THE INTEGRATIVE PSYCHOTHERAPY ALLIANCE: FAMILY,COUPLE AND INDIVIDUAL THERAPY SCALES*

The therapeutic alliance concept has been confined primarily to the literature on individual psychotherapy. This paper formally introduces the concept into the family and marital therapy domain and presents various clinical hypotheses about the nature of the alliance and its role in familyand marital therapy. A systemic perspective is brought to bear on the concept within individual psychotherapy. A new, integrative definition of the alliance is presented that conceptualizes individual, couple and family therapy as occurring within the same systemic framework. The implications of this integrative-alliance concept for family, couple and individual therapy research are examined. Three new system-ically oriented scales to measure the alliance in individual, couple and family therapy are presented along with some preliminary data on their methodological characteristics.     

Psychotherapy with Lesbian,Gay, Bisexual,and Transgender Older Adults

A small literature has addressed psychotherapy with lesbian, gay, bisexual, and transgender (LGBT) samples over the past two decades. Older adults have also been investigated in a growing number of psychotherapy research studies. However, psychotherapy specifically with LGBT older adults has not received adequate investigation. This review relies on converging lines of research to provide an integrated discussion of evidence-based psychological treatments (EBTs) with current research and clinical observations in the field of gerontology and suggests ways in which these topics can inform psychotherapy practice with LGBT older adults. We summarize current research on aging in several areas of practical interest to psychotherapists seeking to apply EBTs in their work with LGBT older adults. These areas include: adult development, coping, stigmatization, social context, and the effects of cohort membership. The results of these studies belie stereotypes regarding both the aging process, in general, and more specifically LGBT older adulthood, with significant implications for the practice of psychotherapy. EBTs are adaptable to a variety of issues encountered in later life by LGBT older adults, and these modifications to therapeutic technique are addressed throughout.     

A BLUEPRINT FOR INCREASING THE RELEVANCE OF FAMILY THERAPY RESEARCH

Family therapy research and psychotherapy research in general have been criticized for their lack of relevance to clinical practice. This paper presents a fivestage model that family therapy researchers can follow to increase the relevance of their work for clinicians and other consumers of family therapy research. Using lessons derived from private industry, the research model is based on a marketing and developmental perspective.     

Cross-Cultural Empathy and Training the Contemporary Psychotherapist

The diversity of today's client population has required that psychotherapy training confront the importance of cultural competence in graduates. Approaches in this area of education create dynamic tensions between stressing therapist openness to diversity and therapist knowledge of clients' cultures. This paper proposes that this attitude-knowledge dilemma in psychotherapy education can be reconciled by helping trainees develop an empathic response capable of transcending cultural differences. Cross-cultural empathy helps provide the therapist with a coherent and familiar means of maintaining affective receptivity in the therapeutic encounter with clients while making use of a repository of information about clients' cultures. Such empathy can also be a base for building the skills needed to develop collaborative relationships with clients who are often disempowered and distrustful. The paper examines approaches and resources for training psychotherapists in cross-cultural empathy.     

Dysfunctional control by client verbal behavior: The context of reason-giving

Dysfunctional control exerted by reason-giving in adult psychopathology is interpreted from a radical behavioral perspective. Verbal-social contingencies which support the establishment of reason-giving and its control over maladaptive actions are reviewed. A contextual approach to psychotherapy, comprehensive distancing, which attempts to weaken dysfunctional verbal control is described briefly. Data relevant to therapeutic process are presented. The overall results suggest that comprehensive distancing facilitates therapeutic change through a process consistent with a behavioral analysis of reason-giving. Suggestions for further research and radical behavioral approaches to psychotherapy are discussed.

     

Conversational evidence in therapeutic dialogue

Family therapists' participation in therapeutic dialogue with clients is typically informed by evidence of how such dialogue is developing. In this article, we propose that conversational evidence, the kind that can be empirically analyzed using discourse analyses, be considered a contribution to widening psychotherapy's evidence base. After some preliminaries about what we mean by conversational evidence, we provide a genealogy of evaluative practice in psychotherapy, and examine qualitative evaluation methods for their theoretical compatibilities with social constructionist approaches to family therapy. We then move on to examine the notion of accomplishment in therapeutic dialogue given how such accomplishments can be evaluated using conversation analysis. We conclude by considering a number of research and pedagogical implications we associate with conversational evidence.     

