Psychotherapy Integration Research Articles

Mentalization as Mediator between Adult Attachment and Interpersonal Distress

Background: The aim of this study was to investigate the mediating role of mentalization in the association between adult attachment and interpersonal problems. Methods: The sample consisted of 89 patients with different types of mental disorders who were at the beginning of treatment in one of two medical centers. Both mediational analysis and path analysis were used to test the model. Results: The proposed model revealed a good model fit. The data indicate that mentalization fully mediates the effect of attachment on interpersonal distress. Symptom severity proved to be a strong confounding variable that influenced all other variables and reduced existing effects. Conclusion: We conclude that both mentalization and symptom distress are key components in the association of adult attachment and interpersonal problems. Therefore, we recommend research on integrative psychotherapy concepts rather than unilateral approaches.

Therapist responsivity to patients’ early treatment beliefs and psychotherapy process.

As the conceptualization of evidence-based practice expands beyond the phasic application of treatment manuals for specific mental health diagnoses, greater attention is being paid to treatment personalization, including at its very first steps. One approach to such early personalization involves therapist flexible responsivity to patients' presenting nondiagnostic characteristics, such as their treatment-related beliefs, that are known to correlate with treatment outcomes. Such tailoring represents one element of the context-responsive psychotherapy integration framework that privileges the therapist's use of evidence-informed strategies in response to specific patient characteristics and contextual process markers (Constantino, Boswell, Bernecker, & Castonguay, 2013). In this article, we map context-responsive psychotherapy integration principles onto a psychotherapy case illustration. Namely, we describe Alice E. Coyne's attempt to navigate responsively a patient's early outcome expectation and treatment credibility perception, both of which revealed the need to change course from an original treatment plan (despite that plan making good sense vis-à-vis the patient's diagnoses and initial positive reaction to the explanation of a specific treatment protocol). In addition, the case illustrates the influence that patient treatment beliefs can have on other early therapeutic processes, such as patient change ambivalence and resistance to the therapy, that also require therapist responsivity in the service of personalization. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Bayesian Approach to Psychotherapy Integration: Strategic Modification of Priors.

Integrative psychotherapies have become the mainstay in mental health care. The most researched therapy, CBT, being integrative itself, continues to integrate such new elements as mindfulness, spirituality, and experiential techniques. There is no commonly accepted strategy for psychotherapy integration. New elements are sometimes added on a trial and error basis with a following post-hoc theoretical and empirical justification. Other times, they are incorporated based on an ad-hoc theoretical premise, and empirical studies follow to support or invalidate it. Nevertheless, four main integrative strategies have been identified as technical eclecticism, common factors integration, principle-based assimilative integration, and theoretical integration (Norcross, 2005). Strategies outside of these four have also been suggested. Recently, a principle of nested hierarchy has been proposed as a way of integrating different strategies into a general roadmap for building an integrative therapy (Krupnik, 2018). The nested hierarchy principle does not, however, offer a strategy for theoretical integration at the top of its hierarchy. In this report, I suggest using the Bayesian theory of psychopathology for such strategy. I propose to apply Bayesian framework to psychotherapy integration and discuss a possibility of using it as a universal strategy called Strategic Modification of Priors (SMOP). I illustrate SMOP's application with a synopsis of a clinical case.

Recording client sessions during psychotherapy training: From “an absurd idea” to “potent learning”

