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)     

Methods and mechanisms in the efficacy of psychodynamic psychotherapy.

Comments on the original article, "The efficacy of psychodynamic psychotherapy," by J. Shedler (see record 2010-02208-012). Shedler summarized a large body of research that shows psychodynamic therapy to have a substantial effect size, comparable to that for many empirically supported treatments. This is an important finding, in part refuting the concerns raised by Bornstein (2001, 2002) regarding the future of psychodynamic approaches had there been no substantial changes in how practitioners and researchers approached the science to demonstrate efficacy. Further, Shedler showed that the efficacy of psychoanalytic psychotherapy is due to therapeutic methods commonly employed in cognitive behavior therapy (CBT), one of the most frequently cited empirically supported approaches for a wide range of psychological conditions. From a methodological perspective, there are some important limitations to the claim of psychodynamic psychotherapy’s comparable efficacy to other empirically supported approaches. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychognosis and psychopedics.

Comments on how psychology is badly in need of a new and more precise term to describe the intimate interpersonal activity between psychologist and emotional upset client. The author states that psychiatrists generally and many clinical psychologists prefer the term "psychotherapy" for the activity involved, possibly because of the association of the term "therapy" with medical treatment; though etymologically the term "psychotherapy," meaning "service of the soul," might be most appropriately preempted by pastoral psychology. According to the author, the contention recently advanced by a committee of the AMA that, since "therapy" is a medical function, psychotherapy can be legitimately performed only by licensed physicians, stretches a tenuous metaphor to the breaking point and seems to demonstrate the prepotency of economic considerations over both logic and social responsibility. Lastly, the author states that the use of terms like psychognosis and psychopedics for diagnosis and psychotherapy, though awkward at first, would further both conceptual clarity and the delineation of the psychologist's (and the delimitation of the physician's) professional responsibility. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The future of systems therapy: Shedding myths and facing opportunities.

Discusses trends in systems therapy. Systems therapy is moving toward paradigmatic parity with more conventional approaches to psychotherapy. Within systems therapy, there has been a breakdown of "schoolism" and a strong movement toward technical eclecticism. There is also a strong movement toward integration within systemic therapy. Systems theory is not yet associated with a large body of research, but it may prove uniquely suited to integrating accumulating research concerning persons in their relational context and to making this research relevant to both conventional and systemic therapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A psychodynamicist looks at modern behavior therapy.

Discusses the growing rapproachement between psychotherapy based on psychodynamic principles and behavior therapy. Both, in the final analysis, are concerned with the elucidation of the psychological processes by which personality and behavior change is brought about. The present article delineates areas of convergence, with special reference to the "treatment package," patient variables, and the therapeutic interaction. It is concluded that psychotherapy of all varieties is made up of learning, unlearning, and relearning experiences that can be mediated in different ways and that the task of the future is to spell out the conditions that promote or impede such learning. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A transvaluation of psychotherapy: a reply to Hans Eysenck.

In an attempt to answer Eysenck's contention that "the figures fail to support the hypothesis that psychotherapy facilitates recovery from neurotic disorder," the author re-examines three vital questions: What is psychoneurosis? What is psychotherapy? and What is improvement or recovery? (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Values in psychotherapy

There is a tension between those who hold that psychotherapy is a scientific discipline and therefore "value-free," and those who believe that values are inherent in the nature of psychotherapy. Psychoanalysis has moved from a science-based ideology, through the ethical concerns of Melanie Klein, to a recognition of the "aesthetic" dimension--the creation of suitable forms that can contain psychological distress. From this latter perspective, the antagonism between religion and psychotherapy, initiated by Freud, becomes less acute. Action-based ethical systems, which ignore the inner world, are critically scrutinized. The evidence suggesting there is a relationship between good outcome in psychotherapy and shared values between therapist and client is reviewed. It is posited that through examination of the "ethical countertransference," therapists should become aware of their own value systems and how they influence practice.     

