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)

The case of Xiang as described by Jane Carroll is indeed disconcerting well beyond the immediately apparent factors contained within the article. While Xiang’s direct medical expenses are excessive and his inability to pay for those expenses and further support his noncustodial family seem to be the main issues up for debate, Xiang, however, is likely going to need much more psychosocial support if he is to regain his previous independent functionality or retain any aspect of a quality of life (...) whilst continuing his indefinitely isolated treatment. In this response, I briefly outline the probable effects of Xiang’s current situation on his social identity and mental health as well as a potential way that we can minimize these adverse effects. (shrink)

The notion of epistemic injustice was first applied to cases of discrimination against women and people of color but has since come to refer to wider issues related to social justice. This paper applies the concept of epistemic injustice to problems in the therapeutic relationship between psychiatrists and psychiatric patients. To this end, it is necessary to acknowledge psychiatrists as professionals with expertise in treating mental disorders, which impair the patient’s rationality, sometimes leading to false beliefs, such as (...) delusions. This paper classifies the characteristic features of the therapeutic relationship in psychiatry into three stages: those of a professional–client relationship, those of a doctor–patient relationship, and those of a psychiatrist–psychiatric patient relationship. Epistemic injustice is prevalent in psychiatric care owing to prejudice against patients with mental disorders. However, it is also predisposed by the roles that psychiatrists play in relation to psychiatric patients. This paper suggests some ameliorative measures based on the analysis. (shrink)

Summary Gestalt Theoretical Psychotherapy, in the broader sense of the term, has developed in various forms on both sides of the Atlantic since the 1920s. Gestalt Theoretical Psychotherapy, in the narrower sense of the term, came into being in the second half of the 1970s in German-speaking countries. In Austria, it is a state-approved, independent scientific psychotherapy method since 1995, and an integrative psychotherapeutic approach based on the Gestalt theory of the Berlin School. With reference to this comprehensive, consistent, scientific (...) theory, this article presents the basic concepts of therapeutic practice in the field of Gestalt psychotherapy. Starting from the overarching whole to the parts, the paper first examines the concept of therapeutic relationship and therapeutic attitude, and then describes the basic principles of the practical design of the therapeutic process. (shrink)

This debate article explores how smart technologies may create a double-edged sword for patient safety and effective therapeutic relationships. Increasing utilization of health monitoring devices by patients will likely become an important aspect of self-care and preventive medicine. It may also help to enhance accurate symptom reports, diagnoses, and prompt referral to specialist care where appropriate. However, the development, marketing, and use of such technology raise significant ethical implications for therapeutic relationships and patient safety. Drawing on lessons learned (...) from other direct-to-consumer health products such as genetic testing, this article explores how smart technology can also pose regulatory challenges and encourage overutilization of healthcare services. In order for smart technology to promote safer care and effective therapeutic encounters, the technology and its utilization must be safe. This article argues for unified regulatory guidelines and better education for both healthcare providers and patients regarding the benefits and risks of these devices. (shrink)

This debate article explores how smart technologies may create a double-edged sword for patient safety and effective therapeutic relationships. Increasing utilization of health monitoring devices by patients w...

Crises in therapist-patient relationship can also become a challenge in clinical supervision. However, success and failure in establishing and maintaining constructive relationships in therapy and supervision is not only subject to a lucky fit of personal characteristics (therapist A gets along well/badly with client B; supervisee A gets along well/badly with supervisor C). Rather, we can identify determining field conditions in the overall therapeutic and supervisory situation for this outcome. We do not only focus on the persons involved, (...) but also on their environment, the task to be accomplished together, further framework conditions and the power relations resulting from their mutual influence-in the supervised case of therapy as well as in supervision itself. We want to examine the structure and dynamics of these relationships from a genuine Gestalt psychological perspective. What contributes to a cooperative atmosphere? When do goals get out of sight? What can make the atmosphere hostile? How do such developments become accessible in supervision? (shrink)

