New Jersey History (NJH - E-Journal)
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Telemental Health During a Global Pandemic: Clinical Lessons from Guided Self-Help, Telephone Therapy Case Studies
No full textI am a fourth year clinical psychology doctoral student at the Graduate School of Applied and Professional Psychology (GSAPP) at Rutgers University. I have devoted much of my graduate training to exploring effective tools for the dissemination and implementation of mental health services, with telehealth chief among them. However, until the COVID-19 pandemic hit, I had had no personal experience delivering psychotherapy treatment via virtual platforms. Reviewing Dr. Logan Durland’s (2020) lessons from treating Parkinson’s disease patients via telephone therapy has served as an excellent guide for navigating treatment, both during the pandemic and in the future
Wanting Too Much and Too Soon – The Therapist´s Clinical Perspective
No full textThis article is a response to commentaries by Kristin Osborn (2020) and Bjorn Philips (2020) on three case studies I conducted (Frankl, Wennberg, Berggraf & Philips, 2020), which involved the use of a 10-session Affect Phobia Therapy (APT) with individuals diagnosed with mild to moderate Alcohol Use Disorder (AUD). The response focuses on four main areas: (a) the tension between the need for systematic assessment and core conflict formulation in each case versus the need for efficiency and accessibility in the design of a "first-line," 10-session version of APT, which is typically much longer in length; (b) specific considerations in applying APT to AUD; (c) research design considerations associated with the three case studies; and (d) my personal experience as the therapist in conducting the 10-session APT with these three AUD cases. I conclude with a proposal for incorporating the critical points from the commentaries into future studies.
Telephone-Based, Clinician-Guided Self-Help Cognitive Behavioral Therapy for Depression in Parkinson's Disease (dPD): The Responder Cases of "Alice" and "Carl," and the Nonresponder Cases of "Ethan" and "Gary"
No full textRoseanne Dobkin and her colleagues (e.g., Dobkin, Interian, Durland, Gara, & Menza, 2018) have developed a 10-session, individual cognitive-behavioral treatment (CBT) program for treating depression in individuals with Parkinson’s disease (dPD). The program has been found to yield statistically and clinically significant success in both uncontrolled group trial designs and randomized clinical trials—originally in a face-to-face version, and then in a telehealth version, using telephone therapy sessions and guided self-help materials for patients. This latter version is herein called "Teleheath Guided Self-Help for dPD," or "TH-GSH-dPD," for short. Applying Fishman, Messer, Edwards, and Dattilio’s (2017) "case studies within psychotherapy trials" methodological model, the present research was designed to complement the group research findings by my conducting systematic, pragmatic case studies (Fishman, 2013) with four patients representative of those in the telehealth studies, given the names of "Alice" (and her caregiver husband "Bob"); "Carl" (and his caregiver wife "Doris"); "Ethan" (and his caregiver wife, "Fay"); and "Gary" (and his caregiver mother, not named). Specifically, Alice and Carl were representative of those patients in the group studies with positive, responsive outcomes; and Ethan and Gary were representative of those patients in the group studies with negative, nonresponsive outcomes. Each case combines (a) quantitative data, comprised of demographic information, psychiatric diagnostic data, neurocognitive data, caregiver distress, and treatment outcome measures; and (b) qualitative data, consisting of recordings of the telephone therapy sessions, my treatment notes, my observations as the therapist, and systematic, post-treatment "Exit Interviews" I conducted with each of the patients and their caregivers about their therapy experience. Each of the four case studies aims (a) to provide a detailed, thickly described portrait of the TH-GSH-dPD treatment process; and (b) to explore the presence and influence of barriers and facilitators of treatment in an idiographic context. Regarding point (b), the following variables that cut across the case studies are explored as appearing to be particularly impactful: patients’ worldviews, patients’ cognitive functioning, caregiver involvement, and homework adherence
A Bridge Over Troubled Water: Commentary on Paul Blimling’s Case of "James" Integrating Music Listening into AEDP
