心理治疗关系之作用机制研究述评

综述心理治疗理论中有关治疗关系之治疗机制的理论观点。发现主要存在三种不同的观点。其中社会影响观点认为治疗关系的作用在增强治疗者在当事人心中的可信性,从而强化了治疗者的说服性信息对当事人态度改变的影响力;心理动力学观点主张移情性治疗关系使得当事人早期的依附情况及当事人的内部工作模型得以在治疗中显现,从而为分析治疗提供依据并指示方向;当事人中心观点则认为良好的治疗关系降低了当事人的防卫性,从而使得当事人的感受和体验可以无障碍地进入意识,进而促进了当事人的一致性。作者提出这个领域今后的研究应该考虑以“跨理论”的角度,加强理论模型的提炼和实际检验     

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).     

A fragmented sense of home: Reconfiguring therapeutic coastal encounters in Covid-19 times

A growing body of research suggests positive links between coastal proximity, interaction, human health and wellbeing. In 2020, following the onset of the Covid-19 pandemic, many people in the UK could not engage in their usual coastal practices due to a national lockdown and associated restrictions, including government bans in entering the sea. This paper shares findings from an exploratory study examining how these restrictions shaped the recreational coastal practices, perceptions and emotions of residents in the case study region of Devon, South West England. In-depth semi-structured interviews were conducted with a purposive sample of 12 residents, with varying domestic and employment circumstances in the pandemic. We foreground three key themes identified through an inductive thematic analysis of the interviews: feeling ‘at home’ with the sea, experiencing a fragmented sense of home with Covid-19, and reconfiguring the coast as a therapeutic landscape. While important to understand the links between coastal proximity, health and wellbeing, we highlight the value of gaining more nuanced insights into the emotional, social, material and temporal dynamics that can re-shape the therapeutic potential of coastal encounter in the largely unprecedented situation of a global pandemic.     

“‘Ninja’ levels of focus”: Therapeutic holding environments and the affective atmospheres of telepsychology during the COVID-19 pandemic

The COVID-19 crisis in Australia led to a rapid increase in the use of telehealth services to offer psychological therapy (often referred to as ‘telepsychology’). In this article, we discuss the intersection of the social psychology concepts of therapeutic holding spaces and containment with more-than-human theory as it relates to Australia's mental health sector during the COVID-19 crisis. Drawing on our recent qualitative survey research into Australian psychologists' use of telepsychology during the crisis, we consider the ways that they worked to build and maintain therapeutic holding spaces and alliances over teleconferencing platforms during this extraordinary time of social crisis and isolation. We explore and contextualise three important findings from our study: 1) the limited viewing area of a flat screen makes it difficult for therapists to read and respond to their client's body language and requires different forms of returned bodily gestures in order to show empathy; 2) most respondents implemented different affective and relational strategies online to ensure they were not missing important non-verbal cues from their clients; and 3) the traditionally ‘safe’ therapeutic holding space created in face-to-face therapy can be easily subverted by client-end interruptions, and concerns around safety or personal privacy in the client's home environment. In bringing these issues to the fore, we highlight the online therapeutic holding space as a temporally and socially situated human-technological assemblage in which a series of affective, spatial, relational and sense-making agencies coverage, opening or closing off capacities for therapists and their clients.     

The therapist with her back against the wall

This clinical paper describes once weekly psychotherapy with two boys with traumatic histories. The way in which the trauma enters the consulting room and the relationship with the therapist is explored. Technical issues are discussed, particularly the understanding of the countertransference and its modulation in communication with the patient. The therapist's intense personal anxiety about failure and about management of the difficulties that arise is linked to the impact of trauma.     

In the spaces between – sustaining creativity in child psychotherapy

This paper gives an account of the developments in the intensive psychotherapy of a seven-year-old boy with global development delay. It also describes the adaptations to technique and the changes in the setting that were required to support the work, which was undertaken in a special school. The importance of the regularity of sessions in helping to establish object constancy; physical and mental boundaries in relation to me/not me; inside and outside is also explored. A central theme of the paper is how close observation can inform the understanding of the emotional states of disabled children, particularly those with little language. The paper draws links between the early communications of mothers and infants and the therapeutic relationship, with reference to music therapy. It describes banging as a form of communication and traces the development of banging into more coherent nursery rhymes arguing that this development is an internalisation of the rhythm of the therapy and of the growing understanding between the child and therapist.     

'Joined-up psychotherapy': the place of individual psychotherapy in residential therapeutic provision for children

This paper looks at the provision of individual psychotherapy within a residential setting for young children. It gives a brief historical context of the work of therapeutic communities, and describes one such community in detail. The paper emphasizes the need for psychotherapy to be fully 8 integrated into the overall treatment of severely damaged children, and seeks to raise questions about the need to modify ideas on confidentiality and boundaries in such a setting. Case material is presented to illustrate this.     

The Narrative/Collaborative Process in Couples Therapy:

A narrative approach to couples therapy provides a glance at the emerging postmodern dialogue. This article discusses changes in the therapeutic relationship, content, and process, emphasizing a feminist perspective. The client/therapist relationship is viewed as a collaborative process by which hierarchical distinctions are decreased. Externalization, deconstruction, and re-authoring are described and demonstrated through a clinical vignette. Our own evolving story as couples therapists is also presented.     

On integrity

This paper argues that, rather than statutory registration, it is the personal integrity of the individual practitioner that will best safeguard the interest of the client and ultimately the image and reputation of the counselling/psychotherapy profession within society. An attempt is made to define integrity as an absolute moral component of the personality and to consider its significance to the therapeutic relationship. Trust, too, is considered as a vital factor in this relationship. As well as the integrity of the individual practitioner, the integrity of the psychotherapy profession as a whole is considered with particular regard to its considerable reliance on the production of theory for its sense of self worth, as opposed to its efficacy as a therapeutic enterprise.     

Quelques réflexions sur l’incidence des valeurs éthiques sur le choix technique des interventions psychothérapeutiques

If we consider the evolution in the patterns of psychopathology during the 20th century, we discover the evolution of ethical values implicit in the theory and their implications as far as our technical choices are concerned. The therapeutic relationship is asymmetrical, not only because of different role positions but also because of an inherent power differential. The therapist is consciously recognized as occupying a superior role because of his or her professional status and at the unconscious level, too, through transfer and projection of different fantasies. Being in charge of the therapeutic process carries with it the professional responsibility for handling this asymmetry. The therapist's theoretical and technical decisions in this regard reflect his or her ideology about power and how it should be used to establish the therapeutic alliance.