Psychotherapy Case Research Articles

Clinical Case of Trauma-Focused Psychodynamic Psychotherapy for a Veteran With PTSD and Race-Based Trauma.

Clinical Case of Trauma-Focused Psychodynamic Psychotherapy for a Veteran With PTSD and Race-Based Trauma.

Éxito terapéutico e instrucciones: comparación del desempeño del terapeuta a través del análisis de la conducta verbal

Instructions are used in clinical practice to facilitate the acquisition of new behaviors and eliminate other problematic ones. Despite various studies on instructions in the experimental field, there is not as much research framed within the clinical realm. Therefore, the objective of this article is to explore therapeutic interaction in relation to instructions. Eleven cases of individual psychotherapy were recorded using an observational methodology and the Acoveo category system. The sample was divided into three groups (success, partial success, and failure) based on their percentage of protherapeutic verbalizations, and the significance and Yule’s Q statistic of three sequential analyses were compared. The relationships studied were: Instruction Follow-up and Positive Reinforcement; Non-Instruction Follow-up and Negative Reinforcement; Instruction Follow-up and Discriminative Stimulus; client and therapist categories, respectively. The results showed that in the second and last relationship in the success group, they were significant unlike the others. In conclusion, in all three groups, therapists reinforced follow-up expressions, but only in the success group were non-follow-up expressions punished, and follow-up affirmed by the client was evaluated significantly.

Psychedelics in Palliative Care, Ready for Primetime! Making the Case for Ketamine-Assisted Psychotherapy

Psychedelics in Palliative Care, Ready for Primetime! Making the Case for Ketamine-Assisted Psychotherapy

Resource-Based Psychotherapy Model Application in the Treatment of Psychological Trauma Consequences.

The ongoing war in Ukraine significantly affects the mental and emotional well-being of its citizens. Consequently, there is an urgent need to explore the use of the resource psychotherapy model to develop effective support methods for trauma victims. The research aims to enrich the understanding of resource-based psychotherapy as an effective tool for supporting people who have experienced psychological trauma and improving their psychological well-being and quality of life. The analytical method, generalization, and systematization were used in this research. A clinical case of psychotherapy of a military man according to the 7-step model of working with the consequences of a psychotraumatic event is considered, which ultimately showed the effectiveness of its application. The study found that the resource psychotherapy model has significant potential for improving the psychological state of victims of trauma, as this approach allows the active use of internal resources of the individual to overcome the consequences of traumatic experiences and restore mental well-being. The results of the study indicate the effectiveness and deep potential of resource-based psychotherapy in working with people facing psychological trauma, helping them to build positive adaptation strategies and strengthen their psychological state. The results of this study may be useful for psychologists and psychotherapists working with people who have experienced traumatic experiences to improve the quality of psychological support and assistance to such people.

Therapists' responsiveness in the process of ruptures and resolution: Are patients and therapists on the same page?

This study examined the association between the rupture-repair process and patients' and therapists' perceptions of the therapist's responsiveness. We used the Rsupture Resolution Rating System to rate early sessions (3-5) in 35 short-term psychodynamic psychotherapy cases. The patients and therapists rated their perceptions of the therapist's responsiveness after each session using the Patient's Experience of Attunement and Responsiveness (PEAR) Scale. Therapists' contribution to ruptures was negatively associated with both patients' and therapists' PEAR ratings. Confrontation ruptures were negatively associated with patients' PEAR ratings, whereas there was no significant association with withdrawal ruptures. Resolution was positively associated with both patients' and therapists' PEAR ratings. In addition, resolution moderated the negative association between ruptures and patients' PEAR ratings. The findings emphasize the link between therapists' responsiveness and the rupture-repair process. They also highlight the significance of providing therapists with the necessary training to recognize these dynamics and engage in discussions about them with their patients when appropriate.

