Paraverbal Communication in Psychotherapy: Beyond the Words

By James M. Donovan, Kristin Osborn, & Susan Rice

The universe of dynamic psychotherapy has undergone slow, but ultimately dramatic change, since the 1970s. Now a new psychotherapist has taken up residence in the office. This book tells the story of what we found when we studied that new therapist directly, by watching her work, on videotape or through extended case excerpts. Here we learn that today’s counselor’s thoughts, words and behaviors sharply set her in contrast to her counterparts of just twenty-five years earlier.

The videotape, for the first time, reveals to us the verbatim spoken exchanges, but also the bodily messages: the tones of voice – the facial expressions – the gestures of patient and therapist as they choreograph their interaction. When we begin to examine the therapy participants as embodied speakers, at this moment we find ourselves on the outskirts of mostly untrodden territory. We sense an evolutionary advance perhaps about to take place on the screen, because we can now choose to study all the extra-verbal information, as well as the verbal, in the therapy interchange.

Read further excerpt from this upcoming book by James M. Donovan, Kristin Osborn & Susan Rice

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How Emotional Access Improves Performance with Kristin Osborn

Join us as we discuss how tapping into one’s emotions and actually experiencing full emotional range is a key ingredient in improving one’s performance.  Kristin brings a wealth of clinical experience in helping people overcome their affect phobias.  We’re going down the rabbit hole today, and Kristin is there to help guide us through some complex topics.

Listen to the podcast:

*recorded December 15, 2020

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Theoretical Reinforcement

‘Leigh McCullough is among psychology history’s most unifying and underestimated theorists. And we had her among us. Leigh died of ALS in 2012.’

Jørn Hokland
March 1, 2021

In the last post, Hillestad criticizes those who claim reinforcement as the only explanation, ie as a one-factor explanation. I agree with this critique, but in the same epistemological ditch we find many of the school fathers of psychology; the clinging to The one principle by which all other (s) principles can be reduced or dissolved. To put it bluntly – Skinner reduced Piaget’s development to reinforcement, just as Piaget reduced reinforcement to development, and Freud reduced free will to deterministic drive, as May dissolved psychological causality in the great freedom. The pattern is the school father who admittedly reveals one important psychological factor, but who at the same time shows a divisive need to claim that all other (s) basic factors are wrong. Hillestad is therefore right that psychology needs a multi-factor theory. But he gives the impression that no one has succeeded in this. Then Hillestad forgets the theorist at Harvard Medical School, also Professor II at NTNU and head of research at Modum Bad – not a divisive school father, but a unifying woman: Leigh McCullough.

It turned out to be valuable that McCullough was already trained in behavioral therapy when she began her apprenticeship with psychoanalyst Habib Davanloo. By studying his patient videos, Davanloo had found that defenses can be effectively detected and blocked, so that the patient in connection with his therapist experiences intense breakthroughs to repressed emotions and memories, with rapid symptom relief as a result. When McCullough saw and learned this, psychoanalysis merged with behavioral therapy: Attachment feelings are the phobic object, defenses are evasive responses, and Davanloo’s ISTDP is at its core exposure therapy with response prevention (in itself a revolutionary method discovered by another woman, Mary Cover Jones, also known as the mother of behavioral therapy).

With the affect phobia theory, Leigh McCullough contributed to a learning-theoretical reformulation of psychoanalytic theory: Sigmund Freud’s anxiety theory (that unconscious emotions trigger anxiety that drives defense against emotions), Anna Freud’s ego psychology (about defense diversity), Bowlby’s attachment theory (which expands Sigmund’s effective method. In addition to affecting phobia formulation, McCullough alleviated ISTDP by down-regulating intense anxiety with CBT interventions, and in the book Treating Affect Phobia (McCullough et al., 2004), she removed the I from ISTDP. In Changing Character (1995) she also went a long way in an intertheoretical reduction of Malan’s conflict triangle (Freud’s anxiety theory) to learning theory: first that emotions learn to trigger anxiety through Pavlovian conditioning (trigging that can be desensitized by Jonesian exposure),

The only thing Changing Character seemed to lack as a complete multi-factor theory, and which Leigh discussed during his stay at NTNU in the early 2000s, was a cognitive theory for the formation of the inner structure of the defenses. Here she showed interest in Piaget’s studies of children’s cognitive development, especially that learning of objects and causality are inextricably intertwined. Causal texture was already explored by Tolman and Brunswik as strategy learning, and what else is defense than causal strategies for avoidance and achievement? Leigh McCullough had a rare ability to find and collect the gold nuggets from the scattered gravel roofs of psychology.

Anyone who had the pleasure of watching Leigh do therapy knows with what warmth and respect she met the patient. In book form, the humanistic in short-term dynamic therapy is well expressed in Jon Frederickson’s Co-Creating Change (2013), where the patient is repeatedly given the choice between either using their habitual but now conscious defense, or knowing the emotional somatic component and impulse and becoming free – an existential choice.

