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Many types of non-professional, non-credentialed relationships are seen by laypersons as analogous to those occuring in psychotherapy. This paper takes a leap backwards several centuries and describes two examples of one such type of interaction as portrayed in artistic masterpieces. In Miguel de Cervantes' novel, "Don Quixote," an elderly, depressed man pursues a restitutive and grandiose delusion of being a heroic knight errant. In Ingmar Bergman's film, "The Seventh Seal," a disillusioned knight returns from the Crusades to face the lethal bubonic plague, and he uses obsessional means in an attempt to outwit death. Both men are accompanied by squires who try, with varying degrees of success, to help their masters relinquish their infantile needs for omniscience and omnipotence, accept their human limitations, and deal more appropriately with their surrounding realities. The powerful and inspiring insights of both works have much to teach contemporary therapists whose patients wear more metaphorical suits of armor. [ABSTRACT FROM AUTHOR]

Therapists who are accustomed to operating in a world where gender roles are becoming increasingly androgynous may underestimate how foreign the experience of psychotherapy can be to "traditional" men. This paper describes the occurrence of transference and resistance encountered by female therapists when seeing male patients at a Veterans Administration (V.A.) Medical Center who identify with traditional American male gender roles. The discussion is informed by recent advances in the theory of male gender identity development and yields new insights into the typical defenses men may bring to the early phases of psychotherapy. Case examples from the authors' practices illustrate strategies for intervening with resistance and enhancing the therapeutic alliance. Common countertransference issues encountered by therapists working with "traditional" men are also discussed. [ABSTRACT FROM AUTHOR]

Logocentrism was conceptualized by Jacques Derrida as connoting the assertion within Western philosophical traditions of certain assumed truths and the exclusion of alternative perspectives. In this paper, the author proposes that the concept of logocentrism may be usefully applied within the clinical situation to enrich understanding of splitting between idealized and devalued perceptions of self and others. He presents a case of a woman with borderline personality disorder to illustrate a logocentric self-structure, as well as how common psychotherapeutic models inadvertently risk reinforcing such structures through the hierarchical nature of the patient-therapist relationship. The process of deconstructing logocentric self-structures is facilitated by the patient experiencing the therapist paradoxically as an extension of the self that sometimes behaves contrary to expectations. Such a deconstructive experience challenges reified perceptions of self and others, serves to broaden the experience of self, and enhances qualities of self-reflection and empathy. To risk meaning nothing is to start to play (Derrida, 1981, p.14) 1981 a [ABSTRACT FROM AUTHOR]

This paper reviews neuroscientific advances across the therapeutic disciplines and outlines new potential insights into understanding the biology of the psychotherapeutic processes. In a quest to understand the modus operandi of psychotherapy, the author reviews the evolution of the biology of psychotherapy. The mechanisms involved in learning processes, such as memory and priming, attachment, and long-term consequences of early life trauma, demonstrate how brain structures can be affected by environmental changes. Finally, the author proposes that verbal and non-verbal aspects of the psychotherapeutic process mediate their therapeutic effects through biological changes as they work on primitive emotional reflexes and stimulate mentalization processes. [ABSTRACT FROM AUTHOR]

Effective intercultural psychotherapy generally has been conceptualized in terms of a specific knowledge and skills base, combined with relevant attention to the practitioner's cultural attitudes and beliefs. Although such an approach continues to be the gold standard in the field, it has yet to be demonstrated that these components are either necessary or sufficient for effective treatment. This paper presents an approach to intercultural therapy based on Gadamer's philosophical hermeneutics. Humans are always in the process of making sense of the world around them, a process which is predicated on culturally given preunderstandings. Cultural difference means that the preunderstandings are rarely mutual, and therefore, communication and psychotherapy are often problematic. These preunderstandings often show up in the form of racial and ethnic prejudice and the therapist is rarely aware of this. Therapist preunderstanding influences all aspects of the psychotherapy process, such as treatment planning interventions chosen, and the therapeutic relationship. Recommendations are given for improving the intercultural therapy process, and draw strongly on the twin notions of the dialogical relationship and cultural imagination. [ABSTRACT FROM AUTHOR]

