In psychotherapy research, treatment efficacy is commonly studied by means of self-report questionnaires to gain quantitative data on symptom development. The data serve as input for statistical analyses up to the level of evidence-based treatment. We analyzed how a patient in a psychotherapy study experienced the translation of her story into quantitative data by combining a phenomenological qualitative analysis of her therapeutic narrative and a visual analysis of her extensively annotated paper-andpencil questionnaires. Our findings provide a practical (...) empirical illustration of the nature and impact of known validity issues. Beyond, we found the act of questionnaire administration affected the primary complaint such that it became performative toward the symptoms under study. We discuss the epistemic consequences for the validity of data, and we argue that valid data collection requires qualitative scrutiny of meaning within data and a concept of validity that allows for consideration of performativity of data collection. (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)

"Co-published simulaneously as Journal of spirituality in mental health, vol. 9, issue 3/4, 2007.".

With its focus on evidence, psychology has grown into a mature, professional, and scientifically supported practice over the last decades. In general, psychotherapy and psychological counselling have shown to be more efficacious than waiting it out and a staggering 350 specific treatments have been scientifically supported as effective. Although, evidencebased treatments seem to work equally well, not all people benefit from evidence-based treatments, and it often remains unclear why. This raised the field-wide concern of what works for whom and (...) sparked a wealth of research on specific ingredients, common factors, process factors, and intra- and... (shrink)

Eating disorders are debilitating diseases that have twin impacts on the body and mind and are associated with a number of physiological and psychological comorbidities (Blinder, Cumella, and Sanathara 2006; Casiero and Frishman 2006), including increased suicide risk (Arcelus et al. 2011; Lipson and Sonneville 2020). In addition, eating disorders are growing in prevalence (Gilmache et al. 2019) and impact women at much higher rates than men (Bearman, Martinez, and Stice 2006), especially in adolescence (Spriggs, Kettner, and Carhart-Harris 2021). Anorexia (...) nervosa (AN) is a particularly devastating eating disorder, with one of the highest mortality rates of any psychiatric disorder (Sullivan 1995). Despite the severity of the condition, current treatments for AN are limited in their efficacy (Khalsa et al. 2017). Based on the growing body of evidence demonstrating the short-term and long-term efficacy of psychedelic-assisted psychotherapy for the treatment of other mental illnesses, I argue that research into psychedelic-assisted psychotherapy for AN should be funded. (shrink)

Infant research observations and hypotheses have raised serious questions about previous mainstream psychoanalytic theories of earliest childhood development. In _Jungian Psychotherapy and Contemporary Infant Research,_ Mario Jacoby looks at how these observations are relevant to psychotherapeutic and Jungian analytical practice. Using recent findings in infant research, along with practical examples from therapeutic practice, he shows how early emotional exchange processes, though becoming superimposed in adult life by rational control and various defenses, remain operative and become reactivated (...) in situations of intimacy. _Jungian Psychotherapy and Contemporary Infant Research _will be of interest to both professionals and students involved in analytical psychology and psychotherapy. (shrink)

Wilkinson's (1) critique of psychoanalysis and psychoanalytically oriented psychotherapy is weakened by inconsistent use of crucial terms, a systematically biased selectivity in reviewing empirical evidence and prior debates, and a failure to address issues crucial for a scientific understanding of psychotherapy.

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 paper discusses several philosophical problems with the use of randomized clinical trials in psychotherapy outcome research. The problems include: the impermanence problem, the identification problem, and idiographic problems. The paper concludes with an assessment of the overall case for and against the use of RCTs in psychotherapy outcome research.

Drawing on a particular emphasis within the phenomenological tradition as exemplified by Maurice Merleau-Ponty and Eugene Gendlin, this book considers the role of the lived body as a way of knowing and being. The author, a psychologist, psychotherapist and qualitative researcher pursues this theme within three practical contexts that illustrate some of the nuances of embodied enquiry: qualitative research, psychotherapy, spirituality. The three sections of the book also provide examples of how embodied enquiry is not just a philosophical (...) perspective but also a practice with very tangible implications for research, psychotherapy and spirituality. (shrink)

The second edition of The Great Psychotherapy Debate has been updated and revised to include a history of healing practices, medicine, and psychotherapy, an expanded theoretical presentation of the contextual model, an examination of therapist effects, and a thorough review of the research on common factors such as the alliance, expectations, and empathy.