No full textThe integration of music listening into Accelerated Experiential Dynamic Psychotherapy (AEDP) is explored through discussion of Dr. Paul Blimling’s (2019) composite case study, "James." AEDP is a healing-oriented, non-pathologizing, experiential therapy model in which the therapist actively seeks to harness glimmers of resilience from the outset of treatment, and to co-engender safety within the therapy relationship in order to unleash the transforming power of attachment and emotion (Fosha, 2000, 2003, 2009, 2018). Blimling’s incorporation of music listening into the treatment of a highly defended, initially hostile patient helped bypass defenses, foster attachment within the therapy relationship, and access and co-regulate the patient’s affective experience. Key AEDP change mechanisms in the treatment included: undoing aloneness; affirmative work with defenses; dyadic affect regulation; emotion processing; and (to a lesser extent), metatherapeutic processing (metaprocessing for short). The latter is a unique and important contribution of AEDP to our field. Since the publication of Fosha’s The Transforming Power of Affect (2000), AEDP itself has evolved from an attachment- and emotion-focused model to also focus increasingly and explicitly on transformational experience as an agent of change. The experience of positive change itself is now seen as an equally important AEDP change mechanism, alongside attachment and emotion processing. Metatherapeutic processing of patients’ experiences of positive change, which involves a recursive alternation between exploration of new experience and reflection on that experience, frequently results in an expansive spiral of the transformational processes and affects identified by Fosha (2009, 2018). In addition to affirming Blimling’s choice of AEDP and his sensitive and skillful integration of music listening into the treatment, I envision how the transformational process described in the case study might have been further expanded, deepened, and consolidated, had the therapist more assiduously and experientially explored the patient’s experiences of positive change
Facing the Music: Further Thoughts on Integrating Music into Psychotherapy
No full textIn this article, I respond to the insightful commentaries by Karen Riggs Skean (2019), by Richard Harrison (2019), and by Ben Adams (2019) on my hybrid case study of "James," a survivor of chronic relational trauma (Blimling, 2019). These commentaries have stimulated me to think further about the impact of music on my individual psychotherapy work, both with James and with subsequent clients, and specifically with regard to its impact on my approach to group psychotherapy work. In addition, these commentaries have raised particular issues that I respond to, including, (a) constructive criticism by Skean and Harrison regarding the potential further use of "metaprocessing" and the developments made in Accelerated Experiential Dynamic Psychotherapy (AEDP) since I completed the Case of James; (b) Skean’s perceptive point explaining how an individual therapist can take a personal passion—like music or literary writing or bicultural identity—and use it to enhance his or her enlivened presence in therapy with a client; and (c) Adams’ thesis that music and psychotherapy both have their origins in the shamanistic practices of our hunter-gatherer ancestors, suggesting that the combination of psychotherapy and music is a kind of return to our very roots
Forests and Trees: Commentary on the Case of "Daniel"
No full textThe Case of "Daniel" (Tice, 2019) provides an in-depth look at the implementation of an empirically supported psychotherapy, Exposure and Response Prevention (E/RP), in the treatment of a boy with a severe and complex symptom presentation. The discussion begins with explication of guiding theory pertaining both to the disorders that were targeted, Obsessive-Compulsive Disorder (OCD) and generalized anxiety disorder (GAD), as well as their cognitive-behavioral treatment. The assessment and hierarchy-development aspects of the case are presented, and treatment targets identified. Implementation of E/RP followed a specific treatment manual, but the discussion of case material goes beyond the manual in addressing the interpersonal context of therapy, challenges met and overcome along the way, and the importance of using positive reinforcement for effort in keeping a child moving successfully towards more and more challenging tasks. The role of the therapist’s own interpersonal style is also addressed in how this factor may facilitate and complicate treatment delivery, and therapists are encouraged to examine how this may affect what they do and do not do even in the context of protocol-driven treatment
When Psychological Comorbidities Demand Flexibility: Treatment Adaptations for Youth Anxiety Disorders
