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.     

Psychotherapy Integration: Contributions from Lifestyle Theory

The lifestyle theory of intervention is evaluated with respect to its status as an integrated psychotherapy using theoretical integration, technical eclecticism, and the common factors approach as criteria. Because lifestyle theory integrates concepts from evolutionary biology, existential philosophy, cognitive psychology, social learning theory, and various therapeutic models it satisfies preliminary criteria for theoretical integration. To the extent that it provides an internally consistent model and makes use of techniques from disparate schools of psychotherapy, it adopts a technical eclectic approach to intervention. The lifestyle model also appears to qualify as an integrated psychotherapy by virtue of its attention to several common factors in psychotherapy.     

A Comparison of Computer-Assisted Psychotherapy and Cognitive-Behavioral Therapy in Groups

This study is the first independent, randomized controlled study in a clinical setting of a computer-assisted therapy program (Therapeutic Learning Program; TLP) developed to permit individualized therapy in a group setting. This software differs from other computer-assisted approaches in that targets for change are chosen by the patient rather than determined by the software. TLP was compared to a standard cognitive-behavioral treatment in 109 patients with 6-month follow-up. Although both treatments were associated with a significant reduction in symptoms of anxiety and depression at posttreatment and follow-up, no differences were found between treatments with respect to patient-rated satisfaction and effectiveness, clinician ratings of improvement, and scores on measures of anxiety and depression. At treatment midpoint patients tended to give more neutral ratings of satisfaction and treatment effectiveness of the TLP treatment, perhaps suspending judgment about this more novel treatment until its completion. It is concluded that at least one form of computer-assisted psychotherapy is as effective and acceptable to patients in a clinical setting as standard short-term cognitive-behavioral therapy conducted by experienced clinicians.     

Ethical Considerations in Psychotherapeutic Systems

Theoretical Medicine and Bioethics - In the process of individual psychotherapy, the client and the therapist work together towards clarifying the client's problems, unlocking vicious circles,...     

“Operationalism” in psychotherapy: A possible means of putting a sorry state of theory in better order?

It will be shown in this paper that the study of the actual conduct of psychotherapy, at least in its classical form with a patient speaking his or her mind in any way the patient desires and a therapist helping the patient pursue those thoughts and wishes and conflicts and hopes for better luck in real life than before, is more conducive to agreement among rather different therapists, to clearer reasoning over psychotherapeutic interventions, and to more promising theoretical articulations than anything available in the theoretical texts of psychotherapy.