A Negotiation Approach to Intake and Treatment Choice

Treatment choice is the decision process whereby the psychotherapeutic methods and the psychotherapist are determined when psychotherapy is recommended for a specific client. In this article the problem of treatment choice is situated within an integrative view of psychotherapy. A review of the literature confirms the usefulness of the following concepts for treatment choice: client preferences, client control of the situation of choice, and the mutual acceptability of differing views of therapists and clients. These research findings reveal the importance of four elements in the psychotherapeutic intake strategy: exploration of the client's perspective, informing the client, negotiation as a process of confrontation between the client's and the clinician's perspective, and the client's ultimate choice between alternative treatment proposals.     

Contributions for Modeling the Psychotherapeutic Process of Change

This essay is a contribution to the discussions on the modeling of the psychotherapeutic process of change. Three aspects are highlighted: an evaluation of the emergence and transformation of novelty in the narratives of the clients; the inclusion of the psychotherapist as a dialogical partner that constructs with the client her new narratives; and a tentative analysis of the meaning-making of this construction along the successive moments of the dialogical exchanges between the client and the psychotherapist. It is finally pointed out some gains in modeling the client-psychotherapist dialogical process of (ex)changes.     

Danger! Psychotherapists at work

The rapid growth of psychotherapeutic movements in recent years has led to a free market. Vast numbers of psychotherapists of different theoretical persuasions are now on offer. While such a choice has its obvious advantages, it creates bewildering confusions in the minds of potential clients. How can the clients tell which psychotherapist or psychotherapeutic entepise to opt for? How can they know whether they have made an appropriate choice? How do they know which therapy works best under which conditions? Are there a set of criteria laid down which might guide the client in making a judicious choice? Can they be assured that after a senes of agreed sessions, they will get better? These are extremely serious issues. The paper discusses the practical and ethical implications underlying these issues and offers specific suggestions and guidelines as to how the clients might safeguard their own interests when it comes to choosing an appropriate psychotherapist.     

Sequential Analysis: Monitoring counselling sessions via skin resistance

Very little has been published on the application of the galvanic skin response (GSR) to counselling and psychotherapy, since research has concentrated on applications to lie detection and biofeedback. Dr Ian N. Marshall developed Sequential Analysis in 1968-69, as a system of psychotherapeutic procedures monitored by GSR, but most of his work remains unpublished. Certain meter techniques are described. It is suggested that the ‘paradoxial’ phenomena would be explained by correlating high/low resistance with withdrawal/involvement rather than with relaxation/arousal. The procedures of Sequential Analysis are described briefly. Finally it is suggested that giving oneself sessions is an effective method for training as a counsellor or psychotherapist, because of the experiential understanding of the processes so obtained.     

On the edge: The psychoanalyst's transference1

Countertransference is a central topic in analytic work and in the literature. The concept of countertransference includes a basic question which has been understood in different ways. The author attempts to differentiate between the psychoanalyst's transference and his countertransference in the analytic process. It is hard to draw a line between them; analysts are always on the edge. The analyst's transference will be explored and described using three approaches: narcissism, regression profile and the analyst's phase of life. Regression profile is a new concept developed by the author, which may help us to understand the core of the analyst's transference in the analytic situation. She illustrates the topic by clinical vignettes.     

Arthur Kronfeld (1886-1941)--a psychiatrist in the service of psychotherapy

The psychotherapeutic life-work of psychiatrist Arthur Kronfeld has almost fallen into oblivion. Against the background of the 100th anniversary of his birth the author traces Kronfeld's psychotherapeutic career, pointing out his activity at the Berliner "Institute of Sexual Research" under Magnus Hirschfeld, and his psychotherapeutic concept--the psychagogic guidance of the patient--and its connection with the individual psychology of Alfred Adler. Kronfeld translated his theoretical positions into activities directed towards socialization and the teachability of psychotherapy which are still worthy of note by those engaged in the field.     

Individual therapy as a special form of complex psychotherapy]

A combination of several psychotherapeutic methods will be meaningfull only if they are tuned to, and supplement, each other. Indiscriminate combinations may produce harmful effects. The choice of psychotherapeutic methods depends upon the objective that the psychotherapist desires to accomplish. In psychotherapy it is essential that all actions taken be governed by plans worked out in accordance with the particular objectives to be accomplished.     

