A process study of long-term treatment: comparing a successful and a less successful outcome

This study examined therapist technique and patient change in emotional experiencing and defense mechanisms in the successful and unsuccessful long-term psychoanalytic treatments of two male patients. Two consecutive sessions every 6 months were analyzed for each patient. Therapist interventions, patient defense mechanisms, and patient emotional experiencing were assessed using the Psychodynamic Intervention Rating Scale, Defense Mechanism Rating Scale and the Experiencing Scale, respectively. Between and within-session analyses were conducted to determine the impact of the patient’s defensive functioning and experiencing on therapist interventions, and the effect of therapist interventions on those same two patient variables. Pearson’s Coefficient was utilized for between-session analysis; within-session analysis tracking moment-to-moment changes in patient and therapist functioning was performed using lag sequential analysis. Across therapy, therapist use of Interpretive Interventions was associated with increased emotional engagement and decreased defense maturity; the use of Supportive Interventions had the opposite effect. Within-session analysis revealed that use of Supportive Interventions when emotional engagement is low, followed by interpretative interventions, occurred in the successful case. Persistent use of Supportive Interventions in the context of low emotional engagement was observed in the unsuccessful case. This study suggests that failure to stimulate emotional engagement through interpretation can negatively affect therapeutic outcome.     

‘Mr K’ – A successful case of analytic oriented therapy documented empirically: the role of the therapeutic relationship and reflexive self-awareness

A successful case of analytic treatment over the course of 250 sessions is described from different perspectives, including considerations from the two-year follow-up. The therapeutic alliance and the patient’s experiencing were evaluated. Pre-treatment diagnosis was validated via diagnostic interview. Symptoms and interpersonal problems were assessed at intervals. Data were analysed using two different time-series analyses. Aspects of agency with regard to mentalizing capacity were assessed with the Metacognitive Assessment Scale. We obtained the following main results: (1) Symptoms and interpersonal problems improved continuously until the end of treatment. Symptom severity fell to below the clinical cut-off. This successful outcome remained stable at the two-year follow-up. (2) The therapeutic relationship improved during the therapeutic process. (3) The patient’s capability for reflexive self-awareness, operationalized as experiencing, decreased. (4) The metacognitive mastery of the patient increased. The following conclusions were made after combining the empirical data with the clinical observations: (1) Mr K improved clinically in terms of symptoms, self-regulation and interpersonal problems as a result of his gaining affect control. (2) The patient’s experiencing does not capture a positive outcome in all cases. (3) Aspects of agency (i.e. metacognitive mastery) deserve further attention in psychoanalytic treatments.     

观点采择是否一定促进内隐宽恕?——受害者对伤害动机认同的调节作用

以往研究多认为观点采择可有效促进宽恕,近期研究则开始关注观点采择诱发宽恕等亲社会行为的边界条件。结合“换位体验”和内隐态度测量范式,本研究考察了受害者对伤害动机的认同在被动和自发观点采择影响内隐宽恕过程中的调节作用。实验1发现当人际伤害中存在人们无法认同的恶意不道德动机时,被动和自发观点采择都抑制了受害者对施害者的内隐宽恕且后者的抑制效应更显著。实验2则进一步操纵了不同类型受害者对施害者伤害动机的认同差异,低认同组与实验1结果相同,即被动和自发观点采择中都抑制了内隐宽恕且后者的抑制效应更显著,但高认同组在两种观点采择中都促进了内隐宽恕且二者的促进效应无显著差异。本研究揭示了伤害动机认同在不同类型观点采择影响内隐宽恕过程中起到的调节作用,进一步丰富了对观点采择和宽恕间复杂关系的认识。     

What Studies of Actors and Acting Can Tell Us About Memory and Cognitive Functioning

ABSTRACT— The art of acting has been defined as the ability to live truthfully under imaginary circumstances. Our many years of researching theatrical expertise have produced findings relevant to text comprehension, learning theory, cognitive aging, and expert memory. In this article, we first discuss how large amounts of dialogue, learned in a very short period, can be reproduced in real time with complete spontaneity. We then turn to abstracting the essence of acting and applying it to diverse undertakings, from discovering optimal learning strategies to promoting healthy cognitive aging. Finally, we address the implications of acting expertise on current theories of embodied cognition.     

