The Metaphor Goddess in Three Quarter Time: A Relational Use of Story And Metaphor

This paper explores co-creating, and integrating metaphor and story within the relational space of patient and analyst where new meanings can be co-authored into a more adaptive autobiography—a tale based on the impressions of life. Through this joint construction of intersecting stories, a person has an opportunity to rewrite a story which allows an individual to function more productively and creatively— a goal of psychotherapy.     

Toward an Integrated Understanding of Dreams

In this paper four different schools of dream analysis—classical, object relations, modern psychoanalytic, and self-psychological—are described, compared, and contrasted. Each approach is then applied to an analysis of the first dream reported by a patient. As each interpretations is accurate and useful in understanding this patient's psyche, it is concluded that an integrated framework should be used in dream analysis.     

The experience of divorce for the psychotherapy patient—A developmental perspective

In this article the dynamics of divorce are discussed from the perspective of psychoanalytic developmental psychology. This theoretical framework is used to highlight and to explain some typical internal and external responses of psychotherapy patients for whom divorce is an issue. A therapeutic stance is suggested that enables the patient to understand the connection between his or her marital situation, early life experience, and past developmental problems. The patient's preoccupation with the unsatisfactory marital relationship can serve as a catalyst for the strengthening of the patient's overall ego functioning. This article demonstrates Kris' (1951) concept that the material at the psychic surface-in this case divorce-needs to be explored in such a way that the patient's ego is enlisted in his or her total growth.     

Micro Ruptures and Repairs in the Beginning Phase of Cross-Cultural Psychotherapy

The article discusses misunderstandings and misattunements that occur in the beginning phase of cross-cultural psychotherapy. Sources of micro ruptures are outlined, including client maladaptive patterns, therapist misunderstandings, cross-cultural misunderstandings due to cultural variations, and asymmetrical power relations involving the impact of prior experiences or current therapy practices. Multiple clinical vignettes illustrate the rupture/repair process, drawing on Safran and Muran’s (2000) list of direct and indirect techniques.     

Patient assertiveness in ethnically diverse older women with breast cancer: Challenging stereotypes of the elderly

Patients' views of patient-physician interactions—particularly the perspectives of older, ethnically diverse women—are poorly understood. The older patient's attitude toward and understanding of the medical encounter, however, are essential to the design of strategies to improve patient-physician communication. To date, investigations have primarily emphasised the ways in which the therapeutic relationship is influenced by immutable patient characteristics. This qualitative study extends previous research findings by looking beyond the effect of ascribed categories (such as age, race, and gender) and focusing on aspects of patient behavior, specifically assertiveness. Focus groups were conducted with older African-, Chinese-, European-, and Hispanic American breast cancer patients from sites in the eastern and western United States. The study explores the potential of a form of patient activation for challenging stereotypes of the elderly and changing health care practitioners' behavior.     

The Clinician as a Dreamcatcher: Holding the Dream

This paper describes the child patient's communication to the clinician of cherished hopes and ambitions—the child's dreams. The clinician performs important holding functions by catching and keeping the child patient's dreams intact for him or her over time. The paper also demonstrates essential mirroring selfobject functions the clinician performs by recognizing and acknowledging the child's dreams in the therapeutic relationship. Dreams are understood as a component of development. The therapist's dreamcatcher role bolsters the child's tentative capacity to be interested in himself/herself and the outside world. Three clinical vignettes are used to highlight the role of the clinician in creating an empathic milieu by acknowledging, understanding, validating and preserving the dreams.     

People in a World Between: Psychodynamic Themes in the Treatment of Bisexual Patients

Normal sexual behavior is on a continuum—with homosexuality at one end, heterosexuality at the other, and bisexuality at the midpoint. Most people have some bisexual potential. A bisexual person is capable of having intimacy with either a man or women but may be made uncomfortable by the ambiguity of their libidinal longings, feel different, isolated, and long to make a clearer gender choice—homosexuality or heterosexuality. The sacrifice to the self and the psychic conflicts that block such a lifestyle resolution brings these bisexuals into treatment and clinicians are confronted with a need to apply psychodynamic theory in new and more flexible ways. Using two case studies this paper discusses forms of androgynous transference, pregnancy fantasy, and dream interpretation that can unfold in the psychotherapy of bisexual patients.     