Leigh McCullough’s original contribution does not lie in the specific interventions – here, like eclectics, she picks up freely from the toolbox. And with modern ISTDP adaptations for fragile and high-resistance patients, this is a more complete model than Leigh’s STDP. But both ISTDP and eclecticism etc. lack deep theoretical integration: Leigh left behind an ingeniously simple multi-factor explanation that gathers most of the basic principles our school fathers divided the subject into. And we had her among us. Leigh died of ALS in 2012.

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Short-Term Psychodynamic Psychotherapy

By Allen Eppel

This book is an easy-to-use guide to short-term psychodynamic psychotherapy for early career practitioners and students of mental health. Written by an expert psychiatric educator, this book is meticulously designed to emphasize clarity and succinctness to facilitate quality training and practice. Developed in a reader-friendly voice, the text begins by introducing the theoretical underpinnings of psychodynamic psychotherapy. Topics include the principles of attachment theory, the dual system theory of emotion processing, decision theory, choice point analysis and a critical review of the research literature. The book then shifts its focus to a description in a manualized format of the objectives and tasks of each phase of therapy within the framework of the engagement, emotion-processing and termination phases. The book concludes with a chapter on psychodynamically informed clinical practice for non-psychotherapists.

Short-Term Psychodynamic Psychotherapy is the ultimate tool for the education of students, residents, trainees, and fellows in psychiatry, psychology, counseling, social work, and all other clinical mental health professions.

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The Client Who Changed Me: Stories of Therapist Personal Transformation

By Jeffrey A. Kottler, Ph. D., Jon Carlson, Psy.D., Ed.D.

Although the impact that clients can have on therapists is well-known, most work on the subject consists of dire warnings: mental health professionals are taught early on to be on their guard for burnout, compassion fatigue, and countertransference. However, while these professional hazards are very real, the scholarly focus on the negative potential of the client-counselor relationship often implies that no good can come of allowing oneself to get too close to a client’s issues. This sentiment obscures what every therapist knows to be true: that the client-counselor relationship can also effect powerful positive transformations in a therapist’s own life.

The Client Who Changed Me is Jeffrey Kottler and Jon Carlson’s testimony to the significant and often life-changing ways in which therapists have been changed by their patients. Kottler and Carlson draw not only upon their own extensive experience – between them, they have more than fifty years in the field – but also upon lengthy interviews with dozens of the country’s foremost therapists and theorists. This novel work presents readers with a truly unique perspective on the business of therapy: not merely how it appears externally, but how practitioners experience it internally. Although these stories paint a complex and multi-layered portrait of the client-counselor relationship, they all demonstrate the profound and unexpected rewards that the profession has to offer.

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Psykoterapi – De sex grundläggande kompetenserna

Författare: Leif Havnesköld, Birgitta Elmquist

Denna bok handlar om psykoterapi. Den skiljer sig dock från många andra metodböcker i ämnet genom att den inte utgår från en specifik inriktning, metod eller skolbildning. I stället beskrivs sex empiriskt grundade kärnkompetenser som, oavsett inriktning, är gemensamma för det goda kliniska arbetet. Boken presenterar dessa kärnkompetenser och hur de kan utvecklas under hela den psykoterapeutiska karriären. De handlar om:• att kunna tillämpa en teoretiskt övergripande, sammanhållen förklaringsmodell för personlighetsutveckling • och psykopatologi• att kunna skapa och bevara en god terapeutisk relation• att ha en modell för klinisk bedömning och konceptualisering • att genomföra själva behandlingen och att använda strategier och interventioner• att kunna avsluta och evaluera behandlingen• att vara medveten om intersektionalitet samt kulturella och etiska aspekters påverkan i psykoterapi.Psykoterapi – de sex grundläggande kompetenserna riktar sig till blivande psykoterapeuter under olika faser av sin utbildning i psykoterapi, blivande psykologer samt till kliniskt verksamma psykologer och psykoterapeuter. Den kan också fungera som stöd och inspiration för lärare och handledare i psykoterapi.


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Can Robots Train Therapists?

Furhat Robotics

Psychotherapy is a notoriously hard discipline to practice and perfect due to a lack of ‘standardized patients’. Robert Johansson, Associate Professor of Psychology at Stockholm University is convinced Furhat is the perfect solution to this problem. With the unparalleled expressivity and conversational capabilities of the Furhat platform, Robert plans to build several virtual standardized patients that can be used to train therapists.

Read more about Robert’s vision – and how robots can help us understand human suffering

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Dr Jonathan Egan and the Journey of Returning to the Self!

From the Therapy Talks Podcast

Show Notes:
Chris talks to Dr Jonanthan Egan about fearing our emotions, the Therapy model Affect phobia and how we can return to the world of living from defensive holding and avoidance of feeling.  He brings a wealth of invaluable experience to the conversation and looks at the challenges of burnout for therapists and how we can move beyond this. A fascinating and insightful conversation.

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