The practice of psychotherapy and spiritual direction

The author compares and contrasts insight-oriented psychotherapy, supportive psychotherapy, and spiritual direction in relation to goals and methods; management of resistance, transference, and countertransference; and selection criteria. The enhancement of spiritual formation through insight-oriented psychotherapy and supportive psychotherapy is also discussed.     

An existential-phenomenological perspective on the concept of ‘resistance’ in counselling and psychotherapy

The various phenomena that are categrised under the label of ‘Resistance’ are of central concern to most models of counselling and psychotherapy. The manner in which resistance is conceptualised has vital implications for therapists approach to the therapeutic relationship. The theory of resistance in classical Psychoanalysis and Cognitive Behavioural Therapy (and particularly Rational Emotive Behaviour Therapy) is examined and then compared to the radical reinterpretation possible in an Existential-Phenomenoogical perspective which promotes the rejection of the role of ‘therapist as expert change agent’.     

Antidepressants in group psychotherapy

This article alerts us to consider depression as a relatively frequent cause of impasse in the course of group psychotherapy. The authors recommend the combined use of antidepressant medication along with group psychotherapy when such depression is confirmed independently outside the group. Common obstacles and pitfalls preventing successful combined treatment are reviewed; the depressive logjam is differentiated from common resistance; and profiles of responders versus nonresponders are described. A rationale of the combined treatment, its results, and implications for group therapists are all delineated.     

Zukunft der Psychotherapie in der Psychiatrie

The conceptual development of the German mental health system can only be understood against the background of the specific historical development process; therefore, the emigration of psychodynamic psychotherapists during the Third Reich as well as the complicated reintegration of psychotherapy into psychiatry during the postwar period are of particular relevance. The current discussion concerning the relationship of psychiatry and psychotherapy is characterized by the development of new techniques and methods and the concept of modular psychiatry, whereas the traditional complex psychotherapeutic procedures are becoming less important. In the future, the development of clinical and scientific research should focus on psychotherapy in old age as well as adolescence psychotherapy, the combination of psychopharmacological and psychotherapeutic treatment and issues concerning chronic courses as well as resistance to therapy.     

A Preliminary Report on Short-Term Group Psychotherapy on An Acute Adolescent Male Service

This article alerts us to consider depression as a relatively frequent cause of impasse in the course of group psychotherapy. The authors recommend the combined use of antidepressant medication along with group psychotherapy when such depression is confirmed independently outside the group. Common obstacles and pitfalls preventing successful combined treatment are reviewed; the depressive logjam is differentiated from common resistance; and profiles of responders versus nonresponders are described. A rationale of the combined treatment, its results, and implications for group therapists are all delineated.     

Overcoming a child's resistance to late adoption: how one new attachment can facilitate another

The paper describes the difficulty which late-adopted children may have in forming attachments to their new parents. It considers the nature of the disorganized attachment pattern which many of these deprived, abused children display and the origin of this pattern in experiences of 'fright without solution'. The psychotherapy of a 9-year-old, late-adopted boy is used to illustrate long-standing resistance to new attachments on account of defences on which security depends, and the persistence of loyalty to prior internal attachment representations. Change becomes possible through psychotherapy in which earlier negative attachment models are externalized together with their associated feelings of 'fright without solution'. For this boy, a long period of rejection of the therapist gave way to a new capacity to play together; this was associated with the development of positive attachments to the boy's adoptive parents.     

A Multi-Theoretical,Evidence-Based Approach for Understanding and Managing Adolescent Resistance to Psychotherapy

Adolescents are often labeled as “resistant” to psychotherapy. Rather than blaming adolescent clients or psychotherapists, this article conceptualizes adolescent resistance as normal behavior emanating from a challenging situation. Based on a developmentally sensitive foundation and drawing from person-centered, motivational, solution-focused, choice theory, cognitive-behavioral, and multicultural perspectives, several practical and evidence-based strategies for managing, reducing, or eliminating resistance are provided. Case vignettes are used to illustrate specific strategies. Successful psychotherapy with adolescents requires flexibility and openness, integration of diverse theoretical perspectives with contemporary empirical knowledge, and an attitude of respect for adolescent autonomy.     

