Relational psychoanalytic enactments and psychotherapy integration: Dualities, dialectics, and directions: Comment of Frank (2002).

Dualities embedded within the relational psychoanalytic enactment concept encourage dialectical thinking and intervention. K. A. Frank's (2002) conceptualization of enactments as entailing structural, functional, and consequential interactions between the intrapsychic and the interpersonal valuably obviates the need to choose between these 2 domains (J. C Anchin, 1985). His incorporation of systems conceptions and the schema construct also renders boundaries between psychoanalysis and other paradigms increasingly permeable. Frank highlighted intrasession and extrasession enactments as intermutual contexts for collab6ratively synthesizing relational analytic and cognitive-behavioral techniques and their respective emphases on insight and action, thereby potentiating integration of structural and behavioral changes. His perspective also converges with contemporary interpersonal theory, research, and practice, fostering superordinate idiographic-nomothetic dialecticism, and with constructivist psychotherapy, spawning additional integrative directions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The empathic power of enactments: The link between neuropsychological processes and an expanded definition of empathy.

In spite of the seeming experiential incongruity between enactments and empathy, clinical observations and recent neurobiological research are providing new ways to examine these two intersubjective processes and consequently expand our understanding of important empathic aspects embedded within enactments. Exploring interpersonal communication, neuroscience has started to delineate neuropsychological processes that similarly shape and underpin both enactments and therapeutic empathy; illuminating what mechanisms they have in common. Of particular interest are findings regarding mirror neurons and the right brain’s sensitivity to nonverbal aspects of emotional communication. These have greatly advanced our understanding of the ever-present nonconscious communication between people and its obvious implications for the inevitability of enactments within the psychoanalytic dyad. By allowing implicit relational and emotional patterns to be fully experienced within the analytic process, enactment enable both participants, and especially the analyst, attain an unmediated connection with what cannot be yet verbalized, a connection that essentially construes an empathic resonance. Furthermore, the analyst’s eventual awareness of the enactment and her disclosure of her participation in it create an empathic reflective space leading the patient to self-reflection, enhanced awareness and emotional integration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intersubjectivity and neuroscience: Understanding enactments and their therapeutic significance within emerging paradigms.

Evolving views of enactments as interpersonal manifestations of dissociated relational styles are increasingly finding support in attachment studies and neuro scientific research. Understanding enactments as an aspect of the intersubjective process and as the ultimate communicators of the patient's neurally encoded early experiences, this paper examines what enactments convey, and explores their interpersonal and neural underpinnings. Unconsciously triggered and communicated within the intersubjective interaction, enactments reveal the participants' implicit, neurally encoded relational and emotional patterns that inevitably come alive within the analytic dyad. It is suggested that the analyst's eventual self-awareness of her own participation, followed by self-disclosure of her experience, promote a conscious, verbally articulated encounter with the patient's unconscious relational styles, creating opportunities for emotional and neural integration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Breaches in the therapeutic alliance: An arena for negotiating authentic relatedness.

Argues that the clarification of the processes involved in working through breaches or ruptures in the therapeutic alliance, is a vitally important task for psychotherapy theorists and researchers. It is suggested that these inevitable problems in the therapeutic alliance provide important opportunities for clarifying factors that may create barriers to authentic relatedness in clients' everyday lives. Working through these problems can provide clients with valuable experience in the important tasks of reconciling the needs for relatedness and agency and of coming to accept both self and other. The current paradigm shift in psychotherapy theory and practice toward more relational and constructivist perspectives, however, has established a particularly ripe climate for enhancing the understanding of the client–therapist relationship through a differentiated exploration of these concerns. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Relational theory and the practice of psychotherapy.

