Symptom-Focused Dynamic Psychotherapy by Mary E. Connors (The Analytic Press) Traditionally, psychoanalytically oriented clinicians have eschewed a direct focus on symptoms, viewing it as superficial turning away from underlying psychopathology. But this assumption is an artifact of a dated classical approach; it should be reexamined in the light of contemporary relational thinking. So argues Mary Connors in Symptom-Focused Dynamic Psychotherapy, an integrative project that describes cognitive-behavioral techniques that have been demonstrated to be empirically effective and may be productively assimilated into dynamic psychotherapy. What is the warrant for symptom-focused interventions in psychodynamic treatment? Connors argues that the deleterious impact of symptoms on the patient's physical and emotional well being often impedes psychodynamic engagement. Symptoms associated with addictive disorders, eating disorders, OCD, and posttraumatic stress receive special attention. With patients suffering from these and other symptoms, Connors finds, specific cognitive-behavior techniques may relieve symptomatic distress and facilitate a psychodynamic treatment process, with its attentiveness to the therapeutic relationship and the analysis of transference-countertransference. Connors' model of integrative psychotherapy, which makes cognitive-behavioral techniques responsive to a comprehensive understanding of symptom etiology, offers a balanced perspective that attends to the relational embeddedness of symptoms without skirting the therapeutic obligation to alleviate symptomatic distress. In fact, Connors shows, active techniques of symptom management are frequently facilitative of treatment goals formulated in terms of relational psychoanalysis, self psychology, intersubjectivity theory, and attachment research. A discerning effort to enrich psychodynamic treatment without subverting its conceptual ground, Symptom-Focused Dynamic Psychotherapy is a bracing antidote to the timeworn mindset that makes a virtue of symptomatic suffering.
Mary E. Connors received her Ph.D. in Clinical Psychology from DePaul University in Chicago and was awarded a Diplomate in Clinical Psychology from the American Board of Professional Psychology. Dr. Connors has taught at the Illinois School of Professional Psychology since 1989. She is also in private practice and conducts psychotherapy, supervision, and consultation. Dr. Connors is the Co-Director of Integrative Health Partners, a practice group dedicated to integrative and mindfulness based treatment.
Excerpt: my early behavioral training emphasized that psychotherapy was something to "do." I learned a variety of active intervention strategies, implemented them, and assessed the outcome. My psychoanalytic training led me to think that perhaps therapy was more about how to be with someone rather than what to do (which was a relief, as I had little idea what I was supposed to do, and how and when to do it!) Yet I liked the idea of being as effective as possible with the various problems that people brought to treatment, and it seemed that knowing some specific things to do at times might facilitate my ability to help. Gradually I began to develop a psychotherapeutic style that incorporated symptom-focused interventions into a dynamic treatment, and I found that such integration seemed coherent as I employed it with my patients.
However, that is not what I was taught. When I began my graduate program in psychology in 1977, the available theoretical paradigms were very different from current versions. The perspectives with which I became most familiarpsychoanalytic and behavioralwere more distant from people's actual experience than is the case today as well as more at absolute odds with one another. The dominant psychoanalytic paradigm was drive theory, and the behavioral theory that I was taught focused primarily on classical and operant conditioning. I began seeing my first patients when I was a young graduate student, and they displayed some complex difficulties, including sexual fetishes, paranoid delusions, and desperate relationship seeking. I found the theories I knew to be disappointing in furthering my understanding of my patients. Try as I might to apply those theories, I had to conclude that response schedules and oedipal issues were of limited explanatory value with my cases. I sought a psychoanalytically oriented internship, for I believed that a theory based on what might be going on inside a person had more potential to illuminate clinical phenomena than a strictly behavioral approach that declared one's inner workings to be irrelevant. I learned about self psychology, some of which strongly resonated with me; for the first time, here was a theory that made sense to me in terms of my own experience. I continued to immerse myself in psychoanalytic theory and found much that was helpful. But I remained unsatisfied concerning what might constitute the most useful explanations and treatment techniques for the range of problems my patients were presenting.
Fortunately, in the last two decades several major advances have clarified our understanding of development, psychopathology, and treatment. One key factor is the ascendency of what has been termed the relational perspective in psychoanalytic thought, so that relations with others, rather than drives, are a conceptual focus. A second major development is the cognitive revolution in behavior therapy. Internal states have become a legitimate focus of inquiry with a new emphasis on cognitive processes and their relationship to affect. Both within psychoanalytic thinking and in clinical theory in general an increased appreciation of the impact of real events on development and psychopathology is evident, for example, in the current high interest in attachment processes and in trauma. Finally, the polarization that historically resulted in mutual suspicion between psychoanalytic clinicians and researchers has been softening to some degree, so that many analytic therapists welcome findings from empirical studies, and researchers have become more appreciative of the value of in-depth case studies and qualitative work.
These paradigm shifts enable collaborative dialogue that was impossible when behavior theory eschewed the notion of subjectivity and psychoanalytic concepts centered on reductionistic intrapsychic structures and functions. All but the most radical behaviorists now consider mental processes to be a useful arena for exploration and intervention, and psychoanalytic conceptualizations of internal events tend to be less reified and more "experience near," as Kohut put it. Students of today have more options than simply declaring allegiance to one of the two major opposing camps and closing their minds to the possibility that the other might have something to offer. These changes suggest to me that an integrative book might be timely.
My particular blend of data and theory is deeply informed by my own subjectivity; in selecting my favorite ideas, I am necessarily omitting many others that readers may wish to incorporate into their perspectives. I hope that my own distillation of theory, research, and practice might be helpful to those of an integrative bent. I wish to stress, however, that these ideas are evolving, and in no way do I view this work as anything but preliminary and tentative. My Zen Buddhist training suggests that one should avoid clinging to "fixed ideas" that obscure the reality of a vast and continuously changing universe. I fail to embody this profound truth most of the time, but I invite readers to join me in striving for a spirit of respectful inquiry, flexibility, and humility concerning what we know and what we think we know.
The overall goals of the psychoanalytic theories that I employ all pertain to living an enriched and enlarged life, with greater self-cohesion, with increased attachment security, and in a subjective world that has been explored and transformed in desired directions. Often psychoanalytic treatment enables an individual to accomplish such goals with no need for active techniques. Some people who are troubled by their symptoms and find such techniques usable may, however, make more rapid progress with the overarching goals of treatment as well as with the specific symptom when an integrative approach is used. The optimal provision of such techniques can supply important selfobject functions, including long-thwarted needs to be instructed in life skills in the context of an important relationship. Use of symptom-focused techniques may facilitate a more secure attachment to the therapist by helping dismissive patients to gain trust and assisting preoccupied and disorganized ones to tolerate limitations on therapist availability. Furthermore, application of such techniques may illuminate some aspects of a patient's internal world, as well as nuances of the intersubjective field, in ways that would not otherwise occur. Use of symptom-focused dynamic psychotherapy involves direct intervention with the symptom that cooccurs with application of psychoanalytic psychotherapy techniques to the person as a whole. Multiple complex processes ensue, with interplay between symptomatic change and overall development such that one facilitates the other. I have argued both that symptoms may require a unique focus and that they must be viewed in the context of the entire intersubjective field. They represent the tip of the iceberg, as it were, and symptom-focused dynamic treatment excludes neither the portion that is visible nor that which is hidden from therapeutic attention.
Image: A Handbook of Theory, Research, and Clinical Practice edited by
Thomas F. Cash, Thomas Pruzinsky (Guilford Press) Presents a
range of approaches to conceptualizing body image. Provides data and clinical
insights on individual and cultural variables in body image, with chapters on
gender, sexual orientation, race ethnicity, and physical characteristics. Body
Image introduce 56 papers on the conceptual foundations of, and multiple
perspectives on, the experience of embodiment. Perspectives include
developmental, assessment, individual and cultural differences, issues in
medical contexts, and negative body image changes through surgical and
psychosocial interventions. Lastly, the editors make recommendations primarily
relating to refining the body image construct For students, researchers,
residents, and practitioners.