Amelioration of transference resistance: substitute therapists in milieu group psychotherapy

Building upon Wolf's (1949) notion of the use of an alternate session in group psychotherapy, this paper suggests that an alternate therapist substituting for an absent regular therapist in milieu group psychotherapy can facilitate similar therapeutic benefits. The mechanism of this process of overcoming transference resistance is seen as twofold: (1) sessions with a substitute therapist allow patients to confront the infantilization often present in a milieu setting and experiment with more autonomous ego functioning. (2) Sessions with a substitute therapist create conditions which are apart from the ongoing process of the therapy group, thereby allowing for a therapeutic splitting process to develop wherein transference feelings about the regular therapist can be expressed to his or her "alter ego." Several case vignettes are presented in order to illustrate the clinical utility of a substitute therapist.     

Clients' Experiences of Obstructive Silence: Integrating Conscious Reports and Analytic Theories

The psychodynamic literature has associated clients' silences in psychotherapy sessions with a variety of processes. These processes include wishes to merge with the therapist, to gain control in session, to communicate the unsayable, to express helplessness and, most frequently, the intertwined processes of resistance and regression. Experiences of obstructive silence—that is, moments in which clients detached from the process of therapeutic inquiry—were examined in this study. A grounded theory analysis was used to explore clients' experiences of silences in psychotherapy across psychotherapeutic modalities. Two types of obstructive pausing processes, Disengaged pauses and Interactional pauses, were identified. The implications of delineating conscious aspects of these complex experiences are stressed and techniques are suggested for therapeutic intervention in moments of experienced threat.     

The validity of psychotherapy 1

How good is psychotherapy as a tool of research into human nature? There is an orthodox defence of it as a research tool, which relies on showing that interpretations are true of the patient when they satisfy certain criteria. This defence is examined and rejected. The reply is considered that an interpretation which ‘keeps things moving’ is true, or an approximation to the truth. This reply is rejected by comparing and contrasting an interpretation in psychotherapy with one from brainwashing sessions. Two suppositions about psychotherapy (which weaken its discovery powers) are deliberately adopted — the suppositions that the material produced is ‘perspective’ and ‘method’ dependent. An unorthodox defence of psychotherapy is then offered — by means of a watery sense of ‘discover’. This enables us to outline a weak sense in which psychotherapy is a valid enterprise, but one which is still strong enough for research purposes.     

Psychoanalytic Psychotherapy with People in Abusive Relationships

Summary

Psychoanalytic perspectives on violence between partners is describedand forms a foundation for an approach to group and individual psychotherapy of men and women in relationships in which there is physical violence between partners. The empirical results of a study of the outcome of psychoanalytically oriented psychotherapy are described. Nineteen men and 16 women completed research measures before beginning psychotherapy and after completing 16 sessions of group psychotherapy. Twelve people who completed group psychotherapy continued in individual psychotherapy and completed measures again after 16 sessions of individual psychotherapy, and nine people completed measures again after the 16 sessions of group and 32 sessions of individual psychotherapy. Statistical analyses addressed outcomes in terms of verbal and physical aggression and dysphoric affects and anger. Both research and clinical outcomes are discussed.     

Wie können Langzeittherapien mit kürzeren Behandlungen verglichen werden?

Long-term psychotherapy is not recommended in the current guidelines, which are based on the criteria of evidence-based medicine, as there is a lack of confirmation for long-term psychotherapy by efficacy studies. Using the example of psychoanalytic long-term psychotherapy this article describes six dilemmas which impede the realization of efficacy studies for long-term psychotherapy. Finally, basic elements of a study design are proposed, which are considered as being adequate to compare (psychoanalytic) long-term psychotherapy with shorter treatment forms in terms of outcome and cost-effectiveness. The anxiety and personality disorders (APD) study is briefly described as an example of a study realizing the proposed design.     

Psychoanalytische Psychotherapie mit niedriger Sitzungsfrequenz

Compared to Freud??s use of six sessions a week, the frequency of therapy has now decreased to a maximum of three or four sessions. The current field of applied psychoanalysis using only one or two sessions a week is of much higher relevance for the worldwide supply of the population with psychotherapy. Not only frequency and duration have decreased over the years but also the sum of applied sessions per patient. This is especially the case in psychodynamic short term psychotherapy. With the change in frequency a change in therapy technique took place resulting in a more active and attentive therapist, an interactive pattern with more dialogue and an avoidance of regressive movements of the patient. The crucial role concerning the work with transference and resistance was maintained in tendency but the specific techniques also underwent modifications. The empirical state of psychodynamic psychotherapy is better than it used to be but further studies are urgently needed.     

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.     

