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Persuasion and Healing: A Comparative Study of Psychotherapy

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... The quote from the Selk'nam shaman in the epigraph of this paper provides another example of this pattern. Frank (1961) emphasizes the symbolism of the extraction trick, comparing the mentality of the patient with that of devotees partaking in communion, 'for whom in one sense the bread and wine are the body and blood of Christ while in another they are just bread and wine' [57]. Even as a patient may understand that the object is not literally being extracted from his body, 'the healing ritual reinforces the image of the shaman as a powerful ally in the patient's struggle with the malign forces that have made him ill' [57]. ...
... The quote from the Selk'nam shaman in the epigraph of this paper provides another example of this pattern. Frank (1961) emphasizes the symbolism of the extraction trick, comparing the mentality of the patient with that of devotees partaking in communion, 'for whom in one sense the bread and wine are the body and blood of Christ while in another they are just bread and wine' [57]. Even as a patient may understand that the object is not literally being extracted from his body, 'the healing ritual reinforces the image of the shaman as a powerful ally in the patient's struggle with the malign forces that have made him ill' [57]. ...
... Frank (1961) emphasizes the symbolism of the extraction trick, comparing the mentality of the patient with that of devotees partaking in communion, 'for whom in one sense the bread and wine are the body and blood of Christ while in another they are just bread and wine' [57]. Even as a patient may understand that the object is not literally being extracted from his body, 'the healing ritual reinforces the image of the shaman as a powerful ally in the patient's struggle with the malign forces that have made him ill' [57]. Performative acts play an important and seemingly effective role in traditional healing practices found all over the world [58]. ...
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The claim of possessing supernatural abilities is a commonly reported phenomenon across human societies. To bolster the credibility of such claims, performers may make use of illusions and sleight of hand to give the appearance of impressive powers. One common trick found among culturally independent hunter–gatherers on every continent they inhabit involves a healer ostensibly extracting from a sick person an object, such as a pebble or insect, that is supposedly causing the patient’s illness. The use and functions of the ‘extraction trick’ are here explored across a global sample of hunter–gatherer societies (N = 74), with attention given to the possible costs and benefits accrued by performers and their patients or audiences. This and similar tricks can be highly deceptive, but they can also be undertaken for entertainment, symbolic reasons, their placebo-like utility to sick patients, or some mixture of each. The recurrent invention of the trick across independent societies, as well as its cultural inheritance and diffusion between groups, indicates that it likely appeals to certain universal facets of human psychology, where experiences of sickness and pain commonly induce one to seek interventive cures from specialists, who in turn may use deceptive displays to give the appearance of greater skill and powers.
... Frank (1973) theorized that all mental health treatments have their characteristic rationale or "myth," i.e. the practitioner's explanation for why the treatment will work. The term was not intended to be pejorative; such myths apply not only to informal treatments, but also to established psychological therapies. ...
... The role that therapy myths (Frank, 1973) may play in relation to mindfulness-based programs (MBPs; Crane et al., 2017) is arguably of particular interest, because MBPs have their roots in both ancient Buddhist spiritual tradition and secular science and therapy (Segal et al., 2002;Williams & Kabat-Zinn, 2011). MBPs have been described as being "informed by theories and practices that draw from a confluence of contemplative traditions, science, and the major disciplines of medicine, psychology and education… [and] draw on aspects of these (contemplative) traditions while leaving behind their religious, esoteric and mystical elements" (Crane et al., 2017, p. 992). ...
... This study compared the effectiveness of secular, spiritual, and philosophically integrated role inductions or "myths" (Frank, 1973), as well as possible congruency effects with spiritual/secular dispositions, on expectations, credibility, and outcomes for a brief online mindfulness meditation intervention. All three induction groups improved across time points on measures of credibility and expectations, state mindfulness and negative affect, but this improvement was similar for all three groups. ...
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Objectives Mindfulness meditation has both spiritual and secular foundations. Drawing on Jerome Frank’s concept of a healing “myth,” this study investigated the relative influence of spiritual and secular inductions to a brief mindfulness-based intervention. We hypothesized that, compared to narrower spiritual or secular presentations, an integrated role induction to mindfulness meditation would be more effective at improving the perceived credibility of, and expectations regarding, this practice, and hence would result in a subsequent mindfulness practice having a greater effect on state mindfulness and affect. We also hypothesized that there would be congruency effects between participants’ dispositional spirituality/secularity and their assigned induction group.Methods Participants (n = 179) were randomly allocated to one of three role inductions (spiritual, secular, or integrated); all then received the same brief, online, mindfulness intervention. Dispositional measures of secularity and spirituality were taken at baseline, and state measures of credibility and expectations, mindfulness and affect were taken at baseline, post-induction, and post-intervention.ResultsFollowing attrition and screening for participation, data from 124 completers were analyzed. Participants improved across time on measures of credibility and expectations, state mindfulness, and negative affect. Contrary to the hypotheses, the integrated induction group did not improve more than the secular or spiritual groups, nor were congruency effects found. However, there was significantly less participant attrition in the integrated group than the other two conditions.Conclusions It is argued that a more broadly accessible “myth” may help more participants to persevere with mindfulness practice.
... Client's expectations and perceived treatment credibility have long been argued to be cocreated by the therapist and his skillful use of persuasive social influence (Corrigan et al., 1980;Frank, 1961;Heppner & Claiborn, 1989;Strong, 1968). In other words, therapists play an active role in shaping these factors throughout the therapy process. ...
... More than 50 years ago, Frank (1961) argued cogently and extensively over the direct link between therapist's persuasive ability and their clinical effectiveness. He later summarized his views when stating that: ...
... Humans have a hardwired need to make sense of their external world and internal experience Wampold, 2007Wampold, , 2012. Feeling that the world or one's experience is overly unpredictable or not understandable are core characteristics of what Frank (1961) termed "demoralization," a distinctive feature of those seeking psychotherapy. Pascual-Leone and describe this common beginning client presentation as global distress, a state "with little or no substantive meaning elaboration," where "the specific concern at hand is often very vague and global," and "clients explicitly state that they do not know why they are feeling so inundated with distress" (pp. ...
... Jerome Frank esitti näkemyksensä teoksessa Persuasion and healing (1961). Tässä -samoin kuin kirjan monissa uusintapainoksissa, jotka hän kirjoitti yhdessä tyttärensä Julia B. Frankin kanssa -hän pyrki sekä luomaan kokonaisteoriaa psykoterapioista ja psykoterapiapotilaan tilanteesta että liittämään psykoterapiat osaksi ihmiskunnan ikiaikaisia parantamisrituaaleja ja -käytäntöjä (Frank, 1961;Wampold, 2001a). ...
... He ovat menettäneet toimintakyvyn suhteessa heitä piinaaviin ongelmiin, menettäneet uskon itseensä ja maailmaan, joutuneet hämmennyksen ja ahdistuksen valtaan ja kokevat joutuneensa eksyksiin. Terapian tehtävänä on palauttaa potilaan toimijuuden tunto suhteessa sekä koettuihin oireisiin että laajemminkin suhteessa itseen ja omaan paikkaan maailmassa, ei niinkään vain poistaa oireita (de Figueiredo, 2007;Frank, 1961). Tässä työssä erityiset tekijät ja tekniikat voivat tulla avuksi ikään kuin rakennuspalikoiksi yhteisen todellisuuden rakentamisessa, elämän ymmärrettävyyden tavoittamisessa ja ihmissuhteiden rikastamisessa. ...