Psychotherapy case formulation for patients with aggressive behaviours in clinical settings: an adaptation of the Multimodal Functional Model

Aggressive behaviours are commonly observed in clinical settings, making it crucial to employ advanced assessment tools to accurately evaluate the likelihood of such behaviour. This article aims to present an assessment framework for developing a psychotherapy case formulation for patients with aggressive behaviours within the context of clinical setting. Recognising the disparities in the usage of aggression, as well as the comorbid nature of aggressive behaviours in patients with various psychopathologies, we propose an integrative framework that addresses these inconsistencies. The framework utilises the Hunter et al.’s (2008) Multimodal Functional Model as a foundation to which we integrated seven other models that are the I3 Model, the Algebra of Aggression model, the General Aggression Model, the Social Information Processing model, the Response Evaluation and Decision model, the Integrative Cognitive Model, and the nosographic model of mental disorders according to DSM-5. All these models were integrated into a comprehensive and expanded version of the Hunter et al.’s multimodal functional analysis worksheet, which combines the bio-psycho-social modalities of behaviour analysis in five factors that are instigation, vulnerability, reinforcement, habit strength, and inhibition. Additionally, case study example is provided to illustrate the development of a case formulation, which serves as a foundation for establishing therapeutic goals and implementing appropriate interventions. By incorporating a comprehensive understanding of aggression and utilising an adaptation of the multimodal functional analysis worksheet, this approach provides clinicians with a robust foundation for formulating effective therapeutic strategies.

Testing and treatment-by-attitude in psychotherapy for pathological narcissism: A clinical illustration.

Pathological narcissism is a personality constellation comprising distorted self-image, maladaptive self-esteem regulation, and difficulties in intimate relationships. Patients with elevated pathological narcissism may not necessarily meet criteria for narcissistic personality disorder, and may seek treatment for a range of mental health concerns across various clinical settings. An understanding of key principles of control-mastery theory(CMT) can help clinicians understand the specific goals and challenges of the individual patient with pathological narcissism, and can illuminate ways in which the patient may work in psychotherapy. This paper outlines how patients with pathological narcissism may engage in testing of their pathogenic beliefs, and how therapists can respond in ways that facilitate the patient's sense of safety and foster psychological work. The role of the therapist's attitude is highlighted as a means for countering pathogenic beliefs associated with pathological narcissism. Clinical material from a single case of time-limited supportive psychotherapy will be used to illustrate these principles and associated therapeutic processes. Insights from CMT regarding pathogenic beliefs and the patient's plan for addressing them can help to explain how therapy works or does not work for patients with pathological narcissism.

Identifying emerging trends and hot topics through intelligent data mining: the case of clinical psychology and psychotherapy

PurposeThe purpose of the paper is to present an integrated methodology for identifying trends in a particular subject area based on a combination of advanced text mining and expert methods. The authors aim to test it in an area of clinical psychology and psychotherapy in 2010–2019.Design/methodology/approachThe authors demonstrate the way of applying text-mining and the Word2Vec model to identify hot topics (HT) and emerging trends (ET) in clinical psychology and psychotherapy. The analysis of 11.3 million scientific publications in the Microsoft Academic Graph database revealed the most rapidly growing clinical psychology and psychotherapy terms – those with the largest increase in the number of publications reflecting real or potential trends.FindingsThe proposed approach allows one to identify HT and ET for the six thematic clusters related to mental disorders, symptoms, pharmacology, psychotherapy, treatment techniques and important psychological skills.Practical implicationsThe developed methodology allows one to see the broad picture of the most dynamic research areas in the field of clinical psychology and psychotherapy in 2010–2019. For clinicians, who are often overwhelmed by practical work, this map of the current research can help identify the areas worthy of further attention to improve the effectiveness of their clinical work. This methodology might be applied for the identification of trends in any other subject area by taking into account its specificity.Originality/valueThe paper demonstrates the value of the advanced text-mining approach for understanding trends in a subject area. To the best of the authors’ knowledge, for the first time, text-mining and the Word2Vec model have been applied to identifying trends in the field of clinical psychology and psychotherapy.

The Many Reasons Why Not to Commit Suicide: The Case of "Maggie"

This case describes the treatment of Maggie, a first-year college student dealing with depression, trauma, and suicidal thoughts and behaviors. It illustrates a conceptualization and practice that takes place within a guiding conception positioned in the "unification pathway" to psychotherapy integration. Specifically, I have developed a foundational, meta-theoretical "big picture," science-based "Unified Theory of Knowledge" (UTOK) that frames the work. It is a model of the evolution of energy, matter, mind, and culture within our universe’s history—that is, from the "big bang" to the multicultural, complex, human societies that dominate the earth today. Within the UTOK metapsychology (Henriques, 2022a), I have described where the discipline of psychology and the theory and practice of psychotherapy are positioned—allowing psychology and psychotherapy to be potentially grounded in a coherent naturalistic ontology that does not reduce to physicalism or overly rely on a natural science empirical epistemology. UTOK shows how we can retranslate the standard biopsychosocial model into a model that defines the layers of existence in terms of life (the realm of living organisms), mind (the realm of minded animals), and culture (the realm of human persons). It uses this new big picture framework to reframe and realign the key insights from the four major approaches to individual psychotherapy—behavioral, experiential/humanistic, psychodynamic, and cognitive—since each school of thought captures crucial aspects of human behavior and experience, both in its flourishing and its entrenchment in maladaptive patterns. Because of the scope and complexity of UTOK, it is not possible to fully summarize it in the pages allotted to it in a PCSP case study. Rather, in the psychotherapy case study of Maggie below, the reader is offered a basic outline of UTOK’s overall structure to provide a sense of what it is all about, together with plentiful references to learn more details about UTOK (e.g., Henriques, 2011, 2022a). This outline is then followed by psychotherapy-specific concepts and a central therapeutic technique—CALM-MO—that logically follow from UTOK and were central in Maggie’s treatment, which is then presented in detail and discussed.

