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This chapter blends together the power of humanistic framework for evidence-based approaches illustrated through clinical stories. These vignettes illustrate the change process and the impact of dealing with uncertainty about a “good outcome” in clinical encounters that practitioners struggle with. This chapter offers ideas and practices on how to stay connected with a perspective of “playing my part” to prevent burnout and keep the focus on growing with both the science and humanistic elements of the therapeutic work.

This study presents a pilot contribution to the new collaborative, multinational study of psychotherapy trainee development that was undertaken by the Society for Psychotherapy Research Interest Section on Therapist Training and Development (see Orlinsky, Strauss, Rønnestad, et al., ). Although the main project is longitudinal in design, this preliminary study investigated cross-sectional differences between trainees in different years of training and explored the influence of core training experiences-including supervision and personal therapy-on their perceived development as therapists. Using the trainee current-progress report that was designed for the Society for Psychotherapy Research Interest Section on Therapist Training and Development project, 90 trainees at 4 different 4-year training programs in Italy provided self-evaluations of their development and of their therapeutic work experiences. Perceived development included overall change, progress, deterioration, overcoming past limitations, and realization of potential as a therapist. Therapeutic work experiences were assessed using scales of healing and stressful involvement (Orlinsky & Rønnestad, ). Year in training and support in supervision predicted perceived development and healing involvement, whereas experiencing criticism in supervision was associated with stressful involvement. Having had personal therapy, and especially ratings of benefit from personal therapy, was also associated with perceived development and healing involvement. Results are discussed with regard of their implications for psychotherapy training.

Objective: The aim of this study was to gain knowledge about how the integration of personal and professional experiences affects therapeutic work. Method: Therapists (N = 14) who had been recommended by their leaders at their individual workplaces were interviewed twice with semi-structured qualitative interviews, which were then subjected to thematic and Interpretative Phenomenological Analysis. Results: All the therapists in the sample described their personal qualities as an experienced tension between their personal strengths and vulnerabilities in the therapeutic setting. This tension came to expression through four subordinate themes: (a) The tension between perceiving oneself as a helper while dealing with one’s own needs for attention and care; (b) The tension between the ability for embodied listening to the patient while tuning into oneself; (c) The tension between staying present while handling aggression and rejection from clients; and (d) The tension in striving for a constructive balance between closeness and distance. Conclusion: The results point to ways in which the personal selves of the therapists may affect their professional role performance. Drawing upon previous research and literature on the topic, the paper discusses how therapists’ personal qualities are experienced as affecting their work and suggests several implications for psychotherapy training and practice.

Unilateral condylar hyperplasia (UCH) is a pathological condition affecting not only facial appearance and occlusal relationships, but also mandibular joints health. The accurate and timely diagnosis, along with a therapeutic work and a multidisciplinary approach, help reduce the morphological alterations caused by this pathology. Orthodontics plays an important role in the various treatment modalities because of its role not only in presurgical dentoalveolar decompensation but also in dentoalveolar compensation with vertical management when the asymmetry allows it. The following therapeutic proposal describes the treatment of patients with active UCH subjected to high condylectomy surgery immediately after orthodontic dentoalveolar compensation with Multi-Loop Edgewise Archwire (MEAW) for the vertical handling of occlusal canting and maintenance of the orthopedic position of the mandible. All cases were satisfactorily resolved with the same diagnostic and treatment protocol. The conclusion is that, with adequate diagnosis and orthodontic management following condylectomy, non-severe cases of UCH may be treated. DOI: http://dx.doi.org/10.17533/udea.rfo.v29n2a11

The general psychotherapy literature has long demonstrated that the therapeutic alliance predicts psychotherapeutic outcome. The relationship between client and therapist is considered the foundation of therapeutic work and is viewed as one of the main tools for achieving client change. In recent years, the therapeutic alliance has proven integral to treatment outcomes in offender therapy settings. To date, research has found that offenders can form a strong working alliance with their therapist and that several therapist and client factors have been found to predict the quality of the therapeutic alliance within offender treatment. This chapter synthesizes findings from studies of the therapeutic alliance in offender therapy settings, with a section devoted to consideration of the therapeutic alliance in the context of treatment high-risk offender populations.