Article
Bruce Wampoldin kontekstuaalinen psykoterapia-ajattelu: Kohti psykoterapian metamallia? Psykoterapiamuotojen jatkuvasti lisääntyessä yhä polttavammaksi nousee kysymys siitä, voidaanko tästä moninaisuudesta pelkistää jokin yleinen psykoterapian malli. Ehdotuksia tällaiseksi malliksi ovat esimerkiksi medikaalinen metamalli, assimilaatioanalyysi, dialogiseen sekvenssianalyysiin perustuva malli, Morrisin käsitteellinen metamalli ja Bruce Wampoldin esittämä kontekstuaalinen metamalli. Artikkelissa esitellään Wampoldin malli ja analysoidaan sen vahvuuksia ja puutteita. Wampoldin ajattelu on ollut Suomessa yhtenä lähtökohtana ns. integratiivisen psykoterapian kehittymiselle. Se on myös ollut vaikuttamassa tuloksellisuustutkimuksen kritiikkiin, joka on ollut tänä vuona ilmestyneen käsikirjan Psykoterapiat lähtökohtana. Artikkelissa tarkastellaan kysymystä, voidaanko Wampoldin esittämää psykoterapian mallia pitää geneerisenä metatason mallina. Voidakseen tulla kutsutuksi psykoterapian yleiseksi metamalliksi teorian tulisi kyetä paitsi selkeyttämään psykoterapian ristiriitaista käsitteistöä myös toimimaan keskitason teoriana (Merton, 1967; Ylikoski, 2008). Näin voitaisiin vaalia yhteyttä sekä psykoterapeuttisiin teorioihin, empiiriseen tutkimukseen että kliiniseen kokemukseen. Osoittautui, että Wampoldin malli kyllä sisältää aineksia tällaiseksi metamalliksi. Toisaalta se on kuitenkin toistaiseksi liian abstrakti, jotta se kykenisi vastaamaan kysymykseen psykoterapeuttisen muutoksen kausaalisista mekanismeista. Se on myös rajaava: Se sulkee tarkastelun ulkopuolelle hoitomuotoja, joita on pidetty ja edelleen pidetään psykoterapioina. Wampoldin malli antaa psykoterapioista myös perusteettoman rationaalisen ja vaihespesifin kuvan. Merkittävää osaa psykoterapioista on vaikea tulkita yksinomaan tästä näkökulmasta.
... Nach diesem Modell lässt sich die Wirksamkeit von Psychotherapie auf vier Aspekte zurückführen: (1) Eine vertrauensvolle, emotional unterstützende Beziehung zwischen Hilfesuchenden und Helfenden in einem institutionalisierten, sozial legitimierten Kontext, (2) die Erwartung, qualifizierte Hilfe zu bekommen, (3) ein plausibles Erklärungsschema ("Mythos") für die Probleme der Patientinnen und Patienten sowie (4) daraus abgeleitete "Rituale" in Form von Aufgaben und Vorgehensweisen zur Problembewältigung. Therapeutische Erfolge basieren laut diesem Ansatz nicht auf der spezifischen Wirkung therapeutischer Techniken, sondern auf deren Funktion im Sinne einer Erwartungsänderung (Remoralisierung) bei den Patientinnen und Patienten [3]. Im deutschsprachigen Raum gilt Klaus Grawe als Wegbereiter schulenübergreifender Wirkfaktoren der Psychotherapie. ...
... Die Formulierung der WEB-Items orientierte sich am Berner Patientenstundenbogen [15] Die Resultate sind mit etablierten theoretischen Modellen konform. Die globalen Wirkfaktoren Therapeutische Allianz, Kognitive Integration und Bewältigung stimmen weitgehend mit den theoretischen Wirkfaktorenkonzepten von Frank [3], Wampold [29] und Lambert [30] überein. Drei Wirkkomponenten von Frank (stützende Beziehung, plausibles Erklärungsmodell, Behandlungsritual) finden sich in den globalen allgemeinen Wirkfaktoren wieder. ...
Article
Zusammenfassung Ziel der Studie Das Zusammenhangsmuster 26 allgemeiner Wirkfaktoren wurde mit dem Ziel untersucht, die Debatte um Wirkmechanismen der Psychotherapie mit empirisch abgeleiteten Sekundärfaktoren (globale allgemeine Wirkfaktoren) konzeptuell zu erweitern und gleichzeitig Aspekte der Reliabilität und Validität eines neuen Instruments zur Erfassung allgemeiner Wirkfaktoren zu prüfen. Methodik Die Aktivierung allgemeiner Wirkfaktoren wurde mit dem Wochenerfahrungsbogen (WEB) bei 502 Patientinnen und Patienten in teil- oder vollstationärer psychotherapeutischer Behandlung erhoben. Die Faktorenstruktur des WEB wurde anhand einer explorativen Faktorenanalyse ermittelt und mit konfirmatorischen Faktorenanalysen geprüft. Ergebnisse Die vier Faktoren Bewältigung, Therapeutische Allianz, Kognitive Integration und Affektive Verarbeitung erklärten 59,8 % der Gesamtvarianz. Konfirmatorische Faktorenanalysen der teil- und vollstationären Stichproben unterstützten diese Faktorenstruktur. Schlussfolgerung Die Studie bietet die erste empirisch fundierte, integrative Kategorisierung allgemeiner Wirkfaktoren. Ergebnisse der internen Konsistenz (Reliabilität) und Konstruktvalidität des WEB liefern Hinweise dafür, dass dieses Instrument für die Untersuchung globaler allgemeiner Wirkfaktoren geeignet ist.
... His emphasis was especially on the placebo effect. In 1961 he published the first explicit model of common factors (Frank, 1961). From that time up to the 1990's he searched for the commonalities among very different healing practices, such as traditional psychotherapy, group and family any particular psychotherapy school and are nowadays understood as transtheoretical and integrative contributions. ...
... Če je Rosenzweig idejo skupnih dejavnikov samo kratko nakazal, pa je bil Jerome Frank prvi, ki se ji je popolnoma posvetil ter jo teoretično in empirično razširil, tako da je še posebej poudaril zdravilni učinek placeba. Prav on je tako leta 1961 objavil prvi eksplicitni model skupnih dejavnikov (Frank, 1961). Od takrat pa vse do devetdesetih let je iskal sorodnosti med tako različnimi dejavnostmi, kot so tradicionalna psihoterapija, skupinske in družinske terapije, stacionarno in farmakološko zdravljenje, medicina, religijsko magično zdravljenje v neindustrializiranih družbah, kulti in oživljanje, ter razvijal svoj model (Frank, 1971;Frank in Frank, 1991), v katerega je zajel štiri dejavnike: a. čustveno nabit, zaupljiv odnos s pomagajočim, ki napaja klientovo zaupanje v terapevtovo kompetentnost; b. zdravilni seting ali kultura, ki vključuje širok razpon dejavnikov, od prostorske ureditve terapevtskih prostorov pa do tega, kar daje določeni obliki terapije ugled ali celo prestiž. ...
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Rosenzweig je leta 1936 po zgledu razsodbe ptiča Dodo iz romana Alica v čudežni deželi opozoril na skupne značilnosti različnih psihoterapevtskih pristopov in na možnost njihove integracije. Z razvojem psihoterapevtske znanosti se je njegova ideja razvila v empirično potrjeno teorijo skupnih dejavnikov in v kontekstualni model, ki na področju varovanja duševnega zdravja predstavlja vse privlačnejšo alternativo medicinskemu modelu. Vendar se je hkrati intenziviralo raziskovanje za potrjevanje medicinskega modela, po katerem k učinku psihoterapije ključno prispevajo specifični dejavniki oz. specifične terapevtske metode in postopki za določene duševne motnje. Poleg znanstvenega in filozofsko epistemološkega polariziranja med raziskovalci so se razplamteli tudi vroči politični spopadi za financiranje psihoterapevtskih storitev, za normativno urejanje psihoterapije v okviru struktur zdravstvenega varstva ter za umeščanje v akademske izobra-ževalne institucije, ki trajajo še danes. Namen članka je s pomočjo prikaza zgodovine raziskovanja in teorije skupnih dejavnikov prispevati k temu, da se ne bi brez potrebe zapletali v neplodno obračunavanje med zagovorniki terapevtskih metod na eni in terapevtskega odnosa na drugi strani. Namesto tega predlagam, da ptiča Dodo v psihoterapevtskih krogih ne sprejmemo le kot simbola za teorijo skupnih dejavnikov, temveč tudi kot glasnika dialoškega pluralizma različnih psihoterapevtskih in raziskovalnih pristopov v smislu psihoterapevtske in interdisciplinarne integracije. V članku je prikazan prvi del zgodovine razvoja teorije skupnih dejavnikov od Rosenzweiga do Frankovega kontekstualnega modela v šestdesetih letih prejšnjega stoletja.
