Psych. 671. Spring 2008, pg. 1
PSYCHOTHERAPY II:
TECHNIQUE, THEORY, AND RESEARCH
NASH (SPRING 2008)
Psychology 671
Spring 2007
Monday 9:00 to Noon
Room: 226-E
Dr. Michael R. Nash
Room 219
mnash@utk.edu
COURSE DESCRIPTION: THE FOUR WINDOWS
Arguably the more you know about human nature the better therapist you will be. From a clinical training
perspective, we have four domains of knowledge, all of them windows, on the nature of the human condition. The
Psychotherapy II course supports student access to three of these windows. Approaching the fourth is a personal
matter.
Window #1. Happily, as you begin to do psychotherapy properly you immediately access a privileged
window on human nature, in part because you are listening with a peculiar mix of whimsy and gravitas, and in part
because by so doing you have an opportunity to overhear yourself on a regular basis. Thoughtful supervision and
earnest self-reflection not only yields the novice clinician hard-won insight into the patient’s condition, but inevitably
acquaints him with aspects of his own interior world which might otherwise escape attention. Hence the mere act of
doing therapy well inevitably enriches your grasp of human experience both as object (i.e., observing patterns of
others), and as subject (observing patterns you yourself experience in response to others). By focusing on solid
therapeutic technique and an attitude of receptivity, this course provides the student entree to this window on human
nature which can support a lifetime of professional and personal maturation.
Window #2. There is another window on human nature which is similarly situated between self and object
and which enriches our knowledge of human change. This is the world of the humanities: myth, theater, art, dance,
music, religion, and great literature. In this course we touch on great literature. As Harold Bloom points out
imaginative literature invites us to over-hear ourselves- - which is not the same as hearing ourselves. We read a
sonnet without any self-consciousness, and we are visited by unbidden feelings or thoughts which are quite
surprising. It is possible (as James, Freud, Fromm-Reichman, Bandura, and others suggest), that therapeutic
change always arises out of the unexpected. This could be the unexpectedness of self-knowledge gained through
over-hearing oneself in therapy, or it may be something imposed by the therapeutic context or by external events.
Either way, a capacity to embrace surprise is at a premium in therapy. Hence, each week we begin by reading one
or two brief and provocative short stories to prepare ourselves to be surprised by our own reactions, to learn how to
welcome the unexpected, and to refine our ability to master change and surprise others. We will be keeping good
company: Updike, Le Guin, E. B. White, Hemmingway, Fitzgerald, Joyce, Hawthorne, and others will point the way.
Windows #3 and #4. Finally, there are two other windows on human nature: science and your own
therapy. The former we will examine in this course; the latter you must explore on your own. In the course we
read research because science can reveal the lawfulness of our patients’ enactments: their clinical presentation,
the determinants of their misery, and the conditions under which therapeutic change occurs. Here the perspective
is human experience as object (i.e., as we observe it to be in the consulting room and the laboratory). You approach
the fourth window when you seek therapy for yourself. Here the perspective is human experience as subject (i.e.,
as you experience it to be in therapy). By pursuing therapy as part of your training you willfully anticipate the
unexpected, and further prepare yourself for surprises of the interior sort.
METHOD
The course will be structured in an advanced seminar format, with students expected to discuss the assigned
readings in light of their own clinical work, both present and past. While the instructor will guide and clarify the
discussion, he will not lecture. His participation will be consistent with a Socratic process (as defined by
philosopher-at-large Mortimer Adler).
Each week one or two students will be responsible for stimulating the discussion. They will meet with the instructor
from 8:30-9:00 A.M. on the Friday before their class to explore how to approach the readings. Preparation for
discussion coordinators should typically include: 1) a brief and thoughtful summary of the reading material; 2)
Psych. 671. Spring 2008, pg. 2
questions and observations; 3) and perhaps, how the material relates to the student's current or past clinical
experiences. Remember, your objective is to provoke and not lead the discussion.
EVALUATION
At this level of training it is expected that genuine curiosity and striving for excellence has replaced grade anxiety as
the primary motivator of class performance. To receive a good grade in this course (a “B”) what you need to do is
thoughtfully read the assigned materials, and make an effort to share your reactions with the class. Most, if not all
people will do this, and will receive a “B.” Receiving anything less than a “B” will require that work be quite a bit substandard (see below). If I feel that a student is flirting with something less than a “B” I will inform him or her privately
at mid-term or earlier. An “A” is given for work which is almost always exceptional throughout the course.
