A survey of mental health care provider's and managed care organization attitudes toward, familiarity with, and use of group interventions

Managed Care has had a significant impact on delivery systems for mental health services. Direct and indirect persuasion to provide more cost-effective treatments has been one consequence. The cost-saving qualities and the effectiveness of group interventions have produced clear expectations for an increased use of therapy groups. This study compared perceptions and uses of group treatments on a national sample of managed care organizations and mental health providers. Because group psychotherapy encompasses such a broad definition, five specific types of group interventions were defined: problem-focused homogenous, process-oriented heterogeneous, psycho-educational, self-help, and short-term groups. Implications of differences and similarities between directors of managed care organizations and treatment providers are examined and discussed across five response categories (familiarity/training, perceived effectiveness, likelihood of reimbursement/referral, daily use, and expectation for future use).     

Use of a reference group in researching children’s views of psychotherapy in Malta

This paper explores the process and outcomes of a children’s reference group within the context of child psychotherapy research in residential care. The reference group was set up to consult children about the design of a research project which seeks to evoke, represent and understand children’s views of psychotherapy. No work to date has explored the experience of reference groups in the context of child psychotherapy in residential care in Malta. The paper contextualises the research within the literature on reference groups in child research, which identifies the potential of reference groups as a participative and co-reflexive activity which can inform research design. The paper critically examines the nature and conduct of the reference group by acknowledging the specific context of this work rather than assuming this is necessarily positive. It does so by specifying and evaluating the outcomes of the reference group in line with its aims. The paper draws on the recordings of the reference group meetings and reference group field notes taken by the researcher as key data which were thematically analysed. The main outcomes of the reference group include children’s contribution to the design of data collection methods especially in terms of not relying only on words during data collection. Children also identified key ethical issues from the point of view of young psychotherapy service users, especially in relation to issues of trust within a residential care context. Children also reviewed and appraised research information material. The reference group process drew from the researcher’s and participants’ contexts and contributed significantly to the researcher’s reflexive process especially in terms of acknowledging his power and positioning as an adult and his dual role as a practitioner/researcher.     

Direktausbildung Psychotherapie an der medizinischen Fakultät

Background

There is ongoing political discussion at the Federal Ministry of Health that a university entrance diploma should allow psychotherapy to be studied directly: Graduation leads to a licensure that qualifies for further specialization, e.g. in cognitive behavioral therapy (CBT) or psychodynamic psychotherapy analog to medical specialization. As psychotherapy has its roots in both psychology and in medicine, the question is raised which faculty should be the future home of direct psychotherapy schools.

Material and methods

A theoretical model curriculum of psychosomatic psychotherapy is proposed. Its structure which is oriented to the established structure of medical training and its contents are described. It is argued that the proposed model in the tradition of psychosomatic medicine is suitable to meet ongoing changes in the structure of psychotherapeutic care due to new challenges in the field of public health.

Conclusion

The study of psychotherapy should be associated with chairs in clinical psychology and psychosomatic medicine in order to maintain and further develop the variety and quality which psychotherapy has gained in Germany.     

Confidentiality and privileged communication in group psychotherapy

The concept of confidentiality is fundamental to all forms of psychotherapy. The idea of protecting confidential material goes as far back as the Hippocratic Oath in ancient Greek history. Centuries later, authors continue to assert that "only by maintaining confidentiality can the essential groundwork of trust in treatment be developed" (Hough, 1992, p. 106). Others have even argued that without confidentiality, psychotherapy has no value (Epstein, Steingarten, Weinstein, & Nashel, 1977). Confidentiality in group psychotherapy is more complicated than in individual therapy because self-disclosure is at the core of group therapy and there are numerous people hearing the disclosures. Confidentiality in group therapy, once ignored in the literature on ethics, is gaining more attention as this modality becomes more widely practiced; so too is an acknowledgement that ethical dilemmas surrounding confidentiality in groups are commonplace. This article discusses the major considerations and dilemmas on confidentiality in group psychotherapy. We first review confidentiality broadly and discuss the ethical principles that are related to confidentiality. In the next section, we discuss the complexities of confidentiality in group psychotherapy. Finally, we review research on confidentiality in groups and describe common ethical dilemmas.     

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.     