AbstractBackgroundAudio‐ or video‐recording of client sessions is often used in psychotherapy training to develop practitioner skills and improve client services. However, opinion on the value and ethics of this practice is divided, with limited empirical research and no published research in an Irish context. This study aimed to add to the literature, asking two main questions: To what extent are client sessions recorded during psychotherapy training in the Republic of Ireland, and what are Irish psychotherapists’ experiences and attitudes regarding this practice?MethodologyAn online survey was distributed to members of the Irish Association of Humanistic and Integrative Psychotherapy (IAHIP) who subscribe to IAHIP web adverts (30% response rate; N = 120). Data were analysed using SPSS and thematic analysis.FindingsJust under half these Irish psychotherapists reported recording client sessions during training; this practice being significantly less common amongst recent graduates. While a small majority agreed with recording during training, a sizeable one‐third disagreed, with others uncertain. Those with regular experience of recording were most supportive of the practice. Positive themes regarding recording were as follows: “strongly enables learning,” “captures reality,” “invaluable opportunity for trainees to have a witness,” and “accountability and protection for clients,” while negative themes were as follows: “an anxious, inhibiting experience,” “distorts/misses reality,” “trainees’ needs impinging on the therapeutic relationship” and “a breach of confidentiality.”ConclusionIrish psychotherapists have strong yet mixed views about recording, reflecting the power of this practice and its ethical complexity. A recommended training protocol for recording client sessions is offered.

Psychotherapy integration and borderline personality pathology: An examination of treatment outcomes.

Psychotherapy integration and borderline personality pathology: An examination of treatment outcomes.

Psychotherapy integration training around the globe: A personal and empirical perspective.

Psychotherapy integration training around the globe: A personal and empirical perspective.

한 부모 가정 아동의 자아존중감과 사회성 향상을 위한 통합예술심리치료 사례연구

본 연구의 목적은 이혼으로 인한 한 부모 가정 아동에게 통합예술심리치료 기법을 활용한 프로그램을 적용하고 이것이 아동의 자아존중감과 사회성에 미치는 영향을 확인하는 것이다. 이를 위해 Y상담센터에 상담을 의뢰한 한 부모 가정 아동 3명을 대상으로 주 1회, 60분씩 총 16회기의 통합예술심리치료 프로그램을 실시하였다. 아동의 변화를 확인하기 위해 자아존중감 검사와 사회성기술평정척도 검사를 사전-사후-추후로 실시하여 점수 변화를 확인하였다. 또한 점수 변화 이외에 회기별 활동에서 관찰된 아동의 변화에 대한 질적 분석도 함께 병행하였다. 연구 결과, 통합예술심리치료 프로그램은 한 부모 가정 아동의 자아존중감 및 사회성 향상에 긍정적인 영향을 미치는 것으로 나타났다. 회기별 활동 분석 결과에서도 통합예술심리치료를 통해 아동들이 자신의 내면을 탐색하고 이해하게 되면서 자신감을 회복하고 긍정적인 자기평가를 하게 되는 모습으로 변화되는 것을 볼 수 있었다. 또한 아동들이 함께 활동을 하며 자연스럽게 공감하고 배려하는 과정에서 긍정적인 상호작용을 경험하게 되었고 또래관계의 즐거움을 느끼게 되면서 원만한 관계형성을 위해 노력하는 모습을 확인할 수 있었다. 이상의 연구결과를 통해 통합예술심리치료 프로그램이 한 부모 가정 아동의 자아존중감과 사회성을 향상시켜주는데 효과적이며 치유와 자아성장을 위한 상담 및 교육 프로그램으로써 유용하게 활용될 수 있음을 확인하였다.

Goal focused positive psychotherapy: an integration of positive psychology and psychotherapy

ABSTRACTThis article introduces the empirical support for and theoretical tenets of Goal Focused Positive Psychotherapy (GFPP), a comprehensive, evidence-based, psychotherapy model. GFPP’s approach emerges from positive and social psychology research, and is informed by psychotherapy research from the common and contextual models. Its interventions focus on idiosyncratic and multiculturally-attuned client factors, particularly client strengths and goals, in an effort to increase subjective well-being and facilitate the client’s experience of a meaningful, satisfying life. Enhanced client well-being provides more robust and abundant resources for proactively addressing presenting concerns without requiring intensive focus on client deficits, symptoms, or trauma. The mechanism of change is positive emotion, as informed by the broaden-and-build [Fredrickson, B. L. (2001). The role of positive emotions in positive psychology: The broaden-and-build theory of positive emotions. American Psychologist, 56(3), 218–226. doi:10.1037/0003-066X.56.3.218] biopsychosocial model. The therapeutic alliance creates a healing context cultivated through a focus on hope, strengths, and client-centred experiences of self-determination.

