Therapists and their patients must deal with the negative sequelae of short term mating strategies. Implications for therapy of Gangestad & Simpson's strategic pluralism theory are compared with those of Buss's sexual strategies theory and Eagly's social role theory. Naive theories held by therapists and patients, as well as prevailing societal views, are posited as influential in determining the course and outcome of therapy.

The DSM-5 Alternative Model for Personality Disorders dimensionally defines personality pathology using severity of dysfunction and maladaptive style. As the empirical literature on the clinical utility of the AMPD grows, there is a need to examine changes in diagnostic profiles and personality expression in treatment over time. Assessing these changes in individuals diagnosed with borderline personality disorder is complicated by the tendency for patients to cycle through multiple therapists over the course of treatment leaving the potential for muddled diagnostic clarity (...) and disjointed case conceptualizations. Following patient trajectories across therapists offers a unique opportunity to examine the AMPD’s sensitivity to and utility for capturing personality stability and change over time for patients with BPD. This article demonstrates the utility of the AMPD for two clinical cases in three distinct ways: highlighting heterogeneity in BPD between patients, comparing improvements in personality severity and style over time, and elucidating profile change across therapist ratings. We present two patients diagnosed with DSM-5 Section II BPD, crossing between two therapists over the course of 3 years of psychodynamic psychotherapy. Treating clinicians rated patients for their respective treatment phases using the Level of Personality Functioning Scale, capturing severity, and the Personality Inventory for the DSM-5, capturing style. AMPD diagnostic profiles differentiated patients with BPD in both severity and style, and captured within-patient change beyond within-therapist response bias. Results indicated greater improvements in personality severity while personality style remained more stable. Implications for the patients’ treatment progress and associated challenges are discussed, as are considerations for the utility of the AMPD in therapy. (shrink)

Compared to other health care professions such as medicine, nursing and pharmacy, few studies have been conducted to examine the nature of practice errors in occupational and physical therapy. In an ongoing study to determine root causes, typographies and impact of occupational and physical therapy error on patients, focus group interviews have been conducted across the United States. A substantial number of harmful practice errors and/or other patient safety events (deviations or accidents) have been identified. Often these events have (...) had moral dimensions that troubled the therapist involved. In this article, six of these transcribed cases are analyzed, using predominant bioethical theories, ethical principles and professional codes of ethics. The cases and their analyses are intended to be exemplary, improving the readers’ ability to discern and critically address similar such events. Several patient safety strategies are suggested that might have prevented the events described in these cases. (shrink)

The ArgumentOne disconcerting aspect of the role of culture in shaping human suffering is the gap between the explanatory models of therapists and patients in multicultural settings. This gap is particularly noted in working with Jewish ultra–Orthodox psychiatric patients whose idioms of distress are often derived from a sacred reality not easily reconcilable with psychomedical reality. To meet the challenge to therapeutic efficacy that this incompatibility may pose, we propose a culturally sensitive therapy based on strategic principles that focus on (...) the patient's mythic world and religious idioms of distress as the kernel of therapeutic interventions. Using one case of post–traumatic stress disorder (PTSD) as illustration, we seek to show how the religious symbols through which the patient's distress was articulated may be manipulated to effect cure. The case highlights the narrative quality of both illness construction and self–reconstruction. (shrink)

Introduction Respecting the Patients’ Rights Charter leads to the demands of patients for their rights and the response of rehabilitation therapists by increasing their compliance. The present study aimed to compare the views of patients and rehabilitation therapists about the importance and extent of compliance with the Patients’ Rights Charter. Methods This cross-sectional study was conducted for 3 months on 114 patients and 55 therapists who were selected using the convenience sampling method. The data collection tools included a demographic information (...) form and the Justification and Practice of Patient Rights Questionnaire. The collected data were analyzed using descriptive statistics, independent t-test, paired t-test, and Pearson correlation coefficient. Results Mean scores of the importance of compliance with the Patients’ Rights Charter were 2.21 ± 0.40 and 2.31 ± 0.43 in the group of patients and therapists, respectively. Moreover, the mean scores of compliance with the Patients’ Rights Charter were 1.45 ± 0.48 and 1.53 ± 0.61 from the perspective of patients and therapists, respectively. There was no statistically significant difference between the views of patients and therapists on the importance and extent of compliance with the Patients’ Rights Charter. Discussion and Conclusion The importance of respecting the Patients’ Rights Charter from the perspective of patients and therapists was at a desirable level while the level of compliance with it from the perspective of both groups was moderate. It seems that more research is needed to explain the causes of this discrepancy and increase compliance with the Patients’ Rights Charter in rehabilitation clinics. (shrink)

The article draws from a personal clinical experience of two suicides, not far removed from each other in time. The first patient was a 33-year-old intellectual suffering from depression with narcissistic traits but no psychotic elements, while the second patient was a 21-year-old student with a manifest psychotic episode behind him and with characteristics of post-psychotic depression at the time of suicide. The two suicides had very different impacts on the therapist: the first left open some “space” (...) for reflection, communication, and working-through, while the second closed such a “space,” leaving only a tiny door to the existential roots of human beings and suffering. The therapist was able to find some “shelter” by talking to supervisors, colleagues, and friends in the first case; in the second, the only possible “shelter” was glimpsed in the philosophy of groundlessness (Ungrund) of the Russian existentialist Nicolai Berdyaev. The personal experiences of the therapist, along with some theoretical interpretations of the after-effects of both suicides, are presented using a psychodynamic and existential–phenomenological understanding of the therapeutic relationship with a psychotic and a non-psychotic patient. The main dilemmas exposed by a patient’s suicide, especially if the patient suffers from psychosis, are difficult to deal with in the usual clinical settings and call for resources beyond it. The authors propose that these can be found in philosophical and theological insights. (shrink)

One way to understand philosophy as a form of therapy is this: it involves a philosopher who is trying to cure himself. He has been drawn into a certain philosophical frame of mind—the ‘disease’—and has thus infected himself with this illness. Now he is sick and trying to employ philosophy to cure himself. So philosophy is both: the ailment and the cure. And the philosopher is all three: pathogenic agent, patient, and therapist.