This paper examines the ramifications of a psychotherapist's self-disclosure stimulated by the film Gloomy Sunday (Barkow, N., 1988, Universal Pictures, 1999). It describes the five-year psychoanalysis of a depressed surgeon who made serious medical errors while treating family members. Analysis provided considerable symptom relief, but decades later the patient again became depressed. His depression was precipitated by his having made a major medical error while treating a family member, his daughter, which had an almost fatal result. The surgeon then resumed psychotherapy two times a week for three years. Cultural and professional similarities between psychiatrist and patient cemented the therapeutic alliance, but the patient's medical errors when treating his family members persisted. The psychotherapist's self-disclosure stimulated by the viewing of the film became a fulcrum for renewed investigation of the patient's childhood unconscious contributions to his psychopathology. It also stimulated self-analysis regarding counter-transference issues in the therapist which was related to his own perceptions of Nazis. The resumed treatment ameliorated the patient's tendency to make medical errors. The description of both treatments is intended to deepen the understanding of a "boundary crossing" intervention that assisted psychotherapeutic progress, and to contribute to further consideration of its benefits and risks. [ABSTRACT FROM AUTHOR]

In this article the classical concept and the use of the 'corrective emotional experience' in psychotherapy is described. This concept is not widely accepted within the standpoint of contemporary psychoanalytic psychotherapy and object relations theories. It has an unfavorable reputation. However, this paper does not advocate discarding this therapeutic idea and action because it does have therapeutic value. The case is made that the search for the bad object, and patient's reenactment of early experiences as they had been, is a corrective emotional experience in that it is a reparative experience. Furthermore, the search for the bad object is necessary for attachment. In addition, the point is made that patients find and create the object, therefore, the corrective emotional experience must be viewed as something that patients find rather than what therapists do. [ABSTRACT FROM AUTHOR]

This paper makes a case for listening and its role in establishing and maintaining meaningful psychotherapeutic relationships. Further, it examines those factors that have contributed to the devaluation and current decline of listening in mental health care. These factors include the abuses of managed care, the marketing and misuse of psychotropic medications, the growth of brief, manualized, empirically supported treatments (ESTs), and the lack of appreciation for unconscious processes and countertransference in the appeal, development and delivery of these interventions. [ABSTRACT FROM AUTHOR]

The process of learning to conduct psychotherapy is extremely challenging, especially in the initial stages. It is not inappropriate for the novice to seek concrete guidance as to how to proceed in the initial work with the patient. Unfortunately, however, the therapist in training may be daunted by the psychodynamic/psychoanalytic literature, which is highly theoretical and bewildering in its diversity. The following material is a compilation of psychotherapy "pearls" that the authors have distilled from the psychotherapy literature, supervision with senior colleagues, and their own clinical experience.(n1) This article is intended as a primer of some technical aspects of psychodynamic work. An attempt has been made to select facets of technique that seem surprising to the inexperienced, as they are different from other types of conventional discourse. The authors have chosen to use "he" instead of "he/she" or "them" to make the paper stylistically more palatable. A bibliography is presented at the end as a guide for the beginning reader. [ABSTRACT FROM AUTHOR]

The term "boundary violation" has become synonymous with unethical practice in psychotherapy, prompting a "black-or-white" view among clinicians and boards of review. But the current conceptual ambiguity about boundary interventions subjects clinicians to after-the-fact second-guessing that can be professionally ruinous at worst and may contribute to stultifying defensive therapeutic rigidity at best. It is crucial to demarcate the differences between boundary violations and boundary crossings (to be defined below) as clearly as possible, to describe the "gray areas" of each, and to recognize the heterogeneity of boundary violations and boundary crossings. These matters are of additional importance to those who teach, train, and supervise the next generation of clinicians. This paper will attempt to delineate a more clinically realistic and useful view of boundary crossings than has been proposed before, and illustrate the practical advantages of recognizing the spectrum of boundary interventions. [ABSTRACT FROM AUTHOR]

Keilson was the first who differentiated between various age groups, regarding the relationship between stressful Holocaust situations and their ultimate effect on later life. In this paper I will compare the developmental needs of different age groups and the devastating reality child-survivors had to go through. In the therapeutic situation with child-survivors who are now in their sixties and seventies, different defense styles become apparent. The therapist will be confronted with an adult who herds an abandoned child within, who has fragmented or no memories of the past and who is not used to being in touch or revealing his hidden painful feelings of longing and grief. [ABSTRACT FROM AUTHOR]

In this paper, three major tasks are undertaken: 1. showing that our traditional understanding of the nature of emotions, which equates them with certain sorts of inherently private affective experiences that are brought about by various causal factors (esp., exciting events, cognitive interpretations, and biological states of affairs), does justice neither to the conceptual nor to the empirical facts; 2. presenting an alternative conception of emotions as a specific class of perceived relationships between oneself and some person, object, event, or state of affairs; 3. demonstrating how this relational conception of emotions heuristically suggests a far greater range of therapeutic options than does the traditional view. [ABSTRACT FROM AUTHOR]

