A DICTIONARY OF PSYCHOTHERAPY

PREFACE My thanks are due to innumerable people who have helped me in many different ways during eighteen months of intensive work, to handle a vast amount of material in a short space of time. First, I am tremendously grateful for the opportunities afforded by the University of Bristol library and, latterly by the Bodleian Library, Oxford, and the library of the Tavistock Clinic, London. In particular I should like to thank the staff of the Inter-Library Loans Service at Bristol University, who have tracked down obscure items for me from libraries all over Britain. Without them it would have been impossible to obtain essential resources. My second debt is to all those experts I have consulted, both formally and informally, regarding different subject areas. Especially I would like to thank Dr Christopher Dare, Consultant Psychiatrist, the Bethlem Hospital and the Maudsley Hospital, London, who gave extensive advice on the psychoanalytic entries; Miss Sally Box, Principal Social Worker in the Adolescent Department of the Tavistock Clinic, London, who advised on the Kleinian entries; Dr Glin Bennet, Consultant Senior Lecturer in the Department of Mental Health, University of Bristol, who advised on the terms relating to Jungian psychotherapy; Dr Dougal McKay, Director of Psychological Services to the Bristol & Western Health Authority, who advised on behaviour therapy, the cognitive therapies and social learning approaches; Dr Andrew Treacher, Lecturer in Mental Health at the University of Bristol, who advised on personal construct theory, social influence theory, outcome studies and many of the entries relating to general psychology; and Mr Philip Kingston, Lecturer in the Department of Applied Social Studies, University of Bristol, who advised on the entries relating to family, marital and systems therapy. Two colleagues have made particular contributions to the specialist areas of psychological tests and philosophical concepts. Mr Peter Gardner, Principal Psychologist for the County of Avon, has contributed the entry under personality tests and assessment and many of the entries on psychological tests; and Mr David Watson, Lecturer in the Department of Social Administration, University of Bristol, has contributed much of the opening descriptions of the following entries: epistemology, causality, phenomenology, Cartesian and the theory of types. I am particularly grateful to Dr R.D. Hinshelwood for his comments on the manuscript as a whole and for his expert help with the psychoanalytic entries, to Dr Malcolm Pines for his help with entries relating to group psychotherapy and to Mr Andrew Samuels for his assistance with entries relating to analytical psychology. Any errors that remain in the text are of course my own. I would also like to thank all the many friends and colleagues who have PREFACE loaned, advised about or given me books and articles from their own libraries. Next, I would like to thank Mrs Sheila Salisbury for typing and word-processing the manuscript with exceptional care and for taking such an interest in it, Philippa Brewster, editor at Routledge & Kegan Paul, for keeping me sane in the early days with regular doses of encouragement, and Elizabeth Taylor for her detailed work on the typescript. And finally, all my friends whom I mainly deserted for a whole year and especially Oi, who put up with it all and only complained when every room in the house was covered with papers and books. Thispageintentionally leftblank This page intentionally left blank ABRAHAM, KARL A A-historical Approaches to psychotherapy which de-emphasise the use of the patient''s history in either diagnosis or treatment or both. Most therapies which are described as a-historical use the term relatively, since some form of history taking is often found helpful even though perhaps not at the beginning of contact with the patient. The term is used to distinguish those psychotherapies (psychoanalysis and the depth psychologies) which connect the patient''s psychopathology with the past and especially with his early experiences of infancy; and those therapies which focus on the presenting problem (behaviour therapy) and on the here and now events of current interaction with the therapist and with his significant others. The distinction is quite hard to maintain since analysts would argue that the analysis of the transftrence and the focus on the patient''s free associations are both here and now emphases; and Jungians would want to claim a future-directed, teleological aspect to their therapy which supersedes in importance the historical exploration. However, these cannot be described as a-historical in the same way since the purpose of both is to link the present with the patient''s past and to enable him to gain insight into the way he is impeded by its influence. Systemic therapies such as family therapy tend to be a-historical as they afford opportunities for exploring the ''horizontal'' network of