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)

The article is based on selected findings from a study in the field of rehabilitation in a religious context viewed from the perspective of cognitive psychology and psychology of religion. The study shows how a therapeutic process can be facilitated in cases where the psychotherapeutic intervention is co-ordinated with a creative, sound religious activity. One central phenomenon that emerged from the study was the experience of a therapeutic dialogue with the divine person God and/ or Jesus being apprehended (...) as a crucial therapeutic agent. The material is analysed focusing on criteria for creative persons and products. A basic mechanism of creativity is hypothesised by Martindale to be defocused attention. The greater the spread of the attention capacity, the more likely the combinational leap, giving the rich possibility of combining elements in new ways. Religion can extend the perspective and thereby increase the possibilities of finding new and appropriate emotional and cognitive combinations. The analysis shows significant creative qualities in the treatment model studied. (shrink)

The article is a description of Rimas Kociunas’ seminar “The picture of human life and the therapeutic process: the introduction of an existential psychotherapist”, held in Moscow from February 13 to 16, 2020. The seminar was devoted to the study of the basic philosophical principles of existential psychotherapy on which work with a client is based. A specificity of existential therapy is the lack of specific technical methods and methods of working with a client, therefore the content of (...) class='Hi'>therapeutic work is determined by a particular vision of a person and his problems. From the point of view of existential therapists, the personality is in constant interaction with the world, the result of which is continuous formation; therefore, instead of studying the qualities and structures of the personality, one should study its life world and ways of building relationships with reality. (shrink)

\noindent\textbf{Introduction} Online interventions hold great potential for Therapeutic Change Process Research (TCPR), a field that aims to relate in-therapeutic change processes to the outcomes of interventions. Online a client is treated essentially through the language their counsellor uses, therefore the verbal interaction contains many important ingredients that bring about change. TCPR faces two challenges: how to derive meaningful change processes from texts, and secondly, how to assess these complex, varied and multi-layered processes? We advocate the (...) use text mining and multi-level models (MLMs): the former offers tools and methods to discovers patterns in texts; the latter can analyse these change processes as outcomes that vary at multiple levels. \noindent\textbf{Method} We (re-)used the data from \cite{Lamers2015} because it includes outcomes and the complete online intervention for clients with mild depressive symptoms. We used text mining to obtain basic text-variables from e-mails, that we analysed through MLMs. \noindent\textbf{Results} We found that we could relate outcomes of interventions to variables containing text-information. We conclude that we can indeed bridge text mining and MLMs for TCPR as it was possible to relate text-information (obtained through text mining) to multi-levelled TCPR outcomes (using a MLM). \noindent\textbf{Discussion} Text mining can be helpful to obtain change processes, which is also the main challenge for TCPR. We showed how MLMs and text mining can be combined, but our proposition leaves open how to obtain the most relevant textual operationalization of TCPR concepts. That requires interdisciplinary collaboration and discussion. The future does look bright: based on our proof-of-concept study we conclude that MLMs and text mining can indeed advance TCPR. (shrink)

The therapeutic and integrative significance of faith in the African quest for healing and wholeness has attracted a considerable level of interest amongst scholars in recent times. Despite the increasing interest in places of healing, faith communities have not paid much attention to studying the intersection of these practices for appropriate community hermeneutics. By means of qualitative methods, this research explored the therapeutic implication of the role of faith in the quest and appropriation of health and wholeness in (...) modern Africa. Exploring perspectives from Ghana and Nigeria, the study engaged, through focus groups and individual interviews, the proper place of therapeutic significance of faith in the quest for healing and wholeness. Findings revealed that the African quest for health and wellness is anchored in the belief of a deity whose presence, love and benevolence transcend the ecclesiastical boundaries of one’s faith tradition. The study further describes the therapeutic and integrative significance of these prevailing faiths in God within the appropriation of health and wholeness in modern Africa, with the possibility of fostering a partnership amongst the three key players in the triangulation process.Contribution: The study falls within the field of practical theology and its major contribution falls within the quest of wellness and healing in Africa. (shrink)

Psychotherapists and counsellors confront several ethical dilemmas as they tend to provide effective services. There has been much debate among psychotherapists and counsellors alike around the utility of therapeutic contracts. Some view contracts as being restrictive to the therapeutic process and often hindering the work done in sessions. In contrast, many counsellors and psychotherapists use those agreements to revisit specific therapeutic topics and establish the guidelines necessary for this professional arrangement. No matter the opinion or preference of (...) contracts, the development of written and/or verbal consent of specific topics in psychotherapy remains essential. This remains one of the formal features of the arrangement and starting relationship in current counselling and psychotherapy practice. This paper aims to discuss the necessity and ethical demand of therapeutic contract in counselling and psychotherapy practice. (shrink)

