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Objectives: This paper aimed to synthesize empirical findings of patient extratherapeutic interpersonal variables associated with individual psychotherapy treatment outcomes in adult outpatients with depression. Methods: A systematic search strategy was used to identify relevant studies. Thematic analysis was used to identify recurring themes in the findings. Results: Forty studies met search criteria. Three themes of patient extratherapeutic interpersonal variables were identified: capacity to engage with others, capacity to navigate relationships, and capacity to achieve intimacy, progressing from basic to advanced levels of interpersonal interaction. Interpersonal variables such as interpersonal distress and style, attachment orientation, and quality of object relations were particularly useful in predicting treatment outcomes, whereas access to social support and marital status provided mixed results, likely because they do not account for relationship quality. Conclusions: Recognizing variables associated with treatment response can help clinicians identify patients at risk for nonresponse and guide efforts for adapting existing therapies and developing new ones. [ABSTRACT FROM AUTHOR]

Borderline personality disorder is a prevalent psychopathology; thus, most graduate students in psychology, residents in psychiatry, and early career clinicians will encounter patients with this disorder in the course of their training or initial professional practice. This paper provides clear and concise guidelines for conducting treatment geared toward the clinician's developmental level. It builds upon the knowledge and skills that are typically acquired during graduate education and training to provide an accessible framework for undertaking psychotherapy with patients who have borderline personality disorder. This paper draws upon common psychotherapeutic factors and existing evidence-based treatments for the disorder to identify principals and interventions that are likely to contribute to therapeutic action. It uses behavioral, cognitive, and psychodynamic interventions to address the patient's multidimensional psychopathology. This approach offers a coherent and integrated treatment framework for the beginning psychotherapy practitioner. [ABSTRACT FROM AUTHOR]

What are some of the most recent, cutting-edge developments and innovations in psychotherapy supervision? And what is their particular significance for supervision now and into its future? In this special supervision issue of the American Journal of Psychotherapy, those questions are considered, and some compelling answers are provided. In what follows, I introduce this special journal issue: (a) define supervision and indicate its purposes; (b) summarize the contents of each innovative paper; and (c) accentuate the significance of each presented development/innovation. The papers contained in this issue boldly speak to supervision's future and provide exciting--and highly profitable-- directions to pursue in forever making psychotherapy supervision a far more anchored, accountable, and educational experience. [ABSTRACT FROM AUTHOR]

The ways terms are defined have a significant impact on psychotherapeutic theory, research, and practice. This paper will provide the definitions of and conceptual distinctions among terms that have emerged from embodied and embedded approaches to the self and its disorders. First, it will offer the distinctions regarding conceptual definitions of disembodiment and hyperreflexivity to differentiate these from other psychopathological configurations and normal conditions. Second, it will present disturbances of the self that arise in the consensual processes of establishing intersubjectivity and manifest themselves in narratives. Third, the paper will present the principles of possible psychotherapeutic interventions for persons with schizophrenia. The conclusion states that both ontological (structural) as well as ontogenetic (autobiographical) aspects should be considered in the hermeneutic process of understanding patients. Content should be a significant element of this latter analysis. [ABSTRACT FROM AUTHOR]

More than 40 years ago eminent psychiatrist Richard Chessick penned a classic, highly prescient psychotherapy supervision paper (that appeared in this journal) in which he identified for supervisors the crucial triad of learning difficulties that tend to confront beginning therapists in their training. These are (a) dealing with the anxiety attendant to the development of psychological mindedness; (b) developing a psychotherapist identity, and (c) developing conviction about the meaningfulness of psychodynamics and psychotherapy. In this paper, I would like to revisit Chessick's seminal contribution about the teaching and learning of psychotherapy and extrapolate his triad of learning difficulties to the process of teaching and learning supervision. The process of being and becoming a psychotherapist has been likened to a developmental journey, and similarly being and becoming a supervisor is increasingly recognized as a developmental journey that is best stimulated by means of didactic and practical experiences (i.e., supervision coursework, seminars, or workshops and the supervision of supervision). In what follows, I would like to explore how Chessick's crucial triad of learning difficulties can be meaningfully extrapolated to and used to inform the supervision training situation. In extrapolating Chessick's triad, beginning supervisors or supervisor trainees can be conceptualized as confronting three critical issues: (a) dealing with the anxiety and demoralization attendant to the development of supervisory mindedness; (b) developing a supervisory identity; and (c) developing conviction about the meaningfulness of psychotherapy supervision. This triadic conceptualization appears to capture nicely core concerns that extend across the arc of the supervisor development process and provides a useful and usable way of thinking about supervisor training and informing it. Each component of the triadic conceptualization is described, and some supervisor education intervention possibilities are considered. [ABSTRACT FROM AUTHOR]

