The Psychoanalytic Study of the Child,Volume VI Edited by Ruth S. Eissler,Anna Freud,Heinz Hartmann,Ernst Kris

Abstract

The effect of affective group bibliotherapy (GB) was compared to affective group therapy (GT) on patients’ functioning in therapy and their session impression. Three small groups totaling twenty–five in–patients in a hospital in Israel participated in the study. Clients concurrently participated in both group types, undergoing three sessions in each condition. In–therapy behaviors were assessed through the Client Behavior System (CBS; Hill &; O’Brien, 1999). Results indicated that in the GB condition compared to the GT condition, clients showed less resistance, used simple responses less frequently, and expressed greater affective exploration. The Session Evaluation Questionnaire (SEQ; Stiles et al., 1994) was used to measure clients’ impressions of the sessions. Results indicated that patients evaluated the two treatment conditions equally. Overall, the results support earlier findings, suggesting that affective bibliotherapy can be an effective method of treatment.     

In the Midst of Multiplicity: How to Stay in the Saddle

The author asks the question, how is the human psyche impacted by the current rapid cultural change, globalization, etc., that is presently occurring in our world. She describes the relationship between the horse and the rider as an amplification of the relationship between the psyche and the ego in coping with change. How does one build a good relationship? In times of confusion and rapid change, the horse will likely panic and throw the rider if there is a poor relationship between them. She describes some of the clients in therapeutic riding centers, particularly the more vulnerable teenage clients, as being “unhorsed”—disconnected from their positive instincts—and how this form of therapy is particularly helpful because it reconnects them with their “inner horse.” She describes how she learned to develop a bonded relationship with her own horse and how that kind of relationship can operate within a context of the cutting horse competition.     

Therapy with Refugee Families: What Is a “Good” Conversation?

This article addresses the question of what is a “good” conversation by analyzing “poor” conversations. During a project on family therapy with refugee families, we often experienced what we labeled as “poor” conversations. We present examples of a variety of such conversations, which we then analyze with reference to therapeutic maps and central concerns of the therapists. We describe four patterns of therapist/client relationships that emerged from this analysis. The main focus of our discussion is to clarify when “poor” conversations may be an important part of the therapeutic process, and when and how they should be avoided. We believe that the issues we raise are central to therapeutic work in general and not just to therapy with refugee families.     

Working through: in-session processes that promote between-session thoughts and activities

This study examined whether clients' ratings of the working alliance as well as their perception of cognitive-behavioral (CB) and psychodynamic-interpersonal (PI) techniques (delivered by therapists who used both) were associated with clients' intersession processes (i.e., their thoughts about therapy and therapeutic activity between sessions). Seventy-five clients who were currently in therapy at a large university counseling center participated in the current study. Multilevel regression analyses demonstrated that alliance and clients' perceptions of their therapists' use of PI techniques were positively associated with clients' general thoughts about therapy between sessions. Also, stronger alliances were associated with more therapeutic activities between sessions and more positive (and less negative) thoughts about therapy between sessions. In addition, clients at later sessions who described their therapists as using more PI techniques also reported engaging in more therapeutic activities between sessions (after controlling for the variance in the other variables, such as use of CB techniques). Clients' perceptions of their therapists' use of CB techniques in the most recent session were not related to thinking about therapy or therapeutic activities after controlling for the variance in the other variables.     

Retention interval modulates the effect of negative arousing pictures on recognition memory

This study examined the modulation of retention interval in the effect of emotion as elicited from negative and positive arousing pictures on recognition memory. Participants underwent seven encoding sessions and one testing session. The encoding sessions were separated by certain lengths of intervals such that there were seven levels of time gaps between encoding and testing. In each encoding session, participants learned a list of 30 pictures (including 10 neutral, 10 positive and 10 negative pictures). In the testing session, they were presented with a list of 210 old and 210 new pictures and made “old/new” and “remember/know” judgements. The results showed that negative arousing pictures enhanced overall recognition in the 2-week interval and enhanced recollection in both the 2-week and 3-week intervals. However, neither negative nor positive arousing pictures had any effect on familiarity regardless of retention interval. The current study contributes to the literature by suggesting that longer retention intervals do not necessarily lead to more pronounced effects of negative arousing pictures and that the modulation of retention interval depends on the specific components of recognition memory.     

