Psychotherapeutic Setting Research Articles

Challenging emotions

This paper contributes to work on emotional geographies by engaging with Liz Bondi's focus on relationality and the challenge to geographers to explore how their emotion might connect with the feelings of their subjects. Through the lens of a focus group meeting that created confusing feelings, it shows the hurdles that geographers face when they engage with practices developed in a psychotherapeutic setting. The paper is not so much a critique, more a desire to continue the conversation regarding how to approach and adopt psychotherapy's theory of practice in a research context.

Potential Curative Space in Relational Family Therapy

A human being is in essence a being of relationships, a being of dialogue, which is why everyone, consciously or unconsciously, unstoppably longs for a relationship with others. Every relationship in this sense contains a potential psychic space between I and you, where the most important psychic elements are created and are conducive to new curative experiences. In this article we demonstrate this creative dimension of the human experience in a psychotherapeutic setting, namely in relational family therapy, where the relationship with others and the therapist is considered as the most significant therapeutic phenomena on the basis of which change and transformation are possible.

Exploring the use of touch in the psychotherapeutic setting: A phenomenological review.

This paper provides a synthesis of the literature concerning the duality of touch and talk between therapist and client in the psychotherapy setting. It discusses the ethical considerations, prohibitions, and attitudes about touch within the psychotherapeutic field. In addition, it looks at the client's perception of touch, types of touch, paradigms, rationales for the use of touch, religious and cultural considerations, the effects of touch, and research implications. Despite the reservations and lack of training around the use of touch in psychotherapy, there is a variety of literature to support its uses, benefits, effectiveness, and rationales, insomuch as there is a variety of literature about prohibitions, contraindications, and cautions of its use. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

A case of body image and eating difficulty

This is a clinical discussion of work with a patient with body image and eating difficulties. Thought is given to the use made of the psychotherapeutic setting by the patient, in which limitation of the work and a pleasant elusiveness hides a more active engagement, as well as a secret involvement with more problematic and destructive processes. This constitutes an actualization of the patient's internal object world. Use is made of particular ideas to make sense of this presentation, in particular those from theories about eating disorders.

Lost in Translation? – Psychotherapie unter Einsatz von Dolmetschern

Language is the most essential tool in psychotherapies. Treatment is not possible if there is no common language between therapist and patient. To enable communication between therapists and patients not speaking a common language, the use of professional trained interpreters is inevitable. With the presence of a third person--the interpreter--a triad is established, which bears difficulties, but also chances. In the present paper, these problems and chances are discussed. Recommendations to optimize the work of interpreters in the psychotherapeutic setting are presented. Interpreters should familiarize themselves with the principles of psychotherapeutic methods and clear role concepts for therapists and interpreters should be defined.

MDMA-Assisted Psychotherapy Using Low Doses in a Small Sample of Women with Chronic Posttraumatic Stress Disorder

The purpose of this study was to investigate the safety of different doses of MDMA-assisted psychotherapy administered in a psychotherapeutic setting to women with chronic PTSD secondary to a sexual assault, and also to obtain preliminary data regarding efficacy. Although this study was originally planned to include 29 subjects, political pressures led to the closing of the study before it could be finished, at which time only six subjects had been treated. Preliminary results from those six subjects are presented here. We found that low doses of MDMA (between 50 and 75 mg) were both psychologically and physiologically safe for all the subjects. Future studies in larger samples and using larger doses are needed in order to further clarify the safety and efficacy of MDMA in the clinical setting in subjects with PTSD.

Balancing Between Empirically-Supported Methods and Individualized Treatment Design in the Case of Geoffrey

This is a response to the commentaries by Dr. Knight (2008) and Dr. Hyer (2008) on “The Case of Geoffrey” (Mohlman et al., 2008). The response focuses on three major themes: the notion of cultural competence in the psychotherapeutic setting; possible risks inherent in and alternatives to the medicalization of mental health treatment for older adults; and the growing use of cognitive remediation in the treatment of psychiatric disorders. We also address some of the other excellent issues raised by Drs. Knight and Hyer regarding cohort effects in the study of older therapy clients and missing elements in the case of Geoffrey.

Longitudinal assessment of psychotherapeutic day hospital treatment for elderly patients with depression

Although previous studies suggested that psychiatric day hospital care is a valuable alternative to inpatient treatment, its effectiveness for elderly patients is disputed. Small number of cases, poor definition of the psychotherapeutic setting, and absence of systematic assessment at different time points may explain the observed discrepancies. We performed an assessment of a psychiatric day hospital treatment combining individual and group psychotherapy in a series of 122 elderly depressed outpatients. The Geriatric Depression Scale, Short Form Survey, as well as a Therapeutic Community Assessment Scale and Group Evaluation Scale were repeated at admission, 3, 6, 12 months and discharge. The day hospital program was based on psychotherapeutic treatment combining individual and group settings. All patients presented with major depression or a depressive episode of bipolar disease. Variables included severity of depressive symptoms, quality of life, adhesion to therapeutic community treatment and progress in groups of psychotherapy, art-therapy, and psychomotricity. There was a significant reduction of depressive symptoms, and improvement in mental quality of life across all time points studied. Adhesion to therapeutic community increased from admission to discharge. This was also the case for the progress in group therapy for all three groups used, yet the evolution of this parameter at intermediate time points was highly variable. Neither demographic characteristics, nor pharmacological treatment or presence of stressful life events predicted the clinical improvement. Psychotherapeutic care program in day hospitals may improve clinical status and quality of life in elderly depressed patients.