... Pri iskanju odgovorov se je najbolj oprl na tradicijo raziskovanja skupnih dejavnikov in kontekstualnega modela v psihoterapiji. Podobno kot Jerome Frank (Frank, 1961(Frank, , 1971Frank in Frank, 1991), ki je skupne dejavnike v psihoterapiji prvi sistematiziral v kontekstualni model, Watkins po analogiji meni, da so tudi v superviziji ključni štirje dejavniki, ki pomagajo k vzbujanju supervizantovega upanja, vere, čudenja in radovednosti za terapevtsko delo: ...
Article
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Skupni dejavniki v superviziji ter njihov pomen za razvijanje kompetentnosti in ekspertnosti z namerno vadbo Common factors in supervision and their significance for the development of competence and expertise through deliberate practice Povzetek Glavne naloge supervizorjev pokrivajo dve področji: a) supervizijo za razvijanje kompetentnosti supervizantov in b) konzultacijo za razvijanje ekspertnosti supervizantov za boljše izide klientov. Vpliv supervizije na supervizante in na razvoj njihove kompetentnosti oziroma ekspertnosti, ki je lahko pozitiven ali negativen, je potrjen z izsledki številnih raziskav. Nejasno pa ostaja, kako supervizija učinkuje na kliente supervizantov. Kljub vse večjemu številu super-vizijskih modelov ni dokazov, da bi bil kakšen od njih boljši od ostalih, tako da vprašanje, katera oblika supervizije je učinkovitejša, še posebej glede na izide klientov, ostaja odprto. Pri iskanju dejavnikov supervizije, ki imajo največji vpliv na izide klientov, se vedno bolj kaže pomen skupnih dejavnikov, ki niso vezani na določen model, teorijo ali celo stroko. Hkrati so raziskave pokazale, da so z izkušnjami supervizorji vse manj zvesti oziroma pripadni določeni teoriji in vse bolj naklonjeni skupnim dejavnikom v superviziji, ki so transteoretični in celo transdisciplinarni. Tako so predstavljeni štirje integrativni, transteoretični modeli skupnih dejavnikov, procesov in praks v superviziji: na učenju temelječi model, supervizijska piramida, generični model in kontekstualni model. V vseh teh modelih je najobetavnejše zagotovilo za kakovostnejšo supervizijo in konzul-tacijo današnjega dne in v prihodnosti stalno spremljanje in evalviranje prakse posameznih supervizantov tam, kjer se odvija, ter upoštevanje povratnih infor-macij o izidih klientov v supervizijskem oziroma konzultacijskem procesu.
... Det udelukker selvfølgelig ikke, at terapeuter fra andre skoler vil kunne vaere enige i en del af indholdet. Som blandt andre Frank (1973) har påpeget, kan der vaere en raekke såkaldte »faelles-faktorer« i al god psykoterapi uanset teoretisk retning; men der er også forskelle. ...
Article
Artiklen drejer sig om uddannelse til psykoterapeut indenfor en psykoanalytisk referenceramme. Der stilles to spørgsmål: 1) Hvad karakteriserer en god-nok psykoterapeut? og 2) hvordan uddanner man til det? i besvarelsen af det første spørgsmål tages der udgangspunkt i Greensans beskrivelse af de personlige egenskaber og færdigheder, det kræver at være en god psykoanalytiker. Der suppleres med eksempler på nogle professionelle færdigheder, som forfatteren gennem sit eget arbejde som supervisor og lærer i psykoterapi har fundet centrale. Det drejer sig om: fortrolighed med offentlige behandlingssystemer, psykoterapeutisk erfaring med børn, færdighed i evaluering og viden om rammer og strukturer om psykoterapi. I besvarelsen af det andet spørgsmål følges den almindelige 3-deling af psykoterapeutuddannelsen i teori, egenterapi og supervision. Indenfor teoriområdet fremhæves især vigtigheden af kendskab til nyere udviklingsteorier. Mht. egenterapi nævnes nødvendigheden af selektion af kandidater, og det drøftes, om analyse eller psykoterapi udgør den bedste uddannelse. Vedrørende supervision gås der især ind på spændingsfeltet mellem metodeindlæring og personlig udvikling; det eksemplificeres gennem beskrivelser af forskellige holdninger til udvikling af psykoterapeuters empatiske formåen. Der suppleres med en beskrivelse af ekspertisebegrebet sat i relation til udøvelse af psykoterapi. Der afrundes med en understregning af nødvendigheden af vedligeholdelse af uddannelse og færdigheder
... Den ovenfor nevnte terapeutiske allianse er en sentral del av det terapirelevante begrepskompleks, som i faglitteraturen benevnes de nonspesifikke faktorer (Frank, 1973(Frank, , 1981. Innen møtene med terapeutene var vi oppmerksomme på disse faktorene, men ikke i en grad som tilsvarte den vekt som våre intervjupersoner tilla dem -spesielt i deres terapeutiske arbeid med ikke-vestlige klienter. ...
Article
Denne artikkelen er basert på en kandidatavhandling, hvor utgangspunktet var en forestilling om at psykoterapi med ikkevestlige klienter kan være utfordrende på grunn av terapeutens og klientens ulike kulturbakgrunner. Avhandlingens kvalitative intervjuer med erfarne terapeuter satte imidlertid fokus på betydningen av de non-spesifikke faktorer i den terapeutiske relasjon, og at disse er like viktige uavhengig av klientens kulturbakgrunn. Artikkelen presenterer en videre bearbeidelse av disse data, og beskriver to studenters voksende erkjennelse av at å være psykoteraput dypest sett kan sies å dreie seg om å være ’et profesjonelt medmenneske’. På denne måten omhandler ikke artikkelen ’demokrati’ i formal-politisk betydning, men snarere hvordan man som terapeut kan møte den ikke-vestlige klient med en demokratisk holdning; en form for ’sinnelagsdemokrati’.
... Saul Rosenzweig (1936) var den første til at foreslå, at psykoterapi primaert virker i kraft af teoretisk nonspecifikke faellesfaktorer. Senere udviklede Jerome Frank antagelsen i en indflydelsesrig bog fra 1961(3. rev. ...
Article
Psykoterapiforskningens start er blevet lokaliseret til 1920, året for grundlæggelsen af det første psykoanalytiske institut, Berlin Poliklinik, hvor man fra starten registrerede patientdata til kvantitativ bearbejdelse. Artiklen gennemgår træk af psykoterapiforskningens historie ved effekt, proces og patientprædiktorer med opdateringer om aktuelle forskningstendenser. Den redegør for forskellige paradigmer for forståelsen af forholdet mellem videnskab og praksis: evidensbaseret psykoterapi, procesbaseret psykoterapi og fællesfaktorterapi. Det konkluderes, at psykoterapiforskningen har haft enorm indflydelse på psykoterapiens anvendelse, primært i kraft af den overbevisende dokumentation for psykoterapiens effekt. Der foregår nu metodisk avanceret forskning i terapiens virkningsmekanismer og patientprædiktorer i bestræbelser for at nå til ”personaliseret” terapi, tilpasset den enkelte patient. Forskningen er dog her fortsat uden klare, praktisk anvendelige resultater.
