Analytic Group Psychotherapy: A Uniquely Effective Crisis Intervention

This paper describes the author's experience doing crisis intervention with survivors of the 9/11 attack on the World Trade Center in New York City. It focuses on enhancing the understanding of and potentially expanding the theory and technique of analytic group therapy as applied to this unique situation.Private practice in     

Practicing Rational Emotive Behavior Therapy and Religious Clients

REBT is a process of: (1) identifying dysfunctional emotions and behaviors which inhibit more effective pursuit of what clients experience as their deepest and most abiding desires; (2) relating these dysfunctions to irrational beliefs; (3) inducing clients to reduce the controlling role played by these beliefs in their lives and (4) adopting more self-helping beliefs and practices related to their goals thus reducing their dysfunctional emotions and behaviors and increasing their joyful living. This article discusses how this can be done from within an individual's supernatural belief system, whether that system is theistic or nontheistic.     

Can men talk about problems with weight? The therapeutic implications of a discourse analytic study

This paper discusses the implications for counsellors of a discourse analytic study examining men's talk about body weight. It is argued that research in the area of problems with body has neglected the growing pressures on men to manage body as a feature of self. This research perpetuates the dominant discursive construction of men's relationship to body as unproblematic — a construction that may present many barriers to men in seeking help for any distress encountered. An analysis of men's talk is discussed in terms of the expectation that body is not problematic and the observable downplaying of any concerns acknowledged. The accountability of body as a site of regulation also emerges within the extracts presented. It is argued that this property within the accounts resonates with work highlighting the growing pressures on men to exercise control over body. The contradictions between the two discourses identified are discussed in terms of their therapeutic implications. It is postulated that male distress emerging from the growing pressures to maintain body weight may be neglected within primary care and therapeutic domains if discourses formulating such difficulties as not relevant to men remain dominant.     

Personality Disorder Attributes as Supplemental Goals for Change in Interpersonal Psychotherapy

Interpersonal Psychotherapy (IPT) is a manualized, short-term (usually 12–16 sessions) based on the assumption that psychological disorders often emerge secondary to social and interpersonal problems that require active intervention to achieve symptom remission. The time-limited nature of IPT compels therapists to establish the goal of diminishing, on a weekly basis, a small number of focused interpersonal problems with a decided emphasis on proximal rather than historic conflicts and associated patterns of behavior. This strategy discourages the adoption of diffuse therapy goals and directions that have more opportunity to emerge in long-term, unstructured treatment modalities. The role of traditional personality testing in short-term therapy, when it occurs, is to identify and quantify symptom clusters that warrant attention as dependent measures in the treatment process. The role of personality factors in the genesis or maintenance of psychological disturbance is rarely addressed. The present article explores theoretical and pragmatic objections to the use of personality testing in IPT. A method is proposed for the limited but systematic incorporation of personality testing in the IPT treatment process using the Millon Clinical Multiaxial Inventory (MCMI-III). While unreasonable to expect personality transformation through short-term therapy, the partial attenuation of maladaptive behavioral, attitudinal, and emotional reactions to stressors could prove exceedingly helpful to short-term treatments such as IPT.     

Ethical Considerations for Therapists Working With Demographically Similar Clients

The increasing emphasis on multicultural competence within psychotherapy continues to highlight the need for being sensitive to key differences between therapist and client. However, this attunement to the psychotherapeutic impact of therapist–client differences may obscure the equally critical need to evaluate ethical problems associated with therapist–client similarities. It will be argued that therapists treating clients who are demographically similar to themselves encounter a unique set of ethical challenges that warrant careful consideration and caution precisely because of therapist–client matching. The extant research on matching therapists and clients based on demographic similarities is discussed, with a particular emphasis on psychotherapeutic outcomes and client preferences. Attention then turns to the nonrational heuristics and biases that can often cloud therapists’ ethical decision making regarding the appropriate uses versus contraindications for demographically matching therapists and clients. Within the discussion of nonrational heuristics and biases, suggestions are offered for managing related challenges for ethical decision making.     

Clients’ experiences of dynamic interpersonal therapy (DIT): opportunities and challenges for brief,manualised psychodynamic therapy in the NHS

Dynamic interpersonal therapy (DIT) is a brief manualised psychodynamic intervention for depression. This is a first study exploring clients’ experiences of DIT specifically and brief, manualised psychodynamic psychotherapy (PP) in general. Interpretative phenomenological analysis was the methodology employed. Five participants completed a semi-structured interview, three weeks to ten months after completing DIT. The scores of pre- and post-therapy outcome measures of depression and anxiety were also available. Two emerging superordinate themes are presented here: (1) ‘The Distinct Features of DIT’, referring to how its therapeutic style and time limitations were experienced and (2) the ‘Impact of Therapy’, referring to perceived outcomes. While previous findings showed that therapist’s perceived limited activity in long-term PP was experienced as hindering/unhelpful, the perceived sense of direction in DIT appeared adequate to most participants. Secondly, the time limitations provoked complex responses. Reactions to the distinct elements of DIT are to be treated both as therapeutic opportunities and as challenges. Further, in line with psychoanalytic theory, most participants described relational changes that went beyond symptom relief and remained in progress after therapy ended. Intriguingly, there was no consistency between participants’ qualitative accounts of change and the scores of the outcome measures.     

Dynamic interpersonal therapy in an NHS tertiary level specialist psychotherapy service

We describe the introduction of dynamic interpersonal psychotherapy (DIT) into an National Health Service (NHS) tertiary psychoanalytic specialist psychotherapy service. Training in DIT began as our contribution to Improving Access to Psychological Therapies and primary care services, supporting the training and supervision of their DIT practitioners. We then discovered DIT could be a valuable treatment within our own tertiary NHS service for patients with complex presentations. Currently fighting for survival, like many NHS psychoanalytic psychotherapy services nationally, we have adopted a manual-guided, psychoanalytically based therapy to broaden our tertiary clinical psychoanalytic service and accommodate trends in mental health service provision, whilst protecting the quality and integrity of our psychotherapy. DIT helped us continue providing relevant and beneficial psychoanalytic and psychodynamic services to individual patients despite limitations of the financially challenged NHS, NICE guidelines and Payment by Results. We outline the progress and outcomes for patients with complex mental health presentations, include individual case discussion and our experience of using the DIT approach within a traditionally longer term psychoanalytic psychotherapy service.