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O F F I C I A L P U B L I C AT I O N O F D I V I S I O N 2 9 O F T H E


In This Issue

A Q-sort Model for the Empirical

Investigation of Psychotherapy Integration

Discourse and Healing

The Fundamental Nature of the
Political Process

Student Paper Award:
The Relationship Between Patients’
Representations of Therapists and Parents

Division 29 2007 APA Conference

2007 VOLUME 42 NO. 3

Division of Psychotherapy 䡲 2007 Governance Structure
President Board of Directors Members-at-Large Michael Murphy, Ph.D., 2007-2009
Jean Carter, Ph.D J. G. Benedict, Ph.D., 2006-2008 Professor and Director of Clinical
5225 Wisconsin Ave., N.W. #513 6444 East Hampden Ave., Ste D Training
Washington DC 20015 Denver, CO 80401 Department of Psychology
Ofc: 202–244-3505 Ofc: 303-753-9258,or 303-526-1101 Indiana State University
E-Mail: jcarterphd@aol.com Fax: 753-6498 Terre Haute, IN 47809
E-Mail: JGBENEDICT@aol.com Ofc: : 812-237-2465 Fax: 812-237-4378
President-elect E-Mail:
Jeffrey Barnett, Psy.D. James Bray, Ph.D., 2005-2007 mmurphy4@isugw.indstate.edu.
747 Buckeye Ct. Dept of Family & Community Med
Millersville, MD 21108 Baylor College of Med Libby Nutt Williams, Ph.D., 2005-2007
E-Mail: drjbarnett1@comcast.net 3701 Kirby Dr, 6th Fl Chair, Dept of Psychology
Houston , TX 77098 St. Mary’s College of Maryland
Secretary Ofc: 713-798-7751 Fax: 713-798-7789 18952 E. Fisher Rd.
Armand Cerbone, Ph.D., 2006-2008 E-Mail: jbray@bcm.tmc.edu St. Mary’s City, MD 20686
3625 North Paulina Ofc: 240- 895-4467 Fax: 240-895-4436
Chicago IL 60613 Irene Deitch, Ph.D., 2006-2008 E-Mail: enwilliams@smcm.edu
Ofc: 773-755-0833 Fax: 773-755-0834 Ocean View-14B
E-Mail: arcerbone@aol.com 31 Hylan Blvd APA Council Representatives
Staten Island, NY 10305-2079 Norine G. Johnson, Ph.D., 2005-2007
Treasurer Ofc: 718-273-1441 13 Ashfield St.,
Steve Sobelman, Ph.D., 2007-2009 E-Mail: ProfID@AOL.COM Roslindale, MA 02131
Department of Psychology Ofc: 617-471-2268 Fax: 617-325-0225
Loyola College in Maryland Jennifer Kelly, Ph.D., 2007-2009 E-Mail: NorineJ@aol.com
Baltimore, MD 21210 Atlanta Center for Behavioral Medicine
Ofc: 410-617-2461 3280 Howell Mill Rd. #100 John C. Norcross, Ph.D., 2005-2007
E-Mail: sobelman@loyola.edu Atlanta, GA 30327 Department of Psychology
Ofc: 404-351-6789 University of Scranton
Past President E-Mail: jfkphd@aol.com Scranton, PA 18510-4596
Abraham W. Wolf, Ph.D. Ofc: 570-941-7638 Fax: 570-941-7899
MetroHealth Medical Center E-Mail: norcross@uofs.edu
2500 Metro Health Drive
Cleveland, OH 44109-1998
Ofc: 216-778-4637 Fax: 216-778-8412
E-Mail: axw7@cwru.edu


COMMITTEES Finance Program
Chair: Bonnie Markham, Ph.D., Psy.D. Chair: Jeffrey J. Magnavita, Ph.D.
52 Pearl Street Glastonbury Psychological
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Education & Training
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Chair: Jean M. Birbilis, Ph.D., L.P. Psychotherapy Research
University of St. Thomas Chair: William B. Stiles, Ph.D.
Student Development Chair
1000 LaSalle Ave., TMH 455E Department of Psychology
Michael Garfinkle, 2007
Minneapolis, Minnesota 55403 Miami University
Derner Institute for Advanced
Ofc: 651-962-4654 Oxford, OH 45056
Psychological Studies
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Adelphi University
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Michael J. Constantino, Ph.D.
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Nominations and Elections
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Chair: Jeffrey Barnett, Psy.D,
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Professional Awards
Ofc: 413-545-1388
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Fax: 413-545-0996

Chair: Jennifer F. Kelly, Ph.D.
PSYCHOTHERAPY BULLETIN Official Publication of Division 29 of the
Published by the American Psychological Association
PSYCHOTHERAPY 2007 Volume 42, Number 2
American Psychological Association

6557 E. Riverdale
Mesa, AZ 85215 CONTENTS
e-mail: assnmgmt1@cox.net President’s Column ................................................2

Perspectives on Psychotherapy Integration ........4

EDITOR A Q-sort Model for the Empirical Investigation
Craig N. Shealy, Ph.D.
of Psychotherapy Integration
Harriet C. Cobb, Ed.D. Interview with Dr. Leon VandeCreek ......................12

Student Feature ......................................................15

Psychotherapists as Witnesses
Washington Scene
Patrick DeLeon, Ph.D. Psychotherapy Research ......................................17
Discourse and Healing
Practitioner Report
Ronald F. Levant, Ed.D. Washington Scene ..................................................21
The Fundamental Nature of the
Education and Training
Jean M. Birbilis, Ph.D. Political Process

Psychotherapy Research Division 29 2007 APA Conference Program ......23

William Stiles, Ph.D.
Student Award Paper ............................................32
Perspectives on The Relationship Between Patients’
Psychotherapy Integration
Representations of Therapists and Parents
George Stricker, Ph.D.

Student Features Membership Application......................................47

Michael Garfinkle, M.A.

Central Office Administrator
Tracey Martin




Opportunities Galore!

As I write this column, a voting seat on the Board.

the year is half over.
We have many things By the time of convention we will have
that are well begun, the current members at large moved into
and those good begin- the Domain Representative positions and
nings create even be ready to roll at the September Board
more opportunities, as meeting!
well as reflecting the
good work that has Convention Fun!
happened so far. We have an exciting convention program,
thanks to Jeffrey Magnavita, our VERY hard
Congratulations to our newly working Program Chair. See the special
elected officers insert to find your favorite programs! I want
We extend a warm welcome to president- to highlight a few special programs. This
elect designate Nadine Kaslow and year we will present our awards and recog-
Members at Large Norman Abeles and nize our hard working volunteers at a spe-
Michael Constantino (Early Career cial event that will come right before our
Psychologist position). Congratulations! social hour. Please plan to attend them both!

Reorganization and Bylaws Revision Conversation Hour (N): Awards and

You, the members, have recently approved Recognition
a revision of our Bylaws that result in a reor- 8/17 Fri: 5:00 PM – 5:50 PM
ganization of our Board of Directors. The San Francisco Marriott Hotel
goal is to provide greater opportunity on Golden Gate Salons B1 and B2
the Board, to increase the effectiveness of
our initiatives vis-à-vis the APA, and to Social Hour
enhance our ability to attend to the needs of 8/17 Fri: 6:00 PM – 6:50 PM
our members. With the Bylaws revision, we San Francisco Marriott Hotel
have increased the number of members-at- Golden Gate Salons B1 and B2
large to 8 and transformed them into
Domain Representatives. The Domain Board member Libby Nutt Williams, ably
Representatives will work collaboratively assisted by Membership Chair Annie Judge
with committee chairs as they share respon- and Student Development Committee
sibility for our Division’s areas of interest member Erin Howard, has developed a
and expertise. The Domains are as follows: special event for our Students and Early
Career Psychologists. Leaders in our field
Science and Scholarship will host lunch tables for informal discus-
Education and Training sion. Watch for the door prize drawing!
Psychotherapy Practice
Public Interest Lunch with the Masters: Luncheon for
Early Career Psychologists Graduate Students and Early Career
Membership 8/18 Sat: 12:00 PM – 1:50 PM
Two Seats for Diversity San Francisco Marriott Hotel
Nob Hill Rooms A and B
And we will continue to have the chair of
our Student Development Committee with continued on page 3
Looking Ahead Barnett will complete plans for the special,
As we move toward the fall, the Board will exciting MidWinter Meeting and CE
continue the transition to Domain Program to be held in St Petersburg
Representatives. Incoming Program Chair Beach, Florida, January 12, 2008, with a
Nancy Murdock will continue to develop day long CE offering from our own Don
plans that are already underway for the Meichenbaum—put it on your calendar
2008 Convention. President-elect Jeff today!

Find Division 29 on the Internet. Visit our site at


A Q-sort Model for the Empirical Investigation of
Psychotherapy Integration
Deborah A. Gillman and Paul L. Wachtel
City College and the Graduate Center, City University of New York

One obstacle to the pursuit of integration presented below, that this is too simple and
in the field of psychotherapy is the preva- linear an explanation, and that the very
lence—in teaching, research, and theoreti- perception of holding the “same” theoreti-
cal discussions—of depictions of the field cal view as another reflects a more complex
that privilege certain labels which refer process in which certain similarities are
more to political divisions within our disci- foregrounded and other, perhaps equally
pline than they do to fundamental concep- weighty, differences are dissolved in the
tual differences. Theoretical allegiances, application of one of the politicized labels
whether in the self-identifications of thera- to any particular individual therapist’s
pists or in research that compares one point of view.
approach to another, tend to be depicted in
terms such as psychoanalytic, cognitive- Therapists who identify with a particular
behavioral, experiential, systemic, and so orientation are unlikely to in fact identify
forth. These accounts implicitly assume with every single feature of that approach,
that these labels each point to a unified and or even every single important feature.
internally coherent set of axioms and con- Rather, what usually occurs, whether
ceptual and therapeutic tools, when in fact acknowledged or not, is that each therapist
they represent a melange of many ele- chooses the best crude approximation to
ments, packaged together less by virtue of his or her views from among the most
logic and coherence than by allegiance to prominent labels available in the profes-
one of the professional groupings that vie sional community. Actual differences and
similarities among therapists do not neces-
for influence (and economic advantage) or
sarily conform very closely to the current
by identification with certain elements of
labels that have come to stand for those
the package that lead therapists to say or
similarities and differences. The promi-
think, “I am A; I am not B.”
nence of those labels, however, makes it
difficult to disentangle perceptually the
The identifications can also frequently be
threads of similarity and difference, and
traced to what labels were highly valued in
hence other configurations and bound-
the particular place where one went to
aries, other ways of representing thera-
graduate school or to the consequences of
pists’ similarities and differences go large-
assortative socialization and social net- ly unrecognized. This is especially the case
works. On a small scale, one of us was part today, when powerful economic interests
of an institute that split at one point along have shaped the very nature of therapy
“theoretical” lines, but where perhaps the outcome research, leading to funding
best predictor of who would choose to be being directed to certain forms of “horse
associated with which theoretical grouping race” studies between horses whose “own-
was who played tennis with whom. Of ers” are usually the standard labels in the
course, one might account for these tennis- field (cf. Arkowitz, in press; Goldfried &
partner preferences on the basis of already- Wolfe, 1998; Wachtel, 2006).
held theoretical assonances. We are sug-
gesting, especially based on the evidence continued on page 5

We wish to describe here a study, originally with the term “the narcissism of small dif-
undertaken with beginning therapists who ferences.” In contrast, the study described
identify themselves as psychodynamically below illustrates how what look like
oriented, that we believe has larger signifi- opposing schools are actually an amalgam
cance as a methodological template for of ideas and preferences that therapists
studying the entire spectrum of therapeutic employ in their own particular fashion,
approaches and for seeing afresh the con- picking and choosing specific features
vergences and divergences that actually from different approaches rather than
exist in the field of psychotherapy. The dividing along “official” orientation lines.
methodology employed in this study, cen- After presenting the findings and their
tering on the use of Q-sorts and follow-up implications for understanding competing
interviews, can, with appropriate modifica- schools within psychoanalysis, we will dis-
tions in the content of the Q-sort cards, read- cuss how such a conceptualization and
ily be applied to the views of therapists of research methodology might be extended
all persuasions. Importantly, the methodol- to the larger realms of psychotherapy and
ogy described here approaches the mapping psychotherapy integration.
of the field of psychotherapy in a much
more empirical manner that is represented The study aimed to investigate whether
by the use of such standard labels as psy- beginning psychodynamic therapists in fact
choanalytic, cognitive-behavioral, experien- can be categorized in their views according
tial, systemic, or (to move to the realm that to the classical-relational dichotomy or
was the particular focus of the study to be whether a more complex configuration is
described next) classical or relational. necessary to capture the structure of their
similarities and differences. The methodolo-
Similarities and Differences among gy consisted of a Q-sort and qualitative
Psychodynamic Therapists: An Empirical interview administered to thirty doctoral
Study students in clinical psychology. The Q-sort
Just as in the larger realm of psychothera- offered a particularly appropriate means of
py, highly politicized labels figure promi- investigating this question because it yield-
nently within the sub-realm of psychody- ed, for each subject, a personalized profile
namic therapy. In the world of psycho- of his or her beliefs regarding the subject
analysis and psychodynamic therapy, the domain. Rather than globally endorsing
two most prominent labels today are “rela- an entire “orientation,” subjects were asked
tional” and “classical” (the latter some- to rank the importance and relevance to
times designated by other labels such as them of specific Q-sort statements that
contemporary Freudian or structural, but reflect aspects of psychodynamic psy-
referring to the same tradition and large chotherapy practice.
configuration as ideas as the label classical
refers to). In the world of psychoanalytic A key feature of Q-methodological
discourse, the assumed antinomy between research is that it permits a form of factor
these two broad schools figures prominent- analytic procedure that, in contrast with
ly, and many psychoanalytic and psycho- standard factor analysis, yields findings
dynamic therapists see the psychoanalytic that reflect groupings of subjects rather
world very largely in terms of two broad than test items. Not all studies using Q-
competing forces. Debates between propo- sorts employ this method of analysis. For a
nents of these two competing positions have discussion of Q-methodology and the
at times been quite heated (e.g., Bachant, options for data analysis, see Gillman, 2006,
Lynch, & Richards, 1995; Benjamin, 1995; as well as Kitzinger, 1999, and McKeown &
Christiansen, 1995; Gill, 1995 Marshall, Thomas, 1988. For examples of other studies
1995; Mitchell, 1995); analysts are familiar continued on page 6

