We know from the research literature that psychotherapy is effective, but we also know that hundreds of diverse therapies are being practiced that have not been subjected to scientific scrutiny; thus, in some circumstances iatrogenic effects do occur. Therefore, it is crucial that we recognize and implement therapeutic interventions that are evidence based rather than succumb to ethical dilemma, frustration, and complacency. Recommendations for family therapists are discussed, including the need to (a) keep abreast of research findings, (b) translate (...) research findings and developments as they apply to clinical practice, (c) prioritize techniques and intervention models, and (d) reexamine funding priorities and research foci. (shrink)

Background: Family therapy is considered as the gold standard in treatment of adolescents with anorexia nervosa (AN). Among the different types of family therapy, multi-family therapy (MFT) is increasingly used for treating AN, and shows promising results. In this article, our focus relied on the patients’ and their parents’ perceptions of the effectiveness and the underlying mechanisms of the MFT. Methods: The present pilot exploratory qualitative study included two focus groups conducted using a semi-structured (...) approach: one with the adolescents (n= 3), and another with one or two of their parents (n= 4 mothers;n= 2 fathers). The subjects discussed were the changes observed in both AN symptoms and family interactions following therapy, and the mechanisms underlying these changes. We crossed the perspectives of the adolescents and of the parents on these two points. Results: Qualitative analysis revealed that while both adolescents and parents had difficulties relating the changes they observed in the last year to MFT, they were able to say that the group cohesion had several positive effects and that their family dynamics had improved. In the light of analysis the adolescents perceived more improvements related eating disorders symptoms than their parents did, while parents were concerned about a negative effect of MFT on their children. Discussion: While both patients and parents perceived improvements in both AN symptoms and family interactions in the past year, it was not clear if they considered MFT to have led to these improvements. FG also explored the MFT mechanisms underlying changes. Both adolescents and their parents stressed the beneficial effects of identification to others members of the group and shared experience to overcome social isolation. Parents also mentioned the sympathy they felt for each other. The idea that they give a central place to families in the therapy was also described by the families. (shrink)

Social anxiety disorders are among the most prevalent mental disorders, with high impact on the life of an affected social system and its individual social system members. We developed a manualized disorder-specific integrative systemic and family therapy for SAD, and evaluated its feasibility in a pilot randomized controlled trial. The ISFT is inspired by Helm Stierlin’s concept of related individuation developed during the early 1980s, which has since continued to be refined. It integrates solution-focused language, social network diagnostics, (...) and genogram work, as well as resource- and problem orientation for both case conceptualization and therapy planning. Post-Milan symptom prescription to fluidize the presented symptoms is one of the core interventions in the ISFT. Theoretically, the IFST is grounded in radical constructivism and “Cybern-Ethics,” multi-directional partiality, and a both/and attitude toward a disorder-specific vs. non-disorder-specific therapy approach. SAD is understood from the viewpoint of social systems theory, especially in adaptation to a socio-psycho-biological explanatory model of social anxiety. In a prospective multicenter, assessor-blind pilot RCT, we included 38 clients with SAD : 18 patients participated in the ISFT, and 20 patients in Cognitive Behavioral Therapy. Within-group, simple-effect intention-to-treat analyses showed significant reduction in social anxiety, while intention-to-treat mixed-design ANOVA demonstrated the advantage of ISFT. Per-protocol analyses supported these results. The remission rate based on blind diagnosticians’ ratings was good to satisfactory ; this has yet to be verified in a subsequent confirmatory RCT. The article will present the ISFT rationale and manual, including a special focus on multi-person settings, and the central findings from our pilot RCT. (shrink)

Despite research supporting the efficacy of family therapy for adolescent depression, little research has been done to clarify the therapeutic variables that Chinese families with depressed adolescents consider helpful in family therapy. This study explored Chinese depressed adolescents’ and their parents’ perceptions of the factors promoting improvement in family therapy. Twelve Chinese families with one adolescent child fulfilling the criteria for major depressive disorder were recruited. A total of 134 family therapy sessions (...) were conducted by 4 therapists. After therapy, semi-structured interviews about the clients’ perceptions of the helpful and effective aspects of therapy were conducted. Thematic analysis was used to analyze the transcribed dialogues. Five overarching themes emerged: factors supporting therapeutic alliance formation, the therapist’s systemic attitude, systemic therapy direction, effective systemic therapy techniques and strategies for dealing with current issues. A trustworthy therapy alliance with a competent and supportive therapist helped depressed adolescents improve by facilitating the expression of their emotions; exploring family interactions, beliefs and emotion flows related to their symptoms; promoting their self-development; and activating their resources. The families valued the respectfulness of the therapists and their collaborative and nonauthoritative approach. Adolescents’ academic difficulties and crises received special attention. The possible clinical implementations of our findings in the design of family therapy strategies for depressed Chinese adolescents are discussed. (shrink)

Reflecting teams play a significant role in family therapy; they broaden perspectives on how family dynamics or problems can be understood. However, what happens when a reflector does not feel compassionate towards a particular family member? There is a risk of biased reflections: families can pick up negative signals, putting the therapeutic relationship at risk. In this paper, I explore how I was supported to explore my lack of compassion for Dad ‘John’. It was only after (...) reaching out to an experienced supervisor who undertook an ‘internalised other’ interview with me – where I played the role of Dad – did my compassion increase. From an ethics of care perspective, I suggest that social professionals need to explore ways to increase empathy and compassion for clients they dislike. If they do not, they are open to valid criticism that they are behaving unethically as professionals. Therefore, there is a need to address deficits in empathy and compassion to sustain ethical social work practices. (shrink)

Difficulties in various cognitive functions are common observations in people experiencing anxiety. However, limited research has investigated the effects of psychotherapy on abnormal cognitive functioning. This study assessed whether psychotherapy-related reductions of anxiety result in improvements of cognitive functioning as well. Fifty-four participants with high self-reported anxiety, divided into two experimental groups (N = 28 and N = 26), and 27 non-anxious control participants (N = 27) completed a battery of memory tasks and anxiety questionnaires in three consecutive time points. (...) In experimental group 1, participants started systemic family therapy immediately after the first time point, while, in experimental group 2, participants begun the same type of therapy three months later at the second time point. The results showed that, compared to control participants, at the beginning of the experiment, participants in the experimental groups had significantly lower memory performance, along with higher anxiety. Psychotherapy had a beneficial effect on anxiety symptoms and cognitive performance, with significant changes occurring only after intervals of treatments. These results show that psychotherapy is effective not only in reducing anxiety symptoms but on cognitive functioning as well. This improvement might be linked to the release of cognitive resources previously absorbed by worrisome thoughts, facilitated by a heightened protection from interference. (shrink)

