The be-coming of a therapist: experiential learning, self-education and the personal/professional nexus

Grounded in a narrative account of the author's own development as a counselling practitioner, it is argued that a programmatic developmental path for therapy practitioners can be singularly inappropriate. Such a route to practitionerhood threatens to interfere with, and even fundamentally to undermine, the necessarily unique idiosyncrasies of practitioner development, and the often ineffable, unspecifiable nature of the therapeutic process itself. Some tensions lying at the heart of the attempt to professionalise the therapy field in Britain are articulated in this personal chronicled history of principled challenge to statutory regulation. The Independent Practitioners Network is introduced as an approach to accountability that strives to avoid many of the worst incoherencies of the 'modernist' bureaucratic institution, and suggestions are made as to how we might enable diverse, innovative practitioner development in Late Modernity.     

The myth of the myth of supervenience

Philosophical Studies - Supervenience is necessary co-variation between two sets of entities (properties, facts, objects, etc.). In the good old days, supervenience was considered a useful...     

Jeffrey J. Magnavita: award for distinguished professional contributions to independent or institutional practice in the private sector

Presents the citation for Jeffrey J. Magnavita, who received the Award for Distinguished Professional Contributions to Independent or Institutional Practice in the Private Sector "for his passionate devotion to the advancement of the practice and science of psychotherapy." Accompanying the citation are a brief profile and a selected bibliography, as well as Magnavita's award address, entitled In Search of the Unifying Principles of Psychotherapy: Conceptual, Empirical, and Clinical Convergence. ((c) 2006 APA, all rights reserved).     

Helping at the edges of life: Perspectives of a psychedelic therapist

A case history is presented of a 70 year old man treated with psychedelic psychotherapy for depression, anxiety, and pain associated with terminal cancer. Interpersonal and intrapersonal aspects of treatment following a single 90 mg dose of dipropyltryptamine (DPT) are described. Comparisons are made between transpersonal, mystical, and religious elements in psychedelic drug experiences and near-death experiences.This paper is based on a study in which the author participated as a research psychotherapist at the Maryland Psychiatric Research Center. The author gives special thanks to the late Dr. T. Glyne Williams for his supervision, and to Dr. Albert A. Kurland for his administrative support of this work, and also thanks Friends of Medical Science Research, the Maryland Psychiatric Research Center, the Maryland Department of Health and Mental Hygiene, and the Mary Reynolds Babcock Foundation for the opportunity to carry out this work.     

Effectiveness of intensive outpatient programming in private practice: integrating practice, outcomes, and business

The development of a model for treating acutely depressed patients on a frequent basis in an independent practice setting is described. Strategies to collaborate with managed care organizations, employee assistance programs, and local provider networks to recruit these patients are outlined. The patients treated in the intensive outpatient program described in this article were primarily depressed, were more acutely distressed than national and local inpatient samples, were often in suicidal crises, and had multiple comorbidities. Nonetheless, they demonstrated significant pre- and posttest improvements on a variety of client- and clinician-rated measures. A dose-response curve further illustrated that significant improvement in depressive symptoms was predictable. Private practitioners can expand their services through the development, implementation, delivery, management, and evaluation of mental health services that respond to market dynamics.     

The role of personal practice in therapist skill development: a model to guide therapists,educators, supervisors and researchers

Prior to 2000, personal practice (PP) for therapists mostly meant personal therapy. Recently a new landscape of PPs has emerged, with meditation-based programs and therapy self-practice/self-reflection (SP/SR) programs playing an increasing role in training and personal/professional development. The challenge now for practitioners and researchers is to refocus on the role of PPs in training and professional development. Are PPs of value - or not? Do they have a role in therapist development? How might PPs enhance therapist skilfulness? Do different PPs act in similar or different ways? Currently, the PP literature lacks a theoretical framework to guide practitioners in their choice of PPs or researchers in their choice of research questions and measures. The purpose of this article is to provide such a framework, the Personal Practice (PP) model. The PP model proposes primary impacts of PPs in four domains: personal development/wellbeing, self-awareness, interpersonal beliefs/attitudes/skills and reflective skills. The model also suggests a secondary impact on therapists’ conceptual/technical skills when therapists use reflection to consider the implications of their PP for their “therapist self”. We offer some suggestions to enhance the quality of future research, and conclude that PPs may play an important and perhaps unique role in therapist training.     

