The self in the couple relationship: part 1

This paper discusses the importance of the ‘good-enough’ development of the core self in the couple relationship. It argues that difficulties in the development of the self lie behind a significant number of troubled couple relationships. Part 1 focuses on individual psychotherapy and how changes to the core self are often attended by shifts in the marital relationship. It traces how this occurs through clinical material and analyses what kinds of changes to the self are needed for the couple relationship to function well. Psychodynamic theory is used to understand the core changes over time and how these are related to significant second-order change in the couple relationship. The construct of the ‘transitional space’ is used to theorize the couple relationship. Implications for the practice of individual psychotherapy are discussed. In Part 2, the significance of change in the experience of the self of one or both partners for a successful outcome of couples therapy is discussed, along with the place of work with individual partner(s) in the course of conjoint couples therapy.     

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.     

Training in and implementation of Acceptance and Commitment Therapy for depression in the Veterans Health Administration: Therapist and patient outcomes

ObjectiveThe U.S. Department of Veterans Affairs has implemented a national dissemination and training initiative to promote the availability of Acceptance and Commitment Therapy for depression (ACT-D). This paper reports on therapist and patient outcomes associated with competency-based training in and implementation of ACT-D.MethodTherapist and patient outcomes were assessed on eleven cohorts of therapists (n = 391) and their patients (n = 745).ResultsThree-hundred thirty four therapists successfully completed all requirements of the Training Program. Ninety-six percent of therapists achieved competency by the end of training, compared to 21% at the outset of training. Mixed effects model analysis indicated therapists' overall ACT-D competency scores increased from 76 to 112 (conditional SD = 6.6), p < 0.001. Moreover, training was associated with significantly increased therapist self-efficacy and positive attitudes toward ACT-D. Therapeutic alliance increased significantly over the course of therapy. Mixed effects model analysis revealed that mean BDI-II scores decreased from 30 at baseline assessment to 19 (conditional SD = 5.6) at final assessment, t(367) = ?20.3, p < 0.001. Quality of life scores also increased.ConclusionsTraining in and implementation of ACT-D in the treatment of Veterans is associated with significant increases in therapist competency and robust improvements in patient outcomes.