Chapter 5 Development,Psychopathology, and Brief Psychotherapy

Abstract

When using a developmental model to conceptualize curative factors in brief psychotherapy, the impact of the developmental process and the nature of the psychopathology presented by the patient must be taken into account. Both factors shape the therapeutic work. A case example of a young adult in the midst of developmental transition illustrates these issues.     

Chapter 2 Using Self Psychology in Brief Psychotherapy

Abstract

This article seeks to help clinicians make the translation from theory to practice when using self psychology to do brief psychotherapy. After a theoretical overview and review of the literature, a series of organizing questions and frameworks is provided to facilitate the clinician's capacity to apply a self psychological point of view to the understanding and conduct of brief treatment.     

Chapter 3 Integrative Short-Term Treatment of the Borderline Patient

Abstract

The realities of current practice necessitate that clinicians engage in briefer forms of treatment with borderline patients despite the fact that long-term treatment has been considered the treatment of choice because of their entrenched and pervasive personality difficulties, severe developmental arrests, and history of trauma. Most short-term treatment models are ill-suited for work with the borderline population because they favor highly motivated and well-functioning patients who have circumscribed problems. Nevertheless, there is a considerable body of practice principles that can be adapted to brief treatment with borderlines. This paper reviews the clinical features of borderline disorders and current views on their origins and treatment and then describes the components of an integrative short-term treatment framework.     

Alfred Adler's Treatment as a Form of Brief Therapy

Alfred Adler was largely overlooked during his era because he viewed people as creative beings in control of their own mental health and resisted the then-standard practice of treating human beings from a pedestal with a normative body of laws. His progressive style of treatment has become more popular in an age when efficient and collaborative treatment is valued for the sake of cost-effectiveness. This article positions Adlerian psychotherapy as a form of brief therapy, effective psychotherapy that takes place in 20 sessions or fewer. The article summarizes the fundamentals of Adlerian theory, outlines the general criteria of brief psychotherapy required by managed care companies, and specifically highlights how Adlerian psychotherapy qualifies as brief psychotherapy.     

Chapter 9 Clinical Risk and Brief Psychodynamic Therapy

Abstract

This article explores the risk environment confronting practitioners of brief psychodynamic treatment, and describes strategies that can help clinicians practice effective risk management. I argue that clinicians can reap only limited benefits from a focus on profiles of high-risk clients and litigation “hot spots.” The optimal approach is attention to the contextual dynamics shaping clinical practice. Among the most important are the relational processes driving the clinician-client dyad, the clinician-client-third party payer triangle, and the interface between the mental health and legal systems. I close with a discussion of the ambiguity and uncertainty that characterize clinical decision making and risk management.     

The Effectiveness of Cognitive Behavioral Therapy for Generalized Anxiety Disorder in a Frontline Service Setting

The goal of the current study was to test the generalizability of cognitive behavioral therapy (CBT) for generalized anxiety disorder (GAD) in a frontline service setting. Twenty‐nine patients who presented to treatment clinics with problematic worry were provided CBT for GAD. Among the intent‐to‐treat sample, there were no significant changes in worry or depression from pre‐ to posttreatment. Treatment completers showed significant pre‐ to posttreatment reductions on measures of worry and depression. The magnitude of change was smaller than has been reported in randomized control trials (RCTs). Although the frontline service setting differed from RCT settings in multiple ways, treatment completers nonetheless achieved moderate to large decreases in self‐reported worry and depression.     

Interpretation of ambiguous information in clinical depression

The present study used two cognitive tasks--a text comprehension task and a homophone task--to investigate whether clinically depressed individuals have a negative bias when interpreting ambiguous information. Previous research indicates that both tasks are sensitive to anxiety-related interpretive biases, and that the former is less prone to response bias effects. Negative memory biases were also assessed. Results showed that, compared with normal controls, depressed individuals made more negative interpretations on the homophone task, and they also showed an enhanced negative recall bias. However, the groups did not differ in interpretative bias on the text comprehension task. Possible explanations of the results are discussed, including the potential influences of self-referent processing and response bias.     

