La psychothérapie assistée par la MDMA dans la prise en charge du syndrome de stress post-traumatique

Posttraumatic stress disorder (PTSD) is estimated to remain chronic and severe for 25–50% of patients despite psychotherapeutic treatment. Part of the reasons is that patients with PTSD can have difficulties in establishing a good therapeutical alliance with the therapist. Moreover, they often fail to re-think the content of the trauma without being overwhelmed by negative emotions and tend to rely on avoidance strategies and/or to abandon the therapy. MDMA (“ecstasy”) is a drug classified as an entactogen (en “within”, tactus “touch”, and gen “produce”), an amphetamine with psychedelic properties that possesses psychopharmacological properties to overcome these issues. Indeed, MDMA triggers the release of oxytocin, which favors the establishment of interpersonal relationship based on kindness and trust. Moreover, MDMA diminishes the activity of the amygdale, allowing patients to work on challenging memories with less fear and anxiety. Finally, MDMA may also provide access to meaningful spiritual experiences, release of tensions and a sense of healing on a non-verbal level that are not completely understood. But are viewed as important by patients. Today, there is no evidence that the use of MDMA in a clinical setting has bad neurologic, psychological or cognitive consequences. Results of phase II trials in the United States and Europe confirm that MDMA favors psychotherapy's outcome without severe adverse effects. Phase III trials are underway. The Multidisciplinary Association for Psychedelic Studies (MAPS) has published online a method proposal and trains therapists in MDMA-assisted psychotherapy.ConclusionFood and Drug Administration (FDA) and European Medicines Agency (EMA) could approve this therapeutic tool in the coming years.     

Research in counselling and psychotherapy Post‐COVID‐19

The COVID‐19 pandemic brings to light many areas the field of counselling and psychotherapy may need to address in future research. We outline several issues stemming from or exacerbated by the pandemic and offer suggestions for future research to address the mental health needs of those impacted. Our suggestions focus on five domains: (a) the health and well‐being of helping professionals, (b) the infodemic, (c) discrimination and minority stress, (d) spiritual and existential dynamics in mental health and (e) couple and family stress and resilience. We aim to provide a multi‐systemic perspective of mental health and well‐being in the time of COVID‐19, as well as encourage current and future studies to incorporate these suggestions to advance the health and well‐being of our communities through evidence‐based treatment approaches.     

Archetypal images emerging in the therapy of Lithuanian cancer patients

The goal of this paper is to show through clinical examples how archetypal images connected with nature emerged in Lithuanian cancer patients, to analyze how these images helped them to get in touch with their emotions and meaningful personal experiences, and to discuss how these archetypal images are related to the Lithuanian cultural unconscious, and may also assist the psychological treatment of cancer. The analyzed examples permit the preliminary conclusion that when ill with cancer, a person's psyche generates universal archetypal images that constitute an important part of the process of coping psychologically with the disease.     

A hermeneutic study of integrating psychotherapist competence in postnatal Child Health Care: Parents’ perspectives

A child's emotional and social development depends on the parents’ provision of optimal support. Many parents with perinatal distress experience difficulties in mastering parenthood and seek help from professionals within primary healthcare. A clinical project was launched in Stockholm, where psychodynamic psychotherapists provided short-term consultations at Child Health Centers. This study qualitatively explored parents’ experiences of perinatal distress and of receiving help by nurses and therapists in the project. Thirteen parents were interviewed, and their responses were analyzed with a hermeneutical method. Three main themes crystallized; accessibility of psychological help and detection of emotional problems; experiences of therapy at the Child Health Center; and the therapists’ technique. Parents were also clustered into three so-called ideal types: the insecure; parents in crisis; and parents with lifelong psychological problems. Parents experienced obstacles in accessing psychological care within primary healthcare. Psychotherapists with a holistic family perspective and who managed to oscillate between insight-promoting and supportive interventions were especially appreciated. Patient categories who benefitted from insight promotion and support, respectively, were identified.     

