Panic disorder and depression: A psychodynamic exploration of comorbidity

Eight of twenty-one patients presenting for treatment in an open trial of brief psychodynamic psychotherapy for panic disorder also carried the diagnosis of major depression. For the patients who completed the study, depression remitted as well as panic disorder. The authors highlight psychodynamic factors that they hypothesize may contribute to the significant overlap between panic disorder and depression, and describe three videotaped cases to illustrate these points.     

The use of observation in the psychoanalytic treatment of a 12-year-old boy with Asperger's syndrome

The author describes some aspects of a once-weekly psychoanalytic psychotherapy of a 12-year-old boy diagnosed with Asperger's syndrome. The patient's emotional and cognitive development had been impaired since early life, possibly due to an internal deficit and to the likelihood of inadequate environmental holding. He was unaware of having difficulties but was underachieving academically, was socially isolated and often visibly unhappy in his life. The patient's denial, splitting, and projection of emotion and insight presented the therapist with the difficult task of how to reach him. In order to communicate with him emotionally, the therapist created a modified technique which reflected the patient's development from part-object to whole-object relationships. This development became apparent in the sessions and was interpreted in the transference relationship. An account of the patient's early years was pieced together from a detailed commentary of what was being observed and intuited by the therapist during the sessions, as well as by an understanding of the countertransference. By the end of two years' treatment, the patient's sensitivity and creativity, which had been buried beneath a self-sufficient, autistic-like encapsulation, finally began to emerge in his communications with his therapist.     

Attack on the Self: Charismatic Leadership and Authoritarian Group Supervision

Charismatic group leadership carries the potential for indoctrination and abuse when countertransference issues remain unexamined. This paper is a personal account of participation by the author in an authoritarian and confrontational supervisory experience with self-serving charismatic leadership. Group casualties are portrayed and discussed. This report applies self-psychological principles to understand the powerful merger of the compliant self and idealized object. Further, the dynamics of group identification with the aggressor are described through the Ferenczian lens of confusion of tongues.     

Spiritual Psychotherapy for Antisocial and Psychopathic Personalities: Some Theoretical Building Blocks

Until now a profound theoretical model for spiritual psychotherapy, which is constructed specifically for nonreligious antisocial and psychopathic patients who have spiritual and philosophical interests, is missing. In this paper some important theoretical issues with respect to spiritual psychotherapy for antisocial and psychopathic patients will be discussed such as the links between spirituality on one hand and authenticity, vanity; emotional, moral, and social capacity; reality testing; creativity; and faith in life on the other. Furthermore, the spiritual psychotherapist's attitude towards his or her patients will be explored.     

Group Therapy with Individuals and Families Coping with Illness or Disability in Israel

This paper illustrates a group intervention with individuals and family caregivers coping with illness/disability, and focuses on the relationship between the process of group development and the process of coping with the illness/disability. People experiencing illness/disability cope with a great deal of pressure and stress that stem from the illness's biopsychosocial demands. A group can provide encouragement and support and reduce helplessness, isolation, and despair through cooperation and use of mutual resources. The design of the intervention was based on our clinical experience with numerous groups for ill/disabled individuals or their family. The process is described and analyzed using examples from three documented groups, and is presented in terms of four variables: group process, group atmosphere, group content, and group intervention.     

Preinternship Preparation of Clinical and Counseling Students in Psychological Testing, Psychotherapy, and Supervision: Their Readiness for Medical School and Nonmedical School Internships

Internship directors have been critical of students' preinternship preparation in test-based assessment and psychotherapy but have not, until recently, expressed their quantitative expectations for this training. Using data from the Association of Psychology Postdoctoral and Internship Centers application form, this study investigated the quantitative statements of 96 counseling and 238 clinical students regarding their preinternship testing, psychotherapy, and supervision training, comparing findings to medical school and nonmedical school directors' quantitative expectations. Results generally demonstrated adequate psychotherapy training but suggested deficiencies in testing training, particularly as related to medical school directors' expectations. Counseling students received more training in individual therapy with adults but not in other forms of therapy. Clinical students produced more integrated test-based reports. Both groups received similar amounts of supervision.     

Narrative in psychotherapy theory,practice, and research: A critical review

This paper offers a critical review of narrative approaches to therapy, in terms of theory, practice and research. It proposes that narrative approaches currently lack a theory that explains adequately how the reworking of narratives brings about changes and how a client's various narratives are integrated. Research approaches to the study of narrative in therapy are at an early stage. A review of current research into narrative approaches to therapy is presented, and suggestions are offered for further research.     

Mobile phone mood charting for adolescents

Mobile phones may provide a useful and engaging platform for supporting therapeutic services working with adolescents. This paper examines the potential benefits of the mobile phone for self-charting moods in comparison to existing methods in current practice. The paper describes a mobile phone application designed by the authors which allows adolescents to record moods on their personal mobile phones. The authors propose that a personal mobile device is more suitable for adolescents than other devices. A pilot study with a non-clinical adolescent group in schools comparing a mobile and a paper diary is presented, along with discussion and analysis of the results. The main finding of the study was that compliance was significantly higher on mobile phones than paper, and the task was not found to be any more difficult to complete using mobile phones than with paper charts. A number of salient issues requiring further research are also identified.     

The Relationship Between Dropout and Outcome in Naturalistic Cognitive Behavior Therapy

Dropout from psychotherapy is frequent and limits the benefits patients can receive from treatment. The study of factors associated with dropout has the potential to yield strategies to reduce it. This study analyzed data from a large sample of adults (N = 1,092) receiving naturalistic cognitive behavioral therapy (CBT) to test the hypotheses that dropouts, as compared to completers, had (1) higher symptom severity at treatment termination, (2) a slower rate of symptom change during treatment, and (3) a higher odds that the therapist rated treatment as ending for reasons related to poor outcome. Results showed that although dropouts ended treatment with higher symptom severity than completers, dropouts and completers did not differ in their rate of symptom change during treatment, suggesting that dropouts had higher symptom severity at termination because they received fewer sessions of treatment, not because their symptoms changed at a slower rate. Dropout was also associated with a higher odds of having a therapist-rated termination reason indicating a poor outcome, suggesting that dropout is more likely if patients are dissatisfied with some aspect of the therapy outcome or process. These findings suggest that strategies for monitoring and enhancing patient satisfaction with the process and outcome of treatment may help patients stay in treatment longer and end treatment with fewer symptoms than if they had dropped out.