Making “Use” of Aggression in Child Psychotherapy

In this article, informed by Winnicott's seminal 1969 article, “The Use of an Object and Relating Through Identifications,” I aim to illuminate the transformational possibilities that emerge when adults view particular forms of aggression as expressions of hope. I examine the processes associated with taking a child from what Winnicott referred to as object relating to object usage, with particular focus placed on the links between theory and practice. I highlight the importance of one mobilizing the social environment toward the attention of the child through limit setting while concurrently tolerating the child's aggressive acts by not retaliating or retreating. This shared relational journey involves helping a child move from the omnipotent but very lonely, anxiety-filled, encapsulated world of their own projections to a coconstituted reality and involves the child engaging in destructive activity (aggression) and the significant adult surviving. It is hope that underpins this destructive enterprise. When the child finally comes to realize that the other is not under their omnipotent control, that is, when the child has tried to destroy, and the other has survived, the child can then, and only then, forge a mutual partnership with the other. Conceptual points are illuminated through the presentation of case material.     

What Happens in Therapy? Adolescents’ Expectations and Perceptions of Psychotherapy

A measure of adolescent pre-treatment expectations/perceptions of psychotherapy was developed, evaluated, and used to examine adolescent expectancies of psychotherapy. The development of the Psychotherapy Expectations and Perceptions Inventory (PEPI) is described and initial psychometric properties reported. Utilizing a sample of adolescents (N = 546), expectancies of psychotherapy were assessed using the PEPI. Results indicate adequate internal consistency and a 3 factor structure. Specifically, factors identified were labeled (1) measuring negative expectancies, (2) process/outcome expectancies, and (3) expectancies for a positive therapeutic relationship. Boys reported greater negative expectancies, but also greater expectancies for a positive therapeutic relationship. Girls reported greater therapy process/outcome expectancies. Prior contact with mental illness was not related to any studied factors. Clinicians may benefit from assessing adolescent expectancies to facilitate rapport and engagement in the therapy to foster more therapeutic change. Future research that examines the relationships between specific demographic characteristics (e.g., socioeconomic status, race/ethnicity, etc.) and service utilization variables among adolescents is warranted.     

Codetype-Based Interpretation of the MMPI–2 in an Outpatient Psychotherapy Sample

In an evaluation of the codetype-based interpretation of the MMPI–2, 48 doctoral student psychotherapists rated their clients’ (N = 120) standardized interpretations as more accurate when based on the profile's codetype, in comparison with ratings for interpretations based on alternate codetypes. Effect sizes ranged from nonsignificant to large, depending on the degree of proximity between the profile's codetype and the alternate codetype. There was weak evidence to suggest that well-defined profiles yielded more accurate interpretations than undefined profiles. It appears that codetype-based interpretation of the MMPI–2 is generally valid, but there might be little difference in the accuracy of interpretations based on nearby codetypes.     

Clients’ Experiences of Disengaged Moments in Psychotherapy: A Grounded Theory Analysis

The study offers an empirically derived model of clients’ experiences of disengaged moments, defined as moments when clients withdraw, distance, or lessen their intensity of involvement with therapy-relevant material or relationships. Interpersonal Process Recall (IPR) interviews were conducted with nine psychotherapy clients of therapists with varied orientations and experience. The interviews were transcribed verbatim and subjected to qualitative analysis using grounded theory analysis (Glaser and Strauss, The discovery of grounded theory: Strategies for qualitative research, 1967) methodology. The results suggested that clients use disengagement for protection from pain, strategic retreat, relationship management, self-through-other discovery, and self-betterment. The core category across all of the experiences of disengagement relates to communicating difficulties and experimenting within the therapy relationship toward self-change. Recommendations are offered for research and practice.     