From the New England Journal of Medicine, April 3, 2003
"Body image, the multifaceted psychological experience of embodiment, profoundly influences the quality of human life," state the editors in the preface to this book. Thomas Cash and Thomas Pruzinsky have managed to pull together a collection of writing to support this powerful statement. The past decade has witnessed a considerable increase in the attention paid by clinicians and researchers to body image. Body Image consists of 57 chapters written by recognized experts, who provide concise, authoritative, state-of-the-art summaries of each topic. This book should prove to be of considerable interest to the many physicians who encounter the complexities of body image in their patients. Although contemporary scholarship concerning body image dates back to the seminal writings of neurologist Paul Schilder, who espoused a biopsychosocial approach to body image, it was not until the 1990s that this topic aroused broad attention. The intervening years were not without scholarship. Seymour Fisher's work and rigorous reviews of relevant concepts, primarily from a psychodynamic perspective, are especially noteworthy. Movement back to a broader, multifaceted view of body image can be attributed in part to Franklin Shontz's influential Perceptual and Cognitive Aspects of Body Experience, published in 1969, and to Body Images: Development, Deviance, and Change, also edited by Cash and Pruzinsky and published in 1990. In that book, the multidimensional and diverse nature of body image was a salient theme explored with an appreciation of broader contexts, such as medical conditions. Several excellent books pertaining to body-image issues were published in the 1990s, but this new book is unique. The editors' stated aims were to produce "an informative and inspiring new volume" that provides contemporary views and "comprehensive coverage" of body image with "clinical perspectives" for practice and "constructive ideas" for future research. The editors succeeded in meeting these ambitious aims. The concise chapters provide balanced views of the myriad topics presented. Although most of the chapters were written by experts in their respective fields, it is refreshing that for some of them the editors enlisted newer clinicians and researchers. The result is that the material is not simply recycled information. The 57 chapters are divided into eight sections (on conceptual foundations, developmental perspectives, assessment, individual and cultural differences, body-image disorders, medical contexts, medical and surgical interventions, and psychosocial interventions), which are followed by a chapter offering conclusions and future directions. The chapters provide brief authoritative accounts, and the annotated referencing points interested readers to key works. The referencing is judicious, and careful editing seems to have minimized duplication and redundancy. Diverse perspectives on body image (including sociocultural, perceptional and cognitive, psychological, familial, and feminist views) are detailed, as are body-image issues across the entire life span. One of the strongest aspects of this book is its consideration of body image in so many different groups (for instance, boys, girls, men, women, persons of various races, and persons with physical disabilities) and of persons with eating disorders and weight-related problems. Particularly impressive is the coverage of body image in medical contexts, including dermatology, dentistry, obstetrics, urology, endocrinology, oncology, and management of human immunodeficiency virus infection and AIDS. The book has practical information for clinicians and clinical researchers. For example, the chapter by Thompson and van den Berg, on measuring body-image attitudes in adolescents and adults, contains concise summaries of relevant methods and instruments along with their strengths, weaknesses, and sources. The chapters on medical, surgical, and psychosocial interventions present balanced summaries of current knowledge and offer suggestions for sensitive clinical care, intervention options, and future research. The chapter by Sarwer is particularly timely given the continued rise in cosmetic surgery. Pruzinsky's chapter on responses to reconstructive surgery for acquired disfigurement offers some valuable observations for those in the healing professions. This timely book may encourage greater communication and cross-fertilization among disciplines and fields. It provides a wealth of ideas for those interested in this fascinating topic and will serve as a valuable and frequently referenced resource. Carlos M. Grilo, Ph.D.
Copyright 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
Philosophy and Psychotherapy: Razing the Troubles of the Brain by Edward Erwin (Perspectives on Psychotherapy: Sage) Clearly written and accessible, this pioneering book analyses the interface between philosophy and psychotherapy. It is the first authoritative work to apply rigorous philosophical discipline to therapeutic claims and counter claims.
Edward Erwin discusses some of the key philosophical issues that have a particular relevance to psychotherapeutic theory ‑ autonomy and free choice, the nature of the self, epistemology, and values and morals ‑ as well as examining specific interdisciplinary issues that cut across the boundaries between philosophy and psychotherapy. Finally, he looks at the `crisis' in psychotherapy today, offering a valuable philosophical insight into the debate about the proliferation and efficacy of therapeutic approaches.
Challenging and incisive, Philosophy and Psychotherapy will encourage all psychotherapists, counsellors and applied psychologists to examine their practice and clarify their thinking. It is a major contribution to the critical analysis of one of the most influential systems of thought and practice of our time.
Author introduction: When Joseph Breuer used his "talking cure" in treating Anna 0 in the late nineteenth century, there were few alternative psychological therapies available. Today, in contrast, there are more than 400 distinct types of psychotherapy. Some closely resemble the original talking cure, at least as it was transformed by Sigmund Freud, but many are quite different. Consequently, the term "psychotherapy" has come to denote virtually any kind of psychological treatment.
As the list of therapies has expanded, the number of types of professionals dispensing psychotherapy has also increased. Practitioners now include psychiatrists, social workers, clinical psychologists, members of the clergy, psychiatric nurses, and counselors, working in hospitals, prisons, corporations, schools, outpatient clinics, private offces, and many other settings in numerous countries around the world. This book is addressed to these professionals and to anyone who has an interest in psychotherapy.
It is also addressed to my fellow philosophers, who, until recently, have written comparatively little about the field. Although some (most notably, Adolf Grunbaum, 1984, 1993) have written about the theories of Sigmund Freud, most philosophers of psychology have focussed in recent decades on cognitive science. It is not surprising that philosophers are attracted to cognitive science given its close connections to logic and philosophy of mind, but the time is right for more philosophers to pay attention to psychotherapy, and some in fact are now doing so ‑ see, for example, the papers in Graham and Stephens (1994), the new journal Philosophy, Psychiatry & Psychology, and recent philosophic works on multiple personality. Psychotherapy, after all, is a huge field (in the United States, clinical psychology, for example, includes more psychologists than all other areas of psychology combined), and it is rich in theory and in issues that ought to be of interest to philosophers. For example, philosophers have written a great deal about the nature of the self, but there is a parallel literature that discusses numerous psychotherapeutic theories of the self, as well as related clinical phenomena.
To take another example, meta‑analysis has produced a revolutionary change in the way outcome literature is now evaluated. The use of metaanalysis, however, has engendered significant epistemological discussions that philosophers of science can both learn from and contribute to. Other psychotherapeutic examples of philosophic interest include: questions about basic criteria for evaluating psychotherapeutic goals and outcomes, the postmodemist epistemology that is becoming increasingly influential in the field of psychotherapy, the new behaviorism, the proper epistemological standards for evaluating clinical work, and various philosophic issues raised in the cognitive‑behavior therapy literature.
If psychotherapy should be of interest to philosophers, what about the reverse question? Why should psychotherapists take a professional interest in philosophy? One can, quite obviously, do psychotherapy without paying much attention to philosophic questions. Yet, at least occasionally, it is useful for psychotherapists to reflect on the field as a whole, or to think through particular questions that are basic to the enterprise. Is the field developing in the right direction? Is progress being made? What are the proper standards for evaluating psychotherapies and therapeutic theories? Many psychotherapy theories talk about the self. What sort of thing is this supposed to be? Are the goals of psychotherapists jointly realizable? For example, is it possible to provide genuine autonomy for the client and yet develop a science of psychotherapy?
There are many different ways to deal with such questions. One could examine the works of particular philosophers, such as Wittgenstein, Sartre, Foucault, or Nietzsche, and see what implications their work has for psychotherapy, or try to determine whether the contributions of psychotherapists bear on the work of the philosophers. Another approach would be to concentrate on a single topic of joint interest to psychotherapists and philosophers, such as multiple personality disorder (now commonly referred to as dissociative identity disorder) or various forms of irrationality. This book adopts neither approach. It is not about the work of any one philosopher, nor is it about any single issue. It is, rather, about many different issues concerning autonomy, value, the self, epistemic justification, and other philosophic matters relevant to psychotherapy.
Except for the applied ethics questions discussed in Chapter 2, the issues of Part I are examples of "pure philosophy." Part II discusses issues in applied philosophy as they arise within some of the main paradigms of psychotherapy. Empirical issues here are interwoven with various evaluative, conceptual, and epistemological questions.
In discussing issues associated with the main paradigms, I have not aimed for completeness. In particular, I do not discuss a "humanistic paradigm" partly because I doubt that there is such a single coherent paradigm (Carl Rogers' views, however, are briefly discussed in Chapter 3).
1 have also included descriptions of various theories and therapies. In some cases, these accounts are very brief, too brief to be of interest to the specialist. I have included them partly because even a superficial statement of certain theories of psychotherapy helps to ground the philosophic discussion, and partly because the field is so fragmented that people working
in one area often complain that their work is unknown to those working in separate areas.
As the reader has no doubt noticed, the subtitle of the book is borrowed from Macbeth; it reflects neither a commitment to nor a rejection of philosophic materialism.
Part I Foundational Questions 1 Autonomy, Free Choice, and the Possibility of a
Psychotherapeutic Science 2 Values and Morals 3 The Self in Psychotherapy 4
Postmodernist Clinical Epistemology: a Critique Part II Psychotherapeutic
Paradigms 5 Behavior Modification and the New Behaviorism 6 Cognitive Therapy
and Behavior Therapy 7 Psychoanalysis and the Psychodynamic Therapies
Epilogue 8 The Crisis in Psychotherapy References Name Index Subject Index
Crucial Choices, Crucial Changes - The Resurrection of Psychotherapy by Stefan De Schill (The Search for the Future, V.3: Prometheus Press) Now with Psychotherapy needing to reinvent itself in order to meet the cost requirements of HMOs, Short-term therapy is becoming a norm though the older theoretical long-term perspectives still dominates training. Crucial Choices, Crucial Changes attempts to address the necessity not only of these changes but also of ways to evaluate various therapeutic protocols. Based on more than 45 years of research at the American Mental Health Foundation (AMHF), this intensive examination of psychotherapy and psychoanalysis points out the important shortcomings in the profession and concludes that there has been a marked decline in the last decades caused by the ever‑increasing use of superficial, facile treatment methods. Nonetheless, AMHF research has resulted in invaluable findings, which separate valid approaches from unsustained theorizing and pseudoscientific pretense. The solutions proposed will lead to the transformation of psychotherapy and psychoanalysis into truly viable crafts.
