Supervising Integrative Psychotherapy in the 21st Century: Pressing Needs,Impressing Possibilities

Supervisors and teachers who are interested in advancing integrative psychotherapy in the 21st century have the dual task of surveying the range of treatment approaches that have been developed and distilling these approaches down to a manageable number of influences that have been found to have the greatest impact on clinical practice over time. It has been proposed that there are four bona fide schools of psychotherapy that would be most useful for comprehensive training and supervision that would contribute to either (a) case conceptualization or (b) the process of clinical interviewing: psychodynamic psychotherapy; cognitive-behavioral psychotherapy; family systems therapy; and, humanistic/client-centered therapy. The goal for such broadly based clinical instruction would be for students, trainees, and interns to have an ability to provide a multi-level case conceptualization for any of the psychotherapy cases for which they are providing treatment. Thorough instruction in clinical reasoning and decision-making in this type of multi-level case formulation can provide some of the most valuable tools for novice and experienced clinicians alike.     

Supervising Psychoanalytic Psychotherapy: Present Knowledge,Pressing Needs,Future Possibilities

Existing research from the fields of education, cognitive science, neuroscience, and psychoanalytic psychotherapy points us toward possibilities for the future of psychoanalytic supervision. This research suggests that we need to go beyond communicating abstract knowledge and make our supervisory relationships more experiential, participatory, relationship-focused, and personal in order to teach usable knowledge, develop complex psychotherapeutic skills, and facilitate emotional and relational development in our supervisees. The author concludes that a relational model of supervision fits this pedagogical profile. After grappling with our resistances to change, the author hopes that more psychoanalytic supervisors will make use of a relational model of supervision, as well as drawing upon new technologies and neuroscience-based teaching techniques.     

Supervising Humanistic-Existential Psychotherapy: Needs, Possibilities

The competency movement within professional psychology, evidence-based practice concepts, and the trend toward incorporating psychological services as a component of an integrated care approach within health care settings are major developments in the changing landscape of psychotherapy practice that have important implications for psychotherapy supervision. This article examines each of these developments as they relate to conducting psychotherapy supervision from a humanistic-existential perspective. The current status of supervision guided by a humanistic-existential framework is described, followed by exploration of needs and possibilities for the future evolution of the supervision approach in light of developments in the field.     

Ethical Considerations for Cognitive-Behavioral Therapists in Psychotherapy Research Trials

Psychotherapy research studies, which balance the pursuit of knowledge with the provision of treatment, can place unique demands on clinicians, patients, and research staff. However, the literature on ethical considerations in psychotherapy trials is minimal. The current paper depicts CBT community standards of practice in the context of two NIMH-funded treatment trials of major depression, both involving CBT and medication. We describe issues that arose; discuss the ethical considerations involved; and describe our course of action, along with our rationale.     

A Comparison of Computer-Assisted Psychotherapy and Cognitive-Behavioral Therapy in Groups

This study is the first independent, randomized controlled study in a clinical setting of a computer-assisted therapy program (Therapeutic Learning Program; TLP) developed to permit individualized therapy in a group setting. This software differs from other computer-assisted approaches in that targets for change are chosen by the patient rather than determined by the software. TLP was compared to a standard cognitive-behavioral treatment in 109 patients with 6-month follow-up. Although both treatments were associated with a significant reduction in symptoms of anxiety and depression at posttreatment and follow-up, no differences were found between treatments with respect to patient-rated satisfaction and effectiveness, clinician ratings of improvement, and scores on measures of anxiety and depression. At treatment midpoint patients tended to give more neutral ratings of satisfaction and treatment effectiveness of the TLP treatment, perhaps suspending judgment about this more novel treatment until its completion. It is concluded that at least one form of computer-assisted psychotherapy is as effective and acceptable to patients in a clinical setting as standard short-term cognitive-behavioral therapy conducted by experienced clinicians.     

Cognitive-Behavioral Versus Supportive Psychotherapy for Intermittent Explosive Disorder: A Randomized Controlled Trial

Few clinical trials have evaluated the efficacy of psychotherapy for Intermittent Explosive Disorder (IED). The present study tested the efficacy of a cognitive behavioral intervention (versus supportive psychotherapy) among adults with IED. In this randomized clinical trial, 44 participants with IED (22 men and 22 women) aged 20–55 years completed twelve 50-minute individual sessions of either a multi-component cognitive behavioral intervention for IED (n = 19) or a time equated supportive psychotherapy (n = 25). At baseline, posttreatment, and 3-month follow-up, all participants received the Overt Aggression Scale–Modified, which was conducted by an interviewer who was blind to the participant’s study condition. During these visits, participants also completed self-report measures of relational aggression (Self-Report of Relational Aggression and Social Behavior), anger (State-Trait Anger Expression Inventory-2), cognitive biases (e.g., Social Information Processing Questionnaire Attribution and Emotional Response Questionnaire), and associated symptoms (e.g., Beck Depression Inventory). Primary study outcomes were aggressive behavior and anger. Though participants in both treatments tended to improve over time, the cognitive behavioral intervention was superior to supportive psychotherapy in decreasing aggressive behavior and relational aggression. These findings support the efficacy of a multicomponent cognitive behavioral intervention in treating aggression in IED.     

