如何建立聊天机器人与用户间的数字治疗联盟：关系线索的作用

近年来,研究者们将“治疗联盟”(Therapeutic Alliance,TA)的概念与在线自助干预(Internet-based Self-help Interventions,ISIs)相结合,以解决ISIs中用户参与度较低的问题。这种在数字环境中形成的TA,被称之为“数字治疗联盟”(Digital Therapeutic Alliance, DTA)。随着人工智能的迅速发展,聊天机器人可模拟人类指导,相对于传统ISIs程序更易于与用户建立关系,可通过友好、尊重、倾听、鼓励、真诚、理解、信任这几个关系线索来促进DTA的发展,为解决用户低参与度的问题提供了一种新思路。未来的研究可从影响因素、ISIs技术迭代、测量规范、实验操纵等方面对DTA作进一步的探索。     

Therapeutic Assessment With Child Inpatients

Growing evidence supports Therapeutic Assessment (TA), a collaborative and therapeutic approach to psychological assessment, as an effective method for enhancing motivation for and engagement with psychotherapy across a variety of clinical populations and treatment settings. However, to date there are no known studies assessing the use of TA in child psychiatric inpatient settings. This article briefly reviews the structure of child and family TA, enumerates the challenges and risks associated with short-term inpatient stays, and proposes a path for integrating TA into these units as a way to enhance the quality of care and reduce the risk of rapid rehospitalization. The authors provide three case examples from a child psychiatric inpatient unit, each using a modified version of TA and each integrating assessments into brief family interventions. The authors conclude with suggestions for best practice for child psychiatric inpatient TAs.     

Can I use TA? Should I use TA? Should I not use TA? Comparing reflexive thematic analysis and other pattern‐based qualitative analytic approaches

Thematic analysis methods, including the reflexive approach we have developed, are widely used in counselling and psychotherapy research, as are other approaches that seek to develop ‘patterns’ (themes, categories) across cases. Without a thorough grounding in the conceptual foundations of a wide variety of across‐case analytic approaches, and qualitative research more broadly—something rarely offered in counselling training—it can be difficult to understand how these differ, where they overlap, and which might be appropriate for a particular research project. Our aim in this paper is to support researchers in counselling and psychotherapy to select an appropriate across‐case approach for their research, and to justify their choice, by discussing conceptual and procedural differences and similarities between reflexive thematic analysis (TA) and four other across‐case approaches. Three of these are also widely used in counselling and psychotherapy research—qualitative content analysis, interpretative phenomenological analysis and grounded theory. The fourth—discourse analysis—is less widely used but importantly exemplifies the critical qualitative research tradition. We contextualise our comparative approach by highlighting the diversity within TA. TA is best thought of as a spectrum of methods—from types that prioritise coding accuracy and reliability to reflexive approaches like ours that emphasise the inescapable subjectivity of data interpretation. Although reflexive TA provides the point of comparison for our discussion of other across‐case approaches, our aim is not to promote reflexive TA as ‘best’. Rather, we encourage the knowing selection and use of analytic methods and methodologies in counselling and psychotherapy research.     

A change in frame and countertransference experiences: Transitioning from face-to-face to telepsychotherapy

Unprecedented changes in traditional psychotherapeutic practice arose from the lockdown restrictions associated with the COVID-19 pandemic. These changes to practice included the imposed change to the therapeutic frame when transitioning clients from face-to-face meetings to delivery of psychotherapy sessions via videoconferencing (defined here as telepsychotherapy). The current study conducted qualitative interviews with 16 Australian psychologists who transitioned their existing adult psychotherapy clients from face-to-face therapy to telepsychotherapy and explored their novel experiences associated with countertransference reactions during this period. Thematic analysis of the interviews revealed several unique findings. The type of countertransference reactions towards existing clients was consistent across both face-to-face and online meetings; however, the felt intensity of countertransference reactions was reduced. Psychologists reported an increased hesitance to work with intense emotions during telepsychotherapy sessions and felt increased pressure to work harder during online sessions when compared to face-to-face meetings. Exposure to their clients' personal and home environments during telepsychotherapy sessions elicited several novel reactions towards their clients. These findings on countertransference and telepsychotherapy are informative for future practice and training. Awareness of these unique countertransference experiences is recommended prior to engaging in telepsychotherapy or when transitioning clients to this modality.     

