Approaching the Transference Relation in Cognitive-Behaviourism: Applying a Lacanian Logic

Authors aiming to conceptualize a ‘cognitive countertransference’ continue to search for the most effective way to integrate psychoanalytic theory, and a coherent definition for such a concept. This paper first argues that authentic attempts at integration of the concept of transference into cognitive-behaviourism require a return to seminal work on Übertragung (transference) and Gegenübertragung (countertransference). References to these terms throughout the work of Sigmund Freud and Jacques Lacan are discussed in the context of the overall progression in the work of both theorists. With regard to two fundamental psychoanalytic concepts that underlie a Freudo-Lacanian understanding of transference – the unconscious and repetition – this paper subsequently explores how a Lacanian logic may inform the emerging ‘cognitive countertransference’ literature. This paper contextualizes such thinking within the ongoing psychoanalytic debate regarding the utility of the analyst's participation in the transference relation. Ultimately, this paper argues that a cognitive countertransference may be redundant in favour of an understanding of shared cotransference, or transference relation, which begets simple theoretical conclusions, and technical recommendations. Implications for cognitive-behavioural theory and practice are examined.     

Transference,countertransference, and reflective practice in cognitive therapy

Background: The concepts of transference and countertransference developed within psychodynamic paradigms. While there is an increasing interest by cognitive therapists in the therapeutic relationship, there is less discussion of the relevance of transference and countertransference. Understanding these concepts may be useful to cognitive therapists as part of reflective practice, especially in regard to understanding and managing countertransference responses. Methods: This article briefly examines the concepts of transference from a number of different perspectives, including social‐cognitive, attachment, cognitive analytic therapy, and schema perspectives. Two aspects of countertransference that are sometimes termed “subjective” and “objective” are also examined. A case example is given to illustrate a cognitive conceptualisation of countertransference. Results: There is some evidence that therapists' countertransference responses can provide insight into clients' experiences and patterns of relating to others. Cognitive therapists may therefore benefit from applying psychodynamic perspectives of countertransference in reflective practice. Conclusions: Transference and countertransference can be understood using cognitive perspectives. These concepts may be helpful for cognitive therapists to consider during reflective practice in self‐supervision and in clinical supervision. It seems important that cognitive therapists do not dismiss these concepts because of their origins but rather investigate the potential applications of these concepts within cognitive frameworks.     

Biased thinking assessed by external observers in borderline personality disorder

Objectives. Biased thinking (to some extent overlapping with the concepts of cognitive distortions and cognitive errors) is a key concept in cognitive therapy of Borderline Personality Disorder (BPD). Specific contents and cognitive processes related to BPD functioning are known. However, most studies are based on self‐report measures which present a number of important limitations, in particular the difficulty in assessing non‐conscious processes infused by affect. So far, no studies were conducted using valid observer‐rated methodology addressing the question of biased thinking in BPD as it unfolds spontaneously in session. Design. This is a controlled interview study comparing two matched groups, BPD patients and healthy controls. Methods. A total of N= 25 clinical dynamic interviews with patients presenting with BPD were transcribed and rated using the Cognitive Errors Rating Scale ( Drapeau, Perry, & Dunkley, 2008 ); their cognitive profiles were compared to those of N= 25 healthy controls who underwent the same procedure. Results. Overall, results indicated that no between‐group difference in the frequency of specific biases was found. However, heightened levels of negative cognitive biases, in particular over‐generalizing and fortune‐telling, were associated with BPD. Furthermore, negative over‐generalizing was associated with the number of BPD symptoms. Conclusions. These results have high levels of ecological validity and are promising for the refinement of cognitive theory of BPD. Clinical implications for assessment and intervention are discussed.     

Collaboration in Psychodynamic Psychotherapy

The concept of the collaborative relationship between patient and therapist has its roots in the psychodynamic literature. We trace the concept of collaboration in psychodynamic psychotherapy from classical psychoanalysis to contemporary psychoanalysis and psychodynamic therapies. The active collaboration between the participants central to Bordin's pan‐theoretical perspective on the alliance is highlighted. Developments in alliance‐fostering techniques and in relational therapy offer the clinician innovative ways to enhance the collaboration and to repair strained or ruptured collaboration. A case study illustrates how the collaborative work in psychodynamic therapy serves as both a means of productive work and as an arena for exploring the evolving here‐and‐now matrix of the relationship.     