Introduction to the Special Issue on Psychotherapy Integration

The practice of psychotherapy has been characterized by division and dogmatism since the origins of talk therapy with Freud (McGoldrick, Gerson, & Petry, 2008; Norcross & Goldfried, 2005). Today th...

Bridging the Divide Between Psychodynamic and Behavioral Approaches for Children with Oppositional Defiant Disorder

ABSTRACTOppositional defiant disorder (ODD) is one of the primary reasons youth are referred to mental health services. Disruptive behavior disorders such as ODD are heterogeneous in their presentation, developmental trajectories, and treatment needs. Given the high attrition rates in child psychotherapy in general, there is a need for a range of interventions tailored to meet the unique needs of each family to help increase familial engagement and positive outcomes for children with ODD.This article outlines composite clinical case material of a child with ODD who was treated with Regulation Focused Psychotherapy for Children (RFP-C), a manualized, psychodynamic intervention for ODD. The case presented is then reconceptualized from a behavioral parent training perspective. This approach uses parent training to encourage positive parenting practices and reduce coercive reinforcement cycles. The case material and its reconceptualization are followed by a discussion of the distinctions between psychodynamic and behavioral approaches to children with ODD. An integrated psychotherapy approach is proposed, and the benefits and challenges of psychotherapy integration are discussed.

Therapeutic difficulties in management of the patient with anorexia nervosa and comorbid borderline personality disorder – case study

Aim: This case report addresses some clinical challenges occurring throughout the therapeutic process of specialized management treatment of Anorexia Nervosa with comorbid Borderline Personality Disorder. Materials and method: Clinical examinations and measures – Structured Clinical Interview for DSM-IV (SCID-II), Eating Attitudes Test (EAT-26), Yale-Brown Obsessive Compulsive Scale modified for Body Dysmorphic Disorder (BDD-YBOCS), Beck Depression Inventory-II (BDI-II), Toronto Alexithymia Scale (TAS-20), and State-Trait Anxiety Inventory (STAI) have been employed to identify the nature and severity of patient’s psychopathology and its potential change throughout the therapeutic process. Results: Despite some improvement in the symptoms of the eating disorder following the treatment, some other measures of psychopathology (e.g., depression) remained at similar level. Conclusions: Only partial improvement in the profile of F.C.’s psychopathology was observed. Discussion: Management of AN with comorbid BPD requires a comprehensive care package including integrative psychotherapy, nutritional interventions and pharmacotherapy at an inpatient setting as well as follow-up care thereafter.

Stuttering therapy - an integration of speech therapy and psychotherapy

No abstract available.

The new great psychotherapy debate: scientific integrated psychotherapy vs. plurality. Why Cognitive-Behavior Therapy is the gold standard in psychotherapy and a platform for scientific integrated psychotherapy

The new great psychotherapy debate: scientific integrated psychotherapy vs. plurality. Why Cognitive-Behavior Therapy is the gold standard in psychotherapy and a platform for scientific integrated psychotherapy

Personal development groups during psychotherapy training: Irish students’ expectations and experiences of vulnerability, safety and growth

ABSTRACT Personal development groups (PDGs) are a common part of counselling, psychotherapy and psychology training programmes, and are believed to facilitate both personal and professional growth. This article reviews the available research evidence for this belief, and reports the findings of a longitudinal study of the expectations and experiences of 32 Irish integrative psychotherapy students during an academic year’s attendance at a PDG. A small but significant increase was found in the students’ ratings of their own interpersonal awareness and skills at the end of the year, students reporting greater ease in sharing their personal thoughts and feelings with others and greater confidence in offering feedback to others. While students reported moderately high levels of safety in their PDGs, they also experienced vulnerability and were concerned about dual relationships and judgement from others. Thematic analysis of the students’ written reflections on the impact of their PDGs indicated that they experienced “personal and professional growth,” felt the “risk and potential in being vulnerable,” and that they were left “wanting more.” The findings from this study and the research review highlight both the benefits and challenges of PDG participation for students; the implications for ethical training practice are also discussed.