Perceived Causal Networks: Clinical Utility Evaluated by Therapists and Patients.

Conceptualizing psychiatric disorders as idiosyncratic networks of mutually reinforcing behaviors and emotions has a long history in the form of psychotherapy case conceptualizations created collaboratively by therapist and patient. However, such methods are typically unsystematic and biased by therapist assumptions. An alternative is Perceived Causal Networks (PECAN), a structured online questionnaire in which patients quantify causal relations between problematic behaviors and emotions, and responses are visualized in the form of a network. In the present study, PECAN was evaluated for clinical utility at the start of therapy for five patients screening positive for depression. As expected, the five networks were found to be highly idiosyncratic, with two revealing the expected maintaining feedback loops. Both therapists and patients evaluated the method as useful in the initial phase of a therapy treatment. Although PECAN shows promise as a clinical tool, findings suggest that the method could be improved by including contextual factors maintaining depression.

Social Withdrawal in Preschool Age: A Clinical Case in Intensive Psychoanalytic Psychotherapy.

In this work, we suggest that children's social withdrawal might be a precursor of Hikikomori, a phenomenon observed among adolescents and young adults. Hence, psychotherapy interventions with preschool children showing signs of social withdrawal might play a critical role in Hikikomori prevention. This paper presents the case of a five-year-old child treated with intensive psychoanalytic psychotherapy who began therapy due to his refusing to go to school and exhibiting isolating behavior from other children. Among other symptoms were regression, emotional tension, nightmares, and nocturnal and diurnal enuresis. Moreover, the relationship in the family was difficult, both between the parents and between the parent and the child. The intensive psychoanalytic treatment involved three weekly sessions for about a year, followed by six months with one weekly session. Besides illustrating the therapeutic process through clinical vignettes taken from the sessions, this paper also provides clues on how early social withdrawal can contribute to the construction of internal personality organizations that lead to social withdrawal up to self-reclusion (or Hikikomori).

From Clinical Encounter to Knowledge Claims: Epistemological Guidelines for Case Studies in Psychotherapy

In the fields of psychoanalysis and psychotherapy, case study researchers rarely justify their knowledge claims on formal epistemological grounds. This poses several issues to the case study method. First, without articulating the standards by which our knowledge is being justified, we are potentially enabling the criticism that case studies are mere anecdotal reports and should not be treated as forms of evidence. Second, without the guidance of wider epistemological standards for case study research, we risk falling into arbitrary justifications of other as well as our own case studies. This paper seeks to address these issues by examining and developing epistemic practices in psychoanalytic and psychotherapy case studies. Drawing from different social science resources, the paper describes three epistemological concepts appropriate for case study research: retroductive reasoning, analytic generalization and working hypothesis. The paper demonstrates how each epistemological concept can be used in psychotherapy research and explicates specific methodological guidelines. Social science definitions and principles are applied in a psychotherapy and/or psychoanalytic research context, and further considerations about canons of evidence are provided. The impetus of this paper is to strengthen qualitative research standards, particularly case study research standards, in clinical case study writing.

Reflective practice and psychotherapy case experience of Specialty Doctors and Associate Specialists (SAS) working in psychiatry: UK-wide survey.

