The sandwich model: The ‘music and dance’ of therapeutic action

My premise is that a ‘layered’ approach is necessary to understand the process of exchanges that result in therapeutic change. I imagine these processes occurring in three layers – although the number of domains in which change is taking place is actually infinite – such as in a sandwich. The top layer, or top slice of bread of the sandwich, represents a broad view of the change process; it is non‐linear and includes the feature of uncertainty, a general principle of dynamic systems theory. The middle layer, or the meat of the sandwich, is explained by theories that are immediately and clinically useful to a therapist, such as psychoanalytic theories. These are primarily linear theories and use language and symbols to ‘tell a story of what happened’. The bottom layer, or bottom slice of bread of the sandwich, is the micro‐process; this layer includes the moment‐to‐moment patterns of coordinated rhythms that both communicate meaning and provide the essential scaffold for all higher‐level change processes. The micro‐process also requires a non‐linear theory to make sense of its variability and emergent properties. Taking a bite out of the sandwich will include a ‘polysemic bundle of communicative behaviors’ (Harrison and Tronick, 2011). I will illustrate the ‘sandwich model’ with the clinical case of the analytic treatment of a 5 year‐old boy.     

The Evolution of Mindfulness‐based Cognitive Therapy

Metcalf and Dimidjian (this issue) present a timely review of the evolving evidence base and mechanisms of mindfulness‐based cognitive therapy (MBCT). The present commentary extends the discussion on the current evidence base for MBCT based on findings from recent meta‐analytic reviews in this field which attest to the promising outcome for mindfulness‐based therapies, particularly for depressed populations. However, the specific effects of MBCT as applied to anxiety, health and developmental populations is still very much in its infancy. The second objective of this commentary extends discussion on the transdiagnostic applications of MBCT versus traditional cognitive behavioural therapy (CBT). It is recommended that with the continuing expansion of MBCT, the effects of this therapeutic approach needs to be evaluated against other empirically supported therapies, including traditional CBT.     

Converting a Freudian analysis into a Jungian one: obsession,addiction, and an answer from Job

In his analyses of obsessional patients, Sigmund Freud suggested that they suffered from intrusive cognitions and compulsive activities. Early psychoanalysts delineated the phenomenology of obsessionality, but did not differentiate what is currently termed obsessive‐compulsive disorder from obsessional personality. However, it was widely recognized that the success of psychoanalysis with obsessional patients was limited due to rigid characterological defences and transference resistances. The present paper examines the case of a middle‐aged obsessional academic who had been treated for nearly twenty years in a ‘classical' Freudian psychoanalysis prior to entering Jungian analysis. It examines how persistent focus on Oedipal conflicts undesirably reinforced the transference resistance in this obsessional man, and suggests that focusing instead on diminishing the harshness of the super‐ego via the therapeutic alliance, and fostering faith in the salutary aspects of unconscious processing has led to salutary results in this case. The biblical book of Job is adopted as ancient instruction in how to address the scrupulosity and addictive mental structuring of obsessionality in analysis.     

ANALYTIC MIND USE AND INTERPSYCHIC COMMUNICATION: DRIVING FORCE IN ANALYTIC TECHNIQUE,PATHWAY TO UNCONSCIOUS MENTAL LIFE

Developed from established psychoanalytic knowledge among different psychoanalytic cultures concerning unconscious interpsychic communication, analysts' use of their receptive mental experience—their analytic mind use, including the somatic, unconscious, and less accessible derivatives—represents a significant investigative road to patients' unconscious mental life, particularly with poorly symbolized mental states. The author expands upon this tradition, exploring what happens when patients unconsciously experience and identify with the analyst's psychic functioning. The technical implications of the analyst's “instrument” are described, including the analyst's ego regression, creation of inner space, taking mind as object, bearing uncertainty and intense affect, and self‐analysis. Brief case vignettes illustrate the structure and obstacles to this work.     

Client as expert: A Delphi poll of clients’ subjective experience of therapeutic alliance formation variables

This study extends prior research that identified client-derived variables believed to contribute to therapeutic alliance development. Forty-two clients participated in a three-round-modified Delphi poll in which the subjective importance of 74 client-derived, common alliance formation variables was rated using a six-point scale. Participants consensually identified 23 variables as highly important, five as moderately important and three as low in importance to the formation of a strong alliance. Variables related to validation and asking about parts of the client’s life other than the presenting concern were considered as most important by at least one-third of the sample. Limitations of the study are presented and implications for theory, measurement, practice and future research are briefly discussed.     