Forensic experts agree that the doctrine of informed consent now applies to psychotherapy. The optimum level of detail and content in this interaction remains nebulous. This study examines opinions and practices of therapists. The authors administered a survey regarding this subject to 231 psychotherapists. Six scales were constructed from this survey. High scores on these scales suggest more positive opinions regarding the application of the doctrine of informed consent to psychotherapy. Psychiatrists scored significantly lower on the Informed Consent (p=0. 005), Written Consent (p<0. 01), and Self-Disclosure (p=0.026) scales than other types of therapists (suggesting a more negative opinion of the application of this doctrine to psychotherapy). Interpersonal therapists scored significantly higher than psychodynamic psychotherapists on the Informed Consent (p=0. 003) and Patient (p=0. 003) scales. Psychodynamic psychotherapists scored significantly lower than therapists with different modalities on the Written Consent scale. This paper suggests that opinions and practices of informed consent for psychotherapy vary with the characteristics of the therapist. More research m this area could serve as a guide for therapists embarking on the process of informed consent or for professional organzations who wish to establish guidelines. [ABSTRACT FROM AUTHOR]

This paper investigates the psychological consequences of a social ethos that has emerged in the 1990s; the Bourgeois Bohemian (in short, Bobo) that claims that the bourgeois striving for financial success and status can be reconciled with the Bohemian striving for creative self-expression. An extended case history shows how a man in his thirties grappled with the inherent complexity and contradictions of the Bobo ethos. The question is raised how, as psychotherapists, we can deal with the individual patient's search for a good life amidst the growing pressure of the Bobo ethos, to get the best of all possible lives, the combination of authenticity and success. [ABSTRACT FROM AUTHOR]

In a world of technological breakthroughs, it is not surprising that psychotherapists have, along with the general population, taken to the multiple possibilities offered by devices or systems that affect communication. E-mail, now an ever-present phenomenon of near "real time" interaction, provides a myriad of possibilities for enhanced dialogue in psychotherapy relationships. This paper will describe the growing phenomenon of e-mail as an adjunctive tool in psychotherapy practice by initially reviewing the most current of the recent literature. The authors will present a model for the adjunctive use of e-mail between patient and therapist. Case material will illustrate this model as applied to ongoing treatment, crisis intervention, and follow-up. [ABSTRACT FROM AUTHOR]

Psychodynamic psychotherapists are not generally accustomed to discussing with patients the impact of their own personal experiences on their clinical work. Psychotherapists who return to work postmaternity leave, however, have both a rich opportunity and a clinical mandate to explore the effects of their new parenting on the treatment field. Pregnant therapists have addressed their pregnancy with their patients; however, the experiences of both therapists and patients postmaternity leave are often not discussed to the same extent. Using the author's own experience following her return to clinical work following the birth of her child, this paper explores the ways that the psychodynamic work is affected when the therapist has become a parent, including: changes in transference work; problems of separation and abandonment; and expanding boundaries. [ABSTRACT FROM AUTHOR]

Clinical study of envy and jealousy in the psychotherapy situation indicates that these two states of mind are biopsychosocial response patterns involving the perceptual, cognitive, affective, and intentional mental functions. These response patterns are evoked by perceptual events that inform the individual of one's relative position vis-à-vis the requirements of one's life. Once these patterns can be discerned in the patient, the clinician is able to hear things in the psychotherapy situation not previously beard and understand, interpret, and work through conflict in a new and useful way. In this paper psychotherapy paradigms and strategies are discussed from the new perspective afforded by the psychology of envy and jealousy. [ABSTRACT FROM AUTHOR]

Many mental health providers believe that psychodynamic psychotherapy under managed care is virtually impossible. Notwithstanding the many adversities posed by managed care, there are ways to productively apply psychodynamic principles within this health care financing system. This paper critically discusses the possibilities and costs of conducting psychodynamic psychotherapy under managed care using theory, practice applications, and a case vignette. Central to the discussion is elaboration of five central differences between traditional psychodynamic treatment versus that conducted under managed care. [ABSTRACT FROM AUTHOR]