This work has already received widespread critical acclaim:
"Crucial Choices, Crucial Changes: The Resurrection of Psychotherapy is one of the most challenging works to appear in decades. It is of paramount importance to the future of psychotherapy. This work examines basic problems of psychoanalysis, psychotherapy, and mental health with three major considerations foremost: the extent to which the welfare of the patient is considered, the examination of present‑day quality of professional work, and the steps that are necessary to bring about decisive improvements in psychotherapeutic effectiveness and teaching." ‑ Psychotherapies (Geneva)
"What a welcome breath of fresh air Dr. de Schill's book is. Dr. de Schill's main work stands as a much‑needed expert correction to the mountain of highly speculative and unanchored theory‑building in the field of psychoanalysis and psychotherapy. On the basis of numerous cogent examples, he demonstrates the need for an expert clinical approach as the indispensable tool for understanding the unique psychological make‑up of the individual. This stands in marked contrast to the facile practice of generalizing broad `theory' to every patient, regardless of his/her individuality in structure and dynamics. I do not know of any analyst more capable of understanding and formulating very complex concepts in a clear and cogent manner. I believe the book will have a major impact where improvement is most needed: (1) in patient care, and (2) in the training of psychotherapists. Dr. de Schill's incisive wit, exceptional clinical acumen, and direct critical evaluation of a large number of renowned writers in our field make the book a most readable and instructive contribution." ‑ Professor Fabian X. Schupper, Vice President of the Institute for the Advancement of Mental Health (Geneva)
"I consider the volume Crucial Choices, Crucial Changes: The Resurrection of Psychotherapy to be a most fascinating, insightful and challenging work.... The incisive changes and reforms worked out by Dr. Stefan de Schill attest to an unusual perceptiveness of the essence and needs of psychotherapy. A dozen years of studies in universities, hospitals, and institutes will not provide even a small percentage of the expert psychotherapeutic knowledge to be found in this volume. The remedies it proposes are indispensable if psychotherapy and psychoanalysis are to be rescued from their long decline and put on the path leading to their unfulfilled potential." Prof. Toni Graf‑Baumann, former director of clinical medicine, Springer Verlag
"This is probably one of the most intelligent and insightful books to appear in psychotherapy and psychoanalysis. It is based on intensive long‑term studies at the American Mental Health Foundation. Undertaken with a constructive intent, Crucial Choices, Crucial Changes: The Resurrection of Psychotherapy is an extremely careful and expert analysis of the problems and shortcomings besetting psychotherapy and psychoanalysis. A major part of the work provides the most knowledgeable description of new and creative measures that are indispensable to the practice of psychotherapy and psychoanalysis." Professor Andre' Haynal, Chairman of the Department of Psychiatry of the University of Geneva
Stefan de Schill is director of research, since 1948, of
the American Mental Health Foundation, New York City.
and Pseudoscience in Clinical Psychology edited by Scott Lilienfeld,
Jeffrey Lohr, Steven Lynn (
and Pseudoscience in Clinical Psychology begins by addressing controversies
in assessment and diagnosis. Discussed are issues surrounding psychological
expert testimony, the uses and abuses of projective techniques, and unanswered
questions about dissociative identity disorder. General controversies in
psychotherapy are covered next, including the efficacy of psychotherapy and the
status of suggestive techniques for memory recovery. Subsequent chapters
evaluate interventions for specific adult and childhood disorders, including
unsubstantiated therapies for alcoholism, infantile autism, and ADHD; widely
promoted treatments for posttraumatic stress disorder; and herbal remedies for
depression and anxiety. The volume also considers the merits of popular
self-help products and mass media advice givers. Providing a balanced,
constructive review of contemporary research, contributors steer away from
reflexive dismissal of new ideas. Throughout, methodological issues are clearly
explained to help readers evaluate evidentiary claims and determine whether
studies are scientifically sound. Each chapter concludes with a glossary of key
accessible, this book fills a crucial gap for mental health clinicians and
researchers; instructors and students in clinical psychology, psychiatry,
counseling, clinical social work, nursing, and related fields; and legal
practitioners whose work bears on issues of mental health. It will serve as an
invaluable text in advanced undergraduateand graduate-level courses in
clinical psychology, psychotherapy, and evidence-based practice.
and Pseudoscience in Clinical Psychology is likely to make a number of
readers angry. Some readers will probably object to portions of the book on the
grounds that their cherished clinical techniques or brands of psychotherapy have
been targeted for critical examination. For them, this book may be a bitter
pill to swallow. Other readers will probably be deeply disturbed, even incensed,
by the growing proliferation of questionable and unvalidated techniques in
clinical psychology. For them, this will be a book that is long overdue. If we
manage to leave readers in both camps at least a bit distressed, we will have
been successful, because we will have gotten their attention.
purpose in this edited volume is to subject a variety of therapeutic,
assessment, and diagnostic techniques in clinical psychology to incisive but
impartial scientific scrutiny. We have elected to focus on techniques that are
novel, controversial, or even questionable, but that are currently influential
and widely used. By providing thoughtful evaluations of clinical techniques on
the boundaries of present scientific knowledge, we intend to assist readers with
the crucial goal of distinguishing science from pseudoscience in mental health
become clear throughout the book, unscientific and otherwise questionable
techniques have increasingly come to dominate the landscape of clinical
psychology and allied fields. Survey data suggest that for many psychological
conditions, including mood and anxiety disorders, patients are more likely to
seek out and receive scientifically unsupported than supported interventions.
Yet no book exists to help readers differentiate techniques within clinical
psychology that are ineffective, undemonstrated, or harmful from those that are
grounded solidly in scientific evidence.
and Pseudoscience in Clinical Psychology is the first major volume devoted
exclusively to distinguishing scientifically unsupported from scientifically
supported practices in modern clinical psychology. Many readers may find this
as we point out later in the book (Chapter 16), the field of clinical psychology
has traditionally been reluctant to subject novel and controversial methods to
careful scientific evaluation. This reluctance has left a major gap, and to a
substantial extent our book will fill it.
urged the authors of each chapter to be as objective and dispassionate as
possible. In addition, we have encouraged them to be not only appropriately
critical when necessary, but constructive. To this end, each chapter features
both a discussion of which clinical techniques are ineffective, unvalidated,
or undemonstrated, and also a discussion of which techniques are empirically
supported or promising. Our mission is not merely to debunk-although in certain
cases debunking is a needed activity in science-but to enlighten. Not all
methods that are novel or superficially implausible are necessarily worthless or
ineffective. Reflexive dismissal of the new and untested is as ill advised as is
blind acceptance. We have tried to ensure that our authors avoid both errors.
and Pseudoscience in Clinical Psychology should be of considerable interest
to several audiences: (1) practicing clinicians across the spectrum of mental
health professions, including clinical psychology, psychiatry, social work,
counseling, and psychiatric nursing; (2) academicians and researchers whose work
focuses on psychopathology and its diagnosis and treatment; (3) current and
would-be consumers of mental health treatment techniques; (4) educated
laypersons interested in mental illness; and (5) graduate students and advanced
undergraduates wishing to learn more about the science and pseudoscience of
clinical psychology. With respect to the latter group, this book is suitable as
either a primary or supplemental text for graduate and advanced undergraduate
courses in clinical psychology, psychotherapy, and assessment. In addition, this
book should be of interest to lawyers, educators, physicians, nurses, and
others whose work bears on clinical psychology and allied mental health
many of the chapters deal with conceptually and methodologically challenging
issues, we have tried to keep technical language to a minimum. In addition, each
of the major chapters of the book contains a glossary of key concepts and terms
that should prove useful to readers unfamiliar with each major content
THERAPY SOURCEBOOK by Francine M. Roberts, PSY.D., R.N. ($28.00, hardcover, 256 pages, Lowell House, ISBN: 1565657934 )
Modern life often presents challenges, conflicts, and disappointments that many people are ill-equipped to deal with by themselves. Anxiety, fear, depression, and relationship concerns often motivate people to seek the help of a professional. For those who have considered or are considering therapy as a means of healing or personal growth, THE THERAPY SOURCEBOOK is a complete guide to understanding the broad range of information about mental health treatments, techniques, and options.
Mental well-being is a highly subjective and personal experience, not necessarily a state of being "normal" but of being well adjusted and self accepting. THE THERAPY SOURCEBOOK defines good mental health attitudes, psychological distress, and the kinds of issues that often prompt people to seek treatment, including anxiety disorders, depression, addiction, relationships, and personality disorders.
Recognizing a need for help is a valid, healthy response to a psychological problem. But knowing how or where to get help can be challenging. Finding the right therapist involves matching the individual with the appropriate treatment. THE THERAPY SOURCEBOOK offers cogent advice on how to find the right therapist; how to establish treatment goals; and how to get the most out of therapy sessions.
Francine Roberts, a licensed psychotherapist, explains the different treatment approaches to therapy, including behavioral, cognitive, psychodynamic, and biological. Depending on the individual and his or her conflict, each approach uses varying aims, goals, and processes for resolving issues. Also included is information on the growing use of pharmacotherapy and common medications used to treat mood disorders and anxiety.
Other forms of therapy may sometimes be more appropriate to a specific situation. Self-help therapies, twelve step programs, and adjunct therapies can be effective means of enhancing treatment. Finally, the human experience offers its own natural therapeutic effects. Life events and relationships can have healing and learning opportunities either alone or in conjunction with therapy.
