Group Psychotherapy Research Studies That Therapists Might Actually Read: My Top 10 List

Much like a bad marriage, the longstanding split between psychotherapy practitioner and researcher continues, each partner feeling unappreciated by and blaming of the other: Therapists are criticized for not reading research and, in turn, criticize researchers for their pursuit of studies that seem irrelevant to the clinical enterprise. In the present article, the author proposes that a shift in the design of psychotherapy research, away from pure outcome studies to models that focus on process, may serve to bridge the divide. Ten research designs exploring aspects of the process of group psychotherapy are illustrated from the recent literature, with the aim of furthering the dialogue between practitioner and researcher.     

Opening Scenarios: A Relational Perspective on How to Deal with Multiple Therapeutic Views

The aim of this work is to provide therapists with a conceptual outline to help them utilize theoretical and methodological perspectives from different psychotherapy models. More specifically, we will start with three basic assumptions from the social constructionist paradigm, particularly effective in bringing together different perspectives in therapy and providing therapists with useful criteria for selecting among them. The assumptions are as follows: (1) the psychological world of the individual is constructed within relational processes, mainly through dialogue; (2) in general, discourse can be classified as either generative or degenerative; and (3) individuals construct their life narratives based also on a common-sense that can derive from psychological theories developed within specific cultural traditions. These assumptions derive mainly from Gergen??s relational perspective (2009) and lead us to foresee a set of implications for clinical practice, where therapist and client are seen as ??multi-beings??, consequently endowed with multiple views, not one.     

What is this thing called love? Desire,psychotherapy and Plato’s symposium

The platonic dialogue, Symposium, is approached here through client work. This rich and complex text is not rushed through as if the point of a conversation must be its swift and clear termination, rather than how potentially fruitful, generative and transformative it is or may come to be when we reflect or engage in further conversation. This paper suggests that Symposium presents us with two ways of thinking about relating to another, and ends with some remarks about this platonic dialogue and psychotherapy that could, of course, be followed by more conversation.     

The Psychoanalytic Other: Commentary on Paper by Helen K. Gediman

Dr. Gediman locates the intersection of modern Freudian and relational theory in the arena of what she calls the “disclosures of everyday analysis” (p. 242). She suggests that because Freudian analysts, like their relational colleagues, work intersubjectively, relational theory does not itself embody a paradigm shift away from the Freudian model. I disagree. Relational theories assume that the analyst's work is inevitably informed by the relational context in a way that precludes clinical certainty. Gediman, however, believes that the analyst is capable of separating her countertransference response from her subjectivity and thus can interpret from a position of clinical certainty. Each set of theoretical assumptions is associated with a somewhat different analytic stance and analytic ideal. Freudian analysts aim for a position of “methodological neutrality” that relies on considerable certainty in the countertransference while giving the analyst plenty of room within which to use her subjectivity. The relational ideal concerns the analyst's capacity to enter into an asymmetrical treatment relationship and to tolerate the uncertainty generated therein.     

Recognizing the infant as subject in infant-parent psychotherapy

Drawing on Winnicott's view of infants as subjects entitled to an intervention in their own right, infants as the referred patient have been seen in infant-parent psychotherapy for 20 years at the Royal Children's Hospital, Melbourne, Australia. This is a radically different view of infant symptomatology than viewing it as only expressing an aspect of the mother's unconscious. The clinical pathway differentiates the therapy from much parent-infant psychotherapy. The author describes the theoretical model of a twofold approach to understanding the infant's experience through interactive dialogue between therapist and infant, and sharing this understanding with the parents, and illustrates it with cases of failure-to-thrive infants. She discusses two criticisms: first, that infant-parent psychotherapy may undermine the parents and, second, that brief parent-infant psychotherapy does not alter parents' insecure attachment status. Videotaped sessions often show rapid improvement; parents generally feel relieved. This approach potentially shapes not only parents' and infants' representations, but also their implicit knowledge of relationships-partly, it is suggested, through activating the mirror neuron system to bring about implicit memory change. Change may therefore be longer lasting than psychoanalytic theory presently conceives. The approach is relevant in an outpatient setting: gains were maintained long term in 90% of out-patient cases.     

Individuation in Marriage

This is an outline of marriage as a relationship which may facilitate continued personal growth and individuation (Jung's concept for the process of selfhood). Seeing marriage, including their own, in this fashion guides the authors in psychotherapy of marital partners and of the relationship.     

