The evolution of psychotherapy and the concept of manualization: An integrative perspective.

In this article, the author examines some historical perspectives that may help psychologists who have recently been reading more about manualized treatments decide how to incorporate such information into contemporary practice. Even before the "age of manualization," each of the major schools of psychotherapy—psychodynamic, cognitive-behavioral, and family systems therapy—suffered from their own respective limitations in being unable to be exhaustive or definitive about the complexities that routinely take place in clinical practice. Perspectives on the role of manualized psychotherapy, the role of nonspecific factors and the therapeutic alliance, and the respective roles of professionalism and behavioral technology are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Clinical Exchange.

The Clinical Exchange invites eminent clinicians of diverse persuasions to share, in ordinary language, their clinical formulations and treatment plans of the same psychotherapy patient--who was not selected or nominated by those therapists--and then to discuss points of convergence and contention in their recommendations. This special Exchange focuses on the psychotherapy of borderline personality traits in the case of Ms. S, a female college student in her 20s presenting for treatment because of depression, "flashbacks" of sexual abuse, and poor interpersonal relationships. Amy Wagner, Kathleen Chard and Thomas Widiger, Joel Paris, Kenneth Silk, and Jeffrey Young, all researchers into personality disorders, are the featured commentators. Finally, Sidney Ornduff, the case contributor, provides a few closing comments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical exchange: Integrating psychotherapy and psychopharmacology-the case of the certified nursing assistant.

The Clinical Exchange invites eminent clinicians of diverse persuasions to share, in ordinary language, their clinical formulations and treatment plans of the same psychotherapy patient-one not selected or nominated by those therapists-and then to discuss points of convergence and contention in their recommendations. This special exchange focuses on the integration of psychotherapy and psychopharmacology in the case of Ms. M, a 64-year-old divorced woman presenting for treatment of depression complicated by an extensive history of medical illnesses, noncompliance with psychiatric treatment, and relationship dysfunction. Physician-therapists David Bienenfeld (integrative psychodynamic and cognitive- behavioral orientation), Paulette Marie Gillig (integrative self psychology and cognitive- behavioral), Steven I. Kramer (psychodynamic and supportive), and David Mintz (psychodynamic) are the featured commentators. Finally, Zia Wahid and Hasrat Khan, the case contributors, provide a few closing comments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of between-session homework in systems-oriented individual psychotherapy.

This article focuses on the use of between-session homework assignments in Unified Therapy, an individual psychotherapy approach that integrates psychodynamic, cognitive-behavioral, and family systems therapies. Unified therapy theory posits that, in clients with personality disturbances, ongoing and recurrent interpersonal behavior patterns within their family of origin serve as both behavioral triggers to and reinforcers of self-destructive or self-defeating behavior. Family behavior is believed to be the most powerful such environmental factor and is believed to have far more influence on patients than a therapist. Homework assignments are geared toward implementing strategies by which dysfunctional family patterns are altered. Strategies are designed by the patient and therapist, using role-playing techniques, which are described. A case example is presented to demonstrate the use of such homework throughout the arc of psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The death of psychoanalysis and depth therapy.

Notes that numerous attempts have been made to explain the demise of psychoanalysis and depth psychotherapy, placing blame on secularism among analysts, insufficient empirical research, prolonged treatment time, monetary considerations, and managed care. The author considers the primary cause to be an implicit cultural movement to squelch serious inquiry into family dynamics and interpersonal relationships, particularly the physical, sexual, and emotional abuse of children. To revive the humane practice of depth psychotherapy, therapists must support research that emphasizes the importance of early psychosocial environmental influences on personality development. Clinicians must also challenge restrictive societal pressure, sacred illusions concerning family life, and their own psychological defenses in order to reestablish a legitimate practice of depth therapy that moves away from the medical model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The cognitive-behavioral relationship record.

