Equine-Facilitated Psychotherapy is widely used, and the uses to which it can be put are still being developed. However, existing knowledge about this field is insufficient, and most of the research suffers from methodological problems that compromise its rigor. This review will explore research into the linked fields of Animal-Assisted Therapy and Equine-Assisted Activities/Therapies related to physical health. Existing knowledge of mental, emotional, and social applications of EAA/T is presented. Evaluation studies in the subfield suggest that people benefit (...) from interventions with horses. However, these studies suffer from fundamental problems, such as small sample size and lack of control groups. Naturalistic inquiry about theoretical aspects highlights the fundamental role that human-horse relations play in EAA/T, but these studies exhibit deficiencies in theory development. A multimethod approach could promote knowledge development for EFP. Suggestions for future research concern methodological solutions to improve evaluation studies, use of grounded theory method to develop theory, as well as applying attachment theory to the human-horse context, which may offer insight about the underlying processes for change. (shrink)

BackgroundThe legal and ethical guidelines of psychological professional associations stipulate that informed consent by patients is an essential prerequisite for psychotherapy. Despite this awareness of the importance of informed consent, there is little empirical evidence on what psychotherapists’ attitudes towards informed consent are and how informed consent is implemented in psychotherapeutic practice.Methods155 psychotherapists in Switzerland completed an online survey assessing their attitudes regarding informed consent. ResultsAmong the surveyed psychotherapists, there was a high consensus on important information that should be (...) communicated to patients in the context of informed consent. Almost all psychotherapists rated confidentiality and its exemptions (95%) and self-determined decision-making (97%) as important. The importance to disclose information regarding fees and the empirical effectiveness of the provided treatment, were both seen as important by more than 80% of participants. The disclosure of personal information about the therapist was rated as important by 60%. Other aspects, which are not direct components of informed consent but rather overarching goals, were also evaluated rather homogeneously: self-determined decision making of the patient was rated as important by almost all of the surveyed psychotherapists (97%). The following components were also judged as important by a majority of the participants: promotion of hope (80%) and discussion of treatment goals (93%). Most psychotherapists described the implementation of informed consent as an ongoing process, rather than a one-time event during the first session of therapy. Therapists’ age, postgraduate training, treated patient group, and setting influenced attitudes towards informed consent.ConclusionsThe present study shows that informed consent is perceived by psychotherapists as both a challenge and a resource. The implementation of informed consent in psychotherapy requires further research from a clinical and ethical perspective. (shrink)

Objective: The present work aims to conduct the first naturalistic empirical investigation of the process and outcome assessment of functional psychotherapy treatment. The FP model of psychotherapy is rooted in psychoanalysis and integrates the verbal communication approach founded on transference and countertransference dynamics with the analysis of bodily processes.Method: The study sample included ten patients recruited on a voluntary basis and treated by clinicians in their private practices. Each patient received FP with an average duration of 40 (...) h. Therapies had weekly sessions, were audio-recorded with the patient’s written consent, and lasted for an average of 10 months. Outcome and process tools included the Minnesota Multiphasic Personality Inventory-2 and the Luborsky’s the Core Conflictual Relationship Theme, used to assess therapeutic benefit, and the Metacognition Assessment Scale and the Italian Discourse Attributes Analysis Program system, used to evaluate therapeutic benefit and process. The MMPI-2 was used also in the follow-up assessment.Results: Results show that FP had a positive therapeutic outcome on the patients assessed in this study, and that the therapeutic benefits were maintained over time. Some specific features of the FP approach were found to contribute more than others to the observed therapeutic benefits.Conclusion: The current investigation constitutes a first step toward assessment of the therapeutic effectiveness of FP. Future developments should apply the methodology to a larger sample, possibly introducing different methodologies to enable detection of specific bodily oriented processes and techniques. (shrink)

This manual presents a carefully researched, detailed psychodynamic treatment program for the alleviation of a transdiagnostic range of primary Axis I anxiety disorders, including panic disorder, generalized anxiety disorder, social anxiety disorder, post-traumatic stress disorder, and related psychological problems. First exploring the principles of psychodynamic theory and formulation, the authors then present a three-phased process of Panic Focused Psychodynamic Psychotherapy-Extended Range : initial evaluation, interpretation of central conflicts and defense mechanisms, and termination. Each phase is discussed in (...) depth and relies on central case illustrations to demonstrate techniques and results. A subsequent chapter explores how to address complex issues that may arise during the course of treatment. Altogether, this manual not only provides a demonstrated, adaptable approach for anxiety disorders, but also clearly embodies a spirit of research and empiricism heretofore rare in psychodynamic psychotherapies, with an eye toward future development. (shrink)

Psychotherapy with the use of psychedelic substances, including psilocybin, lysergic acid diethylamide (LSD), ketamine, and 3,4-methylenedioxymethamphetamine (MDMA), has demonstrated promise in treatment of post-traumatic stress disorder (PTSD), anxiety, addiction, and treatment-resistant depression. Psychedelic-assisted psychotherapy (PP) represents a unique psychopharmacological model that leverages the profound effects of the psychedelic experience. That experience is characterized by strong dependency on two key factors: participant mindset and the therapeutic environment. As such, therapeutic models that utilize psychedelics reflect the need for careful design (...) that promotes an open, flexible, trusting mindset and a supportive setting. To meet this need, the PP model is increasingly supplemented by auxiliary methods, including meditation, relaxation, visualization or spiritual practices. We suggest virtual reality (VR) as a full-spectrum tool able to capitalize on and catalyze the innately therapeutic aspects of the psychedelic experience, such as detachment from familiar reality, alteration of self-experience, augmentation of sensory perception and induction of mystical-type experiences. This is facilitated by VR’s evidenced capacity to: aid relaxation and reduce anxiety; buffer from external stimuli; promote a mindful presence; train the mind to achieve altered states of consciousness (ASC); evoke mystical states; enhance therapeutic alliance and encourage self-efficacy. While these unique VR features appear promising, VR’s potential role in PP remains speculative due to lack of empirical evidence on the combined use of VR and PP. Given the increased commercial interest in this synergy there is an urgent need to evaluate this approach. We suggest specific VR models and their role within PP protocols to inspire future direction in scientific research, and provide a list of potential disadvantages, side effects and limitations that need to be carefully considered. These include sensory overstimulation, cyber-sickness, triggering memories of past traumatic events as well as distracting from the inner experience or strongly influencing its contents. A balanced, evidence-based approach may provide continuity across all phases of treatment, support transition into and out of an ASC, deepen acute ASC experiences including mystical states and enrich the psychotherapeutic process of integration. We conclude that the potential application of VR in modulating psychedelic-assisted psychotherapy demands further exploration and an evidence-based approach to both design and implementation. (shrink)

Using Grunbaum 1984 and 1993 as a springboard, Greenwood (this issue) claims to have offered several methodologically salubrious and exegetically illuminating theses on empirical evaluations of theoretical explanations of psychotherapeutic efficacy. According to his exegesis of Grunbaum's construction (1984, Ch. 2, Section C; 1993, 184-204) of Freud's "Tally Argument," that argument bespeaks a rife neglect of the epistemologically-significant distinction between empirical evaluations of the efficacy of psychotherapy and evaluations of theoretical explanations of that efficacy. Greenwood presents a defense of (...) a qualified version of Popper's critique of psychoanalysis against Grunbaum's objections to it (1984, Ch. 1B). Finally, Greenwood offers a clarification of the concept of a "placebo control" investigation, taking issue with Grunbaum's 1993 (84-87, 91-93). In the present paper, it is argued contra Greenwood that: (1) his purportedly "best" reading of Freud's Tally Argument and of its import founders, (2) the distinction that Greenwood bemoans as being neglected by mental health researchers actually is a commonplace in the literature on treatment-process and therapeutic outcome, (3) Greenwood's defense of Popper's critique of psychoanalysis is an anachronism, and (4) Greenwood's conceptual analysis of placebo controls is nebulous and misconceived. (shrink)