Pregnancy is a challenging time for the patient with psychosis, the fetus, the psychotherapist, and the team treating the patient. Little is known about being a parent with psychiatric illness and how to manage this clinical situation. This paper is the sequel to a previously published case study that described the process of psychotherapy with a schizoaffective patient (See AJP 62/2, 35-49). The patient became pregnant and gave birth to a boy. This paper reports the psychotherapeutic process of the patient during pregnancy, the child's early years, and over ten years after childbirth. The process of psychotherapy is discussed. [ABSTRACT FROM AUTHOR]

Psychotherapists generally feel uncomfortable addressing patients' beliefs, particularly religious beliefs, because of the desire to respect client subjectivity and to avoid the abuse of therapeutic authority. This paper's first contention is that at some junctures, investigation of the client's belief structure can be an important catalyst for change, as exemplified by an extended case example. This stance assumes that much of the individual and collective damage rigid belief systems inflict derives from their function as a defense against death awareness, as described by terror management theory. The paper develops the concept of a therapeutic meta-attitude towards belief, mild Epicureanism, related to the classical Greek philosopher Epicurus (341-270 BC). Mild Epicureanism means to soften attachments to all belief systems, even therapeutic theories, to lower their potential inhibition of personal growth. The paper presents the argument that mild Epicureanism is consistent with most therapeutic approaches, and allows addressing clients' belief without interfering with their right to make up their own minds. [ABSTRACT FROM AUTHOR]

During the last several decades, brief psychotherapeutic approaches to mental health treatment have become increasingly prevalent. This paper describes brief psychotherapy and provides a brief review of the relevant empirical literature. Therapists who are unfamiliar with brief psychotherapy will find that this paper provides a concise introduction to the essential processes and outcomes of this therapeutic approach. [ABSTRACT FROM AUTHOR]

The intent of this paper is to examine the inherent contradictions in the practice of psychotherapy that, if left unexamined, ruin the emancipatory prospects that it holds. Critical theory and, more specifically, Jurgen Habermas' theory of communicative action is utilized as a starting point for reconceptualizing psychotherapy. This paper then establishes a phenomenological and ethical basis for solidarity despite the power differences and conflicting goals for therapists and clients. It draws heavily on a consideration of intersubjectivity and the self as fundamentally relational as conceived by theorists such as Schutz, Levinas, and Vygotsky. Through such an analysis psychotherapy will be constituted consciously as a free space for critique, dissent and action, allowing for a core experience of one's self as a source of power in the social field that will foster replication in society at large. [ABSTRACT FROM AUTHOR]

The present paper discusses the advent and significance of erotic feelings in psychotherapy based on the intersubjective theory. It briefly reviews the coalescence of the tradition of avoidance of physical contact in psychotherapy, and the classical and contemporary approaches to erotic transference. A clinical case is presented in an attempt to expand the significance attributed to erotic feelings in therapy and ways of relating to it: in their intrapersonal and interpersonal meanings and in the dialectics between them. I will later discuss the father figure in feminine development and its transferential and metaphoric meaning against the background of a clinical case, and the importance of the erotic component in the processes of change and development. The paper includes mythological metaphors illustrating the issues in a cultural perspective that constitutes the traditional framework of thinking relevant to the issues which are the subject of this paper. [ABSTRACT FROM AUTHOR]

The issue of abortion typically has been categorized as a "women's issue." However, males whose partners choose to terminate a pregnancy are also affected by the abortion decision. This paper, using the case of Mr. R. as an illustration, explores one man's psychological reactions to his partner's abortion. The paper considers how news of an elective abortion, particularly when it is revealed months after the fact, can again bring to the surface childhood feelings of voicelessness and worthlessness. It offers suggestions as to how these feelings can be addressed in psychotherapy. By exploring verbal and nonverbal cues, therapists can generate ways of addressing postabortion reactions in psychotherapy with men. [ABSTRACT FROM AUTHOR]

This paper gives a brief outline of the Conversational Model which is among the best validated of currently employed psychotherapies. The theory is built around the idea that the central task of psychotherapy is to potentiate the emergence and amplification of that dualistic form of consciousness that William James called self. However, this state of mind cannot be acted upon as if it existed in isolation. Rather, it is part of an ecology that includes the form of relatedness that underpins it. No element of the ecology can change unless the other elements also change. Seen in this way, the form of relatedness is transformational. It is necessarily mediated by conversation consisting of more than its content, the simple transmission of information. The main point of the paper is that the form of the conversation manifests and constitutes not only a form of consciousness but also a form of relatedness. This conception provides a means of testing hypotheses of therapeutic action since it suggests that syntactical structuring, together with the other major elements of language, lexicon, and phonology, allow us to chart the waxings and wanings of personal being in the therapeutic conversation. [ABSTRACT FROM AUTHOR]