Treatment of major depression with psychotherapy or psychotherapy-pharmacotherapy combinations

BACKGROUND: Few reliable correlates of treatment response in depression have emerged despite nearly 40 years of research. We examined the correlates of recovery in a "mega-analysis," or meta-analysis of original data, of 595 patients with major depressive disorder enrolled in 6 standardized treatment protocols. METHODS: All patients (mean age, 44 years; 31% male and 69% female) met criteria for nonbipolar, nonpsychotic primary major depressive disorder and were treated for 16 weeks with either cognitive behavior therapy or interpersonal psychotherapy alone (psychotherapy alone; n = 243) or interpersonal psychotherapy plus antidepressant pharmacotherapy (combined therapy; n = 352). The impact of treatment type, severity, study, and other covariates on recovery rates or time to recovery were examined by means of chi 2, log-rank tests, the Cox proportional hazards model, and sensitivity analyses. RESULTS: Whereas combined therapy was not significantly more effective than psychotherapy alone in milder depressions, a highly significant advantage was observed in more severe recurrent depressions. Poorer outcomes were also observed in women and older patients, although these effects were dependent on inclusion of particular studies. CONCLUSIONS: Mega-analysis is a powerful method for comparing the efficacy of treatments and examining correlates of response. Using this method, we found new evidence in support of the widespread clinical impression that combined therapy is superior to psychotherapy alone for treatment of more severe, recurrent depressions.     

Psychotherapy integration in Portugal.

In answering five questions regarding the status of psychotherapy in Portugal, predominant theoretical orientations, standing of psychotherapy integration, and cultural issues, the author draws a brief sketch of the situation of psychotherapy in Portugal. It is stressed the increasing number of patients seeking therapy as well as the increasing number of professionals providing it, and a growing dialogue between psychologists and psychiatrists. In terms of theoretical orientations, the dominant ones are the analytic/dynamic and the cognitive-behavioral with an increasing number of therapists leaning towards integration. In terms of cultural issues relevant to psychotherapy, it could be said that a significant number of patients deal with issues related to the question of balancing "cooperation/proximity" and "agency/competitiveness," as well as matters of unassertiveness. From the standpoint of the author, major lessons learned from being in Sepi are flexibility, humility, sharing, and something close to the "bearable lightness of being..." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Heart-rate change as a component of the orienting response.

Both Sokolov and the Laceys have proposed that autonomic feedback to central neural structures amplifies or reduces the effects of stimulation. Lacey and Lacey distinguished between the effects of feedback from the cardiovascular system and from other autonomic systems and suggested, specifically, that heart-rate (HR) acceleration should be associated with stimulus "rejection" and HR deceleration with stimulus enhancement. This appeared to be contradicted by evidence that HR increased with the orienting reflex whose function, according to Sokolov, is the enhancement of stimulus reception. However, when studies using simple "nonsignal" stimuli were reviewed, it was found that the criteria identifying an orienting reflex were satisfied by responses of HR deceleration and that instances of HR acceleration probably reflected a "defense," "startle," or "acoustic-cardiac" response. (2 p. ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy and chaos theory: The metaphoric relationship between psychodynamic therapy and chaos theory.

Explored potential benefits and problems in applying chaos theory in psychotherapy through an examination of previous attempts to integrate chaos theory in psychoanalysis and psychodynamic therapy. First, a discussion provides an understanding of basic concepts in chaos theory and reviews applications in psychoanalysis. Second, problems in such application are scrutinized. Finally, the discussion speculates on a general tendency in the literature in psychotherapy and counseling to resort to mathematical analogies, arguing that this attraction may produce an "erroneous metaphor," and gives reasons both for the attraction and its danger. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Techniques for strengthening clients' observing ego.