The Cognitive-Behavioral Relationship Record is a technique designed to help individual psychotherapy clients make sense of chronic relationship problems and to encourage them to experiment with new behavioral solutions. In this paper, the reader is given step-by-step instructions on how to use the Relationship Record accompanied by case illustrations. By conceptualizing relationships in terms of the interplay between two individuals’ cognitions and behaviors, the Relationship Record gives therapists a new tool to address the circular causality in relationship systems. In addition to its usefulness as a therapeutic technique, it may be seen as a step toward the integration of family systems into cognitive–behavioral therapy, or, more specifically, the assimilation of strategic therapy techniques and concepts into Aaron T. Beck’s school of cognitive therapy. The Relationship Record joins a movement in psychotherapy integration to enhance individual-based therapies by assimilating interpersonal approaches. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A quantitative method for the analysis of nomothetic relationships between idiographic structures: Dynamic patterns create attractor states for sustained posttreatment change.

Objective: The present article aimed to demonstrate that the establishment of dynamic patterns during the course of psychotherapy can create attractor states for continued adaptive change following the conclusion of treatment. Method: This study is a secondary analysis of T. D. Borkovec and E. Costello (1993). Of the 55 participants in the original study, 33 were retained for the present analysis due to the homogeneity of psychotherapy outcome among these participants. Of these 33, the majority were White (88%) and female (70%), and the average age was 35.44 years (SD = 14.46). Participants participated in 12 weeks of either cognitive behavioral therapy or applied relaxation. Daily diary entries from the treatment period were subjected to time series analyses in order to determine the degree of order versus disorder present within individual dynamic systems. These idiographic data were then aggregated for nomothetic analysis of treatment outcome via linear mixed effect models. Results: Spectral power due to daily to intradaily oscillations in thrice-daily diary data significantly moderated reliable change over posttreatment follow-up such that lesser power predicted increases in reliable change over the 1-year follow-up period. Additionally, residual variance for dynamic factor models significantly moderated the slope for change over the follow-up period, such that lesser variance—and thus greater order in dynamic systems—predicted increases in reliable change. Conclusions: The degree of order in dynamic systems established during therapy acted as an adaptive attractor state, promoting continued positive gains 1 year after the conclusion of therapy. The present study represents an important innovation in the study of dynamic systems in psychotherapy. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Review of Cognitive therapy with schizophrenic patients.

Reviews the book, Cognitive therapy with schizophrenic patients by Carlo Perris (see record 1989-97536-000). The author wrote this book with the purpose of presenting cognitive psychotherapy as a part of a successful holistic, cognitive behavioral program implemented at small community-based treatment centers, and as individual therapy with relatively young patients suffering from a schizophrenic disorder. The program de-emphasizes the medical model and introduces a 24-hour psychosocial milieu treatment model conducted over at least 9 full months, in which the patient is responsible for goal-setting, interpersonal problem solving, and medication schedule, with little family intervention. Throughout the text, the author writes about cognitive psychotherapy. The words "cognitive psychotherapy" not "cognitive therapy" would seem to be most appropriate for the tide of the book. For some therapists and researchers, specific information on cognitive therapy includes more details on tasks and measures of performance ranging from arousal, attention, and concentration through recognition, recall, immediate, delayed, long-term, and short term and executive functions, that is, the information processing approach. One of the attractions of the book is that readers first learning about cognitive psychotherapy are offered an opportunity to explore the future use of cognitive psychotherapy with schizophrenic patients and other patient groups. For psychotherapists, mental health workers, graduate, and undergraduate students, Cognitive Therapy with Schizophrenic Patients, is a thorough introduction to a new treatment strategy for schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sampling from the recorded therapy interview: The problem of segment location.

To provide some evidence regarding the relative information value of different methods of sampling from the recorded individual psychotherapy interview, patient Experiencing (EXP) ratings were obtained for 5 successive 8-min. portions of 1 therapy hour for each of 24 patients (8 schizophrenics, 8 neurotics, and 8 normals). The results show a significantly different linear trend of EXP ratings over the therapy hour for the neurotic, in contrast to both the schizophrenic and normal groups. These results, suggesting greater between-group differentiation as the interview progresses, are discussed in terms of their implications for sampling procedures in psychotherapy research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The technique of psychotherapy.