This paper argues that a new genre of therapy has appeared in the arena of contemporary spiritual alternative healing, which expresses an outlook never-before-seen in the history of medicine: postmodern therapy. Postmodern therapeutic methods express a popularization of postmodernist philosophy in regards to language’s role in the therapeutic process, expressing a novel cosmology. These methods are illustrated in the paper, and then analyzed in comparison to two other groups of methods: traditional/occult magic, and modern medicine. Finally, PTMs are (...) characterized as neo-magic, bearing features similar to modernistic outlook on the one hand, and features similar to pre-modern magic outlook on the other hand. Thus, these new outlook demonstrate a double appropriation and rejection of perceptions viewed as contradictory – traditional magic and secular science. (shrink)

The COVID-19 pandemic outbreak has led to a general reorganization of health services and an increase in outpatient telemedicine in mental healthcare for physically ill people. Current literature highlights facilitators and obstacles concerning the use of new technologies in psychotherapy, an underrated topic of research in the context of supportive expressive psychotherapy. More insight is needed to explore the characteristics of video in therapeutic alliance for treatment of specific mental disorders experienced in psychosomatics, particularly with people suffering from a (...) disturbed body- and self-image. Using two clinical vignettes, it is the authors’ intention to enrich the critical debate on current knowledge in psychosomatic remote psychotherapy, with special focus on mentalization deficits and their impact on therapeutic alliance in the consultation-liaison psychiatry setting. In particular, we will question the interpersonal processes at stake related to mirroring and the disruption caused by the use of videoconference applications. We will also reflect upon the relationship between the therapeutic alliance and the medical team, and that between patient and psychotherapist. The aim is to improve psychotherapeutic alliance maintained during the pandemic for specific mental disorders and to inform about possible clinical factors that could be the subject of future empirical studies or professional guidelines. (shrink)

Therapeutic privilege is a defence that may be available to doctors who fail to disclose to the patient relevant information when seeking informed consent for treatment if they have a reasonable belief that providing that information would likely cause the patient concerned serious physical or mental harm. In a landmark judgement, the Singapore Court of Appeal introduced a novel interpretation of TP, identifying circumstances in which it might be used with patients who did not strictly lack capacity but might (...) be inclined to refuse recommended treatments. In this paper, we explore the conceptual and practical challenges of this novel interpretation of TP. We propose that more emphasis should be placed on forms of shared and supported decision-making that foster the autonomy of patients with compromised mental capacity while being mindful of the need to safeguard their well-being. The kind of privilege that doctors might need to invoke is one of time and supportive expertise to ensure a flexible, responsive approach calibrated to the individual patients’ needs. The provision of such service would extinguish the need for the novel TP proposed by the Singapore Court of Appeal. (shrink)

Summary Gestalt Theoretical Psychotherapy, in the broader sense of the term, has developed in various forms on both sides of the Atlantic since the 1920s. Gestalt Theoretical Psychotherapy, in the narrower sense of the term, came into being in the second half of the 1970s in German-speaking countries. In Austria, it is a state-approved, independent scientific psychotherapy method since 1995, and an integrative psychotherapeutic approach based on the Gestalt theory of the Berlin School. With reference to this comprehensive, consistent, scientific (...) theory, this article presents the basic concepts of therapeutic practice in the field of Gestalt psychotherapy. Starting from the overarching whole to the parts, the paper first examines the concept of therapeutic relationship and therapeutic attitude, and then describes the basic principles of the practical design of the therapeutic process. (shrink)

Research Doctorate - Doctor of Philosophy (PhD).

Therapeutic alliance is a central concept in psychotherapeutic work. The relationship between the therapist and the patient plays an important role in the therapeutic process and outcome. In this article, we investigate how therapists work with disaffiliation resulting from enduring disagreement while maintaining an orientation to the psychotherapeutic project at hand. Data come from a total of 18 sessions of two dyads undergoing psychoanalytic psychotherapy and is analyzed with conversation analysis. We found that collaborative moves deployed amidst enduring (...) disagreement can assist the therapist in furthering the disagreement as part of the ongoing psychotherapeutic project. Relying on their collaborative format, therapists utilize collaborative moves to temporarily mend the disaffiliation without necessarily changing their position and re-affiliating with the patient. We show how the relation between the therapist and the patient gets transformed in the moment-by-moment work accomplished in the psychotherapeutic talk. (shrink)

An ethnographic field study about the informed consent process in investigational drug trials for seriously ill persons with hepatitis C suggests that nurses and physicians referred to these trials as giving treatment, even though they involved placebos. Interview data and informed consent documents contained frequent references to the term `treatment trial' or `treatment'. Although these findings were unexpected and not the original focus of our study, we consider them in the light of an extensive literature on the `therapeutic misconception' (...) that has been described among physicians and patients with AIDS and other serious illnesses. We also suggest that certain organizational and professional characteristics of nursing and medicine reinforce this tendency to refer to the trials as treatment. Implications for further research are provided. (shrink)