Efectos del mapa conceptual sobre la síntesis de información en un ambiente de aprendizaje interactivo: Un estudio preexperimental

IntroductionThe amount of information during the inverted classroom, as a result of its virtual and face-to-face components, is high. Ultimately, it is expected a greater cognitive load leading to confusion and lack of understanding of the main concepts to the students. The objective of this study is to evaluate the effect of conceptual maps, aimed to synthesize the information and deal with the cognitive load in the inverted classroom.MaterialsWe developed conceptual maps for the synthesis of information in a conventional inverted classroom in surgery during 2017. We constructed the maps using standardized methodologies. We used the CMap Tools software. We evaluated the pre- and post-intervention effects, related with the utility and satisfaction perceived by the students, by the Concept Mapping Questionnaire.ResultsA total of 158 students (pre-test) and 155 students (post-test) were included in the analysis. We found positive effects on interaction (communication, cooperation, and participation), independent learning and connection of concepts, according to student perceptions. The reliability of the instrument was adequate.ConclusionConcept maps are a useful strategy for the synthesis of information in the inverted classroom according to student perceptions. Further studies are required that evaluate, functionally and experimentally, the neuro-cognitive effectiveness of conceptual maps, as well as their effects on long-term learning.     

Theory-based research for understanding the process of dynamic psychotherapy

Research is reviewed on 6 theoretical propositions central to psychodynamic psychotherapy: (1) The establishment of an alliance is important to successful outcome; (2) the patient displays a central relationship theme (transference); (3) transference interpretations are helpful; (4) the therapist aims at accurate interpretations of the transference; (5) the patient gains understanding of self and the relationship pattern; and (6) the patient's improvement is reflected in changes in the relationship pattern, although the pattern is still evident. We suggest concepts that are in need of research development: internalization, resistance, working through, self-understanding and insight, and the therapist's adherence to recommended techniques.     

Synthetic quantitative MRI through relaxometry modelling

Quantitative MRI (qMRI) provides standardized measures of specific physical parameters that are sensitive to the underlying tissue microstructure and are a first step towards achieving maps of biologically relevant metrics through in vivo histology using MRI. Recently proposed models have described the interdependence of qMRI parameters. Combining such models with the concept of image synthesis points towards a novel approach to synthetic qMRI, in which maps of fundamentally different physical properties are constructed through the use of biophysical models. In this study, the utility of synthetic qMRI is investigated within the context of a recently proposed linear relaxometry model. Two neuroimaging applications are considered. In the first, artefact‐free quantitative maps are synthesized from motion‐corrupted data by exploiting the over‐determined nature of the relaxometry model and the fact that the artefact is inconsistent across the data. In the second application, a map of magnetization transfer (MT) saturation is synthesized without the need to acquire an MT‐weighted volume, which directly leads to a reduction in the specific absorption rate of the acquisition. This feature would be particularly important for ultra‐high field applications. The synthetic MT map is shown to provide improved segmentation of deep grey matter structures, relative to segmentation using T₁‐weighted images or R₁ maps. The proposed approach of synthetic qMRI shows promise for maximizing the extraction of high quality information related to tissue microstructure from qMRI protocols and furthering our understanding of the interrelation of these qMRI parameters.     

Effects of initial severity of dysfunctional thinking on the outcome of cognitive therapy

The relation between initial severity of dysfunctional thinking and response to cognitive therapy was examined. Participants from four studies were pooled (n = 133) and the relations between the Dysfunctional Attitude Scale, Cognitive Error Questionnaire, and Hamilton Rating Scale for Depression were examined. Results failed to replicate previous findings of a poorer response to treatment for participants higher in dysfunctional thinking. Failure to replicate was observed across subsamples varying in age and treatment modality. Cognitive therapy may not be contraindicated for persons evidencing higher levels of dysfunctional thinking.     

共情概念的演变

虽然共情概念出现至今已有近百年历史,但共情的概念仍是该领域学者探讨的主要问题之一。该文介绍西方学者有代表性的共情概念及其演变,分析该领域学者对共情的本质、共情中认知和情感成分关系的不同理解。     

Error monitoring and empathy: Explorations within a neurophysiological context

Past literature has proposed that empathy consists of two components: cognitive and affective empathy. Error monitoring mechanisms indexed by the error‐related negativity (ERN) have been associated with empathy. Studies have found that a larger ERN is associated with higher levels of empathy. We aimed to expand upon previous work by investigating how error monitoring relates to the independent theoretical domains of cognitive and affective empathy. Study 1 (N = 24) explored the relationship between error monitoring mechanisms and subcomponents of empathy using the Questionnaire of Cognitive and Affective Empathy and found no relationship. Study 2 (N = 38) explored the relationship between the error monitoring mechanisms and overall empathy. Contrary to past findings, there was no evidence to support a relationship between error monitoring mechanisms and scores on empathy measures. A subsequent meta‐analysis (Study 3, N = 125) summarizing the relationship across previously published studies together with the two studies reported in the current paper indicated that overall there was no significant association between ERN and empathy and that there was significant heterogeneity across studies. Future investigations exploring the potential variables that may moderate these relationships are discussed.     

