The Language Of Therepy Flashcards
To learn useful words and phrases for academic works
index trauma
A PTSD diagnosis term.
A diagnosis of post-traumatic stress disorder (PTSD) requires the identification of one or more traumatic events, designated the index trauma, which serves as the basis for assessment of severity of PTSD. In patients who have experienced more than one traumatic event, severity may depend on the exact definition of the index trauma. Defining the index trauma as the worst single incident may result in PTSD severity scores that differ from what would be seen if the index trauma included multiple events.
When the index trauma included multiple traumas, PTSD severity scores were significantly higher and improvements from pre- to post-treatment were significantly lower than when the index trauma was defined as the worst single incident.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6052424/
attunement
Empathy and attunement underpins therapy. When we empathically attune to another we gently tune into, sense, and resonate with their experience. Think of two violins in a room: It can be amazing to see how when the strings on one are plucked, the other vibrates too when it’s tuned to the same frequency (Rowan & Jacobs, 2002).
Although there is a great deal of evidence that shows how empathy and attunement are among the most demonstrably effective elements of the therapeutic relationship (Cooper, 2008), they are elusive processes and hard to describe. Different theorists define them in different ways: some use the terms interchangeably, others sharply separate them. In general, person-centred therapists are particularly concerned with ’empathy’ while relational psychoanalytic therapists favour a focus on ‘attunement’.
Attunement
Applied to therapy, attunement is the term used to describe our reactiveness to and fit with clients. The process is similar to the way an attuned parent, noticing a child’s distress, will take steps to offer comfort. It’s about giving appropriate responses, not just crying because the client is crying.
It’s common to hear relational psychoanalytic commentators focus more on attunement rather than empathy. When we attune to a client we are brought into harmony with them; we adjust to them in sympathetic, synchronous relationship. Other musical metaphors like resonance, rhythm, duet and chorus come to mind too (perhaps this is unsurprisingly given the ‘tune’ in at-tune).
Attunement is seen as the “performance of behaviors that express the quality of feeling of a shared affect state without imitating the exact behavioral expression of the inner state” (Stern, 1985, p.142). Successful attunement is seen in the way a mother mirrors and enables as she joins with her baby. She matches her child, for example, when the infant is expressing joy, distress or need. In addition, attachment theory suggests that the capacity to reflect on one’s emotional experience and on the mind of the other (called ‘mentalising’) grow through caregiver’s sensitive attunement (Fonagy & Bateman, 2006).
‘Empathic attunement’
While empathy and attunement can be contrasted, they also overlap. The concept of empathic attunement holds both concepts together. For instance, Greenberg, Rice and Elliot (1993, p.104) provide a definition of attunement which implicitly embraces empathy:
In empathic attunement, one tries to respond to the client’s perception of reality at that moment, as opposed to one’s own or some ‘objective’ or external view of what is real… The therapist takes in and tastes the client’s intentions, feelings, and perceptions, developing a feel of what it is like to be the client at that moment. At the same time, he or she retains a sense of self, as opposed to being swamped by or ‘fusing’ with the client’s experience.
Erskine, Moursund and Trautmann (1999) make a similar argument: Effective therapy depends on attunement, with empathy as the foundation. For them, ‘inquiry, attunement and involvement’ are dimensions of an overall empathic frame within which the client’s growth is nurtured. It’s about kinesthetically sensing and moving with the client in a contact-enhancing way.
They offer a comprehensive description of how the multi-layered ways in which therapists use this empathic attunement, as including:
Affective attunement– Here the therapist responds at three levels: noticing the client’s affect; vicariously feeling to the emotion; and communicating a response.Cognitive attunement– With this, the therapist attempts to understand the client’s perspective, thinking and meanings.Developmental attunement– The therapist engaged at this level thinks developmentally and tries to attend to a client’s ‘Child’s’ needs, particularly when they are in more regressed states.Rhythmic attunement– Here the therapist is responsive to the client’s own habitual way of being and rhythmic patterns. For example, if the client is a slow thinking, then the therapist will adapt and similarly go more slowly; if a client is quite regressed, the therapist will speak more simply.