Effects of the function-specific instruction approach to neurofeedback training on frontal midline theta waves and golf putting performance

A recent meta-analysis has shown inconclusive results on the effectiveness of traditional electroencephalography (EEG) neurofeedback training (NFT) protocols in changing EEG activity and improving sports performance. To enhance the effectiveness of EEG NFT protocols, we explored a new approach to EEG NFT, namely the function-specific instruction (FSI) approach. The basic tenet underpinning effective verbal instruction is to induce mental states as the verbal instructions consider the meaning of the brainwave function in the target region and the EEG power magnitude. This study aimed to test whether a single session of FSI is efficacious in improving frontal midline theta (FMT) activity and putting performance. Method: Thirty-six skilled golfers with a handicap of 14.05 ± 9.43 were recruited. A consecutive sampling method was used to form three groups: an FSI group (n = 12), a traditional instruction (TI) group (n = 12), and a sham control (SC) group (n = 12). In the pre- and post-tests, each participant performed 40 putts from a distance of 3 m, and the number of holed putts was recorded. The participants were asked to perform 50 trials in a single session of NFT. Putting performance improved significantly from before to after NFT in the FSI group. Moreover, the FSI group demonstrated a significant decrease in FMT power, whereas the SC group demonstrated a significant increase in FMT power from before to after NFT. These findings suggest that the FSI approach is more effective in enhancing sustained attention and putting performance in skilled golfers than TI.     

Does retrieval intentionality really matter? Similarities and differences between involuntary memories and directly and generatively retrieved voluntary memories

Theories of autobiographical memory distinguish between involuntary and voluntary retrieval as a consequence of conscious intention (i.e., wanting to remember). Another distinction can be made between direct and generative retrieval, which reflects the effort involved (i.e., trying to remember). However, it is unclear how intention and effort interacts. For example, involuntary memories and directly retrieved memories have been used interchangeably in the literature to refer to the same phenomenon of effortless, non‐strategic retrieval. More recent theoretical advances suggest that they are separate types of retrieval, one unintentional (involuntary), another intentional and effortless (direct voluntary retrieval), and a third intentional and effortful (generative voluntary retrieval). Whether this also entails differing phenomenological characteristics, such as vividness, rehearsal, or emotional valence, has not been previously investigated. In the current study, participants reported memories in an experimental paradigm designed to elicit voluntary and involuntary memories and rated them on a number of characteristics. If intention affects the retrieval process, then we should expect differences between the characteristics of involuntary and directly retrieved memories. The results imply that retrieval intention seems to differentiate how a memory appears in a person's mind. Furthermore, we argue that these differences in part could result from differences in encoding and consolidation.     

The emotional male victim: Effects of presentation mode on judged credibility

The emotional victim effect (EVE, i.e., that the emotionality of a victim's demeanor affects perceived credibility) is a robust research finding for female victims of rape but much less explored for other types of victims and crimes. In this article, we investigate the EVE with a male assault complainant. In addition, we vary the presentation mode via which the complainant is shown to the assessors. A sample of law students (N = 81) participated in an experiment where they viewed and assessed credibility of a male complainant who appeared either live or on video. The complainant behaved either in an emotional or a neutral manner. Result showed that the presentation mode but not the EVE affected the assessors' credibility assessments: The complainant was perceived as more truthful when communicating live, as opposed to via video. Practical implications, as well as the generality of the EVE, are discussed.     

On becoming textually active at Youthline,New Zealand

The phones hardly ring at Youthline New Zealand anymore; youth still have problems and seek help, but it mostly happens silently. This article reports on experiences of texting at a 24-hour crisis helpline for young people. To date, there has been no formal evidence base for this practice; however, for new practice, there never is. In prompting discussion, this article attends to the tight constraints that texting imposes, returning to the necessary and sufficient conditions of any effective therapeutic relationship particularly in regard to working with young people. New possibilities are demonstrated with emotional support being demonstrated even in the tightly constrained space of a text-based medium.     

The triumph of American psychiatry: How it created the modern therapeutic state

Over the past 170 years, American psychiatry has progressively asserted its authority over a larger segment of the American population. From the mid-1800s to the end of World War II, psychiatry had authority over the asylum population, which markedly increased in the first half of the twentieth century due to the influence of eugenics, an ideology that argued the ‘mentally ill’ had to be segregated from society. After the war, American psychiatry adopted Freudian conceptions of mental disorders, which enabled it to begin treating people in the community who were ‘neurotic’ in some way, which dramatically expanded its influence in society. Then, in the 1970s, when many in American society were questioning psychiatry’s legitimacy as a branch of medicine, the American Psychiatric Association (APA) responded by adopting a disease model for diagnosing mental disorders, which it set forth in the third edition of its Diagnostic and Statistical Manual. There were no scientific discoveries that led to this new model, but soon the APA was informing the American public that mental disorders were diseases of the brain, and that psychiatric drugs helped fix those diseases, ‘like insulin for diabetes.’ The APA, in concert with pharmaceutical companies, has successfully exported this belief system to much of the developed world. In order to break free of this ‘therapeutic state,’ the public needs to understand the history of how it came to be, and see the social injury it has caused.