Phase 2

Author(s):  
Frederic N. Busch ◽  
Barbara L. Milrod ◽  
Cory K. Chen ◽  
Meriamne B. Singer

This chapter provides an overview of the central psychodynamic techniques of the middle phase of TFPP. Core intrapsychic conflicts that contribute to PTSD symptoms are identified and actively addressed. Interpretation of defenses aids in the elucidation of conflicts. A prominent defense in PTSD, identification with the aggressor, is described in more depth. Exploration of the transference is discussed with attention to the ways in which core conflicts emerge with the therapist. Patients with PTSD trigger particularly intense countertransference reactions, knowledge of which furthers the therapeutic process. The technique of working through is articulated, in which the therapist and patient elucidate how various conflicts and defenses emerge across a range of symptoms, contexts, and relationships. Case vignettes are used to illustrate these approaches.

2018 ◽  
Vol 66 (5) ◽  
pp. 837-860 ◽  
Author(s):  
Paola Solano ◽  
Luca Quagelli

Clinical material from the treatment of a highly destructive schizophrenic patient is used to demonstrate the role and function of therapeutic mediations in promoting transformation and symbolization. Use of the Squiggle Game as a therapeutic mediation is shown to sustain the therapeutic process and to facilitate working through of the obscure and complex dynamics commonly seen in the treatment of psychotic patients. The Squiggle Game presents a first transitional space entailing both the concreteness of psychosis and the potential for symbolization provided by psychoanalysis. The game becomes the first meeting ground for the progressive encounters of the therapeutic couple, primarily because in it the violent destructiveness of psychosis is partly deflected in a way that fosters development of the transference relationship. Step-by-step emotional transformations gained through the Squiggle Game are reported and discussed, together with the patient’s need to rely on nonverbal communicative modes to bring early traumatic experiences that never reached verbalization into treatment. This working through process furthered development of the dyad’s intense transference-countertransference dynamics, which stimulated construction of a link between here-and-now and there-and-then in sessions, leading to the patient’s integration and a sense of the life-historical significance of her experience.


Author(s):  
Maybelle Swaney

Abstract This paper describes a conceptual framework in music therapy with adults with severe and profound levels of intellectual disability. Drawing from Carl Rogers’ person-centered work and his notion of the good life as a direction, the author presents four core relational experiences (curiosity, invitation, celebration, and recognition) that underpin the therapeutic process with this client population. Case vignettes from the author’s clinical work illustrate how core experiences are presented through improvisational musical experiences. Considerations are given to the clinical significance of good-life-oriented experiences on the emotional health of individuals with severe and profound intellectual disability, and to its implications beyond the music therapy space.


1994 ◽  
Vol 57 (1) ◽  
pp. 20-22 ◽  
Author(s):  
Janet Patrick ◽  
Gary Winship

The disposal of a created piece, when art has been used as a medium for therapy, is a most important stage in the therapeutic process. This article reviews the theory regarding disposal and presents case vignettes outlining a variety of approaches. These approaches are discussed and a framework for intervention is offered.


2021 ◽  
Vol 7 (1) ◽  
pp. 327-342
Author(s):  
Gabriela Maffini ◽  
Maristela Jaqueline Reis Peixoto ◽  
Paula Argemi Cassel ◽  
Josiane Lieberknecht Wathier Abaid

Post-traumatic Stress Disorder (PTSD) has been identified in literature as one of the most frequent disorders related to abuse, causing dysphoric symptoms, avoidant behaviors, changes in arousal, reactivity, mood and patient cognitions. For the treatment of this disorder, Cognitive-Behavioral Therapies are pointed out as effective psychotherapeutic approaches to reduce symptoms, develop adaptive coping strategies and redefine trauma. For the care of children and adolescents, in turn, the Trauma-Focused CBT (TF-CBT) is used as an intervention model. This study aimed to review the evidence of results of the TF-CBT protocol for children and adolescents victims of sexual trauma. It is an integrative literature review, of a qualitative nature, using LILACS, PePSIC, PsycNet, PubMed and SciELO as databases. The eight studies found suggest that the techniques employed by the TF-CBT protocol, together with the participation of primary caregivers during the therapeutic process, contributed to the positive results of the treatment. It is concluded that this approach has great efficacy for the reduction of PTSD symptoms, as well as for the remission of the disorder.


2020 ◽  
pp. 088626052093851
Author(s):  
Yael Lahav ◽  
Santiago Allende ◽  
Anat Talmon ◽  
Karni Ginzburg ◽  
David Spiegel

Childhood abuse survivors may display both inward and outward aggression manifested in self-injurious behavior (SIB) and violent acts toward others. Scrutinizing the literature reveals that the relational dynamics between victims and their perpetrators might be involved in these phenomena. Yet, research on this subject matter has been sparse. Filling this gap, this study investigated the contribution of the singular bonds between victims and their perpetrators, known as identification with the aggressor, in explaining survivors’ aggression. The study was conducted among 306 Israeli college/university students who reported a history of childhood abuse. Results revealed that levels of adopting the perpetrator’s experience, identifying with the perpetrator’s aggression, and replacing one’s agency with that of the perpetrator were significantly associated with survivors’ inward and outward aggression. Moreover, profile type—that is, having high versus low levels of identification with the aggressor—was implicated in participants’ SIBs, urge to harm others, and violent acts toward others, above and beyond the effects of gender and posttraumatic stress disorder (PTSD) symptoms. The present findings suggest that identification with the aggressor might make survivors prone to the re-enactment of past abusive dynamics, which, in turn, could eventuate in aggression toward themselves and others.


