is that oriented to pathos. To explicate the art of pathic inquiry, this essay draws upon Nietzsche's depiction of Greek tragedy as structured by the relations between the artistic deities Apollo and Dionysus. As a tragic art, the structure of pathic questioning is formed by the principles these gods embody: reason and passion. Their intertwining within a psychotherapeutic discourse stimulates a liberative self‐knowledge, exemplified here by the differing approaches of Eugene Gendlin and James Hillman.     

Towards trans-cultural histories of psychotherapies

Abstract

Psychotherapy is a regulated form of verbal interaction, which necessarily incorporates broader shared cultural assumptions and narrative templates. Like any form of verbal interaction, it is fluid, adaptable and malleable, particularly when it enters new cultural domains. The increasing global penetration of psychotherapeutic techniques calls for an analysis of the changes, modifications, and innovations of its techniques and accompanying theories. This will eventually allow scholars to view European and North American forms of psychotherapy as variations tied to specific locations and cultures. Tracing the trans-national and trans-cultural dissemination of psychotherapeutic theories and techniques allows historians to chart their inherent variability, test limits, and analyse the broader social and political uses of psychotherapy within different national and cultural contexts. In addition to investigating psychotherapy in its various manifestations, historians should continue to inquire about its personal, social and political uses.     

The Effectiveness of Brief Versus Intermediate Duration Psychodynamic Psychotherapy in the Treatment of Adjustment Disorder

Treatment studies and particularly psychotherapeutic treatment studies of patients suffering from an adjustment disorder are very scarce, leading to insufficient evidence regarding the efficacy of treatment in this population. Whereas timely psychotherapy is known to be of benefit in the treatment of adjustment disorders, the ideal duration of psychotherapeutic interventions is not known. This study examined whether a brief 12-session focused psychodynamic psychotherapy may be as efficient as a longer intermediate-term (1?year) psychodynamic psychotherapy in treating patients suffering from an adjustment disorder. Subjects (n?=?66) were randomly assigned to either brief or intermediate psychotherapy. They were assessed by self-report measures and clinician’s evaluation at baseline, end of therapy, and 9?months after therapy was terminated. The results showed a good overall improvement in the whole group. Furthermore, brief psychotherapy was found to be as good as intermediate psychotherapy both at the end of treatment and at follow-up. Although our study was not designed to confirm the efficacy of dynamic psychotherapy in the treatment of adjustment disorders, our results suggest that brief interventions may be good enough in adjustment disorder, thus allowing treatment of a greater number of patients without compromising for the quality and suitability of treatment.     

Personal Therapy in Psychotherapeutic Training: Current Research and Future Directions

Recent research literature in the field of personal therapy for psychotherapists shows that therapists claim overwhelmingly positive outcomes with few negative effects (Orlinsky et al., The Psychotherapist’s own psychotherapy: Patient and clinician perspectives. Oxford University Press, Oxford, 2005). However, there has been little interest to date in the extent to which the personal characteristics of therapists might have a bearing on the way in which personal therapy is experienced in psychotherapeutic training. This paper reviews some of the current research in the field and then discusses a subset of results from a small-scale qualitatively-driven study (Rizq and Target, Counselling Psychology Quarterly 23(4):1–27, 2010b) suggesting that early attachment experience may be a relevant factor in understanding how a mandatory training therapy is perceived and experienced within psychotherapeutic training. Implications for psychotherapeutic education are briefly discussed and some directions for future research proposed.     

Direktausbildung Psychotherapie an der medizinischen Fakultät

Background

There is ongoing political discussion at the Federal Ministry of Health that a university entrance diploma should allow psychotherapy to be studied directly: Graduation leads to a licensure that qualifies for further specialization, e.g. in cognitive behavioral therapy (CBT) or psychodynamic psychotherapy analog to medical specialization. As psychotherapy has its roots in both psychology and in medicine, the question is raised which faculty should be the future home of direct psychotherapy schools.

Material and methods

A theoretical model curriculum of psychosomatic psychotherapy is proposed. Its structure which is oriented to the established structure of medical training and its contents are described. It is argued that the proposed model in the tradition of psychosomatic medicine is suitable to meet ongoing changes in the structure of psychotherapeutic care due to new challenges in the field of public health.

Conclusion

The study of psychotherapy should be associated with chairs in clinical psychology and psychosomatic medicine in order to maintain and further develop the variety and quality which psychotherapy has gained in Germany.     

Psychotherapie auf Palliativstationen

Exemplary for psychotherapeutic activity in the ??sphere of death?? the article focuses on the present situation of psychotherapists working on palliative care units in Germany. For that a questionnaire has been developed which includes 17 items dealing with fields of concrete psychotherapeutic work, psychotherapy training, relations with teams and institutions, subjectively felt burden and contentment etc. The questionnaire was sent to most of the German palliative care infirmaries. There is a high presence of psychotherapists in these units who are well trained in different therapeutic methods, numerically led by behavior therapy and non-directive therapy. In addition most colleagues are qualified in psychooncology and specialized pain management. Surprisingly topics, such as death or spirituality are not so often found in therapeutic contacts as would be expected. Furthermore there is a rather negative outlook on the preparation for the palliative working field during psychotherapy training. This requires extensions and supplementary curricula concerning existential themes in psychotherapy. The psychotherapists feel well integrated in their therapeutic teams but many of them have a feeling of at best a mediocre appreciation in their institutions. In spite of the difficult and stressful work the general job satisfaction is stated as high to very high.     