Personal positions and voices of a patient diagnosed with borderline personality disorder and the therapist during long-term psychotherapy were studied aiming to find differences in the patterns formed in these aspects of subjectivity according to the level of elaboration of the change episodes achieved by the patient. This case study considered a stage of qualitative analysis where change episodes of the patient were traced through the Change Episodes Model. Later, through the Model of Analysis of Discursive (...) Positioning in Psychotherapy, the voices and personal positions of the patient and her therapist were identified in each of the change episodes. In the stage of quantitative analysis, dynamic patterns in the voices and personal positions were established, accounting for hypothetical attractors using the Space State Grid technique in each of the three different levels of subjective elaboration that constitute the change episodes. The results established differentiated dynamic patterns in the change episodes, coherent with the patient’s change process, and formation of propositive/reflective specific patterns as the patient evolved in the three different levels of subjective elaboration. The above suggests that a subjective transformation process is displayed, and this is manifested in the different voices and personal positions that emerged as the change episodes evolve. The identified dynamic patterns can be considered nonlinear and emergent subjective exchanges between the patient and the therapist throughout the psychotherapy. (shrink)

Chiara Caporuscio and Adrian Kind argue that psychedelic-assisted therapy is different from traditional therapy in an ethically fraught way and, as a result, arguably require ethical guidelines beyond those constitutive of traditional therapy. The way in question pertains to the therapist’s role as participatory sense-maker of the patient’s experiences and, with it, the balance of power between the therapist and the patient. In both traditional and psychedelic-assisted therapy, the therapist role as sense-maker can give rise (...) to an imbalance of power between the therapist and the patient, such as when the therapist’s attempt at sense-making totally disregards the patient’s attempt at doing so. But in psychedelic-assisted therapy, the possibility of such a power imbalance is exacerbated. For, given her use of a psychedelic drug, the patient’s conscious experience is altered in such a way as to render her much more vulnerable than she otherwise would be. To give just one example, since the therapist is perceived by the patient to be an authoritative sense-making guide, the former’s attempts at making sense of the latter’s experiences can have much more influence on a psychedelically intoxicated patient’s interpretation of her experiences than they otherwise would have. Hence, Caporuscio and Kind’s conclusion that the ethical guidelines constitutive of traditional therapy are probably not sufficient for psychedelic-assisted therapy. (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)

This article aims to show that the practice of attention can create an openness to the truth, from where ethics arises. It does so by exploring the role attention plays, according to Ricoeur, in Freud’s thought. Ricoeur shows how in the first stage of Freud’s thinking – that of the Project of a Scientific Psychology – attention is one of the instances in which a purely mechanical quantitative explanation can be questioned. Further on, with the introduction of narcissism, Ricœur shows (...) that attention, insofar as it opens a space for the “wounding truth,” opposes narcissism. Finally, the article explains how in the therapeutic setting an attentional epochē allows the therapist to be “the reality principle in flesh and in act,” so that the ego can gain control. According to Ricœur, this non-judgmental gaze opens a space of truthfulness for the patient’s self-knowledge which, although not being the totality of ethics, constitutes its threshold. (shrink)

The COVID-19-pandemic brought massive changes in the provision of psychotherapy. To contain the pandemic, many therapists switched from face-to-face sessions in personal contact to remote settings. This study focused on psychodynamic therapists practicing Guided Affective Imagery, Hypnosis and Autogenous Relaxation and their subjective experiences with psychotherapy via telephone and videoconferencing during the first COVID-19 related lockdown period in March 2020 in Austria. An online survey completed by 161 therapists produced both quantitative and qualitative data with the latter being subject to (...) a qualitative content analysis. Our research suggests that telephone and videoconferencing are considered valuable treatment formats to deliver psychodynamic psychotherapy. However, therapists’ experiences with remote psychotherapy are multifaceted and ambiguous. In particular, the findings raise questions concerning the maintenance of the therapeutic alliance, the development of the analytic process, the sensitivity to unconscious communication, and the indication for certain types of patients that still need further investigation. Our research indicates that the long-standing reticence toward remote treatments offers among psychodynamic therapists is becoming more differentiated and partially dissolves as therapists gain experiences in their use. Attitudes are becoming more open. At the same time, the way is being prepared to take a closer look at the specific processes and dynamics of remote psychotherapy and to examine them critically in future studies. (shrink)

Background: Eating disorders are serious conditions which also impact the families of adult patients. There are few qualitative studies of multifamily therapy with adults with severe eating disorders and none concerning the practice of therapists in multifamily therapy. Objectives: The aim of the study is to explore therapists’ practice in multifamily therapy. Research design and participants: A grounded theory approach was chosen. Data were collected through participant observation in two multifamily therapy groups and qualitative interviews with the therapists in those (...) groups. Ethical considerations: The study conforms to the principles outlined in the Declaration of Helsinki. All participants in the multifamily therapy groups received information about the research project and signed consent forms. The data are treated confidentially and anonymised. Findings: The core category was identified as ‘having many strings to one’s bow’, consisting of three subcategories: ‘planning and readjusting’, ‘developing as therapist and team’ and ‘regulating the temperature of the group’. This article discusses the empirical findings in the frame of Aristotelian virtue ethics. (shrink)

The Experiential Therapist steps outside of the medical model to explore alternative ways of thinking about mental health disorders. Peter D. Ladd argues that successful treatment results from an informed understanding of a patient’s experience, not an ability to name and categorize difficult experiences as classical disorders.

