RESUMEN

To improve the provision of psychotherapy, many countries have now established clinical practice guidelines for the treatment of specific disorders and mental health concerns. These guidelines have typically been based on evidence from meta-analyses of randomized clinical trials with minimal consideration of findings from qualitative research designs. This said, there has been growing interest in incorporating qualitative research in guideline development processes from both stakeholders and guideline development bodies. In this international collaboration, 19 qualitative psychotherapy researchers from 10 countries articulated the benefits of including qualitative findings within the guideline development process and generated recommendations for guideline developers. The underlying question of this report was "Why and how should qualitative research be used in efforts to develop guidance for psychotherapy practice?" The advantages of reviewing qualitative findings included the ability to identify treatment patterns at the level of in-session dynamics, cultural contexts, interpersonal relationships, and internal experiences, thereby creating guidance that is responsive to clients' needs in the moment-to-moment therapy process. Recommendations are offered at the systemic level (e.g., guideline formation processes, methods of education, research funding priorities). Also, methodological advice is offered for guideline developers when selecting to incorporate qualitative research in the implementation of an expanded guideline development process. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

RESUMEN

Introduction: The study focuses on the orientation to being recorded in therapy sessions, emphasizing that these practices adapt to specific circumstances and influence subsequent actions. The study suggests a way to deal with the insolubility of the "observer paradox": to accept that observation has an impact on the observed, but that the recorder is not necessarily a negative determinant. Furthermore, the study builds on the idea that participants' orientations to the recorder can be seen as actions. Methods: The data included in this study were collected from four psychodynamic therapies. A total of 472 sessions were searched for orientation to be recorded. Twenty-three passages were found and transcribed according to GAT2. Of the 23 transcripts, six excerpts have been analyzed as part of this article. The analysis of this study was done through Conversation Analysis. Results: The study explores how participants use the orientation to be recorded to initiate or alter actions within conversations, which can help achieve therapeutic goals, but can also hinder the emergence of a shared attentional space as the potential to disrupt the therapist-patient relationship. The study identifies both affiliative and disaffiliative practices, noting that managing orientation to be recorded in a retrospective design consistently leads to disruptive effects. Moreover, it highlights the difference between seeking epistemic authority ("being right") and managing recording situations ("getting it right") in therapeutic interactions as a means of initiating patients' self-exploration. Discussion: The integration of recordings into therapeutic studies faces challenges, but it's important to acknowledge positive and negative effects. Participants' awareness of recording technologies prompts the need for a theory of observation in therapeutic interactions that allows therapists to visualize intuitive practices, incorporate active contributions, counteract interpretive filtering effects, facilitate expert exchange, ensure quality assurance, and enhance the comprehensibility of therapeutic processes. These aspects outline significant variables that provide a starting point for therapists using recordings in therapeutic interactions.

RESUMEN

Over the last 102 years, a lot of discussion was being held about the psychoanalytic conception of the "death drive," but still with inconclusive results. In this paper, we start with a brief review of Freud's conception, followed by a comprised overview of its subsequent support or criticisms. The core of our argument is a systematic review of current biochemical research about two proposed manifestations of the "death drive," which could hopefully move the discussion to the realm of science. It was already established that drive satisfaction leads to the secretion of beta-endorphins, and research evidence also shows that the same biochemical mechanisms get activated in the case of masochism and the gambling disorder but only if they are preceded by chronic frustration of the essential drives. We conclude that the actual situation is more complex than Freud hypothesized, and that a fundamental revision of the psychoanalytic drive theory is necessary.

RESUMEN

Conversation analysis (CA) of children-adult-interaction in various contexts has become an established field of research. However, child therapy has received limited attention in CA. In child therapy, the general psychotherapeutic practice of achieving empathy faces particular challenges. In relation to this, our contribution sets out three issues for investigation and analysis: the first one is that practices of achieving empathy must be preceded by efforts aiming to establish which kind of individualized conversation works with this child (Midgley, 2006). Psychotherapy process researchers in adult therapy (Stiles et al., 2015) have found that therapists "invent" a new therapy for each patient (Norcross and Wampold, 2018). The second issue is that it can be difficult for adults to understand the ways in which children express their conflicts and issues. In particular, play activities in therapy, e.g., with dolls, can open up additional scenarios of interaction. The play scenario can be used to disclose unformulated problems masked in everyday and family interactions. The third issue is how to respect the child's higher degree of vulnerability, compared with adult patients. How is it communicated and dealt with in therapy? We present an interaction analysis of a single case study of the first 20 min of a child therapy session with an adopted girl aged 4 years brought to treatment because of "unexplainable rage." The session was videotaped; parents granted permission. We analyze this session using an applied version of CA. In our analysis, we describe "doing contrariness," as a conversational practice producing epistemic and affiliative disruptions, while "avoiding doing contrariness" and "remedying contrariness" are strategies for preserving or restoring the affiliative dimension of a relationship (in child therapy). We show how these practices operate in various modes and how they are used by both parties in our case study to variously aid and impedethe achievement of empathy and understanding.