The author discusses a fragment of the analysis of a patient who had experienced both neglect and sexual molestation during early childhood. The analysand had developed a defensively hypertrophied form of mindedness in an effort to gain some sense of control over bodily experience, which threatened not only his sanity, but his very sense of being. The focus of the paper is on a series of sessions from a period of regression during which the patient experienced psychotic-level anxiety and a feeling of impending psychic disintegration. The author discusses in detail two interventions that he made during this period of analytic work. The first involved the analyst's finding himself speaking with a parental voice with which he took on the responsibility of protectively "minding" the patient while the patient experienced himself on the edge of disintegration. The second spontaneous intervention involved the analyst's inviting the patient to imagine himself at his present age into a story of molestation (based on the patient's history and the history of the analysis) in which the analyst was a third presence bearing witness, bearing language and bearing compassion. These interventions seemed to have been of importance in facilitating the patient's development of a greater sense of being alive in a co-extensive minded body and bodied mind. [ABSTRACT FROM AUTHOR]

The paper concludes with a discussion of the role played by existential death anxiety in the perpetuation of the errors rife in classical psychoanalytic thinking. Lessening our use of dental mechanisms in response to death anxieties is a key requisite for advancing psychodynamic theories in the next one hundred years. [ABSTRACT FROM AUTHOR]

Supervisors of analytic psychotherapy have long wrestled with the question of whether interpretation has a legitimate role in dealing with supervisee countertransference and the transferences of the supervisory experience, itself Currently, the majority view relies on didactic methods to deal with these transferences and avoids interpretation as incompatible with, even dangerous to, the supervisory task. This paper takes issue with this view and uses a clinical example to illustrate the impact and irreplaceable value of direct interpretation m supervision. It demonstrates that interpretation of a resistance in the supervisee can fundamentally and beneficially affect the therapeutic relationship, the supervisory process, and can have unanticipated diagnostic significance. It also demonstrates that, when applied with the same appropriateness and tact taken for granted in psychotherapy, concerns that supervisory interpretation will be traumatizing or counterproductive are unwarranted. [ABSTRACT FROM AUTHOR]

Patients seek psychotherapy for relief of symptoms and resolution of problems in living. Yet, they sometimes balk at the prospect of having to choose a topic without being prompted by therapist questions. This paper suggests that this apparently self-sabotaging behavior represents an acting out of a fundamental existential dilemma for many individuals, i.e., to be or not to be an adult. Adulthood comes with the heavy burden of responsibility for making life choices, and the possibility of making the wrong choices. The psychotherapeutic situation, with its demand that the patient choose a topic, is a microcosm of the adult-adult relationship. The author proposes that the proper treatment for these patients is Generative Caring Psychotherapy, which promotes emotional growth and facilitates patients' transition from childhood dependence to adult responsibility. [ABSTRACT FROM AUTHOR]

Performative statements are much discussed in the philosophy of language, e. g., by the linguistic philosopher, J. L. Austin, where they are distinguished from descriptive statements. Whereas the latter merely describe a current state of affairs from an external standpoint, performative statements enact a new state of affairs merely by being spoken, as when a minister pronounces a couple married during a wedding ceremony. Performative statements are words and deeds at the same time. They are special kinds of statements, requiring certain unique circumstances and relationships so that they can function validly. Leston Havens has made the connection between the ability to make performative statements and the setting of psychotherapy. He has asserted that performative statements are an important part of the psychotherapeutic repertoire and may be an important force in bringing about psychotherapeutic change. In this paper, I try to locate the mechanism by which performative statements may achieve this effect, suggesting that this occurs by means of influencing the patient's will directly. Performative statements work on the will, much as descriptive statements influence the intellect. Philosophical ideas about the will, like Aristotle's notion of weakness of will, may explain some of the phenomena of psychotherapy, including resistance. [ABSTRACT FROM AUTHOR]

Presents a paper which reviews the nonspecific elements of psychotherapy, and inspects cognitive, interpersonal, and analytically oriented therapies to see whether claimed differences are, in fact, sufficient to make differential results likely. Attention called to assumptions implicit in most clinical trials about the effectiveness of once-a-week, short-term treatment.

Some themes of survivorhood are discussed in relation to their effects on the supervisory process. The focus of this paper is on the intrusive themes of survivor shame, survivor rage, and survivor panic. Three illustrative case examples are presented. [ABSTRACT FROM AUTHOR]

The English-speaking clinician frequently evaluates and treats patients whose mother tongue is not English. This paper summarizes some of the evidence supporting an emotional-detachment effect associated with speaking in a second language and describes its implications for the psychotherapy of this population. [ABSTRACT FROM AUTHOR]

Comments on the papers about psychotherapy published in the previous issues of the periodical 'American Journal of Psychotherapy'. Critique on primal therapy; Analysis of phobic behavior.

An introduction is presented in which the editors encourage submission of scholarly papers in psychotherapy and discuss their responsibilities as editor-in-chief and deputy editor of the journal.