Phase 3

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

This chapter highlights the importance of the termination phase to the practice of TFPP. Attachment dysregulation and feelings of abandonment and rage come to the fore within the therapeutic relationship during termination. Careful handling of this process is crucial in helping the PTSD patient move past symptoms to effect therapeutic change. Issues that commonly arise during termination are feelings of loss and mourning, anxiety surrounding separations, aggravation of mistrust and anger, and fantasies and fears of helplessness. Feelings of pride and gratitude may also emerge. Termination is a challenging time in TFPP, and this chapter also focuses on common countertransference concerns and ways of avoiding pitfalls. Clinical vignettes of TFPP terminations are provided.

2018 ◽  
Vol 22 (1) ◽  
pp. 63-84
Author(s):  
John O'Connor

The art of psychotherapy has been defined as the capacity of the psychotherapist’s mind to receive the psyche of the patient, particularly its unconscious contents. This deceptively simple definition implies the enormously complex art of receiving the most disturbed, dissociated, maddening, often young and primitive, frightening, and fragmented aspects of the patient’s multiple ages and selves, in the hope perhaps that we might make available to our own mind, to the patient’s mind, and within the therapeutic relationship, whatever it is that we discover together, perhaps with the possibility that this may allow that these dissociated, fragmented, lost, and potentially transformative aspects of self might become more accessible to both therapist and patient. The complexity of this process is further intensified when cultural difference is an important aspect of therapeutic engagement. This paper will explore this rich and complex art. It will include exploration of psychoanalytic, relational, and transpersonal psychotherapeutic perspectives as they inform the potentials and mysteries of this deeply receptive process. The paper will consider the potential this receiving of the other might have for the growth of both the therapist and patient within the life span of clinical engagement and will include consideration of implications for cross cultural clinical work. Clinical vignettes illustrating and informing the ideas explored in this paper will be woven throughout the paper. Whakarāpopotonga Kua tautuhia te toi whakaora hinengaro ko te kaha o te hinengaro o te kaiwhakaora hinengaro ki te pupuri i te hinengaro o te tūroro, mātuatua nei ko ngā matū maurimoe. E tohu ana te tautuhinga ngāwari nei i te kaha uaua o te mahi pupuri i ngā maramara tirohanga, ngā tau, ngā whaiaro tini o ngā tūroro arā noa atu te wairangi, te noho wehe, te kārangirangi, he taiohi, he māori, whakawehiwehi, i runga i te wawata tērā pea ka tuwhera ki ō tātau ake hinengaro, ko tō te tūroro ki waenga hoki i te whakapiringa haumanu. E kene pea mā te mea ka kitea, e tuku ēnei tirohanga pūreirei, kongakonga, ngaro, ā, ngā tirohanga hurihanga whaiaro e whakamāmā ake ki te kaiwhakaora me te tūroro. Ka kaha ake te auatanga o tēnei hātepe i te mea ko te rerekētanga o te ahurea te wāhanga nui o te mahi haumanu. Ka wheraina e tēnei tuhinga te tirohanga toitaurea mōmona nei. Ka whakaurua te wherawherahanga o te wetewetenga hinengaro, te tātanga, me ngā tirohanga whakaoranga hinengaro wairua i te mea ko ēnei ngā kaiwhakamōhio i ngā pirikoko o tēnei hātepe toropupū tino hōhonu. Ka whakaarohia e te pepa nei te ēkene pea o te whakaurunga mai o tētahi kē atu mō te whakatipuranga o te kaihaumanu me te tūroro i roto i te wā huitahi ai. Ka whakaarohia ake anō hoki ngā hīkaro mō te mahi haumanu ahurea whakawhiti. Ka rarangahia ngā kōrero haumanu e whakaahua e whakaatu ana i ngā whakaaro tūhuraina i roto i tēnei tuhinga.