Psychosis: New Existential, Systemic, and Cognitive-Behavioral Developments

Until recently, perhaps the major avenues of working with severely disturbed patients have been based upon either organic-chemical or intrapsychic determinants and treatment components. One recent development is an emphasis upon interpsychic and interpersonal factors and determinants in both the understanding and the treatment of extreme psychotic disturbances. Existential, systemic, and cognitive-behavioral conceptualizations and therapies maintain substantial independence of one another. Yet these three share at least two significant commonalities. One is that they each emphasise the interpsychic and interpersonal. A second is this first commonality has led to some exciting new developments in the understanding and treatment of psychosis.     

Psychotherapy Research Needs Theory. Outline for an Epistemology of the Clinical Exchange

This paper provides an analysis of a basic assumption grounding the clinical research: the ontological autonomy of psychotherapy—based on the idea that the clinical exchange is sufficiently distinguished from other social objects (i.e. exchange between teacher and pupils, or between buyer and seller, or interaction during dinner, and so forth). A criticism of such an assumption is discussed together with the proposal of a different epistemological interpretation, based on the distinction between communicative dynamics and the process of psychotherapy—psychotherapy is a goal-oriented process based on the general dynamics of human communication. Theoretical and methodological implications are drawn from such a view: It allows further sources of knowledge to be integrated within clinical research (i.e. those coming from other domains of analysis of human communication); it also enables a more abstract definition of the psychotherapy process to be developed, leading to innovative views of classical critical issues, like the specific-nonspecific debate. The final part of the paper is devoted to presenting a model of human communication—the Semiotic Dialogical Dialectic Theory–which is meant as the framework for the analysis of psychotherapy.     

Self-Acceptance Group Therapy: A Transdiagnostic,Cognitive-Behavioral Treatment for Shame

Shame has broad importance to psychological problems. However, few interventions specifically address shame, and most of these have been designed to target shame in the context of particular disorders. Self-Acceptance Group Therapy (SAGT) was developed as a transdiagnostic shame-focused treatment, based on a cognitive-behavioral framework. SAGT is an 8-week treatment that involves psychoeducation and training in the use of cognitive and behavioral shame regulation and support-building skills in order to promote self-acceptance. After describing SAGT, the study presented used an open trial design to examine the utility of SAGT for addressing shame, self-acceptance, quality of life, and relevant psychological problems (e.g., depression, social anxiety). Twenty-four outpatients with elevated shame were assessed at pretreatment, posttreatment, and 1-month follow-up. By post-treatment, results revealed significant improvements in self-acceptance, shame, and borderline personality disorder (BPD) symptoms among treatment completers (n = 18), with all of these improvements maintained at follow-up. Additionally, significant improvements in quality of life, emotion dysregulation, depression, loneliness, and stress were observed at follow-up. Results provide preliminary support for SAGT’s utility in the treatment of shame and related pathology among diverse outpatients.     

Cognitive-Behavioral Treatment of Depression, Part IX: Confronting Predisposing Factors

Cognitive-behavioral therapy can help many depressed clients learn more effective ways of coping with problems in their lives. However, for many clients with chronic or recurrent depression, it can be helpful to examine the biological, psychological, and social/cultural factors that may predispose a person toward depressive episodes. In order to address possible biological predispositions, it is important to assess for a positive family history of depression, evaluate family members' response to previous treatments, and refer for medications when needed. In order to address possible psychological predispositions, it is useful to evaluate long-standing personality styles, identify negative events from childhood, examine the client's relationship with his or her parents, evaluate the history of abuse, and identify early loss experiences. Cultural factors may play an influential role in the etiology of depression, and can be useful to incorporate into a broad treatment plan. However, cultural factors are difficult to modify through individual psychotherapy. Hence, they are unlikely to play a central role in cognitive-behavioral therapy for depression. Overall, therapists working with depressed clients should be prepared to confront a broad range of biological, psychological, and environmental factors that can create or perpetuate a client's risk for depression.     

Cognitive-Behavioral Therapy With Chinese Americans: Research, Theory, and Clinical Practice

In this article, we discuss how to conduct cognitive-behavioral therapy with Chinese Americans. We present an integration of theory, research, and clinical practice to help mental health practitioners understand how Chinese culture may potentially influence the CBT treatment process for Chinese immigrants. Several recommendations are provided as to how to adapt and modify CBT to better meet the therapeutic needs of Chinese American clients. A case example demonstrates how cultural modifications of CBT can lead to effective psychotherapy outcomes for Chinese American clients.     