The Great Psychotherapy Debate: Models, Methods, and Findings comprehensively reviews the research on psychotherapy to dispute the commonly held view that the benefits of psychotherapy are derived from the specific ingredients contained in a given treatment (medical model). The author reviews the literature related to the absolute efficacy of psychotherapy, the relative efficacy of various treatments, the specificity of ingredients contained in established therapies, effects due to common factors, such as the working alliance, adherence and (...) allegiance to the therapeutic protocol, and effects that are produced by different therapists. In each case, the evidence convincingly corroborates the contextual model and disconfirms the prevailing medical model. (shrink)

This article will briefly explore some of the ways in which the past has been used as a means to talk about psychotherapy as a practice and as a profession, its impact on individuals and society, and the ethical debates at stake. It will show how, despite the multiple and competing claims about psychotherapy’s history and its meanings, historians themselves have, to a large degree, not attended to the intellectual and cultural development of many therapeutic approaches. This absence (...) has the potential consequence of implying that therapies have emerged as value-free techniques, outside of a social, economic and political context. The relative neglect of psychotherapy, by contrast with the attention historians have paid to other professions, particularly psychiatry, has also underplayed its societal impact. This article will foreground some of the instances where psychotherapy has become an object of emerging historical interest, including the new research that forms the substance of this special issue of History of the Human Sciences. (shrink)

Borderline Personality disorder is a severe personality dysfunction characterized by behavioural features such as impulsivity, identity disturbance, suicidal behaviour, emptiness, and intense and unstable relationships. Approximately 2% of the population are thought to meet the criteria for BPD. The authors of this volume - Anthony Bateman and Peter Fonagy - have developed a psychoanalytically oriented treatment to BPD known as mentalization treatment. With randomised controlled trials having shown this method to be effective, this book presents the first account of mentalization (...) treatment for BPD. The first section gives an overview of BPD, including discussion of nosology, epidemiology, natural history, and psychosocial aetiology. It additionally summarises the present state of our research knowledge about effective psychotherapeutic treatments and use of medication. The second section outlines the authors' theoretical approach and contrasts it with other well known methods, including DBT, CAT, and CBT. In the extensive final section, the authors outline their clinical approach starting with how treatment is organised. A detailed account of the transferable features of the model is provided along with the main strategies and techniques of treatment. Numerous clinical examples are given to illustrate the core techniques and detailed information provided about how to apply aspects of the mentalization based treatment approach in everyday practice. Aimed at mental health professionals, along with counsellors, psychotherapists, and psychoanalysts, the book will be a valuable tool, providing an effective means of treating those suffering from Borderline Personality Disorder. (shrink)

The current paradigm of mental health has fallen short in its promises to deliver better care and quality of life for those who lives with mental illness. Recent works have expressed the need for more comprehensive frameworks of research, in which phenomenology emerges as a fundamental tool for a new wave interdisciplinary studies with the humanities. In line with this project, this article hopes to explore the relation between education and phenomenologically oriented psychotherapy, through the work of Brazilian (...) educator Paulo Freire. First, we will briefly expose Freire’s biography and main ideas (such as the “banking model of education” and the creation of “culture circles”), showing how they can be useful during the clinical encounter. We will also highlight the importance of dialogical psychotherapy during situations of injustice and oppression. Finally, we will provide some insights that can help build a new paradigm of mental health that is based on a “praxis of freedom”, whether in research or clinical practice. We call this proposal a “Psychotherapy of the Oppressed”. (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)

Relational-Centred Research for Psychotherapists: Exploring Meanings and Experience . Chichester, UK: Wiley-Blackwell. Soft cover (263 pages). ISBN: 978-0-470-99777-2 Indo-Pacific Journal of Phenomenology, Volume 10, Edition 2, October 2010: 87-88.

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)

Smith, Glass, and Miller have reported a meta-analysis of over 500 studies comparing some form of psychological therapy with a control condition. They report that when averaged over all dependent measures of outcome, psychological therapy is. 85 standard deviations better than the control treatment. We examined the subset of studies included in the Smith et al. metaanalysis that contained a psychotherapy and a placebo treatment. The median of the mean effect sizes for these 32 studies was. 15. There was (...) a nonsignificant inverse relationship between mean outcome and the following: sample size, duration of therapy, use of measures of outcome other than undisguised self-report, measurement of outcome at follow-up, and use of real patients rather than subjects solicited for the purposes of participation in a research study. A qualitative analysis of the studies in terms of the type of patient involved indicates that those using psychiatric outpatients had essentially zero effect sizes and that none using psychiatric inpaticnts provide convincing evidence for psychotherapeutic effectiveness. The onty studies clearly demonstrating significant effects of psychotherapy were the ones that did not use real patients. For the most part, these studies involved small samples of subjects and brief treatments, occasionally described in quasibeliavioristic language. It was concluded that for real patients there is no evidence that the benefits of psychotherapy are greater than those of placebo treatment. (shrink)

