I Know That my Redeemer Lives: Relational Perspectives on Trauma, Dissociation, and Faith

This paper focuses the lens of multiplicity on patients’ religious experience in relation to the psychic realities of early or pervasive trauma, where dissociation is not just a normal means of self-regulation, but becomes an entrenched structuring mechanism through which the trauma survivor experiences every relationship, including any relationship to God. What might God or faith look like from the perspective of the traumatized self? This paper considers issues of multiplicity and dissociation as they affect the processing of religious or spiritual experience, with a few brief clinical illustrations, and offers a reading of the biblical book of Job as a metaphor for the inner world of the survivor of early trauma.     

Suicide in Group Therapy: Trauma and Possibility

Abstract

This paper compares and contrasts the experiences of two different long term psychodynamic psychotherapy groups in which a patient suicided. The acute reactions and longer term process of each group is described in detail and discussed. The reactions of the two leaders, married to each other and in a shared supervisory group with the late Anne Alonso, and their own working through of the traumatic losses are explored. Their experiences highlight the importance of open discussion of the suicides in the groups, consultation with senior colleagues, and continual processing of their own reactions as a means of fostering posttraumatic growth. The authors discuss their experience in light of the literature on trauma in groups and the emerging literature on posttraumatic growth and they reflect on implications for the community of group therapists.     

Treating Anti-social Behavior in Adolescents: A Comparison of Multi-modal and Psychodynamic Oriented Group Interventions

This study compared the efficacy of a multimodal intervention (MMI) and a psychodynamic oriented group intervention (POGI) on antisocial behavior among Nigerian adolescents. A pretest-posttest design was used. Forty-one adolescents drawn from the streets of a Nigerian city (N =20), and a state child correction facility (N=21) participated in the study. The children were randomly assigned to a MMI, POGI and waiting list control (WLC) groups. Ages ranged from 10 to 18 years (mean =14.5; SD=2.1). Data collected were analyzed using multiple group comparison procedures. Results showed that MMI significantly reduced self-reported antisocial behavior of the adolescents as compared to WLC and POGI, respectively. A multimodal intervention approach appears to be more effective in treating antisocial behavior in adolescents than a psychodynamic oriented group intervention.     

Optimal Strategies in Couple Therapy: Treating Couples Dealing with the Trauma of Infidelity

Infidelity is one of the most difficult problems to address in couple therapy, most likely because it involves a traumatic relationship event that alters the ways in which couples process information about each other and established behavioral patterns. This article presents a three-stage treatment designed to address the cognitive, behavioral, and emotional sequelae of affairs that integrates cognitive-behavioral and insight-oriented strategies with the literatures on traumatic response and forgiveness. Critical and unique features of this treatment are discussed and a case study is presented to illustrate the treatment methods.     

Interpersonal Perceptions and Metaperceptions in Dialogic Action Therapy: A Relational Methodological Approach to Theory Construction

Abstract

Two forms of understanding in theories of therapy are identified: empathic understanding rooted in individualism, and reality-based understanding that acknowledges the relational character of human existence. We argue for regarding these two forms of understanding as complementary. This requires a paradigmatic shift from methodological individualism to methodological relationalism, which asserts that the analysis of role relationships precedes that of individuals and situations. Informed by methodological relationalism, dialogic action therapy accords prominence to the creation of a therapeutic relationship between therapist and client, between whom bidirectionality of perceptions is inherent. We develop a formal analytic scheme for theory building. Six major constructs, degrees of perception, directionality, agreement, reciprocity, accuracy, and congruence, are employed to facilitate the analysis of therapist and client perceptions and metaperceptions of trust in depth. The implications for therapy and methodology of measurement are discussed.     

Data,Dreams, and Drives: Interpersonal and Relational Innovations in Perspective

My fundamental approach is to first explore the most concrete understanding of any clinical phenomenon. Only after this consideration of the concrete do I go on to consider metaphoric or symbolic meanings. I assume there are specific facts to be discovered about our patients and that those facts are significant in the patient’s psychology. With patients experiencing panic attacks, a detailed interview may reveal a life situation in which the patient should be afraid but does not connect the danger with the symptom. With dreams, this approach endorses a combined intersubjective and objective approach, searching for how a dream may depict a real problematic situation for the dreamer that is being dissociated. Finally, disagreeing with Greenberg and Mitchell that combined drive-relational models do not work, I propose a model of multiple drives that can each be connected with different self-states.     