In this article we illustrate how trainers and trainees negotiate epistemic and deontic authority within systemic family therapy training. Adult education principles and postmodern imperatives have challenged trainers’ and trainees’ asymmetries regarding knowledge and power, normatively implicated by the institutional training setting. Up-to-date, we lack insight into how trainers and trainees negotiate epistemic and deontic rights in naturally occurring dialog within training. Drawing from discursive psychology and conversation analysis, we present an analysis of eight transcribed, videotaped training seminars (...) from a systemic family therapy training program, featuring three trainers and eleven trainees. Our analysis highlights the dilemmatic ways in which participants resist and affirm the normatively implicated trainers’ deontic and epistemic authority. Trainers are shown as mitigating directives and trainees as resisting them, with both displaying knowing, while attending to concerns about symmetry. We discuss our findings’ implications for systemic family therapy training. (shrink)

Mentalization-based family therapy and family rehabilitation represent a rich variety of approaches for assisting families with difficult interaction patterns. On the other hand, adventure therapy methods have been successfully used with families to offer them empowering experiences of succeeding together against difficult odds and to improve communication between family members. Further, the health promoting qualities of spending time outdoors are now well established and recognized. The Nordic approach to mentalization-based family rehabilitation combines adventure, outdoor, (...) and systemic therapy. We provide three examples of nature-based family rehabilitation practices that are delivered as brief, multi-family psychological interventions taking place in nearby nature and aiming to support sustainable, systemic change. The current contribution is a description of clinical practice, not a systematic review or a formal evaluation. We propose that recontextualizing mentalization-based family rehabilitation to the outdoors can not only provide added health benefits, but also strengthen intra-familial attuned interaction and emotional connectedness. The outdoor adventure provides the families with embodied, multisensory experiences of verbal and, especially, non-verbal interaction that can be usefully examined through the lens of theory of mentalization. The concreteness of adventure experiences is particularly beneficial for families that have difficulties in verbal communication and/or utilizing executive functions, perhaps due to neuropsychiatric traits, intellectual disabilities, or learning difficulties. Furthermore, outdoor adventure can support the participants’ connectedness to nature. (shrink)

First published in 1996, _The Embedded Self_ was lauded as "a brilliant and long overdue rapprochement between psychoanalysis and family therapy conceived by a practitioner trained and experienced in both modalities of treatment." Mary-Joan Gerson’s integrated presentation of psychodynamic and family systems theory invited therapists of either orientation to learn the tools and techniques of the other, to mutual benefit. Firmly grounded in detailed case presentations, her focus on family therapy examined its history, organizing concepts, (...) and developmental approaches, and addressed practical questions of diagnosis, clinical interaction, and referrals. A dozen years later, the psychoanalytic community is more open to integrating perspectives, and the growth of analysts working with couples and families necessitates an update of the material presented in _The Embedded Self_. Similarly, the family therapy community has deepened its interest in individual dynamics within systemic patterning. From a new and revised perspective on the possibilities of integration, Gerson covers the latest research in neuroscience and the transmission of affect within intimate relationships, with a new chapter on attachment theory and emotionally focused therapy. Sections on narrative therapy and psychoanalytically-oriented family therapy are expanded as well. _The Embedded Self_ was a sterling introduction to family systems theory and therapy, and enhanced the work of analysts and family and couples therapists alike. The second edition proves no different in its context but wider in its scope, further enhancing the work of the family therapist interested in individual dynamics, and preparing the psychodynamically-oriented therapist who seeks to extend her craft from the dyad to the triad, and beyond. (shrink)

Family therapists face a number of challenges in their work. When children are present in family therapy they can and do make fleeting contributions. We draw upon naturally occurring family therapy sessions to explore the ‘pseudo-presence’ and ‘pseudo-absence’ of children and the institutional ‘gossiping’ quality these interactions have. Our findings illustrate that a core characteristic of gossiping is its functional role in building alignments’ which in this institutional context is utilized as a way of managing (...) accountability. Our findings have a number of implications for clinical professionals and highlight the value of discourse and conversation analysis techniques for exploring therapeutic interactions. (shrink)

The use of video for research purposes is something that has attracted ethical attention and debate. While the usefulness of video as a mechanism to collect data is widely agreed, the ethical sensitivity and impact of recording equipment is more contentious. In some clinical settings the presence of a camera has a dual role, as a portal to a reflecting team and as a recording device to obtain research data. Using data from one such setting, family therapy sessions, (...) this article shows how the role played by recording equipment is negotiated in the course of talk and other activities that constitute sessions. Analysis reveals that members of the therapy interaction orient in different ways and for different purposes to the value of recordings. The article concludes that there are layers of benefit to be derived from recording of clinical interactions, including for members themselves, and this has wider implications for the ways in which qualitative research designs in health sciences are evaluated. (shrink)

This article examines discourse practices surrounding children’s participation, non-participation, and the ‘moral order’ of the family in the setting of family therapy consultations. The analysis focuses on two central issues. First, the relationship between therapists’ questions, the speaker selection techniques built into those questions, and the responses produced by family members. Second, the relationship between turn-taking and the linguistic features of person deixis in disputes that emerge around children’s orientation to implicit accusations in the talk of (...) other participants about them. The findings reveal how a familial ‘moral order’ is often at the root of how children’s competence as participants is managed by the parents, the therapist, and the children themselves. (shrink)

This work adds to the growing literature on children’s talk and the extensive research on interruptions by combining the two. I investigate children in the institutional context of family therapy and their interactions with the parents and therapist. Drawing upon 22 hours of natural family therapy data and four families, I use a discursive approach. I note that children are not attended to when they try to interrupt unless they persist and then the acknowledgement is negative. (...) I show that when the main topic is about extremes of behaviour the child’s none relevant interruption is ignored. There are occasions however when the child interrupts with a topic relevant issue and these are usually attended to. This research has wider implications for therapeutic practice and children’s role in therapy. There is a need for further study of children’s interruptive discourse practice as research in this area is limited. (shrink)