Mindfulness and the myth of mental illness: implications for theory and practice

Over the past 60 years Thomas Szasz (1960, 1961[1974], 2008) has forcefully argued that mental illnesses are mythical since all medical diseases are located in the body and, thus, have somatic causes. This has been accompanied by a scathing and coruscating critique of the whole mental health profession—particularly, those psychologists, psychiatrists and psychotherapists who collude in and exploit the alleged mythology of counterfeit mental disorders and often (unwittingly or deliberately) justify coercion, oppression and pharmacological manipulation of so-called ‘mental patients’ in the name of ‘treatments’. Since mindfulness practitioners—perhaps especially teachers of mindfulness-based cognitive therapy, mindfulness-based stress reduction and related programmes—may, by association, be partially implicated in Szasz's allegations, this article seeks to explore and examine the implications for theory and practice in the field. It will be suggested that the strong foundational, theoretical, research and teaching bases of mindfulness-based interventions offer practitioners a solid defence against the general critique offered by Szasz, and more specific challenges advanced by critics such as Boysen (2007) and Whitaker (2010). However, there may still be potential pitfalls for those mindfulness-based interventions which are too closely allied to the psychiatric/pscychotheraputic establishment, and some suggestions for avoiding such obstacles will be offered through recommendations for maintaining connections between mindfulness and its Buddhist origins.     

The therapist's inner conversation in family therapy practice: some ideas about the self of the therapist, therapeutic impasse, and the process of reflection.

In this article, a distinction is made between the outer therapeutic conversation and the therapist's inner conversation. The therapeutic conversation is a circle of meaning in which both the therapist and the clients play a part. The therapist's inner conversation is described as a negotiation between the self of the therapist and his role. In this process of negotiation the therapist has to take seriously, not only his observations, but also what is evoked in him by these observations, that is, images, moods, emotions, associations, memories, and so on. Furthermore, therapeutic impasse is conceptualized as a paralysis of the circle of meaning and of the therapist's inner conversation. A process of reflection is proposed as a way out of the impasse. In that process, the inner conversation of the therapist is externalized with the help of an outsider. In the final part of this article, a case study illustrates the importance of these ideas for the family therapy practice.     

Interesting times: practice, science, and professional associations in behavior analysis

Neither practitioners nor scientists appear to be fully satisfied with the world's largest behavior-analytic membership organization. Each community appears to believe that initiatives that serve the other will undermine the association's capacity to serve their own needs. Historical examples suggest that such discord is predicted when practitioners and scientists cohabit the same association. This is true because all professional associations exist to address guild interests, and practice and science are different professions with different guild interests. No association, therefore, can succeed in being all things to all people. The solution is to assure that practice and science communities are well served by separate professional associations. I comment briefly on how this outcome might be promoted.     

On self-disclosure: The vulnerable therapist

The therapist may stimulate the family's growth by sharing his personal experiences directly with them. This helps by providing the family with a model of a real (versus symbolic) person and encouraging them to respond in new and competent ways. As a result, the emotional commitment of the therapeutic system may deepen, while unconscious conflicts that have been causing impasses may surface and be resolved. The therapist hopes that his self-disclosure will benefit the therapy, but understands that there are risks involved. Specific guidelines can help in deciding when not to share, what kinds of problems can be revealed, and what attitudes best strengthen this endeavor. Self-disclosure is discussed here in an experiential frame-work. The author illustrates the above points with examples from his own personal clinical and supervisory experiences.The author would like to thank his wife, Linda Barth Garfield, MSS, without whose sustaining support this paper could not have been written, and his partner, Ellen Berman, MD, for her valuable comments and encouragement. The masculine pronoun is used in this paper for convenience, and because the author is often referring to himself.     

The King of Norway: negative individuation,the hero myth and psychopathic narcissism in extreme violence and the life of Anders Behring Breivik

The paper discusses negative individuation and the hero myth as developmental concepts. It is suggested that in negative individuation healthy psychological development is hindered and goes astray. Aggression then becomes the central psychic system. Repressed anger is the core element in psychopathic narcissism (Diamond) and malignant narcissism (Kernberg). Both Diamond and Kernberg extend narcissistic personality structure to antisocial, psychopathic personality in an effort to better understand extreme violence. According to Freud, love (libido) and hate (the death drive) are the major motivational systems in the human psyche. In contrast to Freud, Jung sees libido as a life force in general, not simply as a sexual drive. Jung writes about evil and the shadow but does not present a comprehensive theory of the negative development of an individual's life. The concept of negative individuation connects the shadow and the death drive with psychopathology, psychiatry and psychotherapy. In this paper, I explore these concepts in the light of contemporary affect theory according to Kernberg. I also ask how ideology is tied to extreme violence and how it is possible that narcissistic personality structures can lead to such radically different outcomes as were manifested in the lives of Anders Behring Breivik and Steve Jobs.