Emmanuel Levinas gave an account of radical, asymmetrical responsibility for the Other that is phenomenologically sensible in the proximity of face-to-face relation. This original arrangement, however, is not interminable. The approach of the third party equalizes and creates distance between self and Other by introducing ontology and epistemology. It is a necessary process of totalization that moves from a primordial ethics to justice and institutional fairness. However, Levinas was aware that the third party's presence brought with it a possible forgetting (...) of the Other and a covering over of radical ethics. In this presentation, we propose that the psychotherapeutic process represents a context that bears the proximal dimension described by Levinas while also representing an institution that is, in definition and purpose, totalizing. Furthermore, using a play on words that represents a significant issue in contemporary psychotherapeutic practice, we explore the common presence and impact of third-party payers on the therapeutic relationship, and how third-party payers are disingenuously a-proximal and constantly approximating; faceless and consequently effacing the patient's august dignity, causing a forgetfulness of the justice to which Levinas called institutions. Lastly, we suggest some strategies by which therapists may recover the never-absolved proximity to the Other in a profession susceptible to the a-proximal effects of third-party economics. 2012 APA, all rights reserved). (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Toward a Non-Cartesian Psychotherapeutic Framework: Radical Pragmatism as an AlternativeLouis S. Berger (bio)AbstractPostmodern criticism has identified important impoverishments that necessarily follow from the use of Cartesian frameworks. This criticism is reviewed and its implications for psychotherapy are explored in a psychoanalytic context. The ubiquitous presence of Cartesianism (equivalently, representationism) in psychoanalytic frameworks—even in some that are considered postmodern—is demonstrated and criticized. The postmodern convergence on praxis as a desirable (...) alternative to Cartesianism is reported, and its relevance for psychoanalysis is considered. The severe conceptual difficulties entailed in formulating such an alternative are discussed, as are those difficulties that would be encountered were psychoanalysis to attempt the shift from explanatory mental science to praxis. The principal psychoanalytic problematics explored are: the paradoxical relationships between theory and therapeutic technique; the therapeutic action; and validation of clinical practices. Initial, nontraditional suggestions for addressing these problems are offered.Keywordspsychoanalysis, therapeutic action, representation, state space, praxis, hermeneutics, Descartes, Heidegger, Wittgenstein“But the inability to bring one’s subject under conceptual control, fixing it propositionally, is not the end of thinking; on the contrary, it were better to say that the breakdown of concepts and the failure of words is an opening that takes us out of the realm where representation and calculation are all that matter to thinking.... [T]his is what happens in the Socratic dialogue where the negativity in which one ends up at a loss for words is at the same time that which sets thinking free.”Bruns 1989, 9“To evolve theory as though our methods and processes of study were essentially the same, or could be the same, as those of other sciences, or could be disregarded when it comes to theory, implies a view of reality that is no longer tenable, least of all in that ambiguous area which we call psychic reality. Nevertheless, all of us are still more or less captives of an erroneous understanding of objectivity and objective reality....”Loewald 1970, 45 [End Page 169]CartesianismCartesianism still underlies and dominates much of today’s thought. It is the label for a network of interrelated ideas and themes:the ontological duality of mind and body; the subjective individualism implicit in the ultimate appeal to direct personal verification; the method of universal doubt which was supposed to lead us to indubitable truths; the doctrine that language and signs are an external disguise for thought; the doctrine that vagueness is unreal and that the philosophic endeavor is one of knowing clearly and distinctly a completely determinate reality; and most fundamentally, the doctrine that we can break out of the miasma of our language or system of signs and have direct intuitive knowledge of objects. (Bernstein 1971, 5–6)[The Cartesian assumptions] constitute a picture of science and the world somewhat as follows: there is an external world which can in principle be exhaustively described in scientific language. The scientist, as both observer and language-user, can capture the external facts of the world in propositions that are true if they correspond to the facts and false if they do not. Science is ideally a linguistic system in which true propositions are in one-to-one relation to facts, including facts that are not directly observed because they involve hidden entities or properties, or past events or far distant events. These hidden events are described in theories, and theories can be inferred from observation, that is, the hidden explanatory mechanism of the world can be discovered from what is open to observation. Man as scientist is regarded as standing apart from the world and able to experiment and theorize about it objectively and dispassionately.(Hesse 1980, vii)Hesse goes on to say that “almost every assumption underlying this account has been subjected to damaging criticism,” a view echoed by others: “Most contemporary philosophers have been in revolt against the Cartesian framework” (Bernstein 1971, 5); “A rejection of the Cartesian view is a central theme for both of the giants of twentieth-century philosophy, Heidegger and Wittgenstein” (Sass 1992, 444n 77); and “The notion of alternative conceptual frameworks has been a commonplace of our culture since Hegel” (Rorty 1982, 3).These criticisms arise... (shrink)

In the process of individual psychotherapy, the client and the therapist work together towards clarifying the client's problems, unlocking vicious circles, opening new perspectives and creating a new narrative congruent with the client's experiencing. The real and undeniable situation in individual psychotherapy across different therapeutic systems is that therapists enter the therapeutic encounter equipped with their own vision of humanity and their own particular theory and methods of psychotherapy. Through the differences in power between therapists and clients and the powerful (...) role of language, clients in their dependent position are apt to assimilate the percepts and the ideas of their therapists. Consequently therapists tend to exert a dominant and influential force in their client's lives. This raises a main ethical concern: to what extent do therapists from different therapeutic systems really help clients to recover their freedom to live their lives congruent to their own authentic perceptions and experiences? (shrink)