Despite the availability of evidence-based treatment models for adolescent behavior problems, little is known about the effectiveness of these programs for adolescents with callous-unemotional traits. Defined by lack of empathy, lack of guilt, flattened affect and lack of caring, CU traits have been linked to long-term anti-social behavior and unfavorable treatment outcomes and might be negatively related to outcomes in evidence-based programs such as Functional Family Therapy. This study used a single-group pre-post evaluation design with a sample of (...) 407 adolescents receiving FFT to investigate whether outcomes in FFT are predicted by CU traits and to what extent reliable changes in CU traits can be observed. The results showed that although CU traits are related to increased problem severity at baseline, they predicted neither treatment dropout nor post-treatment externalizing behavior and family functioning. CU traits were related to diminished improvement ratings, in particular with respect to parental supervision. Reductions in CU traits were observed across the time of treatment, and these were most profound among adolescents with elevated levels of CU traits at baseline. Further research should investigate whether certain evidence-based treatment components are more suited for adolescents with CU, and if the addition of specific intervention elements for reducing CU-traits could further improve outcomes for this high-risk population. (shrink)

"Meeting strangers" is a metaphor for the increasingly common experience of working with diversity in family therapy. This book offers a model of cultural family therapy for working with families across cultures, particularly immigrants, refugees, and minorities in mainstream society. -/- The author draws together several emerging trends in therapy and the human sciences: narrative approaches, transcultural psychiatry, studies of autobiographical memory and the distributed and saturated self, translation theory and sociolinguistics. He offers an understanding (...) of the "situated nature" of human problems and tools for translating the family's culture and idioms into a common language in a culturally responsive and collaborative way. -/- Each chapter is both theoretical and practical, far-reaching and grounded in the experiences of families in therapy. The chapters of Part I, Meeting Strangers, introduce themes of cultural family therapy, a synthesis of family therapy and transcultural psychiatry that reframes the presenting issue in therapy as the "presenting culture." Here DiNicola both critiques family therapy's unexamined use of cultural concepts and introduces fresh conceptual tools, such as spirals, masks, and roles, that facilitate the therapist's engagement with the family culture. -/- Part II, On the Threshold: Language, Identity, and Cultural Change, introduces a number of "changelings," "liminal people," and "orphans." Between or on the thresholds of two or more cultures, they struggle with issues around language and translation, identity and cultural change. The overbearing influence of Western concepts is seen in DiNicola's examination of the psychological, social, and cultural implications of the myth of independence. -/- Part III, Families as Storying Cultures, demonstrates in extended cases the power of narrative and of metaphor to transform experience. The final chapter is a moving memoir of the author's fascinating journey to Brazil to meet his father for the first time. -/- The author's aim is "to open space for people who have been treated like minor characters in the drama of family therapy." In doing so, he puts onto center stage all sorts of strangers in society, families of diversity, and their human predicaments, inviting his readers to engage in the full richness and complexity of culture, families, and therapy. (shrink)

IntroductionCouple violence (CV) affects many, and the consequences of those actions are grave, not only for the individual suffering at the hand of the perpetrator but also for the other persons in the family. Violence often happens among more than just the adults within one family. Even if CV has been thoroughly investigated in the general population very few studies have investigated this objective on a clinical sample, and none of these have included family violence.AimThis article identifies (...) and describes the group of clients that have issues of physical couple and family violence. It analyses a model that can help to discover physical violence and help therapists to assess what actions to take in therapy to prevent further physical violence.MethodologyDescriptive analysis, t-tests, and structural equation modeling (SEM) are used on a sample of clients receiving couple and family therapy (CFT) in Norway (N = 830). Family violence is modeled by the partner’s expectations toward each other, levels of anger, sexual satisfaction, and self-control.ResultsOne-in-five clients experienced physical CV in their current relationship and one-in-four experienced physical family violence. The group of clients who experienced CV differed from those without such experiences in having lower income, more prior experience with psychotherapy, more experience with alcohol abuse in childhood, and far more physical family violence in their current family. Our model predicting physical coupl... (shrink)

_Families of Virtue_ articulates the critical role of the parent-child relationship in the moral development of infants and children. Building on thinkers and scientists across time and disciplines, from ancient Greek and Chinese philosophers to contemporary feminist ethicists and attachment theorists, this book takes an effective approach for strengthening families and the character of children. Early Confucian philosophers argue that the general ethical sensibilities we develop during infancy and early childhood form the basis for nearly every virtue and that the (...) parent-child relationship is the primary context within which this growth occurs. Joining these views with scientific work on early childhood, _Families of Virtue_ shows how Western psychology can reinforce and renew the theoretical underpinnings of Confucian thought and how Confucian philosophers can affect positive social and political change in our time, particularly in such areas as paid parental leave, breastfeeding initiatives, marriage counseling, and family therapy. (shrink)

Chronic childhood disease brings psychological challenges for families and carers as well as the children. Roger Bradford explores how they cope with these challenges, the psychological and social factors that influence outcomes and the ways in which the delivery of services can be improved to promote adjustment. Drawing on concepts from health psychology and family therapy, the author proposes a multi-level model of care which takes into account the child, the family and the wider care system and (...) how they interrelate and influence each other. (shrink)

