Pragmatic Case Studies in Psychotherapy最新文献

{"title":"The Role of Exposure Therapy in Accelerated Experiential Dynamic Psychotherapy: The Case of \"Chris\"","authors":"Irada Yunusova","doi":"10.55818/pcsp.v19i2.2134","DOIUrl":"https://doi.org/10.55818/pcsp.v19i2.2134","url":null,"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.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46064743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Case of \"Chris\" through a Principle-Based and Alliance-Focused Lens","authors":"Lauren M. Lipner","doi":"10.55818/pcsp.v19i2.2136","DOIUrl":"https://doi.org/10.55818/pcsp.v19i2.2136","url":null,"abstract":"The case of Chris (Yunusova, 2023) details an 8-session Accelerated Experiential-Dynamic Psychotherapy (AEDP) treatment delivered in the context of a university clinic. Chris is a 30-year-old white male who had nearly completed a doctoral program at the time of treatment. He presented to treatment with the goals of addressing loneliness and depressive thought patterns in the context of the expectation that his emotions were overwhelming and noxious to others. The case illustrates the active role that avoidance and exposure can play in AEDP, with emphasis on affective exposure by way of AEDP’s efforts to increase the patient’s tolerance of their own emotions as well as those of others. The following discussion applies the integrative notion of principles of change in psychotherapy to the case of Chris, with an explicit focus on the therapeutic alliance and the emergence of alliance rupture markers in the development of the case.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136243249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Additional Perspectives on the Case of \"Chris\"","authors":"Irada Yunusova","doi":"10.55818/pcsp.v19i2.2138","DOIUrl":"https://doi.org/10.55818/pcsp.v19i2.2138","url":null,"abstract":"In this article, I respond to commentaries by Dr. Karen Skean (2023) and by Dr. Lauren Lipner (2023) on my case study of \"Chris\" (Yunusova, 2023), a 30-year-old man who presented to treatment with presenting problems related to depression and aspects of complex PTSD. First, I discuss the way in which Skean precisely captures the core processes in my therapy with Chris. This includes (a) how my use of Fosha's AEDP, which emphasizes the development of a close, warm, and open moment-to-moment relationship between therapist and client, incorporated the behavioral concept of exposure; (b) how this use of exposure must be tailored to the individual client in line with Vygotsky's \"Zone of Proximal Development\"; and (c) the role of memory reconsolidation in helping to revise traumatic memories. I also discuss the deep positive impact of the case of Chris, as supervised by Dr. Skean, on my subsequent development as a therapist. Second, I discuss how valuable I found Dr. Lipner's viewing of my description of the clinical process of therapy with Chris through a theoretical lens quite different from the one I used, including (a) Goldfried's \"principles of change,\" and (b) Safran and Muran's model for identifying and repairing \"ruptures in the therapeutic alliance.\"  Finally, I also respond to Dr. Lipner's question about the way in which I handled the exchange of letters with Chris at the end of our therapy.  ","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48000805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maximizing Exposure's Benefit: Making it Possible, Bearable and Fruitful","authors":"Karen Skean","doi":"10.55818/pcsp.v19i2.2137","DOIUrl":"https://doi.org/10.55818/pcsp.v19i2.2137","url":null,"abstract":"Exposure is hypothesized to be a key active ingredient in several approaches to psychotherapy. Dr. Irada Yunusova (2023) explores this as a common element in both Accelerated Experiential Dynamic Psychotherapy (AEDP) and behavioral exposure therapy. The current commentary elaborates on other important factors that contribute to maximizing the effectiveness of interventions in both these models. These include titrating the level of challenge, memory consolidation, common factors, and neuroplasticity. Dr. Yunusova’s detailed case review is an example of assimilative integration, where one can see her incorporation of a model new to her (AEDP) into her home base of Behavior Therapy, as well as the factors noted above that enhance its effectiveness.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136243248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Theoretical, Clinical, Practical, and Personal Reflections on the Case of \"Keo\"","authors":"Jerrold Lee Shapiro","doi":"10.55818/pcsp.v19i1.2130","DOIUrl":"https://doi.org/10.55818/pcsp.v19i1.2130","url":null,"abstract":"I want to thank Arthur Bohart (2023) and Amy Curtis and Ronald Miller (2023) for each writing an excellent commentary on my existential, multicultural case study of \"Keo\" (Shapiro, 2023). In this response, I begin by discussing Bohart’s comments, which deal with more theoretical issues; and then I turn to the questions raised by Curtis and Miller, which address more clinical, practical, and personal issues.