The value turn in epistemology generated a particularly influential new position - virtue epistemology. It is an increasingly influential epistemological normative approach that opts for the intellectual virtues of the epistemic agent, rather than the truth-value of the proposition, as the central epistemic value. In the first part of this article we will attempt to briefly explain the value turn and outline the basic aspects of virtue epistemology, underlining the diversity of epistemic attitudes associated with this approach and their positive (...) impact on expanding epistemological horizons. The second part will be focused on the virtues of epistemic responsibility and epistemic justice as particularly appropriate for evaluating social processes such as, for example, testimony and conversational practices in general. In the third section we will show how the psychiatric and psychotherapeutic communicational act can be more efficiently analyzed and evaluated from the perspective of the virtue of epistemic justice, than from the traditional epistemic approach based on a monist concept of truth. The fourth and fifth section synthesize the discussion by introducing the concept of hermeneutic psychotherapy as a therapeutically and epistemically favorable framework for evaluating communicational acts in psychotherapy. nema. (shrink)

What sets off the termination of analysis and psychodynamic therapy from the variety of endings that enter into all human relationships? So asks Herbert J. Schlesinger in _Endings and Beginnings: On Terminating Psychotherapy and Psychoanalysis_, a work of remarkable clarity, conceptual rigor, and ingratiating readability. Schlesinger situates termination - which he understands, variously, as a phase of treatment, a treatment process, and a state of mind - within the family of "beginnings and endings" that permeate one another throughout (...) the course of therapy. For Schlesinger, therapeutic endings cannot be aligned with the final phase of treatment; ending-phase phenomena are ongoing accompaniments of therapeutic work. They occur whenever patients achieve some portion of their treatment goals and supervene when therapy stagnates. Small wonder that an assessment of the patient's relationship to time and capacity to end therapy are key aspects of diagnostic evaluation. By linking beginning and ending phases not to the chronology of treatment but to the patient’s experience of it, Schlesinger brings revivifying insight to a host of psychodynamic concepts. Nor does he shy away from a trenchant critique of the instrumental “medical model” of psychiatric and psychotherapeutic training, which militates against the therapeutic exploration of treatment endings. Schlesinger's exemplification of how to begin treatment from the point of view of ending; his sensitive delineation of the mid-treatment "ending" crises characteristic of "vulnerable patients"; his richly woven case vignettes illustrating various "ending" contingencies and permutations - these inquiries are gems of pragmatic clinical wisdom. _Endings and Beginnings_ distills lessons learned over the course of a half century of practicing, teaching, and supervising psychotherapy and psychoanalysis and is a gift to the profession. (shrink)

_Objective:_ The present work aims to detect the role of the rate of speech as a mechanism able to give information on patient's intrapsychic activity and the intersubjective quality of the patient–therapist relationship. _Method:_ Thirty clinical sessions among five patients were sampled and divided into idea units ( N = 1276) according to the referential activity method. Each idea unit was rated according to referential activity method and in terms of speech rate (syllables per second) for both patient and therapist. (...) A mixed-effects model was applied in order to detect the relationship between the speech rate of both the patient and the therapist and the features of the patient's verbal production in terms of referential activity scales. A Pearson correlation was applied to evaluate the synchrony between the speech rate of the patient and the therapist. _Results:_ Results highlight that speech rate varies according patient's ability to get in touch with specific aspects detected through referential activity method: patient and the therapist speech rate get synchronized during the course of the sessions; and the therapist's speech rate partially attunes to the patient's ability to get in touch with inner aspects detected through RA method. _Conclusion:_ The work identified speech rate as a feature that may help in the development of the clinical process in light of its ability to convey information about a patient's internal states and a therapist's attunement ability. These results support the intersubjective perspective on the clinical process. (shrink)

O objetivo deste estudo foi relatar características mencionadas por adolescentes do sexo feminino, em avaliação para psicoterapia, acerca de si mesmas, bem como seus planos em relação ao futuro. Participaram do estudo cinco adolescentes de 13 a 17 anos, que vivenciavam em seus contextos familiares a..

Since the Nuremberg trials (1947–1949), informed consent has become central for ethical practice in patient care and biomedical research. Codes of ethics emanating from the Nuremberg Code (1947) recognize the importance of protecting patients and research subjects from abuses, manipulation and deception. Informed consent empowers individuals to autonomously and voluntarily accept or reject participation in either clinical treatment or research. In some cases, however, the underlying mental or physical condition of the individual may alter his or her cognitive abilities and (...) compromise the informed consent process. This is particularly true in chronic psychiatric conditions such as Treatment-Resistant Depression (TRD), where individuals may fail to respond to traditional antidepressant treatments (e.g., psychotherapy, pharmacotherapy). Moreover, it may raise further concerns for an individual’s motivation to consent and the level of understanding of the treatment or research procedure. This paper focuses on the informed consent process for Vagus Nerve Stimulation (VNS) in the treatment of individuals diagnosed with TRD. Specifically, the paper addresses how depression may affect the decision-making capacity of an individual and the potential ethical and legal impact of failure to appreciate the seven elements of the consenting process (competence, voluntariness, disclosure, recommendation, understanding, decision, and authorization). To ensure the protection of vulnerable individuals with psychiatric disorders such as TRD and promote ethical behavior in biomedical research and patient care while avoiding potential legal pitfalls, we propose a paradigm that requires a stringent evaluation process of decision-making capacity for informed consent. (shrink)

Previous research suggested a role of gaze in preference formation, not merely as an expression of preference, but also as a causal influence. According to the gaze cascade hypothesis, the longer subjects look at an item, the more likely they are to develop a preference for it. However, to date the connection between viewing and liking has been investigated predominately with self-paced viewing conditions in which the subjects were required to select certain items from simultaneously presented stimuli on the basis (...) of perceived visual attractiveness. Such conditions might promote a default, but non-mandatory connection between viewing and liking. To explore whether the connection is separable, we examined the evaluative processing of single naturalistic food images in a 2 x 2 design, conducted completely within subjects, in which we varied both the type of exposure (self-paced versus time-controlled) and the type of evaluation (non-exclusive versus exclusive). In the self-paced exclusive evaluation, longer viewing was associated with a higher likelihood of a positive evaluation. However, in the self-paced non-exclusive evaluation, the trend reversed such that longer viewing durations were associated with lesser ratings. Furthermore, in the time-controlled tasks, both with non-exclusive and exclusive evaluation, there was no significant relationship between the viewing duration and the evaluation. The overall pattern of results was consistent for viewing times measured in terms of exposure duration (i.e., the duration of stimulus presentation on the screen) and in terms of actual gaze duration (i.e., the amount of time the subject effectively gazed at the stimulus on the screen). The data indicated that viewing does not intrinsically lead to a higher evaluation when evaluating single food images; instead, the relationship between viewing duration and evaluation depends on the type of task. We suggest that self-determination of exposure duration may be a prerequisite for any influence from viewing time on evaluative processing, regardless of whether the influence is facilitative. Moreover, the purported facilitative link between viewing and liking appears to be limited to exclusive evaluation, when only a restricted number of items can be included in a chosen set. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:“What Is Actually Being Measured?”: Causality and Underlying Scientific Thinking Process in the Assessment of DepressionGreta Kaluzeviciute-Moreton, PhD (bio)Depression is a complex mental health phenomenon due to its multifaceted nature. For one, depression is thought to have a significant genetic component, with studies suggesting that heritability is a significant factor in the development of the disorder (Sullivan, Neale, Kendler, 2000). In clinical psychology, environmental factors such as childhood (...) trauma, chronic stress, social isolation and negative life events (e.g., the loss of a loved one) have been documented as significant risk factors for the development of depression or as trigger events for depressive episodes (Fu & Parahoo, 2009; Kendler, Kuhn, & Prescott, 2004; Neitzke, 2016). Despite this, causal theories of mental health conditions are often tricky and/or scarcely reflected in both diagnostic and rating scales. For instance, the Diagnostic and Statistical Manual of Mental Disorders classifies mental health disorders primarily based on observable symptoms and behaviors, rather than on the underlying psychological and neurobiological processes that may contribute to these symptoms (Kendler, 2006).Similarly, rating scales for depression are typically designed to assess the severity of symptoms, rather than their underlying causes, that is, most rating scales are used as screening tools to identify individuals who may require further evaluation and treatment. Some rating scales may include items related to causal factors, such as the Beck Depression Inventory-II (BDI-II) includes an item that asks about “loss of interest in sex,” which could be related to either biological or psychological factors. Several rating scales include items assessing risk factors for depression, such as family history of depression or personal history of trauma. This may be indicative of both genetic and environmental risk factors, such as the Patient Health [End Page 255] Questionnaire-9, includes an item that asks about family history of depression. However, while risk and causal factors are related, they are distinct in the assessment of depression. Risk factors refer to factors that increase the likelihood of developing depression, while causal factors refer to factors that directly contribute to the development of the condition. The presence of a risk factor does not necessarily mean that an individual will develop depression (Peterson & Seligman, 1984). However, the two are frequently blurred and equated in psychotherapy research (Westen & Bradley, 2005).As such, the historical issues of rating and diagnostic scales, aptly depicted by the Le Moigne (2023) as full of “composite, if not contradictory, heritage, weaving together the classificatory and discontinuous tradition of psychiatry, on the one hand, and the psychometric and continuous tradition of psychology, on the other” (p. XX ), suffer from an epistemological oversight when it comes to the assessment of causal factors in complex mental health conditions, such as depression. In turn, this contributes to a wider psychometric issue: what is actually being measured? Le Moigne’s detailed overview predominantly focuses on “superficial” symptomatology of depression (which contributed to two distinct forms of evaluation: hetero- and self-evaluation), and its subsequent impact on the classification and taxonomy of depression throughout history. However, the overarching conceptualization of depression (including a more detailed consideration of causal factors and their assessment) and the usefulness of rating scales in applied research (such as psychotherapy) remain in the background.The question of “what is actually being measured” is obviously not new in psychometrics. However, it is important to continuously revisit this issue, given that rating scales (such as the BDI) are considered to be universally applicable “evidence-based” tools (Rogers, Adler, Bungay, & Wilson, 2005) as well as a common and well-accepted form of scientific thinking in psychotherapy research (Kaluzeviciute & Willemsen, 2020). From an epistemological point of view, a scientific thinking style entails not only cognitive operations common to methodology, but also practices of generating, sharing, assimilating and transforming knowledge(Hacking, 2012).Therefore, it is important to acknowledge that any scientific tool, including rating scales, encompasses not just what but also how researchers find out about their studied phenomena (i.e., a scientific thinking style conveys a performative quality) (Kaluzeviciute & Willemsen, 2020). As identified by Le Moigne (2023), taxonomy leads toward a category-based logic in that it considers the examined phenomenon to be shared by only a... (shrink)