using the methodology employed here, which the items were developed and mod-
see Stainton Rogers & Kitzinger, 1995, ified, as well as of the rest of the methodol-
and Snelling, 1999. ogy, see Gillman, 2006). The Q-sort state-
ments were reviewed by a panel of senior
The final factors of such analyses reflect clinicians who were strongly identified
clusters of like-minded people based upon with either the classical or relational tradi-
how they complete the Q-sort. This tion in order to ensure the content validity
methodology is particularly well suited to of the items. This review process generated
the question of whether psychodynamic item ratings that categorized items as
therapists group themselves into just two clearly reflecting a relational perspective (8
groups (classical and relational) or out of 54 or 15%); as clearly reflecting a
whether other configurations better cap- classical analytic perspective (14 out of 54
ture the variations among therapists in or 26%); as “bridging” the two orientations
their views about the work. Importantly, rather than being particularly identifiable
this methodology has the potential to dis- as belonging to one or the other (23 out of
cern and discover groupings that are not 54 or 43%); and as reflecting a lack of con-
defined a priori by the researcher sensus, with some (of each orientation)
(Kitzinger, 1999). Participants are not viewing the item as more relational and
required to identify with a particular pre- some as more classical (9 out of 54 or 17%).
existing viewpoint; instead, it is they who
determine the range and configuration of An example of a Q-sort item judged by the
views that exists among them. experts to represent a “relational”
approach to theory or clinical practice was,
Q-methodology was also deemed particu- Therapist self-disclosure is
larly well suited for this exploration of new an inevitable part of the
clinicians’ views since beginners are often process. The question is not
not well informed about the labels for dif- whether to disclose, but how
ferent paradigms or theories. It is thus dif- and when to do so.
ficult for them to accurately and validly
identify themselves as belonging to a par- A representative item judged as clearly
ticular pre-designated orientation, but they representing a “classical” view was,
are capable of conveying their orientation Therapeutic progress is most
empirically through their ratings of the enhanced by the resolution of
various specific Q-sort items. The Q-sort the patient’s difficulties as
thus enabled trainees to indicate their much as possible via inter-
implicit identification with either para- pretations rather than
digm—or with some other organizing con- through support, advice, or
figuration—by stating their relative agree- other kinds of interventions.
ment or disagreement not with an orienta-
tion as a whole, but with very specific Among the items for which the experts
ideas or practices. Whether these choices were split as to whether it belonged to the
cohered into “relational” and “classical” classical or relational perspective was,
configurations or took on some other con- The therapist is involved in
figuration altogether could be approached the construction, not merely
as an empirical question. the discovery, of the patient’s
psychic reality.
The Q-sort consisted of 54 original state-
ments deriving from a sampling of the And a representative “bridging” item, for
entire literature of psychodynamic therapy which the experts tended to assign a rating
(for a more detailed account of the way in continued on page 7

midway between classical and relational niques associated with different “official”
rather than as characteristic of either, was, approaches. Within the psychoanalytic
The dynamics of transference domain, clinicians of all levels of experi-
and countertransference are ence often identify with some elements of
critical in any treatment, but relational or classical models but not others
it is important not to focus on (Frank, 1999). While some psychodynamic
them too exclusively. Atten- clinicians come to identify as purely rela-
tion to the real transactions tional or classical, others, in practice,
that constitute the therapeutic choose to emphasize or prioritize only cer-
alliance is also important. tain features associated with a given
model. In the present study, the results of
The full list of Q-sort items and their desig- the Q-sort analysis implicitly challenged
nation as classical, relational, split consen- the relational vs. classical polarity that is so
sus, or bridging, can be found in Gillman broadly assumed by contemporary psy-
(2006). chodynamic thinkers. Far from aligning
themselves with one of two dichotomized
The Factor Analysis orientations, the therapists in this study
Analysis of the 30 Q-sort distributions implicitly grouped themselves into a much
across the 54 items yielded six factors and more variegated set of commonalities and
(given the bi-polar nature of one factor) differences based on their actual views
seven groupings of trainees whose views about theory and practice. A minority of
were elaborated through interviews. A brief participants primarily prioritized state-
characterization of the essential common ments that were anchored specifically in
features for each of the seven groupings is relational or classical approaches, but the
as follows: (1) those whose highest priority large majority did not. Their Q-sorts
was their commitment to an egalitarian, col- proved to be largely ‘orientation-blind’ as
laborative approach to treatment, (n =13); they ranked the items according to implic-
(2) those who considered their approach to it schemes that had little to do with the
be eclectic and who valued most highly flex- statements’ classification by the experts as
ibility in practice and orientation (n = 4); (3) “relational” or “classical.” What emerged,
those most influenced by object relations essentially, was a trend among beginning
theory, who emphasized their patients’ and clinicians to sort through a range of views
their own intrapsychic processes (n = 2); (4)
that they had been exposed to through
those who were grouped for their preoccu-
their training and develop their own prac-
pation with the issue of therapist disclosure
tice orientation.
(n = 4); (5) those whose endorsements very
closely approximated a classically-oriented The potential for this methodology to be of
approach, primarily in terms of how they use in studying therapists’ views across the
construe the participation of the therapist in full therapeutic spectrum (and across a
the treatment dyad (n = 2); (6) those most
considerably greater range of experience
clearly allied with a relational approach,
than represented in the specific focus of the
whose identification was expressed by their
study discussed here) should be apparent.
prioritizing the importance of therapist sub-
Inclusion of Q-sort statements that derive
jectivity (n = 2); and (7) a final mixed group
from a range of therapeutic approaches (that
of trainees whose commonality is difficult
is, items not restricted, as in the present
to categorize (n = 3). (See Gillman, 2006 for
more details.) study, to variations within the psychody-
namic—or any other—orientation) would
Relevance for Psychotherapy Integration offer an opportunity to examine the larger
Research integrative themes that characterize thera-
In practice, many clinicians utilize tech- continued on page 8

pists’ actual views and practices and to see yet not entirely enamored of newer
how these views and practices do or do not ones, these “bridging” or consensual
fit within the boundaries of the present items carried the day. Twenty-four per-
“standard labels” in our field (e.g., psycho- cent of the study participants, for
dynamic, cognitive-behavioral, family sys- example, (those loading on Factor I)
tems, experiential). We suspect that even particularly prioritized the importance
the participants in this study, who were of the “working alliance,” the “real
specifically chosen for their identification relationship,” and the “humanness” of
with the broad area of psychodynamic the therapist (cf. Norcross, 2002). At
therapy, would, if presented with a variety the same time, although this was the
of “officially” non-psychodynamic items as largest grouping in the study, many
part of a larger and more comprehensive participants did not prioritize these
Q-sort, turn out to prioritize at least some items. Thus, what we found was not
of the non-psychodynamic items over simply an endorsement of motherhood
some others that are more conventionally and apple pie, but a rather specific
psychodynamic. This might especially be prime concern that characterized only
the case if care was taken (as it was in the a subset of the study sample. Recall
present study) to present items in a way here that the nature of the Q-sort task
that did not explicitly label them as belong- does not require participants to state
ing to one orientation or another and that that these items are not important,
attempted to present the items in plain only that they are less important to
English rather than in the jargon of one ori- them relative to others.
entation or another.
It may further be noted that these Factor I
The therapists who were the subjects of trainees, when asked subsequent to the Q-
this study demonstrated that one can iden- sort to state their orientation using up to
tify with aspects of a particular orientation three descriptors, did not necessarily use the
but not necessarily identify with that orien- same labels, even though empirically they
tation label. Therapists representing Factor loaded on the same factor. The descriptors
1, for example, identified with many rela- they used totaled nine different orientation
tionally-oriented ideas, but not with the labels, including “interpersonal,” “relation-
label “relational.” In interviews, they stat- al,” “eclectic,” and “integrative.” In part,
ed that a relational approach was “too this diversity of labels, even though the par-
intense, too confrontational” or that “it can ticipants in this group showed a strong con-
get overused.” It may be anticipated (but of sensus on what most mattered to them in
course needs to be investigated) that in their practice, reflected the fact that the key
similar fashion there will be some subjects items for them were bridging items, items
in a more broadly pitched study who that were not exclusively associated with
endorse certain important features of cog- either the classical or relational school, but
nitive-behavioral, experiential, or family were viewed by the experts as being equal-
therapy, but who are uncomfortable identi- ly characteristic of both.
fying with the particular labels.
In thinking about the importance to the
“Bridging” Ideas and the Trend toward participants of ways of working or think-
Integration ing that are common to both of the com-
The most highly endorsed Q-sort state- peting paradigms examined in this study,
ments in this study were those that one is reminded of the importance of com-
bridged the classical-relational divide. mon factors (e.g., Frank, 1973; Goldfried,
Among this sample of trainees, many 1980) and of the relationship as a crucial
of whom proved to be disaffected from
traditional psychoanalytic models continued on page 9
therapeutic factor that in most studies done working with someone who’s a little more of
thus far affects outcome even more than the a purist and doesn’t draw from so many
“approaches” or “techniques” that are the sources....So when I think about tension in
intended target of most research in this area the field I think about the various infighting
(Norcross, 2002). We speculate that, in within the department, in my program or
developing a broader set of Q-sort items to even within the analytic community.
investigate (in parallel fashion to the study
described here) the ways that therapists rep- Sandra, a 3rd year student is “still trying to
resenting the full range of currently promi- figure out” what orientation “makes the
nent orientations actually sort themselves in most sense” to her. She speculates:
terms of their specific preferences and ways I always assume that I will be a very eclec-
of interacting with patients, we would find tic therapist, which I think is kind of the
that the “bridging” items in that context are popular way to go now.
particularly those related to the establish-
ment of a good therapeutic alliance (which Margo, a 5th year student, describes her
seems to cut across approaches) and those graduate training and supervision as
that contribute to the broader concept of “eclectic” and how this has impacted her
common factors. thinking and practice:
I don’t think anyone works clean. You
The View from the Trenches know, just one theory in mind. And I don’t
If one views the study by Gillman (2006) as think it exists much anymore…I’m very
establishing a potential beachhead for the much into [flexibility]. Flexibility with dif-
broader exploration of commonalities and ferent techniques, so I can get a taste out of
differences among therapists of a wider all of them…Hopefully I’ll be an integrat-
range of “official” orientations, one may ed therapist one day.
view the data from this sample of beginning
psychodynamic therapists as a foreshadow- Trainees also reflected upon being trained
ing of what might be anticipated from the in a culture of distrust among proponents
latter, broader grouping. We can, of course, of different schools of thought. Lori, a 5th
offer here only a small sample of the inter- year student, has felt a pull from professors
view comments made by the therapists in of different orientations to “pick a camp:”
the study discussed here. What follows are I’ve asked numerous people over the years,
“bridging statements” in a different sense, like what’s the difference really? And the
ideas expressed by the upcoming genera- only consistent answer I get is politics.
tion of therapists reflecting their attempts to
make sense of and utilize the range of Ellen, a 6th year student, has also experi-
approaches to which they have been enced the divide among orientations as
exposed in the course of their training. The unnecessarily polarized and suspect:
names have, of course, been changed to pro- The polarity in the literature is unneces-
tect the identities of the participants. sary. The consequence is that people think
the schools are so different. Some things
Sandor, one year out of graduate school, are…[But there is an] unnecessarily divi-
describes his own approach as a mix of sive effect on the way folks talk about
drive structural, object relations, self, fami- things.
ly systems, and cognitive-behavioral tech-
niques. While in training, he experienced Now in her final year of doctoral training,
resistance to his own attempts to integrate: Ellen feels increasingly free of the tension
So it’s in supervision where I’ve faced a cer- among different theoretical approaches—as
tain degree of conflict when it comes to inte- well as free from dictates of her supervisors:
grating models. Not so much in figuring I feel I have reached a point where I have
out how to do it in my own work, but in continued on page 10
my own sense of what kind of therapist I psychoanalysis. Psychoanalytic Psychology,
am…There is no wholesale rejection of one 12, 1, 89-107.
school or the other. I’m picking and choos- Gillman, D.A. (2006). An exploration of the
ing what is best from each school! influence of relational and contempo-
rary Freudian paradigms on the think-
These and other comments speak to some of ing and practice of beginning clinicians:
the challenges faced by these psychody- A Q-methodological study. Unpublished
namic therapists-in-training in response to doctoral dissertation, City University of
their own integrative impulses. Strikingly, New York
however, they also offer a view of the field Frank, K.A. (1999). Psychoanalytic
at large as increasingly accepting—perhaps participation: Action, interaction &
even taking for granted the presence of— integration. Hillsdale, NJ: Analytic Press.
therapists with an “integrative,” “flexible,” Goldfried, M. R. (1980). Toward the delin-
or “eclectic” mindset. With this view of the eation of therapeutic change principles.
field from the perspective of its newest prac- American Psychologist, 35, 991-999.
titioners, we feel optimistic that some of the Goldfried, M. R. & Wolfe, B. E. (1998).
constraints that have arisen from “the war Toward a more clinically valid approach
between the orientations” may be diminish- to therapy research. Journal of Consulting
ing. We hope as well that we have shown and Clinical Psychology, 66 143-150.
the potential for the application of the Kitzinger, C. (1999). Researching subjectiv-
methodology described here to a broader ity and diversity: Q methodology in
inquiry into the thinking and practice of feminist psychology. Psychology of
clinicians from across the therapeutic spec- Women Quarterly, 23, 2, 267-276.
trum. Empirical demonstrations of the dif- Kitzinger, C., & Stainton Rogers, R. (1985).
ferences between how therapists actually A Q-methodological study of lesbian
think, and how they actually are similar or identities. European Journal of Social
different from each other, may help further Psychology, 15, 167-187.
to decrease the stereotypy of thought that McKeown, B., & Thomas, D. (1988). Q
arises from excessive focus on labels that Methodology. (Series: Quantitative appli-
are, in the final analysis, at least as much cations in the social sciences,
political as conceptual and substantive. No.66). Thousand Oaks, CA: Sage
Publications, Inc.
References Marshall, K. (1995). Toward constructive
Arkowitz, H. (in press). The therapist as dialogue: “The ploughshare of evil”
theorist. Applied and Preventive comes again–commentary on the special
Psychology. section on structural and relational psy-
Bachant, J.L., Lynch, A.A., & Richards, choanalysis. Psychoanalytic Psychology,
A.D. (1995). Relational models in 12, 4, 585-592.
psychoanalytic theory.Psychoanalytic Mitchell, S.A. (1995). Commentary on
Psychology, 12, 1, 71-87. “contemporary structural psychoanaly-
Benjamin, J. (1995). Comment. Psycho- sis and relationalpsychoanalysis.”
analytic Psychology, 12, 4, 595-598. Psychoanalytic Psychology, 12, 4, 575-582.
Christiansen, A. (1995). Commentary: Norcross, J. C. (Ed.) (2002). Psychotherapy
Primitive splitting in the field of psycho- relationships that work. New York: Oxford
analysis. Psychoanalytic Psychology, 12, 4, University Press.
599-602. Snelling, S.J. (1999). Women’s perspectives
Frank, J. D. (1973). Persuasion and healing. on Feminism: A Q-Methodological
Baltimore: Johns Hopkins University Study Psychology of Women Quarterly, 23,
Press. 2, 247-266.
Gill, M.M. (1995). Classical and relational
continued on page 11
Stainton Rogers, R. (1995). Q Methodology. Wachtel, P. L. (2006). Psychoanalysis, sci-
In J.A. Smith, R. Harré, & L.V. ence, and hermeneutics: The vicious cir-
Langenhove (Eds.), Rethinking methods in cles of adversarial discourse. Journal of
psychology. London: Sage. European Psychoanalysis, 22, 25-46.


