Family Process 1962-1969

This is a personal recollection of the first 8 years of Family Process, the volumes published under the first Editor, Jay Haley, and strongly influenced by the Mental Research Institute at Palo Alto, of which Haley was a member. The later influence of the group's "double bind" hypothesis of schizophrenia is explored. Some ideas about the influence of theory on practice are suggested. Several examples of experiments in the social setting of family work are picked out of these volumes because of their influence on later programs. Finally, the essay offers a retrospective appreciation of the influence of Gregory Bateson on the mood of "revolution" forecast in the opening years of Family Process.     

Couple Therapy Research and the Practice of Couple Therapy: Can We Talk?

As has been true in every other realm of psychotherapy, couple therapy research generally has had very little impact on the day-to-day practice of couple therapists. To a significant degree, this unfortunate disconnection may be attributable to an overemphasis by researchers in the field on treatment packages and therapeutic methods/techniques. Insufficient attention has been paid to other important sources of influence on treatment outcomes, especially the couple therapist herself/himself. It is argued that effective couple therapy requires a good "fit" between the person of the therapist and her primary theoretical orientation, and that couple therapists may be more influenced by research that addresses process aspects of the therapeutic approaches to which they have their primary theoretical allegiances.     

A pragmatic approach to measuring adherence in treatment delivery in psychotherapy

ABSTRACT

Measuring therapists’ adherence to treatment manuals is recommended for evaluating treatment integrity, yet ways to do this are poorly defined, time consuming, and costly. The aims of the study were to develop a Therapy Component Checklist (TCC) to measure adherence to manualised CBT; to test its application in research and clinical practice; to determine its validity; and consider its cost benefits. We conducted a randomised trial in 230 people with cancer evaluating effectiveness of CBT for depression. In this, therapists delivered manualised treatment. Experts agreed on key components of therapy and therapists were asked to record these after therapy sessions by ticking a TCC. Inter-rater reliability was tested using an independent rater. Therapists delivered 543 CBT sessions. TCCs were completed in 293, of which 39 were assessed by the independent rater. Self-reported TCC data suggested close adherence to the manual. Prevalence-adjusted and bias-adjusted kappa scores suggested substantial agreement, (>0.60) in 38 out of 46 items. Self-rating of adherence saved around £96 per rating. In conclusion the TCC provides a quick and cost effective way of evaluating the components of therapy delivered. This approach could be applied to other psychological treatments and may help with linking therapeutic interventions with outcome.     

单克隆抗体的治病与“致病”

对单克隆抗体在病毒性疾病治疗和引起病毒感染增强两方面的作用进行了综述，分析了各自涉及的机理。指出于者是矛盾的统一体，辨证地看待是前提，深入研究是关键，合理和才是目标。     

Using targeted visceroception to improve interoceptive sensibility and emotion regulation

Focusing on one's body can improve the awareness and regulation of emotion. Interoception – sensing the physiological condition of the body, particularly of the viscera – appears to play an important role. While the majority of previous research studies have examined interoceptive sensitivity (i.e., detection of objectively measurable physiological changes), there has been relatively limited investigation of interoceptive sensibility (i.e., subjective awareness of those changes), and even fewer studies permitting causal conclusions. The current study is part of a randomised controlled trial on visceroception in the context of emotion regulation, using an 8-week intervention involving focused attention on either cardiac or gastrointestinal activity. Group differences in emotion regulation and reactivity were assessed using the Multidimensional Assessment of Interoceptive Awareness (MAIA), the Difficulties in Emotion Regulation Scale, and the Emotion Reactivity Scale (ERS). The findings suggest that focussed attention on gastrointestinal activity (i.e., gastroception), in particular, improves interoceptive sensibility and emotion regulation, as evidenced by increases on the MAIA's Noticing, Body Listening, and Self-regulation subscales, and decreases on the Arousal subscale of the ERS. Gastroception may make distinct contributions to the benefits of body focus in a research context where the gut is often overlooked.     

ON AGGRESSION TURNED AGAINST THE SELF

Deliberate self‐harm is a common presenting problem suffered by young people. Several patients referred to the NHS outpatient clinic where I work have been able to stop harming themselves during intensive psychoanalytic psychotherapy. In this paper, I shall discuss a variety of motives for persistent cutting by one adolescent girl. I am most interested to show how the healthier part of her personality overcame her motives for harming herself, and eventually allowed her to make use of my understanding of a sadomasochistic internal object that worked against us.