... Terapeutfaktorer knyttet til samarbejdsforholdet omfatter: 1. hans eller hendes evne (ekspertice) og 2. vilje til at hjaelpe (engagement), samt 3. hans/hendes bidrag til at styrke klientens positive og realistiske forventninger til psykoterapien. Betydningen af sådanne terapeutegenskaber er fremhaevet i forbindelse med forventningsfaktorer i psykoterapi (Frank, 1973(Frank, /1961) og i teorier om psykoterapi som »social indflydelse« (Strong, 1968). ...
Article
Artiklen forsøger at besvare spørgsmålet om, hvilke egenskaber der bidrager til at gøre en god terapeut »god«, ud fra empiriske undersøgelsesresultater. Først indkredses størrelsen af »terapeutfaktorens« indflydelse i forhold til andre variabler ud fra kvantitative oversigtsopgørelser (såkaldte »meta-analyser « ). Dernæst omtales undersøgelser af terapeutvariabler og af gode og mindre gode terapeuter. Til sidst ses der på undersøgelser; som mere præcist forsøger at fastlægge henholdsvis relationelle og tekniske færdigheders bidrag til psykoterapiens forløb og resultat. Samlet konkluderes det, at terapeutens relationelle færdigheder ser ud til at spille den største rolle i psykoterapi, men at omhyggeligt udarbejdede og videnskabeligt validerede behandlingsprogrammer giver de bedste resultater over for særlige lidelser. Spørgsmålet rejses, om traditionelle terapeutiske uddannelsesprogrammer er egnede til at fremhjælpe de relevante terapeutegenskaber.
... Palabras clave: recursos, protocolo FIND, momentos innovadores, formulación de casos At the onset of therapy, clients usually feel powerless and "demoralized" (Frank, 1961;1973;Frank & Frank, 1991). Even though some aspects of the clients' lives continue to generate positive feelings and well-being, and clients' resources that might help them to improve and cope with the difficulties, they are frequently neglected. ...
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At the beginning of the therapeutic process, clients frequently feel immersed in their problems, and demoralized, with a negative perspective of different areas of their lives. The clients´ discourse is specially focused on difficulties and previous ineffective attempts to overcome their problems. Even though positive aspects of the clients’ life continue to exist, such as resources and strengths, they have little visibility in the clients’ speech and, consequently, in the therapist’s assessment and intervention planning. Moreover, most psychotherapy models emphasize a focus on the deficits of the clients, centered on the correction of difficulties as a way to achieve mental health. In this context, we highlight the importance of integrating resources and strengths of the clients’ life in case assessment, clinical formulation, and treatment planning. This information can be collected in the assessment phase, but in order to make it explicit the relevance of this information we created a protocol designed for this purpose (Feedback Initiated Narrative Development Protocol [FIND]). The first component of FIND invites clients to reflect on aspects beyond their problem like their personal strengths, significant values, positive autobiographical episodes, and useful strategies that have been adopted in the past. This interview was largely influenced by narrative therapy and innovative moments research, and it provides information regarding clients’ resources that may be useful to psychotherapists from different approaches. In this paper, we presented a clinical case formulation considering resources evaluated with the FIND protocol.
... Hope as a mechanism of change for PTSD treatment Given the link between hope and less PTSD symptoms, it follows that bolstering hope would promote recovery during trauma-focused treatment. Hope is considered a "common factor," or transdiagnostic change mechanism that drives improvement across treatment modalities [7, 54,55]. In addition to helping patients achieve treatment goals and cope effectively, hopeful thinking allows them to develop positive relationships with therapists, remain engaged in treatment, and prevents dropout [7,14,56,57]. ...
Article
This paper reviews the present literature examining how hope relates to PTSD and broader functioning after a trauma, including potential underlying mechanisms and significant factors impacting these relationships and the role of hope as a mechanism of change within interventions for PTSD. First, the ways in which trauma impacts hope are discussed. Afterwards, an overview is provided of cross-sectional and prospective research indicating that greater hope reduces the risk of PTSD and promotes positive outcomes of adversity. Next, potential underlying mechanisms and determinants of the relationship between hope and adjustment are explored, including adaptive appraisals, productive coping, and social support. Finally, evidence supporting the role of hope as a mechanism of change in treatments for PTSD is reviewed.
... Type I alliance involves the client's belief in the therapist as a potential helper and is influenced by perceptions of the therapist as empathic, competent, and trustworthy, and type II alliance involves a collaboration between the patient and therapist and the patient's belief that the therapeutic process will result in achievement of goals. The contextual model (Wampold & Imel, 2015), emphasizes the personal relationship as an important therapeutic component (corresponding to "Confidence in therapist"), but also draw on Frank's (1961) ideas that a therapeutic relationship works through the expectations created by specific ingredients and an accepted rationale for the treatment (corresponding to "Confidence in treatment"). Thus, while they are not equivalent to existing relationship constructs, we find that "Confidence in therapist" and "Confidence in treatment" span the array of the main ideas of the common factor theories; that is, the notion that psychotherapy is effective due to the personal relationship between therapist and patient, and a collaborative process where patients experience raised expectations and engage in therapy through a meaningful and coherent treatment rationale. ...
Article
Previous research suggests that common relationship factors are composed of two overarching factors, "Confidence in the therapist" and "Confidence in the treatment." The aim of this naturalistic process-outcome study was to investigate the reciprocal relationships between these two constructs and patients' symptom level across treatment. The sample consisted of 587 patients who were admitted to an inpatient program and treated with psychotherapy for a range of mental health disorders, such as chronic depression, anxiety disorders, and eating disorders. Our data consisted of weekly measures of symptomatic distress (Patient Health Questionnaire) and the common relationship factors were measured weekly using a newly developed scale. Latent curve modeling with structured residuals was used to investigate the between- and within effects of week-to-week changes in the two components as predictors of subsequent symptom level. An increase in both relationship factors predicted a decrease in subsequent levels of symptoms at the within-patient level, and the other way around, but the two relationship factors did not systematically relate to one another at the within-patient level over the course of treatment. Our findings indicate that patients' perceptions of the therapist as a person and their appraisal of the treatment, are important, different predictors of therapeutic change. Furthermore, they support prior research demonstrating a reciprocal relationship between common relationship factors and symptomatic distress and add to existing common factor theory by exploring the role of two central relationship dimensions and using a method which examines reciprocal relationships and within-patient effects simultaneously. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
... It was concluded that all the therapies had different ways of trying to influence, suggest or persuade the person to make the basic changes of current therapy (cf. Frank, 1975). These basic 'techniques' have not changed over generations, but each generation has required new ways to be engaged so that these same old techniques might work. ...
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Abstract In this chapter I wish to look critically at therapies as a whole but focus on ‘contextual’ therapies. I argue that we need to stop treating therapies as self-contained units. Instead, we need to look at the multitude of components shared by almost all therapies whatever their flavour, and whatever components they claim to be unique. I find that almost all therapies have some components that help at least some recipients. With contextual therapies, I question what ‘context’ really means since the main life contexts of humans are neither analysed nor the focus of change. Instead, they rely on non-social accounts of language and its use to avoid analysing the social and societal contexts, including the all-important discursive communities and contexts which shape most of the ‘mental health’ behaviours. Some ways forward which include the components that are working is developed
... That patients who were ghosted experience considerable negative affect as a result of their psychotherapist's behavior is not surprising. Therapists are generally trusted, socially sanctioned healers (Frank, 1961) and, for many patients, are their most consistent and reliable figures. To be rejected, seemingly without cause or explanation, by a person with whom one has shared confidences and likely experienced deeply felt emotions, would understandably evoke intense reactions, especially for those who have endured earlier experiences of interpersonal hurt and rejection. ...