Seeking professional help is not a weakness but a sign of emotional strength. And while therapy is not a panacea, it does offer new ways of thinking and new techniques for changing unhealthy thinking patterns and behaviors. Therapy can complement existing coping mechanisms and provide much needed support for meeting personal challenges. THE THERAPY SOURCEBOOK can be a road map for a journey of positive change and personal growth.
FRANCINE M. ROBERTS, M.D., R.N. is a licensed psychologist, registered nurse, and assistant professor at Thomas Jefferson University. She has more than twelve years clinical health care experience in inpatient, private practice and community service.
THE EXPRESSION OF THE EMOTIONS IN MAN AND ANIMALS by Charler darwin, Definitive Edition Introduction, Afterword and Commentaries by Paul Ekman ($30.00, Oxford University Press 0195112717)
The appearance of this new edition of Darwins extraordinary book is a major event in the human sciences. Everyone interested in emotion --and who isnt?-- should be grateful to Ekman for this book.
Why do we (humans) like to nuzzle, nibble, and bite those we feel affection towards? Why do we blush when we are embarrassed? Are animals capable of emotion? Is a dogs wagging tail, or a cats purr, an emotional signal? And if so, can animals anticipate their emotions? These and many other controversial questions about the emotional lives of people and animals are addressed in THE EXPRESSION OF THE EMOTIONS IN MAN AND ANIMALS, Definitive Third Edition with an introduction, afterword, and commentaries by Paul Ekman.
In Darwins day, every educated person knew of his work and his revolutionary theories about the expression of emotions. Today however, scientists and laymen alike know of Darwin and his theory of evolution, but few are aware of his controversial work on the expression of emotion. How did this best-selling book, by one of the worlds most famous scientists and authors, become virtually forgotten for the last 90 years?
Paul Ekman, Professor of Psychology at the University of California, San Francisco, answers this intriguing question and many others with respect to Darwin and his work on the expression of emotion in this new, definitive edition of THE EXPRESSION OF THE EMOTIONS. Ekman, himself an expert on emotional response who some have called "a human lie detector," discusses the reception of the book at the time of its publication and later, describes Darwins unpublished replies to his critics, considers the impact of Darwins ideas on current research, and provides commentaries that use todays scientific knowledge to elaborate, support, and occasionally challenge Darwins insights.
For this edition, Ekman has returned to Darwins original notes in order, for the first time, to produce a corrected authoritative text, illustrated by the original drawings and photographs positioned exactly where Darwin intended. Also included are several illustrations Darwin discussed, but which never appeared in previous editions. In this definitive edition, todays reader will rediscover Darwins gifts as a writer and insightful scientist that make THE EXPRESSION OF THE EMOTIONS as fresh, accessible, and direct as todays finest popular science writing.
About the Editor: Paul Ekman is Professor of Psychology at the University of California at San Francisco. He is the editor of Darwin and Facial Expression (Academic Press) and The Nature of Emotions (Oxford) and the author of Telling Lies: Clues to Deceit in the Marketplace, Politics and Marriage. Ekman is recognized as the expert on facial expression and emotion and has been reviewed, profiled, interviewed by numerous newspapers, magazines and television programs, including The New York Times, Time, Cosmopolitan, Readers Digest, Glamour, Mademoiselle, Good Morning America, Dateline The New York Times, Time, Cosmopolitan, Readers Digest, Glamour, Mademoiselle, Good Morning America, Dateline NBC, The Oprah Winfrey Show, and CBS News News. In 1994, Ekman received the highest honor awarded by the American Psychological Association for contribution to basic knowledge, the Distinguished Scientific Contribution Award.
How much are our character, intelligence, and lifestyle a result of our genes? In this compelling book, award winning journalist Lawrence Wright reveals how twins are helping to unravel these and other mysteries of human identity.
Recent studies of twins have shaken the field of psychology to its foundations, revolutionizing our understanding of our own personalities. Because identical twins separated at birth share all the same genes, yet live separate lives, they offer a unique opportunity to test theories about the roles played by nature and nurture in shaping who we are.
With its genesis in the authors acclaimed New Yorker magazine article,TWINS directly challenges many long held beliefs. For instance, a series of groundbreaking studies of twins has shown that our genes play a much stronger role in shaping our identities than previously thought. Today, scientists can actually estimate what proportion of our intelligence, our personality, and our behavior is determined by inherited tendencies. Even our political orientation and our religious commitment, it turns out, are largely, governed by our genes. Twins is filled with astounding stories of identical twins who have lived entirely separate lives but have an incredible amount in common: their hobbies, their mannerisms, their taste in music, food, and clothes, their experiences in marriage and divorce, their careers, their sexuality, even the names theyve given their children.
Perhaps even more surprising is the discovery that our family life has startlingly little effect on the type of person we become. The nongenetic factors that have the greatest impact on shaping our lives are not the way our parents raise us, or the kind of family in which we grow up, but our experiences outside our families.
Introducing the latest findings in this heated area of research, Lawrence Wright presents a lively narrative that is at once engaging, provocative, and told with remarkable clarity. The ongoing and often volatile debate of nature vs. nurture has intrigued mankind for centuries. With Twins, Lawrence Wright provides a bold addition to current thinking, and a must read for all those fascinated by the deepest mysteries of human nature and identity.
LAWRENCE WRIGHT is a staff writer for the New Yorker. His work has also appeared in Rolling Stone, the New York Times Magazine, and Texas Monthly. He is the author of three previous books, including Saints and Sinners, and the critically acclaimed Remembering Satan, for which he received the National Magazine Award for reporting in 1993.Kernberg On Love
Kernberg, the internationally renowned psychoanalytic theorist and clinician, examines in this volume the success and failure of sexual love in couples, from adolescence to old age. Dr. Kernberg considers both so-called normal and pathological relationships, including the role of narcissism, masochism, and aggression in each. The result is a book that expands the boundaries of our current understanding of love relationships
Kernbergs is arguably the richest psychoanalytic text on love (in whatever way we may choose to define this most abused of words) since Freuds Three Essays on the Theory of Sexuality. This extremely wide-ranging book, spanning from a biological perspective to the sociocultural a personal as well as professional adventure to read that offers a creative, stimulating reflection on the intricacy of human sexual relations throughout the life cycle.
Years ago, when my writings about patients presenting borderline personality organization were stressing the importance of aggression in their psychodynamics, a colleague and good friend said to me, half jokingly: "Why dont you write about love? Everybody has the impression that you are concerned only with aggression!" I promised him I would do so when some of the puzzling questions in this area had become clearer to me. This book is the result, although I must admit that I have by no means found the answers to all those questions. Nevertheless, I believe I have come far enough in my thinking to share those answers I have found. I hope others will take the opportunity to illuminate what is still obscure.
Over the centuries the subject of love has received a great deal of attention from poets and philosophers. In more recent times it has been scrutinized by sociologists and psychologists. But surprisingly little about love can be found in the psychoanalytic literature.
Again and again, in my attempts to study the nature of love, the relation of the erotic to sexuality became inescapable. I discovered that, in contrast to the abundance of studies on the sexual response from a biological perspective, little had been written about it as a subjective experience. As I explored this subjective aspect with patients, I soon found myself dealing with unconscious fantasies and their roots in infantile sexuality, in short, back to Freud. Clinically I also found that it was through mutual projective identification that couples reenacted past "scenarios" (unconscious experiences and fantasies) in their relationships and that fantasized and real mutual "persecution" derived from the projection of the infantile superego as well as the establishment of a joint ego ideal-powerfully influenced a couples life.
I noticed that it was almost impossible to predict the destiny of a love relation or marriage on the basis of a patients particular psychopathology. Sometimes different types and degrees of psychopathology in the partners seem to result in a comfortable match; at other times the differences seem to be the source of incompatibility. The questions "What keeps couples together? What destroys their relationship?" haunted me and were the impetus for my studying the underlying dynamics of couples in intimate relationships.
My sources of data are the treatment of patients by psychoanalysis and psychoanalytic psychotherapy, the evaluation and treatment of couples suffering from marital conflict, and particularly the long-term follow-up study of couples through the window of the psychoanalysis and psychoanalytic psychotherapy of individual patients.
It did not take me long to discover that it was just as impossible to study the vicissitudes of love without the vicissitudes of aggression in the relationship of the couple as in the individual. Aggressive aspects of the couples erotic relationship emerged as important in all intimate sexual relations, an area in which the pioneering work of Robert J. Stoller has provided significant clarification. But I found the aggressive components of the universal ambivalence of intimate object relations equally important, as well as the aggressive components of superego pressures unleashed in the couples intimate life. A psychoanalytic object relations theory facilitated the study of the dynamics linking intrapsychic conflicts and interpersonal relations, the mutual influences of the couple and its surrounding social group, and the interplay of love and aggression in all these fields.
So, despite the best of intentions, the incontrovertible evidence forces me to focus sharply on aggression in this treatise on love. But, by the same token, the acknowledgment of the complex ways in which love and aggression merge and interact in the couples life also highlights the mechanisms by which love can integrate and neutralize aggression and, under many circumstances, triumph over it.
