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Case Studies In Current Psychotherapy,
Seventh Edition
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In Memory of Four Giants in the World of Psychotherapy
Carl Rogers (1902–1987)
Rollo May (1909–1994)
Joseph Wolpe (1915–1997) and Albert Ellis (1913–2007)
10 family therapy
The Daughter Who Said No / Peggy Papp 149
11 contemplative psychotherapies
Using Mindfulness Effectively in Clinical Practice: Two Case Studies / Tory A. Eisenlohr-Moul, Jessica R. Peters, and Ruth A. Baer 173
12 positive psychotherapy
Strength-Based Assessment in Clinical Practice / Tayyab Rashid and Robert F. Ostermann 193
13 integrative psychotherapies
Integrative Therapy with Mr. F. H. / Larry E. Beutler 204
14 multicultural psychotherapy
Alma / Lillian Comas-DĂaz 215
index 219
contributors
Ruth A. Baer
David H. Barlow
Aaron T. Beck
Larry E. Beutler
Lillian Comas-DĂaz
Marie Crowe
Sally Denham-Vaughan
Tory A. Eisenlohr-Moul
Albert Ellis
Sue Luty
Michael Maniacci
Harold H. Mosak
Robert F. Ostermann
Peggy Papp
Jessica R. Peters
Tayyab Rashid
Jeremy Safran
Marjorie C. Witty
Irvin Yalom
foreword
Observing an expert perform a skills-based task has always been the most effective way for an apprentice to learn a complex procedure. For this reason, witnessing and studying the work of those who have mastered their craft have always been at the heart of the apprenticeship system. This method of training is more effective when it has been preceded by instruction that allows novices to place their observations into a meaningful conceptual context. This book, which presents case studies conducted and written by experts in specific therapeutic modalities, corresponds to the apprenticeship aspect of a training program. The primary text, Current Psychotherapies, parallels these case studies chapter by chapter. Although a reading of that text is not necessary for a fruitful reading of these case studies, it can heighten understanding of what the therapists are doing by presenting the theoretical and applied underpinnings of their systems.
All clinicians personalize the systems that they have studied and chosen to use. Their therapy reflects their personal life histories, the scripts, values, attitudes, and dispositions that form (mostly at a tacit or implicit level) the weft of that elusive fabric we call the psyche. None of us can entirely escape the conditions that have made us who we are, and our experiences inevitably get enmeshed in the treatment plan and the procedures that we use with our clients. For this reason, the therapist, as a person, becomes the primary instrument of therapy. The techniques become secondary.
Most of you who will read these case studies are motivated by an interest in improving your clinical skills. A first reading will excite a sense of profound admiration for the clinicians who worked the marvels of “therapeutic outcome” described in the studies. Their virtuosity should not discourage you from aspiring to their level of expertise. One must keep in mind that these cases are not examples of their least accomplished performances. The editors chose them precisely because they are instructive of the highly evolved clinical skills these therapists possessed at an advanced point in their careers. Although these clients challenged their resources to the utmost, they were clients who were apt, and suitable, for the treatments these therapists were prepared to provide.
Becoming a skilled clinician is like becoming skilled at any other complex human activity. It is the work of the “long-distance runner.” It is building a repertoire of techniques and broad strategies that fit a consistent theoretical paradigm, honing various clinical skills, and learning to recognize the appropriate moments to use them. It is the work of fashioning coherent treatment plans for particular individuals who will be facing us filled with hope and anxiety. It is becoming a therapist with a therapeutic personality—the privileged instrument of every successful therapy, polished by the inevitable stresses, frustrations, and failures of life and of our profession—for not every therapeutic relationship turns out as we had hoped it would.
This book raises questions that go far beyond the boundaries of psychotherapy as that discipline is generally construed. The concerns and the personages that are depicted in these cases implicitly evoke issues of cultural anthropology, social psychology, hermeneutics, psychopedagogy, developmental psychology, and cognitive science.
Psychotherapeutics has borrowed the terms etic and emic from cultural anthropology. The former, etic, characterizes a nomothetic or universal approach to framing theories of personality development; the latter refers to principles that are more culture sensitive and culture bound. An emic approach refrains from generalizing principles
beyond the group in which they have been found to be valid. In the limiting case, it treats each individual as possessing his or her own “culture.”
Inclusion of the case on meditation reflects the editors’ recognition of the richness that non-Occidental philosophies and approaches to healing can bring to the Western therapist. Of course, this East-West conceptualization of the culture specificity of any therapy is not a true dichotomy. Like any other psychological, anthropological, or sociological variable, culture specificity lies on a continuum. All the case studies in this book can be placed somewhere on that continuum.
Readers of this book will no doubt experience an approach-avoidance dilemma with several, if not most, of the therapies described here, for there are drawbacks and benefits for each system. The editors make no apology for that and expect both the practitioner and the trainee to struggle with the issue of choice. The decisions you make about therapy will be quite personal. Some prefer a predominantly intrapsychic approach to therapy; others a more contextual, social engineering approach. Some like the freedom of a time-unlimited model; others a time-limited, even very brief, model. Some will prefer didactic and directive methods; others will be inclined to the Socratic, client-centered approaches. Some will veer to etiological and history-focused exploration; others will prefer teleological, motivational, or even exclusively present-focused perspectives. Some will prefer a reductionistic model; others a holistic model that involves exercise, nutrition, physical fitness, medical exams, and heavy social penetration of clients’ ambient worlds. Some of you will prefer the highly cognitive; others the principally affect-centered. You will find examples of all of these among the 14 case studies of this volume.
