A fate worse than death: The fear of changing.

Contends that resistance is not solely that which blocks the patient's full living—it is also what makes possible the ways in which the patient does "have life." The ways in which persons come to structure who and what they are and what is the nature of the world in which they live are at once the ways that make it possible for them to live their lives and the ways that limit experience and keep them in self-defeating patterns. A clinical example of a 53-yr-old male who drove recklessly on the highway in order to act out his fear of change is given. It is suggested that resistance arises when important life structures are imperiled. The way the therapist perceives the nature of the life structures and the attitude the therapist takes toward the patient's efforts to preserve those structures are essential considerations. The healing power derives from attitudes, empathy, and faith in the growth latent in the patient. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction: Snapshots of psychology circa 1900.

Introduces a series of articles to be published that examines the state of psychology as it was 100 years ago. The author argues that by examining psychology of another time, other ways to construct, understand, and improve it may be revealed. Topics to be discussed include how an experiment is defined, what a control group is, how psychologists use inferential statistics, how journal reports of empirical research should be formatted, what constitutes a proper therapist–client relationship, what words are chosen to develop a taxonomy of behavior and processes, how psychologists choose and define participants to serve in experiments, and what does not fit within the boundaries of psychology. A list of tentative titles is appended. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic engagement with a dying person: Stimulus for therapist training and growth.

The senior author's personal experience with a 57-yr-old woman dying of cancer is presented. It is submitted that the intimate experience of working with and relating to a dying person in psychotherapy is a potent and significant factor in forming and influencing the therapist's understanding and experience of psychotherapy. Flowing from the strength and openness of the patient, the therapist gains a new awareness of the meaning of life, growth, pain, being, and becoming. Therapy comes to be viewed as a cooperative relationship, and the young therapist in particular is faced with many basic theoretical issues—self-disclosure, control, professionalism, and termination. Through this experience the therapist learns about life's most basic forces—living, dying, growing, and changing. Stereotypic preconceptions and ways of perceiving the patient, the therapeutic process, and herself/himself are altered and expanded, revised and abandoned, making room for a new kind and quality of gentleness and sensitivity. (2 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors in premature termination in long-term psychotherapy.

Examined the relationship between patient and therapist variables and the incidence of premature termination at a private outpatient psychotherapy clinic. Using a qualitative rating scheme, 718 long-term psychotherapy cases were reviewed to determine whether termination had been premature. The 273 cases judged to be premature terminations were compared with the patient population as a whole on 10 patient variables. For 27 psychotherapist-Ss (aged 29–68 yrs), the rates of premature termination among their patients were examined with reference to 9 therapist variables. Results indicate that premature patient terminators differed significantly on race, age, source of referral, type of payment, employer, presenting complaint, and diagnosis. Psychologists were found to have significantly lower rates of premature termination among their patients than psychiatrists or social workers. Therapists who had undergone personal therapy showed significantly lower rates than those who had no therapy. Therapists' defense style and life stresses did not relate significantly to rates of premature termination. Results are discussed in terms of motivational factors in patients and identification with the values of long-term psychotherapy by therapists. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Termination in brief psychotherapy: The case for an eclectic approach.

Outlines theoretical perspectives on the termination phase of brief psychotherapy (i.e., termination as either a minimal or central focus in brief therapy). From both case studies and empirical investigations, a flexible approach is advocated in which termination work is in keeping with the goals of treatment and the quality of the therapist–patient relationship. (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)     

Who is afraid of STDP? Termination in STDP and therapist's personality.

The termination phase of Short-Term Dynamic Psychotherapy (STDP) is considered to be of major importance for the success of treatment as a whole. It encompasses the essential conflicts experienced by both therapist and patient in relation to the issues of separation, loss, and imperfection. This article discusses the personality characteristics and personal defenses that assist or hinder the therapist in successfully practicing this mode of dynamic therapy. It also aims at inspiring the psychotherapist to examine his or her attraction or repulsion to working as a short-term psychotherapist, thereby promoting insight, and enabling him or her to broaden his or her therapeutic repertoire. Vignettes from two cases are presented, highlighting some expressions of countertransference and their influence on the process of termination. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapists' view of therapeutic action in psychoanalytic psychotherapy with young adults.

