Some salient lessons from research and practice.

Discusses the therapist's indispensable abilities to listen and to resonate to his or her own inner world and the patient's inner world, and to manage his or her own emotional reactions. In short, transference and countertransference are the key to a successful working alliance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The practice of dynamic pscyhotherapy in a circumscribed community

The paper describes the changes produced in the practice of dynamic psychotherapy when conducted within a circumscribed region. The authors discuss changes in anonymity, roles, and transference relationships for both therapist and patient. The paper demonstrates these effects on the therapist's professional training, his practice, and his family.     

Therapeutic approaches to children in residential treatment: Changes from the mid-1950s to the mid-1970s.

Describes changes during the past 20 yrs in the role and therapeutic functions of psychologists in a residential treatment center for children. The older therapeutic approaches, which focused on psychoanalytically oriented psychotherapy, the child therapist's relations with parents, and psychotherapy with psychotic children are compared with innovative approaches currently employed, including family therapy, behavior therapy with psychotic children, and a recently instituted treatment known as "unit therapy." These newer therapeutic roles have affected the training of psychology interns and the work of staff psychologists and have led to changes in interpersonal perceptions among psychologists and nonprofessionals who are now recognized as playing a more significant role in the therapeutic process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Some factors affecting the quality of therapeutic relationships.

The degree to which the quality of the therapeutic relationship established by two equally "expert" therapists with the same patient sample varies in terms of the therapist's personality and his perceptions of the patients is investigated. "It was found that the therapist who was able to establish the better social relationships also established the better therapeutic relationships. Moreover the therapist who perceived a patient as more closely approximating his 'ideal patient' concept created the better relationship with that patient." 21 references. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Synchronicity and psychotherapy: Unconscious communication in the psychotherapeutic relationship.

Within analytic and psychoanalytic psychotherapies, the unconscious process and communication between patient and psychotherapist is central to the therapeutic work. Unconscious communication may manifest in a variety of ways including through synchronicity. Synchronicity is an acausal yet meaningful connection between an internal mental object and an external event originally described by Carl Jung and his contemporaries. Previous literature has discussed the relationship between synchronicity and psychotherapy but there has been limited attention to synchronistic events linking the patient and psychotherapist. Relational viewpoints that emphasize the therapeutic dyad and the creation of meaning in the therapeutic context provide a contemporary framework for understanding and utilizing synchronicity as it surfaces in psychotherapy. Concepts from psychoanalytic psychotherapy including intersubjectivity, the therapeutic container, transference, and countertransference are explored in relation to synchronicity. Guidance for integrating and utilizing synchronicity in relationally oriented psychotherapy is provided. A clinical case study is presented to illustrate these ideas. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pregnancy in the therapist: Consequences of a gradually discernible physical change.

Explores 3 features of pregnancy in the psychoanalytic therapist: (1) unlike sudden illness, the therapist's pregnancy most often becomes known gradually; (2) the fact of the pregnancy is communicated to the patient largely through the therapist's silent action of sitting, visibly pregnant, in the office; and (3) the therapist's task in deciding when and how to discuss her pregnancy with patients may be complicated by her longing for patients to recognize it. Consequences of these features of the therapist's pregnancy are illustrated with clinical material from 3 cases involving 2 females in their 20s and 1 male in his early 30s. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The place of community in medical encounters

Disease and injury creates a break between the individual and the community which compromises the individual's status within the community as well as the integrity of the self as a "product" of social interaction. Our "everyday" activities are called into question since our ability to fulfill obligations and to achieve many of our ends is diminished through the weakening of our bodies. In light of this account of disease, healing is about restoring the individual to a state of vital functioning, and vital functioning entails communal participation. As John Dewey points out, health as "living healthily" can be understood only in context of each patient's pursuits which are always social and communal. But, if living in community with others is the end-in-view for medical encounters, it too must be implicated in the means to that end. A patient who is given the opportunity to participate as a member of the health care community has already begun within the medical encounter itself to live healthily. It follows, then, that we must work to promote new attitudes within health care towards aiding in the effective agency and participation of patients in their healing process -- i.e., we must see community as healing.     

Reflections on the "unknown" in psychotherapy.

Suggests that "darkness" (in contrast to and in alternation with "light") is useful as a metaphor for representing ever-recurring periods in dynamic psychotherapy during which the therapist does not and cannot know what is occurring in the work with his/her patient. Such unfathomable "dark" periods are a fertile matrix from which central meanings in a patient's life will emerge, provided the therapist does not interfere with their unfolding. However, these "dark" periods are anxiety provoking for the therapist and often result in anxiety-instigated, growth-deflecting efforts at prediction and control. Clinical vignettes are presented to illustrate the inevitable rhythm of alternation in therapy between "darkness" and "light," the imponderability of various key therapeutic events, and the therapist's struggles with these issues. (1 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The substitute therapist as transitional object in the treatment of borderline personality disorders.

Focuses on the use of a substitute therapist (ST) as a transitional object for a 20-yr-old female with borderline features during the temporary absence of her psychotherapist. Events before, during, and after the therapist's absence illustrate several issues of continuity and availability of treatment that lead to recommendations for the use of an ST in treating borderline individuals. A major goal of the ST was achieved in that the likelihood of the patient's acting out in some way before, during, and/or after the therapist's absence was minimized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Some observations on the fallacy of value-free psychotherapy and the empty organism: Comments on a case study.

