Subscribe: Journal of Psychotherapy Integration - Vol 19, Iss 4
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Journal of Psychotherapy Integration - Vol 26, Iss 3

Journal of Psychotherapy Integration is the official journal of SEPI, the Society for the Exploration of Psychotherapy Integration. The journal is devoted to publishing original peer-reviewed papers that move beyond the confines of single-school or single

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Copyright: Copyright 2016 American Psychological Association

The therapeutic alliance: From correlational studies to training models.


In this article, I reflect on the early influences and inspirations that continue to inform my work. I describe my research program on the therapeutic alliance and summarize a study conducted by me and my colleagues examining the efficacy of a brief alliance training for clinicians. I describe additional models of alliance training and end by offering recommendations for future studies of alliance training. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Metatherapeutic processing as a change-based therapeutic immediacy task: Building an initial process model using a task-analytic research strategy.


The present study examined one particular class of therapeutic immediacy events called metatherapeutic processing in accelerated experiential dynamic psychotherapy (AEDP), in which a piece of successful therapeutic work just completed is reviewed and processed by both therapist and client. A task-analytic research strategy was used to analyze 4 clear and exemplary instances of metatherapeutic processing in videotaped sessions conducted by the developer of the approach. A process model was generated in which the therapist’s interventions were represented at the level of change principles, and clients’ change processes were represented along both affective and reflective tracks. Therapist interventions followed 4 principles of change: affirmation, attunement, somatic and experiential focusing, and restructuring. The affective track in the client change processes had 4 components: relief, enlivenment, grief, and peacefulness, while the reflective track had 3 components: self-affirmation, becoming aware of self-limiting beliefs and behavior, and engaging in new emotional coping. Central to metatherapeutic processing events was the change process associated with tracking and processing the experience of positive emotions that organically emerged from successful work with painful emotional experiences. The implications of actively working with clients’ spontaneously emergent positive emotional experiences during metatherapeutic processing will be addressed in relation to therapeutic immediacy, the broaden-and-build theory of positive emotions, and psychotherapy training and practice. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Sediments and vistas in the relational matrix of the unfolding “I”: A qualitative study of therapists’ experiences with self-disclosure in psychotherapy.


Psychotherapy integration aims at transcending the confining borders of single-school approaches. Self-disclosure is an intervention in which the psychotherapist verbally discloses something personal about him or herself. In this study, we investigated therapists’ experiences of using self-disclosures within an integrative context. Interviews were conducted and analyses performed using a hermeneutic–phenomenological framework. The research findings suggest that self-disclosure is an intervention with both potentially beneficial and detrimental effects. We also documented the circumstances under which therapists use self-disclosure, what they self-disclose, and how they act after self-disclosure. We identified 3 themes in use of self-disclosure. In the first theme, Letting the patient lead: “It is never about me,” the concrete therapist–patient encounter was reported as decisive for whether and what to self-disclose. In the second theme, Self-disclosure has been a potent implement in difficult therapies: “At this point it is right to tell you how I really feel,” self-disclosure was presented as a means to overcome difficult tensions in the therapy relationship. In the final theme, Confusing the boundaries: “My experiences can be too much for you to handle,” self-disclosure was described as an intervention with the potential of becoming too emotionally intense, and hence, countertherapeutic. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Integrative treatment of complex trauma: Integrating behavioral, dynamic, and attribution models.


The following article describes an integrative treatment approach to address interpersonal trauma that occurs during formative developmental years with those who engage in maladaptive behaviors such as violence and self-injury. The approach gives careful consideration to the role played by intra- and interpersonal characteristics of individuals who have experienced recurrent trauma at an early age, a consideration often ignored in traditional treatment settings to the detriment of treatment progress (Pacella, Hruska, & Delahanty, 2013). The approach integrates conceptualizations and treatment strategies borrowed from behavioral, psychodynamic, and attribution theories. A unique aspect of the approach includes teaching adaptive replacement behaviors and developing new and positive self-attributions (PSAs). It also emphasizes the importance for trauma survivors to develop a mental representation that helps them soothe in times of stress. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Transtheoretic transdiagnostic psychotherapy.


This article aims to show how a bio↔psychology network (BPN) explanatory system that gives rise to an applied psychological science (APS) clinical orientation supports an approach to psychotherapy that is both transtheoretic and transdiagnostic. Clinical orientations are broader than the underlying theories that authorize them and are therefore easier to unify theoretically. The cognitive, behavioral, cognitive-behavioral, and psychodynamic clinical orientations are already unified in that they all lack mechanism information that can explain how they work. None can explain how we learn and form memories. The brain is a network of neural networks. Therefore some form of network theory is required to provide the missing mechanism information. Network properties presented as psychological principles and elaborated by Tryon (2012, 2014) provide mechanism information that is fully consistent with all of the 4 previously mentioned clinical orientations plus the pharmacological clinical orientation. Interventions based on these principles are therefore transtheoretic. They are also transdiagnostic for theoretical and empirical reasons. Illustrative case examples are provided. The resulting APS clinical orientation is expected to change clinical practice in multiple ways. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Difficult dialogue between next of kin: A Brazilian perspective on obstacles to integration.


