The concept of placebo

This paper attempts to define the concept of placebo as it is used in the clinical context The author claims that X is a placebo if and only if X has such a property d_p, that whenever in a therapeutic situation T a stimulus S appears, then in attending conditions A, it will cause a beneficial reaction R in the patient. Formally, the same structure may be used to define any pharmacologically active drug. The main difference between the drug and a placebo is in the range of possible substitutions for X and the property d. For the active drug there is only one possible substitution for X and property d and it can be scientifically explained why, and how the drug works. In the case of a placebo a set of possible substitutions for X and d is open, and so far it is impossible to offer any scientifically valid explanation of the action mechanism of placebo.     

Therapeutic Use of Humor in Antisocial Personalities

Therapeutic use of humor in patients with antisocial personality disorders is scarcely studied until now. However, therapeutic use of humor could contribute to a growth of social-emotional and moral awareness and capacities, enhancement of self-insight and reality testing, and associated therapeutic progress in these patients. Suggestions are made for a) adequate and safe use of humor in the therapeutic context, and b) effective selection of patients. More research is needed into the effects and adequate strategies of therapeutic humor in different categories of antisocial patients. Furthermore, it is also necessary to investigate how humor could be integrated well in various psychotherapeutic approaches     

From I: A/M to “Who am I?”—Aggregation/Massification and Trauma-Based Affects and Object Relations in Groups: A Response to Earl Hopper

Hopper's portrayal of the fourth basic assumption of Incohesion: Aggregation/Massification has two components: (1) a revision of Turquet's theory of BA Oneness to incorporate the polarity of aggregation and massification stemming from annihilation anxiety; and (2) a conception of the difficult patient as having an encapsulated psychosis. Hopper's theory of the encapsulated psychosis offers an important but incomplete perspective in explaining borderline and narcissistic pathology, as well as psychological trauma. In this response to Hopper, I suggest that the fourth assumption is in fact a still more primitive state of boundary opening and closing. I also see a need to differentiate trauma as such from borderline pathology, and further hold that the relationship between Hopper's British Independent theory and trauma theories based on dissociation needs to be clarified.     

Self Psychology, Dreams and Group Psychotherapy: Working in the Playspace

This paper presents one leadership style within a self-psychological approach to working with dreams in group psychotherapy. It stresses an empathic attunement, the creation of safety, and an experience-near playful relationship. Playful is not used lightly here. It is used in the spirit of Winnicott's intermediate space where a mother suspends questions of what is real or not real and what is me and not me. Freud's analogy to a playspace forms a metaphor for the creation of a special atmosphere in a group, or for that matter in individual work as well, that encourages exploration, risk taking, and vulnerability. Working with dreams in this playspace deepens the curative process, not only for the dreamer, but for the entire group.     

The Deep Structure of Group Life: Unconscious Dimensions

There is a reconsideration and renaissance of interest in expanded conceptions of unconscious processes as they affect individuals and groups (Grotstein, 1999). Recent focus on social unconscious (Hopper, 1996) and cultural unconscious processes (Henderson, 1988) and the nature of intersubjectivity (Harwood and Pines, 1998) raise questions about the location of group analysis. This paper considers the deep structure of group life by examining four functions of the unconscious: repressive, conservative, creative, and mythopoetic (Ellenberger, 1970). On an individual level of analysis, these functions are equated respectively with formative ideas about the: personal–subjective, social–political, intersubjective–cultural and collective–objective unconscious. Group level analogs, as they develop and affect groups and their members, are explored as synthetic, shared, symbolicy and synchronous unconscious processes.     