1. Weekly Response Sheet. Since there are no tests and no required papers for this class, the core of the
learning experience is the thoughtful reading of all the assigned material. Discussion becomes quite
irrelevant if we do not have a common base from which to respond. Accordingly, each week the student
will e-mail to me a response sheet. On this sheet will be at least one question or comment on each of
the assigned readings. The questions or comments must be sufficiently thoughtful to communicate that
a good-faith attempt was made to understand the readings. The response sheet must be in Dr. Nash's
electronic mail box no later than 1:00 AM on the day of the class. Because a sensitive reading of the
material is the foundation of this course, students must not neglect to write and submit the response
sheet. Failure to do so on only one occasion will have no consequence. But woe be unto him who
repeats. A second occurrence will result in an automatic drop of one letter grade for the course.
Subsequent occurrences will have a similar effect. Rules aside, what I want you to do is engage these
readings, and be thoughtful and discerning.
2. The Discussion. While some variability is inevitable from week to week, the student is expected to
participate fully in the seminar format. If the instructor observes that a student is habitually withdrawn
and making no substantive contribution to the discussion, that student will be asked to meet with the
instructor to explore the problem. The student must be aware that lively interaction and critical thinking
is the flesh and blood of this course.
3. Discussion Coordinator. The student's performance as a discussion coordinator and his/her
understanding of the material will be evaluated.
4. The Practice-Research Integration Project (The PRIP): To pass Psychotherapy II the student must
submit to Dr. Nash a fully satisfactorily completed and mentor-approved PRIP plan. The final mentorsigned plan must be submitted to Dr. Nash by April 14. Dr. Nash will then forward the document (with
comments) to the Clinical Faculty just in time for the annual student evaluation meeting. Only under
grave circumstances will Dr. Nash grant an Incomplete. As per the Student PRIP Manual, the PRIP
Plan consists of four of the 12 sections of the PRIP:




Section 1:
Section 2:
Section 6:
Section 7:
Focus and rationale for the study
Review of relevant clinical and research literature study
Clinical research questions
Research Design
Each section of the Plan should be of journal-submission quality. That is, The Plan ought to be suitable
for eventual submission to a learned journal upon study completion. Though Plan length depends on
the anticipated case-based study itself and the writing style of the student, one might imagine the Plan
to be 15-25 pages in length with references. The process leading to the final plan is as follows:


By February 04
By March 24


By April 07
By April 16
The student informs Dr. Nash of mentor identity.
7-8 page preliminary draft/outline to Dr. Nash
w/table of DVs: # and freq of observations, Mentor-signed
OPTIONAL: Draft of Plan to Dr. Nash for comment.
Formal & Final Submission of Plan to Dr. Nash.
Mentor signed
TEXT AND READING MATERIALS (ALL BOOKS REQUIRED)
Gay, P. (1989). The Freud Reader. New York: Norton.
Malan, D. H. (1995). Individual psychotherapy and the science of psychodynamics, (second edition). London:
Butterworths.
Psych. 671. Spring 2008, pg. 3
Psych. 671. Spring 2008, pg. 4
PSYCHOTHERAPY II:
TECHNIQUE, THEORY, AND RESEARCH
NASH (SPRING 2008)
THE READINGS
JANUARY 14
INITIAL MEETING
Bring seminar syllabus. Send reaction e-mail to Nash by January 11
01
Literary prompt:: Maxwell, William (1994). The man who lost his father. In: All the Days and Nights.
01a
Misch, D. A. (2000). Great expectations: Mistaken beliefs of beginning psychodynamic psychotherapists.
American Journal of Psychotherapy, 54, 172-203.
02
Breuer, J., & Freud, S. (1895). Studies in hysteria. (Fraulein Anna O.) In The Freud reader. P. Gay (Ed.),
New York: Norton. pages 61-78.
03
Freud, S. (1895). The girl who couldn't breathe. (Katharina) In H. Greenson (Ed.), Great cases in
psychotherapy, 1973, New York: Aronson, pages 13-24.
JANUARY 28
MORE CASES AND TECHNIQUE
04
Literary prompt:: Maxwell (1994). The Carpenter.
