Recovering Process from Child Sexual Abuse During Adulthood from an Integrative Approach to Solution-Focused Therapy: A Case Study

ABSTRACT

In recent times, strengths-based recovery approaches that focus on the present and build strategies that look toward the future have become popular. However, some cases require the consideration of experiences from previous stages of the clients’ development. This single-case study explores the psychotherapeutic process of a middle-aged woman who presented with a history of child sexual abuse (incest) and a long-term adult diagnosis of depression that was treated in public health services. This psychotherapy involved an integrative approach to solution-focused therapy; specifically, the approach proposed by Yvonne Dolan to work with adult survivors of sexual abuse, in conjunction with techniques and strategies from the transtheoretical model. Measures incorporating therapeutic working alliance and outcomes were administered over sessions. Results showed positive outcomes from this therapeutic intervention, which remained at 3-month and 12-month follow-ups. Implications for practitioners’ specialist practice in health services are discussed, given the complexity of comorbid mental health conditions with a history of child sexual abuse.     

Psychotherapy with Lesbian and Gay Clients from an Adult Life Course Perspective

Abstract

A life course perspective of gay and lesbian adulthood enriches our understanding of clinical presentations and modifies our conception of psychotherapy. The author describes shifts in his psychotherapeutic orientation characterized by an increasing recognition of the importance of social, cultural, and historical forces that shape gay and lesbian mental health. Given the uncharted nature of many gay and lesbian lives across adulthood, existential questions about the meaning of life choices are often present in the consulting room. Therapists working with gay and lesbian clients embark on an empathic journey informed by treatment skills as well as our joint participation in a world of significant social change.     

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.     

Third award: A follow‐up study of patients discharged as “improved” 1

In this study, the author researched his clinical practice in a community mental health center with six parental couples whose latency-aged children suffered from prevalent separation anxiety disorder symptoms. Through thematic analysis of the anamnestic process recordings of 53 parent sessions, the author's speculation on the effectiveness of the supportive psychodynamic psychotherapy techniques to psychodynamic clinical social work practice with parents was confirmed. Nine of thirteen supportive psychodynamically grounded therapy techniques were highlighted, whereas the clinical practice produced three more. The techniques permeated and shaped the author's clinical social work intervention, and a follow-up confirmed the reduction in mental health symptoms for the children and also increased parental satisfaction in response to the interventions.     

Shared Spaces: An Intersubjective Case Study of a Graduate Student by a Graduate Student

The intersubjective therapeutic experience creates a shared space within which client and therapist are affected and changed, as seen in a psychotherapy case involving graduate students and a graduate student clinician. Analysis of a clinical case composite from an intersubjective perspective is the primary tool used to examine client–therapist concurrent graduate work. A composite is used to protect confidentiality. Several themes are explored: anxiety, perfectionism, and socioculturally situated life stage. As a search of the literature revealed no previous work on the intersubjective experience of psychotherapy when client and therapist are engaged in concurrent graduate work, further exploration is encouraged.     

Ego Psychological Contributions to Understanding Psychopharmacology and Clinical Practice in Social Work Education

Due to increasing evidence that supports the efficacy of combined pharmacology and psychotherapy in the treatment of multiple psychiatric disorders, an educational focus on integrated approaches is growing in social work and related fields. However, there are few guiding clinical theoretical models that can help students integrate pharmacology and clinical issues. The authors propose that ego psychology can advance clinical knowledge by helping students understand pharmacological issues and integrate pharmacotherapy with psychotherapy. Assessing ego functions in response to medication referral and use contributes to enhanced assessment and treatment.     

Considering Improvisation: Play,Transitional Space,and Discovery

This article explores the concept of improvisation in the therapeutic setting as a complex construction when elaborated in the idiom of jazz music. A composite clinical case is offered that illustrates an impasse and how improvisational thinking offers a way forward. Improvisation has recently been conceptualized through the metaphor of theater improvisation, dance, and rhythm. The therapeutic hour is considered an improvisational dialogue with the main theme (melody) and counter melodies, and harmonic possibilities that underlie the rhythmic pulse of the hour. Improvisation requires a reflective/interpretive process that draws on patterns, structures, and experiences reformulated in the relational field of the participants. The client initiates the call and response pattern, from which improvisation emerges as a mutual process of discovery. A more relaxed, receptive, and reflective posture extends Winnicott’s 1971 notion of play to integrate classic understanding and relational interaction.     

Experiencing Inequality: Memoirs,Hardship, and Working-Class Roots

Thirty-two literary memoirs constitute the database for this research on how economic deprivation and classism affected the early lives of gifted writers who grew up in poor and working-class families. All the memoirists experienced material deprivation, ranging from severe hunger to insufficient funds for college. Many encountered discrimination based on their lower-class status, attitudinal barriers to intellectual development and upward mobility, and deficits in public school education. Institutional support came from extracurricular activities, public libraries, religious participation, and government funding. The mental health practitioner’s respect is likely to have special potency for clients undermined by past experiences of inequality and classism.     

Return to work: A comparison of two cognitive behavioural interventions in cases of work-related psychological complaints among the self-employed

Abstract

We investigated the effectiveness of cognitive behavioural therapy (CBT) and a combined intervention of workplace- and individual-focused techniques among self-employed people on sick leave owing to work-related psychological complaints (such as anxiety, depression, and burnout). Both interventions were based on CBT; however, one was conducted by psychotherapists and involved extensive CBT, while the other was delivered by “labour experts” and consisted of a brief CBT-derived intervention combined with both individual-focused and workplace interventions. One hundred and twenty-two self-employed people who had applied for sickness benefit from an insurance company enrolled in a randomized controlled design. These individuals were assessed before the intervention and then at 4 months and 10 months after the onset of the intervention. The outcome was assessed based on duration of sick leave until partial and full return to work and on psychological complaints. Significant effects on partial and full return were found in favour of the combined intervention: partial return occurred 17 and 30 days earlier in this group than in the CBT group and the control group, respectively. For full return to work, the difference was approximately 200 days. A decrease in psychological complaints was present in each condition but we found no significant interaction effects. The results suggest that work resumption should be addressed earlier in individuals receiving CBT. This insight is of value for the (scarce) literature concerning interventions for individuals who are on sick leave owing to work-related psychological complaints.     

积极心理学视野下的心理治疗观

积极心理学作为21世纪最具影响力的心理学思潮,深刻影响了当代心理治疗的价值观与方法论。由此而兴起的积极心理治疗方法作为积极心理学的重要实践领域,在理论上坚持积极的人性观,重视来访者自身的积极因素,采用科学的更是艺术的积极治疗方式。技术观上则呈现出不同的方法论取向,发展出博采众长的积极心理治疗技术。但积极心理治疗观中也存在着未来向何处去,方法论的分裂以及是否具有普适性的问题,从而引发了关于与当前心理治疗理论、两种方法论以及东西方治疗模式整合的思考。