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Presence: The Core Contextual Factor of Effective Psychotherapy

Authors:
  • Saybrook University; Existential-Humanistic Institute; Teachers College, Columbia University

Abstract

This article proposes that presence is the core contextual factor of therapeutic effectiveness. Presence is defined as a complex mix of appreciative openness, concerted engagement, support, and expressiveness, and it both holds and illuminates that which is palpably significant within the client and between client and therapist. While the therapeutic alliance, empathy, collaboration, and the provision of meaning and hope have been established as primary contextual factors in the facilitation of effective therapy, this article contends that presence is at their hub. Given that position, it is concluded that although presence is viewed favorably by leading practitioners, there are two major problems with how presence is actually being engaged: The first problem is the way some practitioners are " using " or " performing " presence rather than cultivating it as a therapeutic stance, and the second problem is how the training of therapists is becoming increasingly technical at the very time when the research (informing such training) is becoming contextual, relational, and nontechnical.
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Presence: The Core Contextual Factor of Effective Psychotherapy
[Existential Analysis, 26.2 (pp. 304-312) Copyright, July, 2015,
Society for Existential Analysis. This article is a draft that may not fully reflect the
published article of record.]
Abstract
This article proposes that presence is the core contextual factor of therapeutic
effectiveness. Presence is defined as a complex mix of appreciative openness, concerted
engagement, support, and expressiveness, and it both holds and illuminates that which is
palpably significant within the client and between client and therapist. While the
therapeutic alliance, empathy, collaboration, and the provision of meaning and hope have
been established as primary contextual factors in the facilitation of effective therapy, this
article contends that presence is at their hub. Given that position, it is concluded that
although presence is viewed favorably by leading practitioners, there are two major
problems with how presence is actually being engaged: The first problem is the way
some practitioners are “using” or “performing” presence rather than cultivating it as a
therapeutic stance, and the second problem is how the training of therapists is becoming
increasingly technical at the very time when the research (informing such training) is
becoming contextual, relational, and nontechnical.
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Introduction
The cultivation of presence is key to therapeutic healing. We’ve relied too long on the
verbal and procedural aspects of therapy, all the while overlooking the organic hub of
formally identified therapeutic factors (Geller & Greenberg, 2012; Schneider, 2008;
Schneider & Krug, 2010).
Presence is a potent yet highly delicate form of communication that has been
fostered for decades by existential-humanistic approaches to therapy (Elkins, 2007). It
has also been nurtured by many of the most masterful therapists—regardless of
orientation (Geller & Greenberg, 2012; Wampold, 2006 ). In this light, I contend that
presence is at the core of the so called contextual factors research (Wampold, 2006),
arguably, the most authoritative research on therapeutic effectiveness (Elkins, 2012).
This research shows that contextual (or “common”) factors account for far more of the
variance than techniques in the facilitation of effective psychotherapy, and that despite
decades of conventional thinking, it is the “nonspecific,” atmospheric, contextual factors
that demand our focus.
Among these factors are the therapeutic alliance (bond), empathy, capacity for
collaboration, and provision of meaning and hope (Elkins, 2012; Wampold, 2008). But
equally important, I contend, is that at the fount of each of these factors is presence.
Presence is a complex mix of appreciative openness, concerted engagement, support,
and expressiveness (Bugental, 1987; May, 1983). Furthermore, presence performs both a
holding, that is, containing function and an illuminating, that is, exploratory function; it
both holds and illuminates that which is palpably significant within clients and between
therapists and clients (Schneider, 2008). Hence if we look at each of the identified
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contextual factors, we can see vividly how presence is at their crux. Presence informs the
therapeutic alliance, for example, through the communication of attention, concern,
support, and availability. It is hard to imagine that clients can feel allied with their
therapists if their therapists do not embody (as distinct from merely enact) these above
qualities. Further, it is hard to imagine the salutary effects of such an alliance, such as the
sense of safety, of openness to disclosure, and of support for exploration, without the
steadfastness of abounding presence.
The appreciative openness, concerted engagement, support, and expressiveness
dimensions of presence are also key to the provision of empathy, collaboration, meaning,
and hope. Again, it is difficult to conceive of these latter offerings without the foundation
of presence.
