Contemporary Psychotherapy

Nicholas W. Gelbar (Ed.): Adolescents with Autism Spectrum Disorder: A Clinical Handbook

Murray, Christine, Pope, Amber, and Willis, Ben, Sexuality Counselling: Theory, Research, and Practice

John C. Norcross and Gary R. VanderBos: Leaving It at the Office: A Guide to Psychotherapist’s Self-Care (2nd ed.)

Patient-Made Videos as a Tool of Self-Observation Enhancing Self-Reflection in Psychotherapy Abstract Photographs have been used in psychotherapy from the late 1970s, but patient-made videos have not been used directly as an integral part in individual psychotherapeutic treatment. We now propose a new approach, VideoTalk, using visual material as an aid in the psychotherapy process with a schema therapy framework as an example. VideoTalk builds on life-review method, providing information about the patient’s social relations, coping skills, affect/emotion regulation and schemas. This information is used as a platform for focused patient-made videos, i.e. self-talk at home in a typical problematic situation for the patient. The VideoTalk method enables documentation of the expression of mind states and dysfunctional schemas in a natural environment and related to an everyday emotional context. Subsequently, this video material is watched step by step together with the therapist. In this report, we describe the flow and functionality of the VideoTalk method through the case of a 24-year-old female patient suffering from depression and social phobia. The self-mirroring from the video facilitates self-observations of the patient’s own facial expressions, voice and body posture. We hypothesize that this new information gradually changes emotional processing, leads to better self-awareness and strengthens more functional schemas.

The Integrative Positive Psychological Intervention for Depression (IPPI-D) Abstract Despite the variety of empirically supported treatments for depression, many available evidence-based treatments do not satisfactorily promote or maintain clinically significant changes in patients. Moreover, treatments for depression have been primarily focused on reducing patients’ symptoms or deficits and less concerned with building positive resources that seem to be of interest to depressed individuals. This paper describes a manualized protocol of a new empirically-validated positive psychological intervention for depression, the Integrative Positive Psychological Intervention for Depression, which incorporates a balance between hedonic and eudaimonic components and a combination of in-session exercises and homework. The protocol is a 10-session program, in a group format, and includes interventions that have been shown to be effective in increasing well-being or alleviating depressive symptoms. The rationale for developing this protocol, the underlying theoretical framework and some general guidelines for its application are presented. Furthermore, the implications of this protocol are discussed, demonstrating how it may help to overcome some of the limitations of current, evidence-based psychological treatments for depression.

Self-Awareness, Verbalization and New Meanings as the Heart and Soul of Significant Events in Existential Psychotherapy Abstract This study aimed to qualitatively analyze the significant events that occur during existential psychotherapy sessions from the perspective of the patient. Ten patients completed the HAT—helpful aspects of therapy—shortly after existential psychotherapy sessions during existential psychotherapy treatment, which lasted 1 year and consisted of 48 sessions. The data were analyzed using grounded theory. The results emphasized the following categories: the promotion of self-awareness, the possibility of verbalizing experiences, and the deepening of meanings. In addition to emphasizing human relationships, the patients also emphasized a preference for interventions by existential therapists that were more directive, such as providing feedback, challenging personal beliefs, and asking questions. The results emphasize the integrated use of the two phenomenological methods, specifically, the static and the genetic methods.

Battles of the Comfort Zone: Modelling Therapeutic Strategy, Alliance, and Epistemic Trust—A Qualitative Study of Mentalization-Based Therapy for Borderline Personality Disorder Abstract We propose a model for how therapeutic strategy, alliance, and epistemic trust interact to foster or hinder therapeutic processes. Four individual mentalization-based treatment (MBT) sessions were subjected to an in-depth qualitative comparison and interpretative phenomenological analysis. Two sessions had high adherence and quality ratings, and two exemplified low evaluations. The sessions were from an MBT program for patients with borderline personality disorder. The high-rated therapists were more prone to strategically identify and investigate maladaptive patterns, were more challenging, and brought the patients out of their comfort zone. This therapeutic endeavour seemed to facilitate therapeutic alliance and a productive therapeutic process. Low-rated therapists seemed to be brought out of their own comfort zone (e.g. transferences/counter-transferences), and attempted to amend the relational atmosphere by being supportive. In these sessions, the therapeutic alliance seemed weak, and therapeutic progress was not observed. When therapists strategically and competently challenged problematic patterns, despite disclosing discomfort, alliance was strengthened. It seemed that a clear therapeutic strategy, and skilfull battling of the patients’ comfort zone, fostered the therapeutic process. We hypothesize that epistemic trust may develop as a product of a fruitful and persistent focus on tasks and goals in therapy.