The construct of the observing ego has received little attention in the psychotherapy literature since it was first introduced by Freud, yet its attainment is considered one of the hallmarks of mental health. Despite the importance of increasing clients' observing ego functions, little has been written about how to accomplish this goal in psychotherapy. This article describes an integrative psychodynamic approach to treatment that selectively uses modified techniques from other theoretical approaches. The relationship between the therapeutic alliance and the observing ego is discussed, and 4 techniques for increasing observing ego functions are suggested: (1) the use of clarification following catharsis; (2) increasing reality testing; (3) serving as an auxiliary ego; and (4) the use of distancing techniques such as the conscious projection of a problem, use of metaphors, humor, journals, and the gestalt empty chair technique. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adaptationism, mental health, and therapeutic outcome.

Common views of psychotherapy and mental health regard improved ego adaptation as the predominant goal for therapy. These views originate in the individualism of major models of personality and in the individualistic and secular biases of modern Western culture. Because of its commitment to the self-interested ego as the ultimate unit of analysis, the adaptationist model of has made it difficult for psychotherapy to respond to some of the major sources of mental disorder today: isolation, meaninglessness, and the depersonaliazation of self and others. Therapy must make a special effort to attend and respond to the person's ethical participation in constitutive relationships of several kinds. (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)     

Implications of Loevinger's theory of ego development for time-limited psychotherapy.

Examines the implications of J. Loevinger's (1976) stages of ego development, which are characterized by psychic structures that determine the form in which self and other are experienced, for psychotherapy. The stages of ego development are described, and their association with specific symptoms of psychopathology is discussed. An important distinction in applying developmental concepts to clinical work is the difference between internal developmental stages and external challenges of the life cycle. Case examples of a 42-yr-old woman with an adjustment disorder and a 17-yr-old girl with school and family problems illustrate the use of developmental concepts in time-limited psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Working it out: Using exercise in psychotherapy.

Reviews the book, Working it out: Using exercise in psychotherapy by Kate F. Hays (1999). In this well-organized book, Kate Hays presents exercise as a important component of a multi-modal approach to therapy. The overall content is differentiated into four major sections, in the first of which Hays establishes the value of exercise. The second section moves from theory to the use of exercise as a therapeutic tool. Outlined in the third section are the "Psychological Benefits of Exercise with Specific Populations," overviewing many common clinical populations and specific exercise-based treatment recommendations. The fourth section, "Caveats and Boundaries," is just that, an important collection of chapters that did not find a place elsewhere in the book. This book contributes to a practical and applied view of the synergistic interaction of mind and body. Its essential message adds to the base of literature having the potential to influence private and public programs promoting health and well-being. This book ought to be well received by students and professionals such as educators, clinicians and counsellors of varied disciplines, physicians, physiotherapists, and social workers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The creative process of psychotherapy.

Reviews the book, The creative process of psychotherapy by Albert Rothenberg (see record 1987-98784-000). Rothenberg's most recent work is a slim, elegantly crafted volume bearing an unanticipated impact. The subject, psychotherapy as a "creative process," suggests a threadbare humanistic cliché, a pleasing phrase devoid of meaning or procedural import. However, creativity emerges from this work as an unexpectedly legitimate, specifiable, and procedurally relevant dimension of psychotherapy. Rothenberg sees the creative process as consisting of three basic elements: the "homospatial" process, the "janusian" process, and a more vaguely defined general function labeled "articulation." It is the homospatial and janusian notions that yield the most productive applications to therapy. The homospatial process involves imagining a literal superimposition of two or more discrete sensory entities, entities such as visual images, patterns of sound, and so on. This imagined superimposition is not a regression to primary process, not a condensation or fusion, but rather a dynamic, unstable interaction that yields products both new and valuable. The janusian process refers to simultaneously conceiving two or more antithetical notions. In the author's thinking, articulation is a general function which, while encompassing the previously mentioned processes, includes other patterns as well. Despite isolated deficits, this work is a mature, masterful treatment of a critically important issue in clinical work. The author accurately points out that the richest and most productive therapy is creative, and he encourages us as helpers to give freer rein to our homospatial and janusian functions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)