Narrative empathy.

Therapeutic empathy is described as an active narrative process, in which the therapist attempts to construe and express the inner emotional logic of the client's problem patterns. The empathic narrative is contrasted to the external narrative, which describes the client from the outside and the client's behavior as making sense from the point of view of the theory rather than from that of the client's. The criterion of an empathic narrative is that it elicits from the client the response "That's me!" The external narrative, in distinction, fails to elicit this self-recognition. The persistent rejection of the therapist's formulations by the client and the ensuing state of therapeutic impasse is interpreted as being often due to the therapist's assumption that the client should accept an external narrative as if it were an empathic one. When such a situation develops, the therapist may overcome the impasse by acknowledging the externality of the previous therapeutic narrative and proposing a potentially empathic one in its stead. Three case examples of a 49-yr-old married woman, a teenage girl, and 28-yr-old single male are presented to demonstrate narrative empathy within the therapeutic context. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Covert sensitization with a homosexual: A controlled replication.

Describes the application of covert sensitization to a 22-yr-old male homosexual to determine the feasibility and effectiveness of the technique as described by J. Cautela (see record 1967-08999-001). Covert sensitization was effective in eliminating the deviant behavior, but therapeutic problems arose in that the client developed an intense transference toward the therapist as well as a strong desire to understand his homosexuality. In addition to having to cope with these new aspects of the therapeutic process, a "setback" occurred which required "working through." Results raise the question of whether a behavioral technique itself is sufficient treatment for homosexual behavior, or whether behavioral therapy should be complemented by a psychotherapeutic approach. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical judgment in geropsychology practice.

418 clinical psychologists (aged 28–77 yrs) were mailed a clinical judgment survey containing a standard case history that varied according to age (46 or 72 yrs), class (working or middle), and gender of client. Clients were rated along Likert scales on dependent variables tapping attitudinal (e.g., "usefulness of intervention"), symptomatological (e.g, "disorientation"), and diagnostic dimensions. MANOVA analyses demonstrated that the 72-yr-old client elicited significantly more negative perceptions, including more "psychotic" diagnoses than the 46-yr-old client. Results provide evidence for ageism in the psychotherapy setting and treatment. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A case report of dissociative neurosis (depersonalization disorder) in an adolescent treated with family therapy and behavior modification.

Describes the use of behavioral procedures within the context of systems-oriented family therapy in the treatment of a 15-yr-old girl's functional blackouts. Despite fairly clear psychosexual issues, treatment successfully eliminated blackouts without directly addressing such issues. The matter is discussed with reference to conceptualizing etiology and treatment. Working with the adolescent's family is advocated, the importance of client attributions for therapeutic gain is noted, and issues of validity and generalizability are discussed. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral treatment of mucous colitis.

Reports the case history of a 22-yr-old female student who suffered aproximately 1 colitis attack/day who was apparently successfully treated by a procedure in which the therapist labeled antecedent stress events that appeared to be precipitating the attacks. The client was then taught a behavioral coping strategy to counter the stress events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Operant therapy for excessive checking.

Evaluated a specific therapeutic approach to the treatment of excessive checking things behavior (obsessive compulsive disorder). S was an 18-yr-old high school graduate who had failed to respond to traditional therapy. The strategy was to integrate inconvenient consequences as a part of S's self-control behavior and to delay the occurrence of the deviant behavior. When to increase the intensity of inconvenient consequences to produce a facilitation of the weakening process is discussed. A follow-up study indicates that the present approach is clinically effective. (French summary) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Strategic therapy with children: Single-subject case-study demonstrations.

Discusses 3 child therapy cases to illustrate the utility of the strategic therapy approach. Illustrative therapist–client dialogs and accompanying narration and graphics depicting child symptom reductions are included. Ss were a 9-yr-old female referred to treatment for her emotionality, a 13-yr-old female referred for night fears and insomnia, and an 8-yr-old male who was referred because he frequently argued and talked back to his mother. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Setting limits while enabling self-expression: Play therapy with an aggressive controlling child.