The Voice in Dissociation: A Group Model for Helping Victims Integrate Trauma Representational Memory

The current article focuses on the subjective elements of voice in trauma and dissociation, and the manifestation of voice in four phases of group treatment for victims of extreme, catastrophic events. The voice discussed here is no ordinary voice: it captures an attribute of dissociated representational experience that, though not easily defined, is nonetheless replete with trauma messages from the depth of somatopsychic processes, expressed in the patient's nonverbal talking in gestures, tone of voice, posture, silences, facial expressions, and in rhythm, timbre, movement, and syntax. Dissociation, trauma representational memory, and the phases of a proposed group model are discussed in detail with their respective phase-specific voice.     

Responses to Self-Threat: Linking Self and Relational Constructs with Approach and Avoidance Motivation

Over the past few decades, researchers have amassed a large body of evidence documenting the consequences of self-esteem (SE), attachment styles, rejection sensitivity (RS), domain-specific aspects of SE (e.g., contingencies of self-worth), and RS (e.g., race-RS; appearance-RS) following self-threats. The present article suggests that these personality constructs share a common substrate reflecting approach and avoidance temperament and motivation. Approach and avoidance temperaments are theorized to interact with intrapersonal and interpersonal experiences to shape approach and avoidance motivation. Personality constructs serve as dispositional markers of underlying approach-avoidance motivational orientations, which, in turn, lead to predictable patterns of goal pursuit following self-threats. Individuals who feel self-confident and relationally secure (e.g., high SE, securely attached, and low RS individuals) respond to self-threats by adopting approach-motivated goals to attain positive outcomes. Individuals who lack self-confidence and feel less relationally secure (e.g., low SE, avoidantly attached, and high RS individuals) respond to self-threats by decreasing approach motivation and/or increasing avoidance-motivated goals to prevent negative outcomes. Consequences of adopting approach- and avoidance-motivated goals are discussed.     

Social Cognition and Interpersonal Impairments in Trauma Survivors with PTSD

Trauma survivors with posttraumatic stress disorder (PTSD) often experience psychosocial problems. This article reviews interpersonal factors such as social support, social acknowledgment, and interpersonal impairment that are relevant to the development and maintenance of PTSD. Furthermore, it considers the possible impact of social cognition on PTSD. The capacity to empathize (empathy) and the existence of an individual “theory of mind” are fundamental to human social interaction. We raise the question of whether traumatic experiences may lead to changes in the social cognition of traumatized individuals. The possible effects of perceived social exclusion as a maintenance factor for PTSD are also discussed.     

Insult,then Injury: Interpersonal and Institutional Betrayal Linked to Health and Dissociation

Psychological trauma, particularly trauma involving betrayal, has been linked to health problems. Betrayal trauma is also characterized by dissociation and difficulty remembering as victims face conflicting demands presented by a harmful but important relationship. Institutional betrayal is related to, but distinct from, interpersonal betrayal and in need of research on its unique effects. The current study has two related goals. First, the association between institutional betrayal and health problems is examined. Second, the previously documented association between institutional betrayal and dissociative symptoms is re-examined, while controlling for betrayal trauma. This study utilizes a sample of 302 college students (70% female, 63% Caucasian) who reported their trauma history (Brief Betrayal Trauma Survey), institutional betrayal history (Institutional Betrayal Questionnaire), distress related to health problems (Patient Health Questionnaire), and dissociative symptoms (Wessex Dissociation Scale). We found that institutional betrayal is uniquely associated with both health problems and dissociative symptoms even when controlling for betrayal trauma exposure. Findings add to the understanding of how institutional betrayal is uniquely associated to trauma-related physical and mental health outcomes. Small effect sizes, likely due to low base rates of health problems and dissociative symptoms in college students, and problems generalizing these results to clinical samples are discussed.     

精神动力学评估过程:关于患者的心理学头脑及其与治疗的关系

患者的心理学头脑在精神动力学方向的治疗中起着重要的作用.心理学头脑是指一个人对思维、情感以及行为之间相互联系探查的能力,并且对其经验和行为背后的原因进行探究的动力.这种包含多维度的心理学头脑的概念往往导致了对其理解的歧义,和实证的困难.提供了两种方法对心理学头脑进行操作化评估,即通过量表和操作化访谈来进行.讨论了心理学头脑和治疗的关系.     

