The Value of Research Methods in Psychotherapy Research: A Reply to the Commentary of Dr Norton

Norton's commentary on our article has prompted us to think further about the purpose of psychotherapy research. We agree with his suggestion that researchers have much work to do to understand when and for whom interventions are most efficacious. We hope that our field will make progress in this regard. In this reply, we further describe why we believe careful attention to research methods, such as those highlighted in our article, is key to making progress in psychotherapy research.     

Group-Based Psychotherapy Integration in Theory and Practice: Therapeutic Community Revisited

A group-based theoretical integration model presented in this journal (F. Knobloch, 1996) is elaborated in practice. The core aspects of the group-based system are described and illustrated with clinical examples as they apply to a modified therapeutic community: (a) the creation of the therapeutic world to represent real life and its multiple realities; (b) the group schema model as a context for problem identification and exploration; (c) the collaboration between therapists and group members; (d) the exploration and experimentation of problems through individual and group tasks; and (e) the transfer of new behaviors to real life situations and (f) the systematic application of major psychotherapy theories and techniques.     

Psyche and System: On Progress in the Integration of Individual Psychotherapy and Family Psychotherapy

This article addresses the frequency with which the same group of patients utilizes individual and family therapies, and at the same time do not constitute actual integration. The conditions under which such serial or concurrent utilization of the two forms of psychotherapy may be considered to be integrative are discussed.     

Intersubjectively oriented,time-limited psychotherapy with children: how does the therapist evaluate the therapeutic process and what are the therapist’s tasks?

Based on the therapist’s evaluations of three therapies, this research aims to study the therapeutic process in intersubjectively oriented, time-limited psychotherapy with children. A primary objective is to further develop the therapy method. The study comprises therapies with children 6–11 years of age, who had experienced difficult family situations. Each child received 12 therapy sessions. The number of therapy sessions with children and parents was agreed upon beforehand, and the therapeutic objectives were approved by the parents. Each of the therapy processes were evaluated by the therapist by answering three questions and filling in three forms after each therapy session. The forms were: The Feeling Word Checklist; an alliance form for the child; and a process form. The therapeutic alliance and the behaviour of the therapist during the therapy sessions are discussed on the basis of the total material. The following main tasks for the child therapist emerged: structuring the therapy sessions; following the child’s initiatives; participating and cooperating with the child; exploring the child’s expressions; and understanding and regulating emotions.     

Pretreatment Correlates of the Therapeutic Alliance in the Chronically Depressed

We examined the relationship between patient characteristics and the working alliance in a multisite trial for chronic depression. Patients treated with the Cognitive Behavioral Analysis System of Psychotherapy (CBASP), alone (n = 169) or combined with nefazodone (n = 198), completed the Working Alliance Inventory during the 2nd week of treatment. Within the CBASP alone group, a history of drug abuse/dependence, lower peak social adjustment over the past five years, and lower current social adjustment predicted a significantly poorer alliance. Within the combination group, male gender and a distancing coping style predicted a significantly poorer alliance. Results should be interpreted with caution since they did not replicate across treatment groups, and the number of significant findings were not much greater than chance expectations.     

Pragmatism, Pluralism, and Psychotherapy Relationships: An Interview with John C. Norcross, Ph.D.

John C. Norcross has made significant contributions in the areas of the transtheoretical model of change, psychotherapy integration, and empirically supported psychotherapy relationships. This interview explores the contributions of pragmatic philosophy and his personal upbringing to his work as a psychotherapy researcher and practitioner. Dr. Norcross discusses the status of the psychotherapy integration movement, the work of the Task Force on Empirically Supported Psychotherapy Relationships, and future trends in psychotherapy over the next 25 years. He emphasizes the importance of a methodological rigor that recognizes the unique characteristics of the psychotherapy relationship. He describes his current interest in the psychotherapy of psychotherapists, illustrating it with his personal challenges in balancing work and home.     

后现代视野中的心理治疗及其思考

现代心理治疗与后现代心理治疗在关于认识论、知识的性质、标准、构造以及语言的作用等方面存在诸多差异。前者是对客观与理性的探寻．后者是对主观建构的追求。尽管人们对后现代心理治疗尚有诸多争论,但却能引发人们在扩展对心理治疗性质之认识、推进心理治疗本土化、克服心理治疗中的非人格化倾向等方面的有益思考。     

Client self-image,therapist acting,and the establishment of the therapeutic alliance in a training context