Review the book "The technique of psychotherapy," by Lewis R. Wolberg (see record 1954-08774-000). This is not the case with The Technique of Psychotherapy. It provides one of the most remarkably comprehensive discussions of specifically what to do in psychotherapy that is currently available. The range and specificity of the topics covered is truly astounding. The topics covered deal with almost every conceivable question that the beginning therapist might ask an expert. This book is remarkable not only in the comprehensiveness of its coverage of specific aspects of therapy but also in the flexibility and freedom of dogmatism of the writer. Wolberg's position appears to be best described as eclectic-psychoanalytic. Wolberg has something good to find in all varieties of psychotherapy. Insight therapy, catharsis, re-education, environmental manipulation, support, reassurance, hypnosis, dream interpretation, free association, and persuasion all have their place for different kinds of therapy and for different kinds of cases. It will be useful in teaching psychotherapy and as a reference for those who practice psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Schizophrenia and therapist involvement: Changing the practice of four major psychotherapies.

Describes how therapy experience with schizophrenic patients has impacted on 4 therapeutic approaches—existential psychotherapy, psychoanalysis, client-centered psychotherapy, and family therapy. It is suggested that such experience has led to similar therapist-centered modifications in each of the 4 psychotherapies and that a cross-relevancy between the treatment of schizophrenia and all other psychological disorders has emerged. Aspects of therapy considered include the interpersonal nature of the analytic situation, the communication of empathy, and intervention with dysfunctional family systems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nonverbal synchrony in psychotherapy: Coordinated body movement reflects relationship quality and outcome.

Objective: The authors quantified nonverbal synchrony—the coordination of patient's and therapist's movement—in a random sample of same-sex psychotherapy dyads. The authors contrasted nonverbal synchrony in these dyads with a control condition and assessed its association with session-level and overall psychotherapy outcome. Method: Using an automated objective video analysis algorithm (Motion Energy Analysis; MEA), the authors calculated nonverbal synchrony in (n = 104) videotaped psychotherapy sessions from 70 Caucasian patients (37 women, 33 men, mean age = 36.5 years, SD = 10.2) treated at an outpatient psychotherapy clinic. The sample was randomly drawn from an archive (N = 301) of routinely videotaped psychotherapies. Patients and their therapists assessed session impact with self-report postsession questionnaires. A battery of pre- and postsymptomatology questionnaires measured therapy effectiveness. Results: The authors found that nonverbal synchrony is higher in genuine interactions contrasted with pseudointeractions (a control condition generated by a specifically designed shuffling procedure). Furthermore, nonverbal synchrony is associated with session-level process as well as therapy outcome: It is increased in sessions rated by patients as manifesting high relationship quality and in patients experiencing high self-efficacy. Higher nonverbal synchrony characterized psychotherapies with higher symptom reduction. Conclusions: The results suggest that nonverbal synchrony embodies the patients' self-reported quality of the relationship and further variables of therapy process. This hitherto overlooked facet of therapeutic relationships might prove useful as an indicator of therapy progress and outcome. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychotherapy integration as practiced by experts.

Twenty-four psychotherapists who were experts in psychotherapy integration and had a mean of 32 years of clinical experience completed a questionnaire assessing their practice history and fidelity to various psychodynamic, cognitive–behavioral, humanistic, and family systems theories. They then completed the 100-item Psychotherapy Process Q set (Jones, Hall, & Parke, 1991) modified to be a self-report questionnaire, based on a client they had treated using integrative therapy. Most therapists reported some influence of all 4 orientations, but almost three-quarters indicated that only 1 was a salient influence. Principal components factor analysis revealed 4 factors representing 4 integrative practice styles, which were then correlated with prior prototypes of cognitive–behavioral, psychodynamic, and interpersonal therapies. The first factor, accounting for just over half the variance, most resembled cognitive–behavioral therapy. The second factor shared elements of several orientations, whereas the third factor most resembled psychodynamic therapy. The responses of more than half the therapists loaded on more than 1 factor. Findings demonstrate a diversity of theoretical influences and practices among these experts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effectiveness of psychotherapy: The Consumer Reports study.

Consumer Reports (1995, November) published an article which concluded that patients benefitted very substantially from psychotherapy, that long-term treatment did considerably better than short-term treatment, and that psychotherapy alone did not differ in effectiveness from medication plus psychotherapy. Furthermore, no specific modality of psychotherapy did better than any other for any disorder; psychologists, psychiatrists, and social workers did not differ in their effectiveness as treaters; and all did better than marriage counselors and long-term family doctoring. Patients whose length of therapy or choice of therapist was limited by insurance or managed care did worse. The methodological virtues and drawbacks of this large-scale survey are examined and contrasted with the more traditional efficacy study, in which patients are randomized into a manualized, fixed duration treatment or into control groups. I conclude that the Consumer Reports survey complements the efficacy method, and that the best features of these two methods can be combined into a more ideal method that will best provide empirical validation of psychotherapy. (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)     

Evidence-Based Practice: Beyond Empirically Supported Treatments.

