Pub Date : 2016-03-03DOI: 10.14713/PCSP.V12I1.1944
R. Cohen
Daniel is a 44-year-old Caucasian male who has struggled with chronic depression and extreme sensitivity to feeling judged and criticized. I have seen him for more than ten years in psychoanalytic therapy. While he made significant progress in understanding the childhood determinants of his difficulties and achieved some symptom improvement, Daniel continued to struggle with observing and tolerating his feelings. This case study demonstrates how my decision to integrate techniques from Acceptance and Commitment Therapy (ACT; Hayes, 2005), a contemporary form of cognitive behavioral therapy, broke an impasse in the treatment, allowed the patient to resolve outstanding difficulties, and helped him move towards termination. The case report discusses the challenges of integrating ACT into psychoanalytic work, as well as ways that a psychoanalytic understanding of Daniel’s resistance to ACT techniques made that treatment effective.
{"title":"Getting into the ACT with Psychoanalytic Therapy: The Case of \"Daniel\"","authors":"R. Cohen","doi":"10.14713/PCSP.V12I1.1944","DOIUrl":"https://doi.org/10.14713/PCSP.V12I1.1944","url":null,"abstract":"Daniel is a 44-year-old Caucasian male who has struggled with chronic depression and extreme sensitivity to feeling judged and criticized. I have seen him for more than ten years in psychoanalytic therapy. While he made significant progress in understanding the childhood determinants of his difficulties and achieved some symptom improvement, Daniel continued to struggle with observing and tolerating his feelings. This case study demonstrates how my decision to integrate techniques from Acceptance and Commitment Therapy (ACT; Hayes, 2005), a contemporary form of cognitive behavioral therapy, broke an impasse in the treatment, allowed the patient to resolve outstanding difficulties, and helped him move towards termination. The case report discusses the challenges of integrating ACT into psychoanalytic work, as well as ways that a psychoanalytic understanding of Daniel’s resistance to ACT techniques made that treatment effective.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"12 1","pages":"1-30"},"PeriodicalIF":0.0,"publicationDate":"2016-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67055605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-03-03DOI: 10.14713/PCSP.V12I1.1945
Jill Bresler
In this discussion of Dr. Robert Cohen’s (2016) case study of his client Daniel, several integrative shifts over the course of the long-term, psychoanalytic treatment are noted. Initially, a shift from a traditional psychoanalytic model to a relational model was initiated in order to respond to Daniel's lack of responsiveness to a therapy focused on transference interpretation; and later a shift to employing strategies from Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 2012) was implemented in order to address ruminative thought patterns and accompanying social inhibition. The therapist describes his own process of exploring options flexibly, allowing the reader a rare view into this clinical decision-making process. The treatment as a whole is conceptualized as fostering both mentalization and mindfulness skills in the context of the secure attachment that an intensive treatment tends to foster. The possibility that a shift to ACT provided a bridge to a termination process is discussed.
{"title":"Promoting Psychological Flexibility by Practicing Flexibly: The Therapist as Model","authors":"Jill Bresler","doi":"10.14713/PCSP.V12I1.1945","DOIUrl":"https://doi.org/10.14713/PCSP.V12I1.1945","url":null,"abstract":"In this discussion of Dr. Robert Cohen’s (2016) case study of his client Daniel, several integrative shifts over the course of the long-term, psychoanalytic treatment are noted. Initially, a shift from a traditional psychoanalytic model to a relational model was initiated in order to respond to Daniel's lack of responsiveness to a therapy focused on transference interpretation; and later a shift to employing strategies from Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 2012) was implemented in order to address ruminative thought patterns and accompanying social inhibition. The therapist describes his own process of exploring options flexibly, allowing the reader a rare view into this clinical decision-making process. The treatment as a whole is conceptualized as fostering both mentalization and mindfulness skills in the context of the secure attachment that an intensive treatment tends to foster. The possibility that a shift to ACT provided a bridge to a termination process is discussed.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"12 1","pages":"31-38"},"PeriodicalIF":0.0,"publicationDate":"2016-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67055275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-03-03DOI: 10.14713/PCSP.V12I1.1946
S. Holland
Robert Cohen’s case study of Daniel gives an excellent example of the potential for integrating cognitive-behavioral techniques within a psychoanalytically informed psychotherapy. Dr. Cohen introduces exercises from Acceptance and Commitment Therapy (ACT) into his work with a patient who has become stuck after a long period of good progress in therapy. The use of active techniques from ACT appears to have allowed the patient to make further progress. However, integrating a full range of interventions from first-, second-, and third-wave cognitive-behavioral treatments might have offered additional benefits to the patient as well as providing for a more complete theoretical integration between cognitive-behavioral and psychoanalytic approaches.
