The emerging narrative approach to counselling and psychotherapy

An important recent development within counselling and psychotherapy has been the emergence of narrative perspectives on theory and practice. The task of the counsellor is viewed as that of assisting the client to 're-author' parts of their life-story. The origins of this approach within psychology and social science are discussed, and the central elements of a narrative approach to counselling and psychotherapy are identified. A brief case-study illustrates some of these themes.     

An individual approach to psychotherapy with psychotic patients

In this paper I attempt to explore particular aspects of the therapeutic process, especially the unusual way in which the therapy of this 11-year-old girl, referred for possible or potential anorexia nervosa, came to a sudden end. The oedipal configuration provides a useful theoretical framework in which to consider the course and vicissitudes of treatment. The restoration of a link between the child and her father allowed a distance to be created between mother and daughter. The meaning of this is considered both in terms of external events and clinically within the transference relationship.     

Healing through meeting: A dialogical approach to psychotherapy

The American Journal of Psychoanalysis -     

A time-limited dynamic approach to adolescent inpatient group psychotherapy

In response to sharply curtailed lengths of stay of adolescents in an inpatient psychiatric program, new therapeutic modalities need to be implemented. A time-limited dynamic approach to adolescent inpatient group psychotherapy is presented. The model integrates psychoanalytic and crisis theory into a group format. The primary focus in this model is upon resolution of problematic interpersonal interactions as they are related to the current crisis state. The group process, as related to the adolescent, involves three phases. These include an initial intake phase, which incorporates an ego-functioning assessment; a second or middle phase which focuses on making actions ego-alien; and the termination phase, which incorporates the learning experience and how it relates to the resolution of precipitators of the admission.     

Cotherapy in psychodynamic group psychotherapy: An approach to training

Cotherapy in a training relationship with a senior therapist/supervisor and a trainee/junior leader is presented. A structured training year with planned sessions for the junior leader to lead the group alone, as well as intensive supervision, is described. The training relationship is seen as evolving into an egalitarian, collegial working relationship. An incidental benefit of this cotherapy approach is that additional opportunities are provided for group members to work through attitudes, feelings, and behaviors associated with attachment, interpersonal relationship (autonomy and affiliation), separation, and loss. Potential drawbacks and applications are also noted.The authors express their appreciation to the many group members and cotherapists whose experiences provided the stimulation and clinical material for the present formulation.     

A dynamic/expressive approach to brief inpatient group psychotherapy

Therapeutic action occurs in groups when patients simultaneously become more accepting of their own thoughts and feelings and increase their capacity to share more benign and mature interpersonal relationships with the therapist and other patients. This orientation can guide practitioners of brief inpatient group psychotherapy in choosing when to use interpersonal, problemsolving, or object relations techniques, or more traditional dynamic/expressive techniques. While the brief inpatient modality requires an increase in suppressive techniques compared to the longterm outpatient modality, suppression must be used judiciously, to facilitate rather than interfere with selfunderstanding and development of therapeutic relationships. Specific technical choices are derived from this principle and illustrated with a case example.     

Applying a prospective approach to the working-through phase of psychotherapy

During the working-through phase of psychotherapy, the core of the patient's conflict is revealed and subjected to analysis. Although the working-through has been the subject of much scholarship, little has been written about identifying its onset and termination. This paper introduces a developmental strategy—previewing—derived from the interactional patterns between caregiver and infant. Previewing involves the caregiver's ability to represent, predict and rehearse future maturational changes affecting the infant. Previewing techniques may be applied analogously to the treatment of adult patients to better diagnose the presence of conflict and to facilitate the working-through of conflict.     

Positive psychotherapy: A strength-based approach

Positive psychotherapy (PPT) is a therapeutic approach broadly based on the principles of positive psychology. Rooted in Chris Peterson’s groundbreaking work on character strengths, PPT integrates symptoms with strengths, resources with risks, weaknesses with values, and hopes with regrets in order to understand the inherent complexities of human experiences in a way that is more balanced than the traditional deficit-oriented approach to psychotherapy. This paper makes the case of an alternative approach to psychotherapy that pays equal attention and effort to negatives and positives. It discusses PPT’s assumptions and describes in detail how PPT exercises work in clinical settings. The paper summarizes results of pilot studies using this approach, discusses caveats in conducting PPT, and suggests potential directions.     

A pragmatic approach to measuring adherence in treatment delivery in psychotherapy

ABSTRACT

Measuring therapists’ adherence to treatment manuals is recommended for evaluating treatment integrity, yet ways to do this are poorly defined, time consuming, and costly. The aims of the study were to develop a Therapy Component Checklist (TCC) to measure adherence to manualised CBT; to test its application in research and clinical practice; to determine its validity; and consider its cost benefits. We conducted a randomised trial in 230 people with cancer evaluating effectiveness of CBT for depression. In this, therapists delivered manualised treatment. Experts agreed on key components of therapy and therapists were asked to record these after therapy sessions by ticking a TCC. Inter-rater reliability was tested using an independent rater. Therapists delivered 543 CBT sessions. TCCs were completed in 293, of which 39 were assessed by the independent rater. Self-reported TCC data suggested close adherence to the manual. Prevalence-adjusted and bias-adjusted kappa scores suggested substantial agreement, (>0.60) in 38 out of 46 items. Self-rating of adherence saved around £96 per rating. In conclusion the TCC provides a quick and cost effective way of evaluating the components of therapy delivered. This approach could be applied to other psychological treatments and may help with linking therapeutic interventions with outcome.     

An integrated approach to psychotherapy techniques for patients with personality disorder

Personality disordered patients present with multiple problem areas and potential targets of change. This complex clinical situation can be addressed by an integrated approach to the treatment by using treatment strategies and techniques from the various schools of therapy, sequenced and adapted to the individual patient. An optimal choice and sequencing of treatment techniques is organized around general treatment strategies (assessment and case formulation, treatment structuring, observing the therapeutic relationship, addressing problematic personality organization, and addressing sequential goals) with the severity of the personality disturbance in mind. The biggest threat to successful integration of the treatment is the reaction of severe personality disordered patients who lack an integrated sense of self and suffer from intense, fluctuating emotions that challenge an inexperienced, reactive therapist.     

Researching psychotherapy integration: A heuristic approach

Moustakas argues that questions and methodology in heuristic research flow out of inner awareness, meaning and inspiration. The approach might arguably embrace a combination of qualitative research methods, and constitute a kind of bricolage. This paper describes a heuristic enquiry into psychotherapy integration that used such a combination of methods – an interpretative phenomenological approach, case studies, reflexive action, and writing. It demonstrates how each of these methods contributed to the six phases of heuristic enquiry, from the initial engagement with psychotherapy as a trainee to the creative synthesis of published works and a PhD thesis, together with some reflection on the enquiry's limitations and rigour. Published texts, training, clinical practice and reflexivity constituted the material from which a new organizing framework for understanding psychotherapy integration was formulated. The author reflects on how the research design allowed deep engagement with this material, and changed his perspective of psychotherapy integration. In conclusion, this paper suggests that both psychotherapy integration and heuristic enquiry can only be conducted on an individual and personal basis, and that it is the quality of the relationship, with the client, or the research material, that produces results.