Presence differs from related concepts like rapport and mindfulness. It differs
from rapport in that it refers to more than simple “harmony” or “accord” with another
person. While it certainly can include those dimensions, presence embraces a much
fuller and richer range of elements that may include a degree of discord and discomfort
with another person. The issue is not the degree of tranquility or even necessarily
agreeability within the therapeutic frame, but the sense that one is “there” for another,
appreciative of the opportunity, and available to work it through. Presence differs from
traditional concepts of mindfulness on several counts. First, it expands on the traditional
emphasis of mindfulness (or appreciative openness) within individuals to mindfulness (or
appreciative openness) within relationships. Second, presence, unlike traditional notions
of mindfulness, does not necessarily develop out of a specific set of religious or spiritual
practices; by contrast presence can evolve from a variety of secular experiences such as
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personal struggle, profound interpersonal relationships, reflective and philosophical
education, and depth psychotherapy. Furthermore, unlike conventional mindfulness,
presence does not concertedly aim to dissolve the identity of self (if that is even
achievable), but to expand, deepen, and redefine the identity of self. Finally, unlike
conventional conceptions of mindfulness, presence aims to coexist with and integrate not
necessarily detach from suffering. This latter tenet has key implications for therapy,
because if the aim is to coexist with as distinct from detach from or “pass through
dysphoric states then there may be more room to linger over, struggle with, and even
potentially benefit from the experience of those states. To be clear, nothing that I say
here about presence precludes the incorporation of mindfulness practice—or
philosophy—within its purview. Indeed, in my view, mindfulness practice is a form of
presence. However, what is at issue here is whether the practice is applied in the context
of a living, evolving relationship, or as a more or less isolated technique with strictly
proscribed aims. (See Geller and Greenberg, 2012 for an elaboration on several of the
above points).
The Current Threats to Therapeutic Presence
Perhaps the chief threat to therapeutic presence today is the attempt to relegate it
to a technique. This tendency can be seen in the so called evidence-based practice
movement as well as in some formulations of mindfulness as a component of effective
treatment. In the evidence-based practice movement, presence is too often viewed as
something one performs in order to comply with quantitatively determined protocols.
However, as Kriz and Langle (2012, p. 476) point out there is a striking difference
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between “making use of” humanistic applications of presence and “being” and
embodying those applications. They provide the following vignette to illustrate:
(a) the therapist is trained to behave according to a manual to give
(preformulated) remarks of understanding toward a client (e.g., verbalizing
understanding words and performing understanding gestures) and (b) the
therapist genuinely has the sensitivity to and experience of understanding and
expresses his or her own feelings. (p. 476)
“Accordingly,” the authors “insist on the difference between a therapist (a) behaving as if
he or she can be understanding and (b) being understanding (p. 476).
On the other hand, even theorists such as Steven Hayes (2012) who are supportive
of the centrality of therapeutic presence insist that it must be a “manipulable” variable.
He states that to optimize therapeutic effectiveness psychological science will need to
“formulate rules about how to manage experiential processes. For example
[psychological science] may have to operationalize the training that gives rise to
sensitivity to experiential processes and show experimentally that this training
matters”(p. 463). He goes on to explain “that clinicians can then be taught how best to
establish strong working alliances, which means that the manipulable aspects of the
therapeutic relationship need to be known” (p. 463).
John Norcross, another exponent of the necessity for therapeutic presence, also,
like Hayes, argues for its experimental manipulability. He bases his approach on the
“transtheoretical model” of client-therapy matching (Prochaska & Norcross, 2009),
which pairs empirically supported therapeutic strategies, e.g., relationship-building or
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psychodynamic exploration, with client stages of readiness, such as those of
precontemplation or preparation (Schneider, 2013).
The problem with these “evidenced based” approaches in my view however is
that they can become wooden, contrived, and appropriate to data, but not necessarily the
living, breathing individual sitting across from one.1 The cultivation of presence, in other
words, just as with any of its offshoots, such as empathy, become reducible to in-session
enactments, rather than the experiential, organically cultivated stances that appear to
endure (e.g., see Shedler, 2010). Such stances are not merely learned from a data base,
but through hard-won personal and supervisory experience, through much that one
experiences outside of the classroom, and through exposure to rich experiences of living.
