Psychotherapeutic Setting Research Articles

La résorption de la dissociation psychotique par la solution perverse

AimsThis research aims to demonstrate that, in psychosis, addressing the Other allows the subject to differentiate him/herself and to resort to perverse defense mechanisms in order to tune the therapy. The work sets out to highlight the way in which the body articulates with psychic movements as a result of the transfer. MethodThis study is based on an analysis of the effects of an application by a psychotic patient for hospital admission in a psychiatric ward. We explore the succession of subjective alterations occurring in the patient's discourse and in his acting out, whether addressed to the clinician in the psychotherapeutic setting or to the institution. ResultsThe request for care allows the patient to differentiate, at the cost of a masochistic defensive position. Subsequently, annihilation anxiety triggers an exhibitionist process which can be considered as providing leverage turning masochism into sadism. The violence of this relationship is to be found in the transfer to the institution, where transgression of this framework “stages” what would otherwise have been experienced as real: the fantasy of the beaten child. DiscussionThe psychic impasse in psychosis can have quite specific coordinates: either the patient relinquishes his phallic position towards the Other and it is then exposed to destructive aggression, or he may risk mortifying incest. The patient can work this out in the transfer by identifying with parental aggressors. Making the patient responsible for this scenario gives him the opportunity to appropriate new therapeutic efforts. ConclusionDrive enables the psychotic subject to deploy skills and know-how. The process of subjectivation is backed up by the complementary actions of transfer to the clinician and transfer to the institution. If the institution lays the way for a dynamic of acting out, this will have a stimulant effect in the transfer and will replace self-destruction by the fantasy production that reinforces the trajectory of desire.

The Influence of Feedback From Routine Outcome Monitoring On Treatment Outcomes

Background Feedback is an essential part of Routine Outcome Monitoring. Little is known about the effect of feedback provided to the clinician and patient during treatment. A review of the available literature about feedback given to clinician and patient on treatment outcomes in general psychiatry showed a small, almost negligible effect of the provision of feedback. However, Lambert c.s. found that giving feedback about patient-progress that deviated from the expected outcome in a psychotherapeutic setting was associated with a significant improvement afterwards. Aim To investigate the effect of feedback on treatment outcomes in a general psychiatric outpatient clinic for mood and anxiety disorders in the Netherlands. Method a field study in which more attention was paid to the implementation of feedback than usual. Clinicians were trained in interpreting treatment outcomes and explaining them to their patients. The feedback procedure was then monitored. Three groups of patients were distinguished (1) a group of patients who received obligatory protocolled feedback, (2) a group of patients of whom their clinicians voluntary could view the received feedback and had to fill in GAF and CGI scores concerning te progress of their treatment and (3) a group that received neither feedback nor GAF or CGI scores. All three groups completed relevant outcome measures. Results from the 176 patients 26 % received feedback from their clinician. Their progress was measured regularly. Even with extra attention paid to the implementation, it appears that providing feedback to the clinician and patient has little effect on treatment outcomes.

Touching, Encounter & Group Psychotherapy: Personal Memories of an Old Therapist

“Exploring the Use of Touch in the Psychotherapeutic Setting: A Phenomenological Review.” (2009). The author presents a number of personal perspectives derived from 43 years of practice. It includes empirical findings regarding patients' attitudes toward touching, as well as practical guidelines regarding physical contact in psychotherapy. The paper concludes with a long vignette illustrating the nature of the psychotherapeutic encounter.

Varieties of Silence: Understanding Different Forms and Functions of Silence in a Psychotherapeutic Setting

. The phenomenon of silence as a communication is explored in the dialogue between patient and therapist. The focus is on examining silence in the context within which it occurs, providing the opportunity to understand its variations while keeping in mind that the therapist's own awareness of the meanings is also part of what must be considered. Our aim is to highlight some different meanings and functions that silence can play in the psychotherapeutic relationship, from the perspectives of both the patient and therapist. In the closing section, we not only reflect on the more frightening aspects of silence, but also remind the reader that silence has the potential to help individuals reorient their lives, and that shared silence can function as a gateway for healing.

Grice's cooperative principle in the psychoanalytic setting.