Patients’ Perceptions of Risky Developments During Psychotherapy

Research on risks and unwanted effects is largely missing in psychotherapy. Using exploratory factor analysis six dimensions of personal therapy situation were identified in a preliminary study, three of them were associated with risky developments during the psychotherapeutic process: (1) (poor) quality of therapeutic relationship, (2) burden caused by psychotherapy, and (3) dependency/isolation. Based on the finding of this study an online survey was performed to examine these three dimensions. Aside from these three factors another variable was associated with risky therapy developments: the online questionnaire also asked for premature terminations of psychotherapy as a consequence of risky conditions for the therapeutic development. Risky conditions were found to be associated with the following variables: (1) the combination of female patient–male therapist, (2) the therapeutic orientation (particularly with the psychodynamic approaches) and (3) the duration of therapy. Fewer humanistic and systemic psychotherapies were found among the high risk-prone group of patients who were at risk in at least three of the four variables which were associated with risky developments. Differences in the findings of the study regarding the four therapeutic orientations stress the importance of an extensive differential indication and a cooperative partnership between patient and therapist, in order to facilitate a positive patient participation towards the choice of therapy method and subsequent successful participation throughout the course of treatment. Further studies should also focus on female patient and male therapist psychotherapies.     

„Cognitive Behavioral Analysis System of Psychotherapy“

There are a number of evidence-based methods of psychotherapy for the treatment of depression but most treatment approaches have shown low or moderate success in the subgroup of chronic depression (duration >?2 years) as compared to episodic depression. This could be related to a higher rate of early trauma and specific deficits in cognitive and interpersonal functioning within this group of patients. James McCullough has developed a psychotherapeutic approach known as cognitive behavioral analysis system of psychotherapy (CBASP) specifically for chronic depression to overcome these deficits. In CBASP early negative experiences are associated with current interpersonal problems and a systematic relearning process is initiated. The approach integrates behavioral, cognitive and interpersonal strategies. The CBASP approach is empirically supported by study results and has shown to be effective in both inpatient and outpatient settings. This article presents the development of the approach and therapeutic strategies as well as techniques of CBASP are described.     

The Survey of European Psychotherapy Training 3: what psychotherapy is available in Europe?

Information provided in interview with key informantsin twenty-one European countries showed that there is a wide-range of different modalities of psychotherapy in Europe. Some are limited to their country of development but others are more wide-spread. Only four modalities are practised in the majority of countries. Psychodynamic (in every country), systemic family, gestalt.     

It’s All About the Relationship: The Role of Attachment in Child-Parent Psychotherapy

Research on Child and Adolescent Psychopathology -     

How Separable Are Spirituality and Theology in Psychotherapy?

The authors respond to D. A. Helminiak's (2001) article “Treating Spiritual Issues in Secular Psychotherapy.” They focus particularly on Helminiak's argument for secular spirituality (whether spirituality can be independent of theology/religion) and his inherent biases in discussing the nature and existence of spirituality. The authors argue that all spiritual conceptions have theological implications—and thus a theology, broadly defined—and that theology, in this sense, pervades the theory and practice of all psychotherapists, whether or not they are religious.     

The Idiot's Dreams: Rêverie in Child Psychotherapy

When exploring the frontier of the "border" cases, that is treating severely damaged patients, either by organic pathologies or by severe physical traumas or even by catastrophic emotional events, the classical technique is often forsaken to pioneer new trails, and we may utilize intersubjective actions. Some of these actions may occur very directly and suddenly, only later revealing their meaning in the après coup; others, on the contrary, may be the result of a not always easy or painless choice; in either case, these actions can have a great therapeutic meaning. I ventured to follow one such trail, together with the child I am going to speak of in this paper: the little "idiot" (as he used to name himself). He was suffering from an extremely severe phonologic disorder, which allowed him to utter only inarticulate noises; yet, a rich and deep internal world peeped out in the sessions, a world imprisoned but not completely annihilated by mutism. For many months, I have been trying to lend my voice to this world, by agreeing to narrate "my own" dreams within the play that was taking place in the sessions: in other words, I have tried to make use of my rêverie and capacity of identification in order to express the awful anxieties connected with the child's impossibility to communicate and to be understood: that is, with his huge loneliness. This work of "translation" did not take place with interpretation dresses, but as a repeated narration of dreams and nightmares, apparently mine yet, actually, deeply belonging to him. In this way a first step has been taken towards the raise of trust and hope of being understood, an indispensable requirement for him to finally get-after many years of work-to express himself and to make himself understood.     