Humanising forces: Phenomenology in science; Psychotherapy in technological culture

One of the concerns of the existential‐phenomenological tradition has been to examine the human implications of living in a world of proliferating technology. The pressure to become more specialised and efficient has become a powerful value and quest. Both contemporary culture and science enable us to have a view of human identity that focuses on our ‘parts’ and the compartmentalisation of our lives into specialised ‘bits’. This is a kind of abstraction, which psychology has also, at times, taken in its concern to mimic the natural sciences. As such, it may unconsciously collude with a cultural trend to view humans as objects, like other objects, and thus fit ‘normatively’ into the emerging world of specialised and efficient systems. This paper examines how the findings of a phenomenological study of psychotherapy reflect a movement by people in psychotherapy to recover their sense of human identity in ways that always transcend any form of objectification. Their human complexity is somewhat restored as they move back towards the concrete details of their lives where the human order has its life. In addition to considering the implications of these findings for restoring the uniquely human dimensions of human identity, the paper also considers the methodological role that an existential‐phenomenological approach can play in supporting a broader view of science. In wishing to be faithful to the human order, it champions the value of the human individual as a starting point in human science. This includes a return to concrete experiences, the balance between unique variations and the ground that we share, and the movement from the particular to the general. As such, a phenomenologically oriented psychology may have an important role to play in helping the broader sciences remember the ‘human scale’ of things.     

具身心理治疗:原理与技术

具身心理治疗是以身体心理治疗、舞动治疗为代表的,理论上契合具身认知观点、实践中注重身体作用的一种当代心理治疗取向。它将“身体”与“躯体”区分开来,赋予身体解剖学的、感觉运动的、认知的与嵌入环境等不同层面的意义。当前,已有不少研究证实身体有助于改善治疗关系,促进来访者认知、情绪的改变,并发展出一系列注重身体内外感知、姿势或运动的非言语治疗技术。具身心理治疗重构了身体在治疗过程中的概念与角色,发展了新的技术,是传统心理治疗的有益补充; 但也存在实证证据不足、理论框架尚未完全整合、容易过分强调身体作用等问题。今后需自觉整合其他治疗流派、开发独特的核心技术,推进循证的具身心理治疗的发展。     

History of psychotherapy in Russia and the Soviet Union]

Previously, articles on and contributions to the history of psychotherapy proceeded on the assumption that the most essential sources were to be found in Anglo-Saxon and German literature. Developments in other civilizations were usually treated as undeserving of consideration. It is important to note that a large amount of specialized literature on psychotherapy has been published in the Soviet Union, and this shows that a great importance is attached in that country to the treatment of nervous and mental disorders by psychological methods. A review of the writings of S. S. Korsakov and V. M. Bekhterev shows that the essential principles of group psychotherapy had been recognized by those authors already in the late nineteenth and early twentieth centuries, respectively. Results achieved by Makarenko appear valuable in the light of what we know today. The method of "collective psychotherapy", which was first described by Libch, is discussed in detail. This method is being widely used in the Soviet Union. The concern of this paper is to describe developments which have not so far been covered in our literature, thus attempting to make an addition to psychotherapeutic activity in this country.     

Meeting the challenges of the new NHS for counselling in primary care: a service manager perspective

This paper addresses the challenge of meeting the requirements of the new NHS in primary care, whilst at the same time protecting conditions for counselling as a creative rather than a mechanical process. In managed teams this tension has to be held without the benefit of a long professional history of change and adaptation. The profession of counselling and psychotherapy in primary care has to rapidly find its place within the new structure and take on board new expectations for a profession that has traditionally enjoyed a high level of clinical autonomy.     

Motivating institutionalized adolescents for psychotherapy

In the study of psychotherapy, one surely must come to appreciate the importance of client motivation. Intuitively, its value in obtaining a successful outcome would seem unquestioned. Nonetheless, motivation for treatment has not received the attention in the literature that its importance might warrant. This paper deals exclusively with the adolescent and in particular, the institutionalized adolescent. Often members of this population become known as "untreatable cases" and attempts at treatment result in frustration from emotional and economic drain. This paper reviews the literature regarding client motivation, client preferences, and token economies, and offers recommendations for designing a program to increase motivation for psychotherapy in institutionalized adolescents.     

