Free Will and Therapeutic Change

Much of psychology has minimized, or disregarded, the notion of free will. However, it remains a critical construct in most theories of behavioral and religious change. This paper briefly examines the free will/determinism debate and the construct of free will from the perspective of postmodern/narrative psychology, as well as integrating recent developments in the field of cognitive neuroscience. Finally, the implications of this analysis on personal responsibility in pastoral psychology are discussed.     

Where Has All the Psyche Gone? Searching for Treatments That Focus on Psychological Issues

The field of psychotherapy can be aided by adopting an integrative model that follows a comprehensive biopsychosocial perspective. Unfortunately, recent advances in the field of psychopharmacology have appeared to overshadow the gains that can be made through psychotherapy. Psychotherapists need to protect the psyche that lies at the core of their treatment. Psychotherapy can promote changes in cognitive processes that help to reduce psychiatric symptoms and enhance adaptive functioning. Psychotherapists should not neglect the role of biological or social factors in the etiology or treatment of mental illness. Many clients benefit from a comprehensive biopsychosocial model and interdisciplinary collaboration among mental health professionals. Psychotherapists can maintain a strong emphasis on psychological functioning, while colleagues from other fields focus on the biological and social aspects of mental illness. Furthermore, it seems important for psychotherapists to emphasize the unique qualities of psychotherapy that are distinct from the social support that is provided from a close and confiding friendship.     

“A Forgotten History” and Related Risks for Speech Genre Users in Trauma Mental Health: A Commentary

This paper utilizes the concept of the speech genre as defined by the Russian literary scholarly Mikhail Bakhtin to examine several discourses related to trauma psychotherapy. It explores the theme of A Forgotten History in trauma mental health and then relates it to current problematic patterns in trauma mental health work with international survivors of human rights violations. It considers the theme of A Forgotten History which has been an important narrative in shaping the trauma mental health movement. It argues that it may put genre users at risk of undesirable practices, and cites as examples current trends in torture treatment and trauma training being used with international survivors of human rights violations. Several recommendations for how the trauma mental health field can better conduct itself as a speech genre are proposed.     

Generosity: a psychological and interpersonal motivational factor of therapeutic relevance

This paper examines the role of generosity in analysis. Generosity represents a complex constellation of cognitions and affects that is antithetical to those states of super-ego harshness that characterize many forms of human psychopathology. In development, generosity is evoked by idealization, and a dynamic axis of idealization-generosity promotes relational proximity between the child and its caretakers, and eventually fosters separation and individuation. Generosity is highly sensitive to adverse conditions, and requires environmental conditions that are conducive to psychosomatic well-being. The imaginal basis of generosity is rooted in the myth of the 'hero and the return', which is the mythic foundation of the analyst's role as psychopomp. It is argued that the generosity of the analyst is a cardinal therapeutic factor in treatment.     

Trauma, Regression, and the Intensive Group Experience

Ferenczi contributed a theory of trauma and regression that has application in the contemporary practice of group therapy. This article seeks to present an extension of these seminal ideas in the form of interventions based on therapist induced regression. The Intensive Group Experience (I.G.E.), a time extended group format found to be necessary for extensive emotional reliving and working through of trauma is described. A clinical case example is then discussed in detail and concludes this report.     

My Perspective on Psychotherapy Integration: An Outsider Who's Out of It

My rejoinder is a response to two commentaries on my SEPI keynote in 1997: commentaries written by Goldfried and Cullari. Instead of grappling with the ideas I presented, both respondents were distracted by my satirical beginning. In my talk I proposed a method for studying psychotherapy integration. I am not pessimistic about the potential for integration, nor am I pessimistic about psychotherapy. But I am a skeptic, and science is driven—and indeed advance—by skepticism. In fact, psychotherapy integration requires that its advocates be skeptics. I still do not know what psychotherapy integration is, and remain confused. I can only conclude that I am not only an outsider, but out of it.     

Shame, Women, and Group Psychotherapy

This paper addresses gender-related experiences of shame, focusing on the shame-prone woman. Specifically the varied manifest behaviors, dynamics, and defenses commonly observed in shame-prone women are described. It is recommended that the addition of group therapy to individual treatment, once the client is ready, can expedite progress for these patients, as they are more able to integrate previously disowned and shamed aspects of themselves. A number of potential problems when working with these patients in group are identified and explored.     

Ethnicity, Culture, and Group Psychotherapy

Ethnicity and culture have great therapeutic import in the practice of group psychotherapy, especially given the increasing diversity of the population of North America, and this issue has not received appropriate recognition in the literature. In this paper these terms are defined, and the literature is reviewed. Ethnicity, culture, and psychopathology are discussed, focusing on treatment issues including transference, countertransference, resistance, group cohesion, group process, and multi-ethnic groups. The group therapist must be knowledgeable about ethnic and cultural issues in the lives of the group members in order to promote group cohesion and therapeutic effectiveness. The recognition and exploration of ethnic/cultural differences enhances the work of the group. Recommendations for treatment are discussed.     

The Analysis of Intervention Change in Children and Families: Methodological and Conceptual Issues Embedded in Intervention Studies

This article provides an overview of methodological and conceptual issues underlying the assessment of change during psychotherapy with children and families. Three central considerations are discussed: (1) What changes do we measure? (2) When do we measure change? (3) How do we measure change? The difficulties with the traditional methods of assessing change are highlighted, and suggestions for a new paradigm that calls for expansion of the nomological network relevant to the analysis of change, as well as the inclusion of more assessment points and more reliable and valid measures of the change process, are presented. Illustrations of key points are provided from the Adolescent Transitions Program, a theoretically based intervention program targeting high-risk youth.     

An Integrative Brief Treatment Approach for Obsessive-Compulsive Disorder

This article reports on the integrated application of cognitive therapy, transactional analysis techniques, and the behavioral technique of response prevention using self-instructional training and behavioral substitution in a brief therapy approach. These methods were applied in the case of a young man who presented with compulsions to perform repetitive and ordering rituals with the belief that it would prevent his girlfriend from becoming pregnant. A 21-year-old white male who had performed 3 to 5 hours of rituals daily for several years was able to eliminate the majority of his compulsive behaviors and reduce his level of anxiety after eight clinical therapy sessions. Results were maintained at 6-month follow-up. The clear precipitating factors and the unusual maintaining variables for the disorder in the client are described. The author discusses the case in light of current theoretical, therapeutic, and biomedical understandings of the disorder.