The "ins and outs" of enactment: A relational bridge for psychotherapy integration.

Patients' enactments--their reflexive attempts to influence interpersonal interactions in particular ways based on their psychodynamics, both with the therapist and with others outside the psychotherapy setting--provide an important avenue for advancing the complex task of integrating action-oriented techniques with in-depth exploration. This article, written from a relational psychoanalytic perspective, shows how enactments create a valuable bridge for thinking about and practicing psychotherapy integration. To be most effective, psychotherapists must deal both behaviorally and psychodynamically with enactments, using integrative interventions that simultaneously encourage constructive new and adaptive behaviors, promote important new mutative relational experiences with therapists and with others, and facilitate deep insight. Acting together, these processes contribute to structural, including behavioral, personality reorganization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clients', therapists', and judges' evaluations of psychotherapy.

Asked 41 patients and their 17 therapists to complete a questionnaire indicating problem areas and their severity before and after the 1st and last therapy session. 2 clinical psychologists served as independent judges rating the client questionnaires. The clients' evaluations were unrelated to their therapists' evaluations, but were highly related to the evaluations made by independent judges. Further analyses suggest that the disagreements between clients and therapists stemmed from the therapists' inaccuracy in perceiving the clients' problems and the therapists' tendency to overestimate the progress of therapy relative to clients and independent judges. The results and the broader issue of client-therapist disagreements are discussed in terms of the client as a "consumer." (l6 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stagnation, chaos, and severe character neuroses.

There are a relatively large number of unexplored issues in treating severely neurotic, character-disordered patients. The defining characteristics of these patients are formulated in dynamic, structural, and object relational terms. A discussion of the masochistic character is presented to exemplify such features. It is suggested that treatment is an inescapable struggle due to the distinctly created transference-countertransference ambience wherein character resistances emerge as therapeutic stalemates. The milieus characterized by stagnation and chaos are examined in relation to clinical examples. Finally, three essential technical issues are considered in terms of therapists' capacity to "hold" patients' externalized material, use the countertransference, and sooner or later, interpret primitive defensive constellations and transferences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The dissociative mind.

Reviews the book, The dissociative mind by Elizabeth F. Howell (see record 2005-14945-000). In her book, The Dissociative Mind, Elizabeth Howell presents a complex and thorough overview of what she describes as a "sea change" in psychoanalytic theory. From her vantage point as both psychoanalyst and traumatologist, she demonstrates how, in the last 15-20 years, relational trauma and the resulting impact on the individual mind-namely the splits and fissures that comprise dissociation- have made their way back into psychoanalytic thinking. Howell's elaboration of the overwhelmed, traumatized mind is very useful in clients who present with problems in thinking or who have limited capacity to symbolize. However, detailed clinical material of how an analyst thinking of dissociated self states would work with such a client, what Bromberg termed the "relational bridge," would support her fundamental assertions more effectively. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Describing the face of transference: Psychodynamic therapists' recollections about transference in cases of successful long-term therapy.

This study used the consensual qualitative research method to address questions about therapists' perceptions of transference in long-term therapy: How does transference operate? How is transference dealt with and resolved? What problems do therapists encounter with transference? Eleven dynamically oriented therapists were interviewed by phone about a successful case in which transference was an important part of treatment. On the basis of therapists' recollections, findings suggested that transference operated in a complex manner in terms of source, valence, themes, and the events influencing it; therapists used a wide range of techniques (nonanalytic and analytic) to deal with transference; working alliance, real relationship, and client emotional insight importantly influenced the resolution of transference; and a variety of countertransference reactions and mistakes were encountered when dealing with transference. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Matchmaking in psychotherapy: Patient-therapist dimensions and their impact on outcome.

Patient–therapist matching was investigated using recent theoretical and methodological developments to overcome some of the limitations that have hindered similar past efforts. Two hypotheses were tested: (a) Therapeutic outcome is affected by the interaction between patients' and therapists' self-concepts, and (b) increasing anticomplementarity between therapist self-concept and therapists' perceptions of patients' behavior is negatively associated with patient improvement. Data from the first 2 cohorts of the Vanderbilt II Psychotherapy Project (H. H. Strupp et al; see record 1989-10009-001) were analyzed. They included the therapies of 16 experienced therapists, who saw a total of 48 patients (38 women and 10 men) in time-limited psychotherapy. Patients' ages ranged from 24 to 65 years (M age?=?40). Outcome was measured from the perspective of the patient, therapist, and evaluating clinician. Each hypothesis was supported, but not across all 3 outcome perspectives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors influencing lower-class Black patients remaining in treatment.

