Integrative Psychotherapy With Physicians In the Trenches: Convergence of Cognitive, Existential, and Psychodynamic Processes

In this article, I present insights gleaned from over a decade of working in therapy with physicians in the trenches who practice at general hospitals located in an area afflicted by the community and political violence, and recently, by the COVID-19 pandemic. Psychotherapy with these physicians requires an integrative psychotherapeutic approach that heeds their changing needs. Espousing cognitive-existential psychodynamics (CEP), a theory-based psychotherapeutic perspective developed for complex cases, I show how cognitive, existential, and psychodynamic processes strongly converge during the treatment of physicians in the trenches. Such convergence is manifested in issues of mental representations (of death, medicine, and the hospital) and choice/meaning.

Personal therapeutic approach in Gestalt therapists working with clients suffering from medically unexplained psychosomatic symptoms

Treatment specificity and adherence to treatment manuals represent essential components of the medical model in psychotherapy. The model assumes that psychotherapists who work with the same type of clients and who identify with the same theoretical approach work very similarly. This study illustrates the shortcomings of that assumption and explores how therapists’ individuality forms and shapes their unique approaches that resonate with their own personalities, inclinations, and worldviews. Semi-structured interviews with eight Gestalt therapists working with clients who experienced medically unexplained physical symptoms were analysed using the grounded theory method. Considerable differences were found among the therapists within four domains of the personal therapeutic approach, namely Case Conceptualization, Therapeutic Task, Therapist’s Position, and Alternative Strategy. However, regardless of the differences, all the therapists endeavoured, either implicitly or explicitly, to convey to the clients what they considered to be healthy functioning. There is considerable diversity in the way therapists work even when they subscribe to the same psychotherapeutic approach and work with the same type of clients. The exploration of psychotherapists’ usual strategies, as well as the alternative strategies they use when their usual strategies do not work, appears helpful for capturing their personal therapeutic approaches.

Developing a Brief Tele-Psychotherapy Model for COVID-19 Patients and Their Family Members

Objective: The COVID-19 pandemic is negatively impacting the mental health of COVID-19 patients and family members. Given the restrictions limiting in person contact to reduce the spread of the virus, a digital approach is needed to tackle the psychological aftermath of the pandemic. We present the development of a brief remote psychotherapy program for COVID-19 patients and/or their relatives.Methods: We first reviewed the literature on psychotherapeutic interventions for COVID-19 related symptoms. Based on this evidence, we leveraged ongoing clinical experiences with COVID-19 survivors and family members to design an intervention model that could be disseminated and integrated into the workflow of the mental health system.Results: This 8-session model –inspired by constructivist and hermeneutic-phenomenological therapies– serves COVID-19 patients during hospitalization, remission and recovery. This model can also be delivered to people dealing with the COVID-19 hospitalization/discharge of a family member, or the loss of a family member due to COVID-19.Conclusion: We described a remote psychotherapeutic approach to tackle the COVID-19 pandemic psychological aftermath. To date, the approach seems feasible and highly customizable to patients’ needs. Studies are underway to test its preliminary efficacy. Once proven efficacious, this treatment model could provide a blueprint for future tele-psychology wide-scale interventions.

Does Psychedelic Therapy Have a Transdiagnostic Action and Prophylactic Potential?

Addressing global mental health is a major 21st-century challenge. Current treatments have recognized limitations; in this context, new ones that are prophylactic and effective across diagnostic boundaries would represent a major advance. The view that there exists a core of transdiagnostic overlap between psychiatric disorders has re-emerged in recent years, and evidence that psychedelic therapy holds promise for a range of psychiatric disorders supports the position that it may be transdiagnostically effective. Here, we propose that psychedelic therapy's core, transdiagnostically relevant action lies in its ability to increase neuronal and mental plasticity, thus enhancing the potential for change, which we consider to be a key to its therapeutic benefits. Moreover, we suggest that enhanced plasticity via psychedelics, combined with a psychotherapeutic approach, can aid healthy adaptability and resilience, which are protective factors for long-term well-being. We present candidate neurological and psychological markers of this plasticity and link them with a predictive processing model of the action of psychedelics. We propose that a model of psychedelic-induced plasticity combined with an adequate therapeutic context has prophylactic and transdiagnostic potential, implying that it could have a broad, positive impact on public health.