Dysregulation and Containment in the Psychoanalytic Psychotherapy of a Poorly Controlled Diabetic Patient

Dysregulation, as a phenomenon of disruption in the psychotherapeutic setting, may be evidenced in the psychoanalytic psychotherapy of diabetic patients presenting poor metabolic and treatment control. In the case of a female patient, violations of the setting via acting out behaviors provided an opportunity for working through and understanding in depth the patient's unconscious attempts to activate traumatic childhood experiences and introduce loss and confusion into the relationship with the psychotherapist. Dysregulation was considered in connection with the patient's pathological containment function, in conflicting part self and object representations, and in relation to traumatic experiences of maternal desertion. Improvement of the patient was identified in her relationships with the psychotherapist, significant others, and the medical health providers, as well as in the overall management of her diabetic treatment.

Spätaussiedler und ihre Angehörigen als Patienten im Maßregelvollzug

Young migrants from Russia born in German families are seen as a special risk group for drug and alcohol addiction as well as for criminality. In Russia, they were marginalized as Germans, now in Germany, they are marginalized as Russians--and they repeat in Germany the internal structures of distrust against the police and other government agencies. In prisons and in forensic units, this group of young German-Russians are strongly over represented compared with to share in the general population. In prisons, they are a problem group mainly speaking Russian language, forming mafia like clans and dealing drugs--all this prevents the rehabilitation. In sharp contrast, a forensic department succeeds in integrating these people by a consequent therapeutic community approach with highly frequent group psychotherapy, intensive work, sports, autonomy in cleaning the rooms and individual teaching possibilities in German language and other specialties with a teacher working on the ward. Despite published negative experiences, it is well possible to improve the legal and social prognosis of Russian-German migrants by applying a consequent milieu- and psychotherapeutic setting utilizing actively the resources of these patients.

Neurobiology of the Unconscious

<p>The articles in this issue of <cite>Psychiatric Annals</cite> discuss unconscious processes. The reader will learn about research of the mirror neuron system; the neuroanatomy of unconscious circuits; the distinction between exchanging implicit contents unconsciously and the process of cognitive, verbal exchanges; the manifestation of the unconscious in the psychotherapeutic setting; and how both conscious and unconscious processes create a person’s sense of self.</p>

The golden age of body psychotherapy in Oslo I: From gymnastics to psychoanalysis

During the Second World War, Oslo became a crucial centre for those interested in how the body could be used in a psychotherapeutic setting. There, for a short while, psychiatrists, psychoanalysts, psychologists, physiotherapists, dance therapists, and vegetotherapists discussed passionately with each other. The catalyst of these discussions was Wilhelm Reich, recognized as the founder of body psychotherapists. These discussions are little known because the majority of the literature is in Norwegian. How Scandinavian bodywork influenced psychotherapy is described in this paper. How Reich intervened in these developments, and how these discussions are continued today, will be presented in a follow-up article.

How dogs influence the evaluation of psychotherapists

Research has shown that the presence of a companion animal reduces anxiety, encourages interaction among humans and enhances the way in which people are perceived. These are all effects which would be useful in a psychotherapeutic setting. On this basis the current study investigated the effect of the presence of a dog on the way in which people perceive psychotherapists. The study utilized an experimental design in which participants viewed a videotape of one of two therapists who were either with or without a dog. It was hypothesized that people would respond more positively to the psychotherapists when accompanied by a dog; specifically, that they would be more generally satisfied and would be more willing to disclose personal information, and that these effects would be influenced by attitudes towards pets. The first two hypotheses were confirmed. The effect was most pronounced among those who were the least positive toward the psychotherapist, demonstrating a ceiling effect. Contrary to the last hypothesis, attitudes toward pets had no influence on the perceptions of psychotherapists. History of pet ownership had only minimal impact on the results. Practical applications and directions for further research are discussed.

Eye movement desensitization and reprocessing in the treatment of posttraumatic stress disorder in a patient with comorbid epilepsy

Whether eye movement desensitization and reprocessing (EMDR) treatment of posttraumatic stress disorder (PTSD) causes reactivation of epilepsy is as yet unclear. A 34-year-old woman was treated in an inpatient multimodal psychotherapeutic setting with EMDR for PTSD resulting from sexual harassment and for a moderate depressive episode. She had been diagnosed with idiopathic generalized absence epilepsy in childhood, but had experienced no seizures under lamotrigine medication since 1999. After the second EMDR session, clinical seizures in the form of absences occurred, and were validated by electroencephalography. The seizures ceased after medication with benzodiazepines and an increase in the lamotrigine level. She underwent four more sessions of EMDR treatment successfully without further seizures. Possible triggers are discussed, especially as to whether EMDR treatment played a role in reactivating epilepsy. Further research and publications on the application of EMDR in epilepsy patients are needed.