1. The Sexual Experience
2. Sexual Excitement and Erotic Desire
3. Mature Sexual Love
4. Love, Oedipus, and the Couple
6. Aggression, Love, and the Couple
7. Superego Functions
8. Love in the Analytic Setting
9. Masochistic Pathology
11. Latency, Group Dynamics, and Conventionality
12. The Couple and the Group
Otto F. Kernberg, M.D., is a training and supervising analyst at the Columbia University Center for Psychoanalytic Training and Research, professor of psychiatry at Cornell University Medical College, and director of the Institute for Personality Disorders at the New York Hospital Cornell Medical Center, Westchester Division. He is the author or co-author of many books, including: Internal World and External Reality Object Relations Theory Applied (Jason Aronson) and Ideology, Conflict, and Leadership in Groups and Organizations (Yale)Transpersonal Psychology as a Clinical Guide
PSYCHOTHERAPY AND SPIRIT: Theory and Practice in Transpersonal Psychotherapy by Brant Cortright ($17.95, paper, $54.50, hardcover, 257 pages, references, index;SUNY, State University of New York, 0-7914-3466-4)
PSYCHOTHERAPY AND SPIRIT by Brant Cortright, Director of the Integral Counseling Psychology Program at the California Institute of Integral Studies, brings together in one volume essays highlighting the major developments in the field of transpersonal psychotherapy. They together articulate a unifying theoretical framework and explore the centrality of consciousness for both theory and practice in this discipline. The essays review the major transpersonal models of psychotherapy, including Wilber, Jung, Washburn, Grof, Ali, and existential, psychoanalytic, and body centered approaches, and assess the strengths and limitations of each. The book also examines the key clinical issues in the field. It concludes by synthesizing some of the overarching principles of transpersonal psychotherapy as they apply to actual clinical work. The volume makes a good intermediate introduction to the field.A Basic Reference to Psychodrama : Group Psychotherapy as Experimental Theater by Eva Roine ($29.95, paperback, Jessica Kingsley Publications, 1853024945)
This comprehensive work is grounded on the authors broad knowledge and experience of psychology, the theater and psychodrama. It includes discussion of the theory behind psychodrama as well as the methods used in its practice. Roine writes of technical concepts in a comprehensible and accessible style, giving examples from her work in America and Norway. As well as examining the specific field of psychodrama, she relates the topic to the history and practice of the theater, providing new angles and insights. The volume is one of the most intensive overviews of psychodrama now available. It is recommended not only as introduction but as basic reference to basic practices and theory.
Expressive therapies including psychodrama are becoming steadily more influential and this book has already played a part in that development. It addresses the needs of professionals, students and teachers directly involved in psychodrama and will also be of interest to professionals in other fields.
Eva Roine trained as an actress in London. After four years of acting she became a journalist writing chiefly about the theater. Her clinical work is extensive as is her teaching. She conducted a three year psychodrama program in Krakow, and has worked extensively in Germany and the Nordic countries. a Director of the Norwegian Psychodrama Institute.Hurricane As Archetype
DIVINE TEMPEST: The Hurricane as a Psychic Phenomenon by David E. Schoen ($15.00, sewn paper, 128 pages, 15 illustrations, glossary, bibliography, index; Inner City Books; 0-919123-79-1)
The human response to hurricanes spans a continuum from fascination to terror. Though we recognize the need to protect ourselves from the physical dangers of the great storm, we are yet drawn to witness its awesome power.
The thesis of DIVINE TEMPEST is that the hurricane is a universal symbol of the Self (in a Jungian sense) in its most primordial form. Schoen explores the world views of both aboriginal and modern cultures to paint a vivid picture of how humankind has related to this cataclysm of nature, inwardly and outwardly, for millennia.
Visual imagery, meteorological and historical data, mythological amplification, modern dream material, synchronistic andESP phenomena, and firsthand experience are the substance of this whirlwind text, interwoven into a comprehensive psychological theory about the significance of hurricanes and other great storms.
David E. Schoen, M.S.S.W., has a Diploma in Analytical Psychology from the InterRegional Society of Jungian Analysts, and a Masters degree in clinical social work from the University of Texas in Austin. He is an advisor to the C.G. Jung Society of New Orleans, and has a private practice in Covington. Louisiana.
Hurricanes, a Psychological Approach
I was born and raised in south Louisiana, never very far from the great Gulf of Mexico, hence hurricanes have always been a part of my life geographically and psychologically.
My earliest memory of a hurricane was in the 1950s when I was four or five years of age. I remember flood waters three feet high everywhere around my house in New Orleans. It was exciting and novel: cars parked on neutral grounds, boats floating by the front door, my whole neighborhood a giant swimming pool. Hurricane Betsy in 1965 touched me in a different way. I walked through National Guard tents with hundreds of homeless frightened families huddled together around Army cots, with only meager possessions hastily salvaged from the devastating storm. I saw the mark of floodwaters to the ceiling, almost engulfing the house of a classmate.
In 1969, I walked where the awesome power of Hurricane Camille had taken out complete highways in Bay St. Louis, Mississippi, and swept away whole buildings, leaving nothing but the foundations and concrete slabs. I played touch football once in the eye of a smaller storm during my college days in Lafayette, Louisiana. Ive witnessed towering pine trees (with roots half a mile deep), sway and snap like twigs before the mighty hurricane. Ive weathered Hurricanes Juan and Andrew and dozens of others through the years. I dream of hurricanes, too.
For me and for most people living along the Gulf Coast the hurricane has always been an integral part of our experience, our lore, our culture, our collective psyche. Hurricanes are mysterious, dangerous, fascinating, exciting, frightening, unpredictable, awesome, powerful, special, fun, deathly destructive and uncontrollable. They are interwoven in the fabric and texture of our way of life and our way of looking at life. Let the good times roll, for tomorrow may not come. They fall into a special category of our culture, like Mardi Gras, jazz funerals and the rare snowstorm. We live with the hurricane and it lives within us. Hurricanes move us literally and figuratively, inwardly and outwardly. The hurricane season is paradoxically both feared and anticipated with edgy delight.
The experience of the hurricane is imprinted deeply in me, and its gale force winds have never ceased to whirl powerfully through my veins. This is why I was moved on a personal level to write about hurricanes; they are so close to my spirit and to my soul.
From my own experience, I then formulated objective, theoretical questions: What does the hurricane represent in the psyches of human beings? What does the image of the hurricane signify in history, literature and myth? What does it mean in dreams, fantasies, imagination? How does the image of the hurricane act upon the human psyche, and how does the human psyche act upon and modify the image of the hurricane for its own purposes? How can the hurricane be viewed psychologically, and from a Jungian perspective?
It is to these overarching questions that this book is addressed. I am more concerned with the overview, the big picture of the hurricane, than with attempting to track down every possible allusion and detail associated with it.
My hypothesis is that the hurricane is a universal symbol reflecting an archetypal image of the Self in perhaps its most primordial form. It echoes deeply within the psyches of both aboriginal and mode peoples, whose attempts to deal with it inwardly and outwardly, have both similarities and differences based on the assumptions and world views of each.Cognative Affect
KNOWING FEELING: Affect, Script, and Psychotherapy edited by Donald L. Nathanson ($45.00, hardcover, 425 pages, references, index; Norton: 0-393-7270214-6)
KNOWING FEELING is about knowing feeling in all its aspectsand the difference that makes in psychotherapy. It is the first book to present specific therapeutic techniques and ways of looking at the human condition based on the Tomkins-Nathanson theory of emotion.
Once grasped, Tomkinss affect theory illuminates both the small moments when shame takes over and the large patterns of human emotional interaction. As the contributors demonstrate in these wide-ranging essays, it provides new ways to understand intimacy, human sexuality, and the relationship between infants and their caregivers. It changes the way one assesses a client, forms a diagnostic alliance, or does research on shame and guilt.
In clinical chapters, readers will find that understanding the basic affects-interest-excitement, enjoyment-joy, surprise-startle, fear terror, distress-anguish, anger-rage, dismal, disgust, and shame-humiliation-gives direction and richness to the practice of marital therapy, cognitive therapy, psychopharmacology, art therapy, psychoanalysis, and Jungian depth therapy. It can be applied to the treatment of trauma following abuse or war, in dramatic role-playing for suchPTSD patients, in the remediation of young criminals, and even in the theater.
This is an ambitious and wide-ranging work. Nathansons thought-provoking chapter introductions provide continuity and bridges. Readers open to new possibilities are likely to find that their ways of practicing therapy and of being in the world are profoundly changed by what they learn here.
DONALD L. NATHANSON, M.D., is Senior Attending Psychiatrist at the Institute of Pennsylvania Hospital, Clinical Professor of Psychiatry and Human Behavior at the Jefferson Medical College, and founding Executive Director of the Silvan S. Tomkins Institute, Philadelphia. He is the author of Shame and Pride: Affect, Sex, and the Birth of the Self, and the editor of The Many Faces of Shame.
Dreams in Psychotherapy
The past few years have witnessed rapid evolution in the clinical application of the affect theory introduced by Silvan Tomkins. The steady growth of the international network of study groups chartered by the Philadelphia-based Tomkins Institute has been accompanied by increasingly frequent public presentations by clinicians who have found these theories useful in their practice of psychotherapy. The present text is a group of essays by clinicians and researchers from a wide spectrum of disciplines, each of whom has found that using Tomkinss concepts as the theoretical base for clinical work has made it easier and more effective. It offers links to classical psychoanalysis and Jungian psychology, diagnostic evaluation, psychometrics, cognitive theory and cognitive behavioral therapy, image-oriented psychotherapy, psychopharmacology, couples therapy, sexual counseling, the theater, the evaluation and treatment of massive psychic trauma, and a new sociopolitical system for the management of juvenile offenders.
