JOURNAL OF CONTEMPORARY PSYCHOTHERAPY最新文献

In ths paper I outline my development over fifty years as a therapist, researcher and theorist. I started with empathy as a core helping process seeing it as a moment-bymoment information processing aid as well as a provision of the curative effects of human understanding. Over the years I added a focus on emotion as central to change, and proposed a number of necessary distinctions that needed to be made when working with emotion and concluded that one of the best ways to change emotion was with another emotion. In addition to my focus on moment by moment process I saw that identification of in-session experiential states and case formulation went beyond just being in the moment and helped provide more focus to an essentially phenomenologically based experiential approach.

Borderline personality disorder (BPD) is characterized by a pathognomonic instability of interpersonal relationships. Therefore, a good working alliance in the treatment of BPD may go beyond qualitative aspects like agreement on goals and mutual trust, and in particular depend on a balancing of instability. Yet, little is known about working alliance dynamics in the treatment of BPD. Using daily ratings of the Therapy Process Questionnaire, we retrospectively investigated assessments of the stability of the therapeutic alliance during inpatient treatment in 51 patients with BPD and 66 patients with major depressive disorder. Regression analyses were used to investigate whether working alliance was more unstable in patients with BPD and how it was associated to outcome. The working alliance was found to be significantly more unstable in patients with BPD. Yet, a high dynamic complexity of the working alliance was found to be linked to better outcomes in BPD, possibly hinting at the importance of rupture and repair.

Psychotherapy has evolved over the past 50 years and many seasoned psychotherapists have evolved as well. In the current paper, Dr Paul Wachtel summarizes his evolution as a psychotherapist. Dr. Wachtel is a Distinguished Professor in the Doctoral Training Program in clinical psychology at the City University of New York. For the past 50 years, Dr. Wachtel has been a prolific writer, a skilled clinician, and the chief advocate for integrating different theoretical orientations to enhance the field of psychotherapy. His extensive training in psychoanalysis provided a strong foundation on which to build a comprehensive and integrative view of psychotherapy. The paper provides a fascinating view of a skilled and prolific integrationist [N.B. Abstract created by the journal editor].

In this case study we present an example of a modification of the chair work technique, called ‘chair work with the empathic other’, and examine the process of emotional change of the participant. We find that talking directly to the empathic other supports the participant’s emotional engagement with the task and guides her emotional processing through the four necessary components of successful empty chair work, specified in previous research: experiential access and intense expression of primary adaptive emotion, expression of thwarted need, and a shift in the representation of self and the other. Drawing on self-determination theory, we conceptualize the trainer’s person-centered communication as a basic need-supporting therapeutic action. Throughout the chair work process, the need-supporting positioning of the ‘empathic other’, provided by the trainer, consistently engages the participant in the emotional processing of unfinished business: it deepens and widens her emotional exploration, leads her to express thwarted need, and finally, to change representation of self and other. We discuss the findings within the framework of self-determination theory and in relation to research on emotional change and therapeutic practice. Previous research has pointed out the difficulties many clients face with engaging in chair work. Introducing need-supportive communication, drawing on self-determination theory, we suggest that the modified technique is a possible intervention to facilitate engagement in chair work and emotional change.

Mindfulness and acceptance-based approaches have shown promise as alternative interventions to trauma-focused therapies for PTSD. This open trial examined the potential effectiveness of an 8-session Acceptance and Commitment Therapy (ACT) group in reducing psychiatric symptoms and improving quality of life in outpatient adults (N = 86, 79% female) receiving treatment for PTSD in a health maintenance organization (HMO) psychiatry clinic. The group therapy was an adjunct to usual care and utilized the six core processes of ACT: acceptance, cognitive defusion, mindfulness, self-as-context, values, and committed action. Participants completed self-report measures of PTSD symptoms, depression, anxiety and quality of life; and self-report ACT-specific process measures of acceptance, cognitive defusion and mindfulness at pretreatment, posttreatment and 3-month follow-up. Repeated measures analyses of variance conducted with a completer sample (n = 55) demonstrated significant improvements on all variables with medium to large effect sizes at posttreatment and follow-up. The study findings support further investigation in a randomized controlled trial.

Following statements about preferences for terminology, I describe three therapist characteristics (i.e., diagnostician educator, collaborator) deemed of value when providing psychological treatment for youth. Implementing an empirically supported treatment (EST) is a therapist decision, and while most therapists are aware of an EST that can fit for a specific client, many therapists ask “But is it right for my client?” This paper discusses therapist’s mental processes that may misinform decisions when answering this key question. To assist optimal decision making, and with an eye on maladaptive anxiety in youth as the exemplar, the active components of successful treatments are described, along with illustrations of flexibility within treatment fidelity (Flexibility within fidelity: Breathing life into a psychological treatment manual. Oxford University Press, 2022). Flexibility in implementing active components (e.g. rapport, psychoeducation, cognitive change, exposure tasks), as well as flexibility across modalities of treatment (e.g., in person, online) and working with parents are described.