This article describes the pilot projectShadows&Light Within: Untold Stories—a two-phase, multi-partner community-based project that explores the hypothesis that Autobiographical Therapeutic Performance can help traumatized individuals to improve executive functioning. A group of 10 individuals ranging in age from 32 to 69, with lived experiences at the intersection of trauma, mental health, and the court system, were paired with theater mentor-coaches for a 10-month creative group process, in which they shaped their stories into autobiographical performance pieces, through movement, improvisation, story-telling, (...) and self-discovery. In the second phase of the project, their stories were merged into a theater production, weaving movement, song, and voice, and performed by an ensemble of experienced actors from the community. Pre- and post-interviews and self-report standardized measures of executive functioning were used to assist in establishing criteria and direction for future research. The results suggest that the individuals involved in this pilot may have improved executive functioning and acquired more ability to engage in human service programs designed to increase job readiness and enhance adaptive living skills. (shrink)

The ‘right to the truth’ involves disclosing all the pertinent facts to a patient so that an informed decision can be made. However, this concept of a ‘right to the truth’ entails certain ambiguities, especially since it is difficult to apply the concept in medical practice based mainly on current evidence-based data that are probabilistic in nature. Furthermore, in some situations, the doctor is confronted with a moral dilemma, caught between the necessity to inform the patient (principle of autonomy) and (...) the desire to ensure the patient's well-being by minimising suffering (principle of beneficence). To comply with the principle of beneficence as well as the principle of non-maleficence ‘to do no harm’, the doctor may then feel obliged to turn to ‘therapeutic privilege’, using lies or deception to preserve the patient's hope, and psychological and moral integrity, as well as his self-image and dignity. There is no easy answer to such a moral dilemma. This article will propose a process that can fit into reflective practice, allowing the doctor to decide if the use of therapeutic privilege is justified when he is faced with these kinds of conflicting circumstances. We will present the conflict arising in practice in the context of the various theoretical orientations in ethics, and then we will suggest an approach for a ‘practice of truth’. Last, we will situate this reflective method in the broader clinical context of medical practice viewed as a dialogic process. (shrink)

The mapping of therapeutic collaboration throughout counseling deepens our understanding of how the helping relationship fosters client change. To better understand the process of career construction counseling, we analyzed the therapeutic collaboration on six successful face-to-face cases. The participants were six Portuguese adults, five women and one man, real clients of a career counseling service, and four psychologists, three female and one male trained in the career intervention model. The participants completed demographic questions and measures of career certainty, (...) vocational identity, career indecision, and psychological functioning. The Therapeutic Collaboration Coding System was used to track collaboration throughout all interactive episodes. The clinical significance of the intervention was calculated by analyzing pre-post-test statistical differences for each case, with the Reliable Change Index and Z score. The findings evidenced a pattern of therapeutic collaboration evolution for good outcome cases. Based on this pattern, we propose a model of process-outcome evolution for the three phases of CCC. (shrink)

This article presents a critical discursive analysis around the concept of menstrual health in a series of texts published in book format and in social networks in the last five years (2019-2023) by different activists and menstrual educators in Argentina. In a reading itinerary that goes from the singular to the collective, I identify the configuration of an experiential episteme that redefines the menstruating body as informational and multidimensional, which enables that, in addition to a physiological dimension, its role in (...) different social, political, cultural, environmental and economic contexts is vindicated. I place these examples in the context of the neoliberal precariousness that installs the therapeutic-managerial culture as a moral imperative, while at the same time it challenges certain subjectivities with relative privilege —white, urban, trained and educated women— to dispute and strain meanings. (shrink)

Since its inception in the 1900s, the concept of countertransference has been mired in controversy. Psychoanalytic literature is divided on its utility, significance and its clinical value in psychotherapy. While some psychotherapists have advocated for the importance of therapists’ expertise in the comprehension and processing of countertransference dynamics in the treatment of sexually abused children, others see no value in competency in countertransference in trauma treatment of sexually abused children. The purpose of this article is to explore whether countertransference is (...) a useful therapeutic tool, or a hindrance in the treatment of sexually abused children. A qualitative paradigm, particularly interpretative phenomenology, was employed in this research to make meaning of the therapists’ experiences. The analysis of the results revealed the following five main themes that were supported by 18 superordinate themes. These themes reveal that therapists treating sexually abused children experience a myriad of feelings, including a) feeling emotionally overwhelmed, b) anger toward perpetrators and the need to protect and rescue their patients, c) the importance of social support and self-healing, d) feelings of empathy and identification with the client, and e) erotic countertransference. These findings reveal two contradictory findings. Firstly, they tell of variable utilisation of countertransference among participants and, secondly, they highlight a lack of application of countertransference in the treatment of sexually abused children. The implications of the current study are that there is a need to both highlight the importance of countertransference as a therapeutic tool and to incorporate it in the treatment of sexually abused children. (shrink)

