One of the main challenges in group therapy with drug-addicted patients is collective pseudomentalization, i.e., a group discourse consisting of words and clichés that are decoupled from any inner emotional life and are poorly related to external reality. In this study, we aimed to explore the phenomenology of pseudomentalization and how it was addressed by the therapist in an outpatient group for drug-addicted patients. The group was composed of seven members, and the transcripts of eight audio-recorded (...) sessions were rated and studied. The interventions of the therapist were measured with the mentalization-based group therapy adherence and quality scale by independent raters. Two sessions, one with the highest and one with the lowest adherence, were selected, and the clinical sequences of pseudomentalization were analyzed in a comparative way. The findings revealed that pseudomentalization does occur as a collective phenomenon, akin to “basic assumptions” of Wilfred Bion, which we reconceptualized in this study. Any pseudomentalization seemed to be reinforced by the therapist when she was presenting frequent and long interventions, when abstaining from the management of group boundaries, when providing questions focused more on content than on the mental states of the group members, and when not focusing on emotions. However, the ultimate source of collective pseudomentalization seemed to be the fear of the group members of being overwhelmed by painful emotions, mental confusion, and a loss of identity. The findings also indicated that the principles of MBT-G may be a good antidote to pseudomentalization. (shrink)

The primary purpose behind effectiveness research is to determine whether a treatment with demonstrated efficacy has utility when administered to the general population. The main questions these studies are meant to answer are these: Can the typical patient respond to treatment? Is the treatment acceptable to the typical patient? Can the treatment be administered safely and in its entirety in the typical treatment setting? Is the treatment under study significantly better than the community standard of care both from a cost (...) and outcome perspective? Answering these questions is meant to provide sufficient information to providers and policymakers so that effective interventions can be adopted and become the new community standard. For this research to make a meaningful impact on a provider and policymaker's decision to change the status quo, study interventions should be compared to the existing community standard of treatment, often referred to as treatment as usual. From an ethical perspective, this decision may not always be the safest choice. In some populations, TAU may mean no treatment at all, and in others TAU may be worse than withholding treatment. The effectiveness researcher is then caught between the pull to do no harm and the need for research to have an impact on change. The purpose of this article is to highlight certain conditions when TAU is ethically acceptable and to discuss alternatives when TAU may be an unethical treatment condition. For purposes of precision, we focus exclusively on psychotherapy effectiveness research rather than system-intervention research or medication-intervention research. (shrink)

The primary purpose behind effectiveness research is to determine whether a treatment with demonstrated efficacy has utility when administered to the general population. The main questions these studies are meant to answer are these: Can the typical patient respond to treatment? Is the treatment acceptable to the typical patient? Can the treatment be administered safely and in its entirety in the typical treatment setting? Is the treatment under study significantly better than the community standard of care both from a cost (...) and outcome perspective? Answering these questions is meant to provide sufficient information to providers and policymakers so that effective interventions can be adopted and become the new community standard. For this research to make a meaningful impact on a provider and policymaker's decision to change the status quo, study interventions should be compared to the existing community standard of treatment, often referred to as treatment as usual (TAU). From an ethical perspective, this decision may not always be the safest choice. In some populations, TAU may mean no treatment at all, and in others TAU may be worse than withholding treatment. The effectiveness researcher is then caught between the pull to do no harm and the need for research to have an impact on change. The purpose of this article is to highlight certain conditions when TAU is ethically acceptable and to discuss alternatives when TAU may be an unethical treatment condition. For purposes of precision, we focus exclusively on psychotherapy effectiveness research rather than system-intervention research or medication-intervention research. (shrink)

This article examines a particular kind of business-opening activity found in a specific, and little analysed, type of institutional group meeting: group supervision for psychotherapeutic counsellors. The data consist of a particular set of activities that occur in the initial stages of these meetings, which are neither the kind of pre-meeting talk identified by previous research on interaction in meetings, nor specifically the business of group supervision itself. This phase, referred to as the ‘check-in’, functions as an (...) interim stage between small talk and getting down to business. The analysis shows how the check-in comprises a highly structured set of linguistic sequences whose production is bound up with one of the key interactional features of group supervision: the collaborative orientation to the production and relevance of ‘feelings-talk’. (shrink)

Paying careful attention to the multiple meanings the word ‘institution’ has in French, this article traces the development of institutional psychotherapy’s clinical practice. Through a close reading of Jean Oury’s seminars and clinical writing alongside other key members of the GTPSI (Groupe de travail de psychothérapie et de sociothérapie institutionnelles or Working Group on Institutional Psychotherapy and Socio- therapy), this article argues that institutional psychotherapy’s specificity is in the way in which the clinical and the political (...) are able to connect their praxis. (shrink)