Trauma,protest, and therapeutic culture in Algeria since the 1980s

This article focuses on the shift in sensitivities that took place between the 1980s and 2019 toward psychological suffering in Algeria. Promoters of psychotherapy showed an increase in receptivity—via the media, public authorities, and the general population—to their practices and discourses during this period. Based on professional literature, interviews with psychologists, psychiatrists, and psychoanalysts, and newspaper articles and essays, this article considers the following aspects: the use of psychotherapy, the authority of psychoanalytic/psychopathological analyses, and the ethics of relation in politics. Taking a social and cultural history of politics approach, it traces the discontinuous politicization of psychotherapy over the course of events (namely the uprising of 1988, the civil war of the 1990s, and the 2019 popular movement) and examines the interactions between the state, popular mobilizations, and the psychotherapists. The civil war of the 1990s coincided with the normalization of “trauma” on a global scale, and procedures for the prevention of posttraumatic stress disorder were put in place in Algeria from 1997 onwards. In this process of legitimizing psychological suffering and its treatment, the promoters of psychotherapy who belonged to the less visible margins gained authority. The year-long protest movement (2019) against the regime performed the ethics of relation, focusing on human relations, reflexivity, and living together. Promoters of psychotherapy identified consistently with the political subjectivities produced within the 2019 popular movement characterized by massive pacifist marches against the regime.     

Group Psychotherapy Research: Current Status and Future Trends on the Dawn of the New Millennium

For the past two decades, the group psychotherapy research literature has been dominated by the efficacy study. Over this period of time, this laboratory-based work has acquired a number of methodological requisites all aimed at maximizing its internal validity in order that causal inferences can be made with increasing confidence. These very refinements in methodology, however, have led to increasing criticisms regarding the meaningfulness and relevance of the findings to real-world settings. This paper briefly reviews these developments and offers predictions, gleaned from the current literature, about future directions of research. In particular, three areas are highlighted: (1) the development of effectiveness studies, (2) the greater sophistication of process research, and (3) a renewal of the very early interest in group therapy treatment of medical conditions.     

Psychotherapy and survival in cancer: the conflict between hope and evidence

Despite contradictory findings, the belief that psychotherapy promotes survival in people who have been diagnosed with cancer has persisted since the seminal study by D. Spiegel, J. R. Bloom, H. C. Kramer, and E. Gottheil (1989). The current authors provide a systematic critical review of the relevant literature. In doing so, they introduce some considerations in the design, interpretation of results, and reporting of clinical trials that have not been sufficiently appreciated in the behavioral sciences. They note endemic problems in this literature. No randomized clinical trial designed with survival as a primary endpoint and in which psychotherapy was not confounded with medical care has yielded a positive effect. Among the implications of the review is that an adequately powered study examining effects of psychotherapy on survival after a diagnosis of cancer would require resources that are not justified by the strength of the available evidence.     

A training analysis for psychoanalytic psychotherapists

For historical reasons, psychoanalytic psychotherapy has been regarded as a second-class treatment in comparison with psychoanalysis, and standards for training in it have lagged behind those for psychoanalysis. However, psychoanalytic psychotherapy is the treatment of choice for many healthier (or higher-level) patients who cannot receive analysis for any reason, and also for a large population of more-disturbed patients who are not appropriate for psychoanalysis. Mastering techniques of psychoanalytic psychotherapy may be as difficult as mastering those of psychoanalysis, and should require comparable theoretical training, supervision, and personal treatment. This "development lag" in the training of psychoanalytic psychotherapists has taken place for several reasons: (1) Psychoanalytic ideas first emerged in America in the context of a new movement toward an electric, but dynamic psychiatry from which psychoanalysis had to establish its separate identity. (2) Psychotherapy was associated with techniques of suggestion and manipulation from which psychoanalysis wished to separate. (3) Because psychotherapy was seen as an inferior form of therapy which required little training, institutes were slow in being established, and reluctant to require a "training analysis." It is suggested that with the full training of psychoanalytic psychotherapists, this discipline may be regarded as a profession comparable to psychoanalysis. It is further suggested that the optimal treatment for the full training of the psychoanalytic psychotherapist is psychoanalysis, and that a "training psychotherapy" is not an adequate substitute, but may provide a transitional step to resolve initial resistances and to prepare the therapist for a training analysis.     