Background: The therapeutic itinerary is not limited to the identification and availability of health services offered, but relates to the different individual searches and sociocultural and economic possibilities of each patient. In this study, we discuss the therapeutic itinerary of transsexual people seeking healthcare, from the user’s perspective. Objective: The aim of this study was to discuss the therapeutic itinerary of transsexual people seeking healthcare, from the user’s perspective. Design and participants: Individual interviews were performed with 10 (...) transsexuals at the Trans Space of a University Hospital of Pernambuco, using the Universal Declaration of Human Rights as the theoretical reference and the Bardin’s thematic content analysis as the reference methodological framework. Ethical considerations: This study was approved by the Human Research Ethics Committee at the Federal University of Pernambuco under protocol no. 91284218.5.0000.5208. Findings: The comprehensive care for transsexual people was evidenced through four categories analyzed: low demand of transsexuals in health services; use of social name in health services; care permeated by prejudiced and discriminatory attitudes; and health system and professionals who are not able to meet transgender health issues. Discussion: Transsexual people are stigmatized and experience prejudice in their daily health, in a way they do not enjoy fundamental rights, as if they had fewer rights, or infringe the principle of universality of access to health. Thus, for effective and comprehensive care, the health team must keep up to date on the public policies existing in the healthcare of transsexual people and reconstruct what they understand by gender. Conclusion: Knowledge about the therapeutic itinerary of transgender people may support evaluation processes of health service networks to ensure the access to and reorganization of these services. Understanding this dynamic allows fostering discussions about the structure of health services at all care levels for the care of this population. (shrink)

Psychodrama is an effective psychotherapeutic model but interventions with adolescents require age-tailored techniques that maximize engagement and facilitate communication processes. This study describes a novel adaptation of a therapeutic mask technique to psychodrama with adolescents. Over the course of eight group sessions of psychodrama, five adolescents created their own mask and explored its therapeutic use. Their experiences were captured at the end of each session with the Helpful Aspects of Therapy form, and at the end of the (...) study with the Clinical Change Interview. Awareness/insight/self-understanding, empowerment and relief were the most significant aspects experienced by the adolescents, along with perceived increase of calmness and world connection, satisfaction in interpersonal communication and better emotional expression and regulation. The mask technique was experienced as a playful and engaging task that facilitated insight and interpersonal communication. Findings provide preliminary evidence on the clinical utility of mask-based psychodrama with adolescents. (shrink)

Background: Despite the progress made in recent decades on the phenomenon of futility in adult intensive care, recognizing it during clinical care practice remains a complex and sensitive process, during which questions are often raised for which concrete answers are difficult to find. Aims: To analyze the frequency with which futile nursing interventions are implemented in critically ill patients admitted to adult intensive care in specific situations and how often futile autonomous and interdependent nursing interventions are implemented in the same (...) population, as perceived by adult intensive care nurses. Research design: Cross-sectional, quantitative, and descriptive study, which employed a questionnaire constructed specifically for this research to assess the perception of therapeutic futility in nursing in adult intensive care. Following an evaluation of the psychometric properties, the questionnaire was made available in an electronic format on the EUSurvey platform between August and October 2024. The data was analyzed between November 2023 and March 2024 using the statistical software packages SPSS and R. Participants and research context: A simple random sample of nurses working in level II and level III intensive care units in Portugal. Ethical considerations: Research ethical approvals were obtained, and the participants provided informed consent. Findings/results: Four hundred and fourteen valid questionnaires were obtained. The results allow the identification of thirty-three statistically significant associations, the inference of intervals for the mean and median for the perception of futility of nursing interventions with a 95% confidence interval, and enable the hierarchization of nursing interventions implemented in critically ill patients admitted to adult intensive care units according to the nurses’ perception of their futility. Conclusion: There is a balance in nurses' perception of the futility of their interventions in the specific situations analyzed. There is statistically significant evidence that interdependent nursing interventions are, in general, more frequently perceived as futile when compared to autonomous nursing interventions. (shrink)

There is ongoing debate about whether it is ethically acceptable to allow the creation of cloned embryos in order to produce human stem cells. A cloned embryo is created through a process called somatic-cell nuclear transfer, often known as ‘therapeutic’ cloning. The value of stem cells lies in their capacity to become any sort of cell in the human body. This capacity is particularly useful for treating medical conditions where stem cells can be used to repair or replace damaged (...) tissue. The value of a cloned embryo is that the DNA from a person who needs stem cell treatment can be used to create the clone and thereby minimise the likelihood that any inserted stem cells will be rejected. Research on the use of cloned stem cells is in its earliest stage. (shrink)