Author(s):  
Sabina E. Preter ◽  
Theodore Shapiro ◽  
Barbara Milrod

Chapter 4 describes how to perform child and adolescent anxiety psychodynamic psychotherapy (CAPP) and includes clinical vignettes. Each phase is followed by a delineation of Tom’s treatment. The opening phase describes how the therapist’s listening and assessment of the material lead to a provisional psychodynamic formulation, which is verbalized to the youth. Typical dynamisms are separation anxiety; difficulties tolerating angry, aggressive, and ambivalent feelings; conflicted sexual fantasies; guilt; and ambivalence regarding independence. During the middle phase, therapist and patient collaboratively understand the central psychological conflicts identified and make adjustments to this formulation as needed. The goal is a deepening understanding of the meaning of the anxiety symptoms, with improvement in reflective functioning. The termination phase serves to review the recent changes and to revisit earlier symptoms, particularly if there is a rearousal of symptoms in which separation conflicts are experienced with the therapist. Adaptive and sensible autonomy-seeking is encouraged.


Author(s):  
Michelle S. Ballan ◽  
Maria S. Mera

The termination phase of clinical practice is an important component of the therapeutic process. The ending of the therapeutic relationship, whether planned or unplanned, can elicit feelings of loss, separation, and guilt, impacting both the client and the practitioner. The reasons for ending service and preparation for termination can affect the client's gains. Systematic research on the termination process and the maintenance of gains is needed to further determine variables for successful termination.


2019 ◽  
Vol 36 (02) ◽  
pp. 84-101
Author(s):  
David L. Muir ◽  
Fiona J. Hibberd

AbstractThe concept of exposure is ubiquitous in the research and practice of clinical psychology, most notably in cognitive-behavioural models. Yet there remains confusion and ambiguity around how exposure in ‘exposure therapy’ is characterised. Current definitions are found to be inadequate, as each identifies certain features of the exposure process but omits others. As such, an elaborated model of exposure is presented, referred to here as the re-exposure-extinction learning process. This process involves a complex causal situation consisting of clinical features (the cause/causes, C), acting upon a person (the field, F), to bring about re-exposure to anxiety-provoking stimuli and then extinction learning, leading, over time, to therapeutic change (the effect/effects, E). Importantly, re-exposure and extinction learning are two processes distinct from the therapeutic procedures (i.e., techniques and methods) used to bring them about. Furthermore, these processes are not inherently tied to a particular model of therapy or clinical intervention. They are, therefore, logically independent of the procedures used to facilitate them. Considering this reconceptualisation, we propose that working in the transference, a cornerstone of psychodynamic psychotherapy, can be understood as a complementary and effective method of facilitating the re-exposure-extinction learning process. We argue that this is achieved through enabling a person to repeatedly re-evaluate their fearful expectations as they manifest in the unfolding dynamics of the therapeutic relationship. Finally, some clinical implications indicated by this elaborated model are explored.


2021 ◽  
Author(s):  
Anders Malkomsen ◽  
Jan Ivar Røssberg ◽  
Toril Dammen ◽  
Theresa Wilberg ◽  
Andre Løvgren ◽  
...  

Abstract Background: In the present study, we wanted to explore which metaphors patients suffering from major depressive disorder (MDD) use to explain their experience of being in therapy and their improvement from depression.Methods: Patients with MDD (N = 22) received either psychodynamic therapy (PDT) or cognitive behavioral therapy (CBT). They were interviewed with semi-structured qualitative interviews after ending therapy. The transcripts were analyzed using a method based on metaphor-led discourse analysis. Results: Metaphors were organized into three different categories concerning the process of therapy, the therapeutic relationship and of improvement from depression. Most frequent were the metaphorical concepts of surface and depth, being open and closed, chemistry, tools, improvement as a journey from darkness to light and depression as a disease or opponent.Conclusions: Patient metaphors concerning the therapeutic experience may provide clinicians and researchers valuable information about the process of therapy. Metaphors offer an opportunity for patients to communicate nuances about their therapeutic experience that are difficult to express in literal language. However, if not sufficiently explored and understood, metaphors may be misinterpreted and become a barrier for therapeutic change. Trial registration: Clinical Trial gov. Identifier: NCT03022071. Date of registration: 16/01/2017.