That so much attention has been paid to a theory, indeed to a rigorous, complex, and demanding theoretical system, is in itself remarkable, for all of us feel most comfortable with what we learned during our training and saw validated by articles in journals edited by peers who were similarly committed to that early training. Yet we have become uncomfortable as we survey our therapeutic failures, curious about research into brain mechanisms that disconfirm traditional theory but offer no clear model of the mind, and perturbed by the steady increase in anecdotal reports of therapeutic success involving techniques that seem foreign to our very nature
Take, for instance, the work that Jeanette Wright presents in her chapter on "Image-Oriented Psychotherapy." Trained as an art therapist and steeped in Freudian drive theory, Wright became fascinated by the faces drawn by her patients. With the permission of an artistically gifted woman who bore the diagnostic label of dissociative identity disorder, and whose concept of self seemed split into several distinct alternate personalities, Wright traveled from Iowa to show me a sheaf of her drawings. Not only could we see that these highly evocative pictures represented scenes characterized by intense affective experience, but we could with ease recognize each of the innate affects on the faces of the characters she depicted, even though the artist had no prior knowledge of affect theory. Wright has developed a novel therapeutic technique through which she encourages her clients to use drawings as a way of learning more about their affects, about the consistent and replicable systems through which they have learned to manage these affects, and about the historical sequences that produced these painful scripts, all while teaching new methods of affect modulation. In an era characterized by intense sociopolitical attention to the loss of natural resources and the scarcity of unspoiled territory, Wrights work reminds us that what we ignore as banal and ugly may be the doorway to the new and exciting. This is breakthrough work because it uses information that has always been available in the artistic productions of people in therapy and recognizes that the graphic depiction of facial affect display is all the more important in those whose affective experience has been so intense and painful as to foster dissociative defenses that interfere with awareness.
It was at the suggestion of a student that David Cook, now emeritus professor of counseling psychology at the University of Wisconsin in Stout, began to develop the Internalized Shame Scale (ISS). Previous shame scales had been based on lists of adjectives used by college students, perhaps the best studied cohort in the world of academic psychology. Cook went in the opposite direction, picking statements about shame experience culled from the work of such clinicians as Gershen Kaufman, whose 1980 book Shame: The Power of Caring was one of the first to introduce affect theory in the context of psychotherapy, and psychoanalyst Leon Wurmser, whose 1981 book The Mask of Shame was perhaps the most evocative ever written on what had until then been known as "the ignored emotion." Cook went on to revise and adjust his test in terms of the emerging work on affect theory and to determine the importance to clinical practice of this complex group of scripts. His chapter not only describes the science and logic behind the ISS, but is also a chronicle of his own journey from academic cognitive theory toward affect theory. In a later chapter, psychologist Shelley Milestone, also trained as a cognitive-behavioral therapist, offers a concise outline of her clearly stated and easily learned recommendations for the incorporation of affect theory into classical cognitive therapy.
Vernon C. Kelly, Jr., Training Director of the Tomkins Institute, has a career-long interest in the treatment of couples. Working with Tomkins in the months before the latters death in 1991, Kelly produced an entirely novel definition of intimacy. In the intervening years, he has developed a new system of couples therapy based on these concepts. Briefly stated, it takes note of Tomkinss recognition that all humans are "wired" to enjoy the positive affects and dislike the negative affects. The basic "blueprint" of human psychological function requires that we try to increase positive affect, decrease negative affect, express all affect so these two goals may be accomplished, and develop scripts that foster these three goals. Kelly was the first to recognize that intimacy requires a private interpersonal relationship within which two people seek to mutualize positive affect so that it may be increased as a function of the relationship, to mutualize negative affect so that it may be down regulated, and to develop relationship-specific techniques for the expression of all affect so that it may be managed in the way best for the couple. Treatment, as he explains in this seminal chapter, requires far less attention to the content of quarrels and battles than to the affects that make these issues salient.
As a researcher and teacher for the Post Traumatic Stress Disorder unit of the Philadelphia Veterans Administration Hospital, Andrew M. Stone has found it useful to reevaluate our concepts of trauma in terms of innate affect mechanisms. His first contribution outlines a method of assessment that offers a bridge between the biological and the biographical factors operating in these devastating clinical conditions. My longtime colleague and collaborator, Dr. Stone was the first to suggest that we gather into one volume the growing collection of studies on the clinical applications of affect theory under the title KNOWING FEELING.
Both Dr. Stone and Norfolk-based clinical psychologist Anthony Hite have become intrigued by the changes in the process of diagnosis made possible by an understanding of affect theory and script theory. Each offers a chapter that describes how to approach a new patient or to revise your way of dealing with a patient whose treatment has gotten stuck for lack of understanding of emotional issuestwo contributions that differ dramatically in their focus and style.
A new theory should be capable of integration with the old so that the wisdom acquired by previous generations of clinicians is neither ignored nor lost in the excitement provided by novelty. It was Michael Franz Basch, one of the best known and loved psychoanalytic writers, who first introduced Tomkins and his affect theory to the culture of psychodynamic psychotherapy and psychoanalysis. Here he reminds us that all of the defense mechanisms outlined by Freud are actually affect management scripts. Basch places affect at the center of all considerations of the mental mechanisms. Louis Stewart is a Jungian psychologist who points out that each of the archetypes defined by Jung may be viewed as a specific pattern of affect modulation. Moving easily between the concepts of Jung and those of Tomkins, Stewart asks us to think of myth, personality types, and psychic structure in terms of his own highly personal understanding of innate affect. And, just as it is important to build bridges between these classical systems for the understanding of human function and the new system offered by affect and script theory, our clinical work must be linked firmly to the research of psychologists who study infant and child behavior. Drs. Julie Faude, Wayne Jones, and Michele Robins have collaborated on a scholarly review of work that demonstrates both the innateness of affect and its importance in the establishment of a clinically relevant developmental theory.
Two of the authors are known for the intensity and duration of their work with Tomkins. Like most of us clinicians, I learned of affect theory through the work of Basch and, like so many others who saw in affect theory a way toward new clarity, wrote Tomkins asking for the privilege of a personal conversation. It was my great good fortune to work closely with him during the last decade of his life as I struggled to unlearn the theories of my training and adapt to both a system and a teacher at times clear and simple and at other times maddeningly obscure. Educated first as a research biologist, next as a physician and endocrinologist, and only much later in psychiatry, I kept trying to place the affect system in the body, hoping to establish it within the emerging fields of neuroendocrinology and psychopharmacology. In a series of papers and books, I have focused on the basic biological mechanisms involved in shame affect while trying to clarify the scripts through which it is incorporated into the range of experience from everyday life to severe psychopathology. This work is summarized as the opening chapter of Knowing Feeling. In a later chapter written with the invaluable assistance of psychopharmacologist and longtime colleague James Pfrommer, I suggest a way of understanding the interface between innate affect and the mechanisms of action postulated for some of the best known psychoactive drugs.
Exactly contemporaneous with my relationship with Tomkins was that of Donald Mosher, whose research into the emotionality associated with sexual behavior and experience had led him to affect theory. It was a peculiarity of Silvan Tomkins, possibly born of a professors need to keep separate the research being done by his students, that neither of us knew anything about the other until Tomkinss death in 1991. Moshers work on sexual scripts is the most sophisticated adaptation of script theory to dateoften as complex as that of our mentor while at all times firmly linked to the world of psychotherapy. Here he summarizes what is to appear in his long-anticipated book on sexuality, offering what may be regarded as a glossary for the text of sexual scripts.
Using the emotionality of theatrical performance as their model, Miller James and David Read Johnson outline their novel and sophisticated treatment for posttraumatic stress disorder. Writing from the Veteran Administrations National Center for PTSD, they describe the "relationship lab" within which they use the teachings of leading drama theorists to enhance safer and more meaningful expression of emotion in this cohort. A contrasting view of the drama is presented by its originator, Bruce Shapiro, whose theory of iconicity has now been brought into conformance with our current understanding of human emotion. Shapiro sketches his revolutionary theory for the nature of dramatic performance, remarks on the significance of the theater for emotional health, and suggests the formation of an entirely new method of drama therapy that may be capable of producing deeper levels of change than those in use at this time.
Finally, just as Kelly insists that an understanding of intimacy must be informed by our affect-based theory of the person, the Australian political scientist and criminologist David B. Moore makes us realize that our understanding of society must be assisted by all valid theories of the personality. One of the leaders in the international movement to change the criminal justice system, Moore combines a willingness to read voluminously in any area of scholarship that might impinge on his topic with an unmatched ability to create working relationships among thinkers in disparate fields. When the town of Wagga Wagga, New South Wales, decided to implement the juvenile justice program suggested by John Braithwaite in his 1989 book Crime, Shame and Reintegration, Moore read the world literature on shame and became convinced that affect theory offered the best way of explaining the social phenomena being investigated by his group. His chapter offers a concise summary of modern criminology, describes the operation of the Wagga Wagga model of family group conferencing, and demonstrates how the conferencing system heals a community that has been wounded by crime. The same patterns of affect modulation that produce intimacy in private interpersonal relationships are necessary to create the sociality that forms the sense of community.
