Contents 1 The Dialectics of Psychotherapy: Philosophical and Empirical Debates

Contents 1 The Dialectics of Psychotherapy: Philosophical and Empirical Debates... 1 Dialectical Tensions in Psychotherapy: Philosophical Assumptions... 3 Scientific Modernism... 5 Phenomenology... 7 General Systems Theory... 8 Postmodern Criticism and Philosophy... 10 Dialectical Tensions in Psychotherapy Integration... 12 Integrative Dialectics... 13 Eclectic Dialectics... 14 The Dialectics of Common vs. Specific Factors... 15 The Dialectics of Intervention Levels: Microcontext to Macrocontext... 16 Level of Intervention... 16 The Dialectics of Psychotherapy Research... 18 The Dialectics of Clinical vs. Statistical Significance... 19 Dialectics of Outcome vs. Process Research... 23 The Dialectics of Treatment-Focused vs. Patient-Focused Research... 27 Integrative Implications... 28 Chapter One: Main Points... 30 Further Reading... 31 2 Transtheoretical Approaches: Treatment Planning and the Initial Interview... 33 The Dialectics of Transtheoretical Treatment Planning... 33 The Transtheoretical Model (TTM)... 34 Systematic Treatment Selection... 37 Integrating the Transtheoretical Model and Systematic Treatment Selection... 41 Common Factors in Treatment Planning... 43 Patient-Focused Research... 44 Planning and Assessment in Clinical Care: The PACC Approach... 45 xi

xii Contents Dialectical Tensions Between Client and Therapist During the Initial Interview... 47 Gathering Information While Establishing a Collaborative Relationship... 48 Case Illustration: Integrative Transtheoretical Treatment Planning... 55 Integrative Implications... 56 Case Conceptualization with an Integrative Transtheoretical Approach... 57 Stages of Change and Client Variables... 57 From Macro to Microcontexts... 58 Chapter Two: Main Points... 59 Further Reading... 60 3 Biomedical Approaches to Treatment... 63 Dialectics of the Medical and Psychosocial Models... 64 The Diathesis-Stress Dialectic... 65 Psychosomatic Illness vs. Medical Illness with Psychological Symptoms... 65 Psychopharmacology: A Conceptual Framework... 67 Neurons and Synaptic Transmission... 67 Pharmacokinetics... 69 Pharmacodynamics... 70 Neurotransmitters... 72 Pharmacotherapy... 74 Antidepressants... 74 Antipsychotic Drugs... 84 Analgesics... 85 Anxiolytics... 87 Pharmacotherapy with the Elderly and with Children... 88 Geriatric Psychopharmacology... 89 Pediatric Psychopharmacology... 91 Substance Abuse... 93 Integrative Implications... 96 Integrative Therapy for Schizophrenia... 97 Case Illustration... 100 Chapter Three: Main Points... 101 Further Reading... 104 4 Behavioral Interventions... 105 Conceptual Framework... 106 Exposure-Based Behavior Therapies... 107 Systematic Desensitization (Reciprocal Inhibition)... 107 Eye Movement Desensitization and Reprocessing (EMDR)... 110 Flooding and Implosive Therapies... 111 Acceptance or Mindfulness-Based Interventions... 112 Case Illustration: Exposure Techniques... 112