Independent on Sunday October 2nd One of the country's lead­ing philosophical counsellers, and chairman of the Society for Philosophy in Practice (SPP), Tim LeBon, said it typically took around six 50 ­minute sessions for a client to move from confusion to resolution. Mr LeBon, who has 'published a book on the subject, Wise Therapy, said philoso­phy was perfectly suited to this type of therapy, dealing as it does with timeless human issues such as love, purpose, happiness and emo­tional (...) challenges. `Wise Therapy, is part of a series aimed at promoting an integrative attitude as its ethos. Among all the many perspectives of psychotherapists and counselors, philosophy needs to take its place and needs to find its voice. Tim LeBon has provided an effective means by which counselors can bring philosophy into their work with clients' - APPA journal `Tim Le Bon's Wise Therapy is a comprehensible and well argued book dealing with the practical therapeutic applications of philosophical research that may well be of interest to philosophers but -- as the author himself intends -- will be of most obvious benefit to therapists and counselors, both by informing their dialogue with clients in new ways and by helping them become more informed about ways to resolve the ethical dilemmas arising within the context of their own work' - Metapsychology `A fascinating workshop for therapists and clients, backed up a thorough degree if philosophical acuity' - Journal of the Society for Existential Analysis `I strongly recommend the book for philosophers as well as practitioners, teachers, students and supervisors in counselling and psychotherapy' - Self and Society `Provides some additional and valuable arrows for the therapist's quiver' - Irvin Yalom, author of Love's Executioner `Like Aristotle, Tim LeBon examines what is said and extracts what is best from it…. There are many fascinating exercises designed to bring out and enlighten the client's values, conception of the good life, well-being, happiness, pleasure, and the proper place of reason in life…. Wise Therapy is well written and engaging. The case histories are illuminating examples of therapeutic techniques at work, the thought experiments are well designed, and the philosophical position adapted from the internal debates of the philosophers is level headed…. I recommend it highly to philosophers with an interest in counselling, and psychological counsellors with an interest in philosophy' - Jeff Mason, The Philosophers' Magazine `Tim LeBon has… authored a text which should become a staple on the philosophical counsellor's bookshelf…. Wise Therapy is a concise, well-written book…. His ability to relate philosophical concepts to counselling concerns is admirable and attests to the skill and knowledge he possesses as a working counsellor. But, by far the most important part of Tim LeBon's book to PC is the last chapter, "The Counsellor's Philosophical Toolbox"' - Craig Munns in The Examined Life ` Tim LeBon has done a good job of offering practical approaches to some of the most important and vexing issues that arise in counselling…. Tim LeBon's book contains helpful suggestions, practical information, and useful examples, and would make a good addition to the library of any counsellors willing to allow philosophy to turn mere client sessions into wise therapy' - Peter Raabe, Practical Philosophy Wise Therapy is an original and practical guide to how philosophy can benefit counselling and psychotherapy. Tim LeBon argues that therapy, informed by philosophy, can help clients make better decision and achieve emotional wisdom. He uses philosophical approaches to explore issues of right and wrong, the emotions and reasons, well-being and the meaning of life, and develops a 'counsellor's toolbox' of techniques that can help practitioners apply the wisdom of philosophy to good therapeutic practice. For counsellors who may find philosophical approaches to therapy useful, this work addresses key philosophical topics - the emotions, free will, the meaning of life and ethics. It is jargon-free where possible and assumes no previous philosophical training. From The Independent, 16th November 2004 Plato is my agony aunt It was the end of a love affair that broke her heart. Could the wisdom of the great philosophers show her how to be happy again? Claire Smith tries a novel form of therapy "The unexamined life is not worth living," Socrates said. Nor is the life you're left with after your boyfriend has left you for another woman - at least, that's how it felt in October last year when mine broke rank and went off with an art student from Cleveland, Ohio. We were over there for the opening of his new art exhibition. He'd flown over four days before me and had met her at a party. Supposedly, they "connected". The five months that followed were a roller-coaster of confusion, vitriol and despair. I knew there'd been problems in our relationship. We saw the world very differently; he delighted in the charm of the ordinary, I wanted maximum divinity. He walked; I galloped. He drank tea; I loathed the stuff. But, along the banks of the Thames, we'd made a promise to always stick together. Our love was something unique: "transcendental", I called it. And besides, we recycled. Surely a commitment to save the world would save our relationship? Alas, no. So there I was, a woman scorned. Hell truly hath no greater fury. And what made it worse was that I still believed in our transcendental love. If I wanted to change the way I was feeling, I needed to alter the way I was thinking. But how? A few bottles of wine and a sharp blow to the head might have done the trick. Fortunately, there's an older, more trusted way of turning your head on its head that counsellors are starting to use: philosophy. The idea of employing Plato as an agony aunt was begun in 1981 by the German philosopher Gerd Achenbach. Although philosophy spends a lot of its time asking real-life questions that affect real-life people - What is happiness? And is it always wrong to lie? - most of the debate goes on in ivory towers. What Achenbach and subsequent philosophers including Tim LeBon, the chairman of the UK's Society for Philosophy in Practice, wanted to do was "give practical application" to this gigantic library of great thoughts. So how does it work? Like most types of therapy, you sign up for a set of sessions. "Two would give you a new perspective on one issue; six would help you to make a major life-decision, like a career change; with 12 you can start to rethink your entire life philosophy," explains LeBon. Each session lasts 50 minutes and costs £50 - and, no, you don't have to have any previous knowledge of philosophy. "If you think of Friends, it would suit Ross and Chandler more than Joey," LeBon says. "It's for anyone who wants to make their emotions more intelligent. Or for those who have tried other kinds of therapy, and want something more cerebral." The first session begins with the patient venting off about whatever's troubling them. The rant over, the counsellor then picks out some key concepts that are crucial to the problem - in the case of heartbreak, it is love and happiness that come hurtling to the fore - and then gets the patient to define what they mean. So, what is love? What is happiness? To kick-start the patient's thinking, LeBon describes what a great philosopher had to say about it. In my case, he tells me what Plato wrote about love in his Symposium: that to stop man fighting the gods, Zeus decided to cut each human in two, so they would lose their strength. "This, then, is the source of our desire to love each other," Plato said. "Each of us is a 'matching half' of a human whole, because each was sliced like a flatfish, two out of one, and each of us is always seeking the half that matches him." This method of probing what we might think are "obvious" ideas, such as love and happiness, was devised by Socrates in the squares of Athens. "The only I thing I know is that I know nothing at all," he boasted. What Socrates showed was that although many of the thinkers of his time thought they knew what justice, happiness and goodness meant, their understanding was tied in to their personal agenda and world view, and, what's more, when pushed, their ideas often contradicted themselves. A bit like me on love. Whereas part of my understanding of love was something that gave life meaning, made it worth living and bound us together, I also believed that true love was "transcendental": that it was out of this world, and it didn't matter if the two people who loved each other couldn't get along in the day-to-day. Love was bigger than the mundane. But when it came to the next stage of the therapy, critical thinking - "to check out whether your assumptions stand up to examination" - I walked head first into a contradiction. If I think love's purpose is to make life worth living, but then say it's irrelevant to daily life, surely my two ideas of love are not compatible? As the cogs in my brain start to creak into motion, I feel myself taking a step back from my predicament: thinking about how I've been thinking. This idea I had of transcendental love might have started off as a romantic dream. But when the relationship stopped working, and I found myself feeling trapped and frustrated, I used it to justify the mechanics of a relationship that just didn't work in the daily grind. I used it to lie to myself. In the final stage, LeBon gets me to start thinking about how to go forward. "You can't change what has happened," he says. "You can't change that he's left you, or how you behaved in the relationship. So, as the Stoics did, let's work on controlling the controllables: the things that you can change." To work out what can be changed, he gets me to try out a thought experiment, a method often used in philosophy to imagine other worlds where people can have different codes of behaviour. Thought experiments shatter your preconceived ideas of how the world should be and let your imagination run wild to how the world could be. "I find Viktor Frankl very useful here, the Austrian psychiatrist and concentration-camp survivor who actually believed that everything in life happens for a purpose," LeBon says. "Suppose this break-up did happen for a reason that will work to your benefit," he suggests. "What might that be? The answer might be that you can now focus on something important that was denied in the relationship. Or - the Hollywood version - so you'll meet someone who is really right for you." Temporarily freed of any sense of responsibility for the relationship that was, and its sorry demise, the list came fast. I could now travel more; he didn't like me travelling on my own, but too often he didn't want to go anywhere, preferring to stay in his studio and make art. I'd love to meet someone with a similar sense of adventure to mine. For the first time in two years, I was being honest with myself about what I really wanted - listening to those voices that we all have inside our heads, and too often try to muzzle. So did philosophy save me? Well, I'm now dating a travel writer I have to run to keep up with. I still haven't got over the fact that my replacement came from Cleveland, Ohio. But I guess I never will. Tim LeBon can be reached by e-mail at [email protected] A FEW WORDS FROM THE WISE Compiled by Ed Caesar · "At the touch of love, everyone becomes a poet" - Plato · "There is always some madness in love. But there is also always some reason in madness" - Friedrich Nietzsche · "That man shall live as his own master and in happiness who can say each day 'I have lived'" - Horace · "The good of man is the active exercise of his soul's faculties in conformity with excellence or virtue... Moreover this activity must occupy a complete lifetime; for one swallow does not make spring, nor does one fine day; and similarly one day or a brief period of happiness does not make a man supremely blessed and happy" - Aristotle · "There is nothing on this earth more to be prized than friendship" - Thomas Aquinas · "Whatever you do... love those who love you" - Voltaire · "Happiness is not an ideal of reason but of imagination" - Immanuel Kant · "Happiness is a state of which you are unconscious. The moment you are aware that you are happy, you cease to be happy" - Jiddu Krishnamurti · "Love is an ideal thing. Marriage is a real thing" - Johann Wolfgang von Goethe I shrink, therefore I am Therapy has many answers, but some questions require the help of a philosopher, says Clint Witchalls Sunday November 21, 2004 The Observer Danny had worked in the City of London for 10 years. As a research analyst, stockbroker and fund manager, he'd made a lot of valuable contacts, earnt a lot of cash, and learnt some important business skills. However, as he approached his mid-thirties, he no longer felt good about himself or what he did for a living, and he found his colleagues cold and unfriendly. A chronic illness made him realise his mortality, and he began to reassess his priorities. Danny had been struggling with his career conundrum for nearly five years when he met David Arnaud, a philosophical counsellor. After a few soul-searching sessions, Danny arrived at a decision. Today, he teaches economics to sixth-formers, and he loves it. 'It's a much better lifestyle,' he says. Many people are turning to philosophical counsellors to get answers to questions such as: 'How do I make sense of myself?' 'What is important to me?' 'Where am I going?' These are perhaps not the sort of questions that require psychiatric intervention, but Arnaud, who recently completed the first empirical study of philosophical counselling in the UK, has found that within just five sessions the majority of clients, with important decisions to make, tend to move from a state of concern and confusion to a resolution. Modern philosophical counselling can be traced back to 1981, when the philosopher Gerd Achenbach opened the first practice near Cologne. Achenbach referred to the new discipline as 'therapy for the sane.' Today, there are hundreds of philosophical counsellors around the world, with the movement particularly strong in the US, Britain and the Netherlands. 'The dilemmas people face aren't always primarily psychological,' says Alex Howard, a philosophical counsellor from Newcastle. 'If people face problems that are social or economic, it doesn't make sense to define their problems in purely psychological terms.' Tim LeBon, a founder member of the Society for Philosophy in Practice (SPP) and author of Wise Therapy, adds: 'We are faced with far more life choices than our grandparents, yet have far fewer resources to deal with them. Our grandparents may have gone to a priest or to other family members for advice; most people don't trust these solutions any more and so want to make their own well-informed, well thought-out choices. Philosophical counselling can help these people - people in mid-life crises who are wondering how to make the most of the rest of their life. People who want to take stock of their values.' Where stressed executives might once have been prescribed a course of tranquillisers or antidepressants, they can now get a dose of Bertrand Russell instead: 'Success is too dearly purchased if all the other ingredients have been sacrificed to obtain it.' While some philosophical counsellors do recommend books for their clients to read, most sessions are about helping the client identify faulty thoughts. For example, a briefing in Aristotelian logic might show a client why their beliefs are erroneous. The person might infer that they're a screw-up because they've screwed up. The counsellor could point out that they're making an error called 'fallacy of composition' - that is, what's true of the part isn't necessarily true of the whole. In philosophical counselling, problems aren't pathologised as they are by the psychiatric profession, and the dialogue between client and counsellor is more like a meeting of equals, compared to many therapies where the client is treated like a patient and seen as someone who is, in some way, inadequate. 'Anybody can benefit from philosophical counselling,' says Howard. 'But it does require someone who is willing to take stock.' Lou Marinoff, author of international bestseller Plato Not Prozac! has done much to promote philosophical counselling. 'Some people who have stabilised their neurochemistry and validated their emotions now wish to examine or re-examine the criteria of their beliefs, the principles of their conduct, or the meaning of their lives,' he says. 'With whom shall they do this? Psychologists and psychiatrists can shed light on such issues - as can rabbis, priests, imams and gurus. Philosophers are now rejoining the ranks of helpers.' LeBon believes certain therapies (such as cognitive behavioural therapy) don't go far enough in helping their clients. 'For instance, if you are anxious about your relationship, a cognitive therapist would try to dispute your catastrophising and jump to conclusions to make you feel less anxious,' says LeBon. 'A philosophical counsellor would do this, but would also look for existential meaning in your anxiety - perhaps you really don't want to be in the relationship and that is what your anxiety is telling you.' LeBon also gives short shrift to psychoanalysts. 'There's very little evidence for the Freudian unconscious, and it's time to move on to more intellectually satisfying and helpful therapies,' he says. However, Alain de Botton, the man who popularised philosophy as self-help, isn't ready to bury psychologists and their ilk just yet. 'The truth is that psychoanalysis grew out of philosophy - it's not some completely new idea, and in fact, done properly, psychoanalysis is philosophical anyway. It may even be dangerous to the mental health of some people to suggest a philosopher rather than a properly trained analyst. The knowledge of analysts when it comes to many emotional problems is now much greater than that of most philosophers.' Guardian Unlimited © Guardian Newspapers Limited 2004. (shrink)