RESUMEN

The affective bond between an infant and its caregiver, the so-called mother-infant tie, was analyzed by various reputable psychologists (e.g., Ainsworth, Clark, Erikson, Anna Freud, Harlow, Klein, Spitz, and Winnicott) but both the basic tenets of the bond and the importance of the trauma of maternal deprivation for personality disorders in adults were introduced by Bowlby. Although Bowlby was a trained psychoanalyst, he rejected central cornerstones of Freudian theory (esp. drive theory) and used concepts promulgated by renowned ethologists (Tinbergen and Lorenz) to establish his framework of "instinctive behavior" that has been developed further into the concept of "attachment theory" under the influence of Mary Ainsworth. However, since any precise experimental facts were lacking when Bowlby formulated his ideas on the concept of instinctive behavior, the whole framework is a descriptive, category-driven approach (like the ones of Freudian drives). In order to connect the mother-infant tie - as propounded by Bowlby - with experimental data, this manuscript undertakes a biochemical analysis of it because this strategy proved somewhat successful in relation to Freudian drives. The analysis unfolded that the neurochemical oxytocin, released by the action of sensory nerves, is of utmost importance for the operation of the mother-infant tie. Furthermore, multiple evidences have been presented to the fact that there is strong interaction between unconsciously operating Freudian drives and the consciously acting mother-infant tie (that is now classified as a drive). The outlined interaction in conjunction with the classification of attachment urges as drives gave a very detailed insight into how a SEEKING-derived reward can be evoked during operation of the mother-infant tie. In summary, there is no need to marginalize either the mother-infant tie or Freudian drives but rather there is need to respect both (principally different) impulses in moving toward a more extensive description.

RESUMEN

This paper gives an overview of psychoanalytic process research, which brings to light the complexity of psychotherapy sessions. This complexity is so rich that many instruments intended to make the process measurable failed in the past because they initially used a strategy of complexity reduction. This method however did not help to further our understanding of the complexity involved. Three former presidents of the Society for Psychotherapy Research (Stiles, Hill, Elliot 2015) decided to solve the following equivalence paradox: many therapies work successfully though they all follow different theories, produce a heterogeneity of processes and often enough a misfit between what theories maintain to be a good process and their realization in the treatment room. As theories are often compared to maps, a driver would wonder which route to take. But therapists-as-drivers go undaunted - and nevertheless achieve their goals together with their patients. Norcross and Wampold (2018) found that good therapists invent new therapies with every new patient. They hypothesize that it is because of conversation. This is in accord with the 3 former presidents' proposal to return to detailed single case analyses including the micro-analytic power of conversation analysis of which a few insights are outlined in this article.

Cet article donne une vue d'ensemble de la recherche sur le processus psychanalytique, qui met en lumière la complexité des séances de psychothérapie. Cette complexité est si riche que dans le passé beaucoup d'instruments conçus pour rendre le processus mesurable ont échoué parce qu'initialement une stratégie de réduction de la complexité était utilisée. Cette méthode n'a cependant pas aidé à améliorer notre compréhension de la complexité en question. Trois anciens présidents de la Société pour la Recherche en Psychothérapie (Stiles, Hill, Elliot 2015) décidèrent de résoudre le paradoxe de l'équivalence suivante: beaucoup de thérapies fonctionnent avec succès bien qu'elles suivent des théories diverses, elles produisent une hétérogénéité de processus et assez souvent une inadéquation entre ce que les théories entendent par bon processus et leur concrétisation dans la salle de consultation. Comme les théories sont souvent comparées à des cartes, un conducteur se demanderait quelle route prendre. Mais les thérapeutes-en-tant-que-conducteurs avancent imperturbables - et atteignent pourtant leurs objectifs, en coopération avec leurs patients. Norcross et Wampold (2018) ont trouvé que les bons thérapeutes inventent de nouvelles thérapies avec chaque nouveau patient. Ils font l'hypothèse que cela est dû à la conversation. Ceci va dans le sens de la proposition des trois anciens présidents de revenir aux analyses détaillées de cas uniques ce qui comprend la puissance micro-analytique de l'analyse conversationnelle dont quelques aperçus sont exposés dans cet article.

