Pub Date : 2019-03-24DOI: 10.14713/PCSP.V15I1.2047
L. Sass
I want to commend Nicole Vigoda Gonzalez (2018) for her sensitive, sophisticated, and successful treatment in the case of Rosa; and I want to commend Diana Fosha (2018) for the development of her phenomenologically sophisticated and effective Accelerated Experiential Dynamic Psychotherapy (AEDP) model, which Vigoda Gonzalez used. In this commentary I focus on a contrast between two different perspectives in Fosha’s model, and implications for the case of Rosa. This contrast includes: (a) AEDP’s focus on descriptive phenomenology, emphasizing the richness of each client’s moment-to-moment, subjective experience, versus (b) Fosha’s seemingly unqualified advocacy, in the Second Avatar version of AEDP, of the therapist explicitly encouraging meta-processing—that is, explicit self-awareness—as a final step of therapeutic healing. In my commentary I suggest that there seem to be certain limiting conditions for such advocacy. Specifically, I discuss how the clinical research literature argues that while meta-processing may be very helpful for some clients, for others—e.g., those employing the distancing defenses of derealization and depersonalization—meta-processing can be psychologically counterproductive. I conclude by re-emphasizing the importance of retaining a descriptive phenomenological perspective in AEDP.
{"title":"In the Shadows: On Meta-Awareness and Spiraling Effects in Psychotherapy—Comment on Nicole Vigoda Gonzalez and Diana Fosha","authors":"L. Sass","doi":"10.14713/PCSP.V15I1.2047","DOIUrl":"https://doi.org/10.14713/PCSP.V15I1.2047","url":null,"abstract":"I want to commend Nicole Vigoda Gonzalez (2018) for her sensitive, sophisticated, and successful treatment in the case of Rosa; and I want to commend Diana Fosha (2018) for the development of her phenomenologically sophisticated and effective Accelerated Experiential Dynamic Psychotherapy (AEDP) model, which Vigoda Gonzalez used. In this commentary I focus on a contrast between two different perspectives in Fosha’s model, and implications for the case of Rosa. This contrast includes: (a) AEDP’s focus on descriptive phenomenology, emphasizing the richness of each client’s moment-to-moment, subjective experience, versus (b) Fosha’s seemingly unqualified advocacy, in the Second Avatar version of AEDP, of the therapist explicitly encouraging meta-processing—that is, explicit self-awareness—as a final step of therapeutic healing. In my commentary I suggest that there seem to be certain limiting conditions for such advocacy. Specifically, I discuss how the clinical research literature argues that while meta-processing may be very helpful for some clients, for others—e.g., those employing the distancing defenses of derealization and depersonalization—meta-processing can be psychologically counterproductive. I conclude by re-emphasizing the importance of retaining a descriptive phenomenological perspective in AEDP.","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":"41933261","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 : 2018-12-15DOI: 10.14713/PCSP.V14I2.2039
D. Fosha
The papers in this collaborative commentary explore the importance of engaging issues of sociocultural identity in trauma treatment in general, and specifically in the AEDP treatment of Nicole Vigoda Gonzalez's (2018) case of Rosa. Issues addressed include the role of language, bilingualism and language switching in therapy in general, and a fortiori when trauma or relational trauma is involved. After brief autobiographical sketches of the contributors, organized around each author's personal bilingualism story, there are three separate commentaries: Raymond Rodriguez (2018) begins by elaborating on the construct of sociocultural identity, exploring clients' identification around their native language, and emphasizes how crucial it is to address those concerns in therapy. Next, Yamilka Urquiza Mendoza (2018) introduces the importance of specificity in addressing multicultural issues, proposing that overly broad categories risk cluelessness, just at a higher level of magnification. Taking off from Rosa's being born on a Spanish Caribbean Island, Urquiza Mendoza illustrates how applying the term Hispanic to all Spanish speakers misses the huge ethnic and cultural diversity contained within that overly broad term. In the third commentary, referencing some neurobiological findings on how the traumatized brain processes language, Huan Jacquie Ye-Perman (2018) discusses how choosing to speak in one's non-native language in treatment is not always about distancing and can often be a vehicle for differentiation and exploring new aspects of self-identity. My concluding reflections are on the specific aspects of stance and intervention that allow AEDP to embody fundamental elements, as described by Owen (2013), of the multicultural therapist’s paradigm—i.e., cultural humility, benefitting opportunities, and developing cultural comfort—and to seamlessly manifest them in the nitty gritty of day-to-day, moment-to-moment clinical work. I end with some reflections on what AEDP, with its motto of "make the implicit explicit, and the explicit experiential," needs to do to actively keep optimizing its interventions to meet the challenges of the multicultural orientation framework and to do justice to these vital considerations.