Maintaining neutrality while preserving an empathic, observing, clarifying, confronting and interpretive stance that enables ongoing self-expression, is critical for child therapists. Doing so in the face of aggressive, domineering and occasionally even explosive behavior is a far more difficult and demanding therapeutic task. This paper is an attempt to clarify the problem with a case illustration involving a 5-yr-old female client. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of chloride ion upon chicken visual pigments

Diagnostic and therapeutic proceeding involves usually that physician/psychologist became the subject and patient/client the object in a rational process. - Exactly this can cause disturbances of this process, especially in cases of psychosomatic diseases and emotional disturbances. It will be considered (a) whether a more flexible relationship between physican/psychologist and patient/client can be established, (b) whether reflection of the concordance (or discordance) in "defining the situation" leed to new aspects of physicans/psychologists proceeding. (c) Implications for training, methods, therapy and rehabilation will be discussed.     

System for observing family therapy alliances: A tool for research and practice.

To advance research and inform practice, the authors developed an observational rating system of client behavior reflecting strong and weak therapeutic alliances in couple and family therapy. The System for Observing Family Therapy Alliances (SOFTA), in both English and Spanish, has 2 dimensions that are common across therapy modalities ("emotional connection to the therapist" and "engagement in the therapeutic process") and 2 dimensions that reflect the uniqueness of conjoint treatment ("safety within the therapeutic system" and "shared sense of purpose within the family"). Psychometric support is provided by 5 reliability studies, an exploratory factor analysis with data from 120 diverse English- and Spanish-speaking couples and families, and meaningful associations with various process and outcome indices. Recommendations are made for using the SOFTA in research, training, and (self-)supervision. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward a theory of strategic self-presentation in counseling and psychotherapy.

Introduces an impression-management perspective of the therapeutic process. On the basis of the reciprocal view of social influence, a taxonomy is proposed for classifying certain kinds of client self-presentations as defensive and assertive strategies to influence counselors' impressions and behaviors. A defensive or protective strategy is one in which the client seeks to avoid blame or disapproval by the counselor, whereas an assertive strategy is characterized by attempts to gain approval, credit, or social power in the relationship. Four assertive strategies (ingratiation, supplication, self-promotion, and intimidation) and a defensive strategy ("facework") are described, along with their respective short-term tactics. The theoretical relevance of these strategies is described, including the therapeutic contexts that are likely to elicit each class of self-presentation and potential counselor reactions and interventions. 10 propositions are detailed as directions for future research, and earlier literature on the influence of clients' behaviors on counselors' impressions is reviewed from an impression-management perspective. (78 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contingency self-management in counseling.

Considers that the counselor may often be unable to pinpoint any specific external forces operating on a client to cause undesirable responses, and as a result, the counselor may have to manipulate covert behaviors. Contingency self-management, a process designed to change symptomatic behavior through the control of inner states, is described. The application of contingency management in the counseling process involves the reduction of undesirable behaviors through the learning of specific antecedent verbal behaviors that are incompatible with the target or undesirable response. The client functions as his own change agent by learning how to manage contingencies and self-reinforcing consequences. A case illustration of the technique used with a 19-yr-old nursing student is presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The treatment of anxiety neurosis through rational stage directed hypnotherapy: A cognitive experiential perspective.

Describes the treatment of a 21-yr-old female with anxiety neurosis using rational stage directed hypnotherapy, a cognitive-experiential therapy developed by the 1st author (1974) that directs the client through various developmental growth stages. In this modality, the client connects various ideas with emotions, physiological responses, and behavior. The client is guided by the therapist through the stages of awareness, exploration, commitment, implementation, internalization, and change in the expansion of self-awareness, self-acceptance, and self-direction for therapeutic change. In this case study, the S received 10 wks of therapy, and a 3-mo follow-up was conducted. Measures included objective test results (MMPI, Tennessee Self-Concept Scale), self-report measurements (anxiety, physiological responses), and behavioral data (work output). Particular attention was given to high levels of cognitive control over emotional, physiological, and behavioral states and to the use of hypnosis to enhance the experimental quality of therapy. Results of this case are consistent with previous clinical and experimental studies showing substantive positive changes in thoughts, feelings, bodily responses, and behavior. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Undoing degradation.

