Psychotherapy Work Research Articles

Asylum Seekers and Refugees: An Ethno‐Clinical Approach

‘Ethno‐clinics’ is an impossible word. Defining ‘ethno‐clinics’ is like placing a label on a name, concealing the polysemy of the term. We choose such a word because it is rarely used as a way of doing clinical work in psychotherapy (Dubosc, ; Salmi, ) but we have chosen not to place a ‘registered trademark’ on it, as it usually happens in the ‘free market of ideas.’ The word ‘ethno‐clinics’ is a composition of two words that we will analyse in this essay. We will stress the difference between refugee and asylum seeker due to the generic use by the media of the word ‘refugee’, which is convenient in hiding the fact that the vast majority of immigrants to Europe, in present times, are just asylum seekers; precisely, since Europe does not recognise the human rights of the Other and rejects immigrants, not granting asylum and pushing those people into the backdoor. Nevertheless, ethno‐clinical work does not practice antagonism; it deals with the particular small differences that subvert the complete representation of identity. In Bateson's () terms, a difference that makes a difference. The practice we describe is exercised in the context of a Cooperative Organisation, named Ruah, in Bergamo, Italy.

Finding a New Place to Stand

This article is based on an interview of Colin Wrennall conducted by Keith Tudor. We first met as a result of Keith contacting Colin with regard to The Book of Evan, and got to know each other more through some further conversations. The interview itself was conducted in a conversational style; the resulting article is based on a transcription of the interview and subsequent research, and further writing and editing. The article focuses on and covers Colin’s background and work in farming and psychotherapy and, specifically, psychodrama, and discusses the interplay between these two worlds. Following this and drawing on matters arising from the first part of our recorded conversation and subsequent writing, in the second part of the article, we discuss the phenomenon of our ageing practitioner community, sustainable professional development, and succession-planning. Whakarāpopotonga Ko te uiuinga o Kōrini Werenara e Kīhi Tūhoro te tūāpapa o tēnei kōrero. I ara ake te tūtakitanga tuatahi i te whakapānga atu o Kīhi i a Kōrini mō te pukapuka Te Pukapuka o Ēwana, ā, ka mōhio pai ake i a māua mai i ngā kōrerorerohangai muri ake. He kōrero te momo hiki i te pātaitai, hoi anō nō te hopu reo o taua uiuinga me ngā rangahau te pūtake o tēnei tuhinga. Ka arotake tēnei tuhinga i te whakatipuranga ake o Kōrini me tāna mahi kaipāmu, me te mahi whakaora hinengaro pokapū tonu ki te whakatautau hinengaro, ka matapaki ai i te haeretahinga o ēnei ao e rua. I muri ake mai i nga take ara ake i te wāhanga tuatahi o te hopunga reo me ngā tuhinga i tuhia, i roto i te wāhanga tuarua o te pepa, ka matapakihia te āhua o te taipakeke haere o te hunga mahi o te hāpori, te pupuri whanake ngoio me te whakatakotoranga-tauatanga.

The Translational Value of Psychophysiology Methods and Mechanisms: Multilevel, Dynamic, Personalized.

It has been nearly 15 years since Kazdin and Nock published methodological and research recommendations for understanding mechanisms of change in child and adolescent therapy. Their arguments and enthusiasm for research on mechanisms of behavior change (MOBCs) resonated across disciplines and disorders, as it shined a light on the crucial importance of understanding how and for whom treatments instigate behavior change and how therapeutic mechanisms might be extended to "situations and settings of everyday life." Initial efforts focused on how psychotherapy works and linear models, yet the use of theory to guide the study of mechanisms, and laboratory experiments to manipulate them, is broadly applicable. This article considers dynamic physiological processes that support behavior change. Specifically, it examines the utility of psychophysiological methods to measure and promote behavior change. Moreover, it embeds the baroreflex mechanism, a well-defined heart-brain feedback loop, within the theories and strategies of MOBC research. Individuals' subjective and expressive experience of change does not always align with their physiological reactivity. Thus, behavior change may be best understood when concurrently assessed across multiple biobehavioral levels. Further, behavior is initiated in the moment, often before conscious deliberation, suggesting that multilevel behavior change research may benefit from real-time methodological designs. Last, substance use trajectories vary widely, suggesting that different MOBCs are more or less active in individuals depending on their personal constituency and the functional need that their substance use serves; thus, methods that are amenable to personalized modeling approaches are important.

