Pub Date : 2019-07-12DOI: 10.14713/PCSP.V15I2.2054
Ben G. Adams
This commentary discusses Dr. Paul Blimling’s (2019) composite case of James, a patient with a history of severe childhood interpersonal trauma, who responded remarkably well to individual psychotherapy augmented with the targeted use of self-selected music. I describe how music and psychotherapy both have their origins in the shamanistic practices of our hunter-gatherer ancestors, such that combining psychotherapy and music together is a reconciliation of sorts. The Case of James demonstrates how music can be used in psychotherapy with a counter-dependent patient, to help the patient to access sensitive, vulnerable feelings that normally would never be expressed to another person. In this case, the therapist’s keen sensitivity to the patient’s disorganized attachment style created an environment in which the patient eventually felt safe lowering his defenses and expressing his emotions in the treatment—with the help of five songs. Aside from the direct, visceral benefits of the music itself, the process of asking a relationally traumatized patient to select a song has other potential benefits. For example, it supports the patient’s sense of self (which, in the relationally traumatized patient, is likely fragmented), and it may reduce the "hot seat" feeling with a self-conscious patient, by shifting focus from the patient to the song. Songs selected by patients in advance of a session versus songs selected during a session may provide different types of information, and may have different types of benefits. If I were working with a patient such as James, two additional possibilities I would consider are (a) helping the patient to develop practical skills for managing overwhelming emotions, and (b) making the patient’s goals a more prominent focus throughout the treatment.
{"title":"Self-Selected Music for Relational Trauma: Commentary on the Psychotherapy Case of \"James\"","authors":"Ben G. Adams","doi":"10.14713/PCSP.V15I2.2054","DOIUrl":"https://doi.org/10.14713/PCSP.V15I2.2054","url":null,"abstract":"This commentary discusses Dr. Paul Blimling’s (2019) composite case of James, a patient with a history of severe childhood interpersonal trauma, who responded remarkably well to individual psychotherapy augmented with the targeted use of self-selected music. I describe how music and psychotherapy both have their origins in the shamanistic practices of our hunter-gatherer ancestors, such that combining psychotherapy and music together is a reconciliation of sorts. The Case of James demonstrates how music can be used in psychotherapy with a counter-dependent patient, to help the patient to access sensitive, vulnerable feelings that normally would never be expressed to another person. In this case, the therapist’s keen sensitivity to the patient’s disorganized attachment style created an environment in which the patient eventually felt safe lowering his defenses and expressing his emotions in the treatment—with the help of five songs. Aside from the direct, visceral benefits of the music itself, the process of asking a relationally traumatized patient to select a song has other potential benefits. For example, it supports the patient’s sense of self (which, in the relationally traumatized patient, is likely fragmented), and it may reduce the \"hot seat\" feeling with a self-conscious patient, by shifting focus from the patient to the song. Songs selected by patients in advance of a session versus songs selected during a session may provide different types of information, and may have different types of benefits. If I were working with a patient such as James, two additional possibilities I would consider are (a) helping the patient to develop practical skills for managing overwhelming emotions, and (b) making the patient’s goals a more prominent focus throughout the treatment.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46615205","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 : 2019-07-12DOI: 10.14713/PCSP.V15I2.2055
G. P. Blimling
In this article, I respond to the insightful commentaries by Karen Riggs Skean (2019), by Richard Harrison (2019), and by Ben Adams (2019) on my hybrid case study of "James," a survivor of chronic relational trauma (Blimling, 2019). These commentaries have stimulated me to think further about the impact of music on my individual psychotherapy work, both with James and with subsequent clients, and specifically with regard to its impact on my approach to group psychotherapy work. In addition, these commentaries have raised particular issues that I respond to, including, (a) constructive criticism by Skean and Harrison regarding the potential further use of "metaprocessing" and the developments made in Accelerated Experiential Dynamic Psychotherapy (AEDP) since I completed the Case of James; (b) Skean’s perceptive point explaining how an individual therapist can take a personal passion—like music or literary writing or bicultural identity—and use it to enhance his or her enlivened presence in therapy with a client; and (c) Adams’ thesis that music and psychotherapy both have their origins in the shamanistic practices of our hunter-gatherer ancestors, suggesting that the combination of psychotherapy and music is a kind of return to our very roots.