I want to begin by saying that the terms of reference of this series of lectures grated on me, in particular, the word ‘power’. One thing it conjured up was the criticism made by people who say we use our power over our patients to brainwash them, that the psychotherapeutic relationship is inescapably authoritarian, domineering, coercive. This was widely said in the sixties by leftist and feminists and others who sought a therapeutic relationship that was more equal, (...) co-counselling, for example, where the client and the therapist took turns exposing their problems. In my experience, most people who took up that position eventually saw the merits of relatively orthodox psychotherapy, and many have trained in conventional psychodynamic psychotherapy. I asked my partner, who is also a psychoanalytic psychotherapist, what the term power conjured up for her and got an uncharacteristically sharp response. She said, ‘I hate that word. It’s used by humanistic therapists who are afraid of authority, difference and knowledge and want us all to be the same. It’s like saying colour doesn’t matter. They confuse the abuse of power with the use of power. They assume that all exercise of power is abusive.’. (shrink)

This chapter reviews past and present debates about the therapeutic relationship in order to draw out the ethical implications of relational practices in psychotherapy. The therapeutic relationship has been understood differently across psychotherapeutic approaches, with each tradition responding to the attendant ethical challenges in distinctive ways. Aside from practitioners’ theoretical and practical commitments, the therapeutic relationship has also been, and continues to be, shaped by broader societal influences. The chapter discusses the shifting ethical implications (...) of relational practices, then, as situated in their theoretical and historical contexts. The variability of concerns raised by the therapeutic relationship requires continued ethical analysis in order to confront the diversity and complexity of contemporary clinical practice. (shrink)

Some authors have advanced a contractual model to protect patient autonomy within the therapeutic relationship. Such a conception of the physician–patient relationship is intended to serve both parties by respecting patients' choices and preserving physician integrity. I critique this contractual view and offer an alternative, feminist contextualized approach to autonomy within the therapeutic relationship. This approach places the physician-patient relationship within a larger social context, and indicates the many social inequalities that render insupportable the (...) notion of physicians and patients as contracting equals. (shrink)

In this clinically rich and deeply personal book, Chris Jaenicke demonstrates that the therapeutic process involves change in both the patient _and_ the analyst, and that therapy will not have a lasting effect until the inevitability and depth of the analyst's involvement in the intersubjective field is better understood. In other words, in order to change, we must allow ourselves to be changed. This can happen within the sessions themselves, as one grasps the influence of and decenters from one's (...) own subjectivity, with cumulative effects over the course of the treatment. Thus the process, limitations, and cure of psychotherapy are cocreated, without displacing the asymmetrical nature of roles and responsibility. Essentially, beyond the theories and techniques, it is the specificity of our subjectivity as it interacts with the patient's subjectivity which plays the central role in the therapeutic process. (shrink)

Recognizing and aligning individuals’ unique adaptive beliefs or “priors” through cooperative communication is critical to establishing a therapeutic relationship and alliance. Using active inference, we present an empirical integrative account of the biobehavioral mechanisms that underwrite therapeutic relationships. A significant mode of establishing cooperative alliances—and potential synchrony relationships—is through ostensive cues generated by repetitive coupling during dynamic touch. Established models speak to the unique role of affectionate touch in developing communication, interpersonal interactions, and a wide variety of (...) therapeutic benefits for patients of all ages; both neurophysiologically and behaviorally. The purpose of this article is to argue for the importance of therapeutic touch in establishing a therapeutic alliance and, ultimately, synchrony between practitioner and patient. We briefly overview the importance and role of therapeutic alliance in prosocial and clinical interactions. We then discuss how cooperative communication and mental state alignment—in intentional communication—are accomplished using active inference. We argue that alignment through active inference facilitates synchrony and communication. The ensuing account is extended to include the role of tactile afferents in realizing the beneficial effect of therapeutic synchrony. We conclude by proposing a method for synchronizing the effects of touch using the concept of active inference. (shrink)