Discussion: Androgyny, Personality Theory, and Psychotherapy

Recently formulated conceptions of psychological androgyny appear to involve a variety of metaphorical models whereby masculinity and femininity are said to be balanced, tempered one by the other, integrated, or transcended. Through an application of Stephen Pepper's (1942) root metaphor theory to these models, it is argued that validational research will prove more profitable than theoretical debate over which vision of androgyny is "best". The importance of including measures of self-esteem in sex role research is also emphasized.     

Bulimia: Cognitive-Behavioral Treatment and Relapse Prevention

The authors review the assumptions about processes that maintain bulimic behavior. Specific treatment package recommendations are made on the basis of selected outcome literature. Special issues, such as Axis II diagnosis, hospitalization, and psychopharmaceutics, are addressed.     

Contemporary Psychotherapy: Looking Backward, Looking Forward

This editorial summarizes the founding of the Journal of Contemporary Psychotherapy, and its evolution into its current form. Also, the editor provides several recommendations for authors hoping to publish their ideas regarding psychotherapy. Finally, the current editor acknowledges the numerous people who have worked to develop, improve, and strengthen the journal.     

Researching Grief: Cultural,Relational, and Individual Possibilities

This review of the author’s writings on grief focuses on cross-cultural research, research with 19th-century diaries, and qualitative interview studies of couples and families. The cross-cultural studies show that there are strong cultural differences in how people grieve. The diary data show that some people cycle into and out of intense grieving, even for years after a death, and the cycling is governed partly by what they do to control emotions and what they encounter that reminds them of their loss. The interview studies make clear that grieving is, for many people, relational, so looking only at individual grieving we miss much of the relational dynamics that are central to the experience of grieving for many people.     

Negotiating Interracial Interactions: Costs, Consequences, and Possibilities

ABSTRACT— The United States is becoming increasingly diverse, yet interracial contact continues to be awkward, if not stressful, for many. Indeed, recent research suggests that individuals often exit interracial interactions feeling drained both cognitively and emotionally. This article reviews research examining how interracial encounters give rise to these outcomes, zeroing in on the mediating role of self-regulation and the moderating influence of prejudice concerns. Given that interracial contact may be the most promising avenue to prejudice reduction, it is important to examine factors that undermine positive interracial contact experiences, as well as those that facilitate them.     

Ethics,Alterity, and Psychotherapy: A Levinasian Perspective

Current psychologies of religion reflect the modernist context in which they are situated. Religion is reduced to what is researchable, generalizable, individual and “thin.” This essay suggests that a psychology of religion which takes seriously the implications of Emmanuel Levinas’s emphasis on ethics and the alterity of the Other would result in a different model of psychotherapy. Levinas’s view of the Other as the trace of the transcendent radically changes our understanding of the client within the therapeutic relationship. Levinas begins with ethics and so healing would be, by implication, an ethical enterprise. In a highly secularized, individualized, objectivized culture, a therapy which recognizes the sacred, which models how to view the Other as transcendent, and which does not presume to know, is a gift to the client.     

Cognitive-Behavioral Therapy: The Truth Behind the Allegations

In response to several pejorative statements about Cognitive Behavioral Therapy in a recent issue of Psychotherapy (Silverman, 1999), a point by point counter argument to these criticisms are presented. Among other contentions, Silverman (1999) disparaged empirically validated methods as being simplistic and scientifically impoverished. The validity of these statements are challenged and empirical evidence is presented to support each counter argument. The efficacy of Cognitive Behavioral Therapy for a broad range of disturbances and presenting problems is presented. The future of Cognitive Behavioral Therapy and other empirically validated protocols are discussed, as well as recommendations for their use.     

Naturalism, Reduction and Normativity: Pressing from Below

David Papineau's model of scientific reduction, contrary to his intent, appears to enable a naturalist realist account of the primitive normativity involved in a biological adaptation's being "for" this or that (say the eye's being for seeing). By disabling the crucial anti-naturalist arguments against any such reduction, his model would support a cogni-tivist semantics for normative claims like "The heart is for pumping blood, and defective if it doesn't." No moral claim would follow, certainly. Nonetheless, by thus "pressing from below" we may learn something about moral normativity. For instance, suppose non-cognitivists like Mackie are right that the semantics of normative claims should be "unified": if the semantics of moral claims is non-cognitivist, so too is that of all normative claims. Then, assuming that a naturalist reduction does yield a sound cognitivist account of the primitive normativity, it would follow that our semantics of moral claims is cognitivist as well.