Trainee psychotherapy effectiveness at a psychodynamic training clinic: a practice-based study

The degree to which clinical experience is a significant factor in predicting positive psychotherapeutic outcomes is an open question. Empirical studies comparing experienced and beginning practitioners on differences in client outcomes have yielded mixed results. While multiple sources have indicated that trainees are generally effective therapists, few of these studies have examined the effectiveness of graduate-level therapists in a psychodynamic training program. In this study, conducted in the United States, we use a practice-based research approach to examine the outcomes of clients working with trainees at a community mental health clinic in the northeast United States. The theoretical orientation identified by the clinic and training program is psychodynamic with an interpersonal and/or relational emphasis. Results indicated that clients working with trainees at this clinic demonstrated improvement across several indicators of symptoms and psychosocial functioning over the time they received treatment. Implications for training and service reimbursement are discussed.     

家庭认知环境与0~3岁婴幼儿发展的关系:有调节的中介效应

本研究以5914名0~3岁婴幼儿家长为问卷调查对象,考察了家庭认知环境、入托经历、努力控制对0~3岁婴幼儿发展的影响机制。研究发现：（1）婴幼儿努力控制在家庭认知环境与婴幼儿发展中具有中介效应,即家庭认知环境通过作用于努力控制而对婴幼儿发展产生影响;（2）婴幼儿是否入托在“家庭认知环境→努力控制→婴幼儿发展”这一中介路径的前半段中具有调节作用,当婴幼儿有入托经历时,家庭认知环境对婴幼儿努力控制的影响更大。     

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.     

‘All the Rest is Dance’: another look at Levinas

This paper begins by tracing the growing influence of Levinas’s thought in the humanities. Psychotherapy in particular has drawn on Levinas’s original contribution to ethics and is often inscribed within an existing dialogical frame of symmetry. The article discusses facets of Levinasian thought which have been neglected in psychotherapy, namely the notion of separation, in turn linked to the notions of asymmetry and of the traumatic subject, all at variance with dialogical therapy. A second, equally overlooked aspect of Levinas’s philosophy examined here concerns his politics. Some of the implications highlighted here are controversial: these relate to Levinas ‘naive Zionism’ and a prejudiced position in relation to Arab culture. Others are enlightening even if undeveloped: these relate to Levinas’s decolonial thinking of the 1970s. The paper reflects tangentially on the author’s clinical work, and calls for a more nuanced appreciation of Levinas’s philosophy which does not shy away from critique.     

Infantile defences in parent‐infant psychotherapy: The example of gaze avoidance

Findings from parent‐infant observational research have stimulated the development of intersubjective models of psychotherapeutic action. These models have brought out the infant as an interactive partner with the parent. Conversely, interest in describing the individual psyche of the baby has decreased, especially the unconscious levels of his/her experiences and representations. In parallel, clinicians and researchers have been less prone to apply classical psychoanalytic concepts when describing the internal world of the infant. The author argues that this is inconsistent with the fact that psychoanalytic theory, from its inception, was founded on speculations of the infant's mind. He investigates one such concept from classical theory; the defence. Specifically, he investigates if selective gaze avoidance in young babies may be described as a defence or even a defence mechanism. The investigation links with Selma Fraiberg's discussion of the phenomenon and also with Freud's conception of defence. The author also compares his views on the baby as a subject with those suggested by infant researchers, for example, Stern and Beebe. The discussion is illustrated by vignettes from a psychoanalytic therapy with a 3 month‐old girl and her mother.     

Integrating clients' moment‐to‐moment ratings into psychotherapy research: A novel approach

Counselling and psychotherapy researchers have considerably advanced the field's understanding of psychotherapy processes and how they relate to treatment outcomes. Despite these advances, little is known about the client's perspective of changes in psychotherapy processes that occur throughout a given session (i.e. micro‐processes). To address this gap, this article describes the novel application of methods that assess participants' moment‐to‐moment ratings to psychotherapy research. This method entails recording psychotherapy session content that clients and other potential raters (e.g. therapists, researchers) later review while simultaneously providing continuous ratings of psychotherapy processes (e.g. helpfulness, alliance). In addition, moment‐to‐moment ratings can facilitate significant events research by prompting researchers to elicit client feedback about the moments that are rated the most and least positively. However, few studies have used these methods in the context of psychotherapy research. Studies incorporating these methods may yield findings that advance psychotherapy research, training efforts and clinical practice. For example, studies may examine how the magnitude and timing of clients' moment‐to‐moment ratings of psychotherapy processes are associated with treatment outcomes, therapist ratings and physiological processes (e.g. heart rate variability). Trainee therapists and their supervisors may also use clients' moment‐to‐moment ratings to facilitate attunement to verbal and non‐verbal indicators of moments perceived more positively and negatively. Last, these methods can produce findings that are highly relevant to clinical practice, where therapists routinely navigate fluctuations in psychotherapy processes (e.g. alliance ruptures) that can be assessed using moment‐to‐moment ratings.     

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.     

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.