A Model to Transform Psychosis Milieu Treatment Using CBT-Informed Interventions

Although CBT for psychosis (CBTp) has been recommended as a best practice since 2002, CBTp’s availability is quite limited in the U.S. Integration of CBTp-informed interventions into the milieu of the treatment settings in which the majority of the 2.4 million Americans with psychosis receive treatment may greatly improve access to those services. This paper presents an evidence-based model for training line staff in CBTp principles, in order that more staff throughout the U.S. might better support the recovery of people with psychosis in this way. Examples are provided to illustrate effective strategies and approaches.     

Relational dynamics between psychotherapy clients and clinic administrative staff: A pilot study

Extensive empirical research has established therapeutic alliance as one of the most stable predictors of psychotherapy outcomes. Nearly all the contemporary empirical literature on therapeutic alliance focuses on the therapist-client dyad without attending to the relational experiences many clients in outpatient clinics have with administrative staff. Literatures from the fields of social work, psychiatric nursing and milieu therapy suggest there are more systemic relational and environmental dynamics that impact treatment beyond the therapist-client dyad, although these issues have been considered primarily in inpatient settings. A relational ecology framework has been developed drawing upon relational psychoanalysis, attachment theory and symbolic anthropology to help conceptualise the broader relational dynamics beyond the therapist-client dyad that may impact a more systemic therapeutic alliance in certain outpatient contexts. In an initial cross-sectional pilot study with a sample of clients (N = 107) receiving psychotherapy at a community mental health clinic in the Northeastern United States, the present study found client ratings of both (a) the therapeutic alliance with their therapists and (b) their alliance with administrative staff each significantly positively predicted client ratings of treatment. Thus, ratings of administrative alliance predicted client ratings of treatment over and above the effects of the therapist-client therapeutic alliance. These findings provide preliminary support for further investigation of the relational ecology of outpatient psychotherapy and suggest that client experiences of relational and environmental dynamics with administrative staff may be important contributors to psychotherapy outcomes. Limitations of the present study and implications for future research and practice are discussed.     

心理咨询中好坏效果案例咨询互动的内容分析

目的:了解好坏效果案例咨访互动的特点及差异。方法:运用内容分析法对5个好效果案例和3个坏效果案例的会谈谈话轮进行评定。结果:在治疗师介入上,好坏效果案例存在显著差异;在当事人回应上,二者差异不显著;在治疗性最近发展区上,二者在"确认-安全"和"确认-可忍受冒险"两个区段存在显著差异,其他区段差异不显著。结论:临床工作中可多使用支持性技术,适当结合挑战性技术,并增多落入"确认-可忍受冒险"区段的比例。     

Psychoanalytic psychodrama in France and group elaboration of counter‐transference: Therapeutic operators in play therapy

In France, psychoanalytic psychodrama is mainly envisioned in its individual form – that is, a single patient working with a group of therapists. Its originality consists in bringing together several clinicians within a clinical experience that is shared as a group. This experience is fundamentally different from traditional individual therapies, psychotherapies or group co‐led therapies. Its configuration may be confusing or overwhelming due to the large number of co‐therapists involved in the setting. However, thanks to group elaboration based on the transferential‐countertransferential dynamics induced by the treated patient, this potential ‘cacophony’ can lead to fruitful psychic development embedded in play. This is tied to the co‐therapists' positioning in the transitional space shared with the patient as well as to the patient's subjective appropriation of their initiatives. By reflecting on clinical material taken from actual sessions as well as from the exchanges and elaborations occurring at their margins, this article shows how psychodrama and group come to metabolize the transferential elements, shaping the engagement of participants in the context of improvised play.     

Putting down roots: the significance of technical adaptations in the therapeutic process with fostered and adopted children‡

Severely neglected and traumatised children have also suffered from a lack of the parental nurturing which is needed for ordinary emotional development to take place. Often their past experiences make them unable to utilise the nurturing that foster and adoptive families try to give them and they are delayed or stuck in their development. In therapy, when the early small signs of new emotional development start to emerge, they may be heralded by technical challenges to the therapist. Two examples are given in this paper, which are discussed in the context of Stern et al.’s ideas about moments of meeting, Winnicott’s concepts about transitional phenomena and playing, and Hurry and her colleagues’ thoughts about the therapist as a developmental object. It is argued that it is important for the therapist to be alert to the possible significance of these technical adaptations in terms of the child’s capacity for new emotional development. These often indicate that a watershed in the treatment has been reached and if positively responded to, that the patient is in the process of ‘putting down roots’ in the ground of the therapeutic relationship and starting to grow across a spectrum of developmental pathways.     

Just a joke. Psychogenesis of humor in alcohol advertisements

This article asks what psychic functions humorous alcohol advertisements employ and how they are connected to the wider cultural meanings of alcohol. The material comprises 27 advertisements televised in Europe in 2013. The material is primarily examined using Freud’s ideas regarding the psychogenesis of jokes. Freud’s conceptions of humor provide in-depth point of views to understand how the advertisements address the viewer’s mind. We recognized three psychic processes: the pleasure of nonsense, recognition of the familiar, and liquidation of criticism. We argue that these are essential psychic activities which characterize the more or less unconscious functioning and content of humorous alcohol advertisements. The article suggests that the humorous strategies recall the infantile pleasure connected to playing with language. The humor in alcohol advertisements may also liquidate the critical attitudes toward drinking, enforce the process of denial of addiction and prohibit the reality-based reflection of alcohol use.     

Outcomes of a Therapeutic Gardening Program in a Mental Health Recovery Center

This study evaluated outcomes of a therapeutic gardening project in a community mental health center. The authors worked with 20 adults with severe mental illnesses, to plan, build, and care for raised-bed gardens. Targets for recovery-oriented outcomes related to personal responsibility, emotional and physical well-being, and socialization, were established in advance. Achievement of outcomes was measured using quantitative and qualitative methodology. Results indicated that the program supported recovery. Participants demonstrated significant improvement in mood and markedly higher levels of involvement and spontaneity, when engaged in gardening. Positive changes in diet and social interaction were also reported.     

促进当事人的改变：基于治疗性最近发展区的视角

作为心理治疗的有效区域,治疗性最近发展区是指当事人当前适应问题经验的能力和通过治疗师的协助能够达成的潜在能力之间的距离。早期的同化模型理论更注重对心理治疗改变过程的描述,治疗性最近发展区理论则能够进一步解释治疗师在不同阶段的帮助策略。在研究上,治疗性最近发展区理论建立在非传统的方法论基础上,通过不断累积个案的质性研究,帮助治疗师理解和解释不同咨询效果的互动过程,并使理论得到持续发展;在临床上,治疗性最近发展区为理解心理治疗过程中倒退现象提供了新视角,并能够有效指导在治疗过程中采取挑战性还是支持性策略。未来研究可从临床上探索经验丰富的治疗师的实践智慧,也可选取较大跨度的治疗对话序列,对不同流派的特点,从不同参与者的视角出发进行研究,进而深化对心理治疗过程机制的理解。