Psychotherapy research: an interplay between inner and outer and a succession of meanings

Psychotherapy research is a rapidly developing area of study that aims to explore the integration of inner and outer conditions of an individual’s experience, the interplay between subjective and objective, as well as between individual and collective. Questions regarding a more integrative view and qualitative research in psychotherapy are discussed in the paper. The author introduces some ideas from the studies on psychotherapy effectiveness that were done at Vilnius University by a group of researchers who work in the ‘Centre for research on the psychodynamics of personality’. Clinical psychologists who hold a doctorate degree or who are in doctoral studies in the Department of Psychology at Vilnius University are members of this research group. The subjective understanding about healing episodes and the development of depth premises were the main tasks of these studies. Among other methods, the researchers used the drawing a picture of a healing moment and telling a psychotherapy story recalled by the client to collect data. Two examples of drawing a picture of a healing moment and one example of telling a therapy story are analyzed in the paper. The themes of subjective experience of renewal in psychotherapy as well as the multiplicity of experience and results in psychotherapy are discussed in the paper with case illustrations. This study showed that drawing a picture opens one more dimension of reflection and that it can be an appropriate tool for developing individual narratives as well. Authoring and re‐authoring one’s life narrative is accepted as part of a productive therapy as well as discovering one’s inner authorship. The ability to follow a succession of meanings, as well as a connection to nature and culture could be one of the ways of actualizing an integrative view in psychotherapy research.     

Benchmarking Community-Based Couple Therapy: Considering Measurement Reactivity

Couple therapy has been shown to be effective in randomized clinical trials; however, results from naturalistic couple therapy have been less consistent. This study utilized a benchmarking approach to compare the effectiveness of couple therapy in a community-based setting with findings from efficacy treatments, such as treatment within randomized clinical trials. The current study is the largest couple therapy sample published to date (N = 3,347 couples). Clients in couple therapy were asked to provide initial and weekly ratings of symptomology on the Outcome Questionnaire (OQ-45.2). We found that treatment effect sizes found at community clinics were smaller than efficacy studies (i.e., the benchmark). However, when taking into account measurement reactivity, the effect sizes were comparable. This is the first benchmarking study for community-based couple therapy, allowing for meaningful comparisons and understanding of outcomes in real-world couple therapy. Implications for the field are offered in terms of evaluating community-based psychotherapy studies with benchmarking for couple therapy. Results of this study provide clinicians and researchers a way to meaningfully compare couple therapy outcomes, accounting for differences in community-based practices and randomized clinical trials. This benchmark also underscores the impact of measurement sensitivity, an issue commonly overlooked in psychotherapy research and practice.     

A psycho-analytical approach to the assessment of a psychotic patient

SUMMARY

When approached from a psycho-analytic point of view, psychotic states reveal a wide variety of patterns. Some of these are so complex and so rigid in their organisation as to render the patient quite unsuitable for formal psychotherapy. Others are more benign and accessible to a psycho-analytic approach.

The attempt to assess whether a psychotic patient might benefit from psycho-analytic psychotherapy can be facilitated by the use of certain psycho-analytic concepts which provide “ground rules” for decoding psychotic communication, for understanding the psychotic patient's experience and how it has come about.

This paper represents an attempt to show how the psychoanalytic approach to such understanding can help in the management of the case and open the way for psycho-analytic psychotherapy within the N.H.S. Although extremely limited in its provision of skilled psychotherapy, the N.H.S. provides an extremely rich potential for effective understanding, care and treatment of the psychotic patient if the psycho-analytic approach is sufficiently well understood and implemented.     

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.     

