The educational therapy contribution to a family systems approach

This article draws on the experience of one specialist education unit to demonstrate the usefulness of engaging families directly in the treatment of children showing difficulty in managing tasks and relationships in school. It will look at the overlap of psychoanalytic and systemic ideas and show how theory and practice from both 'schools of thought' allow for a fuller understanding of blocks to school success and also support the family and child in their efforts to 'defeat' a difficulty. I look in particular at the way a psychodynamic focus on a child's inner world can work alongside the systemic focus on family structure, hierarchy and history.     

Emotionally Focused Couple Therapy

Abstract

Working with couples who are both survivors of emotional abuse and are currently in an emotionally abusive relationship can be particularly challenging for the clinician. This article focuses on Emotionally Focused Couple Therapy as a recommended practice approach for clients who are caught in emotionally abusive patterns with one another. The article reviews relevant literature on this approach and illustrates the specific interventions applied lo an emotionally abusive couple.     

Water Mist Punishment for Two Classes of Problem Behaviour

A study with multiple baseline design across situations and response-classes was used to evaluate the effects of a water mist procedure used for punishment of two classes of problem behaviour in a 50-year-old woman with severe mental retardation. Problem behaviour was reduced to less than 5% of baseline. After 19 months the problem behaviour was still reduced, and had stabilized at a level below 10% of baseline. Due to financial economies the local community authorities terminated the treatment, which resulted in a marked increase in the rate of problem behaviour.     

Experiences of Patients in Cognitive Behavioural Group Therapy: A Qualitative Study of Eating Disorders

The aim of this study was to investigate whether there was a difference in skin conductance response between 2 groups of military personnel when exposed to emotionally neutral and charged stimuli. The 2 groups were a combat experience group (n?=?10) with prior experience of emotionally charged war situations and a comparison group (n?=?10) with no such experience. Results showed that the comparison group reacted more strongly to exposure to both charged and neutral pictures than did the combat experience group, regardless of exposure time. The results are discussed in terms of emotional numbing and differences in anxiety state between the 2 groups.     

Clinicians' Perspectives on Negative Effects of Psychological Treatments

Negative effects of psychological treatments is a fairly unexplored area of clinical research. Previous investigations have indicated that a portion of all patients experience negative effects in terms of deterioration and various adverse events. Meanwhile, evidence suggests that many clinicians are untrained in identifying negative effects and unaware of the current research findings. The objective of the current study is thus to investigate clinicians' own perspectives and experiences of possible negative effects of psychological treatments. An invitation to participate in an anonymous online survey consisting of 14 open-ended questions was distributed via three mailing lists used by clinicians that primarily identify themselves as cognitive behavior therapists. The responses were analyzed using a qualitative method based on thematic analysis. In total, 74 participants completed the survey. A majority agreed that negative effects of psychological treatments exist and pose a problem, and many reported having experienced both deterioration and adverse events among patients in their own practice. The thematic analysis resulted in three core themes: characteristics of negative effects, causal factors, as well as methods and criteria for evaluating negative effects. The clinicians recognize that negative effects exist, but many are unaware of the current research findings and are unfamiliar with methods and criteria for identifying and preventing deterioration and adverse events. The results provide evidence for further dissemination of the present knowledge regarding negative effects, particularly during basic clinical training, as well as the need for raising awareness of the available methods for identifying and preventing negative effects.     

An outline explanation of how therapy heals

Therapists are unable to provide a comprehensive account of therapy as an intelligible activity. This is at least partly due to the unresolved problem of explaining how phenomenology is even possible. An alternative to providing a comprehensive account of therapy is to take the fact of phenomenology for granted and provide just an outline account of how therapy heals. One way this can be achieved is to set therapy in the context of medical anthropology which will facilitate a view of therapy as just another healing ritual. Insight into how healing rituals heal is provided in this paper by a long and in-depth look at the so-called ‘paradox’ of the placebo effect. This will reveal the so-called ‘placebo effect’ as a misunderstood, modern example of healing ritual self-healing. In fact, the single term ‘placebo effect’ will be abandoned and replaced by the two concepts of ‘SMCH’ (‘specifically modified consultation and health care’) and ‘RMH’ (‘response to modified health care’). These two concepts provide an outline explanation of how all healing rituals heal and so provide an outline explanation of how the healing ritual of therapy heals, also. At least one problem arises out of explaining therapy as healing ritual self-healing, namely that this conception conflicts with the idea in therapy circles that, in therapy, it is the relationship that counts. Nonetheless, it will be maintained that the purpose of therapy is healing, that the healing that is achieved is self-healing and that its fulfilment is not dependent upon one-to-one relationships. Finally, it will be argued that the further development of therapy requires a better understanding of what aids and obstructs psycho-emotional self-healing.     

Acceptance and values-based action in chronic pain: a three-year follow-up analysis of treatment effectiveness and process

Recent developments in CBT emphasize the promotion of psychological flexibility to improve daily functioning for people with a wide range of health conditions. In particular, one of these approaches, Acceptance and Commitment Therapy (ACT), has been studied for treatment of chronic pain. While trials have provided good support for treatment effectiveness through follow-ups of as long as seven months, the longer-term impact is not known. The present study of 108 participants with chronic pain examined outcomes three years after treatment completion and included analyses of two key treatment processes, acceptance of pain and values-based action. Overall, results indicated significant improvements in emotional and physical functioning relative to the start of treatment, as well as good maintenance of treatment gains relative to an earlier follow-up assessment. Effect size statistics were generally medium or large. At the three-year follow-up, 64.8% of patients had reliably improved in at least one key domain. Improvements in acceptance of pain and values-based action were associated with improvements in outcome measures. A “treatment responder” analysis, using variables collected at pre-treatment and shorter term follow-up, failed to identify any salient predictors of response. This study adds to the growing literature supporting the effectiveness of ACT for chronic pain and yields evidence for both statistical and clinical significance of improvements over a three-year period.     

Processes of change in psychological flexibility in an interdisciplinary group-based treatment for chronic pain based on Acceptance and Commitment Therapy

There are now numerous studies of Acceptance and Commitment Therapy (ACT) for chronic pain. These studies provide growing support for the efficacy and effectiveness of ACT in this context as well as for the role of ACT-specific therapeutic processes, particularly those underlying psychological flexibility. The purpose of the present study was to continue to build on this work with a broader focus on these processes, including acceptance of pain, general psychological acceptance, mindfulness, and values-based action. Participants included 168 patients who completed an ACT-based treatment for chronic pain and a three-month follow-up. Following treatment and at follow-up, participants reported significantly reduced levels of depression, pain-related anxiety, physical and psychosocial disability, medical visits, and pain intensity in comparison to the start of treatment. They also showed significant increases in each of the processes of psychological flexibility. Most uncontrolled effect sizes were medium or large at the follow-up. In correlation analyses changes in the four processes measures generally were significantly related to changes in the measures of depression, anxiety, and disability. In regression analyses the combined processes were related to changes in outcomes above and beyond change in pain intensity. Although in some ways preliminary, these results specifically support the unique role of general psychological acceptance in relation to improvements achieved by treatment participants. The current study clarifies potential processes of change in treatment for chronic pain, particularly those aiming to enhance psychological flexibility.