Covert Conditioning for Persistent Aggressive Behaviors: A Case Illustration

In psychotherapy practice and training, single case study design plays an indispensable role by effectively articulating the application of textbook knowledge, thereby bridging the gap between theory and practice. This article, on similar lines, illustrates one such successful example of the application of the classical behavioral technique of covert conditioning modified with a component of verbal challenging. A woman in her late-thirties reported with long-standing seemingly-resistant-to-treat symptoms of aggressive behavior of beating children. The client had a total of 10 daily sessions of 60–90 minutes each. By the end of one week, she reported not beating children in this period. She felt extremely relieved because it had happened for the first time in 10 years. The intensity of anger had decreased drastically, and she was not shouting any longer. She had to discontinue sessions abruptly due to unavoidable circumstances. Although she was suggested to follow up the intensive sessions again, she was not able to do it due to feasibility issues. The improvement was maintained on follow-up visits after two weeks, four weeks, and three months.

The Pattern-Focused Case Conceptualization Approach

In this era of accountability, therapists and other mental health professionals are expected to employ evidence-based interventions to achieve therapeutic change. Case conceptualization is an intervention that many consider one of the most essential clinical competencies. A useful case conceptualization approach, at a minimum, should explain the presenting problem and guide the planning and implementation of treatment. Approaches that are more clinically valuable will include a third function: anticipate and predict challenges in the treatment process. Analogous to the paradigm shift toward personalized treatments in precision medicine based on biomarkers is a similar shift occurring in psychotherapy practice. It will be based on behavioral markers like the ones in the pattern-focused case conceptualization approach and can explain, guide, and predict treatment challenges, as well as optimize treatment outcomes. A case example illustrates key points.

The Complicit Therapist

This chapter explores therapeutic modalities that fit with a complicit theory of human being: feminist therapy, Interpersonal Neurobiology, Polyvagal Theory, Internal Family Systems and intersubjectivity. It examines how to be both systems-oriented and work from a depth approach which is an element of complicit thinking. In exploring how to work therapeutically within this frame, the chapter reiterates the importance of a nonbinary understanding of human being, which has been one of the main points argued throughout the book. This, ultimately, is why the psychological humanities is important: It allows for both the art and the science of psychotherapy to co-exist in a nonbinary way. The chapter also addresses another of the ongoing themes of the book, a complicit approach to identity politics, which is connected to a social-justice-oriented psychotherapy practice.

Taking the therapeutic community outside in the COVID-19 pandemic

Purpose The COVID-19 pandemic has affected psychotherapy practice. A common change is a move to online sessions over video calls. In their therapeutic community (TC) for those with personality disorders, the authors have used video calls but not all clients could work in this way. The authors decided to meet patients outside and walked with them while adhering to government guidelines. This study aims to present the authors’ experience with one client who was interviewed afterwards about the experience. Design/methodology/approach A total of 10 walking therapy sessions of 60-min duration were conducted with the patient. After the sessions, both the patient and therapist were interviewed about their experience. The resulting interviews with both patient and therapist were thematically analysed independently by both authors. Findings There were common themes to both the client and therapist’s account following thematic analysis. These were: modelling and normalising in the real world, replacing what COVID-19 had taken away from the TC experience, changes at home, therapist disclosure, outcomes and good endings and being outside of the clinical environment. Research limitations/implications The authors have presented a single case of the patient and therapist experience of outdoor therapy sessions in a TC context response to the COVID-19 pandemic. The findings are not generalisable and can only provide a suggestion at the positive potential for working in this way. The authors hope that the positive effects of outdoor therapy noted here may inspire other clinicians to consider similar novel approaches in their work. Originality/value This study describes a novel way that a TC has adapted to the COVID-19 pandemic.

Why Only Efficiency, and Not Efficacy, Matters in Psychotherapy Practice

Evidence-based practice in psychology consists of two quality parameters. One of these quality parameters is efficacy and the other is efficiency. In this article, it is argued that the only relevant parameter for determining quality in clinical care is efficiency. Moreover, emphasising efficacy in psychotherapy practice is symptomatic of a scientocentric ideal in evidence-based practice in psychology. The proper understanding and use of scientific findings entail leaving this scientocentric ideal. In addition, it is crucial that efficiency is related to the ethical aims that constitutes psychotherapy practice.