By considering the nature of the relationship between patient and healer, The Healing Bond explores the responsibilities of both, with a special emphasis on the therapeutic responsibility. The editors and contributors examine both orthodox and unorthodox forms of healing practice and apply a variety of professional and analytic perspectives to the medical profession as a whole. They look at specific areas of health such as midwifery, psychoanalysis, naturopathy, the relations between medicine and state, and the appeal of "quacks." (...) Particular issues of current concern are also discussed, including medical litigation, codes of ethics among complementary practitioners and cooperation between orthodox and complementary medicine practitioners. Contributors: Mary Douglas, Calliope Farsides, David Peters, Roy Porter, Richenda Power, Margaret Stacey, Robert Sumerling, and Gillian Vanhegan. (shrink)

Since its inception in the 1900s, the concept of countertransference has been mired in controversy. Psychoanalytic literature is divided on its utility, significance and its clinical value in psychotherapy. While some psychotherapists have advocated for the importance of therapists’ expertise in the comprehension and processing of countertransference dynamics in the treatment of sexually abused children, others see no value in competency in countertransference in trauma treatment of sexually abused children. The purpose of this article is to explore whether countertransference is (...) a useful therapeutic tool, or a hindrance in the treatment of sexually abused children. A qualitative paradigm, particularly interpretative phenomenology, was employed in this research to make meaning of the therapists’ experiences. The analysis of the results revealed the following five main themes that were supported by 18 superordinate themes. These themes reveal that therapists treating sexually abused children experience a myriad of feelings, including a) feeling emotionally overwhelmed, b) anger toward perpetrators and the need to protect and rescue their patients, c) the importance of social support and self-healing, d) feelings of empathy and identification with the client, and e) erotic countertransference. These findings reveal two contradictory findings. Firstly, they tell of variable utilisation of countertransference among participants and, secondly, they highlight a lack of application of countertransference in the treatment of sexually abused children. The implications of the current study are that there is a need to both highlight the importance of countertransference as a therapeutic tool and to incorporate it in the treatment of sexually abused children. (shrink)

Changing technology, and the pervasive demand created by a greater need in the population for access to mental health interventions, has led to the development of technologies that are shifting the traditional way in which therapy is provided. This study investigated the efficacy of a behavioral couples therapy program conducted via videoconferencing, as compared to face-to-face. There were 60 participants, in couples, ranging in age from 21 to 69 years old. Couples had been in a relationship for between 1 (...) to 49 years. The 30 couples were randomly allocated to the face-to-face or videoconferencing group. They all took part in Couple CARE—a couples behavioral education program which promotes self-change in order to increase relationship satisfaction. The six session manualized intervention was offered in an identical manner to all clients, in each condition. Data analysis was based on several questionnaires completed by each couple at pre, post and 3-months follow-up. Results showed that therapeutic alliance ratings did not differ between groups, but increased significantly over time for both groups. Additionally, the results indicated improvements in relationship satisfaction, mental health, and all other outcome scores over time, which did not differ based on condition. This study uniquely contributes to the literature exploring the use of technology to provide therapy. Specifically, the study provides evidence for couples therapy via videoconferencing as a viable alternative to face-to-face interventions, especially for those couples who may not have access to the treatment they require. It is anticipated that the results of this study will contribute to the field of online therapy, and add to fostering confidence in agencies to allow expansion of services conducted via videoconferencing. (shrink)

Parallels between Moreno's biography and his theory of self -- Moreno's philosophical- theological perception of the self -- Moreno's theory of the development of the self -- The significance of the concept of "role" in Moreno's theory -- The personality theory viewed through psychodrama -- An integrative and critical discussion and analysis of Moreno, personality theory and psychodrama.