Chapter 6 Developmental Perspectives in Brief Treatment of Gay Youth

Abstract

This report explores representative dilemmas of gay youth in the transition from late adolescence to young adulthood and shows how brief treatment may facilitate efforts to work toward greater authenticity in sense of self and identity, revise maladaptive relational patterns, and strengthen coping capacities. It presents the case of an 18-year-old male who was seen in supportive psychodynamic treatment for 13 sessions in a university counseling service. Developmental and relational deficits, rooted in a stigmatized identity, perpetuated problems in functioning. The relational functions and supportive elements of the therapeutic process are emphasized in discussion of curative factors. Establishment of the selfobject bond with the therapist strengthened self, facilitated coping, and improved social functioning. The author emphasizes the importance of considering the impact of internalized homophobia and self-alienation in assessment of functioning and establishment of treatment goals.     

Psychotherapy training in a changing world: A Swedish perspective

The City and Hackney Primary Care Psychotherapy Consultation Service is an innovative, public sector service designed to support GPs in meeting the needs of patients with complex psychological/physical health issues throughout the London Boroughs of Hackney and the City. This paper provides an account of how this new model for the National Health Service (NHS) developed in the context of psychotherapy provision within the NHS, within the national and local context in the UK and gives an overview of some the service's key features and how it differs from other services operating in primary and secondary care. A linked paper, in this journal, explores the reality within which the service functions and describes clinical outcomes, health economic data, the modifications to the original model and prospects for the future.     

Winnicott's children: The holding environment and therapeutic communication in brief and non-intensive work

This paper discusses brief and non-intensive work using a Winnicottian framework for understanding the processes involved. The importance of play, communication and interpretation are considered within the careful establishment of a unique holding environment for each patient. Parallels are drawn with ordinary development and care of the infant and young child. Two clinical examples are given to illustrate these concepts. The first describes the treatment of parents and children following the accidental death of the youngest child, and the second describes time-limited work with a sexually abused and abusing teenage boy. The value of providing a range of psychoanalytic treatments to meet the range of needs of patients is discussed. The importance of conceptualizing such treatments in ways that do not imply that they are ‘diluted’ psychoanalysis is also stressed, particularly with a view to the increasing pressure on therapists to offer help to as many children as possible within limited treatment time.     

玄远之幕的飘落——王弼《论语释疑》的命运

本文通过分析王弼《论语释疑》在中国思想史中的命运 ,探讨儒家经典被玄学所体现的道家思想解释时 ,其思想意义的被改变与被扩展 ;探讨这种改变及扩展给儒学发展带来的种种问题。     

Applying the Visions of Reality to a Case of Brief Therapy

The visions of reality refer to assumptions about the nature and content of human reality and have been used to describe different genres of literature as well as psychoanalytic, behavioral, and humanistic modes of therapy. In this paper, four visions—the tragic, romantic, comic, and ironic—are applied to a single case, spelling out the way in which each can direct the focus of a therapist's attention to different aspects of a client's problems. Each vision can also influence the process of therapy and its goals. Keeping the several visions in mind can broaden both the therapist's and the client's view of the client's life situation and problems, thereby opening up possibilities for integrative work. The paper also spells out the shift in visions of reality that is necessary when conducting brief versus long-term therapy.     

Chapter 1 Pluralism,Pragmatism, and the Therapeutic Endeavor in Brief Dynamic Treatment

Abstract

This article places representative formulations of brief dynamic psychotherapy in the larger context of psychoanalytic thought, reviews relational perspectives that inform contemporary approaches to time-limited treatment, and identifies tasks in continued development of theory, research, and practice. In doing so, it emphasizes the need to consider a broader range of psychopathology, dysfunction, and need in formulations of brief intervention and to develop more flexible and realistic approaches in treatment of vulnerable and underserved populations. The growing emphasis on theoretical pluralism and pragmatism in therapeutic practice generally should facilitate efforts to broaden the base of brief dynamic treatment.     