New and experienced psychotherapists alike can find themselves overwhelmed by an ethical quandary where there doesn't seem to be an easy solution. This book presents positive ethics as a means to overcome such ethical challenges. The positive approach focuses on not just avoiding negative consequences, but reaching the best possible outcomes for both the psychotherapist and the client. The authors outline a clear decision-making process that is based on three practical strategies: the ethics acculturation model to help therapists incorporate personal (...) ethics into their professional roles, the quality enhancement model for dealing with high-risk patients who are potentially harmful, and ethical choice-making strategies to make the most ethical decision in a situation where two ethical principles conflict. Throughout the decision-making process, psychotherapists are encouraged to follow four basic guidelines: Focus on overarching ethical principles Consider intuitive, emotional, and other nonrational factors Accept that some problems have elusive solutions Solicit input from colleagues and consultation groups Numerous vignettes illustrate how to apply positive ethics to many different ethical challenges that psychotherapists will likely encounter in practice. (shrink)

From the Couch to the Circle: Group-Analytic Psychotherapy in Practice is a handbook of group therapy and a guide to the group-analytic model - the prevailing form of group therapy in Europe. The book draws on both John Schlapobersky’s engagement as a practitioner and the words and experience of people in groups as they face psychotherapy’s key challenges - understanding and change. This book provides a manual of practice for therapists’ use that includes detailed (...) descriptions of groups at work; accounts of therapists’ own experience and the issues they face in themselves and in their groups. The book is devoted to the Group-Analytic model but the other principally psychodynamic models of group therapy - the Tavistock, Interpersonal, Psychodynamic, Modern Analytic and Structural/Systemic models - are brought into a comparative discussion and drawn upon to create an integrated and coherent approach. The book is divided into three sections: Foundations – aimed at practitioners using groups of any kind and working at every level, including those providing supportive psychotherapy and providing groups for psychosis, trauma, the elderly, people at risk, the elderly and children; The Group-Analytic Model – defines the group-analytic model at a basic and advanced level; The Dynamics of Change – aimed at group analysts, psychotherapists and psychologists providing short-term psychotherapy and long-term group analysis The book is illustrated with clinical vignettes including incisive, instructive commentaries to explain the concepts in use. It is intended for those seeking psychotherapy, whether to resolve personal problems or to find new sources of meaning in their lives. It is also intended for policy-makers in mental health, students of different models of psychotherapy and the psychosocial field. The comparative discussion running through the text about methods and models of practice will likely be of interest to the wider mental health and psychotherapy fields. The author draws together the inherited wisdom of group analysis since Foulkes’ time and makes his own lasting contribution. From the Couch to the Circle will be an invaluable, accessible resource for psychotherapists, psychoanalysts, psychologists, family therapists, academics, psychologists, mental health practitioners, academics and teachers in psychotherapy. (shrink)

Equine-Facilitated Psychotherapy is widely used, and the uses to which it can be put are still being developed. However, existing knowledge about this field is insufficient, and most of the research suffers from methodological problems that compromise its rigor. This review will explore research into the linked fields of Animal-Assisted Therapy and Equine-Assisted Activities/Therapies related to physical health. Existing knowledge of mental, emotional, and social applications of EAA/T is presented. Evaluation studies in the subfield suggest that people benefit from (...) interventions with horses. However, these studies suffer from fundamental problems, such as small sample size and lack of control groups. Naturalistic inquiry about theoretical aspects highlights the fundamental role that human-horse relations play in EAA/T, but these studies exhibit deficiencies in theory development. A multimethod approach could promote knowledge development for EFP. Suggestions for future research concern methodological solutions to improve evaluation studies, use of grounded theory method to develop theory, as well as applying attachment theory to the human-horse context, which may offer insight about the underlying processes for change. (shrink)

The aim of the article was to develop the thesis that patient’s decisions about truth and responsibility are central to the process of psychotherapy and yet they are rarely explicitly articulated. In the first part of the text, I outlined the anthropological context of the thesis, according to which human intentionality and psychological mechanisms have the status of domains of objective reality that are ontologically separate, although in the patient’s experience they combine with one another. Next, with reference to (...) the classical opinions of psychotherapy, I identified two aspects of patient decisions related to her/his psychopathology: adaptive (more pronounced in childhood) and moral (more pronounced in adulthood). I went on to isolate groups of psychological operating mechanisms involved in both truth- and responsibility-avoidance choices and, using clinical illustration, showed how the therapist can support alternative decisions. Finally, I further clarified the understanding of the proposed working model by indicating the different therapeutic consequences of revealing psychological mechanisms vs. decision-making based on the type of patient disorder and the anthropological-moral character of his/her choices. (shrink)