05
Freud, S. (1905). On beginning the treatment. In The Freud reader. P. Gay (Ed.), New York: Norton. pages
163 - 178.
06
Freud, S. (1905). Fragment of an analysis of a case of hysteria (Dora). In The Freud reader. P. Gay (Ed.),
New York: Norton. READ PAGES 172-173 AND 234-239.
06a Decker, H. S. (1998). Freud’s “Dora” case: The crucible of the psychoanalytic concept of transference. In:
Freud: Conflict and culture—essays on his life, work, and legacy. M. Roth (Ed.), New York: Knopf (105114).
07
Freud, S. (1918) History of an infantile neurosis. (The "Wolf Man"). In The Freud reader. P. Gay (Ed.), New
York: Norton. pages 400-426.
08
McWilliams, N. (1999). Psychoanalytic Case Formulation: The relationship between case formulation and
psychotherapy. 09-29.
08a
OPTIONAL: Buckley, P. (1989). Fifty years after Freud: Dora, the rat man, and the wolf-man. American
Journal of Psychiatry, 146, 1394-1403. READ EVERYTHING EXCEPT “RATMAN”.
08b
OPTIONAL: Buirski, P., & Haglund, P. (1998). The wolfman’s subjective experience of his treatment with
Freud. Psychoanalytic Psychology, 15, 49-62.
FEBRUARY 4
09
UNCONSCIOUS COMMUNICATION – THE TWO TRIANGLES
Literary prompt:: Updike, J. (2006). My father’s tears. The New Yorker, Feb. 27., 71-76.
Malan, D. H. (1995). Individual psychotherapy and the science of psychodynamics. London: Butterworths. Pages
1-105.
FEBRUARY 11
THE SUPPORTIVE RELATIONSHIP
10
Literary prompt: Williams, W. C. (1932). A night in June. In: Make light of it. NY: Random House 136-143.
11
Luborsky, L. (1984). Principles of psychoanalytic psychotherapy. New York: Basic Books. Pages 61-89.
12
Schafer, R. (1983) The analytic attitude. New York: Basic Books. Pages 14-33 (the atmosphere of safety:
Freud’s ‘Papers on technique’ (1911-1915).
Psych. 671. Spring 2008, pg. 5
13
Schafer, R. (1983) The analytic attitude. New York: Basic Books. Pages 34-57.
14
Greenson, R. R. (1960). Empathy and its vicissitudes. International Journal of Psycho-Analysis, 41, 418-424.
Pages 243-249.
15
Winnicott, D. (1956) On transference. International Journal of Psycho-analysis, 31, 386-388. Pages 455-458.
16
Winnicott, D.W. (1984). The development of the capacity for concern. In Deprivation and Delinquency (pp.
100-105). London: Tavistock Publications. (Original work published in 1963).
16a
OPTIONAL: Decety, J., & Jackson, P. L. (2006). A social-neuroscience perspective on empathy. Current
Directions in Psychological Science,15, 54-58.
FEBRUARY 18
EXPRESSIVE TECHNIQUES
17
Literary prompt: Joyce, J. (1914). Araby, In: Dubliners.
18
Freud, S. (1912). The dynamics of transference. S.E., 12, 97-108.
Malan, D. H. (1995). Individual psychotherapy and the science of psychodynamics. London: Butterworths. Pages
106-153.
19
Luborsky, L. (1984). Principles of psychoanalytic psychotherapy. New York: Basic Books. Pages 90-141.
20
McWilliams, N. (1999). Psychoanalytic Case Formulation: Assessing defenses. 85-101.
21
Eagle, M. N. (2003). The postmodern turn in psychoanalysis: A critique. Psychoanalytic Psychology, 20, 411424.
21a
OPTIONAL: Lane, R. C., Koetting, M. G., Bishop, J. (2002). Silence as communication in psychodynamic
psychotherapy. Clinical Psychology Review, 22, 1091–1104.
21b
OPTIONAL: Pesant, N., & Zadra, A. (2004). Working with dreams in therapy: What do we know and what
should we do?. Clinical Psychology Review, 489 – 512.
FEBRUARY 25
22
PSYCHOTHERAPY OUTCOME RESEARCH
Literary prompt:: Waddington, P. (1978). The Street That Got Mislaid, In: Fireside Reader 173-178.