Throughout the last decades, scientific and therapeutic communities have made common efforts to collect reliable information concerning the efficacy of psychotherapies. One of these initiatives has, recently, involved the psychodrama community and its desire to achieve progress in the validation of this therapy. Based on Robert Elliot's Hermeneutic Single Case Efficacy Design (HSCED), we followed five participants (3 women, 2 men, aged 27-48) of a psychodrama group over the course of their therapeutic process, which ranged from 24 months to (...) 5 years. We chose one of them for the single case study. Quantitative outcome measures included the Portuguese versions of the Revised Spontaneity Assessment Inventory, Clinical Outcome Routine Evaluation and the individualized Personal Questionnaire. Qualitative process measures included Helpful Aspects of Therapy Form and the Client Change Interview. Participants generally reported improvement in their personal therapeutic goals, decrease in symptoms and life problems, and some showed a marked increase in spontaneity levels. In the single case presented, these results are confirmed, and following decision criteria it is possible to assert that the participant improved in all the variables assessed and that therapy is the main cause of these changes. Furthermore, the participant frequently rated psychodrama sessions as being helpful and stated they had a transformational impact on his life. This research contributes towards validating psychodrama as an efficient therapeutic method, hopefully stimulating practitioners to integrate therapy and research - which, for years, were considered independent and incompatible - and to facilitate their use in a complementary way. (shrink)

La bibliografía reporta amplitud en lo concerniente al campo de la edición de revistas científicas donde los avances científico tecnológicos aportaron una nueva dinámica. Las nuevas tecnologías de la información y la comunicación sirven de herramientas y han transformado radicalmente el escenario de la evaluación de la publicación científica. Variedad de perspectivas, instrumentos e indicadores impactan en los procesos de evaluación. El objetivo de este trabajo es ofrecer una valoración del proceso actual de evaluación de las publicaciones científicas seriadas. Los (...) procedimientos utilizados son la revisión bibliográfica, análisis de textos y síntesis de los hallazgos desde lo teórico. Se concluye que la publicación científica seriada ha pasado a ser, más que un proceso singular de la comunicación científica, el modo fundamental de evaluación de la calidad del trabajo científico, de ahí la importancia de tener claridad y propuestas propias de los indicadores de la evaluación. There is amplitude in bibliography, regarding the edition of scientific journals, where the scientific technological achievements that have been made in recent times have contributed with a new dynamic. The edition in digital format has its name due to the appearance of the new information and communication technologies. The recently emerged perspectives, instruments and indicators impact evaluation of publications processes and the accreditation in the higher education. The aim of this document is to offer an assessment on the current situation of the evaluation process of serialized scientific publications through the use of indicators. The text analysis and bibliographic review procedures were used to achieve the previous goal. In conclusion, the serialized scientific publications have become the main way quality of scientific research evaluation rather than a specific process of scientific communication. That is why is important to be certain of the combination of indicators for evaluating the scientific publications. (shrink)

Drawing on recent findings, this study examines whether valence concordant electromyography (EMG) responses can be explained as an unconditional effect of mere stimulus processing or as somatosensory simulation driven by task-dependent processing strategies. While facial EMG over the Corrugator supercilii and the Zygomaticus major was measured, each participant performed two tasks with pictures of album covers. One task was an affective evaluation task and the other was to attribute the album covers to one of five decades. The Embodied Emotion (...) Account predicts that valence concordant EMG is more likely to occur if the task necessitates a somatosensory simulation of the evaluative meaning of stimuli. Results support this prediction with regard to Corrugator supercilii in that valence concordant EMG activity was only present in the affective evaluation task but not in the non-evaluative task. Results for the Zygomaticus major were ambiguous. Our findings are in line with the view that EMG activity is an embodied part of the evaluation process and not a mere physical outcome. (shrink)

Extant research underlines the critical challenge for firms to rigorously and consistently evaluate their growing number of cross-sector partnerships for sustainability and suggests formalizing evaluation processes by introducing formal practices. However, empirical research is scant and inconclusive. This study aims to develop an empirically grounded understanding of how firms formalize the evaluation processes of such partnerships and of what drives this formalization, to complement the so far mostly conceptual literature. We inductively analyzed 31 semi-structured interviews with 33 experts (...) from firms and their partnering nonprofits and further secondary data on organizations’ partnerships. We contribute to the cross-sector partnership research by analyzing firms’ practices related to the formalization of the internal as well as the joint partnership evaluation process with nonprofits. We propose a conceptual framework to explain why firms implement different formal practices to reduce the dependency on individuals’ skills, experiences, or judgments in evaluating partnerships. (shrink)

John Greenwood (this issue) claims that neglect of an important methodological distinction has contributed directly to the "epistemic impoverishment" of empirical studies of all forms of professional psychotherapy. I challenge this claim, as well as other important claims he makes about the efficacy of psychoanalysis and other forms of psychotherapy.

Background: Psychopathy and substance use disorders are highly co-morbid and their co-occurrence is associated with higher severity of addictive behavior and increased risk of violent offending. Both substance use disorders and psychopathy are related to prominent impairments in emotion processing, which are also central features of alexithymia. The nature of the relationship between psychopathy and alexithymia is not well understood and has been particularly understudied among substance dependent individuals. Aims: Our goal was to evaluate the levels of psychopathy and alexithymia (...) in a relatively homogeneous sample of heroin dependent individuals and healthy controls and to examine group differences in the pattern of associations between these constructs. Methods: We examined 62 participants (31 heroin dependent individuals and 31 healthy controls) with the Psychopathy Checklist: Screening version (PCL:SV, Hart et al., 1995) and the Toronto Alexithymia Scale-20 (TAS-20, Bagby et al., 1994). Results: Heroin dependent individuals were characterized by higher levels of both psychopathy and alexithymia as compared to the control group. In addition, heroin dependent individuals with higher levels of psychopathy reported more difficulties in identifying and verbalizing emotional states. In the heroin group, alexithymia was more strongly associated with the impulsive/antisocial characteristics (impulsivity, irresponsibility, antisocial behavior) than with the interpersonal/affective features of psychopathy (grandiosity, manipulativeness, lack of empathy and remorse). Conclusions: Our findings suggest that alexithymia may be one potential mechanism linking psychopathy with opioid use disorders. The development of interventions targeting alexithymia could have significant applications in relapse prevention programs and psychotherapy of substance use disorders with concurrent psychopathy. (shrink)