The day is long gone when any one therapist or one school of therapy can promise either explanation or cure for the woes of all. Neither affect theory nor script theory is a form of therapy, even though these concepts fit well into any system of treatment. All of us understand that a mood that persists despite sensible attention to its scripts may actually be due to abnormality of neurotransmitter function, just as the patient whose condition fails to improve no matter what medication is used may (for example) need attention to an interpersonal source of affect better handled in couple therapy. Therapeutic systems that depend on laboratory tests or the verbal productions of patients may be enlivened by attention to drawings. Psychodrama offers an opportunity to try out other ways of beingother patterns of affect modulationjust as hypnosis may allow access to parts of the personality held hostage by mental mechanisms earlier brought into use to manage affective overload. Cognitive therapy works better than psychodynamic insight or uncovering therapy in that fraction of the population for whom a highly structured therapeutic environment is needed to act as scaffold when the individual has little experience of affect modulation. Psychological tests may be used not just for diagnosis but to provoke skeins of associations that may be useful in therapy. A method of treatment based on preexisting sets of symbols, like Jungian psychology, may be used as a grid to anchor the individual who is otherwise skittish about depth psychology.
The history of our evolution as thinking beings changes greatly when one takes into account Tomkinss view of affect. A race of computers unable to assign salience, unable to determine which voice in the Babel of data required the most advanced form of attention, is unlikely to have been able to adjust to the ever-changing demands placed on it by the ability to move away from its roots and into new territory and new problems. We were not assigned the species name homo sentiens, the sentient or thinking human, but homo sapiens, the organism that lives according to innate abilities denoted by the Latin verb sapere, to savor or know, to be sensible or wise. This is a book about what makes us truly human, truly sapient. It is about knowing feeling in all of its aspects.
Good treatment is flexible, tailored to the needs of the individual or the cluster that has sought assistance, and capable of alteration on demand. It is our belief that the new attitudes toward human emotion described in these pages may alert the clinician to a wider variety of treatment options and illuminate ever-changing systems of therapy.
DREAMS AS A TOOL IN PSYCHODYNAMIC PSYCHOTHERAPY: Traveling the Royal Road to the Unconscious by Vincenzo Conigliaro, M.D. ($62.50, hardcover, International Universities Press 0823614395)
Dreams are such a fascinating, powerful, and central aspect of the psychoanalytic process that anyone who provides us with a comprehensive, creative and original work on dreams, dream theory, and the art of dream interpretation is well deserving of note. This study also sheds light upon neglected aspects of these fields. This scholarly and literate book, by a master teacher and clinician, explicates Freudian theory relevant to dream theory and formation in a manner which is both respectful of the novice to the field and holds the interest of the experienced clinician. However, the most valuable sections of the book are those in which Conigliaro demonstrates with a unique clinical and aesthetic sensibility his understanding and interpretation of the dream in the session. In a major portion of this work, Dr. Conigliaro elaborates on Freuds concepts of dreams by sharing with us his own free associations and subjective interpretations of a wide variety of illustrative dreams those inner ruminations that he regularly uses as working hypotheses when treating patients. His extensive, elegant clinical illustrations focus on the analysts internal processes as well as the patients, and are a model for describing analytic work.
"As a researcher in the field of sleep and dreams, I am particularly glad to see the careful discussion of the current scientific studies in this field as they may be used to shed light on dream theory. This admirable synthesis of Freudian dream theory and up-to-date laboratory research will be of much use to the clinician. I recommend Dr. Conigliaros book to any serious psychotherapist who wants to expand his or her psychodynantic perspective and clinical skills by thoroughly mastering the art of modern dream interpretation." Patricia Carrington, Ph.D.
About the Author
Vincenzo Conigliaro, M.D., is Associate Professor of Behavioral Sciences at Fordham University Graduate School of Social Services, and Dean and Medical Director of the Training Institute for Mental Health in New York. Author of more than 25 articles and several book chapters, Dr. Conigliaro has a private practice in psychiatry and psychoanalysis in New York.Catching Affect Experimentally EYE: Emotional Influences in Perception and Attention edited by Paula M. Niedenthal and Shinobu Kitayarna ($58.00, hardcover, Academic Press 0124105602)
This book consists of 13 chapters by experimental psychologists, that together suggest an emerging theme in the current psychological thinking on two issues: (1) the emotion cognition interface, the question of how emotion interacts with other mental processes such as perception and cognition; and (2) nonconscious processing, the question of how and when mental processes proceed without the awareness of the individual (i.e., occur automatically) or are initiated by events of which the individual is not aware (i.e., by implicitly or subliminally perceived information).
The authors of this volume share an interest in emotional influences in perception and attention. Their ideas about where the emotion comes from, the types of feelings they are interested in, and the processes of perception and attention that they believe are affected vary, however. In order to provide something of a common language some attempt is made to define key terms such as emotion, motivation, affect, and mood, and to associate the definitions with different authors.
They see emotion as a set of adaptive functions of acting or responding to stimuli, that are both prewired or "prepared" by biological evolution and yet at the same time, shaped, elaborated, and finely "configured" by learning especially by social and cultural learning. Emotion, then, is seen as a psychological processing structure of action readiness with which to perceive, attend, and respond to biologically, personally, and/or culturally significant stimuli. Emotion consists of myriad component processes organized into some fuzzy sets according to the functional relationship between the organism or the self and its biological or cultural environment. Some components involve cognitive and lexical processing as suggested by recent cognitive appraisal theorists of emotion; other components involve autonomic, efferent, and somatic activations. Clearly, many of these components are interconnected, Recent advances in neuroscience indicate that the brain substrates involved in the processing of emotion are highly integrated with those that participate in memory, learning, and other cognitive processes.
Above and beyond this general definition of emotion, researchers vary considerably in emphasis, and some of them use different, albeit related, terms for it accordingly. Depending on their major emphases, the contributions to this volume can be divided into the following four groups. Although in actuality the groups overlap in some obvious ways, the divisions are offered here as a heuristic frame with which to understand the scope of the current volume.
1. Emotion as a biological function of adaptation. Consistent with a definition of emotion offered by Davidson and Cacioppo, as a self-organizing, integrative state that is coherent across several response systems," Hansen and Hansen emphasize the biologically hardwired processes of emotion and its information processing structure. Adopting a similar biological view of emotion, Derryberry and Ticker highlight the goal oriented function of emotion, for which they use the notion of motivation. They use the term, emotion, somewhat narrowly to refer to a subjective concomitant of the motivation so defined.
2. Emotion as evaluation. Some other contributors to this volume are more psychological in their approach to emotion. Thus, Pratto and Klinger and Greenwald study the evaluative informational function of emotion. Many would agree that this is the central element of emotion, captured by a number of classic dimensions of "good-bad," "approach avoidance," "liked-is-like," and the like. But because evaluation is just one of many components of emotion just noted, Kitayama and Howard use the term affect to narrowly refer to the evaluative dimension of emotion and distinguish it from emotion itself. Affect so defined is also central in social attitudes, as made evident by Fazio et al. in their chapter on an emotional basis of attitude.
3. Emotion as categorical states. When emotional states are fairly enduring and have no specific objects to which the emotion is directed, they are called moods. By contrast, there appear to be a small number of primary emotions that are acute, structurally distinct, and have specific eliciting conditions. Consistent with researchers who study conceptual emotion knowledge and brain substrates of emotion, Niedenthal et al. argue that these categorical states, such as joy, sadness, and fear, have unique information processing effects, organizing memory in a more categorical way. A paper written at the turn of this century by a French physician, Israel Waynbaum, which is included here with an introduction by Robert Zajonc, seem to share this view of emotion.
4. Emotion as activation. Finally another important aspect of emotion is its energizing or amplifying capacity or what has traditionally been called arousal. The emphasis on arousal is evident in a number of influential papers in the history of psychology of emotion including Schachter. It is reflected in the notion of amplification described by Kitayama and Howard. In a related vein, Egeth discusses both promises and problems of this notion in his review of the literature on the effects of arousal in eyewitness testimony. Finally, Derryberry differentiate this unidimensional, admittedly oversimplified notion of arousal into two qualitatively distinct kinds of arousal, called phasic arousal and tonic activation.
Perception and Attention
The present volume is organized into two sections, the first on emotion and perception, the second on emotion and attention. Perception and attention are not strictly separate. They are indeed highly overlapping. The specific effects, experimental tasks, and cognitive mechanisms implicated differ systematically.
Perception is the transformation of sensations caused by an impinging stimulus into an internal representation of that stimulus. There are many component processes that mediate the transformation. And attention mediates perception when it is aligned with the mental pathway corresponding to the perceived event. However, the perceptual phenomena described in chapters in the first section are largely ones in which the mechanism of attention does not, or, in some case, does not exclusively, play a role.
Some chapters are concerned with affect in nonconscious perception. In work of this sort, the issue is whether implicit or explicit measures of affect indicate that the emotional meaning of a stimulus is extracted prior to the conscious detection or recognition of the stimulus. Other work addresses the idea that emotions have automatic effects in early perceptual processes that cause individuals to perceive certain events more efficiently than other events.
