Halachic Judaism's Influence on the Practice of Psychotherapy

This paper enumerates and discusses some halachic principles and values which are exerting increasing influence on the practice of psychotherapy. This trend is linked to the resurgence of spiritual values and content in mainstream psychology and therapy, and to the changing concepts of the philosophy of science. The cultural roots of psychotherapy, specifically the contrast between the Greek and Jewish approaches to freedom are also briefly analyzed. The Jewish stand is viewed as imposing a set of values which has as its core enormous respect for the person and his/her ability to choose. Another factor regarded as pivotal is that Jewish teachings foster esteem for objectivity as opposed to the rampant subjectivity seen in some contemporary psychotherapeutic methods. An additional factor discussed is the relation of character traits to therapy. Finally, some facets of the unconscious are analyzed as to their relation to psychotherapy and Judaism.     

Integrating couples and family therapy into a community alcohol service: a pantheoretical approach

This paper discusses the contribution of family systems theory and therapy to mainstream alcohol treatment programmes. Systemic psychotherapy is integrated with group analytic psychotherapy in a couples and family therapy service within a community alcohol service (CAS) which uses the Prochaska and Diclemente model of stages of change. Problems and solutions in putting these complex ideas into practice are discussed, with specific reference to issues of engagement. An example of our work with a couple is offered to illustrate our weave of theory and practice.     

Six things worth understanding about psychoanalytic psychotherapy

This paper is written for family therapists who may be curious but sceptical about psychoanalysis and psychoanalytic psychotherapy. It examines a number of areas of misunderstanding within mainstream family therapy discourse (diversity, authoritarianism, terminology, blame, history and separation) which, the author believes, have acted to help maintain a false coherence for family therapy through a distorted construction of the otherness of psychoanalytic therapy and, in so doing, inhibited a potentially more productive relationship.     

Marginalisation Is Not Unbearable. Is It Even Undesirable?

Marginalised movements in psychology and psychotherapy tend to retain their identity, and the writings of their founders continue to exercise an influence. Once absorbed into the mainstream the identity is lost, and the founders are relegated to the forgotten past. Movements are kept marginalised when they are at odds with the central, untested assumptions (the hard core) of the mainstream. Many of REBT's insights have already been assimilated by the mainstream, which is currently an alliance between experimental psychology and CBT. But the mechanistic hard core of the mainstream is at odds with normative assumptions about self-worth held by REBT. As long as that continues REBT is likely to remain marginalised, but will keep its most significant insights.     

Systematic Review of the Effects of Religion-Accommodative Psychotherapy for Depression and Anxiety

Integrating religion into psychotherapy may improve treatment for depression and anxiety. This review systematically examines clinical trials of religion-accommodative psychotherapy for depression or anxiety. Results indicate that integrating religion into psychotherapy does not lead to significantly more improvements in depression or anxiety than equivalent therapy without religious components. However, when compared with less stringent control groups, such as supportive psychotherapy, religion-accommodative therapy may be more effective, at least immediately post-treatment. Results from the 11 studies reviewed indicate that psychotherapy integrating religion is at least as effective for treating depression and anxiety as other forms of psychotherapy. Conclusions were limited by lack of power, comparable control groups, focus on anxiety, and treatment manuals.     

Patients’ Perceptions of Risky Developments During Psychotherapy

Research on risks and unwanted effects is largely missing in psychotherapy. Using exploratory factor analysis six dimensions of personal therapy situation were identified in a preliminary study, three of them were associated with risky developments during the psychotherapeutic process: (1) (poor) quality of therapeutic relationship, (2) burden caused by psychotherapy, and (3) dependency/isolation. Based on the finding of this study an online survey was performed to examine these three dimensions. Aside from these three factors another variable was associated with risky therapy developments: the online questionnaire also asked for premature terminations of psychotherapy as a consequence of risky conditions for the therapeutic development. Risky conditions were found to be associated with the following variables: (1) the combination of female patient–male therapist, (2) the therapeutic orientation (particularly with the psychodynamic approaches) and (3) the duration of therapy. Fewer humanistic and systemic psychotherapies were found among the high risk-prone group of patients who were at risk in at least three of the four variables which were associated with risky developments. Differences in the findings of the study regarding the four therapeutic orientations stress the importance of an extensive differential indication and a cooperative partnership between patient and therapist, in order to facilitate a positive patient participation towards the choice of therapy method and subsequent successful participation throughout the course of treatment. Further studies should also focus on female patient and male therapist psychotherapies.     

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.     

Virtual reality in psychotherapy: review.