Contents xiii Operant-Based Behavior Modification... 114 Applied Behavioral Analysis... 114 Behavioral Activation... 125 Case Illustration: Behavioral Activation (Adapted from Jacobson et al., 2001)... 126 Cognitive Behavior Modification Approaches... 127 Psychoeducation and Social Skills Training... 127 Social Learning Programs (SLPs)... 128 Assertiveness Training... 128 Thought-Stopping... 129 Problem-Solving... 129 Self-Instructional Training... 130 Stress Inoculation... 131 Lazarus BASIC-ID Multimodal Therapy... 131 Integrative Implications... 132 Chapter Four: Main Points... 132 Further Reading... 134 Videos... 135 5 Cognitive Approaches... 137 Rational Emotive Behavioral Therapy... 137 Conceptual Framework... 138 Intervention Techniques... 139 Cognitive Therapy... 140 Conceptual Framework... 141 Cognitive-Behavioral Interventions... 143 Case Formulation in Cognitive Therapy... 147 Case Illustration... 147 Schema Therapy... 149 Conceptual Framework... 150 Intervention in Schema Therapy... 153 Case Illustration: Schema Therapy (Summarized from Young et al., 2003, pp. 66 67)... 161 Integrative Implications... 163 Chapter Five: Main Points... 166 Further Reading... 169 Websites... 169 Videos... 169 6 Psychoanalytic Approaches... 171 Psychoanalysis... 172 Freud s Instinctual Drive Theory... 172 Structural Theory... 173 Psychosexual Developmental Stage Theory and Psychopathology... 174 Psychoanalytic Treatment... 176

xiv Contents Ego Analytic Theory... 178 Anna Freud... 178 Erik Erikson... 181 The Conflict-Free Sphere of Ego Function: Hartmann, Mahler, and White... 184 Brief Psychodynamic Psychotherapy... 186 Brief Psychodynamic Intervention and Treatment Planning... 187 Case Illustration: Core Conflictual Relationship Theme Method... 188 Integrative Implications... 190 Chapter Six: Main Points... 192 Further Reading... 193 Videotape... 193 7 Psychodynamic Approaches: Object Relations and Self Theory... 195 Object Relations Theory... 196 Conceptual Framework... 196 Self Theory... 201 Diagnosis and Treatment Planning in Psychodynamic Psychotherapy... 202 Treatment Planning... 203 Psychodynamic Intervention Issues... 208 Case Illustration: Psychodynamic Therapy (Summarized from McWilliams, 2004, pp. 219 259)... 209 Integrating Psychodynamic and Behavioral Therapy... 212 Conceptual Framework: Cyclical Psychodynamics... 213 Case Illustration (Summarized from Wachtel et al., 2005, pp. 347 354)... 215 Integrative Implications... 217 Attachment Research... 217 Patterns of Attachment... 218 Attachment and Problems in Living... 219 Chapter Seven: Main Points... 220 Further Reading... 222 Videos... 222 8 Humanism: Experiential Approaches... 223 Dialectic Tensions in Gestalt Therapy... 224 Perls Classical Gestalt Approach: Conceptual Framework... 225 Perls Theory of Psychopathology... 226 Perls Approach to Therapeutic Intervention... 227 A Contemporary Relational Gestalt Approach (Erving Polster)... 229 Conceptual Framework: Community of Selves... 230 Intervention in Relational Gestalt Psychotherapy... 230 Emotionally Focused Therapy: Bridging the Researcher-Practitioner Gap... 233 Conceptual Framework: Emotionally Focused Therapy... 234

Contents xv Emotion Theory... 235 Intervention in Emotionally Focused Therapy... 237 Continuous Case Formulation with Task Markers and EFT Interventions... 241 Case Illustration (Continuation with Tracey)... 249 Reprocessing Problematic Experiences: Chair Work and Meaning Creation... 251 Case Illustration (Conclusion with Tracey)... 254 Integrative Implications... 258 Chapter Eight: Main Points... 259 Further Reading... 261 Videos... 261 9 Humanism: Phenomenological Approaches... 263 Existential Therapy... 264 Conceptual Framework... 265 Intervention in Existential Approaches... 271 Case Illustration... 278 Carl Rogers Client Centered Therapy... 284 Conceptual Framework... 284 Pretherapy... 287 Motivational Interviewing (MI)... 289 Conceptual Framework... 289 Client and Therapist Activities... 290 Integrative Implications... 294 Chapter Nine: Main Points... 295 Further Reading... 298 Videos... 298 Websites... 298 10 Psychotherapy and Social Context... 299 Individual Psychology... 300 Intentionality... 300 Individual Psychology s Conceptual Framework... 301 Intervention Approach... 306 Case Illustration... 311 Interpersonal Theory: Harry Stack Sullivan... 313 Conceptual Framework... 314 Communication Analysis: Social Reinforcement of Unconscious Processes... 315 Conceptual Framework... 316 Intervention Approach... 319 Case Illustration... 321 Integrative Implications... 323 Self-Regulation and General Systems Theory... 323 Intentionality and Interpersonal Relations as Integrative Concepts... 325