http://relational-integrative-psychotherapy.uk/chapters/empathising-and-attuning/
transference and counter-transference
To understand countertransference, it helps to tackletransferencefirst. Transference was a word coined bySigmund Freudto label the way patients “transfer” feelings from important persons in their early lives, onto the psychoanalyst or therapist.Psychoanalysiswas specifically designed to encourage transference. Intentional opacity andnon-disclosureby the therapist promotes transference; the patient naturally makes assumptions about the therapist’s likes and dislikes, attitude toward the patient, life outside the office, and so forth. These assumptions are based on the patient’s experiences with, and assumptions regarding, other importantrelationships, such aschildhoodrelations withparents. In this way the patient’s formative dynamics are re-created in thetherapyoffice for both participants to observe. Patients discover that some of their assumptions about others, and themselves, are unfounded or outmoded and do not serve them well. This is an important type of insight that can lead to lasting psychological change.
Freudrealized that transference is universal, and therefore could occur in the analyst as well. He did not write much about this, except to say that “countertransference” could interfere with successful treatment. The analyst experiencing countertransference should rid himself of these feelings by having further analysis himself.
Since the 1950s, psychoanalysts and psychodynamic therapists have held a more benign view of countertransference. It is no longer seen as an impediment to treatment (at least not inevitably), but instead as important data for the therapist to use in helping the patient. Countertransference can serve as a sensitive interpersonal barometer, a finely tuned instrument in the field of social interaction. For example, a therapist who feels irritated by a patient for no clear reason may eventually uncover subtleunconsciousprovocations by the patient that irritate and repel others, and thereby keep the patient unwittingly lonely and isolated.
In using countertransference this way, the therapist must consider multiple sources of his or her feelings. Some feelings, positive or negative, may be evoked by the patient. These are particularly helpful ones to notice, especially when the cause is not immediately obvious, as in the example just given. Often, however, feelings may be stirred up by irrelevant characteristics in the patient (e.g., the patient physically resembles the therapist’ssiblingor spouse), by thepriorpatient, or by factors unrelated to therapy (e.g., bad traffic getting to the office, a quarrel at home, an upcoming vacation). This strongly argues for dynamic therapists to pursue such therapy themselves: It “tunes the instrument” to better distinguish countertransference evoked by the patient, versus similar feelings that arise from other causes. Freud’s advice for analysts — to seek additional analysis themselves in the face of countertransference — iswise, although not for the reasons he gave.
I teachpsychiatryresidents to go through a mental checklist whenever they become conscious of possible countertransference:
(1) Is this feeling characteristic, i.e., does the resident have it much of the time? If so, it may say a lot about the resident, but probably nothing about his or her patient.
(2) Is the feeling triggered by something unrelated to the patient? Feelings caused byhunger, one’s personal life, bureaucracy in the medical center, and so forth are not useful data for helping the patient.
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(3) Is the feeling related to the patient in an obvious way? Feeling put off by a patient who is screaming obscenities and viciously destroying the office is countertransference of a sort, but not very illuminating. And finally,
(4) Is the feeling uncharacteristic of the therapist, a reaction to one particular patient, and yet the exact trigger is not immediately obvious? These are the most helpful feelings to notice in oneself, as they often shed light on subtle yet important dynamics in the patient.
Countertransference is not always helpful. Particularly when it is unexamined — or, worse, unrecognized — it can indeed interfere with effective treatment. This can occur even with positive countertransference, as when a therapist is so entertained by a patient’s jokes that the underlying bitterness is ignored, or when an attractive patient is never challenged because the therapist desperately yearns to be liked. More often, though, countertransference is problematic when it is negative. The therapist feels bored, irked, paralyzed, or contemptuous in the presence of a particular patient. It is the therapist’sjobto recognize these feelings and deal with them. Occasionally a therapist must refer the patient to a colleague when the original therapist’s countertransference is unmanageable. Fortunately, in most cases these uncomfortable feelings, once recognized by the therapist, can not only be understood but also used constructively in the treatment.
©2010Steven P. Reidbord MD
https://www.psychologytoday.com/gb/blog/sacramento-street-psychiatry/201003/countertransference-overview
Therapeutic Alliance Ruptures
“the quality of the therapeutic alliance is one of the better predictors of outcome
across the range of different treatment modalities” (Safran, Muran, Samstag, & Stevens, 2002
p.235).