Is how it is said important? The association between quality of therapist interventions and client processing

This study examined the association between the quality of therapist interventions and client in‐session processing using the York Therapist Process Measure (YTPM; Toukmanian and Armstrong, 1998). The instrument's three dimensions — attunement, tentativeness and meaning exploration — were tested separately for their impact on clients' manner of processing and depth of experiencing. For each of the 20 mild‐moderately depressed clients, treated in short‐term experiential therapy, a high and a low client‐process segment was isolated from a session that was judged by an experienced therapist to manifest the greatest amount of “good therapy moments”. Therapist interventions within these segments were then rated on the YTPM. Results revealed significant differences in the quality of therapist interventions between high and low segments. Attunement and tentativeness were associated significantly with greater complexity in manner of processing, and meaning exploration with greater depth in experiencing. The implications of these findings for psychotherapy research and practice are discussed.     

The “Activist Client”: Social Responsibility,the Political Self,and Clinical Practice in Psychotherapy and Psychoanalysis

The idea of the “activist client” is intended to be taken both literally and metaphorically—applying to some extent to a wider range of clients than actual activists. The paper develops a set of ideas about a “political turn” in psychotherapy and psychoanalysis, using the tag “the inner politician.” There is a focus on working directly with political material in the session, and the pros and cos of this practice are reviewed. Wider issues such as social responsibility and social spirituality are discussed, as well as an exploration of the limits of individual responsibility. Some specific topics covered in the paper include the political roots of depression, difficulties with the concept of the therapeutic alliance from the point of view of democratic perspectives on clinical work, and a challenge to the unquestioned valuing of empathy (based on a reading of therapy though a Brechtian lens). There are numerous clinical examples.     

Number and time in acquisition,extinction and recovery

We measured rate of acquisition, trials to extinction, cumulative responses in extinction, and the spontaneous recovery of anticipatory hopper poking in a Pavlovian protocol with mouse subjects. We varied by factors of 4 number of sessions, trials per session, intersession interval, and span of training (number of days over which training extended). We find that different variables affect each measure: Rate of acquisition [1/(trials to acquisition)] is faster when there are fewer trials per session. Terminal rate of responding is faster when there are more total training trials. Trials to extinction and amount of responding during extinction are unaffected by these variables. The number of training trials has no effect on recovery in a 4-trial probe session 21 days after extinction. However, recovery is greater when the span of training is greater, regardless of how many sessions there are within that span. Our results and those of others suggest that the numbers and durations and spacings of longer-duration “episodes” in a conditioning protocol (sessions and the spans in days of training and extinction) are important variables and that different variables affect different aspects of subjects' behavior. We discuss the theoretical and clinical implications of these and related findings and conclusions—for theories of conditioning and for neuroscience.     

Effects of good form and spatial frequency on global precedence

Does the global precedence effect depend on the goodness of the global form and low spatial frequencies? In Experiments 1 and 2, under a variety of attentional and task conditions, a global advantage in response time (RT) occurred in “good,” many-element compound patterns but not in “poor,” few-element patterns (unless the local elements were too small to be easily recognized). Symmetric interference effects were found in all patterns, however, suggesting that global and local information were encoded in parallel and that the global advantage in RT involved some postperceptual processes. Experiments 3A and 3B showed that the global advantage in RT and perceived pattern goodness depend on low spatial frequencies: Lowpass-filtered patterns rated as “good” showed the usual global advantage in RT, but highpass-filtered, many-element forms rated as “poor” did not. These findings suggest that a global advantage in RT requires an unambiguous global form conveyed by low spatial frequencies.     

Symptom reduction and termination: client change and therapist identified reasons for saying goodbye

Empirical efforts have focused on predicting whether or not clients prematurely terminate therapy, with nonattendance of last session equated to premature termination. However, this fails to explore the relationship between clients’ distress reduction and reasons for termination. With this study, we aimed to understand how clients’ distress change relates to premature termination and examine clients’ distress change in conjunction with therapists’ perceptions of termination reasons. We collected data from 797 clients who prematurely terminated or attended termination but completed therapy a minimum of three individual sessions provided by 38 therapists. Clients completed an assessment of psychological symptoms before each session. At the end of treatment, therapists identified the reasons they believed termination occurred for all clients in the sample. Results demonstrate that total sessions attended and missed predict premature termination, whereas distress change does not. Additionally, clients who were believed to accomplish goals do show greater change. However, therapists’ indicated that over half of clients did not reach goals at termination and they did not perceive nonattendance at last session to equate to drop out in all cases. Implications are discussed with respect to understanding why clients’ terminate, therapeutic goal conceptualization, and review of goals during termination in time-limited psychotherapy.     

