The Outcome of Maritally Focused Psychotherapy offered as a Possible Model for Marital Psychotherapy Outcome Studies

Abstract. A model for describing and judging change in a couple relationship is set out, drawing on a follow-up method established at the Tavistock Clinic for the assessment of change in individual patients . We present the follow-up work done with the couple in the chronological order in which it occurred.
Our aim is to show how a psychodynamic formulation of a relationship can be made by using the concept of the shared unconscious phantasy as a factor which describes and justifies treating separate individuals as part of a single system. We suggest that such a framework provides an economic method of formulating a base from which to assess change.     

Homework Assignments in Brief Psychotherapy

ABSTRACT: A rationale is offered for the use of homework assignments in brief therapy. It is argued that such assignments help maintain a therapeutic focus, strengthen the therapeutic alliance, enhance motivation and can reduce termination difficulties. The analysis of resistance to carrying out homework is also discussed and it is suggested that it can be a potent tool in clarifying motivational problems and blocks to the generalisation of therapeutic gains into the patient's daily life. Problems for therapists and patients in using such techniques are also briefly discussed. An extended case example is included to illustrate the practical application of homework assignments.     

Bulimia in Brief Dynamic Psychotherapy

In this paper I present some aspects of a brief psychoanalytically-oriented psychotherapy with a 25-year-old single woman presenting with a longstanding history of bulimia and who was subjected to early traumatisation. In particular, the three main psychodynamic features which emerged during treatment are described. The finding that her binge-eating stopped after the assessment and before formal therapy started remains only partially explicable but some possible underlying factors are discussed. At two years follow-up the patient remains improved.     

Psychodynamic Psychotherapy,Insight, and Therapeutic Action

It has often been observed that, in general, different psychotherapies do equally well. Some have taken this as good evidence that therapeutic action in psychotherapy rests not on the factors specific to individual therapies, but on common factors. I argue against this view in favor of a theory of therapeutic action deriving from psychodynamic psychotherapy. This identifies the therapeutic relationship (and with it, many so‐called common factors) and “psychodynamic insight” as therapeutic factors. I review the evidence from outcome studies and from studies into two concepts related to insight, specifically reflection function and psychological defense. I argue that the best interpretation of the evidence supports the claim that insight, in interrelation with the therapeutic relationship, contributes to therapeutic action.     

Psychotherapy in the General Practice Surgery: Working With and Without a Secure Therapeutic Frame

Many general practices employ psychotherapists and counsellors. Some GPs have also had personal therapy and may have training in counselling or various therapies. Where different approaches are used, conflicts and rivalries can arise. This paper describes a flexible model which has helped one practice negotiate these issues. The model permits several levels of work: from opportunistic counselling in ordinary GP surgeries, to formal 'secure-frame' psychotherapy. The model allows patients and practitioners to sculpt their own experiences of counselling and therapy from a variety of approaches, and allows us to combine therapeutic work with medical practice.     

Exploratory Therapy in Two-Plus-One Sessions I - Rationale for a Brief Psychotherapy Model

This paper presents the rationale for a brief form of psychotherapy based on the Conversational Model of psychotherapy developed by R F Hobson. In the proposed model, termed Two-Plus-One Exploratory therapy, clients are seen for two sessions one week apart followed by a third session three months later. Issues pertaining to service delivery needs and client selection are discussed prior to presentation of (1) the clinical basis for the model, and (2) the research bases relating to number of treatment sessions, treatment span, and planned follow-up. The implications of implementing the proposed model for both psychotherapy researchers and clinicians are discussed.     

Gender Differences in the Structure of Marital Quality

Marriages consist of shared experiences and interactions between husbands and wives that may lead to different impressions of the quality of the relationship. Few studies, unfortunately, have tested gender differences in the structure of marital quality, and even fewer studies have evaluated whether genetic and environmental influences on marital quality differ across gender. In this study, we evaluated gender differences in the structure of marital quality using independent samples of married male (n?=?2406) and married female (n?=?2215) participants from the National Survey of Midlife Development in the United States who provided ratings on twenty-eight marital quality items encompassing six marital quality constructs. We further explored gender differences in genetic and environmental influences on marital quality constructs in a subsample of 491 pairs of twins. Results suggest partial metric invariance across gender but structural variability in marital quality constructs. Notably, correlations between constructs were stronger in women than men. Results also support gender differences in the genetic and environmental influences on different aspects of marital quality. We discuss that men and women may approach and react to marriage differently as the primary reason why we observed differences in the structure of marital quality.     

Brief Psychotherapy in an Adolescent Medical Clinic: A Case Example

A large percentage of the patients who come to an adolescentmedical clinic manifest some degree of psychological distress,but often these patients initially prefer to see their problemsas medical and so do not seek the services of a mental healthpractitioner. The case example presented demonstrates one importantfunction which a specialist in mental health can serve in ageneral medical clinic. It describes the treatment of a 14-year-oldgirl who was depressed and suffering from feelings of depersonalization.It highlights the point that although her symptoms were severeenough to induce her to take a leave of absence from her positionsas vice-president of the student council and president of thePep Club, she had a number of strengths which enabled her tomake use of brief psychotherapy. Thus, she was well suited fortreatment in the medical setting where she presented herself.By participating in treatment there, she was able to attainsome resolution of her difficulties and a remitting of her symptoms,without referral to a psychiatric clinic.     

心理与药物治疗学生考试焦虑的疗效观察

目的 探讨单纯心理治疗、单纯药物治疗以及心理、药物合并治疗学生考试焦虑的疗效。方法 将符合入组标准的69例求助者随机分为3组,分别给予心理治疗、药物治疗及心理合并药物治疗,于考试前2周,考试前1天及下学期考前1天,分别进行HAMA及SAS量表评定。结果．心理治疗组及药物治疗组考试前1天与干预前比较HAMA、SAS评分差异显著,而下学期考前1天同干预前比较无明显差异。心理合并药物治疗组考试前1天及下学期考试前1天,同干预前均有明显差异。结论 对于学生考试焦虑的治疗以心理合并药物治疗的近期及远期效果均优于单一治疗方法,应作为首选。     

Brief Focal Psychotherapy with a Pregnant Woman Presenting with Nightmares of Killing Her Baby: A Case Study

This paper reports an 18 session treatment in brief focal psychotherapy of a case that presented with at least two major contra-indications for this type of therapy: 1) childhood deprivation and 2) the danger of intensification of a depressed illness. This paper shows that the recent traumatic event, in this case a highly ambivalent pregnancy, can help to destabilize the armour of a defensive structure, and bring to the surface primitive fears and conflicts which cause severe symptomatology and distress but which become more accessible to the patient's awareness and more amenable to interpretation. The acuteness of the disturbance brought about by the traumatic event increased the patient's motivation and need for treatment, speeding up the therapeutic process. This brief psychotherapy shows the importance of the working through of the patient's intense hostility towards her mother and towards the therapist in the transference, if a solution of murderous feelings towards her baby are to be achieved. As far as technique is concerned, this paper shows that a thorough interpretation of the negative transference from the early stage of therapy, an unusual number of transference/parents interpretations and the working through of the patients's anger and grief about termination seemed to be essential factors correlated with a positive outcome.     

Psychotherapy and black women: a survey

A survey of black and white psychiatrists on the subject of nonpsychotic black female patients in psychotherapy yielded 93 usable responses. Among the findings are a profile of the average black woman in psychotherapy, responses to questions on clinical and therapeutic issues, and the role of racism as reported by the psychiatrists.