The paper analyzes social work integrating the principles of Gestalt therapy, such as dialogue and phenomenological approach, internalization, responsibility and creative adaptation. The main perspectives of Gestalt therapy, which are related to the cases of social work, contexts and possibilities of therapeutic work, are highlighted. The article also reveals obstacles (e.g. dominant, patronizing, controlling and expert model of client assistance, isolated and restricted by directives the reality of social work, institutionalized social work practices and bureaucratic dependence of social security) that impede the development of therapeutic social work in Lithuania. It can be argued that the perspective for Gestalt therapies is available to social workers who seek therapeutic social work practice methodologies, help relationships, and empower clients for change.

This chapter discusses the author’s professional transformation and career path as a healer/addiction psychiatrist. Clinical vignettes illustrate the affinity of the author’s with Carl Rogers and Richard Asher. It also focuses on the complex realities of the clinical challenges and gives voice to powerfully inspiring, confusing, and transformative experiences in therapeutic work. It demonstrates through the vignettes how to truly connect and “be” with patients.

In this chapter, we explore the story of Stephen, a composite female-to-male transgender client, derived from the practice experiences of the first author. We engage with Stephen’s story in order to explore key aspects of culture-infused counselling. As part of Stephen’s story, we explore the issue of self-harm to illustrate ways counsellors can engage in life-making and self-composition alongside transgender clients. Culture-infused counselling (CIC; Collins & Arthur, 2010a, 2010b) is woven throughout this chapter to illustrate how it brings counsellor and client together in a therapeutic relationship characterized by a commitment to each know the other and to engage in helpful therapeutic work. In reflecting on the application of the revised CIC framework (see Chap. 2), we emphasize the importance of sustaining sensitivity to the role culture plays in shaping client and therapist identities. We also explore how cultural awareness of self informs the therapeutic relationship. Used concurrently, these approaches help sustain a practice in which transgender clients and counsellors can work together in meaningful and forward-looking ways.

This chapter offers clinical reflections from medical trainees and other healthcare practitioners about their work with patients with addiction. These experiences illuminate the impact of therapeutic work on professional and personal transformation.

International audience; How are we to connect the mechanist methodology used by Baglivi in his physiological treatises with the apparently strict empiricism that he promotes in his therapeutic work entitled Practice of Physick, reduc’d to the Ancient Way of Observations? In order to answer this question, we examine the methodological implications of the “history of diseases” that Baglivi promotes by using Bacon’s recommendations in the Novum organum. Then, we compare this result with the place that historians generally gave to Baglivi in the medical context of that time: the place of a dogmatic and “iatromechanist” physician who was far from practical and therapeutic concerns. This confrontation allows us first to apprehend the polemical origin of the so-called “iatromechanism” as a historiographical label, and second, to question the preeminence of the role of observations in the shaping of the classical distinction between “rational” physicians and “empirical” ones. When Early Modern physicians use the dichotomy between “empirical” and “rationalist” in order to discredit what they perceive as oversimplification or dogmatism, there is most often a third group at stake; a group which is depicted as the providential and intelligent solution to sectarianism. For Baglivi, this third group would be an “Empirick rational sect.” The distinction between a medicina prima and a medicina secunda allows us to understand such an apparently paradoxical category.

Background There is limited research on the subjective experience of therapists and their understanding of therapeutic process when working with people from refugee backgrounds. Objective This study provides a qualitative account of therapists’ conceptions of therapeutic practice and experiences of working therapeutically with refugee clients. Method Participants were 12 mental health workers who had worked therapeutically with people from refugee backgrounds, with an average of 7.6 years (range 1.5–16 years) of experience in this field. Participants completed a semi-structured interview and completed a brief quantitative survey. Findings Thematic analysis revealed a number of superordinate themes. Four key themes are explored in this study: principles of therapeutic practice; therapy as a relational experience; the role of context in informing therapeutic work with refugee clients; and the impact of therapeutic work on the therapist. Discussion The results revealed the complexity and demands of working with people from refugee backgrounds. Further, the lack of research evidence for the methods of therapeutic practice described in this study highlights the distinction between naturalistic therapeutic practice and the current state of the evidence regarding therapeutic interventions for refugee clients. The findings have important implications for training and supporting therapists to work with people who have fled their countries of origin and who have often been exposed to highly traumatic events.