Marital Interactions of Male versus Female Alcoholics

This study assessed the interactions of 131 alcoholic and nonalcoholic couples as they engaged in discussions of personally relevant problems. For 50 couples, the husband was alcoholic; for 15 couples, the wife was alcoholic; for 16 couples, both spouses were alcoholics; and for 50 couples, neither spouse was alcoholic. Observations were conducted during sessions when alcohol was consumed and in nondrinking sessions. Female alcoholic couples (with nonalcoholic spouses) demonstrated high negativity in the “no-drink” session, which was normalized in the drink session, suggesting an adaptive function to alcohol use. Concordant couples (both members were alcoholic) also demonstrated high negativity in the no-drink session, but exhibited increased negativity in the drink session, suggesting that concordance has a maladaptive impact on marital interaction. All alcoholic groups demonstrated greater negativity and lower positivity and congeniality in their marital interactions compared to nonalcoholic couples. Couples with male alcoholics were the least divergent from normal control couples. Unique female patterns in alcoholism are discussed in terms of adaptive and reinforcing patterns and spousal influences.     

Constructing Nonagency at the Beginning of Psychotherapy: The 10DT model

This study examined how nine clients discursively constructed non-agency in their first session of individual psychotherapy. With open reading and linguistic analysis of the transcribed first sessions, combined with theory-based considerations, we created a model of discursive means for ascribing agentic and non-agentic positions, the 10 Discursive Tools model (10DT). There was large variability in how the tools functioned to create the impression of problematic agency, and the clients could not be classified according to their tool use patterns. The study shows the potential of the 10DT model for the detailed examination of presentations of “not-being-able” produced by psychotherapy clients.     

Decision Workshops for the Improvement of Decision-Making Skills and Confidence

This article describes the development and evaluation of a workshop program to help people become more confident and effective as decision makers. The workshops, based on conflict theory, consisted of five 2-hour sessions, in which participants learned about the major decisional coping patterns and the critical steps of decision making. Participants also practiced decision-making skills and learned how to use decisional balance sheets, future diaries, and other aids to vigilant decision making. The 76 participants were classified as “problem clients” (N = 44, “learners” (N = 30), and “others” (N = 2). A follow-up questionnaire administered 3 months after the final session revealed that the workshops had promoted increased confidence in decision making and less reported use of maladaptive patterns of decision making.     

Therapeutic relationship and progress in the first six sessions of individual psychotherapy: A panel analysis

The temporal nature of the associations between client-rated therapist empathy and acceptance, and both client-and therapist-assessed therapeutic progress at sessions 2 and 6 were examined pairwise with cross-lagged panel correlatation (CLPC) and linear structural relationships (LISREL) analyses in 37 clients treated in weekly individual sessions of long-term psycoanalytic and person-centred therapy by 37 experienced therapists. Although none of the cross-lagged differences in the three CLPC analyses which met the necessary conditions for interpretation were significant, two of them approached it, suggesting that session 2 client-rated progress was a stronger determinant of session 6 therapist empathy and acceptance than vice versa. However, the LISREL analyses indicated that while session 2 client-rated progress was unrelated to session 6 therapist acceptance, session 2 therapist empathy was negatively correlated with session 6 client-rated progress. furthermore, both session 2 therapist empathy and acceptance were positively associated with session 6 therapist-rated progress, thereby providing some support for the therapeutic role of these two therapist variables as postulated by person-centred theory.     

Predictors and consequences of sudden gains in transdiagnostic cognitive-behavioural therapy for anxiety disorders

Sudden gains—substantial stable symptom improvements between consecutive therapy sessions—are a common phenomenon. As condensed points of change, examination of sudden gains can provide insight into mechanisms of therapeutic change. This study investigated the association between sudden gains and cognitive change, therapeutic alliance, and/or client engagement in transdiagnostic group cognitive-behavioural therapy for anxiety disorders. Of 58 treatment initiators, 21% (n = 12) exhibited a sudden gain. Consistent with previous research, sudden gainers demonstrated significantly greater pre- to post-treatment symptom improvement than non-sudden gainers. Observational coding of therapy sessions found that sudden gains were associated with elevated levels of cognitive change and client engagement in the pre-gain session, and elevated levels of cognitive change and therapeutic alliance in the post-gain session. However, these results varied by use of within- and between-subject control comparisons, highlighting the value using a dual control methodology. In context of previous research, the results on cognitive change replicate previous findings in depressive populations, and clarify mixed findings in anxiety populations. The results on therapeutic alliance replicate previous findings for the first time in an anxiety sample, although the between-subject control comparisons revealed complexity previously undetected. This study was also the first to investigate and thus establish the relation between client engagement and sudden gains.     