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.     

Systematic Interviewing Microskills and Neuroscience: Developing Bridges between the Fields of Communication and Counseling Psychology

Originating in 1966-68, Microcounseling was the first video-based listening program and its purposes and methods overlap with the communications field. This article presents history, research, and present applications in multiple fields nationally and internationally. Recent neuroscience and neurobiology research is presented with the important point—“counseling and communication change the brain and encourage the development of new neural networks.— Multicultural issues are important in the microskills framework. Over 500 databased Microcounseling studies exist with translations in 21 languages. The authors suggest that the communication studies field might wish to consider itself also a mental health profession as the teaching of listening skills and effective communication is central to well-being. Furthermore, communication studies can do much to increase multicultural understanding and cross-cultural communication.     

Expanding the Horizons of Forgiveness Therapy: A Cross-Cultural Application with a Bedouin-Arab Woman

This paper highlights forgiveness therapy, a therapeutic approach that has received limited attention in the social work literature. This study represents a beginning exploration of its cross-cultural application. Theoretical and empirical perspectives on forgiveness and forgiveness promoting psychotherapy are provided, and Enright’s pioneering process model is delineated. A case study of the utilization of forgiveness therapy with an Israeli Bedouin-Arab woman who experienced a traumatic interpersonal injury within the polygamous family is presented. LaRoche and Maxie’s guidelines for conducting cross-cultural psychotherapy are utilized to examine important dynamics that emerge in the case study. These authors’ recommendations, which are consistent with a process-oriented conceptualization of culture, as well as intersectionality, appear potentially useful for informing the transcultural application of forgiveness therapy. Future research questions and directions related to the utilization of forgiveness promoting psychotherapy with diverse populations are considered.     

Au Revoir: An Attachment and Loss Perspective on Termination

Traditional views of psychotherapy hold that termination allows both for a consolidation of therapeutic work and an opportunity to work through issues of separation and loss. Such a view suggests not only that those issues will resolve in treatment, but also that endings are inevitable, permanent, and that the feelings invoked can and should be mastered and worked through. Recent research on termination, attachment, loss and grieving suggests a different conception. Consideration of that research can better ground therapists in more nuanced techniques for ending treatment in both child and adult psychotherapy.

A Self-Psychological Perspective on Chronic Illness

It is becoming increasingly common to encounter patients seeking psychotherapy for symptoms resulting from chronic illness. Regardless of the specific diagnosis, chronic illness is a phenomenon with deep implications for disruption of self-states and narcissistic injuries. Working with chronically ill patients presents many challenges to the patient and the therapist, ranging from acute grief and loss to a reworking of unresolved developmental issues. This paper explores the use of a self-psychological perspective in the treatment of chronic and terminal illness. Approaching treatment from a self-psychological perspective, psychoanalytic psychotherapy can be successfully utilized in conjunction with supportive therapy.     

The Pet Connection: An Attachment Perspective

Using the ethological-evolutionary framework of attachment, and including how the theory has been updated and expanded by findings from attachment-based research, neuroscience and animal studies, this paper proposes that a relationship with a family pet, especially a dog or cat, reflects certain dynamics of attachment which may account for the sense of comfort and connection they provide to individuals at all stages of the life cycle. There is now convincing scientific evidence that companion animals have positive effects on psychological and physical well-being, helping shape how people regulate their emotions, deal with stress or trauma, and relate to others. Discussion considers the implications of these benefits for social work, in particular for policy, prevention, and psychotherapy. An illustration of treatment for pet loss, as well as a framework for promoting attachment in pets adopted from rescue shelters, is also presented. It is recommended that both social work professionals and social work students be educated about the human-animal bond and the significance of pets to so many of our clients.     

The Structure of Empathy in Social Work Practice

This article presents a detailed theoretical framework demonstrating how empathy is used in the practice of social work. This consists of affective, cognitive, and behavioral dimensions of empathy and delineates six latent constructs that make up these dimensions. These constructs are (1) caring, (2) congruence, (3) interpersonal sensitivity, (4) perspective taking, (5) altruism, and (6) the therapeutic relationship. Evolutionary, sociological, and neuroscience theories are used to describe empathy's origins as a historically adaptive and interactional process, and social work theories emphasize empathy as an interpersonal helping strategy and organizing principle essential to the practice of social work.     

