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Abstract: This paper addresses how musical metaphors can be useful in understanding the substructure of psychotherapy by considering how our patients resonate inside us, what that resonance does to and for us, and how these acoustic properties seem to be foundational in the construction of the therapist as an instrument of healing. From this perspective, psychotherapy involves “living music” with another person, as the process of psychotherapy always involves the passing of sound back and forth across an interpersonal divide. This requires both psychotherapist and patient to step into the roles of performer and audience member. Additionally, psychotherapists can be meaningfully thought of not only as an “instrument” of healing, but also an “instrumentalist” who produces unique “therapeutic music.” Moreover, the patient and therapist cocreate the concert space in which treatment is performed. This concert space has unique “architectural,” and thus acoustic, properties within which we hear and remember one another. [ABSTRACT FROM AUTHOR]

Abstract: The physical spaces in which we conduct psychotherapy are an important yet underacknowledged aspect of psychotherapeutic work. Although a few contemporary publications have provided suggestions for the creation of welcoming, comfortable, and efficient practice spaces, considerations of what it means to transform a room into a therapeutic space have remained largely absent from recent literature. This paper reviews the existing literature on this subject and describes the ways in which the therapist's office is intimately tied to several processes of the therapy itself, by way of creating an adaptive environment that is able to meet the needs of both therapist and client over the course of their work together. [ABSTRACT FROM AUTHOR]

Abstract: This issue of the Journal of Clinical Psychology: In Session contains seven essays that give expression to three basic convictions. The first is that therapists who are consistently able to help their patients make constructive changes in their lives practice psychotherapy creatively, whether or not they conceive of therapy as an applied science or as an art form. The second is that cultivating an aesthetic perspective on the communicative exchanges that take place in therapy can enhance a therapist's capacity to serve creatively as an agent of change. The third is that therapists can make better choices on behalf of their patients if they take inspiration from what artists have to teach us about the aesthetic domain of existence. [ABSTRACT FROM AUTHOR]

Abstract: I contend that painting, like psychoanalytic psychotherapy, is an intersubjective process able to connect hearts and minds of painters and viewers alike, because the creative process of making a painting brings painters into more complex and more animated relationship with themselves. My own painting process is largely nonverbal. Interactions between me and my evolving artwork‐in‐process reveal experiences, thoughts, and feelings not yet formulated in words, and so, not available explicitly to conscious awareness until visual representation allows questions of meaning and intention to be thought about and elaborated in the usual, verbal sense. I describe how my particular painting practice provides an experiential frame for the creative process of self‐articulation that goes on in psychotherapy, as well as how the physical and mostly nonverbal dialogue experienced in the painting studio served as a source of listening attitudes and self‐regulation in my work with a patient's inhibited self‐expression and thwarted artistic ambitions. [ABSTRACT FROM AUTHOR]

Abstract: This article describes the author's development of an aesthetic approach to psychoanalytic psychotherapy of patients suffering from traumatic levels of grief by describing her experiences as a patient, a therapist, and a consultant to the design firm that partnered with the National September 11 Memorial and Museum. Using Aristotle's On Poetics as an inspiration, this article explores the ways dialogical storytelling creates a therapeutic “action‐plot” that transforms reversals of fortune. Attending to patients’ first‐person phenomenological experience (without attributing cause), therapists help them transform their losses by listening to their stories. Therapists dwell with them in uncertainties while marking time in regularly scheduled meetings; they accompany their patients on a journey while also orienting to their modes of travel. They simultaneously co‐construct tales of the journey, attentive to the poetic dimensions of sight, sound, and space that they encounter. In so doing, therapists serve not just guides and judges, but artists, bringing meanings to the trail. [ABSTRACT FROM AUTHOR]

Abstract: Insights from the study of literature can inform and clarify concepts to guide psychotherapy practice and research. The author offers instances from narrative fiction (Durrell's Alexandria Quartet) and poetry (Hopkins, Baudelaire) to illustrate how the formulation of experience in words that are evocative (vs. ordinary), original (vs. trite), and precise (vs. approximate) are able to capture attention, move the emotions, and challenge beliefs; and how linkages among experiences, vividly and precisely expressed, create and enhance narrative meaning–revealing the inherent relativity of individual meanings and the need to consider the aggregate of relevant perspectives in every interpersonal situation. [ABSTRACT FROM AUTHOR]