{"title":"A Cognitive-Behavioral Perspective on Robert Cohen's Case of \"Daniel\"","authors":"S. Holland","doi":"10.14713/PCSP.V12I1.1946","DOIUrl":"https://doi.org/10.14713/PCSP.V12I1.1946","url":null,"abstract":"Robert Cohen’s case study of Daniel gives an excellent example of the potential for integrating cognitive-behavioral techniques within a psychoanalytically informed psychotherapy. Dr. Cohen introduces exercises from Acceptance and Commitment Therapy (ACT) into his work with a patient who has become stuck after a long period of good progress in therapy. The use of active techniques from ACT appears to have allowed the patient to make further progress. However, integrating a full range of interventions from first-, second-, and third-wave cognitive-behavioral treatments might have offered additional benefits to the patient as well as providing for a more complete theoretical integration between cognitive-behavioral and psychoanalytic approaches.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"12 1","pages":"39-55"},"PeriodicalIF":0.0,"publicationDate":"2016-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67055384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"アクセプタンス＆コミットメント・セラピーは 「村上春樹」である","authors":"崇. Muto武藤","doi":"10.14713/pcsp.v11i4.1941","DOIUrl":"https://doi.org/10.14713/pcsp.v11i4.1941","url":null,"abstract":"筆者による太郎の事例論文（武藤・三田村，2015）に対する金沢（2015）のコメントに対して，筆者自身の事例研究に対するアプローチの「日本的」である度合いの問題について省察した。筆者の仕事のスタンスを著名な日本の小説家である村上春樹のスタンスに根付かせて，これを探究した。また，Hayes（2015）によるコメントの指摘にも回答を与える。","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"11 1","pages":"162-165"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67055530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"事例研究特集号——はじめに 日本における事例研究：2つの方法，2つの世界観 Part2","authors":"茂. Iwakabe岩壁","doi":"10.14713/pcsp.v11i4.1934","DOIUrl":"https://doi.org/10.14713/pcsp.v11i4.1934","url":null,"abstract":"本特集の目的は大きく異なる事例研究のスタイルを提示し，それらの方法的特徴を比較し，最終的にはそれぞれの強みを組み合わせた事例研究の方法を探究することであった。2編の事例論文は，日本における臨床実践と事例研究の幅を実感できる内容であった。またそれに続く国内外からの4編のコメント，および事例論文著者の回答による対話が起こり，事例研究を通した臨床的学びの場を作り出した。その対話を通して，それぞれの事例研究の特徴がさらに浮かび上がってきた。ここでは，簡潔に2つの事例論文とコメントを振り返り，事例研究の方法論的課題，そして文化の問題について検討したい。","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"18 1","pages":"96-106"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67055244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.14713/PCSP.V11I4.1932
Y. Kanazawa
Muto and Mitamura (2015) are to be highly commended for publishing the case study of Taro. The article is notable for its emphasis on documenting what is behaviorally observable and reliably quantifiable. The authors’ commitment to scientific rigor is laudable. Japanese psychotherapists are strongly advised to use this article as a model of evidence-based treatment in their descriptions of psychotherapy sessions. On the other hand, the reviewer would have liked to see more discussions on contextual factors around Taro, his presenting problems, and his therapy, including therapeutic relationships, Taro’s emotions in therapy sessions and the therapist’s responses to them, possible conflicts in Taro’s family, as well as organizational issues around Taro and his symptoms in his workplace. Measurement tools are available to reliably quantify these variables. Incorporating these measures into the therapist’s work with Taro would help readers better understand the therapeutic process and illuminate the mechanisms of change in the case study.
