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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]

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 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]

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]

When patients fail to respond to psychopharmacologic treatment, one reason is that the meanings that treatment and/or wellness hold for them are psychologically intolerable. The result may be noncompliance with medications or the repeated emergence of intolerable side-effects, or a defensive attachment to the medications that prevents improvement. When treatment resistance emerges from the level of meaning, it may be that it can be resolved only by addressing it at that level. This paper argues for the importance of integrating psychological understanding into the pharmacologic treatment of treatment-resistant patients, and explores some factors that mitigate against integration. Several treatment vignettes are presented, suggesting ways of working with meaning in relation to pharmacology. Finally, the paper explores benefits of integration for treaters, even if integration does not result in the resolution of treatment resistance. [ABSTRACT FROM AUTHOR]

Several researchers have adapted and/or applied dialectical behavior therapy (DBT) for populations with eating disorders. There is a growing body of research that indicates that DBT is an effective treatment option for this population, including those who have co-occurring Axis II disorders. The goal of the current paper is to summarize the research conducted in the area of DBT with those individuals who present with eating disorders only as well as those who present with both eating disorders and Axis II disorders. We also describe a dialectical dilemma, apparent compliance vs. active defiance, which is commonly observed in the group with comorbidities A DBT change strategy, contingency management, is discussed as an intervention to target apparent compliance and active defiance. [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]

Interpersonal Counseling (IPC) comes directly from interpersonal psychotherapy (IPT), an evidenced-based psychotherapy developed by Klerman and Weissman. It [IPC] is a briefer, more structured version for use primarily in non-mental health settings, such as primary care clinics when treating patients with symptoms of depression. National health-care reform, which will bring previously uninsured persons into care and provide mechanisms to support mental health training of primary care providers, will increase interest in briefer psychotherapy. This paper describes the rationale, development, evidence for efficacy, and basic structure of IPC and also presents an illustrated clinical vignette. The evidence suggests that IPC is efficacious in reducing symptoms of depression; that it can be used by mental health personnel of different levels of training, and that the number of sessions is flexible depending on the context and resources. More clinical trials are needed, especially ones comparing IPC to other types of care used in the delivery of mental health services in primary care. [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]

What do we know clinically and empirically about the education of psychotherapy supervisors? In this paper, I attempt to address that question by: (1) reviewing briefly current thinking about psychotherapy supervisor training; and (2) examining the available research where supervisor training and supervision have been studied. The importance of such matters as training format and methods, supervision topics for study, supervisor development, and supervisor competencies are considered, and some prototypical, competency-based supervisor training programs that hold educational promise are identified and described. Twenty supervisor training studies are critiqued, and their implications for practice and research are examined. Based on this review of training programs and research, the following conclusions are drawn: (1) the clinical validity of supervisor education appears to be strong, solid, and sound; (2) although research suggests that supervisor training can have value in stimulating the development of supervisor trainees and better preparing them for the supervisory role, any such base of empirical support or validity should be regarded as tentative at best; and (3) the most formidable challenge for psychotherapy supervisor education may well be correcting the imbalance that currently exists between clinical and empirical validity and "raising the bar" on the rigor, relevance, and replicability of future supervisor training research. [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]

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]

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]

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]

Dealing with children who have disruptive behavior disorders can evoke feelings of frustration and anger in their therapists. D.W. Winnicott discussed the complexities in the treatment of enraging patients in his article "Hate in the Countertransference" (1949). In the following paper, I will depict the relationship between limit setting, projective identification dynamics, and enraging behavior in the treatment of a provocative latency-aged boy. I will argue that poor limit setting caused by powerful projective identification dynamics were central to the pathology of the boy and his family. These dynamics partially repeated in the boy's treatment--an outcome of which Winnicott had warned. The repetition contributed to the boy becoming physically out of control in my office and led to a disruption in his treatment. The establishment of solid limits by addressing projective identification forces was necessary for the improvement in the disruptive behavior of the child. [ABSTRACT FROM AUTHOR]

Experiential Psychotherapy originated in Gendlin's Philosopy of the Implicit. Some of its main concepts are bodily felt sense, fresh emergence of words from the felt sense, and carrying forward the implicit with small steps of change. Presented in this paper are many specific examples of what a therapist may say to the client to encourage the bodily felt sense. Dealing with three obstacles to forming a felt sense, intellectual speculation, drowning in emotions, and self-attacking are discussed. The philosophical concepts in the focusing-oriented school of therapy enable therapists to relate any psychological theory to the client's ongoing experience, allowing therapists from any theoretical orientation to practice in a focusing-oriented way. [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]

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]

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]

The paper argues that (1) full recognition of men's losses in divorce is an essential prerequisite to offering divorced men the emotional help they may need and (2) that since men mourn the losses of divorce differently from women, counselors should take their unique way of mourning into consideration in their treatment of divorced men. The article then offers practical suggestions for when and how to reach out with offers of help to divorced men, ways of facilitating the mourning process of divorced men in therapy, and issues to consider when terminating treatment with divorced men. [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]

In this paper, a hypothetical model of agitation therapy for some categories of antisocial and psychopathic patients/offenders is presented. Agitation therapy is mainly meant for very problematic and aggressive individuals who do not (or hardly) respond (in some periods) to any other type of psychotherapy, neurofeedback, and/or psychopharmacotherapy. The author makes an attempt to develop an adequate model of agitation therapy that makes optimal use of learning moments in controlled conflict situations. During agitation therapy the aggressive antisocial or psychopathic individual will be exposed to external agitation of other patients in a controlled manner in order to increase his/her self-knowledge; awareness of his or her intolerable behavior and limitations; sublimation of aggression/anger; the willingness (and insight in the necessity) to change; feelings of responsibility and emotional, social and moral development. Agitation therapy is not intended to be an isolated form of psychotherapy, but it may be rather often successful in combination with other types of psychotherapy, neurofeedback, and/or psychopharmacotherapy. [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]

Dissociative Identity Disorder (DID) is identified and studied with increasing frequency. However, the controversy that often surrounds DID can make it difficult to approach its treatment in a circumspect manner. This paper will provide an overview of DID treatment as it is practiced by those experienced and skilled in the treatment of this group of patients. The treatment of DID resembles the treatment of other traumatized populations in that it is stage-oriented, beginning with supportive and strengthening work. Various stances toward the treatment of DID are reviewed, and specific issues that arise in the psychotherapy of DID are addressed, suck as pragmatic arrangements, informed consent, work with alters, and the use of specific techniques, such as hypnosis. The employment of therapeutic modalities and ancillary therapies is discussed. The heterogeneity of DID patients is reviewed, and the characteristics of three general groups of DID patients, high, intermediate, and low in both function and prognosis are explored. Considerations in the matching of DID patients to either exploratory or supportive treatments are discussed, and observations are made about both trauma work and the supportive psychotherapy of DID. [ABSTRACT FROM AUTHOR]

The ebb and flow of the diagnosis of Dissociative Identity Disorder (DID) and other dissociative conditions has led to the evolution of theories and treatment modalities to resolve the fluctuating and ephemerous symptoms of these conditions. This paper summarizes the structured cognitive-behavioralbased treatment of dissociative disorders that will foster not only symptom relief but also an integration of the personalities and/or ego states into one mainstream of consciousness. This model of DID therapy is called the tactical integration model; it promotes proficiency over posttraumatic and dissociative symptoms, is collaborative and exploratory, and conveys a consistent message of empowerment to the patient. [ABSTRACT FROM AUTHOR]