Emotion regulation is an umbrella term to describe interactive, goal-dependent explicit and implicit processes that are intended to help an individual manage and shift an emotional experience. The primary window for appropriate emotion regulation development occurs during the infant, toddler, and preschool years. Atypical emotion regulation development is considered a risk factor for mental health problems and has been implicated as a primary mechanism underlying childhood pathologies. Current treatments are predominantly verbal- and behavioral-based and lack the opportunity to practice (...) in-the-moment management of emotionally charged situations. There is also an absence of caregiver-child interaction in these treatment strategies. Based on behavioral and neural support for music as a therapeutic mechanism, the incorporation of intentional music experiences, facilitated by a music therapist, may be one way to address these limitations. Musical Contour Regulation Facilitation is an interactive therapist-child music-based intervention for emotion regulation development practice in preschoolers. The Musical Contour Regulation Facilitation intervention uses the deliberate contour and temporal structure of a music therapy session to mirror the changing flow of the caregiver-child interaction through the alternation of high arousal and low arousal music experiences. The purpose of this paper is to describe the Therapeutic Function of Music, a theory-based description of the structural characteristics for a music-based stimulus to musically facilitate developmentally appropriate high arousal and low arousal in-the-moment emotion regulation experiences. The Therapeutic Function of Music analysis is based on a review of the music theory, music neuroscience, and music development literature and provides a preliminary model of the structural characteristics of the music as a core component of the Musical Contour Regulation Facilitation intervention. (shrink)

Introduction: Despite being considered as a contravention under some countries’ legislation, the therapeutic use of Cannabis sativa has been growing in Brazil, due to the promising results observed in many pathologies. Such a scenario has fostered the need to deepen discussions on the subject and possibly revise legislation governing the substance use and access. Objectives: Identify the types of stigma related to the therapeutic use of Cannabis and describe the strategies people use to overcome stigma. Methods: This integrative (...) review was carried out in the databases PubMed, Scopus, CINAHL, MEDLINE, PsycINFO, Web of Science, and Cochrane Library, with 565 articles being retrieved. Triads’ cross-check were done, first maintaining the “cannabis” and “therapeutic use” pair, added by “stigma,” “bioethics,” “ethics,” “social consequences,” and “legal consequences.” The final selection resulted in six articles. Ethical Consideration: However, the ethical issues that pervade and regulate decisions on this subject must be considered. Results: Different dimensions and types of stigma related to the therapeutic use of Cannabis have been identified. The bioethical principle of autonomy was an expression of citizenship and human rights, mitigating internal conflicts related to self-stigma and the effects of external stigma on the person’s life. Conclusion: It was possible to identify the types of stigma related to the therapeutic use of Cannabis is an internal dimension represented (self-stigma) and an external dimension, represented (social and structural stigmas) and to identify strategies adopted to face this stigma: skills training group for users, elaboration of laws and specific programs to clarify the therapeutic use of Cannabis with a greater social scope, and support for family members. Thus, contributing to the building of people’s autonomy in a broader context of decision-making autonomy and executive autonomy will provide the development of people’s capacity to perform complex tasks of self-management and, consequently, to continue promoting and preserving their decision-making process and their capacity to plan and perform tasks associated with managing their lives and their treatments. (shrink)

Therapeutic misconception involves the failure of subjects either to understand or to incorporate into their own expectations the distinctions in nature and purpose of personally responsive therapeutic care, and the generic relationship between subject and investigator which is constrained by research protocols. Researchers cannot disregard this phenomenon if they are to ensure that subjects engage in research on the basis of genuine informed consent. However, our presumption of patient autonomy must be sustained unless we have compelling evidence of (...) serious misunderstanding. This article argues that the mere expression of aspects of therapeutic misconception should not necessarily displace the presumption of subject autonomy or undermine ethical inclusion in research for at least three reasons. First, some interpretations of the empirical data do not suggest misunderstanding. Second, assessment of misestimation and optimism are delicate and value-laden, and turn quickly from questions of autonomy to questions of judgment. Third, incomplete understanding may yet be sufficient to allow a subject to engage in a substantially autonomous decision-making process. Our point is not to dismiss the possibility of genuine therapeutic misconception, but to question its frequency and fatality to the consent process. (shrink)