It is no accident in this vein that a recent study in Science showed that concerted exposure
to literary fiction (as distinct from popular fiction, nonfiction, and no reading) promoted
enhanced capacities for imagination, sensitivity to others, and attunement to others’
subtle emotional expressions (Comer, Kidd, & Castano, 2013).
Presence as a Personal Cultivation
While contextual or common factors theory initially emerged through the failure
of techniques to correlate with therapeutic effectiveness (Wampold, 2001), this finding
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1I want to be clear that my concern about basing therapeutic presence and other
contextual factors on essentially experimental evidence does not mean that practitioners
who prioritize such evidence are wooden or mechanistic in their approach to clients.
Quite the contrary in many instances; however, my contention is that their present-
centeredness when optimized is probably not the result of their efforts to directly
replicate experimental research findings, but is the result of a rich and complex
cultivation that is in many ways incidental to and quite likely superior over such
replication, and that this is in fact what is borne out by the contextual factors research on
therapeutic outcome.
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has morphed in recent years into a recognition that personal dimensions of therapy are
most salient. The contemporary literature is replete with this shift in emphasis (see
Bohart & Tallman, 2010; Duncan, 2015; Norcross & Lambert, 2011; Wampold, 2006).
In my view, Wampold and others who developed the contextual factors theory of
therapeutic effectiveness are now advocating that the factors should be cultivated,
integrated with existing clinical knowledge, and personally engaged; not on the basis that
they should be performed, enacted, or mechanically manipulated. We are moving
headlong into an efficiency oriented, quick fix, and appearance oriented society.
Virtually everything we have learned from the depth psychologies over the last one
hundred years raises alarming questions over these contemporary developments. People
learn least about themselves when they are hurried, when they multitask, and when they
are consumed by pat or simplistic formulae (Carr, 2011). They learn most on the other
hand, when they are sensitively heard, when they can explore, and when they can open to
their most intimate desires (May, 1981; Yanchar, Spackman, & Faulconer, 2013). Is this
not what a substantive therapy should provide? Why would we support a therapy that
recapitulates the very problems that bring many people into therapy in the first place—
the wooden, the mechanical, and the manipulated? Why not devise a science that can
distinguish “best practices,that is a contextually centered, intimate point of view from
an “exacting,” aggregated point of view? This is a point of view that mindfully blends
quantitative and qualitative research with long term, in depth training; personal training
that emulates a mentorship model and that betokens the intimacy and discernment of an
optimal therapeutic relationship.
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Consider the recent findings of Fauth, Vinca, Gates, Boles, & Hayes (2007). In a
comprehensive review of the psychotherapy training literature they concluded that
“traditional psychotherapy training practices which emphasize didactic teaching methods,
adherence to manual-guided techniques, and/or applications of theory to clinical work via
supervised training cases, do not durably improve the effectiveness of psychotherapy” (p.
384). They went on highlight the “heretofore overlooked organizational/treatment
culture in the ultimate success of psychotherapy training,” and demonstrated how this
culture can be enhanced through the development of present-centered skills. These skills
consist in what they call (1) “responsiveness,” or the capacity of clinicians to “recognize,
attend, and empathically respond to clients’ needs , as expressed implicitly or explicitly
within the psychotherapy session;” (2) “pattern recognition,” or the expansion of the
capacity to “respond to the most important events and experiences within a given
psychotherapy session;” and (3) “mindfulness,” or the deepening of “moment-to-moment
awareness and acceptance of one’s experience” (pp. 385-386). To facilitate these
capacities, the researchers recommended a training environment that shifts from an
emphasis on didactic-verbal learning to one that stresses individual and social (or
“comindful”) meditation practices, role play exercises, and critical observation of video
demonstrations (pp. 386-387).
The researchers summarize: “we propose that future psychotherapy training focus
on a few “big ideas,” such as therapeutic responsiveness;..the development of
psychotherapist meta-cognitive skills (i.e., pattern recognition and mindfulness) via
experiential practice and constructive feedback, and [close attention] to the
organizational/treatment context” (pp. 389-390).
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The findings of these more traditional researchers have been powerfully affirmed by an
emerging set of qualitative investigations. Arguably, these qualitative inquiries are superior
to the quantitative at articulating the power of therapeutic presence to affect the entire
therapeutic enterprise. This was certainly the point of view of Geller and Greenberg (2012),
who made a strong case for presence as a core dimension of practice.
