One or Two Session Psychotherapy with University Students

Abstract

One or two session psychotherapy has a long history, and well-known practitioners have made use of it. Favorable results have been reasonably well documented. Often it has been done out of necessity, less frequently because all were satisfied that it sufficed. Problems that lend themselves to one or two sessions are: psychological work which has already been done but for which affirmation is sought, requests for diagnostic evaluation, and less often but more challenging, intrapsychic conflict requiring uncovering work. Patient characteristics and therapist attitudes are discussed. For one or two sessions of treatment to occur the therapist must be alert to the possibility, must assess quickly when a case is in hand, set the process in motion, and determine a satisfactory stopping point. It is suggested that the college population lends itself especially well to one or two sessions of psychotherapy, not only from the standpoint of the limited resources of many student health services but also for the ego strengthening potential it provides.     

Introduction

ABSTRACT

This essay develops several perspectives on Bion’s concept of primal scene and introduces a series of sex papers on aspects of the primal scene: its developmental implications, implications for thinking, a way of examining the forces of silence and transgression in psychoanalytic institutions, the mythic dimensions of the primal scene and its lens into considerations of race and racism.     

Phenomenology and intersubjectivity: considerations for webcam-facilitated psychotherapy

ABSTRACT

The clearest distinction between webcam-facilitated versus face-to-face psychotherapy is the available sensorial information. The following questions guide this discussion: 1. How do our senses inform the psychotherapeutic process? 2. What are the implications for the therapeutic process when sensory information is different than during face-to-face therapy? This examination of the role of the senses in the creation of knowledge is grounded in phenomenology. Individual unity of consciousness and reciprocal understanding are applied to literature on webcam-facilitated therapy. An amalgam clinical example illustrates these phenomenological concepts and role of intersubjectivity. The core issues are involvement of sensory processes in the process of psychotherapy and co-construction of knowledge. By accepting the limitations of therapist knowledge, the client is encouraged to articulate and develop their own knowledge, and make conscious their unconscious. It is not necessary for therapist and client to share a physical space for co-creation of knowledge necessary for client transformation.     

“Let’s talk about the real issue”: Localized perceptions of environment and implications for ecosocial work practice

ABSTRACT

This interpretive study investigated how residents from socioeconomically challenged communities in North St. Louis understand and make meaning of environmental change and its impact on their well-being. Based on these localized data, we argue that racial minorities facing socioeconomic challenges may experience some environmental issues as less of an immediate concern than violence and racism. However, race and racism shape both the realities of environmental threats as well as residents’ perceptions about environmental injustice in their communities. This study informs ecosocial work practices such as educating communities on local environmental issues and mobilizing community members toward environmental decision-making.     

Cross Cultural Perspectives in Treating the Gay Male Trauma Survivor

Summary

In recent years, there has been an increased emphasis on cultural considerations in psychotherapeutic treatment. Sound psychotherapy is ideally culturally sensitive and concerned with the context within which the client developed and exists. At the same time it is often difficult for many clinicians to navigate the cultural within the psychological framework. When both patient and clinician share more than one language in common, there are a variety of subtle issues that surface. In psychotherapy, “coordinate bilinguals,” those who learn their languages separately, during different developmental stages and contexts, tend to have greater access to their emotional experiences within their first language. When the client presents with a sexual trauma history, the language spoken during the abuse will also have an effect on the language used in the psychotherapy. The case history of Lucio, a Latino gay male, is discussed in terms of the cultural and psychological elements of his treatment by a bilingual North American therapist. This therapist's psychotherapeutic conceptualizations and treatment approaches are examined and reviewed in a written dialogue/ discussion with a Latino psychologist.     

Dangerous Liaisons: The Time Is Out of Joint

ABSTRACT

Anne is an older woman, with a history of severe, complex trauma, including abandonment and multiple rounds of sexual abuse, which started in her early childhood and was followed by sexual exploitation in a previous experience of therapy. In this article I discuss her treatment with me in the context of the #MeToo movement and the rest of the current troubling sociopolitical constellation. I argue that when tanks crash into our bedrooms and transform them into battlefields, seismic psychic change occurs: catastrophic or healing or both. I also contemplate the nature of the psychoanalytic contract between patient and therapist, as well as the limits of the psychoanalytic endeavor in the face of massive social and historical trauma, “when the time is out of joint” (Shakespeare, “Hamlet”).     

Thinking the unthinkable: 'white liberal' defences against understanding in anti-racist training

Abstract

This article describes and analyses a range of group processes which occurred during anti-racist training workshops with qualifying social work students. The principal focus is to understand white students' defences against authentic learning about their own anxieties with respect to their black colleagues, and how unless these are surmounted they will constitute a continuing block to the possibility of a 'depth' engagement with racism.     