Physiotherapy raises serious bioethical questions that are far too little discussed. Concerns include the lack of a clearly defined end point, the closeness of interaction between therapist and patient, the patient’s own share of responsibility, and the common failure to refer patients for rehabilitation.Physiotherapy has evolved dramatically in recent years, to the point where it is now a major healthcare profession offering assessment, diagnosis and treatment for a wide range of conditions, from sports injuries to rehabilitation for (...) major injuries and diseases. According to the World Confederation for Physical Therapy, “Physical Therapy is providing services to people and populations to develop maintain and restore maximum movement and functional ability throughout the lifespan” .1However, almost uniquely among the healthcare professions, physiotherapy has aroused little or no philosophical interest or engagement. This is surprising, because some of the salient features of physiotherapy raise interesting and to some extent novel problems in ethics. There are, it is true, some papers on ethically related themes,2–5 but in comparison with the size of the discipline and the complexity of the problems, the profile of physiotherapy in bioethics is worryingly low.A first problem is that unlike many areas of medicine—surgery, for example, or radiography or obstetrics and gynaecology—physiotherapy has no obvious end point. In medicine, the end points of treatment are generally well defined, with only a few exceptions, such as plastic surgery or psychiatry. It is my impression that physiotherapy, with few exceptions, does not operate with the concept of end points. Although what physiotherapy aims at is clear, the point at which the aims are achieved is uncertain. For example, in many cases the patient would go on benefiting from sessions of physiotherapy, perhaps with diminishing returns but still with …. (shrink)

The standard approach to ethics in psychotherapy is to focus on the therapist. Although normative “boundary” ethics revolves around what the therapist ought, or ought not, to do, virtue ethics can revolve around the kind of person the therapist ought to be. One can thus apply virtue ethical theory to clinical practice and argue for therapist virtues that are relevant to meeting professional standards and to working effectively through the problems that arise in psychotherapy. Considerably less (...) attention has been paid to how virtue ethics relates to the patient. The ethics of psychotherapy can also revolve around the sort of person the patient should be. I argue that there are nascent virtues which the patient can bring to psychotherapy that, when cultivated with the therapist, can facilitate a beneficial outcome and virtues that can be seen as psychotherapeutic goals toward which the patient ought to strive. (shrink)

Telepsychiatry has long been discussed as a supplement to or substitute for face-to-face therapeutic consultations. The current pandemic crisis has fueled the development in an unprecedented way. More and more psychiatric consultations are now carried out online as video-based consultations. Treatment results appear to be comparable with those of face-to-face care in terms of clinical outcome, acceptance, adherence and patient satisfaction. However, evidence on videoconferencing in a variety of different fields indicates that there are extensive changes in the communication (...) behaviour in online conversations. We hypothesise that this might impact ethically relevant aspects of the therapeutic relationship, which plays a prominent role in psychiatry. In this paper, we review effects of video-based consultations on communication between therapists and patients in psychiatry. Based on a common understanding of video-based consultations as changing the lived experience of communication, we categorise these effects according to sensory, spatial and technical aspects. Departing from a power-based model of therapeutic relationships, we then discuss the ethical significance of this changed communication situation, based on dimensions of respect for autonomy, lucidity, fidelity, justice and humanity. We conclude that there is evidence for ethically relevant changes of the therapeutic relationship in video-based telepsychiatric consultations. These changes need to be more carefully considered in psychiatric practice and future studies. (shrink)

One of the main challenges in group therapy with drug-addicted patients is collective pseudomentalization, i.e., a group discourse consisting of words and clichés that are decoupled from any inner emotional life and are poorly related to external reality. In this study, we aimed to explore the phenomenology of pseudomentalization and how it was addressed by the therapist in an outpatient group for drug-addicted patients. The group was composed of seven members, and the transcripts of eight audio-recorded sessions were rated (...) and studied. The interventions of the therapist were measured with the mentalization-based group therapy adherence and quality scale by independent raters. Two sessions, one with the highest and one with the lowest adherence, were selected, and the clinical sequences of pseudomentalization were analyzed in a comparative way. The findings revealed that pseudomentalization does occur as a collective phenomenon, akin to “basic assumptions” of Wilfred Bion, which we reconceptualized in this study. Any pseudomentalization seemed to be reinforced by the therapist when she was presenting frequent and long interventions, when abstaining from the management of group boundaries, when providing questions focused more on content than on the mental states of the group members, and when not focusing on emotions. However, the ultimate source of collective pseudomentalization seemed to be the fear of the group members of being overwhelmed by painful emotions, mental confusion, and a loss of identity. The findings also indicated that the principles of MBT-G may be a good antidote to pseudomentalization. (shrink)

There is increasing recognition within psychoanalysis and related therapies that awareness of the body is important in understanding and treating patients. Psychic Threats and Somatic Shelters explores the ways in which adults and children become acquainted with the range of physical issues that arise within their psychoanalytic or psychological treatments. Nitza Yarom discusses in a practical and clinically focused way the large variety of physical outlets which today's person uses to shelter from the many troubles and restrictions that are placed (...) on everyday life. Her book is divided into two main sections: Somatic shelters, which explores the variety of physical symptoms encountered by patients, including problems with weight and eating; with sensation through sight, sound, smell and taste; in movement through hyper activity or rigidity and through the communication of physical pain. Embodied dialogue, in which the author updates the use of the basic technical principles of psychoanalysis to involve the body in the treatment including transference and counter-transference between analyst and patient. In Psychic Threats and Somatic Shelters the emotional communication of these body narratives are vividly demonstrated in the treatments presented, here the interaction in the consulting room is revealed in bodily resonance and its therapeutic effects. This book is written for psychoanalysts and psychotherapists, psychologists, body therapists, family therapists, social workers and art/movement therapists. (shrink)

