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Journal of Psychotherapy Integration - Vol 26, Iss 4



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 dual–dialectical conceptualization: A case of Crohn’s disease.

2016-01-11

[Correction Notice: An Erratum for this article was reported in Vol 26(4) of Journal of Psychotherapy Integration (see record 2016-11420-001). In the first sentence of the abstract, the word “Crohn’s” was misspelled as “Cohn’s”. All versions of this article have been corrected.] This article describes psychotherapy with a young patient with Crohn’s diseases. The presented psychotherapeutic approach demonstrates the psychotherapeutic application of the dual–dialectical conceptualization to physical illness patients. The dual–dialectical conceptualization is grounded in 3 major rules: duality, contradiction, and complementarity. On the basis of the assumption that patients habitually regard their problems as 1-dimensional and thus tend to become 1-dimensional in a completely negative attitude, the dual–dialectical conceptualization suggests a psychotherapeutic process in order to help patients expand their negative and 1-dimensional, perhaps “stuck,” problem into an alternative positive mental state. A novel psychotherapeutic tool known as differentiation/integration work is introduced to provide physically ill patients with freedom of choice and help them distinguish between the alternatives suggested in their verbal expressions and psychotherapeutic themes. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



“The dual-dialectical conceptualization: A case of Crohn’s disease”:Correction to Navon (2016).

2016-03-07

Reports an error in "The Dual–Dialectical Conceptualization: A Case of Crohn’s Disease" by Shaul Navon (Journal of Psychotherapy Integration, Advanced Online Publication, Jan 11, 2016, np). In the first sentence of the abstract, the word “Crohn’s” was misspelled as “Cohn’s”. All versions of this article have been corrected. (The following abstract of the original article appeared in record 2016-00309-001.) This article describes psychotherapy with a young patient with Crohn’s diseases. The presented psychotherapeutic approach demonstrates the psychotherapeutic application of the dual–dialectical conceptualization to physical illness patients. The dual–dialectical conceptualization is grounded in 3 major rules: duality, contradiction, and complementarity. On the basis of the assumption that patients habitually regard their problems as 1-dimensional and thus tend to become 1-dimensional in a completely negative attitude, the dual–dialectical conceptualization suggests a psychotherapeutic process in order to help patients expand their negative and 1-dimensional, perhaps “stuck,” problem into an alternative positive mental state. A novel psychotherapeutic tool known as differentiation/integration work is introduced to provide physically ill patients with freedom of choice and help them distinguish between the alternatives suggested in their verbal expressions and psychotherapeutic themes. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Defiance, denial, and defining limits: Helping family caregivers of individuals with dementia distinguish the tap-out from the cop-out.

2015-11-23

An approach to psychotherapy that integrates cognitive–behavioral, existential, experiential, and psychodynamic perspectives can help family members caring for an individual with dementia approach the challenges and stresses of caregiving in more effective, thoughtful, and connected ways. This article focuses on the process of helping caregivers differentiate challenges that require perseverance from goals that are unrealistic, face emotions evoked when limits are reached, and stumble toward acceptance and growth. The progressive nature of dementia presents caregivers with a constant barrage of new challenges, which demand that caregivers dynamically shift between (a) accessing grit and meaning making as fuel for perseverance and (b) recognizing their limits. While the refusal to recognize limits has been valorized by society, a failure of “limit recognition” may represent attempts to avoid painful emotions such as hopelessness. The experience of hopelessness may function as an important signal of one’s limitations and, if incorporated into caregiver experience effectively, may paradoxically allow for a broader range of possibility and creativity as limits are recognized, mourned, and accepted. I argue that the process of moving from denial to despair to acceptance is largely unwilled. The therapist’s capacity to face and transform his or her own experience of hopelessness into acceptance may be an important prerequisite to helping caregivers to do the same. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Use of self-regulation principles to improve adolescent treatment adherence to the medical regimen for diabetes.