Over the last 30 years,psychotherapyresearch has clearly demonstrated that the quality of the relationship between client and therapist (or what is referred to as the therapeutic alliance) is a much better predictor of whether therapy works than the particular brand of therapy (e.g.,cognitive-behavioral, psychodynamic, humanistic, etc. (See more by clicking on the article below)
Jeremy D. Safran Ph.D.
https://www.psychologytoday.com/gb/blog/straight-talk/201801/therapeutic-alliance-ruptures
References
[1] Safran, J.D., Crocker, P., McMain, S., & Murray, P. (1990). The Therapeutic alliance rupture as a therapy event for empirical investigation. Psychotherapy, 27, 154-165.
[2] Safran, J.D., Muran, J.C., Wallner Samstag, L. & Stevens, C. (2001). Repairing therapeutic alliance ruptures. Psychotherapy, 38, 406-412.
[3] Safran, J.D. ,Muran, J. C., Demaria, A., Boutwell, C., Eubanks-Carter, C. & Winston, A. (2014). Investigating the impact of alliance focused training oninterpersonalprocess and therapists’ capacity for experiential reflection. Psychotherapy Research, 24, 269-285.
[4]Center for Alliance Focused Training
[5] Safran, J.D., Muran, J.C., & Eubanks-Carter, C. (2011). Repairing alliance ruptures.Psychotherapy, 48,1, 80-87.
Coregulation
Coregulation is defined as warm and responsive interactions that provide supportandthathelpsomeoneunderstand, express, and modulatehis or herfeelings, thoughts, and behaviors(Gillespie,2015).
Throughcoregulation,childrenlearn how to managetheirattention and emotions in order to complete tasks, control impulses,andsolve problems (McClelland &Tominey, 2014).Thisrequiresthemto attune to subtle cues of distress, curiosity, bids for attention, fear, and joy.
Theconceptof coregulation can also be applied to adult relationships.
Couplesin whichone or both partners experienced parental misattunments, neglect, or abuse, thefear and insecuritythey experienced as children ledto poor self-regulation(internal)and coregulation(with another)skills,resultinginstress and lack of attunement in their current relationship.
Moreover, ifadults experiencedchronic childhood stress,theirhypothalamicpituitaryadrenal(HPA) axishabituatedand sustains activity. This “on switch” can lead to underdevelopment of the prefrontal cortex, whichmoderates social behavior, complex thinking, and decision making (Kumar et al., 2014).
Phenomenology - the intentionality of consciousness (Husserl)
An approach that concentrates on the study of consciousness and the objects of direct experience (rather than the nature of being).
Transcendental phenomology - Edmund Husserl (possible to suspend personal opinion to arrive at a truth - one reality)
Existential Phenomenology - Merleau-Ponty and Jean-paul Satre (the lived experience, the concrete)
Hermeneutic (interpretive) Phenomenology- Martin Heidegger (there are endless numbers of realities)
Transcendence
The experience to discover meaning.
Knowing is always and only through a state of pure consciousness…
There is
Locus of evaluation (external or internal)
‘Locus of evaluation’ is ‘that to which people refer in order to make judgements about themselves, others and the world’ (Feltham and Dryden, 1993: 106).
‘Locus’ is Latin for ‘place’, so the term describes the place from which a person makes a value judgement.
The term was first used byCarl Rogers
If a person is operating from an internal locus of evaluation, then they trust their own instincts – that is, they use their organismic valuing process.
However, many people operate from an external locus of evaluation; this means that theyintroject the valuesof others, often parents or significant others, throughconditions of worthacquired in childhood.
‘People often judge themselves according to whether others find them acceptable or wanting’ (Tolan, 2003: 5).
