Non-directive psychotherapy

Psychotherapy is a word to describe an age-old process. It would be better not to speak of psychotherapy, but of psychotherapies. Specialists are not the only ones who act as psychotherapists, since every human being fills this role at one time or another. Besides this, no two persons follow an identical approach. Finally, all therapists change technique constantly. The kinds of psychotherapy must therefore approach infinity.Some physicians appear to assume that only one type of psychotherapy may claim a scientific basis. Although Freud first put psychotherapy on a scientific path, there is no reason to say that Freud must be the last in this field. Over the past few years a new trend has started in psychotherapy which deserves close study. This new trend challenges some old beliefs and gives a new tool to help patients of some types. It is called non-directive or client-centered psychotherapy. This therapy does not try to solve the patient's problems for him, but rather establishes the conditions under which a patient can work out his own salvation. Each year non-directive psychotherapy grows in importance. Much can be learned from the method.     

THE PSYCHOTHERAPEUTIC APPROACH TO EMOTIONAL PROBLEMS

Physicians are confronted with more and more psychological problems in their daily practice. Not only must a physician be able to recognize the problems, he must also be prepared to treat a certain number of them. Some of the patients will improve just because of a good relationship with the physician. Others will require more definitive, yet comparatively simple, psychotherapy. On the other hand, some patients with clear-cut emotional problems are best treated by the physician''s traditional medical approach rather than by some type of “formal” psychotherapy. In some circumstances psychotherapeutic efforts may be damaging.     

Une approache pratique des résistances psychologiques aux traitements par injections intracaverneuses (I.I.C.)

Intra-cavernous injection of vasoactive substances has dramatically modified the medical approach of erectile dysfunction. There are psychological and ethical difficulties to this therapeutic procedure, and it is likely that they do contribute to the high drop out rate encountered with this method. According to our clinical experience, we suggest several attitudes in order to facilitate patient's and partner's acceptance:

? There is no opposition between psychotherapy and intra-cavernous injection, they may be regarded as complementary.

? It is advisable to find means to reduce the fear induced by self injection, by reassuring the patient, and making the act easier by choosing the most simple injection material. The pharmacological action must be explained, as well as the side effects.

? Pharmacologically induced erection is often described as artificial, although intra-cavernous injection of vasoactive substances is a symptomatic treatment just as many other symptomatic treatments. It compensates a functional insufficiency, restoring a physiological state very close to normal as far as erection is concerned, but has no effect on sexual excitation, glans intumescence and the development of the ejaculatory climax reflex. The sexuel relation's erotization lays only within the couple, and remains entirely apart from any iatrogenic effect.

? Should the treatment remain secret? Inta-cavernous injection must not systematically be performed withtout the partner knowing about it, although the act should remain discrete and intimate.

One should not encounter psychic or ethical difficulties in erectile dysfunction treatment with intra-cavernous injection of vasoactive substances, provided that it has been properly prescribed, well explained, and that it is part of a psychotherapy. It is doubtless that many refusals or therapy withdrawals are caused by poor or lack of technical initiation, on one hand, and by not taking into account the psychic and ethical aspects of the method, on the other hand.     

Donor Conception Disclosure: Directive or Non-Directive Counselling?

It is widely agreed among health professionals that couples using donor insemination should be offered counselling on the topic of donor conception disclosure. However, it is clear from the literature that there has long been a lack of agreement about which counselling approach should be used in this case: a directive or a non-directive approach. In this paper we investigate which approach is ethically justifiable by balancing the two underlying principles of autonomy (non-directive approach) and beneficence (directive approach). To overrule one principle in favour of another, six conditions should be fulfilled. We analyse the arguments in favour of the beneficence principle, and consequently, a directive approach. This analysis shows that two conditions are not met; the principle of autonomy should not be overridden. Therefore, at this moment, a directive counselling approach on donor conception disclosure cannot be ethically justified.     

Depolarization of the Client's Moral Position as a Method of Psychological Consultation

In an earlier article we attempted to construct a universal psychotherapeutic theory. On the basis of an analysis of the works of Freud (1923), Carl Rogers (1965), and V. Frankel (1990), we distinguished some universal principles in explaining the mechanisms of formation of neurotic symptoms and formulated, in a more general way, the principal goal of psychotherapy of neuroses (Kapustin, 1993). We also showed that these principles can be used to explain the mechanisms of a broader range of clients' problems in psychological consultation (Kapustin, 1994). We regarded the purpose of a psychological consultation for this range of problems as a somewhat universal one, independent of the content of the problems or of the symptoms accompanying their mental disorders. Further development of our theory will inevitably require the development of a technique of consultation that fits the language and the concepts of the given theory.     