Telepsychotherapy is an increasingly common way of conducting psychotherapy. Previous research has shown that patients usually have positive experiences of online therapy, however, with large individual differences. The aim of this study was to explore patients’ experiences of transition from in-person psychotherapy sessions to telepsychotherapy during the COVID-19 pandemic, as well as variation in the experiences with regard to the patients’ personality orientation. Seven psychotherapy patients in Sweden were interviewed and the transcripts were analyzed using thematic analysis. Additionally, the participants (...) were asked to rate their dissatisfaction/satisfaction with the transition, how hindering/helpful the transition was, and how unsafe/safe they felt after the transition in comparison to before. Personality orientation on relatedness or self-definition was assessed applying a self-assessment instrument. The participants experienced telepsychotherapy as qualitatively different from in-person psychotherapy. They reported several essential losses: the rituals surrounding therapy sessions were lost, including the transitional time and space between their every-day life and the therapy sessions, less therapeutic work was done, the therapists could lose their therapeutic stance, the sense of rapport was impaired, and the patients felt less open and emotionally available. On the other hand, some patients could feel freer online. As six of the participants had an anaclitic personality orientation, the present study could especially contribute to the understanding of how patients with strong affiliative needs and fear of abandonment experience the transition to meeting their therapists via communication technology. The participants’ self-ratings showed that they were only marginally dissatisfied with the transition and experienced the transition as slightly hindering, whereas they felt rather safe after the transition, indicating low concordance between qualitative and quantitative evaluations. New studies are needed to explore the introjective patients’ experiences of the transition. An essential topic is also to collect evidence and to test how the impaired sense of rapport when using communication technology can be remedied by adequate, patient-tailored interventions, a topic that has to be included in psychotherapy education and training. (shrink)

This article examines how therapists and patients start building and managing relationships and pursue institutional goals at the same time. Based on a corpus of 6 audio-recorded therapies (client-centered therapy and psychodynamic therapy), I investigate first encounters between therapists and patients as the starting points of any therapeutical process and the place where a relationship between the interactants is established for the first time. Following a microlinguistic qualitative approach and applying methods from conversation analysis and discourse analysis, I show how (...) therapists, on the one hand, try to align with patients to build a positive working alliance and, on the other hand, work to fulfill specific interactive tasks of therapeutic discourse which demand disaligning with the patients’ communicative activity and their interactive expectations. Specific interactive “jobs” that need to be fulfilled in psychotherapy are identified, namely the performance of institutional roles by the interactants, the establishment of an interaction structure and the pursuit of helpful change in the patient. I show at which places in the interaction therapists (dis-)align with the patients’ projected communicative activity and how aligning and disaligning are related to the interactive process and the establishment and performance of these interactive jobs. The analysis shows that, at the beginning of therapy, alignment and disalignment are both important processes for the following reasons: Aligning with the patient contributes to a positive relationship, which has been shown to be vital for successful psychotherapy, while disaligning introduces the patient to the specific discursive mechanisms that characterize therapeutic discourse and constitute the basis for its effectiveness. Overall, the paper argues that reducing therapy to a dichotomy between relationship and “technique” seems overly simplistic, as both aspects need to be handled and managed at the same time. (shrink)

Questions assumptions about what it is to be a human being by examining the ideas of thinkers such as Foucault, Winnicott, Lacan and Jaspers. Chessick combines succinct summaries of the writings of these European thinkers with critical commentaries.

Why do 'maladies of the soul' such as hysteria, anxiety disorders, or depression wax and wane over time? Through a study of the history of psychiatry, Mikkel Borch-Jacobsen provocatively argues that most mental illnesses are not, in fact, diseases but the product of varying expectations shared and negotiated by therapists and patients. With a series of fascinating historical vignettes, stretching from Freud's creation of false memories of sexual abuse in his early hysterical patients to today's promotion and marketing of depression (...) by drug companies, Making Minds and Madness offers a powerful critique of all the theories, such as psychoanalysis and biomedical psychiatry, that claim to discover facts about the human psyche while, in reality, producing them. Borch-Jacobsen proposes such objectivizing approaches should be abandoned in favor of a constructionist and relativist psychology that recognizes the artifactual and interactive character of psychic productions instead of attempting to deny or control it. (shrink)

Today in Japan psychoactive drugs are widely prescribed for various psychiatric disorders including so-called ‘functional’ disorders. They are undoubtedly effective in relieving various psychological and behavioral symptoms. However, Japan has yet to address some basic questions: (1) uncertainty concerning the cause of various psychiatric functional disorders; (2) unknown factors that affect the function of psychotropic drugs in patients; (3) the difficulty in obtaining objective data concerning the effects of these medications * both on the brain and the psychological symptoms (behavior); (...) and most importantly, (4) due to both the behavioral and organic (brain and CNS) effects of psychoactive drugs, the difficulty in evaluating the risk/benefit ratio between the behavioral (primary) effect and the organic (side) effect. In addition, there are bioethical problems, since these uncertainties tend to permit too broad a range of intention and too many modes of intervention in (a) prescribing and (b) taking psychoactive drugs on the part of therapists and patients, respectively. Though the increased risk of the inappropriate use of these drugs – the non-therapeutic uses, and their over-prescription – has been indicated in other industrialized countries, it has not yet been fully recognized and adequately discussed in Japan. Moreover, it is necessary to establish a sound basis for the ‘somato-psychic’ evaluation of these effects in the context of the physician-patient relationship, including the patient's family and even the broader society. Keywords: bioethics, pharmacological treatment, primary and secondary effects, psychiatric-functional disorders, risk/benefit ratio CiteULike Connotea Del.icio.us What's this? (shrink)