{"title":"Introduction to Commentaries on Sociocultural Identity, Trauma Treatment, and AEDP Through the Lens of Bilingualism in the Case of “Rosa”","authors":"D. Fosha","doi":"10.14713/PCSP.V14I2.2039","DOIUrl":"https://doi.org/10.14713/PCSP.V14I2.2039","url":null,"abstract":"The papers in this collaborative commentary explore the importance of engaging issues of sociocultural identity in trauma treatment in general, and specifically in the AEDP treatment of Nicole Vigoda Gonzalez's (2018) case of Rosa. Issues addressed include the role of language, bilingualism and language switching in therapy in general, and a fortiori when trauma or relational trauma is involved. After brief autobiographical sketches of the contributors, organized around each author's personal bilingualism story, there are three separate commentaries: Raymond Rodriguez (2018) begins by elaborating on the construct of sociocultural identity, exploring clients' identification around their native language, and emphasizes how crucial it is to address those concerns in therapy. Next, Yamilka Urquiza Mendoza (2018) introduces the importance of specificity in addressing multicultural issues, proposing that overly broad categories risk cluelessness, just at a higher level of magnification. Taking off from Rosa's being born on a Spanish Caribbean Island, Urquiza Mendoza illustrates how applying the term Hispanic to all Spanish speakers misses the huge ethnic and cultural diversity contained within that overly broad term. In the third commentary, referencing some neurobiological findings on how the traumatized brain processes language, Huan Jacquie Ye-Perman (2018) discusses how choosing to speak in one's non-native language in treatment is not always about distancing and can often be a vehicle for differentiation and exploring new aspects of self-identity. My concluding reflections are on the specific aspects of stance and intervention that allow AEDP to embody fundamental elements, as described by Owen (2013), of the multicultural therapist’s paradigm—i.e., cultural humility, benefitting opportunities, and developing cultural comfort—and to seamlessly manifest them in the nitty gritty of day-to-day, moment-to-moment clinical work. I end with some reflections on what AEDP, with its motto of \"make the implicit explicit, and the explicit experiential,\" needs to do to actively keep optimizing its interventions to meet the challenges of the multicultural orientation framework and to do justice to these vital considerations.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44697452","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 : 2018-12-15DOI: 10.14713/PCSP.V14I2.2040
R. Rodriguez
This paper explores social-cultural identities, in particular language, as an integral component in culturally competent psychotherapy. Integrating in treatment discussions around the complex matrix of intersecting socio-cultural identities between client and therapist enhances the therapeutic relationship and promotes treatment gains. Trauma processing, in particular, is enriched when issues of power and privilege as they pertain to socio-cultural identities are addressed. Using bilingualism and language switching in treatment are described as therapeutic interventions in working with clients who share a common language with the therapist. The importance of addressing race-based oppression and trauma is also noted.