Comment upon ‘"Poor girl": a case of active psychosis’: how therapeutic schemas may limit our work

The paper explores the effect of group participation on depressed women's ‘doing depression’ and ‘doing pleasure’ in Finland over three time periods. Quantitative data and qualitative data are analysed. To assess statistically the differences between the time periods, the Wilcoxon matched-pairs signed-ranks z-test is applied to the quantitative data. Coping with emotions through self-focused attention, depressed women are reluctant to initiate instrumental behaviour. They tend to respond to their lives in a ruminative way. Moving towards pleasure rather than depression characterized women's activities as a result of the group process; they learned to embody health, while envisaging hope for the future. Our emphasis on embodiment allows us to consider agency as a contemporary group therapeutic effect as well as to contextualize psychotherapy research within post-modern thinking. While the findings do not provide an indisputable list of the ways women's activities changed over time or all the advantages of group participation, they do suggest areas for future exploration in connection with depressed women's healthy embodiment in a healing group context and advance an understanding of how the experience and duration of depression can be altered if the public and private boundaries of depressed women's embodied routines are broken down and self-isolation is challenged.     

Social justice and remembering “the personal is political” in counselling and psychotherapy: So,what can therapists do?

This brief contribution argues for the importance of a social justice perspective in counselling and psychotherapy, particularly within the current international socio‐political context. Much has been said about social justice over recent years in the fields of psychology, psychotherapy and counselling. Professionals and academics have expressed some concerns about what it might actually mean, or how difficult it might be in practice to engage with this perspective. In this paper, the activist phrase “the personal is political” (Hanisch, 1970) is used to illustrate the way in which a social justice approach to counselling and psychotherapy does not need to be complicated, but rather a foregrounding of a particular understanding of well‐being and the people we work with. Following this, some concrete and straightforward suggestions for how therapists might begin to act on their social justice values are made.     

Psycho-analysis in the National Health Service General Hospital

SUMMARY

The paper describes the author's experience of practising psychotherapy based on psycho-analytic principles in three National Health Service Hospitals. Each is associated with a Post-Graduate institute. The Royal Marsden Hospital associated with the Institute of Oncology specialises in the treatment and study of cancer in all its forms in all ages. The Hammersmith Hospital is the site of the Royal Post-Graduate Medical School and it has an Obstetric and Gynaecology Unit which is part of the Institute of Obstetrics and Gynaecology. The Royal National Throat, Nose and Ear Hospital is a more compact specialist hospital associated with and containing the Institute of Laryngology and Otology.

In this paper instances are described where psychotherapy of Kleinian orientation has been helpful and has often been the only means of assisting patients by increasing their understanding and diminishing mental pain. The effects of introducing a psychotherapeutic rather than a psychiatric approach into the work of these departments is also described. The application of basic and fundamental analytic principles had a considerable advantage over the non-analytic psychological approach and was, in these circumstances, complementary to the one based on the medical/scientific model. This was particularly true of painful ‘terminal’ conditions. Liaison difficulties arise initially from the fact that medical and non-medical colleagues are commonly without experience of psychodynamic thinking and practice, and instead have many misconceptions about its nature and value. When the usefulness of the approach becomes evident to such colleagues prejudice gives way to understanding and co-operation. This has proved to be the most effective way of introducing analytically orientated psychotherapists and psycho-analytic thinking into the National Health Service, at the same time restoring to patients their dignity and supplying their needs as individuals for sensitive consideration and care.     

‘And when you were a child?’: how therapists working with parents alongside individual child psychotherapy bring the past into their work

When a child is offered psychotherapy, it is common that regular meetings will be offered to the parents. However, there are debates in the literature about the degree to which such parent work should include a focus on the parents’ own childhood experiences. This study aimed to examine the way that those offering parent work as part of a study evaluating the treatment of adolescent depression dealt with this issue in their work with parents, both in the study and in routine clinical practice. Design: five therapists were interviewed on the subject of working with parents’ childhood experiences within parent work parallel to child psychotherapy. Data were analysed qualitatively, using Interpretative Phenomenological Analysis. Findings: participants described the need to consider the different parameters of this work to individual adult therapy; in addition, participants felt that it was necessary to negotiate permission to work on the parents’ childhood experiences. They also spoke of making use of insight into the repetition of the parents’ history, the analysis of parental projections and offering containment within the relationship; this varies from the ‘transference work’ of individual therapy and a different style of interpretation was described. Conclusions: there is a need to give more attention to the neglected field of working with parents alongside individual child psychotherapy, especially at a time when such work is under threat within many public services. There are particular technical issues related to work with parents’ own childhood histories that are different to how one might work in individual therapy with a parent.     