Intergenerational Transmission: Individuation and Intimacy Across Three Generations

This study examined the transmission of intergenerational family processes across three generations, employing Williamson's construct of Personal Authority in the Family System (PAFS) as a theoretical back-drop. From a PAFS perspective, psychological health is viewed as directly related to the degree of individuation and intimacy (PAFS) experienced within the family of origin. Overall, the results provided a degree of support for the intergenerational transmission hypothesis. The strongest predictor of the transmission process was from the participant/parent relationship to the participant/spouse relationship (spousal fusion/individuation). Separate male and female analyses of the Spousal Fusion/Individuation model found a moderate effect for females and a large effect for males. A small effect was found in predicting nuclear family triangulation from parent and spouse variables, although there was no gender effect. The findings suggest that degree of individuation and its related constructs are more critical in the transmission process than is intimacy.     

Relational dynamics between psychotherapy clients and clinic administrative staff: A pilot study

Extensive empirical research has established therapeutic alliance as one of the most stable predictors of psychotherapy outcomes. Nearly all the contemporary empirical literature on therapeutic alliance focuses on the therapist-client dyad without attending to the relational experiences many clients in outpatient clinics have with administrative staff. Literatures from the fields of social work, psychiatric nursing and milieu therapy suggest there are more systemic relational and environmental dynamics that impact treatment beyond the therapist-client dyad, although these issues have been considered primarily in inpatient settings. A relational ecology framework has been developed drawing upon relational psychoanalysis, attachment theory and symbolic anthropology to help conceptualise the broader relational dynamics beyond the therapist-client dyad that may impact a more systemic therapeutic alliance in certain outpatient contexts. In an initial cross-sectional pilot study with a sample of clients (N = 107) receiving psychotherapy at a community mental health clinic in the Northeastern United States, the present study found client ratings of both (a) the therapeutic alliance with their therapists and (b) their alliance with administrative staff each significantly positively predicted client ratings of treatment. Thus, ratings of administrative alliance predicted client ratings of treatment over and above the effects of the therapist-client therapeutic alliance. These findings provide preliminary support for further investigation of the relational ecology of outpatient psychotherapy and suggest that client experiences of relational and environmental dynamics with administrative staff may be important contributors to psychotherapy outcomes. Limitations of the present study and implications for future research and practice are discussed.     

Relationships as dialogues

This article discusses five interrelated conceptions of dialogue in the works of Russian scholar Mikhail Bakhtin that ground relational dialectics theory: (a) dialogue as constitutive process, (b) dialogue as dialectical flux, (c) dialogue as aesthetic moment, (d) dialogue as utterance, and (e) dialogue as critical sensibility. The author's recent research in relational dialectics is discussed, as are directions for future research. Relational dialectics is positioned as a sensitizing theory different from systems theory and other dialectically oriented approaches.     

From Enemy Combatant to Strange Bedfellow The Role of Religious Narratives in the Work of W. R. D. Fairbairn and D. W. Winnicott

Psychoanalysis has a well-documented history of antipathy toward religion. As a consequence of the postmodern shift in philosophy, however, there are those who, albeit cautiously, are attempting to approach religion with a renewed spirit of dialogue and inquiry as a narrative among many narratives that has informed and even enriched the development of psychoanalysis.

In this spirit of dialogue, the author traces the influence of early religious affiliations on two object relations theorists, W. R. D. Fairbairn and D. W. Winnicott. Fairbairn's early imbibing of Calvinist theology in Scotland and Winnicott's involvement in the Wesleyan church are detailed. The theological differences between these Protestant perspectives (which form counterpoints to one another) are clarified and the perspectives are positioned within the framework of British culture. These religious themes are then identified within the works of Fairbairn and Winnicott.

As a final consideration, the relational nature of the Judeo-Christian God, and the subsequent view of human life that flows from that theology, are posited as influential in the development of the relational shift in psychoanalysis. The author details the association between this shift and the seminal work of Fairbairn and Winnicott.     

Pastoral Conversation: Relational Listening and Open-Ended Questions

This article suggests that the most important thing a pastoral counselor does is to listen carefully to the client. It emphasizes the will to listen and a more relational understanding of listening as a natural outcome of the evolutionary history of psychotherapy. It highlights the importance of the work of Goolishian and Anderson (1992) and Anderson (1997) for this more relational view of therapeutic conversation. The article further suggests that one of the implications of a new conception of listening is an innovative understanding of open-ended questions for facilitating an inherently creative therapy conversation more than information gathering.     