Through a warm and passionate investigation of the most fundamental properties of human behaviour, Psychotherapy and Science shows how a scientific foundation for psychotherapy is both necessary and feasible. Addressing psychotherapy's need for a coherent theoretical grounding, the book argues that there are striking parallels between the emotion-processing mind and phenomena that have been scientifically observed and charted in the areas of evolution, the immune system and the brain. The idea that scientific theories might be applied to (...) psychotherapy is thoroughly explored in a surprisingly accessible manner. Throughout the book, the ways in which science has a bearing on the clinical techniques and practice of psychotherapy are emphasized, and priority is given to the needs of psychotherapists to focus their theoretical and clinical efforts on understanding the deep, evolved factors behind human suffering, deception, self-limitations and death anxiety. This rare and engaging insight into a scientific quest for better psychotherapeutic knowledge offers a truly original way through the current impasse of ever-divergent theories, and is one of the most cogent challenges to psychotherapy in recent times. It is essential reading for all training and practising psychotherapists, and for those involved in related research. (shrink)

EBM, and the hierarchy of evidence it prescribes, is a controversial model when it comes to research into the effectiveness of psychotherapeutic treatments. This is due in part to the so-called ‘Dodo Bird verdict’, which claims that all psychotherapies are equally effective, and that their effectiveness is largely due to the placebo effect. In response to this controversy, I argue that EBM can nevertheless be made to fit research into the effectiveness of psychotherapy, once a piecemeal approach (...) to conducting RCTs is taken. Such an approach involves studying the contributions made by individual treatment components. (shrink)

The aim of this essay is to provide an overview of how Existential Therapy is fundamentally different from every kind of psychotherapy, including existential psychotherapy. Existential Therapy is no kind of psychotherapy. Confusing the practicing of the two can harm people and thoughts. Existential Therapy is therapy for existence, whereas psychotherapy is therapy for life, a remedy for the problems of living. The adequate distinction between life and existence is an issue that shamefully has gone unaddressed (...) in existential philosophy, existential psychology and research, and existential psychotherapy. This essay describes the main differences between life and existence, and then takes a look at what is healthy for existence versus what is healthy for life. What is found to be most unhealthy for existence is metacarnalizing, recoiling from carnal limits. Metacarnalizing is a primary existential reversal. Existential therapy unreverses existential reversals. Existential therapy unreverses metacarnalizing. Existential therapy essentially de-metacarnalizes. The issue of metacarnalizing and de-metacarnalizing is absolutely alien to all forms of psychotherapy for life. The essay is followed by an appendix, "An Existential View of Physics," which mainly describes the metacarnalizing basis of physics throughout its history. (shrink)

That memory reconsolidation is the process underlying decisive, lasting therapeutic change has long been our proposal, and the recognition of its critical role by Lane et al. is a welcome development. However, in our view their account has significant errors due to neglect of research findings and neglect of previous work on the clinical application of those findings.

In this paper I propose a model of the fundamental components of psychoanalytic psychotherapies that I try to explicate with contemporary theories of the Bayesian brain and the Free Energy Principle (FEP). I first show that psychoanalytic therapies require a setting (made up of several envelopes), a particular psychic state and specific processes (transference, free association, dreaming, play, reflexivity and narrativity) in order to induce psychic transformations. I then analyze how these processes of transformations operate and how they can be (...) enlightened by the FEP. I first underline the fact that psychoanalytic therapies imply non-linear processes taking time to unfold and require a setting containing high entropy processes. More precisely, these processes are characterized by an interplay between extension and reduction of free energy. This interplay also favors the emergence of new orders of subjective experience, which occur following states of disorder, according to a certain energetic threshold allowing the modification and improvement of mental functioning. These high entropy states are also characterized by random functioning and psychic malleability which favors the exploration of subjective experience in an original manner. Overall, the approach proposed in this paper support the dialogue between psychoanalysis and other fields of research while underlining how psychoanalytical theoretical and conceptual constructs can also be useful to other disciplines, in particular the neurosciences of subjectivity. (shrink)