Aim: The aim of this paper is to present the development and evaluation of an art psychotherapy brief treatment method for complex depression for patients referred to mental health services.Background: Art Psychotherapy literature describes a range of processes of relational change through the use of arts focused and relationship focused interventions. Complex depression has a prevalence of 3% of the population in the West and it is recorded that in 2016 only 28% of that population were receiving (...) psychological treatment. This study was developed to test the hypothesis of whether an accessible and acceptable approach to the treatment of complex depression could be developed in relation to existing evidence-based practice within mental health services.Method: The United Kingdom Medical Research Council phased guidance for complex intervention development was used to develop the intervention. The process included producing a literature overview, systematic description of clinical practice, including a logic model and a clinical protocol. The art psychotherapy protocol described an arts-based dynamic interpersonal therapy approach, offered 1:1 over 24 sessions. Further to this the intervention was tested for referrer acceptability. The intervention is in the early stages of evaluation, using changes to the patient's depression and anxiety measured pre- and post-treatment with a follow-up measure at 3 months following completion of treatment.Results: Phase I of the study provided a good basis for developing a logic model and protocol. The authors found that there was good clinical consensus about the use of a structured clinical art psychotherapy method and the literature overview was used to support specific examples of good practice. The verification of clinical coherence was represented by a logic model and clinical protocol for delivering the intervention. The acceptability study demonstrated very high levels of acceptability for referrers reporting that ADIT was acceptable for patients with complex/major depression, that they were likely to refer to ADIT in the future that the use of arts was likely to improve accessibility the use of arts was likely to improve outcomes and that offering ADIT was an effective use of mental health resources.Discussion: Phase I of this intervention development study demonstrated theoretical and practice coherence resulting in a clinical protocol and logic model. Whilst Phase II of this study showed promising results, Phase II would need to be sufficiently scaled up to a full trial to further test the intervention and protocol. (shrink)

Deepfakes are hyper-realistic but fabricated videos created with the use of artificial intelligence. In the context of psychotherapy, the first studies on using deepfake technology are emerging, with potential applications including grief counselling and treatment for sexual violence-related trauma. This paper explores these applications from the perspective of medical ethics and health law. First, we question whether deepfake therapy can truly constitute good care. Important risks are dangerous situations or ‘triggers’ to the patient during data collection for the creation (...) of a deepfake, and when deepfake therapy is started, there are risks of overattachment and blurring of reality, which can complicate the grieving process or alter perceptions of perpetrators. Therapists must mitigate these risks, but more research is needed to evaluate deepfake therapy’s efficacy before it can be used at all. Second, we address the implications for the person depicted in the deepfake. We describe how privacy and portrait law apply and argue that the legitimate interests of those receiving therapy should outweigh the interests of the depicted, as long as the therapy is an effective and ‘last resort’ treatment option, overseen by a therapist and the deepfakes are handled carefully. We suggest specific preventative measures that can be taken to protect the depicted person’s privacy. Finally, we call for qualitative research with patients and therapists to explore dependencies and other unintended consequences. In conclusion, while deepfake therapy holds promise, the competing interests and ethicolegal complexities demand careful consideration and further investigation alongside the development and implementation of this technology. (shrink)

The second edition of The Great Psychotherapy Debate has been updated and revised to include a history of healing practices, medicine, and psychotherapy, an expanded theoretical presentation of the contextual model, an examination of therapist effects, and a thorough review of the research on common factors such as the alliance, expectations, and empathy.

The Great Psychotherapy Debate: Models, Methods, and Findings comprehensively reviews the research on psychotherapy to dispute the commonly held view that the benefits of psychotherapy are derived from the specific ingredients contained in a given treatment (medical model). The author reviews the literature related to the absolute efficacy of psychotherapy, the relative efficacy of various treatments, the specificity of ingredients contained in established therapies, effects due to common factors, such as the working alliance, adherence and allegiance (...) to the therapeutic protocol, and effects that are produced by different therapists. In each case, the evidence convincingly corroborates the contextual model and disconfirms the prevailing medical model. (shrink)

Niiles-Mäki, Anne Logotherapy as philosophical therapy - philosophical background, area of applicability, applied methods, Two-Staged Separation Diagnostics of disorders Jyväskylä: University of Jyväskylä, 2021, 267 p. (JYU Dissertations ISSN 2489-9003; 432) ISBN 978-951-39-8863-0 (PDF) -/- This Dissertation belongs to the field of Philosophy. It deals with Logotherapy, a philosophical therapy form; its philosophical background, field of use, methods and diagnostics. Because of its nature as studying therapy, it belongs also in the field of human sciences and is a qualitative research. (...) As research approach, I have selected in philosophical research commonly used phenomenological-hermeneutic research approach and as for method, I chose content analysis method, which is necessary, in particular because one of the main aims in this study is to show how and why Logotherapy differs from the philosophical basis due to therapy forms that have emerged from the basis of Psychiatry and Psychology. Logotherapy also differs from other philosophical therapies because Logotherapy is based on Logotheory or Logophilosophy, which is a specific Existential-phenomenological theory, that has developed only to be applied in Logotherapy. This is why the content analysis of Logotherapy is a major part of studying Logotherapy. Logotherapy – unlike Psychotherapy – is focused on the Noological dimension of the consciousness, which is healthy by its principles. Psychotherapy doesn’t recognize the Noological dimension on the consciousness, but focuses on the disorders, that originate from the Psychic dimension of the consciousness. But the disorders in Noological and in Psychic dimension are different as their quality and not to be put together as mental disorders. -/- As research material, I have used the writings of Viktor Frankl, who developed Logotherapy, and the studies and theories concerning Logotherapy, that have been relevant to this study. I have also used the statistics and studies involving mental health, that have had interesting content and results related to Logotherapy. In this Dissertation, I also had to use the writings of the philosophers, psychiatrists and psychotherapists that influenced Viktor Frankl’s thinking and the writings of the philosophers, psychiatrists and psychotherapists that were relevant in studying and understanding the subject. This Dissertation is divided to 13 main chapters, from which the first six (1-6) deal with the basic assumptions and basic logotheoretic principles of the study, starting with methodology and studying process. Chapters 7-10 deal with the philosophical basis of Logotherapy, its field of use and applications. Chapters 11-12 present, among others, the Logotheoretic theory of consciousness and the Two-Staged Separation Diagnostics of disorders. Chapter 13 is focused on evaluation of the study and taking a stand towards new kind of logotherapeutic applications. Attachment “Exercise matrix for using in therapy process” is from A. Stropko. Exercise matrix has been modified and translated into Finnish. -/- Keywords: Viktor Frankl, Logotherapy, Logophilosophy, consciousness, Noological dimension of consciousness, Logotheoretic theory of consciousness, purpose, values, Existential Vacuum, Existential Analysis, worldview, Two-Staged Separation Diagnostics of disorders, medicalization. (shrink)