Neurodynamics inside therapeutic interaction: a case study with simultaneous EEG recording / La neurodinámica en el contexto de la interacción terapéutica: un estudio de caso con una grabación simultánea de EEG

Recent research on processes of psychotherapy has focused on the study of patient-therapist regulation. Evidence concerning verbal and nonverbal coordination as predictors of therapeutic alliance and outcome in psychotherapy has been cumulating. These, along with others results in the field of social neuroscience, suggest that behavioural coordination may have neurophysiological correlates, which play a role in the regulatory process in psychotherapy. Here we introduce an observational paradigm and analytic method to assess the joint neurodynamic activity of patient and therapist. Additionally we report results from ongoing psychotherapy sessions. Our work highlights the involvement of brain activity in the psychotherapeutic process and provides novel insights on how psychotherapy works, in order to further the understanding of the embodied characteristic of the therapeutic interaction.

From Pathological Merger to a Reflective, Triangular Space: Parent-Infant Psychotherapy with a Mother with Borderline Personality Disorder

ABSTRACTThis article looks at Parent-Infant Psychotherapy work with a mother with Borderline Personality Disorder and her infant son. Mother had suffered a traumatic childhood and, when her son was born, withdrew into a delusion of merger with him, avoiding what she experienced as a violent, threatening and confusing world. Drawing on psychoanalytic and attachment-mentalization theories and neuroscientific and developmental research, this article explores mother’s difficulties in acknowledging her baby as a separate being, and the impact this had on baby, who was slowly turning toward an autistic way of functioning. The article discusses the therapeutic challenges in creating a reflective, triangular space where both mother’s and baby’s experiences could be thought about and understood. Finally, the author considers an interpretative stance that includes both mother’s and baby’s shared and their separate experiences.

Microanalysis of Multimodal Communication in Therapy: A Case of Relational Trauma in Parent-Infant Psychoanalytic Psychotherapy

ABSTRACTThis article explains the role of multimodal, microanalytic examinations of the therapeutic process in parent-infant psychotherapy. The work described involves the adaptation of the microanalytic approach that has been applied to exploring the dyad and the rich interactional sequences of behaviors that constitute the parent-infant relationship. The approach in this article widens the focus to include the therapist’s interactions with parent and infant in considering how parent-infant psychotherapy works. Using a clinical case study, several perspectives of the therapeutic processes, including transcripts from videoed sessions, microanalysis of a brief five-second event; clinical session notes, and the therapist’s own narrative, are drawn upon to follow the therapeutic encounter and to consider how the micro-interventions on the part of the therapist, often in the form of subtle embodied communications, interact with the evolving interactional behaviors of the dyad to bring about change in the parent-infant relationship.

“Part of me feels like there must be something missing”: a phenomenological exploration of practising psychotherapy as a clinical psychologist

ABSTRACTThe experience of practising psychotherapy as a clinical psychologist was explored through a small number of in-depth interviews. Using Interpretative Phenomenological Analysis, three main themes were identified: “Feeling there’s something missing”, “Being able to get in there emotionally” and “Needing somewhere to go for support”. This study suggests that training for psychotherapy work can be experienced as piecemeal and fragmented, contributing to professional self-doubt, with clinical psychologists seeking more structured, cohesive training in this area. It also suggests that engagement in personal therapy can contribute to greater emotional capacity as a psychotherapy practitioner, although clinical psychologists can fear engaging in something that is unfamiliar. In addition, the psychologists highlighted the felt necessity of safe and satisfying supervision for resilient practice.

A systematic review of anxiety interventions in stroke and acquired brain injury: Efficacy and trial design

ObjectiveThere is little randomized controlled trial (RCT) evidence to guide treatment for anxiety after stroke. We systematically reviewed RCTs of anxiety interventions in acquired brain injury (ABI) conditions including stroke and traumatic brain injury (TBI) in order to summarize efficacy and key aspects of trial design to help guide future RCTs. MethodsWe searched the Cochrane trial register, Medline, Embase, PsychInfo and CINAHL systematically up to August 2017. Two independent reviewers systematically selected studies and extracted data. We summarized the effect size, key study characteristics and sources of potential bias in trial design. Results14 studies (12 stroke; one stroke & TBI; one TBI) with 928 participants were included. Meta-analysis of five psychotherapy comparisons favoured intervention over control (standardized mean difference (SMD): −0.41 [−0.79, −0.03], I2=28%); Overall effect size of pharmacotherapy comparisons favoured intervention over control (SMD: −2.12 [−3.05, −1.18], I2=89%). One comparison of mixed pharmacotherapy and psychotherapy favoured intervention over usual care (SMD: −4.79 [−5.87, −3.71]). One comparison favoured forest therapy versus urban control (SMD: −2.00 [−2.59, −1.41]). All positive studies carried high or unclear risk of bias. Sample sizes were small in all included studies. ConclusionsThere is low quality evidence to suggest that psychotherapy and pharmacotherapy may be effective interventions in the treatment of anxiety after stroke based on underpowered studies that carried high risk of bias. Large-scale well-designed definitive trials are needed to establish whether pharmacological or psychotherapy works. Our review highlighted key considerations for investigators wishing to design high quality trials to evaluate treatments for anxiety after stroke.