Through one clinical example involving complex post-traumatic stress disorder, this paper explores the ways in which the psychoanalytic psychotherapist may need to find creative ways of working which incorporate findings from neuroscience whilst holding the basic frame and methods of the traditional psychoanalytic approach. This entails bringing knowledge of how the body (including the brain) works into the consulting room. In particular, the author describes ways of accompanying the patient during florid flashbacks to chronic and severe childhood abuse and of using grounding techniques afterwards, so that anxiety levels can be sufficiently contained for the necessary therapeutic work to take place. The role of supervision is also explored in terms of how the dynamic of rescuer/victim/persecutor may be played out in the supervisory relationship. Unusually, some of the patient's own reflections, written at the end of the therapy, have been incorporated into the paper. Consideration is given to whether departures from standard psychoanalytic technique constitute boundary violations or useful enactments, which can be seen as a form of creativity which enables the work to move on.

Psychoanalytic theory offers a varied conceptual system for considering psychosis by providing a coherent representation of the anxieties and processes at work in adult patients. But at the practical clinical level, it is not enough simply to ‘think about psychosis’ and have a theoretical system in place. The therapist must also ‘have psychosis in mind’, that is, get to grips with its forms of logic, gain familiarity with its workings, and learn to understand and accept the effects it has on the therapeutic relationship and on their own expectations. Clinicians engaged in this type of work must be able to tolerate getting back in touch with processes deemed archaic at the core of their own psychological functioning, which will impact their ability to listen and think. These chaotic processes demand a change of approach since they cause a ‘desymbolisation’ that perturbs the internal mental structure of the therapist. This ‘desymbolisation’ is therefore the locus of the therapeutic work, which must attempt ...

In this article we first contextualize and then outline a model of TFP adapted for working with adolescents with Borderline Personality Disorders. We discuss how to take the normal developmental challenges of adolescence, such as separation-individuation in consideration, and how to support this in the context of the therapeutic work, while at the same time stimulating curiosity through clarification and confronting the adolescent with self-defeating and destructive patterns and dangerous behavior. Furthermore, we give examples of working with split–off parts of self and other representations through clarification to increase self-awareness and confrontations with contradictions within the adolescents communication and nonverbal behavior, with the aim of facilitating the integration of identity.

In this chapter, Fraser Brown, Cindy Dell Clark, and Michael Patte introduce us to the “continuum from playing to play therapy” as it manifests in playwork, child life, occupational therapy and play therapy; all the while reflecting on the power of play to help children in medical crisis and demonstrating that children have the freedom to play as they wish, and they do so in non-clinical settings to better cope with stresses or illness. The clinical examples in this chapter corroborate that professionals trained in disparate fields act to catalyze, direct, compensate, and amplify playfulness, a testament to play’s robust, resilience-enhancing potential.

Wittgenstein’s greatness is tied to his capacity to combine a firm clear-sighted vision of philosophy as a non-scientific ‘a priori’ activity with a penetrating skepticism of the results of, and need for, a priori metaphysics. His discovery of ‘critique of language’ as a way of philosophizing anew allows him to appeal to his readers—as fellow masters of language—without the need to agree on matters of opinion. In this paper I defend two main ideas: (1) that the emphasis on language as a rule-governed activity in Wittgenstein scholarship is misguided and inevitably collapses into a metaphysics of language like that to be found in the Tractatus—precisely what Wittgenstein is trying to avoid; and (2) that we can only understand the philosophical therapeutic work that criteria perform in Wittgenstein’s philosophy if we abandon the idea that they are to be understood as expressions of linguistic rules.

