Wish and overgeneralization model for psychotherapy integration.

This article introduces a clinical Wish and Overgeneralization (W&O) Model for dynamic, cognitive and narrative procedures, supported by a metasynthetic study linking cognitive overgeneralization and psychodynamic transference and determining it to be the antithesis of wish – a Luborsky (1988a) transference component. The model emphasizes symptoms and patient core themes: The therapist interprets the conflict between wish and overgeneralization, indicating how it confirms the overgeneralization and sabotages the wish. He helps the patient identify unique outcomes (White & Epston, 1990) for formulation of positive self-statements (Meichenbaum, 1994, 1985, 1977) and proposes an alternative narrative based on a coherent experience. This integrative therapy thus combines insight-oriented and coping strategies. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

"I apologize for being late": The courteous psychotherapist.

Psychotherapists may behave discourteously toward clients, often unconsciously and without being aware of it. The effort here is to alert therapists to the simplest ingredient of the positive therapeutic relationship--behaving courteously toward our clients. A limited number of pitfalls are discussed including: tardiness, tiredness and fatigue, in-session electronic interruptions, drinking alone in the presence of the client, checking the clock, and improperly addressing clients by name. This brief list encourages therapists to be alert to these as well as other behaviors that may have the potential to be offensive. When therapist discourteous behavior has taken place, it is important for therapists to do what they can to repair the damage, especially if a rupture has ensued. It is recommended that therapists encourage clients to discuss their feelings about the offending behavior in the presence of the nondefensive therapist. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Errors and misconstruals in the reporting of Freud's work: An illustration.

In an article published in this journal, Gornick (see record 1987-13536-001) discussed the situation of the female analyst or therapist and the male patient. In attempting to establish a "new narrative:" she made reference to Freud's ideas about transference. However, many of the references misstate or misconstrue Freud's position. This thesis is illustrated by a detailed examination of five errors contained in a brief section of Gornick's article entitled "The Erotic Transference." The article closes with a plea for scholarly accuracy in portraying the positions of those with whom one disagrees. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A parallel scales approach to the study of the exploratory task in psychotherapy.

Introduces a process scoring system that consists of parallel scales for patient and therapist responses. The ultimate goal of the scoring system is to facilitate investigation of relationships between therapist–patient interaction patterns in exploratory aspects of psychotherapy and counseling and treatment outcomes. The conception of expressive-exploratory aspects of therapy as a shared task of therapeutic alliances on which the scales are based is explained, and illustrative previous research on the relationship between therapist and patient levels of functioning in the exploratory task is reviewed. An interactional version of the assumption of a positive association between therapist and patient levels of process functioning was derived and tested in 22 psychotherapy interactions involving 6 patients, aged 19–28 yrs. Results show a tendency for process levels of therapist and patient responses to fluctuate in the rather closely linked, tandem fashion that was predicted. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The handbook of constructive therapies: Innovative approaches from leading practitioners.

Reviews the book, The handbook of constructive therapies: Innovative approaches from leading practitioners by Michael F. Hoyt (see record 1998-07937-000). The range of therapies fitting within the "constructivist" rubric includes (but is not limited to) narrative, solution-focused, solution-oriented, possibility, dialogic, reflective, and various aspects of family therapy. How does one teach-or learn-constructivism? A handbook, after all, is designed as a guide that tells you how to do things. For some of these authors, constructivism is an attitude, a perspective, a way of listening and being in dialogue. It is evanescent, in the unique moment. Others share specific techniques, some of which have become nearly reified through workshop presentations. Taken as a whole, these chapters work both within and across each other, comparable to the effective functioning of reflecting teams. The many voices complement and add further meaning. Most chapters are engagingly and clearly written, inviting the reader to further comprehension. Case examples, some in considerable detail, add to that understanding. As the chapters intersect and "speak" to each other, the reader can reflect on the "meta issues": the role of therapist, who is therapist, what is therapy, and what is therapeutic. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hierarchical continuous-time sequential analysis: A strategy for clinical research.

Presents a strategy for analyzing interdyadic differences in sequential data on social interactions. The social interactive data could be, for example, a nonverbal behavior such as eye gazes within dyads, with measurement of both the sequence of behaviors and their durations. This article shows (1) how one can statistically describe an interactional structure within each dyad governing the stream of that dyad's social interactive behavior and (2) how scores describing dyadic structures can be related to covariate information about the dyads. The covariates could include, for example, ratings of therapist skill or client psychopathology. Methods for relating measures of within-dyad structures in interactive behavior to between-dyad covariates could be a powerful tool for research on psychotherapy process or interpersonal relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

If sex enters into the psychotherapy relationship.