Discusses the article by R. J. Kohlenberg (see PA, Vol 52:Issue 5). The psychotherapist always treats a person, not a passive organism, and the therapist's moral values inevitably influence his interactions with the patient, regardless of whether the therapist's stance is made explicit. Ultimately, all therapies are seen as attempts at persuading a thinking and feeling person to behave differently. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The positive therapeutic relationship as accreditation.

In formal accreditation ceremonies, one person acts by virtue of his or her position to confirm another person in a new position in a community. The new position, or "status," is such that the confirmed individual now enjoys expanded eligibilities for participation in that community. This article explores the power inherent in viewing the positive therapeutic relationship as an ongoing, informal rite of accreditation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dreams about the therapist: Mood, interactions, and themes.

Analyzed the mood, interactions, and themes in the manifest dream representations reported by 67 25–71 yr old psychotherapist volunteers, who each reported 1 dream about his/her own therapist. Ss tended to have unpleasant dreams featuring therapists who were frustrating or gratifying. In the dreams, friendly, aggressive, and sexual interactions were initiated by therapists; only the friendly interactions tended to be reciprocated. Four overarching themes emerged: separation-rejection, seduction-antagonism, protectiveness-responsiveness, and praise. It is proposed that these characteristic ways of dreaming about the therapist depict issues of central importance for many patients, and reflect patients' effective use of the transference to work on their concerns. (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)     

A continuum of listening and interventions.

The continuum of listening discussed in this article includes the analyst's or therapist's states of consciousness; his or her focus of attention, ranging from free floating to sharply focused; and the kinds of interventions that he or she can formulate at each point on the continuum. At one end, the analyst is relatively unaware of many of his or her own thought processes, and interventions surprise the analyst because they are formulated unconsciously. They may appear as a slip of the tongue or as a vivid image. In the middle range of the continuum, the analyst functions in more usual states of awareness, and interventions address well-developed themes of all types, especially transference themes. At the most conscious, sharply focused end of the continuum, the analyst's interventions clarify affects and address defenses and minute forms of resistance. There is also a strong emphasis on focusing on the conscious thoughts and feelings of the analysand or patient. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Endangered by interpretations: Treatment by attitude of the narcissistically vulnerable patient.

Some narcissistically impaired patients present a particularly difficult therapeutic challenge. They often cannot tolerate interpretations because they view interpretations as humiliating evidence that they are shamefully defective. For these patients, "treatment by attitude" and without significant interpretation may be the only way they can feel safe enough to allow the therapeutic process to unfold. Two cases are discussed. In the 1st case, the usual therapeutic attitude of nonjudgmental acceptance was sufficient. The 2nd case was counterintuitive because the patient needed the therapist to demonstrate a complete lack of worry about the patient for her to make progress. Although the therapist's attitude is part of every treatment, it may be particularly important in the treatment of more severely disordered patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The self in the family system: Expanding the limits of family therapy.

Reviews the book, The self in the family system: Expanding the limits of family therapy by Michael P. Nichols (see record 1987-98398-000). The authors' major thesis is that having recognized the importance of family dynamics (the "system") on the behavior of the individuals within it, systems theory has neglected both the individual self as well as the influence of the self on the system. Nichols demonstrates this by quoting the more influential family systems theorists and by the use of numerous clinical vignettes, and then he sets about to remedy the situation. In so doing he effectively integrates and synthesizes current psychodynamic theories with current systems theory. The result is a powerful argument for the absolute necessity of expanding existing limits of family therapy and attending to the unique feelings, perspectives, motivations, and personal responsibility of the individuals comprising the system. This broadened perspective of the family therapist's role necessarily requires knowledge of and expertise with both systems theory and current psychodynamic theory and practice. Nichols does not advocate individual therapy within a family context. Rather he emphasizes the need for the family therapist to effectively and flexibly shift from a focus on the family dynamics to the individual dynamics depending on the relatively greater therapeutic usefulness of either perspective at any given point in treatment. For those family therapists who have not reached Nichols's conclusions, this book deserves to be read critically, carefully, and with ruthless honesty. Finally, any practicing psychotherapist, student, or teacher will find this book to be an essential addition to his or her personal library. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapy of psychic trauma resulting from attempted filicide.

Peter, a 5-yr-old "favorite child" survived an attack in which his mother slashed his throat with a razor. Peter's reactions to the trauma, his attempts at resolution of ambivalence toward his mother, and finally the emergence of transference and castration anxiety are discussed. Peter's reactions and attempts at conflict resolution are illustrated by excerpts from therapy sessions and discussed from the perspective of normal child development. Parental dynamics, court involvement, and the therapist's countertransference are presented, with suggestions as to how similar cases can be managed to avoid premature termination. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The pregnant therapist: Countertransference dilemmas and willingness to explore transference material.

Examines one female therapist's countertransference (CTR) reactions during her 1st pregnancy and her willingness to explore certain aspects of the transference. Two clinical vignettes illustrate the ways in which CTR reactions during this pregnancy either facilitated or disrupted the treatment process. In the 1st clinical example, the timing and effect of the therapist's pregnancy on a 30-yr-old female patient stimulated in the therapist feelings of narcissistic vulnerability and guilt. In the 2nd vignette, the demanding and intrusive behaviors of a 34-yr-old woman aroused anxiety and ambivalence in the therapist about the physical changes in early pregnancy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)