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.     

Recognizing and utilizing projective identification in brief psychodynamic therapy: A case example

Projective identification is a means by which clients unconsciously communicate their affective, and often intolerable, experiences. Being on the receiving end of a client’s projective identifications can be elusive, confusing, and intense; consequently, the information afforded by projective identification is often disregarded in the therapeutic process. This paper will provide a case example of the author’s personal affective and clinical experiences with a 19-year-old client to illustrate the process of recognizing and utilizing projective identification in brief psychodynamic psychotherapy. Implications and challenges for utilizing projective identification in brief therapy are discussed.This paper was presented at the Annual Convention of the American Psychological Association, Honolulu, Hawaii, July 2004.     

Exploration of the reasons for dropping out of psychotherapy: A qualitative study

Elucidating the reasons for dropping out of psychotherapy can lead to the development of interventions aimed at reducing patient drop out. The present study aimed to explore patients’ reasons for dropping out of psychotherapy in Kermanshah, Iran. The present qualitative study was performed using conventional content analysis. The current sample included 15 participants consisting of 7 patients who dropped out of psychotherapy and 8 psychotherapists who have previously experienced patient dropout. A semi-structured interview was used for data collection. All interviews were audio recorded and subsequently transcribed. Content analysis using constant comparisons was performed for transcribed interviews. Four main categories emerged as reasons for dropping out of psychotherapy: dissatisfaction with the quality of psychotherapy, financial problems in psychotherapy, unprepared socio-cultural context of psychotherapy, and psychotherapy as a non-user friendly treatment. Additionally, specific subcategories within each main category were documented. The results revealed distinct reasons for psychotherapy drop out in the current Iranian-based sample. These identified reasons should be considered and addressed at the onset of treatment as well as in the development of formal interventions aimed at reducing dropout. Further research investigating the antecedents leading to patient drop out is recommended.     

The Implications of Social Neuroscience for Expectation States Theories

We review recent findings from the social neuroscience literature that links status differentiation between individuals to neurological processes, and draw out the implications of those findings for expectation states theories, including its dominant theory of status‐organizing processes – Status Characteristics Theory. Our underlying assumption and implicit argument is that social neuroscience research is useful for both bolstering and corroborating some core sociological claims. In addition, it sheds light on some of the ongoing theoretical debates within sociology. We highlight and discuss the following four social neuroscience findings: 1) Neural activity varies depending on whether an individual is interacting with someone of a lower, equal, or higher status; 2) There is an interplay between status and affect such that status processes may promote the control of emotional reactions; 3) Both men and women are neurologically attuned to high status opposite sex conspecifics; and, 4) Status differences are processed in the same region of the brain as numerical or size differences, and this region is responsible for the coding of information along continuous dimensions. The implications of these points are discussed with respect to sociological theories.     

An Examination of Mandated Versus Voluntary Referral as a Determinant of Clinical Outcome

A literature review was undertaken to examine evidence for the effectiveness of psychotherapy with mandated clients. The primary question addressed was whether or not clients mandated to therapy, whether by court order or by order of their employers, show poorer outcomes than clients who enter therapy voluntarily. To this end, research on client resistance and motivational readiness to change was reviewed. This was followed by an examination of research on the effectiveness of mandated treatment. The question of the potential influence of relationship factors such as the therapeutic alliance was also addressed. The literature review was followed by suggestions for future research on the effectiveness of treatment for clients with mandated or voluntary referral status.     

Focal psychotherapy and self pathology: A clinical illustration

This paper examines the concept of “focal psychotherapy” as a form of psychoanalytic psychotherapy utilizing essentially the same conceptualization of the therapeutic process as long-term psychotherapy or psychoanalysis, mainly that the primary interventions are interpretive. Since in this treatment process a narrower sector of the psychopathology is reactivated than in long-term psychotherapy, the psychotherapy is restricted to the exploration and working through of a focal conflict precipitated by a recent event which has overwhelmed the patient's characterological defense mechanisms. The case report illustrates the applicability of focal psychotherapy to patients whose core pathology is understood to consist of deficits in the structure of the self rather than structural conflict.