Psychoanalysis, in Freud’s day and our own, has met with and continues to meet with staunch opposition from critics. The most ruinous criticism comes from philosophers, with a special interest in science, who claim psychoanalysis does not measure up to the above-board canons of acceptable scientific practices and, thus, is not scientific. It is common today to direct such criticisms to all metempirical forms of psychotherapy—i.e., psychotherapies that in no way concern themselves with grounding their claims with empirical (...) class='Hi'>research. The most common defense is to cold-shoulder the criticism and counter that psychoanalysis, whether or not Freud recognized it, is a hermeneutical, not an etiological, method of therapy. In that regard, its measure of success is not symptom-removal or redirection of drive-energy in socially condoned or acceptable ways, but broadened understanding through a commonly created myth, effected by therapist and patient, for the patient’s wellbeing. In this undertaking, I argue that the hermeneutical apologia of psychoanalysis is a dodge, not a defense—an impenetrable asylum in which therapists can find refuge by buffering themselves from the possibility of criticism of the scientificity of their discipline. Because hermeneuticism disavows the possibility of knowledge in any meaningful sense—and, with that, scientific knowledge gained through observation or experimentation—it levels the epistemological playing field. With knowledge impossible and science annulled, no “investigative” inquiry or discipline can claim a status superior to any other and, hence, psychotherapy is an investigative discipline as legitimate as any other. The literature on the hermeneutic defence of psychotherapy is vast—too vast for anything but a representative sample of it in this critique. I focus merely on some of the most recent literature. (shrink)

With the advent of COVID-19, a sudden, unexpected, and forced shift has been produced in the field of psychotherapy. Worldwide, many therapists closed their offices and started to deliver psychotherapy online through a screen. Although different media started to be incorporated, videoconferencing is undoubtedly the most common way in which therapists are doing therapy these days. This is catalyzing a rapid change in the practice of psychotherapy with probable lasting effects and deserves to be carefully reflected upon. (...) Therefore, in this paper our aim is to outline the main challenges for a medium that may have arrived to stay. In that sense, we review the literature to describe the state-of-the-art regarding the main aspects of videoconferencing psychotherapy as well as to suggest possible avenues for future research and practice. (shrink)

Conversational artificial intelligence (CAI) presents many opportunities in the psychotherapeutic landscape—such as therapeutic support for people with mental health problems and without access to care. The adoption of CAI poses many risks that need in-depth ethical scrutiny. The objective of this paper is to complement current research on the ethics of AI for mental health by proposing a holistic, ethical, and epistemic analysis of CAI adoption. First, we focus on the question of whether CAI is rather a tool or (...) an agent. This question serves as a framework for the subsequent ethical analysis of CAI focusing on topics of (self-) knowledge, (self-)understanding, and relationships. Second, we propose further conceptual and ethical analysis regarding human-AI interaction and argue that CAI cannot be considered as an equal partner in a conversation as is the case with a human therapist. Instead, CAI’s role in a conversation should be restricted to specific functions. (shrink)

Currently there are several psychotherapy modalities utilising theory and research from neuroscience in treatment frameworks for mental health and recovery from trauma. In Australia this includes: the Conversational Model of Psychodynamic Psychotherapy, a contemporary psychodynamic approach used for treating Borderline Personality Disorder and other trauma-related disorders; Electroencephalogram Neurofeedback, a brain training therapy which has been used as an adjunct to counselling/psychotherapy in traumatic stress and developmental trauma; and Somatic Experiencing, an integrative mind-body approach based on body (...) responses to threat and fear, especially thwarted attempts to enact fight or flight in the face of threat. These modalities have a promising but still-limited evidence base. This paper explores the role of different types of evidence to frame a descriptive review of the current evidence base available for clinicians practicing in these three modalities. While large clinical trials can provide evidence of comparative effectiveness, case studies, observational, qualitative and practice-based enquiry can assist in discovering other aspects of therapy important for individual clients and practitioners. Existing frameworks of evidence- and ethics-informed health and clinical decision-making suggest an ethical approach can incorporate new, developing and evidence-building therapies. Recommendations include careful consideration of informed consent for therapy including disclosure of efficacy and safety, and specific to psychotherapies incorporating neuroscience, a need for practitioners to reflectively assess their own knowledge, competence, heuristic approaches and biases. (shrink)