Drawing from a qualitative study they did in 2002 as the centerpiece of their formidable
research on therapeutic presence they elaborate four dimensions that are key to therapeutic
presence“the sense of being grounded, which includes feeling centered, steady, and
integrated inside one’s own body and self;” the sense of being immersedin the moment
with the client;” the sense of “spaciousness or an expansion of awareness and sensation
while being tuned into the many nuances that exist at any given moment with the client;”
and the sense of “intention for presence to be with and for the client’s healing process” (p.
109).
Geller and Greenberg go on to consider the implications for training such therapeutic
presence and conclude:
Training…needs to include relational practices (e.g., group drumming, relational
mindfulness) to help therapists remove the barriers to meeting another with
presence as well as to deepen the ability to be fully open with another while in
contact with their own experience, the foundation for relating with presence.
Rather than minimizing the value of intervention, we are strongly
suggesting that the cultivation of therapeutic presence of the person and his or
her personal growth should be an equal adjunct in psychotherapy training and can
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enhance the efficacy of therapeutic technique. It is essential to balance the doing
mode of therapy with the being mode for greatest efficacy in the client’s
healing.” (p. 260)
Finally, a qualitative study by Pierson et al. (2015) relates how presence was
key to the experience of an existential-humanistic therapy training program conducted by
the Existential-Humanistic Institute located in San Francisco. An “overarching
assumption” of the program “is that it is the client’s in-the-moment-experiencing that
forms both the underlying and the actual process in therapy” (p. 644). This assumption, in
turn, led to the corollary emphasis on trainee attunement to “process,” that is,
preverbal/kinesthetic dimensions of practice, as much if not more than “content,” or
verbal/analytical dimensions. Trainees engaged this process emphasis through a “mix of
didactic presentations, relevant videos, faculty demonstrations, experiential exercises, and
role play practice” (p. 644).
Citing the survey data compiled by Krug and Piwowarsky concerning trainees’
experience with the program, the authors note that five major themes emerged: (1) the
enhancement of trainees’ relationships to the unknown; (2) the enhancement of trainees’
personal growth and shifts in personal identity; (3) the incorporation of trainees’ skills into
their professional environments; (4) the deepening of trainees’ relationships with
existential-humanistic concepts, from a “dryer, more theoretical knowing to a livelier,
embodied kind of knowing; and (5) a striking degree of trainee appreciation for the
“personal touch” of the training environment.
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Some of the trainee comments that were gathered included: “The awareness of how
much more growth I have ahead is no longer intimidating, and I am more willing to take
risks;” and “I think I have…dropped some of my own protections….My heart is
more open;” and “It would not be a stretch to say I am a completely different person than I
was before…more secure, present, willing, and mostly alive;” and finally “The [trainings]
were reflections of true encounters among like-minded people…willing to relate to one
another at a much deeper level” (pp. 646-647).
In a special issue of the APA journal Psychotherapy, eight leaders from
diverse areas of therapeutic practiceincluding the aforementioned Stephen Hayes
concluded that “the authentic personal relationship is fundamental to effective practice”
(Schneider & Langle, 2012, p. 481). They also went on to suggest that the enhancement of
therapeutic presence is dependent upon “the person of the therapist….
This means that not only should training focus on the cultivation of personal
skills, such as empathic listening and forming an alliance, but it should also
concentrate on the therapist’s own life, his or her own emotional and intellectual
growth and his or her own responsiveness to clients’ needs. These elements may
be stimulated by relevant reflections on psychology, culture, and the arts, but they
may also be explored by personal therapy, meditation, and experiential exercises
(e.g., dyadic role play). The intent here should be on helping trainees to become
well-rounded (engaging-empathic) people, not just competent technicians (p.
481).
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What these reformers of training advocate for then is a renewed focus on
presence, the core of effective therapy, and an abiding focus on the experiential skills
required to facilitate such presence, both in the instructor and in the student. They
advocate for a fresh focus on process as distinct from content-rich emphases in
conventional clinical training programs; and they encourage a revamping of the
cognitive-behavioral hegemony in clinical graduate education (see also Levy &
Anderson, 2013).