2015-11-23

A substantial percentage of youngsters with diabetes have treatment adherence problems that inevitably reduce treatment efficacy. Effective adherence to a diabetes treatment regimen requires adolescents’ motivation to manage goal pursuit in the face of personal and situational obstacles. However, interventions are usually associated only with health promotion and not with the motivational structure typical of adolescents, their perceived purpose in life and their meaningful personal goals. Using principles for the motivation and self-regulation of goals adapted from the fields of social and personality psychology, we suggest a motivation-based conceptual framework to address the problem of treatment adherence. We argue that the failure to adhere to treatment is partially the result of the conflict between adolescents’ health-related goals and their personal goals. We suggest that adolescents’ motivation for treatment adherence can be increased and reinforced by forging an association between their personal life goals and their health-related goals. We present a 2-phase model for goal setting and goal striving that aims to improve patient evaluation and ability to cope with resource delusion in the face of numerous self-regulatory challenges associated with adherence to the medical treatment regimen for diabetes. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



An integrative trauma-based approach toward chronic pain: Specific applications to interstitial cystitis/bladder pain syndrome.

2016-01-11

The impact of chronic illness on an individual’s life is profound, affecting physical, social, and vocational functioning. Incurring and living with illness can dramatically alter an individual’s life trajectory, challenging identity and ideas of the future. The illness itself can be physically and psychologically traumatic. Vulnerability to trauma increases when individuals have poor preexisting coping mechanisms and with illness severity. In this paper, we discuss interstitial cystitis/bladder pain syndrome (IC/BPS), a disabling chronic pain condition with no known cure. The traumatic potential of IC/BPS is high due to the nature and severity of the condition, ambiguity of symptoms, patient characteristics, and treatment process. Psychotherapy in IC/BPS is extremely complex, where therapists are tasked with assisting in managing pain and illness against a background of traumatic life experiences, identity confusion, and negative treatment experiences with medical providers. The literature on psychotherapeutic approaches specific to IC/BPS is limited, presenting additional challenges. We focus on the potential additive utility of integrating psychodynamic approaches to trauma with existing interventions for chronic pain for those who suffer from IC/BPS. We describe a clinical case to illustrate our approach. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Growing through pain: An integrative approach to treating chronic pain and emotional distress.

2016-06-02

In this article, I present an integrative framework for working with patients, and particularly adolescents, experiencing medical illness, chronic pain, and acute emotional distress. These patients may benefit most from a treatment that combines cognitive–behavioral, relational–psychodynamic, and existential approaches. This article examines the process of integrating existential and psychodynamic-informed aspects of treatment with cognitive–behavioral therapy by highlighting the critical importance of validating and normalizing emotional distress, encountering existential anxieties, and engaging authentically with resistance, enactment, and transference–countertransference reactions in the “here-and-now” of the therapy relationship. Through clinical vignettes, I show how an integrative approach to treatment facilitated the development of affective awareness and expression, self-differentiation and identity-formation, and the existential struggle to make self-affirming choices in the case of a late adolescent male with significant physical limitations, severe emotional distress, and frequent, dread-inducing encounters with mortality. Relevant conceptual and theoretical underpinnings and intervention principles are presented both in the introduction and throughout the case illustration, and specific treatment recommendations are provided in the discussion section. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Teaching behavioral medicine professionals and trainees an elaborated version of the Y-Model: Implications for the integration of cognitive–behavioral therapy (CBT), psychodynamic therapy, and motivational interviewing.

2016-08-08

The Y-Model is used to teach evidence-based psychotherapy to mental health care trainees. We adapt the Y-Model to help teach psychotherapy to providers in medical settings (e.g., physicians, nurses, dietitians, physical therapists, etc.). This elaboration of the Y-Model aids educators to help learners overcome multiple barriers that inherently exist as new psychotherapy concepts are being assimilated in medical settings. The stem of the Y-Model represents foundational therapeutic principles and techniques common to all psychotherapy approaches. One branch of the Y-Model represents cognitive–behavioral therapy (CBT) techniques, while the other represents psychodynamic therapy (PT). Because motivational interviewing (MI) is highly utilized in medical settings and share foundational therapeutic principles, we conceptually integrate MI with the stem of the Y-Model to present one cohesive, unified teaching model that utilizes high yield interventions in behavioral medical settings. Furthermore, helping the trainee to identify their default communication style also tends to improve learning of foundational psychotherapy principles. Theoretical differences, therapist relationships, and therapeutic techniques are outlined and contrasted in user-friendly charts to facilitate teaching and learning. Finally, a case example demonstrates how this model is applied with behavioral medicine providers. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Integrative psychotherapy of patients with schizophrenic spectrum disorders: The case of a musician suffering from psychotic episodes.