Distress related to sexual orientation is a common focus in psychotherapy. In some instances the distress is external in nature as with persecution, and in others it is internal as with self-acceptance issues. Complicating matters, sexual orientation is a very complex topic producing a great deal of confusion for both clients and therapists. The current paper provides a four component model—sexual orientation dimensions, activation of these dimensions, the role of erotic fantasy, and social construction of sexual orientation—that in combination provide a comprehensive perspective. Activation of dimensions is a novel contribution not proposed in any other model. With improved understanding of sexual orientation issues, and utilization of this knowledge to guide interventions, psychotherapists can improve outcomes with their clients. Also described is how dimensions of sexual orientation relate to transgender. In addition to improving psychotherapy outcomes, the four-component model presented can help reduce discrimination and persecution, by demonstrating that the capacity for both homoerotic and heteroerotic behavior is universal. [ABSTRACT FROM AUTHOR]

In this paper 12 common errors that occur in the course of psychodynamic psychotherapy are reviewed. Rationales for why we consider these to be errors are described, and vignettes are used to illustrate the errors, lastly, recommendations for alternate approaches consistent with effective psychodynamic psychotherapy are presented. The errors reviewed include concerns regarding the maintenance of appropriate limits and boundaries; decisions regarding the focus and form of treatment; no-suicide contracts; fee arrangements; missed sessions; psychological testing of psychotherapy patients; selecting appropriate patients for psychotherapy; and the importance of personal psychotherapy for the therapist. The suggestions provided are consistent with what we believe are the goals of psychodynamic psychotherapy: autonomy, insight, and self-determination. [ABSTRACT FROM AUTHOR]

As a core component of multicultural orientation, cultural humility can be considered an important attitude for clinical supervisees to adopt and practically implement. How can cultural humility be most meaningfully incorporated in supervision? In what ways can supervisors stimulate the development of a culturally humble attitude in our supervisees? We consider those questions in this paper and present a model for addressing cultural humility in clinical supervision. The primary focus is given to two areas: (a) modeling and teaching of cultural humility through interpersonal interactions in supervision, and (b) teaching cultural humility through outside activities and experiences. Two case studies illustrating the model are presented, and a research agenda for work in this area is outlined. [ABSTRACT FROM AUTHOR]

The paper describes how standard psychotherapy techniques need to be modified to suit the specialized needs of patients diagnosed with schizophrenia. Patients with psychosis often have lost their ability to use words to describe their inner states. As a result, traditional forms of psychotherapy which depend so crucially on the use of language are compromised. The goal of treatment at the start is to help the patient recover his ability to use language to describe his inner life. Eventually, this enables the patient to make use of more traditional forms of psychodynamic treatment. [ABSTRACT FROM AUTHOR]

Davanloo's Intensive Short-term Dynamic Psychotherapy has been the subject of various reviews. Davanloo has published extensively on his early work, but there have been no publications on his most recent work--most notably his Montreal Closed-circuit training program. This program focuses on his most recent discoveries and techniques and is a unique, videotaped supervisory program. It focuses on self-assessment and peer-assessment. It is also a unique format in which to review Davanloo's theoretical conceptions of resistance and the transference component of the resistance. This paper will review the early work of Davanloo as well as his most recent research findings. A case from the Montreal Closed-circuit training program will be reviewed in detail to highlight these findings. [ABSTRACT FROM AUTHOR]

Radically Open-Dialectical Behavior Therapy (RO-DBT) is a transdiagnostic treatment designed to address a spectrum of difficult-to-treat disorders sharing similar phenotypic and genotypic features associated with maladaptive over-control--such as anorexia nervosa, chronic depression, and obsessive compulsive personality disorder. Over-control has been linked to social isolation, aloof and distant relationships, cognitive rigidity, high detailedfocused processing, risk aversion, strong needs for structure, inhibited emotional expression, and hyper-perfectionism. While resting on the dialectical underpinnings of standard DBT, the therapeutic strategies, core skills, and theoretical perspectives in RO-DBT often substantially differ. For example, RO-DBT contends that emotional loneliness secondary to low openness and social-signaling deficits represents the core problem of over-control, not emotion dysregulation. RO-DBT also significantly differs from other treatment approaches, most notably by linking the communicative functions of emotional expression to the formation of close social bonds and via skills targeting social-signaling and changing neurophysiological arousal. The aim of this paper is to provide a brief overview of the core theoretical principles and unique treatment strategies underlying RO-DBT. [ABSTRACT FROM AUTHOR]

Psychiatry and related mental health fields, in particular psychotherapy, have a long history of close ties with the humanities. That bond has weakened, however, over the last few decades as medicalized views of mental health and treatment have emerged. In this paper, we explore the potential of the reintroduction of the humanities, specifically novels and related literary genre, into the supervision of student clinicians working with clients who have psychosis. We believe that incorporation of novels and related literary genre into supervision can lead to unique and deepened understanding of the experience of psychosis, and can create an opportunity for a working therapeutic alliance. The potential mechanisms that create these unique opportunities to understand psychopathology are explored, and considerations for the implications for treatment, training, and future research are presented. [ABSTRACT FROM AUTHOR]