Working in the transference: Clinical and research perspectives

The aim of this paper is to address a matter that has been noted, but not adequately confronted, in the psychotherapy research literature – that different psychoanalytic psychotherapists mean very different things by the expression transference interpretations. We explore the matter in three ways: firstly, by providing a brief overview of clinical perspectives on transference interpretations; secondly, by looking at examples of transference interpretations provided by researchers who have studied this form of clinical intervention; and thirdly, by reporting an empirical study of the quality, frequency, and distribution of transference interpretations employed by a psychoanalytic psychotherapist in the course of three routine psychodynamic assessment interviews in the National Health Service (NHS). We emphasize that the meaning of a clinical concept such as transference interpretation is grounded in a set of therapeutic principles and practices that are difficult to characterize by means of a succinct definition. It follows that we should be circumspect about generalizing from research on the therapeutic effectiveness of transference interpretations when what is meant may differ widely from study to study.     

The appraisal of threat and the process of selective attention in clinical and sub-clinical anxiety states I: Theoretical issues

The present paper is the first of two which seek to integrate the concepts of anxiety and attention within a cognitive framework and assess the empirical evidence which bears on this relationship. The current discussion concentrates on theoretical issues. An initial section examines the concept of attention at what Marr (1982) called the computational level of analysis. This is followed by a discussion of anxiety as a paradigm case within cognitive-appraisal models of emotion, particularly that of Oatley and Johnson-Laird (1987). An integrated framework is then proposed, in which four types of bias in attentional processing associated with anxiety are posited. This is supplemented by a discussion of the concept of self-focused attention.     

What is narrative therapy and what is it not? The usefulness of Q methodology to explore accounts of White and Epston's (1990) approach to narrative therapy

Objective. ‘What is narrative therapy and how do you do it?’ is a question that is repeatedly asked of narrative therapy, with little consistent response. This study aimed to explore and distil out the ‘common themes’ of practitioner definitions of White and Epston's approach to narrative therapy. Design. This was an Internet‐based study involving current UK practitioners of this type of narrative therapy using a unique combination of a Delphi Panel and Q methodology. Method. A group of experienced practitioners were recruited into the Delphi Poll and were asked two questions about what narrative therapy is and is not, and what techniques are and are not employed. These data combined with other information formed the statements of a Q‐sort that was then administered to a wider range of narrative practitioners. Findings. The Delphi Panel agreed on a number of key points relating to the theory, politics and practice of narrative therapy. The Q‐sort produced eight distinct accounts of narrative therapy and a number of dimensions along which these different positions could be distinguished. These included narrative therapy as a political stance and integration with other approaches. Conclusions. For any therapeutic model to demonstrate its efficacy and attract proponents, an accepted definition of its components and practice should preferably be established. This study has provided some data for the UK application of White and Epston's narrative therapy, which may then assist in forming a firmer base for further research and practice. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message: ? Narrative therapy and how it is carried out remain unclearly defined, which limits studies of the efficacy of this approach. ? Experienced practitioners of narrative therapy were able to identify a set of core concepts, values and techniques over which there was some consensus. ? This study also identified the different ‘positionings’ of narrative therapy that have contributed to its opacity and have highlighted the diversity in therapist practice.     

A Special Feature on Collaboration in Psychotherapy

Collaboration between a psychotherapist and a patient occurs at the intersection of the therapeutic relationship and treatment method. Many methods contribute to collaboration, which is then experienced as a respectful, mutual, cooperative relationship. Despite its noble history and its empirical evidence as an important attribute in psychotherapy, collaboration has rarely been operationalized and illustrated in ways that might concretely guide clinical practice. This article introduces an issue of the Journal of Clinical Psychology: In Session designed to describe and illustrate the role of the psychotherapist in facilitating collaboration. Expert practitioners present case examples of collaboration in psychodynamic psychotherapy, cognitive‐behavioral therapy, experiential therapy, family therapy, mindfulness‐based cognitive therapy, multicultural therapy, and in the context of pharmacotherapy. In the final article, a practitioner‐friendly review of empirical research on collaboration is offered.     