Experience of psychotherapy of psychosomatic disorders

Purpose of the article – to define and describe the organizational and rich in content aspects of psychoanalytic-oriented psychotherapy of psychosomatic disorders as displays of violation of psychical health. In the described going near psychotherapy of psychosomatic disorders authors leaned against the theoretical analysis of foreign and domestic literature and researches, presented in magazines on medicine, psychology and psychotherapy; generalization and systematization of ten year own work psychotherapy experience of work (psychoanalytic-oriented direction) with clients which have psychosomatic disorders. A selection made fifty persons in age from 27 to 50 years. The organizational features of psychotherapy work selected with psychosomatic disorders, which consist in obligatory combination of analytical therapy with pharmacological therapy and different kinds corporal-oriented and art-therapies, and in combination a group and individual forms of psychotherapy. The rich in content features of psychotherapy work with psychosomatic disorders consist in the psychotherapy accompaniment of client through a row successive the stages, each of which has goals and tasks, dominant psychotherapy strategies and am preparatory for subsequent. Thus, authors are offer the algorithm of psychotherapy work with clients by psychosomatic disorders, developed taking into account their individual typology, psychoemotional and cognitive features.

Beyond Clinical Case Studies in Psychoanalysis: A Review of Psychoanalytic Empirical Single Case Studies Published in ISI-Ranked Journals.

Single case studies are at the origin of both theory development and research in the field of psychoanalysis and psychotherapy. While clinical case studies are the hallmark of psychoanalytic theory and practice, their scientific value has been strongly criticized. To address problems with the subjective bias of retrospective therapist reports and uncontrollability of clinical case studies, systematic approaches to investigate psychotherapy process and outcome at the level of the single case have been developed. Such empirical case studies are also able to bridge the famous gap between academic research and clinical practice as they provide clinically relevant insights into how psychotherapy works. This study presents a review of psychoanalytic empirical case studies published in ISI-ranked journals and maps the characteristics of the study, therapist, patient en therapies that are investigated. Empirical case studies increased in quantity and quality (amount of information and systematization) over time. While future studies could pay more attention to providing contextual information on therapist characteristics and informed consent considerations, the available literature provides a basis to conduct meta-studies of single cases and as such contribute to knowledge aggregation.

Adolescent Patients’ Responses to Interpretations Focused on Endings in Short-Term Psychoanalytic Psychotherapy

ABSTRACTDiscussing endings is a crucial part of the work of short-term psychoanalytic psychotherapy with adolescents, but there are different views on how best this should be done and whether it is helpful or appropriate to link endings to interpretations of the transference. This study looks at how adolescent patients suffering from moderate to severe depression respond to interpretations around endings in a 28-session long, manualized psychoanalytic psychotherapy. Data come from a randomized clinical trial in which all sessions were audio-recorded. Purposive sampling was used to identify four sessions with four different adolescents in which therapists raised the issue of upcoming endings, explored the patients’ emotional responses, and linked these to the transference. The four extracts were transcribed and analysed using conversation analysis. Findings show that patients either emphasized or diminished the importance of their relationship to the therapists and the consequences of the separation from them in response to transference interpretations. They managed the conversational exchange by either “trouble-telling” or “story-telling.” The authors reflect on the implication of patients’ responses for treatment technique and consider whether transference work with adolescents should be paced and adapted more flexibly in short term psychoanalytic psychotherapy.

Successful schooling for pupils with intellectual disabilities: the demand for a new paradigm

A comprehensive review of educational interventions for pupils with intellectual disabilities showed that most studies report positive results for a variety of interventions. The aim of this article is to explore how these results can be understood. We draw on similar earlier findings concerning intervention effects in psychotherapy and social work, discussing the so-called Dodo bird conjecture, indicating that established methods for identification of evidence-based practices can provide false, positive results influenced by so-called common factors present in most interventions. In conclusion, we argue for a new paradigm of research on educational interventions for pupils with intellectual disabilities, replacing the present ambition to find evidence-based support for specific interventions in favour of a line of research exploring alternative explanations in terms of, for instance, common positive factors.