It may be unethical to deny children with cystic fibrosis access to ethically approved clinical trials from which they might benefitDespite advances in nutritional management, aggressive antibiotic usage, and physiotherapy, cystic fibrosis remains a life limiting illness with high morbidity that imposes considerable burdens on children and families.1 Although survival to 40 years is predicted for children born in 1990s, the median age of death in 2003 was 24.2 years .The pathophysiological features of CF are produced by a defective gene (...) on chromosome 7, resulting in the defective production of a protein that regulates cellular ion transport. Defective ion transport is thought to lead to increased mucus viscosity , with poor airway clearance, recurrent bacterial infection, lung damage, and death.Gene therapy , the insertion of a normally functioning gene into deficient host cells using a suitable vector, is a potential treatment or cure for diseases produced by single gene defects—for example, CF. Gene therapy does, however, have potential or actual risks, leading many to suggest that evidence of efficacy in adults should be demonstrated before trials are conducted in children. Many serious diseases in adults such as CF have their onset in childhood. If early treatment provides greater hopes of benefit, children may be more appropriate targets for GT in CF than adults. It may be unethical to deny them access to properly constructed, ethically approved clinical trials from which they might benefit.Since research in children should be scientifically valid, in the child’s best interests, and the subject of valid consent, this article will consider these parameters in relation to trials of GT in children with CF. Because of the importance of consumer participation in the design of research we present the results of a questionnaire about GT trials delivered …. (shrink)