While psychotherapy is helpful to individual clients, the slim cadre of therapists and the vast number of disturbed people precludes any hope that more than a relative few will receive help. Nowhere is the futility of psycotherapy as obvious as among the poor and powerless whose suffering, crowding, and dispair will yield only to social and political solutions. In the United States the expansion of the number of psychiatric diagnoses and the demographic changes in populations will only make larger (...) the gap in numbers between therapists and clients. Psychotherapy is an expensive oddity to the poor, but their taxes will help the affluent obtain prepaid care. Psychotherapy does reveal some of the social and economic factors, like bad parenting, homelessness and unemployment, that cause emotional disturbances. But one-to-one treatment, medical or psychological, does not, and cannot, affect incidence. The rightward movement of American psychiatry, supported by political conservatives and by activist parent-groups, espouses an organic explanatory model for all mental disorders and for a wide range of human problems. Only effective primary prevention leading to social change will reduce future incidence. (shrink)

Mental health professionals face many complex questions in the course of their work with clients and patients. Among the most difficult are dilemmas that involve ethical issues. This book presents a forthright exploration of these dilemmas and the ethical considerations they raise. Drawing on extensive interviews, the author identifies common ethical problems that practitioners encounter. What happens, for example, when personal interests intrude into therapy? How can the therapist make an accurate assessment of his or her appropriateness as a care (...) provider for a particular patient? What about confidentiality? How are problematic financial arrangements best addressed? The author goes on to show how these dilemmas may be intensified by the unique assumptions of different therapeutic orientations--individual, group, family, marital, and organizational--and how professionals can learn from such experiences to better understand and apply their particular approach. This analysis--and the words of the therapists themselves--provide both a guide to practice and a unique store of experience for the growing number of researchers and students concerned with ethical problems in psychotherapy. (shrink)

ObjectivesAs the largest cohort of healthcare workers and nurses can practice as psychotherapists to integrate the psychotherapeutic interventions as part of routine care. The present study aims to evaluate the effectiveness of supportive psychotherapy on patients who had been scheduled to undergo a fiberoptic bronchoscopy procedure.MethodsThis study retrospectively analyzed 92 patients who underwent FOB, which was divided into the SPT group and usual-care group based on whether patients were given SPT interventions or not. The Patient Health Questionnaire-9 (...) and Hospital Anxiety and Depression Scale were used to determine the severity of depression and anxiety, as well as the 36-Item Short-Form Health Survey questionnaire to evaluate the health-related quality of life. Moreover, the patients' satisfaction was assessed based on the Likert 5-Point Scale.ResultsThe baseline status of anxiety, depression, and HRQoL in patients was similar in the SPT group and the usual-care group with no significant difference. Both PHQ-9 score and HADS-D score in the SPT group after intervention were lower than that in the usual-care group, accompanied by the deceased HADS-A subscale. Moreover, the improved HRQoL was found in the patients undergoing FOB after SPT interventions as compared to those receiving conventional nursing care using the SF-36 score. Additionally, the patient satisfaction in the SPT group was higher than in the usual-care group.ConclusionsThe study demonstrated that anxiety and depression, as negative emotions, can be reduced by supportive psychotherapy in patients receiving FOB with improved mental health and satisfaction with nursing care. (shrink)

The work of every school of psychotherapy and every therapist is inevitably structured by a value system and requires codes of ethics and practice. This book addresses the conscious and unconscious aspects of the value system in which therapists are situated. Values and Ethics in the Practice of Psychotherapy and Counselling explores the central issues through the experience of the contributors, each of whom is well known in this field. Each chapter will raise questions for the reader which (...) will stimulate individual thinking about practice or can form a basis for discussion and debate for training or graduate groups. The book is firmly rooted in practice. Each chapter deals with a different aspect of the psychotherapist's work beginning with the general underlying principles, continuing through matters of technique and on to contextual issues. Finally the book moves to the outer world, politics and spirituality as ways of connecting inner and outer, social and individual. The arrangement of chapters allows for flexibility and creativity while providing a coherent structure. Values and Ethics in the Practice of Psychotherapy and Counselling is recommended reading for psychotherapists, psychoanalysts and counsellors in training and practice. (shrink)