{"title":"Facing the Music: Further Thoughts on Integrating Music into Psychotherapy","authors":"G. P. Blimling","doi":"10.14713/PCSP.V15I2.2055","DOIUrl":"https://doi.org/10.14713/PCSP.V15I2.2055","url":null,"abstract":"In this article, I respond to the insightful commentaries by Karen Riggs Skean (2019), by Richard Harrison (2019), and by Ben Adams (2019) on my hybrid case study of \"James,\" a survivor of chronic relational trauma (Blimling, 2019). These commentaries have stimulated me to think further about the impact of music on my individual psychotherapy work, both with James and with subsequent clients, and specifically with regard to its impact on my approach to group psychotherapy work. In addition, these commentaries have raised particular issues that I respond to, including, (a) constructive criticism by Skean and Harrison regarding the potential further use of \"metaprocessing\" and the developments made in Accelerated Experiential Dynamic Psychotherapy (AEDP) since I completed the Case of James; (b) Skean’s perceptive point explaining how an individual therapist can take a personal passion—like music or literary writing or bicultural identity—and use it to enhance his or her enlivened presence in therapy with a client; and (c) Adams’ thesis that music and psychotherapy both have their origins in the shamanistic practices of our hunter-gatherer ancestors, suggesting that the combination of psychotherapy and music is a kind of return to our very roots.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43063793","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 : 2019-07-12DOI: 10.14713/PCSP.V15I2.2051
G. P. Blimling
The purpose of this study is to explore the utility and feasibility of incorporating client-chosen music listening into a short-term dynamic therapy model in an individual with trauma. Specifically, Diana Fosha’s Accelerated Experiential Dynamic Psychotherapy (AEDP) was chosen due to its focus on emotional experience and attachment. Relevant literature regarding the current clinical applications of music is presented, along with research supporting music’s effects on relevant psychotherapeutic mechanisms such as affect, autobiographical memory, and attachment. These effects are illustrated through the use of the hybrid case example of "James," a composite psychotherapy client who struggles with symptoms stemming from relational trauma. In addition to being informed by clinical examples in relevant psychological literature, James' case is assembled from actual psychotherapy cases of the author. Demonstrating this client’s course of treatment provides an avenue for describing key clinical issues related to the utility of music within a more traditional short-term dynamic therapy model. By adopting a qualitative, disciplined inquiry approach, treatment is tailored to the client’s unique psychological struggles within the context of historical, contextual, and relational factors. Following a pragmatic case study research format (Fishman, 2005), case material is analyzed both qualitatively and quantitatively. Discussion explores how an integrative treatment approach, exemplified in the case of James, can effectively combine psychodynamic, relational, and musical elements in treating individuals with relational trauma and the resulting pathology. James’ case is designed to be a resource for therapists who seek to gain additional understanding of a new component in providing effective and meaningful treatment for individuals with relational trauma.
{"title":"The Effect of Integrating Music Listening With an Attachment- And Affective-Focused Short-Term Psychotherapy in an Individual With Relational Trauma: The Case of \"James\"","authors":"G. P. Blimling","doi":"10.14713/PCSP.V15I2.2051","DOIUrl":"https://doi.org/10.14713/PCSP.V15I2.2051","url":null,"abstract":"The purpose of this study is to explore the utility and feasibility of incorporating client-chosen music listening into a short-term dynamic therapy model in an individual with trauma. Specifically, Diana Fosha’s Accelerated Experiential Dynamic Psychotherapy (AEDP) was chosen due to its focus on emotional experience and attachment. Relevant literature regarding the current clinical applications of music is presented, along with research supporting music’s effects on relevant psychotherapeutic mechanisms such as affect, autobiographical memory, and attachment. These effects are illustrated through the use of the hybrid case example of \"James,\" a composite psychotherapy client who struggles with symptoms stemming from relational trauma. In addition to being informed by clinical examples in relevant psychological literature, James' case is assembled from actual psychotherapy cases of the author. Demonstrating this client’s course of treatment provides an avenue for describing key clinical issues related to the utility of music within a more traditional short-term dynamic therapy model. By adopting a qualitative, disciplined inquiry approach, treatment is tailored to the client’s unique psychological struggles within the context of historical, contextual, and relational factors. Following a pragmatic case study research format (Fishman, 2005), case material is analyzed both qualitatively and quantitatively. Discussion explores how an integrative treatment approach, exemplified in the case of James, can effectively combine psychodynamic, relational, and musical elements in treating individuals with relational trauma and the resulting pathology. James’ case is designed to be a resource for therapists who seek to gain additional understanding of a new component in providing effective and meaningful treatment for individuals with relational trauma.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41348393","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 : 2019-07-12DOI: 10.14713/PCSP.V15I2.2052
K. Skean
This commentary discusses the therapy of a hybridized client (Blimling, 2019) with a difficult relational trauma history in which client-chosen music was combined with a short-term treatment utilizing Accelerated Experiential Dynamic Psychotherapy (AEDP). This combination bypassed rigid defenses and allowed access to a level of affect not ordinarily available to the client, allowing significant symptomatic and relational shifts to occur. Primary goals of helping the client deal with a major loss, reduce his level of depression, and improve his interpersonal functioning were met. Implications for the use of integrative methods with short-term models and the importance of therapist flexibility are discussed.