In the following proceeding, we draw on methods developed for behavioral therapy, but it should be emphasized that the PCS can also be adapted and used for any other policy procedures. Broadly speaking, therapeutic work can be divided into three blocks: a) the initiation of treatment, including the establishment of the working relationship, diagnosis, and the motivation of the patient, b) the treatment of the mental disorder, including the development of a disorder model, harnessing the motivation to change, and the implementation of interventions, and c) the end of therapy, including stabilization of newly learned behavior and relapse prevention.

Background and Purpose There has been growing interest in direct visualization of the vessel wall with high-resolution vessel wall MR imaging (VW-MR imaging) as an adjunct to conventional techniques for imaging the cranio-cervical arteries(CTA, MRA, and DSA). Whilst adequate for revealing abnormalities of the vessel lumen, conventional techniques fail to fully characterize pathology that resides within the vessel wall.1 Materials and Methods We utilized VW-MR imaging in the pre-therapeutic work-up of two patients undergoing endovascular therapy: - A patient with a giant carotid ICA pseudoaneurysm - A patient with a complex vertebrobasilar junction fenestrated aneurysm with the aneurysm located asymmetrically in one limb of the fenestration. Results VW-MR Imaging provided significant information that could not be discerned from conventional luminography: 1) Relatively acute thrombus may be differentiated from relatively chronic thrombus on the basis of layering, allowing for an assessment of the relative degree to which the patient may withstand aggressive endovascular manipulation. 2) Vessel wall contrast enhancement was depicted. While the exact significance of this finding is a subject of intense research2, it has been suggested that this may reflect an underlying inflammatory etiology for the aneurysm.3 3) The angio-architecture of both the aneurysm and the parent vessel were better depicted than on conventional imaging. 4) VW-MR imaging may provide reliable quantification of wall thickness.4 5) VW-MR imaging was critical in defining the lumen with respect to the aneurysm sac in our fenestrated aneurysm case and in planning where to place a flow diverting stent.5,6 Conclusions: VW-MR Imaging has multiple potential benefits in the pre-therapeutic work-up of aneurysmal disease and is already used on a clinical basis at many centers. Figure Legends: 1) VW-MR demonstrates position of the lumen for flow diverter placement. 2) Architecture of pseudoaneurysm is defined including outflow tract, high flow jet and extensive thrombus. Disclosures: G. Deib: None. B. Wasserman: None. M. Lim: None. G. Toth: None. E. Obusez: None.

Resumen: Este trabajo tiene como intencion expresa acercar el foco de nuestra atencion hacia dos elementos que habitan en el pensamiento junguiano: La dimension espiritual que se deriva de la forma en que Jung concibe su propia labor terapeutica, asi como de su comprension del significado de la vida y del valor que en ella tiene el sufrimiento y la afliccion que le son asociados. La “cura de almas” como algo que, en definitiva, desborda necesariamente el marco de la medicina y la psicologia cientificas. El complejo entramado de los presupuestos metafisicos y de las filiaciones filosoficas que, de forma sucesiva, va a ir adoptando el discurso junguiano a lo largo de su gestacion. Palabras clave : arquetipo- proceso de individuacion- si-mismo- enantiodromia- persona- sombra- animus- anima- imaginacion activa- wu-wei- proyeccion psicologica- pleroma- metanoia- hierogamia. Abstract : This work aims to express approach the focus of our attention to two elements that inhabit the Jungian thought: The spiritual dimension which is derived form that Jung conceives its own therapeutic work, as well as their understanding of the meaning of life and the value that it has suffering and grief that are associated with it. “Cure of souls” as something that, ultimately, necessarily goes beyond the framework of scientific medicine and psychology. The complex network of metaphysicians budgets and the philosophical affiliations which, successively, will go by adopting the Jungian thought along its gestation speech. Key words : archetype, individuation process, self, enantiodromia, persona, shadow, animus, anima, active imagination, wu-wei, psychological projection, pleroma, metanoia, hierogamy.