Class,race, and the disposal of urban waste: Locations of landfills,incinerators, and sewage treatment plants

This study compared the socioeconomic status, racial composition, and ethnic composition of 49 randomly selected U.S. cities with those of the census tracts containing the solid waste disposal facilities and sewage treatment plants for those cities. Contrary to the environmental racism and classism hypotheses, residents of tracts with landfills or incinerators had higher incomes and were less likely to be minority group members than residents of the cities that generated the refuse—although they did have somewhat lower education levels. There were few differences between the population characteristics of the cities and the census tracts that contained their sewage treatment plants. Possible explanations for these findings are discussed.     

Psychotherapy with Deaf and Hard of Hearing Individuals

ABSTRACT

This qualitative study explored the subjective experiences of deaf and hard-of-hearing individuals in psychotherapy. Which culturally syntonic considerations are necessary for effective psychotherapy with deaf and hard-of-hearing individuals? The findings support the literature on multiculturalism and deafness that entail effective communication, empowerment processes, cultural sensitivity, therapist role flexibility, the imparting of information, and the development of a positive therapeutic relationship. The data focuses on the experience of communicating rather than focusing solely on the acquisition of content as well as the understanding the clinical dynamics of the transcultural relationship in order to make effective use of the social work relationship in treatment. The findings of this study add richness and depth to the existing literature on psychotherapy, with emphasis on the experiential processes of treatment.     

A Measure of Accountability: Clients' Perceptions of a University Mental Health Service

Abstract

The University Counseling Center at the State University of New York at Stony Brook has developed a psychodynamic model for brief therapy in order to meet increased demands for service with limited staff resources. Because the center has both a multidisciplinary staff and graduate student training program, the aim of the model was to translate already existing theories of time-limited psychotherapy into practical, usable, teachable techniques. A major issue addressed was the reluctance to accept brief therapy because of its perception of being superficial and amenable only to symptom relief as opposed to “preferred” long-term treatment, seen as providing in-depth change and personality reorganization.

The model developed is based on one or two assessment sessions followed by eight sessions of treatment. The major distinguishing characteristic of the model consists of the explicit setting of two goals with the patient. Goal I is based on an assessment of the presenting problem and is directed toward symptom relief. Goal II is based on a characterological-thematic assessment of the patient and is directed toward major theme-process issues in which the presenting problem is imbedded. The eight treatment sessions are seen as a dynamic whole. Both goals I and II are explicitly contracted for, and each session number is announced by the therapist.

Experience with the model to date has shown that eight sessions produce characteristic initial, middle, and late sessions, with planned termination, a powerful, dynamic feature not usually utilized with many psychotherapies in which natural or calendar events tend to provide motivation for termination. In addition, major characterological changes can begin when the patient participates in the ego-synthesizing function of understanding the thematic issues within which specific behaviors and emotional reactions are a part.     

Students at St. Joseph's College: Why they are Survivors

Abstract

The 1985–86 academic year was the year of the ACHA Task Force on AIDS, and it also was the first year in which the Northwestern University mental health staff conducted psychotherapy with students wherein AIDS was an issue. We might consider this a “baseline year.” In order to document the first step along what is certain to become a long road ahead, the author reviews the 21 out of 800 cases where the issue of AIDS was discussed, even minimally. Seven cases were summarized to illustrate the spectrum of AIDS concerns and therapist interventions. The review of cases revealed a tendency to split the knowledge of risk from the apprehension of the meaning and emotional significance of one's behavior. This disavowal tended to occur in therapists also.

The psychological, medical, and psychiatric literature on AIDS was reviewed in order to provide a context for the case review. The author examines some of the psychotherapeutic and psychoeducational issues faced by therapists in their work with students during this developing epidemic and the concomitant consciousness raising that is occurring.     

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.     

Family therapy and terminal illness

Abstract

This article describes the experience of a family therapist working in a family with an adolescent child suffering from a terminal illness. This work was undertaken in the framework of the Mexican Institute of Social Security.

In dealing with patents afflicted with incurable diseases such as renal deficiency, osteosarcoma or leukemia, which will eventally lead to death, it is important to know about the successive stages in this progression from life to death and to understand them. Some authors have studied in general the reactions of the dying and their families. Kubler-Ross (1970) reports denial, resentment, bargaining, depression and acceptance; Eric Lindemann (1944) mentions pain, anxiety, tension and guilt as the main components of mourning.