Virtual reality (VR) has recently emerged as a potentially effective way to provide general and specialty health care services, and appears poised to enter mainstream psychotherapy delivery. Because VR could be part of the future of clinical psychology, it is critical to all psychotherapists that it be defined broadly. To ensure appropriate development of VR applications, clinicians must have a clear understanding of the opportunities and challenges it will provide in professional practice. This review outlines the current state of clinical research relevant to the development of virtual environments for use in psychotherapy. In particular, the paper focuses its analysis on both actual applications of VR in clinical psychology and how different clinical perspectives can use this approach to improve the process of therapeutic change.     

The Findings of a Cochrane Meta-Analysis of Couple Therapy in Adult Depression: Implications for Research and Clinical Practice

The association between depressive symptoms and distressed intimate relationships supported the assumption that couple therapy, by focusing on the interpersonal context of depression, might be more effective as a treatment for depression than individual psychotherapy or drug therapy. This issue was addressed by a Cochrane meta-analysis assessing the evidence from clinical trials of couple therapy for depression in comparison with individual psychotherapy, drug therapy, and no/minimal intervention, including fourteen studies with 651 participants. No study was found free of bias and the quality of the evidence was low, with major problems of small sample sizes, missing outcome data, selective reporting, lack of information on random sequence generation and allocation concealment, recruitment of people not representative of clinical practice, and allegiance bias. The meta-analysis showed that both couple therapy and individual psychotherapy improved depressive symptoms at end of treatment and after 6 months or longer, with moderate effect sizes, without any difference between the two treatments. Couple therapy was more effective in reducing couple distress. This effect was larger in studies with distressed couples only and should be considered as relevant in its own right. Couple therapy is a viable option for the treatment of a depressed partner, especially in discordant couples. Future research should address several issues left open to provide a sound empirical foundation for clinical practice.     

When it comes to evaluating psychodynamic therapy, the devil is in the details

Comments on the original article, "The efficacy of psychodynamic psychotherapy," by J. Shedler (see record 2010-02208-012). As Shedler noted, some researchers have reflexively and stridently dismissed psychodynamic therapy (PT) as ineffective without granting outcome studies on this modality a fair hearing. We applaud Shedler's efforts to bring PT into the scientific mainstream and hope that his article encourages investigators to evaluate claims regarding PT's efficacy with a more objective eye. Nevertheless, as Shedler also observed, one reason for the scientific community's premature dismissal of PT is traceable to some psychodynamic practitioners' historical antipathy toward controlled research and propensity to overstate PT's efficacy. Regrettably, Shedler falls prey to the latter error by glossing over key methodological details, ignoring crucial findings that run counter to his position, and overstating the quality and quantity of the evidence base for PT. Because of space constraints, we focus only on a handful of the more serious shortcomings of Shedler's analysis (a more complete review of these issues is available from the first author on request).     

Die DPG-Praxis-Studie

All psychotherapeutic methods must be scientifically evaluated. Empirical evaluation of evidence is a prerequisite for acceptance as scientific psychotherapy as well as for payment by health insurance. Currently the psychotherapy methods accepted within the German health system (behavioural therapy, psychodynamic psychotherapy, and analytic psychotherapy) are reviewed by a governmental evaluation committee concerning evidence, necessity and cost-effectiveness. The DPG practice study has basically two aims: 1) to conduct a large naturalistic study to investigate effectiveness, sustainability and economic aspects of psychodynamic and analytic psychotherapy and 2) to offer a framework for psychoanalytic institutes, members, candidates or groups to realize own research ideas by collecting additional data within the study. The present article describes the background, main research questions, structure and design of the DPG practice study with regard to the evaluation questions.     

Confidentiality and privileged communication in group psychotherapy

The concept of confidentiality is fundamental to all forms of psychotherapy. The idea of protecting confidential material goes as far back as the Hippocratic Oath in ancient Greek history. Centuries later, authors continue to assert that "only by maintaining confidentiality can the essential groundwork of trust in treatment be developed" (Hough, 1992, p. 106). Others have even argued that without confidentiality, psychotherapy has no value (Epstein, Steingarten, Weinstein, & Nashel, 1977). Confidentiality in group psychotherapy is more complicated than in individual therapy because self-disclosure is at the core of group therapy and there are numerous people hearing the disclosures. Confidentiality in group therapy, once ignored in the literature on ethics, is gaining more attention as this modality becomes more widely practiced; so too is an acknowledgement that ethical dilemmas surrounding confidentiality in groups are commonplace. This article discusses the major considerations and dilemmas on confidentiality in group psychotherapy. We first review confidentiality broadly and discuss the ethical principles that are related to confidentiality. In the next section, we discuss the complexities of confidentiality in group psychotherapy. Finally, we review research on confidentiality in groups and describe common ethical dilemmas.     

