Searching for the facts in the clinical setting with couples

This paper describes a research proposal to examine whether or not the underlying analytic concepts behind the couple psychoanalytic psychotherapy model used at the Tavistock Marital Studies Institute in London are sufficiently coherent, both conceptually and clinically, to be used as the basis for a system of audit which respects the unique data produced in analytic psychotherapy. This 'psychoanalytic' system of audit is one which is characterized particularly by the use of the therapists' subjectivity, rather than attempts to be objective and gather data through such things as random controlled trials or generic outcome questionnaires. The paper describes the approach to the subject and the mix of qualitative and quantitative methods used. As the Tavistock Marital Studies Institute has a history of contact with Jungian analysts from the Society of Analytical Psychology, Jungian concepts are included in the model. The research is part of a professional doctorate in couple psychoanalytic psychotherapy at the Tavistock Marital Studies Institute in conjunction with the University of East London, entitled 'Conceptualizing audit in Couple Psychoanalytic Psychotherapy'.     

“Procrustean Psychotherapy” or Differential Therapeutics: Teaching Treatment Selection to Trainees

Most clinical training programs and treatment facilities offer a relatively narrow range of treatment alternatives to their interns and therefore produce procrustean psychotherapists. One way to remedy this unfortunate situation is to emphasize the importance of differential therapeutics and treatment selection at the outset of their training program. A suggestion on how to accomplish this on a minor scale is described in this paper.     

Therapy at the Cultural Interface: Implications of African Cosmology for Traumatic Stress Intervention

The topic of intercultural or multicultural therapy continues to stimulate much debate in the field of psychotherapy. Intercultural counseling training emphasizes respect for cultural beliefs as a core dimension of appropriate intervention. This paper addresses the limitations of this perspective in guiding therapists when faced with a clinical situation in which the non-challenging of cultural belief systems seems counter-therapeutic. The discussion is focused around critical observations of circumstances in which conventional African wisdom, as understood by clients presenting for trauma counseling, appeared to be counterproductive for their recovery in terms of western intervention principles. In psychotherapy for traumatic stress and traumatic bereavement, such tensions appear to arise particularly strongly because of the inevitable search for meaning in the face of extraordinary life events. Focusing on meaning making, cognitive intervention, schema realignment and reframing within trauma therapy, the paper explores ethical considerations and areas of potential conflict with reference to theory and clinical case material. Some strategies for therapeutic engagement are proposed.     

A Developmental Approach to the Supervision of Therapists in Training

Supervision is considered essential to therapeutic effectiveness yet trainees frequently report negative supervisory experiences. Although such experiences may be due to inadequate or poor supervision, more often they result from differing needs or expectations among trainees. Thus, supervisors must struggle to determine how to best conduct supervision. We propose that many negative experiences result from a supervisors inattention to the trainees development as a mature individual. By examining the cognitive and emotional development of trainees supervisors are offered a framework from which to select interventions and strategies that encourage rather than discourage trainees.     

Treating the “Mischances of Character,” Simply and Effectively

Cluster B personality disorders, particularly borderline personality disorder (BPD) and narcissistic personality disorder (NPD), are simultaneously among the most disruptive and impairing and among the least well studied, especially regarding treatment. In this paper we present an approach to treating these disorders that emphasizes motivation for treatment, self-control, and a highly structured way to reduce personality disorder symptomatology. Initial testing of the approach on nine patients with BPD and six patients with NPD indicates promise. Case reports are used to illustrate the approach.     

Rules Versus Principles in Psychotherapy: Implications of the Quest for Universal Guidelines in the Movement for Empirically Supported Treatments

In this article we briefly review the mission and criteria of the EST movement and several of its criticisms. We question an often-unacknowledged feature of the EST initiative—its foundation in a rule-governed approach to the regulation of psychotherapy—and argue that this approach encounters significant problems that are better resolved through an alternative, principle-based approach. The contrast between these perspectives is illustrated by presenting results of a qualitative research project identifying the implicit principles actually used by expert therapists across psychotherapy orientations to regulate values and interventions within their practice.     

Rebirth fantasy and the psychoanalytic process

In this paper, Jungian and Freudian perspectives on the fantasy of rebirth are explored and a brief review of the literature on the theme is used to show how that the rebirth fantasy seems to be a universal fantasy in the human mind, connected with the experience of both destruction and creation. In the psychoanalytic process the rebirth fantasy is connected with initial hopes for a better life, but is also a vehicle for creating the analytic pair and for separating from the 'totalitarian object'. An account of clinical work with a patient is given to illustrate the mutual and parallel process of rebirth in both the patient and the therapist. For the patient, the therapy was experienced as an awakening or a birth. The therapist was initially doubtful about the patient's capacity to engage in the analytic process but his involvement and interest were 'born' during the early sessions, enabling the patient to rely on him to lead her out of the claustrophobic power of the totalitarian object.     

Phases of Group Development: A View from Self Psychology

This paper delineates four phases of group development from the standpoint of self psychological theory. The author contends that a stable sense of groupself develops over time and that the groupself has a distinct number of phases, each of which has a therapeutic impact on members. The individual patient's selfobject experiences include a relationship to the group-as-a-whole, a transference state of which the leader is but one part. Thus, rather than dilute the transference, group analysis offers a unique opportunity to help the individual experience him or herself within a selfobject matrix that extends beyond the dyad. Group analysis leads to a strengthening of the self, especially as it enables the self to experience itself as part of a group identity, which provides alter-ego selfobject experiences, as well as a sense of acceptance within a larger community. This paper attempts to clarify how different selfobject experiences may be highlighted within the groupself at different stages of group development.     

Bridging Technical Eclecticism and Theoretical Integration: Assimilative Integration

Assimilative integration is a new type of psychotherapy integration introduced by Messer in 1992. This paper explains the where, what, when, and how of this integrative route, outlines its advantages and weaknesses, and discusses areas for potential assimilative practice in various models of therapy. Following a brief review of the current status of psychotherapy integration and its practices, assimilative integration is conceptualized as a mini theoretical integration and as theoretical eclecticism it is offered as a bridge between theoretical integration and technical eclecticism. Assimilative integration is proposed as the best theoretically and empirically based integrative approach available at this time, particularly for therapists who have been trained in a single mode of therapy before they became integrationists.     

Indirect Communication as an Insight-Oriented Technique with the Resistant and Intellectually Limited

A proactive cognitive–behavioral approach that presents interpretative options indirectly to children is introduced as a method to promote insight in psychotherapy. The treatment of a resistant, intellectually limited Hasidic 10-year-old child, with secondary personality disorder features, is described. By talking to himself and musing out loud, the therapist resorted to vocalized guesswork when frequent impasses occurred during sessions. As different options were verbalized in interpreting the child's affect, his reactions were monitored by the therapist and elaborated upon. In an approach akin to shaping in the conditioning literature, dynamics of behavior and acting out were uncovered, allowing social adjustment and promoting adaptive behavioral development. The intervention is conceptualized within the framework of cognitive behaviorism, and informed by insight-oriented dynamics as adapted for the resistant and intellectually limited.