Analytic Psychotherapy Research Articles

Intervenções com análises de contingências e tarefas de casa na FAP

Os efeitos terapêuticos das interpretações funcionais e das tarefas de casa, condensadas na regra 5 da Psicoterapia Analítica Funcional são pouco conhecidos. Objetivou-se investigar relações entre a regra 5 e comportamentos do terapeuta e do cliente. O método consistiu em registrar e categorizar interações terapeuta/cliente. Participaram duas díades terapeuta/cliente. Conduziu-se um delineamento A/A+B/A/A+B para uma das díades e um processo terapêutico com FAP sem introdução de variáveis para a outra. Os dados foram analisados com inspeção visual, com correlação de Spearman e com análise de probabilidade transicional. Para ambas as díades, as clientes emitiram análises de contingências mediante procedimento para evocá-las e identificaram tarefas de casa importantes quando as terapeutas evocaram e consequenciaram autoorientações. A regra 5 não influenciou os comportamentos das clientes de analisar contingências, de fazer auto-orientações e de relatar melhorias extrassessão para a díade 1. Discute-se a influência da modelagem de análises de contingências e das auto-orientações na melhora clínica.

Ativação comportamental: Apresentando um protocolo integrador no tratamento da depressão

A Ativação Comportamental (BA), embora venha sendo reapresentada à comunidade de pesquisadores e clínicos como uma dentre as novas terapias comportamentais de terceira geração, desponta desde a década de 1960 com uma longa história de pesquisas e aprimoramentos. Atualmente, coexistem mais de um modelo de protocolo desse sistema de psicoterapia. O presente artigo apresenta um protocolo integrador de BA para o tratamento da depressão unipolar adotado em contexto de clínica escola. Nele, três tipos de depressão são apresentados desde a sua concepção funcional, como a determinada por punição, a determinada por extinção operante e, ainda, a determinada por estimulação aversiva não contingente. Para cada tipo, são apresentadas análises funcionais e intervenções baseadas em propostas de ativação simples e/ou complexas. Ao longo das intervenções propostas, são também apresentadas interfaces de integração com outras abordagens de terceira geração, como a Psicoterapia Analítica Funcional (FAP) e a Terapia de Aceitação e Compromisso (ACT).

Psicoterapias comportamentais no tratamento da depressão

A depressão é um dos transtornos psiquiátricos mais prevalentes no mundo. Estima-se que 5% da população tem depressão. Tratamentos farmacológicos somados as psicoterapias têm mostrado resultados eficientes no tratamento da depressão. As psicoterapias comportamentais têm sido utilizadas no tratamento dessa patologia. Resultados como redução dos sintomas, aumento no repertório social e melhora nas relações sociais têm sido frequentemente associados a essas intervenções. O presente estudo bibliográfico objetivou descrever as intervenções comportamentais e suas aplicações no tratamento da depressão. As psicoterapias comportamentais aplicadas no tratamento da depressão encontradas na literatura foram: terapia comportamental ou analítico-comportamental; terapia da aceitação e compromisso; psicoterapia analítico funcional; ativação comportamental e terapia cognitivo-comportamental. De acordo com esta literatura, o indivíduo com depressão tende a apresentar redução na frequência de comportamentos reforçados positivamente (atividades prazerosas) e aumento, concomitante, de comportamentos de fuga e esquiva de situações aversivas. Parece que perda de reforçadores positivos e aumento de estímulos aversivos, bem como, dificuldade em lidar com situações-problema favoreceriam o desenvolvimento da depressão. O tratamento da depressão envolveria discriminação dos estímulos mantenedores desse transtorno, instalação e manutenção de comportamentos incompatíveis com os sintomas (queixa do cliente),aumento e/ou instalação de habilidades sociais, e aumento de atividades prazerosas. Um olhar global sobre esse fenômeno permite que o terapeuta identifique os déficits comportamentais que o indivíduoapresenta. Assim, modificar comportamentos e pensamentos parece ser importante quando se pretende tratar a depressão. As terapias “da aceitação e compromisso” e “ativação comportamental” apresentaramresultados significativos na prevenção do reaparecimento dos sintomas em longo prazo.

La integración más allá del diagnóstico: Aplicaciones de los nuevos modelos transdiagnósticos


 
 
 Presento en este el artículo una visión de los modelos transdiagnósticos desde una perspectiva de alguien que llega a él desde los modelos integradores en psicoterapia, concretamente desde la psicoterapia cognitivo analítica. Expondré de las características generales de los modelos transdiagnósticos, centrándome en la polisemia del término transdiagnóstico y la necesidad de definir con una mayor claridad los diferentes significados que se dan para este término. Se han descrito muchas variables que se han denominado transdiagnósticas y pasaremos una revisión a las mismas. Se abordará alguna reflexión en torno a temas de interés muy actual en relación al campo transdiagnóstico como es la regulación emocional, la función reflexiva como un factor común y el mindfulness, concebido desde la perspectiva transdiagnóstica y terminaré describiendo los modelos clásicos dentro del campo de la psicoterapia transdiagnóstica y me centraré fundamentalmente en las aplicaciones de los modelos transdiagnósticos en los trastornos de la personalidad.
 