Fear of breakdown and the unlived life

Winnicott's Fear of breakdown is an unfinished work that requires that the reader be not only a reader, but also a writer of this work which often gestures toward meaning as opposed to presenting fully developed ideas. The author's understanding of the often confusing, sometimes opaque, argument of Winnicott's paper is as follows. In infancy there occurs a breakdown in the mother–infant tie that forces the infant to take on, by himself, emotional events that he is unable to manage. He short‐circuits his experience of primitive agony by generating defense organizations that are psychotic in nature, i.e. they substitute self‐created inner reality for external reality, thus foreclosing his actually experiencing critical life events. By not experiencing the breakdown of the mother–infant tie when it occurred in infancy, the individual creates a psychological state in which he lives in fear of a breakdown that has already happened, but which he did not experience. The author extends Winnicott's thinking by suggesting that the driving force of the patient's need to find the source of his fear is his feeling that parts of himself are missing and that he must find them if he is to become whole. What remains of his life feels to him like a life that is mostly an unlived life.     

Does the two-chair dialogue intervention facilitate processing of emotions more efficiently than basic Rogerian conditions?

Processing difficult emotions is assumed to be of importance in therapeutic change. In this study, we examine whether a two-chair dialogue in Emotion-focused Therapy (EFT) is associated with a change in emotional processing, measured as changes in emotional arousal and emotional experiencing. In a multiple baseline design, 20 clients in treatment for depression or anxiety first received five, seven or nine weekly sessions of baseline treatment providing Rogerian conditions and affect attunement. In the second phase, two-chair intervention was added for the five consecutive sessions. All sessions were subdivided into 2 min segments which were rated using the Client Emotional Arousal Scale III and the Experiencing Scale. Analyses indicated a significantly higher number of high-arousal segment in the latter phase. Individual clients’ change trajectories were not significantly steeper in the second phase. Experiencing increased throughout both phases of treatment. However, after introducing the two-chair dialogue the Experiencing change trajectory was not significantly steeper than in the baseline phase. Findings suggest that both the two-chair dialogue and the Rogerian conditions with affect attunement focus are effective in facilitating emotional processing. Results are consistent with previous research, suggesting that the two-chair dialogue is an emotionally evocative intervention. Implications and limitations are discussed.     

成年女性情景自传体记忆的现象学体验：年龄与时间的作用

目的：考察成年女性情景自传体记忆(EAM)的现象学体验是否受年龄和事件发生时间的影响。方法：95名老、中、青年女性被试详细回述童年及近一年的自传体事件各一件,并完成自传体记忆问卷。结果：所有被试在近期记忆的大多数体验得分上显著高于童年期记忆,年龄主效应及交互作用不显著。在近期记忆的情绪体验上,中、老年女性比青年女性更积极。结论：成年女性EAM的现象学体验受时间影响明显,受年龄影响不大;中、老年女性的EAM现象学体验表现出一定的积极情绪偏向。     

We have travelled a long distance and sorted out the mess in the drawers: Metaphors for moving towards the end in psychotherapy

Aim: To explore the process of ending in psychotherapy, in particular how clients and therapists draw on their notions of client improvements and prepare for the upcoming end. Data: The data comes from an intensive process‐outcome study at the University of Oslo, Norway. The study includes audio‐recording from all sessions and separate post‐therapy interviews with clients and therapists. Twelve psychotherapy dyads were selected because they had reached a ‘good enough’ ending. Therapy duration ranged from 7–43 months. The number of sessions ranged from 10–67. Method and analysis: A hermeneutical‐phenomenological approach analysed and combined the observational and reflexive data. The analysis was carried out using a method for systematic text condensation and through reflexive dialogues with the material and between the researchers. Findings and discussion: The language of improvement towards the end of treatment seemed packed with metaphors conveying growth in both affective and relational management. Metaphors based on travel (how they have moved); cleaning (how they have cleaned up and sorted out things); sensing (how the clients have grown stronger, got their heads above water and see things differently); and the clients’ feeling of having received something (gifts or tools) are widely used. Such metaphors are created in the interaction with a mutual sensitivity to their capacity to confirm and regulate affect towards the end. In this sense, the metaphors celebrate accomplishments in a way that exceeds therapy, and the client can keep them to use afterwards.     

The effect of religiosity and spirituality on psychological well-being among forensic psychiatric patients in Canada

All patients in a multilevel secure forensic psychiatric centre were surveyed to determine the relationship between religiosity and spirituality, and depression, anxiety and satisfaction with life. Of the whole population, 90% responded; 5% were females and 47% aboriginal. The mean anxiety and depression scores using the Beck anxiety and depression inventories were low at 11.4 and 17, respectively. Weekly attendance at worship and the private intrinsic religiosity scores were higher than comparable samples of Canadians and general mental-health inpatients. Satisfaction with life score was positively correlated with all religiosity and spirituality variables. There was an inverse relationship between the Existential Well-Being scale and depression scores. The Existential Well-Being scale also correlated positively with satisfaction with life. Weekly worship attendance was inversely correlated with depression scores. These results point to some important differences between this patient population and the general population.