This paper demonstrates how ubuntu relational philosophy may be used to ground beneficial coercive care without necessarily violating a patient’s dignity. Specifically, it argues that ubuntu philosophy is a useful theory for developing necessary conditions for determining a patient’s potential dangerousness; setting reasonable limits to the duty to protect; balancing the long-term good of providing unimpeded therapy for patients who need it with the short-term good of protecting at-risk parties; and advancing a framework for future case law and appropriate regulations (...) in the care of psychotherapy patients. Issues regarding the decision to breach medical confidentiality in psychotherapeutic care are ultimately reserved for the courts. Professional assessment might be an important first step in this process, and court rulings govern most aspects of this assessment. However, current case law, especially in the United States, places an unreasonable expectation on psychotherapists to protect all at-risk parties or foresee that a patient intends to follow through on said threats. It has largely failed to guarantee psychotherapy patients unlimited access to care, while potentially inhibiting future honest communication between patients and health professionals and endangering the safety of others. Of these decisions, the two most prominent are the 1976 Tarasoff decision and the 2016 Volk decision. This paper argues for the possibility of grounding good laws in ubuntu African philosophy in a way that protects others from harm and ensures unimpeded access to care without necessarily breaching medical confidentiality. (shrink)

Previous studies seldom touch on aspects of psychotherapeutic encounters between therapists and clients with particular disorders. Little attention has been paid to the sequence organization of psychotherapeutic interaction between therapists and clients with depression in Chinese medical settings. By adopting conversation analysis, we investigated the specifics of psychotherapeutic encounters, specifically, the transformative sequences of psychotherapeutic interaction between therapists and Chinese adolescents with depression. We identified the fourth aspect of clients’ experience transformed in the Chinese psychotherapeutic interaction with adolescents with depression: (...) cognition, and described how the sequential organization of therapists’ actions facilitates the momentary transformation of clients’ experience in the psychotherapeutic processes. This study not only adds to the conversation analytic study on the transformative sequences in psychotherapeutic interaction but also sheds some light on the study of how therapists transform clients’ experience in Chinese psychotherapeutic interaction. (shrink)

Therapeutic alliance is a central concept in psychotherapeutic work. The relationship between the therapist and the patient plays an important role in the therapeutic process and outcome. In this article, we investigate how therapists work with disaffiliation resulting from enduring disagreement while maintaining an orientation to the psychotherapeutic project at hand. Data come from a total of 18 sessions of two dyads undergoing psychoanalytic psychotherapy and is analyzed with conversation analysis. We found that collaborative moves deployed amidst enduring disagreement can (...) assist the therapist in furthering the disagreement as part of the ongoing psychotherapeutic project. Relying on their collaborative format, therapists utilize collaborative moves to temporarily mend the disaffiliation without necessarily changing their position and re-affiliating with the patient. We show how the relation between the therapist and the patient gets transformed in the moment-by-moment work accomplished in the psychotherapeutic talk. (shrink)

Using a “psychotherapeutic attitude”, as a criterion and measure of the psychiatrist’s involvement in clinical relationship (with the “trial identification” according to Fliess), some phenomenological and epistemological considerations are offered about diagnostic assessments, as a synchronic and diachronic recognising process. Inspired by Gehlen’s notion of “exoneration” (i.e., the reducing and focusing of the perceptive experience as applied to the wealth of the perceptible), this paper examines how the mind of a skilled diagnostician might work. Three levels are explored: firstly, “the (...) symbolic perception”, where perceptive/emotional data derived by “trial identification” and worked through during one’s professional experience, automatically selects wide fields of allusions (e.g., in the psychopathological prefigurations, suggested by the ‘‘contact’’); then, we consider the “exoneration” of scientific hypothesis, which allows the psychiatrist to give a scientifically recognisable form to the first diagnostic outlines gathered in the interpersonal communication; and thirdly, the holistic reflection is examined, which returns the doctor’s focus to the patient’s individual problems, after going through different and, at times, very high inference levels. It is not a question of phases, but of varyingly interwoven moments in the mind of the skilful clinician, which are based on the dialectics of identification/separation. (shrink)

Using Grunbaum 1984 and 1993 as a springboard, Greenwood (this issue) claims to have offered several methodologically salubrious and exegetically illuminating theses on empirical evaluations of theoretical explanations of psychotherapeutic efficacy. According to his exegesis of Grunbaum's construction (1984, Ch. 2, Section C; 1993, 184-204) of Freud's "Tally Argument," that argument bespeaks a rife neglect of the epistemologically-significant distinction between empirical evaluations of the efficacy of psychotherapy and evaluations of theoretical explanations of that efficacy. Greenwood presents a defense of a (...) qualified version of Popper's critique of psychoanalysis against Grunbaum's objections to it (1984, Ch. 1B). Finally, Greenwood offers a clarification of the concept of a "placebo control" investigation, taking issue with Grunbaum's 1993 (84-87, 91-93). In the present paper, it is argued contra Greenwood that: (1) his purportedly "best" reading of Freud's Tally Argument and of its import founders, (2) the distinction that Greenwood bemoans as being neglected by mental health researchers actually is a commonplace in the literature on treatment-process and therapeutic outcome, (3) Greenwood's defense of Popper's critique of psychoanalysis is an anachronism, and (4) Greenwood's conceptual analysis of placebo controls is nebulous and misconceived. (shrink)

The Tao Te Ching is a principal text of the ancient Spiritual tradition of Chinese Taoism. It is a compilation of wisdom sayings attributed to Lao Tzu, the old boy/philosopher/Master, recorded over two-thousand years ago and which has since undergone hundreds of translations, commentaries and adaptations. Tao Te Ching maxims are wise counsel given by sages to feudal rulers on how to harmoniously order their states and peacefully govern their peoples at a time in Chinese history of pervasive socio-political conflict (...) and upheaval. The wisdom sayings have become universally meaningful and perennially relevant guidelines for successful leadership as well as for optimal living. The present work is an original rendering of the 81 Tao Te Ching passages wherein identifying with the essential Reality of Tao and its dynamic-kinetic energetic characteristics, qualities and activities are considered to constitute the unique individuality, true integrity, innate wisdom and potent Virtuosity of our inner human nature. The psychotherapeutically-oriented commentaries given for each of the passages are not only useful for professionals engaged in the attending relationship/process of psychotherapy but also for anyone interested in wisely and Soulfully living a more Spiritually awakened, natural, contented and enjoyable human life."--Amazon.com. (shrink)