Psychotherapists in mental health institutions as a professional group are part of the medical system, and from this perspective, as representing an occupation that serves the public health interests, as well as those of the individual seeking help. Despite the different existing therapeutic approaches and diverse forms of therapy deriving from these approaches critical theories, however, consider psychotherapy as a profession with a specific jurisdictional claim and own highly specific interests. In contrast to most of the recent discussion (...) around therapy culture, in this article, I argue that sociology and social theory could benefit from an understanding of psychotherapy as a profession with a separate logic and claim for jurisdiction for mental health. Moreover, I present some general trends showing that, regarding psychotherapy, we face a concurrence of a professionalisation, and simultaneously, an already ongoing deprofessionalisation. To develop my argument, I first discuss the perspectives of sociology of the psychotherapy professions. Second, I present the potential lack of professionalism in four dimensions. Third, I discuss possible tendencies of deprofessionalisation. Finally, I conclude by pointing out the importance of theorising the psychotherapy professions for medical sociology. (shrink)

Women are diagnosed with clinical depression at twice the rates as men. Treating depression through psychotherapy or medication both focus on changing an individual, rather than addressing socioecological influences or social roles. In the current study, participants read of systemic inequality contributing to differential rates of depression in either American men or women, or in two fictitious Australian First Nation groups. Participants then considered the acceptability and efficacy of treating depression through psychotherapy, medication, or social change. When socioecological (...) inequities and unequal social roles were presented through an unfamiliar foreign lens, participants were more likely to recognize the systemic unfairness, and endorsed social change more than psychotherapy or medication as a treatment strategy. However, when identical social inequities and social roles were presented through descriptions of American men and women, social intervention was less likely to be endorsed, and psychotherapy or medication gained in acceptability. Participants of color were also more likely to recognize and endorse social change as a strategy for treating depression, while those reporting a history of psychotropic medication for affective disorders rated medication as more effective and acceptable. (shrink)

BackgroundThe legal and ethical guidelines of psychological professional associations stipulate that informed consent by patients is an essential prerequisite for psychotherapy. Despite this awareness of the importance of informed consent, there is little empirical evidence on what psychotherapists’ attitudes towards informed consent are and how informed consent is implemented in psychotherapeutic practice.Methods155 psychotherapists in Switzerland completed an online survey assessing their attitudes regarding informed consent. ResultsAmong the surveyed psychotherapists, there was a high consensus on important information that should be (...) communicated to patients in the context of informed consent. Almost all psychotherapists rated confidentiality and its exemptions (95%) and self-determined decision-making (97%) as important. The importance to disclose information regarding fees and the empirical effectiveness of the provided treatment, were both seen as important by more than 80% of participants. The disclosure of personal information about the therapist was rated as important by 60%. Other aspects, which are not direct components of informed consent but rather overarching goals, were also evaluated rather homogeneously: self-determined decision making of the patient was rated as important by almost all of the surveyed psychotherapists (97%). The following components were also judged as important by a majority of the participants: promotion of hope (80%) and discussion of treatment goals (93%). Most psychotherapists described the implementation of informed consent as an ongoing process, rather than a one-time event during the first session of therapy. Therapists’ age, postgraduate training, treated patient group, and setting influenced attitudes towards informed consent.ConclusionsThe present study shows that informed consent is perceived by psychotherapists as both a challenge and a resource. The implementation of informed consent in psychotherapy requires further research from a clinical and ethical perspective. (shrink)

IntroductionApproaches to improve heart rate variability and reduce stress such as breathing retraining are more frequently being integrated into psychotherapy but little research on their effectiveness has been done to date. Specifically, no studies to date have directly compared using a breathing pacer at 6 breaths per minute with compassion focused soothing rhythm breathing.Current StudyIn this randomized controlled experiment, 6 breaths per minute breathing using a pacer was compared with compassion focused soothing rhythm breathing, with a nature video being (...) used as a control group condition.MethodsHeart rate variability measures were assessed via electrocardiogram and respiration belt, and an automated blood pressure machine was used to measure systolic diastolic blood pressure, and heart rate. A total of 96 participants were randomized into the three conditions. Following a 5-min baseline, participants engaged in either 6 breath per minute breathing, soothing rhythm breathing, or watched a nature video for 10 min. To induce a stressful state, participants then wrote for 5 min about a time they felt intensely self-critical. Participants then wrote for 5 min about a time they felt self-compassionate, and the experiment ended with a 10-min recovery period.ResultsConditions did not significantly differ at baseline. Overall, HRV, as measured by standard deviation of NN intervals, low frequency HRV, and LF/HF ratio, increased during the intervention period, decreased during self-critical writing, and then returned to baseline levels during the recovery period. High frequency HRV was not impacted by any of the interventions. The participants in the 6 breath per minute pacer condition were unable to consistently breathe at that rate and averaged about 12 breaths per minute. Time by Condition analyses revealed that both the 6 breaths per minute pacer and soothing breathing rhythm conditions lead to significantly higher SDNN than the nature video condition during breathing practice but there were no significant differences between conditions in response to the self-critical and self-compassionate writing or recovery periods. The 6 breath per minute pacer condition demonstrated a higher LF HRV and LF/HF ratio than the soothing rhythm breathing condition, and both intervention conditions had a higher LF HRV and LF/HF ratio than the nature video.ConclusionsAlthough the 6 breath per minute pacer condition participants were not able to breath consistently at the low pace, both the participants attempting to breathe at 6 breaths per minute as well as those in the soothing rhythm breathing condition effectively increased HR variability as measured by SDNN, and attempting to breathe at 6 breaths per minute led to the highest LF HRV and LF/HF ratio. Both breathing approaches impacted HRV more than watching a relaxing nature video and can potentially be used as key adjuncts in psychotherapy to aid in regulating physiological functioning, although it appears that consistent breathing practice would be needed. (shrink)