{"title":"Integrating Client-Chosen Music in Relational Trauma Treatment: Pathways to the Heart","authors":"K. Skean","doi":"10.14713/PCSP.V15I2.2052","DOIUrl":"https://doi.org/10.14713/PCSP.V15I2.2052","url":null,"abstract":"This commentary discusses the therapy of a hybridized client (Blimling, 2019) with a difficult relational trauma history in which client-chosen music was combined with a short-term treatment utilizing Accelerated Experiential Dynamic Psychotherapy (AEDP). This combination bypassed rigid defenses and allowed access to a level of affect not ordinarily available to the client, allowing significant symptomatic and relational shifts to occur. Primary goals of helping the client deal with a major loss, reduce his level of depression, and improve his interpersonal functioning were met. Implications for the use of integrative methods with short-term models and the importance of therapist flexibility are discussed.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41794126","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 : 2019-07-12DOI: 10.14713/PCSP.V15I2.2053
Richard L Harrison
The integration of music listening into Accelerated Experiential Dynamic Psychotherapy (AEDP) is explored through discussion of Dr. Paul Blimling’s (2019) composite case study, "James." AEDP is a healing-oriented, non-pathologizing, experiential therapy model in which the therapist actively seeks to harness glimmers of resilience from the outset of treatment, and to co-engender safety within the therapy relationship in order to unleash the transforming power of attachment and emotion (Fosha, 2000, 2003, 2009, 2018). Blimling’s incorporation of music listening into the treatment of a highly defended, initially hostile patient helped bypass defenses, foster attachment within the therapy relationship, and access and co-regulate the patient’s affective experience. Key AEDP change mechanisms in the treatment included: undoing aloneness; affirmative work with defenses; dyadic affect regulation; emotion processing; and (to a lesser extent), metatherapeutic processing (metaprocessing for short). The latter is a unique and important contribution of AEDP to our field. Since the publication of Fosha’s The Transforming Power of Affect (2000), AEDP itself has evolved from an attachment- and emotion-focused model to also focus increasingly and explicitly on transformational experience as an agent of change. The experience of positive change itself is now seen as an equally important AEDP change mechanism, alongside attachment and emotion processing. Metatherapeutic processing of patients’ experiences of positive change, which involves a recursive alternation between exploration of new experience and reflection on that experience, frequently results in an expansive spiral of the transformational processes and affects identified by Fosha (2009, 2018). In addition to affirming Blimling’s choice of AEDP and his sensitive and skillful integration of music listening into the treatment, I envision how the transformational process described in the case study might have been further expanded, deepened, and consolidated, had the therapist more assiduously and experientially explored the patient’s experiences of positive change.
