Rc480a78 2007

Escape Plan From a Borderline Woman

When Your Loved One Has Borderline Personality Disorder

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616.89'14--dc22 2006027421

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and the Routledge Web site at http://www.routledge-ny.com

Contents

About the Editors ix

Contributors xi

The Art and Science of Psychotherapy: An Introduction xvii

Stefan G. Hofmann and Joel Weinberger

SECTION I Theoretical Issues

1 Discovering What Works in the Community:

Toward a Genuine Partnership of Clinicians and Researchers 3

Drew Westen

2 Methodcentric Reasoning and the Empirically Supported Treatment Debates 31

Mark A. Blais and Mark J. Hilsenroth

3 An Integrative, Principle-Based Approach to Psychotherapy 49

John E. Pachankis and Marvin R. Goldfried

4 Efficacy, Effectiveness, and the Clinical Utility of Psychotherapy Research 69

Peter E. Nathan

5 The Local Clinical Scientist 85

George Stricker

SECTION II Nonspecific and Common Factors

6 Empirically Supported Common Factors 103

Joel Weinberger and Cristina Rasco

7 Toward the Integration of Technical Interventions, Relationship Factors, and Participants Variables 131

David Clinton, Elaine Gierlach, Sanno E. Zack, Larry E. Beutler, and Louis G. Castonguay

8 Alliance Ruptures: Theory, Research, and Practice 155

Karyn D. Ruiz-Cordell and Jeremy D. Safran

9 Understanding and Working with Resistant Ambivalence in Psychotherapy: An Integrative Approach 171

Hal Arkowitz and David Engle

SECTION III Treatments of Axis I Disorders

10 General Principles for the Treatment of Emotional Disorders Across the Lifespan 191

Jill T. Ehrenreich, Brian A. Buzzella, and David H. Barlow

11 The Art of Evidence-Based Treatment of Trauma Survivors 211

Brett T. Litz and Kristalyn Salters-Pedneault

SECTION IV Treatments of Axis II Disorders

12 Personality Diagnosis with the Shedler-Westen Assessment Procedure (SWAP): Bridging the Gulf Between Science and Practice 233

Jonathan Shedler

13 The "Art" of Interpreting the "Science" and the "Science" of Interpreting the "Art" of the Treatment of Borderline Personality Disorder 269

Kenneth N. Levy and Lori N. Scott

Conclusions Let a Hundred Flowers Bloom; Let One Hundred Schools of

Thought Contend 301

Joel Weinberger and Stefan G. Hofmann Index 307

About the Editors

Stefan G. Hofmann, Ph.D., is an associate professor at the Department of Clinical Psychology at Boston University and the director of the social anxiety program at the Center for Anxiety and Related Disorders. He received his Ph.D. (1993) from the University of Marburg, Germany. His main research interests are in the area of psychotherapy research, anxiety disorders, especially social phobia, and the psychophysiology of emotions. He is an Aaron T. Beck Scholar and the recipient of numerous awards, including a First Independent Research and Transition Award from the National Institute of Mental Health, two Young Investigator Awards by the Alliance for Research on Schizophrenia and Depression, and awards from the Anxiety Disorders Association of America and the Association for Clinical Psychosocial Research. He is editor of Cognitive and Behavioral Practice, associate editor of Cognitive Behaviour Therapy and the International Journal of Psychology, and is a member of the editorial board of various journals. He has published more than 100 books, book chapters, and articles, including the popular text (together with Dr. Martha Tompson) Treating Chronic and Severe Mental Disorders: A Handbook of Empirically Supported Interventions.

Joel Weinberger, Ph.D., received his doctorate in clinical psychology from the New School for Social Research and completed a postdoctoral fellowship in human motivation at Harvard University. He is currently professor of psychology at the Derner Institute of Advanced Psychological Studies at Adelphi University. He is author or co-author of more than 60 published articles and chapters. His interests include unconscious processes, personality, motivation, and effective components of psychotherapy. Dr. Weinberger has co-edited (with Dr. Todd Heatherton) a book on personality change. He received a First Award from NIMH. He was conferred the Ulf Kragh Award (University of Lundh, Sweden) for his work on unconscious processes. Dr. Weinberger is also a practicing clinical psychologist.