Article
Psychotherapist ghosting is a type of inappropriate, therapist-initiated termination of treatment in which the therapist ceases communication with their patient without prior notice. A total of 77 patients (M age = 34) who reported being ghosted by their therapist completed a web-based therapist ghosting survey (TGS) that assessed their perceptions of multiple aspects of this event. Results indicated that these patients, on average, unsuccessfully attempted to contact their therapist four times following being ghosted but that the great majority never again communicated with this therapist; they attributed being ghosted to several possibilities, including their therapist's finding them too difficult, their therapist's own problems, and/or a major event in their therapist's personal life. They experienced shock, frustration, anxiety, resentment, and sadness as a result of this action, emotions that tended to dissipate over time. Given its emotional toll on patients and the ethical violation inherent in the act of ghosting, further research on the prevalence, consequences, and therapists' motives for this behavior seems imperative. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
... Grencavage & Norcross (1990) found core common factors including client characteristics, therapist qualities, change processes, treatment structure, and therapeutic relationship with treatment relationship/alliance as most important. Frank (1973) summarized different elements necessary to facilitate change: new learning opportunities, enhancing the patient's hope and relief, supplying an opportunity for mastery, overcoming alienation from others, and eliciting emotional arousal. ...
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What helps a client embrace change? Growth mindset and positive mental health aid psychotherapeutic change. Positive mental health facets aiding change include wellbeing, emotional regulation, distress tolerance, interpersonal effectiveness, self-control, self-awareness, and spirituality. The literature review examined the formulation, principles, critique, and function of growth mindset construct within contexts of success, talent, neuroscience, trauma, impairment, and each positive mental health facet. The review indicated growth mindset impacts change. The objective involved testing for evidence of associated relationship between growth mindset and positive mental constructs using Pearson's correlation coefficient. Utilization occurred of eight self-rating measures, one each for wellbeing, emotional regulation, distress tolerance, interpersonal effectiveness, self-control, self-awareness, and spirituality. Growth mindset measures received individual comparison with nine positive mental health measures. The null hypothesis was r ≤ .03. There were nine alternative hypotheses, one per positive mental health measure. The sample size was 148, obtained by internet survey distribution. The result was failure to reject the null hypotheses for all nine alternative hypotheses allowing for the following conclusions: no evidence of associated relationships; growth mindset and positive mental health constructs are meaningful and useful; belief alone does not lead to change effort. Recommended research includes qualitative case studies, quasi-experiment comparisons, development of enhanced measurements, or longitudinal observation. Keywords: growth mindset, fixed mindset, positive mental health, psychotherapeutic change, change beliefs
... Roughly speaking, Frank (1961) argues that what is required is a novel framework for understanding one's problems and a means of resolving them according to this framework. Thus, the framework must be persuasive to the client, what William James (1954), might refer to as a "live hypothesis". ...
... The authors thought that the acceptability and tolerability of treatment methods depended largely on how credible patients found the rationale behind each treatment. In his seminal book Persuasion and Healing: A Comparative Study of Psychotherapy, Frank (1961) asserts that one of the common characteristics of efficacious psychotherapies is the use of rationales that provide reasonable explanations for patients' symptoms and proposes procedures for resolving them. ...
Article
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Eye Movement Desensitisation and Reprocessing (EMDR) is an established psychotherapy that utilises repetitive, bilateral stimulation, such as saccadic eye movements, to treat the symptoms associated with traumatic experiences. Much of the attention EMDR has received has focused on its use in treating post-traumatic stress disorder (PTSD), which has resulted in its inclusion in several treatment guidelines. There is, however, emerging evidence that suggests a promising role for EMDR in managing a wide range of other mental and physical health conditions. High-quality studies demonstrate the efficacy of EMDR in managing conditions such as anxiety disorders, obsessive–compulsive disorder, major depressive disorder and chronic pain. Preliminary studies have also investigated its use in conditions such as bipolar disorder, eating disorders, substance misuse, psychotic disorders and sleep disturbances. The major studies exploring these applications of EMDR, outside of PTSD, are reviewed in this article.
... Assimilating the client's perspective into early assessment and responding accordingly would require trainees to be conversational in different therapies and principles so that they can offer the best-fitting therapy rationales (myths) and related strategies (rituals; Frank, 1961). In this sense, treatment selection and therapist behavior would become less about the professionals' view of strict adherence to single treatment packages and more about clinicians privileging clients' perceptions of therapists behaving in ways that match the client's story (by drawing flexibly on those conversational understandings of existing theories or even by trying on new variants with client feedback). ...
... One of the essential aspects of psychotherapy is the therapeutic alliance between patient and psychotherapist. It is recognised as a common factor for the effectiveness of psychotherapy (Frank, 1961;Grawe et al., 1994;Lambert & Barley, 2001;Orlinsky & Howard, 1987;Rogers, 1951). The therapeutic alliance can be assessed with the Working Alliance Inventory, proposed by Bordin (1979), which covers the following three aspects: the patient's and the psychotherapist's consensus on goals and the process of the therapy, grounded on a shared view on the mental health disorder and its aetiology, as well as a positive emotional bond based on acceptance and trust. ...
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Videoconferencing psychotherapy (VCT) is an effective treatment option. Yet, it is unclear whether a similar therapeutic alliance as in conventional face‐to‐face psychotherapy (F2F) can be achieved, since previous studies yielded mixed results. Furthermore, surveys about the attitudes towards VCT amongst patients have been missing until now. The current study gathered opinions from patients and psychotherapists about the perceived comparability of VCT and F2F regarding contextual factors and treatment characteristics, focusing on therapeutic alliance and empathy. An online survey amongst patients (N = 189) and practitioners (N = 57) taking part in cognitive behavioural therapy was conducted after the first lockdown in Germany due to the COVID‐19 pandemic and a resulting transition from F2F to VCT for most participants. While patients experienced therapeutic alliance and empathy as comparable, psychotherapists indicated advantages of F2F. Both groups indicated advantages of F2F for the therapy contents and expressed advantages of VCT for flexibility regarding location and time. More than half of the participants expressed a preference for a combination of analogue and digital therapy. The perceived disadvantages of VCT can be addressed, for example, with training programmes for psychotherapists targeting communication in VCT and adapting established psychotherapy methods to a digital format to further improve VCT.
... Conceptually, patient OE has long been of interest to therapists as a theory-common treatment factor (see Greenberg et al., 2006). From one framework, OE may reflect Frank's (1961) notion of remoralization, or heightened optimism in there being one or more pathways to change (perhaps including the treatment and/or therapist). With more of such hope in the personal applicability and feasibility of these pathways, theory suggests that people would derive more benefit from the therapy in which they will, or have begun to, engage (Snyder, 2002). ...
Article
Research on close relationships demonstrates that dyadic convergence, or two people becoming more similar in their experiences and/or beliefs over time, is commonplace and adaptive. As psychotherapy involves a close relationship, patient-therapist convergence processes may influence treatment-specific outcomes. Although prior research supports that patients and therapists tend to converge on their alliance perspectives over time, which associates with subsequent patient improvement, no research has similarly examined belief convergence during therapy. Accordingly, this study focused on patient-therapist convergence in their outcome expectations (OE), a belief variable associated with patient improvement when measured from individual participant perspectives. We predicted both that significant OE convergence would occur and relate to better posttreatment outcome. Data derived from a trial of naturalistic psychotherapy. Patients and therapists repeatedly rated their respective OE through treatment, and patients rated their symptom/functional outcomes at posttreatment. For dyads with the requisite OE data (N = 154), we tested our questions using multilevel structural equation modeling. Counter to our hypotheses, there was no discernable OE convergence pattern over treatment (γ₁₀₀ = 0.01, SE = 0.03, p = .690) and OE convergence was unrelated to outcome at the between-dyad level (γ₀₂₀ = 2.37, SE = 10.28, p = .818). However, on its own, higher early patient OE was significantly associated with better outcome at the between-dyad level (γ₀₅₀ = -0.04, SE = 0.01, p = .007). Results suggest that OE may be more of a facilitative patient versus relational process factor. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
... Some theories try to explain why expectations are influential. Frank (1961) believed that a demoralized client has negative expectations about the outcome and/or therapeutic activities, which negatively affects the outcome. In fact, a demoralized patient will be less involved in therapy. ...