2019 ◽  
pp. 088626051987230
Author(s):  
Yael Lahav ◽  
Anat Talmon ◽  
Karni Ginzburg

Identifying with the aggressor is a process wherein victims of abuse, particularly during childhood, take on their perpetrator’s experience. The victim defers to the perpetrator and adopts the perpetrator’s experience, learns the perpetrator’s desires and needs, and gratifies them. Although the clinical and theoretical literature suggests that identification with the aggressor occurs in the aftermath of abuse and has negative long-term implications, to date this concept has not been empirically investigated. To facilitate an exploration of this subject, the current study evaluated the psychometric properties of a new measure: the Identification With the Aggressor Scale (IAS). The study was conducted among convenience samples of students using online surveys. In Study 1, the IAS was administered to 318 students. In Study 2, the IAS, and a battery of questionnaires assessing features of abuse, dissociation, posttraumatic stress disorder (PTSD) symptoms, and posttraumatic guilt were administered to a convenience sample of 368 students. Four reliable IAS factors emerged from Study 1: Adopting the perpetrator’s experience concerning the abuse, identifying with the perpetrator’s aggression, replacing one’s agency with that of the perpetrator, and becoming hypersensitive to the perpetrator. In Study 2, a confirmatory factor analysis confirmed the scale’s underlying factor structure. A history of childhood abuse, recurrence and severity of abuse, and the perpetrator being a parental figure were all associated with higher IAS scores. In addition, IAS scores were correlated with dissociation, PTSD symptoms, and posttraumatic guilt. The present findings indicate that the IAS has good psychometric properties, making it useful as an assessment tool in future research.


2019 ◽  
Vol 1 (1) ◽  
pp. 32-45
Author(s):  
Konstantin Nemirovsky

One hundred years ago Freud set mourning against melancholia in the belief that endured losses leads to depression. However, it is not only unmourned grief, but unworked-through violence that leads to destruction and enables the victim the possibility of ridding themselves of unbearable psychic pain. The solutions to this predicament are different; from identification with the aggressor to turning this pain against himself, resulting in depression, self-injuries, and suicide. This article illustrates the principle at three different, but interrelated levels: personal, familial, and social. It suggests that not only individuals or families resist mourning, but that multiple generations in different countries may not be able to complete the working through of these traumas. This may lead to constant re-enactment of the scenario and strangles development.


Author(s):  
Anke Maatz ◽  
Lena E. Schneller ◽  
Paul Hoff

This chapter situates privacy and confidentiality as central ethical, legal, and anthropological concepts for psychotherapeutic practice. It first provides some conceptual background and clarification of the concepts before considering their specific relevance in the context of psychotherapy. In particular, it explores a unique significance that, it is argued, privacy and confidentiality acquire in the therapeutic process to do with the anthropological dimension of privacy, its psychological function, and the specific dynamics of the therapeutic relationship. Based on four case vignettes, potential ethical conflicts about privacy and confidentiality are then discussed. Finally, principles that can guide practitioners in responding to ethical conflicts about privacy and confidentiality in clinical practice are provided.


2015 ◽  
Vol 7 (4) ◽  
pp. 76
Author(s):  
Robert E. Krout

Summary: Over the past ten years songwriting has emerged as a popular method for many clinicians working in a therapy context. This book provides the first comprehensive examination of the contemporary methods and models of songwriting involved and also discusses the environmental, sociocultural, individual and group factors which might support or constrain this therapeutic process. Methods that focus predominantly on lyric creation, music creation, or on both are described and illustrated by case vignettes and samples of song materials, and supported by pictorial representations of the methods. The role of music and music technology is highlighted as an important component of the therapy process. Finally this book also pays attention to comparing and contrasting models of songwriting according to the orientation of the therapist. Models outlined include those informed by behavioral, cognitive-behavioral, psychodynamic, humanistic, feminist, community music therapy, and resource- oriented music therapy approaches.


2019 ◽  
Vol 28 (2) ◽  
pp. 245-250
Author(s):  
Ann E. Perreau ◽  
Richard S. Tyler ◽  
Patricia C. Mancini ◽  
Shelley Witt ◽  
Mohamed Salah Elgandy

Purpose Audiologists should be treating hyperacusis patients. However, it can be difficult to know where to begin because treatment protocols and evidence-based treatment studies are lacking. A good place to start in any tinnitus and hyperacusis clinic is to incorporate a group educational session. Method Here, we outline our approach to establishing a hyperacusis group educational session that includes specific aspects of getting to know each patient to best meet their needs, understanding the problems associated with hyperacusis, explaining the auditory system and the relationship of hyperacusis to hearing loss and tinnitus, describing the influence of hyperacusis on daily life, and introducing treatment options. Subjective responses from 11 adults with hyperacusis, who participated in a recent clinical group education session, were discussed to illustrate examples from actual patients. Conclusions Due to the devastating nature of hyperacusis, patients need to be reassured that they are not alone and that they can rely on audiologists to provide support and guidance. A group approach can facilitate the therapeutic process by connecting patients with others who are also affected by hyperacusis, and by educating patients and significant others on hyperacusis and its treatment options. Supplemental Material https://doi.org/10.23641/asha.8121197


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