Grice's "cooperative principle," including conversational implicatures and maxims, is commonplace in current pragmatics (a subfield of linguistics), and is generally applied in conversational analysis. The author examines the unique contribution of Grice's principle in considering the psychotherapeutic setting and its discourse. Such an investigation is called for chiefly because of the central role of speech in psychoanalytic practice (the "talking cure"). Symptoms and transference, which are characterized as forms of expression that are fundamentally deceptive, must be equivocal and indirect, and must breach all four of Grice's categories and maxims: truth (Quality), relation (Relevance), Manner (be clear), and Quantity. Therapeutic practice, according to Freud's "fundamental rule of psychoanalysis," encourages the parties (analysand and analyst) to breach each and every one of Grice's maxims. Using case reports drawn from the literature, the author shows that these breachings are essential for therapeutic progress. They serve as a unique and important ground for revealing inner (psychic) contents, and demarcating real self from illusive self, which in turn constitutes leverage for integrating these contents with the self.

Remediation and Cognitive Enhancers in Schizotypal Personality Disorder

Individuals with schizotypal personality disorder (SPD) often present with cognitive impairment similar, but of a lesser magnitude to, what is seen in schizophrenia. Cognitive dysfunction combined with social and perceptual disturbances, which are the hallmarks of this disorder, are directly related to substantially lower functioning. There is no FDA-approved medication for cognitive deficits in SPD; however, potential agents, including α2a and dopamine agonists, are under investigation. Cognitive remediation therapy (CRT) is a behavioral treatment that has been shown to improve cognitive and psychosocial functioning in individuals with schizophrenia. Application of CRT in this population is novel and more large-scale studies are needed, but this treatment holds promise for the cognitive and social deficits of SPD. There may be a synergy between cognitive remediation and cognitive enhancers such as the α2a agonist guanfacine; research in this area is nascent. Lifestyle modifications such as the use of memory aids, planners, and structured schedules, as well as exercise, may be beneficial for cognitive functioning in this population. Additionally, social skills training in a psychotherapeutic setting can be helpful. Patients frequently present with comorbid mood and anxiety symptoms, and standard SSRI treatment to ameliorate symptoms can have a positive secondary effect on cognitive functioning. For the patient with psychotic-like features, treatment with atypical antipsychotics may also improve overall functioning.

Psychology and spirituality: is there a place on the Couch for transcendence?

Even though psychology and spirituality may appear at first glance as two quite different fields, it is possible to
 find innumerous points of convergence and ways of integration in these fields. From a clinical perspective it seems
 a worthwhile endeavor to explore spirituality and its interweaving with mental health to have a more integrative
 comprehension of clients’ functioning and to deliver psychotherapy in a more holistic way. This approach may
 allow individuals to overcome a rooted Western tendency of viewing human beings as having compartmentalized
 or dualistic dimensions. The goal of this paper is to approach spirituality through object relations theory and to
 propose one possible way to integrate spirituality in the psychotherapeutic setting, considering ego developmental
 stages and discussing a developmental model of spirituality. Finally, some possible clinical implications and benefits
 are pointed out as a result of making room available for transcendence on the “couch”.
 Key-words: Object relations; Spirituality; Attachment; Transcendence; Ego development.

Dreams and change processes in an ex-prostitute under relational psychoanalytic psychotherapy: Ferenczian and relational views

This paper explores the change processes that took place in a woman, an ex-prostitute, in the context of psychotherapeutic treatment over a period of over three years. The treatment took place within a relational psychotherapeutic setting influenced by the ideas formulated by Sándor Ferenczi regarding trauma, as well as by his intense involvement with and commitment to his patients, as expressed in his Clinical Diary of 1932 (Ferenczi, 1988). Zoe, the current patient, was a woman born in Latin America who emigrated to Spain at the age of 28 and became trapped, for nearly a decade, in a mesh of prostitution networks. She eventually entered regular psychotherapeutic treatment at the age of 39. Her change process is an example of the mutual influence between the factors of resilience that characterized her and the opportunity for co-creation that the treatment signifies. The marks of the intense traumatic burden of Zoe's history and the rays of sunlight and hope that she is currently experiencing become intermingled in the dreams evoked and brought to the treatment setting. Zoe's capacity for resilience and the potential for founding self-object relations, ethically implied, that therapists can offer construct a scenario that brings back to life the essence of Ferenczi from 1932.