[Excerpted From Editor's Introduction] Matthew Crippen takes this up in a Marcusian critique of Wittgenstein that attends, among other things, to the place of silence in that discourse. Referring to Horkheimer’s citation of the Latin aphorism that silence is consent, Crippen is critical of Wittgenstein’s admonition that we must pass over in silence those matters of which we cannot speak. This raises fascinating questions for critical theory that Crippen explores particularly with reference to Marcuse’s concept of one-dimensionality. To the extent (...) that Wittgenstein’s philosophy is “therapeutic,” it may effectively contain dissent by “helping” dissenters become “well-adjusted.” Marcuse, of course, was particularly concerned with the power of Total States— and particularly those engendered by advanced industrial capitalism—to contain dissent precisely by using therapeutic techniques to maintain adjustment. Bringing Marcuse and Wittgenstein together here has particularly explosive possibilities. In the context of a Total State, transformation depends on the possibility of calling the State into question from the inside (since “total” States systematically eliminate “outsides”). This is the point at which Wittgenstein’s silence becomes most intriguing. What is it, we must ask, that we cannot say? Silence may be (as Martin Luther King, Jr. said) more than consent: there comes a time when silence is betrayal. But this is one of many places where it pays to look at what is done as much as what is said. What game, we might ask, is Wittgenstein playing? And, more to the point, what is the field of play that joins Wittgenstein and Marcuse? John Cage famously said “I have nothing to say and I am saying it and that is poetry as I need it...” Crippen begins a process (via Wittgenstein) of putting poetry into play that has important implications for the public work of philosophers. (shrink)

In this clinically rich and deeply personal book, Chris Jaenicke demonstrates that the therapeutic process involves change in both the patient _and_ the analyst, and that therapy will not have a lasting effect until the inevitability and depth of the analyst's involvement in the intersubjective field is better understood. In other words, in order to change, we must allow ourselves to be changed. This can happen within the sessions themselves, as one grasps the influence of and decenters from one's (...) own subjectivity, with cumulative effects over the course of the treatment. Thus the process, limitations, and cure of psychotherapy are cocreated, without displacing the asymmetrical nature of roles and responsibility. Essentially, beyond the theories and techniques, it is the specificity of our subjectivity as it interacts with the patient's subjectivity which plays the central role in the therapeutic process. (shrink)

Background: Nurses who practice limitation of therapeutic effort become fully involved in emotionally charged situations, which can affect them significantly on an emotional and professional level. Objectives: To describe the experience of intensive care nurses practicing limitation of therapeutic effort. Method: A qualitative, phenomenological study was performed within the intensive care units of the Madrid Hospitals Health Service. Purposeful and snowball sampling methods were used, and data collection methods included semi-structured and unstructured interviews, researcher field notes, and participants’ (...) personal letters. The Giorgi proposal for data analysis was used on the data. Ethical considerations: This study was approved by the Ethical Research Committee of the relevant hospital and by the Ethics Committee of the Rey Juan Carlos University and was guided by the ethical principles of voluntary enrollment, anonymity, privacy, and confidentiality. Results: In total, 22 nurses participated and 3 themes were identified regarding the nurses’ experiences when faced with limitation of therapeutic effort: (a) experiencing relief, (b) accepting the medical decision, and (c) implementing limitation of therapeutic effort. Conclusion: Nurses felt that, although they were burdened with the responsibility of implementing limitation of therapeutic effort, they were being left out of the final decision-making process regarding the same. (shrink)

The Netherne Hospital in Surrey is perhaps the most prestigious site in the history of British art therapy, associated with the key figures Edward Adamson and Eric Cunningham Dax, whose pioneering work involved the setting-up of a large studio for psychiatric patients to create expressive paintings. What is little-known, however, is the work of the designated scientist for psychiatric research, Hungarian Jewish émigré Francis Reitman, who was charged with an overall scientific analysis of the artistic products of the studio. Schooled (...) in the biological psychiatric tradition of Ladislas J. Meduna in Budapest prior to his exile to the Maudsley Hospital in 1938 – and committed to treatments such as leucotomy and electro-convulsive therapy (ECT) – Reitman was an unusual candidate for research into the unconscious processes behind art and psychosis. Yet he authored two highly popular and widely reviewed books on his analyses of the abundant artistic output created by patients with schizophrenic diagnoses at the Netherne. In his Psychotic Art (1950) and Insanity, Art and Culture (1954), Reitman compared such schizophrenic images with those produced by artists under the influence of mescaline and examined the artistic output of patients having undergone leucotomy. This article draws on archival materials and Reitman’s original research publications in order to reconstruct his theory of schizophrenic art within the complex context of postwar British psychiatry, negotiating as he did between biologically reductive understandings of Freudian and Jungian psychoanalytic categories, and ultimately synthesizing concepts from both. It also analyses Reitman’s implicit theory of the therapeutic mechanism of art in the treatment of psychiatric patients. (shrink)