MARRIAGE PROBLEMS—Dealing with Them in Private Practice

Marriages and divorces in Los Angeles County almost equal each other. Marriage per se is not the cause of neurosis. When two neurotic persons marry, the resulting neurotic interaction too often ends in conflict, broken homes and a new generation of neurotic children.Psychotherapy must be related to the diagnosis of family psychopathology, should include all the involved members and should be directed toward the realistic goal of integrating them into family living.Of 100 cases taken from the author''s experience, 64 involved married couples and the majority of these had serious interspouse conflicts. In 37 cases both spouses were treated and substantial psychotherapy was given to one or both of the partners. It included one or more modalities varying from electroshock therapy, tranquilizers, and such psychotherapy as supportive, dynamic interpretive, individual, spouses together, group and hypnotherapy. Thirteen achieved clinical recovery, nine improved, twelve were still in therapy. In three cases therapy failed.     

The Executive and Neurosis

Executives are prone to overwork, to need to achieve and to need to compete. The dynamics responsible for this pattern were also the dynamics of the breakdown in 16 executives with neurosis. Overcompensation for inferiority feelings, often originating in low socioeconomic childhood background, and ambivalence to the father with repression of hostility were prominent, the main ego mechanisms of defence being repression and denial. The patients often attempted to turn psychotherapy into discussions and had difficulty in accepting a non-directive approach.     

EMOTIONAL FACTORS IN PHYSICALLY HANDICAPPED CHILDREN

The staff of the Reiss-Davis Clinic for Child Guidance has been concerned with the emotional factors in physically handicapped or chronically ill children. It is felt by the staff that work with these children must include not only the known procedures to improve or correct their physical condition, but also efforts directed toward preventing or removing any evidence of emotional or psychological crippling.The symbolic or unconscious meaning of the disability is of great importance in this work. Attitudes of the parents may seriously interfere with the handicapped child''s ability to develop his maximum level of functioning and adjustment. Individual and group psychotherapy was found of value in helping these parents.     

Parkinson's disease.

In Parkinson''s disease there is degeneration of neurons in the substantia nigra, with consequent depletion of the neurotransmitter dopamine. The triad of tremor, rigidity and bradykinesia is the clinical hallmark. Drugs currently used for palliative therapy fall into three categories: anticholinergic agents, dopamine precursors (levodopa combined with extracerebral decarboxylase inhibitors) and artificial dopamine agonists. It has been argued, on theoretical grounds, that some drugs slow the progress of Parkinson''s disease, although no firm evidence has supported this. Treatment must be individualized, and more than one type of drug can be given concurrently after a careful build-up in dosage. We review the adverse effects of various drugs and consider new developments such as slow-release preparations, selective D-1 and D-2 agonists and transplants of dopaminergic cells into the brain. The treatment of Parkinson''s disease can be demanding, rewarding and sometimes frustrating, but it remains a most challenging exercise in pharmacotherapy.     

Evolutionary Tradeoffs between Economy and Effectiveness in Biological Homeostasis Systems

Biological regulatory systems face a fundamental tradeoff: they must be effective but at the same time also economical. For example, regulatory systems that are designed to repair damage must be effective in reducing damage, but economical in not making too many repair proteins because making excessive proteins carries a fitness cost to the cell, called protein burden. In order to see how biological systems compromise between the two tasks of effectiveness and economy, we applied an approach from economics and engineering called Pareto optimality. This approach allows calculating the best-compromise systems that optimally combine the two tasks. We used a simple and general model for regulation, known as integral feedback, and showed that best-compromise systems have particular combinations of biochemical parameters that control the response rate and basal level. We find that the optimal systems fall on a curve in parameter space. Due to this feature, even if one is able to measure only a small fraction of the system''s parameters, one can infer the rest. We applied this approach to estimate parameters in three biological systems: response to heat shock and response to DNA damage in bacteria, and calcium homeostasis in mammals.     