Background: This paper assesses acculturation and ethnic matching of therapist and patient as predictors and moderators of treatment outcome in a 12-week effectiveness study of Interpersonal Psychotherapy for depressed adolescents (IPT-A) versus treatment as usual (TAU). The treatment was delivered in school-based health clinics in which care was provided for a predominantly Latino patient population. Methods: Birthplace, length of residence in the United States (U.S.), and therapist-patient ethnic matching were examined as predictors and moderators of treatment outcomes for depression, social functioning, and global functioning scores. Results: Birthplace significantly moderated treatment condition in predicting week 12 depression severity and improvement, and marginally significantly moderated treatment in predicting week 12 depression symptoms, with U.S.-born adolescents who received IPT-A having better outcomes. Birthplace predicted week 12 self-reports of depression, social (overall, school, and family) and global functioning, with U.S.-born adolescents faring worse across treatment conditions. Foreign-born adolescents treated with IPT-A as compared to TAU who lived for a longer period of time in the U.S. demonstrated better overall social functioning as compared to foreign-born adolescents who had lived for a shorter period of time in the U.S. Ethnic matching predicted significant reduction in depression severity and improved overall social functioning, and marginally significant improvement in week 12 depression scores, regardless of treatment condition. Conclusions: IPT-A may be a culturally responsive treatment for depressed Latino youth who are struggling with acculturation issues that affect their significant relationships. Ethnic matching appears beneficial for the general population in reducing depression and improving social functioning. [ABSTRACT FROM AUTHOR]

What are some of the most pressing needs currently confronting clinical supervision? In this paper, I give attention to that question. Drawing on two 1990 reviews for comparative purposes, I examine where supervision is now relative to four areas: (a) supervision training and practice; (b) measurement; (c) difference and diversity; and (d) research. Lines of advance, pressing needs, and potential remedies are considered across each area. Effort is made to accentuate the "robustly international" nature of clinical supervision and its increasing globalization. [ABSTRACT FROM AUTHOR]

Theoretical models abound within clinical supervision, but these rarely have been applied to supervision evaluation. Instead, it appears that reviewers and researchers have simply transferred to supervision the conceptual frameworks used within medicine, especially the idea that clinical outcomes are the "acid test" of supervisory effectiveness or quality. Following a careful examination of the key literature, in this paper I argue that this has led to an overemphasis on clinical outcomes, with the net effect of reducing scientific confidence, understanding, and the effectiveness of supervision. To begin to rectify this bias, an augmented fidelity framework is used to reformulate evaluation, drawing on some of the key concepts guiding evaluation within related fields (i.e. service evaluation; staff development; psychotherapy; applied research). The resulting evaluation model is specific to clinical supervision and can help to increase our understanding, enhance our practice, re-prioritise research, and inspire confidence in supervision. [ABSTRACT FROM AUTHOR]

Although learning objectives, often in the form of competencies, are now standard for training mental health professionals, they are not generally used to guide psychotherapy supervision. Nevertheless, when learning objectives are not used to guide supervision, supervisors and supervisees often remain uncertain about the goals of supervision, how those goals should be attained, and how they should be assessed. In this paper we review the literature on learning objectives for psychotherapy training and supervision, outline reasons for using learning objectives in psychotherapy supervision, and suggest ways to use learning objectives in training. [ABSTRACT FROM AUTHOR]

When children are abused they utilize strategies already in place to cope with stress. These strategies develop during early life within the family and may be part of the unconscious framework formed within attachments and relationships. The case presented illustrates a teen-aged girl who was the victim of sexual abuse and experienced depression, PTSD and substance abuse. This paper describes the psychodynamic psychotherapy used to examine the patient's coping skills, which predated the abuse, and how these coping mechanisms were used to ameliorate her symptoms. [ABSTRACT FROM AUTHOR]

The Constructivist Grounded Theory Study reported in this paper is based on the narrative experiences of psychotherapists who used the intersession experience of having an imagined conversation with a client. The therapists reported that they use imagined conversations with clients between sessions when they have reached an impasse in the therapeutic process, and they noted the experience helps them solve the difficulty by helping to provide greater insight into their clients' perspectives. The participants' experiences suggest a theory that explains how imagination can help one understand another: motor memory may surface implicit relational knowing. [ABSTRACT FROM AUTHOR]

In modern psychiatric classifications the term paraphilia has replaced the term perversion by changing the scope of the definitions from avoided procreation to failures of relationship-aspects of sexuality. Contemporary psychoanalysts also seem less interested in pleasure seeking aspects, which were so important within original Freudian thought, and instead concentrate interpretation on hostility and the history of the representation of objects. This paper discusses the connection between distinct object representations in perversions and attachment theory and neurobiological representations. It will discuss the observation that the neglect of pleasure seeking in perversion often results in a failure to recognise the addiction-like aspects of perversion, which seem to be particularly relevant to modern psychiatric and psychological thinking. The SEEKING-system (Panksepp, 1998) is used to conceptualise a neurobiological basis for pleasure seeking. This SEEKING- system may be "hijacked" by rewards in different forms of addiction as well as in sexual obsessions. The polarity between "drive representation" and "object representation," as created by Freud (1933, 1940a), may correspond to the polarity identified in contemporary thinking between the addictive or compulsive characteristics of sexual gratification (drive representation) and the influence of early object representation on the later ability to integrate instinctual wishes into relationships (object representation). [ABSTRACT FROM AUTHOR]