Studying experienced therapists' implicit theorizing may contribute to our understanding of what is helpful and what hinders treatment with particular patient populations. In this study, 16 therapists' views of curative factors, hindering factors, and outcome were explored in 22 interviews conducted at termination of individual psychoanalytic psychotherapy with young adults. Grounded theory methodology was used to construct a tentative model of therapeutic action based on the therapists' implicit knowledge. The results indicated that developing a close, safe and trusting relationship was viewed as the core curative factor in interaction with the patient making positive experiences outside the therapy setting and the therapist challenging and developing the patient's thinking about the self. The therapeutic process was experienced as a joint activity resulting in the patient becoming a subject and acquiring an increasing capacity to think and process problems. The patient's fear about close relationships was seen as hindering treatment and leading to core problems remaining. The model is discussed in relation to major theories of therapeutic action in the psychoanalytic discourse and previous research focusing on young adults' view of curative and hindering factors in psychotherapy. Implications for practice and further research are suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The coordinating style construct: An approach to conceptualizing patient interpersonal behavior.

Defines coordinating style as how a patient coordinates contributions to an interaction with an interviewer's contributions and the patient's own contributions at other points in time (i.e., does the patient build on what the therapist says and allow the therapist to respond to what the patient contributes to an exchange?). The construct's psychometric properties were investigated based on assessments of intake interview behavior and improvement in brief action-oriented therapy of 30 outpatients (aged 19–58 yrs). Results indicate that coordinating style can be measured reliably, and they provide support for the construct's convergent, discriminant, and predictive validity and relevance for the establishment of a productive therapeutic relationship. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Termination anxiety as it affects the therapist.

Addresses the concept of termination anxiety as it affects the therapist by tracing the various sources of uneasiness around the ending of therapy and theorizing about the defense maneuvers a therapist may use in order to circumvent the anxiety. Five sources of anxiety the therapist may begin to experience when approaching the termination phase of therapy include separation anxiety, anxiety over loss of professional role during termination, a reaction to a client's termination anxiety, uneasiness over the implied importance of termination, and the loss of a meaningful relationship. Defense maneuvers a therapist may use in order to circumvent the anxiety include reversal of affect, projection, "principlization," turning against the self, and turning against the other. It is suggested that therapists may better realize the goals of therapy by trying to maintain the highest emotional availability during sessions through acknowledging and recognizing termination anxiety and the concomitant defensive maneuvers. (40 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Termination of therapy: An effort at integration.

This article explores convergences and divergences among 3 different approaches to termination in therapy. Of particular concern are questions of what constitutes the "reality" of termination. Is refusal to taper off sessions or to keep the door open for potential resumption of the work a useful aid in helping the patient come to terms with the reality of termination's finality? Or is it a needless imposition on the patient of a particular view of the therapeutic process that happens to be held by the therapist? Also examined are the complexities of what it means for the process of termination to be pursued collaboratively and the implications for termination decisions of contemporary insights into the 2-person nature of the therapeutic process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The context of therapist behavior and outcome prediction.

A review of the research on the relation between therapist behavior and psychotherapy indicates that outcome should include the context of therapist behavior. The context has been deemphasized by measuring therapist behavior alone, sampling the session nonintensively at random or fixed points, and using statistics that focus on proportions or averages of ratings within a given time. The context of therapist behavior can be examined by measuring patient behavior, studying critical incidents or whole sessions, and using statistical analyses that focus on the probabilities of transitions between behaviors. Further development of existing theories of psychotherapy may provide guidelines for studying context. In particular, more emphasis should be placed on the patient–therapist interaction. (54 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attachment to the therapist.

This study examines the ways in which therapists function as attachment figures for patients. Patients in long-term psychoanalytic therapy answered questionnaires about their feelings about their therapists and their closest personal relationships. Components of attachment prominent in the therapeutic relationships were looking up to the therapist and feeling the therapist was responsive to emotional needs. Stronger attachment to therapists was associated with greater frequency and duration of therapy, a stronger working alliance, and greater security of the patients' attachment style, as well as with the gender of the patient and therapist. Using attachment theory to understand psychoanalytic relationships emphasizes the unique importance of a therapist to a patient and can offer new perspectives on both therapeutic and attachment processes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive match as a predictor of psychotherapy outcome.