Pour présenter la thérapie familiale psychanalytique, l’auteure en évoque la genèse en France, en explicite les visées, puis s’attache à en décrire le processus. En appui sur le cas clinique d’une famille suivie, sont mis en évidence les points délicats depuis la demande de la famille jusqu’à l’arrêt de la thérapie. La technique est décrite ainsi que les différentes étapes qui tentent d’amener chacun à gagner en individuation. L’auteure insiste sur les prérequis nécessaires de la formation dispensée aux thérapeutes qui (...) s’engagent dans cette pratique. (shrink)

On peut considérer que ce qui se produit dans le travail familial thérapeutique avec une famille dans une institution donnée est révélateur du fonctionnement de la famille tel que cette dernière le projette sur l’institution. Mais ce qui se passe dans cette thérapie peut aussi refléter le fonctionnement de l’institution à ce moment précis : ce qui se vit dans l’institution a souvent des répercussions sur les prises en charge thérapeutiques.

On peut considérer que ce qui se produit dans le travail familial thérapeutique avec une famille dans une institution donnée est révélateur du fonctionnement de la famille tel que cette dernière le projette sur l’institution. Mais ce qui se passe dans cette thérapie peut aussi refléter le fonctionnement de l’institution à ce moment précis : ce qui se vit dans l’institution a souvent des répercussions sur les prises en charge thérapeutiques.

Paternal authority is recommended as a valid Christian resource for conflict resolution in biomedical (and other inner-familial) decision making. Its bases are explored in view of the two-fold creation account in Genesis, interpreted in the light of the Pauline theology. In addition, a theological account is proposed that portrays the taxis between husband and wife as a condition under which humans can seek to emulate the inner-Trinitarian love. The relationship between that love (as portrayed in St. Basil’s On the Holy (...) Spirit), the love between God and man, and the love between the sexes (as further extended to the children in a family that constitutes a “small church”), is described in terms of an interplay between the Divine offer of grace and the human response of obedience. In framing their marital love according to the model of Christ and His Church, couples can also profit from the ascetical therapy predicted for their fallen nature in the “curse” that drove our forefathers from Paradise. (shrink)

Cet article interroge l’espace thérapeutique mouvant expérimenté dans une téléconsultation avec un couple. Il décrit les frontières polytopiques d’une séance online. Désormais, l’espace thérapeutique réunit trois lieux qui se superposent : chez le thérapeute, chez le patient et l’interface de rencontre, la plateforme numérique. L’auteure constate l’émergence d’une illusion partagée entre le thérapeute et son patient, favorisée par la superposition de deux mondes : virtuel et réel, dans l’écran et hors de l’écran. Le passage à une thérapie conjugale à distance (...) déplace les symptômes sur l’aspect territorial du cadre, tout en permettant de déployer un nouveau processus thérapeutique. Puisque les patients font entrer le regard du thérapeute dans leur habitat intérieur, la question du privé et de l’intime se pose : qu’est-ce qui est dévoilé? Le couple peut jouer avec la création de la mise en scène jusqu’à la « profanation rituelle », la transgression du cadre. L’article apporte une illustration clinique d’une « séance à l’envers ». (shrink)

Herbert, Dilinie Dignity Therapy provides patients with a terminal illness the opportunity to share their life experiences. Their life narrative is reflected upon, shared, transcribed, and later bequeathed to their family and friends. The generativity document produced as a result of Dignity Therapy is a declaration and a lasting legacy, a manuscript that holds meaning and makes meaning at a point in life when people may feel a sense of despair and loss. This article will follow the (...) development of Dignity Therapy, and why it should be acknowledged as an integral aspect of end-of-life care for patients, their families and friends, and healthcare professionals. (shrink)

La régression est un concept connoté de façon souvent négative et elle est souvent uniquement perçue dans sa valeur descriptive et phénoménologique. Dans cet article sur la thérapie de couple, l’auteur distingue les états régressés, sur lesquels s’ancre en partie la constitution du couple, et le processus régressif, qui a lieu au cours de la thérapie. Le thérapeute de couple doit être sensible à ce processus tant dans la compréhension qu’il aura des étapes de la thérapie que dans sa propre (...) position psychique interne. (shrink)