Metacognitive beliefs and psychological well-being in paranoia and depression

Introduction. Despite the growing interest in the effects of metacognitive beliefs and psychological well-being on psychiatric conditions, little is known about how these two variables interact in clinical samples. The central aim of this study was to investigate the role of some metacognitive beliefs in the relationship between psychological well-being dimensions and psychopathology.

Methods. Fifty-five participants with persecutory delusions diagnosed with schizophrenia or other psychotic disorders, 38 participants with a major depressive episode, and 44 healthy controls completed the 30-item short form of the Metacognitions Questionnaire (MCQ-30) and the 54-item form of the Ryff Scales of Psychological Well-Being (PWB).

Results. MANCOVA analyses revealed group differences on four subscales of PWB (self-acceptance, autonomy, personal growth, and environmental mastery), as well as on three subscales of MCQ-30 (uncontrollability of worry, need to control thoughts, and lack of memory confidence). Moderation analyses showed the interaction between persecutory thinking and cognitive self-consciousness to be a predictor of psychological well-being.

Conclusions. These findings suggest that psychological well-being is particularly compromised in participants with a high level of persecutory thinking when they have low levels of cognitive self-consciousness.     

Electrophysiological evidence for early perceptual facilitation and efficient categorization of self‐related stimuli during an Implicit Association Test measuring neuroticism

The Implicit Association Test (IAT) is a widely used latency‐based categorization task that indirectly measures the strength of automatic associations between target and attribute concepts. So far, little is known about the perceptual and cognitive processes underlying personality IATs. Thus, the present study examined event‐related potential indices during the execution of an IAT measuring neuroticism (N = 70). The IAT effect was strongly modulated by the P1 component indicating early facilitation of relevant visual input and by a P3b‐like late positive component reflecting the efficacy of stimulus categorization. Both components covaried, and larger amplitudes led to faster responses. The results suggest a relationship between early perceptual and semantic processes operating at a more automatic, implicit level and later decision‐related categorization of self‐relevant stimuli contributing to the IAT effect.     

Return of emotion in psychosocial community research

The community social psychology literature shows some evidence that affective factors are involved in community interventions, but there has been no systematic approach to the study of emotion. We define and characterize emotion as affect to study its relationship with consciousness-raising and action within community processes. Our theoretical position hinges on three main concepts: self-esteem, affective binding, and commitment towards community work. Our perspective is illustrated by a Participatory Action Research project in a poor neighborhood in Caracas, Venezuela. We observed and manipulated the emotional component. The results indicated the importance of emphasizing the affective factor in this kind of work. We describe a Consciousness-Affect-Action model to study community processes. © 1998 John Wiley & Sons, Inc.     

Changes in clients' relational patterns with parents and therapist during psychodynamic psychotherapy: Their association and relation to treatment outcome

Objective

The study aimed to explore how changes in clients' relational patterns during psychodynamic psychotherapy relate to treatment outcomes and therapy effectiveness.

Method

Seventy clients receiving psychodynamic psychotherapy in a university counseling center were interviewed three times and filled out the OQ-45 questionnaire five times during therapy. We used the Core Conflictual Relationship Theme (CCRT) to study clients' relational patterns. Mixed models were used to assess the interaction between clients' CCRT intensity toward their parents and toward their therapists, treatment effectiveness, and treatment outcome.

Results

First, we found that clients' relational patterns with their parents correlated with relational patterns with their therapists across several time points in therapy. Then, we found significant interactions, indicating that treatment effectiveness moderates the relationship between clients' CCRT intensity and treatment outcomes.

Conclusions

The findings suggest that the transference phenomenon is related to therapy outcomes differently in effective and less-effective therapies, depending on the transference intensity. Further research is needed to expand knowledge about the intensity of transference and its possible impact on treatment choice and management.     

Illness through the eyes of the child: the development of children's understanding of the causes of illness

In this study 158 children, 80 children with diabetes mellitus and 78 healthy classmates, were interviewed about their concept of different types of illness (a cold, diabetes, infection, the most and least serious disease) and illness-related concepts (pain, becoming ill and going to the doctor or hospital). Special attention was given to the relationship between development of thinking and the variables anxiety, locus of control and family- and school functioning. The results show that the ideas of the children about the causes of illness follow a sequence of developmental stages, described as 'Through the Eyes of the Child' (TEC) model. Perception seems to be the child's central auto regulative system of cognitive development. The findings suggest that thinking about illness develops relatively independently of other influences. The practical relevance of knowing how children's thinking about illness develops is elaborated in terms of their implications for health education. Immature thoughts of children about illness can be detected and accepted and not dismissed as irrational. With the help of this model, health education of the child can be facilitated.