Psychotherapists and counsellors confront several ethical dilemmas as they tend to provide effective services. There has been much debate among psychotherapists and counsellors alike around the utility of therapeutic contracts. Some view contracts as being restrictive to the therapeutic process and often hindering the work done in sessions. In contrast, many counsellors and psychotherapists use those agreements to revisit specific therapeutic topics and establish the guidelines necessary for this professional arrangement. No matter the opinion or preference of (...) contracts, the development of written and/or verbal consent of specific topics in psychotherapy remains essential. This remains one of the formal features of the arrangement and starting relationship in current counselling and psychotherapy practice. This paper aims to discuss the necessity and ethical demand of therapeutic contract in counselling and psychotherapy practice. (shrink)

The few people familiar with the pseudo-Platonic dialogue Axiochus generally have a low opinion of it. It's easy to see why: the dialogue is a mish-mash of Platonic, Epicurean and Cynic arguments against the fear of death, seemingly tossed together with no regard whatsoever for their consistency. As Furley notes, the Axiochus appears to be horribly confused. Whereas in the Apology Socrates argues that death is either annihilation or a relocation of the soul, and is a blessing either way, "the (...) Socrates of the Axiochus wants to have it both ways": death is both annihilation and a release of the soul from the body into a better realm. This may be used to construct a valid argument for the conclusion that death is not evil, but at the expense of having a contradiction as one of its premises. But D. S. Hutchinson has recently proposed that these inconsistencies shouldn't surprise us if we view the Axiochus as "an unconventional version of a very conventional genre--the consolation letter." In this paper I expand on Hutchinson's brief suggestion and argue that the Axiochus can be rehabilitated by paying attention to its genre. Although the Axiochus does display many similarities to the consolation letter, the shift from letter to dialogue does--pace Hutchinson--significantly affect what's going on. Within the dialogue, Socrates behaves toward Axiochus in a way similar to the way the author of a consolation letter behaves towards the letter's reader: he is willing to use inconsistent arguments, borrowed from any source, in order to soothe the patient. However, in depicting this type of consolatory relationship between Socrates and Axiochus, the dialogue itself is not aiming at consoling its readers. Instead, it should be seen as displaying for the reader's consideration a certain type of consolatory argumentative practice. -/- Socrates notes that Axiochus is "very much in need of consolation" (365a), and he uses any means necessary to accomplish this task. Socrates exhibits many ways in which he is willing to sacrifice argumentative hygiene for the sake of therapeutic effectiveness. These include: -/- * Use of arguments with inconsistent premises, presented in propria persona. * Appeals to emotion * Tailoring arguments to the audience. * Presenting invalid arguments so as to induce unjustified but comforting beliefs. * Evasion. In these respects, I think that Socrates' argumentative practice is best compared to PH III 280-1, where Sextus Empiricus says that the skeptic will deliberately use logically weak arguments as long as they work. Dorothy Tarrant claims that what links the Socrates of the Axiochus to Socrates as he appears elsewhere in the Platonic corpus is his evident care for the welfare of his interlocutor's psyche. But this concern takes a quite different form in the Axiochus than it usually does. As with Sextus, psychic therapy in the Axiochus involves relief from pain. The primary difference between them is that Socrates, unlike Sextus, is not aiming at producing epochê in his patient. (shrink)

The mapping of therapeutic collaboration throughout counseling deepens our understanding of how the helping relationship fosters client change. To better understand the process of career construction counseling, we analyzed the therapeutic collaboration on six successful face-to-face cases. The participants were six Portuguese adults, five women and one man, real clients of a career counseling service, and four psychologists, three female and one male trained in the career intervention model. The participants completed demographic questions and measures of career (...) certainty, vocational identity, career indecision, and psychological functioning. The Therapeutic Collaboration Coding System was used to track collaboration throughout all interactive episodes. The clinical significance of the intervention was calculated by analyzing pre-post-test statistical differences for each case, with the Reliable Change Index and Z score. The findings evidenced a pattern of therapeutic collaboration evolution for good outcome cases. Based on this pattern, we propose a model of process-outcome evolution for the three phases of CCC. (shrink)

