JOURNAL OF CONTEMPORARY PSYCHOTHERAPY最新文献

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.

There is a mental health crisis in the United States that shows no signs of abating. Prevalence rates of mental disorders among both adults and children are rising and there are simply not enough mental health professionals to meet the growing demand. To address this problem, digital programs are being designed to diagnose and treat mental health conditions either adjunctively to a human clinician or as stand-alone treatments. Such developments hold great promise in ameliorating the mental health professional supply shortage. However, certain limitations of digital programs may prevent many users from desiring a digital psychotherapist. This paper surveys both the promise, and limitations, of digital psychotherapies.

Henri Grivois has posited that psychosis involves the subjective experience of oneself as the center or focal point of the world. In this experience, the world that is typically unrelated to oneself becomes incomprehensible, and in its place is the sense that all life events are directly related to oneself or that one is perpetually at the center of all noteworthy activity. We suggest that this experience of centrality can be understood through the lens of the integrated model of metacognition. Specifically, we explore the idea that the metacognitive domain of decentration, or the ability to form ideas about the larger community one is a part of, can be used to operationalize and measure centrality. We propose a three-phase approach to addressing centrality within an integrative psychotherapy focused on subjective and experiential aspects of recovery. These phases focus on the patient’s experience of centrality and include (1) inviting the therapist to join one’s centrality, (2) acknowledging others as different from oneself, and (3) recognizing alternative perspectives in the world. We provide case examples and explore the metacognitive tasks and potential barriers associated with each phase.

The most important lesson that I have learned in my half century as a therapist (and therapy researcher) is that principles matter more than processes. I had the great good fortune to arrive in Philadelphia at a time when Beck and colleagues were just beginning to test the efficacy of cognitive therapy for depression and what I learned was that helping clients (and myself) get the better of depression involved two main principles: (1) when in doubt do whatever you would have done if you were not depressed (behavioral); and (2) do not believe everything you think - check it out (cognitive). A third major principle is that the most powerful way to test an existing belief is to use one’s own behaviors to test its accuracy, which usually means doing whatever you least want to do in that situation (opposite action). I find that focusing on these principles is wholly liberating in the therapy process; I am free to be myself, to follow any line of inquiry, to respond to any request and to comport myself much as I would with any friend outside of therapy. This focus on principles has been good for my clients and even better for me.

Abstract

Panic disorder (PD) affects family members and can be influenced by familial factors. Adverse family events may contribute to anxiety and PD. We examined a family therapy case of a client with PD in South Korea. We used a thematic analysis to analyze therapy transcripts and video recordings and displayed our findings using a network. We identified five stages of the psychological process in the development of PD: (1) formation of anxiety, (2) sheltered life, (3) crisis, (4) loss of haven, and (5) inner breakdown. External situations, family dynamics, and psychological experiences at each stage are examined. Family dynamics that occurred as the family coped with external situations contributed to the client’s psychological experiences, which triggered anxiety that led to PD. This study suggests family dynamics can be associated with one’s internal experiences that could lead to PD, highlighting the importance of functional family dynamics and coping when facing crises.

Psychoanalysis brings some specific aspects of treatment technique to the field of mental health practice today, such as highlighting the dynamics within therapeutic relationship (especially regarding emotional and unconscious elements), the role of defense mechanisms etc. Moreover, by means of taking a particular therapeutic stance, psychoanalysis offers some shared mental space for patients. The present paper argues that this stance is characterized by the capacity to “not act”, that is: by passive receptivity. To view this as some specific “negative skill” in psychotherapy in general means to align common elements of effective psychotherapy with the capacity to explore the uncommon, unfamiliar or unforeseen in particular psychotherapeutic processes. The paper sketches how this can be employed in psychotherapy training as well as in psychotherapy integration.

The term ‘Common Emotional Disorders’ refers to a range of clinical conditions such as anxiety disorders, panic atacs, mild and moderate depressive states, sleep disorders, somatoform disorders and post-traumatic stress disorder. The aim of the present article is to investigate the effectiveness of a specific group psychotherapy protocol for common emotional disorders. The outcome was evaluated in terms of reduction of anxiety-depressive symptoms. The aim is for this protocol to represent a first and valid intervention tool in the public context, in compliance with national indications in terms of cost-effectiveness. The protocol is structured in seven modules, each of which deals with the pivotal points of a psychotherapeutic pathway. It has a total duration of 6 months, and was applied to 61 adult patients afferent to a Mental Health Centre (45 F and 16 M). Results show a significant reduction in overall symptom severity and an extensive improvement in both depressive and anxious symptoms, as well as a self-perceived degree of improvement in subjective well-being. This protocol has the advantage of being able to group together patients with comorbid clinical conditions and symptom heterogeneity and offers them proven cognitive-behavioral treatment.