El presente trabajo ofrece una reseña de un proceso de investigación en psicoanálisis, el cual da cuenta de la complejidad de las sesiones psicoterapéuticas. Esta complejidad es de tanta riqueza que muchos instrumentos con los que se intentó medir el proceso, en el pasado, fracasaron utilizaron inicialmente una estrategia que reducía la complejidad. Este método sin embargo no ayudó a promover nuestra compresión sobre la complejidad allí implicada. Tres ex presidentes de la Sociedad para la Investigación de Psicoterapia (Stiles, Hill, Elliot 2015) decidieron resolver la siguiente paradoja de equivalencia: muchas terapias trabajan con éxito aunque siguen diversas teorías, producen una heterogeneidad de procesos y bastante a menudo un desajuste entre lo que las teorías sostienen que es un buen proceso y su realización en el consultorio. Si se compara a las teorías con los mapas, un conductor se preguntaría que ruta tomar. Pero los terapeutas-como-conductores impertérritos - logran no obstante sus metas junto con sus pacientes. Norcross y Wampold (2018) encontraron que los buenos terapeutas inventan nuevas terapias con cada nuevo paciente. Ellos hipotetizaron que era debido a la conversación. Esto se encuentra en sintonía con las propuesta de los tres ex presidentes de retornar al análisis del caso único detallado incluyendo el potencial micro-analítico del análisis conversacional del cual se subrayan algunos insights en el presente artículo.

Asunto(s)

RESUMEN

Independent of theoretical orientation therapies of all kind are talk-in-interaction. Influential overall conceptualizations (as e.g. intervention) belong to a certain model of medicalizing the psychotherapeutic endeavor. Talk-in-interaction is the base for applying Conversation Analysis (CA) in psychotherapeutic process research. CA is a powerful tool originating from social science taking data, hypotheses and theories from careful observing in a similar way as infant observers did. The common discovery is that conversation precedes language. Some features of infantile proto-conversation survive in adult life. CA has directed careful attention to processes like turn-taking, repair, conditional relevances, etc. in observing the rules of interaction. However, in studying psychotherapy process turn-by-turn analysis alone does not suffice. It can be completed by a new model of common ground activities and package-by-package analysis turning attention to new objects of observation in therapeutic conversation (allusions, metaphorical framing activities). We propose a methodology for both kinds of analyses based on transcribed examples from the CEMPP-Project. This exploratory designed project (Conversation analysis of empathy in Psychotherapy Process; supported by the Köhler Foundation, Germany) compared psychoanalytic, psychodynamic and cognitive-behavioral treatments in five dyads each taking transcribed sessions from the beginning, the middle phase and the end; our database includes 45 transcribed sessions.

RESUMEN

Cognitive linguistics and conversation analysis (a) converge in the analysis of category bound activities and (b) in viewing thinking and talking as embodied activities. The first aim of this paper is to outline these powerful theories as useful tools for the analysis of enacting empathy. The second aim is to outline these theories as useful tools for the analysis of how empathy is co-enacted in clinical conversation documented in transcripts. Cognitive Linguistics and Conversation Analysis converge in detecting patterns of I-You-relationships with roots in early preverbal embodied protoconversation continuing to more symbolic conversational level. The paper proposes to describe this continuity of empathic conversation in musical metaphors like balance, rhythm and resonance. In a first section transcripts from therapeutic sessions are presented. In a second section linguistic and other research data are presented in order to bring empirical data to this new conception of how empathy can be understood, how it is done and how two participants cooperate to enact empathy. Ideas for further research are outlined.

RESUMEN

This study was conducted to analyze how male sexual offenders construct mental images of masculinity and femininity to provide insight into therapeutic treatment for such patients. Thematerial examined in this studywas comprised of 21 videotaped prison group therapy sessions in which the participating sexual offenders talked about their crimes and biographies. Aqualitative data analysis softwarewas usedto apply a modified grounded theorymethodology to the transcribed sessions. The resulting categories can be understood as descriptions of how the imprisoned men constructed gender images, and were based on three narrative levels: the structure of narration, the narrative positions in the story, and the interaction between the narrator and the other participants. According to the categories describedin the narrative positions (the narrated self and the narrated significant male others), we constructed masculinity categorizations which corresponded to specific images of femininity (derived from the narrated significant female others).The constructionsprovided insight into the selfimage of the narrator, as well as the accountability and positioning of himself and the other in regard to perpetrator-victim constructions. The study further revealed whether the participants either accepted or rejected responsibility and guilt for their crimes; this is essential for psychotherapeutic process and treatment.

Asunto(s)

RESUMEN

We live in a world of competing family models of which the standard model--two adults of different sex with two children of different sex--is only one among many others. Besides this sociocultural context this article focusses on the inner contexts of familytherapeutic dialogues. Processphantasies and the role of metaphor are underlined. This articles gives clinical advice how to carefully listen to the use of metaphors by family members and how to deal with them. Three extended transkripts of family sessions are presented.

Asunto(s)