Challenges and Opportunities in Psychotherapy

Special Issue:

Challenges and Opportunities in Psychotherapy

Céu Tristão Martins Conceição
Psychologist and Psychoanalyst, PhD – Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil

Ivone Minhoto Meinão
Rheumatologist, MD, PhD- Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil

Sérgio Luís Blay
Professor of Psychiatry and Psychoanalysis, MD, PhD – Department of Psychiatry, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil

Emília Inoue Sato
Professor of Rheumatology MD, PhD – Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil


Objective: To evaluate the effectiveness in the long-term follow-up of brief group psychoanalytic psychotherapy in improving quality of life, symptoms, coping strategies, anxiety, and depression levels in systemic lupus erythematosus (SLE) patients.

Methods: Prospective, randomized clinical trial including 80 SLE patients divided into two groups: therapy (n=37) and control (n=43), with standard clinical care. Therapy group received weekly therapy for 20 weeks. The assessments were at baseline, after 20 weeks and after 24 months from the end of intervention. Damage and disease activity were assessed by rheumatologists. Self-administered questionnaires were supervised by blind evaluators: quality of life, symptoms, coping strategies, anxiety, and depression. Intent to treat statistical analysis. Comparisons of variance between groups over time (ANOVA repeated measures). P <0.05 significant.

Results: At baseline, both groups were homogeneous. After intervention, therapy group showed significant improvement in most domains of quality of life, symptoms, all domains of anxiety, and depression and several domains of coping strategies. Benefits in quality of life and coping remained at 24 months follow-up. However, the improvement in anxiety, and depression was not maintained. Medications and clinical variables did not change.

Conclusion: This study showed the effectiveness of brief group psychoanalytic psychotherapy in improving quality of life, symptoms and coping strategies in SLE patients even in the long-term follow-up. Depression and anxiety levels reduced at the end of therapy, although, the improvement did not last 24 months.

Keywords: clinical trial, coping strategies, long-term follow-up, psychoanalytic psychotherapy, quality of life, systemic lupus erythematosus

Kenneth Barish, PhD
Weill Cornell Medical College New York, USA


In this article, I will present a contemporary understanding of the nature of empathy and the importance of empathy in successful psychotherapy with children. This perspective highlights the intrinsic relationship of empathy and affect. I will consider how the child therapist’s empathy is expressed and offer a specific hypothesis on the therapeutic efficacy of empathic understanding in clinical work with children.  Finally, I will discuss how the experience of empathic understanding is beneficial in the emotional life of the child and in all human relationships, throughout life.

Christina Löwenborg
Licensed psychotherapist and a certified supervisor, Stockholm, Sweden.


The purpose of the case description is, from a user perspective, to describe a crucial element of a psychotherapeutic process, where client and therapist work to enact the client’s perceptions and experiences via tangible, visual and representative methodology, and to explain, in context, relevant starting points in taping, psychodrama and the mode concept in schema therapy.

The case study is built on qualitative method and comprises a presentation of a psychotherapeutic process, as well as a description of theoretical and methodical starting points in the methodology. The case study consists of a selection of material from a psychotherapy process with a client during the period 2014–16.

The outcome is presented in text and images on the basis of a described change process.

The principal conclusions in the case study demonstrate that the combination of taping, psychodramatic techniques and the mode model from schema therapy share several common denominators. The theoretical and methodical starting points can be combined and can contribute to identifying the following factors as significant parts of the therapeutic process described: visualization of vulnerabilities, identification of unsatisfied needs, mentalization and change in behavior.

The case description is relevant given that the combined methodology is still an innovative area, and the case description has a contribution to make to development of the methodology within the area.

Liselotte Grünbaum
Aalborg University, Denmark


This qualitative research study concerns the complexity of the concept of transgenerational trauma as unfolded in a child psychotherapy with a 3½-7 ys. old boy, referred for psychological assessment and treatment because of severe developmental delay, prolonged separation protests and oppositional behaviour. A systematic inductive-deductive qualitative analysis of the therapist’s detailed notes of therapy sessions was carried out. This yielded four intertwined sources of anxiety in mind of the young child, together blocking his mental-emotional development: 1) Introjective identification with parental trauma and loss. 2) His own traumatic anxiety left by a dog attack and an episode of stone-throwing. 3) Precocious awareness of social discrimination. 4) Age-appropriate, but undigested developmental phantasy and related anxiety, conflict, and defense. In conclusion, this study elucidates the complexity of second generation experience, even in young children, when considered in the psychosocial context of growing up. We know that severe retardation of early development may have lasting consequences for the child’s further personality development and cognitive abilities. It is therefore vital that psychological and medical practitioners working with massively traumatised parents are aware of the complex relationships between parental anxiety and their young children’s development of attachment and related separation-individuation.