Positive Psychology Interventions as an Opportunity in Arab Countries to Promoting Well-being AbstractIn this perspective paper, we emphasize the importance of further research on culturally-sensitive positive psychology interventions in the Arab region. We argue that these interventions are needed in the region because they not only reduce mental health problems but also promote well-being and flourishing. To achieve this, we shed light on the cultural elements of the Arab region and how the concept of well-being differs from that of Western (...) culture. We review the research conducted in Arabia, briefly evaluate the quality of this research and list some adapted measurements. We furthermore propose guidelines and recommendations for future evidence-based positive psychology interventions research to align with the national culture in various sectors and community samples that contribute to the development of well-being in the Arab world.Introduction Extensive research on Positive Psychology Interventions (PPIs) - defined as activities focus on promoting positive feelings, thoughts, or behaviour (Sin & Lyubomirsky, 2009) - has shown their effectiveness in well-being and mental illness (e.g., Chakhssi et al., 2018; Hendriks et al., 2020). A recent review of 347 studies showed that PPIs have a significant effect on promoting quality of life and well-being and reducing anxiety and depression (Carr et al., 2020). However, the issue is that most of these studies (82%) remain narrow in focus only on Western Educated Industrialised Rich Democratic (WEIRD) countries (Hendriks et al., 2019). Therefore, they may not be effective for other countries such as the Arab countries where there are various cultural differences. This highlights the key role that culture can play in enhancing PPIs engagement, acceptability, and eventually, effectiveness (Hendriks & Graafsma, 2019). Recently, the field of PP in the Arab region has begun to grow (Basurrah et al., 2021; Rao et al., 2015). However, studies conducted in these countries are scant and of poor methodological quality. We have found humble quantity and quality of empirical studies. Yet, Arab countries, home to 5% of the world’s population, have a burden of mental health problems above global levels (GBD 2015 Eastern Mediterranean Region Mental Health Collaborators, 2018). Prevalent stigma, war and conflict were some of the contributors (Maalouf et al., 2019). Thus, to properly address this cultural stigma against mental health problems, PPIs could provide an additional role alongside traditional psychology approaches (e.g., Cognitive Behavioural therapy - CBT). Further, in light of the political conditions that some Arab countries are going through and the negative effects that they cause, it has become necessary to use the method of prevention that is the focus of PP and not only of treatment as a strategy for applications and practice. It has been noted that the mental health care system in the Arab region focuses highly on illnesses treatment and neglects the significant role that PP plays in enhancing human potential and well-being. We - here in Arabia –are becoming more influenced by many global issues particularly the COVID-19 pandemic and their impact on mental health and well-being (e. g. prevalence of stress, anxiety, depression among the general population during the pandemic (Salari et al., 2020). In response, Waters et al. (2021) have recently presented how positive psychological factors can play a significant role in buffering mental illness, enhancing mental health throughout the pandemic, and building positive processes and capacities that can help to promote future mental health.Here in this perspective paper, we highlight the cultural aspects of Arab countries. Specifically, we present previous PPIs research conducted in Arabia and briefly evaluate the quality of this research. Importantly, we discuss the need of developing an indigenous and culturally sensitive PP among the Arab region (Lambert et al., 2015).Arab Culture “Arab World,” which comprises 5% of the world’s population, refers to the Arab countries in the Middle East and North Africa. Despite the increasing pace and progress of different businesses in many Arab countries, individual communities are still limited in certain prominent economic places. Arab people rather gather in collective communities. They generally share the same Arabic Islamic culture, speak the same language, and descend from the same Arab families when going back in history no matter what nationality they have nowadays. Yet, very many changes came to communities before borders were drawn between countries and after. For instance, geography, topography, demography, and socio-economic status affect peoples’ nature of jobs and lifestyles. For example, Arabs in the east, west, or the middle have similar tongues; however, almost every Arab country has its accent. Therefore, people need to go back to the formal Arabic language ‘Fus-ha’ or learn more about different Arabic dialects when communicating cross-countries. According to Hofstede’s model (2011) based on the individualism-collectivism dimension, the Arab countries (Eastern society) have been classified as a collectivist culture, where their identity and decisions are influenced by social systems. In contrast, the United States (Western society) has been classified as an individualist culture focusing on individual decisions. Although there are degrees of individualism among Arabs in certain countries, they still share collective common characteristics. Here, we explore the meaning of collectivistic conceptions of the self, emotions, values, and religion in Arab countries and how they differ from those in individual Western cultures. The Self Since the field of PP focuses on the development of self, it is vital to recognize that self-concept varies across cultures. Individualism generally emphasises the self-directed and autonomous individual (Realo et al., 2002). People in individualist countries focus primarily on their personal characteristics (e.g., motives, abilities) to build their self-concept. On the other hand, collectivism refers to several social structures that highly value the groups to which people belong, such as family and tribe (Realo, 2003). People in collectivist countries such as the Arab countries focus primarily on their relationships with others to build their self-concept (Markus & Kitayama, 1991). Hence, research from Arab countries should focus on the core elements of collectivism when implementing PPIs to make a significant, meaningful impact. For example, people from a collective culture may experience a greater enhancement in well-being when practising interventions that are more prosocial and group-oriented such as compassion, performing acts of kindness, writing a gratitude letter, and using character strengths in everyday context including social context, compared with self-oriented interventions such as identifying character strengths. Emotions, value, and Religion Research shows that Western culture emphasises the goal of maximizing positive emotions, while Eastern culture emphasises embracing and balancing positive and negative emotions (Leu et al., 2011). To illustrate, culture plays an important role in influencing perceptions of happiness. People in individualist countries value happiness highly. In contrast, people from the collective countries value low arousal positive emotions (Leu et al., 2011) and exhibit a fear of happiness (Joshanloo & Weijers, 2014; Joshanloo, 2013). Hence, the influence of positive emotions plays a limited role in the mental health of Eastern society. Speaking of Value, for an Arab, the family is the centre of honour and the most important social unit. This loyalty has an impact on every part of an Arab’s life. Arabs honour their families and highly value their friendships. Therefore, future research could shed more light on group-oriented interventions (e.g., kindness) that focus more on the relationship with family, friends, and community. When it comes to religion, Arab society has a rich culture in values and believes that place a high emphasis on spirituality. Religion is the most important and distinctive aspect of Arab culture. Arab countries vary in terms of religion, with Islam being the predominant religion in most of them. Well-being (Hedonic and Eudaimonic) It is necessary here to clarify what is meant by hedonic and eudaimonic definitions of well-being. While the term ‘Hedonic’ is based on the pursuit of maximum levels of pleasure (feeling good), the term ‘Eudaimonic’, on the other hand, is based on meaning and the development of virtues (functioning well; Keyes & Annas, 2009). Research indicates that cultures are not equally supportive of hedonic and eudaimonic aspects (Joshanloo & Jarden, 2016). In comparison to collectivism, hedonism appears to be more congruent with individualism (Joshanloo, 2014). Pleasure and positive emotions are considered a way to pursue happiness in Western culture, while this method is not highly favoured in Eastern cultures (Lee et al., 2013); Because they consider suffering and negative emotions as contributing factors to spiritual development. Therefore, the eastern perspective is more in line with a eudaimonistic view which emphasises virtues, meaning, and feeling of belongingness. However, although we believe that both approaches can be found to a certain level in both cultures, the differences suggest that there are different routes to happiness. Positive Psychology in the Arab region Positive psychology - "the scientific study of what makes life most worth living" (Seligman & Csikszentmihalyi, 2000) - is one of the newest branches of psychology. It focuses on three main pillars: (1) positive subjective experiences (such as happiness and love); (2) positive individual characters (such as gratitude and compassion); and (3) positive institutions (for the application of positive principles within institutions and organizations; Seligman & Csikszentmiha lyi, 2000). Some of the main topics of interest in positive psychology include character strengths, gratitude, hope, happiness, mindfulness, optimism, positive thinking, and resilience. Within the applications of this science, various domains of well-being (such as happiness, engagement, positive emotions, and meaning) can be enhanced by practising positive psychology interventions (Sin & Lyubomirsky, 2009). Interestingly, these interventions have also produced benefits beyond well-being, such as reduced mental health issues (Chakhssi et al., 2018; Hendriks et al., 2020).Nowadays, PP is increasingly noticed in the Arab world (Lambert & Pasha-Zaidi, 2019; Rao et al., 2015). In recent years, there has been a great effort to explore the PP field across Arab countries. Several initiatives have emerged aimed at promoting well-being and flourishing. For example, the Middle East Journal of Positive Psychology published its first volume in 2015. On the International Day of Happiness in 2017, United Arab Emirates