Enjoy the warm Florida sunshine in January and

plan to attend this outstanding workshop.

Presenter: Donald Meichenbaum, Ph.D.

Program Title: Core Tasks of Psychotherapy:

What “Expert Psychotherapists Do”

When: Saturday, January 12, 2008 from 9:00 – 4:00 (6 CEs)

Where: Tradewinds Island Resorts

St. Petersburg Beach, Florida

Look for registration information in

the next issue of the Psychotherapy
Bulletin, or, when it becomes available,
on-line at divisionofpsychotherapy.org




Interview with Dr. Leon VandeCreek
Michael S. Garfinkle, MA, Adelphi University

Leon D. VandeCreek, for three years and found that I really liked
Ph.D. is a fellow and teaching as much as I liked my job in the
former President of the counseling center. It was also at that time
Division of Psycho- that I co-authored my first book. I then
therapy (2005-2006), a went back to graduate school for my Ph.D.
fellow of Divisions 12, at the University of South Dakota in 1969
31, and 42, and a fellow and then did an internship in 1971-1972 at
of the American Psycho- Carter Memorial Hospital in Indianapolis.
logical Association.
Professor and former MSG: And was that your first experience work-
Dean in Wright State University’s School of ing with children?
Professional Psychology, Dr. VandeCreek has
authored more than 20 books and over 150 arti- LV: It was my first major experience. It was
cles and presentations on issues including outpatient and inpatient with kids. One of
professional ethics and risk management. the interesting things is that this particular
hospital had one of the first autism
Michael S. Garfinkle, MA is the Chair of research projects, which was my first expe-
Student Development of the Division of rience with major developmental disor-
Psychotherapy (2006-2008) and is a Ph.D. can- ders.
didate in clinical psychology at Adelphi
University. He is also a research fellow at the MSG: Did that stay with you as an interest?
New York Psychoanalytic Institute.
LV: Only peripherally, as I primarily work
with adults and adolescents, but still per-
MSG: Can you tell us about the path that ini- form assessments with children. From the
tially brought you to clinical psychology? internship in 1972, I moved to a job at the
Indiana University of Pennsylvania and
LV: As a college student in the 1960s at they were just developing Masters pro-
Calvin College in Grand Rapids, MI, I did- grams, including in clinical psychology.
n’t really have any professional direction in Eventually, I became the director of the
mind. I grappled with several different col- Masters Program, and then in the 1980s
lege majors including sociology, theology, was one of the co-authors for a proposal for
and eventually settled on psychology in a Psy.D. in Clinical Psychology and became
large part because my advisor said, “you the director of that program. In 1994, I
have to pick something.” So, I picked psy- moved to Wright State to become the dean
chology because I had taken courses in the of the School of Professional Psychology.
subject that I had enjoyed. I finished my
degree in psychology and applied for a MSG: And what attracted you to Wright
Masters in Clinical Psychology at Bowling State?
Green State University and once I got into
the clinical side of things, I really got excit- LV: It was an opportunity to be involved at
ed in that area. I finished my Masters an administrative level. The School of
degree and got a job that was half time at a Professional Psychology only houses the
counseling center and half time teaching at doctoral program, so there isn’t the regular
Tri-State College in Indiana. I stayed there continued on page 13
competition between undergraduates and when there was minimal attention paid to
graduates, research and practice. risk-management, though there was an
awareness of broad ethics. My experience
MSG: Among the expansive range of topics you of students today is that they are fairly
have written on, you recently published a book alert and concerned about staying out of
with Samuel Knapp on “Practical Ethics for trouble. The concern about teaching ethics
Psychologists” (APA, 2006). How did you get today is not only about teaching students
interested in professional ethics? how to stay out of trouble, but rather also
teaching that ethics can help psychologists
LV: I’m not sure of the origins…When I be the best practitioners that they can be.
moved for my first postdoctoral job at the
Indiana University of Pennsylvania, one of MSG: You have written on risk management in
the courses I taught was on ethics and I working with patients with memories of abuse.
think I was one of the only people in the What inspired this work?
department at the time who wanted to
teach that course. And I’ve taught a course LV: That was a hot topic for awhile in the
on ethics every year since 1975. 1990s. That was an area of risk manage-
ment where health professionals, including
MSG: And your interest in a positive approach psychologists, didn’t pay attention to the
to practical ethics? science, to evidence-based practice. And
the general public just caught up to pretty
LV: I think the thrust of the past decade has lousy practice and health professionals
been to make ethics much more hands-on were sued as a result. That topic faded, and
and applied and less theoretical and hypo- what’s left is really good research in mem-
thetical. And over the years, I’ve been con- ory. That’s kind of characteristic of the
sidering how to get this message across to ethics/risk management business: that
students and make it stick? Ethics for me, some of these topics wax and wane, that
and for students, can be hard to read about some of these topics come in a frenzy and
and dull; finding ways to make ethics then fade, like recovered memories and sex
appealing and interesting is important. with patients. I think just about everyone
Also, with the development of positive agrees on those topics today.
psychology, the focus has shifted from how
to avoid getting into trouble, to “how can I MSG: In your scholarship, you have written a
be the best psychologist I can be.” fair number of articles on issues of student
training and clinical supervision. Can you
MSG: What ethical challenges do new clini- comment on the state of student training in
cians face that are different from previous clinical psychology at present?
LV: I think there has been good research
LV: All of society is more focused on indi- and literature on supervision in the last
vidual rights and the risks that go along decade, gearing supervision to address
with it. It has become a lot easier to sue where the student is in training (i.e., the
each other and make complaints to licen- beginning phase, middle phase, etc.). A
sure boards and there is greater awareness couple of real concerns I have for psy-
out there that you can make a complaint to chotherapy and assessment training is that
a board by just writing a brief letter. What I think that we still have a lot of basic train-
we have is an increased public awareness ing and supervision being provided by
of what one’s expectations for service folks who are not masters in it. Students
should be and what to do if those expecta- still get supervision in psychotherapy from
tions aren’t met. The threats are much
greater than in the 1970’s and the 1980’s continued on page 14
faculty who practice very little or who are to say with confidence: that’s a really good
not observed themselves to see how good psychologist or a really good supervisor.
they are. I think that the supervisors could
be credentialed as Master Psychotherapists MSG: Two presidents later, how do you think
or Master Assessors. In Boulder Model the Division of Psychotherapy is doing? Where
schools, we hope that the supervisors in would you like to see the Division focus its
research are scholars themselves. We don’t efforts?
want faculty on dissertation committees
who don’t engage in scholarship them- LV: I made a decision after completing my
selves, so why should it be different on the past-President year to shift out of a leader-
practice side? ship role in the division. I’d been involved
in a leadership role in the Division for
Here’s another example. In some commu- about 15 years. From my vantage point
nities, graduates of the doctoral programs now, the Division has very good leader-
become the supervisors of the next genera- ship. Division 29, along with other divi-
tion of doctoral students. Now, while there sions, suffers from declining membership,
may be good ones in the mix, we’re really likely because of the demographics of new
running the risk of a very inbred system psychologists and the income of new psy-
without outside critical review. Sometimes chologists. Personally, I’d like the division
it’s a geographical problem, but we don’t to continue working in areas of psy-
have any external validation measures in chotherapy training and research, how to
place for doctoral supervision in most assure that good psychotherapy training is
instances. occurring. It’s an important topic and one
that would be well served if the Division
Ethics and positive psychology value cre- took a leadership role.
dentialing supervisors instead of the cur-
rent practice, which goes something like: MSG: Well, thank you for this interview.
“you’re a good supervisor unless you’ve
been sued, but short of that I’m sure you’re LV: You’re welcome.
fine.” No, we need to be able to have ways


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Psychotherapists as Witnesses
Erin Howard, Lehigh University

As the two-year anniversary of Hurricane to come (APA Policy and Planning Board,
Katrina approaches, it becomes increasing- 2006). Certainly, as applied psychology
ly relevant for psychotherapists to consider training programs continue to build on
its relevance in our work and lives. Has multicultural and social advocacy
Katrina, and its continuing aftermath, emphases (e.g., Goodman et al., 2004), the
affected how we think about our clients? issue of adequately preparing therapists to
Has it affected how we think about psy- manage this clinical demand warrants con-
chotherapy? About trauma? Has it affected sideration.
our attention to, or interest in political
issues? In issues of socioeconomic standing Though nearly two years have passed, our
and social class identity? In advocacy? responses to Hurricane Katrina are also rel-
evant to our future clients and clinical
Hurricane Katrina demanded the attention work. By profession, psychotherapists
of the entire nation – even of other parts of serve most fundamentally as witnesses of
the world – and raised a magnifying glass humans’ experiences. At its best, the psy-
to our nation’s ability to support its mem- chotherapy experience invites clients’
bers. Lower social class individuals com- deepest truths, those rich in pain, sorrow,
prise not only a significant population in fear, and anger. We request transparency so
Gulf Coast areas in general, but also in that growth is possible. So that clients can
those areas most devastated by the hurri- learn to experience joy, peace, and content-
cane (The Center for Social Inclusion, edness in spite of, or perhaps because of,
2006). Low income individuals are also their darkest moments. Our ability to rec-
among those most vulnerable to the psy- ognize and understand the influence of
chological consequences of disaster (Ahern social class on patients’ problems and life
& Galea, 2006). Despite progress in re- experiences can be critical in providing
building and community repair efforts in sensitive, helpful treatment – particularly
the Gulf Coast, studies (e.g., Centers for for those patients who are socioeconomi-
Disease Control and Prevention, 2006; cally disadvantaged or experiencing prob-
Eisler, 2007) indicate that the mental health lems in which social class status plays a
needs of Gulf Coast survivors and resi- significant role.
dents are still great. Many psychothera-
pists have responded to this need by vol- The years to come will bring continued
unteering with various crisis response repair efforts to the Gulf Coast, and even-
organizations to support ongoing aid tually, the physical destruction left in the
efforts, though overall, volunteer efforts wake of the hurricane may no longer be
are dwindling (The Greater New Orleans visible. People may feel, as some do cur-
Community Data Center, 2007). The rently, that it is time to move on and give
unusually prolonged exposure to stressors attention and resources to other issues.
resulting from Hurricane Katrina and its How will Katrina have affected us then?
aftermath, such as property and job loss What can we do to remain affected? To
and increased violence, suggests that sur- remain witnesses?
vivors may continue to experience a signif-
icant need for mental health care for years continued on page 16
Ahern, J. & Galea, S. (2006). Social context 2007 from http://usatoday.com/news/
and depression after a disaster: The role nation/2007-01-15-katrina-mental-
of income inequality. Journal of health_x.html.
Epidemiology & Community Health, 60, Goodman, L., Liang, B., Helms, J., Latta, R.,
766-770. Sparks, E., & Weintraub, S. (2004).
American Psychological Association Policy Training counseling psychologists as
and Planning Board. (2006). APA’s social justice agents: Feminist and mul-
response to international and national ticultural principles in action. The
disasters and crises: Addressing diverse Counseling Psychologist, 32, 793-837.
needs: 2005 annual report of the APA The Center for Social Inclusion. (2006,
Policy and Planning Board. American August). The race to rebuild: The color
Psychologist, 61, 513-521. of opportunity and the future of New
Centers for Disease Control and Orleans. New York: Author. Available
Prevention (2006, January). Assessment from http://www .centerforsocialinclu-
of health-related needs after hurricanes sion.org/projects_katrina.html.
Katrina and Rita – Orleans and Jefferson The Greater New Orleans Community
parishes, New Orleans area, Louisiana, Data Center. (2007, March). The Katrina
October 17-22, 2005. Morbidity and Index: Tracking recovery of New
Mortality Weekly Report, 55, 38-41. Orleans and the metro area. New
Eisler, P. (2007, January). New Orleans feels Orleans, LA: Greater New Orleans
pain of mental health crisis: Those in Nonprofit Knowledge Works. Retrieved
need find very few doctors or facilities. on March 17, 2007 from
USA Today. Retrieved on January 23, http://www.gnocdc .org/index.html.