To put it more squarely, it is simply unconscionable that a profession that prides
itself on fidelity to its own research persistently countermands that research with its
support of clinical graduate programs that emphasize technically driven, formulaic
curricula (see Heatherington et al, 2013). I understand perhaps the political and economic
bases for that support, but this should not prevent us as a profession from taking stands
that accurately reflect the research—and in this case, the research compels a major shift
in emphasis toward humanistically and relationally oriented training.
Let me conclude then where I began: The cultivation of presence is integral to the
contextual factors associated with effective psychotherapy; the current emphases on the
verbal and procedural aspects of therapy, while notable, are secondary; finally, the
optimization of presence is neither “performed” nor “enacted.” It is lived.
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... Therapeutic presence has gained increased attention as research has further demonstrated its importance in creating a safe therapeutic environment and developing the therapeutic relationship (Colosimo & Pos, 2015;Geller, 2013;Geller & Greenberg, 2012;Geller, Greenberg, & Watson, 2010;Geller & Porges, 2014;Geller, Pos, & Colosimo, 2012;Schneider, 2015). Geller & Porges (2014) reiterate that therapeutic presence is central to developing a positive therapeutic relationship. ...
... IPNB and polyvagal theories offer neurophysiological understandings about the mechanisms regulating social relationships and the importance of a sense of interpersonal safety to creating a condition in which clients can be receptive in therapy (Geller & Porges, 2014). The ability of the therapist to create a sense of safety, then, is an essential element in improving therapeutic outcomes and may be accomplished by maintaining a state of focused self-and other-awareness and physiological attunement which has been termed "presence" (Colosimo & Pos, 2015;Geller & Porges, 2014;Schneider, 2015). The purpose of this study was to improve our ability to conceptualize the therapeutic system in a multifactor setting and our understanding of the physiological processes involved in therapeutic presence so we can better understand how it may impact therapeutic outcomes. ...
Thesis
Full-text available
Extensive interdisciplinary common factor research has identified the therapeutic relationship as a consistent factor influencing therapeutic outcomes. We use polyvagal and interpersonal neurobiology (IPNB) theories to guide an examination of the physiological mechanisms at work in the therapeutic relationship. Both polyvagal and IPNB theories provide understandings about how humans are neurophysiologically wired for social connection. Each points to a sense of safety as being essential for meaningful connection to occur and clarifies that physiological attunement is an observable indicator of interpersonal connection. In this study, we use these theories to guide an examination of therapist physiological influence on clients in couple therapy, using continuous in-session data collection of respiratory sinus arrhythmia (RSA) for 22 heterosexual married couples and their therapist. Data were modeled in a multi-level path analytic framework to account for within-individual and within-couple effects. Results indicated that therapist RSA does not significantly predict lagged client RSA. A discussion of potential limitations, suggestions for therapists and recommendations for future study is included.
... La présence est un concept central en psychothérapie (Schneider, 2015), être présent à l'autre, au-delà de l'écoute, être là et demeurer. La présence se caractérise par une écoute empathique, un accordage émotionnel, une attention aux ruptures et réparations de la relation. ...
... In this context, presence refers to a state of non-focused attention, but it is a wide and open attention that is susceptible to capturing subtle changes and potentially meaningful phenomena in the environment (see also Geller & Greenberg, 2002). Presence encompasses appreciative openness, relational and situational engagement, support, and expressiveness, and facilitates participatory sensemaking between patient and therapist (Schneider, 2015). It requires a sense of the physical space, a spatial awareness of "being there" 14 , that is, of being immersed in the situation. ...