Psychoanalysis, in its purist mainstream sense, tends to be considered as an isolationist discipline that steers clear of interdisciplinary connections with other psychotherapies. Its drive for purity does not open up to influences that cast as alien and a threat to its core principles. We refer to Hegelian dialectics in an attempt to offer an alternative approach to interdisciplinarity in clinical psychoanalysis. Psychoanalysis entertains a complex dialectical relationship with the major theories it opposes. In this dynamic, psychoanalysis begins by negating (...) the non-psychoanalytic theory as a part of self-negation (Hegel calls this phase self-alienation). But in its own process of growth, it negates this negation and reabsorbs the alienated self part. Reabsorbing the negated component, psychoanalysis does not revert to its original identity but becomes sublated into a different, more complex idea. In this epistemological process, psychoanalysis deals with its own practical and theoretical anomalies and lacunas. The paper illustrates this process using three central developments in the history of psychoanalysis: empathy in self psychology (connection with Rogers' humanist psychology), short-term dynamic psychotherapy (connection with short, intensive therapies), and mentalization-based psychotherapy (connection with cognitive-behavioral therapies). In all of these cases, psychoanalysis integrates components it previously opposed and changes these components to their own, specific characteristics. We address the epistemological shifts in the scientific status of psychoanalysis and show their connection to dialectics. Finally, we conclude that dialectical development is what allows psychoanalysis to remain relevant and up to date, to be open to interdisciplinary influences without its identity and tradition coming under threat. (shrink)

Instead of attempting to reduce rituals of healing to so‐called primitive psychotherapy this essay raises the question of whether contemporary psychotherapies might not fruitfully be viewed as ritual processes through which a small segment of modern society receives ritual leadership in times of crisis. Selected phenomena in contemporary psychotherapeutic practice are analyzed in an attempt to discern the ritual processes which are manifest in them. It is concluded that most modalities of contemporary psychotherapy manifest elements of ritualized submission, (...) containment, and enactment. (shrink)

Since Freud, clinicians have understood that disturbing memories contribute to psychopathology and that new emotional experiences contribute to therapeutic change. Yet, controversy remains about what is truly essential to bring about psychotherapeutic change. Mounting evidence from empirical studies suggests that emotional arousal is a key ingredient in therapeutic change in many modalities. In addition, memory seems to play an important role but there is a lack of consensus on the role of understanding what happened in the past in bringing about (...) therapeutic change. The core idea of this paper is that therapeutic change in a variety of modalities, including behavioral therapy, cognitive-behavioral therapy, emotion-focused therapy, and psychodynamic psychotherapy, results from the updating of prior emotional memories through a process of reconsolidation that incorporates new emotional experiences. We present an integrated memory model with three interactive components – autobiographical (event) memories, semantic structures, and emotional responses – supported by emerging evidence from cognitive neuroscience on implicit and explicit emotion, implicit and explicit memory, emotion-memory interactions, memory reconsolidation, and the relationship between autobiographical and semantic memory. We propose that the essential ingredients of therapeutic change include: (1) reactivating old memories; (2) engaging in new emotional experiences that are incorporated into these reactivated memories via the process of reconsolidation; and (3) reinforcing the integrated memory structure by practicing a new way of behaving and experiencing the world in a variety of contexts. The implications of this new, neurobiologically grounded synthesis for research, clinical practice, and teaching are discussed. (shrink)

Objective: Deficits in affective processing are associated with impairments in both mental and physical health. The role of affective processing in patients with functional somatic complaints such as irritable bowel syndrome remains unclear. Most studies have focused on the capacity for emotional awareness and expression, but neglect other dimensions of affective processing. Therefore, this study aimed to systematically analyze differences in six different dimensions of affective processing between patients with IBS and healthy controls. Additionally, we exploratively investigated the impact of (...) IBS symptom severity, psychological distress, and attachment styles on affective processing in IBS. Methods: A controlled cross-sectional multi-center study was conducted. Overall, 127 patients with IBS were compared with 127 matched HCs using multivariate analysis of variances. Affective processing was operationalized in line with the affect cascade model on six specific dimensions: emotional experience, emotional awareness, affect tolerance, affect differentiation, affect regulation, and emotional communication. They were measured using two subscales of the Mentalizing Questionnaire and four subscales of the Operationalized Psychodynamic Diagnosis–Structure Questionnaire. Linear regression analysis was used to investigate the influence of IBS symptom severity, depression, anxiety, and anxious and avoidant attachment styles on the different dimensions of affective processing in IBS. Results: Patients with IBS compared to HCs showed deficits in all six dimensions of affective processing. Deficits were largest for affect tolerance and lowest for emotional experience and emotional awareness. Moderate effect sizes were found for affect differentiation, emotional communication, and affect regulation. Moreover, explorative analyses indicated that affective processing in patients with IBS was significantly influenced by levels of anxiety and insecure attachment. Conclusion: The results indicate a specific pattern of affective processing abilities in patients with IBS. The deficits in affective processing are more prominent in the area of understanding and tolerating difficult affective states than experiencing affective states. This opens interesting perspectives for the development of specific psychotherapeutic interventions. (shrink)