Psych. 671. Spring 2008, pg. 6
23
Clarkin, J. F., Levy, K. N., Lenzenweger, M. F., & Kernberg, O. F. (2007). Evaluating Three Treatments for
Borderline Personality Disorder: A Multiwave Study, American Journal of Psychiatry, 161, 1-7.
24
Abbass, A. A., Hancock, J. T., & Kisley, S. (2006). Short-term psychodynamic psychotherapies for common
disorders. Cochrane Review, 1-20.
25
Luborsky et al. (2002). The dodo bird verdict is alive and well-mostly. Clinical Psychology: Science and
Practice, 9, 2-12.
26
Peterson, D. R. (2004). Science, scientism, and professional responsibility. Clinical Psychology: Science
and Practice, 11, 196-210.
27
Westen, D., & Bradley, R. (2005). Empirically supported complexity. Current Directions in Psychological
Science, 14, 266-271.
28
Kazdan, A. E. (2006). Arbitrary metrics. American Psychologist, 61, 42-49.
29a
OPTIONAL: Norcross, J. C. & Prochaaka, J. O, (1984). Where do behavior (and other) therapists take their
troubles?: II. Behavior therapist, 7, 26-27.
29b
OPTIONAL: Westen, D., Novotny, C. M., & Thompson-Brenner, H., K. (2004). The Empirical Status of
Empirically Supported Psychotherapies: Assumptions, Findings, and Reporting in Controlled Clinical Trials.
Psychological Bulletin, 130, 631-663.
29c
OPTIONAL: Chambless, D. L., Ollendick, T. H. (2001). Empirically supported psychological interventions:
Controversies and evidence. Annual Review of Psychology, 52, 685-716.
MARCH 03
ANALYSIS OF THE TRANSFERENCE
30
Literary prompt:: O'Connor, Frank (1980). My Oedipus complex. In Collected stories. pages 282-292.
31
Freud, S. (1914). Remembering, repeating, and working through. S.E., 12, 145-156.
32
Freud, S. (1915). Observations on transference love. S.E., 12, 157-171.
33
Greenson, R. R. (1967). The technique and practice of psychoanalysis. New York: International University
Press. Pages 258-325.
34
McWilliams, N. (1999). Psychoanalytic Case Formulation: Assessing relational patterns. 120-157.
34a
OPTIONAL: Hilsenroth, M. J., Ackerman, S. J., Blagys, M. D., Baity, M. R., & Mooney, M. A. (2003). Shortterm psychodynamic psychotherapy for depression: An examiniation of statistical, clinically significant, and
technique-specific change. Journal of Nervous and Mental Disease, 191, 349-357.
MARCH 10
ANALYSIS OF THE TRANSFERENCE: FURTHER ELABORATION & CASE
35
Literary prompt:: Maxwell, William (1994). What he was like. In: All the Days and Nights.
36
Gill, M. M. (1982). The analysis of the transference. In S. Slipp (Ed.), Curative factors in dynamic
psychotherapy. Pages 104-126. 30
37
Strupp, H., & Binder, J. L. (1984). Psychotherapy in a new key. New York: Basic Books. Pages 143-168. 31
38
Strupp, H., & Binder, J. L. (1984). Psychotherapy in a new key. New York: Basic Books. Pages 194-258 (a
clinical case example). 32
39
Gorman, H. E., (1999). Interpreting transference in the supervision of psychoanalytic psychotherapy. American
Journal of Psychotherapy, 53, 452-466.
Psych. 671. Spring 2008, pg. 7
MARCH 24
DOES LITERATURE AND MYTH INFORM (OR MISINFORM) US ABOUT THERAPY
AND HUMAN NATURE?
40
Bloom, H. (2001). A conversation with literary critic Harold Bloom. Harvard Business Review, May, 63-68. 34
41
Hawthorne, N. (1835). Young Goodman Brown.
42
Barthelme, D. (1964). The School.
43
Malamud, B, (1983). My son the murderer.
44
Maxwell, William (1994). The masks. In: All the Days and Nights.
45
Maxwell, William (1994). The two women friends. In: All the Days and Nights.
46
Bowles, P. (1988). A distant episode. In: The selected stories. (NOTA BENE.: this is an optional reading
which most of you should in fact not read for reasons that will quickly become evident to those who do read
it. If you decide to begin this story, feel perfectly free to stop without finishing).