A Mother,A Baby,and Two Treatment Approaches: Discussing A Switch Case from CBT and Mentalization Perspectives

ABSTRACT

As the literature on perinatal depression and anxiety grows, there is an increased need for dialogue among theoretical approaches for mother-infant mental health. This article describes a community mental health program incorporating a range of treatment models for pregnant and postpartum women experiencing issues during the transition to parenthood. Perinatal distress can affect parenting practices, from breastfeeding to health care access, creating the need for targeted, practical, and concrete interventions. Interventions that aim to foster secure attachment relationships and mentalization capacities can also help increase maternal sensitivity and attunement and joy in caregiving, and reduce withdrawn/hostile behaviors that may be associated with perinatal distress. The article describes psychotherapy with a mother and her newborn that began from a cognitive-behavioral approach and transitioned to a psychodynamic mentalization-focused treatment. Working principles and examples of two additional components of treatment, a group psychotherapy and research measures, are discussed. The case helps demonstrate how attachment theory can inform treatment and build a bridge between alternative approaches.     

WHO (OR WHAT) CAN DO PSYCHOTHERAPY:

Research suggests that paraprofessional therapists usually produce effects that are greater than effects for control conditions and comparable to those for professional therapist treatment Other nonprofessional psychological treatments, such as selfadmimstered materials and self-help groups, have also demonstrated positive effects Because of the promise of these nonprofessional treatments, their potential for low-cost service delivery, and the important theoretical questions that studies comparing them can answer, psychotherapy outcome research should shift away from comparisons of different professional therapies and instead compare nonprofessional therapies with professional therapy     

Listening Perspectives for Emotional-Relatedness Memories

When considering memory, it is as important to relinquish the distinctions of Platonic triadism—cognition, emotion, and motivation—as it is to abandon Cartesian dualism. Calling on contemporary infant research and neuroscience, the author asserts there is no memory save emotional memory. The human mind as given to us to know can be seen as springing from early-learned patterns of emotional relatedness that are retained in the personality and expressed in later significant interpersonal relationships, including the therapeutic one.

Influenced by the current relational movement on psychotherapy theory and practice, six trends in modern psychoanalytic thinking constitute a paradigm shift in the direction of listening for emotional-relatedness memory patterns brought by both participants into the interpersonal field of psychotherapy and psychoanalysis. Four listening perspectives are suggested for systematically framing different types of relatedness possibility patterns as they emerge in the course of the therapeutic engagement. Of special interest is the earliest “organizing” relational experience that manifests in therapy as two participants move toward interpersonal connection, only to have one or the other break or rupture the developing intimacy. To illustrate how primal patterns of flight, fight, and flee emerge in the transference–countertransference matrix, clinical examples are given. This paper illustrates how the relational paradigm stands on new philosophical, epistemological, and interactional ground when relatedness perspectives are used for listening and responding to (i.e., for framing) various levels of relational complexity possibility.     

Relational ecologies of psychotherapy: The influence of administrative attachment on therapeutic alliance

There is now vast and multi-faceted empirical literature on the impact of relational dynamics in psychotherapy, and relationality is a central theme within contemporary psychoanalytic theories. Yet, there is virtually no literature addressing the relational dynamics around outpatient psychotherapy that influence the wider therapeutic alliance, that is the relational dynamics that unfold between clients and administrative office staff in making initial contacts and appointments, completing paperwork, negotiating payment, discussing insurance coverage, working through crisis calls, and the myriad of other forms of interaction which serve to form the relational ecology of psychotherapy. Milieu therapy or the use of supportive and structured therapeutic environments has been given significant attention in inpatient settings; however, administrative relational factors or administrative staff characteristics have seemingly been ignored in outpatient psychotherapy and psychoanalysis literatures. Many outpatient clinical practice settings involve multiple levels and dimensions of relationality between clients, administrative personnel, and therapists which shape the potential for secure continuous containment and various forms of attachment to psychotherapeutic space. In this paper, we describe several clinical illustrations of relational dynamics between clients and office staff which influence therapeutic alliance and outline the contours of our emerging idea of administrative hospitality based on relational psychoanalysis, attachment theory, symbolic anthropology, and stigma research. In doing so, we draw on our collective experience working in several outpatient clinics and insights from our current context in an urban outpatient training clinic which emphasises psychodynamic practice. Our goal is not a comprehensive analysis of the relational ecology of psychotherapy but to offer an initial exploratory account of some of the administrative relational dynamics in and around outpatient psychotherapy which go beyond the therapist-client dyad. The anthropological concept of liminality is connected to relational psychoanalytic theories to describe the important dynamics of transitional space in an overall process of relational transformation.     