PREDICTORS OF ENGAGEMENT IN PSYCHODYNAMIC PSYCHOTHERAPY DERIVING FROM PRE‐ASSESSMENT QUESTIONNAIRES

Patients attending the Maudsley Hospital Psychotherapy Unit complete a semi‐structured questionnaire as a matter of standard procedure prior to assessment. Clinical experience suggests that this instrument reveals important aspects of a patient's internal world, regularly borne out at the assessment interview. The questionnaire may thus contribute to predicting engagement in the therapeutic relationship. To evaluate this hypothesis we conducted a qualitative analysis of 40 questionnaires, 20 of patients who attended 20 sessions or more, the other 20 of patients who discontinued at or before the sixth session. We differentially explored characteristics that may indicate the probability of patients' engagement and, hence, help to predict outcome in terms of completion of the treatment. The results indicate that there are no strong discriminating factors discernable in the questionnaires for the prediction of engagement in psychotherapy. Two themes emerged from the analysis that seemed to have a moderate bearing on completion. These are the willingness of patients to observe themselves reflectively as well as the awareness that psychotherapy might be a difficult but necessary and beneficial undertaking.     

Beyond Viral: Interpersonal Communication in the Internet Age

Contemporary scholarship on mindfulness casts it as a form of purely nonevaluative engagement with experience. Yet, traditionally mindfulness was not intended to operate in a vacuum of dispassionate observation, but was seen as facilitative of eudaimonic mental states. In spite of this historical context, modern psychological research has neglected to ask the question of how the practice of mindfulness affects downstream emotion regulatory processes to impact the sense of meaning in life. To fill this lacuna, here we describe the mindfulness-to-meaning theory, from which we derive a novel process model of mindful positive emotion regulation informed by affective science, in which mindfulness is proposed to introduce flexibility in the generation of cognitive appraisals by enhancing interoceptive attention, thereby expanding the scope of cognition to facilitate reappraisal of adversity and savoring of positive experience. This process is proposed to culminate in a deepened capacity for meaning-making and greater engagement with life.     

Interaction of therapeutic process and alliance during psychological assessment

Utilizing a collaborative therapeutic assessment (TA) model proposed by Finn and Tonsager (1997), we examined the interaction between therapeutic alliance and in-session process during the assessment phase of treatment. This study compares the utility of the TA model (n = 38) versus a traditional information gathering model (n = 90) of assessment. The results of this study indicate that the use of a TA model may decrease the number of patients who terminate treatment against medical advice. The Session Evaluation Questionnaire (Stiles & Snow, 1984), Combined Alliance Short Form (Hatcher & Barends, 1996), and Penn Helping Alliance Questionnaire-Revised (Barber & Crits-Christoph, 1996) can reliably measure the patient's experience of the assessment. The psychological assessment process may impact the patient's experience of assessment feedback and aid in the development of a therapeutic alliance. The therapeutic alliance developed during the assessment was found to be related to alliance early in psychotherapy. We discuss the theoretical, clinical, and research implications of these findings.     

‘Learning from research’: Therapist perspectives on the benefits and challenges of participating in a longitudinal,systematic case‐study

Objectives: In psychotherapy research we have often neglected to examine the impact of research procedures on therapy process and outcome. Such information is extremely important in helping us evaluate the validity of our findings, increase relevance of research for practice, and choose appropriate methods for future projects. The aim of this paper is to share the experience of six person‐centered therapists, who participated in a longitudinal, systematic study, and present their reflections about the impact of research on therapy process, therapeutic engagement and professional development. Methods: The findings have emerged from semi‐structured interviews that took place after the first, sixth (middle) and last therapy session. In total 18 interviews were conducted. These data were part of a much larger research protocol that included a number of outcome and process measures. Results & Conclusions: The analysis of therapist narratives revealed important benefits for those participating in systematic case study research. The use of Brief Structured Recall methods and qualitative interviewing was an important factor in promoting therapist reflexivity and professional development. The importance of a strong research alliance and the active involvement of the client in the research process is discussed.     

Saudi therapists' lived experience of self-awareness

Self-awareness and self-reflection in psychotherapeutic processes have been critical components for effective counselling and psychotherapy. However, little qualitative research in Saudi Arabia has been conducted that aims to explore the therapist's subjective experiences of the self in their professional work. Therefore, the purpose of this phenomenological study was to understand the therapist's self-awareness within psychotherapy, by focusing on the therapist's lived experience of self-awareness and exploring how therapists recognise themselves as an integral component of the therapeutic relationship. Semi-structured interviews were conducted with six experienced and accredited psychologists with at least three years of clinical experience, and the qualitative data were analysed using interpretative phenomenological analysis (IPA). Five superordinate themes emerged from the data; that is, development of the professional self, use of self, self-oriented, supervision and experience. This study provides an understanding of the therapist's self in psychotherapy, as it shows that self-awareness is important for therapists to manage their feelings, thoughts and behaviours in meeting with clients and that it is a valuable resource for a therapist to become aware of and reflect upon the process within oneself. This understanding is integrated into the training programmes in counselling psychology, especially in the areas of self-awareness and personal development.     