This study examined how clients’ self-image and perception of therapist’s behavior are related to the therapeutic alliance, as well as how these variables change in the psychotherapy process in trainee-led psychotherapy. A total of 164 participants (M = 28.9 years) who attended two semesters of treatment at the Psychology Clinic of Umeå University completed the Working Alliance Inventory (WAI) to evaluate their perception of their alliance with the therapist. They also completed two questionnaires based on the Structural Analysis of Social Behavior (SASB) model to give insight into their self-image patterns and to analyze their perceptions of the therapist’s behavior. The results show that a positive self-image and positive perceptions of the therapist’s actions increased significantly over the course of the therapy, with a corresponding decrease in negative patterns. The alliance scores show that the therapeutic alliance gains significance over time and that it is influenced more by the perception of the therapist’s behavior than by the self-image. The self-image becomes relevant after the mid part of therapy, underlining the role of the therapist in co-creating the treatment relationship. The implications of these results are discussed, and so are directions for future research in other trainee-led settings and samples.     

An Overview of Directions in Psychotherapy Integration Research

In general, empirical research in psychotherapy integration has lagged behind the growing theoretical and clinical interest in the field. Even though many of the theoretically integrative treatment models currently available are based on empirical findings and clinical observations, the models themselves remain, for the most part, untested. Rigorous examination of integrative psychological theories and therapeutic programs is a necessary and useful way to increase our understanding of the process of psychotherapy and establish the efficacy and effectiveness of integrative therapies. The present article explores five different research areas in the field of psychotherapy integration, discussing several published studies in each area. The utility of this research for practicing clinicians is also discussed. Additional investigations in these areas and others are encouraged, with the goals of greater understanding of psychotherapy, as well as the further development and acceptance of integrative approaches.     

文化心理学视域下的心理治疗

近年来,心理治疗的文化取向日益为心理学界所关注。在概要分析文化心理学理论取向和传统心理治疗特点的基础上,重点对文化心理学取向下的心理病因观、医患关系、心理治疗方法、心理治疗效果评价观做了相应分析,并对未来文化取向下的心理治疗理论进行了展望,希望对我国心理治疗理论和实践有所帮助。     

Chapter 1 Pluralism,Pragmatism, and the Therapeutic Endeavor in Brief Dynamic Treatment

Abstract

This article places representative formulations of brief dynamic psychotherapy in the larger context of psychoanalytic thought, reviews relational perspectives that inform contemporary approaches to time-limited treatment, and identifies tasks in continued development of theory, research, and practice. In doing so, it emphasizes the need to consider a broader range of psychopathology, dysfunction, and need in formulations of brief intervention and to develop more flexible and realistic approaches in treatment of vulnerable and underserved populations. The growing emphasis on theoretical pluralism and pragmatism in therapeutic practice generally should facilitate efforts to broaden the base of brief dynamic treatment.     

The Play Relationship and the Therapeutic Alliance

Abstract

This article examines the function of play in normal development and within the treatment relationship in both child and adult psychotherapy. Noting its developmental function and the natural role that play has as a mode of communication with children, the author emphasizes the centrality of play in the construction of the therapeutic alliance. The therapeutic alliance is characterized here as a libidinal attachment, a new object relationship through which developmental experiences involving play may be revivified and, ultimately, may lead to the forging of more enduring and successful adaptations. Two detailed clinical vignettes furnish illustrations of the ways in which play themes and scenarios develop in therapy, and how their association to the therapeutic alliance and transference relationship may be understood and interpreted.     

A Participant-Observer's Perspective on Psychotherapy Integration

Jacobson has raised a number of issues about the usefulness of psychotherapy integration. Some of his concerns stem from his doubt that people are capable of change, and some that appear to be the result of a misinterpretation of what constitutes psychotherapy integration. This article attempts to clarify some of these misunderstandings, which seem to be the result of equating psychotherapy integration with the integration of theories. Comments are also made about the research underpinings related to work in this area.     

Outsight: Radical Behaviorism and Psychotherapy

Clinical experience suggests that a variety of neurotic and personality disorders are effectively treated by an approach to therapy that is relatively passive in appearance and is directed towards the development of self-knowledge. Behavior theory provides an economical, naturalistic analysis of the therapeutic effects of this approach. Punishment, a common method of controlling forbidden behavior, can result in pathologic avoidance and deficient awareness of one's own behavior and its relation to the environment. Traditional methods of psychoanalysis and behavior therapy provide circumstances that help the patient to observe acts and feelings and their relation to elements of the environment that are otherwise avoided. These procedures may work best when self-observation is (1) not selectively reinforced by the therapist, and (2) supplemented by explicit training in behavior analysis. These elements are combined in a treatment approach for generating observations of one's own behavior and its functional significance in the natural environment.     

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.