Abstract

While some therapists are consistently more effective than others (Heinonen & Nissen-Lie, 2020), there is very little investigationon the in-session processes of these highly effective therapists. One exception is the qualitative and quantitative study of 10 cases of the documented “supershrink” Erigoni (“Eri”) Vlass (Hansen, Lambert, & Vlass, 2015a), so defined on the basis of exceptional outcome data from Lambertet al.’s (1996) Outcome Questionnaire-45 (https://www.oqmeasures.com/oq-45-2/). The present project builds on the Hansen et al. study by providing detailed qualitative analysis, using Glaser & Strauss’s (2017) “grounded theory” approach of the transcripts of three new, separate, therapy “mini-cases” seen by Eri, as an added resource to ongoing therapy with one of the authors (T.R.). The cases included “Anne”and “Mel,” each seen for twosessions, and “Susan,”seen for one session. The qualitative analysis explored supershrink Eri’s clinical way of being and in-session approachas she carriedout therapeutic actions that allowed for an optimized approach that is both unique to herself and adaptable to each client. The results yielded two core categories: “(1)Keeping a natural, fluid rhythm during the session while balancing directive exploration, frequent associations, and interpretations with a sense of support, empathy and understanding;”and “(2) Fostering a sense of agency, mutual collaboration and positive expectation while co-constructing a credible narrative to be used in hypnosis.” Further, the analysis yielded three sub-categories for category 1, and four subcategories for category 2.  

Keywords: master therapists; therapeutic expertise; superior outcomes; “supershrink”; qualitative, grounded theory analysis; case study; clinical case study

Continuing Education Information

2 CE Credits, Instructional Level: Intermediate

2 Contact Hours (New York Board of Psychology)

Learning Objectives:

1. Describe the grounded theory method.
2. Apply techniques that will help improve your effectiveness as a therapist.

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CE Disclaimers

The National Register of Health Service Psychologists is approved by the American Psychological Association to sponsor continuing education for psychologists. The National Register maintains responsibility for this program and its content.

The National Register of Health Service Psychologists is recognized by the New York State Education Department’s State Board for Psychology as an approved provider of continuing education for licensed psychologists #PSY-0010

Abstract

Obsessive-compulsive disorder (OCD) is a chronic incapacitating mental health condition that is underrepresented in clinical treatment settings. The worldwide treatment gap for OCD is estimated at 60% (Kohn et al., 2004), a figure that reflects a shortage of specialized services, delayed help-seeking in suffers, and a mounting cost to society. The treatment of choice for OCD is a combination of cognitive-behavioral therapy (CBT) and pharmacotherapy (SSRIs), which has been proven efficacious in measurably reducing symptoms to below the clinical threshold (McKay et al., 2015). Nevertheless, when evaluated holistically, the success rate of the first-line treatment is limited. This study provides a literature review of the various psychodynamic models of obsessive-compulsive pathology and their attendant approaches to treatment. At present, empirical evidence for psychodynamic therapies for OCD is lacking (Leichsenring et al., 2015).

To fill this gap in the research, this pragmatic case study (PCS; Fishman, 1999) aims to demonstrate the viability of short-term psychodynamic psychotherapy (STPP) as an effective treatment for OCD. Specifically, this pilot case study examines the theoretical implementation of Leichsenring and Steinert’s (2017) empirically-derived, manual-guided STPP treatment for OCD, rendered as a treatment for “Serena,” a 28-year-old female patient presenting with mild-to-moderate symptoms of OCD. Serena is a hybrid case, which is an aggregate of actual, de-identified psychotherapy cases and clinical examples from the relevant psychological literature. Through a disciplined inquiry approach, Serena’s treatment process is systematically described. Treatment outcomes are analyzed both qualitatively and quantitatively. This case study attempts to illustrate the interplay between symptom expression and the not-always-linear progress toward structural change. I conclude with a discussion of the applications and limitations of the hybrid case study and STPP for OCD, as well as implications for psychotherapy integration.

Continuing Education Information

3 CE Credits, Instructional Level: Intermediate

3 Contact Hours (New York Board of Psychology)

Learning Objectives:

1. Describe conceptualizations of obsessive-compulsive disorder (OCD) through a psychodynamic lens
2. Explain the components of short-term psychodynamic psychotherapy (STPP)
3. Identify the themes of specific modules within the STPP protocol

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CE Disclaimers

The National Register of Health Service Psychologists is approved by the American Psychological Association to sponsor continuing education for psychologists. The National Register maintains responsibility for this program and its content.

