Couple therapy for depression

Relationship problems and depression often influence one another in a bidirectional, recursive fashion. Results from several clinical trials have demonstrated that couple therapy is effective in improving depression and reducing relationship problems. In this article, we describe an approach to working with depression in partnered individuals who are also unhappy in their relationship. This cognitive-behavior approach strives to (a) eliminate major stressors and reestablish positive activities in the relationship, (b) improve communication and problem solving in the relationship, and (c) solidify gains made in therapy and prevent relapse. The typical course of therapy is described and demonstrated in a case illustration. Couple therapy is a promising treatment for depressed individuals in distressed relationships.     

Healing into wholeness: psychotherapy practice informed by the Discipline of Authentic Movement

In this article I offer personal reflections as a somatic and movement psychotherapist whose practice is profoundly influenced by the Discipline of Authentic Movement. The fundamental elements of the Discipline are discussed: close attention to embodied experience on the part of a mover and a witness; the relational resonance between them; and the rigour of speaking directly from experience. This foundation serves as the core of my therapy practice, whether or not we are working within the movement form itself. Attention is drawn, in particular, to the intersection between psychological processes and experience of utter presence in the moment. At this gateway the concentration on personal embodied history may open out to spaciousness, no longer bounded by the personal, and a knowing that we are whole and complete, just as we are. Here we meet the healing that is inherent in the relational practice of presence.     

Couple therapy with combat veterans and their partners

Service members returning from Iraq and Afghanistan face psychological challenges that can exert profound effects on families and couples, but can also be treated within a systemic context. Couple therapy offers a means of increasing social support, decreasing interpersonal conflict, and addressing the experiential avoidance that maintains posttraumatic symptoms. For combat veterans and their partners, we present an adaptation of integrative behavioral couple therapy (IBCT) that reduces conflict and encourages intimacy through acceptance and skills strategies. By doing so, IBCT exposes service members in couple therapy to emotions, interpersonal situations, and activities that facilitate recovery from combat-related distress. We illustrate common presenting problems in this population and the utilization of IBCT with a case example.     

Breathwork in body psychotherapy: Clinical applications

The use of conscious breathing practices for the purpose of physical, psychological, emotional and spiritual healing has a long and extremely varied history, yet little work has been done to bring these practices into a coherent and unified form that contributes to the field of body psychotherapy (BP). This article focuses on translating theoretical themes developed in a previous publication (Caldwell & Victoria, 2011. Body, Movement and Dance in Psychotherapy, 6(2), 89–101) into practical applications in the BP profession. The authors propose six clinical themes for the use of breath in BP, a balanced breathing exercise, and four clinical models for integration into BP practice. Recommendations are made for future research and training in this crucial area of BP.     

Embodiment and embedment: integrating dance/movement therapy,body psychotherapy,and ecopsychology

This article presents a vision of an emergent ecosomatic psychology that integrates somatic psychology's theories and practices of embodiment with ecopsychology's insights about embedment. Branches within somatic psychology, dance/movement therapy, and body psychotherapy have honed therapeutic practices for embodying the self, engaging in embodied relationships, and opening up to possibilities of transpersonal experiences through the body and movement. Incorporating ecopsychology's emphasis on the development of an ecological identity, inspired by systems and relational views of health, and drawing from theories of participatory consciousness and reciprocity, an integrative framework of embodied embedment practices are proposed for developing an embodied ecological self.     

A cloud and a box: an embodied triangle of imagery work in relational body PTSD psychotherapy supervision

This paper considers the place of imagery in supervision and their relational and corporeal resonances in the supervisory relationship. Drawing on Keleman's (1985) formative psychology concepts in order to explore clinical material through a composite case vignette from her supervision practice, the author considers her parallel process and describes the role of her countertransference in the embodied triangle of supervisor, supervisee and client.     

Beyond the patient: couple and family therapy for individual problems

We introduce the Journal of Clinical Psychology: In Session issue on couple and family therapies for adult psychological problems and health-compromising behaviors. The 8 articles, each with an extensive case study, represent different theoretical orientations (cognitive-behavioral, psychoeducational, systemic-strategic, experiential) and address problems with depression, anxiety, severe mental illness, substance use disorders, and dysfunctional coping with chronic illness. We identify points of consensus and divergence among the different therapies and consider implications for training psychotherapists.     