No full textThe first author (LEP) is a third year clinical psychology doctoral student at the Graduate School of Applied and Professional Psychology (GSAPP) at Rutgers University, working under the supervision of the second author (AQ) at GSAPP’s Anxiety Disorders Clinic, which the second author directs. As a fellow student clinician, the first author had a particular appreciation for Dr. Alexander Tice’s treatment of "Daniel" (2019), a client with a complex clinical presentation who appears to have greatly benefited from his treatment with Tice, under the supervision of Dr. Martin Franklin. Much of Tice’s experience applying theoretical principles to treating specific disorders, as well as finding a delicate balance between manual-based treatment and real-world clinical application of those manuals, reflects the experiences of the first author (LEP) as a cognitive-behavioral therapist working at a graduate student training clinic
In the Shadows: On Meta-Awareness and Spiraling Effects in Psychotherapy—Comment on Nicole Vigoda Gonzalez and Diana Fosha
No full textI want to commend Nicole Vigoda Gonzalez (2018) for her sensitive, sophisticated, and successful treatment in the case of Rosa; and I want to commend Diana Fosha (2018) for the development of her phenomenologically sophisticated and effective Accelerated Experiential Dynamic Psychotherapy (AEDP) model, which Vigoda Gonzalez used. In this commentary I focus on a contrast between two different perspectives in Fosha’s model, and implications for the case of Rosa. This contrast includes: (a) AEDP’s focus on descriptive phenomenology, emphasizing the richness of each client’s moment-to-moment, subjective experience, versus (b) Fosha’s seemingly unqualified advocacy, in the Second Avatar version of AEDP, of the therapist explicitly encouraging meta-processing—that is, explicit self-awareness—as a final step of therapeutic healing. In my commentary I suggest that there seem to be certain limiting conditions for such advocacy. Specifically, I discuss how the clinical research literature argues that while meta-processing may be very helpful for some clients, for others—e.g., those employing the distancing defenses of derealization and depersonalization—meta-processing can be psychologically counterproductive. I conclude by re-emphasizing the importance of retaining a descriptive phenomenological perspective in AEDP
Adapting an Exposure and Response Prevention Manual To Treat Youth Obsessive-Compulsive Disorder and Comorbid Anxiety Disorder: The Case of "Daniel"
No full textExposure and Response Prevention (E/RP) is an evidenced-based, short-term (12-20 sessions) treatment for Obsessive-Compulsive Disorder (OCD). This treatment has been shown to be effective in randomized control trials (RCTs), including pediatric samples (Franklin et al., 2011). Despite the strong evidence supporting the effectiveness of E/RP, the current E/RP literature remains wanting in terms of clinical process research to support novice clinicians in the adaptation of the principles, techniques, and interventions with such a complex and heterogeneous disorder, as well as with youth suffering from comorbid disorders. Thus, the present study aims to provide a detailed account of the course of a 25-session E/RP treatment and its outcomes with a 14-year-old called by the pseudonym "Daniel," to protect his identity. Guided by the Pragmatic Case Study Method (Fishman, 1999, 2005, 2013), as the therapist I examined this case in systematic qualitative detail and also gathered and analyzed data from standardized quantitative assessment measures. The study concludes with an analysis of the process used in meeting Daniel’s positive treatment goals as well as a discussion of the importance of adaptations made to the E/RP manualized protocol to address the entire range of Daniels’s symptoms
In the Light: On Meta-Experience and Spiraling Effects in Psychotherapy—Commentary on Louis Sass’s Commentary on Diana Fosha’s Commentary on Nicole Vigoda Gonzalez’s Case of "Rosa"
No full textIn the previous issue of this journal, I commented (Fosha, 2018) on the psychotherapy case study of "Rosa," written by Nicole Vigoda Gonzalez (2018). To address Rosa’s relational trauma and major depression, Vigoda Gonzalez effectively put into clinical action the psychotherapy model I developed, called Accelerated Experiential Dynamic Psychotherapy (AEDP). In my commentary, I discussed how AEDP’s four-state transformational phenomenology can be used to guide the therapist’s choice of interventions. I also showed how the moment-to-moment tracking of the vitality affects accompanying affective experiences is crucial to (a) the processing of core emotions to a healing conclusion, and (b) the metatherapeutic processing (or metaprocessing for short) of this healing—two core concepts in AEDP. In the current issue of the journal, Louis Sass (2019), an internationally recognized expert on phenomenology and psychopathology, has commented on my commentary, endorsing the importance of a phenomenological perspective in psychotherapy. He also raised some concerns about the use and usefulness of metaprocessing for some types of clients, especially those with the distancing defenses of derealization and depersonalization. In this article I respond to Sass’s important and very thoughtful points