The article is based on selected findings from a study in the field of rehabilitation in a religious context viewed from the perspective of cognitive psychology and psychology of religion. The study shows how a therapeutic process can be facilitated in cases where the psychotherapeutic intervention is co-ordinated with a creative, sound religious activity. One central phenomenon that emerged from the study was the experience of a therapeutic dialogue with the divine person God and/ or Jesus being apprehended as a (...) crucial therapeutic agent. The material is analysed focusing on criteria for creative persons and products. A basic mechanism of creativity is hypothesised by Martindale to be defocused attention. The greater the spread of the attention capacity, the more likely the combinational leap, giving the rich possibility of combining elements in new ways. Religion can extend the perspective and thereby increase the possibilities of finding new and appropriate emotional and cognitive combinations. The analysis shows significant creative qualities in the treatment model studied. (shrink)

While the evidence on the effectiveness of different psychotherapies is often strong, it is not settled whereby and how these therapies work. Knowledge on the causal factors and change mechanisms is of high clinical and public relevance, as it contributes to the empirically informed advancement of psychotherapeutic interventions. Here, digitalized research approaches might possess the potential to generate new insights into human behavior change, contributing to augmented interventions and mental healthcare practices with better treatment outcomes. In this perspective article, we (...) describe recent findings of research into change mechanisms that were only feasible with digital tools and outline important future directions for this rather novel branch of research. Furthermore, we indicate several challenges and pitfalls that are to be solved, in order to advance digitalized psychotherapy process research, both methodologically and technologically. (shrink)

In dialogue with the most famous myth for the origin of different languages - The Tower of Babel - A Psychoanalytic Exploration on Sameness and Otherness: Beyond Babel provides a series of timely reflections on the themes of sameness and otherness from a contemporary psychoanalytic perspective. How are we dealing with communication and its difficulties, the confusion of tongues and loss of common ground within a European context today? Can we move beyond Babel? Confusion and feared loss of shared values (...) and identity are a major part of the daily work of psychoanalytic psychotherapists. Bringing together an international range psychoanalytic practitioners and researchers, the book is divided into six parts and covers an array of resonant topics, including: language and translation; cultural identity; families and children; the cyber world; the psychotherapeutic process; and migration. Whereas the quest for unity, which underpins the myth of Babel, leads to mystification, simplification and the exclusion of people or things, multilingual communities necessitate mutual understanding through dialogue. This book examines those factors which further or threaten communication, aiming not to reduce but to gain complexity. It suggests that diversification enriches communication and that, by relating to others, we can create something new. As opposed to cultural and linguistic homogeneity, Babel is not only a metaphor for mangled communication, alienation, and distraction, it is also about the acceptance or rejection of differences between self and other. This book will be of great interest to psychoanalytic psychotherapists and researchers from a wide variety of backgrounds. (shrink)

In dialogue with the most famous myth for the origin of different languages - The Tower of Babel - A Psychoanalytic Exploration on Sameness and Otherness: Beyond Babel provides a series of timely reflections on the themes of sameness and otherness from a contemporary psychoanalytic perspective. How are we dealing with communication and its difficulties, the confusion of tongues and loss of common ground within a European context today? Can we move beyond Babel? Confusion and feared loss of shared values (...) and identity are a major part of the daily work of psychoanalytic psychotherapists. Bringing together an international range psychoanalytic practitioners and researchers, the book is divided into six parts and covers an array of resonant topics, including: language and translation; cultural identity; families and children; the cyber world; the psychotherapeutic process; and migration. Whereas the quest for unity, which underpins the myth of Babel, leads to mystification, simplification and the exclusion of people or things, multilingual communities necessitate mutual understanding through dialogue. This book examines those factors which further or threaten communication, aiming not to reduce but to gain complexity. It suggests that diversification enriches communication and that, by relating to others, we can create something new. As opposed to cultural and linguistic homogeneity, Babel is not only a metaphor for mangled communication, alienation, and distraction, it is also about the acceptance or rejection of differences between self and other. This book will be of great interest to psychoanalytic psychotherapists and researchers from a wide variety of backgrounds. (shrink)

The recognition of the other as subject has achieved a prominent place in contemporary psychoanalysis on both sides of the analytic relationship, but this development has tended to focus on the recognition of who the other is and has been. It is the purpose of this article to add the future, the transcendent experience of the other, to the recognition of the other in the analytic dyad. Heidegger's concept of the “ek-static” will be used to elucidate the human subject as (...) moving beyond him or herself in a continual process of becoming. The result of the peeling back of defenses is not a homunculus waiting to be unearthed, but affective dispositions and desires that have yet to become organized modes of being. It is the purpose of the analytic process to bring this potential to fruition. For this process to take place, the therapist must have a concept of not only who the patient is, but also who she or he is not but may be. It will be suggested that dispositional affects, desires, and passions that emerge when defenses give way provide clues to unformed possibilities that can become ways of being if perceived as such by the therapist. A clinical strategy is proposed in which the analytic space becomes a negative capability for the formation of new ways of being and relating. This idea is illustrated with a clinical example in which the patient's compliant pattern was transcended. (shrink)

In this paper, I have examined in some detail a number of examples of actual and potential consensus between Jewish ethics and the practice of modern psychotherapy, psychology, and psychiatry. Moreover, I have posited cpecific halakhic models which represent analogies to modern psychotherapeutic principles and practices, which through analogy lend specific halakhic guidelines to modern practice. The unitary halakhic approach presented here is thus both heuristic – in that it seeks to demonstrate the ways in which psychotherapeutic processes are (...) essentially halakhic ones – as well as practical. Through this approach, psychological theory and practice have been brought into intimate contact with the ethical requirements of the halakhically committed mental health practitioner and his or her patient, filling an inexcusable void in halakhic application to modern technology, and setting a direction for future work in this area. CiteULike Connotea Del.icio.us What's this? (shrink)