MARCH 31
COUNTERTRANSFERENCE: OBSTACLE OR OPPORTUNITY
47
Literary prompt:: FIitzgerald, F. S. (1937). An alcoholic case.
48
Kernberg, O. F. (1965). Counter-transference. Journal of the American Psycho-analytic Association, 13, 3856.
49
Gabbard, G. O. (2001). A contemporary model of countertransference. Journal of Clinical Psychology, 57,
983-991.
50
Winnicott, D.W. (1958). Hate in the countertransference. In Collected Papers: Through pediatrics to
psychoanalysis (pp. 194-203). New York: Basic Books. (Original work published in 1947).
51
Eagle, M. N. (2000). A critical evaluation of current conceptions of transference and countertransference.
Psychoanalytic Psychology, 17, 24-37.
52
Gutheil, T. G., & Gabbard, G. O. (1998). Misuses and misunderstandings of boundary theory in clinical and
regulatory settings. American Journal of Psychiatry, 155, 409-414.
53
Lomax, J. W., & Gabbard, G. O. (2004). Transference Love: An artificial rose?, 50, 311-322.
54
Meissner, W. W. (1998). Neutrality, abstinence and the therapeutic alliance. Journal of the American
Psychoanalytic Association, 46, 1089-1128.
Psych. 671. Spring 2008, pg. 8
54a
OPTIONAL Geller, J. D., Lehman, A. K., & Farber, B. A. (2002). Psychotherapists’ representations of their
patients. Journal Of Clinical Psychology, 58, 733–745.
54b
OPTIONAL Mehlman, E., & Glickauf-Hughes, C. (1994). The underside of therapy: Confronting hateful
feelings toward clients. Psychotherapy, 31, 434-439.
54c
OPTIONAL Gabbard, G. O. (1996). Lessons to be learned from the study of sexual boundary violation.
American Journal of Psychotherapy, 50, 311-322. 41d
54d
OPTIONAL: Betan, E., Heim, A. K., Conklin, C. Z., & Westen, D. (2005). Countertransference phenomena
and personality pathology in clinical practice: An empirical investigation. American Journal of Psychiatry,
162, 890-898.
APRIL 07
ANALYSIS OF RESISTANCE
55
Literary prompt:: Williams, W. C. (1939). The use of force. In: The farmer’s daughter: Collected short
stories.
56
Literary prompt:: Joyce, J. (1914). Eveline. In: Dubliners
57/58 Greenson, R. R. (1967). The technique and practice of psychoanalysis. New York: International University
Press. Pages 59 -70, 96-148.
59
Schafer, R. (1983) The analytic attitude. New York: Basic Books. Pages 162-182.
60
Blatt, S. J. & Erlich, H. S. (1982). Levels of resistance in the psychotherapeutic process . In P. Wachtel
(Ed.), Resistance: Psychodynamic and behavioral approaches (pp. 69-91). New York: Plenum.
61
Blatt, S. J. & Erlich, H. S. (1982). A critique of the concepts of resistance in behavior therapy. In P. Wachtel
(Ed.), Resistance: Psychodynamic and behavioral approaches (pp. 197-204). New York: Plenum.
62
OPTIONAL Gans, J.S., & Counselman, E. F. (1996). The missed session: A neglected aspect of
psychodynamic psychotherapy. Psychotherapy, 33, 43-50.
APRIL 14
TREATMENT OF SEVERE DISORDERS
63
Literary prompt:: White, E. B. (1939). The door.
64
Literary prompt:: Le Guin, (1990). Texts. In: The sound of writing.
65
Freud, S. (1917). Mourning and melancholia. In The Freud reader. P. Gay (Ed.), New York: Norton. pages
584-589.
66
Winnicott, D.W. (1958). The depressive position in normal development. In Collected Papers: Through
pediatrics to psychoanalysis (pp. 262-277). New York: Basic Books. (Original work published in 1954).
Malan, D. H. (1995). Individual psychotherapy and the science of psychodynamics. London: Butterworths. Pages
154-215.
67
Kernberg, O. F. (1993). Suicidal behavior in borderline patients: Diagnosis and psychotherapeutic
considerations. American Journal of Psychotherapy, 47, 245-254.
