Emotional regulation: implications for the psychobiology of psychotherapy

A range of studies have contributed to understanding the psychobiology of emotional regulation. Functional imaging studies have demonstrated that cortico-limbic circuitry plays an important role in mediating processes such as reappraisal and suppression. Dorsolateral prefrontal cortex may be important in conscious reframing, while ventromedial prefrontal cortex and orbitofrontal cortex may be particularly important in emotion evaluation. Gene variants and early environments impact underlying emotional regulation and its neurobiology. It may be hypothesized that during interventions such as psychotherapy there are improvements in emotional regulation, together with the normalization of related psychobiological mechanisms.     

Universes of discourse: implications for counselling and psychotherapy

All individuals can be envisaged as living within a number of parallel universes of discourse, where different meanings and values may apply; these may be characterised by different language 'registers'. The process of counselling and psychotherapy itself constitutes such a universe. The inner and outer worlds of the client also constitute different universes that may themselves each consist of a number of distinct universes. Decisions made with respect to one universe may have different meanings or adverse consequences in another; it therefore beholds the therapist to be aware of, and alert to, these differences.     

Mirror neurons: their implications for group psychotherapy

Recently discovered mirror neurons in the motor cortex of the brain register the actions and intentions of both the organism and others in the environment. As such, they may play a significant role in social behavior and groups. This paper considers the potential implications of mirror neurons and related neural networks for group therapists, proposing that mirror neurons and mirror systems provide "hard-wired" support for the group therapist's belief in the centrality of relationships in the treatment process and exploring their value in accounting for group-as-a-whole phenomena. Mirror neurons further confirm the holistic, social nature of perception, action, and intention as distinct from a stimulus-response behaviorism. The implications of mirror neurons and mirroring processes for the group therapist role, interventions, and training are also discussed.     

Medical psychotherapy consultation: psychoanalytic psychiatry for the patient and professional

An NHS Mental Health Trust Medical Psychotherapy Consultation Service using psychoanalytic psychiatry to help the patient and professional is described. The Consultation Service established in 2000 is offered to secondary acute and community mental health teams and primary care. The service was evaluated as a basis for regional and national development. Between 2006 and 2013, 87 consultations from 210 were sampled to ascertain demographic and diagnostic profiles and outcomes of the consultation process. We conducted an online survey of local consultant psychiatrists’ views about the service, and undertook a thematic analysis of the free text comments. We also conducted a survey of members of the Royal College of Psychiatrists’ Medical Psychotherapy Faculty to ascertain whether similar consultation services existed elsewhere in the UK and had been evaluated. The Leeds model of psychoanalytic consultation – a ‘consultation sandwich’ – is described. From a psychoanalytic perspective, the work of consultation is seen as an extension of the dynamic field of the analytic situation. This paper develops the concept of a bastion – an omnipotent reserve in and between the patient and professional derived from adhesive identifications leading to stuck relationships. The adhesive identification in the patient and professional acts like a ‘grievance glue’ – a mutual manifestation in a last bastion of painful limitations not faced, losses not grieved.     

Sibling dynamics and group psychotherapy

The role of sibling dynamics in group psychotherapy has received relatively little attention in the literature. Our clinical experience suggests that sibling issues regularly arise in the practice of group psychotherapy. This article provides an integrative view of sibling relationships from a family systems and self psychology orientation to group therapy. Special emphasis is placed on developmental and cultural differences as they affect sibling dynamics and the group leader's role. A number of case examples are offered to illustrate ways to view clinical challenges in a manner consistent with the influence of sibling relationships on group members and group process.     

Constructivist psychology of child abuse and implications for psychotherapy

Abstract

This paper reviews constructivist and related literature on child abuse and psychotherapy. Constructivist psychology, with its emphasis on the personal, socially embedded construction of meaning, is uniquely situated to contribute to humanistic psychotherapy for child victims and adult survivors. Conversely, work with abused clients deepens our understanding of developmental meaning‐making processes and the social ecologies of meaning within which they unfold.

Constructivist approaches to child abuse are inherently humanistic, focusing on the child victim's and adult survivor's attempts to make meaning of their experiences, including the often traumatic experiences of abuse and the relational contexts in which it occurs. This paper first discusses how constructivist psychology may deepen our understanding of the impact of abusive experiences, the reverberation of those experiences through subsequent living, and the role of constructivist therapies in the healing process. Secondly, this paper explores reflexive aspects of work with abuse survivors that may challenge our cultural and professional assumptions and deepen our commitment to constructivist, humanistic, and feminist psychotherapies.     