Psychotherapy with the use of psychedelic substances, including psilocybin, lysergic acid diethylamide (LSD), ketamine, and 3,4-methylenedioxymethamphetamine (MDMA), has demonstrated promise in treatment of post-traumatic stress disorder (PTSD), anxiety, addiction, and treatment-resistant depression. Psychedelic-assisted psychotherapy (PP) represents a unique psychopharmacological model that leverages the profound effects of the psychedelic experience. That experience is characterized by strong dependency on two key factors: participant mindset and the therapeutic environment. As such, therapeutic models that utilize psychedelics reflect the need for careful design that promotes (...) an open, flexible, trusting mindset and a supportive setting. To meet this need, the PP model is increasingly supplemented by auxiliary methods, including meditation, relaxation, visualization or spiritual practices. We suggest virtual reality (VR) as a full-spectrum tool able to capitalize on and catalyze the innately therapeutic aspects of the psychedelic experience, such as detachment from familiar reality, alteration of self-experience, augmentation of sensory perception and induction of mystical-type experiences. This is facilitated by VR’s evidenced capacity to: aid relaxation and reduce anxiety; buffer from external stimuli; promote a mindful presence; train the mind to achieve altered states of consciousness (ASC); evoke mystical states; enhance therapeutic alliance and encourage self-efficacy. While these unique VR features appear promising, VR’s potential role in PP remains speculative due to lack of empirical evidence on the combined use of VR and PP. Given the increased commercial interest in this synergy there is an urgent need to evaluate this approach. We suggest specific VR models and their role within PP protocols to inspire future direction in scientific research, and provide a list of potential disadvantages, side effects and limitations that need to be carefully considered. These include sensory overstimulation, cyber-sickness, triggering memories of past traumatic events as well as distracting from the inner experience or strongly influencing its contents. A balanced, evidence-based approach may provide continuity across all phases of treatment, support transition into and out of an ASC, deepen acute ASC experiences including mystical states and enrich the psychotherapeutic process of integration. We conclude that the potential application of VR in modulating psychedelic-assisted psychotherapy demands further exploration and an evidence-based approach to both design and implementation. (shrink)

I propose to demonstrate the clinical plausibility of the ‘psychotherapy scene’ of the Bacchae, which is subjected here to a purely psychiatric analysis: all my interpretations and conjectures are based on clinical data and psychiatric theory only. Euripides' objective and rational treatment of the irrational, the accuracy of his descriptions of abnormal behaviour, which are compatible, down to the last detail, with descriptions found in modern psychiatric texts, and his capacity to present not simply a partial list of symptoms, but (...) a coherent clinical picture are taken for granted and will not be discussed further in the present context. The focus of my enquiry is exclusively the psychiatric plausibility of Euripides' description of the psychotherapeutic process.It goes without saying that, since ‘instant cures’ are impossible, Euripides condensed a normally fairly long procedure into a single scene, selectively high-lighting only what would be the crucial moments of a real psychotherapy. His summary of the psychotherapy is as satisfactory as that of a modern psychiatrist. In fact, Euripides' masterly selectivity actually facilitates the understanding of the psychodynamics of Agave's recovery. This enables me to comment on the Euripidean text in exactly the same way as I commented on the verbatim transcript of the psychotherapy of one of my Plains Indian patients. (shrink)

Opinion is divided about the certainty of the evidence base for gender-affirming medical interventions in youth. Proponents claim that these treatments are well supported, while critics claim the poor-quality evidence base warrants extreme caution. Psychotherapy is one of the only available alternatives to the gender-affirming approach. Discussion of the treatment of gender dysphoria in young people is generally framed in terms of two binary approaches: affirmation or conversion. Psychotherapy/exploratory therapy offers a treatment option that lies outside this binary, although it (...) is mistakenly conflated with conversion therapies. Psychotherapy does not impose restrictive gender stereotypes, as is sometimes claimed, but critically examines them. It empowers young people to develop creative solutions to their difficulties and promotes agency and autonomy. Importantly, an exploratory psychotherapeutic process can help to clarify whether gender dysphoria is a carrier for other psychological or social problems that may not be immediately apparent. Psychotherapy can therefore make a significant contribution to the optimal, ethical care of gender-dysphoric young people by ensuring that patients make appropriate, informed decisions about medical interventions which carry risks of harm and have a contested evidence base. (shrink)

Conversation analytic research has advanced understanding of the psychotherapeutic process by understanding how psychotherapy is organised over time in and through interaction between clients and therapists. This study progresses knowledge in this area by examining how psychological accounts of experience are progressively developed across a range of helping relationships. Data include: approximately 30 h of psychotherapy sessions involving trainee therapists; approximately 15 h of psychotherapy demonstration sessions involving expert therapists; and approximately 30 h of everyday conversations involving close friends or (...) family members. This article reports an analysis of techniques that are used to bring together two experiences that were discussed separately, to proffer a candidate connection between them. This proffering of candidate connections was recurrently used in psychotherapy. If confirmed by a client, a proffered connection could be used to develop a psychological account of a client’s experiences, which could then warrant some psychological intervention. In contrast, the proffering of connections was observed in only one of the everyday conversations included in the current study, where it was used to develop psychological accounts of experience. This shows that although proffering candidate connections is an everyday interactional practice, it appears to be used with greater frequency in psychotherapy, to advance its specific institutional aims. (shrink)