Describes the concept of "degradation ceremony," sets forth the nature of degrading treatment, and outlines therapeutic strategies for undoing the degradations that psychotherapy clients have undergone. Six elements of the process of undoing degradation are illustrated by case vignettes of victims of incestuous involvement. It is argued that the therapist's task is to accredit the client; that is, to bring about an enhancement of status and thus eligibility for community participation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The therapeutic context: Preconditions for change in psychotherapy.

Discusses 4 aspects of therapeutic context: therapeutic alliance, client's expectations of change, treatment rationale, and therapeutic impact. To illustrate the central role of the therapeutic context in treatment outcome, a clinical case is discussed in which systematic desensitization was used to treat a choking phobia. Throughout the therapy process, there was minimal client collaboration and the treatment failed to produce any symptom change. However, significant improvement did occur subsequent to an event high in therapeutic impact that provided a plausible treatment rationale to the client, increased the client's expectation of change, and established a therapeutic alliance. This case illustrates the importance of relationship and context in psychotherapeutic change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic focusing in time-limited group psychotherapy.

The degree to which treatment outcome is related to therapeutic focusing, leader skill, and positive aspects of the therapeutic relationship was examined in time-limited group psychotherapy. Measures tapping each of these domains were assessed at Sessions 3, 8, and 14 in 15-week therapy groups led by 4 expert professional group therapists and 4 "natural-helper" nonprofessionals. Significant differences were found on process measures for both the leader skill condition and time factors. In addition, both the quality of the therapeutic relationship and the degree of therapeutic focusing independently predicted client improvement. Specifically, the results indicate that therapist focusing occurs differentially and is only predictive of improvement in professional groups, whereas a positive therapeutic relationship is only predictive of early positive improvement in nonprofessional groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Now tell me, what is your orientation to religion?"--Therapeutic attitude and management as an expression of religious faith

The essence of the therapeutic process is the relationship: the client experiences that the therapist is prepared "to be there" and to remain with him/her on the journey unconditionally. A possible goal of personal life, as well as of a therapeutic process, is to become oneself. This is described in the biblical symbol of Exodus: the motivation of the way and all existential experience of being on the way are a possibility to interpret my human existence and to fit it into the wider horizon of religious understanding; to know and experience a liberator-God (a God who sets me free) as the very basis of my development. To what extent therapy--as part of the way the therapist and the client go together--always also touches a religious dimension is shown by giving examples of some attitudes and consequent actions.     

Convergence: A phenomenon in counseling and in psychotherapy.

"As originally used… 'convergence' referred to a lessening of discrepancy in judgments made by pairs (or larger groups) of subjects." It is anticipated that "in the therapeutic interaction itself a dependent event of convergence analogous to that of convergence in judgment-making… shifts in degree toward norms and standards made available to him by the therapist" will be found on the part of the client. "Indeed, in examining others' systematic discussions of the therapeutic process and their supporting evidence, we are struck more by the relevance and potential utility of the convergence postulate than by its spanking newness." The convergence postulate "affords meaningfulness and focus to the making of a social-structural analysis of the therapeutic process." Research "on therapeutic convergence may help make clear in what ways therapy, as a social event, may differ from other diadic relationships in everyday life." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Narrative approaches to supervision and case formulation.

Reviews the literature on the use of narrative in personality theory and its application in the clinical practice literature. A constructionist approach to supervision is proposed that integrates narrative approaches with the supervisory process. Clinical supervision and case formulation are discussed as the result of a dialog between the supervisor and supervisee about the client's story, the supervisee's story about the client, and the professional story offered by the supervisor, resulting in a new case formulation and treatment plan. The new narrative allows a collaborative, empathic approach to both the supervisee and client. Case examples of a single male in his early 20s with complaints of feeling overwhelmed, nervous, and experiencing sleep and appetite disturbances, and of a single mother in her early 30s presenting with concerns about raising her 4-yr-old son illustrate the narrative approach. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Experimenting with experience: A psychotherapeutic case study.

Applied personal construct theory to a 24-yr-old Australian female who was anxiety-ridden to demonstrate some of its advantages as a therapeutic tool. The limited choices available to the client (because of her oversimplified and confused ways of viewing her world) are described, together with her related anxiety, shame, fear, and depression. Implications for the selection and training of therapists are explored. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)