Terry B. Northcut

Utilizing cognitive-behavioral techniques in psychodynamic practice with clients diagnosed as borderline

Many factors, including theoretical controversies, treatment constraints, and an increasing awareness of the high incidence of childhood trauma, compel practitioners to reevaluate both theory and practice in the treatment of clients diagnosed as borderline. Our purpose in this paper is to encourage clinicians who practice primarily from a psychodynamic perspective to reconsider the judicious use of relevant cognitive/behavioral techniques with this population. We focus on the rationale of utilizing relevant cognitive/behavioral techniques in out-patient settings, and discuss specific problem areas where these techniques might be useful. These problem areas include (1) cognitive and affective splitting, (2) affective dysregulation, and (3) faulty attributions. Each problem area is discussed with clinical illustrations of appropriate cognitive/behavioral interventions. The vignettes also illustrate the essential role the therapeutic relationship plays in order for cognitive/behavioral interventions to be effective.

Assessment of cognitive schemas and attributions in psychodynamic treatment

Abstract The authors draw upon cognitive‐behavioral, psychodynamic, and the integrative theories and literature to propose assessment guidelines which pay attention to the understanding and use of cognition in treatment. They demonstrate how the careful assessment of schemas and attributions, when completed as part of a general ego psychological assessment, engages the client, facilitates the integration of historical and current affects and events, and offers a means of systematically exploring and challenging motivating beliefs and assumptions about the operation of the world. Contemporary clinical examples and a focus on cognitions in the social realm, typically a neglected dimension, are utilized to illustrate theoretical concepts.

Listening to Both Sides of the Therapeutic Dyad: Self-Disclosure of Gay Male Therapists and Reflections From Their Gay Male Clients

Clinicians vary as to their beliefs about the use of self-disclosure in psychotherapy depending on theoretical framework, experience level, and the problem focus. Given the limited number of studies examining therapeutic pairs (client and clinician), this study used qualitative methodology to interview gay male therapists and their gay male clients about how therapist self-disclosures affected their therapy. Results show that clients often felt aware of therapist self-disclosures, whether explicit or implicit, and believed the disclosures assisted them in feeling connected to their therapists and served to normalize the clients’ experiences. Limitations to the study are discussed.

Ethiopia’s social protection landscape: Its surface and underlying structures

This article demonstrates the utility of explicating underlying forces that have brought about, shaped and underpinned provision of social protection in each sub-Saharan African country. It does so in the context of examining six such forces, namely: tradition and culture, drought and famine, relations among key actors, the mainstream paradigm of development, the poverty reduction agenda of the ruling party, and constrained fiscal space that have historically contributed to current provision of social protection in Ethiopia. Recommendations are given for social work policy practice to enable decision-makers to integrate developmental and human rights objectives in Ethiopia’s forthcoming national social protection strategy.

The slippery slope of constructivism

Abstract While constructivism as both a philosophy and a clinical practice is being embraced by many individual and family practitioners, it remains controversial. This paper examines the difficulties one encounters in trying to balance the clients “relative truths” with those around them, including that of the therapist. Through the use of clinical vignettes, the authors demonstrate the difficulties inherent in dealing with ambiguities in the clinical situation, balancing the clients perspective, with that of a predominant culture or biological “fact,” and considering the issue of the clients “veracity.” Particular attention is paid to the difficulties involved in work with trauma survivors, whose own recollections of events may be ambiguous. Finally, the authors discuss the implications that constructivism holds for research and social action and advocacy. In sum, the authors recognize significant promise in the constructivist perspective, but caution clinicians to consider the inherent difficulties in a theory that relies on the relativity of truth.

Beginning with the Clients: Mindfully Reconciling Opposites with Survivors of Trauma/Complex Traumatic Stress Disorders

Since 2009, Warriors at Ease (WAE) has trained yoga and meditation professionals around the world to work skillfully and safely with active duty service members, veterans, their families, and caregivers. The WAE approach has three pillars: teaching that is trauma-informed, military culture-sensitive, and evidence-based. The article describes how fundamentally opposite the experience of trauma and the experience of yoga are, and how those opposite qualities create a powerful “alchemy of opposites” that catalyze deep healing from trauma. The authors discuss how to work with client resistance to nontraditional therapies and delineate the key factors that any mindful yoga instructor/therapist should incorporate into his/her client relationships to create optimal safety.

Beginning with the Concept: The Meanings of Mindfulness

This chapter explores the concepts of mindfulness, the mechanisms of action that make it important for clinicians and clients, the similarities and differences with psychotherapy, and the contraindications or pitfalls inherent in the process of mindfulness. The components of mindfulness, attention, exposure, and acceptance of what is happening in the moment facilitate practitioners’ having compassion and empathy for themselves and others. However, as with therapeutic processes, these are subjective experiences that have different repercussions based on individuals’ psychological, sociological, and biological contexts. Social workers must continue to be mindful of introducing any trend or technique into practice without sufficient training, personal and professional experience, and qualitative and quantitative support. Despite the deceptive idea that mindfulness is strictly a solitary activity, engaging a client mindfully requires an embodied relational experience.

On the Road to Mindfulness: Concluding Thoughts

Themes from each of the chapters are reviewed and summarized. Directions for future research are also explored. Mindfulness has important implications for personal and professional practice including greater acceptance and compassion for self and others.

Beginning with the Context: The Mind–Body Conundrum

Conceptualizing mindfulness as a whole body experience rejoins the mind and the body in a way that the western world has historically had difficulty reconciling and operationalizing. Clinical social workers, physicians, and healers in many if not all cultures recognize that our bodies can be understood as conduits or carriers of messages if we listen carefully. Consequently, this chapter looks at results of empirical study and the narratives surrounding the study of both mind and body in the United States to gain a more complete understanding of how to best intervene clinically that respects these messages.

Introduction: The Tincture of Time

Acknowledging and accepting mindfulness into clinical social work compels us to think about the implications for our understanding of human behavior, our social systems, our educational structures, our understanding of health and mental health, and our approach to clinical research. Time and care is needed to examine mindfulness with critical optimism and its implications for practice now, and in the near future.