Analysis of Assimilation During Psychotherapy With People Who Have Mental Retardation

The assimilation model provides a structured account of changes occurring within psychotherapy. The model proposes that clients assimilate their problematic experience through the development of schema observable in psychotherapeutic settings. The research procedure involved applying the Assimilation of Problematic Experiences Scale (APES) to transcripts from 8 clients. Quantitative methods were applied to examine whether clients with mental retardation illustrate changes in level of assimilation within and across sessions. Results suggest that people with mental retardation do assimilate problematic experiences during psychotherapy. Methodological issues and clinical implications are discussed. Our goal was to provide a clinically relevant account, applicable to the achievements of people with mental retardation, in the context of psychotherapy.

Jeg hadde slik en underlig drøm i natt…

Stokkeland, J.M. (2005). Last night I had the strangest dream…Nordisk Psykologi, 57, 345–364. Through the scrutiny of a series of dreams from a female patient, the author illustrates one way of working with dreams in the psychotherapeutic setting, and how main characters in the psychoanalytic tradition—with the dream as their point of departure- have shown us some of the workings of the mind. The author lays special stress on the British object relational thinkers and tries to delineate how close examination of dreams can be a valuable tool in orienting oneself at what is going on in the transference and countertransference. Among the contributions that the article touches upon, are Melanie Kleins thinking on internal objects, Ronald Fairbairns idea of an internal saboteur and what Donald Meltzer calls the aesthetic conflict.

Strengthening the parent–child relationship: a review of family interventions and their use in medical settings

The quality of family functioning is important for both psychological well-being and physical health. This review describes family interventions that aim to improve the strength of the parent-child relationship and considers ways in which these approaches can be applied to physical health care. This review first describes the development of family therapy in dealing with children's behavioural and emotional difficulties. As shown in psychotherapeutic settings, parenting skills can affect children's emotional well-being and ability to control their own conduct. Intervention strategies that focus on developing the ability of parents to provide a benign and nurturing parenting style are considered. The review then considers how the principles of family therapy can be applied to settings where physical health is the central issue. In medical settings, families are not only affected by medical interventions but they can also serve to facilitate or hinder clinical effectiveness. Illustrations of how these interventions can be applied in medical settings are provided. Although a practising clinician will need training in using family therapy techniques, it may be possible to recruit a family therapist to help in particular cases.

Resource-Oriented Music Therapy—The Developement of a Concept

In this paper 1 discuss the developement of my own music–therapeutic concept in the years from 1960 to 2000. I started to develop this concept in a clinical psychotherapeutic setting. After the German reunification in 1990, new extensions emerged including applications of music therapy in social therapy and prevention and a shift from a primarily pathogenetic to a salutogenetic approach. Consequently, resource–oriented thinking and acting came to play an increasingly important role in the development of my concept.

Implementing the care programme approach in psychotherapeutic settings

The care programme approach (CPA) should be implemented across all mental health services. However, the specific needs of psychotherapeutic settings were not recognised in the official documentation. The scope for conflict between therapeutic practices and CPA requirements may have increased following revision of CPA guidelines. A recent survey of consultants in psychotherapy confirmed that implementation of CPA remained uneven. The additional time required, threats to confidentiality and a negative impact on the therapeutic relationship were common concerns. Positive effects on assessment procedures and liaison between services were also reported. Practical suggestions for minimising potential negative effects of CPA are given. It is recommended that all services providing psychological therapies develop a written policy for the local implementation of CPA.

From interactions to mental representations: Psychodynamic parent – infant therapy in a case of severe eating and sleep disorders

This paper describes the process of psychodynamic psychotherapy with an infant and his family, during a developmental phase in which the infant's mental organization was in transition from the level of interactions to representations. The treatment of a 23-month-old boy suffering from a severe sleeping and eating disorder was initiated in a parent – child psychotherapeutic setting. The sleep disorder was a consequence of separation anxiety. Additionally, phobic avoidance of new oral experiences led to an eating disorder. These symptoms had developed in the context of dysregulation of the triadic family relationships (mother – father – children), which tended to split into two-plus-one relationships. After one year, the setting was changed to alternating individual and family sessions. Due to his developing symbolic capacities, the boy was able to express his inner concerns and his internalised affect-laden experiences through play and actions. His internal world could now be addressed by interpretations. New psychodynamic theories and research results on early triadic development were taken as the theoretical background for the psychotherapeutic work. We understood the course of the treatment and the development of the transference/countertransference relationships in terms of processes of triadification (at the level of interpersonal relationships) and triangulation (at the level of intrapsychic representations).