Kulturdynamisches Modell der bikulturellen Identit?t

In intercultural psychotherapeutic treatment, the psychological integration of different cultures within an individual has to be involved as an additional developmental dimension. Individual change during the process of migration considered as desirable adaptation has often been conceptualized in terms of a bicultural identity, which includes aspects of the culture of origin as well as aspects of the host culture. The theoretical foundation of the concept of bicultural identity, however, has remained insufficient. The culture-dynamic model presented here differentiates personal and social identity according to the identity concept proposed by Mead (Geist, Identit?t und Gesellschaft, 1988, Suhrkamp, Frankfurt a.?M.). Personal identity is essentially formed by an individual??s culture of origin, while influences of the host culture primarily affect the social identity. For healthy coping with the challenges associated with migration and adequate support of this process in intercultural psychotherapy, it can be assumed that a stabilization of personal identity is required to allow for a dynamization of social identity. Implications for identity constitution in second generation immigrants, in different stages of lifespan development and in the process of learning the language of the host culture are discussed.     

Revisiting the Cultural Dope

This essay focuses on the ??cultural dope,?? an ironic reference in Harold Garfinkel??s Studies in Ethnomethodology to the rule-following actor in conventional sociological theories. In the nearly half-century since the publication of that book, the ??cultural dope?? has been incorporated into numerous criticisms of ??models of man?? in the human sciences. Garfinkel??s account appeals to many writers because it seems to present an alternative picture of the actor: an individual who is self-aware, reflective, and skilled in the conduct of daily affairs. A problem with such a generalized picture of the actor is that it may seem to encourage uncritical acceptance of whatever ??the public?? (or a broad segment of the public) happens to believe or support. This paper revisits Garfinkel??s account of the cultural dope, and contrasts ??conservative?? and ??radical?? readings of what Garfinkel does with that figure. The ??conservative?? reading leaves the edifice of a social-structural model largely intact, and provides an alternative, more complex, picture of individual action than that of a cultural dope. The ??radical?? reading places relevant social structures in a dependent relation to the contingencies of action, and thus destabilizes the very theoretical edifice that sets up the problem of how to integrate individual actions with stable social structures. In line with the ??radical?? reading, this paper suggests that Garfinkel creates serious difficulty for any generalized ??model of man,?? regardless of whether it portrays the individual as active or passive, well-informed or ignorant, or reflexive or not.     

The Zhuangzi and You 遊: Defining an Ideal Without Contradiction

You ?[ is a crucial term for understanding the Zhuangzi. Translated as ??play,?? ??free play,?? and ??wandering,?? it is usually defined as an ideal, playful Zhuangzian way of being. There are two problems with this definition. The first is logical: the Zhuangzi cannot consistently recommend playfulness as an ideal, since doing so vitiates the essence of you??it becomes an ethical imperative instead of an activity freely undertaken for its own sake. The second problem is performative: arguments for playful Zhuangzi as exemplar resemble those of the logicians and philosophers who appear to come in for Zhuangzian criticism. This essay addresses these tensions by demonstrating how the Zhuangzi ambiguates the nature and value of you. Apparent endorsements of you are not freestanding, instead occurring in grudging replies of teachers to overly zealous students. In light of this recontextualization, a new version of you is offered that accommodates ??non-playful?? ways of being.     

Uncertainty in Clergy’s Perspectives on Homosexuality: A Research Note

This research note analyzes expressions of uncertainty in clergy??s perspectives on homosexuality. We conducted interviews with forty Christian clergy who lead congregations in the vicinity of one large southeastern US city. Seven in ten clergy interviewed expressed uncertainty in their personal opinions about homosexuality, uncertainty about how they should act pursuant to the issue, or both. We describe clergy??s experiences with these uncertainties and analyze the patterns in which it appears in their opinions and actions regarding homosexuality. The nuance evident in these patterns illustrates how a range of superseding factors influence clergy??s opinions about homosexuality and the extent to which they feel constrained in taking action with regard to the issue. We argue for the conceptual value of a framework that provides space for analysis of uncertainty in public opinion about contentious social issues such as homosexuality.     

The wagon-wheel illusion in continuous light

The fact that a perceptual experience akin to the familiar wagon-wheel illusion in movies and on TV can occur in the absence of stroboscopic presentation is intriguing because of its relevance to visuo-temporal parsing. The wagon-wheel effect in continuous light has also been the source of considerable misunderstanding and dispute, as is apparent in a series of recent papers. Here we review this potentially confusing evidence and suggest how it should be interpreted.     

Single session and walk‐in psychotherapy: A descriptive account of the literature

Over the last several decades single session psychotherapy has become a mainstream psychotherapeutic approach. A steadily increasing demand for psychotherapeutic services and a continuous reduction in mental health care resources worldwide are both largely responsible for this development. This paper describes single session psychotherapy and provides a brief review of the relevant literature. Single session psychotherapy delivered in walk‐in settings is also discussed. Therapists who are unfamiliar with single session psychotherapy will find that this paper provides a concise introduction to the essential processes and outcomes of this psychotherapeutic approach.     

Does Media Type Matter? The Role of Identification in Adolescent Girls�� Media Consumption and the Impact of Different Thin-Ideal Media on Body Image

Previous research on media exposure and body image focuses on TV and magazines, rather than the under researched types of media heavily consumed by adolescents, such as music videos. The present research, involving 199 adolescent girls (aged 14?C16) from South-East England, examines girls?? media consumption (types and genres) and identification with media models, then uses an exposure experiment to investigate whether the different media formats in which ??body perfect?? ideals are presented affects their impact on body image. ??Study 1?? showed that neither type nor amount of media use was related to body dissatisfaction, however media model identification was. ??Study 2?? demonstrated that regardless of media type, experimental exposure to the body perfect led to significantly higher body and appearance dissatisfaction, compared to control images, but primarily amongst those girls who strongly identified with media models. Theoretical and intervention implications are discussed.