心理健康服务的文化胜任力：理论取向与实践策略

心理健康服务的文化胜任力随着欧美对多元文化群体的重视而逐渐发展起来。该领域存在两种不同的理论取向及相应的实践策略。内容取向关注静态的、结构化的文化胜任力; 过程取向则关注动态的、非结构化的文化胜任力。两种取向的异同体现了文化胜任力的研究和实践中对文化特异性和普遍性因素的平衡。在此基础上, 本文最后讨论了如何参考国外经验, 立足中国现实问题和加强社会心理服务体系建设的大背景, 来发展中国的文化胜任力。     

心理治疗中的脱落

脱落是指在心理咨询与治疗中, 来访者由于种种原因在导致他前来寻求帮助的心理困扰或问题尚未解决之前就终止治疗的现象。研究者对脱落概念内涵的理解比较一致, 但脱落的操作性定义存在多种且各有利弊。脱落在临床治疗中普遍存在; 脱落率在跨研究间的结果差异很大, 并受到脱落的操作性定义和研究设计类型的重要影响。传统的静态的变量在预测脱落时存在明显局限, 治疗同盟等治疗过程预测变量近年来得到更多重视, 并丰富了我们对来访者脱落的深入理解。为减少脱落, 研究者建议为来访者提供治疗前准备, 对治疗过程中的关键变量进行评估并根据具体情况采用合适的干预策略。未来研究需要完善脱落的操作性定义, 更多地在自然治疗设置下进行研究, 进一步深化脱落的预测变量研究, 并关注治疗外重要事件及文化背景对脱落的影响。     

In Experiential Sessions, There Is No Therapist or Client: There Is a “Teacher” and a “Practitioner”

In virtually every kind of psychotherapy, therapist and client attend mainly to one another throughout almost the entire session. If each experiential session is to be successful in enabling the person to become the whole new person that the person can become, and to become free of the painful feeling in the painful situation, the radical alternative is for the experiential teacher–therapist and the person to attend mainly to the third thing that is the important center of attention for the person. An even more radical glimpse into the future includes the person having one's own sessions by oneself, complemented by skill-development sessions with the experiential teacher.     

Treating a Chronically Depressed Adolescent Female Using the Cognitive Behavioral Analysis System of Psychotherapy: A Case Study

A case is presented of an adolescent female with double depression who was treated using the Cognitive Behavioral Analysis System of Psychotherapy (CBASP). CBASP is designed to teach a social problem-solving procedure called Situational Analysis (SA). Generalized treatment effects were measured through monitoring of diagnostic status, two administrations of the Minnesota Multiphasic Personality Inventory-Adolescent, weekly administrations of the Child Depression Inventory, and acquisition performance ratings on the SA task. The results showed that CBASP appeared to be an effective treatment. The double depressive disorder remitted, and the patient learned to identify behavioral consequences as well as target and attain her interpersonal goals. CBASP can be effective for adolescents, although modifications of the adult form of the therapy may be necessary.     

Family Processes and Treatment Outcome in the MTA: Negative/Ineffective Parenting Practices in Relation to Multimodal Treatment

To elucidate processes underlying therapeutic change in a large-scale randomized clinical trial, we examined whether alterations in self-reported parenting practices were associated with the effects of behavioral, medication, or combination treatments on teacher-reported outcomes (disruptive behavior, social skills, internalizing symptoms) in children with attention-deficit hyperactivity disorder (ADHD). Participants were 579 children with Combined-type ADHD, aged 7–9.9 years, in the Multimodal Treatment Study of Children with ADHD (MTA). We uncovered 2 second-order factors of parenting practices, entitled Positive Involvement and Negative/Ineffective Discipline. Although Positive Involvement was not associated with amelioration of the school-based outcome measures, reductions in Negative/Ineffective Discipline mediated improvement in children's social skills at school. For families showing the greatest reductions in Negative/Ineffective Discipline, effects of combined medication plus behavioral treatment were pronounced in relation to regular community care. Furthermore, only in combination treatment (and not in behavioral treatment alone) was decreased Negative/Ineffective Discipline associated with reduction in children's disruptive behavior at school. Here, children in families receiving combination treatment who showed the greatest reductions in Negative/Ineffective Discipline had teacher-reported disruptive behavior that was essentially normalized. Overall, the success of combination treatment for important school-related outcomes appears related to reductions in negative and ineffective parenting practices at home; we discuss problems in interpreting the temporal sequencing of such process-outcome linkages and the means by which multimodal treatment may be mediated by psychosocial processes related to parenting.     

Definitional and Research Issues in the Common Factors Approach to Psychotherapy Integration: Misconceptions, Clarifications, and Proposals

This paper focuses on two common misconceptions of common factors in therapy. The first misconception entails the confusion between common factors and therapeutic factors, and thus the inappropriate and misleading use of the term therapeutic common factors in various situations. The second misconception is the mixing of commonalities of different kinds and levels in proposed lists and studies of common factors. These areas are discussed and clarified, and recommendations designed to facilitate conceptual and methodological improvements relative to each misconception are offered. The selection of best levels and kinds of common factors to be studied are further explored (i.e., the study of client change events and antecedent therapist behaviors across different therapies), and specific proposals for their research are outlined.