Dynamic interpersonal therapy in an NHS tertiary level specialist psychotherapy service

We describe the introduction of dynamic interpersonal psychotherapy (DIT) into an National Health Service (NHS) tertiary psychoanalytic specialist psychotherapy service. Training in DIT began as our contribution to Improving Access to Psychological Therapies and primary care services, supporting the training and supervision of their DIT practitioners. We then discovered DIT could be a valuable treatment within our own tertiary NHS service for patients with complex presentations. Currently fighting for survival, like many NHS psychoanalytic psychotherapy services nationally, we have adopted a manual-guided, psychoanalytically based therapy to broaden our tertiary clinical psychoanalytic service and accommodate trends in mental health service provision, whilst protecting the quality and integrity of our psychotherapy. DIT helped us continue providing relevant and beneficial psychoanalytic and psychodynamic services to individual patients despite limitations of the financially challenged NHS, NICE guidelines and Payment by Results. We outline the progress and outcomes for patients with complex mental health presentations, include individual case discussion and our experience of using the DIT approach within a traditionally longer term psychoanalytic psychotherapy service.     

A fertile matrix: the birth of the Forensic Psychotherapy Society

This paper traces some aspects of the fertile matrix within which, over many years, the application of a psychoanalytic perspective to clinical work with the most severely mentally ill, difficult and at times frightening patients in secure and community settings has evolved and now led to the recent inauguration of the Forensic Psychotherapy Society (FPS), a new Member Institution of the British Psychoanalytic Council. The Society provides both a framework for a national, multidisciplinary professional training in psychodynamic forensic psychotherapy and the potential launching pad for an active post-qualification organisation supporting CPD and all other forms of professional development. The particular contributions to the birth of the FPS of the Forensic Psychotherapy Department at West London Mental Health NHS Trust, partly because we know it best but also because it is part of the largest forensic psychiatric service in the United Kingdom, are described.     

An Integrative Approach to Conceptualizing and Treating Complex Trauma

Complex trauma (CT) often presents with polymorphous symptoms (i.e., emotional dysregulation, dissociation, somatic distress) resulting from repeated and chronic exposure to traumatic stressors. While the public is increasingly aware of posttraumatic stress disorder (PTSD) and its accompanying symptoms, the phenomena of complex trauma is less recognized and understood. Since the trauma reactions with CT typically occur during childhood, and the symptoms go well beyond PTSD, the authors of this article assert that an integrative approach is needed that synthesizes the most effective elements of cognitive-behavioral therapy (CBT) while blending a self-psychological approach. A review of the literature addresses the definition of complex trauma, cognitive-behavioral conceptualizations and treatment approaches, self-psychological models, current theories of attachment, and advances in neuropsychoanalysis. An integrative model is then proposed, supported by clinicians in the trauma field, identifying three intertwined phases of treatment.     

管理者大五人格与心理契约违背对辱虐管理的影响:基于特质激发理论的实证分析

基于特质激发理论探讨管理者人格特质和心理契约违背对实施辱虐管理的影响,并进一步分析了管理者人格特质与心理契约违背之间的交互作用对辱虐管理的影响。以213份两轮时点的配对问卷为样本,通过多元线性回归方法进行实证检验,结果表明:(1)管理者的亲和力对辱虐管理有显著的负向作用,而神经质则对辱虐管理有显著的正向作用;(2)管理者心理契约违背对辱虐管理有显著的正向影响;(3)心理契约违背不但调节了管理者亲和力与辱虐管理之间的负向联系,还调节了神经质与辱虐管理之间的正向联系。     

Clinical Exchange: The Architectural Failure

The Clinical Exchange invites eminent clinicians of diverse persuasions to share, in ordinary language, their clinical formulations and treatment plans of the same psychotherapy patient—one not selected or nominated by those therapists—and then to discuss points of convergence and contention in their recommendations. This Exchange concerns a Mr. L, a 47-year-old, married man presenting for outpatient individual psychotherapy with chief complaints of depression, anxiety, and a lengthy history of vocational underachievement. Drs. Herbert Fensterheim, Leslie Greenberg, and Leigh McCullough, who anchor their practices in the cognitive-behavioral, experiential, and psychodynamic orientations, respectively, are the featured commentators. Finally, Dr. Jerold Gold, the case contributor and Mr. L's psychotherapist, provides a few closing comments.     

A Leader-Led Supervision Group as a Model for Practicing Genetic Counselors

With the stage set by the overview of supervision models in the previous paper, thispaper now presents the development and evolution of a currently ongoing leader-ledsupervision group for experienced genetic counselors. I discuss the procedures forgetting started; the creation and maintenance of the contract; typical issues and themesconsidered; the format for case presentation; and the overall growth of the group and itsmembers.     

Microcosm–Macrocosm

Much has been learned in the 20th century about the impact of covert group dynamics on the individual, the family and small group on the micro level and about institutions, communities, national and international process on a macro level. However, as we enter the new millennium this knowledge seems dwarfed by the burgeoning of knowledge about the brain and biological approaches to disturbed human behavior, casting a worrisome shadow on the future of dynamic group therapies. This article explores the impact of socio-economic-political forces on mental health delivery systems from the vantage point of group process and therapy, and raises questions about possible interventions to restore a balance between social dynamics and biology.     

The Future of Training and Credentialing in Group Psychotherapy

High-quality group psychotherapy training is seen as more important than ever in the current health care environment. The training opportunities available at present are assessed. It is argued that there is a body of knowledge about generic group psychotherapy that can and should be taught, and that there are appropriate people to teach it. Credentialing is discussed, and it is suggested that the assessment of actual work in clinical situations must be emphasized if such efforts are to be meaningful.     

Will the Mother-Group Have a Face? The Future of the Facilitating Environment

The author predicts that maintaining the responsible practice of group psychotherapy in the coming years will require attention to three areas of professional life. The training of group therapists must include group-as-a-whole, in addition to intrapsychic and interpersonal, theoretical constructs. A supportive network of professional colleagues must be available to provide consultation and continuing education. Finally, a culture that values the necessary components of group psychotherapy practice must be encouraged and supported.     

Spiritual Psychology and Psychotherapy: Is There Theoretical and Empirical Support?

This paper provides a meta-theoretical context for a spiritually oriented psychotherapy, namely Constructivism. It also presents some empirical and theoretical support for this Constructivist position which is consistent with cognitive psychology and concepts from both Western and Eastern traditions. It summarizes the work of Mahoney on Constructivism and integrates it with Personal Construct Psychology. It then provides the perceptual, theoretical, and empirical underpinnings for an integrative, holistically oriented clinical model that focuses on how clients construct their realities. The paper concludes with a discussion of the levels of therapeutic work that clients contract for, placing them in charge of their lives. The goal, for clients who chose the deepest path, is the philosophical understanding that they create the relative realities to which they respond, causing both their suffering and potential liberation. The ultimate choice is theirs, and not the therapist's.