Reviews the book, Relational theory and the practice of psychotherapy by P. L. Wachtel (see record 2008-01938-000). Having produced important texts involving the integration of a psychoanalytic perspective with cognitive–behavioral and family systems perspectives, in the current book he turns his attention to seemingly divergent lines of thought within psychoanalysis itself. Psychoanalysis—that variegated, continually branching and diversifying body of theory and practice that started with Sigmund Freud but which has moved so far beyond its origins so as to be almost unrecognizable in some respects—is certainly Wachtel’s primary home. In this book, Wachtel sets out to try and get the house in greater order, both for psychoanalytic inhabitants themselves and for visitors from other theoretical homes. The collection of psychoanalytic perspectives that have gradually taken context into account as being equally important to those factors that are internal are referred to as relational. And it is to these perspectives, which sometimes diverge in significant ways from each other and also from “one-person,” internally focused perspectives, that Wachtel devotes his attention in this book. With Relational theory and the practice of psychotherapy, Paul Wachtel has written an important book, one that will be particularly stimulating and useful to graduate-level-and-above students of psychotherapy. It will also be accessible, thought provoking and clarifying to open-minded psychotherapy practitioners of all stripes, particularly those who do not identify themselves as relational, psychoanalytic, or even psychodynamic. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A relational approach to group therapy for women with bulimia nervosa: moving from understanding to action

This article explains how the psychology of women can inform group treatment by translating relational theory (RT) into practice within a short-term outpatient bulimia group. First, the article provides a brief overview of a relational understanding of women's psychological development, the etiology and maintenance of bulimia nervosa, and group psychotherapy. Then, clinical vignettes illustrate the application of RT in practice through discussion of four main healing factors at work in the different stages of the group. Through promoting validation, self-empathy, mutuality, and empowerment, the leader helps group members identify and change relational patterns that have kept them connected with food and disconnected from themselves and others. The goal of treatment is to help members move toward mutually empathic and empowering relationships inside and outside the group.     

Stephen A. Mitchell (1946–2000).

Memorializes Stephen A. Mitchell, a teacher, administrator and practitioner in psychoanalysis and psychotherapy. Mitchell was a leading proponent of an integrative, relational perspective in psychoanalysis. Mitchell was sympathetic to the plight of psychologists and others excluded from established organizations, and he helped them to establish their own innovative training programs not only in the US but also abroad (e.g., Canada and Israel). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Arousing primary vulnerable emotions in the context of unresolved anger: “Speaking about” versus “speaking to”.

Arousing and processing primary vulnerable emotions is a core change mechanism across a wide range of psychotherapies and clinical populations. This study examined the utility of 2 emotion-focused interventions—relational reframes and empty-chair enactments—in terms of arousing primary sadness associated with loss and longing among individuals suffering from unresolved anger. Twenty-nine women reporting unresolved anger underwent a single, analogue emotion-focused therapy session comprised of empathy, relational reframe, and empty-chair interventions. The arousal of sadness was measured with voice signal, voice quality, and speech fluency measures. Results indicated that both relational reframe and empty-chair interventions led to increased arousal of sadness relative to baseline nonemotional speech. Empty-chair interventions also led to increases in fear/anxiety, presumably due to the potential for rejection or attack by the significant other (i.e., attachment figure). Treatment implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Symptom-focused dynamic psychotherapy.

Early psychoanalytic perspectives were characterized by an emphasis on purported unconscious processes that contraindicated direct interventions with symptoms. However, the modern relational psychoanalytic approach offers a sophisticated base for the assimilation of action-oriented techniques. I provide a rationale for including a direct focus on symptoms in some treatments and argue that symptom intervention alone will be insufficient in many cases. My integrative model permits direct work with symptoms as well as an appreciation of their biopsychosocial etiology within a particular context. Symptom-focused dynamic psychotherapy is informed by current relational perspectives including attachment theory and self psychology. Action-oriented techniques from the cognitive–behavioral tradition may be incorporated on the basis of the patient’s needs and the intervention’s usability within a particular therapeutic relationship. Integrative treatment fosters the development of a consolidated and integrated self and promotes secure and balanced relationships with others. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived support and relational effects in psychotherapy process constructs.