{"title":"The Case of \"Rosa\": Exploring Socio-Cultural Identities in Treatment","authors":"R. Rodriguez","doi":"10.14713/PCSP.V14I2.2040","DOIUrl":"https://doi.org/10.14713/PCSP.V14I2.2040","url":null,"abstract":"This paper explores social-cultural identities, in particular language, as an integral component in culturally competent psychotherapy. Integrating in treatment discussions around the complex matrix of intersecting socio-cultural identities between client and therapist enhances the therapeutic relationship and promotes treatment gains. Trauma processing, in particular, is enriched when issues of power and privilege as they pertain to socio-cultural identities are addressed. Using bilingualism and language switching in treatment are described as therapeutic interventions in working with clients who share a common language with the therapist. The importance of addressing race-based oppression and trauma is also noted.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41397226","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 : 2018-12-15DOI: 10.14713/pcsp.v14i2.2042
Huan Jacquie Ye-Perman
Vigoda Gonzalez’s (2018) case study provides an excellent illustration of how AEDP leads to deep and effective treatment for a client with attachment trauma, leading not only to significant symptom reduction but also to profound change for the better. In this review, I provide additional observations and analysis of AEDP as reflected in this case, both in terms of specific interventions and the phenomenology of transformation. From the practice of multiculturalism in psychotherapy, I also highlight Vigoda Gonzalez’s bi-linguistic ability and bi-cultural background as facilitative for the therapy process. I examine the various factors that play into the impact of ethnicity/language-matching, and suggest that the lack of such matching is by no means an automatic hindrance for the therapy process. Similarly a client's choosing to speak in a language not native to them in therapy can be a vehicle for the exploration of new experiences, and new aspects of self. It is my belief that what is most important is for the culturally sensitive therapist to actively explore different means of communication within and beyond the boundaries of language, thus staying closely attuned to the client’s emotional experiences.
{"title":"The Case of “Rosa”: AEDP in the Realm of Cultural Diversity—One's New Language as a Vehicle for Exploring New Aspects of Identity","authors":"Huan Jacquie Ye-Perman","doi":"10.14713/pcsp.v14i2.2042","DOIUrl":"https://doi.org/10.14713/pcsp.v14i2.2042","url":null,"abstract":"Vigoda Gonzalez’s (2018) case study provides an excellent illustration of how AEDP leads to deep and effective treatment for a client with attachment trauma, leading not only to significant symptom reduction but also to profound change for the better. In this review, I provide additional observations and analysis of AEDP as reflected in this case, both in terms of specific interventions and the phenomenology of transformation. From the practice of multiculturalism in psychotherapy, I also highlight Vigoda Gonzalez’s bi-linguistic ability and bi-cultural background as facilitative for the therapy process. I examine the various factors that play into the impact of ethnicity/language-matching, and suggest that the lack of such matching is by no means an automatic hindrance for the therapy process. Similarly a client's choosing to speak in a language not native to them in therapy can be a vehicle for the exploration of new experiences, and new aspects of self. It is my belief that what is most important is for the culturally sensitive therapist to actively explore different means of communication within and beyond the boundaries of language, thus staying closely attuned to the client’s emotional experiences.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48125339","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 : 2018-12-15DOI: 10.14713/PCSP.V14I2.2038
D. Fosha
This paper, using the methodology of moment-to-moment microanalysis of videotape-based clinical transcripts, explores how Nicole Vigoda Gonzalez’s (2018) case study manifests AEDP’s fundamental transformational phenomenology in clinical action. Vigoda Gonzalez’s highly effective AEDP therapy of Rosa is informed by AEDP’s first "avatar" or iteration (prior to 2008), at the time, a three-state phenomenology. Yet, a close reading of the case reveals the very transformational phenomena, systematically and abundantly reflected in the author’s clinical data, that necessitated the theoretical and clinical developments of AEDP’s second avatar (post-2008) and the current four-state model of transformational change. It is a validation both of the soundness of this student therapist's clinical work and of the accuracy and power of AEDP’s healing-oriented transformational theory that constructs not in the author’s repertoire are nevertheless reflected and illustrated in the unfolding of Rosa’s treatment. This most interesting and unusual experience further illustrates how a descriptive phenomenology, guided by AEDP’s North Star, i.e., its orientation toward the wired-in healing within, can constitute an empirically sound alternative to the manualization of psychotherapeutic treatments. Also uncannily, this parallels the emphasis in Owen's (2013) multicultural orientation (MCO) framework on the need for "values" or "virtues," such as cultural humility, to "inform therapeutic activities as an alternative to the focus on multicultural competencies."
