Automatic processing of pain: the change of implicit pain associations after psychotherapy

This study explores the utility of a pain IAT for the assessment of dysfunctional cognitive beliefs in chronic pain patients before and after a cognitive behaviour therapy. A patient group suffering from chronic pain (N=25) treated with a 4-week cognitive behavioural psychotherapy is compared with an untreated healthy control group (N=27) at two points in time. In addition, both groups completed a self-esteem questionnaire (Rosenberg-scale) and a self-esteem IAT. In the clinical group a questionnaire assessing self-reported pain cognitions was administered. The pain IAT was able to differentiate between chronic pain patients and healthy controls before the treatment. Most important, pain-related implicit associations could be shown to change over the course of treatment in the clinical group of chronic pain patients. Results provide first evidence for an application of the IAT in chronic pain research.     

The multi-level approach: a road map for couples therapy

This paper presents a multi-level framework and road map to guide the therapeutic process. Starting with the couple's reactive pattern, the multi-level approach first orients the therapist on how to create a "holding environment." It then suggests how the therapist, in collaboration with the couple, can proceed to explore interactional, sociocultural/ organizational, intrapsychic, and intergenerational processes that might be fueling the couple's dynamics. Central to this approach is the construct of the vulnerability cycle, a nexus of integration that helps the therapist stay anchored while moving through the many layers of therapeutic work. The overall goal is to help the partners move from reactivity to responsibility for their own feelings and behavior; from impasse to a greater ability to reflect, express feelings, listen, negotiate, and make choices about how to be in the relationship. This paper describes a range of concepts and interventions from basic to complex; it is intended as an organizational tool for practice and clinical training.     

An Integrative Approach to Somatoform Disorders Combining Interpersonal and Cognitive-behavioral Theory and Techniques

Data regarding the treatment of somatoform disorders suggest that the gains associated with current psychopharmacologic or psychotherapeutic treatments are modest at best. There have been a few moderately effective treatments for selected functional somatic syndromes, but patients who present with multi-system symptoms meeting criteria for the DSM-IV somatoform disorders are notoriously unresponsive to treatment. Experts in the field have advocated several approaches, including interpersonally oriented and cognitive-behavioral therapies, and have emphasized the importance of the provision of reassurance within the doctor-patient relationship. While each individual approach has merit, none is likely to be maximally efficacious as a stand-alone treatment. In this article we describe the theoretical underpinnings and technical aspects of a treatment for somatizing patients that integrates these three elements.     

Investigating the effects of tic suppression on premonitory urge ratings in children and adolescents with Tourette's syndrome

Tics represent a complex class of behaviors that have a neurobiological origin and are influenced by factors both internal and external to the individual. One factor that has gained recent attention is the premonitory urge. Contemporary behavioral models suggest that some tics are preceded by aversive somatic urges that increase in severity when tics are suppressed and are attenuated by performance of the tic. It has been proposed that the removal of premonitory urges may strengthen or maintain tics via negative reinforcement. This investigation is the first to empirically evaluate the effect of tic suppression on the premonitory urge phenomenon. Five children and adolescents, ages 8–17 years, participated in the study. Using an ABAB reversal design, tic frequency and subjective premonitory urge ratings were recorded under conditions of free-to-tic baseline (BL) and reinforced tic suppression (differential reinforcement of zero-rate behavior). Results show that four of the five children demonstrated reliable suppression. Of the four children who achieved suppression, three demonstrated a pattern in which subjective urge ratings were higher during suppression than during BL. Results provide preliminary support for the negative reinforcement view of tic function for some children.     

Enhancing resilience: families and communities as agents for change

In this article, the Linking Human Systems (LINC) Community Resilience model, a theoretical framework for initiating and sustaining change in communities that have undergone rapid and untimely transition or loss, is presented. The model assumes that individuals, families, and communities are inherently competent and resilient, and that with appropriate support and encouragement, they can access individual and collective strengths that will allow them to transcend their loss. This competence can be nurtured by helping people regain a sense of connectedness with one another; with those who came before them; with their daily patterns, rituals, and stories that impart spiritual meaning; and with tangible resources within their community. Rather than imposing artificial support infrastructures, LINC interventions engage respected community members to act as natural agents for change. These "community links" provide a bridge between outside professionals, families, and communities, particularly in circumstances in which outside intervention may not be welcomed. The article illustrates how LINC interventions successfully have been used in communities around the world.     

The role of a mentoring group for family therapy trainees and therapists of color

This article discusses the development, process, and impact of a mentoring group for family therapists of color. A within-group process for trainees of color in a predominantly White institution can provide a valuable resource for support, validation, empowerment, and collective action. The article examines how such mentoring promotes the effectiveness of therapists of color, as well as the practices and goals of social justice and diversity within training institutions and the field in general. Reflections and recommendations for implementing such a group are offered, as well as a personal narrative of a group member's experience of finding her voice in the group.     

Interfaces: toward a new generation of systemic models in family research and practice

After reviewing Engel's bio-psycho-social proposal and Kandel's "principles for an integration between mind and brain," the author introduces a set of akin propositions that aim at integrating neurosciences, genetics, the mind, and the social world into a succinct set of systemic formulations focusing on interlevel interfaces, with profound implications for the training, practice, and research in the field of family processes and therapy.     

生殖系基因治疗技术的伦理论争及其核心问题

目前关于生殖系基因治疗技术的伦理争论仍然十分激烈。这些争论的核心环节在于"父母生育一个健康血缘后代的需要"如何获得道德合理性论证,而目前很多研究在某种程度上忽视了这一问题,因而既不能解释这些伦理争论产生的原因,也不能为解决这一问题提供有效的指导。     

Family Focused Treatment for Patients with Bipolar Disorder in Turkey: A Case Series

Family-focused therapy (FFT) is a 9-month, 21-session structured psychoeducational treatment for bipolar disorder. Several US-based studies have documented its efficacy as adjunctive to medication for depression stabilization and relapse prevention. However, FFT has never been applied outside of the United States. The objective of this case series is to explore the applicability of FFT in a non-Western culture. Ten patients with bipolar disorder and their family members attended the 9-month FFT as adjunctive to pharmacotherapy in an outpatient specialty clinic in Izmir, Turkey. Patients improved in Global Assessment of Functioning Scores and Clinical Global Impression Scores from pre- to posttreatment. Case studies are given, which illustrate the differences between Western and non-Western families coping with bipolar disorder. FFT was easily applied to a Turkish sample with few changes in format or focus. Adaptations included substitution of oral for written therapeutic tasks or homework assignments. Randomized controlled trials are needed to test the clinical effectiveness of FFT and other psychosocial interventions in non-Western cultures.     

Relational Drawings in Couple Therapy

In couple therapy sessions, partners often get into long and drawn-out discussions, heavy with pain, resentment, and blame. It is vital for the therapist to avoid becoming entangled in these escalating interactions. In this article, as one way of avoiding these interactions, a protocol is proposed of using relational drawings in couple therapy for opening space for new stories. This approach is strongly rooted in extensive therapeutic experience, as well as in dialogical ideas. Not the content of the partners' imagery is central, but rather the dialogical exchange about the drawings. In particular, the focus of the therapist is on the partners' interactions, their hesitations and their surprises. Working in this way opens space for the partners to reflect on what they experience as crucial in their bond. The protocol is illustrated with two detailed case examples.