Psychotherapy with the terminal patient and their family is intimately concerned with the separation process, which is always accompanied by anxiety; this can become so acute that it feels like death or total annihilation. The family responds in many ways to this anxiety, but will often not express these feelings; the therapist has to try to discover at which stage of mourning the family has arrived. This is even more important where the patient is an adolescent who has no hope of achieving his longing to live. It is important that we are dealing here with anticipatory mourning, which can prevent serious reactions following bereavement. Great care is required in uncovering feelings of hostility, anger, fear, repulsion and frustration. The patient too must be encouraged to express his feelings; this will relieve tension, and make it easier for the family to accept the reality of what is going to happen.

It is important to keep the family informed about the medical requirements of the treatment. These should be explained very clearly, so that all members understand, accept and cooperate in such tasks as ensuring attendance at out-patient consultations, laboratory investigations and taking the medicine prescribed. We find that often only one member of the family, usually the mother, carries the whole responsibility of caring for the patient. All these matters need to be discussed with the whole family, together with such matters as the patient's school attendance, any problems of family relationships, and plans for the future. The worker needs to help family members to continue their personal growth and development while understanding this crisis, which might otherwise arrest them.

Treatment should not be rigidly planned at the start; as in all psychotherapies, it is necessary to make an initial evaluation of the degree of function and dysfunction in the family. This appraisal is made by exploring family problems, areas of conflict and the resources which are mobilized to support the system. In this process the worker collects all the elements which enable him to get a picture, free from his own technical preferences, so that the data can be integrated, taking into account the opinions of experts on structural family therapy, triaxial or psychodynamic views among others.

In the case I shall describe, we used a combination of theories and techniques, mainly derived from systems theory and psychoanalysis. A purist attitude was not adopted, because our main aim was to find what was of most immediate benefit to patient and family.     

A Comparative Study of a Phenol-Based Mouthwash as a Gargle or a Spray with a Saline Gargle

Abstract

The authors suggest that psychotherapy and career counseling with college students can be identified as potentially concurrent and interactive processes. They seek to increase awareness of this connection and underscore the value of its application when it is appropriate to do so.

Selecting a career is a crucial developmental task for young adults and is, to varying degrees, an integral part of their psychosocial adjustment. The literature is reviewed from five perspectives: the psychodynamic model of career counseling; case examples; integration of career counseling and psychotherapy; a review of the developmental theories of Erikson, Farnsworth, Chickering, and Medalie; and empirical justification.

The authors discuss the rationale for merging student psychotherapy and career counseling and offer case examples.     

A Client Perspective on Therapist Self-Disclosure

Abstract

Options of “coming out” in differing therapeutic modalities are considered. Modalities considered include traditional psychotherapy, alternative therapies, and managed care systems. Therapist disclosure situations are discussed from the viewpoint of both client and practitioner. Vignettes describing therapy experiences of adult lesbian and gay clients in a variety of clinical settings are presented. Clinical issues pertaining to therapist disclosure of sexual orientation receive consideration in terms of client self-determination as well as in terms of the options or limitations imposed by different modalities. Distinctions are drawn between disclosure in predominately lesbian and gay practice settings and disclosure in predominately heterosexual settings.     

Phase Oriented Psychotherapy for Gay Men Recovering from Trauma

Summary

Gay men live in a culture of trauma in the United States. Phase Oriented Psychotherapy offers an integrative treatment model for helping gay men overcome the helplessness and disconnections that result from trauma. Successful recovery in this model yields a basic cognitive shift from indiscriminately attributing traumatic significance to present events to accurately differentiating discomfort from danger and responding to situations with aware choice. The model is a synthesis of the phase-oriented model of recovery with the principles of gay-affirmative psychotherapy. Recovery occurs over stages: (a) Stabilization of symptoms and the development of coping skills; followed by (b) Integration of dissociated or fragmented aspects of experience (including affects, sensations, beliefs, memories, identity); leading to (c) New Self and Relational development. This type of work will present distinct challenges to both therapist and client. Specific techniques are offered to aid the therapist both to assist the client and protect him/herself.     

Feminist psychotherapy with japanese women

Abstract

It has been ten years since first feminist therapy practice took place in Japan. Under circumstances in which there is still great lack of acceptance and understanding of psychotherapy in general, the need for feminist therapy is increasing today. After the revision of laws and institutions has succeeded, we Japanese women need to face a reality in which we learn how to build a flexible strength to negotiate with our environment. It is not easy to grasp a suitable identity avoiding the so-called super woman image. This paper illustrates the activities of Feminist Therapy at “Nakama” (means companion) and some issues regarding feminist therapy that need be discussed. One case is also discussed from a feminist perspective. Although not being presented, in this paper, the issue of sexual violence against women and need for care of the victims is an initiative that needs to be taken by feminist therapist.