Supervising Psychoanalytic Psychotherapy: Present Knowledge,Pressing Needs,Future Possibilities

Existing research from the fields of education, cognitive science, neuroscience, and psychoanalytic psychotherapy points us toward possibilities for the future of psychoanalytic supervision. This research suggests that we need to go beyond communicating abstract knowledge and make our supervisory relationships more experiential, participatory, relationship-focused, and personal in order to teach usable knowledge, develop complex psychotherapeutic skills, and facilitate emotional and relational development in our supervisees. The author concludes that a relational model of supervision fits this pedagogical profile. After grappling with our resistances to change, the author hopes that more psychoanalytic supervisors will make use of a relational model of supervision, as well as drawing upon new technologies and neuroscience-based teaching techniques.     

The trauma triangle

Recent research supports the hypothesis that more active engagement of the patient in occurring illnesses improves quality of life and probably even life expectancy.In this study experience and theoretical knowledge from psychotherapy is transplanted to clinical practice in order to improve the physician's engagement in the patient-disease relationship. By defining severe and long-term illnesses as a psychotrauma, the transfer of the psychotherapeutical model leads to the creation of a new triangular relationship: patient-illness-doctor. Practical examples are used as illustrations for the conceptual differences between psychotherapy and clinical medicine. Options for dialogue show the difference between adaptation (learning to live with) and adjustment (active coping strategies and controlling). The hypothesis is that a better dialogue will reduce illness-related stress, giving the patient better and more effective access to personal psychic and physical support systems.     

Three modes of psychotherapy and their requisite core skills

The field of psychotherapy suffers from the lack of an integrative meta‐perspective on the large variety of existing psychotherapies and on the therapeutic skills involved. In the present paper, it is suggested that the development of a more comprehensive view of this field may be facilitated if we differentiate between three modes of psychotherapy, which require different therapeutic core skills: (a) an educational mode, which requires teaching skills; (b) a reparative mode, which requires analytic‐conceptualising skills to identify some kind of disordered functioning, in combination with specific relational‐technical skills to repair this dysfunction; and (c) a developmental mode, which involves engaging in a therapeutic relationship with patients to facilitate their personal growth, and which requires non‐directivity skills. In addition, some therapeutic skills (e.g., awareness and communication skills) may be more or less important in all modes of treatment. Concrete manifestations of the three different modes of psychotherapy are discussed in terms of five different theoretical perspectives on psychotherapy: the common factors, the humanistic‐experiential mindfulness cognitive‐behavioural (CBT) and psychodynamic perspective. The common factors model is criticised as being insufficient in several respects. Finally, it is argued that if personal therapeutic skills are essential to the effects of psychotherapy, then empirical research on psychotherapy needs to be re‐oriented towards a person‐oriented study of therapist skills in action, in the context of a study of the interaction between therapist and patient.     

At the verge of unthinkable anxiety: On the relevance of a neurophysiologically informed relational perspective on meaning-making in psychosis

Abstract

This article examines the relevance of relationally oriented psychoanalytic phenomenology as a frame of reference for understanding psychotic states in schizophrenia. The etiology and structural characteristics of such states are examined from both a neurophysiological, and a relational and interpersonal point of view. Many findings indicate organic abnormalities in schizophrenia, acquired through an exposure to physical risk factors and genetic predisposition, but relational traumas also seem to have an impact on the form and content of psychotic states. This may happen through interruptions in the “use-dependent” maturation of the brain in a relational milieu. In addition, at the level of meaning-making, we find that the emotional and relational contexts—both past and present—give the substance or “raw material” for hallucinations and delusions. In a psychotic state, the person also tries to handle basic affects and relational needs, and to make meaning in states of overwhelming chaos and anxiety. Donald W. Winnicott's theory of “a holding environment”, Stephen Mitchell's theory of the relational matrix, and Stolorow, Atwood, and Orange's concepts of a “shattered world” and annihilation anxiety are used as a framework in the analysis of the phenomenology of psychosis. Two case illustrations, one from child psychotherapy and one from therapy with an adult patient, are used to illuminate the theoretical points of view.     

Considerations in Francisco Varela for Psychotherapy of Sense

Under the influence of dialogic and narrative models, relational systemic psychotherapy has shifted its attention towards understanding the relational self, its agency and off-centered nature. In order to substantiate its new clinical positions, it has reached for other disciplines such as philosophy and literature. Francisco Varela’s approach regarding the ontological aporia between the individual and the relationship may provide conceptual foundations to propose a clinical understanding where identity and sense play a key role. By considering intentionality as the engine of everything that’s living, Varela generates a difference between the extensive environment in which individuals unfold, and the singular investiture of significance through which people seek relationships to recognize their identity. A model for a relational psychotherapy of sense is proposed, based in Francisco Varela’s conceptual influences.