Previous accounts of psychiatry within Communist Europe have emphasized the dominance of biological approaches to mental health treatment. Psychotherapy was thus framed as a taboo or marginal component of East European psychiatric care. In more recent years, this interpretation has been re-examined as historians are beginning to delve deeper into the diversity of mental healthcare within the Communist world, noting many instances in which psychotherapeutic techniques and theory entered into clinical practice. Despite their excellent work uncovering these hitherto neglected (...) histories, however, historians of the psy-disciplines in Eastern Europe have neglected to fully consider the ways that post-World War II psychotherapeutic developments were not simply continuations of pre-war psychoanalytic traditions, but rather products of emerging transnational networks and knowledge exchanges in the post-war period. This article highlights how psychotherapy became a leading form of treatment within Communist Yugoslavia. Inspired by theorists in France and the United Kingdom, among other places, Yugoslav practitioners became well versed in a number of psychotherapeutic techniques, especially ‘brief psychotherapy’ and group-based treatment. These developments were not accidents of ideology, whereby group psychotherapy might be accepted by authorities as a nod to some idea of ‘the collective’, but were rather products of economic limitations and strong links with international networks of practitioners, especially in the domains of social psychiatry and group analysis. The Yugoslav example underscores the need for more historical attention to transnational connections among psychotherapists and within the psy-disciplines more broadly. (shrink)

Ethics and Decision Making in Counseling and Psychotherapy has a distinct and timely focus on counseling as a profession. Chapters address the mental health professions, values in counseling, decision making, ethical principles, ethical standards, technology, ethical climate, and office/administrative practices. The early chapters present a foundation for ethical practice of the profession and provides solid building blocks to the more advanced perspectives in later chapters. Chapters on specialty practice are lively and contemporary overviews of these practice areas in counseling (...) that reflect more recent trends to increased differentiation of these areas of practice. Each specialty has its own chapter to allow for an extended discussion of the unique aspects of the field that provide clarity to understanding the particular ethical issues and standards that apply in each specialty. The specialty areas recognized by CACREP are included: mental health counseling; school counseling; couple, marital, and family counseling; rehabilitation counseling; addictions counseling; career counseling; and group counseling. This book is broad in its coverage of the most practiced specialties in mental health practice, and provides an efficient and effective overview of the broad scope of particular areas addressed in counseling. (shrink)

This edited volume comprehensively examines the critical ethical challenges that arise in the practice of counselling and psychotherapy. It translates philosophical positions and professional ethical guidelines in a way that can be applied to practice. The various chapters focus on specific ethical issues that emerge in working with a range of different client groups; for example, children, couples and families. While some ethical imperatives are common across the board, others could be more closely associated with certain client groups. Practitioners (...) might experience uncertainty in working with vulnerable client groups; for example, lesbian/gay/transgender/intersex (LGBT) clients, or persons who report intimate partner violence. Several chapters raise questions, provide information and additional resources to enhance ethically informed practice. Chapter contributions also highlight the ethical dilemmas that might be unique to certain contexts; for example, private practice, schools and consultation-liaison settings. This volume also addresses contemporary and relatively less understood playing fields like 'digital ethics' related to therapist-client interface in the internet space and the navigation of ethical dilemmas in the newly emerging field of employee assistance programmes which address mental health needs in the corporate sector. Written by experienced practitioners of psychotherapy, and culturally contextualized, this is a valuable resource for academics and practitioners interested in psychotherapy and counselling. (shrink)