Coming together and remaining a part: Development of a group-as-a-whole compass. Part II

Group-as-a-whole theory is an attempt to explain the collaboration and synergy that results when patients share their care. The art and science of treating individuals within psychotherapy groups is enriched by an understanding of the unique mediums ³ through which a group comes into being and the more general domains within which it comes to be known. This paper continues the development of a group-as-a-whole compass, as an integration of extant models and theories (Ettin, 1996). The focus shifts from conceptual and spatial models to an exploration of the cultural and relational processes that make up whole-group functioning. The paper comes full circle with hypotheses drawn about how a psychotherapy group, as a holistic phenomenon, is composed and maintained.Private practice, East Brunswick, New Jersey.     

The integration of psychotherapy: Goal or utopia?

Both researchers and therapists stress the importance of integrating different forms of psychotherapy. Integration may be achieved in three ways. Supporters of the “empirical strategy” believe that more research is the solution. Followers of the “conceptual strategy” try to theorize on psychotherapy using psychological and sociological concepts. Other researchers see a “linguistic strategy” as the way to achieving a better understanding of psychotherapy. Whether any of these strategies will enable us to increase our insight into psychotherapy is questionable. All focus on technical aspects, that is, on the means to achieve effects. Yet, therapeutic effects cannot be understood unless they are interconnected with diagnostics. This paper argues that an integrated theory should be developed which includes diagnostics and treatment and which is supported by a theory on psychological (dys)functioning.     

Psychoanalytic psychotherapy in paediatric liaison: a diagnostic and therapeutic tool

Paediatric liaison work requires an appreciation of the interweaving of the different factors involved when a child has physical symptoms. Psychoanalytic psychotherapy is usually viewed simply as a potential treatment option. This paper argues that its use is both therapeutic and diagnostic and that it should be valued for this breadth of contribution. The therapeutic process is conducted in a way that can promote an understanding of the child and their context and thus enhance the ability 9 to meet the child's needs by all involved in their care. This can be achieved without sacrificing the degree of privacy that the psychotherapist/patient relationship requires. Material is presented from the psychotherapy of a child who had an hereditary condition which moved unexpectedly into a terminal 2 phase after psychotherapy was started. Examples are given to illustrate the importance of the understanding gained from therapy and how, through an integrative process, it was used to assist the overall 4 care. The material also describes the potential diagnostic use of information from psychotherapy when this is formulated by consideration of conscious and unconscious mechanisms alongside mental state phenomenology. This has implications for the relationships between disciplines and for their training requirements.     

The Integration of Behavior,Vol. III by Thomas M. French

This article presents a model for understanding development within children's psychotherapy groups. It is proposed that two complementary cultures exist within children's groups, one, indigenous peer culture, strictly of the children's making and the other, therapeutic group culture, created by the therapist in collaboration with group members. The therapist is wise to approach indigenous peer culture as an ethnographer might a native culture, with an emphasis on observation and seeking understanding rather than on intervention. The therapist can use the indigenous peer culture to speak to the children in their own language and eventually to engage them in collaboratively building a meaning system that is uniquely designed to address their psychotherapeutic needs. The article defines these concepts, develops them theoretically, and illustrates them clinically.     