How to Code Correctly for E/M Payment

How to Code Correctly for E/M Payment

Selective Effects of Psychotherapy on Frontopolar Cortical Function in PTSD.

Exposure therapy is an effective treatment for posttraumatic stress disorder (PTSD), but a comprehensive, emotion-focused perspective on how psychotherapy affects brain function is lacking. The authors assessed changes in brain function after prolonged exposure therapy across three emotional reactivity and regulation paradigms. Individuals with PTSD underwent functional MRI (fMRI) at rest and while completing three tasks assessing emotional reactivity and regulation. Individuals were then randomly assigned to immediate prolonged exposure treatment (N=36) or a waiting list condition (N=30) and underwent a second scan approximately 4 weeks after the last treatment session or a comparable waiting period, respectively. Treatment-specific changes were observed only during cognitive reappraisal of negative images. Psychotherapy increased lateral frontopolar cortex activity and connectivity with the ventromedial prefrontal cortex/ventral striatum. Greater increases in frontopolar activation were associated with improvement in hyperarousal symptoms and psychological well-being. The frontopolar cortex also displayed a greater variety of temporal resting-state signal pattern changes after treatment. Concurrent transcranial magnetic stimulation and fMRI in healthy participants demonstrated that the lateral frontopolar cortex exerts downstream influence on the ventromedial prefrontal cortex/ventral striatum. Changes in frontopolar function during deliberate regulation of negative affect is one key mechanism of adaptive psychotherapeutic change in PTSD. Given that frontopolar connectivity with ventromedial regions during emotion regulation is enhanced by psychotherapy and that the frontopolar cortex exerts downstream influence on ventromedial regions in healthy individuals, these findings inform a novel conceptualization of how psychotherapy works, and they identify a promising target for stimulation-based therapeutics.

Entering chair work in psychotherapy: An interactional structure for getting emotion-focused talk underway

This paper examines the interactional accomplishment of chair work, which is one type of therapeutic intervention for exploring client emotions in Emotion Focused Therapy (EFT). During this intervention, therapists guide clients to speak with either a conflicted aspect of self (two-chair work) or with a non-present significant other to address unresolved feelings or ‘unfinished business’ (empty-chair work). Using the methods of conversation analysis, we examine ten video-taped EFT sessions that incorporate chair work. It was found that chair work entry is regularly accomplished through four distinct interlocking interactional phases: 1) Formulating the client's trouble; 2) Recruiting participation in chair work; 3) Readjusting the participation frame; 4) Making contact. We will show how each phase orients to specific interactional concerns that often pertain to managing epistemic and/or deontic authority and also to accommodating the participants into entering a new participation frame. Although gaining client confirmation and compliance was at times promptly achieved within these phases, clients also regularly delayed their affiliative uptake of the therapist's prior action. We will show, in these cases, how therapists perform additional interactional work to get chair work entry back on track.

El sentido de la vida. Un ejemplo de intervención

Desde el origen de los tiempos el ser humano se ha cuestionado el significado de la vida. Grandes pensadores y filósofos han planteado en innumerables ocasiones cuál es el sentido de la vida. La Psicoterapia Integradora Humanista, a través de sus planteamientos teóricos y metateóricos, junto con la sabiduría de la Psicología Existencial, recoge el tema y lo plantea como algo concreto a trabajar en la sala de terapia. El presente artículo está basado en el taller realizado en el I Congreso Internacional de Psicología y Psicoterapias Humanistas que se celebró en Barcelona en noviembre de 2015. Como el taller, el artículo se plantea en dos partes. Una primera en la que hay una revisión teórica de la cuestión existencial, basada principalmente en la temática de Irvin Yalom (la muerte, la libertad, el aislamiento y el sentido de la vida). En la segunda parte, se plantea una posible intervención para trabajar en psicoterapia el sentido de la vida, junto con la reflexión final sobre los aspectos genéricos a tener en cuenta a la hora de enfocar este tema en terapia.

