How I Have Changed Over Time as a Psychotherapist.

Reflecting on my career as a psychotherapist has led me to consider 3 major areas that have affected the way I practice, namely, assimilative integration, the visions of reality, and brief psychodynamic therapy. Although starting out as a traditional psychoanalytic therapist, I became more integrative as I was exposed to other approaches and to patients with a variety of needs. As a result I developed a mode of integration, which I call assimilative. After applying the literary genres of tragedy, comedy, romance, and irony to psychoanalytic, behavioral, and humanistic psychotherapies, I found that they also could be used to describe any patient's multiple facets and psychological challenges. I demonstrate here how such visions helped in the treatment of a case of bipolar disorder. Upon recognizing the need for briefer forms of treatment, I developed an interest in conducting, conceptualizing, and researching brief psychodynamic therapy. I conclude the article by answering questions posed by the editors regarding how I have changed over time in conducting psychotherapy.

Three mechanisms of change in psychodynamic therapy: insight, affect, and alliance.

Excerpts of therapist-patient dialogue are presented to demonstrate three important elements of a successful session of psychodynamic therapy. These are the provision of insight through the use of transference, a focus on patient affect, and the therapist's attention to aspects of the therapeutic alliance. The article, in addition to explicating the clinical process in psychodynamic therapy, gives a theoretical explanation for the emphasis on each of these three elements and provides research support for their application.

An adjudicated hermeneutic single-case efficacy design study of experiential therapy for panic/phobia.

This article illustrates the application of an adjudicated form of hermeneutic single-case efficacy design, a critical-reflective method for inferring change and therapeutic influence in single therapy cases. The client was a 61-year-old European-American male diagnosed with panic and bridge phobia. He was seen for 23 sessions of individual process-experiential/emotion-focused therapy. In this study, affirmative and skeptic teams of researchers developed opposing arguments regarding whether the client changed over therapy and whether therapy was responsible for these changes. Three judges representing different theoretical orientations then assessed data and arguments, rendering judgments in favor of the affirmative side. The authors discuss clinical implications and recommendations for future interpretive case study research.

A psychodynamic perspective on resistance in psychotherapy: vive la résistance.

The term resistance has an overly negative connotation, indicating a recalcitrant, oppositional tendency on the part of psychotherapy clients. This article emphasizes the inevitability and ubiquity of resistance and argues that it should be greeted as a therapist's friend, not as an enemy. It is the way in which clients present themselves to the world in general and to the therapist in particular. Five forms of resistance are presented, including: resistance to the recognition of feelings, fantasies, and motives; resistance to revealing feelings toward the therapist; resistance as a way of demonstrating self-sufficiency; resistance as clients' reluctance to change their behavior outside the therapy room; and resistance as a function of failure of empathy on the part of the therapist. Vignettes from the author's practice and from the cases presented in this issue are discussed in terms of these five modes of resistance and their treatment.