Psychoanalytic Theory and Psychotherapy: A Dynamic Systems View of Change

This paper explores the application of nonlinear dynamic systems theory and concepts to the investigation of the psychotherapeutic situation. Although dynamic systems theory was originally applied in the study of chemistry, mathematics, and physics—not initially for its application to psychotherapy—its emphasis on contextualization provides a rich platform for the reconsideration of how change occurs in the therapeutic dyad. This paper first reviews some tenets of dynamic systems theory, in particular the general processes of system change including the introduction of novelty and perturbation. It then examines some psychoanalytic theories from a dynamic systems vantage point. This is followed by the presentation of two cases that illustrate the application of systems concepts to clinical work. This paper concludes that psychoanalytic psychotherapy from the perspective of dynamic systems theory views moments of change as unpredictable, soft assembled, and emergent in the dialogue and context created mutually by therapist and patient.     

Psychotherapy Quality Assessment

Abstract

In the first section of this paper, Dr. Whitaker argues that there are both practical and heuristic reasons for developing a systematic method for assessing the quality of psychotherapy in a university mental health service. He maintains that, though the task of psychotherapy quality assessment is a complex undertaking, it is possible to take steps toward its accomplishment in a responsible way while still keeping the task within manageable proportions.

In the second section, Dr. Sarnat describes one in a series of efforts at quality assessment at the Mental Health Division of the University of Massachusetts Health Services. She describes the development of a new method of recordkeeping and record review, and the results of a review of three different samples of records. She concludes that the method is feasible, useful, and meaningful for quality assessment in that setting, although the method is admittedly limited in what it can measure.

In the final section, Dr. Arnstein comments on the above, adding a note of caution about both the feasibility and the wisdom of embarking on a program of quality assessment of psychotherapy. He elaborates some of the difficulties that may prevent one from arriving at a valid assessment.     

Lesbians in Psychotherapy

SUMMARY

Using self-report measures, this study explored the relationship of attachment style and internalized shame among 100 self-identified lesbians. The participants were in the highest stage of lesbian identity integration (Cass's model, stage 6, synthesis) and were in ongoing interpersonal psychotherapy. Compared to earlier research on a non-clinical national sample of 317 self-identified lesbians, this sample of mid-life lesbians (predominantly European-American and college educated) reported higher levels of secure attachment and lower (non-clinical) levels of internalized shame. Collectively, scores of the four attachment styles predicted 43% of the variability in internalized shame. Secure attachment significantly predicted reduced shame. This article includes a discussion of theoretical and practical implications of the findings.     

Mutual Transformation in Psychotherapy

A growing body of psychoanalytic literature recognizes that dynamic therapy can be transformative for therapists as well as for patients. Relational concepts such as co-construction and mutual regulation highlight interactive processes that facilitate bidirectional change. This paper summarizes the theoretical rationale for mutual transformation, presents a detailed case study illustrating how transformation evolves, and concludes with a brief commentary written by the patient.     

Integrative Curricular Options

In order for social work education to contribute to improving practice, it needs to reflect the complexity and diversity of the demands for services in practice. An integrative curricular model can contribute to this. This paper examines the social work curriculum, its application to practice in a tripartite model, and issues coinciding with this approach. The framework includes an integration of the technocratic, conflict, and process models into the curriculum.     

Supportive Psychotherapy for Borderline Patients

SUMMARY

An imagined conversation between a clinician/teacher and a beginning therapist conveys the concept of a psychoanalytically informed supportive psychotherapy for borderline patients and incorporates the major hypotheses as to the origin of the disorder. Within a basically developmental point of view, the treatment recognizes the contributions of genetics, animal studies, neuroscience, early interpersonal relationships and the object relations that derive from them. The psychodynamics of a typical case are considered from all of these viewpoints, while the student-therapist is encouraged to keep in mind the basic concepts of psychoanalysis. These include: unconscious mental activity, transference, and the internalization of the therapist's attitude of respectful listening, which leads to the capacity to listen in that way to oneself and others.     

Psychotherapy as an eductional process

Clients in psychotherapy with social workers, psychiatrists and psychologists learn things that they did not know previously. This learning modifies their view of reality and themselves. Clients learn that their problems are, to an extent universal, interpersonal—both out from themselves and to themselves from others, due to experiences in their past in their families, perhaps solvable by identifying with successful others, often due to unrealistic expectations about themselves, others and existence in general. Successful therapy is marked by culture-building interaction by the client and the therapist with the client's subjective understanding modified to enable greater autonomous action.     