Discourse and Healing
Robert L. Russell, Ph.D., Medical College of Wisconsin

Our field has made much progress in iden- Having embraced aspects of Frank’s views
tifying core discourse components of ther- in the late 1970’s, it was natural for me to
apy but less progress in explaining how build a research program focused on thera-
such components heal those suffering from peutic and narrative discourse (e.g.,
various forms of psychopathology. In this Czogalik & Russell, 1995; Russell, 1999,
brief paper, I describe one very prominent 2004; Russell, Bryant, & Estrada, 1995). I
component of therapeutic discourse, com- situated this work within a developmental
pare it to previously identified common and pragmatic language framework
factors, and offer some thoughts about (Russell, 2007). Augmenting Frank’s
how it may function therapeutically. insights with empirical findings obtained
through time-series based micro-analytic
Over four and half decades ago, Jerome and other studies of therapeutic discourse
Frank published his groundbreaking work, promised to reveal clinically relevant
“Persuasion and Healing: A Comparative details. I understood that these would need
Study of Psychotherapy” (1961). As most consideration from theoretical and practi-
students of psychotherapy know, Frank cal perspectives. Such consideration might
identified four common factors appearing then refine and deepen our understanding
in all forms of healing and therapy: the of common and specific factors and other
therapeutic relationship, rationale, task, important features of treatment. In addi-
and setting. These were said to interact and tion, a developmental and pragmatic lan-
influence patients in five ways: through guage framework appeared compatible
learning, hope of relief, provision of suc- with Frank’s views about psychopatholo-
cess experiences, emotional arousal, and gy, the central role of verbal processes in
alleviation of a demoralizing sense of alien- treatment, and the type of findings that
ation. The continuing focus of theory, emerge from linguistic, discourse, narra-
research and training on these and other tive and time series based microanalyses of
common and specific factors attests to therapy process.
Frank’s prescience and widespread influ-
ence (Kazdin, 2005; Kiesler, 2004). Empirical findings based on time-series
based studies of therapeutic processes
What is seldom appreciated, however, were recently summarized in a meta-ana-
were Frank’s concluding views that 1.) The lytic review (Russell, Jones, & Miller, 2007).
state or condition common to all patients Consideration of these studies revealed
that can be treated by therapy is demoraliza- four client and five therapist processes that
tion, 2.) “Insofar as psychopathological comprise the core foci around which thera-
processes are amendable to psychotherapy, peutic interaction is structured. The four
they are conceptualized as expressive disor- client foci were organized around the com-
ders of communication…“ and 3.) “The major munication of affect, the sometimes painful
psychotherapeutic tools are communicative therapeutic work of self-formulation and
symbols—that is, words.“ (p. 323). It is insight seeking, relationship hopes, wor-
sobering to remind ourselves that Frank’s ries, and difficulties, and information
theorizing was undertaken from the point exchange, including communications
of view of a psychopathologist as much as
from the point of view of a therapist. continued on page 18
about needing help. The five therapist foci temporal orientation, contentless verbal-
were organized around the use of specific izations, and affirming. The interactional
verbal interventions, the communication meaning of this factor was glossed as “I am
of supportive understanding and empa- continuing my exchange of objective infor-
thy, an interest in obtaining further infor- mation about the events currently happen-
mation, information pertaining primarily ing in my life and showing you I am atten-
to the parameters of the treatment, and tively listening.” (p. 172).
personal, self-disclosing information.
Based on analyses of the therapeutic inter- The interactional meaning of this factor did
action of nearly 500 clients and 100 thera- not figure centrally in Frank’s depiction of
pists, with ratings obtained on 25,000 units common therapeutic factors. It is focused on
of discourse on approximately 1000 vari- what the client is doing rather than on the
ables, these nine core areas of client and therapist. It would be easy to dismiss
therapist discourse provide an empirically Continuing Information Exchange as mere-
supported, process-sensitive anatomy of ly a prologue to, or a consequence of, thera-
psychotherapy. In effect, these nine dis- pists’ therapeutic maneuvers. However,
course foci revealed by analyses conduct- from a developmental and pragmatic lan-
ed at the micro-analytic level appeared to guage point of view, this dismissal would be
comprise core or common factors that cut unfortunate. Information exchange may be
across therapies. as important as the more glamorous techni-
cal interventions by the therapist (e.g., inter-
The question naturally arises as to whether pretation, reflection, confrontation). I sug-
these new empirical findings require mod- gest that the alternation between speaking
ification of, or merely exemplify in empiri- and listening roles in discourse creates a
cal detail, Frank’s original common factors. pattern of perspective-taking out of which
As with most complex questions, the emerges the basic building blocks of the self
answer is not a simple yes or no. As an and the interpersonal world. The alterna-
example, I here consider one of the four tion provides grounds for the possibility of
common client factors, the client’s provi- linguistic communication per se. This may
sion of objective information, which had be why the socializing agents of society seek
also emerged in our own studies of thera- its achievement in children with an intensi-
peutic discourse. ty afforded few other functions. How else
can one explain the countless hours spent
In a time series based study of adult thera- by caregivers with their infants, playing
py (Czogalik & Russell, 1994), based on seemingly meaningless games structured in
over 350,000 ratings of client utterances, a turn-taking or alternating pattern? Out of
the factor Continuing Information the alternation of speaking and listening, a
Exchange accounted for the most process space is created in and through which a self-
variance. This factor has been prominent in-relation is born.
across our studies, disorders, therapists,
and cultures (i.e., therapies conducted in I suggest that the alternating roles
Germany in German versus therapies con- captured by Continuing Information
ducted in the US in English). This was a Exchange enable the client to re-create this
bipolar factor. The process variables with basic perspectival space for the (re)discov-
salient positive loadings on this factor ery of their voice and interpersonal ear.
included neutral description, informing, This alternation occurs while clients are
continuing, present orientation, and objec- speaking about objective events and listen-
tive events. Variables with negative load- ing to someone who is responding to them.
ings included minimal display, minimal This factor seems to be about locating the
technical activity, back channel regulators
(e.g., hmm, ah, oh), lacking indication of continued on page 19
client within the objective coordinates simple yes or no. The demoralizing sense
defining their current situation. The client of alienation could be lessened as the client
is trying to give voice to the contexts, situ- learns, sometimes emotionally, that she can
ations, and events that she currently finds share her world in the relationship with the
herself in. These are communicated to the therapist. She could experience success in
therapist as best as the client can, in fits and relating interpersonally in both speaking
starts, a broken branch here, an overturned and listening roles. As the client gains a
stone there, with the growing hope that the voice and tunes her ear, her landscape may
therapist has heard her communications become less demoralizing, perhaps provid-
well enough to identify her current “land- ing a glimmer of hope, if for no other reason
scape of action“ (Bruner, 1986, p.14). Thus, than that it now houses a self in relational
by joining in, the therapist can start to spec- dialogue. Consequently, the client’s alter-
ify the client’s landscape, its contours and nation of the provision of information with
contents, by a useful set of descriptors (i.e., their communication of active listening
words). Far from being only the transfer of may function in some of the same ways as
information from a speaker to a hearer, this the more paradigmatic therapist or treat-
first factor functions as a discourse com- ment related factors featured in Frank’s
pass for the client: “I am trying to commu- treatise so many years ago.
nicate the objective events in my current
life that continue to be topics of my con- On the other hand, the underlying
versational concern. These comprise the mechanism, the common curative factor,
conversational topography of my objective may simply be exposure to and participa-
existence now. Can anyone, can you, hear tion in affirming discourse exchanges,
where I am. I am listening to and for you.” including but not restricted to Continuing
Information Exchange (Russell, Green-
The existentialists might say that all clients wald, Shirk, 1991; Shirk & Russell, 1996).
are alienated from their own existence and This, after all, is how expressive and adap-
are thus estranged from others as well. The tive communication is learned in the first
voice of the therapist, then, contains hope place. Ideally, future research on discourse
of both reunion and communion. The processes in therapy will proceed with
client strains to listen to the therapist. methods capable of capturing both con-
There is work being done, perhaps even stituent processes and holistic forms of
remoralization, in the acknowledgement of communicative interaction.
the therapists voice, in the anticipation of
being known by, and knowing, an affirm- References
ing other. Every head nod, every back Bruner, J. (1986). Actual Minds, Possible
channel indicator, every affirmation and Worlds. Cambridge, MA: Harvard
display of attention to the therapist’s voice, University Press.
pulls the client back into the crucible of Czogalik, D., & Russell, R. L. (1994). Key
communication, where her socialization processes of client participation in psy-
and character were once forged and where chotherapy: Chronography and narra-
it can now be forged again. tion. Psychotherapy, 31, 170-182.
Czogalik, D., & Russell, R. L. (1995).
If Continuing Information Exchange, along Interactional structures of therapist and
with the alternation of speaking and listen- client participation in adult psychother-
ing roles it implies, is a common client fac- apy: P-technique and chronography.
tor in all types of therapies, does its Journal of Consulting and Clinical
absence from Frank’s list suggest that its Psychology, 63, 28-36.
influence on progress or outcome affects Frank, J. D. (1961). Persuasion and healing: A
change via mechanisms that he did not comparative study of psychotherapy.
identify? Again the answer may not be a continued on page 20
Baltimore: The Johns Hopkins psychotherapy: A synthetic review of
University Press. (Quotes are from the P-technique studies. Psychotherapy
1974 revised edition, New York: Research, 17, 271-288. Shirk, S. & Russell,
Schocken Books). R. L.(1996). Change processes in child psy-
Kazdin, A.E. (2005). Treatment outcomes, chotherapy: Revitalizing treatment and
common factors, and continued neglect research. New York: Guilford Press.
of mechanisms of change. Clinical Psy-
chology: Science and Practice, 11, 184-188.
Kiesler, D. J. (2004). Intrepid pursuit of the
essential ingredients of psychotherapy.
Clinical Psychology: Science and Practice, Robert L. Russell, Ph.D. is currently Professor
11, 391-395. of Pediatrics at the Medical College of
Russell, R. L. (1999). Child psychotherapy Wisconsin/Children’s Hospital of Wisconsin.
process research: Suggestions for the He is Director of Research at the Child
new millennium. In S. W. Russ and T. H. Development Center and a member of the
Ollendick (Eds.), Handbook of psychother- School Performance Program in which he pro-
apies with children and families (p. 541- vides assessment and treatment for school aged
552). New York: Klower children with learning, language, and psychi-
Academic/Plenum Publishers. atric disorders. Dr. Russell received his Ph.D.
Russell, R.L. (2004). Minding our thera- from Clark University in 1984 and an MA in
peutic tales: Treatments in perspec- Linguistics in 1986 from the University of
tivism. In L.E. Angus& J. McLeod (Eds.) North Carolina, Chapel Hill. He has taught at
The Handbook of Narrative and the University of Kentucky, New School for
Psychotherapy (pp. 211-226). Thousand Social Research, and at Loyola University prior
Oaks, CA: Sage Publications, Inc. to his current appointment. He is currently
Russell, R. L. (2007). Social Com- conducting research on the pragmatic language
munication Impairments: Pragmatics. competence of children with language disorders
In R.L. Russell & M.D. and ADHD in addition to his research on
Simms (Eds.) Language, Communication, and processes of treatment in child and adolescent
Literacy: Pathologies and Treatments. therapy. The current piece shares the title of a
Pediatric Clinics of North American, 54, book-in-progress.
Russell, R., Bryant, F., & Estrada, A. U. Address for editorial correspondence:
(1995). Confirmatory p-technique analy- Robert L. Russell, Ph.D.
ses of therapist discourse: High versus Professor, Pediatrics
low quality child therapy sessions. Director of Research
Journal of Consulting and Clinical Child Development Center
Psychology, 64, 1366-1376. Medical College/Children’s Hospital of
Russell, R. L., Greenwald, S. & Shirk, S. R. Wisconsin
(1991). A meta-analytic review of lan- Department of Pediatrics
guage changein child psychotherapy. 8701 Watertown Plank Rd.
Journal of Consulting and Clinical PO Box 26509
Psychology, 59, 916-919. Milwaukee, Wisconsin 53226 0509
Russell, R. L., Jones, M.E. & Miller, S.A. Phone: 414-456-4430
(2007). Core process components in Email: rrussell@mcw.edu

The Fundamental Nature of the Political Process
Pat DeLeon, former APA President

A State-Based Dialogue: On July 10, 2007 ed by the supervising psychiatrist. This bill
the Governor of the State of Hawaii vetoed allows psychologists to prescribe psy-
SB 1004 which would have allowed appro- chotropic medications to patients of all
priately trained psychologists, working ages, including children, elderly, and those
within our state’s community health cen- with medical illnesses in addition to med-
ters, to prescribe. As Mike Sullivan ical conditions. Psychologists with limited
observed: “A veto was inevitable some- didactic and clinical training are not pre-
where sooner or later. Hawaii came closer pared to handle the side effects of psy-
than anytime in over two decades – major chotropic medications on patients with
progress. Hats off to Jill and Robin and medical complications. In recognition of
Ray!” The Governor’s veto message: “The this concern, both the Board of Medical
stated purpose of this bill ‘is to authorize Examiners and the Board of Psychology,
appropriately trained and supervised the professional licensing bodies for these
licensed medical psychologists practicing two professions, have asked that this bill
in federally qualified health centers, to pre- not become law. For the foregoing reasons,
scribe psychotropic medications for the I am returning Senate Bill No. 1004 without
treatment of mental illness.’ This bill is my approval.”
objectionable because its actual effect goes
beyond its stated purpose by allowing psy- The ApA President: “We welcome (the)
chologists who obtain the second of two veto of this legislation and the legislature’s
tiers of prescriptive authority established decision not to attempt to override
by the bill—a prescription certificate – to her veto. These actions placed the health
practice outside of federally qualified and welfare of patients above politics.
health centers (FQHCs) and to prescribe Psychiatric disorders—and medications—
medications to individuals who are not have an impact on the patient’s whole
patients at FQHCs. Furthermore, this bill body, not just his or her brain.... (I)t is dan-
does not require medical supervision of gerous and unwise to allow prescribing of
psychologists holding a prescription cer- pharmacologic treatments by those... who
tificate. This bill is also objectionable have no medical training. Properly pre-
because psychologists do not have the scribed, psychiatric medications are safe
training necessary to prescribe drugs and and effective, but they are not without
this bill does not require sufficient didactic risks.... Moreover, over half of all patients
and clinical training for prescriptive with mental illnesses have other medical
authority.... complications that must be taken into con-
sideration when prescribing psychiatric
“In addition, this bill gives psychologists medications. This also clearly requires
with prescriptive authority a scope of prac- medical education and training and exper-
tice broader than that afforded to the PDP tise. The APA applauds the leadership and
[DoD] psychologists. PDP psychologists continued efforts by patients, their families
were limited to prescribing psychotropic and physicians in Hawaii to ensure that
medications to patients between the ages Hawaiians are not subjected to substan-
of 18 and 65 with mental conditions but dard and potentially dangerous care. The
without medical complications as evaluat-
continued on page 22
APA strongly supports its state associa- vidualized care in which educated con-
tions in their ongoing efforts to vigorously sumers will actively utilize the most up-to-
resist efforts to allow psychologists to date technology to ensure that they have
practice medicine without the benefit of access to the type (and quality) of health-
medical school and supervised medical care that they desire? Does organized med-
residency.” icine have any appreciation for the critical
importance of the psychosocial-economic-
It is important in the public policy arena to cultural gradient of care or the benefit to
periodically reflect upon the “bigger pic- patients inherent in non-silo oriented,
ture.” This year a chiropractor-access bill interdisciplinary care? Given the half-
passed the Hawaii legislature to be vetoed truths and misrepresentations in the
by the Governor at the recommendation of Governor’s veto message, does organized
the Hawaii Medical Association. The HMA medicine really believe in data-based,
President: “The governor has stated her objective determinations of quality care –
intent to veto HB 436, which would man- including decades of evidence demonstrat-
date that Medicaid and QUEST cover chi- ing that a wide range of non-physician
ropractic services. I support the veto of this healthcare providers provide outstanding
bill. Medicaid and QUEST are intended to (if not superior) care? Jim Quillin’s testi-
be basic medical assistance programs. mony: “With respect to safety, medical psy-
Chiropractic services are not basic medical chologists certified in Louisiana saw a total
services that should be included in this of 7,260 patients in 2005, after receiving the
‘safety net’ state program. The stated pur- authority to prescribe. Of those patients,
pose of this bill is to ‘improve healthcare 3,863 (53%) were provided prescriptions....
access in Hawai’i by requiring medical There were no adverse events associated
assistance programs such as QUEST and with this expanded practice.” Does orga-
Medicaid to include chiropractic coverage.’ nized medicine appreciate that patients are
However, enactment of this law will harm ultimately responsible for their own health
access to quality healthcare. Current physi- care—for determining what services, and
cian reimbursement rates under Medicaid from which providers, they will receive?
and QUEST have remained low. As a con-
sequence of low reimbursement rates, a Perhaps one should consider politics a full
substantial number of Hawai’i physicians contact sport. We recommend the insight-
have had to stop accepting Medicaid or ful book Food Fight by two of our profes-
QUEST. Other physicians have left the sion’s visionaries, Kelly Brownell and
state. Accordingly, any additional money Katherine Horgen. The focus of their con-
that is available for these two programs cern is America’s growing obesity crisis,
should be spent on increasing physician especially among our nation’s children.
reimbursement rates. It would be a bad
precedent if this bill became law. If more This year, the Robert Wood Johnson
people use chiropractic services than were Foundation announced a $500 million ini-
anticipated, then even more money will tiative, over five years, to Reverse
have to be appropriated to cover these ser- Childhood Obesity, noting that about 25
vices. In addition, in tough financial times, million kids and teens in the nation are
other services may have to be cut to ensure overweight or obese: “Childhood obesity is
that these services remain fully funded.” one of the most urgent and serious health
threats confronting our nation. It deserves
We would ask: Is organized medicine real- a serious response.” Called by critics the
ly interested in fostering the health policy “Mullah of the Twinkie tax,” Kelly truly
changes necessary such that the healthcare appreciates that to make a lasting differ-
environment of the 21st century will affir-
matively embrace patient-centered, indi- continued on page 26
San Francisco, California
FRIDAY, AUGUST 17, 2007 Poster Session One
8/17 Fri: 3:00 PM - 3:50 PM
Symposium: Forgiveness Reconsidered—
Exploring Underlying Constructs and Moscone Center, Halls ABC
Their Application to Psychotherapy Participant/1st Author: Megan M. MacNamara,
8/17 Fri: 8:00 AM - 9:50 AM MA
Moscone Center, Room 310 Participant/1st Author: Priscilla R. Fleischer,
Chair: Donna S. Davenport, PhD Participant/1st Author: Satoko Kimpara, MS
Participant/1st Author: Andrew Reichert, BA Participant/1st Author: Matteo Bertoni, MS,
Participant/1st Author: Rod Hetzel, PhD MA
Participant/1st Author: Donna S. Davenport, Participant/1stAuthor: Anne C. Erlebach, MA
PhD Participant/1st Author: Sarah Knox, PhD
Participant/1stAuthor: Randolph Pipes, PhD Participant/1st Author: Barbara M. Kaplan, PhD
Discussant: Michael Duffy, PhD Participant/1st Author: Georgiana S. Tryon, PhD
Participant/1st Author: Rafael S. Harris, Jr, PsyD
Symposium: Emotion-Focused Therapy of Participant/1st Author: Mona Bapat, MS
Depression—An Evidence-Based Participant/1st Author: Chris Brown, PhD
Psychotherapy Participant/1st Author: Michele B. Hill, PhD
8/17 Fri: 10:00 AM - 11:50 AM Participant/1st Author: Courtney A. Swatta,
Moscone Center, Room 3007 PsyD
Participant/1st Author: George J. Kallas, PsyD,
Chair: Leslie S. Greenberg, PhD PhD
Participant/1st Author: Leslie S. Greenberg, Participant/1st Author: Shelah D. Adams, MA
PhD Participant/1st Author: Pedja Stevanovic, BA
Participant/1st Author: Jeanne C. Watson, PhD Participant/1st Author: Sara J. Lederer, MA
Participant/1st Author: Robert K. Elliott, PhD Participant/1st Author: Hung-Bin Sheu, MA,
Symposium: Can We Identify MVPs Participant/1st Author: Gregory S. Chasson, MA
(Most Valued Psychotherapists)— Participant/1st Author: Clara E. Hill, PhD
Therapists Effects in Psychotherapy Participant/1st Author: Shelley N. Osborn, BS
Participant/1st Author: Satoko Shiraishi, MA
8/17 Fri: 12:00 PM - 1:50 PM
Participant/1st Author: Lee A. Thrash, PhD
Moscone Center, Room 2006 Participant/1st Author: Zac E. Imel, MA
Chair: Raymond A. DiGiuseppe, PhD Participant/1st Author: Kristin M. Perrone, PhD
Participant/1st Author: Jeb Brown, PhD
Participant/1st Author: Stevan L. Nielsen, PhD
Participant/1st Author: William B. Stiles, PhD Conversation Hour: Awards and Recognition
Discussant: Raymond A. DiGiuseppe, PhD
8/17 Fri: 5:00 PM - 5:50 PM
San Francisco Marriott Hotel, Golden Gate
Symposium: Lying in Psychotherapy— Salons B1 and B2
Clients’ Views, Therapists’ Views, Theoretical
and Practical Considerations
8/17 Fri: 2:00 PM - 2:50 PM Social Hour
Moscone Center, Room 3012 8/17 Fri: 6:00 PM - 6:50 PM
Chair: Randolph Pipes, PhD San Francisco Marriott Hotel, Golden Gate
Participant/1st Author: Randolph Pipes, PhD Salons B1 and B2
Participant/1st Author: Leslie Martin, PhD
Participant/1st Author: Caroline Burke, PhD continued on page 16
Discussant: Annette S. Kluck, PhD