{"title":"A Bridge Over Troubled Water: Commentary on Paul Blimling’s Case of \"James\" Integrating Music Listening into AEDP","authors":"Richard L Harrison","doi":"10.14713/PCSP.V15I2.2053","DOIUrl":"https://doi.org/10.14713/PCSP.V15I2.2053","url":null,"abstract":"The integration of music listening into Accelerated Experiential Dynamic Psychotherapy (AEDP) is explored through discussion of Dr. Paul Blimling’s (2019) composite case study, \"James.\" AEDP is a healing-oriented, non-pathologizing, experiential therapy model in which the therapist actively seeks to harness glimmers of resilience from the outset of treatment, and to co-engender safety within the therapy relationship in order to unleash the transforming power of attachment and emotion (Fosha, 2000, 2003, 2009, 2018). Blimling’s incorporation of music listening into the treatment of a highly defended, initially hostile patient helped bypass defenses, foster attachment within the therapy relationship, and access and co-regulate the patient’s affective experience. Key AEDP change mechanisms in the treatment included: undoing aloneness; affirmative work with defenses; dyadic affect regulation; emotion processing; and (to a lesser extent), metatherapeutic processing (metaprocessing for short). The latter is a unique and important contribution of AEDP to our field. Since the publication of Fosha’s The Transforming Power of Affect (2000), AEDP itself has evolved from an attachment- and emotion-focused model to also focus increasingly and explicitly on transformational experience as an agent of change. The experience of positive change itself is now seen as an equally important AEDP change mechanism, alongside attachment and emotion processing. Metatherapeutic processing of patients’ experiences of positive change, which involves a recursive alternation between exploration of new experience and reflection on that experience, frequently results in an expansive spiral of the transformational processes and affects identified by Fosha (2009, 2018). In addition to affirming Blimling’s choice of AEDP and his sensitive and skillful integration of music listening into the treatment, I envision how the transformational process described in the case study might have been further expanded, deepened, and consolidated, had the therapist more assiduously and experientially explored the patient’s experiences of positive change.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46258090","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 : 2019-03-24DOI: 10.14713/PCSP.V15I1.2044
M. Franklin
The Case of "Daniel" (Tice, 2019) provides an in-depth look at the implementation of an empirically supported psychotherapy, Exposure and Response Prevention (E/RP), in the treatment of a boy with a severe and complex symptom presentation. The discussion begins with explication of guiding theory pertaining both to the disorders that were targeted, Obsessive-Compulsive Disorder (OCD) and generalized anxiety disorder (GAD), as well as their cognitive-behavioral treatment. The assessment and hierarchy-development aspects of the case are presented, and treatment targets identified. Implementation of E/RP followed a specific treatment manual, but the discussion of case material goes beyond the manual in addressing the interpersonal context of therapy, challenges met and overcome along the way, and the importance of using positive reinforcement for effort in keeping a child moving successfully towards more and more challenging tasks. The role of the therapist’s own interpersonal style is also addressed in how this factor may facilitate and complicate treatment delivery, and therapists are encouraged to examine how this may affect what they do and do not do even in the context of protocol-driven treatment.
{"title":"Forests and Trees: Commentary on the Case of \"Daniel\"","authors":"M. Franklin","doi":"10.14713/PCSP.V15I1.2044","DOIUrl":"https://doi.org/10.14713/PCSP.V15I1.2044","url":null,"abstract":"The Case of \"Daniel\" (Tice, 2019) provides an in-depth look at the implementation of an empirically supported psychotherapy, Exposure and Response Prevention (E/RP), in the treatment of a boy with a severe and complex symptom presentation. The discussion begins with explication of guiding theory pertaining both to the disorders that were targeted, Obsessive-Compulsive Disorder (OCD) and generalized anxiety disorder (GAD), as well as their cognitive-behavioral treatment. The assessment and hierarchy-development aspects of the case are presented, and treatment targets identified. Implementation of E/RP followed a specific treatment manual, but the discussion of case material goes beyond the manual in addressing the interpersonal context of therapy, challenges met and overcome along the way, and the importance of using positive reinforcement for effort in keeping a child moving successfully towards more and more challenging tasks. The role of the therapist’s own interpersonal style is also addressed in how this factor may facilitate and complicate treatment delivery, and therapists are encouraged to examine how this may affect what they do and do not do even in the context of protocol-driven treatment.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46301695","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 : 2019-03-24DOI: 10.14713/PCSP.V15I1.2043
A. Tice
Exposure and Response Prevention (E/RP) is an evidenced-based, short-term (12-20 sessions) treatment for Obsessive-Compulsive Disorder (OCD). This treatment has been shown to be effective in randomized control trials (RCTs), including pediatric samples (Franklin et al., 2011). Despite the strong evidence supporting the effectiveness of E/RP, the current E/RP literature remains wanting in terms of clinical process research to support novice clinicians in the adaptation of the principles, techniques, and interventions with such a complex and heterogeneous disorder, as well as with youth suffering from comorbid disorders. Thus, the present study aims to provide a detailed account of the course of a 25-session E/RP treatment and its outcomes with a 14-year-old called by the pseudonym "Daniel," to protect his identity. Guided by the Pragmatic Case Study Method (Fishman, 1999, 2005, 2013), as the therapist I examined this case in systematic qualitative detail and also gathered and analyzed data from standardized quantitative assessment measures. The study concludes with an analysis of the process used in meeting Daniel’s positive treatment goals as well as a discussion of the importance of adaptations made to the E/RP manualized protocol to address the entire range of Daniels’s symptoms.
