Search

This systematic case study investigated the nature of corrective emotional experiences (CEEs) that occurred over the course of psychotherapy in a single case and how those in-session CEEs were related to changes in the client's life. Client's e-mails on her experience of therapy sessions and postsession changes sent to the therapist, as well as outcome and postsession measures, were analyzed. The client was a Japanese woman who sought help for a variety of psychological symptoms including depression, anxiety, and emotional dysregulation. A long-term therapy of 67 sessions was conducted by a Japanese male psychotherapist who followed an integrative affect-focused approach. The quantitative analysis showed that the client achieved clinically significant change in depression, anxiety, self-compassion, interpersonal functioning, and self-esteem over the course of therapy. A grounded-theory analysis of client e-mails to the therapist showed that she experienced a deep connection with the therapist, gained a sense of relief through experiencing her disavowed feelings, and developed a positive sense of self in the course of her sessions. The client felt she had gained strength, had deepened her understanding of her feelings and behaviors, and that she was beginning to develop new relationships with others. The understanding of the theory of CEEs through this case, cultural issues, and the limitations and future directions of this study are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Accelerated experiential dynamic psychotherapy (AEDP) is an integrative model of psychotherapy that brings together relational and experiential work, with the aim of not only alleviating suffering but also bringing about flourishing. The present study took place within a developing AEDP practice research network and examined outcomes for 62 self-referred adults treated using a 16-session format of AEDP treatment. Participants completed self-report measures before and following treatment. Measures assessed a variety of psychological problems, subjective distress, as well as aspects of positive psychological functioning. Treatment occurred in naturalistic independent practice outpatient settings in the United States, Canada, Israel, Japan, and Sweden. Large effect sizes (d > 0.80) were obtained for clinical problems and subjective distress. The majority of patients evidenced clinically reliable change according to Jacobson, Roberts, Berns, and McGlinchey's (1999) criteria. Effectiveness was further examined by dividing the sample into a clinical group with pervasive and severe problems and a subclinical group with fewer problems and mild severity. Within the clinical group, total and global scores on all measures improved significantly following treatment. Effect sizes were d > 1.00 for all scales. The subclinical group also demonstrated significant improvements, with effect sizes ranging from d = 0.46 to d = 2.07. These results provide initial empirical support for the effectiveness of AEDP as a model of therapy that can effect meaningful and significant improvements across a range of psychological symptoms. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Systematic case studies can benefit understanding of the process and outcome of Accelerated Experiential Dynamic Psychotherapy (AEDP; Fosha, 2000) and other affect-focused and experiential therapies by expanding the scope of investigation from the moment-to-moment emotional change on which these therapies are particularly strong to changes that occur over and across sessions. Systematic case studies are also important because the link between in-session changes and changes in the client behavior and interpersonal relationships in daily life can be explored. In the engaging AEDP case study of "Rosa" (Vigoda Gonzales, 2018), the language switching that allowed Rosa to access painful emotions had an additional relational implication in that the therapist was able to directly connect to Rosa’s child self, which was encoded in a different language than her adult self. I suspect that this prevented Rosa and the therapist from running into difficulties due to the potential mismatch in their backgrounds. Corrective emotional experience seen in this therapy confirmed the finding by my own case study research team (Nakamura & Iwakabe, 2018b) that client therapeutic gains are most clearly reflected in new relationships rather than existing attachment relationships. My commentary concludes with some questions posed to the author relating to the issue of effective training in empathic attunement and working with strong emotions in therapy.

Interest in psychotherapy integration has steadily expanded over the past decades, reaching most continents of the world and more mental health professionals than ever. Nevertheless, a country’s cultural and historical background significantly influences the nurturance or hindrance of integrative endeavors. This chapter seeks to explicate the current climate of psychotherapy integration in different continents and specific countries. With the aid of local integrative scholars, brief descriptions are presented on integrative practice, training, and research, as well as on cultural and sociopolitical issues that have shaped this movement’s impact around the world.

The goal of this special issue is to present two dramatically different models of case studies, to compare their methodological features, and to explore potential ways to integrate the two to make best use of their respective strengths. The two case study articles present an opportunity to view the breadth of psychotherapy case studies and psychotherapy practice inJapan. The commentaries provided by four eminent psychologists from both in and outsideJapan, and the subsequent responses from the two main authors, produce rich and stimulating dialogue that provides a forum for learning through case studies. This dialogue also helps to delineate the features of each case study. Reflecting on the two case study articles and the four commentaries, as the action editor of this special issue I offer my own observations, focusing on methodological issues of case studies and also on issues associated with differing cultural practices.

The evidence debate in psychotherapy pays little attention to developing an evidence base for training practices. Understanding effective training requires an examination of what makes training work. This article examines the role of case studies in psychotherapy training. This has not been articulated explicitly or researched systematically in spite of its cardinal importance. An analysis of the role of case studies in psychotherapy training is presented. Reading, watching, or hearing about cases can offer novice psychotherapists access to a closed world; access to psychological theory in action; access to whole courses of therapy; access to different approaches; access to significant moments; access to the therapeutic relationship; access to a wide range of client types; access to working in different contexts; and the opportunity of identifying with therapists and clients. Writing or presenting cases offer students the opportunity of: learning to integrate information into a relevant whole; being in th...