University launched its Emirates Center for Happiness Research. Meanwhile, Effat University in Saudi Arabia started the first Positive Psychology and Well-being Research Lab, the first symposium, and the first PP course. In 2019, Louise Lambert and Nausheen Pasha-Zaidi published the first regional text entitled “Positive Psychology in the Middle East/North Africa.” There are other efforts spent in the region as well; such as the work conducted in Egypt. Ibrahim Younus established the Arab Association for Positive Psychology https://www.psycholearn.com/en/associative.php which provides several courses on PP and also published a book entitled “The Power of Positive Psychology” (Younus, 2017). Despite this development, nothing can compare to the quantity and even quality of research in other countries. In light of our observations, the few PP studies may be attributed to the lack of awareness of the constructive approach and prevention compared to problem-solving. An Arab dentist once said: “people do not come to me until they are badly in pain.” In any case, many studies have taken place in Arab countries in the last decade, more of which are descriptive and less of which experimental. For example, Abdel-Khalek (2010) found positive correlations between quality of life, subjective well-being, and religiosity among students in Kuwait. Abdel-Khalek (2016) developed “the Arabic Scale of Religiosity,” which significantly correlated with PP variables among students in Algeria, Kuwait, and Egypt. Recently, empirical studies on PPIs have arisen in Arab-Islamic countries. More attention has been focused on promoting well-being and alleviating the high burden of mental health problems in the region (GBD 2015 Eastern Mediterranean Region Mental Health Collaborators, 2018). For instance, several studies examined the effectiveness of mindfulness among university students (e.g., Al-Ghalib & Slim, 2018; Awad, 2019; Thomas et al., 2016), parents of children with autism (Rayan & Ahmed, 2016) and addicted adults (Al-Rashidi, 2018). Such an intervention has positive effects. Participants who practised mindfulness reported reduction in stress and depression as well as improvement in well-being and resilience. Moreover, the results of a recent pilot study found positive impacts on enhancing emotional regulations and reducing stress among Arab teachers (Berkovich-Ohana et al., 2020). Some studies have also begun to examine various interventions targeting character strengths (Basurrah et al., 2020; Chérif et al., 2020), self-compassion (Elaiwah, 2017), positive thinking (Mohammed et al., 2014; Hadad, 2014), and hope (Zaki, 2016). Interestingly, a new finding considering the fear of happiness among people from collective countries has been examined. Lambert et al. (2019) provided evidence that a 14-week PPIs programme has an impact on reducing the fear and fragility of happiness beliefs among university students in the United Arab Emirates.Since Arab countries place great emphasis on spirituality, several authors have considered the aspect of religion when implementing PPIs. For instance, an empirical study by Al-Seheel and Noor (2016) found that expressing gratitude towards God “Allah” increases the happiness of the Muslim more than the usual gratitude intervention. Additionally, Al-Ghalib and Salim (2018) examined a religiously sensitive mindfulness-training programme with university students and found a positive effect on life satisfaction and a slight reduction in stress, depression, and anxiety. Hence, the role of religion is vital to make the interventions more relevant to Arab culture where people can connect Islamic philosophy with PP theories and practices. These studies reviewed here provide further support for the need for culturally sensitive interventions among the Arab population. More recently, the first systematic review of PPIs in Arab countries was conducted by Basurrah et al. (2021; the protocol has been published in BMJ Open and the final manuscript has been submitted for publication). Reviewing a total of 39 studies, the most commonly studied interventions were mindfulness, positive thinking, and resilience. Only a handful of studies examined gratitude, character strengths, forgiveness, self-compassion, savouring, or finding flow. Further analysis revealed that most studies from Arab countries have several methodological limitations. This included a lack of protocol guidelines, few well-designed randomized controlled trials (RCTs), blinding issues, small sample sizes, lack of active control groups, and lack of research into certain populations (e.g., teachers, employees, and people in distress in refugee camps). Discussion PP was founded on an individualistic framework (Christopher & Hickinbottom, 2008). To ensure that PPIs are culturally meaningful, this paper includes some cultural elements of the Arab region that should be considered to serve the needs of the Arab population. In the Arab world, some people may believe that PP is solely about happiness and being positive. If so, it is important to educate the public about the findings of rigorous studies evaluating PPIs such as gratitude, hope or flow on health, well-being and performance. To explain the value and effectiveness of these evidence-based approaches, examples might include studies linking gratitude with benefits for people with heart disease (Cousin et al., 2021), or how PPIs can promote quality of life in cancer patients (Casellas-Grau et al., 2014). There is some evidence about PPIs being effective in improving well-being in the Arab region, but research in this region is still in its infancy and little information is available regarding PPIs and the experience of Arabs participating in such interventions. Hence, there is still much more to investigate in this regard. Future research should empirically examine the effectiveness of various unstudied interventions such as savouring, gratitude, self-compassion, character strengths or finding flow. A combination of quantitative and qualitative approaches is required to provide an in-depth understanding of Arabs’ experience and impressions of PPIs and how and why they work. This may provide useful information to inform the appropriate design of PPIs to suit Arab culture and needs. Furthermore, while some research on PPIs has been carried out in the region, most of these studies have been of poor quality that suffered from small sample sizes, confounding factors, and a high degree of bias. To overcome these issues, future research should improve research quality, including protocol guidelines and well-designed RCTs. In particular, research should include randomization, allocation, blinding, power analysis to determine adequate sample size, active control groups to reduce bias, and follow-up periods of at least 12 months.Among the most popular resources that future PP practitioners may refer to are the International Positive Psychology Association (IPPA) and the International Positive Education Network (IPEN). Also, we recommend the Middle East Journal of Positive Psychology and the first regional book (Lambert & Pasha-Zaidi, 2019). To develop and/or adapt a multi-component PPIs, we would recommend referring to Character Strengths (Peterson & Seligman, 2004), the theory of well-being (PERMA Model: Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment; Seligman, 2011), and the Five Ways to Well-being: Connect, Be Active, Take Notice, Keep Learning, and Give (Aked et al., 2008). Finally, single-component PPIs are based on theories like Broaden-And-Build (Fredrickson, 2004), Hope (Snyder et al., 2002), and Self-Determination (Deci & Ryan, 2012) can be also considered. Two other concepts that would be usefully applied are ‘Savouring’ (Bryant & Veroff, 2007) and Phillip Zimbardo’s Time Perspective (Stolarski et al., 2015). For instance, savouring has a positive temporal orientation to reminiscing the good memories from the past, enjoying the hedonic present moments, and willing proactively to make a better future. Now, what is even maybe more interesting for Muslims is “Transcendent Future” where all intentions, words and actions are devoted to that life after death. In addition, there is a model already prepared for the clinical purpose called Positive Psychotherapy (PPT). Tayyab Rashid and Martin Seligman published a PPT manual for clinicians in 2018. And for cross-cultural applications, including Muslim Arab culture, Rashid and Al-Haj Baddar (2019) have written a paper presenting PPT and its efficacy. PPT overview in detail shows sessions, themes, skills, practice, and cultural considerations where a mixture of PPIs based on PERMA, Strengths, and other PP concepts can be found. Regarding PP measurements, it is highly recommended to generate indigenous tools based on cultural backgrounds reviewed here in the article. An example of this is a tool for measuring Muslim well-being by including domains beyond what is found in Western literature. So far, in the Arab region, several attempts have been made to adapt PP tools. For example, Marei Salama-Younes (2018) validated the Arabic versions of different measures of well-being (e.g., satisfaction with life scale, the subjective vitality scale). Other validated scales as well include the self-compassion scale (Alabdulaziz et al., 2020), and the passion scale (Salama-Younes & Hashim, 2018). Conclusion This paper has discussed the cultural aspects of Arab countries and the need of developing culturally sensitive PPIs. The past decade has seen an increase in mental health problems in the Arab region. Stigma and lack of awareness have been always there. Among the issues are also wars, conflicts, and displacement in many Arab countries such as Iraq, Lebanon, and Palestine (Hassan et al., 2016). These indicate an urgent need to prevent mental illness and promote well-being. Indeed, we highlighted the importance of integrating culture with PPIs, following the guidelines for the cultural adaptation of PPIs (Hendriks & Graafsma, 2019) and the ethical guidelines for PP practice (Jarden et al., 2020). Another significant contribution of this paper is to highlight the importance of improving the quality of research conducted in Arab countries. In brief, this paper has several practical implications. It is an open invitation for researchers, policymakers, and practitioners alike to be more exposed to PP; as well as to better conceptualising and adapting interventions and measurement tools to the local culture in different sectors to maximize their effectiveness. And as we consider it as an invitation for us too, here we are starting a PPIs practice guide in Arabic language and for Arab practitioners. The insights gained from this paper may be useful for placing well-being on top of priorities for achieving individual, organizational, and optimal national functioning in different sectors. There is also a need to change the stigma or negative beliefs about seeking health for psychological support, which is an issue for countries in the Middle East (Baess, 2018). (shrink)