SATURDAY, AUGUST 18, 2007 Participant/1st Author: Jill C. Slavin, MA
Participant/1st Author: Brian H. Stagner, PhD
Symposium: Unifying Principles of Participant/1st Author: Jeffrey A. Rings, MA
Psychotherapy—What Have We Learned Participant/1st Author: Melissa S. Roffman, MA
From 100 Years of Clinical and Empirical Participant/1st Author: John L. Powell, MA
Investigation? Participant/1st Author: Arne Kristian
8/18 Sat: 8:00 AM - 9:50 AM Henriksen, PhD
Participant/1st Author: Robert J. Reese, PhD
Moscone Center, Room 3009 Participant/1st Author: Steven G. Benish, MSE
Chair: Jeffrey J. Magnavita, PhD Participant/1st Author: Melissa K. Smothers,
Participant/1st Author: Jacques P. Barber, PhD MA
Participant/1st Author: Jay L. Lebow, PhD Participant/1st Author: Frances A. Kelley, PhD
Participant/1st Author: Lorna Smith Benjamin, Participant/1st Author: William K. Lamb, PhD
PhD Participant/1st Author: J.R. Fuller, PhD
Participant/1stAuthor: Arthur Freeman, EdD Participant/1st Author: Diana L. Sanchez, MA
Discussant: Theodore Millon, PhD, DSc Participant/1st Author: Yun-Jy Yeh, MEd
Participant/1st Author: Valerie R. Wilson, MA
Luncheon for Graduate Students and Early Participant/1st Author: D. Brian Smothers, MA
Career Participant/1st Author: Erlanger A. Turner, MS
8/18 Sat: 12:00 PM - 1:50 PM
San Francisco Marriott Hotel, Nob Hill Rooms
Symposium: Psychotherapist Self-Care—
A and B
Leaving It at the Office
8/18 Sat: 4:00 PM - 5:50 PM
Symposium: Evidence-Based Psychodynamic
Moscone Center, Room 307
and Cognitive Therapies—Recent Findings
and Future Challenges Chair: John C. Norcross, PhD
Participant/1st Author: Judith S. Beck, PhD
8/18 Sat: 2:00 PM - 3:50 PM
Participant/1st Author: Laura S. Brown, PhD
Moscone Center, Room 307 Participant/1st Author: Lillian Comas-Diaz, PhD
Cochair: Jacques P. Barber, PhD Participant/1st Author: Florence W. Kaslow, PhD
Cochair: Robert J. DeRubeis, PhD Participant/1st Author: Michael P. Leiter, PhD
Discussant: William B. Stiles, PhD Participant/1st Author: Alvin R. Mahrer, PhD
Discussant: James D. Guy, PhD
Poster Session Two
8/18 Sat: 4:00 PM - 4:50 PM SUNDAY, AUGUST 19, 2007
Moscone Center, Halls ABC
Participant/1st Author: Tamara S. Shafer, BA Symposium: Psychotherapists Around the
Participant/1st Author: Timothy P. Melchert, World—-Meeting Needs of the Global Village
PhD 8/19 Sun: 9:00 AM - 10:50 AM
Participant/1st Author: Jennifer L. Wilson, BA Moscone Center, Room 309
Participant/1st Author: J. Alison Bess, PhD Chair: Craig N. Shealy, PhD
Participant/1st Author: Zohar Itzhar-Nabarro, Participant/1st Author: Gregg R. Henriques,
Participant/1st Author: Matthew J. Taylor, PhD Participant/1st Author: Shagufa Kapadia, PhD
Participant/1st Author: Nancy A. Fry, MBA Participant/1st Author: Noelle Robertson, PhD
Participant/1st Author: Christy D. Hofsess, MEd Participant/1st Author: Eleanor H. Wertheim,
Participant/1st Author: Robinder P. Bedi, PhD PhD
Participant/1st Author: Rebecca Oakes, PhD Discussant: Jeffrey J. Magnavita, PhD
Participant/1st Author: Rachel E. Crook Lyon,
Participant/1st Author: Lana O. Beasley, MA
Participant/1stAuthor: Frank Fedde, MA
Participant/1stAuthor: Scott A. Baldwin, PhD continued on page 17

Symposium: Guiding Evidence-Based Workshop: Two Become One and Then There
Practice With Outcome Data Are None! Relationships and Couples
Therapy Revisited
8/19 Sun: 11:00 AM - 12:50 PM
8/20 Mon: 11:00 AM - 11:50 AM
Moscone Center, Room 309
Moscone Center, Room 2006
Chair: David W. Smart, PhD
Participant/1st Author: David D. Dayton, BA Cochair: Robert W. Resnick, PhD
Participant/1st Author: Takuya Minami, PhD Cochair: Rita F. Resnick, PhD
Participant/1st Author: Russell J. Bailey, BS
Participant/1st Author: Richard L. Isakson, PhD Symposium: International Perspectives on
Discussant: Brent S. Mallinckrodt, PhD Feminist Multicultural Psychotherapy—-
Content and Connection
MONDAY, AUGUST 20, 2007 8/20 Mon: 12:00 PM - 1:50 PM
Symposium: Culturally Competent Moscone Center, Room 262
Intervention for Abused, Suicidal African Chair: Elizabeth Nutt Williams, PhD
American Women Participant/1st Author: Laura S. Brown, PhD
8/20 Mon: 8:00 AM - 9:50 AM Participant/1st Author: Norine G. Johnson, PhD
Moscone Center, Room 3003 Participant/1st Author: Ellyn Kaschak, PhD
Participant/1st Author: Kathryn L. Norsworthy,
Cochair: Nadine J. Kaslow, PhD
Cochair: Natalie C. Arnette, PhD
Discussant: Oksana Yakushko, PhD
Participant/1st Author: Natalie C. Arnette, PhD
Discussant: Nadine J. Kaslow, PhD

Symposium: Cognition and Suicide—-

Theory, Research, and Therapy
8/20 Mon: 10:00 AM - 10:50 AM
Moscone Center, Rooms 202/204/206
Chair: Lisa A. Firestone, PhD
Participant/1st Author: David Jobes, PhD
Participant/1st Author: M. David Rudd, PhD
Participant/1st Author: Gregory K. Brown, PhD




ence, one must have vision, persistence, what he was to tell me—‘Son, if you don’t
and presence. “Proposals to change the quit, you win.’ He was right.”
food environment present the food indus-
try and the nation with serious challenges. A Federal Dialogue: This Summer, Senator
The industry must fight off unwanted leg- Enzi, ranking member of the Health,
islative, regulatory, and legal action that Education, Labor and Pensions (HELP)
could damage business while at the same Committee, introduced legislation (S. 1783)
time it engages in practices such as mar- laying out a healthcare vision for the 21st
keting to children that are increasingly century. “Health care reform is one of the
unpopular. The nation must decide how to biggest needs in this country. It is the
deal with the food industry. Food compa- fastest escalating price in this country. It is
nies confront the paradox of claiming pub- the biggest cost to companies and individ-
lic health as their priority while knowing uals in this country. We need to have a
that profits increase when people eat more. solution. I have been working with Senator
If the nation moves to a healthier diet, Kennedy (who)... has a very full plate with
some segments of the industry will benefit the Higher Education Act, the higher edu-
and others will suffer.... Without active dis- cation reconciliation, information technolo-
cussion, the nation will default to current gy, and I could go on to mention about 53
practices.... Tight connections between the bills we are working on in that committee.
food industry and key governmental offi- So I have had some latitude as ranking
cials are legendary.... Striking parallels member to try to pull together some infor-
exist between the beginning of the war on mation—some legislation that would deal
tobacco and where the nation stands now with health care for this Nation. This is a
with food. First let us address a key issue – work in progress. This is not a finished
that food and tobacco are not the same. We document....
agree that they are not the same. People do
not have to smoke, but they must eat.” “Without the work of everyone on this, it
can’t be done. If it gets polarized, it can’t be
Kelly and his colleague highlight food done. This is something which has to be
industry tactics that are highly relevant for done in a very bipartisan way. I hope we
all who seek to modify the status quo of have a framework from which we can all
healthcare (including obtaining prescrip- operate, making changes, finding third
tive authority): • Claim commitment to ways. I work on an 80-percent rule. I antic-
public health; • Influence public policy ipate and from experience have found that
directly; • Seek influence through cam- usually everybody can agree on 80 percent
paign contributions; • Silence critics by of the issues, and among the 80 percent of
suing or intimidation; and, • Shift the the issues on which they agree, they can
focus of discussion. “First they ignore you. agree on 80 percent of any one of those
Then they laugh at you. Then they fight issues. You never get a perfect bill around
you. Then you win” [M.K. Gandhi]. Being here. If you can get 80 percent, you can get
personally involved is critical. Mike is a lot done. That is what we are trying to do
absolutely correct. Our sincerest congratu- on health care.... Eighty percent would be a
lations and appreciation to Robin huge difference and will help out a lot of
Miyamoto, Jill Oliveira, Ray Folen, and people.
HPA Executive Director Carol Parker.
Hawaii’s psychologists have made a major “So I rise today to talk about an issue that
contribution to society and our profession. is literally a heartbeat away from devastat-
Louisiana’s Jim Quillin: “I thought of a ing the lives of every American; that is, our
cold day in a duck blind many years ago current health care crisis. Undeniably, we
when my father told me that there would
come times in my life when I’d remember continued on page 27
have a problem. There are 46.1 million fear how the initial proposal dealt with
Americans, according to the last tabula- insurance mandates.... While the next step
tion, who are uninsured. Now, we always is probably one of the most obvious ones, it
talk about that figure and change it slight- is also one many have not yet discussed.
ly differently because there are 7 million of Currently, HIPPA portability protections
those people who make over $80,000 a year are provided to group health plans....
and don’t have insurance, so they must However, those consumer protections are
chose not to have insurance, but they are not provided nearly as well to individuals
uninsured.... Health care costs are outstrip- who are purchasing in the individual
ping inflation. They are increasing annual- market. Ten Steps blends the individual
ly at three times the rate of the Consumer and group market to extend important
Price Index. It is little surprise that three HIPPA portability protections... so the
out of every four Americans are concerned insurance security can better move with
about health care—three out of four.... you from job to job.... The sixth step
Thankfully, I am not here today to talk emphasizes preventive benefits and helps
about these problems; I am here to provide individuals with chronic diseases better
real solutions. Americans need and manage their health. America should have
deserve real solutions to this crisis now, health care, not sick care. Prevention, pre-
and they are counting on this body to work vention, prevention. That makes a big dif-
together to get that. The time has come to ference in the cost.... (A)nother key step is
move beyond the rhetoric and principles to to give individuals the choice to convert
true comprehensive health care reform. the value of their Medicaid and SCHIP pro-
Congress could enact 10 major steps for gram benefits into private health insur-
health care reform. These 10 steps are the ance, putting them in control of their
basis of the legislation I am introducing health care, not the Federal Government....
today, the Ten Steps to Transform Health The eighth step is a bipartisan proposal...
Care in America, or simply ‘Ten Steps’.... the ‘Wired for Health Care Quality Act,’
which encouraged the adoption of cutting-
“First, we eliminate unfair tax treatment of edge information technologies in health
health insurance, which expands choices care to improve patient care, reduce med-
and coverage and gives all Americans ical errors, and cut health care costs....
more control over their health care.... The (T)he ninth step helps future providers and
second step would increase affordable nurses pay for their education while
options for working families to purchase encouraging them to serve in areas with
health insurance through a standard tax great need.... The final step decreases the
deduction.... The third step is what makes skyrocketing cost of health care by restor-
this a hybrid approach. I couple the stan- ing reliability in our medical justice system
dard deduction with a refundable, through State-based solutions.... The
advanceable, assignable tax-based subsidy. Institute of Medicine... estimated that pre-
That is a mouthful, but it ensures that ventable medical errors kill between 44,000
Americans receive this credit in a meaning- and 98,000 Americans each year.... We have
ful way that allows them to purchase real an opportunity, we have an obligation to
insurance coverage.... The fourth key step take care of the people of this country, and
is to provide market-based pooling to they are demanding it. Let’s work from a
reduce growing health care costs and basis of some information and see where
increase access not only for small business- we can take it so that we get a solution and
es, unions and other kinds of organizations we get action now.”
and their workers, members, and fami-
lies.... Of course, a big elephant in the room
was dealing with those who were misled to continued on page 28
Ray: “Organized medicine poorly repre- unfounded scare tactics and fill their testi-
sents the public sector physician working in mony with outright lies and distortions.
underserved areas. Facing limited resources When it comes to scope of practice, objective
and strapped with huge patient care loads, data and disconfirming evidence be
these colleagues greatly appreciate and sup- damned, resulting in countless thousands
port the other helping professionals who are being denied necessary health care.”
willing to share the load. It is dismaying
that, in contrast, organized medicine is most Aloha,
interested in protecting turf. They use Pat DeLeon