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"361 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135595087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Existential Psychotherapy in a Deep Cultural Context: The Case of “Keo”","authors":"Jerrold Lee Shapiro","doi":"10.55818/pcsp.v19i1.2127","DOIUrl":"https://doi.org/10.55818/pcsp.v19i1.2127","url":null,"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.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45512128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Existential Psychotherapy in a Community Context: The Inspiring Case of \"Keo\"","authors":"Amy Curtis, Ronald B. Miller","doi":"10.55818/pcsp.v19i1.2129","DOIUrl":"https://doi.org/10.55818/pcsp.v19i1.2129","url":null,"abstract":"Shapiro’s (2023) case of Keo is an important contribution to the body of case study literature about the practice of culturally informed existential psychotherapy. We hope it receives wide readership, especially among clinical and counseling psychologists who are in the early stage of their careers and working with diverse populations. The author is dedicated to addressing the client’s anxiety and dread of his future from an existential perspective, but must adapt this therapeutic approach to the client’s cultural worldview. The blend of existential psychotherapy with community and family interventions make this case an exemplar of creative adaptation to the needs and culture of the client. We do wonder whether some of the author’s perspective on and maintenance of professional boundaries in a small-town environment might, on occasion, present substantial difficulties in managing or understanding dynamics in the psychotherapy relationship. We also note how little is said (except that peer consultation was utilized) about how the author managed his own anxiety in relation to the client’s need for periodic breaks from weekly sessions, and in relation to the client’s invitation to social events. Finally the delay of 50 years between the successful termination of psychotherapy and publication of the case study is also a point of curiosity, and to our minds not adequately addressed in the paper. We speculate on what this might mean in hopes of learning more in the author’s reply.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"127 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135595085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Musings on the Case of \"Keo\" From a Person-Centered Point of View, With a Focus on Therapist Responsiveness","authors":"Arthur C. Bohart","doi":"10.55818/pcsp.v19i1.2128","DOIUrl":"https://doi.org/10.55818/pcsp.v19i1.2128","url":null,"abstract":"In this commentary I will look at the case of \"Keo\" (Shapiro, 2023) both in terms of recent trends in the field, and from my person-centered point of view. It turns out that these two perspectives overlap.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135595086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applying the Schema Therapy Approach of Edwards’ Case of Kelly to Patients With Dissociative Identity Disorder (DID): The Cases of Susie and Anna","authors":"J. Margolin","doi":"10.55818/pcsp.v18i3.2124","DOIUrl":"https://doi.org/10.55818/pcsp.v18i3.2124","url":null,"abstract":"David Edward' case of Kelly is a vivid demonstration of the power of Schema Therapy to address the present day emotional difficulties of Kelly, an individual with a background of traumatic childhood experiences. The therapy drew on Kelly's imagination and emotional memories to elicit distinct child-parts (called child \"modes\" in Schema Theory) of herself emerging from that traumatic background. Specifically, Edwards' interventions involved entering Kelly's inner world and therapeutically interacting with her modes. While Kelly's problems were primarily limited to her inner experience rather than to her behavioral functioning, I have found that Edwards' approach with Kelly applies to the cases I see who are much more seriously disturbed than Kelly. Specifically, I see cases with Dissociative Identity Disorder (DID), who share the experience of childhood trauma with Kelly, but whose behavioral lives can be chaotic and highly disturbed, sometimes requiring hospitalization. In this commentary I will briefly describe Edwards' Schema therapy model exemplified in the case of Kelly and illustrate the value of the model as applied to two cases of DID, Susie and Anna, that I have seen. ","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44172782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kelly’s Circle of Safety and Healing: An Extended Schema Therapy Narrative and Interpretative Investigation","authors":"D. Edwards","doi":"10.55818/pcsp.v18i3.2119","DOIUrl":"https://doi.org/10.55818/pcsp.v18i3.2119","url":null,"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.","PeriodicalId":53239,"journal":{"name":"Pragmatic Case Studies in Psychotherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43205469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}