In 1988, Colorado instituted a new regulatory system that was opposed by psychologists and social workers. We surveyed 306 psychotherapists about their attitudes regarding this system, which included profession-specific licensing boards and an omnibus board to handle grievances. Social workers and psychologists, members of more established professions, opposed creating an omnibus licensing board and favored the return of profession-specific grievance functions. Members of the newer professions and unlicensed psychotherapists were not as opposed to omnibus boards. All groups agreed in their (...) positive ratings of the performance of the Colorado grievance structure. These results are discussed in terms of "capture" theory, which postulates that professions capture governmental regulation and use it for their own interests. (shrink)

For a long time the human sciences have debated the relationship between social structures--the group, and subjectivity--the individual, with much of the debate centering round areas such as identity, (gender, race, sexuality), discourse, (talk, conversation, the limits of language), and therapy. This book, by a well-known and highly respected academic in the cross-cutting fields of gender studies, therapy, and psychoanalysis, brings together important material on these debates, and provides a substantial contribution to theory on the relationships between psychology, (...) class='Hi'>psychotherapy, and social theory. (shrink)

This article examines the cultural practices through which a group of professionals infuse their work and community with charisma. Although previous research has theorized the “charisma of office” (Weber 1978), we know little about how the occupants of such offices sustain it. I focus on a group of psychoanalytically-inclined psychotherapists, whose field, despite its early charismatic beginnings, has been especially embattled in recent decades. Drawing on ethnographic and interview data, I reveal how they share stories emphasizing their “idealization” (...) by others, draw boundaries between their professional and private lives to manage their work identities, and perform interpersonal affective work that shores up their claims to extraordinary abilities. Together, these cultural practices constitute charisma within the professional group. This article thus makes a case that, as expertise becomes increasingly contested, we must look beyond social organization and the evidentiary bases of knowledge to understand professional authority. (shrink)

Two inimical interpretations of psychotherapy look to many of the same features of empirical research. One camp infers that placebo effects are impossible in principle in psychotherapy; the other camp infers from the same research that psychotherapy is essentially placebo. I examine the crucial discussions and conclude that these opposing evaluations ensue because each group presumes a different baseline from which the significance of the research is gauged. I show how different baselines set different standards of (...) significance and invite different comparisons between therapeutic and non-therapeutic practices. Attention to this point about the baseline of significance puts the placebo debate in sharper relief and frames more clearly the merits and demerits of each position. It also leads to the conclusion that neither group really lays hold of in-principle claims, since both interpretations rest on context-dependent features of the empirical situation. Along the way, I discuss salient features of outcomes research, meta-analysis, and the role of symbols in therapeutic transactions. I close with some remarks that link the proliferation of therapies with cultural splintering generally and suggest how this might bear on the placebo issue. (shrink)

In the present study, qualitative and quantitative studies were conducted to explore differences between stakeholders in expectations of gendered robots, with a focus on their specific application in the field of psychotherapy. In Study I, semi-structured interviews were conducted with 18 experts in psychotherapy to extract categories of opinions regarding the use of humanoid robots in the field. Based on these extracted categories, in Study II, an online questionnaire survey was conducted to compare concrete expectations of the use (...) of humanoid robots in psychotherapy between 50 experts and 100 nonexperts in psychotherapy. The results revealed that compared with the female participants, the male participants tended to prefer robots with a female appearance. In addition, compared with the experts, the nonexperts tended not to relate the performance of robots with their gender appearance, and compared with the other participant groups, the female expert participants had lower expectations of the use of robots in the field. These findings suggest that differences between stakeholders regarding the expectations of gendered robots should be resolved to encourage their acceptance in a specific field. (shrink)

Farhad Dalal argues that people differentiate between races in order to make a distinction between the "haves" and "must-not-haves", and that this process is cognitive, emotional and political rather than biological. Examining the subject over the past thousand years, Race, Colour and the Process of Racialisation covers theories of racism and a general theory of difference based on the works of Fanon, Elias, Matte-Blanco and Foulkes, as well as application of this theory to race and racism. Farhad Dalal concludes that (...) the structures of society are reflected in the structures of the psyche, and both of these are colour coded. This book will be invaluable to students, academics and practitioners in the areas of psychoanalysis, group analysis, psychotherapy and counseling. (shrink)