Must the clinician choose between a practice that is strictly objective and data based and one that is purely subjective and experience based? Optimally, practitioners need to follow a model of evidence-based psychotherapy practice, such as the disciplined inquiry or local clinical scientist model, that encompasses a theoretical formulation, empirically supported treatments (ESTs), empirically supported therapy relationships, clinicians' accumulated practical experience, and their clinical judgment about the case at hand. Some shortcomings of ESTs are reviewed, and a form of evidence for psychotherapy practice is presented that entails the accumulation of systematic case studies published online. Practitioners can contribute to such a database and be guided in their practice by those cases most relevant to their clients' problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Therapeutic experiencing: The process of change.

Reviews the book, Therapeutic experiencing: The process of change by Alvin R. Mahrer (1986). In one sense, Mahrer makes the reviewer's task easy by summarizing in his introduction such key points as the purpose of his book, its scope, and its intended readership. Mahrer has two stated purposes: one is "to show how to do experiential therapy" and the other is "to build upon the various members of the experiential family and to propose a single theory of experiential psychotherapy complete with its own methods of bringing about therapeutic change." There are three conditions, however, which must be met in order to enable the reader to do experiential therapy. The first is that the reader is familiar with and sympathetic to existential-humanistic thinking. It is to all such therapists, as well as to their patients, that this book is addressed. The other two conditions that must be fulfilled in order to undertake experiential therapy are that the reader understands how to start each experiential therapy session and knows how to listen experientially. These latter two conditions are the subject of an earlier book by Mahrer, Experiential Psychotherapy: Basic Practices, which is thus basic reading for anyone intending to apply the method described in the current volume, as these two conditions together comprise the essential first of five steps that constitute each experiential psychotherapy session. The current volume picks up the method only at step two, "carrying forward of potentials for experiencing," and covers the remaining steps as well: "experiencing the relationship with deeper potentials, experiential being of the deeper potentials, and being/ behavioral change." In Therapeutic Experiencing , Mahrer stipulates that the patient should have a minimum of three hundred sessions, distributed over a 3-year period, and return for therapeutic work every two years or so for about 10 to 15 sessions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An augmented model of brief psychodynamic interpersonal therapy for patients with nonepileptic seizures.

Nonepileptic seizures (NES) are one of the most common functional (medically unexplained) symptoms seen by neurologists. Although most experts consider psychotherapy the treatment of choice, few therapeutic approaches have been described in detail. Given that NES occur in the context of many different psychopathologies, it remains uncertain whether there is 1 intervention that can benefit all comers or whether it is necessary to offer individualized psychotherapy. This article describes an approach grounded in psychodynamic interpersonal therapy but augmented with elements of cognitive–behavioral therapy, somatic trauma therapy, and the involvement of caregivers and family members. The approach was developed in the setting of a specialist psychotherapy service for patients with functional neurological disorders presenting to British hospital-based neurologists. The authors have previously shown that it is associated with significant improvements in psychological functioning, health-related functioning, and a symptom count. Three case reports illustrate how the treatment can be adapted to meet different patients' needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic Engagement With Adolescents in Psychotherapy.

Therapeutic engagement of adolescents is critical to maximizing the success of any psychotherapy intervention. Therapists have found that engaging adolescents is especially challenging and that there are several reasons for this. Most psychotherapy models are based on treatments that work for adults. These methods are frequently not conducive to engaging adolescents because of their developmental immaturity, the stigma many adolescents associate with psychotherapy, and adolescents feeling forced into psychotherapy. Existing empirical and clinical knowledge about therapy process, adolescent development, and adolescent interactions with their social ecology can be used to guide psychotherapists working with this population. Engaging adolescents in psychotherapy and establishing a strong therapeutic alliance with adolescents require that therapists express empathy and genuineness, utilize developmentally appropriate interventions, address the stigma, and increase choice in therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)