The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta‐analysis of direct comparisons

Although psychotherapy and antidepressant medication are efficacious in the treatment of depressive and anxiety disorders, it is not known whether they are equally efficacious for all types of disorders, and whether all types of psychotherapy and antidepressants are equally efficacious for each disorder. We conducted a meta-analysis of studies in which psychotherapy and antidepressant medication were directly compared in the treatment of depressive and anxiety disorders. Systematic searches in bibliographical databases resulted in 67 randomized trials, including 5,993 patients that met inclusion criteria, 40 studies focusing on depressive disorders and 27 focusing on anxiety disorders. The overall effect size indicating the difference between psychotherapy and pharmacotherapy after treatment in all disorders was g=0.02 (95% CI: −0.07 to 0.10), which was not statistically significant. Pharmacotherapy was significantly more efficacious than psychotherapy in dysthymia (g=0.30), and psychotherapy was significantly more efficacious than pharmacotherapy in obsessive-compulsive disorder (g=0.64). Furthermore, pharmacotherapy was significantly more efficacious than non-directive counseling (g=0.33), and psychotherapy was significantly more efficacious than pharmacotherapy with tricyclic antidepressants (g=0.21). These results remained significant when we controlled for other characteristics of the studies in multivariate meta-regression analysis, except for the differential effects in dysthymia, which were no longer statistically significant.     

The Isis Centre: a counselling service within the National Health Service.

A new centre has been established to provide readily accessible counselling, consultation, and mental health information. People may refer themselves or are recommended to attend by general practitioners or other agencies. The counsellors have varied backgrounds in paramedical or counselling services, and they are supported by psychiatrists. Of a sample of 100 clients, four were referred to one of the team''s psychiatrists and 33 visited the centre only once. The centre''s staff aim to adopt a flexible approach to the client and his problems, and formal psychiatric categories have not been found useful. Provision is made for people who want to solve their problems by discussion rather than medication and those for whom the existing psychiatric services may have little time to spare. Consequently, the approach adopted by the Isis Centre, whereby many people benefit from psychotherapy yet the psychiatrist deals directly with only a few selected cases, contributes towards meeting the great need for psychiatric services and using the psychiatrist''s skills more effectively.     

Evolution of viral structure

Viruses vastly outnumber their host cells and must present a huge selective pressure. It is also becoming evident that only a small percent of the eukaryotic genome codes for molecules involved in cellular structures and functions, and that much of the remainder may have a viral origin. Viruses clearly play a central role in the biosphere, but how is this viral world organized? Classification was originally based on virus morphology and the particular host infected, but now there is an increasing trend to rely on sequence information. The type of genome (e.g., RNA or DNA, single- or double-stranded) provides fundamental classification criteria, while sequence comparisons can provide fine mapping for closely related viruses. However, it is currently very difficult to identify long-range evolutionary relationships. We present here a different approach, based on the idea that each virus has an innate "self." When the structures and functions characteristic of this "self" are identified, then they uncover relationships beyond those accessible from sequence information alone. The new approach is illustrated by sketching some possible viral lineages. We propose that urviruses were present before the division of cellular life into its current domains, and that the viral world has lineages that can be traced back to the root of the universal tree of life.     

The role of pattern recognition in creative problem solving: A case study in search of new mathematics for biology

Rosen classified sciences into two categories: formalizable and unformalizable. Whereas formalizable sciences expressed in terms of mathematical theories were highly valued by Rutherford, Hutchins pointed out that unformalizable parts of soft sciences are of genuine interest and importance. Attempts to build mathematical theories for biology in the past century was met with modest and sporadic successes, and only in simple systems. In this article, a qualitative model of humans' high creativity is presented as a starting point to consider whether the gap between soft and hard sciences is bridgeable. Simonton's chance-configuration theory, which mimics the process of evolution, was modified and improved. By treating problem solving as a process of pattern recognition, the known dichotomy of visual thinking vs. verbal thinking can be recast in terms of analog pattern recognition (non-algorithmic process) and digital pattern recognition (algorithmic process), respectively. Additional concepts commonly encountered in computer science, operations research and artificial intelligence were also invoked: heuristic searching, parallel and sequential processing. The refurbished chance-configuration model is now capable of explaining several long-standing puzzles in human cognition: a) why novel discoveries often came without prior warning, b) why some creators had no ideas about the source of inspiration even after the fact, c) why some creators were consistently luckier than others, and, last but not least, d) why it was so difficult to explain what intuition, inspiration, insight, hunch, serendipity, etc. are all about. The predictive power of the present model was tested by means of resolving Zeno's paradox of Achilles and the Tortoise after one deliberately invoked visual thinking. Additional evidence of its predictive power must await future large-scale field studies. The analysis was further generalized to constructions of scientific theories in general. This approach is in line with Campbell's evolutionary epistemology. Instead of treating science as immutable Natural Laws, which already existed and which were just waiting to be discovered, scientific theories are regarded as humans' mental constructs, which must be invented to reconcile with observed natural phenomena. In this way, the pursuit of science is shifted from diligent and systematic (or random) searching for existing Natural Laws to firing up humans' imagination to comprehend Nature's behavioral pattern. The insights gained in understanding human creativity indicated that new mathematics that is capable of handling effectively parallel processing and human subjectivity is sorely needed. The past classification of formalizability vs. non-formalizability was made in reference to contemporary mathematics. Rosen's conclusion did not preclude future inventions of new biology-friendly mathematics.     