Contributors

Hal Arkowitz, Ph.D., is associate professor of psychology at the University of Arizona. He has published in the areas of anxiety, depression, psychotherapy, and psychotherapy integration. He is co-author of Ambivalence in Psychotherapy: Facilitating Readiness to Change and has co-edited Psychoanalytic and Behavior Therapy: Toward an Integration, and the Comprehensive Handbook of Cognitive Therapy. For 10 years, he served as editor of the Journal of Psychotherapy Integration. Since receiving his Ph.D., he has also maintained an active clinical practice and values the interplay between research and practice.

David H. Barlow, Ph.D., received his doctorate from the University of Vermont in 1969 and has published over 500 articles, chapters, and books mostly in the area of the nature and treatment of emotional disorders. He is the recipient of numerous awards, including the distinguished Scientific Award for Applications of Psychology from the American Psychological Association.

Larry E. Beutler, Ph.D., is distinguished professor and former chair, and director of training at the Pacific Graduate School of Psychology in Palo Alto, California. Dr. Beutler is the past editor of the Journal of Clinical Psychology and of the Journal of Consulting and Clinical Psychology. He is a fellow of the American Psychological Association and the American Psychological Society. He is the past-president of the Society for Clinical Psychology (Division 12 of APA), a past-president of the Division of Psychotherapy (APA), and a two-term pastpresident of the (International) Society for Psychotherapy Research (SPR). He is the recipient of the Distinguished Career Award from SPR and of a Presidential citation from the American Psychological Association. He is the author of approximately 300 scientific papers and chapters, and is the author, editor, or co-author of 14 books on psychotherapy and psychopathology. Dr. Beutler is the co-editor (with L. G. Castonguay) of a task force report, titled "Principles of Therapeutic Change that Work" that was co-sponsored by the Society of Clinical Psychology (Division 12) and the North American Society for Psychotherapy Research.

Mark A. Blais, Psy.D., graduated from Nova Southeastern University in 1990 where he specialized in psychodynamic psychology and psychological assessment.

He is currently associate chief of psychology at Massachusetts General Hospital and associate professor of psychology at Harvard Medical School. His professional activities include teaching and supervising psychology interns, providing psychological and neuropsychological assessment consultations, and conducting individual psychotherapy. His research interests include evaluating psychiatric treatment outcomes and studying personality development and its disorders.

Brian A. Buzzella is currently pursuing his doctorate in clinical psychology at Boston University. His research interests include the developmental progression and treatment of emotional disorders in childhood and adolescence. Currently, he is working on a parent-training manual for the treatment of children with Selective Mutism.

Louis Castonguay, Ph.D., completed his doctorate in clinical psychology at the State University of New York at Stony Brook and a postdoctorate at Stanford University. He is currently an associate professor at the Department of Psychology at The Pennsylvania State University. His empirical work focuses on the process of change in different forms of psychotherapy, the efficacy of integrative treatments, and the conduct of effectiveness studies (especially in the context of Practice Research Networks). He is former president of the North American Society for Psychotherapy Research and recipient of the Early Career Contribution Award from the Society of Psychotherapy Research, the David Shakow Early Career Award from the Division of Clinical Psychology of the American Psychological Association, the Jack D. Krasner Memorial Award and the Distinguished Psychologist Award from the Division of Psychotherapy of the American Psychological Association, as well as other research awards.

David Clinton is a Ph.D. student at Pacific Graduate School of Psychology in Palo Alto, California. He plans to be both a practitioner and a researcher of psychotherapy process and has co-authored several articles on prescriptive psychotherapy and systematic treatment selection.