Empirically supported treatments have brought much enthusiasm for establishing a firm empirical basis for clinical practice. However controversies about what constitutes evidence in psychotherapy and what research methodologies qualify as sufficiently rigorous to produce such evidence also abound. Although most psychotherapy researchers are in agreement with the underlying rationale that psychotherapy should be based on rigorous scientific research, many are in disagreement as to what constitutes ideal scientific practice in evidence-based psychotherapy; alternative frameworks of evidence have been proposed. This paper first reviews different models of evidence, namely empirically supported treatments, empirically supported psychotherapy relationships, research informed principles of therapeutic change, and evidence-based practice in psychology, and discusses their relative strengths and limitations. Secondly, it illustrates three research topics and corresponding strategies that both supplement these evidence models and deepen an understanding of process and outcome in psychotherapy. These three areas are: mechanisms of change, systematic case studies, and researcher-practitioner collaboration.

This commentary focuses on two case comparison studies, one by Burckell and McMain (2011) on Dialectical Behavior Therapy for borderline personality disorder, and one by Watson et al. (2011) and Goldman et al. (2011) on Emotion-Focused Therapy for depression. The associated case comparison method, which evaluates and contrasts one successful case against one unsuccessful case that are both conducted in similar conditions, provides a unique opportunity for deepening our understanding of therapeutic change. Both therapies are integrative approaches that are clinically state-of-the art and empirically supported, and that have been drawing considerable attention from practitioners and researchers. In this commentary, I first discuss the case comparison method by reviewing previous such approaches, I then examine each pair of case studies with a focus on (a) findings on factors influencing success and limited success, and (b) methodological issues associated with the application of this unique method. Finally, I end my commentary with a suggestion for conducting case comparison studies.

Psychotherapy in Japan is a relatively new area of practice growing rapidly in the last 10 years, especially in the area of education as the problems associated with school-aged children such as bullying and truancy became one of the major social challenges. The majority of Japanese psychotherapists practice approaches developed in North America and Europe, and Jungian theory has been influential to Japanese psychotherapists. Psychotherapy integration in Japan often take a form of cultural integration that takes two routes: adjusting and modifying technical procedures in the western psychotherapy to suit Japanese client population and developing theoretical concepts that are more in agreement with Japanese culture and its underlying worldview. Psychotherapists in Japan emphasize the importance of a non-talking cure, or silent processes and often employ nonverbal tasks such as drawing and sandbox. They have also developed innovative theoretical constructs that emphasize the importance of healthy dependence between mother and child.

The aim of this study was to investigate the divergence of client and trainee-therapist views of the different aspects of the alliance over the course of counseling and to relate those divergences to session-level therapeutic impacts. Forty-eight trainees and their clients completed therapies averaging 14 sessions. Results indicate that divergences in perspective did not influence the clients’ evaluations of the impact of their sessions. Only client ratings of the alliance were significantly correlated with positive session impacts. Measurements of the alliance taken at early, middle, and late phases indicated that, although both client- and therapist-rated alliance scores increased over time, convergence did not increase as therapy progressed. Implications for conceptualizing divergence as an expectable process that may not be a hindrance to positive therapy and the differences between experienced and trainee-therapists are discussed. Divergente Perspektiven zur Arbeitsbeziehung Das Ziel der Untersuchung...

This study explored the relationship between therapist interpretations and optimal in-session client processes in 20 sessions conducted by exemplary psychotherapists of three different theoretical orientations: Client-Centred Therapy (CCT), Rational-Emotive Behaviour Therapy (REBT), and Gestalt/Existential Therapy (GT). The results indicated that interpretations were used with similar frequency across therapeutic approaches, but they were neither superior nor inferior to other interventions in relation to the occurrence of optimal in-session client processes. The results support the notion that interpretation is a commonly used therapist intervention and that different therapies accentuate different aspects of interpretation. Implications for psychotherapy integration are offered and the findings are discussed with reference to theory and clinical practice.

Counselor and client 'statements from 21 sessions with eminent counselors were used to examine the relationship of counselor response modes to categories of client good moments at different alliance levels. Loglinear modeling procedures indicated that the alliance was present in all best-fitting models of the data. Exploratory examination of the models revealed that client good moments did not necessarily increase in frequency as the alliance increased. Further, different categories of interventions were associated with client good moments of provision of significant information at different alliance levels. The findings suggest that qualitatively different therapeutic processes are in operation at different alliance levels.

The relationship between client emotional expression and therapist interventions was studied in two working alliance conditions. An events-focused methodology was used to examine a total of 8 events taken from a variety of therapeutic orientations. Results indicated that, in the presence of a good client–therapist relationship, therapists showed higher levels of empathy and effectively focused on the immediately expressed feelings; in turn, their clients were engaged in exploration of feelings. In poor-relationship dyads, clients expressed negative feelings toward the therapists. Interventions rated as effective by clinical judges were characterized by accurate therapist understanding of clients' emotional expressions and working with strains in the therapeutic relationship. Ineffective interventions were associated with inaccurate assessments of clients' emotional states. Intensive analysis of these sessions led to three distinct models of in-session emotional expression events. Theoretical and practical implications of these models will be discussed.

This article explores potential benefits and problems in applying chaos theory in psychotherapy through an examination of previous attempts to integrate chaos theory into psychoanalysis and psychodynamic therapy. First a discussion provides an understanding of basic concepts in chaos theory and reviews applications in psychoanalysis. Second, problems in such applications are scrutinized. Finally, the discussion speculates on a general tendency in the literature in psychotherapy and counseling to resort to mathematical analogies, arguing that this attraction may produce an "erroneous metaphor," and gives reasons both for the attraction and its danger.