Clinical Expertise in Psychotherapy: How Expert Therapists Use Theory in Generating Case Conceptualizations and Interventions

Case conceptualization is a primary skill that may be the linchpin of clinical practice as it sets the framework for making sense of a patient’s difficulties and guides a path toward change. Providing meaning and structure to often ambiguous and nuanced clinical information, an apt case conceptualization facilitates the therapist’s complex integration of core therapeutic skills to produce expert performance. Rooted in the cognitive sciences literature on expertise, we introduce the concept of metabolizing theory to capture expert therapists’ capacity to use theoretical and clinical knowledge in an intuitive, flexible manner that responds and adapts to the unique and complex context of the treatment.     

Children's and adults’ understanding of the “disgust face”

By the age of 4 years, children (N=120) know the meaning of the word disgust as well as they know the meaning of anger and fear; for example, when asked, they are equally able to generate a plausible cause for each of these emotions. Yet, in tasks involving facial expressions (free labelling of faces, deciding whether or not a face expresses disgust, or finding a “disgust face” in an array of faces), a majority of 3- to 7-year-old children (N=144) associated the prototypical “disgust face” with anger and denied its association with disgust (25% of adults on the same tasks did so as well). These results challenge the assumption that all humans easily recognise disgust from its facial expression and that this recognition is a precursor to children's understanding of the emotion of disgust.     

Searching for the enriching sense of otherness: The psychoanalytic psychotherapist as a meaning-bearing other

Abstract

This paper is a theoretical and clinical examination of the patient's search for the otherness of the therapist as a prerequisite for change and development in relational psychoanalytic psychotherapy. A basic assumption is that being in a relationship as well as being a personal self, is to be understood, as being with a “meaning-bearing other”; that is, someone who allows for the possibility of meaningful thoughts and feelings, either through an actual communicative presence or as a consciously, prereflective, or unconsciously imagined communication partner. The term “meaning-bearing other” is used to differentiate distinct, although often synchronic, modes of relatedness. The need for intersubjective “depth”—that is, to discover the otherness of the other, and for oneself to be recognized as an experiencing subject—is regarded as a main motivational force. Winnicott's, as well as Sullivan's developmental approaches, Mitchell and Aron's views on psychoanalytic interaction, and Heidegger and Gadamer's phenomenology and hermeneutics are used as theoretical points of reference for the present discourse. The theoretical points of view are examined and discussed through excerpts from twice-a-week psychotherapy with a six-year old girl.     

Introducing the sick face

Research on disgust in neuroscience, medicine, and psychology often relies on a disgust facial expression from a standardized set. Two studies (N = 60 and N = 160) compared this standard disgust face to a new facial expression called the “sick face” posed by three different actors asked to look as if they were sick and about to vomit. Relative to the standard disgust face, the sick face was significantly more likely to be endorsed as disgust, less likely to be endorsed as another emotion, and rated as conveying disgust more intensely. Disgust may not have a facial signal, but various faces may serve as cues to disgust.     

Application of social identity theory in group therapy with stigmatized adults.

Social identity theory was applied in group therapy for adults with mild mental retardation. Social identity theory suggests that social group membership, also called collective identity, has an impact on self-esteem. Individuals will try to maintain self-esteem by viewing their social groups positively. This may not be possible for individuals who are members of a stigmatized group. However, it may be possible to enhance self-esteem by broadening one's awareness of collective identity. Furthermore, being able to positively view other individuals who are co-members of one's own stigmatized group can also have positive consequences for self-esteem. A clinical vignette demonstrates this process in group therapy. Results are discussed as being applicable to members of various stigmatized groups.     

Message size constraints on discourse planning in synchronous computer-mediated communication

Three groups of 20 dyads planned the MTV Music Video Awards Show over computers. The groups varied in whether they could send 4-line, 10-line, or 18-line messages, in part to examine whether increased planning efficiency in computer-mediated communication reflects communication strategies associated with constraints on message size. The results demonstrate that increased efficiency is not a function of such design features as the maximum message that may be sent. However, the subjects in the 4-line condition sent shorter messages to one another, were less likely to engage in a strategy of making multiple suggestions that required a single assent, and were more likely to differ in the relative proportion of their contributions to the discourse. The subjects in the 10-line condition had shorter maximum messages (and proportionately more disfluencies) than did those in the 18-line condition, despite the finding that the maximum messages of the latter would have also fit within 10 lines. Thus, the results also support a claim that size of the text window may result in different discourse management strategies and may influence an initial discourse-planning stage.     

Differentiation in preschooler's categories of emotion

Two studies (N = 68, ages 2;0-3;11; N = 80, ages 2;6-4;11) explore the idea that, rather than starting with a separate mental category for each discrete emotion, children start with two broad categories (positive and negative) and then differentiate within each until adult-like categories form. Children generated emotion labels for (a) facial expressions or (b) stories about an emotion's cause and consequence. Emotions included were happiness, anger, fear, sadness, and disgust. Both conditions yielded the predicted pattern of differentiation. These studies of younger children found the face more powerful in eliciting correct emotion labels than had prior research, which typically relied on older preschoolers.     

Body—object interaction ratings for 1,618 monosyllabic nouns

Body-object interaction (BOI) assesses the ease with which a human body can physically interact with a word’s referent. Recent research has shown that BOI influences visual word recognition processes in such a way that responses to high-BOI words (e.g., couch) are faster and less error prone than responses to low-BOI words (e.g., cliff ). Importantly, the high-BOI words and the low-BOI words that were used in those studies were matched on imageability. In the present study, we collected BOI ratings for a large set of words. BOI ratings, on a 1–7 scale, were obtained for 1,618 monosyllabic nouns. These ratings allowed us to test the generalizability of BOI effects to a large set of items, and they should be useful to researchers who are interested in manipulating or controlling for the effects of BOI. The body-object interaction ratings for this study may be downloaded from the Psychonomic Society’s Archive of Norms, Stimuli, and Data, www.psychonomic.org/archive.