The National Register of Health Service Psychologists is recognized by the New York State Education Department’s State Board for Psychology as an approved provider of continuing education for licensed psychologists #PSY-0010

Abstract

A healthy marriage is a crucial protective factor for adapting to the challenges of late life. Emotionally Focused Therapy (EFT) for couples is an attachment-based model of psychotherapy that emphasizes here-and-now processing of emotion in a safe holding environment, enhanced understanding of the patterned interactions between self and other, and a non-pathologizing, growth-oriented approach toward couples’ difficulties. This pragmatic case study examines the benefits of EFT for addressing issues specific to late life, including existential concerns such as aging, illness, and mortality, caregiving burdens and stress, cumulative relational trauma over the lifespan, and forgiveness and healing from emotional injuries. The study involved a 20-session treatment of a couple named “Alice” and “Steve,” aged 74 and 75, respectively, with Steve suffering from advanced Parkinson’s Disease. The couple presented with hopelessness and resentment about their caregiving situation, unresolved traumas from early childhood fueling their relationship’s sore spots, and unprocessed grief and fears concerning losses at the end stage of life. The EFT-guided treatment focused on promoting transformational and corrective experiences of secure attachment bonding. Throughout therapy, Alice and Steve cultivated coherent, positive perspectives of their marriage and related hardships by engaging in reminiscence; embraced their longings for each other by relinquishing their defenses against loss and mourning; and strengthened the legacy of their marriage by exploring their shared values and vision of family life. At the end of therapy, the clients retrospectively completed several standardized, quantitative measures assessing aspects of emotional and relational health. Their responses evidenced their heightened emotional awareness and acceptance, increased marital adjustment and satisfaction, and improved attachment security over the course of the therapy. This case study highlights EFT as a potent therapeutic intervention for fostering relationship health in later-life individuals to reduce the public health risks associated with social disconnection and loneliness in the aging population.

Continuing Education Information

3 CE Credits, Instructional Level: Intermediate

3 Contact Hours (New York Board of Psychology)

Learning Objectives:

1. Identify the benefits of Emotionally Focused Therapy (EFT) for addressing late-life issues.
2. Discuss the effects of EFT on secure attachment bonding. 
3. Explain the public health implications associated with social disconnection and loneliness when using EFT. 

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CE Disclaimers

The National Register of Health Service Psychologists is approved by the American Psychological Association to sponsor continuing education for psychologists. The National Register maintains responsibility for this program and its content.

The National Register of Health Service Psychologists is recognized by the New York State Education Department’s State Board for Psychology as an approved provider of continuing education for licensed psychologists #PSY-0010

Abstract

Regulation Focused Psychotherapy for Children (RFP-C) is a manualized, time-limited, psychodynamic approach for children who experience challenges with emotion regulation and demonstrate externalizing behavior problems (Hoffman et al., 2016). In research settings, it takes place over ten weeks and includes 16 sessions with the child and four with the child’s parents. This protocol can be extended or modified in regular clinical practice.

The current study utilized a dual case study method to analyze pretreatment and post-treatment measures and compare psychotherapy outcomes and process in RFP-C between a successful and an unsuccessful case. Data examined included (a) quantitative outcome measures; (b) case conceptualizations and clinical vignettes drawn from review of session videos; (c) post-treatment interviews with parent, child, and therapist; and (d) psychotherapy process codings of child and parent sessions. These data were employed to (a) identify differential psychotherapy processes; (b) assess parental defense mechanisms; (c) assess parental attachment classifications; and (d) evaluate therapist countertransference ratings.

Results indicated that many variables contributed to successful versus unsuccessful treatment outcomes, including but not limited to (a) child’s spontaneity; (b) active participation and emotional expression throughout treatment; (c) themes of child play; (d) therapist’s countertransference; (e) child and parental defense mechanisms; and (f) parental attachment styles. Taken together, findings from this study contribute to the literature on therapeutic outcomes for children and families and highlight some of the essential characteristics of successful psychotherapy process. Limitations of the study and directions for future research are also discussed.

Continuing Education Information

3 CE Credits, Instructional Level: Intermediate

3 Contact Hours (New York Board of Psychology)

Learning Objectives:

1. Describe Regulation Focused Psychotherapy for Children (RFP-C).
2. Identify variables that contribute to successful treatment outcomes for RFP-C. 
3. List essential characteristics of a successful therapeutic process. 