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.     

Returning to psychotherapy with the same therapist: A self psychological perspective

Terminations or interruptions of psychotherapy which have been followed by a patient's resuming therapy with the same therapist at a later time have often been viewed as premature with the implication that the initial therapy has been inadequate or deficient. This paper suggests, however, that a patient returns to the same therapist because the selfobject bond established in the initial treatment is still intact, and that the hiatus between treatments can be a time of further development and strengthening of self structure. Two clinical cases are described which illustrate these ideas.     

Self psychology and the psychotherapy of psychotic patients: A case study

Self psychology has previously been employed in describing the treatment of narcissistic personality disorders. This article discusses the clinical application of concepts of self psychology to the psychotherapy of a psychotic patient. Empathy and the concept of empathic failure were very helpful in conceptualizing the therapeutic process. The two selfobject transferences of mirroring and idealization were both present in this case, and the recognition and interpretation of these transferences were critical in understanding the therapeutic process. The patient's delusional experiences receded and began to be less disruptive as the selfobject transferences emerged and remained in place. The resurgence of delusional material was usually indicative of a failure of empathy and a disruption of the selfobject transference. This patient's ability to regulate his anxiety and calm himself was considerably enhanced during the course of treatment. Self psychology and the understanding it provides proved to be of great value in the treatment of this patient and has wide applicability to the psychotherapy of psychosis.     

Containing Violence: A Case Study Illustration of Bion's Container-Contained Model as Applied to Mother–Infant Intervention

Secure Beginnings is a program of psychotherapy for pregnant women with potential problems in the formation of the parent–child relationship including, in the extreme, infant maltreatment. The core of the therapeutic process is to help the mother recognize and think through unbearable thoughts and feelings rather than project expectations of abandonment, hate, helplessness or ridicule into her infant. Case material, from 18 months of treatment, is used to illustrate the Secure Beginnings approach. The case is a mother with psychosis and addiction who lost nine previous children to foster care.     

PSYCHOTHERAPY IN PRISON: THE FRAME IMPRISONED

Very little is written in the literature by or about clinicians providing psychotherapy in prison. This article will examine psychotherapy in prison through the criteria of Langs’ (Psychotherapy: A basic text. Northvale, NJ: Jason Aronson) therapeutic frame. These criteria include: stability and neutrality of the therapeutic setting, therapist anonymity, fee consideration, and confidentiality. I will use my experiences from various prison settings to examine similarities and differences between psychotherapy inside and outside prison.I wish to thank Drs. Jacqueline Helfgott, David Lovell and Lorna Rhodes for their generous time and suggestions toward making this, originally lengthy article, manageable and readable. I am solely responsible for whatever shortcomings remain.     

The Effects of Suicide on the Private Practitioner: A Professional and Personal Perspective

A patient's suicide has a profound effect on the therapist and psychotherapy with a chronically suicidal patient is particularly troubling. Guilt over one's failure to recognize the warning signs, fear of one's incompetence or irresponsibility, shame that one has failed, and fear of being blamed by the patient's loved ones and by colleagues are feelings that frequently surface and that can result in isolating a practitioner from the very sources of peer support that are necessary in order to resolve the trauma. This article explores the effects of suicide on the private practitioner. It discusses how burnout and vicarious traumatization impact upon the therapist who treats the chronically suicidal patient. Two clinical examples illustrate the impact of working with imminent suicide and the aftermath of a patient's death from a personal perspective. Recommendations are made to help private practitioners maintain equilibrium when working with these overwhelming case situations.     