{"title":"The Role of Context in the Case of Taro","authors":"Y. Kanazawa","doi":"10.14713/PCSP.V11I4.1932","DOIUrl":"https://doi.org/10.14713/PCSP.V11I4.1932","url":null,"abstract":"Muto and Mitamura (2015) are to be highly commended for publishing the case study of Taro. The article is notable for its emphasis on documenting what is behaviorally observable and reliably quantifiable. The authors’ commitment to scientific rigor is laudable. Japanese psychotherapists are strongly advised to use this article as a model of evidence-based treatment in their descriptions of psychotherapy sessions. On the other hand, the reviewer would have liked to see more discussions on contextual factors around Taro, his presenting problems, and his therapy, including therapeutic relationships, Taro’s emotions in therapy sessions and the therapist’s responses to them, possible conflicts in Taro’s family, as well as organizational issues around Taro and his symptoms in his workplace. Measurement tools are available to reliably quantify these variables. Incorporating these measures into the therapist’s work with Taro would help readers better understand the therapeutic process and illuminate the mechanisms of change in the case study.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"60 1","pages":"279-284"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67055407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.14713/PCSP.V11I4.1929
Hiroaki Kumano
Murase’s (2015) case study of Mr. R meticulously examined the process of psychotherapy with a severely disturbed male client who received a variety of diagnoses such as personality disorder, schizoaffective disorder, and nonspecific psychotic disorder. His condition was drastically improved through interaction with the therapist using the medium of drawing. The severity of his condition was shocking enough for me as a psychiatrist in private practice to carefully examine the differences and similarities with the assessment and intervention that I usually practice as a behavior therapist. This case study took the form of a "narrative case study," in which there were no quantitative outcome measurements used; however, there were more similarities than differences with single case experimental design in behavior therapy. Intervention in this case was carried out through communication enabled by drawing. It can be inferred that central to this process were emotional expression through drawing and the accurate verbal responsiveness of the therapist. As the intervention progressed, there emerged discontinuous change in the client without his making conscious efforts to do. I examine the mechanism behind this next. Murase’s intervention seems to be directed at the client’s living and its context itself, while setting the initial condition and constraining condition that determine the new emerging context. This is in sharp contrast to behavior therapy that directs its intervention to facilitate continuous change in a set of behaviors selected by the assessment using functional analysis. In this case study, the initial condition consists of the assessment expressed as "first take the pulse of the situation before you, then apply the method that best conforms to it (p.109)," which enabled two constraining conditions: the framework for self-expression in the form of drawing, and honest attitude and responsiveness with no evasiveness or shakiness. These are core facilitative determinants of this therapy. Finally, I conclude my commentary by discussing how case studies can provide models and guidance for future generations of therapists and therapy researchers.
{"title":"Discontinuous Change Facilitated by Emotional Expression Through Drawing and the Accurate Verbal Responsiveness of the Therapist","authors":"Hiroaki Kumano","doi":"10.14713/PCSP.V11I4.1929","DOIUrl":"https://doi.org/10.14713/PCSP.V11I4.1929","url":null,"abstract":"Murase’s (2015) case study of Mr. R meticulously examined the process of psychotherapy with a severely disturbed male client who received a variety of diagnoses such as personality disorder, schizoaffective disorder, and nonspecific psychotic disorder. His condition was drastically improved through interaction with the therapist using the medium of drawing. The severity of his condition was shocking enough for me as a psychiatrist in private practice to carefully examine the differences and similarities with the assessment and intervention that I usually practice as a behavior therapist. This case study took the form of a \"narrative case study,\" in which there were no quantitative outcome measurements used; however, there were more similarities than differences with single case experimental design in behavior therapy. Intervention in this case was carried out through communication enabled by drawing. It can be inferred that central to this process were emotional expression through drawing and the accurate verbal responsiveness of the therapist. As the intervention progressed, there emerged discontinuous change in the client without his making conscious efforts to do. I examine the mechanism behind this next. Murase’s intervention seems to be directed at the client’s living and its context itself, while setting the initial condition and constraining condition that determine the new emerging context. This is in sharp contrast to behavior therapy that directs its intervention to facilitate continuous change in a set of behaviors selected by the assessment using functional analysis. In this case study, the initial condition consists of the assessment expressed as \"first take the pulse of the situation before you, then apply the method that best conforms to it (p.109),\" which enabled two constraining conditions: the framework for self-expression in the form of drawing, and honest attitude and responsiveness with no evasiveness or shakiness. These are core facilitative determinants of this therapy. Finally, I conclude my commentary by discussing how case studies can provide models and guidance for future generations of therapists and therapy researchers.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"11 1","pages":"255-263"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67054821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.14713/PCSP.V11I4.1933
T. Muto
In response to Kanazawa's (2015) commentary on my case study of Taro (Muto & Mitamura, 2015), I reflect on the issue of the degree of "Japaneseness" in my approach to the case study. I pursue this by anchoring the perspective of my work in the perspective of the well-known Japanese novelist, Haruki Murakami. I also respond to a point made by Hayes (2015) in his commentary on my case study.
{"title":"Acceptance and Commitment Therapy is \"Haruki Murakami\"","authors":"T. Muto","doi":"10.14713/PCSP.V11I4.1933","DOIUrl":"https://doi.org/10.14713/PCSP.V11I4.1933","url":null,"abstract":"In response to Kanazawa's (2015) commentary on my case study of Taro (Muto & Mitamura, 2015), I reflect on the issue of the degree of \"Japaneseness\" in my approach to the case study. I pursue this by anchoring the perspective of my work in the perspective of the well-known Japanese novelist, Haruki Murakami. I also respond to a point made by Hayes (2015) in his commentary on my case study.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"11 1","pages":"285-287"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67055151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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