Considering methodological integrity in counselling and psychotherapy research

Within the field of counselling and psychotherapy research, qualitative methods have been a longstanding tradition of inquiry due to the mutual interest of therapists and researchers in both internal experiences and intersubjective processes. Methodological integrity is a conceptual framework that has been advanced to increase the rigor of these methods. In this paper, we consider the value of this concept for counselling and psychotherapy researchers and reviewers. This framework guides investigators and reviewers to consider how procedures can be adapted to meet the goals of specific studies, given their characteristics and approach to inquiry. In this brief article, we exemplify the relevance and application of this concept to this field by describing the decision‐making process within the designing of a qualitative research project to investigate clients' needs within rape crisis counselling. Through this exemplar, we also provide guidance to counselling and psychotherapy researchers on considerations during the process of research review and reporting.     

Therapeutic factors in two forms of inpatient group psychotherapy: Music therapy and verbal therapy

Therapeutic processes in one type of creative arts group psychotherapy, music therapy, were compared with verbal group psychotherapy. Sixty-one short-term inpatients ranked group psychotherapy curative factors and completed satisfaction ratings. Therapists rated 201 group therapy sessions— 109 music therapy and 92 verbal therapy. Statistical analysis revealed that patients highly valued both group formats. The mean curative factor rankings for both groups included cohesiveness, instillation of hope, and altruism among the most helpful factors. Therapists' ratings indicated qualitative differences between the two groups. Music therapy involved more therapeutic interaction among patients and emotional expression, whereas verbal therapy emphasized concrete problem solving.Supported in part by Biomedical Research Support Grant Program grant #S07-RR05755 from the Division of Research Resources, National Institutes of Health.     

Storymaking: In-between anthropological enquiry and Transactional Analysis Psychotherapy

The author discusses the relationship between anthropological enquiry and Transactional Analysis (TA) counselling and psychotherapy practice. Both disciplines of anthropology and TA offer an exploration of the individual's story. The concept of in-between-ness can add an extra dimension to working with clients in acknowledging the place of the client's story and the psychotherapist's role in witnessing as a way of making meaning of the whole. Ethnographical extracts are examined to illuminate how the application of anthropological insights and concepts can enhance TA psychotherapy practice.     

Neurodynamics inside therapeutic interaction: a case study with simultaneous EEG recording / La neurodinámica en el contexto de la interacción terapéutica: un estudio de caso con una grabación simultánea de EEG

Recent research on processes of psychotherapy has focused on the study of patient-therapist regulation. Evidence concerning verbal and nonverbal coordination as predictors of therapeutic alliance and outcome in psychotherapy has been cumulating. These, along with others results in the field of social neuroscience, suggest that behavioural coordination may have neurophysiological correlates, which play a role in the regulatory process in psychotherapy. Here we introduce an observational paradigm and analytic method to assess the joint neurodynamic activity of patient and therapist. Additionally we report results from ongoing psychotherapy sessions. Our work highlights the involvement of brain activity in the psychotherapeutic process and provides novel insights on how psychotherapy works, in order to further the understanding of the embodied characteristic of the therapeutic interaction.     

Power and Pleasure

SUMMARY

In exploring issues of power and pleasure in relationships the author uses Erikson's (1965) developmental 'eight ages of man' as both a conceptual framework and a way of describing aspects of the developmental growth of boys as men, and he completes Erikson's (1968) epigenesis of the life cycle in relation to identity and intimacy. Drawing on literature on male psychology, his own experience and his experience as a counsellor and a Transactional Analysis (TA) psychotherapist in clinical training, the author focuses on male identity and men's capacity for intimacy in relationships. The use and abuse of power in achieving male identity, and the implications for mutual pleasure and interdependence in intimate relationships are outlined and practice issues for counselling and psychotherapy with men in relation to identity and intimacy issues are considered.     

Empathy as dialectic imagination

Abstract

The importance of relationship processes for humanistic and psychodynamic therapists makes empathy a critical concept in psychotherapy. Experimental work suggests that learning occurs only when the subject is actively and cooperatively engaged in the learning process. Similarly, psychotherapy is only effective when the client is willingly active in the therapeutic process. A crucial aspect of the therapist's activity is empathic imagination, defined here as the use of “dialectic” thinking capacities‐the recognition of conceptual alternatives in a given situation. These processes are at the heart of a humanistic view of agency. The therapist's use of this capacity allows imaginative projection into aspects of the client's experience, helping the client to feel understood in the relationship and emboldened to consider new possibilities in life.     