Studied early termination from individual therapy in a community mental health clinic with 43 lower-class Black patients assigned to therapists who were Black or White. The only significant correlate was the interaction between sex of therapist and sex of patient. Patients remained longer with therapists of the opposite sex. No significant correlations were found between remaining in treatment and Black patients' attitudes toward Whites, patients' perceptions of therapists' understanding and acceptingness, or patient–therapist discrepancies in their perception of therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Direction of affective influence in psychotherapy.

Administered a structured response questionnaire to 45 patient-therapist pairs after each of a series of individual psychotherapy sessions in which feelings experienced by each during the session were reported. Causal analyses of nonexperimental data suggested that for relatively inexperienced therapists, the patients' positive feelings were a sufficient condition for the therapists' positive feelings. The reverse was the case for more experienced therapists. For negative feelings, however, therapists' feelings of uncertainty and apprehension were generally a sufficient condition for the patient to experience dysphoric affect. Extremely positive or negative affective experiences of either participant tended to preclude and be precluded by opposite experiences in the other. (17 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On the "Music of Thought": The Use of Metaphor in Poetry and in Psychoanalysis.

The author considers the clinical use of metaphor--when psychoanalytic psychotherapists move intentionally to figurative and comparative language in talking with their patients--by comparing it to the use of metaphor in poetry. Both poets and psychoanalysts, despite the differences in the aims of their arts, rely on this way of speaking in order to evoke, discover, and create meaning. A consideration of the way therapists use metaphors sheds some light on essential clinical processes--and on the current debate between "classical" and "post-modern" ways of understanding what psychoanalysts do. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What are the benefits of mindfulness? A practice review of psychotherapy-related research.

Research suggests that mindfulness practices offer psychotherapists a way to positively affect aspects of therapy that account for successful treatment. This paper provides psychotherapists with a synthesis of the empirically supported advantages of mindfulness. Definitions of mindfulness and evidence-based interpersonal, affective, and intrapersonal benefits of mindfulness are presented. Research on therapists who meditate and client outcomes of therapists who meditate are reviewed. Implications for practice, research, and training are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Responding to therapists' sexual abuse of adult incest survivors: Ethical and legal considerations.

Adult survivors of incest are high-risk candidates for subsequent sexual abuse by their therapists. As with incest, therapists' sexual abuse of their patients has become known as "the problem with no name." In addition, many of the ways in which the profession of psychology and the judicial system respond to patients' allegations of sexual abuse by their therapists often parallel the responses family members and authority figures made to the original allegations of incest. This article discusses some of the complex interactions among therapeutic dynamics and ethical and legal issues associated with this professional dilemma, and outlines ways in which the profession might begin to address this dilemma. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client and therapist variability in clients' perceptions of their therapists' multicultural competencies.

This study examined therapist differences in their clients' ratings of their therapists' multicultural competencies (MCCs) as well as tested whether therapists' who were rated as exhibiting more MCCs also had clients who had better therapy outcomes (N = 143 clients and 31 therapists). All clients completed at least 3 sessions. Results demonstrated that therapists accounted for less than 1% of the variance in their clients' Cross-Cultural Counseling Inventory–Revised (CCCI-R; T. D. LaFromboise, H. L. K. Coleman, & A. Hernandez, 1991) scores, suggesting that therapists did not differ in terms of how clients rated their MCCs. Therapists accounted for approximately 8.5% of the variance in therapy outcomes. For each therapist, their clients' CCCI-R scores were aggregated to provide an estimate of therapists' MCCs. Therapists' MCCs, based on aggregate CCCI-R scores, did not account for the variability in therapy outcomes that were attributed to them. Additionally, clients' race/ethnicity, therapists' race/ethnicity, or the interaction of clients'–therapists' race/ethnicity were not significantly associated with clients' perceptions of their therapists' MCCs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapists' emotional reactions to substance abusers: A new questionnaire and initial findings.