This article addresses the way in which therapeutic practice in an English prison creates conditions whereby both prisoners and prison officers are caught up in networks and relationships of power that contribute to the constitution of particular subjects. The development of therapeutic practice, in relation to prisons and probation, is described and contextualised. Subsequently, the practices of group therapy in operation at Grendon prison - a rather unique institution built on principles of therapeutic community – are analysed (...) with a focus on five ”practices of moulding,” namely, naming, confession, assessment and surveillance, tolerance and participation. The argument that psychotherapy, under conditions of imprisonment, is a form of repression or social control is discussed and dismissed as too simple a model to account for the relations of power and constitutive practices that effect all participants, not only prisoners. Members of staff, as well as prisoners, are shown to be caught up in the disciplinary web. Discipline, as opposed to control, is advocated as a more appropriate concept for understanding therapeutic practices in prison. The work of Thomas Mathiesen, on the concept of synoptic power, is introduced to help illustrate these dynamics. The article represents a shift in my own thinking, from scepticism to a pragmatic idealist position, that creates space for institutions like Grendon to be imagined as potential least worst options for people convicted of offences and obliged to serve “time”. It is my hope, argued for in the article, that Grendon can be conceived of as a “visionary space” with emancipatory potential. (shrink)

Nursing on paper: therapeutic letters in nursing practice This paper offers a selected piece of interpretive research extracted from the context of a larger research study. The hermeneutic research inquiry described in this paper involved the examination of the nursing and family therapy intervention of therapeutic letters. It incorporated the textual interpretation of 11 therapeutic letters, clinical sessions with three families, clinical team discussions, and research interviews with four family members and three nurse clinicians who participated in (...) the writing of the letters. This particular paper extracts segments of the research related to the letters received by two participants, as well as some general findings, with a focus on the possibilities and influences of therapeutic letters in nursing practice. The findings of this research offer suggestions, not as a template, but as an inspiration and evocation to write therapeutic letters that address the obligation of meeting people experiencing illness at the point of their suffering, with words and questions that invite relationship, reflection, and are large enough to sustain a meeting. (shrink)

The COVID-19 pandemic outbreak has led to a general reorganization of health services and an increase in outpatient telemedicine in mental healthcare for physically ill people. Current literature highlights facilitators and obstacles concerning the use of new technologies in psychotherapy, an underrated topic of research in the context of supportive expressive psychotherapy. More insight is needed to explore the characteristics of video in therapeutic alliance for treatment of specific mental disorders experienced in psychosomatics, particularly with people suffering from a (...) disturbed body- and self-image. Using two clinical vignettes, it is the authors’ intention to enrich the critical debate on current knowledge in psychosomatic remote psychotherapy, with special focus on mentalization deficits and their impact on therapeutic alliance in the consultation-liaison psychiatry setting. In particular, we will question the interpersonal processes at stake related to mirroring and the disruption caused by the use of videoconference applications. We will also reflect upon the relationship between the therapeutic alliance and the medical team, and that between patient and psychotherapist. The aim is to improve psychotherapeutic alliance maintained during the pandemic for specific mental disorders and to inform about possible clinical factors that could be the subject of future empirical studies or professional guidelines. (shrink)

Adolescents are often an overlooked clinical population. Among school-based practitioners, there is a natural inclination to focus the delivery of mental health services, assessment measures, and intervention plans on younger children, and there is a strong research base to support these programs. On the other hand, the waiting rooms of most practitioners in private practice are filled with young and middle-age adults, couples, or families with young children. Because most therapists do not specialize in working with teens, who might make (...) up only a small portion of their overall caseload, there is a need for high quality, easily implemented activities to help engage with adolescent clients.This book provides an overview of the principles of therapeutic storytelling, developmental issues of adolescents and young adulthood, and their strengths-based model, before moving into a series of chapters devoted to specific issues. Commonly encountered topics such as sexuality, parent & peer relationships, substance abuse, violence & gangs, bereavement, and cultural and religious issues are covered within the chapters. (shrink)

The mental health professions operate largely so as to objectify a language of mental deficit. In spite of their humane intentions, by constructing a reality of mental deficit the professions contribute to hierarchies of privilege, reduce natural interdependencies within the culture, and lend themselves to self-enfeeblement. This infirming of the culture is progressive, such that when common actions are translated into a professionalized language of mental deficit, and this language is disseminated, the culture comes to construct itself in these terms. (...) This leads to an enhanced dependency on the professions and these are forced, in turn, to invent additional terms of mental deficit. Thus, concepts of infirmity have spiraled across the century, and virtually all remaining patterns of action stand vulnerable to deficit translation. Required within the professions are new linguistic formulations that create a reality of relationships without evaluative fulcrum. (shrink)

Explores the relationship between health and religion based on the model offered by the Hindu traditions of Yoga, Ayurveda, and Tantra.