current relationships in vivo which tends to reduce the need to examine ''vertical'' networks of past relationships. This would not, however, be true of transgenerational family therapy or psychoanalyticfomily therapy. Some forms of strategic therapy, brief therapy and crisis intervention are almost entirely ahistorical, the best example being brief symptom-focused therapy. Cooklin (1982) discusses some of the issues involved in comparing historical with a-historical approaches to the treatment of systems. Any discussion of the two is inevitably value-laden, as those who advocate an a-historical approach are often concerned to move away from what they perceive as the deterministic framework of history, whilst those who underline the need for using the patient''s historical context are anxious to establish the logical and scientific status of a deductively derived theory of change. COOKLIN, A. (1982) Change in ''here and now'' systems vs systems over time (in Bentovim, A., Gorell-Barnes, G. and Cookling, A. (eds), Family Therapy: Complementary Frameworks of Theory and Practice, Academic Press, London.) See also Behavioural analysis, Phenotype. A-symptomatic Having no symptoms. Abraham, Karl (1877-1925) One of Freud''s earliest and most senior collaborators, Abraham holds a foremost place in the history ofpsychoanalysis. Born in Bremen of Jewish parents, he studied medicine at Freiburg and later joined the Vienna Psychoanalytic Circle along with lung, Adler, Ferenczi and others. In 1910, he founded the Berlin Institute which became one of the foremost psychoanalytic training institutes. Abraham was one of Freud''s most stalwart supporters and the two men engaged in regular correspondence over theoretical and technical issues. He took an active part in trying to keep Freud''s circle free of ''dissent'', although Freud expressed concern at Abraham''s zeal, pointing out that it was easier for Abraham than for Jung, ''because of racial kinship'', to remain consistent in his acceptance of Freud''s work. Abraham made important contributions to the theory of psycho-sexual development, subdividing the oral stage into oral-dependent and oralaggressive; and the anal stage into analeliminative and anal-retentive. He had a considerable influence on many psychoanalysts whom he analysed himself at the Berlin Institute, including Helene Deutsch, Karen Homey and Melanie Klein. He died in 1 ABREACTION Berlin of a lung complaint in 1925, leaving his major works to be collected together in 1948 and published as ''Selected papers on psychoanalysis''. His daughter, Hilde, became a wellknown analyst in London. Abreaction The release of emotional energy which occurs either spontaneously or during the course of psychotherapy and which produces catharsis. Spontaneous abreaction usually occurs soon after a traumatic event and this has the effect of mobilising the individual''s coping behaviour and hastening his re-adaptation to the new situation. If spontaneous abreaction does not occur, the affect attached to the memory of the loss is repressed and is likely to produce symptoms of depression, withdrawal or other neurotic presentations. The term was introduced by Breuer and Freud (1893) to describe the release of emotion attached to a previously repressed experience, and abreaction is still considered to be an important element in the therapeutic process not only within psychoanalytic therapies but also among many forms of group p~ychotherapy, encounter groups, Gestalt therapy and those therapies that make use of p~chodrama and re-enactment to help the patient integrate repressed material. Not all abreaction leads to catharsis however, and sometimes the patient may be left worse off than before following an abreaction. The therapeutic inducement of abreaction needs to take place in a protected setting with the safeguards that the therapeutic relationships can afford. Barber (1969) has discussed its use in hypnosis, and Wolpe (1973), in behaviour therapy. Wolpe suggests that the therapeutic effects obtained during abreaction might be a special case of the non-specificfoaors that operate in a proportion of cases receiving any form of psychotherapy. BARBER, T. X. (1969), Hypnosis: A Scientific Approach (Van Nostrand, Reinhold & Company, New York). BREUER, J. and FREUD, S. (1893), ''On the psychical mechanism of hysterical phenomena: preliminary communication'' (in 2 Studies on Hysteria, Standard Edition of the Complete Psychological Works ofSigmund Freud, vol. 2, Hogarth Press, London). JUNG, C. G. (1928), ''The therapeutic value of abreaction'' (Collected Works, vol. 16, Roudedge & Kegan Paul, London). WOLPE, J. (1973), The Practice of Behaviour Therapy (Pergamon Press, New York). See also Trauma. Absent member manoeuvre A form of resistance identified by Sonne et al. (1962) in the context offomily therapy. A key member of the family absents himself either from the first session so that treatment cannot begin or during a critical phase later on in the