This paper aims to extend Romanshyn's reading of van den Berg's metabletics as a process of recovering metaphoricity. Drawing upon research in contemporary cognitive linguistics, metabletics can be recast in terms of a process of re-metaphorization that requires a repeated sequence of stages. Initially a collective figuration exists in the culture as a form of negative metonymy, which serves the function of concealing a latent and taken-for-granted cultural meaning. By transforming the figuration from a form of negative metonymy to positive (...) metonymy, the metabletic method reveals how one cultural event has stood for another cultural event. In the final stage of the metabletic process, the researcher shows how the cultural event not only has stood for another cultural event, but can been understood metaphorically in terms of, or through, the other cultural event. This final step recovers the metaphoricity of the cultural meaning, which in turn frees up the possibility for creating new meanings that were previously foreclosed. (shrink)

The creation of poetry can be an intensely healing process, as therapeutic as the other arts and talking therapies. This paper examines three areas. First, it sets out some opinions about the specific qualities of poetry that make it particularly valuable as part of a therapeutic process. It goes on to give exemplified information about how poetry is used within healthcare in Britain. Finally, it indicates the current growth of interest in this area, with brief descriptions of pilot (...) research studies where poetry has been offered by a writing therapist, or by nursing or medical practitioners. (shrink)

This thesis promotes a therapeutic revision of fundamental assumptions in contemporary ontological thought. I show that none of the extant standard theories of objects provides a viable account of the numerical, qualitative, and trans-temporal identity of objects, and that this is due to certain substance-ontological premises. I argue that in order to state the identity conditions of objects we must abandon these premises, together with the idea that objects enjoy ontological primacy. ;I follow a methodological program of formally criticizing (...) an ontological framework by demonstrating that each of the theories developed within this framework is incoherent, i.e., either inconsistent or subject to vicious regress. I proceed in three steps. First, I show that the substance-ontological paradigm cannot be characterized in terms of its basic entities, since there is no extensional, intensional, or functional definition of the notion of substance common to all extant substance ontologies; consequently, I propose to describe the substance-ontological paradigm in terms of its basic assumptions. ;Second, I analyze the contemporary discussion of the problem of individuality, the problem of universals, and the problem of persistence, and uncover 22 characteristic implicit assumptions of substance ontology. I show on the basis of representative examples that, due to their commitment to substance-ontological presuppositions, all extant types of solutions to the three mentioned problems are incoherent. In particular, I take issue with the bare particular view, the qualified particular view, and the bundle view of individuality; different varieties of platonist and nominalist theories of universals and of relational and functional theories of predication; and the endurance and perdurance approaches to persistence. ;Third, while historical process-ontological schemes have dropped some of the revealed substance-ontological presuppositions, I finally explore the result of rejecting all of them and sketch a scheme based on dynamic masses which promises to yield coherent explanations of the ontological features of those complex processes which we commonly consider to be objects. (shrink)

Experiences of substitute decision-makers with requests for consent to non-therapeutic research participation during the dying process, including to what degree such requests are perceived as burdensome, have not been well described. In this study, we explored the lived experiences of family members who consented to non-therapeutic research participation on behalf of an imminently dying patient. We interviewed 33 family members involved in surrogate research consent decisions for dying patients in intensive care. Non-therapeutic research involved continuous physiological monitoring (...) of dying patients prior to and for 30 min following cessation of circulation. At some study centres participation involved installation of bedside computers. At one centre electroencephalogram monitoring was used with a subset of participants. Aside from additional monitoring, the research protocol did not involve deviations from usual end-of-life care. Thematic analysis of interviews suggests most family members did not perceive this minimal-risk, non-therapeutic study to affect their time with patients during the dying process, nor did they perceive research consent as an additional burden. In our analysis, consenting for participation in perimortem research offered families of the dying an opportunity to affirm the intrinsic value of patients’ lives and contributions. This opportunity may be particularly important for families of patients who consented to organ donation but did not proceed to organ retrieval. Our work supports concerns that traditional models of informed consent fail to account for possible benefits and harms of perimortem research to surviving families. Further research into consent models which integrate patient and family perspectives is needed. All data relevant to the study are included in the article. (shrink)

During psychotherapy, patient and therapist tend to spontaneously synchronize their vocal pitch, bodily movements, and even their physiological processes. In the present article, we consider how this pervasive phenomenon may shed new light on the therapeutic relationship– or alliance– and its role within psychotherapy. We first review clinical research on the alliance and the multidisciplinary area of interpersonal synchrony. We then integrate both literatures in the Interpersonal Synchrony (In-Sync) model of psychotherapy. According to the model, the alliance is (...) grounded in the coupling of patient and therapist’s brains. Because brains do not interact directly, movement synchrony may help to establish inter-brain coupling. Inter-brain coupling may provide patient and therapist with access to another’s internal states, which facilitates common understanding and emotional sharing. Over time, these interpersonal exchanges may improve patients’ emotion-regulatory capacities and related therapeutic outcomes. We discuss the empirical assessment of interpersonal synchrony and review preliminary research on synchrony in psychotherapy. Finally, we summarize our main conclusions and consider the broader implications of viewing psychotherapy as the product of two interacting brains. (shrink)