Unerwünschte und schädliche Wirkungen von Psychotherapie

Unwanted effects or even damage due to psychotherapy are largely neglected issues within psychotherapy research as compared to other fields. On the other hand, it is reasonable to assume that unwanted effects of a treatment which intends to influence patients into a positive direction are very likely. The rate of negative effects of psychotherapy (the deterioration effect according to Bergin) is consistently estimated to be 10% of all cases and shows this same rate in a variety of studies. This review highlights side effects of psychotherapy both on the part of the patients and of the therapists. It reports unwanted effects related to different psychotherapeutic methods, i.e. psychoanalysis, cognitive behaviour therapy, client-centered psychotherapy and – beyond these basic orientations – group psychotherapy. The paper also reports on negative effects of psychotherapy on an untreated partner. Finally, some proposals are given on how negative effects of psychotherapy could be diminished. The authors especially highlight the possibilities of changing the therapist, the treatment technique, or the theoretical treatment approach as a way to reduce negative effects.     

Sind Psychotherapeuten heimliche Evaluatoren?

Evaluation and psychotherapy share a variety of common features. Both concepts embrace a wide variety of models and applications and are frequently met with opposition and scepticism. A more detailed comparison indicates the close relation between evaluation and psychotherapy and gives authority to the stance that psychotherapists’ resistance to evaluation is futile. The rising demands on psychotherapists for accountability and evidence of what works have increased the practical, academic, and political importance of developing appropriate evaluation approaches. This paper argues that psychotherapists, in their own interest, need to play an increasingly active role in developing useful methods, objectives, and indicators with respect to the evaluation of psychotherapeutic processes.     

Interpretive work in milieu groups

Interpretive work in milieu psychotherapy groups aims to bring concealed and hidden material to the fore so that it can be discussed openly. A host of clinically important issues thrive in the milieu, about which the patients are fully aware, but are unable to discuss. Two types of interventions are described whose goal is to overcome resistance to discussion; they are clarifying interpretations and making a parallel statement. Clarifying statements help patients understand their experience in the milieu; they are interpretive when they bring avoided material into the open. In those instances where resistance to discussion is great, the subject first appears in metaphor, is worked with, and then emerges in a displaced form. Working indirectly with metaphor and displaced material can serve to overcome transference resistance. The therapist then need only ask a direct question or make a statement in order for the avoided material to emerge. The combination of working with displaced material followed by a question or statement that is framed in terms of that theme has an interpretative function.     

Psychotherapy process and research: Missing persons and missing values

The task of ‘understanding’ in psychotherapy is compared with the mundance basis of interpersonal understanding. This implicates a discussion of three ‘principles’ which are put forward as distinguishing features of psychotherapy: ‘empathy’ (as a process, not a technique); ‘interpretation’ (particularly with regard to its relation to values); and the ‘faded person of the psychotherapist’ (related to empathy and interpretation, but particularly the power and remoteness of therapist). This allows a critical evaluation of psychotherapy research. Process research, particularly the innovative work of Robert Elliott, which seems best able to meet criticisms related to the sensitivity of research methodologies, is given particular attention. However, epistemological limitations are identified which are likely to unnecessarily distort the meaningfulness of the ‘events’ of psychotherapy.     

Psychotherapie®

Psychotherapy has not escaped the societal changes of the last decades, which are labelled by sociologists as “reflexive modernization”. Nevertheless, psychotherapists occasionally are supposed to avoid a discussion of issues related to modern societies. This article discusses economization, connected with reflexive modernization, in relation to psychotherapy focussing on the question if psychotherapy has already become a “product” (or is imminent to that). This question is discussed in connection with three specific issues: parallels between psychotherapy and industrial production related to terms such as quality assurance and quality management, the question of a monopoly within psychotherapy, similar to monopolies of industrial companies, and, finally, some phenomena connected with a boom of specific psychotherapies of the recent years that indicate the product-character of psychotherapy.     

Short-term psychodynamic intervention in an urban health clinic: A case report

This paper describes the application of short-term dynamic therapeutic techniques to treat both symptom disturbance and character pathology in an urban mental health clinic. Short-Term dynamic psychotherapy focuses extensively on the subjectivity and inner life of the patient with emphasis on repressed anger, sadness and desire. Methods to overcome patient ambivalence and resistance to psychotherapy are presented. The clinical psychodynamics associated with early life trauma are illustrated with a case of an African-American patient.Acknowledgments for support & critical feedback are expressed to Christine Baker, Ph.D., John Swanson, ACSW, Duncan Walton, Ph.D., and Isabelle Beveridge (Graphics).