Using Daydreams in Psychodynamic Psychotherapy

Daydreams, long recognized as containers of unarticulated, unrecognized and/or unconscious material, can be subtle but powerful tools for introducing clients to the process of exploring internal experience. They offer a crucial, relatively non-threatening path to self-understanding for individuals who come into therapy without the capacity for introspection, tolerance of affect, and sense of agency that are requisite for the process of psychodynamic psychotherapy. In part because they are often available to conscious awareness, they are an amazingly useful medium through which to help many of these clients gain access to their internal world. They encourage the development of the capacity to symbolize, to play, and eventually to embrace the potential space of internal experience that makes it possible to have a rich and fulfilling life in the external world. In this article, the author introduces the use of daydreams in psychodynamic psychotherapy, focusing specifically on three specific areas: resistance, somatization, and transference.     

Ritual,Change and Psychotherapy

Symptomatic behavior often appears or is initially perceived during transitional stages in the life cycle when changes in behavior and relationships are culturally appropriate. Symptomatic behavior legitimates lack of change in the relationships of the symptomatic individual and those in his or her social context. By this it provides a pseudo-solution to the universal problem of dependency and autonomy (Sluzki & Vernon, 1971), which must be solved by individuals in every society. Many non-Western societies have rites of passage (van Gennep, 1960) to ritualistically mark significant transition. The performance of these rituals helps individuals change their position in the social context while at the same time validating the context. Rites of passage are characterized by paradoxical communications. The paradoxical structure of these rituals will be described and implications for the use of ritual in family therapy will be suggested using a case example as illustration.     

The Place of Values In Psychotherapy

Psychotherapy is a value-laden process because the very notions of therapeutic', 'cure', and 'health' involve patients and therapists in making value choices. Two hierarchies of health values as they apply to therapy are reviewed. The first guides the therapist in setting limits on pathological behavior and constitutes the so-called 6 D's of pathology: destructiveness, dysphoria, disorganization, deviancy, dependency, and disillusionment. The second illuminates the therapist's role-modeling or ideal-setting function and takes the form of a developmental sequence of positive health values, as derived from Kohlberg's work on moral judgment. These health values, from the lowest to the highest forms, are fit-survival, pleasure-seeking, social-belonging, structural duty, adaptive flexibility, and universal commitment. this hierarchy has important implications for understanding the nature of therapeutic changeand the appropriate matching of therapist and patients     

Psychotherapy with Traumatized Southeast Asian Refugees

Southeast Asian refugees have suffered severe traumas, and face the challenges of adapting to a new and unfamiliar land. The paper identifies techniques for time-limited mental health treatment with this group. These include the initial task of establishing clinician credibility (by focusing on symptom reduction), assisting resettlement, and working through the traumas they suffered. In addition, the special challenges of working with refugees are addressed.     

Issues of Divine Healing in Psychotherapy

Abstract

Despite Biblical and empirical support for divine healing, there are several barriers to accepting it as an aspect of psychotherapy for many professionals and religious people. Two of the major barriers to the acceptance of divine healing are professional ideologies and theories. These professional stances likely play a critical role in the disinterest in religion and spiritual experiences reported by the majority of professionals that conduct psychotherapy.

Another barrier is the divergent theologies regarding spiritual experiences such as divine healing. Many persons of theistic faith subscribe to theologies that often impede experiences of healing by the Holy Spirit. Finally, the scientific method is often used to address questions about spiritual experiences that are more likely conundrums. However, belief in divine healing ultimately is based on faith.     

Psychotherapy with the Father-Absent Military Family

Defense department regulation changes concerning military dependents have had a marked impact on a large number of service families. One outcome is a specific fractured family—father-absent military family—which has unique characteristics and distinctive problems. In addition to explicit features of military families in general, dynamics of the father-absent fragment are discussed. A psychotherapy strategy is also presented which has been shown to be of value in promoting continued growth in the father-absent military family     

Sexually Abused Children's Opposition to Psychotherapy

As children enter therapy, they form beliefs (conceptualizations) about the reasons for their attendance. Some of these conceptualizations may lead to premature termination of therapy or impede its progress. Four of these conceptualizations are explored in this paper: therapy as an indication of illness, therapy as punishment, therapy as an accusation, and therapy as another form of abuse. The process of the formation of these conceptualizations is outlined. The ways in which sexually abused children's experiences may make them particularly prone to form these conceptualizations are discussed. The benefits of exploring the child's resulting opposition to therapy are also explored.