Philosophical differences and lack of a common language are acknowledged hindrances for psychotherapy integration. To identify additional obstacles for psychotherapy integration, the authors employed a grounded theory analysis of 22 clinician interviews on psychotherapy integration obtained from Brazilian therapists from 2 closely related schools of psychotherapy (11 Gestalt therapists, 11 psychodrama therapists). A complex conceptual category “obstacles for integration” emerged from the analysis. Further analysis of this category was undertaken for the purpose of more thoroughly investigating how therapists from these 2 related approaches argued their views on “obstacles to psychotherapy integration.” Analysis showed that not only did participants lean heavily on theoretical discourse but also they employed an “adversarial attitude” that depreciated their “neighboring” professional community. Arguments of this nature included denying that the other school had something different to offer, displaying concern that integration would weaken or undermine their home school’s interests, and believing that the dynamics of the extant professional field in Brazil would make psychotherapy integration fail. Several participants appeared to idealize their own community and debase the “other” or to claim a need for strict fidelity for protecting their “slice of the market.” We conclude that future efforts to understand and overcome resistance against psychotherapy integration should look beyond clinical arguments to take the dynamics of in-group–out-group social comparison into account. This should include consideration of political struggles over resources, therapists’ need for safety and belonging, and therapists’ need to protect their investment in training and status within their disparate professional communities. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Psychologists’ perceptions of the importance of common factors in psychotherapy for successful treatment outcomes.


Research has extensively identified common factors and their contribution to successful psychotherapeutic outcomes. However, there are various inconsistencies in the literature and much debate regarding their importance and role in therapy. As such, in this study, we examined the extent to which different common factors are important in psychotherapy from the clinicians’ perspective. Sixteen common factors were identified from a previous literature synthesis and consensual process method. Participants were expert psychologists (N = 21; 13 females) with an average of 23 years of experience providing psychotherapy. Participants completed a Q-sort task focusing on the common factors, and grouped them into categories of importance in practice. The data was analyzed using a Q-methodology technique. While most participants believed most of the common factors were important for facilitating successful therapeutic outcomes, there were mixed preferences. On average the most important common factor was the therapeutic alliance, and the least was combatting client’s feelings of isolation. The Q-methodology analysis indicated two factors representing unique viewpoints. The study provides knowledge about the degrees of importance of the common factors as perceived by clinicians. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Testing the impact of Key Strategies Training for Individual Psychotherapy on understanding, confidence, and intention to use skills in practice.


This study represents a preliminary test of the impact of Key Strategies Training for Individual Psychotherapy (KST-IP), a new method of integrative training for graduate psychology students. Trainees received 8 weeks of training, introducing them to practical skills designed to explore and transform thoughts, feelings, and actions. A total of 24 skills were taught; 4 skills for exploration and 4 skills for transformation for each of 3 theoretical models: cognitive, emotion-focused, and behavioral. After receiving KST-IP, trainees reported increased understanding, confidence, and intention to use skills drawn from all 3 theories. These results provide preliminary support for the feasibility and impact of KST-IP. Future research can be used to overcome limitations associated with the current study. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

“I’m a translating body”: Therapists’ experiences working with children diagnosed with autism spectrum disorder.


Working with autism spectrum disorder (ASD) is a challenging, complex, and often frustrating process that may elicit questions as to the effectiveness of various modes of therapeutic treatment. The aim of this study was to explore the lived experience of therapists working with children with ASD through in-depth interviews with 28 practicing therapists from different professional orientations. The findings converge on the therapists’ perceived difficulties and modes of coping; their “discursive identification” with their clients; their concern with boundary lines on both the concrete bodily and metaphoric levels; the centrality of the body within the intersubjective encounter; and the development of “implicit bodily relational knowing,” which enables empathy and connectedness, when conventional and verbal modes of communication are severely impaired. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Psychotherapy for personality disorders: Questions of clinical utility.


Patients with personality disorders (PDs) represent a particular burden for the health system and the clinicians attempting to treat them. The current commentary complements reviews of outcome studies on treatments for PDs by focusing on the clinical utility as defined by the American Psychological Association. As such, extending that notion, clinical utility of a treatment comprises aspects of implementation and training in the model as well as qualities of the therapeutic technique and relationship. Our review suggests that a certain caution needs to be applied when reading outcome studies based on specific methodological caveats. In specific contexts, inpatient and day hospital treatments have some initial appeal in reducing symptoms, in particular for the treatment of more severe forms of Cluster A and B PDs. In general, treatments for PDs are long-term treatments, administered in rather high dosage, which tends to be true irrespective of the treatment model. For specific treatment targets, there is emerging evidence on effectiveness of short-term interventions. The therapeutic relationship with patients with PDs may be characterized by strains and interactional difficulties that may be addressed using clinically adapted treatment strategies. To be effective, therapists should have an open-minded and flexible approach to therapy, which is particularly central from an integrative perspective. Finally, we state that a key element for implementation of an effective treatment model is a manual-based training that, albeit controversial, remains a key component allowing for the trainee therapist to self-monitor his or her progress and get specific help in supervision as part of the learning process. We advocate that clinicians and administrators should consider these points as being specifically related with clinical utility of treatments for PDs because they contribute to optimize the implementation process of a therapy approach to a specific context. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)