‘I want to erase him from my memory,’ she said, ‘his eyes, his eyes staring at me … they are there every night, his hand … every night it hits me again and again …’. On the basis of these few words taken from the therapeutic work with Keltoum, the author reflects theoretically and clinically on the place of memory in a traumatism: a fixed memory, a ‘frozen image’, the signs of a traumatic compulsion to repeat, are the expressions of a process of psychic disorganization but also of a ‘symbolized and symbolizing’ memory anticipating a possible historicization of this memory, of a path, therefore, towards a resolution of the trauma resulting from a process of psychic integration and reorganization.

This article highlights the issue of how the practice of psychoanalytic therapy is affected by its being conducted within the context of war and terror. The author confides not having given this question any systematic thought prior to writing the article, in spite of having lived and worked for decades in that context. He shows how his personal history and the course of his career as a therapist were intertwined with the history of the political conflict, and politically involved though he was, he seems to have vertically split-off its potential effect on his therapeutic work. Four vignettes are presented to explore the clinical and ethical dilemmas he faced under these circumstances, and an attempt is made to seek some answers.

Phenomenology has inspired many forms of therapeutic practice over the past century. This paper summarizes fundamental aspects of phenomenological practice, which are often forgotten. It covers phenomenological, eidetic and transcendental reductions and briefly introduces other aspects of structural existential analysis such as four worlds model, timeline, and emotional compass. The work is brought to life with the case illustration of a client discovering how to make sense of her world by applying phenomenological principles.

Socrate and Erickson: so far, so close. The aim of this article is to show the role of Erickson as a philospher, in a diachronic comparison with Socrates. A comparison between eras and different cultures in the Socratic thought in Greece, in the 5th century B.C and in the ericksonian thought in the United States, in the 20th century. Socrates spreaded the knowledge to those of mankind who had an innate aptitude. After a dialectic and non retorical confrontation, based on "to know thyself" they could reach the knowledge and the erudition. Through the maieuticus they could become men of art. Erickson by means of hypnosis prepared the change in people, using their positive experiences, allowed the individual to evolve, giving them the time they need, whilst maintaning their psychic skills, so they can increase their awareness. Using Platon’s dialogues “Phaedrus” and "Charmides" this article demonstrates the Socratic thought, comparing it with the elements of the Ericksonian therapeutic work taken from the writings of Zeig, Erickson’s student and current director of the M.H.E foundation. La finalita del presente scritto e quella di proporre la figura di Erickson in veste di filosofo in un confronto diacronico con Socrate. Un confronto di epoche e culture differenti che si manifestano nel pensiero socratico della Grecia del V secolo a.C., e in quello ericksoniano degli Stati Uniti d’America del XX secolo d.C. Socrate trasmetteva la conoscenza solo agli uomini che possedevano una predisposizione innata, dopo di che attraverso il cammino in un confronto dialettico e non retorico nel ‘conoscere se stessi’, progressivamente si giungeva alla conoscenza e alla sapienza utilizzando la maieutica per divenire uomini d’arte. Erickson con l’ipnosi predisponeva il cambiamento nelle persone utilizzando le loro esperienze positive lasciando che la singola persona potesse evolvere rispettando i propri tempi e le proprie facolta psichiche, giungendo a un ampliamento della conoscenza di se stessi. Quindi verranno commentate alcune parti del Fedro e del Carmide di Platone nelle parti utili al confronto per enucleare l’operato socratico e si paragonera con gli aspetti del lavoro terapeutico ericksoniano dagli scritti di Zeig allievo di Erickson e attuale Direttore della Fondazione MHE.

Movement disorders and psychomotor deficiency is highly represented among patients in Schizophrenia – residual type.Our therapeutic work and the results we are herewith presenting, reveal that the psychomotor deficiency by Schizophrenia residual conditions represent new and significant indication fields for specific rehabilitation treatment in psychiatry.Evaluation of efficacy after 6 weeks specific rehabilitation treatment with the Vilan method showed: very satisfactory results in correction of involuntary movements of the torso,  bradykinesia of the hands, praxia and the simple simultaneous movements; satisfactory correction of involuntary movements of the extremities, walking and the facial gestures. No correction was in: involuntary movement of mouth and face, tremor, ideation, ideo‑motor series and in complex simultaneous movement.