Article
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Expectations can influence the outcome and the process of psychotherapy. Hence, this article aims to overview the types of expectations, i.e., outcome, treatment and change. Both patients’ and therapists’ expectations are considered. Furthermore, determinants of expectations and moderators/mediators of expectations-outcome relationship are described. We provided theories that try to explain the influence of expectations and their relationship with the psychotherapy process. Various instruments for measuring expectations and practical advice to manage expectations in psychotherapy will be discussed. Clinicians should become increasingly aware of their own and clients’ expectations. Future studies should investigate the impact of every kind of expectation and its moderation/mediation role with other psychotherapy processes.
... It has therefore been suggested that although psychotherapeutic interventions differ in their explanatory models, they ultimately are grounded in the same common factors [for a critical assessment, see (94)]. Regarding these common factors, we mainly find three theories: the contextual model of Wampold (95), the generic model of Orlinsky (96) and the model of Frank (97) (which has no specific name). ...
Article
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Psychedelics are experiencing a renaissance in clinical research. In recent years, an increasing number of studies on psychedelic-assisted treatment have been conducted. So far, the results are promising, suggesting that this new (or rather, rediscovered) form of therapy has great potential. One particular reason for that appears to be the synergistic combination of the pharmacological and psychotherapeutic interventions in psychedelic-assisted treatment. But how exactly do these two interventions complement each other? This paper provides the first account of the interaction between pharmacological and psychological effects in psychedelic-assisted treatment. Building on the relaxed beliefs under psychedelics (REBUS) hypothesis of Carhart-Harris and Friston and the contextual model of Wampold, it argues that psychedelics amplify the common factors and thereby the remedial effects of psychotherapy. More precisely, psychedelics are assumed to attenuate the precision of high-level predictions, making them more revisable by bottom-up input. Psychotherapy constitutes an important source of such input. At best, it signalizes a safe and supportive environment (cf. setting) and induces remedial expectations (cf. set). During treatment, these signals should become incorporated when high-level predictions are revised: a process that is hypothesized to occur as a matter of course in psychotherapy but to get reinforced and accelerated under psychedelics. Ultimately, these revisions should lead to a relief of symptoms.
... Extrapolating from a well-established finding of process-outcome psychotherapy research, a certain discomfort associated with the general change mechanism problem activation (Grawe, 1997) may in fact be necessary for corrective acceptance-promoting experiences to occur. Almost all conceptualizations of psychotherapy share the view that, in order to overcome their emotional problems, patients must come into direct contact with them (Frank, 1961;Grawe, 1997;Orlinsky et al., 1994), that is, "the only way out is through" (Pascual-Leone and Greenberg, 2007). Referring to psychedelicassisted therapies, Carhart-Harris et al. (2018b) concurred that "challenging experiences can indeed be therapeutically beneficial, but only if personal insight and/or an emotional catharsis follows the relevant experience of psychological struggle". ...
Article
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Background: Many benefits and some harms associated with psychedelic use could be attributable to these drugs’ acceptance/avoidance-promoting effects and corresponding changes in psychological flexibility. Underlying psychological mechanisms are insufficiently understood. Aim: The purpose of this study was the validation of a psychological model of acceptance/avoidance-promoting psychedelic experiences, which included the development of a theory-based self-report instrument: the Acceptance/Avoidance-Promoting Experiences Questionnaire (APEQ). Its two main scales, acceptance-related experience (ACE) and avoidance-related experience (AVE), represent the theorized model’s core constructs. We aimed to test the model’s central assumptions of complementarity (ACE and AVE may occur alternatingly but not simultaneously, and are therefore empirically independent), intertwinedness (subaspects within ACE and AVE are mutually contingent and therefore highly inter-correlated), context-dependence (ACE and AVE depend on context factors) and interaction (longer-term outcomes depend on the interplay between ACE and AVE). Method: A bilingual retrospective online survey including 997 English- and 836 German-speaking participants. Each participant reported on one psychedelic experience occasioned by lysergic acid diethylamide (LSD), psilocybin, mescaline, or ayahuasca. Results: Whereas ACE and AVE were found to be relatively independent aspects of participants’ reported psychedelic experiences (complementarity), their subaspects were mostly distinguishable but strongly correlated among each other (intertwinedness). Therapeutic, escapist, and hedonic use motives were differentially associated with ACE and AVE (context-dependence), which were in turn associated with retrospective changes in psychological flexibility following participants’ reported experiences. The positive association between ACE and increased psychological flexibility was significantly moderated by AVE (interaction). Conclusion: These results provide an initial validation of the APEQ and its underlying theoretical model, suggesting the two can help clarify the psychological mechanisms of psychedelic-induced benefits and harms. Both should be further investigated in prospective-longitudinal and clinical studies.
... It is very interesting to see that recent models of the common factors in psychotherapy put a great emphasis on the creation of hope in the client and the belief of the therapist in his/her method, and link these with success in psychotherapy (Wampold & Imel, 2015). J. Frank (1991) even speaks of the therapist's theory as a 'myth' and the therapeutic encounter as a 'ritual'. Wampold and Imel (2015) argue that it may not be so much certain techniques which bring about therapeutic change, but more the creation of a special, trustful relationship between therapist and client which is shaped by a shared belief, in the sense of a positive expectancy, that the therapy will be effective and produce meaningful changes for the client. ...
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The aim of this article is to give an introduction to the theoretical model of Jungian psychotherapy (JP) and the role of spirituality in it, with a special focus on the concept of synchronicity (meaningful coincidences), by which the application of a spiritual viewpoint in JP will be exemplified. The paper gives an overview of the empirical studies of the effectiveness of JP and then focuses on the results of an empirical study on the occurrence of synchronistic events in psychotherapy and how they are integrated in the therapeutic process. JP can be called the prototype of a spiritually integrated psychotherapy, since Jung was the first in the development of psychotherapy who put a strong emphasis on a spiritual perspective and who succeeded to integrate spirituality into his psychotherapy approach with a coherent theoretical model in the background. Moreover, Jung's psychology became a major reference point for many other spiritual psychotherapy approaches which developed in the twentieth century. Regarding the studies on the effectiveness of JP it can be said that there is some empirical support pointing to the effectiveness of JP, but there is a strong need for further research, especially with randomized controlled trial designs. The paper presents the results of a study investigating how psychotherapists integrate synchronistic experiences and make use of these to support the therapeutic process. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... The social network also includes the medical professionals that are called upon to assist. The professional's knowledge, training, and experience in providing ethical care are core to optimizing treatment and recovery, and Frank (1974) emphasizes four essential qualities of healing and healers across time and culture that combat demoralization: an emotionally charged, confiding relationship with the healer; a designated place of healing; a rationale that explains health and illness and a path to healing; and, active belief and participation in the procedure or ritual process that restores health. ...
... Since the early and pioneering work of Rogers (1957) and Frank (1961), the therapist variable came rather slowly into the focus of psychotherapy research. Part of the therapist variable is the personality of the psychotherapist, which in turn, is determined in part by his/her attachment style. ...
Article
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In a preceding study by Peter & Böbel (2020), it has been found that insecurely attached psychotherapists differ in nine personality styles from securely attached ones. The aim of the present study was to replicate these findings and to investigate whether they also apply to other health professions such as dentists. About 891 subjects from two German professional societies for hypnosis were surveyed online with a personality questionnaire [Personality Styles and Disorder Inventory (PSDI)] and an attachment questionnaire [Relationship Scale Questionnaire (RSQ)]. Since these subjects were interested in hypnosis and used it in their practice (HYP), 150 dentists without a hypnosis context (NONHYP) were studied as a control group with the same survey. The results of the preceding attachment study could be replicated: Insecurely attached healthcare professionals differed significantly from securely attached ones in the same nine (plus one, i.e., 10) personality styles if they use psychological methods including hypnosis. If they do not use psychological methods (like the NONHYP dentists), they differ in half of the personality styles. No within-sample and no between-sample differences have been found in the assertive/antisocial (AS) personality style. No within-sample differences have also been found in the conscientious/compulsive (ZW) and the intuitive/schizotypal (ST) personality styles. However, large between-sample differences were obvious in ZW and the ST. Both of the samples of the dentist were much more compulsive than the two psychotherapeutic samples. In addition, both of the HYP samples were much more schizotypal than the NONHYP samples. The latter is the general signature of those individuals who are interested in hypnosis and were metaphorically termed homo hypnoticus by B. Peter. It seems that AS, ZW, and ST are independent of attachment.