A Study on the Symbols and Themes of Sandplay Therapy for Children of Myanmar Refugees living in Malaysia

This study categorized and analyzed the themes and symbols that appeared in the sandplay therapy of Myanmar Chin children living as refugees in Malaysia. The researcher provided individual sandplay therapy to five children attending a UN refugee school in Malaysia for four weeks in July 2018. There were five sessions for each child and 50 minutes per session. The researcher used a Kalffian sandplay approach to provide a free and protected space for the children. They used Creswell’s (2007) qualitative case study method to understand the themes and symbols and, through a comprehensive analysis of all cases, they found five common themes and symbols. These themes were ‘fear/threat and the resistance from the heart to it’, ‘protection and care’, ‘the existence of god and guilt feelings’, ‘the effort to recover normal life’, and ‘do not give up hope for a normal life’. The refugee children expressed their emotional pain in the sand tray so that the traumas they had experienced while escaping and the chaos in their present lives appeared prominently and repeatedly there. As the sessions progressed, however, they expressed a hope to return to their normal lives as they recovered some sense of stability. They could more easily express their inner pain in sandplay than in language, and project themselves safely and express their emotions. It is a fact that, like all other children, the innate and archetypal healing power of these refugee children’s psyche allowed them to respond strongly to sandplay, despite the short-term therapeutic intervention, the horrors of their experiences and the unstable situations they face. Future research should evaluate the effectiveness of a psychotherapeutic approach that considers the social and cultural specificity of refugee children and their various emotional problems and secure economic aid and legal status for them.

“Breaking down the wall” patients` and families` experience of multifamily therapy for young adult women with severe eating disorders

BackgroundThis paper addresses patients` and families` experience of multifamily therapy (MFT) for young adults (18–22) with an eating disorder (ED). EDs are serious illnesses leading to lowered quality of life for the patient and their family. The Regional Centre for Eating Disorders (RESSP) at Nordland Hospital in Bodø, Norway has developed an adjunct psychotherapeutic approach for the treatment of young adult patients with severe EDs. The patient’s family members take part in the multifamily therapy (MFT) group programme.MethodsThe aim of the study was to explore patients` and families` experience of MFT for young adult women with severe EDs. A Grounded Theory (GT) approach was used. Data were collected by field observations in two MFT groups, qualitative group interviews and qualitative individual interviews with patients and their family members. Data were analysed using the constant comparative method. The data analysis consisted of open and selective coding and memo writing.ResultsTwo main categories were identified: ‘Connectedness and recognition’ and ‘Opening up and sharing`.MFT was described as a space for recognition within which it was possible to speak of things happening in the family with others with similar difficulties. It felt good and freeing, but also painful, to meet others with similar experiences. The participants had in common a considerable loneliness because it is difficult for outsiders to grasp what it is like in a home dominated by an ED. The meeting with other families created an underlying safety. The participants received help to distinguish between realistic and unrealistic concerns and learned about openness and communication in relation to their daughter. Some women with EDs said that MFT was most important for the parents but also had been good for them as things had become better at home.ConclusionThe participants reported that their family had become better at talking to each other after having been in MFT. As a result, they were able to speak more openly about difficult things and share feelings. This gave rise to increased understanding. The study shows that MFT was found to be valuable and important. Never before had these families had such an opportunity, something so directly tailored to them. MFT for adults can be developed further and used in other groups, such as those concerning other chronic illnesses.