Zipora Shechtman
Haifa University, Israel


In light of the growing needs of people for mental health services and the limited resources available, the literature calls for moving from individual therapy to group therapy. Parents of challenging children may be considered one such vulnerable population for whom the lack of professional assistance not only affects parents’ mental health and functioning but also that of their children. Group psychotherapy is an efficient and effective solution for parents: Research has concluded that group therapy is equally or more effective compared to individual therapy. Yet, group therapy is not frequently used with parents, mainly because psychologists are not trained to conduct such groups. Parent groups require therapists who understand parent-child relationship and who are trained in special methods and techniques that help parents engage in the group process. The aim of this paper is two–fold:  1. Present a group therapy modality to increase intimacy in parent-child relationships that relies on the creative arts; 2. Provide outcome and process research based on four large studies, to support the validity of the intervention.

Mahrer N. E.
Psychology Department, University of La Verne, La Verne, CA.

Sommer V. S.
Psychology Department, University of La Verne, La Verne, CA.

Berman D. I.
Psychology Department, University of La Verne, La Verne, CA.

Ngo N
Department of Anesthesiology Critical Care Medicine, Children’s Hospital Los Angeles

Gold J. I.
Keck School of Medicine, University of Southern California, Departments of Anesthesiology, Pediatrics, and Psychiatry & Behavioral Sciences


Youth with chronic medical conditions need accessible and effective mental health interventions to address high levels of disruption in their psychological, social, and emotional development. Acceptance and Commitment Therapy (ACT) is an empirically supported psychotherapy based on behavioral interventions that combines the principles of Relational Frame Theory and Mindfulness. ACT has been shown to be effective in populations of youth with various chronic conditions. As telehealth use has increased, ACT has been administered virtually on an individual level to adults and adolescents with chronic conditions, including chronic pain and Type II diabetes. However, few studies have incorporated a group-based element to the virtual delivery of ACT, which may be more accessible, cost-effective and may have additional therapeutic value in the form of peer connection and cohesion. To investigate the potential benefits of a virtual group model, we developed a web-based virtual ACT (vACT) group intervention for youth with chronic illness aged 14-21. The 6-week virtual group consisted of 1.5-hour sessions that each focused on a unique ACT concept: acceptance, values, mindfulness, cognitive defusion, experiential avoidance, and willingness/commitment. Additionally, the sessions included exercises to engage group members and teach skills. Baseline, post-, and follow-up data were collected on stress, mental health, functional outcomes, and satisfaction from one participant, “Kasey”, a 14-year-old Latina adolescent with comorbid Type I diabetes, depression, and anxiety. This case report details the procedures for the vACT group, discusses the barriers, and provides examples and recommendations for future administration of the group model. The report also describes Kasey’s experience during the group and presents quantitative/qualitative data supporting her improvement. Kasey’s perceived stress declined across sessions, while her anxiety sensitivity and depressive symptoms improved from the moderate range to the mild range, with sustained improvements at follow-up. Additionally, Kasey reported improvements in her peer relations with sustained improvements at follow-up, which was initially a significant concern. This case report provides promising preliminary data for the virtual administration of a group-based ACT intervention. We hope that clinicians can use this approach to provide evidence-based services that can reach a wider range of youth with chronic illnesses who may not otherwise have access to care and/or are estranged from their peers.

Andrew M Manocchio
Department of Clinical Psychology, College of Health Professions, Mercer University, Atlanta, GA, USA

Abigail O. Akpobiyeri
Department of Clinical Psychology, College of Health Professions, Mercer University, Atlanta, GA, USA

Mark A Stillman
Department of Clinical Psychology, College of Health Professions, Mercer University, Atlanta, GA, USA


Research has suggested that elite athletes display a proneness to psychopathology, as well as increased likelihoods of engaging in risky behaviors, compared to the general population.  This review addresses a gap in the literature pertaining to the pharmacotherapeutic and psychotherapeutic modalities in sports settings, resulting in either monotherapy or combination therapy.  We advocate for a risk-benefit assessment to guide this process, with an aim to implement the least invasive, pragmatic option for intervention. This assessment is informed by weighing potential barriers to psychotherapy with elite athletes, (e.g. stigma, time constraints, altered expectations of outcomes, and personality factors) against the benefits and barriers of pharmacotherapy (e.g., side effects that may impact performance). We recommend evidence-based practices that align with a balance of both the athlete’s and the organization’s goals; ultimately, preserving the well-being and rights of the athlete. Finally, treatment must be tailored to address variables that are relevant to elite athletes (e.g., side effects impacting performance, altered expectations, doping regulations). We suggest the notion of “flexibility within fidelity” in our stepwise guide, in that there can be fluidity and movement across the assessment stages to adjust recommendations as needed for the sake of optimizing the athlete’s care and goals.

Call for papers

Have a manuscript to publish in the society's journal?