Results of Psychotherapy

A controlled double blind study was made of 299 non-psychotic female psychiatric clinic patients divided into six groups, with members of each group dealt with in a different manner from those in other groups. Those in one group had one or two hour-long psychotherapy sessions a week. Four groups were limited to brief visits but were given one of three kinds of drugs or a placebo. One group was merely put on a waiting list and received no therapy. As determined by a variety of independent measures, there was a fairly uniform average improvement of all groups except the one that received no treatment. Follow-up 10 to 18 months after termination of treatment revealed that the average patient had maintained her improvement and that those who had received no treatment showed considerable improvement after they were removed from the waiting list.The findings suggested that the widespread preference for the traditional outpatient psychotherapy is based as much on the physician''s bias as on proven greater effectiveness over briefer treatment methods. There was some confirmation that many things other than the development of understanding enter into much of the so-called psychoanalytically oriented psychotherapy and may have profound effect on the outcome.     

Constructions dans l’analyse: le transfert comme construction d’un espace porteur et comme reconstruction

The author argues that Binswanger’s daseinsanalyse is far from contradicting what Freud established in the field of analytical therapy. On the contrary, it enriches psychotherapy by making explicit what it is capable of constructing. This paper focuses on the transferential aspect of this construction. Übertragung, or transference, calls upon the world of the patient, its emotional space inhabited by the patient’s body and the bodies of others. This world, along with its underlying dramatics, not only requires recognition, but also carriage (Tragung) to the analyst’s side, at least if the analyst is to succeed in revealing the unconscious part of this world to foster its transformation rather than repetitions of the mechanisms that freeze it. The author reflects on the “gestation” and “carriage” metaphors to show how therapeutically effective the “carrier-experienced space” can be.     

Logic modeling and the ridiculome under the rug

Logic-derived modeling has been used to map biological networks and to study arbitrary functional interactions, and fine-grained kinetic modeling can accurately predict the detailed behavior of well-characterized molecular systems; at present, however, neither approach comes close to unraveling the full complexity of a cell. The current data revolution offers significant promises and challenges to both approaches - and could bring them together as it has spurred the development of new methods and tools that may help to bridge the many gaps between data, models, and mechanistic understanding.Have you used logic modeling in your research? It would not be surprising if many biologists would answer no to this hypothetical question. And it would not be true. In high school biology we already became familiar with cartoon diagrams that illustrate basic mechanisms of the molecular machinery operating inside cells. These are nothing else but simple logic models. If receptor and ligand are present, then receptor-ligand complexes form; if a receptor-ligand complex exists, then an enzyme gets activated; if the enzyme is active, then a second messenger is being produced; and so on. Such chains of causality are the essence of logic models (Figure 1a). Arbitrary events and mechanisms are abstracted; relationships are simplified and usually involve just two possible conditions and three possible consequences. The presence or absence of one or more molecule, activity, or function, [some icons in the cartoon] will determine whether another one of them will be produced (created, up-regulated, stimulated) [a 'positive' link] or destroyed (degraded, down-regulated, inhibited) [a 'negative' link], or be unaffected [there is no link]. The icons and links often do not follow a standardized format, but when we look at such a cartoon diagram, we believe that we 'understand' how the system works. Because our brain is easily able to process these relationships, these diagrams allow us to answer two fundamental types of questions related to the system: why (are certain things happening)? What if (we make some changes)?     

Savants rêveurs et rêveurs savants: Freud lecteur de la science française des rêves

This paper sets out to place The Interpretation of Dreams within an historical context. It argues that it is impossible to have complete confidence in Freud’s words when, in his letters to Wilhelm Fliess, he characterized himself as a mere discoverer. In reality, Freud also felt he belonged to a learned community of dream specialists, whom I call “dreaming scientists” and “scientific dreamers”. Here, I offer, as example, a portrait of Freud as a reader of two French authors, Alfred Maury, and, indirectly, Léon Hervey de Saint-Denys. I analyze how Freud positioned himself as Maury’s successor and sometimes experienced dreams like Hervey de Saint-Denys. The premise of this work is that we must set aside Freud if we want to venture into the learned dream culture peculiar to the 19th century. Only afterwards can we return to Freud and place him in this context as a creative heir.