Short-Term Group Therapy for Complicated Grief: The Relationship Between Patients’ In-Session Reflection and Outcome

Objective: The objective of the present study was to examine the nature of patients’ work in two types of short-term group psychotherapy. The study sought to investigate the relationship between patients’ psychodynamic work versus supportive work in group psychotherapy and treatment outcome at termination and at 6-month follow-up. Psychodynamic work refers to reflection regarding intrapsychic motivations, defenses, and relational patterns, and supportive work refers to practical problem solving. Method: Participants were 110 patients who completed two forms of group therapy for complicated grief: interpretive therapy and supportive therapy. Two types of patients’ in-session activity—psychodynamic work and supportive work—were rated by group therapists in both treatments. Pre-post and follow-up outcome domains included general symptoms, grief symptoms, and life dissatisfaction/severity of target objectives. Results: There was no significant difference in the nature of patients’ therapeutic work between interpretive and supportive groups. Psychodynamic work was associated with pre-post improvement in grief symptoms. Psychodynamic work was also associated with further improvement in grief symptoms at 6-month follow-up, along with improvement in broader symptom domains. Supportive work was not associated with any pre-post or follow-up benefit. Conclusion: The findings provide evidence that psychodynamic work—focused on the development of insight and self-reflection—in group psychotherapy can contribute to further benefit after the completion of treatment. This finding cut across two approaches to short-term group therapy for complicated grief, suggesting that it may reflect a general curative mechanism of group treatments.

Interoceptive exposure at the heart of emotional identification work in psychotherapy

IntroductionEmotional avoidance is a target process, offered by modern psychotherapies. Emotional exposure is often difficult to put in place when there is a major cognitive and behavioral avoidance. Education on emotional processes is necessary but often insufficient during individual follow-up.ObjectivesThe longitudinal study seeks to verify whether work on exposure and emotional identification influences the decreased level of anxiety and depression.AimsIntroduction of interoceptive exposition in psychotherapy decreases the frequency of emotional avoidance.MethodGroup psychotherapy composed of two modules: interoceptive exposure and emotional identification was proposed to patients with anxiety and depressive disorders. A group of 6 participants was evaluated at three times: T0 before the start of the group, T1 post-module 1 and T2 post-group. Assessments of HAMA anxiety, MADRS depression, QEC cognitive avoidance, UPPS impulsivity, MCQ-30 metacognition and emotional regulation REQ-21 have been proposed.ResultsSignificant differences were observed between pre- and post-intervention scores (Friedman test). The HAMA anxiety rate (P = 0.006) and the MADRS depression (P = 0.047) decreased. Participants in the group were less likely to use QEC thought substitution (P = 0.009) and urgency in their UPPS reactions (P = 0.03). Moreover, their external dysfunction REQ. 21 decreases (P = 0.03).ConclusionFaced with emotional avoidance, work on emotional identification requires prior interoceptive exposure. It is a first stage of work that involves sensitizing to the presence of emotional bodily sensations. Group work facilitates exposure to emotion and its identification; decentration leading to emotional intensity decrease. The work on the interoceptive exhibition facilitates the emotional exposure while participating in the deactivation of the associative emotional network.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Does psychotherapy work? An umbrella review of meta-analyses of randomized controlled trials.

To map and evaluate the evidence across meta-analyses of randomized controlled trials (RCTs) of psychotherapies for various outcomes. We identified 173 eligible studies, including 247 meta-analyses that synthesized data from 5157 RCTs via a systematic search from inception to December 2016 in the PubMed, PsycINFO and Cochrane Database of Systematic Reviews. We calculated summary effects using random-effects models, and we assessed between-study heterogeneity. We estimated whether large studies had significantly more conservative results compared to smaller studies (small-study effects) and whether the observed positive studies were more than expected by chance. Finally, we assessed the credibility of the evidence using several criteria. One hundred and ninety-nine meta-analyses were significant at P-value ≤ 0.05, and almost all (n = 196) favoured psychotherapy. Large and very large heterogeneity was observed in 130 meta-analyses. Evidence for small-study effects was found in 72 meta-analyses, while 95 had evidence of excess of significant findings. Only 16 (7%) provided convincing evidence that psychotherapy is effective. These pertained to cognitive behavioural therapy (n = 6), meditation therapy (n = 1), cognitive remediation (n = 1), counselling (n = 1) and mixed types of psychotherapies (n = 7). Although almost 80% meta-analyses reported a nominally statistically significant finding favouring psychotherapy, only a few meta-analyses provided convincing evidence without biases.

Image and Imagination: Deepening Our Experience of the Mind

ABSTRACTThe perspective on images presented in this article grows out of an understanding of the brain and mind as image-based. Building on the work of neurobiology, linguistics, and cognitive neuroscience, this article explores the mind’s natural proclivity for imagination and creativity. These capacities for creativity and imagination are applied to the work of psychotherapy. Clinical material is provided to illustrate the approach. What will emerge from this article is a realization that patient and therapist can lean upon the imaginative potentials of the mind to further the overall psychodynamic goals of change and healing.