... Vsem je namreč skupno, da jih je mogoče razumeti kot zdravilne rituale, ki nagovorijo in povečajo pričakovanja, motivacijo, zaupanje in vero klientskega sistema ter tako delujejo kot placebo (Duncan, 2016). Kljub temu da je Frank (1961) pred 60 leti ugotovil, da je spodbujanje klientovega upanja in pozitivnih pričakovanj ključni dejavnik pri mnogih oblikah zdravljenja (od šamanizma preko klasičnih medicinskih posegov do psihoterapije), mnogi avtorji (npr. Davis in dr., 2012;Ward in Wampler, 2010;Tambling in Johnson, 2010) navajajo, da v PDP literaturi zasledimo relativno malo raziskav o pričakovanjih klientskega sistema. ...
Article
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Teorija skupnih dejavnikov temelji na izsledkih raziskav, da k učinkovitosti psihoterapije prispevajo predvsem značilnosti, ki so skupne vsem psihoterapevtskim pristopom, kar velja tudi za partnersko in družinsko psihoterapijo (PDP). Potem ko opiševa razloge za relativno prezrtost teorije skupnih dejavnikov v zgodovinskem razvoju PDP, prikaževa širše in ožje konceptualizacije skupnih dejavnikov v PDP ter opiševa skupne dejavnike, ki so v primerjavi z individualno terapijo za PDP edinstveni. Ob navedbi glavnih kritik na račun teorije skupnih dejavnikov na področju PDP hkrati opozoriva, na katerih točkah je ta kritika neutemeljena. Zavzemava se za preseganje polarizacije med zagovor-niki specifičnih in skupnih dejavnikov, saj kontekstualni model, ki je nastal na podlagi teorije skupnih dejavnikov, vključuje tudi specifične dejavnike. Potem ko opiševa pomen teorije skupnih dejavnikov za izobraževanje iz psihoterapije nasploh in iz PDP, zaključiva s ključnimi vodili za partnerske in družinske terapevte, ki izhajajo iz teorije skupnih dejavnikov.
... Pomemben dejavnik učinkovitosti vseh psihoterapevtskih pristopov je, da nudijo klientom razlago njihove duševne motnje ali stiske, na osnovi katere se oblikujejo terapevtske aktivnosti oziroma načrt terapije, torej določena struktura terapije. Kot je poudaril že Jerome Frank (1961Frank ( , 1971, se razlage in načini obravnave različnih psihoterapevtskih smeri zelo razlikujejo, vendar terapija brez kakršnekoli razlage, načrta in posledično strukture (kjer bi bil dovolj samo odnos z empatičnim terapevtom) ne more biti optimalno učinkovita, še posebno glede omilitve simptomov, kar se ujema z ugotovitvijo Hoffmanna in Barlowa (2014). Posledično ni mogoče izvesti nadzorovane klinične raziskave, ki bi primerjala specifične pristope s "psihoterapevtskim pristopom skupnih dejavnikov". ...
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Potem ko sem v predhodnem članku opisal Dodova zgodnja leta, to je razvoj teorije skupnih dejavnikov od Rosenzweiga do Frankovega kontekstualnega modela, tokrat nadaljujem s pregledom Dodovih mladostniških in odraslih let, ki se raztezajo od prvih metaanalitičnih raziskav o učinkovitosti psihoterapije do Schiepkovega nelinearnega dinamičnega modela. Tretja faza raziskovanja psihoterapije (med letoma 1970 in 1983) je prinesla velike izboljšave raziskovalne metodologije, ki so omogočile kakovostnejše preučevanje terapevtskega odnosa in razvoj metaanaliz, ki so potrdile visoko splošno učinkovitost psihoterapije. Po eni strani so se intenzivirala prizadevanja za standardizacijo psihoterapevtskih intervencij, po drugi strani pa je Dodo spodbudil prizadevanja za integracijo psihoterapevtskih pristopov in razvoj transteoretičnih modelov. V četrti fazi (od leta 1984 do danes) je tako v psihoterapevtski znanosti kot tudi klinični praksi prišlo do paradigmatskih premikov, npr. do prehoda od empirično podprtih terapij k na izsledkih temelječi praksi in na praksi temelječih izsledkov ter do razcveta integrativnih in transdiagnostičnih pristopov. Razvoj različnih konceptualizacij skupnih dejavnikov in njihovo empirično potrjevanje je Dodu omogočilo vstop v odrasla leta, tako da je v okviru Wampoldovega kontekstualnega modela prispeval k preseganju dihotomije med terapevtskim odnosom in tehnikami. Schiepkov sinergetični nelinearni dinamični model pa omogoča vpogled v dinamiko interakcij med skupnimi in specifičnimi dejavniki. Psihoterapevtska znanost in klinična praksa sta od svojih začetkov do danes, tudi zahvaljujoč Dodovi pomoči, dosegli visoko stopnjo razvoja. Na osnovi obilja kliničnih in raziskovalnih izsledkov psihoterapevtom različnih pristopov ponuja možnost paradigmatskega preskoka v novo, bolj integrirano razumevanje psihoterapevtske stroke kot samostojnega poklica, v učinkovitejše in uspešnejše oblike klinične prakse in preventive ter v celovitejše, didaktično naprednejše oblike izobraževanja. Hkrati pa Dodo onkraj različnih psihoterapevtskih šol kot meta integrator ponuja vizijo širše integracije znanosti in prakse (model znanstvenika praktika), biološkega, psihološkega in socialnega, kvantitativne in kvalitativne metodologije, nomotetičnosti in idiografičnosti, teoretičnih razlag in kliničnega razumevanja, personalizirane medicine in psihoterapije ter medicinskega in kontekstualnega modela.
... Z uravnoteženim in skrbnim izborom raziskav je na novo utemeljil kontekstualni model, ki v primerjavi z medicinskim omogoča popolnoma nove uvide v delovanje psihoterapije. Kritiziral je pretirano poudarjanje empirično podprtih metod psihoterapije, ki temeljijo na medicinskem modelu, in pozval k nadaljevanju raziskovanja teorije skupnih dejavnikov, iz katere je v šestdesetih letih prejšnjega stoletja izrasel kontekstualni model (Frank, 1961(Frank, , 1971Frank in Frank, 1991;Možina, 2020b). ...