 

Blocking Avoidance and Escape Responses: Relations With Clinically Relevant Behaviors

Abstract: The current study aims to evaluate the possible effects of interrupting problematic clinically relevant behaviors on the percentage of these responses and of clinical improvement-related responses. Two clients were treated with Functional Analytic Psychotherapy (FAP), alternating two conditions (ABAB). On condition A, procedures to the therapist consisted of responding to the clinical improvement responses, and to description of outside of therapeutic setting behaviors, but therapists were advised to ignore problem behaviors emitted in session. During condition B, therapists followed the same procedures, but they were oriented to block (interrupt) problematic responses emitted in session. Results suggest increase in the percentage of problem behaviors during condition B. Results are discussed, highlighting the viability of planning the contingent response the therapist emits to clinically relevant behaviors.

Relationship science informed clinically relevant behaviors in Functional Analytic Psychotherapy: The Awareness, Courage, and Love Model

The use of idiographically defined target behaviors in Functional Analytic Psychotherapy (FAP) has limited participation in a reticulated model of treatment development. One way to address this limitation is to offer a standardized set of clinical targets for FAP. The current study details a method of identifying standardized treatment targets in FAP using the Awareness, Courage, and Love (ACL) model. The applicability of the model was assessed by evaluating the degree to which previously identified clinical targets in FAP research correspond with the proposed specific categories of the ACL model. There is an 83.67% fit between past idiographic targets and current standardized targets. We discuss how ACL may be clinically useful and encourage more integrative treatment development for FAP.

Contextual Behavioral Science and Global Mental Health: Synergies and opportunities

Global Mental Health (GMH) initiatives aim to address inequities in mental health care across the world. Particular emphasis is placed on building mental health service capacity in low- and middle-income countries (LMIC) where over 80% of the global population live. Consistent with this approach, concerted efforts are being made to globally disseminate psychological interventions. These initiatives must negotiate tensions that exist between making interventions sufficiently scalable, whilst retaining aspects of the psychotherapy process that maximize both the acceptability and efficacy of psychological interventions. This paper reflects on the important contribution that Contextual Behavioral Science (CBS) can make to GMH. CBS draws on behavioral and environmental principles that translate into various therapeutic applications [including Acceptance and Commitment Therapy (ACT) and Functional Analytic Psychotherapy (FAP)] and social change initiatives (such as the PROSOCIAL approach). Consideration will be given to the cross-cultural utility and validity of CBS approaches, and the way in these can help ensure that GMH initiatives extend beyond narrow efforts to address symptoms of mental disorders to include a focus on enhancing wellbeing. It is proposed that knowledge from ACT and FAP can help build sophistication in efforts to develop and deliver ‘therapist-free’ psychological interventions that will need to retain sensitivity to clients’ emotional expressions. In addition, the PROSOCIAL approach provides opportunities for groups of people to cooperate effectively to achieve shared aspirations and build ‘communities of support’ that can serve to optimize peoples’ mental health and wellbeing.

Migration as an Unconscious Search for Identity: Some Reflections on Language, Difference and Belonging

The author addresses some issues regarding patients who relocate and who struggle with adaptation to a new reality. She argues that emigration is a complex psychological phenomenon that requires a therapist to pay special attention to the issue of language, difference and identity, and suggests that the issues of different culture and language in analytic psychotherapy need to be considered as part of a wider cultural context to which we all belong, rather than a specialized area of interest. The paper illustrates, through the clinical example of an East European male patient, that the psychic work of emigration can be understood as a process of integrating splits between pre‐ and post‐migration selves. The author concludes that the analyst needs to let herself be involved as a ‘real person’ to reach the non‐interpretative aspects of the patient's psyche through a mutuality of shared experience to promote a change.

