Facilitated Disclosure Versus Clinical Accommodation of Infidelity Secrets: An Early Pivot Point in Couple Therapy. Part 2: Therapy Ethics,Pragmatics, and Protocol

In couple therapy, one partner's private disclosure of infidelity presents a potentially polarizing issue involving the therapist's decision to facilitate disclosure or accommodate non-disclosure. Some therapists may assume accommodating an infidelity secret is the most compassionate and efficient option. We consider this decision in the context of therapy ethics of equal advocacy and confidentiality, implications for individual and relationship healing, and pragmatic aspects of conducting therapy. We conclude that measured disclosure of infidelity, determined by the aggrieved spouse, best resolves the potential collision of multilateral advocacy with confidentiality and offers the best prospects for a working therapy alliance and couple healing and renewal. A clinical protocol for facilitating disclosure of infidelity secrets is presented.     

Borderline Personality Disorder,Divorce and Family Therapy: The Need for Family Crisis Intervention Strategies

Recent literature reviews, point out the lack of crisis intervention and crisis prevention programs that are in existence to address crises experienced by first-degree and divorced family members of Borderline Personality Disorder (BPD) probands. The focus of such intervention programs should be to facilitate the improved ability of the first-degree and divorced family members to manage and transcend the unstable family environment. Correlations between personal instability and frequency of psychosocial crises have been examined, as well as the ripple effect of frequent individual crises on family environments. Reviews of current therapeutic interventions, as well as a synthesis of practical family therapy interventions focusing on breaking the cycle of dysfunctional multi-generational family environments are also examined.     

Young children's interpersonal trust consistency as a predictor of future school adjustment

Young children's interpersonal trust consistency was examined as a predictor of future school adjustment. One hundred and ninety two (95 male and 97 female, M_age = 6 years 2 months, SD_age = 6 months) children from school years 1 and 2 in the United Kingdom were tested twice over one year. Children completed measures of peer trust and school adjustment and teachers completed the Short-Form Teacher Rating Scale of School Adjustment. Longitudinal quadratic relationships emerged between consistency of children's peer trust beliefs and peer-reported trustworthiness and school adjustment and these varied according to social group, facet of trust, and indicator of school adjustment. The findings support the conclusion that interpersonal trust consistency, especially for secret-keeping, predicts aspects of young children's school adjustment.     

Chaotic attractors in the therapeutic system 1

Because little research had been done on the presence and role of latent communication in the context of team‐conducted family therapy, the writers set out to monitor unconscious responses generated under these conditions. Specifically, they investigated an ongoing family treatment situation conducted according to the “reflecting team model.” One team of therapists handles the actual treatment session, while the other observes from behind a one‐way mirror. During the course of a session, the second team makes suggestions to the treatment team either by telephone or by calling the therapists out of the treatment room.

As the project developed, the writers found that the unconscious responses of both family and treatment teams indicated a process at work beyond the conscious intentions of the participants. That is, the therapeutic enterprise was functioning as a dynamical system, whose increasing complexity suggested a self organizing principle at work. This paper traces the development of the system's movement toward greater complexity, identifies the specific interventions that indicate this process, describes how all participants demonstrated a high degree of resonance and synchronization with this overarching‐self organizing pattern. This paper serves to alert therapists to the role of unconscious communication within the therapeutic system and postulates that the generation of form within psychotherapy follows many of the same self organizing processes found in other human and non human systems.     

Toward an ethic of the biosphere

This article consists of three parts. The first explores the relation between paradox, de-paradoxication, and time, which I hold to be a relatively unattended yet very important tandem of concepts in Luhmann's work (Luhmann, 1993, 1995; Rasch, 2000). The second part will try to theoretically think through (de-paradoxicalize) a conundrum of present time: globalization and its opponents. In the third and last part, I briefly explore the paradox of conscious evolution, taking into account the specifics of the relations between social systems of communication and individual psychic systems in Luhmann's theory.     

Knowledge and economic growth—creativity,learning and knowledge utilization

The purpose of this study is to discuss the dynamic interdependence of knowledge and economic growth. We show that the traditional economics, which treats knowledge as parameters and is mainly developed within linearized, stable and static frameworks can hardly explain the modern economic complexity. We argue that it is necessary to treat creativity, learning and knowledge utilization as endogenous dynamic processes of social and economic evolution. To handle with the complicated dynamic interdependence of wealth and knowledge accumulation, we need to apply genuine nonlinear dynamic theory. In particular, we discuss possible benefits of government's intervention in education and science to the society when the social and economic evolution is characterized of nonlinearity, instability and multi‐equilibria.     