treatment process. Family therapists vary in their response. Some refuse to see the family if the key member is absent; others prefer to work with the resistance, using it as a means of understanding the roles taken by individuals and the way in which coalitions and alliances are formed. SONNE, J. et al. (1962), ''The absent member manoeuvres as a resistance in family therapy of schizophrenia'' (Family Process, vol. 1, pp. 44- 672). See also Folie a deux. Acceptance A quality believed to be necessary for a therapist to display in relation to the client, in order to promote effective psychotherapy. Van der Veen (1970) defines acceptance as ''valuing or prizing all aspects of the client including the parts that are hateful to himself or appear wrong in the eyes of society''. Used interchangeably with unconditional positive regard by client-centred therapists, the concept of acceptance enables the therapist to distinguish between the client''s self and his behaviour - a distinction which other schools of therapy, for example behaviour therapy, would find difficult to sustain. Acceptance involves the recognition by the therapist of the client''s worth without necessarily implying either approval of his behaviour, or an emotional attachment on the part of the therapist. ACTING OUT DER VEEN, F. (1970), ''Client perception of therapist conditions as a factor in psychotherapy'' (in Hart,]. T. and Tomlinson, T. M. (eds), New Dimensions in Client Centred Therapy, Houghton Mifflin, Boston). VA~ See also Accommodation, Core conditions, Empathy, Joining, Non-specific foctors, Relationship factors. Accommodation Term used to describe the need for the therapist to adapt and harmonise his style and techniques with each particular family or client. The term is used mainly in the context of fomi(y therapy but the process is relevant to all modalities and is fundamental to the creation of a therapeutic alliance. The therapist responds to this need by developing joining techniques and creating the core conditions of the treatment process. Both these enable him to move from a position of accommodation to a position of challenge, promoting change, insight and the acquisition of new skills for problem solving interventions. In the context of family therapy, accommodation lays the groundwork and makes possible the restructuring interventions by which the family system begins to change. MINUCHIN, S. (1974), Families and Famiry Therapy (Tavistock, London). Accreditation See Regulation (ofpsychotherapists). Ackerman, Nathan Ward (1908-1971) Pioneer offamiry therapy, Ackerman was born into aJewish family in Bessarabia. He was one of five children that survived infancy, the family emigrating to the United States in 1912. He studied medicine at Columbia University, New York, and later psychiatry. Between 1937 and 1942 he was a candidate at the New York Psychoanalytic Institute, working simultaneously as a psychiatrist for the Jewish Board of Guardians. In 1937 he married Gwendolyn Hill and they had two daughters. He became a member of the American Psychoanalytic Association in 1943, but in 1955 he helped found the American Academy of Psychoanalysis which became a principal alternative organisation for those who refused to confine psychoana(ysis to being a medical speciality. His approach to psychoanalysis was unorthodox and creative and although he retained his links with, and use of, psychoanalytic theory throughout his life, his appreciation of the wider social and cultural determinants of psychological disturbance began to lead him towards the treatment of the family as a group. In 1960 he founded the Family Institute, New York, and from then on he specialised in the practice and teaching of family therapy. In the same year, he co-founded, with Don Jackson, the journal Famiry Process, which remains the foremost family therapy journal in the world. He left behind a huge legacy of books and articles and also film material of his clinical work. His best-known books are The Psychodynamics ofFamiry Life (1958) and Treating the Troubled Famiry (1966). Acting in Term sometimes used as a contrast to acting out to denote an intermediate form of expression, which lies midway between acting out on the one hand and verbalisation on the other. Body postures, facial expressions and the patient''s whole repertoire of non-verbal communication, adopted during the therapeutic session, is thus described as acting in. The term is also used to describe any behaviour that occurs within the therapeutic session (as a substitute for the work of verbalising repressed material), as contrasted with that which occurs outside the session. DEUTSCH, F. (1947), ''Analysis of postural Quarterry, vol. 16, behaviour'' (P~ychoanarytic pp. 195-213). MAHL, G. F. (1967), ''Some clinical observations on non-verbal behaviour in interviews'' (J. ot'' Nervous and Mental Diseases, vol. 144, pp. 492-505). Acting out The making conscious of unconscious impulses and conflicts through action. Freud 3