The debate on the validity of the evidence-based medicine (EBM) paradigm in psychiatry and psychotherapy has tended to be rather polarized. Critics of the paradigm maintain that there is a basic conflict between the general knowledge of treatment of groups of patients ('techne') and the contextual understanding of individual patients ('phronesis'). This paper argues that the existence of firm general knowledge is crucial to the legitimacy of the psychiatric as well as the medical profession as a whole, and defends (...) the controlled clinical trial as a central instrument to establish such knowledge. At the same time, however, the paradigm does not solve the old Aristotelian techne–phronesis dilemma, which seems to be more or less inescapable. Focusing on psychotherapy, the paper discusses problems connected with the 'techne-oriented' use of diagnostic principles and of therapy manuals, the criteria for therapeutic progress, and the apparent conflict between experimental efficacy and practical effectiveness. (shrink)

Background: Past research has highlighted the role of trauma in social adjustment problems, but little is known about the underlying process. This is a barrier to developing effective interventions for social adjustment of traumatized individuals. The present study addressed this research gap through a cognitive model.Methods: A total of 604 young adults from different backgrounds were assessed through self-report questionnaires. The data were analyzed through path analysis and multivariate analysis of variance. Two path analyses were conducted separately for migrant and (...) Australian groups.Results: Analyses indicated that cognitive avoidance and social problem solving can significantly mediate the relation between trauma and social adjustment. According to the model, reacting to trauma by cognitive avoidance can disturb the cognitive capacities that are required for social problem solving. Consequently, a lack of effective social problem solving significantly hinders social adjustment. There were no significant differences among the Australian, non-refugee immigrant and refugee participants on the dependent variables. Moreover, the hypothesized links between the variables was confirmed similarly for both migrant and Australian groups.Conclusion: The findings have important implications for interventions targeting the social adjustment of young individuals. We assert that overlooking the processes identified in this study, can hinder the improvement of social adjustment in young adults with a history of trauma. Recommendations for future research and practice are discussed. (shrink)

This paper argues that paradox offers an ideal didactic context for open-ended group discussion, for the intensive practice of reasoning, acquiring dispositions critical for mathematical thinking, and higher order learning. In order to characterize the full pedagogical range of paradox, I offer a short overview of the effects of paradox, followed by a discussion of some parallels between the use of paradox in paradoxical psychotherapy and the use of the koan in Zen Buddhist spiritual training. Reasoning with paradoxes (...) in a community of mathematical inquiry is interpreted as a comparative if not isomorphic pedagogical and cognitive phenomenon. Finally, some broad implications are drawn for mathematical inquiry with paradoxes. (shrink)

This dissertation is focused on the validity of “the data” that are collected in psychotherapy research for the purpose of evidencing treatment efficacy. In the ‘Evidence Based Treatment’ paradigm, researchers rely on the so-called ‘gold standard methodology’ to gather sound and trustworthy evidence, which increasingly influences the organization of mental health care worldwide. In the gold standard, data are collected by quantified self-report measures, to assess the presence and severity of symptoms before and after treatment. When the pre-post difference (...) is larger for a group of people that received the treatment of interest and a group of people who received no or an alternative treatment, the treatment of interest is called effective. In this methodological procedure, researchers tend to assume that when this gold standard methodology is conducted properly, “the data” will speak for themselves. However, when evidence is based on data, that evidence is principally limited by that data. In other words: output depends on input. That implies that when input is flawed, output will be flawed, even when the very best methods of analysis would be used. So what if “the data” yield validity issues despite being collected by validated measures? When “the data” do not straightforwardly evidence treatment effects, will the subsequent steps in the analysis of these data be enough to secure that the evidence in the end does evidence treatment efficacy? In this dissertation, the focus is turned to validity of “the data” that are concretely provided by patient-participants by scoring their own experienced symptoms in self-report questionnaires, in function of evidencing treatment efficacy. A series of empirical case studies were conducted to scrutinize how patient-participants in a randomized controlled psychotherapy study experienced the process of data collection, and how these experiences affected the data that they provided. Each of the studied patient-participants experienced a substantial effect of the questionnaire administration on their complaints. This impacted the level of complaints, but also changed the way in which the complaints were understood at all, and how patient-participants perceived themselves. Thus, rather than neutrally measuring symptoms, questionnaire administration changed the experienced complaints ‘performatively’, which turned measurement into a clinical intervention of its own. Consequently, what is measured cannot straightforwardly be called ‘treatment efficacy’, as it may be entangled with, enabled by or even obstructed by effects of measurement and research. Therefore, the act of measurement itself can pose a vital threat to the validity of “the data”. This way, the empirical case studies exhibited that data can yield validity problems despite the use of validated measures. Consequently, the validity of a measure as such is no guarantee for the validity of data. Nonetheless, in gold standard research, the data are straightforwardly taken as input for analyses of general treatment efficacy. The question is what happens with those validity issues on the level of individual data, when they pursue their journey towards becoming evidence. In this dissertation, it was argued that the validity issues are not sufficiently solved in the methodological steps after data collection, so when data are invalid in the beginning, these validity issues will simply become part of the data set that forms the input for analysis of the final evidence. This urges that validity issues should be solved on the level of individually provided data, as the validity issues will otherwise become inherent to “the data”. Put formally: valid data is a precondition for evidence in EBT. In conclusion, it is crucial for a sound evidence-base to scrutinize the validity of data in function of the overall goal and utility of the research. For this, it is important not to take “the data” as speaking for themselves, but to regard them as clinical narratives, which are framed in a specific format to be communicated between researcher and respondent in a research context. This emphasizes that the choice for a certain format determines what can be evidenced, so it is vital that these choices indeed allow for obtaining evidence that is useful and valid to serve the clinical goal of EBT. (shrink)