When clients want to pay more for psychotherapy: ethical issues and implications

One ethical issue that commonly comes up in clinical practice is the negotiation of fees with clients. Although the APA Ethics Code provides standards regarding clients who are unable to or do not pay (Standard 6.04), little guidance is given pertaining to fee limits for clients who want to pay more. This issue is explored using a real case example, including the relevant ethical codes to be considered. The necessary “gray” areas of ethical decision-making are demonstrated through my own decision process. Implications for future scenarios are discussed.     

The Difference Catholic Makes: Catholic Faculty and Catholic Identity

This study examines, for the case of Catholics, the thesis that a "critical mass" of devoted faculty members—50 percent or more, according to the papal document Ex Corde Ecclesia—serves to promote or preserve the religious character of religiously affiliated institutions of higher education. Factor analysis and structural equations are employed to analyze a random sample of faculty members ( n = 1,290) and institutional profiles ( n = 100) of American Catholic colleges and universities. Catholic faculty show higher support for Catholic identity in latent structures of aspiration for improved Catholic distinctiveness, a desire for more theology or philosophy courses, and longer institutional tenure. Institutions having a majority of Catholic faculty exhibit four properties consistent with stronger Catholic identity: a policy of preferential hiring for Catholics ("hiring for mission"), a higher proportion of Catholic students, higher faculty aspiration for Catholic identity, and longer faculty tenure in the institution. These latter two characteristics are not due simply to aggregation, but are stronger, on average, for Catholic faculty when they are in the majority. Preferential hiring marks Catholic identity, but is ineffective to increase the proportion of Catholic faculty. I conclude that the prediction of the critical mass thesis is correct.     

Counselling and psychotherapy as a form of learning: some implications for practice

This paper explores counselling and psychotherapy as a form of learning. Previous experiences may create distortions in meaning-making perspectives, distortions that create templates for evaluating future experience. These templates act as barriers to being open to experience; thus there is an inability to learn from experience. The process of therapy can provide a learning milieu for the exploration and working through of these barriers, with a potential outcome of a return to learning from experience. It is suggested here that intrinsic to the learning milieu created in therapy there are elements of significant, transformative and emotional learning. Therapy is thus a reparative discourse that facilitates a return to learning from experience. A deconstruction of this concept is provided here as a way of developing the exploration of counselling and psychotherapy as a form of learning.     

Maternal styles in infant psychotherapy: Treatment and research implications

Infant psychotherapy, in which the mother is requested to follow the baby's activities without initiating or directing, is described. Mothers demonstrate different styles of involvement with their infants: a protective mode, a prohibitive mode, a competitive mode, and other ways of interfering with their infants' tendency to explore the environment. Attempts to analyze such factors as position, distance and movement are discussed. Research for recording and analyzing the movement of infant and mother dyads is proposed.     

Disasters and helpers: Psychological dynamics and implications for counselling

This paper reviews the recent research on those individuals who might be regarded as the ‘hidden victims' of disasters—the ‘Helpers'. It focusses on the complex interaction between disaster events, coping strategies and individual and personality factors as determinants of psychological and emotional problems in helpers. The discussion seeks to heighten the awareness of professional counsellors of the contribution that they can make to the training, debriefing and counselling of individuals fulfilling the role of helper by illustrating the problems that typify the helper's experience and by discussing a technique for dealing with these problems. Being prepared for the type of problems likely to be encountered and how these problems might be tackled is an important determinant of the effectiveness of the service provided. Duckworth's (1986) problem-solving approach to counselling helpers is assessed and subsequently used as a basis for discussing the role of the above information in the design and application of this problem-solving approach to dealing with the difficulties experienced by helpers as a result of their involvement in disasters.     

Group psychotherapy of the characterologically difficult patient

A broad range of characterologically difficult patients present for treatment in psychotherapy groups. Despite different clinical presentations, including features of the schizoid, borderline, and narcissistic personality disorders, these patients share a common developmental failing. Specifically, these individuals have failed to attain object constancy and the associated stable internalization of tolerably ambivalent representations of the self, and of the other, in relationship with one another. Splitting mechanisms predominate over integrative ones, as primitive defenses are utilized to deal with the individual's powerful needs and fears related to engagement and intimacy. These maladaptive interpersonal styles are clearly illuminated in group therapy, but often to the exclusion of the latent, intrapsychic derivatives of this behavior, with detrimental effects. This paper examines the group therapy of such patients from the perspective of object relations and self psychology theories, models that provide the essential link between the interpersonal and the intrapsychic worlds.     

Promoting patient safety: implications for pastoral care

This article provides an overview of current issues in patient safety, the subject of recently-implemented JCAHO standards, with attention to issues of special interest to pastoral care professionals and Clinical Pastoral Education (CPE) students. Case studies of patient safety initiatives in two health care systems are used to illustrate the relationship between institutional core values and the just treatment of injured patients and their families, and to suggest opportunities for chaplains to contribute to patient safety efforts in their institutions. A list of suggested readings and online resources is included.