Psychotherapy Process Measure Research and the Evaluation of Psychotherapy Orientation: A Narrative Analysis

This article discusses the need for a systematic method that enables researchers to evaluate integrative therapy approaches using a range of therapy process measures. The Narrative System Process Coding (NPCS; Angus, Hardtke, & Levitt, 1996) is proposed as such a method, and is applied with the Experiencing Scale (Klein, Mathieu, Gendlin, & Keisler, 1970) and the Levels of Client Perceptual Processing (LCPP; Toukmanian, 1986) to three brief good outcome integrative therapy modalities to illustrate this need. The study found higher Experiencing Scale scores to be most strongly related to an experiential approach to therapy and to the NPCS internal narrative processes. Higher LCPP scores were most strongly related to the NPCS reflexive narrative process and to a perceptual-processing approach. The discussion initiates a discourse on the importance of explicating process measures' origins when comparing different therapy approaches in order to allow for the meaningful consolidation of process research findings.     

Ferenczi's Rise and Fall from “Analytic Grace”: The Ferenczi Renaissance Revisited

In the last 20 years a Ferenczi Renaissance has been slowly building. There has been a rediscovery of the significance of Sándor Ferenczi, who can be considered the clinical genius of psychoanalysis. The politics of psychoanalysis led to the suppression of Ferenczi's ideas, removing his influence from psychoanalysis for about 50 years. Ferenczi's ideas and methods significantly deviated from his mentor, Sigmund Freud; he offered an alternative theory, The Confusion of Tongues and a new method, Relaxation Therapy. Ferenczi's pioneering contributions to analytic therapy include: the introduction of empathy into the analytic relationship; the curative function of the relationship in the analytic encounter; the role of activity in analytic therapy; the importance of non-interpretative behavior by the analyst; the function of the experiential and emotional dimensions in analytic therapy; analyst self-disclosure; and mutual analysis.     

Resistance as a Problem for Practice and Theory

Resistance is one of the most problematic and potentially counterproductive concepts in the entire field of psychotherapy. It is at the same time one of the most crucial, pointing toward perhaps the single most important factor—or, more accurately, set of factors—in determining the success or failure of the therapeutic enterprise. Drawing on the articles by Davis and Hollon, Prochaska and Prochaska, Reid, and Eagle in this issue, as well as on the author's own perspective, this paper explores this seeming contradiction in order to point toward an integrative resolution of the differing perspectives on resistance and related phenomena.     

Some Thoughts on the Integration of Narrative and Humanistic/Existential Approaches to Psychotherapy

Although humanistic and narrative approaches to psychotherapy make some different assumptions about the nature of the human condition and emphasize different aspects of human functioning in their therapeutic endeavors, I argue here that the underlying assumptions of these two approaches reflect a common view of humanness, thus making these two approaches candidates for attempts at integration. Four areas of commonality are discussed in detail: (a) life as a process of continual development, (b) the nature of experience and the process of meaning creation, (c) the nature of psychological dysfunction, and (d) the nature and importance of human relationships. The implications of these commonalities for the practice of therapy from an integrated perspective are explored in an extended case example.     

Corporal Punishment by American Parents: National Data on Prevalence, Chronicity, Severity, and Duration, in Relation to Child and Family Characteristics

We present data on corporal punishment (CP) by a nationally representative sample of 991 American parents interviewed in 1995. Six types of CP were examined: slaps on the hand or leg, spanking on the buttocks, pinching, shaking, hitting on the buttocks with a belt or paddle, and slapping in the face. The overall prevalence rate (the percentage of parents using any of these types of CP during the previous year) was 35% for infants and reached a peak of 94% at ages 3 and 4. Despite rapid decline after age 5, just over half of American parents hit children at age 12, a third at age 14, and 13% at age 17. Analysis of chronicity found that parents who hit teenage children did so an average of about six times during the year. Severity, as measured by hitting the child with a belt or paddle, was greatest for children age 5–12 (28% of such children). CP was more prevalent among African American and low socioeconomic status parents, in the South, for boys, and by mothers. The pervasiveness of CP reported in this article, and the harmful side effects of CP shown by recent longitudinal research, indicates a need for psychology and sociology textbooks to reverse the current tendency to almost ignore CP and instead treat it as a major aspect of the socialization experience of American children; and for developmental psychologists to be cognizant of the likelihood that parents are using CP far more often than even advocates of CP recommend, and to inform parents about the risks involved.