Developed and tested the Ratings of Emotional Attitudes to Clients by Treaters (REACT) scale. The REACT was administered to 52 therapists and 140 cocaine-dependent outpatients, at sessions 2, 5, and 24 of psychotherapy. It was found to have high internal consistency at each time point, moderately high convergent validity with therapists' (but not patients') therapeutic alliance ratings, and a factor structure that appeared to meaningfully derive 4 factors: "therapist in conflict with self," "therapist focused on own needs," "positive connection," and "therapist in conflict with the patient." Therapists' emotional responses were found to become more negative over the course of treatment, and, when compared by theoretical orientation, were found more positive for 12-step drug counselors than for cognitive or supportive-expressive therapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A-B therapist distinction, patient diagnosis, and outcome of brief psychotherapy in a college clinic.

Prior studies suggest that therapists' A-B status (types catagorized by the Whitehorn-Betz A-B scale) interacts with patient diagnosis in determining the outcome of psychotherapy (A > B with schizophrenics, B > A with neurotics). To discern whether the hypothesis would apply to brief psychotherapy in a college clinic, the "outcomes" obtained by 3 A and 3 B therapists with their schizoid and neurotic patients (N = 57) were examined in a 2 * 2 factorial design. Analysis of 3 dependent measures based on therapists' and patients' posttherapy ratings reveal considerable support for the hypothesis, particularly for therapists' appraisals of their own effectiveness (interaction, p     

The Effect of Therapist Availability on the Frequency of Patient-Initiated Between-Session Contact.

Does therapist availability affect the frequency of patient-initiated between-session phone contacts? There are few empirical data to inform therapists on this question: This study was designed to redress this literature gap. Results demonstrated that in general, therapists' availability policies did not strongly relate to patient-initiated contacts. However, there were some exceptions: The more willing therapists were to receive crisis intervention and mental status update calls, the fewer calls they received. Additionally, when therapists were less willing to be contacted between sessions, patients with personality disorders and/or poor global functioning tended to make more nonemergency calls to the therapist, whereas patients with elevated suicidality tended to make fewer nonemergency calls between sessions. The implications of the results on therapists' policies and patients' expectations are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Revising memories and forming new connections: A comment on "The reunion process: A new focus in short-term dynamic psychotherapy."

It is both exciting and an honor to have the opportunity to comment on interesting articles in our field. And interesting this one is! It brings together multiple sources of information and ideas to create a revisioning of the therapeutic approach in a way that is stimulating and intriguing. Dr. Sandler (see record 2007-09422-001)presents what he terms a "reunion process," in which he proposes connecting with positive attachment experiences as a way to intervene with patients who, despite "having done the necessary work on the painful memories of attachment failures" face relapse and return of symptoms. His explanations of the process of connecting with positive attachments raise challenging questions about roles and functions of memory, therapeutic techniques and processes, and our explanations for how and why psychotherapy works. In this brief comment, I offer reactions and questions that I hope will be part of the continuing dialogue about this fascinating process we call psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Feelings of inexperienced therapists in psychotherapy: a factor analytic study

The Therapy Session Report, a parallel-structured response questionnaire, was utilized to study the feelings of inexperienced therapists. 57 college student applicants at a university counseling center reported on their perceptions of their therapists' feelings immediately following an intake interview. The 19 therapists, clinical psychology graduate students in training, also reported what they felt during the intake session. Factor analysis of patients, perceptions of their therapists' feeling resulted in four factors, the first two accounting for 85% of the common variance. Factor analysis of therapists, perceptions of their own feelings resulted in nine factors. Results suggest that, while patients view their therapists in generally negative positive terms, inexperienced therapists experience considerable affective discomfort during their intake sessions.     

Defining "addiction."

For centuries, the word "addiction" meant being "given over" or devoted to something. However, the 19th century temperance and anti-opium movements used it in a more restrictive way, linking "addiction" to drugs, to illness or vice, and to withdrawal symptoms and tolerance. Both the traditional and restrictive meanings survived into the present. In the ensuing uncertainty about its meaning, some authorities now wish to replace "addiction" with substitute terms like "drug dependence", "substance abuse", etc. We hope to show that the term "addiction" is too valuable to discard. Its traditional sense designates the profoundly important, albeit sometimes harmful, capacity of people to become "given over." On the other hand, the restrictive meaning refers only to a special case, which is defined arbitrarily and inconsistently. It is outmoded because of these problems. The traditional meaning remains useful, but can be improved by clarifying the distinction between "positive" and "negative" addictions originally proposed by Glasser (1976). (PsycINFO Database Record (c) 2010 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)