This chapter explores goal-oriented practice across therapies: cognitive behaviour therapy (CBT), psychoanalytic psychotherapy, psychoanalytic child psychotherapy, interpersonal psychotherapy (IPT), humanistic and existential therapies, systemic family therapy, and online therapy. Each section gives an overview of the approach and sets out ways that goals are conceptualized, negotiated, and embedded. Examples are given to illustrate how goals are used. Differences are found across these approaches in the methods used to negotiate goals, and the extent that these are made explicit and embedded in the work. Greater similarities are found in the use of goals in CBT and IPT, compared with the less directive modalities of humanistic, psychodynamic, and systemic psychotherapies. Differences are also found within modalities (e.g. psychoanalytic psychotherapy for adults versus psychoanalytic child psychotherapy). However, the chapter demonstrates the many similarities in the use of goals as a common factor across these different therapeutic approaches.
Background Mentalizing and psychological mindedness are two key, partially overlapping facets of social cognition. While mentalizing refers to the ability to reflect on one’s own mental states and the mental states of others, psychological mindedness describes the ability for self-reflection and the inclination to communicate with others about one’s own mental states. Purpose This study examined the development of mentalizing and psychological mindedness throughout adolescence and into young adulthood, and the interplay between the two with gender and the Big Five Personality Traits. Methods 432 adolescents and young adults (ages 14–30) were recruited from two independent schools and two universities. Participants completed a set of self-report measures. Results A curvilinear trend in both mentalizing and psychological mindedness indicated a gradual development of these capacities with age, peaking in young adulthood. Across all age groups, females had consistently higher mentalizing scores than males. For females, scores only changed significantly between age bands 17–18 to 20+ (p<0.001), ES (d = 1.07, 95% CI [.1.52–.62]). However, for males, a significant change in scores appeared between two age bands of 14 to 15–16 (p<0.003), ES (d = .45, 95% CI [.82–.07]), and 17–18 to 20+ (p<0.001), ES (d = .6, 95% CI [.1.08–.1]). The change in psychological mindedness scores differed, and females did not have consistently higher scores than males. Females’ scores were only significantly higher for ages 14 (p<0.01), ES (d = .43, 95% CI [.82–.04]), and 15–16 (p<0.01), ES (d = .5, 95% CI [.87–.11]). As with the development of mentalizing abilities, female scores in psychological mindedness remained stable from 14 to 18 years of age, with a significant change between age bands 17–18 and 20+ (p<0.01), ES (d = 1.2, 95% CI [1.7–.67]). Contrastingly, for males significant change occurred between 15–16, 17–18 (p<0.01), ES (d = .65, 95% CI [1.1–.18]) and 20+ (p<0.01), ES (d = .84, 95% CI [1.5–.2]). A significant positive association was found between mentalizing and psychological mindedness and the personality traits of Agreeableness, Openness to Experience and Conscientiousness (p<0.0001). Psychological mindedness had a weaker positive correlation with Extraversion and Openness to Experience (p<0.05). Conclusions The discussion is focused on the interpretation of the findings in light of social cognition and brain development research.
There is considerable interest in the recruitment, training and retention of workers in the field of mental health, as evidence shows significant problems in the retention of highly qualified professionals in this field. Large numbers leave, some leaving the professions for other careers as a result of burnout, caused in part by the emotional burden of work in stressful and emotionally charged environments. We propose a training approach in which students are encouraged to reflect on their own emotional responses to such stressful and upsetting situations. We argue that this approach, in allowing them to be more at ease with themselves, would make them both more available to the emotional experiences of their patients, and in turn enhance their own resilience and capacity to survive stressful situations.We took for our study a cohort of trainees from The Tavistock Clinic in London, a major training institution providing post-graduate mental health courses based in psychoanalytic and systemic theory. We aimed to investigate what the students reported to be the key components in these trainings to enhance their capacity to manage in their demanding and highly stressful work environments, alongside ordinary human experience. The trainees were from a range of backgrounds and included doctors, psychologists, social workers and teachers. The courses had in common the following elements: small work discussion groups providing an opportunity to reflect on their work in practice, lectures on background theory, tutorials, and small seminar groups to which they brought ongoing observations of young children in ordinary settings. Some also had the opportunity to undertake supervised clinical work in the Clinic.We used a detailed qualitative questionnaire to elicit the trainees' expectations and experience of the trainings. In addition, all participants completed the 30-item General Health Questionnaire (GHQ), and some took part in the Adult Attachment Interview, later rated for Reflective Function.
This paper explores the provocative question in the title through the authors’experiences of working within a couple psychotherapy service. In it we hope to chart how it became possible to undertake empirical research in a clinical setting. Underlying the question we found a number of others. For example, when and how does empirical research threaten or enhance couples’therapies? Is empirical research a toxic introject, an idealized object and/or a real cultural, developmental experience for a clinical service? The process of change described in this paper involved conflict and took time to develop. We hope to demonstrate that what was achieved was done without detriment to the quality of the service offered and was not at the expense of those who used it. Our view is that the careful engagement we describe is most likely to have had a beneficial impact on both.
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