This paper describes the semiotic process by which parents, as attachment figures, enable infants to learn to make meaning. It also applies these ideas to psychotherapy, with the therapist functioning as transitional attachment figures to patients where therapy attempts to change semiotic processes that have led to maladaptive behavior. Three types of semiotic processes are described in attachment terminology and these are offered as possible precursors of a neuro-behavioral nosology tying mental illness to adaptation. Non-conscious biosemiotic processes in infant-parent attachment (...) are the basis for early adaptation as well as adaptation or maladaptation in adulthood. Mother-infant interaction can be described as a series of signs, each interpreted so as to dispose the behavior of the other interactant towards the goal of protecting the infant from danger and distress. Regulating arousal, scaffolding infants’ behavior in the infants’ zone of proximal development, and repairing ruptures in the interaction are crucial to infants’ development and adaptation. In semiotic terms, each person activates multiple interpretants to make meaning of sensory stimulation. Non-verbal semiotic synchrony establishes the relationship whereas shared repair of ruptures promotes change. Attachment strategies, as learned adaptations to threat, are neuro-psychological strategies for making meaning of sensory information so as to dispose protective behavior. Type A privileges cognitive-temporal information, Type C affective information, Type B has no bias. Type A and C limit semiotic freedom by using ‘short-cuts’ in processing that produce quick protective behavior in the short-term. Type B includes more representations, and thus more semiotic freedom, resulting in slower responses and long-term flexibility. Attachment strategies function as meta-interpretants for applying one semiotic process to most incoming information about danger. A, B, and C case examples are analyzed in semiotic terms. Psychotherapy can be considered a helping process embedded in a transitional attachment relationship. For psychotherapy to be successful, both somatic stabilization and a therapeutic relationship are needed. Treatment that uses scaffolded semiotic processes in each patient’s ZPD to repair moment-to-moment ruptures holds the potential to reorganize attachment strategies and transfer that potential to reflective language and relationships outside the therapy. The outcome should be greater semiotic freedom such that the individual can trust their own mental processes and use them to establish safe relationships. Language can speed the process, but premature reliance on verbal transformations of non-conscious information can carry misattributions into a second layer of misconstrued meaning and maladaptive behavior. Even when dangerous family relationships and external danger cannot be changed, patients can come to know their own minds and use information to regulate their behavior. The goal of psychotherapy is to free patients from their past by enabling them to be secure about the functioning of their own minds, so that they can both avoid eliciting harm and also establish supportive relationships. (shrink)

In the course of the long 18th century, medical theory and theories underwent profound changes. These in turn reflected discontinuities and often conflicting assumptions and premises, engendering divergent concepts of physiology and pathology. However, most theoretical considerations were only very inconsistently and partially reflected in therapeutic practice, which continued to be governed by experience with traditional and known medicinals and by patient expectations regarding provider practices. Additional factors in therapeutic decision making were economic considerations and preferences for particular (...) therapies in certain social and religious networks. The present volume deals with some aspects of this complex relationship between medical theory and therapeutic practice, using a transatlantic perspective. Individual essays reflect the current state of historical research in Germany, the US and Great Britain. (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)