The following case studies will be rich ore to exploit, but in mining them, you will inevitably transform them. These studies are like rushing streams, of which the Greek philosopher Heraclitus spoke, into which you can dip your foot (or even plunge). You cannot, however, do the same thing twice, not because the case history will change, but because you will have changed at a second reading. Be that as it may, you have a banquet table set before you. The chapters were a pleasurable and useful read for me. I have no doubt they will also be for you.
Frank Dumont Professor Emeritus McGill University
acknowledgments
We are grateful to dozens of colleagues and friends who have taken time to discuss psychotherapy with us and to share their ideas about how it can best be taught. Sometimes, these conversations took hours and went on late into the evening; at other times, a friend would make a casual comment that would later shape our decisions about which cases to include in Case Studies in Psychotherapy. Although Current Psychotherapies chapter authors usually selected the case study used to supplement their chapters in Case Studies in Psychotherapy, we sometimes solicited outside advice and opinions, and we are indebted to the following individuals who helped in a variety of ways with the preparation of this book.
Bernard Beitman
University of Missouri–Columbia
Juris Draguns
Pennsylvania State University
Ken Freedland
Washington University
Glenn Good
University of Florida
James Hennessy
Fordham University
Lockie Johnson
Saba University School of Medicine
Judy Kuriansky
Columbia University
Tony Marsella
University of Hawaii
Richard Nelson-Jones
Cognitive Humanistic Institute, Chiang Mai, Thailand
Tom Oltmanns
Washington University
Paul Pedersen
University of Hawaii
Chris Pearce
California School of Professional Psychology
Paul Priester
University of Wisconsin–Milwaukee
Morgan T. Sammons
California School of Professional Psychology
Sombat Tapanya
Chiang Mai University
Robert Woody
University of Nebraska–Omaha
Christoph Zepeda
California School of Professional Psychology
preface
Psychotherapy is a difficult calling. Its practice requires creativity as well as intelligence, ingenuity as well as training, and hard work as well as good intentions. It is easy to do badly but exceedingly difficult to do well. Its ranks include both charlatans and grand masters. Psychotherapy involves skills that are almost never completely mastered, and it provides opportunities for, and indeed demands, lifelong learning.
Unfortunately, the very features that make psychotherapy so fascinating also make it difficult to teach or explain. Those of us who presume to instruct others in this arcane craft realize that modeling is our most powerful tool, and it is often more heuristic to show students what we do rather than tell them what we do. However, all of us realize the limits of our own training: There are myriad clients with multiple problems, and their needs are protean.
One way to deal with the limits of our own experience and training is to expose students to role models through case histories such as those collected in this volume. Each case in Case Studies in Psychotherapy is written by an experienced psychotherapist, and each parallels a chapter in the tenth edition of the companion volume, Current Psychotherapies.
Hundreds of thousands of students have used Current Psychotherapies to learn about the theoretical underpinnings and fundamental methods of a dozen or so therapeutic systems, and the cases in the current volume have been carefully selected to expand and supplement the information in the parent text. This seventh edition includes new cases to illustrate psychoanalysis, client-centered therapy, positive psychotherapy, and contemplative approaches to psychotherapy. These cases illustrate the clinical work of some of the leading figures in the world of psychotherapy.
The serious student of psychotherapy can benefit greatly by reading Case Studies in Psychotherapy in tandem with the core chapters in Current Psychotherapies. I’m convinced students who make this investment will appreciate more fully both the beauty and the art of psychotherapy.
Danny Wedding dwedding@alliant.edu
case studies in psychotherapy
Editors’ Introduction
This case study illustrates many of the concepts described in more detail in the Safran and Kriss chapter on psychoanalysis in Current Psychotherapies. It is also an excellent introduction to long-term psychotherapy (Dr. Safran worked with Simone for four years, typically seeing her three times each week).
The case shows a therapist and patient working together to resolve transference and countertransference issues, and it illustrates the key psychoanalytic concept of recapitulation of the past in the present. Simon’s relationship with her parents is explored in depth (including the “sexual energy” exchanged between father and daughter), and Dr. Safran is able to help his patient understand how the “hole or emptiness inside her” might relate to her bulimia. The case also shows how the therapist and patient worked through termination issues, and it illustrates the ways in which psychoanalysts use dreams in therapy.
It will be useful for you to consider what recommendation you would make if you were a claims reviewer for an insurance company and you were asked to justify the need for four years of treatment for this young woman. Should there be limits to treatment or should it be open ended with termination set by the therapist and patient? How often do psychotherapy patients present with a history of childhood sexual abuse? Were Simone’s beliefs about the likelihood of her becoming pregnant through immaculate conception genuine delusions?
It will be especially useful for you to compare and contrast the way Dr. Safran approaches this case with the approaches advocated in other chapters in Current Psychotherapies. Is psychoanalysis the treatment of choice for bulimia? Do this patient’s other problems justify four years of psychotherapy, or is psychoanalytic treatment best conceptualized in terms of personal growth rather than symptom reduction? Does the fact that Simone continued to periodically binge after termination suggest that treatment wasn’t effective, or is relapse almost inevitable in cases such as this?
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