La régression est un concept connoté de façon souvent négative et elle est souvent uniquement perçue dans sa valeur descriptive et phénoménologique. Dans cet article sur la thérapie de couple, l’auteur distingue les états régressés, sur lesquels s’ancre en partie la constitution du couple, et le processus régressif, qui a lieu au cours de la thérapie. Le thérapeute de couple doit être sensible à ce processus tant dans la compréhension qu’il aura des étapes de la thérapie que dans sa propre (...) position psychique interne. (shrink)

À partir d’une situation de couple dans lequel la communication semble bloquée par un trop plein de souffrance, due en partie à des traumatismes dans les liens de filiation de part et d’autre, l’auteure, grâce à un groupe de recherche, expérimente la nécessité d’un nouvel espace pour réguler un transfert massif. Le groupe de recherche prend en quelque sorte le relais de l’appareil psychique du thérapeute et met en scène les émotions et les représentations qui sont à l’œuvre au sein (...) du groupe thérapeutique. Il devient un lieu de dépôt et de mentalisation des émotions qui circulent dans le transfert, et se fait le porte-voix des souffrances traumatiques enfermées dans les incorporats, ces ratés de l’introjection. (shrink)

Dans cet article l’auteur définit sa notion de spaciogramme comme une représentation projective groupale de l’espace familial vécu. C’est une médiation thérapeutique favorisant un travail psychique de figurabilité. Il donne accès par un effet « squiggle » à une interfantasmatisation en thérapie psychanalytique. Le spaciogramme est décrit en analogie isomorphe avec l’image projective du génogramme, avec les contenants généalogiques, et avec l’image inconsciente du corps psychique groupal familial (le corps généalogique). Il traduit dans le transfert et la régression, une représentation (...) des mécanismes de défense groupaux, du maillage des liens de filiation et d’affiliation, de la transmission généalogique de l’héritage psychique de la famille. (shrink)

In this paper, we apply the perspective of intra-organismal ecology by investigating a family of ecological models suitable to describe a gene therapy to a particular metabolic disorder, the adenosine deaminase deficiency (ADA-SCID). The gene therapy is modeled as the prospective ecological invasion of an organ (here, bone marrow) by genetically modified stem cells, which then operate niche construction in the cellular environment by releasing an enzyme they synthesize. We show that depending on the chosen order (a (...) choice that cannot be made on \textit{a priori} assumptions), different kinds of dynamics are expected, possibly leading to different therapeutic strategies. This drives us to discuss several features of the extension of ecology to intra-organismal ecology. (shrink)

Nombreux couples arrivent en thérapie avec une demande d’amélioration de leur communication. Or les mots semblent dangereux, investis d’un pouvoir sur l’autre. Quel danger représente le fait de dire? L’exposition de la situation d’un couple recomposé permet d’évoquer différentes dimensions de la thérapie psychanalytique en couple dont celle du discours. Contradictions et paradoxes mettent en lumière les conflits identitaires d’appartenance constitutifs du lien du couple. L’usage du verbe et ses effets fâcheux montrent combien au nom du discours s’organisent les résistances (...) en groupe. C’est au thérapeute que revient la tâche de rendre possible le passage par le verbe, en travaillant les interactions et projections inconscientes dans l’interrelation, de cette difficulté à dire pour chacun. (shrink)

Nombreux couples arrivent en thérapie avec une demande d’amélioration de leur communication. Or les mots semblent dangereux, investis d’un pouvoir sur l’autre. Quel danger représente le fait de dire? L’exposition de la situation d’un couple recomposé permet d’évoquer différentes dimensions de la thérapie psychanalytique en couple dont celle du discours. Contradictions et paradoxes mettent en lumière les conflits identitaires d’appartenance constitutifs du lien du couple. L’usage du verbe et ses effets fâcheux montrent combien au nom du discours s’organisent les résistances (...) en groupe. C’est au thérapeute que revient la tâche de rendre possible le passage par le verbe, en travaillant les interactions et projections inconscientes dans l’interrelation, de cette difficulté à dire pour chacun. (shrink)

Dans cet article l’auteur définit sa notion de spaciogramme comme une représentation projective groupale de l’espace familial vécu. C’est une médiation thérapeutique favorisant un travail psychique de figurabilité. Il donne accès par un effet « squiggle » à une interfantasmatisation en thérapie psychanalytique. Le spaciogramme est décrit en analogie isomorphe avec l’image projective du génogramme, avec les contenants généalogiques, et avec l’image inconsciente du corps psychique groupal familial (le corps généalogique). Il traduit dans le transfert et la régression, une représentation (...) des mécanismes de défense groupaux, du maillage des liens de filiation et d’affiliation, de la transmission généalogique de l’héritage psychique de la famille. (shrink)

