Clinical dilemmas in psychotherapy: A transtheoretical approach to psychotherapy integration.

Abstract

TRANSFERENCE, COUNTERTRANSFERENCE, AND RESISTANCE: UNCONSCIOUS DETERMINANTS OF DILEMMAS Transference, countertransference, and resistance are all psychological processes that affect the ongoing nature of psychotherapy, and all are presumed to be unconsciously determined (Auld & Hyman, 1991). Transference is an unconsciously influenced emotional reaction of the patient to the psychotherapist and (in a less technical sense) other health care providers that originates from the patient's earlier experiences related to significant others, especially caregivers, and that are inappropriate to the present context or way in which the therapist is currently dealing with the patient. Countertransference is the unconscious reactions of the psychotherapist (and other clinicians as well) that are stimulated by a given patient, the characteristics of a given patient, and, in particular, to the transferences of a given patient, that is, "countertransference proper" (Orr, 1954). If not consciously recognized by the therapist, these internal reactions are likely to be dealt with inappropriately by the clinician in his or her verbal or behavioral responses to the patient. Finally, resistance is an unconscious influence within the psy-127

Supervising Integrative Psychotherapy in the 21st Century: Pressing Needs, Impressing Possibilities

“…Such integration largely hinges on having a clinical rationale, a critical concept in integrative psychotherapy, for utilizing a given intervention or paradigm at a given phase of treatment (Scaturo 1994(Scaturo , 2005. Without a carefully deliberated rationale, attempts at integration can become haphazard at best and may often be based upon methods and techniques that are considered ''fashionable'' among clinicians at the time (Dryden 1984) rather than those that are employed in the patient's clinical best interest.…”

“…Isaac Disraeli, the 19th-century literary scholar and father of one of Great Britain's most eminent prime ministers, Benjamin Disraeli, was fond of quoting an old Latin proverb, ''Cave ab homine unius libri,'' or, ''Be cautious of the man of one book'' (Disraeli 1861). In the new millennium, the mental health consumer would be wise to, ''Be cautious of the psychotherapist with one manual'' (Scaturo 2005). Regrettably, there remains considerable disincentive among academicians to advance plurality, eclecticism, and common factors in the understanding of this profession.…”

“…In psychodynamic psychotherapy, the therapeutic focus is defined as the nucleus of the patient's problem that encompasses the cardinal symptom, a developmental impasse, a related intrapsychic conflict, a self-defeating belief about the self, a persistent interpersonal dilemma, and/or a maladaptive coping pattern (Scaturo 2002(Scaturo , 2005Schacht et al 1984;Sifneos 1992). In this instance, our young patient displays both cardinal symptoms of depression: pervasive sad mood and loss of interest in pleasurable activities.…”

“…To contend with this proliferation of diverse approaches and techniques, some practitioners have attempted to find a common theoretical language that can help us grapple with this conceptual Tower of Babel (e.g., Goldfried 1995;Marks et al 2005;Messer 1987;Miller et al 1997;Scaturo 2005Scaturo , 2010aScaturo , 2011. At present, an international Task Force has been assembled for a Common Language for Psychotherapy (CLP) Project sponsored by 12 psychological, psychiatric, and psychotherapeutic organizations worldwide.…”

“…A slightly different distillation regarding schools of psychotherapy has been identified by Scaturo (2001Scaturo ( , 2005, who has focused on the following three bona fide schools of treatment at the foundation of theoretical pluralism for psychotherapeutic treatment and supervision that have ''withstood the test of time'': psychoanalytic and psychodynamic psychotherapy; behavioral and cognitive-behavioral therapy; and, family systems therapy. Additionally, humanistic and client-centered therapy constitutes a major theoretical force in understanding the process of psychotherapy (Scaturo 2002(Scaturo , 2005(Scaturo , 2010b, although its primary contribution to training may be more relevant to teaching effective clinical interviewing skills (Truax and Carkhuff 1967) and negotiating a sound therapeutic alliance (Safran and Muran 2003) rather than as a diagnostic system that contributes substantively to case formulation (Ells 2010).…”