1204 – The uncanny - a cinematic and psychodynamic exploration

The “Uncanny” (Das Unheimliche), a concept coined by Sigmund Freud (1919) and presented in art and psychotherapy. It is when an experience can be familiar, yet foreign at the same time, resulting in an uncomfortably strange or familiar feeling. A theoretical investigation and comparison of the “Uncanny” concept in the cinematic and psycho-therapeutic setting. 1. Exploring the cinematic Uncanny motifs in two films by screenwriter, Charlie Kaufman: “Being John Malkovich” and “Adaptation”. 2. Exploring these motifs and understanding them in the context of a case study of prolonged psycho-dynamic psychotherapy. 3. Outlining practical implications for the use of this concept in psycho-dynamic psychotherapy. Through cinematic analysis of the films we describe the development of the uncanny experience. Thereafter, through narrative analysis of a case report, we refer to the obstacles created by the “Uncanny” experience in the psycho- therapeutic process. The cinematic motifs (“The Double” and “The Secret”) involved in the creation of the “Uncanny” experience are present and have a major effect on the therapeutic process. Exemplifying and analyzing their presentation seem to clarify possible obstacles that challenge the therapist. The “Uncanny” is a concept that describes the human experience of sudden familiarity in a novel and strange situation. In this study we describe this phenomenon through psychoanalytic literature and explore it via popular films. It seems that recognizing the Uncanny in the therapeutic process may assist in engaging a therapeutic relationship and improving therapy outcomes.

A Developmental Approach to Gifts in Long-Term Group Psychotherapy Extending from an Anniversary Ritual

Therapists have been quietly receiving gifts from patients for many years, but only recently have they been acknowledging and reporting such transactions. Most of the literature on the subject, which has been sparse, has been limited to the individual psychotherapy setting. In this article, we take up the issue within the group psychotherapeutic setting, surveying the literature, and describing our own experience with what became a gift-giving ritual in our long-term open-ended therapy group. We offer a group developmental perspective for informing therapeutic responses to gifts, and suggestions for the technical management of this kind of transaction.

Work-focused treatment of common mental disorders and return to work: A comparative outcome study.

The aim of this study was to compare the effectiveness of two individual-level psychotherapy interventions: (a) treatment as usual consisting of cognitive-behavioral therapy (CBT) and (b) work-focused CBT (W-CBT) that integrated work aspects early into the treatment. Both interventions were carried out by psychotherapists with employees on sick leave because of common mental disorders (depression, anxiety, or adjustment disorder). In a quasi-experimental design, 12-month follow-up data of 168 employees were collected. The CBT group consisted of 79 clients, the W-CBT group of 89. Outcome measures were duration until return to work (RTW), mental health problems, and costs to the employer. We found significant effects on duration until RTW in favor of the W-CBT group: full RTW occurred 65 days earlier. Partial RTW occurred 12 days earlier. A significant decrease in mental health problems was equally present in both conditions. The average financial advantage for the employer of an employee in the W-CBT group was estimated at $5,275 U.S. dollars compared with the CBT group. These results show that through focusing more and earlier on work-related aspects and RTW, functional recovery in work can be substantially speeded up within a regular psychotherapeutic setting. This result was achieved without negative side effects on psychological complaints over the course of 1 year. Integrating work-related aspects into CBT is, therefore, a fruitful approach with benefits for employees and employers alike.

Placebo forte: Ways to maximize unspecific treatment effects

Placebo effects spark more and more interest in both medicine and psychotherapy. Neurobiological findings have helped to understand underlying biochemical and neurological mechanisms although many questions remain to be answered. One common denominator of empirical findings regarding placebo effects across a wide range of clinical conditions (e.g., depression, Parkinson’s disease, pain, neurological disorders) is the involvement of higher cognitive brain functions associated with the prefrontal cortex. It is meanwhile commonly accepted that placebo effects involve self-regulatory mechanisms whose role in mediating those effects have not been thoroughly investigated yet. We propose a theoretical framework which helps to identify relevant functional mechanisms. Drawing on psychological findings, we propose a mechanism by which placebo effects can be maximized in any type of medical and psychotherapeutic setting.