To survey nationwide opportunities for Balint-type and reflective support group participation and psychotherapy training among doctors classified as Specialty Doctors and Associate Specialists in psychiatry ('SAS psychiatrists') and the professional benefits and barriers to access. Approximately 9% of SAS psychiatrists responded, from all UK regions. A minority reported participating in a Balint-type group (27.3%) or reflective practice/support group (30.9%), and only 6.5% were not interested in participating. Although 44.8% planned to see a psychotherapy case, most reported barriers, particularly time constraints, job plans and lack of support. The 22.1% who reported already gaining psychotherapy case experience reported many benefits, including becoming a better listener (84.8%), more empathetic (81.2%), enjoying work more (78.8%) and overall becoming a better psychiatrist (90.9%). The reported interest in Balint group and psychotherapy training opportunities exceeded existing provision; psychotherapy case experience benefited professional development and self-reported clinical capabilities. Healthcare trusts and boards need to consider more actively supporting SAS psychotherapy training and reflective practice.

What is preventing psychotherapy case studies from having a greater impact on evidence-based practice, and how to address the challenges?

What is preventing psychotherapy case studies from having a greater impact on evidence-based practice, and how to address the challenges?

An overview of options on working with anxiety within the framework of the Transactional Analysis based on a case study

This article examines the practical case of psychotherapy of a client with anxiety. It presents an overview of various tools and methods, an analysis of the work, with advantages and disadvantages of various work methods highlighted. It is concluded that it is possible to work with anxious clients in a transactional-analytical approach. Psychotherapy should include structural and functional analysis, deconfusion of the Child's feelings, building up the Adult's support, development of inner care, training in new safe ways of behaving in situations that cause anxiety.

A psychotherapist’s lived experience in-session with an asylum seeker and translator: An autoethnographic case study

ABSTRACT Featured in this article is a psychotherapy case study recounted from the lived experience of the psychotherapist working with an asylum seeker from Afghanistan, with the help of a translator. The method applied is an aesthetic inquiry adapted from Autoethnography which engages the practitioner as the researcher who enters the ‘field’ of the therapy situation. The reflexive writing of the case story, which is integral to the method, sets off a heuristic process, integrating research and practice. Reading this case study, one may grasp the nuances and the atmosphere of an otherwise linguistically challenging therapeutic situation. The story and Gestalt therapy theory are weaved together, which makes palpable, intangible aspects of the therapeutic process.

Exploring the Future Social Identity of a PhD Student Dealing With Anxiety: A Psychotherapy Client Study

This psychotherapy case study examines the brief therapeutic journey of a young woman presenting with academic anxiety and the flexible person-centred approach adopted by her therapist, the author. Application during therapy sessions of concepts from humanistic therapy and beyond, such as configurations of self and imagining future possible selves, enabled the client to unravel her anxiety and eventually discover the underlying tension existing between her internal versus external locus of self-evaluation and self-worth, leading her to contemplate her overall social identity and future life choices. The study aimed to stimulate in the client open reflection about how an internal dialogue between parts of the self may reveal underlying internal tensions and how envisaging possible future selves can help identify how self-criticism may be socially and culturally conditioned. This study, being a single-client study, was tailored for the specific therapeutic goals and personality of the client, and thus the generalisability of this therapeutic approach is limited. However, the study aims to shed light on how we may better support through psychotherapy and counselling students at elite universities with a working-class background, who commonly struggle to “fit in” to this environment and make sense of their changing present and future social identity.

Une étude clinique autour de la parentification et de son élaboration dans la psychothérapie psychanalytique

ObjectiveThe purpose of this article is to highlight the imprint of the parentification process in a patient in the context of a four-year psychoanalytic psychotherapy, through the analysis of the parentification process in its intrapsychic, intersubjective, and transsubjective dimensions. MethodAfter the end of the therapy, the psychotherapist returns to the material, which involved a patient who presented a depressive disorder and a parentification process during their childhood. We analyzed different themes related to parentification: infantile history, parental imagos, identifying dynamics, parental couple and conjugality, siblings, family functioning, choice of professional career and the relationship to work, and finally, a possible intergenerational or transgenerational transmission of parentification. ResultsWe observed changes to the patient's subjective suffering: better insight, changes in parental imagos, and also changes in the relationship with others (partner and children) as a consequence of an elaborative process around her parentification. In this case, parentification appears as a response to the traumatic infantile parental perception, as a defensive organization, as a survival solution organized around the symbiotic relationship between the child and the sick parent and, later, in relationships of great dependence with her spouse or her children. Throughout the psychotherapy process we observed: a childhood story marked by a generational reversal, an invasive parental imago, narcissistic identificatory dynamics, a parental couple characterized by dysfunctional conjugality, a special place in her siblings, a familial functioning marked by confusion between roles and generations, a professional choice in the field of care, a potential intergenerational or transgenerational transmission of parentification, and finally a dysfunctional parenthood over several generations. The narcissistic dimension of parentification observed in this patient seems to be linked to the omnipotent position vis-à-vis her “failed” parents, which activates a megalomaniacal narcissism and a heroic masochism. DiscussionFor the psychotherapist, the method of treatment and the method of research overlap. The work of writing this case of psychoanalytical psychotherapy allows for new reflections in its aftermath, other elaborations on the material of the sessions, and a tridimensional exploration of the process of parentification: intrapsychic, intersubjective, and transubjective. ConclusionWe underscore the contribution of the clinical elements revealed by the analysis of the transfer/counter-transference dynamics in the process of deparentification.