‘Things said or done long ago are recalled and remembered’: The ethics of mindfulness in early Buddhism,psychotherapy and clinical psychology

I argue that current theoretical understandings of mindfulness as an attention regulation strategy for psychological stress reduction and enhanced adaptation to society may produce de-ethicised therapeutic applications. I show how understandings of mindfulness in early Buddhism, psychotherapy and clinical psychology have changed over time. Current understandings of mindfulness as a skill or technique of bringing non-judgmental awareness (or bare attention) to present moment experience are historically recent and differ from early Buddhist understandings in at least one crucial respect: definitions of mindfulness as attentional control or metacognitive awareness lack an emphasis on deep ethical reflection. As such, we need to re-ethicise our conceptual understanding of mindfulness by remembering early Buddhist texts, where mindfulness involves the cultivation of an ethically sensitive style of remembering, which has largely been lost in contemporary definitions.     

Holism in Psychotherapy and Spiritual Direction: A Course Correction

The authors offer a course correction for understanding the term holism as used in spiritually oriented psychotherapy literature. This is done to allow the relationship between psychotherapy and spirituality to expand beyond limited dualistic conceptualizations. They first address numerous sources from which spiritually oriented psychotherapy arose and then explore the ill‐defined relationship between the psychological and the spiritual dimensions of human existence. Next, holism is distinguished from 2 common forms of dualistic “elementism” that are frequently misrepresented as holism. The authors conclude by presenting a holistic conceptualization of the relationship between the dimensions of psychotherapy and spirituality.     

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.     

Control-Mastery

Abstract

This paper will introduce the theory of Control-Mastery, an empirically supported, cognitively oriented interpersonal theory of psychotherapy. Control-Mastery theory offers a distinctive approach to counter-transference in particular and suggests a unique way to understand unconscious functioning. The theory also provides specific guidelines for conducting psychotherapy as well as a useful framework for understanding the impact of familial as well as cultural context on individual psychological struggles.     

Reflections on group treatments as corrective experiences for addictive vulnerability

This article addresses how and why groups help people with addictive disorders feel better and change. It advances the position that problems in self-regulation and the psychological suffering that ensues are at the root of addictive disorders. Group work is especially effective in addressing these problems, providing a means of relief, and examining co-occurring characterological problems. The evolution of these ideas and the generation of a model for group therapy for substance abusers are traced over a 30-year period, and a list of principles about how and why group treatments work is presented. In addition, a number of advantages that group psychotherapy has over 12-step programs for some patients are provided. Group psychotherapy is presented as a unique corrective emotional experience.     

Rashomon Revisited: A Re-analysis of the Film and Implications for Mass Psychology

The author notes that the title of the film has been used to identify a social-psychological concept that has been widely applied in the literature. The author gives a synopsis of the film. In order to debunk the standard interpretation of the film and provide a new one, the author places the making of the film in an historical context. This requires an explication of the absorption of the samurai into modernized Japan and the country’s history before, during, and immediately after World War II. The perception of the Emperor as a deity and his de-deification are central to understanding the culture and the problem of managing aggression in that society. The social structure of the society can be described as massification. The effects of these sociocultural issues on psychotherapy in Japan are discussed along with the implications for group psychotherapy.     

Reencounter With History and Memory Through a Therapeutic Process

In this co-authored paper, two clinical cases of extreme trauma from political persecution are presented, both of which were treated at ILAS, a center dedicated to treating survivors of such traumatization in Chile. In the first instance we refer to a woman who has been imprisoned and tortured in the first years of the dictatorship and who seeks psychotherapy 30 years after her experience. In the second case we refer to the daughter of whose parents were both detained and disappeared who seeks psychotherapy after she testifies in a film about the political repression in Chile. Both come to therapy many years after their original experience, triggered by testimony they gave for a documentary film about the Coup d’Etat in Chile. Using our understanding of intersubjective theory, most important the aspects of recognition and witnessing, we underscore the crucial role of the social context of the therapeutic dyad that allows the silence to lift. This gives way to the reparative function that words have when spoken to a live available person who represents society at large.