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Topic 7 Psychotherapies
Published in Melvyn W.B. Zhang, Cyrus S.H. Ho, Roger C.M. Ho, Basant K. Puri, Get Through, 2016
Melvyn W.B. Zhang, Cyrus S.H. Ho, Roger C.M. Ho, Basant K. Puri
Negative reactions during dynamic psychotherapy Resistance: The patient is ambivalent about getting help and may oppose attempts from the therapist who offers help. Resistance may manifest in the form of silence, avoidance or absences.Acting out: This typically refers to the poor containment of strong feelings triggered by the therapy.Acting in: This typically refers to the exploration of therapist’s personal and private information by the client or even presenting a symbolic gift to a therapist.Negative therapeutic reaction: This refers to the sudden and unexpected worsening or regression in spite of apparent progression during therapy (such as premature termination of therapy by the client without any explanation despite a period of engagement).
Principles of treatment for the mentally disordered offender
Published in John C. Gunn, Pamela J. Taylor, Forensic Psychiatry, 2014
Pamela J Taylor, Peter F Buckley, Gill McGauley, Jen Clarke, Estelle Moore, Elena Carmen Nichita, Paul Rogers, Pamela J Taylor, Fred Browne, Gisli Gudjonsson, John Gunn, Gary Rix, Leslie Sohn, Pamela J Taylor
Staff must be able to withstand a multiplicity of strong emotional reactions if they are to maintain a therapeutic relationship with offender-patients. Poor, even counter-therapeutic relationships may take the form of the intense, unstable and affectively suffused relationships characteristic of borderline states, or the derogation of those offering help and attempts to deceive them, which staff managing people with personality disorders may find so provocative and castrating. At these moments, a psychodynamic view of the case may be helpful in offering a framework for conceptualizing the negative therapeutic reaction and the counter-intuitive observation that the patient is sabotaging therapy, irrespective of its modality, just at the moment it is felt to be helpful or heralding change.
Attachment-Based Psychotherapies for People with Acquired Brain Injury
Published in Giles N. Yeates, Fiona Ashworth, Psychological Therapies in Acquired Brain Injury, 2019
Giles N. Yeates, Christian E. Salas
The interactions described earlier progressively showed the therapist that a relational pattern was being enacted in the therapeutic space. A pattern where one member of the dyad (the therapist) became the team leader and saviour, whilst the other (Mr F) turned into a passive and obedient patient. Interestingly, this pattern mirrored the one observed in Mr F’s relationship with his son and past relationship with his father, as well as the current relationship between grandiose and vulnerable aspects of himself. In therapy, though, Mr F returned to the place of a silent and passive son, one who blindly obeyed his father. It is possible to hypothesise here that this movement helped him to tolerate the loss of his position of a superman or saviour by placing these characteristics into someone else whom will occupy that role. As the reader can imagine, to be idealised as a therapist is a risky business, since therapists are humans and humans are destined to make mistakes and fail. Idealisation is a double-edged sword, since it can quickly turn into devaluation when the person is not ‘up to the standards’. It is extremely important then to address during rehabilitation these intrapersonal and interpersonal patterns before a negative therapeutic reaction is triggered. The main intervention in this case consisted in helping Mr F to become aware of this interactional pattern, particularly in relation to how he expected other people to occupy this position of ‘all knowing’ guide. Using metaphors from the managerial world, a world that was close to him, the possibility of considering other types of leadership was discussed. For example, horizontal forms of leadership, which were based on mutual collaboration. These metaphors resounded strongly in him, particularly as a way of understanding and modifying the relationship with his son Paul.
On Caring in Psychiatry
Published in Psychiatry, 2021
At the same time, self-disclosure in trauma therapy needs to have thoughtful, careful, consistent boundaries, and avoid confessions; the latter is often the result of flailing desperation by the therapist when therapy appears to be consistently going south or irremediably stuck. The DID patient often asks for “information” about the therapist. However, the traumatic transference interpretation is that “information”, “role descriptions” have never predicted behavior for the DID patient. They learn about the therapist from how the therapist responds, reacts, over the course of years of treatment, although the patient may not trust his/her “lying” eyes. It is experienced as a potential trick. The therapist is just the trickiest, cagiest person the patient has ever known. When the patient finally relaxes his/her guard, then the therapist will pounce, and show the true – abusive, exploitative – colors, with the profound humiliation of the patient. Hence, the patient devises a way to make the other shoe drop, because it is too horrifying to wait for it. This is actually the major source of negative therapeutic reaction in this patient population.
Freud’s Rejection of Hypnosis: Perspectives Old and New:Part III of III—Toward Healing the Rift: Enriching Both Hypnosis and Psychoanalysis
Published in American Journal of Clinical Hypnosis, 2019
Recently I saw in consultation a patient apparently stalemated in psychodynamic treatment. In hypnosis, I asked her to envision a blank screen and to allow an image to develop that would tell us something about why her treatment had become so difficult. She burst out of trance in tears, wailing, “He really hates me!” Her therapist was treating her at a reduced fee. She had developed an overwhelming conviction that he resented her, regretted taking her into treatment, and could hardly wait to get rid of her. Driven by guilt and shame, she was sliding into a negative therapeutic reaction. I inferred as well that she (unconsciously) feared recovery would separate her from the therapist, for whom she had powerful unacknowledged affectionate feelings. These findings helped get her treatment back on track.