Solution-Focused Brief Therapy and the Kingdom of God: A Cosmological Integration

The core cosmological dimension of Solution-Focused Brief Therapy (SFBT) and Christianity emphasizes a similar truth—the future is now. As humans live in their preferred realities, they experience the future, problem free solution for their lives from a SFBT perspective. The Christian tradition emphasizes the in-breaking Kingdom of God beginning with the Christ event. The end has entered the now. However, the final consummation of the end-times is still as yet in the future which means that sin and death are part of the world. This Christian understanding of sin and fallenness provides humility to SFBT’s inherently positive view of the world (Bidwell, D. R. Am J of Pastor Couns, 3:3–21, 1999), while SFBT encourages Christians to see the kingdom of God in the now instead of the future.     

From Interpretation to Commentary: Truth and Meaning in Psychotherapy

Some of the epistemological consequences of adopting the narrative point of view in psychotherapy are explored. Attempts to apply principles and norms from the philosophy of science to psychotherapy are criticized, since psychotherapy is not a science, but a technique. In addition, those models, related to the acquisition of knowledge, that consider that knowledge could increase by apposition without transforming the subject who is knowing are discussed. Natural science and hermeneutic metaphors are not suitable for understanding the practice of psychotherapy. Traditionally, the interpretation of symptoms or problems to solve has been the main instrument in therapy. In other words, the therapist tries to look for the truth hidden under the symptom, which then becomes a sign. Our proposition is to substitute these metaphors for the paradigm of text commentary. Text commentary, instead of providing a unique truth, provides a set of meanings suggested by a commentary. Characteristics that allow one to distinguish a good and a bad commentary, and implications of the paradigm described for the training of psychotherapists, are discussed.     

非自杀性自伤与接纳承诺疗法的多维解析

接纳承诺疗法干预非自杀性自伤已经被一些临床案例证实疗效显著,与其他传统的心理治疗相比,接纳承诺疗法的干预效果更加持久。首先分析了非自杀性自伤基本含义以及各类特征,从心理动机的角度简要说明了非自杀性自伤发生的原因,再结合接纳承诺疗法的心理病理模型及治疗模型,阐述了接纳承诺疗法是通过提高个体心理灵活性减少非自杀性自伤发生的的理论依据与治疗过程,最后梳理了近年来国外学者通过接纳承诺疗法干预非自杀性自伤的实证研究及效果,为其他研究者实践该疗法治疗非自杀性自伤提供借鉴思路。     

Interpretation and judgmental biases in social phobia

Previous research demonstrated that social phobia is characterized by content-specific interpretation and judgmental biases. The present study investigated whether this interpretation bias occurs not only in ambiguous, but also in positive and negative social events, and whether social phobic patients (SPs) are more characterized by a judgmental bias in costs than in probability. Besides, we argued that the judgmental bias observed in former studies could also be attributed to accurate estimations of SPs (of, for example, stuttering). Therefore, we assessed judgmental bias by the ratings of probability and costs of a negative evaluation (e.g. ‘people dislike me’) and not, as in previous studies, of negative social events (e.g. ‘stuttering’). SPs (n=228) and normal controls (n=33) were presented social and non-social events ranging from positive to profoundly negative. They ranked four different interpretations on likelihood to assess interpretation bias, and rated the profoundly negative interpretation on probability and cost to assess judgmental bias. SPs demonstrated content-specific interpretation and judgmental biases that also occurred in positive and negative social events. In contrast with expectations, SPs were characterized by a judgmental bias in both costs and probability.     

Raising Fees in Group Therapy: Some Ethical and Clinical Implications

Of all money matters in group psychotherapy, one of the most neglected in the literature is the issue of raising the fees. The premise of this paper is that there are ethical and clinical considerations to group fee increases. One consequence of the lack of attention to the subject of raising of fees is that many neophyte group leaders do not learn about its complexity. It will be argued that the raising of fees is not merely a straightforward matter of informing groups about an impending change in the amount of money that they will pay but rather, it is a knotty, emotionally charged issue with both realistic and subjective components for members and leaders alike. Further, it will be argued that the issue of raising fees in group therapy is dissimilar, in significant ways, from raising fees in individual treatment. When leaders use subjective criterion to decide an increase, then the group process may be disrupted. Suggestions for reform will be offered.