Abstract: Is there an aesthetic dimension to therapeutic action? The author proposes that while the arts, in this example, dance, can serve as a bridge to give form and expression to the ineffable for both the artist and the observer, language, especially metaphorical language, in the context of a resonating therapeutic relationship, similarly gives form and enhanced meaning to what has been felt but not yet understood. Even if the content is painful, the process of mutually creating a common language that reorganizes the mind is aesthetically pleasing. [ABSTRACT FROM AUTHOR]

Objective In this study, we examined the mechanisms of action of complicated grief treatment (CGT), an efficacious psychotherapy for complicated grief. Method We explored 3 putative mediators (guilt/self-blame related to the deceased, negative thoughts about the future, and avoidance) among treatment completers assigned to either CGT (n = 35) or interpersonal psychotherapy (n = 34) in a previously reported randomized controlled trial. Antidepressant use was examined as a moderator of mediation effects. Results A reduction in guilt/self-blame, negative thoughts about the future, and avoidance behavior each mediated the relationship between treatment group and complicated grief outcomes. Reduction in avoidance emerged as an independent mediator after controlling for all mediators. Conclusion Reducing avoidance of situations and emotions connected to the loss seems to be a key mechanism of change in CGT. Revising counterfactual thinking around troubling aspects of the death may also play a role in facilitating effective adaptation to loss. [ABSTRACT FROM AUTHOR]

Objective Explanatory models (EMs) are a collection of beliefs about a disorder that can help us understand help-seeking and treatment pathways in diverse contexts. In 2 related studies, we explore EMs about depression held among both clinical and nonclinical samples in Uganda. To explore the potential of EMs to predict help seeking, we assessed the relationship between 2 main aspects of the EM: problem conceptualization and treatment. Method In Study 1, we interviewed and assessed EMs of depression for 135 lay community members and 111 professional practitioners using a vignette. In Study 2, we assessed actual EMs among 33 clinically depressed adults. We transcribed all interviews and analyzed and coded the content. In Study 1, we used logistic regression to examine the relationship of problem conceptualization and stigma to treatment choice; in Study 2, we used Fisher's exact tests to examine the relationship between conceptualization and treatment. Sociodemographics such as age, income, and language were also examined. Results Interviews elicited a diverse range of beliefs about the nature of depression and the types of treatment needed. However, problem conceptualization did not predict treatment in either group. Instead, education and interview language predicted treatment in clinical and nonclinical samples. Conclusion Although EMs can be useful for both exploring mental health and treatment-related beliefs in clinical settings and developing mental health services, contextual factors may be more significant predictors of help seeking. [ABSTRACT FROM AUTHOR]

Introduction Internet-based cognitive behavioral therapy for depression (iCBT) has been advanced as a valuable alternative treatment option, generating promising results. However, little is known about its underlying mechanisms of change. Objective We aimed to provide an overview of the state of the art regarding the mechanisms of iCBT for adult depression, in the context of iCBT efficacy. Method We conducted a systematic qualitative review of 37 randomized clinical trials, assessed the risk of bias in the included studies, and used a systematic evaluative framework to establish the scientific status of iCBT, based on evidence regarding clinical efficacy and mechanisms of change. Results Findings indicated that iCBT mechanisms of change are clearly underinvestigated, although iCBT is relatively efficacious, at least in the short term. The quality of iCBT randomized clinical trials proved to be suboptimal. Conclusions The iCBT theory should be clearly specified and adequately investigated to design and implement highly efficacious therapeutic packages. Without considering the iCBT mechanisms of change along with iCBT efficacy, the extent to which iCBT is an empirically validated treatment remains questionable. [ABSTRACT FROM AUTHOR]

Objectives We examined core features of patient suitability for cognitive-behavioral therapy (CBT) and their ability to predict CBT outcomes. Method A sample of 256 outpatients diagnosed with depression and anxiety disorders were assessed using the Suitability for Short-Term Cognitive Therapy (SSCT) scale. Therapists rated patients' symptom severity using the Clinical Global Impression scale before and after therapy. Results A factor analysis of the SSCT scale yielded 2 factors: (a) Capacity for Participation in CBT Process and (b) Attitudes Relevant to the CBT Process. A multiple regression analysis revealed that only Capacity for Participation in CBT Process uniquely predicted improvement at termination. Conclusions These findings highlight the importance of assessing the suitability of CBT for individual patients. Specifically, patients with greater capacity to identify and articulate thoughts and feelings and to share them in a nondefensive, focused way benefit most from CBT. [ABSTRACT FROM AUTHOR]