Being in‐between: The relevance of ethnography and auto‐ethnography for psychotherapy research

Aims: This paper proposes that ethnography and auto‐ethnography can make important contributions to counselling and psychotherapy research. Auto‐ethnography is a recent methodological approach that focuses on the subjective experiences of the researcher. It is informed by anthropology, which encourages the researcher to journey alongside the persons being observed and to make meaning of complex symbolic systems in their lives. Method: Examples from a study of therapeutic processes in a mental health setting for women are examined. Discussion: If auto‐ethnography situates the researcher with the insider's perspective and ethnography is from the outsider's perspective, the researcher is caught ‘in‐between’ these two approaches. Acknowledging the concept of ‘in‐between‐ness’ can both cause discomfort and transform the experience of all who engage in the process and enhance the quality of the research.     

Therapeutic assessment case study: treatment of a woman diagnosed with metastatic cancer and attachment trauma

This article presents a Therapeutic Assessment (TA) case study of a woman recovering from 4 years of intense medical treatment for stage IV cancer. The inclusion and utility of using the Adult Attachment Projective Picture System (AAP) in the TA is highlighted. The client's attachment classification as unresolved helped identify that her current experiences with dissociation and problems restructuring her life following cancer remission were related to severe childhood sexual abuse, which she had suppressed for decades. The AAP also provided information regarding the unconscious defensive processes the client employed to cope with attachment distress and her inability to find comfort and support from others. These findings were instrumental in guiding the subsequent psychotherapy. The TA process, particularly the assessor-client relationship, facilitated an experience of containing her previously unintegrated and dysregulated affect. A single-case experiment using daily measurements suggested that participation in TA coincided with symptomatic improvements in multiple domains. These improvements were maintained during 4 months of biweekly psychotherapy after the completion of the TA. This case illustrates the applicability of the TA model in health care settings, demonstrates the usefulness of the AAP in the context of TA, and provides empirical support for the effectiveness of the TA model in initiating symptom improvement.     

Studying the process of psychoanalytic parent–infant psychotherapy: Embodied and discursive aspects

This paper presents findings from an intensive, mixed methods case study of one session of psychoanalytic parent–infant psychotherapy (PPIP) addressing early relational trauma, and aims to shed light on the multimodal interactive processes that take place in the moment-to-moment exchanges comprising the therapeutic encounter. Different research methods were used on video material from PPIP sessions, including microanalysis of adult–infant interactions, discourse analysis of talk, and coding systems developed to study parent–infant interaction. These different perspectives were brought together with the clinical narrative to illuminate the complex, dynamic processes of parent–infant–therapist interaction. More specifically, the detailed analysis of one interactive episode revealed brief behavioral manifestations of fearful and disoriented states of mind, reflecting dysregulated interaction between mother and infant, which also powerfully affected the therapist. The processes through which the therapist gradually resolves this rupture are also described in detail. Through this pilot study, we were able to show that it is possible to systematically study the process of PPIP. The study contributes to the growing psychotherapy research literature that takes into account both the verbal domain and implicit, interactional processes in therapeutic practice, and underscores the therapist's comprehensive engagement in the therapeutic process.     

Building capacity or enforcing normalcy? Engaging with disability scholarship in Africa

In contemporary South African academia, “community engagement” is a valued commodity. My work as a nondisabled white man with disability activists and as editor of the African Journal of Disability is viewed as good for my career, and as an appropriate form of engagement and empowerment. In this article, I engage critically with the question of the extent to which capacity building is simply about increasing capacity. I ask whether capacity building inevitably involves elements of disavowal of the experience and competencies of less powerful people. I compare capacity building to the enforcement of normalcy, a process which disability scholars criticize with justification. I ask whether it is possible in unequal social contexts to engage with the politics of voice without imposing a hegemonic narrative on nondominant voices. I suggest links between the politics of engaged scholarship and processes of domestication of troubling bodies and minds.     

Stories,stories everywhere; But not a truth to think

Abstract

Black Sheep and Kissing Cousins: How our family stories shape us by Elizabeth E. Stone New York: Penguin, 1989

Narrative means to therapeutic ends by Michael White and David Epston New York: Norton, 1990

Between psychology and psychotherapy: A poetics of experience by Miller Mair London: Routledge, 1989

Moments of engagement by Peter Kramer New York: Norton, 1989

Metaphor & meaning in psychotherapy by Ellen Y. Siegelman New York: Guilford Press, 1990