Attachment theorists have highlighted the role of the therapist in providing a ‘secure base’ for therapy. This raises the question of how therapists with insecure as well as secure attachment styles manage the integration of their personal experience and their therapeutic work. This study explored the relationship between family therapists’ adult attachment styles, influences on their career choice and their approach to therapy. Participants’ (n = 11) attachment styles were previously assessed using the self-report Experiences in Close Relationship questionnaire. Three participants were assessed as having a ‘secure’ attachment style; three were ‘preoccupied’, three ‘fearful’ and two ‘dismissing’. They were interviewed about their practice and the impact of past or current relationships on their development as therapists. Interpretive Phenomenological Analysis was used to analyse the verbatim accounts into cluster of master themes and subthemes. The analysis identified two master themes: understanding one’...

Therapeutic work with alcoholics has revealed the difficulties these patients encounter in their sexual relationships and how these difficulties affect their sexual satisfaction. The aim of this research is to determine the sexual satisfaction and the possible sexual dysfunctions of abstaining alcohol-dependent patients. The sample comprised 150 alcoholic patients undergoing rehabilitation. We show that alcoholism has a direct impact on the quality of the sexual life of these patients, mainly due to sexual dysfunction and premature ejaculation in males and the avoidance of sexual relationships and dissatisfaction in females. This affects commitment to the couple relationship and hence their intimacy and mutual sexual satisfaction.

This research explores therapists’ reactions to discussions of religion and spirituality in secular psychotherapy. We used a mixed method design including qualitative and quantitative components to examine data from 14 mental health professionals. Therapists acknowledged the importance of, and outlined reasons for, engaging in religious/spiritual discussions. They provided examples of the diverse ways in which their own views on religion/spirituality have an effect on their therapeutic work. Therapists view attention to religion/spirituality in trauma therapy as necessary. They see an emphasis on religion/spirituality within the treatment of traumatized clients as possessing distinctive qualities in comparison to their treatment of other populations.

Couple therapy, as a distinct focus of therapeutic work, has been emerging from under the light of family therapy for many years. In the past 20 years or so, distinct approaches have also emerged: ...

This article proposes that an important aspect in treating adults with early parental loss is helping them retrieve a positive inner sense of the deceased parent. Not having an inner representation of the parent is experienced as a double loss: the actual loss due to death, and additionally, the loss due to a lack of memory and inner connection to the deceased. Access to memories and inner representations are often lost in the process of defending against layers of pain experienced at the death of the parent. This article first discusses salient issues to be dealt with when treating such adults and then speaks to the value of therapeutic work which encourages retrieving memories and positive identifications with the deceased parent.

In this paper, the concept of improvisation in psychotherapy is reviewed. The concepts of effective therapist (a) and improvisation are described, distinguishing the resources that influence both elements are linked, becoming in the psychotherapeutic success. 3 Creative methodologies therapeutic work are described. Literature from psychology and policy was reviewed and it was concluded that a (an) effective therapist improvising successfully establishes a positive link with the person and makes flexible use of psychological technique and their own knowledge based on the needs presents person served. Finally, some thoughts are raised to visualize the cross-influence exercise paradigm, gender and class in the therapeutic process.

Technology and informatics become part of our daily life. Conversely, the on-line therapeutic work is a reality presenting new possibilities and challenges for the professionals. Hardware and software turned more sophisticated as well as the new technological solutions to surpass communication barriers. Several studies reveal that “computerized psychology” is a poorly investigated field, which makes it a very promising study area. This paper presents a work in progress project, which consists on the development of an application that will facilitate the interaction among psychologists and patients. The application has two goals. The first one will allow to a professional in the field of psychology, to obtain a preliminary analysis of the patient's condition, even before the face-to-face appointment. A registered patient may submit narratives in which he reports his situation, and the application will subsequently treat the text and will analyze it. Then, a graphical presentation focused, fundamentally, on user's five senses indicators (hearing, smell, touch, vision and taste) will be designed. Finally, the data analysis will be presented to the assigned psychologist. The second goal is to evaluate, automatically, the patient tests. Games and other activities will be reported as prescriptions. The presented application was designed based on the opinion of the psychologists interviewed. Since the communication process will be text and the patient will be free to send it, any time, to the psychologist, it is our conviction that patients will adhere to use it. A group of patients intervene in the practice tests conducted.