2006 ◽  
Vol 12 (5) ◽  
pp. 329-337 ◽  
Author(s):  
Jack Nathan

The author explores key issues related to psychotherapeutic work with people who self-harm. Particular attention is given to the powerful countertransference feelings that practitioners often experience in this work and the importance of managing these. Rather than maintaining a detached distance, therapists should emotionally engage with the patient's experience, creating a unique therapeutic relationship. The common patterns, functions and meanings of self-harm are discussed, with clinical vignettes that highlight the underlying dynamics of the behaviour. Self-harm is a survival stratagem, and methods for helping patients to find other ways to cope are suggested. One such is mentalisation, which can enhance the patient's capacity to think, not impulsively act. If patients learn how to assess more accurately their own and other people's states of mind, less destructive behaviours can emerge.


2020 ◽  
Vol 13 (3) ◽  
pp. 180-200
Author(s):  
Carolina Altimir Colao ◽  
Nelson Valdés-Sánchez

Research on the therapeutic relationship has underscored its central role for the therapeutic change process, indicating the relevance of determining the specific elements and mechanisms involved in its configuration (Knobloch-Fedders, Elkin, & Kiesler, 2014). Research on ruptures of the therapeutic relationship has yielded particular contributions to better understanding the interpersonal negotiation process involved in the patient-therapist interaction. Although previous studies have contributed to the objective characterization and the exhaustive description of ruptures, more research is needed to further specify markers that allow a better understanding about how patterns of affective regulation between patient and therapist are involved and contribute to the emergence of these events and the attempts at reparation. The aim of this study is to characterize patient’s and therapist’s facial-affective behavior associated to verbal relational offers (RO) during rupture (R) and resolution strategy (RS) events in a brief psychodynamic therapy. Facial-affective behavior was determined using the Facial Action Coding System (FACS), ROs were derived from the content analysis of session transcripts, and R and RS were determined using the 3RS. Nested analyses were carried to establish associations between variables. Results indicate characteristic patient-therapist facial-verbal regulatory patterns for both rupture and resolution strategy events. These findings underscore the value of combining multiple approaches to allow an access to observable indicators of dyadic affect regulatory processes that can contribute to better understand and be attentive to the oscillations of the therapeutic relationship.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
A. Malkomsen ◽  
J. I. Røssberg ◽  
T. Dammen ◽  
T. Wilberg ◽  
A. Løvgren ◽  
...  

Abstract Background In the present study, we wanted to explore which metaphors patients suffering from major depressive disorder (MDD) use to explain their experience of being in therapy and their improvement from depression. Methods Patients with MDD (N = 22) received either psychodynamic therapy (PDT) or cognitive behavioral therapy (CBT). They were interviewed with semi-structured qualitative interviews after ending therapy. The transcripts were analyzed using a method based on metaphor-led discourse analysis. Results Metaphors were organized into three different categories concerning the process of therapy, the therapeutic relationship and of improvement from depression. Most frequent were the metaphorical concepts of surface and depth, being open and closed, chemistry, tools, improvement as a journey from darkness to light and depression as a disease or opponent. Conclusions Patient metaphors concerning the therapeutic experience may provide clinicians and researchers valuable information about the process of therapy. Metaphors offer an opportunity for patients to communicate nuances about their therapeutic experience that are difficult to express in literal language. However, if not sufficiently explored and understood, metaphors may be misinterpreted and become a barrier for therapeutic change. Trial registration Clinical Trial gov. Identifier: NCT03022071. Date of registration: 16/01/2017.


Author(s):  
Fina Pla

This article takes the reader on a journey with two different parts. In the first one, contributions on the transference/countertransference theme provided by bioenergetic authors are presented giving an overview of the richness and creativity of each author. In the second part, a reflection about the impact of Attachment Theory, Relational Psychoanalysis and Neuroscience in the therapeutic relationship in Bioenergetic Analysis is provided. The impact of new concepts is exposed and the rethinking of old ones is revised. The result is a new, enriched view of the therapeutic relationship and its transferential/countertransferential processes where the therapeutic process becomes an interrelational somatosensory process within the therapeutic dyad. Some short clinical vignettes are provided.


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