Patient Suicide: A Survey of Therapists' Reactions

A substantial proportion of therapists will at some point in their professional life experience the loss of a patient to suicide. Our aims were to assess how therapists react to patient's suicide over time and which factors contribute to the reaction. One third of the therapists, mostly women, suffer from severe distress. The impact is not different for therapists in institutional settings and therapists in private practice. The item “overall distress” immediately after the suicide predicts emotional reactions and changes in behavior. Our data suggest that identifying the severely distressed subgroup could be done using a visual analogue scale for overall distress. As a consequence, more specific and intensified help could be provided to these individuals.     

The two time vectors of Nachträglichkeit in the development of ego organization: Significance of the concept for the symbolization of nameless traumas and anxieties1

The author describes Freud ’s conception of Nachträglichkeit as an active process that bridges the gap between past affective vicissitudes and the cognitive present by way of meaning. Symbolization is thereby subsequently [nachträglich] conferred on early traumatic events, which thus become susceptible to omnipotent control. The two time vectors of Nachträglichkeit are discussed: the first is a causal process operating in the forward direction of time against the background of a factual reality, while the second is a backward movement that permits an understanding of unconscious scenes and phantasies taking place at primary-process level. This twofold temporal motion was observed and described by Freud early on. However, its significance often remained hidden prior to his study of Moses. It was mostly overlooked in English and French translations, thus giving rise to a one-sided understanding of the concept in the various psychoanalytic cultures, as either deferred action or après-coup. Freud ’s Moses study addresses both temporal aspects of Nachträglichkeit, seeking not only to reconstruct a past event on a causal, deterministic basis, but also to understand the subjective truth of that event in the transference along the retrograde time line. The decisive criterion for the conceptual and clinical separation of the two time vectors is the development of ego organization and the capacity for symbolization. The two vectors should not be separated on the factual level, as both aspects of Nachträglichkeit are essential to the understanding of unconscious processes, combining as they do in a relationship of circular complementarity.     

Clinical supervision in cognitive behavior therapy improves therapists’ competence: a single-case experimental pilot study

ABSTRACT

Clinical supervision is a cornerstone in psychotherapists’ training but there are few empirical evaluations on the effects of supervision on therapists’ competencies. The aim of this study was therefore to evaluate the effects of standardized supervision on rater-assessed competency in Cognitive Behavior Therapy (CBT). Six therapists with basic training in CBT were provided with protocol-based clinical supervision in CBT in a single-case experimental multiple baseline design. The supervision focused on specific CBT competencies and used experiential learning methods such as role-play. Each therapist recorded weekly treatment sessions during phases without and with supervision. The therapists’ CBT competence was assessed by third-party raters using the Revised Cognitive Therapy Scale (CTS-R). Statistical analyses showed that the therapists’ CTS-R scores increased significantly during the phase with supervision with a mean item increase of M = 0.71 (range = 0.50–1.0) on the supervision focus areas. This is one of the first empirical studies that can confirm that supervision affect CBT competencies. The results also suggest that supervision can be manualized and that supervisees have a positive perception of more active training methods. Further studies are needed to replicate the results and to find ways to improve the impact of supervision.