Frequency of Interpersonal Trauma Types,Avoidant Attachment,Self-Compassion,and Interpersonal Competence: A Model of Persisting Posttraumatic Symptoms

Given limited knowledge about how psychosocial factors interact to modulate posttraumatic stress symptoms, this study evaluated an integrative model proposing that experiencing more interpersonal trauma types (e.g., abuse, assault, rape, etc.) leads to greater avoidant attachment and lower self-compassion, which limits the development and use of effective interpersonal skills. In turn, lower levels of self-compassion and interpersonal competence perpetuate posttraumatic symptoms. Anonymous trauma-experienced adults (n = 132) completed self-report measures in an online study hyperlinked on trauma support websites. Data were subjected to confirmatory factor analysis and structural equation modeling, which provided support for the hypothesized model. Specifically, higher frequency of interpersonal trauma types experienced was linked to higher avoidant attachment and lower self-compassion, which in turn were associated with lower interpersonal competence, which correlated with greater posttraumatic stress symptoms. Although cross-sectional data cannot address directionality of associations, this study’s findings emphasize the potential utility of future longitudinal research designed to examine possible causal relationships among these specific psychosocial factors. For example, study findings suggest that those who experience more types of interpersonal trauma and who are characterized by avoidant attachment and lower self-compassion and interpersonal competence may be the most susceptible to experiencing severe posttraumatic symptoms. However, findings also suggest that efforts to increase self-compassion and interpersonal skills may help reduce symptoms.     

Working with Interpreters in Therapy Groups for Forced Migrants: Challenges and Opportunities

ABSTRACT

Despite the inherent value and effectiveness of group therapy, group therapists often face language and cultural barriers in facilitating groups for immigrants and, in particular, forced migrants. Without adequately addressing these barriers, group therapists are unlikely to deliver culturally responsive and clinically effective treatments. In this article, modes of interpretation and roles of interpreters in mental health care are first discussed. Next, we highlight clinical, cultural, and ethical challenges of incorporating interpreters in group therapy, with special attention to issues in therapy groups for forced migrants. Opportunities and suggestions for maximizing the value of interpreters in group therapy are offered.     

Treating Insecure Attachment in Group Therapy: Attachment Theory Meets Modern Psychoanalytic Technique

Attachment theory is a comprehensive, empirically supported theory of emotional, relational, and neurophysiological development. Modern psychoanalysis is a theory of technique that addresses early psychological deficits and conflicts considered beyond the reach of traditional psychoanalysis. Both orientations have influenced the theory and practice of group psychotherapy and emphasize personality maturation as a treatment goal. This paper explores their potential synergies when treating preoedipal, insecurely attached emotional states, disrupted emotional self-regulation, and impaired mentalization. Theoretical and technical applications are suggested that may enhance the treatment of disordered attachment in group psychotherapy. By addressing insecure attachment as resistance, modern psychoanalytic techniques may engage the emotional substrates of the attachment process to facilitate the expansion of relational capacities, mentalization, self-regulation, the differentiation of self/other representations, and epistemic trust.     

Comparing Values and Methods in Psychodynamic and Cognitive-Behavioral Therapy: Commonalities and Differences

To determine the underlying values and methods in cognitive-behavioral and psychodynamic therapy and to address the implications of those values and methods for integrating the two therapies, the Process Value and Methods Survey was sent to members of The Association for Advancement of Behavior Therapy (cognitive-behavioral sample) and Division 39 of American Psychological Association (psychodynamic sample). Members were asked to endorse items based on their ideal understanding of their respective orientations. A Principal Components Analysis (PCA) of the combined samples yielded six components for values, of which four were significant according to orientation. A second PCA, for therapeutic methods, yielded six components, five of which were significant according to orientation. In both PCAs, components significant for an orientation were consistent with the corresponding constructs of that orientation. The relationship between method and value components as well as how value components may be related to clinical practice and psychotherapy integration is discussed.     

Interpersonal Functioning and Trauma: The Role of Empathy in Moderating the Association of PTSD and Interpersonal Functioning

Research demonstrates consistent associations between symptoms of posttraumatic stress disorder (PTSD) and reductions in interpersonal functioning. Moderators of this association, however, remain relatively unexplored. The current study aimed to examine the extent to which aspects of empathic responding may influence the relation between PTSD symptom dimensions and interpersonal functioning in students exposed to significant trauma. Participants (N = 94, 85.1% female, 86.2% White/Non-Hispanic) completed an initial screening to assess for trauma exposure and associated symptoms of PTSD. Interpersonal functioning and dimensions of empathic responding were measured using a series of self-report and lab-based tasks. Hierarchical regression models provided evidence for a consistent association between post-trauma arousal-reactivity and reductions in interpersonal functioning. Results also indicated a moderating effect of affective empathy (β = −.37, p = .010, f² = .086). Simple slopes and Johnson-Neyman plots identified an association between arousal-reactivity and functioning at low (β = 1.57, p < .001, f² = .301) versus high (β = .31, p = .417, f² = .008) levels of empathic response to a positively valenced film. Results offer preliminary support for a potential buffering effect of affective empathy on interpersonal functioning in individuals reporting chronic, trauma-related symptoms.