The significance of William James' ideas for modern psychotherapy

The functional psychology first developed by William James in 1890 exerts a strong but unrecognized influence on the thinking of most modern psychotherapists. Indeed, in many ways, clinical functionalism is the hidden philosophy which holds together the mainstream of eclectic psychotherapy. This article considers the general impact of James' point of view on modern psychotherapy and the specific relevance of James' ideas about emotions and consciousness.     

Psychotherapie oder Psychopharmakotherapie oder Kombinationstherapie?

Current meta-analyses convincingly show the effectiveness of psychotherapy. For many mental disorders psychotherapy is the therapy of choice and superior to an exclusive pharmacotherapy. A psychotherapy is still effective far beyond the end of psychotherapy. Mild and moderate depressive episodes can be successfully treated by psychotherapy alone. A combination treatment is indicated for severe depressive episodes and a chronic course. Cognitive behavior therapy (CBT) is the method of choice for anxiety disorders where CBT can be initiated in order to build up self-efficacy and medication can be omitted at first. A combination treatment is only indicated when the response is insufficient. For obsessive-compulsive disorder with predominantly compulsive behavior CBT with exposure and reaction management is the method of choice. Combination treatment is indicated particularly for predominantly obsessive thoughts and comorbid depression. In posttraumatic stress disorder a trauma-focussed CBT is the method of choice. For posttraumatic stress disorder selective serotonin reuptake inhibitors are indicated only for comorbid disorders. For all disorders benzodiazepines should be prescribed only in justifiable exceptional cases for short-term administration. For individualized differential indications the effects of simultaneous psychopharmacotherapy on the therapeutic process must be taken into consideration.     

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.     

Some unresolved issues in philosophy and psychology: their implications for therapy

This paper is divided into two interrelated sections: the first section examines the scientific status of mainstream Western psychology. It will also consider the major arguments concerning the relationship of mainstream Western psychology to philosophy—in particular to metaphysics and the philosophy of science. It will be argued that psychology has turned away from its past philosophical heritage and has thus, short-changed itself by avoiding the very issues, which form an integral part of one's subjective and existential world and of the therapeutic process. The second section argues that, to a large measure the contemporary approaches to counselling and psychotherapy have moved away from the scientific ideologies, which guide research within mainstream Western psychology. Over the last 30 years or more, counselling and psychotherapy as ‘disciplines’ have proliferated into several sub-disciplines. This has made it difficult, if not impossible, to determine their pedigree and parentage. Although a great deal of ingenuity has gone into the construction of such new therapies, very little effort has gone into testing their validity. Unless serious attempts are made to bring about a rapprochement, it is likely to lead to a state of ‘epistemological anarchy’, or, anything goes.     

ABSTRACTS

This is an essay on the history of family diagnosis and therapy. The role of the family in the etiology of psychopathology was a longstanding "blind spot." Family psychotherapy is gradually developing as a form of psychotherapy with indications and contraindications of its own. Comparison studies with other forms of psychotherapy should be done.     

Postmodernism versus psychotherapy

‘Postmodernism’has made a substantial impact on various schools of psychotherapy, including family therapy.‘Postmodern’therapists tend to focus on the productive capacities of language, developing narrative styles for their work.‘Postmodern’family therapy is differentiated from modernist approaches by its disavowal of truth claims and its encouragement of alternative‘voices’or narratives. In this paper, it is argued that this represents too narrow an approach to psychotherapy and to postmodernism. Postmodernism takes as a central concern the limits of symbolization, so a postmodernist therapy would deal primarily with failures of language. Language-based therapeutic procedures such as those to be found in family therapy are consequently not postmodernist. This state of affairs should be welcomed, as a truly‘postmodern’mode of therapy would probably celebrate irrationality.     

Politics on the Couch? Psychotherapy and Society—Some Possibilities and Some Limitations

The ideas and practices of psychotherapy, together with fresh thinking from many other sources, can help to revitalize Western politics which seem broken and moribund. The author describes various professional experiences of his own at the interface of politics and psychotherapy. These include consulting with mainstream and activist politicians and groupings. He discusses how politics in the West is changing in the general direction of what he calls “transformative politics.” He also asks if psychotherapists can make a difference in the political world today, explaining that, though enthusiastic about the prospect, he is also skeptical about it because the record of psychotherapists' involvement in politics is not very good. The paper includes an experiential and personally oriented section (“The Inner Politician”) that looks at how the political self is formed in culture, family, and the inner world. The notion of differing political styles as a source of conflict is explained and explored. The author concludes with some reflections on the relations between psychotherapy, politics, and spirituality.