Features of formation and system of psychoprophylaxis of suicidal behavior in young patients with depression

The work covers the study of the formation of suicidal behavior in young adults with depressive disorders and developing of pathogenetic based system of its prevention. There were clinical and psychopathological signs of depressive disorders in young patients analyzed. Anxiety, asthenia, asthenic-apathetic and melancholy variants of depressive disorders in young patients with suicidal behavior were highlighted. In this study, there were the markers of suicide risk for young patients with depressive disorders determined: high suicide risk, low death self-consciousness, high anhedonia level, clinical manifestations of anxiety and depression by the hospital anxiety and depression scale, severe anxiety and depression by the Hamilton anxiety rating scale, major depressive episode by the Montgomery-Asberg depression rating scale. It has been proved that in observed young patients with depressive disorders with suicide behavior increased concentrations of serotonin, cortisol, noradrenaline and decreased levels of adrenaline and melatonine in plasma were observed. These changes were determined as neurohormonal background for depletion of adaptation resource in stress situations. There were approaches to differentiated prevention of suicidal behavior in depressive disorders in young people validated that include pharmacotherapy (selective SSRI, melatonin, serotonin and norepinephrine), psychotherapy and psychoeducation. Psychotherapeutic complexin patients with depressive episode must include personality-oriented psychotherapy, cognitive behavioral therapy, family therapy and autogenous training; in disorders of adaptation – rational psychotherapy, cognitive-behavioral analytic psychotherapy, family therapy, autogenic training. Psychoeducation should be carried out using information modules, training a positive self-image, improved compliance; formation of communication skills, problem solving, interpersonal interaction and problem-oriented discussions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Extended Behavior-Context Relations: a Molar View of Functional Analytic Psychotherapy

This paper seeks to reinterpret current tenets of functional analytic psychotherapy (FAP) using some assumptions of molar behaviorism. In it, a conceptual alternative to the molecular approach is proposed to explain the mechanisms of change of FAP. To achieve this goal, the utility and limitations of using discrete responses and stimuli as units of analysis are discussed. As an alternative, this paper suggests, as proposed by molar behaviorism, using activities as the unit of analysis. The use of activities as the unit of analysis would allow analyses of clinical behavior as choices in different time scales and measurements of clinical behavior using time allocation. Using choice behavior to analyze data allows analyses of behavior in terms of its short-term and long-term value. It is argued that time allocation as a unit of measure is more appropriate than the rate of behavior because it allows the continuous measurement of behavior and comparisons of disparate behaviors as they occur during therapy sessions. Finally, a multi-scale analysis would allow the articulation of long-term and short-term contingencies that are related to therapy and behavioral change.

Saying good goodbyes to your clients: A functional analytic psychotherapy (FAP) perspective.

Functional analytic psychotherapy (FAP) promotes client growth by shaping clients' daily life problems that also show up in session with their therapists. FAP therapists create evocative contexts within therapy that afford clients the opportunity to practice, refine, and be reinforced for new, more adaptive behaviors which then can be generalized into their outside lives. In FAP, the termination process will vary from client to client depending on the nature of the client's problems and targets. For many clients, the process can be a rich, multifaceted, final opportunity to evoke, reinforce, and promote generalization of clients' in-session improvements, particularly improvements related to vulnerable self-expression in the service of intimate and close relationships. By making explicit agreements at the outset of therapy to participate in an intentional termination process, and by later providing an evocative structure for ending therapy with vulnerable emotional expression, clients have the opportunity to develop more adaptive behaviors in the context of relationship endings which can be a painful part of the human experience. Equipped with the skills of open-hearted communication developed from an authentic relationship with their therapist, clients can leave therapy on a trajectory of further growth in interpersonal connection and living more boldly. (PsycINFO Database Record

Psychoanalytic Group Psychotherapy

ABSTRACTThis piece explores the principles of analytic group psychotherapy which inform the understanding of psychopathology, the conditions and goals of treatment, the use of the group, and the role of the therapist. The clinical example will be considered primarily in contrast to the analytic approach presented here, from which it differs in many significant ways.

Review of Listening with the fourth ear: Unconscious dynamics in analytic group psychotherapy.

Review of Listening with the fourth ear: Unconscious dynamics in analytic group psychotherapy.

A therapeutic dilemma: symbolic versus literal approach whilst working with adolescent patients, shown with the use of clinical examples.

The purpose of this paper is to discuss a dilemma often faced by psychotherapists from various therapeutic schools: a choice between a symbolic and literal approach. Authors, Jungian Analysts and Clinical Psychologists with long-term clinical experience, focused in their article on that how this dilemma manifests in analytical psychotherapy of adolescent patients. In order to illustrate this issue, Authors introduced two clinical examples from their analytical work with adolescents. The article has been prepared based on the material presented by the Authors during the 23rd International Conference on Adolescent Medicine & Child Psychology “Unveiling Novel Therapies and Developmental Strategies to Help Children Grow Better”, organised by Conference Series on the 28th-29th of September 2017, in Berlin. Some of the patients' data has been changed due to confidentiality.

The meaning of recovery in analytical psychotherapy

Analytical psychotherapy offers a treatment framework which takes a very specific stance. It is based on the principle of not attacking the symptom head on, but seeing it as an event conveying meaning and a function. This approach still fulfils a therapeutic objective, that of supporting patients with regard to the psychological side of their life and helping them to deploy their own potentialities.