Evolution and human choices

The postmodern world seems to have conclusively lost faith in the heady promises of human emancipation through rational understanding that have pervaded the Western world since the time of the Enlightenment. As the end of the millennium approaches and the evidence of man‐made environmental degradation accumulates nihilism and malaise color the future. This article argues that a clear understanding of both evolutionary forces and human consciousness permits to formulate a guardedly optimistic alternative view. It is advanced that the very sense of despair current circumstances have created may trigger a move toward a new form of psycho‐functional adaptation, simultaneously constituting a first instance of “conscious evolution” and fulfilling the progressive promise intrinsic in the full use of our rational faculties.     

Understanding,respecting and integrating difference in therapeutic practice

The purpose of this paper is to promote thought and discussion around how and why we treat patients in chosen ways. In the present climate practitioners are required to treat patients following NICE guidelines in which cognitive behavioural therapy (CBT) is the treatment of choice in the majority of diagnoses. This paper raises concerns that this may lead to an homogenization of treatment, loss of invaluable skills and understanding from other treatment approaches, and loss to the patient who may be best cared for by a combination of treatments and approaches, most notably patients presenting with complex pathology. This paper aims to present this as a general principle, and by way of example, will focus on coupling two specific treatment orientations, cognitive behavioural therapy with psychodynamic psychotherapy, with the specific diagnosis of obsessive compulsive disorder (OCD).

Methods: Clinical material is drawn from case studies from practice in secondary adult mental health care services within the NHS. All patients were referred to the psychological services for treatment for OCD and provided with 1:1 therapy with UKCP‐registered therapists. Details have been anonymized by describing fictitious cases re‐constructed from clinical material. A theoretical understanding is included which provides both an overview for integrating treatment for the specific example of OCD and is intended by extension to other diagnoses.

Results: Working with the commonalities of therapeutic approaches, and integrating specific skills of CBT and psychodynamic psychotherapy, appears to offer a viable mode of treatment for cases resistant to single‐orientation therapies.

Conclusions: Coupling the skills of different therapies can be effective in treating complex patients that are referred to the secondary mental health services. Conversely, restricting practice to single orientation therapies can lead to an impoverished care for patients and diminution of invaluable therapeutic skills which may become underused, undervalued and lost in the practice of mental health care within the NHS. Acknowledgement of the skills of others, valuing these and learning from each other can help to avoid the defensive reactions of practitioners, where each may defensively retreat to their corners of specialism. Respecting and sharing skills from different orientations, and acknowledging this in the NICE guidelines, is good for both mental health services and patient care and addresses the concerns raised by practitioners exemplified by Bateman (2000 Bateman, A. 2000. Integration in psychotherapy: An evolving reality in personality disorder.. British Journal of Psychotherapy, 17(2): 147–156.  [Google Scholar], p. 147) that ‘psychotherapy continues to be bedeviled by ideological schisms with practitioners apparently ignoring alternative conceptualizations and potentially superior interventions’.     

Suicide and masochism: The evolving relationship between guilt,suffering, self-attack and suicide

Masochism is a complex and intriguing phenomenon. Self-attack may serve many purposes. Some patients suffer through harsh self-criticism, bodily harm, or even tormenting thoughts of death, without actually killing themselves. Some of these patients ultimately may go on to die by suicide, but for many, the self-torturing aspect may exist independently in acute or chronic forms. This paper addresses the complex relationship between masochism and suicide as two separate yet interconnected phenomena.     

Anger communication in deaf children

In this study, we investigated how deaf children express their anger towards peers and with what intentions. Eleven-year-old deaf children (n=21) and a hearing control group (n=36) were offered four vignettes describing anger-evoking conflict situations with peers. Children were asked how they would respond, how the responsible peer would react, and what would happen to their relationship. Deaf children employed the communicative function of anger expression differently from hearing children. Whereas hearing children used anger expression to reflect on the anguish that another child caused them, deaf children used it rather bluntly and explained less. Moreover, deaf children expected less empathic responses from the peer causing them harm. Both groups did, however, expect equally often that the relationship with the peer would stay intact. These findings are discussed in the light of deaf children's impaired emotion socialization secondary to their limited communication skills.