This paper presents a reconceptualization of autonomy as the iterative realization of one’s capacity for “effective self-definition,” that is, possessing a sense of clarity and coherence in “who I am,” and exercising the decisional and volitional ownership over my life that this engenders. This process is “Relational,” wherein people’s interpersonal interactions have a deep and pervasive influence on their ability to recognize and exercise their autonomous capacities. This Relational understanding of autonomy is contextualized within the field of addiction rehabilitative practice. (...) Addiction is a pathology that progressively and insidiously undermines autonomy – producing a number of negative consequences that present themselves along a “continuum of pervasiveness.” In order to most fully foster rehabilitation, therapeutic alliances should to be attentive to facilitating autonomy’s dialogical antecedents. Here, interpersonal recognition can help clients to more fully recognize their own autonomous resources – enabling them to embark on their rehabilitative journey and achieve broader autonomous living. This paper concludes by proposing ways that practitioners can manifest their recognition of their clients’ autonomy within the therapeutic encounter. (shrink)

The “therapeutic misconception” describes a process whereby research volunteers misinterpret the intentions of researchers and the nature of clinical research. This misinterpretation leads research volunteers to falsely attribute a therapeutic potential to clinical research, and compromises informed decision making, therefore compromising the ethical integrity of a clinical experiment. We review recent evidence from the neurobiology of social cognition to provide a novel framework for thinking about the therapeutic misconception. We argue that the neurobiology of social cognition should (...) be considered in any ethical analysis of how people make decisions about participating in clinical trials. The neurobiology of social cognition also suggests how the complicated dynamics of the doctor-patient relationship may unavoidably interfere with the process of obtaining informed consent. Following this argument we suggest new ways to prevent or at least mitigate the therapeutic misconception. (shrink)

Communicating an unfavourable prognosis while maintaining patient hope represents a critical challenge for healthcare professionals. Duty requires respect for the right to patient autonomy while at the same time not doing harm by causing hopelessness and demoralisation. In some cases, the need for therapeutic privilege is discussed. The primary objectives of this study were to explore HPs’ perceptions of hope in the prognosis communication and investigate how they interpret and operationalise key ethical principles. Sixteen qualitative semistructured interviews with HPs (...) from different positions and experience, including doctors and nurses in four different departments, were conducted in the Ticino Cantonal Hospital, Switzerland. The interviews were recorded, transcribed verbatim and analysed using thematic analysis. HPs defined prognosis and patient hope as interdependent concepts related to future perspectives for subjective quality of life. Two main factors allow HPs to maximise the benefits and minimise the harm of their communication: respecting the patient’s timing and sharing the patient’s wishes. Time is required to reframe needs and expectations. Furthermore, communication needs to be shared by HPs, patients and their relatives to build common awareness and promote a person-centred approach to prognosis. In this process, interprofessional collaboration is key: doctors and nurses are complementary and can together guarantee that patients and relatives receive information in the most appropriate form when they need it. Organisational aspects and the HPs’ emotional difficulties, particularly in coping with their own despair, are barriers to effective communication that need further investigation. (shrink)

The aim of this article was to interpret Habermas's concept of language in terms of its therapeutic potential which can be effectively realized in nursing practice. Drawing on Habermas's definition, we analyse the components of rational communication which are necessary for the patient and the therapist to achieve understanding. In doing this, we examine not only lifeworld, system and validity claims, which are well‐known notions within Habermas's theory of communicative action, but also less frequently studied elements of this theory, (...) such as everyday world, to which the patient refers in the process of self‐understanding and identity construction. We also address culture and language as a pre‐rational factor which can disturb, or even preclude, communication and understanding. In such circumstances, we propose supplementing the Habermasian therapeutic project with a psychoanalytical interpretations of the utterances of the patients who have difficulty defining the situation within which therapy is possible. (shrink)

Culture can broadly be defined as “the values, norms, and assumptions that guide human action”. In contrast with the broader civilian society, the experiences and environments within the military community create a unique cultural subset. The United States armed forces are unified by their primary mission to provide external defense, security, and protection, and each branch shares a unique core set of values and norms. Because this culture is so complex and unique, it can sometimes be a challenge for many (...) civilian professionals to work with this community, so having a strong competency in understanding military culture, as well as knowledge of specific conflicts and wars, one is not only able to begin to understand the lives and personalities of our soldiers but also able to recognize that this culture aids in survival. This paper will demonstrate and discuss the importance of competency in military culture when practicing music therapy or other interdisciplinary approaches within the process of group therapy with veterans. Other topics covered will include: issues of social transmission as it relates to transitioning into civilian society; the importance of being a witness to veterans’ stories; and facilitators’ ethical responsibilities when working with this population. (shrink)