This article was originally published by the Committee on Women in Psychology to inform the public about the harmful effects of therapist–patient sexual intimacy. The Committee points out that sexual contact between a therapist and his or her patient is prohibited by the Ethical Principles of Psychologists of the American Psychological Association, as well as by the ethics codes of most other associations representing the professions licensed to conduct psychotherapy. The Committee discusses how to tell whether a therapist's conduct is appropriate and the importance of discussing with the therapist anything that he or she does that leads to discomfort whether or not it is sexual in nature. It also points out the negative effects of ending therapy to have a personal relationship. The Committee presents a range of actions that might be taken if sexual intimacy does occur. Although originally published as a consumer-oriented brochure, the article provides information for psychotherapists, trainers of psychotherapists, and other individuals concerned with therapy ethics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Narrative empathy.

Therapeutic empathy is described as an active narrative process, in which the therapist attempts to construe and express the inner emotional logic of the client's problem patterns. The empathic narrative is contrasted to the external narrative, which describes the client from the outside and the client's behavior as making sense from the point of view of the theory rather than from that of the client's. The criterion of an empathic narrative is that it elicits from the client the response "That's me!" The external narrative, in distinction, fails to elicit this self-recognition. The persistent rejection of the therapist's formulations by the client and the ensuing state of therapeutic impasse is interpreted as being often due to the therapist's assumption that the client should accept an external narrative as if it were an empathic one. When such a situation develops, the therapist may overcome the impasse by acknowledging the externality of the previous therapeutic narrative and proposing a potentially empathic one in its stead. Three case examples of a 49-yr-old married woman, a teenage girl, and 28-yr-old single male are presented to demonstrate narrative empathy within the therapeutic context. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical monitoring for patients with severe craniocerebral injury

In references to an individual, agency refers to the capacity of the individual for meaningful action. Protecting and nurturing patient agency is a central feature of nursing work. The moral ideals and aim of nursing practice reflect a commitment to the patient that includes the patient as central to the determination of what happens to her or him. Whereas we most commonly think of the capacity to make these determinations as autonomy, I use the term agency because autonomy is a complicated and contested issue within philosophy and ethics. In an earlier issue, I suggested that an understanding of place is important to ethics. This is so because different places or institutions do different kinds of work, have different values, endow ethical concepts with different meanings, are structured by different visions, and are controlled and influenced by different kinds of knowledge and power. All these factors work together to determine a person's agency within a given place or environment. For example, home care providers cannot act in patients' homes in the same way they can act in a hospital, and providers cannot act in a school the way they act in a hospital. At the same time, patients' power to act is constrained in the hospital in ways that it is not in their homes. In the following narrative of an experienced home care nurse, I examine the ethical concern that can result from a commitment to patient agency by home care providers.     

The psychotherapist's experience of interest and boredom.

Explores the clinical utility of conceptualizing the intensity and direction of psychotherapists' interest in their patients in terms of the interdependent aspects of the patient–therapist relationship. An evolving interpretive framework is presented that takes into account the affective, cognitive, and motivational properties and the object-relational nature of interests. Focus is on the therapeutic possibilities and limitations of the hypothesis that the ebb and flow of a therapist's interest in a particular patient occurs in the context of a complex interaction in which both patient and therapist play important roles. The origins, meanings, and management of boredom in the therapeutic situation are given special consideration. A clinical vignette illustrates the interactional nature of boredom in the therapeutic situation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reunion at last--But with whom? A reply to Drs. Carter and Binder.

In their commentaries on The Reunion Process: A New Focus in Short-Term Dynamic Psychotherapy (see records 2007-09422-003 and 2007-09422-003), Drs. Binder and Carter have both suggested that the progress reported in the case history was due to the relationship between patient and therapist, rather than the intrapsychic work of reunion with the patient's parents. In my rejoinder, I will argue that the therapeutic relationship is absolutely necessary to a successful treatment, but not always sufficient to help the patient resolve his difficulties. Although current research demonstrates that the relationship in the office has a greater effect on outcome than technique, this research is based on existing technique; it is always possible that a new technique could be more effective than preceding ones. I note that there may be other reasons for skepticism about the reunion process. For example, the therapist may feel so empathic with the patient's anger that forgiveness and a sense of reunion are not considered possible. I conclude that using this method will give the patient a deep sense of reunion, both with the therapist and with his early attachment figures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How Does Narrative Cue Children's Perspective Taking?

Three experiments with a total of 120 children between 4 and 9 years of age revealed systematic errors in the recall of deictic terms from a narrative. In some cases, the terms were inconsistent with the perspective of a protagonist. The errors occurred in all age groups and were at the same level whether the protagonist was "good" or "bad" but were less common in a narrative that did not include a protagonist. The pattern of errors suggests that children adopted a perspective within the narrative. Moreover, it seems that whereas the form of the narrative is sufficient to provoke a shift in perspective, children might find it even easier to adopt a perspective when the narrative content is about a protagonist. It thus seems that the form and the content of the narrative (that it is about a person) can combine to give a strong cue to perspective. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The legal implications of sexual activity between psychiatrist and patient

The author examines the legal and professional sanctions against sex between therapist and patient. The relevant literature of criminal law suggests that charges of rape or related sexual offenses against psychotherapists who exploit their patients are a remote possibility. Although sexual activity between therapist and patient may form the basis of a malpractice claim, the existing case law is complicated, and the legal distinctions are not always consistent with good psychiatric practice. Professional associations lack the legal expertise and indemnification to act in these situations, but medical boards in some states have the power to revoke licenses. In the end, patients must depend on the decent moral character of their therapists.     

