Intimacies: An Integrative Multicultural Framework for Couple Therapy

Implicitly or explicitly, our ideas about intimacy are the most fundamental notions giving direction to the process of couple therapy. Yet, as a field, we have spent little time conceptualizing intimacy and even less time considering the diversity of priorities and meanings couples bring to our offices. In Part One, Varieties of Intimacy, I describe a kaleidoscope of contexts—socio‐historical, cultural, gender, life cycle, and developmental—that inform our ideas and expectations for intimacy in couples’ relationships. I highlight different spheres in which intimacy may take place such as the emotional, sexual, intellectual, or familial. I propose a starting point in which the therapist, in a collaborative manner, helps the partners articulate their yearnings and priorities in order to negotiate a shared vision. In Part Two, Conceptualizing Intimacy, I suggest an experiential definition that gives room for each partner's subjective meanings, yet consider diverse relational processes that may need to be addressed for a resilient ebb and flow of intimate experiences. In Part Three , Sexual Intimacy, I outline conditions in which sex is more likely to be experienced as intimate rather than nonintimate. Finally, in Part Four, I describe Therapeutic Principles to guide the therapist in taking couples from reactivity to dialogue to negotiations of intimacy. The integrative framework proposed here discourages monolithic a priori notions of intimacy and highlights instead: nuanced meanings, relational processes to be considered differentially, present and past emotional blocks, and a flexible clinical approach to foster conditions for the creation and resilience of intimate experiences.     

Positive mental health,positive affect and suicide ideation

Background/ObjectivePositive mental health (PMH) has been shown to confer resilience against suicide ideation. However, the mechanisms underlying the positive effect of PMH on suicide ideation/behavior are largely unknown. The current study aimed to determine whether positive affect mediates the association between PMH and suicide ideation.MethodA total of 150 adult outpatients (65.3%; female; age: M(SD)=37.79(13.50), range:18–77) completed measures on PMH, positive and negative affect, as well as suicide ideation. Data were collected using self-report questionnaires. Linear hierarchical regression analysis was used to analyze the data. Positive affect was considered to mediate the association between positive mental health and suicide ideation.ResultsWhile positive affect fully mediated the significant negative association between PMH and suicide ideation, negative affect did not reveal to be a significant mediator of this relationship.ConclusionsThe protective influence of PMH against suicide ideation is due to heightened positive affect: If positive mental health translates into positive affect, then suicide ideation becomes less likely.     

THE STORIED ANALYST: DESIRE AND PERSUASION IN THE CLINICAL VIGNETTE

Beginning with the quintessentially psychoanalytic tales of Freud, the case history has held a privileged position in the history and practice of psychoanalysis. Psychoanalysts grow up with, grow into, and grow out of these narratives as clinical practitioners. Alongside the representational aspects of these case histories, there is a rhetorical or persuasive force that significantly influences us. The author contends that the theory of narrative and rhetoric can inform the how, the why, and the “so what?” of our relationship to these stories of psychoanalysis.     

The measurement of impairment due to eating disorder psychopathology

Eating disorders have a profound and highly specific impact on psychosocial functioning. The aim of this research was to develop a measure of such secondary impairment. A 16-item, self-report instrument was developed, the Clinical Impairment Assessment (CIA), which was designed to measure such impairment overall and in three specific domains (personal, cognitive, social). The psychometric properties of the instrument were evaluated using data collected in the context of a transdiagnostic treatment trial. The findings consistently supported the utility of the instrument with the CIA being shown to have high levels of internal consistency, construct and discriminant validity, test-retest reliability, and sensitivity to change. The CIA should be of value to clinicians when assessing patients with eating disorders and their response to treatment. It should also help inform epidemiological research.     

Professional education of psychologists using online problem‐based learning methods: Experience at Charles Sturt University

Abstract: Problem‐based learning (PBL) is a pedagogical approach to professional training that emphasises the development of clinical reasoning skills and self‐directed learning. In contrast to more traditional lecture‐based approaches that focus upon the linear acquisition of course content, PBL is undertaken in the context of actual case presentations. Although PBL has been adopted widely in the professional training of medical practitioners and nurses, it is only just beginning to be used in the professional education of psychologists. This paper examines the nature and benefits of PBL for education in clinical and forensic psychology by outlining its implementation and development at Charles Sturt University, located in a rural area of Australia. Although a full and independent evaluation of PBL for education in clinical or forensic psychology is yet to be undertaken, this paper argues that PBL can make a significant contribution to professional training in psychology.     

Measuring Treatment Outcome for Children with Serious Emotional Disturbances: Discriminant Validity and Clinical Significance of the Child and Adolescent Functioning Assessment Scale

We investigated the use of a popular measure, the Children and Adolescent Functional Assessment Scale (CAFAS), in treatment outcome research. The sample included 70 children who had been discharged from an elementary therapeutic classroom (Intensive Mental Health Program). Significant relationships were found between decreases in CAFAS scores and optimal educational placement, contributing to evidence of the scale’s discriminant validity. Clinically significant change in CAFAS scores was also investigated, with a 30 point change in score most accurately discriminating between placements after discharge. Further investigations of real world outcomes versus changes in score on this measure are warranted.     

Feedback in Couple and Family Therapy: A Randomized Clinical Trial

Routine Outcome Monitoring (ROM) is recommended as a psychotherapy procedure to serve as clinical feedback in order to improve client treatment outcomes. ROM can work as a warning signal to the therapist if the client shows signs of no change or deterioration. This study has investigated whether any difference in outcome could be detected between those clients in couple and family therapy who used the Systemic Therapy Inventory of Change (STIC) feedback system (ROM condition) versus those who were offered treatment without the use of STIC (“treatment as usual” or TAU condition). A sample of 328 adults seeking couple and family therapy in Norway was randomly assigned to ROM versus TAU conditions. Outcome measures were The Outcome Questionnaire–45 and The Revised Dyadic Adjustment Scale. The results demonstrated no significant differences in outcomes between the ROM and TAU. Possible explanations of this result related to design and implementation issues are discussed.     

Les compétences mobilisées par le psychologue dans la pratique de l’éducation thérapeutique : exemple d’une prise en charge d’un patient obèse

The Therapeutic Education is a tool allowing the patient to find its own strategies of change by confronting with the point of view of others, by approaching new knowledge and recapturing some skills. The change involves a multitude of psychological processes, which we rarely question. What place do we grant to these psychological processes? What is the role of the psychologist of the health in the ET. We shall approach these notions by discussing a clinical case of a patient obese having participated in a therapeutic patient education “for a long-lasting loss of weight” (Medical Unit of the Nutrition, CHU de Toulouse).     

The place of once-weekly treatment in the work of an analytically trained child psychotherapist

In this paper, I explore how we might link ideas about clinical facts to current issues in child psychotherapy research. I consider what our understanding of clinical facts might contribute to our research methods and how our research methods might better represent the clinical facts. The paper introduces a selection of psychoanalytic writers' formulations of the concept and describes some of the debates about the shortcomings of the traditional style of case reporting. The importance of keeping emotional experience central in our research is discussed. I describe a research method that I believe has the potential to capture and describe some of the complicated processes of change in psychotherapy. This is the concept of the ‘turning point’ session. Introducing the paradigm of complexity theory, I briefly explore how we might think about and understand the relationship between processes revealed through detailed analysis of a single session and change over a longer period of therapy.