A Comparison of Audio Recordings and Therapist's Process Notes in Child and Adolescent Psychoanalytic Psychotherapy

Therapistsʼ process notes - written descriptions of a session produced shortly afterwards from memory - hold a significant role in child and adolescent psychoanalytic psychotherapy. They are central in training, in supervision, and in developing oneʼs understanding through selfsupervision and forms of psychotherapy research. This thesis examines such process notes through a comparison with audio recordings of the same sessions. In so doing, it aims to generate theory that might illuminate the causes of significantly patterned discrepancies between the notes and recordings, in order to understand more about the processes at work in psychoanalytic psychotherapy and to explore the nature of process notes, their values and limitations. The literature searches conducted revealed limited relevant studies. All identified studies that compare process notes with recordings of sessions seek to quantify the differences between the two forms of recording. Unlike these, this thesis explores the meaning of the differences between process notes and recordings through qualitative data analysis. Using psychoanalytically informed grounded theory, in total nine sets of process notes and recordings from three different psychoanalytic psychotherapists are analysed. The analysis identifies eight core categories of findings. Initial theories are developed from these categories, most significantly concerning the role and influence of a ʻcore transference dynamicʼ between therapist and patient. Further theory is developed on the nature and function of process notes as a means for the therapistʼs conscious and unconscious processing of the session, as well as on the nature of the influence of the relationships – both internal and external – within which they are written. In the light of the findings, a proposal is made for a new approach for learning about the patient and clinical work, ʻthe comparison methodʼ (supervision involving a comparison of process notes and recordings), and, in particular, for its inclusion within the training of psychoanalytic psychotherapists. Further recommendations for research are also made.

Professionalising positive psychology: Developing guidelines for training and regulation

Although positive psychology (PP) was initially conceived as more a shift in perspective (towards the “positive”) than a new field per se, in pragmatic terms, it is arguably beginning to function as a distinct discipline, with people self-identifying as “positive psychologists.” Thus, we contend it is time for the field to start developing a system of professional (e.g., ethical) guidelines to inform the practice of PP. To this end, we outline one such possible system, drawing on guidelines in counselling and psychotherapy. Moreover, we argue for the creation of two tiers of professional identity within PP. Firstly, people with a master’s qualification in PP might label themselves “positive psychology practitioners.” Secondly, we raise the possibility of creating a professional doctorate in PP which would enable graduates to assume the title of “positive psychologist.” We hope that this paper will contribute towards a dialogue within the field around these issues, helping PP to develop further over the years ahead.

Working with the complexities of adolescent mental health problems: applying Time‐limited Adolescent Psychodynamic Psychotherapy (TAPP)

This article discusses the application in a CAMHS setting of a distinctive intervention for adolescent mental health difficulties, Time‐limited Adolescent Psychodynamic Psychotherapy (TAPP). TAPP has been developed specifically for working with adolescents and the characteristic developmental and psychosocial complexities they present to mental health services. It is widely recognised that supporting the developmental process in adolescence is central to therapeutic interventions and the therapeutic aim of TAPP is to enable recovery of the capacity to meet developmental challenges. The key factors of TAPP are described, including the formulation and working with a developmental focus, the therapeutic stance, working with transference and counter‐transference, working with time limits, and the emphasis on engagement of adolescents in therapy in TAPP. The experiences of introducing and developing TAPP in the CAMHS service are discussed with two brief and one extended case examples and this leads to a discussion of the kinds of outcomes achieved. It is concluded that TAPP is a key and relevant intervention for adolescents in complex and vulnerable situations; further work will be undertaken to continue its application in these settings and to formally assess outcomes.

Psychotherapy and its alternatives: Commentary on a critique

In this commentary, Michael Rustin reviews the articles in the symposium, outlining their main aims and arguments. He goes on to provide some critical reflections, asking questions about the key concept of the ‘therapeutic state’. He notes that little attention is given to psychoanalytic or other psychological theories of the mind, as distinct from the biological models which are the main object of criticism in the symposium. He argues that just as it is justifiable and useful to take account of theories of the mind in considering issues of mental health and therapy, so it is desirable also to take account of the structures of society which have responsibility for generating conditions of mental well- or ill-being, and to reflect on how these may be changed. The commentary argues that the counter-cultural and somewhat ‘post-modern’ critical approach which informs the symposium can only form part of a sufficient response to the problems which the symposium identifies.

Psychotherapy in a neoliberal world

The neoliberal regime has significant consequences for the psychotherapies. In particular, the idea that individuals is deserving of support from society and government when they need it – for example in managing the inevitable stresses of the life cycle – is being displaced by an ideology of total individual responsibility. Psychotherapies framed around relational conceptions of the self find themselves particularly out of key with this dominant way of thinking. Governmental approaches to developmental needs become more instrumental, measurement-oriented and ‘disciplinary’ in this situation. Market incentives and disciplinary sanctions are introduced to ensure that institutions and their personnel conform to governmental directives. There is pressure on psychotherapists to adapt to this instrumentalised environment to survive. However, ‘expressive individualisation’ was also stimulated by the cultural liberation of the 1960s, and survives alongside the ‘possessive individualism’ of neoliberalism. This alternative culture has not been entirely suppressed, and therapies continue to be sought which offer the possibility of self-understanding and growth, although the pressure is for such therapies to become luxury goods. What is at risk under neoliberalism is the idea that society should support the self-development and self-understanding of all its citizens, as an aspect of a modern kind of democratic citizenship.