Anthony Storr offers a lucid and objective look at Freud's major theories, evaluating whether they have stood the test of time, and in the process examines Freud himself in light of his own ideas. 'a model exercise in synthesis, and the final essay on the 'appeal' of psychotherapy is especially neat.' -Independent.

In lieu of an abstract, here is a brief excerpt of the content:Buddhist-Christian Studies 20 (2000) 321-323 [Access article in PDF] Frederick J. Streng Book Award David Loy Interview The 1999 winner of the Frederick J. Streng Book Award is David R. Loy, professor on the Faculty of International Studies at Bunkyo University in Chigasaki, Japan. Professor Loy received the award for his book, Lack and Transcendence: The Problem of Death and Life in Psychotherapy, Existentialism, and Buddhism, published by (...) Humanities Press (New Jersey) in 1996. The book places Western patterns of thought developed in tandem with Christian ideas into dialogic contact with Buddhism. It is thus a very Buddhist book, but a signal contribution to the practice of Buddhist-Christian dialogue. Buddhist-Christian Studies asked David about his writing of the volume.Buddhist-Christian Studies: Why did you write this book?David Loy: It was the product of an existential crisis, both intellectual and personal. My father, who had always been healthy and full of life, suddenly became ill with pancreatic cancer. Then my Zen teacher Yamada Koun had a bad fall that led to his death a year later. Not long before that my relationship with him and the Sanbo Kyodan had become somewhat problematic. This threatened my 'spiritual ground'. Finally, I was without a job. All this gave me plenty of time not only to sit intensively but also to read widely everything I could find on death and related issues.Did you think that sitting and studying would lead to a book?I didn't know. I could feel something gestating. I realized something was needed in this area. I was (and still am) very impressed by the last two books of Ernest Becker, but despite their brilliance his notion of death-denial is a little off-center from a Buddhist perspective. Fear of death projects our problem into the future, while the groundlessness of our sense-of-self accounts better for our sense-of-lack right here and now.What was the final trigger for doing the book?Another Zen teacher suggested that I try to write a Zen teisho [sermon or talk]. I sat down but after a few lines so many other thoughts began to bubble up that I couldn't write them down fast enough. There was no obvious or immediate logical connection among them, but they kept coming. This went on for about two, almost non-stop, days. After that the thoughts slowed down. I read over the notes I'd written, which led to more ideas, and then I began to perceive their relationship. After five days or so I had a detailed outline for the book, and the real work began. [End Page 321]What kind of response to the book, both positive and negative, have you received?There have not been many reviews, but they have generally been positive. It's not an easy book to evaluate: it brings together many different thinkers and traditions in order to address many different issues. In the process it attempts what is almost a grand synthesis of Buddhism, existentialism, and psychotherapy around the notion of our 'sense of lack', which I argue motivates us all. This involves close readings of Freud, Heidegger, Nietzsche, Nagarjuna, and many others. Unfortunately, the print is small and not easy to read, the cover is ugly, and the price is too high. For all these reasons readers have my sympathies! But there are some readers for whom the book really 'clicks'. I'm pleased that it seems to work on the existential as well as the intellectual level, for such people.After several years of reflection, would you write it any differently today?Yes, probably. The first thing I would do is take out the last chapter "Transcendence East and West," which was an afterthought and doesn't really fit in very well. As published, the chapter takes the concept of 'lack' into a new dimension which needs to be worked out much more carefully than I did in the book. It argues that, in place of the usual East-West dichotomy, it is more insightful to view South Asian Indian- influenced cultures as in some ways... (shrink)

The history of mental illnesses is as old as human history. Mental disorders are affected by changing social and cultural factors during the historical process, and have been conceptually restructured and their definitions and classifications have been changed. The evolution of obssessive-compulsive disorders with roots as old as human history into modern concepts took place in the 19th century. The first scientific views on the spiritual origin of OCD belong to S. Freud. Freud observed that mental causes in OCD (...) are different from other mental disorders, and he examined obsession as a separate and specific disorder. Over time, it has been understood that OCD is a very common disorder. The American Psychiatric Association (APA) has classified OCD under an independent title in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by removing it from the category of anxiety disorders. OCD is a mental disorder caused by mental actions such as obsessive thoughts (obsessions) and / or repetitive and compulsive behaviors (compulsion). The patient is often aware that such thoughts and behaviors are irrational and absurd. For this reason, he tries to get away obsessive thoughts that he finds contrary to his beliefs, opinions, moral values and logic from his mind. However, as he tries, obsessive thoughts become more and more frequent and create a great anxiety in the person. This time, the patient resorts to compulsions to alleviate the anxiety he feels or to get rid of it completely. As his compulsions repeat, his anxiety increases and he goes into a vicious circle. There are many symptom subgroups of OCD that seriously worsen the quality of life of the individual. One of these, and even the most overwhelming, is religious obsessions. It has been thought that there has been a relationship between religion and OCD for a long time in the psychology literature, and some remarkable studies have been conducted to clarify this relationship. Although there are many research findings showing that religion is an indispensable element in the protection of the mental health integrity of the individual, some forms of religious understanding and some experiences gained as a result of religious experiences may affect the concerns about OCD. This stage of religiosity is closely related to some sub-symptom groups of OCD. The explanations of the founder of the psychoanalytic method, Freud psychoanalytic method, and his followers made a great contribution to the understanding of OCD. However, since the psychoanalytic method exhibits a theoretically reductionist approach to religion, it is possible that the individual's devotion to religion is initially evaluated as a pathology or at least an important obstacle to insight. Today, cognitive behavioral psychotherapies are considered the most effective psychological treatment method for OCD, but their success rates in the treatment of religious OCD are low. Since religious OCD concerns often involve spiritual issues rather than concrete repeatable situations, behavioral methods can be quite difficult to apply in the treatment of religious OCD. Therefore, traditional psychotherapy approaches, even if they are not openly against religions, are insufficient to relieve the suffering in the lives of individuals with religious obsessions, as they generally neglect the religious dimension. Due to the vacuum that arises from restricting spiritual treatments to secular approaches, religious patients are threatened by the illegal practices of people who abuse religious feelings. Clinically, religious obsessions are more worrying and overwhelming. Therefore, their treatment is more difficult than others. Selective approaches that use different scientific disciplines together in the treatment of OCD and can stretch around religious beliefs and values can create more effective treatment models. Thus, the success rate in the treatment of religious OCD can be carried to higher levels thanks to the appropriate cooperation of the disciplines of medicine, psychology and theology. There is a rich religious cultural heritage that can support this collaboration in terms of theological disciplines. As an example, Abū Zayd al-Balkhī (d. 322/934), in his Maṣāliḥ al-abdān wa-l-anfus, probably made a clear distinction between neuroses and psychosis and classified neurotic disorders for the first time about ten centuries before Freud. In this study, the importance of approaching to religious obsessions as both a psychological disorder and a theological problem is emphasized. For this reason, cooperation of psychiatric and psychological approaches with spiritual counseling and guidance is recommended in the treatment of religious OCD. The difficulty in distinguishing whether the symptoms seen in a religious person are normal, natural religious thoughts and behaviors of religious life or abnormal appearances in the religious guise necessitates this interdisciplinary cooperation. (shrink)

How do social audiences negotiate and handle stigmatized organizations? What role do their heterogenous values, norms and power play in this process? Addressing these questions is important from a business ethics perspective to improve our understanding of the ethical standards against which organizations are judged as well as the involved prosecutorial incentives. Moreover, it illuminates ethical concerns about when and how power imbalances may induce inequity in the burdens imposed by such social evaluations. We address these questions building on (...) two event-based case studies involving Hells Angels Motorcycle Club Norway, and contribute to organizational stigma theory in three ways. First, social evaluations of a stigmatized organization by multiple audiences are found to interact, collide and combine in a labelling contest. Second, we show that labels employed in this contest are pushed to either negative extremes or positive extremes. Finally, we show when and how power represents a double-edged sword in social evaluation processes, which can be wielded either to the benefit or to the detriment of the actors under evaluation. (shrink)

Definition of the problemFrom an ethical point of view we analyse the ruling of the German Federal Joint Committee (Gemeinsamer Bundesausschuss, G‑BA) of September 2019 to revise the guidelines about the coverage of noninvasive prenatal tests (NIPT) by mandatory health insurance, in order to include them under specified conditions. The decision contains four essential elements: a definition of the aim of NIPT testing (to avoid invasive testing), a criterion of access (test must be “necessary” for the pregnant woman to tackle (...) her individual situation), statements about the process of decision-making (after counselling by a physician and case by case) and a normative contextualization (termination of pregnancy under § 218 a German penal law) which is to be found in its explanations. There are tensions in the proposed model that oscillate about two axes: (1) The suffering that results from a possible birth of a child with trisomy or from not knowing about the genetic condition of the fetus can ultimately only be evaluated subjectively, from the perspective of the pregnant woman. (2) The meaning of an individual decision in the case-by-case model remains unclear because when judging about individual cases general points of view also need to be considered. However, we argue that the model of the G‑BA could be a sociopolitically and ultimately also ethically defensible pragmatic solution, exactly because of its paradoxes and its inherent flexibility. (shrink)