Cyber Counseling for Queer Clients and Clinicians

Abstract

As the Internet grows, so does its use by mental health professionals and by clients seeking mental health services. Drawing on his own experience as an example, the author describes how the Internet can enhance clinical practice. Social service professionals can utilize the Internet to provide a supportive forum for patients grappling with issues of self-identity; facilitate communication between therapist and client; provide community education about mental health issues; provide referrals to local social service professionals; market a private psychotherapy practice; and provide patient billing, scheduling, and record keeping.     

Integrating Gestalt psychotherapy into social work practice with adult oncology patients

This article will provide an examination of Gestalt psychotherapy and its application to adult cancer patients. Gestalt psychotherapy can be utilized as a psychosocial intervention targeted to meet the needs of oncology patients. The following article will examine Gestalt therapy theory and review basic principles to utilize in clinical practice. The authors will highlight the populations to which Gestalt has been applied, and additional case vignettes will demonstrate concrete ways to incorporate this theory into practice with oncology patients.     

Culturally Relevant Psychotherapy for Perinatal Depression in Low-Income Ob/Gyn Patients

To minimize barriers to care, ameliorate antenatal depression, and prevent postpartum depression in low-income women, we propose that a culturally relevant version of brief interpersonal psychotherapy (IPT-B) may be an effective approach. IPT-B is a modified form of Interpersonal Psychotherapy (IPT), an efficacious treatment for depression that we have altered to address the needs of women who have difficulty adhering to longer courses of psychotherapy. Culturally relevant additions to IPT-B include (1) a pre-treatment engagement strategy consisting of an ethnographic interview accompanied by psychoeducation to engage women in treatment; (2) convenient delivery of IPT-B in a public care Ob/Gyn clinic where the women receive prenatal services; (3) flexible scheduling of treatment sessions at the clinic or on the phone; and 4) facilitation of access to social services.     

The Relevance of Psychoanalytic Ideas to Crisis Work

The therapeutic aim of crisis work typically has been to help the patient regain a pre-morbid state of functioning with an almost exclusive focus on the amelioration of immediate symptomatology. Drawing on our experience in a crisis team of a major metropolitan hospital with a large Hispanic and African-American population, we contend that crisis work ought not to focus myopically on symptom removal and must include, to the highest degree possible, an exploration of the multiple meanings contained in what is possibly a turning point in the patient's life. Toward this aim, we describe three psychoanalytic principles believed to be particularly relevant to crisis work that have, nonetheless, traditionally been deemed inappropriate for this treatment modality. These principles are historicity, neutrality, and fantasy. Discussion of the principles are presented within the context of case material.     

The uninterpreted rage: Protecting the therapeutic alliance in the treatment of borderline patients

After reviewing differing approaches to the treatment of the borderline patient, this paper describes the treatment of a patient whose negative transferences are not interpreted by the therapist; rather, the focus is on maintaining the therapeutic alliance via the awareness of the kinship selfobject function of the therapist and merger with the idealized selfobject.There is no end unless the bottom of the trough has been reached, unless the thing feared has been experienced. (Winnicott in Casement, 1991, pp. 129–130). As a matter of fact in these cases it is of decisive importance for the psychotherapist to remain clearly differentiated from the core of psychopathology—if he cannot achieve this separation and becomes drawn into the patient's delusions, he loses his tie to the healthy remainder of the patient's psyche and thus his therapeutic leverage. The maintenance of a realistic, friendly relationship with the psychotherapist is thus of crucial importance in the treatment of the psychoses and borderline states ... (Kohut, 1971, p. 30).     

Career Counseling With Black Men: Applying Principles of Existential Psychotherapy

Counselors may benefit from applying principles of existential psychotherapy to career counseling with Black men. Existential psychotherapy asserts that there are 4 issues that all people experience: death, freedom, isolation, and meaning. The life experiences of Black men, including difficulty with their careers, suggest that they may struggle with these existential concerns, particularly finding meaning in their lives. Because work and issues in other domains of life (e.g., family, community) often intersect, an existentially based career counseling approach may prove useful. An overview of existential psychotherapy is presented, followed by a discussion of its applicability to career counseling with Black men. In addition to suggestions for career counselors, recommendations for training and professional development are offered.