The Psychodynamics of Performance Anxiety: Psychoanalytic Psychotherapy in the Treatment of Social Phobia/Social Anxiety Disorder Abstract The optimal treatment for Social Phobia/Social Anxiety Disorder (SP/SAD) remains an open question despite the existence of a variety of controlled studies, including randomized trials of cognitive behavioral and psychodynamic therapies. Moreover, individuals with Performance Anxiety, a colloquial term for SP/SAD, are typically treated by lay coaches and unlicensed practitioners, who focus on managing the symptoms of “stage fright.” This paper describes the psychodynamic (psychoanalytic psychotherapy) treatment of an individual with manifestations of SP/SAD in the realms of public speaking, musical performance, and professional accomplishments. The narrative identified contributions of childhood abuse, gender concept confusion, mismatched parent–child interactions, and conflicts concerning aggression and entitlement. It became clear that strong feelings associated with anxiety concerning self-worth were at play that left the patient no possible alternatives to wishes for idealized perfection. These findings served as the basis for a therapeutic approach from a self-psychology perspective that focused on empathy, shared emotional experiences, attunement, and being known. Psychoanalytic psychotherapy is a robust and potentially valuable option for individuals willing to undertake a more intensive therapy whose benefits extend beyond symptomatic relief.

Metacognitive Therapy in Patients with Tinnitus: a Single Group Study Abstract Tinnitus is often in comorbidity with anxiety and depression, and several authors have proposed a reduced efficiency of the top-down executive control in its perception. This single-group study describes a novel application of the metacognitive therapy (MCT), which works on a top-down engagement of proactive attentional control mechanisms on a group of patients with tinnitus, to see its impact on the perception of tinnitus and its anxiety and depression correlates. Eight metacognitive therapy group-sessions were proposed to a group of nine patients, as part of a regional project conducted at the University General Hospital “Paolo Giaccone” of Palermo. The last was a follow-up session, proposed three months after the seventh. The Tinnitus Handicap Inventory (THI) and the Hospital Anxiety and Depression Scale (HADS) were administered during the first, the seventh and the follow-up group session. The distress perceived by tinnitus (THI), lowered at a tolerable level at re-test, by maintaining this result up to 3 months after the conclusion of the experience (F(2) = 13.1, p = 0.001; effect size = 0.731). Distress scores (HADS) (F(2) = 8.3, p = 0.016; effect size = 0.462) and anxiety sub-scores (F(2) = 12.06, p = 0.001; effect size = 0.670) improved at the end of the experience, and the benefits stayed stable over the course of the follow-up, while depression scores did not change (p = 0.549). The use of MCT appears to offer promise in reducing the perception of the tinnitus and the anxiety of participants and reduces the significance of annoying thinking. Further studies are necessary to test its efficacy and replicability in a controlled trial.

Strategic Symptom Displacement in Therapy of a Motor Conversion Disorder Comorbid with PTSD: Case Presentation Abstract There is no psychotherapy of choice for conversion disorders. We present a case of a motor conversion disorder comorbid with posttraumatic stress disorder, where we designed a psychotherapeutic approach based on the Bayesian model of brain functioning, specifically, the Bayesian model of functional neurologic symptoms. The model posits that such symptoms are produced as a result of hyper-precise prior beliefs (priors). Priors can be both conscious and unconscious and exist at different levels from perceptual to cognitive. Decreasing their precision/rigidity may then alleviate the related symptoms. In accord with this rationale, we used cognitive, experiential, and behavioral interventions meant to target and modify the putative priors. Central to this strategy was strategic symptom displacement. Application of this intervention coincided with reduction of the target motor symptom, indicating a possibility of causal relationship. We suggest strategic symptom displacement as an integral part of a universal therapeutic approach targeting priors: strategic modification of priors.