2016-06-30

Psychotherapy of patients suffering from schizophrenic disorders remains controversial. There are promising descriptions of treatments, and some empirical studies show that different forms of psychotherapy are effective. However, there are few models to combine different psychotherapeutic strategies in a comprehensive way. Here we propose a model of integrative psychotherapy that is based on the therapeutic alliance and the general principles of understanding and communication. It comprises cognitive–behavioral, psychodynamic, and existential elements. These aspects are applied hermeneutically to the narrative of a case of schizophrenia. After remission of the acute symptoms, integrative psychotherapy played the major role in the recovery of the patient. It is shown how therapeutic alliance and understanding and communication in a general sense interacted with behavioral, cognitive, psychodynamic, and existential strategies. The patient himself assessed these strategies and approved his case report. General principles of psychotherapy gain contextual meaning by the analysis of individual narratives. In the case of schizophrenia, the gap between hermeneutics and science can be bridged by an interdisciplinary concept of coherence. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Recovery in bipolar disorders: Experienced therapists’ view of their patients’ struggles and efforts when facing a severe mental illness.

2016-09-15

The aim of this study was to explore how experienced therapists view recovery in bipolar disorders. In what ways do professionals conceptualize and give meaning to processes of healing and growth? How do they experience working with their patients toward recovery? We conducted 12 semistructured interviews and analyzed the resulting transcripts, following a hermeneutical–phenomenological approach. The study was developed within a reflexive–collaborative framework, in which a group of service users participated as coresearchers in designing the study, developing the interview guide, and analyzing the data. This collaboration was directed at enhancing the quality of the investigation by establishing a reflexive dialogue. The participants’ descriptions of recovery in bipolar disorders are summarized according to 3 themes, outlining important aspects of their patients’ struggles and efforts: (a) “a puzzling given,” (b) “the protagonist of the recovery process,” and (c) “the heroic fighter does not always win.” The themes’ relations to established theory, research, and practice, along with the limitations and strengths of the study, are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



The evolving science of anger management.

2016-09-29

This study reviews relevant literature on (a) treatment outcomes for anger management programs, and (b) research on emotional process work during treatment. It is argued that relying on conscious deliberate cognition to regulate emotion is not effective for individuals who have long periods of intense emotional arousal. The most significant problem is the refractory period during which cognition is governed by emotion, allowing only thoughts that confirm, justify, or heighten the emotion. Up until now, these 2 fields of inquiry have remained relatively separate. A call for further research is made after examining the results of a pilot study by the author. Descriptive statistics reveal significant progress following a 3-month treatment period with outcome data collected at the end of treatment and at a 3-month follow-up. The conclusion is that violence prevention programs based primarily on psychoeducational and cognitive–behavioral methods are not the only method for addressing the problem of anger, and perhaps not as effective as other options. Further research is needed to determine if those with severe anger and rage problems require the integration of emotional process work along with traditional treatment approaches. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



A CAT envelope to deliver EMDR: Cognitive analytic therapy around eye movement desensitization and reprocessing.

2016-06-27

Two psychological therapy approaches are outlined: cognitive analytic therapy (CAT) and eye movement desensitization and reprocessing (EMDR). Substantial benefits are to be gained, particularly for patients with complex interpersonal trauma, in combining the 2; providing EMDR within the CAT envelope. This synthesis harnesses the benefits of a CAT reformulation framework of understanding and a proven CAT therapeutic approach generally with the well-established therapeutic efficacy and expediency of EMDR. An overview of each single approach is given, followed by the rationale and the main benefits and limitations of the combined approach, with clinical illustrations. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)