Background: Mental health professionals working in correctional contexts engage a double role to care and control. This dual loyalty conflict has repeatedly been criticized to impede the development of a high-quality alliance. As therapeutic alliance is a robust predictor of outcome measures of psychotherapy, it is essential to investigate the effects of this ethical dilemma. Methods: This qualitative interview study investigates patients’ perceptions of their therapists’ dual role conflict in court-mandated treatment settings. We interviewed 41 older incarcerated persons using a (...) semi-structured interview guide, the interviews were subsequently analyzed following thematic analysis. Results: We first present the patients’ perceptions of their treating psychotherapist’s dual loyalty conflict, which was linked to their overall treatment experience. In a second step, we outline the study participants’ reasons for this judgment, which were most commonly linked to feelings of trust or betrayal. More specifically, they named certain therapist characteristics and activities that enabled them to develop a trustful therapeutic alliance, which we grouped into four topics: respecting the patient’s pace and perceived coercion; patient health needs to be first priority; clarity in roles and responsibilities; and the art of communication – between transparency and unchecked information sharing. Discussion: Developing a high quality alliance in mandatory offender treatment is central due to its relationship with recovery and desistance. Our findings show that some therapists’ characteristics and activities attenuate the negative impact of their double role on the development and maintenance of the alliance. To increase the effectiveness of court-mandated treatments, we need to support clinicians in dealing with their dual role to allow the formation of a high quality therapeutic alliance. Our qualitative interview study contributed to this much-needed empirical research on therapist’ characteristics promoting a trustful relationship in correctional settings. (shrink)

A good number of therapists have tumed to the antirealism of postmodern theory in general, and postmodern literary theory in particular, to justify their antitheoretical preferences. Does this turn make sense? Given what drives the antitheoretical agenda - the aspiration to individualize therapeutic practice so as to optimize each client’s unique potential for change - the answer is no. More specifically, I argue that it is the composition (i.e., the completeness) of the theoretical system that guides therapeutic practice, rather than (...) the therapist’s epistemological leanings, that does have considerable bearing on the recalcitrant problem of individualizing practice, otherwise known as the nomothetic/idiographic problem.Bon nombre de thérapeutes se sont toumés vers I’antiréalisme de la théorie postmoderne, en particulier de la théorie littéraire postmoderne, pour justifier leurs positions antithéoriques. Qu’en est-il de ce choix? Si l’on considère le moteur de l’idéologie antithéorique - à savoir l’aspiration à individualiser la pratique thérapeutique afin d’optimiser le potentiel de changement propre à chaque patient - il faut admettre qu’elle ne tient pas. De façon plus spécifique, je soutiens que c’est la composition (c’est-à-dire la complétude) du système théorique qui guide la pratique thérapeutique, non pas les inclinations épistémologiques du thérapeute, lesquelles ont par ailleurs une incidence considérable sur le problème tenace de I’individualisation de la pratique, connu aussi en tant que problème nomothétique/idiographique. (shrink)

The COVID‐19 pandemic has placed extraordinary stress on frontline healthcare providers as they encounter significant challenges and risks while caring for patients at the bedside. This study used qualitative research methods to explore nurses and respiratory therapists' experiences providing direct care to COVID‐19 patients during the first surge of the pandemic at a large academic medical center in the Northeastern United States. The purpose of this study was to explore their experiences as related to changes in staffing models and to (...) consider needs for additional support. Twenty semi‐structured interviews were conducted with sixteen nurses and four respiratory therapists via Zoom or by telephone. Interviews were transcribed verbatim, identifiers were removed, and data was coded and analyzed thematically. Five major themes characterize providers' experiences: a fear of the unknown, concerns about infection, perceived professional unpreparedness, isolation and alienation, and inescapable stress and distress. This manuscript analyzes the relationship between these themes and the concept of moral distress and finds that some, but not all, of the challenges that providers faced during this time align with previous definitions of the concept. This points to the possibility of broadening the conceptual parameters of moral distress to account for providers' experiences of treating patients with novel illnesses while encountering institutional and clinical challenges. (shrink)

Over the past decade, psychotherapy and counselling have become more and more popular, with many people turning to therapists in the hope of finding a better, happier, more fulfilling life. In this cogently argued and beautifully written book, Peter Lomas, argues that as psychotherapy enters the mainstream, therapists have become dependent on the technical aspects of their profession at the expense of the many moral issues involved. Indeed, they have become so afraid of moralizing or of departing from what Lomas (...) views as a spurious scientific neutrality that the dialogue between therapist and patient tends to be distorted, potentially confusing, and too remote from the healthy reality of ordinary conversation. In this provocative analysis, drawing on his day-to-day experience of working with patients, Peter Lomas explores the consequences of this dichotomy, such as the loss of spontaneity and avoidance of closeness which may hinder rather than help the healing process. He looks at the problems associated with issues of power, and its abuse, which is central to psychotherapy, and explores the dilemmas involved when there is a clash of moral beliefs between the two people. This is a lucid and thought-provoking addition to the literature on psychotherapy, and will appeal both to trainee and practising therapists and counsellors, for people in therapy, and for those considering embarking upon it. (shrink)

Patient competence, defined as the ability to reason, appreciate, understand, and express a choice is rarely discussed in patients with obsessive compulsive disorder, and coercive measures are seldom used. Nevertheless, a psychiatrist of psychologist may doubt whether OCD patients who refuse treatment understand their disease and the consequences of not being treated, which could result in tension between respecting the patient’s autonomy and beneficence. The purpose of this article is to develop a notion of competence that is grounded (...) in clinical practice and corresponds with the experiences of patients with obsessions and/or compulsions. We present a naturalistic case study giving both the patient’s and the therapist’s perspective based on in-depth interviews and a narrative analysis. The case study shows that competence is not merely an assessment by a therapist, but also a co-constructed reality shaped by the experiences and stories of patient and therapist. The patient, a medical student, initially told her story in a restitution narrative, focusing on cognitive rationality. Reconstructing the history of her disease, her story changed into a quest narrative where there was room for emotions, values and moral learning. This fitted well with the therapist’s approach, who used motivational interventions with a view to appealing to the patient’s responsibility to deal with her condition. We conclude that in practice both the patient and therapist used a quest narrative, approaching competence as the potential for practical reasoning to incorporate values and emotions. (shrink)