One mechanism implicated in much of this work is that of spreading activation. Spreading activation involves the automatic transfer of excitation between interconnected elements of the cognitive processing system. In such models, for example, preliminary nonconscious processing of the visual (or auditory) held primes corresponding perceptual pathways, thereby making some representations more likely than others to organize perception or bias responses. internal sources of activation include emotional state and. relatedly, arousal. Kitayama and Howard suggest, for example, that emotional arousal can amplify activation of perceptual pathways that have been previously excited.
The tasks that allow the researcher to measure the efficiency or ease with which a perceiver can detect a stimulus are most often used in the examination of automatic activation in perception. In theory the tasks involve measurement of the facilitation in the ease of perception of a primed, compared to a nonprimed, stimulus. In practice, of course, subjects communicate perceptibility with a motor response. Consequently, a problem with such tasks is that it is difficult to separate the facilitation of a perceptual response from that of a motor response.
Attention is held to be a limited capacity mechanism that mediates conscious awareness of internal and external events. Events that are the focus of attention receive the benefit of conscious processing. Processing "costs" accrue when attention has been allocated to certain events but processing of different events is required for some task. One of the classic paradigms for studying the allocation of visual and auditory attention is the Stroop task in which interference with conscious attention by automatic processes such as access to the semantic meaning of words can be observed. Several of the authors of the chapters contained in this volume have used the Stroop task to examine the effects of negative and positive information on the allocation of visual attention.
This work attempts to offer a series of operationalized approaches to the discrimination of attention and perception as affected by emotional arousal.
RECLAIMING HERSTORY: Ericksonian Solution-Focused Therapy for Sexual Abuse by Cheryl Bell Gadshy and Anne Siegenberg ($33.95, hardcover, 272 pages, Brunner/Mazel, ISBN: 0876307772)
Women who have survived sexual abuse are among the most traumatized individuals who seek therapy. Assisting such clients to reframe and transcend their abusive pasts requires enormous sensitivity and therapeutic skill.
RECLAIMING HERSTORY offers help to therapists to hone their craft with its solution-focused, Ericksonian approach and highly refined techniques for working with this population. The approach the authors present has evolved through work with hundreds of sexual abuse survivors. The authors have found their techniques to be remarkably effective in helping clients to regain a sense of freedom and empowerment in their lives.
The authors view the healing process as a collaborative partnership in which the therapist co-creates with the client a positive context for healing. This process is comprised of four distinct stages through which every client must pass in order to achieve their own unique potential. The book clearly describes the primary symptoms and features of each of these four stages:
It also presents, for each stage, a series of detailed metaphorical stories, exercises, and rituals designed to assist a client who is traversing a particular stage. Numerous suggestions, lists, questions, and vivid case studies help the therapist to identify and assess the individual needs of a particular client and then pinpoint those tools that will best facilitate the healing process at a given stage.
Recognizing the severe toll that work with sexually abused clients can take on the therapist, RECLAIMING HERSTORY also provides strategies for self care that can be used during various stages of therapeutic practice. The volume also provides a timely and important discussion of the controversial "false memory backlash" and its impact on the survivor and implications for the therapist.
Cheryl Bell Gadshy, M.A., M.F.C.C., is Coordinator, Sexual Assault Resolution Program, Family Services of the North Shore, North Vancouver. B.C., Canada. She also has a private practice specializing in childhood trauma and hypnotherapy.
Anne Siegenberg, M.S.W., R.S.W., is Family Therapist at the Jewish Family Service Agency, and Group Facilitator with survivors of sexual abuse at Family Services.
ON PLAYING A POOR HAND WELL: Insights from the Lives of Those Who have Overcome Childhood Risks and Adversities by Mark Katz ($29.00, hardcover, 187 pages, references, index; Norton; 0-393-7270232-4)
Robert Louis Stevenson said, "Life is not so much a matter of holding good cards, but sometimes of playing a poor hand well." Many adults who now enjoy happy and productive lives grew up under emotionally and environmentally difficult conditions that were beyond their control. As children they were clearly at risk of developing serious problems later in life. Yet they never did. Why not? What was the secret of their strength, their resilience? How did they turn their lives around?
Others who were exposed to similar adverse childhood conditions were less fortunate and continued to struggle with serious difficulties into their adult years. Yet many eventually successfully turned their lives around. How did they do it? What were the turning points in their lives?
ON PLAYING A POOR HAND WELL sets out to answer these questions. The book begins with insights into childhood risks and adversitiesenduring and inescapable stressful experiences, such as growing up under violent, dangerous, or abusive conditions, or experiencing years of school failure as a result of serious learning disabilities or attention problems. The author then explores the latest research into lifes trajectories and culls the lessons we must learn in order to provide avenues through which turning point experiences and second-chance opportunities can occurto change the odds, so to speak, for individuals who were dealt a poor hand.
ON PLAYING A POOR HAND WELL focuses on how people overcome different adversities not simply on the effects these stresses had on their lives. This book will enable disadvantaged individuals and their families to validate the pain theyve endured and to celebrate their resilience.
It is written as much for clients as for therapists and moves toward basic self acceptance.
MARK KATZ, Ph.D., is the director of Learning Development Services in San Diego and supervising psychologist at San Diego Center for Children. He is also the educational consultant to the Casey Family Program and a consultant to the San Diego Unified School Districts PARD (Partners for Attention Related Disorders) Project.
Other practical titles that address the treatment of abuse:
TRUE AND FALSE ALLEGATIONS OF CHILD SEXUAL ABUSE: Assessment and Case Management edited by Tara Ney, Ph.D. is the first volume to address, through the expertise of a diverse group of scholars and practitioners, current research and the clinical, legal and ethical issues that arise in sexual abuse cases.
ENDING THE CYCLE OF ABUSE: The Stories of Women Abused as Children and the Group Therapy Techniques that Helped Them Heal by Philip G. Ney, M.D., F.R.C.P. and Anna Peters is an accessible tool for both therapist and abuse victims in the group endeavor.
OPENING THE DOOR: A Treatment Model for Therapy with Male Survivors of Sexual Abuse by Adrienne Crowder, M.S.W. is written in clear, concise language, and features a four-phase treatment model that presents in detail the therapeutic tasks necessary for each phase.
CHILDREN SPEAK FOR THEMSELVES: Using the Kempe Interactional Assessment to Evaluate Allegations of Parent-Child Sexual Abuse by Clare HaynesSeman, Ph.D. and David Baumgarten, J.D. This pioneering volume describes the Kempe Interactional Assessmentfor Parent-Child Sexual Abuse, which facilitates the emergence of reliable data without the pressure of directly questioning the child.
FOCUSED PSYCHOTHERAPY: A Casebook of Brief, Intermittent Psychotherapy Throughout the Life Cycle by Nick Cummings with Mike Sayama ($34.95, hardcover, Brunner/Mazel 0876307896)
Confronted with the harsh financial realities of managed care, many psychotherapists fear they will be unable to provide their clients with appropriate treatment regimens that will stay within the boundaries determined by the increasing presence of Health Maintenance Organizations (HMOs) and other forms of managed care.
FOCUSED PSYCHOTHERAPY offers practitioners an approach to psychotherapeutic treatment that is financially viable and has sufficient clinical depth to assure genuine psychological growth. This highly practical model of "brief, intermittent therapy throughout the life cycle," a method that originated at the Kaiser Permanente HMO in Northern California under the direction of senior author Nick Cummings, is based on the developmental model of Erik Erikson, the Strategic Therapy of Milton Erickson, and 30 years of empirical outcomes research in which helping the patient in the most effective and efficient ways were the primary criteria.
The book describes a general theoretical and practical approach to focused psychotherapy, including the metapsychological assumptions of this type of therapy, techniques to utilize resistance in the service of healing and growth, and a way of structuring treatment episodes. The volume goes on to present, with numerous clinical case examples, the application of this approach to various diagnostic categories. Various chapters examine diagnostic schema that differentiates between patients who suffer, and those who cause others to suffer, as well as between patients who can be helped through insight and those who cannot. These diagnostic criteria are consistent with the categories of DSM IV, but are grouped according to psychodynamics and treatment implications rather than according to symptomatology homework assignments to both continue the process of change between sessions and convince patients that they are truly partners in their own treatment.
Finally, the book explores the incidence of suicide among borderline personalities, hysterics, paranoid schizophrenics, adolescents, the elderly and others.
FOCUSED PSYCHOTHERAPY will be essential for all psychotherapists striving to maintain the most efficient and, more important, the most effective treatment methods while working in our continually changing health care environment.
Nick Cummings, Ph.D., Sc.D., is President, of the Foundation for Behavioral Health, former President of the American Psychological Association, and founder of the California School of Professional Psychology. He is the founding CEO of American Biodyne, now MedCo Behavioral Care Systems. Dr. Cummings also launched the National Council of Schools of Professional Psychology, as well as the American Managed Behavioral Care Association, and he is founder of the National Academies of Practice in Washington, D.C. Dr. Cummings wrote and implemented the first comprehensive psychotherapy insurance benefit at Kaiser Permanente HMO in the 1950s. He is the author of over 300 scientific articles, book chapters, and books.
Mike Sayama has also written SAMADHI: Self Development
in Zen, Swordsmanship, and Psychotherapy (SUNY Series in Transpersonal
and Humanistic Psychology, hardcover, Paperback). This title integrates martial arts training with traditional spiritual disciplines as analogous to some goals in transpersonal psychotherapy.
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