Inferring the popularity of an opinion from its familiarity: A repetitive voice can sound like a chorus.

Despite the importance of doing so, people do not always correctly estimate the distribution of opinions within their group. One important mechanism underlying such misjudgments is people's tendency to infer that a familiar opinion is a prevalent one, even when its familiarity derives solely from the repeated expression of 1 group member. Six experiments demonstrate this effect and show that it holds even when perceivers are consciously aware that the opinions come from 1 speaker. The results also indicate that the effect is due to opinion accessibility rather than a conscious inference about the meaning of opinion repetition in a group. Implications for social consensus estimation and social influence are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Heart-pothesis" is a two-edged sword.

Challenges the notion of a "heart-pothesis," the act of bestowing scientific status on a personal conviction, presented in S. I. Abramowitz's (1978) article on Black patient–White therapist relationships. Some individuals may overestimate or refuse to see discrimination, while exclusive focus on equality and nondiscrimination fails to address larger issues of accessibility and outcome of treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Collaborative "expertise" after the discursive turn.

Given recent developments in discursive psychology, and a growing number of postmodern and collaborative therapies, it is time to revisit what it means to be competent or expert as a therapist. This article takes the view that competence (instead of "expertise"), for therapists who practice from a discursively informed perspective, involves a therapist's ability to reflectively and resourcefully engage in different forms of discourse with clients--lexibly. This includes the therapist's ability to engage clients within their own discursive forms, discern with clients the possibilities and constraints afforded by those forms, and transcend the limitations of those forms with credible invitations into other, more resourceful discourses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Coasting in the countertransference: Conflicts of self interest between analyst and patient.

Reviews the book, Coasting in the countertransference: Conflicts of self interest between analyst and patient by Irwin Hirsch (see record 2008-02945-000). The term countertransference now often incorporates all the conscious as well as unconscious reactions a therapist has toward their patient, and as such has become a primary source of data about the patient’s intrapsychic and interpersonal experience. In his remarkable book Coasting in the Countertransference, Irwin Hirsch returns us to the earlier more problematic notion of countertransference, only Hirsch’s focus is no longer on the internal drives and resistances of the therapist. For Hirsch, the economic and social circumstances under which psychotherapists practice have a dire—and mostly unacknowledged—impact on clinical processes. This is an absolutely necessary book that forces us to reexamine some of the painful social conundrums of the current state of dynamic psychotherapy as well many of the contemporary technical innovations which we are most smugly pleased with. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Termination from a psychoanalytic perspective.

The following principles of termination have been derived from the confluence of psychoanalytic and other perspectives: (a) The timing of the termination is determined by the patient; (b) the frequency of meetings should be reduced and a final appointment scheduled some time after the second-to-last meeting; (c) the patient's stressors, previous dominant ways, and new ways of responding should be reviewed; (d) what the patient believes was accomplished should be discussed, (e) the therapist should inquire what was helpful and hurtful; (j) the therapist should inquire, if appropriate, whether there is something negative about the therapy leading the patient to terminate; (g) the therapist should equalize the relationship; and (h) the patient should be invited to correspond in the future. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

When the therapist needs therapy: Characterological countertransference issues and failures in the treatment of the borderline personality disorder.

Addresses a number of defenses and identity issues presented by the borderline patient that assault the ego boundaries and limits of the therapist and that encourage the therapist to act out his or her denied or unresolved identity issues with the patient. The primary defenses that will be discussed are splitting, primitive idealization, projection, projective identification, denial, omnipotence, and devaluation. The primary identity issues to be addressed in both the patient and the therapist are a split self rather than a sense of a real self, ego identity disturbances and ego deficits, boundary and limits difficulties, and the superego demand of perfection with accompanying despair, guilt, anger, and shame. Recommendations are made to enable therapists to more effectively address these issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A study of the dilemmas involved in work with schizophrenic patients.

Discusses some of the difficulties involved in transference and its handling with schizophrenic patients, using the treatment of a 22-yr-old chronic schizophrenic male as an illustration. Two major findings have emerged since Freud's contention that the schizophrenic could not form a transference relationship: The schizophrenic can form a transference relationship to the therapist, although (1) it may be of a different kind than that of the neurotic, and (2) for some therapists it is no longer the major tool of therapy. As the nature of the relationship changes from that of one whole person relating to another to that of a mother relating to a child, there is a shift in therapeutic technique. Whereas, in the former relationship, interpretation of the transference is primary, in the latter, the context or the setting for that interpretation becomes primary. The therapist must create a safe environment for schizophrenics as they regress to dependence. The therapist must be willing and able to merge with the patient, to be mother to the infant patient. This stance requires the utmost from the therapist, and thus countertransference acquires major importance in this work. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)