APA Division 29
The Division of Psychotherapy
present the
14th Annual
Rosalee G. Weiss Lecture
for Outstanding Leaders in Psychology
“Racial Microaggressions in Everyday Life:
Impact on Mental Health & Clinical Practice”
Delivered by
Derald Wing Sue, Ph.D.
Chair: Anthony Jackson, Ph.D.
Sunday, August 19, 2007
3:00 p.m. to 3:50 p.m.
Moscone Center • Room 200

Dr. Weiss established the Rosalee G. Weiss Lecture Series in 1994 to honor his
wife, and he ensured its perpetuity with a gift to the Foundation in 1999.
Divisions 29 and 42, upon approval by the APF Board of Trustees, select an annu-
al lecturer to speak at the APA convention. The individual must be an outstand-
ing leader in the arts or sciences whose work has had significant impact on the
discipline of psychology or an outstanding leader in any of the specialty areas
within the sphere of psychology.

About Derald Wing Sue, Ph.D.

Derald Wing Sue, Ph.D., is a pioneer in the field of multi-

cultural psychology. While some scholars were doubtful of
the practicality of multicultural psychology, Wing Sue had
already written and researched in the field extensively,
being one of the frontrunners to uncover the flourishing dis-
cipline. Wing Sue received his doctorate from the University
of Oregon, and is a professor of psychology and education
in the Department of Counseling and Clinical Psychology at
Columbia University. His research challenges monocultural
foundation of psychology. In 1972, he co-founded and
served as the first president of the Asian American Psychological Association. He
has also served as president of the Society for the Psychological Study of Ethnic
Minority Issues and the Society of Counseling Psychology (Division 17 of
American Psychological Association). Wing Sue has worked to set up cultural
diversity training programs for many companies and organizations. Today, two
of Wing Sue’s books have been identified as the most frequently cited works in
multicultural psychology, indeed a testament of his contribution to the field.


Each year, the Student Development Committee of the Division of Psychotherapy

calls for papers for three awards, which are then juried by the members of the
committee. In 2007, the committee received nearly 30 submissions of high caliber
from students across North America. Each winning submission receives a com-
memorative plaque and a cash prize, presented at the annual meeting of the APA
in San Francisco. Psychotherapy Bulletin is pleased to publish the winning paper
from each award category.

Ms. Jesse Metzger, of Columbia University, is the recipient of this year’s Donald
K. Freedheim Student Development Award. The Freedheim Award is conferred
on the author of the best paper written on psychotherapy theory, practice, or
research. This year’s winner, written by Ms. Metzger is titled: Between Patients’
Representations of Therapists and Patients.

Mr. Peter Panthauer, of Adelphi University, is the recipient of this year’s Diversity
Award. The Diversity Award is conferred on the author of the best paper that
address issues of race, gender, and cultural issues in psychotherapy. Mr.
Panthauer’s award-winning paper is titled: Therapy with Lesbian Couples.

Ms. Deleene Menefee, of the University of Houston, is the recipient of this year’s
Mathilda B. Canter Education and Training Award. The Canter award is
conferred on the author of the best paper on education, supervision, or training
of psychotherapists. Ms. Menefee’s paper on Perceptions of Trainee Attachment in
the Supervisory Relationship, was this year’s award winning paper.

Michael S. Garfinkle
Chair, Student Development Committee

The Relationship Between Patients’ Representations
of Therapists and Parents
Jesse A. Metzger, Teachers College, Columbia University

Abstract content)—of patients’ representations is

The purpose of this exploratory research was to the focus of the present research.
examine and compare the formal properties of
psychotherapy patients’ internalized represen- In psychology as well as the arts, the study
tations of their parents and those of their thera- of representation has addressed the dis-
pists. A further comparison was made between tinction between the form of a representa-
representations of parents following recall of a tion and its content. The content is the
pleasant memory of the parent (“good parent” what, the form is the how—the manner,
representations), and representations of parents shape, or defining characteristic by which a
following recall on an unpleasant memory of representation is known. With respect to
the parent (“bad parent” representations). mental representations of internalized
Results indicate that patients represent their objects, Geller, Cooley, and Hartley (1981-
therapists significantly less in the form of 82) have observed that forms of representa-
images and “felt” sensations than either the tions do not merely act “on behalf” of con-
“good” or the “bad parent,” and that their ther- tent, they in fact play a role in shaping con-
apist representations are significantly less vivid tent: “formal processes are implicated in
overall than either parent representation. perceiving an object, in re-representing the
Results further indicated that the more patients object in its physical absence, and in com-
tend to represent their “bad parent” in the form municating the experience from one per-
of images and “felt” sensations, the more they son to another” (p. 130).
tend to represent their therapist in the form of
real or imagined dialogues; by contrast, the Understanding how patients represent sig-
more patients tend to represent their “good par- nificant others in the mind has much clini-
ent” imagistically, the less they tend to repre- cal utility in terms of assessing and facili-
sent their therapist in lexical form. The findings tating the flexibility with which patients
and their implications are discussed. represent these significant others.
Theoretical (Bruner, 1964; Horowitz, 1983)
and empirical work (Geller et al., 1981-82;
The Relationship Between Geller & Farber, 1993; Orlinsky, Geller,
Patients’ Representations of Tarragona, & Farber, 1993; Rosenzweig,
Therapists and Parents Farber, & Geller, 1996) has demonstrated
Patients beginning therapy carry with the existence of three categories of repre-
them the influence of previously internal- sentational form used by individuals when
ized relationships, most saliently, those of calling forth representations of significant
their primary caregivers or parents. From others or events: imagistic, enactive, and
this object relational perspective, therapy lexical (Horowitz). The imagistic mode
can be looked at as a process of under- involves the calling forth of visual, audito-
standing and reworking representations. ry, olfactory, and other perceptual images,
Success of therapy depends on both the and is distinct among the three modes in its
beginning contents and organization of the ‘proximity’ to perception and affect. The
patient’s representational world, and the enactive mode is characterized by the
therapist’s recognition of and sensitivity to experience of “felt” bodily sensations, or
that world. The organization—or form (vs. continued on page 33
the sense of diffuse, emotionally-laden cally represent the nonverbal, perceptual-
atmospheres. The lexical mode—the clear- ly-based aspects of therapy sessions.
est, most logical, and most communicable Patients with high scores on the enactive
of the modes—is characterized by language- factor experience tend to evoke their thera-
based or conceptual thought. pist via “certain characteristic bodily sen-
sations” and are aware of “a particular
In Horowitz’s (1983) view, the flexible emotional atmosphere” that gives them a
interrelatedness of the three modes of rep- sense that their therapist is “with them”;
resentational thought is a sign of psycho- this mode of representation can be distin-
logical health, giving an individual’s expe- guished from that comprised of particular
riences depth and breadth of meaning. images or notional thought. Finally,
However, individuals can sometimes patients with high scores on the lexical fac-
become one-sided, have only one mode tor tend to represent the therapeutic inter-
available, or vacillate in an unintegrated action in terms of real or imagined dia-
way among the modes: “Characterological logues with the therapist.
styles result, in part, from a restrictive
selection of and preferences for certain Research using the TES has shown that
modes of representing experience and the patients typically use all three modalities
use of various strategies to negotiate the to evoke representations of their therapists
relationships among them” (Geller et al., and the therapeutic relationship, but that
1981-82, pp. 130-131). What is happening auditory and visual imagery tend to be the
in such cases, proposes Horowitz, is that most characteristic forms of therapist rep-
repression is occurring at the boundaries resentation (Geller & Farber, 1993; Orlinsky
between these representational systems. A et al., 1993; Wzontek, Geller, & Farber,
goal of psychotherapy is thus to reestablish 1995). Other variables, such as the length of
continuity between ideas and attitudes in time in therapy and whether the subject is
various modes of representation. a current or former patient, have been
studied in connection with the modalities
Patients’ representations of their therapists of therapist representations. Research on
The first known systematic study of the whether length of time in therapy affects
forms of therapist representation was patients’ tendency to represent their thera-
undertaken by Geller et al. (1981-82). Using pist via particular modalities has yielded
as a conceptual starting point Bruner’s mixed results. Two studies investigating
(1964) and Horowitz’s (1972) categories of the hypothesis that patients’ internalized
representational form, the authors devel- representation of their therapists vary with
oped the Therapist Embodiment Scale time in treatment—with patients in early
(TES) as a system for characterizing the phases of treatment having less articulated
forms in which “evocative memories” of and differentiated representations than
significant others enter awareness. A factor those in latter phases—did not confirm this
analysis of the TES in the Geller et al. con- hypothesis (Barchat, 1989; Wzontek et al.,
firmed the presence of the three distinct 1995). However, in an examination of pos-
representational modalities in patients’ sible non-linear trends, Rosenzweig et al.
representations of their therapists: imagis- (1996) found that patients within three
tic, haptic (later renamed “enactive”), and phases of therapy differed significantly in
conversational-conceptual (used inter- the extent to which they employed the
changeably with “lexical”). Each of these imagistic mode of therapist representation.
modalities makes possible a different form Specifically, patients who had been in ther-
of imaginatively reliving the experience of apy between one and three years tended to
being in the physical presence of the thera- use visual imagery in evoking a represen-
pist. Patients with high scores on the imag-
istic factor are especially able to schemati- continued on page 34