Transsexualität

Transsexuality is a process with biological, psychological and social aspects. It makes the person concerned feel subjectively appendant to the other gender. The own gender is objectively sensed but it is experienced as foreign. Because of this deep internal certainty, transsexual persons change into their inner chosen gender. This change goes along with a psychosocial alteration of role and in most cases with a hormonal and surgical conversion. Psychotherapy with transsexual persons is known to be difficult and disappointing. The aim of this review is to invalidate these prejudices and to encourage psychotherapeutic treatment of transsexual persons. It also will give all necessary information for this kind of psychotherapy. Generally the psychotherapeutic accompaniment of transsexuals is definitely a meaningful experience for a psychotherapist, in which basic issues of human existence are being touched.     

The King and his Fool*

The Fool in Shakespeare's King Lear is portrayed as an unsuccessful medieval psychotherapist. Parallels are drawn with modern psychotherapeutic practices, especially the potentially dangerous misuse of humour, metaphor, paradox and absurdity by inexperienced therapists.     

Psychoanalytic witnessing as a prerequisite to psychotherapy with a severely sexually abused young adolescent male ex-inner city gang member

This paper discusses psychoanalytic witnessing as the prerequisite for psychoanalytic psychotherapy with a severely sexually traumatised young adolescent boy, Dean. This form of witnessing acted as a prior stage for treatment through the psychotherapist acknowledging Dean’s trauma, without seeking to symbolise its registration in the psychotherapeutic relationship. As sexual abuse is about something done to the person, this acknowledging crucially conveys belief in the truth of what has happened to the patient at the hands of the external world. My work with Dean taught me that such acknowledgment allows for such traumatised patients to then feel more able to accept interpretations based upon what they are doing to the external world, encapsulated in the transference to their psychotherapist. Because trauma is often so deeply felt, and leaves patients dissociated or fragmented, seeking evidence of its presence needs keen observation. Here the paper discusses an experience of bodily countertransference that alerted me to the location of Dean’s trauma’s registration in our relationship. Overall, the paper seeks to demonstrate the importance of psychoanalytic witnessing as a form of containment in itself, and the essential basis for psychotherapeutic work using symbolisation and the transference.     

Pastoral psychotherapy as Gnostic event

An essay suggesting ways in which the accelerating recovery of ancient Gnostic literatures might have relevance for contemporary pastoral psychotherapeutic practice.Terrill L. Gibson, Ph.D., is an Associate with Pastoral Therapy Associates in Tacoma, WA, He is a pastoral psychotherapist and a diploma Jungian analyst.     

Psychoanalytic psychotherapy and student counselling

This paper explores the experience of a psychotherapist working in a university counselling service, indicating the contribution I think a psychoanalytic orientation can make to this kind of work. The exposed ‘coal face’ nature of the work is illustrated, and some of the psychotherapeutic implications of working within a large organisation discussed. There is an exploration of institutional dynamics which bear directly upon the psychotherapist, in terms of what it is possible to provide, and of professional self-preservation and self-esteem. Analysis of the uses made of the counselling service is seen as a contribution towards enabling the service to represent properly itself and its concerns within the institution.     

Resistance and countertransference in child and adolescent psychotherapy

Countertransference brings to light the influence of both anxiety and family processes on the child's or adolescent's maturation and character development. The significance of developmental, dynamic, and family-interpersonal factors have all been stressed as part of the latent communication inherent in resistance. Family influences on resistance and countertransference have to be the subject of analytic scrutiny. The engagement of children and adolescents in the therapeutic process seriously threatens parents' defensive operations both as couples and as individuals. Countertransference responses afford the opportunity not only to clarify the meaning of resistances but also to pinpoint anxieties that have been reexperienced by the child or adolescent with the analyst at points of threat and disorganization. The twofold therapeutic task with children and adolescents consists of delineating and counteracting the family's negative impact on the child's development and self, in addition to addressing the children's contribution to their own pathological traits and immaturities. Countertransference anxiety confirms the dynamic and family implications of the analyst's participation with the patient. Countertransference resistance suggests the analyst's lack of openness in investigating how the treatment has evoked the child's anxiety, the parent's anxiety, and the analyst's anxiety. Resistance-transference-countertransference exchanges reveal the child's or adolescent's efforts to move towards health while emerging from the internalized family.     