This paper explores the history of ELIZA, a computer programme approximating a Rogerian therapist, developed by Jospeh Weizenbaum at MIT in the 1970s, as an early AI experiment. ELIZA’s reception provoked Weizenbaum to re-appraise the relationship between ‘computer power and human reason’ and to attack the ‘powerful delusional thinking’ about computers and their intelligence that he understood to be widespread in the general public and also amongst experts. The root issue for Weizenbaum was whether human thought could be ‘entirely (...) computable’. This also provoked him to re-consider the nature of machine intelligence and to question the instantiation of its logics in the social world, which would come to operate, he said, as a ‘slow acting poison’. Exploring Weizenbaum’s 20th Century apostasy, in the light of ELIZA, illustrates ways in which contemporary anxieties and debates over machine smartness connect to earlier formations. In particular, this article argues that it is in its designation as a computational therapist that ELIZA is most significant today. ELIZA points towards a form of human–machine relationship now pervasive, a precursor of the ‘machinic therapeutic’ condition we find ourselves in, and thus speaks very directly to questions concerning modulation, autonomy, and the new behaviorism that are currently arising. (shrink)

This paper explores the history of ELIZA, a computer programme approximating a Rogerian therapist, developed by Jospeh Weizenbaum at MIT in the 1970s, as an early AI experiment. ELIZA’s reception provoked Weizenbaum to re-appraise the relationship between ‘computer power and human reason’ and to attack the ‘powerful delusional thinking’ about computers and their intelligence that he understood to be widespread in the general public and also amongst experts. The root issue for Weizenbaum was whether human thought could be ‘entirely (...) computable’. This also provoked him to re-consider the nature of machine intelligence and to question the instantiation of its logics in the social world, which would come to operate, he said, as a ‘slow acting poison’. Exploring Weizenbaum’s 20th Century apostasy, in the light of ELIZA, illustrates ways in which contemporary anxieties and debates over machine smartness connect to earlier formations. In particular, this article argues that it is in its designation as a computational therapist that ELIZA is most significant today. ELIZA points towards a form of human–machine relationship now pervasive, a precursor of the ‘machinic therapeutic’ condition we find ourselves in, and thus speaks very directly to questions concerning modulation, autonomy, and the new behaviorism that are currently arising. (shrink)

The authors find it more useful to payattention to relationships than to boundaries.By focusing attention on bounded, individualpsychological issues, the metaphor ofboundaries can distract helping professionalsfrom thinking about inequities of power. Itoversimplifies a complex issue, inviting us toignore discourses around gender, race, class,culture, and the like that support injustice,abuse, and exploitation. Making boundaries acentral metaphor for ethical practice can keepus from critically examining the effects ofdistance, withdrawal, and non-participation.The authors describe how it is possible toexamine the practical, moral, and ethicaleffects (...) of our participation in relationshipsby focusing on just relationships rather thanon boundaries. They give illustrations andclinical examples of relationally-focusedethical practices that derive from a narrativeapproach to therapy. (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)

Tschacher and Haken have recently applied a systems-based approach to modeling psychotherapy process in terms of potentially beneficial tendencies toward deterministic as well as chaotic forms of change in the client’s behavioral, cognitive and affective experience during the course of therapy. A chaotic change process refers to a greater exploration of the states that a client can be in, and it may have a potential positive role to play in their development. A distinction is made between on the one hand, (...) specific instances of instability which are due to techniques employed by the therapist, and on the other, a more general instability which is due to the therapeutic relationship, and a key, necessary result of a successful therapeutic alliance. Drawing on Friston’s systems-based model of free energy minimization and predictive coding, it is proposed here that the increase in the instability of a client’s functioning due to therapy can be conceptualized as a reduction in the precisions with which the client’s prior beliefs about themselves and their world, are held. It is shown how a good therapeutic alliance results in the emergence of a new hierarchical level in the client’s generative model of themselves and their relationship with the world. The emergence of this new level of functioning permits the reduction of the precisions of the client’s priors, which allows the client to ‘open up’: to experience thoughts, emotions and experiences they did not have before. It is proposed that this process is a necessary precursor to change due to psychotherapy. A good consilience can be found between this approach to understanding the role of the therapeutic alliance, and the role of epistemic trust in psychotherapy as described by Fonagy and Allison. It is suggested that beneficial forms of instability in clients are an underappreciated influence on psychotherapy process, and thoughts about the implications, as well as situations in which instability may not be beneficial for therapy, are considered. (shrink)

