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.     

How talking therapists experience working with adult clients who have autism

This research aims to gain new insight by exploring the thoughts, feelings and experiences of therapists working with clients who have autism. Three professional talking therapists participated in the study. Unstructured interviews were conducted and analysed using interpretive phenomenological analysis. Six main themes and 13 sub-themes were found which include therapists’ validation of autism, how therapists integrated autism when addressing mental health problems, how their personal experiences of autism impacted on their work and how they experienced the situation in which autism emerges during the therapy. Helpful suggestions are made for clinicians, namely, to zoom-in and zoom-out of autism, hold the knowledge that people with autism process information differently, incorporate working with trauma, consider disclosing a personal connection to autism and consider carefully whether, or not, to tell a client that they may have autism.     

A journey through languages: A systematic literature review on the multilingual experience in counselling and psychotherapy with children and adolescents

The purpose of this research was to address the gap in the existing literature on the multilingual aspect of language in psychotherapy with children and adolescents. This research aimed at interpreting possible meanings for clients of being multilingual in the therapeutic process as well as reflect on the influence of clients’ multilingualism in the therapeutic relationship. The researcher used a systematic literature review (PRISMA guidelines, 2009) to select articles based on empirical qualitative/mixed studies with participants up to 25 years old or adults referring to childhood/adolescence. The researcher used thematic synthesis (Thomas & Harden, 2008) to extract, analyse and interpret data. The rigour of this study was enhanced by the use of auto-ethnography as a source of evidence (McLeod, 2015). The auto-etnography documents self-reflections on personal experience of being multilingual contributing to deeper contextualised knowledge. The findings confirm previous research on the existence of a link between multilingualism and “identity” (Costa, 2020, p. 5). This research suggests that the meaning a client gives to bilingualism can be co-constructed within an attuned therapeutic relationship. In this co-construction journey, there is a significant opportunity for children and young people in finding their way through languages, hence reaching emancipation and affirmation in the world. The main limitation of this research relates to the fact that there are not many studies with children/young people. This led the researcher to also include studies based on a mixed sample and with adults referring to childhood/adolescence, which might have influenced the interpretation of findings.     

The use of augmentative alternative communication in psychotherapy

The use of augmentative alternative communication (AAC) in psychotherapy is particularly important for psychotherapists who may have a disability related to speech-language production. The aim of our study was to examine the perceptions of using AAC in psychotherapy. We recruited 186 participants and randomly assigned them to either watch a video of a therapist using AAC or employing traditional talk psychotherapy. Subsequently, we asked participants to complete the Counsellor Rating Form-Short (CRF-S), respond to a question about behavioural intention to seek psychotherapy and complete the Working Alliance Inventory-Observer form (WAI-O). Most participants perceived the use of AAC to be related to the therapist having a disability. The use of AAC had higher ratings on the CRF-S and higher scores on the WAI-O. There were no significant differences in behavioural intention between the therapist using AAC or traditional talk psychotherapy. The use of AAC is a viable option for psychotherapy and is beneficial. Psychotherapists with a disability affecting speech-language production may opt to use AAC as others perceive the therapist positively, the alliance is rated higher and therapists do not need to be concerned with patients not wanting to seek out their services.