While scientific interest in the relationship between psychotherapeutic praxis and spirituality is growing, there is still little knowledge on this topic, especially in an East Central European context. To explore how psychotherapists understand spiritual issues and experiences they encounter in their work and to learn what happens to these issues in the course of psychotherapy, this study analyses semi-structured interviews with 30 Hungarian psychotherapists. Applying a grounded theory analytical strategy, three main topics were identified: the therapist's attitude towards spirituality leaves (...) a discernible trace in the psychoterapeutic treatment; the therapist influences the way spiritual issues are treated; and the therapist may have a shared spiritual experience with the client. We present individual variations of these experiences as they appear in the code tree. Results are interpreted with reference to a systemic view of the psychotherapeutic process, the intersubjective space of patient and therapist, and the notion of the therapists’ mentalizational capacity. (shrink)

The operation of power within psychotherapeutic practice is explored in this article through an analysis of radio therapeutic discourse. A Foucauldian methodological approach is adopted where the operation of power is conceptualized in terms of practices concerning the constitution and regulation of the self and which employs the analytics of problematization and ethical self-formation. Ten complete calls were examined for the effect of therapeutic intervention on callers' accounts of their problems; two calls are reported in detail. It was found that (...) through therapeutic problematization callers' worries were restructured so that the locus of concern was shifted towards the caller's relationship with themselves, in particular providing the means through which callers might regulate their own behaviour and normalize their future possible conduct. In this way callers were invited to account for themselves as both the target of and the responsible agent in their own cure. Thus power is linked with psychotherapeutic practice — in this setting — through the production of certain kinds of person with certain kinds of responsibilities. Finally, it is argued that here the psychotherapeutic process is more moral than `psychological' and that the ethical operation of therapeutic discourse is linked to our contemporary `therapeutic' moral order. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 4.1 (1997) 91-93 Concurrent Contents: Recent and Classic References at the Interface of Philosophy, Psychiatry, and Psychology Articles Allen, J. F., J. Hallperin, and R. Friend. 1985. Removal and diversion tactics and the control of auditory hallucinations. Behavior Research and Therapy 23:601-605.Baker, H. D. 1995. Psychoanalysis and ideology: Bakhtin, Lacan, and Zizek. History of European Ideas 20:499-504.Bernet, R. 1994. Derrida-Husserl-Freud: The trace of transference. Southern (...) Journal of Philosophy 32 suppl.:141-158.Boden, M. A. 1996. Commentary on "Towards a design-based analysis of emotional episodes." Philosophy, Psychiatry, & Psychology 3, no. 2:135-136.Castelfranchi, C., and M. Miceli. 1996. Commentary on "Towards a design-based analysis of emotional episodes." Philosophy, Psychiatry, & Psychology, no. 2:129-133.Fowes, B. J., and F. C. Richardson. 1996. Why is multiculturalism good? American Psychologist 51, no. 6:609-621.Frith, C. 1996. Commentary on "Free will in the light of neuropsychiatry." Philosophy, Psychiatry, & Psychology 3, no. 2:91-93.Forde, R. 1996. Inclusion of psychosocial conditions in clinical practice and the problem of medicalization. Theoretical Medicine 17, no. 2:151-161.Gaylin, W., and D. Doukas. 1995. The second-hand suicide threat. Hastings Center Report 25:20-22.Gillet, G. 1995. Consciousness, thought, and neurological integrity. Journal of Mind and Behavior 16, no. 3:215-233.Haskell, R. E. 1993. Realpolitik in the addictions field: Treatment-professional, popular-culture ideology, and scientific research. Journal of Mind and Behavior 14, no. 3:257-276.Kuys, T. 1995. The tally argument again. Methodological Science 28, nos. 2-3:43-55.Lear, J. 1995. The heterogeneity of the mental: Sebastian Gardner's irrationality and the philosophy of psychoanalysis. Mind: A Quarterly Review of Psychology and Philosophy 104:863-879.Libet, B. 1996. Commentary on "Free will in the light of neuropsychiatry." Philosophy, Psychiatry, & Psychology 2, no. 3:95-96.Lloyd, D. 1996. Commentary on "Toward a design-based analysis of emotional episodes." Philosophy, Psychiatry, & Psychology 3, no. 2:127-128.Pepper-Smith, R., W. R. C. Harvey, and M. Silberfeld. 1996. Competency and practical judgment. Theoretical Medicine 17, no. 2:135-150. [End Page 91]Spence, S. A. 1996a. Free will in the light of neuropsychiatry. Philosophy, Psychiatry, & Psychology 3, no. 2:75-90.------. 1996b. Response to the commentaries. Philosophy, Psychiatry, & Psychology 3, no. 2:99-100.Stein, D. J. 1996. The philosophy of psychopathy. Perspectives in Biology and Medicine 39:569-580.Stephens, G. L. 1996. Commentary on "Free will in the light of neuropsychiatry." Philosophy, Psychiatry, & Psychology 3, no. 2:97-98.Varela, C. R. 1995. Ethnogenic theory and psychoanalysis: The unconscious as a social construction and a failed explanatory concept. Journal for the Theory of Social Behavior 25:4.Weisberger, A. M. 1995. The ethics of the broader usage of Prozac: Social choice or social bias? International Journal of Applied Philosophy 10, no. 1:69-74.Wright, I., A. Sloman, and L. Beaudoin. 1996a. Response to the commentaries. Philosophy, Psychiatry, & Psychology 3, no. 2:137.------. 1996b. Towards a design-based analysis of emotional episodes. Philosophy, Psychiatry, & Psychology 3, no. 2:101-126. Books American Psychiatric Association. Task Force on Consent to Voluntary Hospitalization. 1993. Consent to voluntary hospitalization. Washington, DC: American Psychiatric Association.Christiansen, H. D. 1972. Ethics in counseling: Problem situations. Tucson: University of Arizona Press.Clark, P., and C. Wright, eds. 1988. Mind, psychoanalysis and science. New York: Blackwell.Comerchero, V., ed. 1970. Values in conflict: Christianity, marxism, psychoanalysis, existentialism. New York: Appleton-Century-Crofts.Epstein, R. S. 1994. Keeping boundaries: Maintaining safety and integrity in the psychotherapeutic process. Washington, DC: American Psychiatric Press.Fairbairn, G. J. 1995. Contemplating suicide: The language and ethics of self harm. New York: Routledge.Grubb, A., ed. 1991. Decision-making and problems of incompetence. New York: John Wiley & Sons.Haas, L. J., and J. L. Malouf. 1995. Keeping up the good work: A practitioner's guide to mental health ethics. 2nd ed. Sarasota: Professional Resource Exchange.Hacking, I. 1995. Rewriting the soul: Multiple personality and the sciences of memory. Princeton: Princeton University... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Clinical CommentaryRathi Mahendran, Associate ProfessorThe doctor-patient relationship has an important role in medical practice and in medical ethics.1 In modern times, the word “boundary” is used to frame the relationship. In the context of therapy, Gutheil and Simon have described it as “the edge of appropriate or professional behaviour, transgression of which involves the therapist stepping out of the clinical role”.2 Boundaries establish for medical professionals the distinctions between (...) professional and personal identity.3 In a therapeutic setting, boundaries distinguish acceptable and appropriate interactions and the parameters of professional conduct.4 Implicit in the concept of boundaries are the basic ethical principles of beneficence (doing good, acting in another person’s best interests), non-maleficence (doing no harm) and justice with respect for the individual’s needs and autonomy.The doctor-patient relationship is particularly important in psychological therapies where trust, integrity, confidentiality, a safe environment and empathy are fundamental to the therapeutic process. A person with BPD manifests emotional dysregulation with instability in interpersonal relationships, self-image, affect and impulsivity.5 This, together with identity disturbances, makes them a particularly vulnerable group with heightened reliance on their therapist.6Psychotherapy has been described as an interaction which serves to alleviate distress, change behaviour and alter the patient’s perspective of issues. This description however does not reflect the magnitude and significant power differentials in the relationship. Trust and a close bond are needed to allow issues to be addressed.7 In the process, patients’ fantasies and unmet emotional needs [End Page 191] might lead them to knowingly or unknowingly view their therapist differently and to seek a relationship. Similarly, multiple factors in the therapist (situational factors, intrapsychic and interpersonal factors) can undermine the therapeutic process.8Boundary TransgressionsThere is really no universal definition for a “therapeutic boundary” possibly because, as Simon explains, it is “a function of the nature of the patient, the treatment and the status of the therapeutic alliance”.9 Minor violations are referred to as boundary crossings which may arise because the therapist exhibits poor judgement.10 Such actions are non-exploitative and pose little risk to patients.11 Duckworth et al. describe how boundary crossings begin as “exaggerations of desirable attitudes”. Special arrangements and sessions for the patient and extending therapy sessions may be construed as desirable and arguably as effective for the therapeutic alliance.12 Yet, if not examined objectively, they become “subtle breaks in the therapeutic frame”.13Psychotherapists trained in analytic therapy hold very rigid views of doctor-patient interactions in psychological therapy. Some would argue that providing a personal telephone number for a patient in crisis situations is a permissible boundary crossing.14 Similarly, self-disclosure for modelling and on-site behaviour therapy interventions may be viewed as necessary for the therapeutic encounter.15The most commonly recognised boundary crossing, however, is self-disclosure.16 It occurs when the therapist relates a personal experience or information to the patient which is how the incident began in this case.17 It gradually progressed to an informal, friendly style of interaction, accepting a hug, thanking her for being a good friend, all of which are dissonant with the psychotherapeutic process.18In the first place, should the therapist have even offered to drive her home, notwithstanding the heavy downpour? While that offer could be viewed as helpful, the disclosure of marital problems was inappropriate and created confusion. We can only speculate upon the therapist’s behaviour. Was he trying to establish for his patient that they were both experiencing problems to gain her trust? Was he exhibiting some form of identification or did he have some unmet need for affirmation and for care and nurturance? It is difficult to rationalise the apparently thoughtless and impulsive behaviour.19The therapist was, at that point, vulnerable with marital problems and facing separation.20 Procci has highlighted that therapists who breach boundaries, “usually have serious personal problems and may have a psychiatric diagnoses”.21 Even though the relationship was non-sexual, it [End Page 192] moved beyond a boundary crossing and should be viewed as a boundary violation. While the most serious form of boundary violation is the sexual encounter... (shrink)

