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PubMed1985

The quality of the psychotherapeutic process in brain-injured patients.

This paper reviews the various mental processes which occur in patients with organic brain damage and the changes to which these patients are subjected. At the early stages directly following injury, it is necessary to restructure the personality and help it emerge from the chaotic state characterizing this phase. Later treatment concentrates on giving meaning to the different object relationships and the dialectic between self-representation and object representation. Special stress is put on the therapist's role as a receptacle for the aggressive contents which the patient transfers to him and on the necessity, on he therapist's part, to master his own counter-transference reactions and to present an identification model permitting the restoration of the patient's inner world. The psychotherapeutic model is based on the already existing models in other area of mental pathology, which have been developed in recent years, in particular in the theory of narcissism and object relations.

Brain Injuries↗
PubMedDate not supplied

[Psychotherapeutic process in a day hospital: results of a survey and importance of qualitative data].

This survey was carried out in a psychiatric day hospital over three years on all patients admitted. The aim was to assess the patients' state at discharge, and to identify the factors to explain the clinical changes, in particular to evaluate the impact of the various types of therapy proposed. The patients were evaluated when they entered the hospital and at discharge using mainly validated translated English-language questionnaires ("Health Sickness Rating Scale" of Luborsky, "Helping Alliance questionnaire" of Luborsky), but also two instruments developed and validated by our team: "Clinical Evaluation Profile", and the "Commitment Scale". The results provide not only a good description of the patients' state at arrival but also of their evolution. The factors found to be important in the evaluation were similar to those identified in most of previous studies, i.e. the initial severity, and quality of the therapeutic relationship, but we also found that the degree of commitment of the patients to the various therapies offered was important. In addition, we found that, when using the commitment scale in homogeneous subgroups of patients (identified using the CIM 9 diagnostic scale) were examined, the favourable outcome of a given psychotherapeutic approach was dependent on the type of the pathology. Thus, patients with personality disorders and high scores at the commitment scale benefited above all from group therapy. The reverse was found for patients with neurotic disorders. For patients suffering from schizophrenia the most important factor was the commitment to the background milieu of the hospital. These observations are in contradiction with some of the main conclusions (known as the equivalence paradox) from english and american studies over the last 40 years of Psychotherapy Research, which state that all psychotherapies are equivalent, and that the reason why some give successful results, and other do not can, only be by non specific factors (i.e. the quality of the therapeutic bond, patients' motivations, etc.). From our results, if homogeneous subgroups of patients are considered and if we use subjective (commitment to the therapy) instead of hard data (as for example having this type of therapy or an other one, or the length of therapy, ect.), we can distinguish the effect of the various psychotherapeutic approaches at least in a psychiatric institution.

Adult↗
PubMed1980

Electroencephalographic analysis: a methodology for evaluating psychotherapeutic process.

The relationship between individual differences in listening style and clinical sensitivity was studied. Listening style is conceptualized as extending from a critical, analytic, focused attitude to a holistic, intuitive, free-floating attitude. We studied the listening styles of psychiatric residents while they listened to a tape recording, a 17-minute fragment of a psychotherapy that had been rated by a panel of experts as containing 22 cues reflecting the patient's concern with termination of treatment. The ability of clinicians to identify these cues is our experimental measure of clinical sensitivity. Our measures of listening style include eyeblink rate, memory for high-imagery words, and electroencephalogram recorded from electrodes over the right and left temporal areas, all measured while psychiatric residents listened to the tape. Results suggested that an abundance of alpha indicates a readiness on the part of the listener to process clinically relevant information. In addition, a listening style with engagement of the right hemisphere predicted clinical sensitivity. These findings suggest ways to study how the skilled clinician "tunes" himself empathically to his patient.

Alpha Rhythm↗
PubMed2000

[Origins of dialogue: phenomenological theories of intersubjectivity in developmental perspectives and as a foundation of psychotherapeutic processes].

Recognizing the other with his/her psychic peculiarity is an important assumption for psychotherapy. But how is empathy possible? Answers are to be expected by phenomenological-philosophical approaches concerning intersubjectivity and infant research. They are described in a comprehensive way and related to each other in spite of their epistemological differences. As can be seen in the beginning of showing and reading maternal emotions (so-called "social referencing") an infant is able to show intersubjective behaviour from the age of nine months on. Research on the reflected image of the infant and the development of shame shows that consciousness of the ego is not built before the age of one and a half years. These empirically well established results contradict those phenomenological approaches claiming that the other cannot be experienced directly but via cognitive analogies of own emotions (Lipps, Husserl). They better fit an anthropology that states the human being as an innate dialogically structured one and therefore being capable of empathy. Therefore the base for a deeper understanding of the following results of psychotherapy-research is established: 1. Early infant's memories probably do not exist as isolated images but are embedded in interactional structures. 2. Strict therapeutical abstinence may be experienced as a denial of communication and may have a retraumatic effect. 3. Quality of therapeutical relationship is crucial for the success of psychotherapy.

Child↗
PubMed2004

Role of imaginary companion in promoting the psychotherapeutic process.

An imaginary companion (IC) has been considered to be a transitory phenomenon sometimes seen in the normal developmental process of children. In recent years, however, it has been observed that ICs are related to various disorders, and their clinical significance is again attracting notice. Although an IC may in certain ways aggravate the patient's symptoms and regression, an IC may also serve to advance the therapy, for example by indicating the location of the patient's troubles, or acting as an intermediary between the therapist and patient. In cases of dissociative (conversion) disorders, it is generally difficult for patients to verbalize their troubles, but the present patients gained insight into themselves by closely examining their ICs. Imaginary companions are not simply entities incidental to the disorder, and by incorporating them into the therapeutic strategy as a presence supporting the patient's growth, it is possible that the psychotherapy may proceed more smoothly.

Adolescent↗