Deficits in metacognitive abilities, which enable persons to make sense of their own mental states and those of others, often are observed among persons with schizophrenia. To address these deficits we have sought to develop a metacognition-oriented form of psychotherapy that may foster self-reflectivity leading to the ability to think critically about delusional beliefs and to engage in and sustain healthy social exchanges. To illustrate Metacognition Oriented Therapy, we analyzed its application in an early psychotherapy session with a young woman who had disorganized schizophrenia. In this paper we specifically explore how the therapist followed a sequence of steps aimed at: 1) reconstructing episodes in life-narratives, 2) helping the patient name distressing emotions that appear in the narrative episode, 3) validating and normalizing the patient's experiences, 4) promoting awareness of emotional triggers and the links between affects and social behavior, and 5) validating emerging subjective experiences. We stress how these procedures helped the patient eventually become more able to start questioning her own delusional beliefs. The generalization of these procedures to the psychotherapy of schizophrenia is discussed. [ABSTRACT FROM AUTHOR]

Some patients are unable or unwilling to step into the difficult and uncharted explorations that psychoanalytic work entails; in this paper the author shows how the effort to establish analytic contact with each individual can provide a level of valuable support, containment, and growth for many patients. Such patients may display great resistance to the challenge of psychoanalytic treatment, subtly inviting the analyst, through projective identification processes, to succumb to countertransference acting out. These turbulent patients often leave treatment in very abrupt and unprocessed manners. It is suddenly all over and that is that. This abrupt dismissal is usually a continued expression of the remaining pathology and conflictual phantasies that had been played out in the transference throughout the span of the analytic process. We cannot always prevent this. Rather than seeing this as a complete failure, we can try to maintain ourselves within the depressive position by realizing we are being used by turbulent patients as provisional placeholders and temporary containers. This is a model of grieving in which we acknowledge and accept what we cannot have, what we are not, and what should be but is not. Struggling with these issues in the countertransference is critical to our ability to help such patients because these are the exact issues the patients cannot bear in their lives. And, if we cannot bear them, then the patient has no hope of ever surviving them. [ABSTRACT FROM AUTHOR]

The psychotherapy supervisor's development (i.e., the unfolding process of growth in being and becoming a supervisor) has long been considered a substantive issue in clinical supervision. Theory and clinical wisdom suggest that supervisors' level of development can have a significant and far-reaching impact on the supervision experience, potentially affecting supervisory alliance formation, in-session conceptualization and strategy utilization, and even the outcomes experienced by both supervises and patients. Consensus seems to be that there is a critical need for empirical study of psychotherapy supervisor development. But with a generation of theory and research on psychotherapy supervisor development behind us, what do we know (or not know); where does this area of inquiry stand today, and what do we need to know about supervisor development going forward? In this paper, I attempt to address those questions. I examine the last 30-year period (approximately) of supervisor development theory, measurement, and quantitative and qualitative study, provide a contemporary status report of sorts on this subject; and identify some important matters for research and practical consideration. Despite a generation of inquiry, the psychotherapy supervisor still remains the largely unknown party in the supervision experience. But that long-standing reality can be changed, some possibilities for doing so are presented, and the promise of supervisor development study is seen to be an ever-inviting hope that awaits realization. [ABSTRACT FROM AUTHOR]

It has become widely accepted that nontransference interpretation can have power (Blum, 1983). My intent in this paper is to describe an active, intentionally evoked, but uninterpreted, positive transference that is designed to effect change in the patient in an otherwise psychoanalytically oriented therapy. The changes may range from symptom relief to more significant change, as reflected in modifications in the patient's self-perception, perception of others (self-object constellations), and experience in the world. Apart from interpretation of conflict revealed in the patient's experience of the world, the uninterpreted positive transference offers a new object relationship devoid of significant conflict that may closely approximate an ideal of the good parent (the internalization of a good object). In this respect, it contributes strongly to a change in the representational world. The positive transference is not only the substrate of the ongoing process of therapy, but also a useful product of the process. To implement this change the therapist develops a therapeutic stance through specific actions and an attitude that offers the patient a new and benevolent object. [ABSTRACT FROM AUTHOR]