Belly dance and its links to body psychotherapy

This paper describes the therapeutic use of belly dance therapy (BDT) for women, context and process, on its own and in relation to body psychotherapy and the Chakra system. It gives a brief history of belly dance, references the author’s personal journey and describes a case study. It illustrates how BDT can empower women to serve themselves in their pleasure and pain by awakening the dissociated, traumatised parts of the body and non-verbal body memories through sensing and feeling the body and verbally articulating this.     

Resisting oppression: body psychotherapy techniques to empower women

Many women regularly experience sexist events and are the targets of sexual objectification. Objectification theory claims that repeated exposure to sexual objectification is likely to result in self-objectification, where value is put on external appearance over internal experience. Ambivalent sexism theory explains a two-factor system, made up of hostile sexism and benevolent sexism, which acts to keep women in a marginalised position. Both theories expose a plethora of potential negative consequences, including body shame, self-doubt, and self-harming tendencies. Somatic literature demonstrates that oppression can live in the body and posits that an important path to healing can be through the body. The theoretical model presented here aims to decrease self-objectifying behaviour in women by proposing body psychotherapy techniques intended to increase internal somatic awareness and cultivate greater relationship with the body.     

Made to Measure: Adapting Emotionally Focused Couple Therapy to Partners' Attachment Styles

This article summarizes the theory, practice, and empirical findings on emotionally focused couple therapy (EFT), now one of the best documented and validated approaches to repairing close relationships. EFT is based on an attachment perspective of adult intimacy. The article then considers how individual differences in attachment style have an impact on affect regulation, information processing, and communication in close relationships and how the practice of EFT is influenced by these differences.     

A study of significant moments of change in body psychotherapy

This article is based on research exploring significant moments of change in individual body psychotherapy. It involved semi-structured interviews with two body psychotherapists and two body psychotherapy clients. The research found that significant moments of change were identifiable. The participants gave precise and detailed accounts of the moment(s), and how the changes generalised to daily life. The longevity of the therapeutic relationship and the interactions during, and following the change moment were important for the change to stabilise.     

Brief Therapy and Family/Couple Therapy: An Essential Redundancy

"Brief" therapy and "family/couple" therapy are largely overlapping and redundant. Although there are almost no family/couple therapies that explicitly set time limits on treatment as a matter of course, the four central technical factors of brief therapy almost inevitably lead to therapeutic brevity in systems-oriented treatment. In this paper I emphasize that family/couple therapists tend to adhere to the dominant treatment values of brief individual therapists and set out the therapeutic values among family/couple therapists that increase the likelihood of most family/couple therapy being brief. Finally, I propose that families' and therapists' expectations about the length of treatment serve an important role in establishing the therapeutic alliance. The empirical study of the components of such expectations, and discrepancies in such expectations between therapists and families, may provide a fruitful approach for optimizing the therapeutic alliance and thus positively influencing treatment outcomes.     

Considerations of verbal and non-verbal communication in body psychotherapy

Communication with others has both verbal and non-verbal aspects. This article describes theory about the use of language in body psychotherapy, ways of the psychotherapist relating to the client's language, and the psychotherapist using language with different therapeutic purposes in mind. Illustrative case vignettes are included. Links are made to current thinking in neuroscience and cognitive psychology. Language in the therapeutic relationship is discussed in terms of emotional regulation and spiritual awareness by combining verbal and non-verbal communications with intention, presence, contact and awareness.     

Banter in psychotherapy: Relationship to treatment type,therapeutic alliance,and therapy outcome

Introduction

The use of humor in psychotherapy is widely considered to improve therapy outcomes and typically depends on context, patient sensitivity, and the therapist's humor style. Different types of humor may impact treatment type, therapeutic alliance, and therapy outcome; however, evidence from psychotherapy sessions on the role of banter has been sparse to date. Therefore, the study aims to examine banter in a secondary analysis of psychotherapy sessions.

Method

The sample consisted of 68 depressed outpatients treated with one of three treatment types: psychoanalytic therapy (PA), psychodynamic therapy (PD), and cognitive-behavioral therapy (CBT). Banter and therapeutic alliance were rated for therapy sessions taken from the middle phase of treatment, outcome was assessed at the end of treatment.

Results

The main findings were (1) clinical examples of banter in psychotherapy were found in 62 from 68 sessions, (2) significantly more bantering in the main bantering category of facilitation for CBT sessions as compared to other treatment types, (3) facilitative banter as a significant predictor for the positive introject, (4) a significant correlation between bantering and bond between therapist and client. Furthermore, based on these results, psychometric properties of the Klagenfurt Bantering Instrument (KBI) are reported.