共同因素心理治疗整合模式的回顾与评析

共同因素心理治疗整合模式是现代心理治疗整合运动中最早被提出的一种心理治疗整合模式。通过对共同因素整合模式的创建背景、发展历程及基本观点进行了梳理简述,认为其在促进心理治疗各流派融合的同时也人为地造成了“共同因素VS特异因素”新的对立,探讨了唯有建基于人的整合本性的心理治疗整合视野才能促进心理治疗整合运动未来的健康发展。     

How wide is the widening scope of psychoanalysis and how solid is its structural model? Some concerns and observations

The author advances the thesis that in the past 35 years there has been a relatively silent but nonetheless significant movement within the mainstream of American psychoanalysis toward a more "modest" position. This movement has been stimulated from different sources, sometimes with diverse goals and different programs. One determinant was the reaction to the post-World War II euphoria in regard to psychoanalysis and its possible therapeutic powers. Another element has been the ongoing consolidation of our knowledge and understanding of the ego-psychological, structural-model approach to analytic theory and technique, an approach which emphasizes both intrapsychic conflict and compromise formations. A consequence of this more modest position has been a greater appreciation of the limitations of psychoanalysis as well as the significance of those limitations. This more realistic appraisal of psychoanalysis may not have encouraged the widening scope of the indications for analysis, but the enhanced understanding of its limitations offers the promise of more effective psychoanalytic work in areas that have not been considered ideal for the so-called "traditional" analysis. It is suggested that more sophisticated approaches in the analysis of resistance and character, of "conflict" (in distinction to "diagnoses"), together with a more applicable understanding of the psychoanalytic process, can all contribute to a deepening, if not necessarily widening, of our psychoanalytic endeavors.     

Hidden in Plain Sight: The Active Ingredients of Executive Coaching

We propose that I/O psychologists who coach executives have overlooked psychotherapy outcome research as a source of information and ideas that can be used to improve our executive coaching practices. This research, based on thousands of studies and many meta-analyses, has converged on the conclusion that four "active ingredients" account for most of the variance in psychotherapy outcomes. We describe how this literature has identified four primary "active ingredients" that account for most of the variance in psychotherapy outcomes: 1) Client/extratherapeutic factors (40%), 2) The relationship or alliance (30%), 3) Placebo or hope (15%), and 4) Theory and technique (15%). Working on the assumption that psychotherapy and executive coaching are sufficiently similar to justify generalization from one domain to the other, we describe these four active ingredients at length and explore how they may be at work in the executive coaching process. We also suggest that I/O psychologists have training and experience that allows us to leverage some of these active ingredients in our executive coaching (e.g., understanding of client individual differences related to coaching outcomes). But we also have areas of weakness (e.g., building a strong working relationship with an individual client) that may need to be bolstered with additional training and development experiences.     

Body language and metaphors revealed through applications of Movement Psychotherapy in a hospice: A clinical case of refractory pruritis

Movement psychotherapy (MP), and dance/movement therapy (DMT), are body-orientated psychotherapy approaches that use movement for the integration of emotional, cognitive, physical, social and spiritual aspects of self (European Association Dance Movement Therapy, 2010). It is distinctively a combination of moving and sensing the body with verbal self-reflection (Bloom, 2006). Several papers have presented DMT as a treatment in general medical care and cancer care, but there is still a paucity of evidence-based studies. The authors describe a clinical case illustrative of many of the situations in which facing death was particularly tormenting. The emotional pressure can produce a barrier of communication with the risk of rupturing the therapeutic relationship. The movement therapist’s function is to clarify the elements of body language and this has important implications for clinical practice because the end-of-life decisions are difficult, like palliative sedation therapy (PST). Even if procedural guidelines for PST help physicians and care teams through the decision-making process and make them more comfortable when responding to physical suffering, physicians more frequently report an emotional pressure when their patients experience psychological symptoms, with the risk that PST could become a potential “counterphobic defence to treat”.     

Will managed care change our way of being?

The authors studied psychotherapeutic practices commonly used in managed care settings and the theories and rhetorical strategies that justify them to speculate about if or how they are beginning to influence societywide understandings about the proper way of being human at the turn of the millennium. The practices--and effects--of managed care regulations on the self are interpreted by studying how the patient, the therapist, and the therapeutic relationship come to light in managed care settings. These categories are then used to speculate about the configuration of the newly emerging, 21st-century self. By extending hermeneutic concerns about instrumentalism and technicism, the authors suggest a new way of thinking about psychotherapy modeled less on positivist science and more on moral discourse. Finally, given this more hermeneutic understanding of psychotherapy, the authors speculate about alternative conceptions and arrangements of care.