While the real relationship has long been addressed in psychoanalysis and psychotherapy, the matter of the real relationship in psychotherapy supervision has yet to receive any attention. Ample supervisory focus has indeed been given to the working alliance and transference-countertransference configuration (including parallel processes), but after a century of psychotherapy supervision, any mention whatsoever of real relationship phenomena is absent. In this paper, the following hypotheses are proposed: The real relationship (1) is a crucial component of the supervision relationship that has transtheoretical implications; (2) exists from the moment supervision begins until its end; (3) is the forever silent yet forever substantive contributor to supervisory process and outcome; (4) exerts a significant impact on (a) the development and establishment of the supervisory working alliance and (b) the unfolding and eventual utilization of the transference-countertransference experience in the supervisory situation; (5) consists of at least two dimensions in supervision--realism and genuineness--that vary along valence and magnitude continua (building on the works of Greenson and Gelso), and (6) deserves a place of eminence equal to the working alliance and transference-countertransference configuration if supervision theory, practice, and research are to be most fully informed. The possibility of using recent real relationship research in psychotherapy as a prototype to inform future research in supervision is presented, and two case examples are provided to illustrate the seeming power of real relationship phenomena in psychotherapy supervision. [ABSTRACT FROM AUTHOR]

While the constructs of the working alliance, parallel process, and counter-transference have long had transtheoretical appeal for many supervision practitioners, what empirical data-quantitative or qualitative-are there that support their use in psychotherapy supervision? In this paper, I attempt to address that question by: (1) identifying empirical, data-based efforts to research the supervisory working alliance (n=17), parallel process (n=7), and countertransference (n=1); (2) reviewing and determining for each study sample characteristics, measures used, procedure, analyses used, findings, and limitations; (3) identifying the primary conclusions that can be drawn from that review and analysis; and (4) considering the implications and directions for future supervision research and practice. While the data appear strongest for the supervisory working alliance and tentatively support its place in psychotherapy supervision, research on alliance, parallel process, and countertransference is still very much in its infancy and sorely limited empirically. Some avenues for remedying previous study deficiencies are presented, and the hope and caution of future research on these constructs are considered. [ABSTRACT FROM AUTHOR]

The concept of projective identification has, since its introduction by Melanie Klein over half a century ago, caused much controversy amongst psychoanalysts and psychotherapists. In this paper the author traces some of the key theoretical developments of the concept since its introduction in 1946, including: normal and pathological projective identification, aspects of symbolisation and projective identification as an intrapsychic mechanism. An extended case report of a patient in weekly psychoanalytic psychotherapy is offered in order to expand upon some of the theoretical ideas previously considered. Emphasis is placed on the patient's use of intrapsychic projective mechanisms and the emergence and mutation of such mechanisms in the therapeutic relationship. [ABSTRACT FROM AUTHOR]

Early attachment relationships and their inherent emotional regulation formatively effect psychoneurobiologic development. Implicitly learned relational interactions begin within the context of such relationships, and as habitual responses to strong emotions, such as fear, ultimately define character. The psychotherapeutic attachment relationship can positively affect change in developmental processes compromised in earlier relationships, influencing character change. The early attachment relationship is evaluated for features that become relevant as the therapeutic attachment relationship and real relationship-the realistic and genuine elements of the therapeutic relationship, affect psychoneurobiologic change in the patient. This paper asserts that the real relationship deepens therapeutic attachment relationships, improves emotional regulation processes, and stimulates further development of processes such as mentalization. Current research studies are considered regarding areas of the brain potentially affected in psychotherapeutic processes. [ABSTRACT FROM AUTHOR]

Cognitive-behavioral therapy (CBT) with exposure and ritual prevention (ERP) is widely accepted as the most effective psychological treatment for obsessive compulsive disorder (OCD). However, the extant literature and treatment manuals cannot fully address all the variations in client presentation, the diversity of ERP tasks, and how to negotiate the inevitable therapeutic challenges that may occur. Within this article, we attempt to address common difficulties encountered by therapists employing exposure-based therapy in areas related to: 1) when clients fail to habituate to their anxiety, 2) when clients misjudge how much anxiety an exposure will actually cause, 3) when incidental exposures happen in session, 4) when mental or covert rituals interfere with treatment, and 5) when clients demonstrate exceptionally high sensitivities to anxiety. The goal of this paper is to bridge the gap between treatment theory and practical implementation issues encountered by therapists providing CBT for OCD. [ABSTRACT FROM AUTHOR]

Transference occurs in many relationships and personal interactions as well as in the therapeutic setting. Caregiving is a dynamic role. Transference issues arise from a highly interactive and complex relationship. Our patients and families communicate with us constantly if we remain open to the messages. The role of the immediate caregiver is vital to the well being of the patient. Understanding the complexities of the interaction helps us to understand the dynamics of the caring relationship. Presented in this paper are examples of the varied forms of transference issues that arise in a caregiving relationship. Improved communication--to identify and address these issues--helps to meet therapeutic goals by optimizing the health care partnering. [ABSTRACT FROM AUTHOR]

This paper describes how the trend toward emphasizing evidence-based practice and empirically supported treatments is likely to affect the practice of counseling and psychotherapy in the future. Several specific predictions are described and discussed, particularly those of Nicholas Cummings. Predictions include that evidence-based practice and general psychotherapy will diverge; eventually only evidence-based practice will be reimbursed and covered by liability insurance; and psychotherapy will become briefer and more integrated into the healthcare system. [ABSTRACT FROM AUTHOR]