Conclusion

From a bantering perspective, this study emphasizes the need to consider session context, client response, and sarcastic markers when categorizing negative banter using the KBI.     

A psychoanalytic perspective of endings in therapy: A dance movement psychotherapy case study

This paper is an account of time-limited dance movement psychotherapy in an inner-city London school during my final year of training for an MA in Dance Movement Psychotherapy. I describe the treatment of a traumatised 9-year-old boy using psychoanalytic theories, in particular Winnicott's ideas. This patient suffered at an early age from the drastic separation of his father and, when he was 6 years of age, various dramatic events led to the hospitalisation of his mother due to psychiatric problems. The impending ending of the therapy and the trainee's repetition of a ‘neglectful transference’ triggered powerful memories of traumatic past separations, which aroused deep-seated anxieties in the patient and trainee alike. The work towards a ‘good enough’ ending in the new therapeutic relationship was of great value to the patient's recovery. Parallels are drawn with the trainee's feelings of ending her dance movement psychotherapy course.     

Homework assignments in relational psychoanalytic treatment of personality disorders: A case study of a patient with narcissistic personality disorder

Homework assignments, or specific tasks patients are asked to engage in or complete between sessions, are a controversial topic among psychoanalysts. While many argue these interventions contradict psychoanalytic principles, others believe they can help address problems and promote coping skills. We propose that homework can be a legitimate aspect of relational psychoanalysis when used in a way that is attuned to the patient's experience and that homework may be an important component of treating personality disorders (PD). We present the case of a man diagnosed with narcissistic PD. He often felt superior to and reported that he despised others, though the core self-image was of fragile. He embraced the role of the omnipotent caregiver, which came with boredom and anger and lack of satisfaction in his social life. The patient tried to control therapy, asserting that he could psychoanalyze himself. As a result, therapy was stalled and progress was limited. At this point, the therapist asked him to complete homework assignments that encouraged him to refrain from his compulsive caregiving to better understand what motivated this behavior. Through this process, the patient came to realize he acted out of avoidance, as he did not want to disclose his own vulnerabilities and flaws. At that point he was able to experience relationships while adopting different stances and finding new meanings. We argue that homework can be fully integrated into the relational psychoanalytic repertoire to improve self-reflection and foster change in patients with PD.     

Cognitive-behavioral conjoint therapy for posttraumatic stress disorder: application to a couple's shared traumatic experience

Cognitive-behavioral conjoint therapy for posttraumatic stress disorder (CBCT for PTSD) is designed to improve PTSD symptoms and enhance intimate relationship adjustment. Phase 1 includes psychoeducation about the reciprocal influences of PTSD symptoms and relationship functioning, exercises to promote positive affect and behaviors, and conflict management skills. In Phase 2, behavioral methods are used to address avoidance and emotional numbing and to increase relationship satisfaction. Couples engage in activities to promote approaching, rather than avoiding, feared situations. Phase 3 focuses on specific trauma appraisals and here-and-now cognitions that maintain PTSD and relationship problems. This article provides an overview of the treatment, a review of the outcome research, and a case illustration of a couple with a shared trauma (a stillborn child).     

Stirring the depths: transference,countertransference and touch

The author explores transferential dynamics arising in the context of touch and tactile contact in the therapeutic relationship. The paper sets out with a brief review of transference phenomena and theory followed by considerations of the reciprocal nature of touch and of inter-personal dynamics evoked by touch. Relational perspectives of touch are used to contextualise some common challenges arising when we either consider or use touch in psychotherapy. Composite case vignettes from the author's practice provide clinical examples and evaluations to illustrate how psychodynamic and biodynamic aspects of the therapeutic relationship may interact with one another. The paper also highlights the crucial importance for therapists to remain anchored in their own bodies and personalities to navigate the depths stirred by touch safely.     

Body psychotherapy and social theory

This paper argues and tries to demonstrate that, alongside neuroscience and relational psychotherapy, body psychotherapy can and should draw on a third important source beyond its own tradition: the social sciences and social theory of embodiment. After establishing and outlining the enormous body of relevant material, hardly used so far within our discipline, I move on to the theoretical underpinnings of this material, and in particular social constructionist approaches to embodiment. From this, I explore some of the fundamental theoretical approaches used in the social sciences, based on the work of Michel Foucault and of Maurice Merleau-Ponty, and try to show their implications for body psychotherapy.