Jeffrey L. Binder

Essential activities in a session of brief dynamic/interpersonal psychotherapy.

Therapeutic discourse combines inquiry and dialogue strategies, which correspond, respectively, to the construction and deconstruction of a patients maladaptive personal story line. This story line refers to a pattern of dysfunctional thinking/emotional management and a corresponding maladaptive interpersonal pattern that has been identified as the root cause of the patients presenting problems. Identifying and critically examining a patients personal story line is the superordinate technical strategy that guides our work each session. More specific technical guidance is provided by the change processes that we attempt to activate in each session: cognitive insight around emotionally loaded issues, corrective emotional/interpersonal experiences, and practice implementing the insights gained during a therapy session.

Does the supervisor's teaching style influence the supervisee's learning prescribed techniques?

Abstract Objectives: This study examined the directive and non-directive supervisors’ instructional styles, supervisees’ interactive communications within supervision sessions as well as the relative success of supervisees’ learning to apply specific techniques within psychotherapy. Method: The developers of Time-Limited Dynamic Psychotherapy (TLDP) provided the supervised training for 16 therapists as part of the “Vanderbilt II” psychotherapy project. Supervision sessions were rated for supervisors’ adherence to TLDP content. Both supervisors and supervisee were rated for classroom interactive behaviors of “initiation” speech (e.g., introducing ideas) and “responsive” speech (e.g., amplifying the other speakers topic). The third therapy session was targeted for discussion within supervision. Therapy sessions immediately before and after supervision were rated on TLDP adherence. Results: One of the supervisors (Supervisor A) was found to use an instructional style of relatively more initiation-based speech, whereas the other (Supervisor B) used more response-based speech. Technical adherence for supervisees of Supervisor A was significantly higher than those assigned to Supervisor B. Supervisees’ initiation-based speech during supervision predicted less use of TLDP techniques in the therapy session after supervision. Supervisors’ interactive style was not associated with therapy adherence. Conclusions: Relatively more directive and structured supervision may influence the acquisition and use of manual-prescribed therapy techniques.

Countertransference and the Therapist's Inner Experience: Perils and Possibilities

This is the best work on countertransference that I have read. The preceding statement might sound like hyperbole, so I will try to justify it. The book is not without limitations. I will get to them, but first the rationale for my enthusiasm. The authors, Gelso and Hayes, have between them many years of experience practicing and teaching psychotherapy and also conducting process outcome research on the therapeutic relationship and countertransference. Exposure to the psychotherapeutic process from the foregoing perspectives is reflected in the multifaceted view of countertransference presented. Also relevant is that Gelso and Hayes’s main theoretical influences are psychodynamic and humanistic. Conceptual mastery of their guiding theories likely contributed to the effortlessly straightforward, jargon-free, clear, succinct, and tightly organized text. Further, what the authors have to say predictably will appeal to and inform therapy trainees, trainers, practitioners, and researchers of all theoretical persuasions. ‘‘Countertransference’’ is a concept introduced by Freud and associated primarily with psychoanalytic theories of therapy. Over the decades of the 20th century, as psychoanalytic theory evolved and split into several major theories (e.g., classic, object relations, interpersonal, relational), so, too, the concept of countertransference acquired several definitions. In Chapter 1, Gelso and Hayes adroitly summarize the history of the concept and conclude that the various definitions of countertransference associated with each theoretical position all have limitations. In Chapter 2, they propose an alternative definition crafted from elements of the major psychoanalytic theoretical positions. Theirs is labeled the ‘‘countertransference interaction hypothesis’’ in which countertransference is defined as ‘‘the therapist’s internal or external reactions that are shaped by the therapist’s past or present emotional conflicts and vulnerabilities’’ (p. 25). Such reactions are said to be ‘‘triggered’’ by specific attitudes, sentiments, communications, or behavior from the patient that resonate with a therapist’s ‘‘sore spots’’ (i.e., unresolved conflicts or vulnerabilities). A basic premise of the authors is that countertransference is present to some extent in the process of all psychotherapies (at least individual therapy with adults), regardless of the theoretical approach or type. The therapist is neither a dispassionate observer nor an impersonal technician. Rather, therapists of all theoretical persuasions are participant-observers in a process that shapes the subjective experiences of both patient and therapist. Countertransference is a universal part of the therapist’s broader experiential world, which is engaged in every therapeutic encounter. A corollary proposition is that countertransference, if not recognized and managed well, can have detrimental effects; conversely, if appropriately managed, countertransference can contribute to therapeutic progress. In Chapter 3, definitions and roles of countertransference are examined in three major theoretical positions: psychoanalytic, cognitive behavioral, and humanistic. Gelso and Hayes also discuss what they view as key shortcomings in the conceptualization and management of countertransference that are associated with each theoretical model. Similar to the authors’ review of the history of the concept of countertransference, in Chapter 3 they summarize an impressive amount of information and clearly highlight their major points. Chapter 4 contains the authors’ vision of the therapist’s experiential world, of which countertransference is an important component. They argue that the common distinction between ‘‘subjective’’ and ‘‘objective’’ countertransference is a false dichotomy and assert that all therapist reactions are subjective. Their alternative position is to identify the central distinction as between therapist reactions to patient behaviors that would draw comparable reactions from most people and therapist reactions that are evoked by patient actions that resonate uniquely with a therapist’s unresolved issues. Only the latter constitute countertransference. Management of countertransference is discussed in Chapter 5. Gelso and Hayes offer a ‘‘theory’’ of countertransference management, along with specific recommendations on management strategies and techniques. This discussion has enormous practical utility and could be expanded into a separate monograph. Unfortunately, as is typical for clinicians and clinical researchers, the authors rely on the language of clinical theory to describe therapist skills that are needed to implement countertransference Psychotherapy Research, July September 2009; 19(4 5): 612 614