{"title":"Moment-to-Moment Guidance of Clinical Interventions by AEDP’s Healing-Oriented Transformational Phenomenology: Commentary on Vigoda Gonzalez’s (2018) Case of \"Rosa\"","authors":"D. Fosha","doi":"10.14713/PCSP.V14I2.2038","DOIUrl":"https://doi.org/10.14713/PCSP.V14I2.2038","url":null,"abstract":"This paper, using the methodology of moment-to-moment microanalysis of videotape-based clinical transcripts, explores how Nicole Vigoda Gonzalez’s (2018) case study manifests AEDP’s fundamental transformational phenomenology in clinical action. Vigoda Gonzalez’s highly effective AEDP therapy of Rosa is informed by AEDP’s first \"avatar\" or iteration (prior to 2008), at the time, a three-state phenomenology. Yet, a close reading of the case reveals the very transformational phenomena, systematically and abundantly reflected in the author’s clinical data, that necessitated the theoretical and clinical developments of AEDP’s second avatar (post-2008) and the current four-state model of transformational change. It is a validation both of the soundness of this student therapist's clinical work and of the accuracy and power of AEDP’s healing-oriented transformational theory that constructs not in the author’s repertoire are nevertheless reflected and illustrated in the unfolding of Rosa’s treatment. This most interesting and unusual experience further illustrates how a descriptive phenomenology, guided by AEDP’s North Star, i.e., its orientation toward the wired-in healing within, can constitute an empirically sound alternative to the manualization of psychotherapeutic treatments. Also uncannily, this parallels the emphasis in Owen's (2013) multicultural orientation (MCO) framework on the need for \"values\" or \"virtues,\" such as cultural humility, to \"inform therapeutic activities as an alternative to the focus on multicultural competencies.\"","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49489487","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 : 2018-09-13DOI: 10.14713/pcsp.v14i1.2034
Karen Riggs Skean
This commentary discusses the therapy of a complex trauma survivor combining Accelerated Experiential Dynamic Psychotherapy (AEDP) with culturally competent strategies, particularly the use of a shared second language of origin. This combination potentiated the transformation of early affectively and bodily held memories and facilitated a successful outcome. Implications for short-term models and the training of therapists are discussed.
{"title":"AEDP and Cultural Competence in Developmental Trauma Treatment","authors":"Karen Riggs Skean","doi":"10.14713/pcsp.v14i1.2034","DOIUrl":"https://doi.org/10.14713/pcsp.v14i1.2034","url":null,"abstract":"This commentary discusses the therapy of a complex trauma survivor combining Accelerated Experiential Dynamic Psychotherapy (AEDP) with culturally competent strategies, particularly the use of a shared second language of origin. This combination potentiated the transformation of early affectively and bodily held memories and facilitated a successful outcome. Implications for short-term models and the training of therapists are discussed.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67058155","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 : 2018-09-13DOI: 10.14713/pcsp.v14i1.2032
Nicole Vigoda Gonzales
The psychological sequelae of prolonged and repeated exposure to relational trauma can manifest into a challenging clinical picture typically known as Complex PTSD. Accelerated Experiential Dynamic Psychotherapy (AEDP) is a multimodal and integrative model particularly designed to address attachment disturbances and extreme forms of affective avoidance and dysregulation commonly seen in survivors of relational trauma. Conducting this treatment in a language that is not the patient’s native tongue may interfere with emotional processing, a key component of AEDP. The purpose of this study is twofold. First, it aims to examine the benefits of experiential and attachment-based models for the treatment of "Rosa," a bilingual woman and survivor of relational trauma, who presented to treatment with depressive and Complex PTSD-like symptom. Second, the study explores whether actively incorporating Rosa’s bilingualism and ethnic identity into the treatment enhanced her capacity for emotional processing and other related aspects of AEDP. This exploration constitutes an ideal avenue for documenting the clinical challenges one may encounter in doing psychotherapy with bilingual trauma survivors. For in this type of therapy, the affective processing of traumatic memories can be lost in translation. This requires the creation of an individualized treatment plan that can address these barriers, amplifying the emergence of relational safety and ultimately facilitating the patient’s new experience of core state (Fosha & Yeung, 2006), an integrated state of clarity, ease, and self-compassion.