Thesis
Full-text available
The quality of patient and therapist relationship has been identified as the main common factor for the success of a therapeutic process. However, the research on the therapeutic relationship has been overly influenced by cognitivist approaches in cognitive science and mindreading and simulationist theories of empathy. These approaches to intersubjectivity, however, do not do justice to the complexity of the therapist-patient interactions and the transformative potential of therapeutic encounters. In this regard, two outstanding problems can be identified in psychology and cognitive sciences: methodological individualism and the mindbody divide. As an alternative, the present thesis proposes an enactive approach to psychiatry and psychotherapy that goes beyond a purely “mentalistic” conception of the therapeutic alliance and empathy towards a second-person and embodied perspective, highlighting the constitutive role of pre-reflective engagements of therapists and patients in the therapeutic process. It builds on the enactive theory of intersubjectivity as participatory sense-making, which describes the coordination of intentional and non-intentional activities as preconditions from which shared meanings emerge in interpersonal interactions. On this basis, clinical empathy is defined as a participatory and pre-reflective process of knowing-how to respond to the solicitations of patients. Along with the relational turn in psychotherapy, the thesis adopts a second-person perspective by placing participatory sense-making processes at the center of the investigation. Accordingly, it presents three pieces of work applying the enactive framework to research in psychotherapy: (1) a comment on correlational studies on non-verbal coordination and psychotherapeutic outcome, where new working hypothesis and interpretation of empirical data are suggested; (2) an interpretativephenomenological-analysis of the pre-reflective intercorporeal mechanisms involved in the transition from face-to-face to online therapeutic settings, and (3) a phenomenological-enactive analysis and classification of therapeutic interventions on the body in dialogic therapies. These works illustrate that the enactive framework can potentially promote a particular way of doing science in psychotherapy research. In addition to that, the thesis suggests a theoretical deepening of the theory of participatory sense-making under the lens of two related perspectives – phenomenology of atmospheres and Gilbert Simondon’s philosophy of individuation. This analysis highlights the pathic character of the lived body and the pre-individual dimension of experience. The discourse on atmospheres is contrasted with enactive-ecological theories of affordances and a possible definition of mental disorders as disorders of affectivity is suggested. The thesis concludes that the theory of participatory sense-making should be understood in terms of transindividuality, that is, as holding the tension between the sense of belonging to a “primordial we” and the objectification of the other, a tension that allows for differential degrees of pre-individual affective participation. This perspective is particularly relevant to understand the complexity of modes of participation in the therapist-patient dyad.
... How do these influence your approach to therapy? 3. How might you work to further develop these relational qualities in yourself? Schneider (2015) advocated that presence is the foundation for the effectiveness of all psychotherapy and, in particular, existentialhumanistic psychotherapy. He described presence in existentialhumanistic therapy as, ...
Chapter
This appendix provides a guide for students considering becoming an existential-humanistic therapist. Drawing from lessons from the book, students are invited to reflect upon the themes and questions to help determine if this theoretical orientation is a good fit for them.
... Within existential psychology, the concept of presence is foundational (Schneider, 2015). Schneider describes presence as, "a complex mix of appreciative openness, concerted engagement, support, and expressiveness" (p. ...
... Presence refers to a complex mix of appreciative openness, concerted engagement, support, and expressiveness (Schneider, 2015), which involves aspects of awareness, acceptance, and availability in both therapists and clients (Schneider, 2019). It requires the therapist to be grounded in contact with oneself, being open, receptive, and immersed in the moment, and having a larger sense of awareness and perception (Geller & Porges, 2014). ...
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Therapeutic relationships with well-established alliances and favorable signs of therapist empathy and genuineness are strong predictors of successful psychotherapy. However, amassing the declarative knowledge associated with knowing that a constructive therapeutic relationship contributes to successful outcome is insufficient in preparing a clinician with the procedural knowledge leading to him or her knowing how to competently implement this. The present article strives to address this gap by definitionally and descriptively unpacking key aspects of alliance building, and therapist empathy and authenticity/genuineness, for pragmatic learning purposes. It is argued that a humanistic revival in the education and training of beginning psychotherapists is long overdue to enable them to acquire the self-expansion, relational versatility, and ethical sensibility necessary to optimally perform their clinical duties.
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The ubiquity of telecommunications technologies and the internet facilitates offering different mental health services to the public, and the ongoing advancement in technologies introduces new venues to a range of psychotherapeutic services. It is critical to all clinicians and professionals in information and communications technology to have a clear understanding of the opportunities and challenges of these technologies. This article outlines the technologies that are currently used as part of psychotherapy. In particular, the paper discusses some of the current state of clinical research, advantageous and disadvantageous that relate to the use of these technologies.
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Understanding others’ mental states is a crucial skill that enables the complex social relationships that characterize human societies. Yet little research has investigated what fosters this skill, which is known as Theory of Mind (ToM), in adults. We present five experiments showing that reading literary fiction led to better performance on tests of affective ToM (experiments 1 to 5) and cognitive ToM (experiments 4 and 5) compared with reading nonfiction (experiments 1), popular fiction (experiments 2 to 5), or nothing at all (experiments 2 and 5). Specifically, these results show that reading literary fiction temporarily enhances ToM. More broadly, they suggest that ToM may be influenced by engagement with works of art.