Zakasnela psihoterapija darovitih - prikaz slučaja

Leading authors in research on giftedness highlight that in childhood the talent exists only as a potential for future achievements. On the other hand, lately, the aspects of atypical and unevenly development have been defined. They can slow or even prevent a person from realizing achievements that are in correlation with the potential that has been observed in childhood. Moreover, the more cognitive development or the development of a specific gift is pronounced, the uneven development and personality traits may be pronounced as well, with a risk of developmental disorders, psychiatric symptoms and emergence of psychopathology rising. Even asking for help on time, after the first symptoms are recognized, does not give security. Psychological and psychotherapeutic help need to be long term and well structured. In this paper we show unstructured and discontinuous psychiatric treatment to a multi-gifted patient, who started his psychotherapeutic treatment with group analytic psychotherapy in his late adult life.

Effects of Functional Analytic Psychotherapy Therapist Training on Therapist Factors Among Therapist Trainees in Singapore: A Randomized Controlled Trial

Functional Analytic Therapy (FAP) therapist training protocol was effective in improving empathy and FAP skills among Singaporean therapist trainees. These improvements were maintained at 2-month follow-up. The training was found to be acceptable in the Singaporean context, although several adaptations were suggested to increase the compatibility between FAP principles and local cultural norms.

Functional Analytic Psychotherapy for Nursing Home Residents: A Single-Subject Investigation of Session-by-Session Changes

Nursing home settings contain unique environmental factors that may promote the acquisition and maintenance of problematic interpersonal behaviors. Functional Analytic Psychotherapy (FAP) is a contextually-based behavior therapy that can be used to modify problematic interpersonal behaviors via carefully provided and contingent in-session responses of the therapist to client behaviors. Thus, FAP would appear to be a particularly well-suited intervention approach for nursing home residents. To date, the effects of FAP have not been reported for nursing home residents. The current single case study assessed the effects of FAP on three nursing home residents using a single-subject AB design. The AB design consisted of a 2-weeks baseline phase followed by a 4-week FAP treatment phase. The nursing home residents completed pre-treatment and post-treatment measures of interpersonal relating. Client interpersonal behaviors were also recorded during each session and coded into two categories: Maladaptive in-session behaviors and adaptive in-session behaviors. Using the reliable change index and Swanson’s dsw to evaluate questionnaire outcomes, results indicated that all three participants reported a significant change in interpersonal functioning. Analysis of in-session behavior indicated that there were significant decreases in maladaptive behaviors and an increase in adaptive behaviors for two clients. Finally, observed in-session behavior changes were congruent with self-reported changes in interpersonal behavior. These results indicate that FAP was an effective intervention for these nursing home residents.

The Preoedipal and Oedipal Structure of Termination: An In-depth Case Study.

Much has been written about the Oedipus complex as a central organizing focus for the understanding of early developmental attainments as well as for the structuring of the personality, but nowhere are triangular forces more vitally active, clinically, than in the termination phase. The decision to end, once agreed upon, typically sets in motion a symmetrical process in which two dynamics occur concurrently. First, what drives the termination is a mourning process in which the primary task is to relinquish the analyst as a transference object and to establish the analyst as an internal object. In parallel, oedipal structures take hold of the termination process so that the final working-through and the resolution of the transference/countertransference can be maximized-with the goal of integration. An eight-year, four-times-a-week analytic psychotherapy on the couch is described to illustrate the critical role of triangulation dynamics in termination. Using in-depth transcripts of dream and sessional material, the author highlights a number of conscious and unconscious resistances in the patient to this phase of work that were particular to his perverse oedipal pathology. Ron Britton's concept of an organized oedipal illusion or an oedipal delusion as defenses against the termination phase proved helpful to both patient and psychotherapist in negotiating some of the heightened emotional aspects of the final working-through.

Psychoanalysis in China: an Essay on the Recent Literature in English

Using extensive quotation, the author reviews the introduction and current state of psychoanalysis and psychoanalytic psychotherapy in China from the vantage point of recent publications in English. Psychoanalysis was briefly introduced to China before the Communist era, then forbidden, and has experienced an accelerated reintroduction since the late 1980s. The author briefly summarizes the cultural and historical background of China relevant to the introduction of psychoanalysis, the traumatic history of China, and the deep structure of thought and philosophical differences from Western culture that challenge a simple imposition of psychoanalytic ideas and practice, and some psychological effects of rapid cultural change throughout China. Training programs in China, the general enthusiasm for analysis among the Chinese, and a number of notable contributions by Western and Chinese authors are discussed. Also surveyed are the use of distance technology for training and treatment, the personal experience of Chinese senior and junior colleagues, and ongoing challenges to the continuing growth of psychoanalysis and analytic psychotherapy in China.