In this paper, the case is made that providing therapy to a client can be therapeutic for the therapist. Therapist change is not intentionally sought nor professionally delivered, but is from those client interactions experienced as healing. The possible mechanisms of change for the therapist include exposure of much about him- or herself, being "on the line" in therapy, and the therapeutic relationship as a collaborative, two-way system. In the collaborative system, much might affect a therapist, including how the client understands and reacts to the therapist's disposition, motivation, self-disclosure, and skill and what the client reveals about his or her life that may lead the therapist to a new sense of her or his own life. [ABSTRACT FROM AUTHOR]

Elvin Semrad was among the most influential and beloved teachers of psychotherapy in his generation. His legacy as a clinician, teacher, and mentor is still felt today, even among those who never knew him directly. What and how he taught remains as relevant as ever in the psychotherapeutic care of troubled individuals. His was primarily a psychiatry of affects and bodily feelings, and he focused uncannily and empathically on the patient's experience. The basis of his rich, heartfelt, wise, and inimitable approach was not just classically psychoanalytic, or existential, or ego-oriented, or self-psychological, or interpersonal-relational, or even humanistic or adaptational. Rather, it was all of these in a uniquely "Semradian" integration geared toward elucidating patients' experience that had arrested them during their life course and their avoidance of "acknowledging, bearing, and putting into perspective" what they were up against. This paper describes who he was and gives a personal perspective on his influence--how and what he taught and why he had such an effect on those who knew him. [ABSTRACT FROM AUTHOR]

Cognitive Behavior Therapy (CBT) is the evidence-based treatment of choice for Obsessive-Compulsive Disorder (OCD). The central technique of this approach is Exposure and Response Prevention (EX/RP). Examination of EX/RP treatment of OCD reveals severe shortcomings. The technique, while generally quite effective, cannot deal with patients who are unable to comply with EX/RP's difficult regime, resulting in a significant percentage of patients who refuse treatment and dropouts. Also, for optimal results, the therapist should be present while the patient carries out EX/RP therapy. This severely reduces the therapist's resources since leaving the clinic and being personally present during EX/RP in the patient's real life circumstances is not something therapists can do easily. These limitations acutely compromise the applicability of this technique to clinical practice. Research into Cognitive Therapy without EX/RP does not show superiority to EX/RP. In this paper, I illustrate a Strategic/Behavioral Treatment (SBT) for OCD that easily and elegantly overcomes the limitations of Cognitive Behavioral Therapy (CBT) treatment (thereby increasing its effectiveness), present three case studies, and offer suggestions for further research. [ABSTRACT FROM AUTHOR]

It is difficult to locate, understand, and interpret the transference state of some patients In the course of psychoanalytic treatment. This paper examines the use of the countertransference to assist in making "analytic contact," the analyst's attempt to engage the patient in an exploration of unconscious phantasies, transference patterns, defenses, and internal experience of the world. The goal of analytic contact is the identifying, understanding, and working through of core object relational phantasy states. Countertransference can be valuable in helping analysts find their way to the transference, especially when projective identification processes exclusively shape it. Case material, examined from a Kleinian perspective, is used to show work with patients exhibiting difficult to access transference states primarily determined by projective identification based phantasies. [ABSTRACT FROM AUTHOR]

People with borderline personality disorder (BPD) often describe a longstanding depression or dysphoria central to the disorder. The dimension of chronic inner dysphoria is reflected in the DSM criterion of "emptiness" and is demonstrated on self-report measures of depression. In this paper, we report on outcomes for patients with BPD treated with outpatient psychodynamic psychotherapy based on the Conversational Model. Data were collected using the Zung depression scale and the Westmead severity scale at 1 year and at 2 years from two groups of patients. One group had 1 year in psychotherapy, the other had 2 years in therapy. While general symptom scores improved steadily over time in the two-year group, gains for the one-year group tapered off in the second year. Change in depression scores continued at an unchanged rate in the second year for the two-year group compared to a leveling out of gains in the group treated for one year. Gains in general symptom scores were more substantial, suggesting that change in affect occurs more slowly than other symptomatic changes. Drawing upon our findings and those of others in the field, it appears that this slowness of affective change may reflect that patients with BPD have an inner world where predominant negative affectivity became established early in life in the context of disturbances of relatedness. This has implications for the appropriate duration of psychotherapeutic engagement with this group. We argue for more prolonged psychotherapy in this group, which is consistent with current understanding of processes of attachment and development. [ABSTRACT FROM AUTHOR]

Attachment styles impact relationships. Research illustrates the importance of attachment from infancy to adulthood across all cultures. The focus of this paper is to explore attachment theory within the context of the therapeutic process with the inclusion of multicultural implications. [ABSTRACT FROM AUTHOR]