This article examines the use of adventure-based experiential therapy (AET) with child and adolescent psychiatry inpatients. AET environments, indications, practicality, therapeutic effects and research are outlined and clinical findings are reported. Activities such as rock-climbing, exploring a creek and caving are discussed and the limitations of AET in the hospital setting are addressed. AET activities range from leisure-time activities and activities that facilitate change to actual therapeutic work. Case studies showing the effects on individuals and groups, with and without specific processing of the activity, are surveyed and the similarities to mentalization-based psychotherapy are touched upon. Possible future research directions are suggested. As AET treatments are not commonly discussed in child and adolescent psychiatry, this article seeks to be a catalyst for further discussion and research.

The study explored ways that therapeutic work can be done with bereaved families in the Zimbabwean, African cultural context. The study used stories that families provided about their losses. These narratives were explored as ways to inform therapeutic practice. Findings were that a focus on solutions is valuable as an adaptive intervention and might prove to be one of the most effective means by which a number of people in Zimbabwe learn to cope with grief and adapt after the death of loved ones.

In this paper, the author reflects on the issues of memory and the writing of personal memoirs, and how this impinges on our professional work. Her title is drawn in part from the work of theoretical physicists who can hypothesise about the existence of dark matter by measuring the deformations it causes in surrounding stars and galaxies. What she suggests is that there may be limitations in keeping strictly to disciplinary boundaries, and our professional lives may defy our efforts to box them in. The opening of doors to a more extensive world of ideas is often helpful, both for psychoanalysis and for the fields which it can illuminate and by which it can also be illuminated. She uses the example of the publication and critical reception of her own memoir, Pieces of Molly to make links with our professional selves and our clinical work. She draws on the work of Freud, and other seminal thinkers in the field, as well as her own clinical work to illustrate the ways in which mental space and the memories wi...

This article describes a new method of sandtray therapy, the Therapeutic Sandstory Method, as a therapeutic journey for children and adolescents. Three main theoretical tenets to the Therapeutic Sandstory Method are described. These are sandtray therapy, storymaking in therapy, and narrative letter writing. The article provides a stage-wise description of the method and concludes with a brief case study by means of illustration. It is proposed that the Therapeutic Sandstory Method provides an effective short- to medium-term therapeutic engagement which can be used in a range of settings outside the confines of the consulting room and in under-resourced settings. It is ideally suited for therapeutic work in a postmodern constructionist orientation and seeks to empower children and adolescents, affirming alternative identities and exceptional life stories.

This article presents a transactional analytic model of therapeutic work with couples. The authors offer a perspective on the psychological structure of couples and their developmental dynamics and...

Recent decades have witnessed an extraordinary amount of conceptual and empirical work on attachment theory in psychology and psychotherapy. Attachment theory is discussed in the present article as a way of understanding and fostering therapeutic work with 2 other key relationship constructs that have been theorized to be elements of all psychotherapies: client transference and the real relationship existing between the therapist and patient. Fundamental features of attachment, transference, and the real relationship are summarized. Particular emphasis is given to the role of the therapist as a secure base and a safe haven within the real relationship, and to the patient's internal working model as it relates to transference. A case of long-term psychodynamic psychotherapy conducted by the first author is presented to illuminate the 3 main constructs. The case demonstrates both the usefulness of attachment theory and the fact that any single theory cannot explain all of the complex features of a given treatment.