This volume describes the main theoretical aspects of this practice based on an open-ended dialogue between a philosophical practitioner and a client or a group ...

Self-management interventions are a heterogeneous group of interventions that are regarded as important tools for the management of chronic diseases. They consist of a broad range of techniques and are available for a large variety of chronic organic as well as mental conditions or illnesses, which are by definition generally chronic. These interventions aim that the individual concerned takes substantial responsibility for managing the symptoms, treatment, and physical and psychosocial consequences associated with having a chronic medical condition, disability or (...) disease. Alternate terms used in this context, among others, are self-care... (shrink)

Treatments for students with problematic levels of music performance anxiety commonly rely on approaches in which students are referred to psychotherapists or other clinical professionals for individual care that falls outside of their music training experience. However, a more transdisciplinary approach in which MPA treatment is effectively integrated into students’ training in music/performing arts colleges by teachers who work in consultation with clinical psychologists may prove more beneficial, given the resistance students often experience toward psychotherapy. Training singing teachers, and (...) perhaps music teachers at large, to use an evidence-based coaching strategy like Acceptance and Commitment Coaching to directly manage students’ MPA is one such approach. Building on the work of a previous study in which ACC was administered by a singing teacher to a musical theatre student with problematic MPA, we piloted the effectiveness of a six-session, group ACC course for a sample of performing arts students with MPA related to vocal performances, using a mixed-methods design. The coach here was also a singing teacher without a clinical background, and her training in ACC by a clinical psychologist was of a similar duration as the previous teacher’s. Similar to the musical theatre student, the students reported being significantly less fused with their MPA-related cognitions, more accepting of their MPA-related physiological symptoms, and more psychologically flexible while performing in general, and these improvements were maintained after 3 months. Furthermore, they appeared to lower their shame over having MPA and change how they thought in relation to one another. Of note, these improvements were similar to those shown by seven vocal students with MPA after they received Acceptance and Commitment Therapy from a clinical psychologist, but with larger reductions in shame and better acceptance of MPA, which suggests a non-clinical, group ACC intervention that includes supportive discussions to normalize MPA and challenges attempts to control it may be more helpful than individual psychotherapy. These results are promising and indicate a brief training in ACC may be sufficient for singing teachers to provide significant benefit for students with problematic MPA. (shrink)

ObjectiveDropout rates are a prominent problem in youth psychotherapy. An important determinant of dropouts is the quality of the therapeutic relationship. This study aimed to evaluate the association between the therapeutic relationship and dropouts in an intensive mentalization-based treatment for adolescents with personality disorders.MethodsPatients included were either dropouts or completers of an intensive MBT. The therapeutic relationship was measured with the child version of the Session Rating Scale, which was completed by the patient after each group therapy session. (...) For each patient, the treatment termination status was indicated by the treatment staff. The reliable change index was calculated for the C-SRS to determine significant changes in the therapeutic relationship.ResultsWhile both groups started with similar scores on the C-SRS, the scores between dropouts and completers differed significantly at the end of the treatment period. On average, during therapy, an increase was seen in the scores of completers, and a decrease was seen in the scores of dropouts. While dropouts could not be predicted based on the C-SRS scores, a significant decrease in C-SRS scores during the last two sessions occurred more often for dropouts than for completers.ConclusionOur findings show that to prevent dropouts, the patient’s judgment of the quality of the therapeutic relationship should be monitored continuously, and decreases discussed with the patient and the group. (shrink)

Malm and colleagues (2008) consider (and reject) five arguments putatively justifying the idea that healthcare workers (HCWs) have a duty to treat (DTT) during a pandemic. We do not have sufficient...