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This article summarizes and discusses the main themes to emerge from this special section on the renewal of humanism in psychotherapy. It is concluded that (1) despite some controversies, humanism is both a viable and growing influence among the leading specialty areas of psychotherapy; (2) humanism is a foundational element of effectiveness among these specialty areas; and (3) humanistic training is essential to the development of trainees in the aforementioned specialty areas. The implications of these findings for each of the specialty areas, for the profession of psychotherapy, and for the public at large are elaborated, concluding with a call for a reassessment of priorities in the research, practice, and training of standardized mental health delivery. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
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Embodied familiarization is offered as an overarching conception of learning informed by work in the hermeneutic philosophical tradition, especially the writings of Heidegger, Merleau-Ponty, Taylor, and Dreyfus. From this perspective, learning is conceptualized as meaningful engagement that involves a shift in embodied familiarity—that is, a shift in one’s sense of “dwelling” and capability. This view of learning differs from others in that it is based on an agentic account of human practical involvement (viz., participational agency) and makes no effort to explain learning-related phenomena through mental representation or other reified constructs. As an alternative to traditional learning theories in psychology, embodied familiarization treats concernful, practical involvement as its primary ontological commitment. This conceptual alternative is described through a discussion of four lived phenomena (antecedent familiarity, encounters with unfamiliarity, exploration, and tacitization) and three modes of familiarity (basic, working, and skilled). (PsycINFO Database Record (c) 2013 APA, all rights reserved)
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Longitudinal data of psychotherapy theoretical orientations (PTO) for faculty from within clinical psychology programs were analyzed for a period of over two decades. Results from multilevel modeling demonstrated that clinical psychology has moved from a field that was relatively balanced in percentages of faculty from cognitive-behavioral (CBT), psychodynamic, humanistic, behavioral, and family PTOs to one that has shown highly significant linear growth for a single PTO: CBT. All other PTOs (except family) showed significant linear decline. To some extent, important research findings from other PTOs have been co-opted into CBT, but essential aspects of this work have been stripped down, muddied, or lost in a conflation with CBT treatments. We suggest that the field has lost significant intellectual diversity during the past two decades and identify how intellectual monocultures have been damaging to the success of other scientific disciplines and research groups. Tangible solutions are offered to correct this trend, including the establishment of an intellectual diversity task force, the APA's dissuasion of the establishment of monocultures within its evaluation of training, increased support for research investigation of more diverse approaches to psychotherapy, organizing of minority PTOs in order to lobby for larger research and professional training goals, and increased mentoring opportunities from minority PTO faculty.
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This article summarizes recent findings from analyses and meta-analyses of psychotherapy research that show that so-called empirically supported treatments (ESTs) are no more effective than are traditional psychotherapies. In addition, the findings show that specific modalities and techniques have little, if anything at all, to do with therapeutic benefits and that client improvement and therapeutic outcome are instead the result of other factors in the therapeutic situation such as the alliance, the therapist, the relationship, and other contextual factors. The article shows how these findings deconstruct the whole notion of ESTs and make the current debate about them meaningless. Finally, the article discusses implications of the findings and urges humanistic psychologists and other proponents of traditional psychotherapies to shift the debate away from modalities and techniques and to focus on the factors that are actually responsible for therapeutic benefits.
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Our comments begin with a short review of some of the differences in narratives concerning the history and the origin of humanistic psychology (HP) between the United States-portrayed in several of the position papers-and Europe. Second, we discuss the effectiveness and conceptual understanding of HP and its implication for training. Third, we make reference to humanistic therapeutic goals and the humanistic background of multicultural modalities. Our proposition is that the term "humanism," as it is used in some of the articles, needs significant clarification for it to be a viable working concept within this modality and other modes of practice. Finally, although appreciating the focus given to common aspects in both "contextual cognitive-behavioral therapy (CBT)" and HP, we claim that some methodological stances, which might be seen as leading to a "dead end" from the perspective of cognitive-behavioral therapy research, are essential for HP and, moreover, connect HP to the modern interdisciplinary discourses of systems science. (PsycINFO Database Record (c) 2012 APA, all rights reserved).