Article
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V članku s pomočjo ptiča Dodo prikažem razlike med kontekstualnim in medicinskim modelom ter kako Dodo poskuša v psihoterapevtski znanosti in klinični praksi s pomočjo integracije med različnimi psihoterapevtskimi pristopi in metodologijami raziskovanja spodbuditi prehod od znanstvenega monizma k dialoškemu pluralizmu. Prizadeva si za sožitje medicinskega in kontekstualnega načina védenja oziroma objektivistične/nomotetične in sistemske/konstruktivistične/hermenevtične epistemologije. Tako sožitje je možno v okviru integrativne psihoterapije, ki ne predstavlja nove psihoterapevtske šole oziroma pristopa, temveč meta-model na osnovi znanosti o kompleksnosti. Glede na obstoječe psihoterapevtske pristope gre torej za meta-raven, ki omogoča integracijo naslednjih dimenzij onkraj posameznih psihoterapevtskih šol: znanosti in prakse (model znanstvenika praktika); biološkega (še posebej živčnega), mentalnega (psihološkega) in socialnega delovanja; kvantitativne in kvalitativne metodologije; nomotetičnosti in idiografičnosti; teoretičnih razlag in kliničnega razumevanja; medicinskega in kontekstualnega modela. Hkrati z Dodovo pomočjo postaja jasno, da psihoterapija ni več samo uporabna psihologija, temveč samostojen poklic, stroka in znanstvena disciplina na stičišču več različnih disciplin, kot so psihologija, filozofija (epistemologija, hermenevtika), medicina (psihiatrija), biologija, nevroznanost, družbene vede, pa tudi metode linearne in nelinearne analize časovnih vrst, ki izhajajo iz fizike in matematike ter informatika (npr. z uporabo računalniško podprtih sistemov povratnega informiranja). Za medsebojne povezave in meta-teoretični okvir, vključno s transdisciplinarno terminologijo, služi znanost o kompleksnosti (ki med drugim vključuje teorijo kompleksnih dinamičnih sistemov in sistemske teorije). Predlagani koncept integrativne psihoterapije, ki, podprt s povratnim informiranjem v dejanskem času terapevtske obravnave, spodbuja procese samoorganizacije, omogoča sintezo klasičnega razcepa med medicinskim in kontekstualnim modelom.
... The focus of the present study was more specifically on disclosure about physical health information (PHI) in psychodynamic psychotherapy. Given the growing body of literature about the mind-body connection, evidence that many clients have somatic complaints that influence their well-being (Kroenke, 2003), and the possibility that bodily complaints are a bad prognostic indicator for client change (Frank, 1973), it makes sense that psychodynamic psychotherapists would attend to PHI in psychotherapy. Further, in open-ended psychodynamic psychotherapy, clients are not primed to discuss anything in a specific, focused or limited manner; although, themes do develop that connect client reactions to insight and change and these themes evolve over time as external events (e.g., relationships, PHI) occur. ...
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In this exploratory study, 54 adult clients seen by 11 therapists in open-ended individual psychodynamic psychotherapy reported about disclosure and nondisclosure of physical health issues (PHI) within psychotherapy. Although clients reported at intake that they had moderately severe PHI, they discussed these issues in therapy only in 12% of sessions, and clients initiated the discussion about these issues nearly 75% of the time. The most frequently disclosed PHI were sleep, weight, illness, and pain. Clients were more likely to disclose if PHI were distressing, related to their mental health, relevant to the psychotherapy process, a priority, and if there was enough time in therapy for discussion. At the client level for disclosed PHI, depth of discussion was associated with client-rated alliance; clients who generally rated the alliance high were those who disclosed about the PHI, initiated the PHI discussion, and were not distressed by the PHI. At the session level, clients rated the alliance higher when they were distressed by the PHI but did not discuss it in depth. For nondisclosed PHI, clients reported a higher alliance if they generally and in particular sessions were not distressed about the PHI. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... Back in 1961, Jerome Frank published his famous book Persuasion and Healing in which he argued that change in patients during psychotherapy occurs when factors that are common to all forms of psychotherapy operate in concert [20]. Frank's work has been a great inspiration for research in understanding what affects the outcome of psychotherapy. ...
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... Afortunadamente, y precisamente a partir de los estudios sobre equivalencia de resultados, que acotaban, como se ha visto, la influencia de lo específico de cada escuela en el éxito terapéutico a tamaños del efecto inferiores a 0.20 (Lambert, 1992;Lambert y Ogles, 2004;Wampold e Imel, 2015;Wampold, et al., 1997), una parte importante de la investigación sobre psicoterapia se ha centrado en determinar cuáles son los factores o ingredientes específicos que determinan el éxito terapéutico y que, dado que diferentes terapias funcionan bien, deben ser comunes a todas ellas. La teoría seminal de los factores comunes es de Jerome Frank (Frank, 1961;Frank, 1973;Frank y Frank, 1991) y aunque después ha habido otros modelos para estudiar los factores comunes (Castonguay, 1993;Garfield, 1995;Golfried, 1980;Orlinsky y Howard, 1986), a él le debemos el primer gran impulso teórico a mirar la psicoterapia desde sus componentes y no desde la explicación que de ella da su escuela. Iremos enseguida con algunos de los resultados de la investigación sobre los factores específicos que influyen en el éxito terapéutico, pero antes vamos con otra de las consecuencias de cuestionar la primacía de las escuelas: el movimiento de integración y el eclecticismo técnico. ...
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Psihoterapija brez diagnoz in njen prispevek k družbeni pravičnosti: V spomin Grahamu Barnesu (1936-2020) 23 Psychotherapy without diagnoses and its contribution to social justice: In memoriam Graham Barnes (1936-2020) »Ljudje nas, psihoterapevte, vedno znova sprašujejo: 'Kakšne vrste terapevt si? Kakšen je tvoj pristop?' Vsi imamo različne stile, vendar smo sprejeli predpostavko, da moramo biti terapevti določene vrste, da moramo pripadati določenemu psihoterapevtskemu pristopu. Kakšna potrata virov, kakšna izguba človeških zmožnosti, da se moramo terapevti stlačiti v majhne škatle, na katerih so različne nalepke. Po dolgih letih študija psihoterapije moramo postati te ali one vrste terapevti, namesto da bi postali človeški terapevti! Terapevti, ki se v popolnosti odzivajo na vsakega klienta, ki vstopi skozi naša vrata.« (Graham Barnes, 2010a: 152) Povzetek V članku, napisanem v spomin Grahamu Barnesu, prikažem njegov projekt »refleksivne« oziroma »rekurzivne psihoterapije«, ki na krožen način obrača psihoterapijo k sebi in prevprašuje njene temeljne predpostavke. Z refleksivnim načinom mišljenja ne moremo izstopiti iz teorije, temveč lahko doživimo nekaj novega preko primerjalne epistemologije. To vključuje razvijanje teorije o teorijah in jezika o jeziku ter zavedanje, da je razlaga doživetja hkrati novo doživetje. Na podlagi lastne izkušnje učenja z Barnesom prikažem njegovo pojmovanje tragedije duševnega zdravja in psihoterapije ter njegovo prizadevanje za udejanjanje psihoterapije, ki ni osredotočena na teorijo in ki psihopatologije ne pojmuje kot odkritja temveč kot izum. Nadaljujem z osvetlitvijo treh konceptov-pravičnosti, ljubezni in modrosti-ki so po Barnesovem mnenju ključne sestavine psihoterapije kot pogovorne aktivnosti in načina prepričevanja, ki lahko prispeva k razvoju civilizacije in demokracije. Na primeru koncepta »slušne halucinacije« in vinjete iz klinične prakse prikažem, kako lahko refleksivna psihoterapija preokviri psihopatologijo, tako da prepreči patologizacijo, 1 Mag. Miran Možina, psihiater in psihoterapevt, SFU Ljubljana, miranmozina.slo@gmail.com 2 Članka ne posvečam le dragemu Grahamu, ki je umrl 9. avgusta 2020, temveč tudi svoji mami, ki je novembra 2020 odšla v šestindevetdesetem letu starosti: »Čeprav nisi prav dobro razumela moje življenjske poti, ki jo utira nekaj, kar je tudi meni nedoumljivo, in čeprav so se ti zdele čudne previsne steze, po katerih se poskuša vzpenjati moja misel, si me vedno, res vedno podpirala v moji nenasitni radovednosti, sli po učenju in potrebi po ustvarjalnem izražanju. Do konca svojih dni si dostojanstveno nosila svojo samoto, ki bi ti jo lahko pogosteje blažil z druženjem, a sem naju za to prikrajševal z vsakim tekstom, vključno s tem, ki sem ga pisal na račun prostih trenutkov.« 3 Članek je bil objavljen v Možina, M. (2020). Psihoterapija brez diagnoz in njen prispevek k družbeni pravičnosti: V spomin Grahamu Barnesu (1936-2020). Kairos-Slovenska revija za psihoterapijo, 14(3-4), 259-315.
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