tation of their therapist more often than helpful treatment had been thus far was
patients who had been in therapy either positively correlated with the tendency to
less than one year or more than three years. use the imagistic and enactive modes of
representing the therapist. In an examina-
In an examination of whether therapist tion of both current and former psy-
representations depend on termination sta- chotherapy patients, Geller and Farber
tus, Geller and Farber (1993) demonstrated (1993) found that whereas among patients
that current and former patients did not currently in therapy, self-reported
differ significantly in the extent to which improvement was significantly correlated
they employed each of the three factor- with the tendency to represent the thera-
generated modalities to represent their pist in the imagistic mode, among former
therapists. Furthermore, among patients patients, use of the enactive mode was pos-
currently in therapy, the frequency of use itively correlated with outcome. Because
of discrete forms to represent the therapist patients who possess this latter representa-
was unrelated to the number of sessions tional capacity are able to remain “in
attended. These findings are consistent touch” with their therapist’s presence, and
with those of Barchat (1989) and Wzontek to “sense” the emotional atmosphere that
et al. (1995), described above. Among those accompanies feelings of relatedness, the
who have terminated therapy, however, authors concluded that “in more successful
the number of sessions attended was found therapies, the therapist apparently
to be significantly related to preferred becomes ‘a felt part of’ the patient” (p.
mode of representation: the greater the 177). These findings taken together suggest
number of sessions, the less frequent the that the tendency to embody the therapist
use of the imagistic mode of representing imagistically and/or in terms of “felt” sen-
one’s therapist and the more frequent the sations is associated with better outcomes.
use of the lexical mode. These findings
were interpreted to mean that current Parental representations
patients’ modes of constructing representa- Parental representations, in contrast to
tions of the information contained in their therapist representations, have not been
unfolding therapy experiences do not subject to research via different modalities
become progressively more conceptual as defined in the present study. However,
and less sensory in nature during the research has both compared parental and
course of therapy. Once terminated, how- therapist representations in terms of devel-
ever, patients appear to more frequently opmental level, and examined the relation-
invoke the therapist’s voice as a preferred ship of parent and therapist representa-
modality of representation. tional level to outcome. This research can
serve as a broader context in which to
In terms of outcome, in Geller et al.’s (1981- embed the more specific definitions of rep-
82) original study, self-reported improve- resentational “multimodality” utilized in
ment was significantly correlated with the the present study.
use of the imagistic and enactive modes of
representation: the tendency to experience The developmental or conceptual level of
the therapist imagistically or in terms of object representations has been a focus of
“felt” sensations was associated with posi- study in recent years (see Blatt &
tive self-perceived outcomes. Subsequent Auerbach, 2001). Based in developmental
research using the same instrument (the object relations theory, in this line of
Therapist Embodiment Scale, or TES) has research representations are seen as exist-
yielded similar results. For example, ing on a continuum, with low-level repre-
Honig, Farber, and Geller (1997) found sentations being concrete, literal, fixed, and
that, in a community-based sample of cur-
rent patients, patients’ perceptions of how continued on page 35
global, and high-level representations ing can become more differentiated, inte-
being more differentiated, complex, inte- grated and more intersubjectively related
grated, and abstract (Blatt, Wiseman, during clinical treatment. The implications
Prince-Gibson, & Gatt, 1991). Research of these findings include the potential use-
examining the conceptual levels of parent fulness of evaluating the differentiation-
and therapist representations has shown relatedness of patients’ descriptions of self
that there is a significant correlation and significant others in clinical practice.
between the two, particularly when the As Blatt and Auerbach note, “comparison
parent represented is the mother (Bender, of the changes in patients’ representations
Farber, & Geller, 1997; Honig et al., 1997). of parents and therapist suggests the cru-
Honig et al. (1997), for example, found that cial role of the therapist in facilitating clin-
patients who formed more highly integrat- ical change (2001, p. 147).
ed and differentiated representations of
their mothers were more likely to form As mentioned, although the research
highly integrated and differentiated repre- reviewed in this section did not examine the
sentations of their therapists, whereas formal properties of parental and therapist
patients whose maternal representations representations as defined in the present
were more primitive and less differentiated study (i.e., imagistic, enactive, and lexical),
tended to create therapist representations the findings taken together suggest that
that reflected these same qualities. The helping patients to develop more differenti-
finding is consistent with theory and ated and complex representations of objects
research that suggest that an individual’s leads to better outcomes. Whether the flexi-
level of object representation is relatively ble interplay among the three modes of rep-
stable and generalizable (e.g., Bowlby, resentational thought (Horowitz, 1983) rep-
1988). However, Honig et al. also found resents more “differentiated” or “complex”
that the overall level of the maternal object representational thinking is a question that
representation, as well as its level of com- cannot be answered by the present study.
plexity, was significantly higher than over- However, if representational form is consid-
all level of therapist representation. Thus, ered to play a critical role in the shaping of
although patients’ levels of object represen- content, it is reasonable to assume that the
tation were found to be positively correlat- greater the multimodal flexibility, the
ed, the overall mean scores for conceptual greater the complexity and richness of rep-
level of therapist and maternal representa- resentational thought.
tions differed significantly. The authors
attribute this finding to the fact that
“Good parent” vs. “bad parent”
patients had only known their therapists
for a limited time and could not develop
There appear to be at least two potentially
realistically complex, differentiated repre-
clinically relevant reasons for distinguish-
sentations of them.
ing between “good parent” and “bad par-
ent” representations. First, it may be useful
Other research, however, has shown that
to discover whether “good parent” and
therapist representations, as well as parent
“bad parent” representations differ from
representations, become more complex
each other in form. Are “bad parents” more
and differentiated over treatment and that
vividly experienced in the form of images,
this higher developmental level is associat-
whereas “good parents” are more vividly
ed with better clinical outcomes (Blatt &
experienced as “felt” parts of oneself?
Auerbach, 2001; Diamond, Kaslow,
Although the degree to which one experi-
Coonerty, & Blatt, 1990; Stayner, 1994).
ences the “good” or “bad parent” in a par-
These findings support the notion that rep-
ticular modality is likely to depend on that
resentational structures that organize expe-
rience and patterns of interpersonal relat- continued on page 36
individual’s characteristic style (Geller et pist to make inferences about the transfer-
al., 1981-82; Horowitz, 1983), a goal of the ence relationship and to guide the treat-
present research is to determine whether ment accordingly. As McWilliams (2004)
there are general patterns to the ways in has observed, the therapist simultaneously
which patients represent these differing serves both as a new object (who differs
mental constructs. from previous, disappointing objects of
attachment) and as a figure to whom old,
In addition, to separate the “good parent” maladaptive patterns of relating inevitably
and the “bad parent” is to gain a fuller get transferred. Understanding whether
understanding of the nature of the “bad patients tend to transfer their “good par-
parent” representation. Writers working ent” or their “bad parent” onto the thera-
from clinical, case study perspectives (e.g., pist can provide information about which
Loewenstein, 2004), as well as those work- of these functions the therapist primarily
ing from transtheoretical positions (e.g., serves. Although the present study does
Westen, 1991) have likewise observed that not seek to elucidate under what particular
representations of the so-called “bad par- circumstances patients differentially trans-
ent” may become dissociated from fer the “good” or “bad parent” onto the
patients’ awareness, particularly when therapist (and it is assumed that patients
there are severe disturbances in early object do both at different times, or perhaps even
relationships. Thus, by focusing attention simultaneously), it can elucidate whether
explicitly on representations of the “bad there are general patterns to these types of
parent,” information about the representa- transference among patients in therapy.
tion of this particular construct may be
more fully understood. Furthermore, parti- An important methodological question
tioning out the ‘purely’ “bad parent”— relates to how or under what circumstances
clarifying the ways in which he or she is we can expect patients to call forth represen-
represented—may be beneficial in under- tations of their “good” and “bad parents.” In
standing particular biases or restrictions therapy with adults, discussions of parents
the patient may have in terms of moving typically revolve around significant memo-
flexibly among modes of thought. For ries, often those occurring early in life. There
example, when it comes to imagining the is some evidence to suggest that certain
“bad parent,” do patients typically revert kinds of memories reflect core object rela-
to the enactive mode of representation? tional themes, thus achieving some degree
(That is, do “bad parents” evoke more of isomorphism with representations as
unformulated, “felt” sensations than do defined throughout this paper.
“good parents”? ) If so, this may be a signal
that unformulated experiences of “bad- Broadly speaking, autobiographical mem-
ness” need to be translated into the more ories are the most likely to evoke object
accessible imagistic or lexical forms. representations. Pillemer’s (1998) distinc-
tion between the imagistic (sensory, per-
A second reason for teasing apart the ceptual, affective, and automatic) level and
“good parent” from the “bad parent” is the verbal (language-based and purpose-
that comparing each of these separately to ful) level of autobiographical memories—
the therapist representation offers an in its striking resemblance to Horowitz’s
opportunity to see which of the parental (1983) distinction between imagistic
representations the therapist representa- (and/or enactive) and lexical modes of rep-
tion more closely resembles. Are therapists resentation—lends support to the use of
coming to resemble the “good parent” or autobiographical memories as a stimulus
the “bad parent” in how they are repre- for parental representations. Within the
sented in the mind of the patient? This
kind of discovery could enable the thera- continued on page 37
class of autobiographical memories, fur- tions and therapist representations? Put
ther subtypes can be delineated that bear differently, are there ‘preferred’ modes of
directly on the evocation of object repre- representational thought and/or degrees
sentations. Singer and colleagues, for of vividness depending on whether the
example, have demonstrated that “self- patient calls to mind their therapist, their
defining” memories (vivid memories that “good parent,” or their “bad parent”? 2)
reflect enduring concerns or unresolved What are the relationships among the dif-
conflicts of the personality) are linked to ferent forms of representation used for the
critical relationship themes that are different target figures? 3) Are there differ-
expressed in both patients’ intimate rela- ences in form between representations of
tionships and the transference dynamics of the “good parent” and representations of
the therapy (Singer & Blagov, 2004; Singer the “bad parent”?
& Singer, 1994). Finally, early memories
may be particularly evocative of represen- Method
tations. In a discussion of Martin Participants
Mayman’s early memories technique, by The sample consisted of a total of 20 psy-
which patients produce memories about chotherapy patients, drawn from two dif-
their early experiences and relationships ferent sources. One group of subjects was
with caregivers, Fowler, Hilsenroth, and drawn from a subject pool utilized by
Handler (2000) note that one of the benefits Farber, Geller, and Rohde (1995).
of early memories is their ability to “sum- Specifically, this group consisted of 12 indi-
marize the patient’s subjectively experi- viduals who were currently in therapy at
enced history, allowing the therapist to the time of that study. These subjects were
comprehend the patient’s view of self, recruited by Farber et al. from a university-
other, and their world view” (p. 30). based training clinic in a large urban com-
munity. The sample consisted of 9 women
In summary, given the evidence that self- and 3 men who volunteered to participate
defining, autobiographical, and early in a research project on the process of psy-
memories are vivid, personally meaning- chotherapy. The age range of these subjects
ful, and isomorphic with the representa- was between 24 and 45.
tions they are intended to evoke, it can be
reasonably assumed that guiding patients For the purposes of the current study, a sec-
to produce these types of memory—either ond group of subjects was recruited from the
pleasant or unpleasant—about their rela- same university-based clinic (in the academ-
tionship with a parent will produce mean- ic year of 2005-2006) in order to increase the
ingful representations of the “good” and sample size. This group consisted of eight
“bad parent.” individuals (seven women, one man), all
currently in therapy at the clinic, who volun-
Research Questions teered to participate in a research project on
To date, no study has examined the formal “patient views of psychotherapy.” Their
(i.e., imagistic, enactive, and lexical) prop- ages ranged from 23 to 58.
erties of parent representations, nor has
there been any explicit comparison of the The combined sample thus included a total
formal properties of parent and therapist of 16 women and 4 men with a mean age of
representations. Given the lack of data to 30. Sixteen of the subjects were White,
support any specific hypotheses, the ques- three were Black, and one designated
tions posed in the present study are con- “other” as his or her ethnic category. In
sidered exploratory in nature. Specifically, terms of education level, five of the sub-
these questions are: 1) Are there differences jects had attended some college, four had
in form and/or overall vividness between
“good parent”/“bad parent” representa- continued on page 38
completed college, eight had attended Embodiment Scale-Pleasant [PES-p] and
some graduate school, and three had com- the Parent Embodiment Scale-Unpleasant
pleted a masters degree. In terms of marital [PES-u]).
status, ten were single, five were in rela-
tionships, and five were married. The sub- Whereas the first group of subjects com-
jects had been in therapy an average of 14 pleted a number of other measures in addi-
months, with a range from 1 month to 91 tion to the demographic face sheet, TRI-II,
months (7.5 years). Frequency of sessions and PRI, the second group completed only
ranged from once to twice weekly; the these measures. Only participants in the
mean number of sessions was 98.7. second group received a nominal compen-
sation for their participation.
Instruments and Procedure
Subjects were given a packet of materials to The Therapist Embodiment Scale (TES). The
complete and return to a box located in the TES is a method for assessing the formal
clinic. Included in this packet were an properties of patients’ internal representa-
informed consent form, a face sheet tions (as distinct from their particular the-
requesting demographic information, the matic contents). It asks patients to rate the
Therapist Representation Inventory, relative contribution of words, pictures,
revised version (TRI-II; Geller, Behrends, sounds, bodily sensations, and so forth to
Hartley, Farber, & Rohde, 1992), and the their conscious experiences of the therapist
Parent Representation Inventory (PRI; outside therapy. The TES is a 12-item, nine-
Smirnoff, 1986). Information about the the- point, Likert-type rating scale wherein
oretical underpinnings, development, and patients are asked to determine the extent
psychometric properties of the TRI can be to which (1 = not at all typical; 3 = slightly
found in Geller et al. (1981-1982). typical; 5 = moderately typical; 7 = quite
Information about the PRI can be found in typical; 9 = highly typical) each item typi-
Smirnoff (1986). fies the means by which they evoke images
of their therapist. A factor analysis (princi-
The face sheet requested the subject’s gen- pal axes with varimax rotations) per-
der, age, educational level, ethnicity, and formed by Geller et al. (1981-1982) generat-
marital status. In addition, subjects were ed a three-factor solution to the TES, with
asked to report for how long their current each factor seen as representing a distinct
(and any past) psychotherapy had contin- form of representation (cf. Horowitz, 1983).
ued, and the number of times per week In the present study, one item from the 12-
attended. item scale was removed prior to data
analyses, since that item had failed to load
The TRI-II (Geller et al., 1992) has five onto any factor in Geller et al.’s original
parts, is self-administered, and is designed analysis. However, the one item that was
to measure the content, form, function, and shown by Geller et al. to load onto two fac-
other phenomenological properties of tors was retained, given the exploratory
patients’ internal representations of their nature of the present study and the fact
therapists. The PRI has two parts, is self- that overlap between the two factors was
administered, and is designed to measure statistically controlled in the data analyses.
the form and other phenomenological
properties of patients’ internal representa- The first factor (Imagistic) contains five
tions of their parents following the recall of items that assess the extent to which
both a pleasant and an unpleasant early patients’ use perceptual (visual, auditory)
memory. Included in the present study is imagery in imagining the therapist in his or
an analysis of one subscale of the TRI (the her absence (e.g., “I picture a specific
Therapist Embodiment Scale [TES]), and
both subscales of the PRI (the Parent continued on page 39
expression on my therapist’s face”; “I imag- Results
ine a particular quality to the sound of my Overall Scale and Factor Reliability
therapist’s voice”). Patients with high scores Given that one of the goals of this research
on this factor are especially able to schemat- was to understand how the “good parent”
ically represent the nonverbal aspects of and the “bad parent” are represented in the
therapy sessions. The second factor minds of patients (since the TES has never
(Enactive) contains three items and reflects been used for anyone other than thera-
experiences that are kinesthetically or pro- pists), the factor structures of the TES, PES-
prioceptively felt rather than cognitively p, and PES-u were examined. As can be
experienced (e.g., “I experience myself in seen in Table 1, moderate reliability was
certain bodily sensations”; “I am aware of a obtained for the overall scales and most of
particular emotional atmosphere which the scale factors. The average reliability for
gives me the sense that my therapist is ‘with the Imagistic factor across all three scales is
me’”). The third factor (Conversational- .63; the average reliabilities for the Enactive
Conceptual) contains three items and and Conversational-Conceptual factors are
reflects the degree to which the therapist .47 and .49, respectively. The moderate reli-
representation takes the form of abstract ability of the both the scales overall and the
ideas or concepts that comprise the lan- factors supports their use in the data analy-
guage of the therapeutic interaction (e.g., “I ses that follow.
think of specific comments my therapist has
made to me”). In addition to assessing the Descriptive Data and Comparisons Among
formal properties of representations (per the Overall Scale and Factor Means
factors), the TES also provides a measure of As an initial step in the data analysis, the
the overall vividness of the representation’s overall and factor means on the TES, PES-
manifest configuration (per the overall p, and PES-u were computed. As can be
score) (Geller et al., 1981-1982). seen in Table 2, based on the nine-point rat-
ing scale, the means for the Imagistic and
The Parent Embodiment Scale-Pleasant (PES- Conversational-Conceptual scores on the
TES fell between designations for “slightly
p) and Unpleasant (PES-u). The PES-p and
typical” and “moderately typical,” and the
PES-u are companion pieces to the TES;
mean for the Enactive scores on the TES fell
they are identical to the TES, but differ in
between “not at all typical” and “slightly
that they are administered following the
typical.” The means for all three factor
subject’s recall of either a pleasant memory
scores on both the PES-p and the PES-u all
of their relationship with a parent, or an
fell around “moderately typical.” The
unpleasant memory of their relationship
overall mean for the TES fell around
with a parent (“Please reflect on a specific
“slightly typical,” whereas the overall
pleasant/unpleasant memory of your rela-
means for the PES-p and PES-u fell around
tionship with either your mother or your “moderately typical” on the nine point
father from your early childhood. Imagine scale. Examination of the average item
and relive this incident in as much detail as factor means (adjusted means) indicates
possible: Try to remember thoughts, feel- that whereas for the PES-p and PES-u, the
ings, and sensations”). The items of the Imagistic factor has the highest mean
PES-p and PES-u are identical to those of of the three factors, for the TES, the
the TES, except that the words “my thera- Conversational-Conceptual factor has the
pist” are replaced with “him or her” (refer- highest mean.
ring to the parent being imagined). Like
the TES, the PES-p and the PES-u assess In order to determine if there were
both the formal properties and overall detectable patterns of patients’ tendency to
vividness of patients’ internal representa- represent their therapist, their “good par-
tions of their parents.
continued on page 40
ent,” and their “bad parent” in particular Overall Vividness of Representations
forms, a repeated measures test was con- To determine whether the overall vivid-
ducted. As indicated in Table 2, the extent to ness of either parental representation
which patients’ representations were imagis- (“good” or “bad”) predicted the overall
tic in nature differed significantly depending vividness of the therapist representation, a
on the target figure. Specifically, patients regression analysis was performed. As can
tended to represent their therapist less imag- be seen in Table 4, the results indicate that
istically than either parent, and to represent the vividness of both parental representa-
their “good parent” less imagistically than tions significantly predicted the vividness
their “bad parent.” The extent to which of therapist representations, but in oppo-
patients’ representations were enactive in site directions. The more vivid the “bad
nature also differed significantly depending parent” representation, the more vivid the
on the target figure, with patients tending to therapist representation (b = .748, p = .014),
experience their therapists less as a “felt” whereas the more vivid the “good parent”
part of themselves than either their “good” representation, the less vivid the therapist
or “bad parent.” There were no significant representation (b = -.792, p = .010).
differences in the extent to which patients
tended to represent their therapists, “good,” Descriptive Data: Individual Items
and “bad parents” in conversational-concep- An examination of the mean scores on the
tual form. In terms of the overall vividness items comprising the TES, PES-p, and PES-
of representation, patients’ representations u (see Table 5) indicates that patients typi-
of their therapists were significantly less cally use all three modalities (Imagistic,
vivid than their representations of either the Enactive, and Conversational-Conceptual)
“good” or the “bad parent.” to evoke representations of their therapists
and their parents following recall of both a
Relationship Among Factors pleasant and unpleasant memory. As indi-
In order to determine whether there were cated in Table 5, the items with the highest
predictive relationships among the factors of mean scores on the TES were “I think of
the three scales, a multivariate analysis of specific comments my therapist has made
variance was conducted. As can be seen in to me” (M = 5.05) and “My image of my
Table 3, the results indicate that higher PES- therapist is not tied to a specific time or
u Imagistic scores significantly predicted place (M = 4.30). The items with the high-
higher TES Conversational-Conceptual est mean scores on the PES-p were “I imag-
scores (l = .372, p = .016; b = .648, p = .005), ine [my parent] in a particular place” (M =
and that higher PES-u Enactive scores pre- 6.70) and “I picture a specific expression on
dicted higher TES Conversational- [my parent’s] face” (M = 5.70). The items
Conceptual scores (l = .451, p = .040; b = .527, with the highest mean scores on the PES-u
p = .016). That is, the more patients tended to were “I imagine a particular quality to the
represent their “bad parent” imagistically sound of [my parent’s] voice” (M = 6.85), “I
and/or enactively, the more they tended to imagine [my parent] in a particular place”
represent their therapist in conversational- (M = 6.65), and “I picture a specific expres-
conceptual terms. A marginally significant sion on [my parent’s] face” (M = 6.65).
finding was that higher PES-p Imagistic
scores predicted lower TES Conversational- Discussion
Conceptual scores (l = .483, p = .055; b = - Returning to the first research question,
.658, p = .011). In other words, the more which asked whether there are differences
patients tended to represent their “good par- in form and/or vividness between “good
ent” imagistically, the less they tended to parent”/“bad parent” representations and
represent their therapist in conversational- therapist representations, the findings sug-
conceptual terms. No other significant rela-
tionships among the factors were found. continued on page 41
gest that indeed, there are such differences. tion than the “good parent” representation.
One, patients tend to think of their parents The more vividly the “bad parent” is expe-
significantly more in the form of images rienced, the more the work of therapy is
and “felt” sensations than they do their catalyzed. An intense negative representa-
therapist, and two, patients’ representa- tion of a parent translates to a more intense
tions of both the “good” and “bad parent” representation of the therapist (positive or
were significantly more vivid overall than negative, or a mixture), whereas an intense
therapist representations. Furthermore, positive representation of a parent does not
with respect to the question of the relation- translate to an intense representation of the
ships among the different forms of repre- therapist; in fact, it appears to dilute it, or
sentation used for the different target fig- make it less intense. Perhaps having partic-
ures, the results yielded a third finding that ularly intense images of the “bad parent”
the more patients tend to represent their leads the patient to characteristically cope
“bad parent” in the form of images or with new figures or situations by being
“felt” sensations, the more they tend to vigilant (i.e., using all their sensory chan-
represent their therapist in the form of real nels to obtain information). The more vivid
or imagined dialogues. Finally, with the “badness” of the parent, then, the more
respect to the question of whether there are vigilant the patient must be in order to
differences in form between representa- cope with the expectation of more “bad-
tions of the “good parent” and representa- ness” from other figures (e.g., the thera-
tions of the “bad parent,” it was found that pist). Their senses are operative in order to
patients tend to think of their “bad parent” cope with expected “badness.” This phe-
significantly more in the form of images nomenon may simply not occur in the
than they do their “good parent.” presence of vivid feelings of “goodness.”