{"title":"The Merits of Integrating Accelerated Experiential Dynamic Psychotherapy and Cultural Competence Strategies in the Treatment of Relational Trauma: The Case of \"Rosa\"","authors":"Nicole Vigoda Gonzales","doi":"10.14713/pcsp.v14i1.2032","DOIUrl":"https://doi.org/10.14713/pcsp.v14i1.2032","url":null,"abstract":"The psychological sequelae of prolonged and repeated exposure to relational trauma can manifest into a challenging clinical picture typically known as Complex PTSD. Accelerated Experiential Dynamic Psychotherapy (AEDP) is a multimodal and integrative model particularly designed to address attachment disturbances and extreme forms of affective avoidance and dysregulation commonly seen in survivors of relational trauma. Conducting this treatment in a language that is not the patient’s native tongue may interfere with emotional processing, a key component of AEDP. The purpose of this study is twofold. First, it aims to examine the benefits of experiential and attachment-based models for the treatment of \"Rosa,\" a bilingual woman and survivor of relational trauma, who presented to treatment with depressive and Complex PTSD-like symptom. Second, the study explores whether actively incorporating Rosa’s bilingualism and ethnic identity into the treatment enhanced her capacity for emotional processing and other related aspects of AEDP. This exploration constitutes an ideal avenue for documenting the clinical challenges one may encounter in doing psychotherapy with bilingual trauma survivors. For in this type of therapy, the affective processing of traumatic memories can be lost in translation. This requires the creation of an individualized treatment plan that can address these barriers, amplifying the emergence of relational safety and ultimately facilitating the patient’s new experience of core state (Fosha & Yeung, 2006), an integrated state of clarity, ease, and self-compassion.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67058524","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 : 2018-09-13DOI: 10.14713/PCSP.V14I1.2033
Shigeru Iwakabe
Systematic case studies can benefit understanding of the process and outcome of Accelerated Experiential Dynamic Psychotherapy (AEDP; Fosha, 2000) and other affect-focused and experiential therapies by expanding the scope of investigation from the moment-to-moment emotional change on which these therapies are particularly strong to changes that occur over and across sessions. Systematic case studies are also important because the link between in-session changes and changes in the client behavior and interpersonal relationships in daily life can be explored. In the engaging AEDP case study of "Rosa" (Vigoda Gonzales, 2018), the language switching that allowed Rosa to access painful emotions had an additional relational implication in that the therapist was able to directly connect to Rosa’s child self, which was encoded in a different language than her adult self. I suspect that this prevented Rosa and the therapist from running into difficulties due to the potential mismatch in their backgrounds. Corrective emotional experience seen in this therapy confirmed the finding by my own case study research team (Nakamura & Iwakabe, 2018b) that client therapeutic gains are most clearly reflected in new relationships rather than existing attachment relationships. My commentary concludes with some questions posed to the author relating to the issue of effective training in empathic attunement and working with strong emotions in therapy.
{"title":"Case Studies in Accelerated Experiential Dynamic Psychotherapy (AEDP):Reflections on the Case of \"Rosa\"","authors":"Shigeru Iwakabe","doi":"10.14713/PCSP.V14I1.2033","DOIUrl":"https://doi.org/10.14713/PCSP.V14I1.2033","url":null,"abstract":"Systematic case studies can benefit understanding of the process and outcome of Accelerated Experiential Dynamic Psychotherapy (AEDP; Fosha, 2000) and other affect-focused and experiential therapies by expanding the scope of investigation from the moment-to-moment emotional change on which these therapies are particularly strong to changes that occur over and across sessions. Systematic case studies are also important because the link between in-session changes and changes in the client behavior and interpersonal relationships in daily life can be explored. In the engaging AEDP case study of \"Rosa\" (Vigoda Gonzales, 2018), the language switching that allowed Rosa to access painful emotions had an additional relational implication in that the therapist was able to directly connect to Rosa’s child self, which was encoded in a different language than her adult self. I suspect that this prevented Rosa and the therapist from running into difficulties due to the potential mismatch in their backgrounds. Corrective emotional experience seen in this therapy confirmed the finding by my own case study research team (Nakamura & Iwakabe, 2018b) that client therapeutic gains are most clearly reflected in new relationships rather than existing attachment relationships. My commentary concludes with some questions posed to the author relating to the issue of effective training in empathic attunement and working with strong emotions in therapy.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49167063","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 : 2018-02-25DOI: 10.14713/pcsp.v13i4.2022
R. Karlin
Hamburg, an experienced and expert therapist, presents two successful psychotherapy cases. In both cases he viewed success as being the product of his use of metaphor, the patients' successful surmounting of a high difficulty task, hypnosis, and nonspecific factors. One of the cases involves a medically unexplained chronic and disabling pain. With a couple of brief vignettes of my own, I suggest careful screening, as using hypnosis to control medically unexplained, chronic pain may cause problems for some patients with major psychopathology (e.g., paranoid schizophrenia). Next, I note that clinical data will reflect back to us the a priori assumptions and interests we bring to it. As an example of how often and misleadingly this can happen, I discuss the autobiographical nature of clinical personality theories. Finally, I agree with Hamburg about the importance of ubiquitous nonspecific effects and note my difficulty accepting that they may be more important than the specific things we do deliberately in psychotherapy.