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CE Disclaimers

The National Register of Health Service Psychologists is approved by the American Psychological Association to sponsor continuing education for psychologists. The National Register maintains responsibility for this program and its content.

The National Register of Health Service Psychologists is recognized by the New York State Education Department’s State Board for Psychology as an approved provider of continuing education for licensed psychologists #PSY-0010

Abstract

Multicultural psychology emphasizes the role of social, cultural, and gender forces in creating an individual’s identity; the social and cultural world in which they live; and the psychological strengths that different cultures have to offer. In a complementary way, feminist psychology highlights the importance of collectivist alternatives to mainstream, individualistic thinking in the U.S.; and the identification and dismantling of patriarchal power structures that oppress women. Combining these two in a multicultural, feminist approach to psychotherapy highlights the importance of relating to clients with an understanding of, sensitivity to, respect for, and responsiveness to their cultural identities and life situations. This also involves the therapist building on strengths that come from some cultures bringing a collectivist rather than an individualist orientation to life’s challenges, such as combatting child maltreatment.

To illustrate the potential of a multicultural, feminist approach to psychotherapy in cases of child maltreatment among minority individuals, the present article offers two highly successful case studies. The first involves “Bashiir,” a 16-year-old African, first-generation immigrant young man from Somalia; and the second involves “Jacquaan,” a 15-year-old African American young man. Both individuals were referred to therapy because of poor school attendance and academic difficulties, and associated symptoms consistent with a Post-Traumatic Stress Disorder (PTSD) diagnosis. These symptoms derived from the clients having lived in poor, dangerous, high crime communities. A crucial component in both cases was the process by which the therapist employed the multicultural feminist approach to cross age, racial, gender, and socioeconomic-class lines to establish a very strong, trusting relationship between the therapist and the client, and between the therapist and the clients’ families.

Continuing Education Information

3 CE Credits, Instructional Level: Intermediate

3 Contact Hours (New York Board of Psychology)

Learning Objectives:

1. Identify definitions and conceptualizations of child maltreatment. 
2. Discuss approaches and adaptations to evidence-based approaches to trauma treatment using a multicultural, feminist psychology framework.  
3. Select multicultural, feminist principles to address child maltreatment in their client population.  

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CE Disclaimers

The National Register of Health Service Psychologists is approved by the American Psychological Association to sponsor continuing education for psychologists. The National Register maintains responsibility for this program and its content.

The National Register of Health Service Psychologists is recognized by the New York State Education Department’s State Board for Psychology as an approved provider of continuing education for licensed psychologists #PSY-0010

Abstract

This case describes the treatment of Maggie*, a first-year college student dealing with depression, trauma, and suicidal thoughts and behaviors. It illustrates a conceptualization and practice that takes place within a guiding conception positioned in the “unification pathway” to psychotherapy integration. Specifically, I have developed a foundational, meta-theoretical “big picture,” science-based “Unified Theory of Knowledge” (UTOK) that frames the work. It is a model of the evolution of energy, matter, mind, and culture within our universe’s history—that is, from the “big bang” to the multicultural, complex, human societies that dominate the earth today. Within the UTOK metapsychology (Henriques, 2022a), I have described where the discipline of psychology and the theory and practice of psychotherapy are positioned—allowing psychology and psychotherapy to be potentially grounded in a coherent naturalistic ontology that does not reduce to physicalism or overly rely on a natural science empirical epistemology.

UTOK shows how we can retranslate the standard biopsychosocial model into a model that defines the layers of existence in term of life (the realm of living organisms), mind (the realm of minded animals), and culture (the realm of human persons). It uses this new big picture framework to reframe and realign the key insights from the four major approaches to individual psychotherapy – behavioral, experiential/humanistic, psychodynamic, and cognitive—since each school of thought captures crucial aspects of human behavior and experience, both in its flourishing and its entrenchment in maladaptive patterns.

Because of the scope and complexity of UTOK, it is not possible to fully summarize it in the pages allotted to it in a PCSP case study. Rather, in the psychotherapy case study of Maggie below, the reader is offered a basic outline of UTOK’s overall structure to provide a sense of what it is all about, together with plentiful references to learn more details about UTOK (e.g., Henriques, 2011, 2022a). This outline is then followed by psychotherapy-specific concepts and a central therapeutic technique—CALM-MO—that logically follow from UTOK and were central in Maggie’s treatment, which is then presented in detail and discussed.