In this article we present a phenomenological single-case study of a client’s experience of her therapist’s bodily movement in the context of narrative therapy. A client was interviewed regarding her experience of selected bodily movements of the therapist based on a video recording of one of her therapeutic sessions. The movements were analyzed through Maxine Sheets-Johnstone’s cardinal structures of movement while the interview was analyzed through a modification of Giorgi’s method for phenomenological psychology. We focused on the relationship (...) between the therapist’s bodily movement and therapeutic movement in the client and arrived at general structures of the client’s experience of being moved by movement. The experience comprises three core constituents: ‘shifts in sense of self’, ‘sense of togetherness’ and ‘feelings of mobility’, and reveals that the therapist’s bodily movements can lead to therapeutic changes compatible with the aim of narrative therapy. (shrink)

This paper inspects the relationship between problem analysis—a fundamental part of many therapeutic approaches—and meaning. In the first part, I argue that problem analysis emerges from the representational theory of meaning. I introduce Wittgenstein’s version of this theory as presented in the Tractatus Logico-Philosophicus, and examine its difficulties. Later, I focus on two fundamental themes of late Wittgenstein’s Philosophical Investigations: private language and rule-following. I argue that the rule-following paradox has disproven the representational theory of meaning. I briefly (...) describe the private language argument and rule-following paradox—a sceptical paradox. Then I provide my reading of Kripke’s sceptical solution to it. I present its implications regarding the meaning and how this is relevant to problem analysis and therapeutic conversations in general. (shrink)

This article examines how therapists and patients start building and managing relationships and pursue institutional goals at the same time. Based on a corpus of 6 audio-recorded therapies (client-centered therapy and psychodynamic therapy), I investigate first encounters between therapists and patients as the starting points of any therapeutical process and the place where a relationship between the interactants is established for the first time. Following a microlinguistic qualitative approach and applying methods from conversation analysis and discourse analysis, I show (...) how therapists, on the one hand, try to align with patients to build a positive working alliance and, on the other hand, work to fulfill specific interactive tasks of therapeutic discourse which demand disaligning with the patients’ communicative activity and their interactive expectations. Specific interactive “jobs” that need to be fulfilled in psychotherapy are identified, namely the performance of institutional roles by the interactants, the establishment of an interaction structure and the pursuit of helpful change in the patient. I show at which places in the interaction therapists (dis-)align with the patients’ projected communicative activity and how aligning and disaligning are related to the interactive process and the establishment and performance of these interactive jobs. The analysis shows that, at the beginning of therapy, alignment and disalignment are both important processes for the following reasons: Aligning with the patient contributes to a positive relationship, which has been shown to be vital for successful psychotherapy, while disaligning introduces the patient to the specific discursive mechanisms that characterize therapeutic discourse and constitute the basis for its effectiveness. Overall, the paper argues that reducing therapy to a dichotomy between relationship and “technique” seems overly simplistic, as both aspects need to be handled and managed at the same time. (shrink)

The doctor-patient relationship is examined an emphasis on the comparison between professional and moral principles. Many therapeutic measures have opposite-directed alternative steps with an equal degree of justification, so that no logical preference is attainable and conflicts ensue. Thus patients come for relief and are ordered to endure further pain and discomfort; or weaker individuals exaggerate their complaints hypochomdriacally, and thus need a great deal of understanding, yet paradoxically they are prone to receive less support than stronger ones. (...) Further conflicts arise between our devotion to human well-being and dignity, and our obligation to disrespect some of their rights for self-determination. Furthermore, various dutifully performed doctoring activities run counter to our own social needs and interests; last, but not least, human imperfection colours some of our decisions, putting a definite blemish on their value. In conclusion, physicians must bear the constant burden of paradoxically-opposed alternatives, and they confront pitfalls of worongdoing at every therapeutic step. Their only guidelines are intuition and professional dedication. (shrink)