Rechtliche Grundlagen der psychosomatischen Rehabilitation Auswirkungen auf die Psychotherapeut-Patient-Beziehung

The legal foundation of psychosomatic rehabilitation, which amounts to more than half of all inpatient psychotherapies performed in Germany, includes the duty of the patient to cooperate, the pre-condition that there is a chance for increasing or restoring patient’s ability to work, and the obligation for therapists, to perform a socio-medical rating of patient's ability to work as well as a judgement about his/her credibility concerning the asserted handicaps and disabilities. All this has an influence on the relationship between psychotherapist und patient and leads to problems in the treatment especially of those patients, who wish to retire. For the psychotherapist not only counter—transferences may be difficult to handle but also role conflicts resulting above all from the challenge being simultaneously psychotherapist and medical expert, who has to rate patient's ability for work and his credibility. To keep capacity of acting, the psychotherapist should reflect these issues and make them transparent for the patient. Sufficient supervision is very important. This will not only improve patient's, but also pension scheme's profit.     

Einzel- und Paarintervention f��r depressive Koronarpatienten

Depressive symptoms in patients presenting with coronary heart disease have an impact on quality of life, health behavior, and prognosis. The psychotherapeutic interventions which had been tested for their efficacy in previous randomized controlled trials, showed only minor effects. A stepwise approach consisting of individual and group psychotherapeutic interventions was tested for efficacy in a German multicenter study. The presented paper describes the therapeutic procedure for two individual sessions and one couple session by means of case examples. The main focus was to determine depressive symptoms along with underlying maladaptive personality traits such as negative affectivity and social inhibition (type D pattern). Depressive mood, disappointments and mortifications both in private and professional life and also during the previous treatment are verbalized. Dysfunctional relation patterns and maladaptive sickness behavior are taken up by the psychotherapist and alternative behavior patterns are developed. The objective of the couple session is strengthening the partnership resources and offering relief of fears and worries relative to the heart disease. The psychotherapeutic procedure is psychodynamically oriented but also contains cognitive-behavioral and interactional treatment approaches.     

Psychotherapy with an adolescent boy who refused medical treatment

In this paper we describe psychotherapeutic work carried out in a paediatric hospital to illustrate the important contribution of a psychoanalytically-oriented approach in a hospital context. The work concerns an adolescent boy who had undergone several surgical operations with the result that some of his natural orifices were obstructed and artificial ones had to be created. He was referred to us because he refused pharmacological and rehabilitative treatment necessary prior to further surgery and his eventual recovery. The boy's experience of loss of control of his life and the more primitive anxieties of not feeling safely contained in his physical and psychic skin emerged and were worked through in the psychotherapeutic relationship. The parallel work with medical staff reduced the risk of splitting and acting out by the patient and professionals. The approach adopted enabled this boy to resume his medical treatment and his developmental process.     

Interpersonal exposure to danger and risk-taking in the group therapy process]

The writer singles out from the complexities of the group psychotherapeutic process the dynamic pair: inter-personal exposure to danger and the taking of risk. According to his empirical experience and tests the degree of risk-taking is a good parameter for assessing the psychotherapeutic process. For this purpose the inter-action matrix devised by Hill proves itself most useful.     

Plädoyer für eine Direktausbildung zum Psychotherapeuten

The undisputed necessity of a reform of the Psychotherapist Act could open up the chance to reconsider the training of psychological psychotherapists and to completely renew the structure from the ground up. This article proposes that psychotherapy training should be designed based on the profession itself. Starting from the question of what a good psychotherapist needs to have learnt, a study curriculum is drafted which is structured towards this professional target from the very beginning. This direct training imparts psychotherapeutic competence based on a broad psychological, medical and social scientific education, encourages targeted social competences and enables clinical experience in advance. The training terminates after six years with a state examination and qualification for the profession of psychotherapist. Subsequently, qualified psychotherapists undertake a four-year in-house advanced professional education to an adult or pediatric and adolescent psychotherapist. After completing half of the study period, i.e. after three years, students decide on one of the scientifically recognized courses and subsequently the study course is partly procedure-related and mostly interprocedural. The study incorporates a practical year which accompanies the last four semesters as a half day practical training. Universities which want to offer this study course must be qualified to award doctorates and have a psychotherapy research walk-in clinic. They must also cooperate with recognized training partners who participate in the course of the study and professionally structure the four-year in-house advanced professional education.