In the present contribution, we argue that all health care professionals and particularly psychotherapists should provide a plausible rationale for their treatment including an etiological model and a model of unique and common change mechanisms. The provision of a plausible rationale has two goals: (1) meet the ethical challenge of informed consent, and (2) to improve treatment outcome by fostering the meaning response. In the course of the ethical and a legal obligation of psychotherapists to obtain patients’ informed consent before (...) initiating psychotherapy, patients have the right to receive maximally comprehensive information for providing their consent, which - among other information about the treatment (such as general psychotherapeutic approach, setting, and procedures) – should include a plausible treatment rationale. A useful concept in conceptualizing and communicating a treatment rationale as part of the informed consent procedure is Moerman’s general notion of the meaning response as the physiological or psychological effects of meaning in the course and treatment of an illness. The more compelling the rational explanation of the targeted treatment effects, the stronger the meaning response is expected to be. As the mechanisms of change in psychotherapy are known to be quite abstract and considered common to all approaches to a large extent, it seems especially important to provide a convincing treatment rationale to strengthen trust in the therapist and potentially foster positive expectations of process and outcome. To that extent, strengthening a patient`s meaning response to information provided at the beginning of psychotherapy may be central to activating common therapeutic factors. (shrink)

New technologies such as smart sensors improve rehabilitation processes and thereby increase older adults’ capabilities to participate in social life, leading to direct physical and mental health benefits. Wearable smart sensors for home use have the additional advantage of monitoring day-to-day activities and thereby identifying rehabilitation progress and needs. However, identifying and selecting rehabilitation priorities is ethically challenging because physicians, therapists, and caregivers may impose their own personal values leading to paternalism. Therefore, we develop a discussion template consisting of a (...) series of adaptable questions for the patient–physician encounter based on the capability approach. The goal is to improve geriatric rehabilitation and thereby increase participation in social life and well-being. To achieve this goal, we first analyzed what is considered important for participation on basis of the capability approach, human rights, and ethics of care. Second, we conducted an ethical analysis of each of the four identified dimensions of participation: political, economic, socio-cultural, and care. To improve compliance with rehabilitation measures, health professionals must align rehabilitation measures in an open dialogue with the patient’s aspiration for participation in each dimension. A discussion template based on the capability approach allows for a proactive approach in patient information and stimulates a critical assessment of treatment alternatives while reducing the risk of imposing personal values. (shrink)

Lessons from a great yoga master and an eminent psychoanalyst that explore what psychotherapy and yoga philosophy have in common Yoga philosophy and Freud's revolutionary approach to psychology could not have been developed in more different times, places, or cultural conditions. And yet these two profound and dynamic systems of understanding human behavior, emotions, perception, and what's essential in our existence have an astonishing amount to share. What we learn by comparing their similarities as well as their differences can enhance (...) how we comprehend our lives and our potential for change. In Freud and Yoga, the great yoga master T.K.V. Desikachar and the eminent psychoanalyst Hellfried Krusche examine forty classic sayings, or sūtras, from the vantage point of their respective disciplines. Through clear, candid conversations that draw on long experience and are illustrated by case studies from the clinic and the shala, these two experts explain the concepts, terms, forces, and processes in their traditions. Therapists and patients, yoga adepts and professionals, and readers interested in psychology and spirituality will find this unique investigation fascinating, enriching, and useful. In a time when Western and Eastern modalities have ever more to offer each other, Freud and Yoga is a watershed work--one that draws us closer to understanding our own nature and the deep workings of the human psyche. (shrink)

Studies report that psychotherapists overestimate their own performance. This study aimed to examine if the self-assessment bias in psychotherapists differs between therapeutic orientations and/or between social comparison groups. Psychotherapists gave subjective estimations of their professional performance compared to two social comparison groups. They further rated the proportion of their patients recovering, improving, not changing, or deteriorating. In total, N = 229 Austrian psychotherapists participated in the online survey. Psychotherapists rated their own performance on average at M = 79.11 relative to (...) “all psychotherapists” vs. at M = 77.76 relative to “psychotherapists with the same therapeutic approach”. This was not significantly different between therapeutic orientations. A significant interaction between social comparison group and therapeutic orientation revealed a drop of self-assessement bias in social comparison group “same approach” vs. “all psychotherapists” in psychodynamic and humanistic therapists. Psychotherapists overestimated the proportion of patients recovering, improving and underestimated the proportion of patients not changing and deteriorating, with no differences between orientations. The self-assessment bias did not differ between therapeutic orientations, but the social comparison group appears to be an important variable. A major drawback is that results have not been connected to patient-reported outcome or objectively rated performance parameters. (shrink)

Patient competence, defined as the ability to reason, appreciate, understand, and express a choice is rarely discussed in patients with obsessive compulsive disorder, and coercive measures are seldom used. Nevertheless, a psychiatrist of psychologist may doubt whether OCD patients who refuse treatment understand their disease and the consequences of not being treated, which could result in tension between respecting the patient’s autonomy and beneficence. The purpose of this article is to develop a notion of competence that is grounded (...) in clinical practice and corresponds with the experiences of patients with obsessions and/or compulsions. We present a naturalistic case study giving both the patient’s and the therapist’s perspective based on in-depth interviews and a narrative analysis. The case study shows that competence is not merely an assessment by a therapist, but also a co-constructed reality shaped by the experiences and stories of patient and therapist. The patient, a medical student, initially told her story in a restitution narrative, focusing on cognitive rationality. Reconstructing the history of her disease, her story changed into a quest narrative where there was room for emotions, values and moral learning. This fitted well with the therapist’s approach, who used motivational interventions with a view to appealing to the patient’s responsibility to deal with her condition. We conclude that in practice both the patient and therapist used a quest narrative, approaching competence as the potential for practical reasoning to incorporate values and emotions. (shrink)

