Supervising the therapy of patients with eating disorders

Article Abstract:

An important part of psychotherapeutic training involves the supervision of the therapeutic process. This activity, like an apprenticeship or studio critique, exposes the student of psychology to complexities of psychotherapeutic treatment which cannot be assessed by classroom experience alone. In some ways supervision is analogous to psychotherapy itself, as it results in a close relationship between patient and clinician, and involves degrees of trust allowing certain unconscious behaviors to emerge. For example, information that has been previously unconscious may emerge from an examination of the type of clinical situations the student selects. Countertransference is a phenomenon that commonly occurs in the psychotherapeutic context, where the therapist develops an emotional relationship with the patient and may even lose his objectivity. This phenomenon was examined in the supervision of patients with eating disorders, and the relationship between the therapist and patients in long-term treatment for anorexia or bulimia was observed. These patients are especially prone to have issues about secrecy and disclosure, which can elicit a strong response from the therapist, who may feel compelled to pursue the secret data with the idea that it will be helpful to the patient, or simply out of curiosity. There are hazards involved in trying to prematurely extract information from a patient, and this may sometimes jeopardize the whole process. Other responses of the therapist that have been observed in conjunction with working with patients with eating disorders are rage (which may cause feelings of shame by the therapist) and sexual tension (such as when a patient tries to eroticize a nurturing relationship); guilt and discomfort may be the reaction of the clinician. Other scenarios and potential hazards in the process are discussed, along with some parallels that are observed between the treatment and the supervision. In summary, supervision of psychotherapy of patients with eating disorders allows a good opportunity to examine countertransference issues and also presents a set of special therapeutic problems. Neglect of these countertransference processes may jeopardize the therapeutic process. However, examination of them can be a valuable training tool. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Eating disorders, Study and teaching, Therapist-patient relations, Countertransference (Psychology), Psychotherapist and patient

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The use of writing in psychotherapy

Article Abstract:

The written word can be more distinctive and precise than the spoken word. Despite this, it has generally been overlooked as an adjunct to more traditional 'talk' therapy, except for occasional use in the more cognitively or behaviorally oriented therapies where written homework assignment may be given. Writing can be used by therapists from most theoretical backgrounds before, or as an adjunct to, ongoing therapy. Writing is one of a secondary set of means (the first is the relationship between the therapist and the patient) that the therapist can use to structure interventions outside sessions. There is little historical or empirical information on the use of writing in psychotherapy. However, it is clear that writing and talking differ sufficiently, and that they may complement each other. There should be an agreement at the beginning of therapy if writing is to be used regarding the time to be spent writing assignments. Resistance can then be addressed early, and the feasibility of writing as a part of psychotherapy can be assessed. While writing can enhance therapy, it is also suggested that the use of writing outside sessions can shorten the process of therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Writing

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Developing the story in psychotherapy

Article Abstract:

The process of psychotherapy opens the door to many paradoxes which cannot always be easily resolved by recourse to psychoanalytic theory, which itself may obscure the complexity of the psychological paradox. A model of psychotherapeutic practice is proposed which emphasizes the validity of the patient's own images while de-emphasizing theory. The metaphor of the therapist as the 'editor' of the patient's narrative helps to bring out clearly the many paradoxes entailed by therapy. In this model, the therapist is advised to suspend disbelief in the patient's 'fictions'; to look for elements in the patient's story that may reveal new stories; and to look for hidden themes in the patient's interactions with the therapist. Emphasizing the imagery in the patient's stories contributes to understanding and empathy.

Psychological aspects, Storytelling, Paradox, Fiction

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