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Psychotherapy has developed from four foundational schools of psychoanalytic, cognitive behavioural, humanistic, and transpersonal psychology, and it has been estimated (Karasu 1986; Corsini 1995) that over 400 systems of psychotherapy have evolved. However, empirical studies (Asay & Lambert 1999) suggest that the quality of the therapeutic relationship, regardless of system, is the major influence on therapeutic outcome. These professional factors, and other economic and social influences (Norcross & Newman 1992), engendered a psychotherapy integration movement and a burgeoning of integrative approaches and publications. This movement, formalised by SEPI in 1982, is described currently by three main routes to integration (Safran and Messer 1997), which offer little guidance and leave several issues unresolved (Hollanders 2000b). This PhD thesis presents a new organising framework by which psychotherapy integration can be understood, described and developed. It consists of three dimensions I call constructive, complicit and contiguous integration, and it forms the connecting principle for the published works. The works cover over six years of qualitative inquiry into psychotherapy integration using a heuristic research strategy (Moustakas 1990), which incorporated interpretative phenomenology, case studies, reflexive action and writing as component methods. The new organising framework redefines the current topography of psychotherapy integration and provides an innovative tool for aspiring integrationists. Constructive integration repositions the existing routes to integration and is illustrated by articles on games and projective identification, relationship in organisations, Jung and object relations, and countertransference. Complicit integration emphasises how higher-order integrative approaches simplify the current complexity of psychotherapy. This is exemplified by articles on Clarkson's relational framework in Kleinian psychotherapy and brief dynamic therapy. Contiguous integration reflects how psychotherapy relates to the world at large. Freud's anthropology, Bion's group theories and Jung's collective unconscious are examples of this dimension. I present four articles on organisational and social artefact to further illustrate this dimension. Finally, I present an article on psychotherapy integration itself, which describes these dimensions and the innovative framework they form. I then highlight why this PhD thesis represents a significant and original contribution to knowledge.

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This study examined the use of a simulated patient, or programmed patient, to train clinical psychology graduate students to be empathic and respectful in the psychotherapeutic relationship. Twenty-five subjects were given a 50-minute training session with a simulated patient, an alternate training which consisted of viewing a video tape or were no-attention control subjects. The video tape used for the alternate training consisted of the section of "Three Approaches to Psychotherapy" in which Carl Rogers interviews the client, Gloria, followed by a discussion of empathy and respect. Training with the simulated client consisted of interviewing the "client" and receiving feedback from her. Pre-post empathy and respect skills were evaluated with Carkhuff's 5-point scales. Subjects' responses to recorded client statements were judged by two trained raters. Interjudge agreement ranged from .66 to .74. Analysis of variance revealed no significant difference between increases in empathy and respect for the three experimental groups. Subjects with more than one year of graduate clinical training profited significantly more (p = .05) from both training experiences than did subjects with less than one year of training. There was also a significant interaction between experimental training received and level of clinical experience, inexperienced subjects scoring higher with the simulated patient than with the video tape training. More advanced subjects scored higher with the video training than with the simulated patient training. Interview data indicated that the training with the simulated patient was perceived as useful and, in the case of more-experienced subjects, as being superior to the training with the video tape. Possible difficulties with the measurement of empathy and respect are discussed. The use of simulated patients is reviewed and the selection and training of simulated patients discussed in some depth.

D.Litt. et Phil.

This study investigates a single retrospective case of psychoanalytic infant observation. Two principal aims emerged from the evolving investigation. The first concerned the methodology involved in examining observational data using psychoanalytic methods, the second being the exploration of what can be learned from the systematic study of a single recorded case of infant observation using Grounded Theory. The focus for the study concerned the infant’s first year and considered the structuring of the infant’s psychic life, which takes place in the initial relationship(s). From the phenomenological description of behaviours in the observed context, combined with the emotional field described in the observation reports,emotional meaning was inferred. The systematic use of line-by-line coding, abductive reasoning and the formation of categories led to discussion of the following detail:The first month of life; Exploration of the period when mother was traumatically absent, followed by her return; Selected observations that reveal parent/infant recovery. Several conclusions are reached regarding the observed infant. The first concerns the identification of synchronous rhythms or patterns in the mother/infant relationship where they were found to form a backdrop to aesthetic reciprocity. Rupture in aesthetic attunement was instrumental in activating a cascade of early proto-defensive organisation into later development. This took the form of oral preoccupation; namely regurgitation, rumination and choking. Whilst this defensive organisation may be specific to the observed infant, the study draws attention to developmental processes that may be relevant to infants in general. There is evidence to support how babies are more integrated than first thought by Bick (1968) and are ‘open’ to triangular relating in the first weeks. Proto-defensive structures may be evidenced from the start of post-natal life. This study makes a contribution to the body of knowledge concerning rumination in infancy.

The research is a small-scale study of the potential benefits of Child Psychotherapy assessment of Looked After Children in transition, for the child and for the professional network caring for the child where the child psychotherapist-researcher is part of the network working together to plan for the child’s long-term future. The assessments aim to bring specific understanding of the child’s emotional state and emotional needs, of his perception of what has happened in his life and of the ways in which his development has been influenced by these external events and perceptions. The assessments also explore the potential for the work to help the child make sense of his history and of himself and the assessments aim to be a distinct and essential part of the overarching assessment process which informs preparation of the children and their prospective carers for permanent alternative placement. Four latency-aged children in transition were assessed in an inner-city community-based Child and Adolescent Mental Health Service by the clinician-researcher. using Standard child psychotherapy techniques were used with some adaptations of technique to address the children’s transitional status. The assessment framework included in-depth interviews with social workers and foster carers and information from schools. Process recordings of the assessment sessions are the primary data in this enquiry and these are analysed using an adapted version of Grounded Theory methodology. The depth and complexity of the children’s experiences and their internal worlds is strikingly revealed by the assessments, in new and compelling detail. All of the assessments were highly significant in shaping short and long-term provision for the children. The outcome of the study strongly supports the inclusion of child psychotherapy assessment as part of an integrated, multi-disciplinary assessment process for all children in transition. The method of assessment and of analysis of data transfers well to a range of Looked After Children in transition in the study as well as providing an effective basis from which to communicate clearly and effectively across interdisciplinary boundaries: making possible a more truly representative, responsive and integrated map for the future.

M.A. (Clinical Psychology) / Please refer to full text to view abstract

From introduction: This study is an attempt to explore and describe phenomenologically a clients total retrospective experience of psychotherapy. The research consistently and radically approaches the phenomenon of the experience of psychotherapy from the clients own perspective and is conceived as a mutual project between researcher and subject. The phenomenological method is used to explicate the subjects qualitative experience of psychotherapy so as not to impose any presuppositions regarding the nature of this experience. At all times the research remains as faithful as possible to the subjects personal account of her therapy experience