{"title":"Adapting an Exposure and Response Prevention Manual To Treat Youth Obsessive-Compulsive Disorder and Comorbid Anxiety Disorder: The Case of \"Daniel\"","authors":"A. Tice","doi":"10.14713/PCSP.V15I1.2043","DOIUrl":"https://doi.org/10.14713/PCSP.V15I1.2043","url":null,"abstract":"Exposure and Response Prevention (E/RP) is an evidenced-based, short-term (12-20 sessions) treatment for Obsessive-Compulsive Disorder (OCD). This treatment has been shown to be effective in randomized control trials (RCTs), including pediatric samples (Franklin et al., 2011). Despite the strong evidence supporting the effectiveness of E/RP, the current E/RP literature remains wanting in terms of clinical process research to support novice clinicians in the adaptation of the principles, techniques, and interventions with such a complex and heterogeneous disorder, as well as with youth suffering from comorbid disorders. Thus, the present study aims to provide a detailed account of the course of a 25-session E/RP treatment and its outcomes with a 14-year-old called by the pseudonym \"Daniel,\" to protect his identity. Guided by the Pragmatic Case Study Method (Fishman, 1999, 2005, 2013), as the therapist I examined this case in systematic qualitative detail and also gathered and analyzed data from standardized quantitative assessment measures. The study concludes with an analysis of the process used in meeting Daniel’s positive treatment goals as well as a discussion of the importance of adaptations made to the E/RP manualized protocol to address the entire range of Daniels’s symptoms.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42504465","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 : 2019-03-24DOI: 10.14713/PCSP.V15I1.2045
Liza E. Pincus, Andrea M. Quinn
The first author (LEP) is a third year clinical psychology doctoral student at the Graduate School of Applied and Professional Psychology (GSAPP) at Rutgers University, working under the supervision of the second author (AQ) at GSAPP’s Anxiety Disorders Clinic, which the second author directs. As a fellow student clinician, the first author had a particular appreciation for Dr. Alexander Tice’s treatment of "Daniel" (2019), a client with a complex clinical presentation who appears to have greatly benefited from his treatment with Tice, under the supervision of Dr. Martin Franklin. Much of Tice’s experience applying theoretical principles to treating specific disorders, as well as finding a delicate balance between manual-based treatment and real-world clinical application of those manuals, reflects the experiences of the first author (LEP) as a cognitive-behavioral therapist working at a graduate student training clinic.
{"title":"When Psychological Comorbidities Demand Flexibility: Treatment Adaptations for Youth Anxiety Disorders","authors":"Liza E. Pincus, Andrea M. Quinn","doi":"10.14713/PCSP.V15I1.2045","DOIUrl":"https://doi.org/10.14713/PCSP.V15I1.2045","url":null,"abstract":"The first author (LEP) is a third year clinical psychology doctoral student at the Graduate School of Applied and Professional Psychology (GSAPP) at Rutgers University, working under the supervision of the second author (AQ) at GSAPP’s Anxiety Disorders Clinic, which the second author directs. As a fellow student clinician, the first author had a particular appreciation for Dr. Alexander Tice’s treatment of \"Daniel\" (2019), a client with a complex clinical presentation who appears to have greatly benefited from his treatment with Tice, under the supervision of Dr. Martin Franklin. Much of Tice’s experience applying theoretical principles to treating specific disorders, as well as finding a delicate balance between manual-based treatment and real-world clinical application of those manuals, reflects the experiences of the first author (LEP) as a cognitive-behavioral therapist working at a graduate student training clinic.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45314649","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 : 2019-03-24DOI: 10.14713/PCSP.V15I1.2049
D. Fosha
In the previous issue of this journal, I commented (Fosha, 2018) on the psychotherapy case study of "Rosa," written by Nicole Vigoda Gonzalez (2018). To address Rosa’s relational trauma and major depression, Vigoda Gonzalez effectively put into clinical action the psychotherapy model I developed, called Accelerated Experiential Dynamic Psychotherapy (AEDP). In my commentary, I discussed how AEDP’s four-state transformational phenomenology can be used to guide the therapist’s choice of interventions. I also showed how the moment-to-moment tracking of the vitality affects accompanying affective experiences is crucial to (a) the processing of core emotions to a healing conclusion, and (b) the metatherapeutic processing (or metaprocessing for short) of this healing—two core concepts in AEDP. In the current issue of the journal, Louis Sass (2019), an internationally recognized expert on phenomenology and psychopathology, has commented on my commentary, endorsing the importance of a phenomenological perspective in psychotherapy. He also raised some concerns about the use and usefulness of metaprocessing for some types of clients, especially those with the distancing defenses of derealization and depersonalization. In this article I respond to Sass’s important and very thoughtful points.