The purpose of the present study was to measure client affect over small timescales within therapy sessions, in order to identify affective patterns that might distinguish good versus poor sessions. Toward this end, patterns of affect were observed across 15-s intervals throughout one therapy session for each of four different clients being treated for generalized anxiety disorder using cognitive-behavioral therapy. The primary hypothesis was that during “good” therapy sessions (as defined by high session alliance scores and good therapy outcomes), clients would exhibit a pattern of positive–negative–positive (PNP) affect during the course of the session, reflecting prolonged periods of negative affect consistent with productive therapeutic work, situated between periods of positive feeling. Clients in “poor” sessions were not expected to show this pattern. The findings were consistent with predictions. There was also a non-significant trend suggesting that clients in good sessions demonstrated a greater frequency of very small PNPs—as brief as 45 s—suggesting a potentially greater number of “micro-episodes” of therapeutic work. Implications of the findings are discussed.

The Contextual Assessment and Treatment Schema has been used for the last twenty years in psychological and therapeutic work in the United States and Latin America. It is used in combination with the author's Mattering Map based in contextual theory and practice. This article discusses its application with immigrant clients to the North American countries of the United States and Canada.

The purpose of this paper is to demonstrate the importance of using a culture-infused counseling approach when working with adolescents who use social media. The majority of contemporary youth are frequent users of web-based communication modalities such as social networking sites, and smartphones, and they are navigating the developmental tasks of adolescence in this digital environment. Digital youth are growing up in a significantly different environment than previous generations and as such, they should be considered as a distinct cultural group. Those counselors who work with digital youth may benefit by taking a culture-infused approach to therapy as they would have a better understanding of the systemic and contextual factors that influence their clients and their presenting concerns. Such an approach would include three cultural competencies: awareness, knowledge, and skill.

Therapeutic work with patients who are chronically suicidal and have borderline personality disorder (BPD) is challenging, and clinicians often resort to setting firm limits or excessively cautious interventions in efforts to prevent manipulation, regression, or over-dependence. Litigation and malpractice fears reinforce these stances, and reduced compensation for additional time and energy devoted to patients adds further disincentives to sole providers. However, elements of the working alliance and therapeutic limits are within the therapist's control. A case vignette illustrates an individual therapist's modification of usual therapeutic limits while working with a chronically suicidal patient with BPD within a dialectical behavior therapy (DBT) framework over a 16-week period. Discussions regarding the case, interventions used, DBT, and legality concerns follow.

Over the past decade, there has been an explosion of interest in clinical applications of attachment theory. In the present article, we briefly describe John Bowlby's model of therapeutic change, the therapeutic relationship, and the therapist's role in emotional healing. We then review empirical evidence for three key propositions in Bowlby's model. First, a client's sense of security during therapy is crucial for facilitating therapeutic work. Second, a therapist's own sense of security contributes to positive therapeutic outcomes. Third, attachment insecurities can be effectively reduced in therapy, and movement toward greater attachment security is central to achieving favorable therapeutic outcomes. In sum, research evidence confirms the importance of establishing what Bowlby called a safe haven and a secure base within a therapeutic relationship.

Recent scientific evidence highlights the importance of the body, in its both cognitive and emotional aspects, and this stimulates therapists to seek more integrated forms of therapy. This article introduces the Neo-Funcionalism approach, which is a key therapeutic approach that emphasises the importance of the body. The first part of the article provides evidence supporting the approach and discusses two of its most important components: the 'functions' and the 'basic experiences'. In the second part of the article, the two conceptual components are discussed with reference to a case report of therapeutic work.

What does Adler mean to us 75 years after his death? An initial appraisal of Gisela Eife’s paper: »Some thoughts on a post-Adlerian Individual Psychology«. Personal experience and further thoughts. After a positive assessment of Gisela Eife’s paper (in this issue), the author turnst o the question of whether the Adlerian holisitic approach can prevent us from seeing the details in our therapeutic work. Based on personal experience, the author shows that concepts from the Freudian tradition are necessary in order to gain a deeper understanding of psychic processes. Furthermore, the author points out the importance of recent research results which have been discussed in the context of empirical infant research studies. Finally, it is suggested that Adler’s holistic perspective could be particularly helpful in understanding the intra-psychic and inter-subjective conflicts of later life.