The aim of the study described in this paper was to develop a method for measuring the therapeutic alliance from an intersubjective perspective and to evaluate the efficacy of the measure in predicting psychotherapy outcome. We conducted the study using data from 22 patient-therapist dyads engaged in a 30-session protocol of a brief relational therapy. The alliance measure chosen for this purpose was the short form of the Working Alliance Inventory. We used the subjective patient and therapist versions of the measure and created a correlation index representing the intersubjective congruence between patients and therapists on their ratings of the alliance. We examined the relations among the measures, as well as their predictive relation to an outcome measure. The results showed significant intercorrelations among the three alliance measures, suggesting that all captured aspects of the therapeutic alliance. In addition, all three measures were significantly predictive of outcome, with the correlation index appearing more powerful. [ABSTRACT FROM AUTHOR]

This paper examines attachment theory in the context of the biology of affect regulation and the convergence of these in psychotherapeutic processes. Because of recent advances in understanding how the infant brain/mind/ body is shaped by the infant's first social experiences, the purpose of this investigation is to extract those underlying mechanisms that expand adaptive and regulatory capacities and to review their application within the therapeutic relationship. Interdisciplinary advances are indicating that just as the infant-mother relationship is fundamentally a psychobiological dyadic system of emotional communication and affect regulation, this same system underlies the essential mechanisms that adaptively sustain subsequent relationships--including the therapeutic alliance. This review highlights the importance of right-hemisphere-to-right-hemisphere emotional and relational processes--moving away from the traditional emphasis on "left-brain" verbal and cognitive processes--thereby underscoring the necessity for therapist understanding of implicit, nonverbal communication as well as self-integration and awareness in order to help increase their client's capacity for the same. We propose a model of therapeutic communication that takes these factors into account for the therapist, the client and the relationship. [ABSTRACT FROM AUTHOR]

In this paper, we consider the use of e-mail in psychotherapy and its impact on the experience of therapy for both patient and clinician. We discuss in detail the potential for boundary compromise by e-mail use and consider how e-mail may undermine the therapeutic alliance and the cultivation of empathy. Case studies illustrate the possible positive aspects of e-mail and elucidate several fundamental problems with any use of e-mail in psychodynamic treatment. [ABSTRACT FROM AUTHOR]

A survey conducted by America Online (AOL®) in 2005 reported the startling finding that almost 50% of those posting entries on internet logs (weblogs or blogs), use them as a form of self-therapy. This finding went relatively unnoticed by psychotherapists and other mental health professionals. Given the rather significant global population of bloggers (those who post internet journal entries) and readers, and the seemingly intractable problem of mental illness worldwide (according to the World Health Organisation, the global burden of mental illness accounts for more than the burden of all cancers put together), the possibility of blogging as self-therapy deserves greater attention. Research investigating the health possibilities of blogs holds particular promise, at least for those disposed to writing and those working with patients who write. This paper addresses the question of how one might blog within a social network as a form of self-therapy. Based on an interview conducted with a blogger in May 2007, we construct a portrait of an individual who uses a blog as self-therapy. [ABSTRACT FROM AUTHOR]

In this paper, an experiential process-directive approach is presented in which the therapist is guided by the Rogerian core attitudes for offering a therapeutic relationship and for intervening in a process-enhancing way. I elaborate on how interventions that originate in the therapist's empathic-resonance process influence the client's experiencing in a process-enhancing way. A process-diagnostic model, based on distinctions among different aspects of the experiential exploration process, forms the framework in which the various interventions are classified according to dominant process intention. Three major process intentions are distinguished: becoming aware of experiencing, regulating (increasing or decreasing) the intensity of experiencing so that it becomes possible to hold the experience in attention, and exploring that leads to further unfolding and change. Therapy excerpts illustrate this approach. [ABSTRACT FROM AUTHOR]

Phenomenological analyses suggest that persons with schizophrenia have profound difficulties with meaningfully engaging the world and situating a sense of self intersubjectively, which leads to the experience of self as absent. In this paper we explore the implications of this view for understanding the workings and potential of individual psychotherapy. Following an examination of individual psychotherapy transcripts for over 60 persons with schizophrenia--spectrum disorders we offer four principles for psychotherapy and provide clinical vignettes to exemplify these points. We suggest that the psychotherapy of persons with schizophrenia may be conceptualised as a "dialogical prosthesis" that helps individuals recover past selves then kindle internal and external dialogue, which partially enables a sense of the self to emerge. The therapeutic process consists of assisting persons to move towards recovery by providing an intersubjective space where they can evolve the first-person perspective of themselves and the second-person perspective when encountering others. [ABSTRACT FROM AUTHOR]

The psychiatric consultation has not been adequately exploited as a therapeutic device. Although, the original abstinent model for psychodynamic psychotherapy has become more flexible, passive listening with interventions to elicit diagnostic "data" remains the prevailing mode in psychiatric consultation. In this paper I develop the idea of the consultation as an active process (Viederman, M., 2002) that engages the patient emotionally for therapeutic effect. [ABSTRACT FROM AUTHOR]