Clinical Translation of Memory Reconsolidation Research: Therapeutic Methodology for Transformational Change by Erasing Implicit Emotional Learnings Driving Symptom Production

After 20 years of laboratory study of memory reconsolidation, the translation of research findings into clinical application has recently been the topic of a rapidly growing number of review articles. The present article identifies previously unrecognized possibilities for effective clinical translation by examining research findings from the experience-oriented viewpoint of the clinician. It is well established that destabilization of a target learning and its erasure (robust functional disappearance) by behavioral updating are experience-driven processes. By interpreting the research in terms of internal experiences required by the brain, rather than in terms of external laboratory procedures, a clinical methodology of updating and erasure unambiguously emerges, with promising properties: It is applicable for any symptom generated by emotional learning and memory, it is readily adapted to the unique target material of each therapy client, and it has extensive corroboration in existing clinical literature, including cessation of a wide range of symptoms and verification of erasure using the same markers relied upon by laboratory researchers. Two case vignettes illustrate clinical implementation and show erasure of lifelong, complex, intense emotional learnings and full, lasting cessation of major long-term symptoms. The experience-oriented framework also provides a new interpretation of the laboratory erasure procedure known as post-retrieval extinction, indicating limited clinical applicability and explaining for the first time why, even with reversal of the protocol (post-extinction retrieval), reconsolidation and erasure still occur. Also discussed are significant ramifications for the clinical field’s “corrective experiences” paradigm, for psychotherapy integration, and for establishing that specific factors can produce extreme therapeutic effectiveness.

Pathways to progress for integrative psychotherapy: Perspectives on practice and research.

Pathways to progress for integrative psychotherapy: Perspectives on practice and research.

Toward an Integration of Constructivism and Existential Psychotherapy

Constructivism and existential psychology are distinct approaches to therapy that share many important commonalities. Included in the commonalities are a focus on meaning, relationships, change, and experience. We maintain that an existential-constructivist foundation can provide an ideal foundation for integration that can deepen approaches to therapy that resonate with aspects of existential and constructivist therapies. Three approaches to therapy highlight possibilities for integration: caregiver family therapy, equine-facilitated therapy, and substance abuse therapy. Building from these examples, various approaches to integration emerging from constructivism and existentialism can prove fruitful for developing a constructivism-existential psychology integration.

A Strong Woman: A Psychodynamic Perspective on Religion and Culture in a Grieving Mother

This is a case report that depicts spiritual integration in grief psychotherapy with a culture-sensitive perspective. Topics addressed by this article include: 1) The impact of death of a neonate on an individual’s faith; 2) The role of psychosocial development and factors on the process of grieving; 3) Therapist self-disclosure as a tool in working with resistance.

Topic-focused analysis in a case of integrative psychotherapy with a father fearing his own anger

Even though evidence-based knowledge is considered the foundation of clinical practice, many clinicians question the clinical relevance of published research. Clinicians increasingly define themselves as having an integrative stance, in contrast to the tendency for most research to be based on clearly defined psychotherapies. Qualitative single case studies make it possible to generate knowledge about what actually occurs in integrative therapy. Topic change process analysis (TCPA) is used in the analysis of brief integrative therapy conducted by a very experienced psychotherapist drawing on a complex variety of therapeutic approaches. The client was a man in his late thirties, worrying about his strong anger, particularly related to one of his children. Analysis of topic areas, topic shifts, response patterns within topics and changes in perspective made it possible to identify key processes and key patterns of the therapy which resulted in a very positive outcome for the client. Implications of these findings for practice, and future research, are discussed.

Psychotherapy integration and alliance: An examination across treatment outcomes.

Psychotherapy integration and alliance: An examination across treatment outcomes.