La supervision individuelle ou en groupe permet à tout thérapeute formé selon les concepts théoriques et l’approche clinique de la psychanalyse de forger ses propres outils. Dans un groupe de supervision, chacun apporte les difficultés sur lesquelles il bute dans la mise en place et le déroulement d’une thérapie. Le groupe réfléchit, dans tous les sens du terme, ce qui permet au thérapeute de percevoir ce qui jusque là lui échappait – qu’il s’agisse du fonctionnement symptomatique des patients entre eux (...) ou de ce qui se passe entre eux et lui lorsque s’éclairent les mouvements du transfert. Le groupe est à la fois environnement sécurisant, structure et appareil de liaison, la groupalité étant une dimension du sujet. Tout se passe comme si l’appareil psychique groupal reprenait à son compte le travail d’élaboration psychique du thérapeute, qui, pour le moment, se plaint de ne plus avoir la capacité de penser. Le superviseur est garant du cadre. De lui dépend également la spontanéité et la qualité des échanges ainsi que le climat de confiance indispensable au plaisir de travailler ensemble dans un rapport de parité. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Human Gene TherapyMary Carrington Coutts (bio)On September 14, 1990, researchers at the U.S. National Institutes of Health (NIH) performed the first approved gene therapy procedure on a four-year-old girl named Ashanti DeSilva. Born with a rare genetic disease, severe combined immune deficiency (SCID), Ashanti lacked a healthy immune system and was extremely vulnerable to infection. Children with SCID usually develop overwhelming infections and rarely survive to adulthood; even (...) a common childhood illness like chicken pox is life-threatening. Ashanti led a cloistered existence, avoiding contact with people outside her family, remaining in the sterile environment of her home, and battling frequent illnesses with massive amounts of antibiotics.In Ashanti's gene therapy procedure, her own white blood cells were genetically modified and then infused back into her bloodstream. Laboratory tests show that the therapy has strengthened Ashanti's immune system. She no longer has recurrent colds, has been allowed to attend school, and has been immunized against whooping cough. This gene therapy procedure is not a cure, however. The genetically-treated white blood cells only survive for a few months and must then be replaced, but Ashanti's future is much brighter because of the new therapy (VI, Thompson [The First] 1993).Although this simplified description of Ashanti's gene therapy procedure sounds like a happy ending, it is little more than an optimistic chapter in a long story. The road to the first approved gene therapy procedure was rocky and fraught with controversy. The biology of human gene therapy is very complex, and there are still many techniques that need to be developed and diseases that need to be understood more fully before gene therapy is well established. The public policy debate surrounding the possible use of genetically engineered material in human subjects is equally complex. Major participants in the debate come from the fields of biology, government, law, medicine, philosophy, politics, and religion, each bringing different views to the discussion.In studying the ethics of gene therapy, one should draw a distinction between [End Page 63] therapy on somatic (non-reproductive) cells and germ (reproductive) cells. Only the germ cells carry the genes that will be passed on to the next generation. Reactions to gene therapy have varied widely. Some commentators on gene therapy object to any form of genetic manipulation, no matter how well-intentioned (VI, Rifkin 1983). Another reaction is to allow the use of somatic-cell therapy, but not to approve the use of germ-line therapy, which could have unforeseeable effects on future generations. A different stance is that, with proper regulation and safeguards, germ-line gene therapy is a logical extension of the progress made to date and that it is an ethically acceptable procedure.TechniquesTo date, 43 research protocols have been approved for somatic-cell gene therapy in the United States. The techniques employed in each protocol vary, but in general a virus is used as a "vector" to insert the desired gene into the DNA of the patient's cells, in order to compensate for a defective gene. For Ashanti's gene therapy, this technique involved obtaining white blood cells and introducing properly functioning genes into as many of the cells as possible. The normal genes were delivered through the use of a specially-engineered virus.Although similar techniques are used in germ-line gene therapy, the procedure is more difficult. There are two basic ways to perform germ-line gene therapy: (1) to treat a preimplantation embryo that carries a serious genetic defect before its implantation in the mother, which necessitates the use of in vitro fertilization techniques; or (2) to treat the germ cells (sperm or egg cells) of afflicted adults so that the genetic defects would not be passed on to their offspring, which requires the technical expertise to delete the defective gene and insert a properly functioning replacement. Because of the complexity of the procedures involved and the attendant ethical controversy, germ-line therapy is not currently performed.Candidate Diseases for Gene TherapyAt present, gene therapy is likely to be most successful in treating diseases that are caused by single-gene defects and has been approved for treating diseases such... (shrink)

Cet article propose une réflexion sur les liens fraternels dans le cadre d’une thérapie familiale à partir des conceptions théoriques sur le fraternel de R. Kaës, sur l’illusion groupale de D. Anzieu et sur les notions de transgénérationnel dans une famille. L’objectif est de montrer la pertinence d’une approche de thérapie familiale psychanalytique à partir d’un cas d’une fratrie de quatre garçons dont l’aîné est le porteur des traumatismes parentaux et considéré comme le « bouc émissaire » de la famille. (...) Plusieurs hypothèses sont proposées qui permettent de comprendre l’importance du traumatisme en fonction de la place qu’occupe chacun des enfants de la fratrie, un « pacte dénégatif » pouvant s’être instauré comme organisateur des liens entre les frères. La thérapie familiale souligne la nécessité du travail de métabolisation de la famille et de différenciation entre les frères, au prix dans le cas présenté, d’une autonomisation réelle d’un des membres de la fratrie. (shrink)

The purpose of this qualitative case study is to describe in-depth the experience of Korean students undergoing group music therapy. Seven students participated in eight consecutive weeks of group music therapy. The researcher collected and triangulated three data resources: individual interview transcripts, participant journals, and audiotaped sessions. The data were analyzed using the case study method and peer debriefing was conducted for trustworthiness. The four emergent themes and six categories were as follows: (1) Discovering who I am (categories: (...) what it means to be me, learning about self), (2) Inside group music therapy (categories: it was flowing like water, silence, I can do whatever I want safely here, and the truth of my family), (3) The role of music, and (4) What we learned with books became real. The results indicated that the student therapists’ experiences were linked to their personal development, unique experience of group music therapy dynamics, musical experience as an emotional container, and clinical development. Finally, it is recommended that cultural adaptations are made by providing both structure and space for Korean students to express themselves. (shrink)

Dans cet article, l’auteur reprécise les critères analytiques de la psychothérapie de couple telle qu’elle est enseignée et transmise au sein de l’AFCCC. Ysont présentés le dispositif, le cadre et le processus analytiques, puis la formation du psychothérapeute de couple. L’ensemble de cette présentation est encadré par de multiples citations de psychanalystes appartenant à divers es sociétés membres de l’API (Association psychanalytique internationale).

Dans cet article, l’auteur reprécise les critères analytiques de la psychothérapie de couple telle qu’elle est enseignée et transmise au sein de l’AFCCC. Ysont présentés le dispositif, le cadre et le processus analytiques, puis la formation du psychothérapeute de couple. L’ensemble de cette présentation est encadré par de multiples citations de psychanalystes appartenant à divers es sociétés membres de l’API (Association psychanalytique internationale).

Comatose survivors of cardiac arrest may die following withdrawal of life-sustaining therapy (WLST) due to poor neurologic prognosis. Family members, acting as surrogate decision makers, are frequently asked to decide whether the patient should continue to receive ongoing life-sustaining therapy such as mechanical ventilation in this context of risk of death following removal. Sometimes, physicians and family members disagree about what is in the patient's best interest, and this conflict causes distress for both families and medical (...) personnel. This article examines themes recorded in the medical records of 24 cardiac arrest patients at Columbia University Medical Center (CUMC) whose families chose to pursue continued life support despite physician recommendations for withdrawal. In documented conversations between patients' families and their providers, the most prominent themes included faith in miracles, the inappropriateness of "playing God," the value of more time with the patient, and differences in how providers and family members perceived the patient's status. (shrink)