Hitting the Bull’s Eye in Personality Disorders Psychotherapy

Psychotherapy of personality disorders (PD) is gaining momentum, though the progress has been mostly concerned borderline PD, with the other disorders largely neglected. In parallel, many empirically tested approaches focus on a limited understanding of psychopathology, for example poor mentalization or affect dysregulation, while PD are complex entities; they require clinicians paying attention to multiple therapy targets in order to be treated effectively and for a hope of actual recovery. I contend here that a more comprehensive account of psychopathology is needed; therefore the papers in this special issue focus on some of these aspects, such as difficulties in mental state understanding, dysfunctional representations of self with others, poor affect regulation and lack of access to adaptive and healthy self-aspects. The papers included in this special issue try and provide the readers with an intensive qualitative account of how therapists can act and yield improvements in these domains, with the hope of improving clinicians’ abilities to treat PD no matter what their preferred orientation is.     

Collaborators in the Marginalization of REBT—The Use and Misuse of Three Approaches to Psychotherapy and Other Videotaped Demonstrations

Long time users of the 1965 film, Three Approaches to Psychotherapy (TAP), have fostered the marginalization of Rational Emotive Behavior Therapy (REBT). For more than three decades, the counseling profession has consistently and relentlessly embraced TAP as an accurate, timely, and realistic portrayal of what RET, and now REBT, is all about—despite indications, then and now, that the demonstration was seriously flawed and the film is now hopelessly outdated. The need for accurate, timely and realistic multimedia demonstrations is essential to the training of mental health professionals.     

What is the Place of Clinicians’ Religious or Spiritual Commitments in Psychotherapy? A Virtues-Based Perspective

Value neutrality in psychotherapy is widely acknowledged to be a myth, and a majority of US physicians report that their religious faith influences their practice. Most attention to therapists’ religious and spiritual commitments has focused on ethical boundaries, transference/countertransference dynamics and questions about how to relate religious and psychological truth. No consensus exists about the legitimate place in psychotherapy of clinicians’ differing value commitments. Therapists’ virtues are vitally important in psychotherapy, not least in the relational and aspirational process by which the patient identifies with the therapist as they engage together in confronting obstacles which the patient has been unable to surmount alone. Among the individual and cultural factors that shape a therapist’s virtues are spiritual traditions, which encourage preferred or characteristic virtues. Arguably, these include for Jews, communal responsibility and critical thought; for Christians, love and grace; for Muslims, reverence and obedience; for Buddhists, equanimity and compassion; for Hindus, appreciation of Dharma and Karma; and for secularists, respect for scientific evidence and intelligibility. These have differing implications for treatment, as illustrated through the use of a hypothetical case. Attention to differing spiritual and religious virtues in a pluralistic culture offers opportunities for creative dialogue, collaborative teaching and interdisciplinary research.     

The “ABCs” of REBT I: A Preliminary Study of Errors and Confusions in Counselling and Psychotherapy Textbooks

In this study, a random sample of twenty counselling and psychotherapy textbooks were studied with respect to the errors and confusions made by the authors of these textbooks with respect to the ??ABCs?? of REBT. A total of 240 of such errors/confusions were found with most being made about beliefs at ??B??, particularly about irrational beliefs. A variety of errors and confusions were also made about (i) the relationship between ??B?? and ??C?? (including whether or not such a relationship is causal), (ii) the relationship between irrational beliefs and disturbed responses at ??C??, (iii) ??A?? and (iv) ??emotional ??Cs??. Twenty errors were even made about the name of the therapy! It was suggested that one way of addressing this state of affairs would be for the Albert Ellis Institute to commission a group of REBT experts to write a document especially for authors of counselling and psychotherapy textbooks and for publishers of these works that specifies clearly and accurately agreed wisdom about the ??ABCs?? of REBT. The weaknesses of the current study were noted and suggestions for future research made.     

Real Relationship: The “Something More” of Psychotherapy

Although it often operates silently, the personal relationship is a part of everything that transpires between therapist and client. Following the psychoanalyst Ralph Greenson's (1967) early lead, the term Real Relationship is used to capture this personal aspect of psychotherapy. It is divided into two elements, realism and genuineness; and both these elements are further divided into magnitude and valence aspects. Research on the real relationship is almost nonexistent, and to an important extent this is due to the lack of a reliable, valid, and convenient measure. The author is involved in a research project aimed at developing such measures from both the client and therapist perspective. Examples of items are provided.