The challenge of understanding process in clinical behavior analysis: the case of functional analytic psychotherapy

Whether explicitly acknowledged or not, behavior-analytic principles are at the heart of most, if not all, empirically supported therapies. However, the change process in psychotherapy is only now being rigorously studied. Functional analytic psychotherapy (FAP; Kohlenberg & Tsai, 1991; Tsai et al., 2009) explicitly identifies behavioral-change principles used to bring about therapeutic improvements in adult outpatients whose clinical problems stem from ineffective interpersonal repertoires. These principles include contingent responding to behavioral excesses and deficits by a therapist who has established him- or herself as a salient source of social reinforcement. Empirical support for FAP is emerging, but a variety of pragmatic and theoretical questions warrant investigation. Among the issues described in this paper are the training and dissemination of procedures for how to conduct a functional analysis, how to train therapists to identify functional stimulus classes, how to best address decreasing problem behavior without creating an aversive environment, how to enhance generalization, and how to account for the principle of equifinality when trying to specify therapeutic procedures. These and other issues stem largely from trying to disseminate a behavioral principle-based intervention rather than a topographically specified intervention. These issues present challenges and research opportunities for applied clinical behavior analysts if they wish to extend their science to address clinical issues important to the treatment of adult outpatients with normal intellectual functioning.     

How do psychological treatments work? Investigating mediators of change

Little is known about how psychological treatments work. Research on treatment-induced mediators of change may be of help in identifying potential causal mechanisms through which they operate. Outcome-focused randomised controlled trials provide an excellent opportunity for such work. However, certain conceptual and practical difficulties arise when studying psychological treatments, most especially deciding how best to conceptualise the treatment concerned and how to accommodate the fact that most psychological treatments are implemented flexibly. In this paper, these difficulties are discussed, and strategies and procedures for overcoming them are described.     

Models of Psychotherapy: Implications for Pastoral Care Practice

Pastoral care givers are called to provide care and counseling to parishioners that are suffering in many ways. A core question is what does a pastor rely on to provide this care? Pastors usually call on models of psychotherapy to inform their care giving. A framework of theological anthropology, cosmology, soteriology and harmatiology is developed for analyzing the worldviews inherent in models of psychotherapy. The specific models of Adler’s Individual Psychology, Narrative therapy, Horney’s personality theory, and Intersubjective theory are used to demonstrate the application of this framework. Several pastoral care implications are developed following the application of the framework.     

Archetypes as action patterns1

Abstract: The discovery of mirror neurons by researchers at the University of Parma promises to radically alter our understanding of fundamental cognitive and affective states. This paper explores the relationship of mirror neurons to Jung's theory of archetypes and proposes that archetypes may be viewed as elementary action patterns. The paper begins with a review of a proposed interpretation of the fainting spells of S. Freud in his relationship with Jung as an example of an action pattern that also defines an archetypal image. The challenge that mirror neurons present to traditional views in analytical psychology and psychoanalysis, however, is that they operate without recourse to a cognitive processing element. This is a position that is gaining increasing acceptance in other fields as well. The paper therefore reviews the most recent claims made by the Boston Process of Change Study Group as well as conclusions drawn from dynamic systems views of development and theoretical robotics to underline the conclusion that unconscious agency is not a requirement for coherent action. It concludes with the suggestion that this entire body of research may lead to the conclusion that the dynamic unconscious is an unnecessary hypothesis in psychoanalysis and analytical psychology.     

Clinician Perspectives of Diagnosis and Perceived Client Change in “Real World” Psychotherapy for Youth Emotional and Behavioral Disorders

We investigated the extent to which clinician-assigned diagnoses of emotional and behavioral disorders and clinicians’ perceptions of client change are consistent with structured measures of youth clinical functioning and parent/family characteristics within the context of usual care or “real world” psychotherapy. A total of 54 therapists from two publicly-funded youth outpatient mental health clinics and 128 youths and parents from the therapists’ combined caseloads were included in the study. Clinician-assigned diagnosis and youth and family demographics were collected at the initial visit, clinician-reported perceived client change was collected at 6-month follow-up, and structured measures of youth clinical functioning and parent/family characteristics were collected at both time points. Results indicate some overlap between clinician-assigned diagnosis, clinician-reported perceived client change, and structured measures of youth clinical functioning and parent/family characteristics after controlling for demographic factors. Results are discussed in terms of implications for the implementation of evidence-based practices in real world community settings.     

Single session and walk‐in psychotherapy: A descriptive account of the literature

Over the last several decades single session psychotherapy has become a mainstream psychotherapeutic approach. A steadily increasing demand for psychotherapeutic services and a continuous reduction in mental health care resources worldwide are both largely responsible for this development. This paper describes single session psychotherapy and provides a brief review of the relevant literature. Single session psychotherapy delivered in walk‐in settings is also discussed. Therapists who are unfamiliar with single session psychotherapy will find that this paper provides a concise introduction to the essential processes and outcomes of this psychotherapeutic approach.     

构建医学院校创新性实验教学体系的思考

医学是一门实践性和应用性很强的学科,实验教学是高等医学教育中的重要组成部分,它不仅是对理论教学的补充,更是培养学生动手能力、综合分析问题、解决问题能力的重要教学环节,是培养学生的科研思维和创新精神的重要手段,具有其他教学环节不可替代的作用.     

协作还是斗争——心理障碍治疗百年

长期以来,在心理障碍治疗领域存在着心理治疗师与精神科医生的相互斗争,从协作的角度对心理治疗百年史进行回顾,认为百年心理治疗史实际上是心理医生与临床医生相互斗争走向协作的历史。这一过程可大致区分为自发、附属、斗争到整合四大阶段。就长远来看,在心理障碍的治疗中,这两类专业人员的相互配合是不可避免的。     

心理咨询和治疗的知情同意原则及其影响因素

随着心理咨询和治疗的发展,患者的知情同意成为临床心理学实践的一个基本伦理观念和原则。首先提出心理咨询和治疗实践中的知情同意问题,介绍心理咨询和治疗知情同意的要素、过程、内容、意义和影响因素,并附心理咨询和治疗提供给患者的知情同意问卷,旨在引起从业者的注意和重视,并在临床实践中自觉地遵守。     

叙事心理治疗的特征及其与中国文化的契合

基于后现代文化理念的叙事心理治疗,其主要特征与中国文化的契合体现在:问题外化的治疗手段顺应中国人的面子心理和辩证的思维方式;关系取向的治疗立场更适合具有关系自我观的中国人;关注差异的治疗模式与中医的个体化治疗模式不谋而合;重视来访者的内在力量可充分发挥中国人善于自律和反思的特长。