{"title":"Metaphor, Verstehen or Neither: A Reflection on Hypnotic Analgesia and Active Ingredients in Psychotherapy","authors":"R. Karlin","doi":"10.14713/pcsp.v13i4.2022","DOIUrl":"https://doi.org/10.14713/pcsp.v13i4.2022","url":null,"abstract":"Hamburg, an experienced and expert therapist, presents two successful psychotherapy cases. In both cases he viewed success as being the product of his use of metaphor, the patients' successful surmounting of a high difficulty task, hypnosis, and nonspecific factors. One of the cases involves a medically unexplained chronic and disabling pain. With a couple of brief vignettes of my own, I suggest careful screening, as using hypnosis to control medically unexplained, chronic pain may cause problems for some patients with major psychopathology (e.g., paranoid schizophrenia). Next, I note that clinical data will reflect back to us the a priori assumptions and interests we bring to it. As an example of how often and misleadingly this can happen, I discuss the autobiographical nature of clinical personality theories. Finally, I agree with Hamburg about the importance of ubiquitous nonspecific effects and note my difficulty accepting that they may be more important than the specific things we do deliberately in psychotherapy.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"13 1","pages":"338-347"},"PeriodicalIF":0.0,"publicationDate":"2018-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42043532","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 : 2018-02-25DOI: 10.14713/pcsp.v13i4.2023
S. R. Hamburg
I am grateful to Linda McMullen (2018) and Robert Karlin (2018), for their commentaries on my case studies of Margie and Amie (Hamburg, 2018). Although case studies do not permit strong claims regarding treatment efficacy, they allow strong claims for the plausibility that treatments are efficacious. From a pragmatic standpoint, that is sufficient to justify proposing the treatments to other practitioners to be tried and tested by them, thereby ultimately contributing to the sum total of psychotherapy craft knowledge. On the topic of the placebo effect, the perspectives of researchers and clinicians, based as they are on different kinds of knowledge, can differ to the point of irreconcilability. What have hitherto been characterized as non-specific contributors to treatment outcome might better be classified as specific factors yet to be identified.
{"title":"What Are Case Studies Good For? A Response to Commentaries by McMullen and Karlin","authors":"S. R. Hamburg","doi":"10.14713/pcsp.v13i4.2023","DOIUrl":"https://doi.org/10.14713/pcsp.v13i4.2023","url":null,"abstract":"I am grateful to Linda McMullen (2018) and Robert Karlin (2018), for their commentaries on my case studies of Margie and Amie (Hamburg, 2018). Although case studies do not permit strong claims regarding treatment efficacy, they allow strong claims for the plausibility that treatments are efficacious. From a pragmatic standpoint, that is sufficient to justify proposing the treatments to other practitioners to be tried and tested by them, thereby ultimately contributing to the sum total of psychotherapy craft knowledge. On the topic of the placebo effect, the perspectives of researchers and clinicians, based as they are on different kinds of knowledge, can differ to the point of irreconcilability. What have hitherto been characterized as non-specific contributors to treatment outcome might better be classified as specific factors yet to be identified.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"13 1","pages":"348-352"},"PeriodicalIF":0.0,"publicationDate":"2018-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44366321","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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