The Therapeutic Process attempts to present an informative, sequential, well-defined, and clinically rich guide to the process of psychodynamic psychotherapy. The book was specifically designed to have broad appeal and value, for the beginning clinician to more experienced clinician, or the clinician who also teaches students of psychoanalytic psychotherapy. For the beginning clinician, the book has many illustrative examples, and terms are well defined. For the long-time clinician, the book attempts to put clearly into words, what (...) many of us have thought all along. This book arose from a series of lectures that were part of a course for the psychiatric residents at UCLA Neuropsychiatric Institute and Hospital, as well as from the instruction of many therapists from other mental health disciplines. The challenge in the initial instruction of psychoanalytic psychotherapy is always to be able to introduce fundamental concepts and convey the importance of a solid theoretical background, while concurrently addressing the clinician's pressing desire and often immediate requirement to understand the clinical process. Novel heuristic models are described and illustrated in clinical vignettes, in order to quickly bring together clinical and theoretical terms with the practice and process of psychotherapy. (shrink)

Through a warm and passionate investigation of the most fundamental properties of human behaviour, Psychotherapy and Science shows how a scientific foundation for psychotherapy is both necessary and feasible. Addressing psychotherapy's need for a coherent theoretical grounding, the book argues that there are striking parallels between the emotion-processing mind and phenomena that have been scientifically observed and charted in the areas of evolution, the immune system and the brain. The idea that scientific theories might be applied to (...) psychotherapy is thoroughly explored in a surprisingly accessible manner. Throughout the book, the ways in which science has a bearing on the clinical techniques and practice of psychotherapy are emphasized, and priority is given to the needs of psychotherapists to focus their theoretical and clinical efforts on understanding the deep, evolved factors behind human suffering, deception, self-limitations and death anxiety. This rare and engaging insight into a scientific quest for better psychotherapeutic knowledge offers a truly original way through the current impasse of ever-divergent theories, and is one of the most cogent challenges to psychotherapy in recent times. It is essential reading for all training and practising psychotherapists, and for those involved in related research. (shrink)

Psychotherapy style is conceptualized as the therapeutic method that a therapist employs while working with clients during treatment. It influences both the therapeutic process and results of therapeutic actions. The present study developed and validated the Psychotherapy Style Scale. By following a systematic psychometric development process, a three-factor structure of the PSS was identified. Exploratory factor analysis and confirmatory factor analysis provided evidence of multidimensional structure and validity of the PSS. Cronbach’s α suggested that the resulting (...) scale was highly reliable. Criterion validity was also satisfactory, demonstrated by correlations between the scale and criterion validity measures. The PSS has the potential to help better understand therapists’ behavioral characteristics and select the most appropriate therapists for clients who undergo psychotherapy. (shrink)

In this paper it is suggested that Freud's 'tally argument' (Grunbaum 1984) is not best interpreted as a risky claim concerning the efficacy of psychoanalytic therapy, but as a risky claim concerning the implications of theoretical psychoanalytic explanations of the efficacy of psychoanalytic therapy. Despite the fact that Freud never empirically established that these implications hold, the 'tally argument' does draw attention to a critical distinction that is too often neglected in contemporary empirical studies of psychoanalysis and other forms of (...) psychotherapy: between empirical evaluations of the efficacy of psychotherapy and empirical evaluations of theoretical explanations of the efficacy of psychotherapy, and the different forms of comparative enquiry relevant to each. It is argued that the contemporary neglect of this critical distinction, in conjunction with the common negative conception of placebo control treatments in psychotherapy research, has led to the epistemic impoverishment of experimental studies of the various professional psychotherapies. In consequence, although there is good empirical evidence for the efficacy of psychoanalysis and other forms of professional psychotherapy, there is no good empirical evidence for theoretical psychoanalytic explanations of the efficacy of psychoanalysis, or for traditional theoretical explanations of the efficacy of other forms of professional psychotherapy. (shrink)

Building on a functionalist framework for decision-making in legal translation, a holistic approach to quality is presented in order to respond to the specificities of this field and overcome the shortcomings of general models of translation quality evaluation. The proposed approach connects legal, contextual, macrotextual and microtextual variables for the definition of the translation adequacy strategy, which guides problem-solving and the rest of the translation process. The same parameters remain traceable between the translation brief and the translation product (...) both in pre-delivery revision and in post-delivery assessment. They are the yardstick for identifying predictable evaluative criteria and competence requirements for translators and quality controllers. The implications of the approach on quality assessment and quality management practices are also discussed. Overall, the model illustrates the potential benefits of enhancing predictability and reducing subjectivity on the basis of specific legal translation methodologies. It supports the need for legal translation expertise in quality evaluation and the relevance of Legal Translation Studies to raising standards in professional practice. (shrink)

This book takes the discursive and postmodern turn in psychotherapy a significant step forward and will be of interest to all those working in mental health who want to work wiht clients in ways that will facilitate challenges to oppression and processes of emancipation. It achieves this by: · reflecting on the role of psychotherapy in contemporary culture · developing critiques of language in psychotherapy that unravel its claims to personal truth · the reworking of a place (...) in the transforative therapeutic practice Deconstruction is brought to bear on the key conceptual and pragmatic issues that therapists and clinical psychologists face, and the project of therapy is opened up to critical attention and reconstruction. The book provides clear reviews of different viewpoints and will help readers to orient themselves on the complex terrain of debates. (shrink)

Evaluation processes are a basic component of creativity. They guide not only the pure judgement about a new artefact but also the generation itself, as creators constantly evaluate their own work. This paper proposes a model for automatic story generation based on the evaluation of stories. A model of how quality in stories is evaluated is presented, and two possible implementations of the generation guided by this evaluation are shown: exhaustive space exploration and constrained exploration. A theoretical (...) model and its implementation are explained and validation of the evaluation function through comparison with human criteria is described. (shrink)

In this paper, I respond to some criticisms of Greenwood (1996) advanced by Grunbaum (1996) and Erwin (1996). I argue that Grunbaum's problematic account of "placebo effects" and placebo control treatments does not really address, far less resolve, the problems with experimental evaluations of psychotherapy documented in my original paper.

Background: Informed consent is essential for the ethical conduct of clinical research and is a culturally sensitive issue. But, a measurable Chinese version of the scale to evaluate the informed consent process has not yet been explored in the existing literature. Research objectives: This study aimed to develop and psychometrically test the Chinese version of the Informed Consent Process Scale. Research design: Back-translation was conducted to develop the Chinese version of the questionnaire. A cross-sectional survey was administered, after (...) which an exploratory factor analysis was conducted. Participants: We recruited a total of 375 participants who had experience in signing an informed consent form within the previous 3 years in Taiwan. Ethical considerations: This study was approved by two Institutional Review Boards and the autonomy of the participants was respected. Findings: The Chinese version of the Informed Consent Process Scale is composed of three factors with 23 items showing evidence of acceptable reliability and validity. Three major factors were extracted and labeled: Factor 1 – ‘Understanding of the research’, Factor 2 – ‘Trust and confidence’ and Factor 3 – ‘Doubt and uncertainty’. The three factors accounted for is 52.954 of the total variance with Cronbach’s α of.917. Discussion and conclusion: The finding corroborates previous studies showing that participants had too little understanding on the informed consent forms they signed and implied the need to clarify the critical points in clinical research. The psychometric results indicated good internal consistency and validity for this newly constructed instrument, and it was found worthy of conducting further testing and application. (shrink)

Instead of attempting to reduce rituals of healing to so‐called primitive psychotherapy this essay raises the question of whether contemporary psychotherapies might not fruitfully be viewed as ritual processes through which a small segment of modern society receives ritual leadership in times of crisis. Selected phenomena in contemporary psychotherapeutic practice are analyzed in an attempt to discern the ritual processes which are manifest in them. It is concluded that most modalities of contemporary psychotherapy manifest elements of ritualized submission, (...) containment, and enactment. (shrink)