TRANSFORMATION OF DISTRESS IN EUSTRES

Purpose. Based on a theoretical analysis of the psychology of stress resistance of the individual, the author presents his technique of working with stress issues. Methods.Theoretical analysis of psychotherapeutic areas of work with stress issues in psychological science. Attention is paid to the integrative approach in dealing with distress: cognitive psychotherapy, gestalt approach, neurointegrative psychotherapeutic approach, bodily psychotherapy, existential psychotherapy and symbol-drama.Research of empirical indicators of efficiency of application of a new method of work with distresses: diagnostics of stress, on Max Luscher’s color cards; author’s method “Diagnosis of stress resistance of the individual”; FPI test to diagnose balance; D. Amirkhan’s method “Indicator of coping strategies”, method of research of volitional self-regulation Zverkova-Eidman, test method of research of ability to self-regulation by N.M. Peisahov.Results. Theoretical studies of stress psychology, in particular various psychotherapeutic approaches with stress issues, provided an opportunity to integrate the methods of work of prominent scientists and practitioners and to develop their own approach. An empirical study of the problem of transformation of distress into eustress revealed that most of the participants who became subjects (a sample of more than 100 people) cannot cope with negative stress and perceive it as something unnecessary and negative phenomenon in human life. After the introduction of the author’s method of transforming distress into eustress, most participants immediately recognize the changes and re-evaluate their attitude to stress. Which is confirmed by interview and testing. Conclusions. The results of empirical diagnostics indicate the effectiveness of the method of transformation of distress into eustress. Observations and conversations provided an opportunity to state the following: participants in stress development developed their most current stressful situations, learned skills of self-transformation of negative stress into positive; there was a change of negative programs for successful strategies of stress management, increased self-regulation, stress resistance, balance. The projective method “Color test by M. Luscher” confirmed the absence of internal conflict and the presence of healthy conditions.Key words:transformation, eustress, distress, psychotherapy, integrative approach, development. Мета. На основі теоретичного аналізу психології стресостійкості особистості авторка презентує свою техніку роботи зі стресовою проблематикою. Методи. Здійснюється теоретичний аналіз психотерапевтичних напрямів роботи зі стресом у психологічній науці. Приділяється увага інтегративному підходу в роботі з дистресами, а саме когнітивній психотерапії, гештальт-підходу, нейроінтегральному психотерапевтичному підходу, тілесній психотерапії, екзистенціальній психотерапії та символ-драмі. Досліджуються емпіричні показникиефективності застосування нового методу роботи з дистресами, такі як діагностика стресу за кольоровими картками Макса Люшера, авторська методика «Діагностика стресостійкості особистості», тест FPI для діагностики врівноваженості, методика Д. Амірхана «Індикатор копінг-стратегій», методика дослідження вольової саморегуляції Звєрькова-Ейдмана, тестова методика дослідження здатності до саморегуляції Н.М. Пейсахова. Результати. Теоретичні дослідження психології стресу, зокрема різних психотерапевтичних підхо-дів до роботи зі стресовою проблематикою, дали можливість інтегрувати методи роботи видатних нау-ковців та практиків і розробити свій підхід. Емпіричне дослідження проблеми трансформації стресу дало змогу констатувати, що більшість учасників тренінгу, які стали досліджуваними (вибірка ста-новить більше 100 осіб), сприймають стрес як негативне та непотрібне явище в житті людини. Після упровадження авторського методу трансформації стресу більшість учасників визнають зміни і переоці-нюють своє ставлення до стресу, що підтверджується шляхом співбесіди та за допомогою тестування.Висновки. Про ефективність застосування методу трансформації дистресу в еустрес свідчать результати емпіричної діагностики. Спостереження та бесіда дали можливість констатувати, що учасники тренінгу з розвитку стресостійкості опрацювали свої найактуальніші стрес-ситуації, навчилися навичкам трансформації стресу, а саме відбулася зміна негативних захистів на вибір успішних стратегій опанування стресом, підвищено рівень саморегуляції, стресостійкості, врівноваженості. Проєктивна методика «Кольоровий тест М. Люшера» підтвердила відсутність внутрішнього конфлікту та наявність здорових станів.Ключові слова: трансформація, еустрес, дистрес, психотерапія, інтегративний підхід, розвиток.

Basic Principles for Therapeutic Relationship and Practice in Gestalt Theoretical Psychotherapy

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

Exploration of Everydayness in Schizophrenia: A Phenomenological Approach

This article explores everydayness as a specific form of experience of the world and its alterations in schizophrenia. In the field of phenomenological psychopathology, the transformations of subjective experience in schizophrenia have been the subject of a great deal of work, but the relationship between these alterations of subjective experience and the experience of the everyday remains largely unexplored. A phenomenological point of view leads us to explore everydayness as a constitutive framework of experience, one that may be impeded in schizophrenia. The question of the everyday allows us to bridge the gap between the descriptions of subjective experience proposed by phenomenological psychopathology and what is at stake in therapeutic treatment. It seems to us that the work of constructing an individual narrative of the everyday may be a useful psychotherapeutic approach for helping patients rebuild the framework of everydayness.