Recent research has indicated that only a small portion of supportiveness reflects the objective properties of providers. Instead, supportiveness primarily reflects the unique relationships among specific recipients and providers (i.e., relational effects), thus suggesting new approaches to support interventions. The authors investigated the possibility that similar relational effects occur for therapy process constructs (e.g., working alliance). Isolating relational effects in psychotherapy requires that each client receive treatment from more than one therapist during the same period of time. Therefore, we conducted analog studies in which therapy clients and students viewed videos of therapists and then rated expected therapist supportiveness and expected therapy process constructs for each therapist. Two studies indicated very strong relational effects in therapist supportiveness and therapy process constructs. In addition, process constructs were correlated strongly with supportiveness (Study 1) and favorable affect (Study 2) for relational effects specifically. Implications for integrating research on perceived support and therapy process were discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender bias in short-term therapy: Toward a new model for working with women patients in managed care settings.

Examines a gender bias in short-term psychodynamic psychotherapy (PP) in a managed care setting, namely, the implicit relationship between separation and psychological development in treatment. The author proposes that brief PP is modeled after classic developmental theory where separation is the marker of development. While separation may be essential for male development, continuity of connection is critical for female development. Since brief therapy does not allow for continuity of connection, it does not integrate an important aspect of the female developmental and relational experience into the treatment. An extended model of psychotherapy, which uses a limited number of therapy sessions but provides more of an ongoing therapeutic relationship, is proposed as an alternative for women patients who need both time and continuity of connection for self-development. Cases of 5 women (aged 27–52 yrs) illustrate the model's stages. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A-B variable and reactions to nonimmediacy in neurotic and schizoid communications: A longitudinal analogue of psychotherapy.

Selected 36 A- and 36 B-type male undergraduates from the scores of 225 Ss on a 19-item version of the A-B scale. Ss responded verbally and therapeutically to neurotic and schizoid videotaped enactments displaying improvement, no change, and deterioration over the course of psychotherapy and exhibiting high and low conditions of verbal nonimmediacy in their communications to the therapist. A types were more immediate with the schizoid, and Bs with the neurotic, communications. Results concerning the longitudinal response to the changing display of nonimmediacy were equivocal, but subjective reaction conformed to expectancies and there was other, indirect support for the longitudinal hypothesis. Substantive conclusions are drawn concerning verbal nonimmediacy in relation to therapist-patient compatability-incompatability and as a potential intrachannel process variable in psychotherapy. The nonimmediacy model is confirmed and extended in a complex, ongoing, dyadic interaction. (24 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assimilative integration in constructivist psychotherapy.

Assimilative integration is discussed in relationship to constructivist psychotherapy. Keeping in mind the assimilative integrationist view that it is important to provide a coherent justification when importing therapy techniques across theoretical orientations, the utilization of three techniques is discussed from a constructivist perspective-using relational countertransference, disputing irrational beliefs, and self-monitoring. The notion of meaning-based practice (MBP) is introduced as a unifying rationale for incorporating nonconstructivist techniques into constructivist therapeutic practice. Examples from a therapy case in which using relational countertransference, disputing irrational beliefs, and self-monitoring were assimilated into a constructivist perspective are described and analyzed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attachment as a transformative process in AEDP: Operationalizing the intersection of attachment theory and affective neuroscience.

While many models of individual psychotherapy acknowledge the significance of attachment theory for clinical work, Accelerated Experiential Dynamic Psychotherapy (AEDP) seeks to operationalize the intersection of attachment and affective neuroscience to introduce innovations in its clinical practice. AEDP's stance and techniques aim to (a) foster attachment security through the clinical process, and (b) harness the transformative resilience of secure attachment to potentiate deep and lasting psychological change. Viewing secure attachment as a transformative experience, case vignettes offer examples of AEDP attachment-based work: moment-to-moment experiential work processing attachment security as a powerful new experience; and then, its metatherapeutic processing. Integrating a new, positive relational experience in the here-and-now organically evokes the painful experiences of the original relational trauma. Thus, traumatic memories are also worked through in the service of positive psychological transformation. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Narratives and Culture: "Thickening" the Self for Cultural Psychotherapy.