MDMA enhances “mind reading” of positive emotions and impairs “mind reading” of negative emotions

3,4-Methylenedioxymethamphetamine (MDMA, ecstasy) increases sociability. The prosocial effects of MDMA may result from the release of the "social hormone" oxytocin and associated alterations in the processing of socioemotional stimuli. We investigated the effects of MDMA (125 mg) on the ability to infer the mental states of others from social cues of the eye region in the Reading the Mind in the Eyes Test. The study included 48 healthy volunteers (24 men, 24 women) and used a double-blind, placebo-controlled, within-subjects design. A choice reaction time test was used to exclude impairments in psychomotor function. We also measured circulating oxytocin and cortisol levels and subjective drug effects. MDMA differentially affected mind reading depending on the emotional valence of the stimuli. MDMA enhanced the accuracy of mental state decoding for positive stimuli (e.g., friendly), impaired mind reading for negative stimuli (e.g., hostile), and had no effect on mind reading for neutral stimuli (e.g., reflective). MDMA did not affect psychomotor performance, increased circulating oxytocin and cortisol levels, and produced subjective prosocial effects, including feelings of being more open, talkative, and closer to others. The shift in the ability to correctly read socioemotional information toward stimuli associated with positive emotional valence, together with the prosocial feelings elicited by MDMA, may enhance social approach behavior and sociability when MDMA is used recreationally and facilitate therapeutic relationships in MDMA-assisted psychotherapeutic settings.

“If Someone Speaks there is Light:” The Words of the Witness in the Silence of Trauma

The aim of this paper is to think over the importance of words and their transformative power in the psychotherapeutic treatment of adolescent patients who have been abused and ill-treated within their families. In particular, we try to analyze the long and winding path leading from abuse to the restoring and the introjection of what we term “the law” in these patients. The law structures the inter-subjective space with meanings and is based on the recognition, the respect and the value of the otherness. It is an open, unsaturated, transformative work. The therapeutic setting, our law, is shaped to be the place of differences and agreements: it is a parental function, which separates and protects at the same time. In our adolescent patients who have experienced trauma, the identification process based on self-awareness cannot occur, and a pseudo-identity develops, based identification with the trauma. The psychotherapeutic setting is attacked as the place of recognition and evidence, involving the threatening fantasy of a catastrophic change. Working with these patients in treatment, the therapists primary function is to be a living witness and the therapeutic setting is the frame within which the denied truth can be recognized and testified. “If somebody speaks there is light” is a metaphor for the therapy. Keywords: Adolescents, psychological trauma, abuse, psychotherapy

P-1131 - Some experiences of group psychotherapy in Orthodox community of rehabilitation of drug addicts

Introduction The paper presents a two-year experience of group psychotherapy drug female, fifteen-day rhythm, in a medium-sized group, in the Orthodox community. In the psychological structures of the group members are clearly distinct diagnostic deficit, which require the interpretations that would allow identification introjection of the therapist as a model, and facilities related to Orthodox spirituality can be used in it. The group cohesion contributes the contents related to the difficulty and beauty of common prayer. Objectives The basic method of operation is based on newly discovered faith in God the Holy Trinity. The Psychological methods in the therapeutic process in the Community are: witnissing - the clients speak about the previous life experience, work on personal commitments - this is the feature which is not sufficiently developed, the division - through the lens of evangelical talking about the realization of personal commitments. Aims We follow the role of group psychotherapy in the milieu of other therapeutic methods. Through group psychotherapeutic process, we monitored the level of introjection of spiritual experiences. Methods The contents of spiritual experience in group psychotherapy protocols determining transferance-countertransference relationship and the course of the therapeutic process. Knowledge of the theoretical assumptions of Orthodox spirituality allows the therapist effectiveness of using countertransference. Results During the two years of psychotherapy clients have accepted psychotherapeutic setting limits, enabling transmission and psychotherapeutic process. Conclusion The clients who have remained in the Community have developed the ability to create deeper introjection and more lasting benefits of spiritual and emotional contents.

Using everyday technology to enhance evidence-based treatments.

Technologies such as smartphones and digital cameras are an increasingly ubiquitous part of modern life, and the increasing convenience of these electronic tools provides psychotherapists with opportunities to incorporate these technologies into psychotherapy. In the face of so much opportunity, psychotherapists must learn how to incorporate these tools effectively and responsibly. The authors present three case studies that demonstrate the use of digital technology to individualize and enhance the efficiency of existing evidence-based treatments. In the first, digital pictures were used to track the treatment progress of a client who compulsively hoards. In the second, a smartphone was used to record a personalized progressive muscle relaxation file for a client with agoraphobia, hypochondriasis, and generalized anxiety disorder. In the third, a smartphone was used to photograph and send pictures of in-session work to a client with trichotillomania and generalized anxiety disorder. The implications and ethical considerations of using technology in psychotherapeutic settings are explored, and practical strategies are provided for incorporating common digital technology into psychotherapeutic practice.