Borderline Bir Eyleme Vurum Savunması Olarak Aşırı Film/Dizi İzleme: Klinik Bir Olgu Sunumu Üzerinden Sinemaya Çok Yönlü Psikolojik Bakış

Psikoterapi insanların kendilerini tanıdıkları, keşfettikleri ve değiştirdikleri ruhsal sağaltım mekanizmalarının işlediği bir tedavidir. Psikoterapi 20. asrın çocuğudur ve yaklaşık yüz yıldan beri de sürekli gelişmekte, yenilenmekte ve zenginleşmektedir. Bu çalışmada, bir psikoterapi vakasının psikoterapi süreci çerçevesinde psikolojinin sinemaya bakışı, sinemanın/dizilerin nasıl bir borderline eyleme vurum savunması olabileceği, postmodern insanın içine düştüğü varoluşsal buhranın ve bunaltının aşılmasında sinemanın nasıl bir psikolojik mekanizmayla aracı bir fonksiyon yüklenebileceği ele alınmıştır. Çalışmada yer alan psikodinamik kuramlar çerçevesinde (Masterson terapisi) yapılan klinik değerlendirmeyle şizoidi savunmaları olan uzaklaşmacı borderline teşhisi olan “Samyeli” vakası temel odağımızdır. Bu kişinin psikoterapi süreci yaklaşık 2 yıl sürmüştür. Samyeli’nin sağaltımında Masterson terapisinin kuramsal ve teknik aygıtları kullanılmıştır. Vakanın terapi süreci sonlandığında ise bu vakanın sadece erken bebeklik ve çocukluk deneyimlerinin dinamikleriyle değerlendirilmeyecek kadar multifaktöriyel bir çeşitlilik barındırdığı, çağ insanının varoluşsal ve sosyopsikolojik sorunlarına ışık tuttuğu ve hatta sinemapsikolojik açıdan da oldukça derin ve zengin dinamikler barındırdığı anlaşılmıştır. Bu sayılan sebeplerden ötürü de vaka sunumunda her ne kadar bu kişinin terapi süreci Masterson kuramının dinamikleriyle anlatılıp daha çok sinema/dizi konuları bir eyleme vurum savunması olarak ele alınacak olsa da aslında dolaylı olarak değinilecek konularda sinema ve psikoterapi ilişkisinden, sinemanın pozitif psikolojik, varoluşsal ve klinik etki mekanizmalarından, nesne ilişkileri temelli deterministik kuramlarla modernite eleştirisi üzerinden zemin bulan ve kıta felsefesinin ilham üflediği varoluşçu kuramların insanı ve sorunlarını anlamada nasıl bir tamamlayıcılık ve bütünsellik çerçevesinde birleştirilebileceği gibi konular üzerinde de durulacaktır.

Friends as Family: Using Composite Psychotherapy Case Material to Explore the Importance of Friendships for Unaccompanied Adolescent Refugees Coping with the Challenges of Resettlement in Ireland

Abstract Given the absence of family support and the depth of shared experiences, friendships for unaccompanied adolescent refugees often take on ‘suffused’ functions which blur the boundaries between conventional friendship and family roles. This study explores the ways in which such friendships help unaccompanied adolescent refugees to cope with the migration journey and the challenges of resettlement in Ireland. Innovative composite case material was constructed from my reflections on my psychotherapy work with 33 unaccompanied adolescent refugees (engaging in an average of 16 sessions each), as recorded in a reflective clinical journal and portrayed in eco-map photographs between 2016 and 2020. Reflexive and polytextual thematic analysis identified four themes, which captured the deep emotional and experiential bonds of these friendships, their importance in helping these young people to cope with the stressors of resettlement, perceptions of friends as proxy family, and the importance of God as a friend.