In his ‘script theory,' Tomkins first proposed that people unconsciously organize their life experiences in terms of narrative structures he termed “scripts.” I use a clinical vignette to illustrate how the psychotherapeutic process of “making the unconscious conscious” involves becoming aware of the maladaptive scripts that people unwittingly live by, and developing them into the “conviction narratives” proposed by the authors.

The psychotherapeutic technologies of the social sciences and humanities are the result of a long process that has shaped its theory and social and therapeutic practice, as part of a specific cultural and ideological context. The use of these technologies as a fundamental prerequisite has a human factor that determines the implementation of communicative mechanisms within the framework of set goals and objectives. Psychotherapeutic technologies are based on a “theory of the human,” which is not a scientific theory in the (...) strict sense of the word, but nonetheless allows for empirical and operational interpretation. (shrink)

Psychodrama is an effective psychotherapeutic model but interventions with adolescents require age-tailored techniques that maximize engagement and facilitate communication processes. This study describes a novel adaptation of a therapeutic mask technique to psychodrama with adolescents. Over the course of eight group sessions of psychodrama, five adolescents created their own mask and explored its therapeutic use. Their experiences were captured at the end of each session with the Helpful Aspects of Therapy form, and at the end of the study with (...) the Clinical Change Interview. Awareness/insight/self-understanding, empowerment and relief were the most significant aspects experienced by the adolescents, along with perceived increase of calmness and world connection, satisfaction in interpersonal communication and better emotional expression and regulation. The mask technique was experienced as a playful and engaging task that facilitated insight and interpersonal communication. Findings provide preliminary evidence on the clinical utility of mask-based psychodrama with adolescents. (shrink)