Compared with mainstream medicine and complementary and alternative therapies, the practice of psychotherapy has enjoyed a relative pass when it comes to ethical evaluation. Therefore, contributions to the, although slowly growing, body of literature on psychotherapy ethics are to be welcomed. In his paper ‘Psychotherapy, placebos, and informed consent’, Garson Leder takes issue with what he calls the ‘go open’ project in psychotherapy ethics—the idea that the so-called ‘common factors’ in therapy should be disclosed to prospective patients. Although Leder does (...) not give a detailed list, the common factors include therapist characteristics, patient characteristics, and the working alliance. He argues that the project advocating disclosure of these factors is flawed on two grounds: that information about common factors is not necessary for informed consent; and clarity about specific mechanisms of change in therapy is consistent with ‘many theory-specific forms of psychotherapy’. There are multiple serious problems with Leder’s critique of the recent literature, including how he represents the contours of the debate, which I list, and address in this response. (shrink)

Stay up-to-date on the ethical and legal issues that affect your clinical and professional decisions! Ethical and Legal Issues for Mental Health Professionals: A Comprehensive Handbook of Principles and Standards details the ethical and legal issues that involve mental health professionals. Respected authorities with diverse backgrounds, expertise, and professional experience discuss contemporary theories emphasizing professional ethics, the ramifications of professional actions and decisions, and ethical standards on teaching, training, research, and publication. This informative handbook provides invaluable up-to-date information and guidelines (...) vital for every mental health professional. This book is a thorough examination of ethical behavior which can be used as a reference source for the professional or a textbook for graduate students. The handbook itself is divided into five sections. The first section is a detailed introduction of ethics, law, and licensing. The second section presents general ethical principles like competence, integrity, and respect for individual rights and dignity. The third section examines confidentiality, privilege, consent, and protection. The fourth section focuses on general ethical standards in practice, including sexual contact, multiple relationships, and bartering. The fifth section presents the ethical principles and standards in teaching, training, and research. Appendices include the Ethical Principles of Psychologists and Code of Conduct (American Psychological Association, 2002) and the Code of Ethics of the National Association of Social Workers (National Association of Social Workers, 1999). Ethical and Legal Issues for Mental Health Professionals: A Comprehensive Handbook of Principles and Standards discusses: the history of basic approaches and issues in ethical philosophy five fundamental areas in the process of developing competence the necessary ingredients for the mental health professional's practice of integrity aspirational versus enforceable standards of ethics concern for the welfare of others as a core ethical principle the notion of social responsibility in the ethics codes of psychologists and social workers ethical principles, statutes, and case law protecting privacy and confidentiality issues involving the therapist-patient privilege the "duty to protect" doctrine and relevant legal issues the dynamics of multiple relationships and boundary violations sexualized dual relationships between psychologists and patients possible conflict of interest in bartering for services the requirements and implementation of maintaining patient records to avoid ethical and legal problems possible ethical dilemmas involving referrals and fees much, much more This Handbook is an essential resource for all mental health professionals, including psychologists, psychiatrists, social workers, counselors, therapists, and graduate students in mental health and the related fields. Ethical and Legal Issues for Mental Health Professionals: A Comprehensive Handbook of Principles and Standards is the first of three volumes under this title. The following volumes will focus on forensic settings and special populations/special treatment modalities. (shrink)

IntroductionThe Managing Cancer and Living Meaningfully therapy for patients with advanced cancer was tested against a supportive psycho-oncological counseling intervention in a randomized controlled trial. We investigated whether CALM was delivered as intended ; whether CALM therapists with less experience in psycho-oncological care show higher adherence scores; and whether potential overlapping treatment elements between CALM and SPI can be identified.MethodsTwo trained and blinded raters assessed on 19 items four subscales of the Treatment Integrity Scale covering treatment domains of CALM. A (...) random sample of 150 audio recordings were rated on a three-point Likert scale with 1 = “adherent to some extent,” 2 = “adherent to a sufficient extent,” 3 = “very adherent.”ResultsAll 19 treatment elements were applied, but in various frequencies. CALM therapists most frequently explored symptoms and/or relationship to health care providers and allowed expression of sadness and anxiety about the progression of disease. The exploration of CALM treatment element SC_1 was most frequently implemented in a satisfactory or excellent manner, whereas the treatment element SMP_4: Therapist promotes acknowledgment that some life goals may no longer be achievable was not implemented in a satisfactory manner. In terms of treatment differentiation, no treatment elements could be identified which were applied significantly more often by CALM therapists than by SPI therapists.ConclusionResults verify the application of CALM treatment domains. However, CALM therapists’ adherence scores indicated manual deviations. Furthermore, raters were not able to significantly distinguish CALM from SPI, implying that overlapping treatment elements were delivered to patients. (shrink)

Objective: This study examined whether patients who were randomly assigned to their preferred therapy arm had stronger engagement with their treatment than those who were randomly assigned to a non-preferred therapy arm.Method: Data were drawn from a RCT comparing Individual Meaning-Centered Psychotherapy, with Individual Supportive Psychotherapy, in patients with advanced cancer. Treatment engagement was operationalized as patients' perceptions of the therapeutic alliance with their therapist and therapy sessions attended. Two 2 by 2 Analysis of Variance models were used, with (...) treatment preference and treatment assignment as the independent variables and working alliance and number of sessions attended as outcome variables.Results: Patients who preferred and were assigned to IMCP reported a significantly stronger alliance than those who preferred IMCP but were assigned to ISP.Conclusions: The findings from this study have broader implications for research on psychotherapy beyond the appeal of IMCP in advanced cancer patients. Patients who prefer a novel psychotherapy that they cannot engage in elsewhere, but receive the standard treatment may experience weaker alliance than patients who prefer the standard but receive the novel therapy.Trial registration:Clinicaltrial.gov ID: NCT01323309. (shrink)