Exploring the impact of personality dimensions in late-life depression

In last years, the concept of personality moved from the stability of categorical models over the lifespan to the complex interactions between gene, environment, and clinical expression according to the dimensional approaches. Within this framework, studies start to explore the impact of personality on the evolution and treatment of depression in old age.(Figure is included in full-text article.) Empirical evidence from younger patients has repeatedly confirmed that personality traits predict treatment course and outcome of depression. Epigenetic changes may partly determine the individual differences in personality changes facing life stresses. The limited number of studies on late-life depression revealed the differential impact of personality in early-onset versus late-onset depression. In this age group, the standardized assessment of personality traits allows predicting treatment outcome in psychotherapeutic settings for depressive outpatients. Studies on the interaction between genetic background and personality expression in late life are still missing. Personality traits emerge as a potentially powerful determinant of the clinical outcome in old-age depression. The integration of psychological and molecular genetics findings offers a new perspective into the personality-depression relationship. Its modulation by the accumulation of individual stressful life-events may play a main role in the outcome of late-life depression.

Transference as a Measurable Social-Cognitive Process: An Application of Scilligo's Model of Ego States

Freud's original intuition about transference—that we repeat in the present certain key relational patterns from the past—is supported by findings from recent social-cognitive research that shows transference to be a ubiquitous process in daily life, not limited to the psychotherapeutic setting or to relationships with early caretakers. An understanding of transference manifestations helps us not only to make sense of our clients' transactional patterns but also to work through the conscious and unconscious self-other representations that interfere with our own work as psychotherapists. Scilligo's ego states model offers a method for analyzing transference as a normal and modifiable social-cognitive process.

Effectiveness of Outpatient, Day Hospital, and Inpatient Psychotherapeutic Treatment for Patients with Cluster B Personality Disorders

Background: For patients with cluster B personality disorders there is no consensus regarding the optimal treatment setting. The aim of this study was to compare the effectiveness of different psychotherapeutic settings for patients with cluster B personality disorders, i.e. outpatient, day hospital, and inpatient treatment. Methods: The study was conducted between March 2003 and June 2008 in 6 mental health care centres in the Netherlands, with a sample of 207 patients with a DSM-IV-TR axis II cluster B diagnosis. Patients were assigned to 3 different settings of psychotherapeutic treatment and effectiveness was assessed at 18 months after baseline. An intention-to-treat analysis was conducted for psychiatric symptoms (Brief Symptom Inventory), psychosocial functioning (Outcome Questionnaire-45), and quality of life (EQ-5D), using multilevel statistical modelling. As the study was non-randomised, the propensity score method was used to control for initial differences. Results: Patients in all 3 settings improved significantly in terms of psychiatric symptoms, social and interpersonal functioning, and quality of life 18 months after baseline. The inpatient group showed the largest improvements. The comparison of outpatient and inpatient treatment regarding psychiatric symptoms showed a marginally significant result (p = 0.057) in favour of inpatient treatment. Conclusions: Patients with cluster B personality disorders improved in all investigated treatment settings, with a trend towards larger improvements of psychiatric symptoms in the inpatient setting compared to the outpatient setting. Specialised inpatient treatment should be considered as a valuable treatment option for cluster B personality disorders, both in research and in clinical practice.

Integrative psychosomatics east–west in pain treatment

Asian and western cultures have developed different concepts of the connection between body, mind and spirit strongly influenced by culture, worldview and spirit of the age. These concepts are reflected in different medical systems, their different diagnostic and therapeutic procedures. An integration process of different psychosomatic concepts is going on in east and west. In the last decades the west has become increasingly interested in the holistic/psychosomatic approach of acupuncture, Ayurveda and Tibetan medicine. After the integration of western scientific medicine China is looking more and more for western mental health strategies, respectively, for western psychotherapy and its broad spectrum of schools. Based on the different historical and cultural background the process of integration is different. In this context also the phenomenon of pain is differently understood in east and west. It cannot be separated from the laws of universe and nature as well as from the human nature. The concepts of acute and chronic pain are diverse. Chronic pain is a specific reaction and part of a long time process of imbalance in the relations between the somatic, energetic/psychic and mental level of the patient. The treatment of pain should be an integrative therapeutic setting of different biomedical and CAM strategies including diagnostics and methods of Asian medical systems, their specific psychotherapeutic settings in combination with western psychotherapeutic interventions. The concepts of Asian medical systems are opening the possibility to work out an individual and specific therapeutic setting.