{"title":"In the Light: On Meta-Experience and Spiraling Effects in Psychotherapy—Commentary on Louis Sass’s Commentary on Diana Fosha’s Commentary on Nicole Vigoda Gonzalez’s Case of \"Rosa\"","authors":"D. Fosha","doi":"10.14713/PCSP.V15I1.2049","DOIUrl":"https://doi.org/10.14713/PCSP.V15I1.2049","url":null,"abstract":"In the previous issue of this journal, I commented (Fosha, 2018) on the psychotherapy case study of \"Rosa,\" written by Nicole Vigoda Gonzalez (2018). To address Rosa’s relational trauma and major depression, Vigoda Gonzalez effectively put into clinical action the psychotherapy model I developed, called Accelerated Experiential Dynamic Psychotherapy (AEDP). In my commentary, I discussed how AEDP’s four-state transformational phenomenology can be used to guide the therapist’s choice of interventions. I also showed how the moment-to-moment tracking of the vitality affects accompanying affective experiences is crucial to (a) the processing of core emotions to a healing conclusion, and (b) the metatherapeutic processing (or metaprocessing for short) of this healing—two core concepts in AEDP. In the current issue of the journal, Louis Sass (2019), an internationally recognized expert on phenomenology and psychopathology, has commented on my commentary, endorsing the importance of a phenomenological perspective in psychotherapy. He also raised some concerns about the use and usefulness of metaprocessing for some types of clients, especially those with the distancing defenses of derealization and depersonalization. In this article I respond to Sass’s important and very thoughtful points.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48728154","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 : 2019-03-24DOI: 10.14713/PCSP.V15I1.2046
A. Tice
In this article, I respond to commentaries by Martin Franklin (2019) and by Liza Pincus and Andrea Quinn (2019) about my case study of "Daniel" (Tice, 2019), a 14-year-old young man presenting to therapy with Obsessive Compulsive Disorder (OCD) and Generalized Anxiety Disorder (GAD). I treated Daniel with a manual-based, 25-session treatment centered around the cognitive-behavioral approach of Exposure and Response Prevention (E/RP). A major theme running through my case study and the two commentaries is the need for flexibility in adapting the manual to be responsive to a variety of factors associated with Daniel’s disorder, such as his personality, interests, life situation, attitude towards his symptoms, and his way of relating to the therapist. In the context of the commentaries, I review a variety of the specific ways in which I learned to be flexible. Some of these included (a) focusing on nonspecific factors in developing a strong therapeutic alliance and rapport; (b) paying particular attention to how I communicated relevant psychoeducational concepts to Daniel, particularly by the use of metaphors, in preparing him for the E/RP procedures and in encouraging his participation; and (c) focusing on the process of making decisions at important clinical choice points.
{"title":"The Case of \"Daniel\": Flexibly Delivering an Inherently Challenging Treatment in the Face of a Complex Presentation","authors":"A. Tice","doi":"10.14713/PCSP.V15I1.2046","DOIUrl":"https://doi.org/10.14713/PCSP.V15I1.2046","url":null,"abstract":"In this article, I respond to commentaries by Martin Franklin (2019) and by Liza Pincus and Andrea Quinn (2019) about my case study of \"Daniel\" (Tice, 2019), a 14-year-old young man presenting to therapy with Obsessive Compulsive Disorder (OCD) and Generalized Anxiety Disorder (GAD). I treated Daniel with a manual-based, 25-session treatment centered around the cognitive-behavioral approach of Exposure and Response Prevention (E/RP). A major theme running through my case study and the two commentaries is the need for flexibility in adapting the manual to be responsive to a variety of factors associated with Daniel’s disorder, such as his personality, interests, life situation, attitude towards his symptoms, and his way of relating to the therapist. In the context of the commentaries, I review a variety of the specific ways in which I learned to be flexible. Some of these included (a) focusing on nonspecific factors in developing a strong therapeutic alliance and rapport; (b) paying particular attention to how I communicated relevant psychoeducational concepts to Daniel, particularly by the use of metaphors, in preparing him for the E/RP procedures and in encouraging his participation; and (c) focusing on the process of making decisions at important clinical choice points.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43631836","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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