A change in frame and countertransference experiences: Transitioning from face-to-face to telepsychotherapy

Unprecedented changes in traditional psychotherapeutic practice arose from the lockdown restrictions associated with the COVID-19 pandemic. These changes to practice included the imposed change to the therapeutic frame when transitioning clients from face-to-face meetings to delivery of psychotherapy sessions via videoconferencing (defined here as telepsychotherapy). The current study conducted qualitative interviews with 16 Australian psychologists who transitioned their existing adult psychotherapy clients from face-to-face therapy to telepsychotherapy and explored their novel experiences associated with countertransference reactions during this period. Thematic analysis of the interviews revealed several unique findings. The type of countertransference reactions towards existing clients was consistent across both face-to-face and online meetings; however, the felt intensity of countertransference reactions was reduced. Psychologists reported an increased hesitance to work with intense emotions during telepsychotherapy sessions and felt increased pressure to work harder during online sessions when compared to face-to-face meetings. Exposure to their clients' personal and home environments during telepsychotherapy sessions elicited several novel reactions towards their clients. These findings on countertransference and telepsychotherapy are informative for future practice and training. Awareness of these unique countertransference experiences is recommended prior to engaging in telepsychotherapy or when transitioning clients to this modality.     

Multi(ple) cultural voices speaking “Outside the Sentence” of counselling and psychotherapy

This paper examines the notion that marginalized clients through their socio-cultural and geo-political histories are positioned “outside” the masculine cultural metaphors and conventional theoretical epistemologies of counselling, psychology and psychotherapy. In other words, these minoritized clients are “outside the sentence” of the texts and contexts of therapy. The discursive practice of therapeutic reconstitution and restoration produces a particular set of vocabularies and sentences that facilitate transformation and psychic equilibrium consistent with the process of individuation and self actualization. However, for marginalized groups, such as black and other visible minority, women, deaf, gay and lesbian clients the hegemonic masculine narratives of counselling psychology and psychotherapy only make it possible for these clients to be “outside the sentence”, not just grammatically and metaphorically of the therapeutic project, but in the external reality of how the practice is clinically governed. In other words, the social and cultural marginalization outside the clinic room is in a dialectical relationship with the therapy dyad. For the minoritized client being “outside the sentence” produces the effect of being “inside” another process, i.e., the history of subjugation, domination, diaspora, and displacement. This paper explores this issue and argues that the only way for counselling, psychology and psychotherapy to bring the diversity client “within the sentence” of therapy is to assign and re-inscribe the history, memory and pain of “the Other” voices to the “inside” of the therapeutic space, to interrupt and disrupt the hegemonic masculine narratives, thus transforming “non-sentences” into sentences and paragraphs, and eventually into essays of the discursive subject.     

Effects of client personality on dominance and affiliation during early sessions of rational-emotive psychotherapy

This is a study of effects of client personality on interpersonal presentation during early Rational-Emotive therapy (RET). Independent variables were intake scores for clients from the Millon Clinical Multiaxial Inventory (MCMI; Millon, 1983). Dependent variables, from audiotapes of sessions at the Institute for RET (IRET), were Revised Interpersonal Adjective Scale (IAS-R; Wiggins, Trapnell and Phillips, 1988) ratings of clients and therapists. Three commonly adaptive axis II traits (histrionic, narcissistic and antisocial) had significant positive effects on clients, increasing their apparent interpersonal dominance. Paranoid traits, which have previously shown either neutral or positive patterns, mirrored the adaptive patterns. Compulsive traits, which have also been helpful in other stressful situations, seemed maladaptive, however, here. Finally, six commonly maladaptive axis II traits (schizoid, avoidant, dependent, passive-aggressive, schizotypal and borderline) had weak, insignificant effects on clients. In general, these findings suggest that the IRET therapeutic setting may be a psychologically “safe” place for clients. Personality traits that are usually troublesome did not impair self presentation in early sessions of RET, and several usually positive traits appear helpful. The order of authorship was determined by mutual agreement, based on the number of hours each author committed to the project. Dempsey's thesis, based on his work, was submitted in partial fulfillment of the requirements for Henry Rutgers Scholars honors at Rutgers College. Lamon's thesis, based on his work, was submitted in partial fulfillment of the requirements for the Ph. D. at the University of Vermont.     

心理治疗的会谈间体验对治疗效果的影响——来自追踪研究的证据

采用多层线性分析方法,在短程心理咨询的连续会谈中检验来访者的会谈间体验对咨询效果的影响。以36名个案、151次会谈为样本,结果发现,来访者的症状总体呈线性下降趋势;不同来访者症状变化的速率存在个体差异,会谈间体验的情绪因子能解释症状变化速率总变异的40.79%。结论：在短程心理咨询中,来访者想起咨询会谈或/和咨询师时的情绪体验能显著预测咨询效果。