63 cognitively matched or unmatched patient–therapist pairs were followed in a double-blind methodology utilizing the Interpersonal Discrimination Test (IDT) as a measure of cognitive match between each pair. Premature termination occurred for 60% of the unmatched pairs and for 24% of the matched pairs. The Global Assessment Scale indicated a significantly faster rate of improvement for the remaining matched pairs at the 12-wk mark. Unmatched pairs eventually reached similar endpoints with final termination outcome measures being unable to distinguish between the 2 groups. Findings demonstrate the ability of the cognitive-match methodology, and specifically the ability of the IDT, to predict higher rates of early and dissatisfied terminations when patients and therapists are unmatched in cognitive structure. Findings confirm an earlier finding by J. E. Carr (1970) of greater improvement after 12 wks of treatment for matched vs mismatched patient–therapist pairs. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The guru and therapist: Goals and techniques in regard to the question of the chela and patient.

Attempts to clarify the goals of nondualistic religious traditions using Buddhism as an example. It is argued that since the therapist and guru hold entirely different views on human existence, they differ remarkably in their goals and techniques and in what they consider to be a legitimate question on the part of the patient and chela (disciple). A comparison is made between how the therapist and guru interact with their respective "patients." (7 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chance encounters: Unintentional therapist disclosure.

Explores how chance encounters influence the interpersonal relationship for both patient and therapist. Both patient and therapist experiences of the therapist's subjectivity may become accessible and available for analysis. Such encounters may reveal aspects of the interpersonal matrix that were previously defended against. In the chance meeting, the patient has the opportunity to experience the therapist as a separate person or as an extension of the self, as an object available for idealization or devaluation, or as a subject in his or her own right. Likewise, the therapist has the opportunity to experience him- or herself in ways that may be either concordant or discordant with the interpersonal relationship in the consulting room, bringing into focus new aspects of the interpersonal matrix. Case material highlights the challenges created by unintentional disclosure, by exploring the therapist's anxiety about such experiences. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Comparing therapist and client perspectives on reasons for psychotherapy termination.

Examines the extent of agreement on the reasons for psychotherapy termination given by therapists and their clients. 194 client files in a psychology training clinic were reviewed to obtain reasons for termination cited by therapists in treatment termination reports. Telephone interviews were conducted with 87 of these former clients to determine their perspectives on reasons for termination. Consistent with previous research, there was little concordance among the reasons cited by therapists and by clients regarding clients' decisions to terminate therapy. Of the clients identified by therapists as terminating because of the successful attainment of therapeutic goals, three-quarters reported this reason as important in their termination decision; of those clients reporting termination because of attaining therapeutic goals, only half were identified by therapists as having achieved their goals. Dissatisfaction with therapy and/or the therapist were reported by many clients as important in their termination decisions; such factors were rarely cited by therapists as reasons for termination. Attention to discrepancies between client and therapist expectations of therapy and therapy termination is necessary to reduce the high rate of premature termination in psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using the patient's plan to assess progress in psychotherapy.

Describes the application of a formulation of the patient's plan in psychotherapy research. Use of patient plan formulations to (1) study the effects of therapist intervention on patient progress (within-session change) and (2) develop individualized psychodynamic outcome measures (plan attainment) are discussed in studies by G. Silberschatz (1986) and Silberschatz et al (see record 1987-07982-001), respectively. If the therapist helps the patient disconfirm pathological beliefs (by passing tests or intervening in plan-compatible ways) the patient is likely to progress toward achieving therapy goals with a more favorable outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexualization of therapeutic relationships: The dual vulnerability of patient and therapist.

Contends that consumerism (a humanistic-egalitarian therapeutic orientation) and feminism have heightened awareness of the problem of sexual intimacies between patients and therapists. Evidence suggests that sexual intimacy between patients and their therapists has become a more common mode of experience than previously thought. Sexual abuse occurs when the relationship between the patient and therapist is violated, and the patient is victimized by the therapist; erotic involvement between patient and therapist has been likened to incest. Data from the 1970's show that the overwhelming majority of sexually abusive therapists are male. Education during therapists' training period and alternatives for therapists at risk for sexually abusive behavior, including avoidance, referral, treatment programs, and punishment, are suggested as ways to deal openly with this small but severe problem. Public education, in a nonalarmist manner, is also recommended. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)