Jill T. Ehrenreich, Ph.D., received her doctorate in 2002 from the University of Mississippi. She is research assistant professor of psychology and associate director of the Child Program in the Center for Anxiety and Related Disorders at Boston University, where her research focuses on the etiology and treatment of adolescent anxiety and depression.

David Engle, Ph.D., has been a practitioner and instructor of gestalt and experiential psychotherapy for many years. He is a co-author of Focused Expressive Psychotherapy and Ambivalence in Psychotherapy: Facilitating Readiness to Change. He is also author or co-author of numerous articles about the treatment effects of experiential approaches to therapy. He has been a summer faculty member at the University of Arizona. Dr. Engle was the coordinator of the

Arizona Psychotherapy Project at the University of Arizona College of Medicine for five years. He is currently in private practice in Tucson, Arizona and has a special interest in the psychosocial effects of chronic disease on patients.

Elaine Gierlach is working on a Ph.D. in clinical psychology at the Pacific Graduate School of Psychology in Palo Alto, California. She is a research assistant and program director of the Medical Reserve Corps program within the National Center for the Psychology of Terrorism.

Marvin R. Goldfried, Ph.D., is distinguished professor of psychology at Stony Brook University. He is a diplomate in clinical psychology and recipient of numerous awards from the American Psychological Association, and awards from the Association for Advancement of Behavior Therapy (AABT) and the Society for Psychotherapy Research (SPR). He is past president of SPR, founder of the journal In Session: Psychotherapy in Practice, and author of numerous articles and books. Dr. Goldfried is cofounder of the Society for the Exploration of Psychotherapy Integration (SEPI) and founder of AFFIRM: Psychologists Affirming Their Lesbian, Gay, Bisexual and Transgender Family (www.sunysb.edu/affirm).

Mark J. Hilsenroth, Ph.D., is an associate professor at the Derner Institute for Advanced Psychological Studies, Adelphi University. He is a diplomate of the American Board of Assessment Psychology (ABAP). He has published broadly in the areas of applied clinical practice, specifically psychological assessment and psychotherapy. Dr. Hilsenroth has served as an associate editor for the Journal of Personality Assessment and currently is on the editorial boards of The Clinical Supervisor, Psychotherapy, Psychotherapy Research, and Stress, Trauma & Crisis: An International Journal.

Kenneth N. Levy, Ph.D., is an assistant professor in the Department of Psychology at The Pennsylvania State University. Dr. Levy is also an adjunct assistant professor of psychology in psychiatry at the Joan and Sanford I. Weill Medical College of Cornell University. His primary interests are in attachment theory, social cognition, emotion regulation, borderline personality disorder, and mechanisms of change in psychotherapy.

Brett Litz, Ph.D., is a professor in the Department of Psychiatry at Boston University School of Medicine. Dr. Litz conducts research on the risk and resilience factors that affect mental health adaptation to trauma across the life span, various forms of early intervention for trauma, and emotional-regulation in trauma-linked disorders. In his capacity as associate director of the Behavioral Sciences Division of the National Center for PTSD at the VA Boston Health Care System, Dr. Litz is responsible for overseeing educational activities pertaining to clinical care and research.

Peter E. Nathan, Ph.D., is currently University of Iowa Foundation Distinguished Professor of Psychology and Public Health. After receiving his doctorate in clinical psychology from Washington University, he spent seven years on the faculty of Harvard Medical School. He then joined the faculty of Rutgers University in 1969 where, from 1983 until 1989, he was Henry and Anna Starr Professor and Director of the Center of Alcohol Studies. After two years at the MacArthur Foundation in Chicago, between 1987 and 1989, on leave from Rutgers, he spent six years at the University of Iowa as provost. Dr. Nathan has been president of the Division of Clinical Psychology of the APA and the recipient of the APA Award for Distinguished Professional Contributions to Knowledge.