xvi Contents Chapter Ten: Main Points... 326 Further Reading... 328 Website... 328 Videos... 328 11 Contemporary Interpersonal Approaches... 329 Communication Theory: Process vs. Content... 330 Interpersonal Process in Therapy... 332 Conceptual Framework... 332 Interpersonal Process Intervention Principles... 336 Interpersonal Reconstructive Therapy... 344 Case Formulation in Interpersonal Reconstructive Therapy... 345 Structural Analysis of Social Behavior... 346 Therapeutic Intervention... 349 Case Illustration (Summarized from Benjamin, 2006, pp. 2, 17 20)... 356 Interpersonal Therapy... 358 Conceptual Framework... 358 Intervention Techniques... 359 Case Illustration (Summarized from Crowe and Luty, 2005)... 360 Integrative Implications... 362 Chapter Eleven: Main Points... 363 Further Reading... 364 Video... 365 12 Family Systems and Couples Approaches... 367 Systems Approaches to Family Therapy... 368 Cybernetics and Family Systems Theory... 368 Strategic Family Therapy... 370 Multigenerational Approaches... 374 Structural Therapy... 377 Experiential Therapy with Couples and Families... 384 Attachment-Based Family Therapy... 389 Postmodern Family Approaches... 390 Narrative Therapy... 391 Solution-Focused Therapy... 392 Other Approaches... 393 Object Relations Family Therapy... 394 Cognitive-Behavioral Couples and Family Therapy... 394 Integrative Implications... 397 Chapter Twelve: Main Points... 398 Further Reading... 399 Videos... 399 Websites... 400

Contents xvii 13 Ecosystemic Issues and Approaches... 401 Privileged and Oppressive Ecosystems... 402 Feminism and Multiculturalism... 404 Minorities and Oppression in the United States... 405 Ecosystemic Interventions... 413 Family Networking... 414 Multisystemic Therapy... 417 Community Mental Health... 421 Power, Symptoms, and Ethics... 423 Integrative Implications... 424 Chapter Thirteen: Main Points... 425 Further Reading... 427 Videos... 427 Websites... 427 14 Postmodernism and Integrative Therapies... 429 Constructivism in Therapy... 430 Intersubjective Approaches... 430 Cognitive-Experiential-Interpersonal Negotiation of Alliance Ruptures... 433 Integrative Postmodernism: Functional Contextualism... 442 Dialectical Behavior Therapy... 443 Acceptance and Commitment Therapy... 450 Integrative Implications... 465 Chapter Fourteen: Main Points... 465 Further Reading... 468 Video... 468 Websites... 468 15 Epigenetic Systems: A Meta-Integrative Model of Human Functioning and Therapy... 469 An Epigenetic Systems Model of Human Development and Functioning... 472 Motivation: Interpersonal Needs and Self-Determination Theory... 474 Cognitive-Experiential Self-Theory (CEST) and Personal-Agentic Processes... 476 Developmental Stages and Tasks... 477 Problems in Living... 482 Case Illustration: Epigenetic Case Conceptualization... 486 Epigenetic Systems and Treatment Planning... 489 Intervention Principles... 491 Epigenetic Treatment Planning and Intervention... 492 Case Illustration: Epigenetic Treatment Planning... 494

xviii Contents Integrative Conclusions... 496 Chapter Fifteen: Main Points... 497 Further Reading... 500 Appendices... 501 Appendix A: Initial Interview & Treatment Planning Tools... 501 Appendix B: Therapeutic Intervention Tools... 504 Bibliography... 505 Author Index... 537 Subject Index... 543

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