The first finding—that therapists, as com- The somewhat more subtle third finding—
pared to parents, tend to be represented less that the more patients tend to represent
in the form of images and “felt sensations,” their “bad parent” in the form of images or
but not less in the form of dialogues—seems “felt” sensations, the more they tend to
to make intuitive sense, given that the pri- represent their therapist in the form of real
mary activity of therapy is talking. or imagined dialogues—seems to suggest
Furthermore, Honig et al.’s (1997) reason- that there is something about the (affec-
ing—that patients, who have known their tively-charged) images and (relatively
therapists for considerably less time than unformulated) enactive modes that are
their parents, cannot develop as realistically translating to the therapeutic dialogue.
complex, differentiated representations of Again, this supposition is fairly intuitive,
their therapists—may also be applicable given that the reason for going to therapy
here: given that the therapist is a relatively is to work out, through talking, the “bad”
new figure in the patient’s life, their repre- stuff from one’s relationship with one’s
sentation in the patient’s mind is indeed parent, not the “good” stuff. That a high
likely to be less vivid in terms of images, felt degree of imagistically and experientially-
sensations, and overall. felt “badness” corresponds with greater
lexical involvement with the therapist may
One way to understand the second find- simply suggest that the patient really is
ing—that the more vivid the “bad parent” using the lexical mode to work though
representation, the more vivid the thera- theretofore unformulated “badness.”
pist representation, but the more vivid the
“good parent” representation, the less However, such use of therapy may also be
vivid the therapist representation—is that defensive in nature, or may not allow the
the therapist representation is more iso- patient to make full use of the therapist
morphic with the “bad parent” representa- continued on page 42
either as a transferential figure or as a facili- The final finding, that patients tend to
tator of multi-modal experience (Horowitz, think of their “bad parent” significantly
1983). The question is: are the strongly-expe- more in the form of images than they do
rienced images and felt sensations being too their “good parent,” may in fact be the
much translated into words in therapy? (i.e., most interesting aspect of this study. It is,
is there “an avoidance of image associations in a sense, the ‘purest’ finding, in that a
to contents expressed in words,” or “an inat- comparison is drawn between split repre-
tention to dim or fleeting image episodes” sentations of the same person. If the ther-
[p. 289], as Horowitz noted)? Is defensive apist understands how (especially nega-
intellectualization, in which ideas emerge tive) representations are being experi-
without continuity with other ideas and feel- enced by the patient, he or she might seek
ings, taking place? If so, we as clinicians to make interventions commensurate with
might want to be attentive to the ways in the representational properties that com-
which vivid (affectively-charged) imagery prise them. For example, if we know that
or diffuse bodily sensations associated with the “bad parent” is experienced most
the “bad parent” may be getting dissociated vividly in terms of the quality of his or her
somehow, substituted with language in the voice, we might ask the patient, “What
therapeutic dialogue. If the therapist or the did he or she sound like?” in order to
therapeutic situation is represented only or evoke the representation and its attendant
primarily in lexical terms (and not imagisti- emotions most fully. Such data adds to
cally or as a “felt” part of the patient), we our body of knowledge about the ways in
might worry that the therapist as a “healing which individuals represent significant
figure” or “good object” is not being fully others in the mind; they suggest that dif-
internalized (that is, the therapist is only ferently valenced representations may be
being internalized in one particular form). encoded differently, which can enable the
therapist to understand how to work dif-
ferentially with them in therapy.
When we think of “working through” the
patient’s problems “in the transference,” are One limitation of the present study is the
we not assuming that the patient is fully small sample size, which limits the gener-
reexperiencing the parent in the therapist? alizability of the findings. In addition, the
The findings of this study suggest that splitting of parent representations into
patients may not be experiencing their ther- “good” and “bad,” but not splitting thera-
apist as fully as they do either their “good” pist representations in a likewise fashion,
or their “bad parent”—they are only per- may present various conceptual problems.
haps reexperiencing the therapist on one Still, given that the aim of this exploratory
level, the lexical one. Their thoughts and research was to begin to elucidate the rela-
feelings about their therapist may be more tionship between therapist and parent rep-
formulated and coherent (lexical), but the resentations, and to apply the TES to par-
less formulated aspects (images, felt experi- ent representations, the results suggest that
ences) of the transference may not be taking further investigations in this area are not
hold in the therapy. If indeed one of our only warranted but potentially of great
goals as clinicians is to help patients “work clinical utility.
through” relational problems through the
transference, we may need to think about References
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Table 1
Reliability Coefficients of Scale Overall and Factor Scores; Averaged Factor Reliabilities
TES PES-p PES-u Average
Imagistic (F1) .54 .66 .68 .63
Enactive (F2) .10 .68 .64 .47
Conversational-Conceptual (F3) .42 .61 .44 .49
Overall .55 .65 .55 -

Table 2
Means and Standard Deviations of Factor and Overall Scores: Differences Between the TES,
PES-p, and PES-u
Factor and Overall M SD Adj. M M SD Adj. M M SD Adj. M F
Imagistic (F1) 19.10a 7.9 (3.82) 25.95b 9.1 (5.19) 28.90 8.8 (5.78) 6.846*
Enactive (F2) 6.45a 3.5 (2.15) 14.15 6.6 (4.72) 13.55 7.0 (4.52) 13.236**
Conv-Conc (F3) 16.90 6.7 (4.23) 16.45 7.7 (4.11) 18.70 6.8 (4.68) .666
Overall 38.35a 11.8 (3.49) 51.05 14.5 (4.64) 54.30 13.3 (4.94) 10.978**

Notes. The TES, PES-p, and PES-u scales were scored on a 9-point basis (1 = not at all typical; 9 = highly
typical); adjusted means reflect average item means. N = 20 in all cases except PES-p Imagistic (F1) and PES-p
Overall (N = 19).
Significantly different than PES-p and PES-u (p < .05). b Significantly different than PES-u (p < .05).
* p < .01. ** p < .001.

Table 3
Multivariate Analysis of Variance
TES Imagistic (F1) TES Enactive (F2) TES Conv-Conc (F3)
β β β
PES-p Imagistic (F1) -.208 -.071 -.658a
PES-p Enactive (F2) -.046 -.197 -.029
PES-p Conv-Conc (F3) -.140 -.021 -.114
PES-u Imagistic (F1) -.050 .017 .648**
PES-u Enactive (F2) .392 .304 .527*
PES-u Conv-Conc (F3) .118 .045 .129
Note. Wilks’ Lambda (λ) for PES-u Imagistic (F1) = .372, p = .016; for PES-u Enactive (F2) =
.451, p = .040; for PES-p Imagistic (F1) = .483, p = .055.
approaching significance
* p < .05. ** p < .01. continued on page 45
Table 4
Regression Analysis for Variables Predicting Vividness of Therapist Representations
Vividness of Therapist Representation
B SE B β
Vividness of Pleasant Parent Representation -.648 .223 -.792*
Vividness of Unpleasant Parent Representation .654 .238 .748*
Note. R2 = .37 (p = .02).
* p = .01

Table 5
TES, PES-p, PES-u Item Endorsement Comparison
Factor 1: Imagistic Mode
1. I imagine my therapist (parent) in his/her office
(a particular place) 4.25 3.09 6.70 a 2.85 6.65 b 2.74
2. I picture a specific expression on my therapist’s
(parent’s) face 4.25 2.63 5.70 b 2.52 6.65 b 2.60
3. I see my therapist (parent) gesturing 2.50 2.06 3.95 2.76 5.85 2.83
5. I imagine my therapist (parent) dressed in a certain way 4.00 2.36 4.40 2.78 2.90 2.67
6. I imagine a particular quality to the sound of
my therapist’s (parent’s) voice 4.10 2.99 5.20 2.93 6.85 a 2.43
Factor 2: Enactive Mode
8. I experience myself in certain bodily sensations 2.10 2.00 4.00 2.79 5.75 2.84
10. I imagine myself in physical contact with my
therapist (parent) 1.40 .99 4.95 3.05 3.75 3.04
11. I am aware of a particular emotional atmosphere which
gives me the sense that my therapist (parent) is “with me” 2.95 2.50 5.20 2.53 4.05 3.32
Factor 3: Conversational-Conceptual Mode
4. I imagine just my therapist’s (parent’s) head and face 3.45 2.50 3.85 2.81 3.60 3.08
6. I imagine a particular quality to the sound of my
therapist’s (parent’s) voice 4.10 2.99 5.20 2.93 6.85 a 2.43
7. I think of specific comments my therapist (parent)
has made to me 5.05 a 2.39 4.05 2.76 4.95 2.78
9. My image of my therapist (parent) is not tied to a
specific time or place 4.30 b 3.18 3.35 2.78 3.30 2.77
Indicates highest-rated item on scale. b Indicates second-highest-rated item on scale.


Distinguished Psychologist Award for Contributions to Psychology and

Psychotherapy: The Distinguished Psychologist Award is based on significance
of contributions to the practice, research, and/or training in psychotherapy. The
2007 award is made to Gary R VandenBos, Ph.D. and Carol D Goodheart, Ph.D.

American Psychological Foundation Division of Psychotherapy Early Career

Award is awarded for the first time in 2007, to Michael J. Constantino, Ph.D.

Please join us in celebrating our award winners at the Division 29 Award and
Recognition Hour, Friday, August 17th at 5:00 pm, San Francisco Marriott Hotel,
Golden Gate Salons B1 and B2, to be followed immediately by the Division 29
Social Hour.



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