John Pachankis is completing his Ph.D. in clinical psychology at the State University of New York at Stony Brook. His research interests include identifying the effective components of psychotherapy for individuals facing identity-related stress. He is currently conducting research that examines the mental health implications of possessing a concealable stigma.

Cristina Rasco is a second year doctoral candidate at Adelphi University in Clinical Psychology. Her interests in the field are in unconscious processes, psychotherapy research, and treating culturally diverse populations.

Karyn Ruiz-Cordell is an advanced Ph.D. candidate in clinical psychology at the New School for Social Research in New York City.

Jeremy D. Safran, Ph.D., is professor and director of clinical psychology at the New School for Social Research in New York City. He is also senior research scientist at Beth Israel Medical Center, and on faculty at the New York University Postdoctoral Program in Psychotherapy and Psychoanalysis. He has published several books including: Emotion in Psychotherapy, Interpersonal Process in Cognitive Therapy, Widening the Scope of Cognitive Therapy, Negotiating the Therapeutic Alliance: A Relational Treatment Guide, and Psychoanalysis and Buddhism: An Unfolding Dialogue.

Kristalyn Salters-Pedneault, Ph.D., is a postdoctoral fellow at the National Center for PTSD Behavioral Science Division, VA Boston Healthcare System. Her research focuses on operant and associative conditioning processes as they relate to the emotional disruption typical of chronic PTSD. She is also interested in how contemporary learning research may improve interventions for PTSD and other trauma-linked conditions.

Lori N. Scott is a doctoral student in clinical psychology at The Pennsylvania State University. She is interested in social cognition, mechanisms of change in psychotherapy, and borderline personality disorder.

Jonathan Shedler, Ph.D., is clinical associate professor at the University of Denver and associate clinical professor at the University of Colorado Health

Sciences Center. He has authored scientific papers on a wide range of topics in psychology and psychiatry and is co-author of the Shedler-Westen Assessment Procedure for personality diagnosis.

George Stricker, Ph.D., is professor of psychology at Argosy University, Washington, D.C. He received the American Psychological Association (APA) Award for Distinguished Contribution to Applied Psychology, the APA Award for Distinguished Career Contributions to Education and Training in Psychology, the Florence Halpern Award for Distinguished Professional Contributions in Clinical Psychology from the Society of Clinical Psychology (Division 12), and the Bruno Klopfer Lifetime Achievement Award from the Society for Personality Assessment. He has been president of the Division of Clinical Psychology of APA, the Society for Personality Assessment, and the National Council of Schools of Professional Psychology. His most recent books are A Case Book of Psychotherapy Integration, with Jerry Gold, and The Scientific Practice of Professional Psychology, with Steven Trierweiler.

Drew Westen, Ph.D., is professor, Departments of Psychology and Psychiatry and Behavioral Sciences, and director of the Clinical Psychology Program at Emory University. Prior to joining the faculty at Emory, he taught at the University of Michigan, Harvard Medical School, and Boston University. Professor Westen is both a clinician and an active researcher, who has written upwards of 100 scientific papers and 2 books, and has been funded on his work on the classification of personality pathology in adolescents and adults by the National Institutes of Mental Health. He is currently an investigator on an NIMH Center Grant on biological and psychosocial predictors of treatment response in first-episode major depression. His major areas of research are personality and personality disorders, adolescent psychopathology, psychotherapy, eating disorders, emotion regulation, emotional influences on political decision making, and the intersection of psycho-dynamics and cognitive neuroscience. He has been a commentator for All Things Considered on National Public Radio (NPR) and has performed as a stand-up comic. He is currently working on a book, tentatively titled, The Political Brain: And What Happens When You Don't Use It.

Sanno E. Zack is a doctoral candidate at The Pennsylvania State University, working with Louis Castonguay. She has life span clinical interests and conducts research related to adolescent psychotherapy process and outcome.

The Art and Science of Psychotherapy: An Introduction

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