Continuing Education Information

2 CE Credits, Instructional Level: Intermediate

2 Contact Hours (New York Board of Psychology)

Learning Objectives:

1. Describe the Unified Theory of Knowledge (UTOK)
2. Explain how UTOK reframes behavioral, experiential/humanistic, psychodynamic, and cognitive approaches to psychotherapy.

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CE Disclaimers

The National Register of Health Service Psychologists is approved by the American Psychological Association to sponsor continuing education for psychologists. The National Register maintains responsibility for this program and its content.

The National Register of Health Service Psychologists is recognized by the New York State Education Department’s State Board for Psychology as an approved provider of continuing education for licensed psychologists #PSY-0010

Abstract

The aversive and insidious impact of unresponsive and punishing parenting practices is often evident in the psychological wellbeing, affective expression, and interpersonal dynamics of adult clients. Behavioral and dynamic theories regarding emotional development in the context of learning and trauma, and their corresponding treatments of emotional avoidance, are often viewed as distinct. The following study serves to first explore factors of change in Exposure Therapy (a behavioral treatment) and in Accelerated Experiential Dynamic Psychotherapy (AEDP; a relational and experiential treatment). Next, detailed consideration of the case of “Chris” is utilized to highlight elements of AEDP and Exposure Therapy present across eight individual treatment sessions. Finally, the case study serves to propose that the key principle of change in this treatment—that is, the approach of previously-avoided emotional experiences within the context of interpersonal relationships—is ultimately the same when conceptualized from both an exposure-based and an AEDP-based approach.

The study explores the treatment of “Chris,” a 30-year-old man who presented to treatment with chronic feelings of loneliness, a family history of neglect, a tendency to avoid accessing and expressing affect, and a pattern of relating to others that is characteristic of dismissing/avoidant attachment. The predominantly AEDP-guided treatment, which lasted for 8 in-person sessions over a period of about 6 weeks with a virtual follow-up session 8 months later, involved establishing a secure attachment relationship within the therapeutic alliance from which to jointly approach previously-avoided emotional experiences. Across sessions, Chris demonstrated an increased willingness to access previously-avoided emotions, express his emotions to others, and tolerate the emotional expression of others, ultimately leading to a decreased sense of loneliness. A combination of qualitative and quantitative indicators evidenced the positive impact of treatment on Chris’s self-awareness, self-compassion, and quality of life. This study serves to highlight commonalities in conceptualization and effective treatment of emotional avoidance due to aversive parenting practices across dynamic and behavioral orientations in the hopes of increasing accessibility of treatments across orientations and improving treatment integration.

Continuing Education Information

2 CE Credits, Instructional Level: Intermediate

2 Contact Hours (New York Board of Psychology)

Learning Objectives:

1. Apply a framework for Accelerated Experiential-Dynamic Psychotherapy (AEDP) and Exposure Therapy across eight individual treatment sessions.
2. Discuss the key principle of change in AEDP treatment and how it relates to other therapeutic approaches.

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CE Disclaimers

The National Register of Health Service Psychologists is approved by the American Psychological Association to sponsor continuing education for psychologists. The National Register maintains responsibility for this program and its content.

The National Register of Health Service Psychologists is recognized by the New York State Education Department’s State Board for Psychology as an approved provider of continuing education for licensed psychologists #PSY-0010

Abstract

This is a narrative case study of the psychotherapy of “Keo,” a 23-year-old native Hawaiian man who came from a deprived and abusive background. After a period of seeming to turn his life around, Keo became depressed and withdrawn upon learning of a native Hawaiian culture curse that had been perpetrated on him and his sister. In the 24 sessions I saw Keo, I drew on my existential therapy principles to focus on his subjective reality and to work in conjunction with the Hawaiian subculture associated with the curse, including referral to a Kahuna, a healer in the native Hawaiian culture. A major existential dialectic that emerged in the case was Keo’s pull towards freedom from the curse versus his pull towards the status quo to avoid the anxiety associated with change.

Continuing Education Information

2 CE Credits, Instructional Level: Intermediate

2 Contact Hours (New York Board of Psychology)

Learning Objectives:

1. Apply existential psychotherapy principles in cultural contexts. 
2. Identify the role of culture in existential theoretical orientation and the individual subjective experience.