A national survey sent to 450 female and 450 male licensed psychologists (return rate = 42%) found that about 73% of the participants reported encountering at least one patient who claimed to recover previously forgotten memories of childhood sex abuse. About 21% of the therapists concluded that, for at least one patient, the memory was false; about 50% of the therapists reported that at least one patient had found external validation for the abuse; about 12% of the (...) therapists reported at least one client who later decided that the memory was false; and about 15% of the therapists reported that at least one client who recovered memories filed a civil or criminal complaint. About 15% of the therapists reported encountering at least one patient alleged to have sexually abused a child who later recovered previously forgotten memories of the abuse. About 21% of these therapists concluded that, in at least one case, the memory was false; about 6% of the therapists concluded that, in at least one case, there appeared to be external validation for the memories; about 1% reported that, in at least one case, the person recovering the memories concluded that the memories had been false; and about 6% of these therapists reported at least one case in which a civil or criminal complaint had been filed against their client. Findings were analyzed in terns of therapist gender, patient gender, and theoretical orientation. (shrink)

Nursing students face various ethical issues, which may cause stress, that require coping strategies. This study investigated the thoughts and feelings underlying the coping behaviors adopted by nursing students when addressing ethical issues. Semi-structured interviews were conducted from September to October 2011 with 11 students enrolled at University A who had completed basic nursing and specialty practicums and consented to participate in the study. Data were analyzed using qualitative methods. The participant narratives about ethical issues encountered during clinical practicums were (...) organized into four themes and 20 scenarios. The ethical issues concerned the attitudes and conduct of nurses, doctors, physical therapists, and other medical professionals. Seven coping behaviors were identified. The results revealed that nursing students waver between valuing their relationships with nurses and their relationships with patients when they encounter an ethical issue. When their relationships with nurses were emphasized, their ethical values were restructured. These findings suggest the need to address the affective domain early on in lectures and in-class practice, and to create an environment in which students taking practicums can easily express their feelings and internal value system changes. (shrink)

Homeopathy is over 200 years old and is still experiencing an uninterrupted influx of new practitioners and patients. Many patients and therapists swear by this "alternative healing method", which in some countries is even financed by health insurances. This seems completely incomprehensible to critics: For them it is clearly evident that homeopathy is hopelessly unscientific and has at best a placebo effect. The positions of supporters and opponents seem to be just as immutable as they are incompatible. This book answers (...) some essential and fascinating questions: What remains of the founding ideas of homeopathy in 21st century medicine? Does it really work and, if so, how? Which of the original theories can we still apply today with a clear conscience and use for the benefit of patients and the healthcare system? Where does homeopathy have its limits and does it indeed need to be critically reconsidered and evaluated? The author has dealt with the points of criticism for years, but at the same time also takes seriously the wishes and concerns of patients who often feel insufficiently cared for by conventional medical practice. Against the background of her own personal history, her book attempts to bridge the gap between these two traditionally opposing camps. (shrink)

In this paper we investigate the behavior patterns of Alzheimer patients and multihandicapped persons communicating with peers and therapists in an interaction situation. Communicative items were analyzed automatically and sorted into patterns. The results showed that despite their reported ‘linguistic’ disabilities, the patients not only played their role in the interaction, but were also able to lead the conversation and take initiatives. In spite of their vulnerability, both types of patients, particularly those with Alzheimer’s disease, exhibited the ability to integrate (...) new information and to get involved in the dialogue. (shrink)

The Healing Virtues explores the intersection of psychotherapy and virtue ethics - with an emphasis on the patient's role within a healing process. It considers how the common ground between the therapeutic process and the cultivation of virtues can inform the efforts of both therapist and patient. Within this book, the Duff R. Waring argues that there is a case for patient virtues that are crucially relevant to working through the problems in living that arise in (...) psychotherapy, e.g., honesty, courage, humility, perseverance. The central idea is that treatment may need to build virtues while it ameliorates problems. Hence, the patient's work in psychotherapy can both challenge character strengths and result in their further development. (shrink)

As far back as we know, there have been individuals incapacitated by memories that have filled them with sadness and remorse, fright and horror, or a sense of irreparable loss. Only recently, however, have people tormented with such recollections been diagnosed as suffering from "post-traumatic stress disorder." Here Allan Young traces this malady, particularly as it is suffered by Vietnam veterans, to its beginnings in the emergence of ideas about the unconscious mind and to earlier manifestations of traumatic memory like (...) shell shock or traumatic hysteria. In Young's view, PTSD is not a timeless or universal phenomenon newly discovered. Rather, it is a "harmony of illusions," a cultural product gradually put together by the practices, technologies, and narratives with which it is diagnosed, studied, and treated and by the various interests, institutions, and moral arguments mobilizing these efforts. This book is part history and part ethnography, and it includes a detailed account of everyday life in the treatment of Vietnam veterans with PTSD. To illustrate his points, Young presents a number of fascinating transcripts of the group therapy and diagnostic sessions that he observed firsthand over a period of two years. Through his comments and the transcripts themselves, the reader becomes familiar with the individual hospital personnel and clients and their struggle to make sense of life after a tragic war. One observes that everyone on the unit is heavily invested in the PTSD diagnosis: boundaries between therapist and patient are as unclear as were the distinctions between victim and victimizer in the jungles of Southeast Asia. (shrink)

This revised workbook is designed for patients' use as they work, either with a qualified mental health professional or on their own, to manage social anxiety. Based on the principles of cognitive-behavioral therapy, the treatment program described is evidence-based and proven effective. Complete with user-friendly forms and worksheets, as well as relatable case examples and chapter review questions, this workbook contains all the tools necessary to help patients manage their anxiety and improve their quality of life.