The dominant framework for understanding selfhood in contemporary psychology has been one that privileges a highly individualistic conception of self. This is reflected in both the language and approaches of psychotherapy where the influence of contextual factors (factors outside of the individual) are given marginal consideration in order to maintain some type of 'objectivity' or 'neutrality' in counseling. We argue that an understanding of selfhood which does not take into account the 'relational' nature of selfhood as well as the cultural or historical context of the client, will likely alienate clients who do not view their self through the individualized lenses of (North American) psychology. In order to deal with this problem, we adopt an approach to cultural (and cross-cultural) psychology that views the self as a relational narrative. Such a narrative does not imply an unrestricted freedom to construct our self, but understands the limits to selfhood implied in the web of meanings constitutive of our culture and the web of relations from which our self emerges. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Considering "self-ful" desire.

Excessive anxiety about being selfish can, paradoxically, lead to an unconsciously motivated lack of concern about the impact of one’s desires on others. That which is repudiated by the patient as "not me" may become enacted between the patient and analyst, and then become subject to formulation and exploration. Two cases are presented in which excessive worry over selfishness creates unconsciously motivated self-centered behavior, and resulting relationship difficulties and transference-countertransference enactments. The author suggests that extreme anxiety over selfishness may be partially engendered by a lack of intersubjective recognition of desires in early life. The notable lack of language in English that embraces the positive aspects of self-interest is also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to symposium on constructing self with others.

The notion that the self is interpersonally embedded can be found throughout psychology's history. This article presents convergent work from different areas of contemporary psychology that supports and elaborates this notion. M. Baldwin's (1997) experimental work in social cognition demonstrates that self-evaluation varies with the relational schema that is activated. C. R. Snyder and R. L. Higgins (1997) present a social–cognitive personality theory of how people maintain their self theories to satisfy internal and external audiences. S. J. Blatt, J. S. Auerbach, and K. N. Levy's (1997) object-relations theory of the role of mental representations of self and others in psychopathology is supported by research that changes in these representations are associated with improvement in psychotherapy. J. Martin and J. Sugarman's (1997) social–cognitive theory of counseling and psychotherapy as conversational reconstructions of self theories also has research support and raises the issue of whether the self is agentic if socially constructed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship patterns of never-married men and their implications for psychotherapy.

Interviewed 30 never-married, White, heterosexual men aged 40–50 yrs concerning their relational patterns with regard to experiences in the families in which they grew up, romantic relationships, friendships, views of marriage, and thoughts about generativity. These men all valued independence and self-reliance, and practiced avoidance and emotional detachment in their relationships. Implications for psychotherapy are discussed in regard to the varied levels of functioning presented by the sample. Therapeutic difficulties include the potential for clients to flee psychotherapy prematurely or to approach psychotherapy in a guarded, tentative manner, because they fear losing their independence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship formation and relational control as correlates of psychotherapy quality and outcome.

This study examined the nature of therapist–client interactions within and across seven psychotherapy cases (a) to test whether therapeutic outcome is a function of a transition from relational incongruence to relational congruence (S. Strong, 1982), and (b) to investigate the relation of relational congruence and control to qualitative aspects of the therapy relationship and to therapy outcome. Measures of therapist and client response patterning served as indices of relational congruence and of relational control. Relationship quality was assessed in terms of therapist and client ratings of their working alliance and of therapy session depth and smoothness. Outcome was operationalized in terms of symptom reduction. Results showed limited support for a relationship between relational congruence and therapy outcome and suggested that relational control is not a significant factor in client or therapist evaluations of relationship quality or therapy outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empathic relational bonds and personal agency in psychotherapy: Implications for psychotherapy supervision, practice, and research.

Although psychotherapy researchers have become increasingly interested in identifying common factors that contribute to effective therapeutic practices, across psycho-diagnostic categories and treatment approaches, relatively little attention to date has been focused on the impact of these research findings for psychotherapy supervision and training programs. To address this gap, in this article we describe key components of an integrative psychotherapy supervision and training program that focuses on the development of a strong therapeutic alliance as an empirically supported, common principle of change in psychotherapy. We review empirical research evidence that addresses the contributions of therapist empathic engagement for the development of secure, relational bonds, heightened client agency, and the development of strong therapeutic alliances, and we discuss the implications of these findings for therapy practice and supervision training. We conclude with specific recommendations for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)