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CE Disclaimers

The National Register of Health Service Psychologists is approved by the American Psychological Association to sponsor continuing education for psychologists. The National Register maintains responsibility for this program and its content.

The National Register of Health Service Psychologists is recognized by the New York State Education Department’s State Board for Psychology as an approved provider of continuing education for licensed psychologists #PSY-0010

Abstract

The Dialectical Behavioral Therapy Clinic at Rutgers University (DBT-RU) is a research and training clinic that adapts the DBT Manual to provide short-term (6-months long), comprehensive DBT for community adults presenting with BPD and associated problems. The present project reports an example of the DBT-RU model in action, including the decision-making processes involved, by presenting the case of “Jane,” for whom I was the therapist. At the beginning of therapy Jane was a 32-year-old, heterosexual, Caucasian, single mother of a 7-year-old son; and she worked as a medical technician. Her presenting problems met the full DSM-5 criteria for BPD. Her symptoms, following DSM-5 numbering, included: 1) frantic efforts to avoid abandonment; (2) recurrent unstable and intense relationships; (3) identity disturbance (in self and religious beliefs); (4) impulsivity; (6) affective instability; (7) chronic feelings of emptiness; and (8) inappropriate, intense anger. In addition, she reported past suicidal ideation that was “very strong.” In line with Jane’s intense and challenging presenting problems, the process of therapy was complex with many starts and stops. However, over the course of therapy she showed important, substantial improvement, as reflected by both quantitative measures and qualitative indicators. To aid the reader in following the complex organization of this case study, an outline of it is presented in Appendix 1.

Continuing Education Information

2 CE Credits, Instructional Level: Intermediate

2 Contact Hours (New York Board of Psychology)

Learning Objectives:

1. List the four components of Dialectical Behavioral Therapy.
2. Apply diagnostic criteria for Borderline Personality Disorder to patients.
3. Evaluate the target hierarchy within Dialectical Behavioral Therapy.
4. Utilize patient goals to formulate a treatment plan.

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CE Disclaimers

The National Register of Health Service Psychologists is approved by the American Psychological Association to sponsor continuing education for psychologists. The National Register maintains responsibility for this program and its content.

The National Register of Health Service Psychologists is recognized by the New York State Education Department’s State Board for Psychology as an approved provider of continuing education for licensed psychologists #PSY-0010

Abstract

This is a narrative case study of the psychotherapy of Kelly (pseudonym) that describes processes that took place within the last 17 sessions of a longer therapy of 67 sessions over a period of 26 months. A phenomenologically grounded and coherent account takes readers on an experiential journey that enables them to live through aspects of the process at least partially. These processes began in session 52 in which Kelly saw an image of a circle of caring people within which a series of child parts of herself were able to find a sense of safety and holding. Over the course of the sessions, eight different child parts approached and eventually entered the circle, each representing a different dissociated set of early schema patterns, each with its own related emotional distress. Through dialogue work and imagery rescripting, the predicament of each child and her unmet needs were brought into focus. This served as the basis for providing corrective emotional experiences that led to the child parts feeling able to voluntarily step into the circle. The material serves as the basis for theoretical-interpretative investigations with a focus on the phenomenology of memory and transformation in experiential psychotherapy. This is organized under several themes: (1) complexes, schemas, and internal working models; (2) autobiographical memory and the working self; (3) the “theater of consciousness” and the “theater of the imagination”; (4) understanding the figures that entered Kelly’s healing circle; (5) how far back can we remember? (6) reparenting, corrective experiences, and imagery rescripting; and (7) coping decisions and demanding and punitive features in coping modes. A brief conclusion aims to contribute to our understanding of the phenomenology of corrective experiences and psychological transformation.

Continuing Education Information

2 CE Credits, Instructional Level: Intermediate

2 Contact Hours (New York Board of Psychology)

Learning Objectives:

1. Describe the processes that take place within the later  sessions of a longer psychotherapy period, including the use of schema patterns, dialogue work, and imagery rescripting.
2. Identify the four broad categories of schema mode.
3. Use relevant assessments at appropriate stages of the psychotherapy process to monitor patient progress.

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CE Disclaimers

The National Register of Health Service Psychologists is approved by the American Psychological Association to sponsor continuing education for psychologists. The National Register maintains responsibility for this program and its content.

The National Register of Health Service Psychologists is recognized by the New York State Education Department’s State Board for Psychology as an approved provider of continuing education for licensed psychologists #PSY-0010