68
Eagle, M. (1984). Recent developments in psychoanalysis: A critical evaluation. New York: McGraw-Hill
(pages 127- 143, with special attention to 137-143).
69
Karon, B. P. (2001). The tragedy of schizophrenia without psychotherapy. The 2001 Frieda FrommReichmann Lecture. Michigan State University.
Psych. 671. Spring 2008, pg. 9
69a
OPTIONAL: Levy, K. N (2006). Change in attachment patterns and reflective function in a randomized
control trial of transference-focused psychotherapy for borderline personality disorder. Journal of
Consulting and Clinical Psychology, 74, 1027-1040.
APRIL 21
SHORT-TERM PSYCHOTHERAPY
70
Literary prompt:: Hemmingway, E. (1933). A clean, well-lighted place. In: Winner take nothing.
71
Magnavita, J. J. (1993). The evolution of short-term dynamic psychotherapy: Treatment of the future?
Professional Psychology: Research and Practice, 24, 360-365.
72
Strupp, H. H. (1994). Psychoanalytic innovations circa 1946: A retrospective review of Psychoanalytic therapy
by Alexander and French. Contemporary Psychology, 255-257.
73
Strupp, H., & Binder, J. L. (1984). Psychotherapy in a new key. New York: Basic Books. Pages 3-27.
74
Mann, J. (1973). Time limited psychotherapy. Cambridge, MA: Harvard University Press (Chapter entitled:
“The sequence of dynamic events;” pages 30-46).
75
Sifneos, P. (1978). Short-term Anxiety-Provoking Psychotherapy. In H. Davanloo (Ed.), Basic principles and
techniques in short-term psychotherapy. New York: SP Medical & Scientific Books, pages 35-42.
76
Augsburger, T. (1998). Specificity of technical interventions in Davanloo’s Intensive Short-Term Dynamic
Psychotherapy, Part I. International Journal of Intensive Short-Term Dynamic Psychotherapy, 12, 231-251.
77
OPTIONAL: Augsburger, T. (1998). Specificity of technical interventions in Davanloo’s Intensive Short-Term
Dynamic Psychotherapy, Part II. International Journal of Intensive Short-Term Dynamic Psychotherapy, 12,
253-269.
77a
OPTIOINAL: Hoyt, M. F. (1985). Therapist resistances to short-term dynamic psychotherapy. American
Academy of Psychoanalysis, 13, 93-112.
77b OPTIONAL: Davanloo, H. (1978). The case of the teeth-grinding woman. In H. Davanloo (Ed.), Basic principles
and techniques in short-term psychotherapy. New York: SP Medical & Scientific Books, pages 171-199
APRIL 28
TERMINATION
78
Literary prompt:: Williams, W. C. (1932). Dance Pseudomacbre. In: Make light of it. NY: Random House.
79
Literary prompt:: Maxwell, William (1994). The man at the railroad crossing. In: All the Days and Nights..
80
Luborsky, L. (1984). Principles of psychoanalytic psychotherapy. New York: Basic Books. Pages 142-158.
81
Strupp, H., & Binder, J. L. (1984). Psychotherapy in a new key. New York: Basic Books. Pages 259-266.
Malan, D. H. (1995). Individual psychotherapy and the science of psychodynamics. London: Butterworths. Pages
216-231; 280-285.
82
Schafer, R. (1973). The termination of brief psychoanalytic psychotherapy. International Journal of
Psychoanalytic Psychotherapy, 2, 135-148.
83
Van Denburg, T. F., & Van Denburg, E. J. (1992). Premature termination in the midst of psychotherapy: Three
psychoanalytic perspectives. Psychotherapy, 29, 183-190.
84
Nash, M. R. (1993). Transcript of termination session in short-term dynamic psychotherapy. Unpublished
manuscript
Psych. 671. Spring 2008, pg. 10
85
OPTIONAL Maholick, L. T., & Turner, D.W. (1979). Termination: That difficult farewell. American Journal of
Psychotherapy, 33, 583-591.
86
OPTIONAL Penn, L. S. (1990). When the therapist must leave: Forced termination of psychodynamic therapy.
Professional Psychology, 21, 379-384.
87
OPTIONAL Noy-Sharav, D. (1998). Who is afraid of STDP? Termination in STDP and therapist’s personality.
Psychotherapy, 35, 69-77.