Gender dysphoria (GD) is marked by an incongruence between a person’s biological sex at birth, and their felt gender (or gender identity). There is continuing debate regarding the benefits and drawbacks of physiological treatment of GD in children, a pathway, beginning with endocrine treatment to suppress puberty. Currently, the main alternative to physiological treatment consists of the so-called “wait-and-see” approach, which often includes counseling or other psychotherapeutic treatment. In this paper, we argue in favor of a “third pathway” for the (...) diagnosis and treatment of GD in youths. To make our case, we draw on a recent development in bioethics: the phenomenological approach. Scholars such as Slatman and Svenaeus have argued that the extent to which the body can (or should be) manipulated or reconstructed through medical intervention is not only determined by consideration of ethical frameworks and social and legal norms. Rather, we must also take account of patients’ personal experience of their body, the personal and social values associated with it, and their understanding of its situation in their life: their narrative identities. We apply this phenomenological approach to medicine and nursing to the diagnosis and treatment of GD in youth. In particular, we discuss Zahavi and Martiny’s conception of the phenomenological interview, in order to show that narrative techniques can assist in the process of gender identification and in the treatment of youth presenting with GD. We focus on two case studies that highlight the relevance of a narrative-based interview in relations between patients, HCPs, and family, to expose the influence of social ideologies on how young people presenting with GD experience their bodies and gender. (shrink)

It is often emphasised that persons diagnosed with borderline personality disorder show difficulties in understanding their own psychological states. In this article, I argue that from a phenomenological perspective, BPD can be understood as an existential modality in which the embodied self is profoundly saturated by an alienness regarding the person’s own affects and responses. However, the balance of familiarity and alienness is not static, but can be cultivated through, e.g., psychotherapy. Following this line of thought, I present the idea (...) that narrativising experiences can play an important role in processes of appropriating such embodied self-alienness. Importantly, the notion of narrative used is that of a scalar conception of narrativity as a variable quality of experience that comes in degrees. From this perspective, narrative appropriation is a process of gradually attributing the quality of narrativity to experiences, thereby familiarising the moods, affects, and responses that otherwise govern ‘from behind’. Finally, I propose that the idea of a narrative appropriation of embodied self-alienness is also relevant to the much-debated question of personal responsibility in BPD, particularly as this question plays out in psychotherapeutic contexts where a narrative self-appropriation may facilitate an increase in sense of autonomy and reduce emotions of guilt and shame. (shrink)

The recognition and incorporation of evidence-based neuroscientific concepts into creative arts therapeutic knowledge and practice seem valuable and advantageous for the purpose of integration and professional development. Moreover, exhilarating insights from the field of neuroscience coincide with the nature, conceptualization, goals, and methods of Creative Arts Therapies, enabling comprehensive understandings of the clinical landscape, from a translational perspective. This paper contextualizes and discusses dynamic brain functions that have been suggested to lie at the heart of intra- and inter-personal processes. (...) Touching upon fundamental aspects of the self and self-other interaction, the state-of-the-art neuroscientific-informed views will shed light on mechanisms of the embodied, predictive and relational brain. The conceptual analysis introduces and interweaves the following contemporary perspectives of brain function: firstly, the grounding of mental activity in the lived, bodily experience will be delineated; secondly, the enactive account of internal models, or generative predictive representations, shaped by experience, will be defined and extensively deliberated; and thirdly, the interpersonal simulation and synchronization mechanisms that support empathy and mentalization will be thoroughly considered. Throughout the paper, the cross-talks between the brain and the body, within the brain through functionally connected neural networks and in the context of agent-environment dynamics, will be addressed. These communicative patterns will be elaborated on to unfold psychophysiological linkage, as well as psychopathological shifts, concluding with the neuroplastic change associated with the formulation of CATs. The manuscript suggests an integrative view of the brain-body-mind in contexts relevant to the therapeutic potential of the expressive creative arts and the main avenues by which neuroscience may ground, enlighten and enrich the clinical psychotherapeutic practice. (shrink)

Drawing from field theory, Gestalt therapy conceives psychological suffering and psychotherapy as two intentional field phenomena, where unprocessed and chaotic experiences seek the opportunity to emerge and be assimilated through the contact between the patient and the therapist (i.e., the intentionality of contacting). This therapeutic approach is based on the therapist’s aesthetic experience of his/her embodied presence in the flow of the healing process because (1) the perception of beauty can provide the therapist with feedback on the assimilation of unprocessed (...) experiences; (2) the therapist’s attentional focus on intrinsic aesthetic diagnostic criteria can facilitate the modification of rigid psychopathological fields by supporting the openness to novel experiences. The aim of the present manuscript is to review recent evidence from psychophysiology, neuroaesthetic research, and neurocomputational models of cognition, such as the free energy principle (FEP), which support the notion of the therapeutic potential of aesthetic sensibility in Gestalt psychotherapy. Drawing from neuroimaging data, psychophysiology and recent neurocognitive accounts of aesthetic perception, we propose a novel interpretation of the sense of beauty as a self-generated reward motivating us to assimilate an ever-greater spectrum of sensory and affective states in our predictive representation of ourselves and the world and supporting the intentionality of contact. Expecting beauty, in the psychotherapeutic encounter, can help therapists tolerate uncertainty avoiding impulsive behaviours and to stay tuned to the process of change. (shrink)