Phenomenology
Setting aside, as much as possible, the pre-existing assumptions that one holds in relation to an area of experience, and through this strategy gradually arriving at a disclosure of the essence, or essential qualities of that experience.
proclivities
proclivity /prə kl v ti/ n. (pl. proclivities) a tendency to choose or do something regularly; an inclination or predisposition towards a particular thing: a proclivity for hard work. late 16th century: from Latin proclivitas, from proclivis ‘inclined’, from pro- ‘forward, down’ + clivus ‘slope’. Procne / pr kni/ [GREEK MYTHOLOGY] the sister of Philomel.
subjective v objective mental experience
subjective adj. 1 based on or influenced by personal feelings, tastes, or opinions: his views are highly subjective | there is always the danger of making a subjective judgement - dependent on the mind or on an individual’s perception for its existence.
objective adj. 1 (of a person or their judgement) not influenced by personal feelings or opinions in considering and representing facts: historians try to be objective and impartial - not dependent on the mind for existence; actual: a matter of objective fact.
proclivities
proclivity /prə kl v ti/ n. (pl. proclivities) a tendency to choose or do something regularly; an inclination or predisposition towards a particular thing: a proclivity for hard work. late 16th century: from Latin proclivitas, from proclivis ‘inclined’, from pro- ‘forward, down’ + clivus ‘slope’.
janusianprocess
Albert Rothenberg, a noted researcher on the creative process, has extensively studied the use of opposites in the creative process. He identified a process he terms “Janusian thinking,” a process named after Janus, a Roman God who has two faces, each looking in the opposite direction. Janusian thinking is the ability to imagine two opposites or contradictory ideas, concepts, or images existing simultaneously. Imagine, if you will, your mother existing as a young baby and old woman simultaneously, or your pet existing and not existing at the same time.
Rothenberg found that geniuses resorted to this mode of thinking quite often in the act of achieving original insights. Einstein, Mozart, Edison, Van Gogh, Pasteur, Joseph Conrad and Picasso all demonstrated this ability. It was Vincent Van Gogh who showed in Bedroom at Arles how one might see two different points of view at the same time. Pablo Picasso achieved his cubist perspective by mentally tearing objects apart and rearranging the elements so as to present them from a dozen points of view simultaneously. Looking back at his masterpiece, Demoiselles d’ Avignon, it seems to have been the first painting in Western art to have been painted from all sides at once. The viewer who wishes to appreciate it has to reconstruct all of the original points of view simultaneously. In other words, you have to treat the subject exactly as Picasso had treated it in order to see the beauty of the simultaneity.
In physics, Einstein was able to imagine an object in motion and at rest at the same time. To better understand the nature of this paradox, he constructed an analogy that reflected the essence of the paradox. An observer, Einstein posited, who jumps off a house roof and releases any object at the same time, will discover that the object will remain, relative to the observer, in a state of rest. The unique feature of this analogy was that the apparent absence of a gravitational field arises even though gravitation causes the observer’s accelerating plunge. This analogy and its unique feature inspired his insight that led him to arrive at the general theory of relativity.
https://www.creativitypost.com/article/janusian_thinking
Are artists the product of healthy or unhealthy psychology
I have therefore discovered three specific cognitive creative processes:sep-con (sep=separate; con=connected) articulation, janusian process, and homospatialprocess(see previous posts). These processes are all healthy and adaptive.
https://www.psychologytoday.com/intl/blog/creative-explorations/201503/creativity-and-mental-illness
My systematic research has consisted of intensive interview series focused on workinprogress with a large number of outstanding literary prizewinners and Nobel laureatesinthe sciences throughout Europe and the USA. In addition, an extensive controlledexperiment regarding the findings showed that Nobel laureates in science and othercreative persons scored statistically significantly higher on features of the janusianprocess than patients with a wide range of psychiatric diagnoses, strongly differentiatingcreativity and mental illness. (Rothenberg, A. Psychopathology and creativecognition. Acomparison of hospitalized patients, Nobel laureates, and controls. Arch. Gen.Psychiatry, 1983;40:937‑942.)
Jackson Pollock, the father of abstract expressionism,was clinically diagnosed with bipolar illness andalcoholdependence. In the 1930s, he engaged inJungiananalytictherapy, which commonly involves the analysis ofdrawings. He submitted a large number all derivative
from other artists: surrealists, Mexican muralists, Picasso,and his mentor Thomas Hart Benton.(see example Untitled,above left), nonethat gaveanyevidence of his ownbreakthroughartistic mode. It was notuntil the summerof 1939, whenhe wasimproving, by hisown statementdevoidofmoodiness andanxietyand attending nparties wherehewas the only non-drinker, that heintroduced abstractexpressionist painting (see example, below, left).
