This hands-on manual from Leigh McCullough and associates teaches the nuts and bolts of practicing short-term dynamic psychotherapy, the research-supported model first presented in Changing Character, McCullough's foundational text. Reflecting the ongoing evolution of the approach, the manual emphasizes "affect phobia," or conflict about feelings. It shows how such proven behavioral techniques as systemic desensitization can be applied effectively within a psychodynamic framework, and offers clear guidelines for when and how to intervene. Demonstrated are procedures for assessing patients, formulating core conflicts, and restructuring defenses, affects, and relationship to the self and others. In an easy-to-use, large-size format, the book features a wealth of case examples and write-in exercises for building key clinical skills. The companion website (www.affectphobiatherapy.com) offers useful supplemental resources, including Psychotherapy Assessment Checklist (PAC) forms and instructions.

Full author info (did not fit in title information field):
Leigh McCullough, PhD, Psychotherapy Research Program, Harvard Medical School, Boston, MA, Nat Kuhn, MD, Psychotherapy Research Program, Harvard Medical School, Stuart Andrews, MA, LMHC, Psychotherapy Research Program, Harvard Medical School, Amelia Kaplan, BA, doctoral candidate, Graduate School of Applied and Professional Psychology, Rutgers/m-/The State University of New Jersey, Piscataway, NJ, Jonathan Wolf, BA, doctoral candidate in medicine, Boston University School of Medicine, Boston, MA, and Cara Lanza Hurley, MA, doctoral candidate, Clinical Psychology Program, Loyola University Chicago, Chicago, IL

Introduction

1

(12)

PART I. THEORY, EVALUATION, AND FORMULATION

Affect and Affect Phobia in Short-Term Treatment

13

(22)

What Is an Affect Phobia?

13

(1)

Why This Therapy Focuses on Affect

14

(4)

The Definition and Classification of Affect

18

(4)

Adaptive versus Maladaptive Expression of Affects

22

(2)

The Development and Treatment of Affect Phobias: An Introduction

24

(3)

The Importance of Anxiety Regulation

27

(2)

Goals of Treatment

29

(6)

Exercises

32

(3)

Affect Phobia, Psychodynamic Conflict, and Malan's Two Triangles

35

(20)

Reformulating Psychodynamic Conflict as Affect Phobia

35

(2)

Understanding Affect Phobias by Using Malan's Two Triangles: The Universal Principle of Psychodynamic Psychotherapy

37

(7)

Making Important Distinctions about Feelings

44

(2)

Restructuring Affect Phobias through Systematic Desensitization: The Main Treatment Objectives

46

(9)

Exercises

51

(4)

Assessment and Selection of Treatment for the Patient

55

(26)

Overview of the Initial Assessment

55

(2)

How the DSM Multiaxial Assessment Guides Treatment Selection

57

(5)

How to Rate the Global Assessment of Functioning (GAF) Scale

62

(3)

Indications and Contraindications for Short-Term Dynamic Psychotherapy

65

(3)

Using the GAF Scale to Tailor Treatment to Patients' Needs

68

(4)

The Supportive--Exploratory Continuum of Interventions

72

(9)

Exercises

75

(6)

How to Formulate a Core Psychodynamic Conflict: Spotting Affect Phobias

81

(32)

An Overview of the Formulation Process

81

(5)

Identifying Defenses: How Adaptive Feelings Are Avoided

86

(2)

Identifying the Adaptive Activating Feelings: What Feelings Are Feared and Avoided?

88

(1)

Identifying Anxieties/Inhibitions: The Reason Why Adaptive Feelings Are Avoided

89

(3)

Summarizing the Formulation in Terms of Affect Phobia

92

(2)

Examples of How to Formulate Core Conflicts

94

(4)

Identifying Pitfalls in Formulating Core Conflicts

98

(3)

Repetition to Revise and Refine the Formulation

101

(8)

Exercises

101

(8)

PART II. DEFENSE AND AFFECT RESTRUCTURING

Introduction to Part II

109

(4)

Defense Restructuring, Section 1: Defense Recognition

113

(25)

Overview of Defense Recognition

113

(6)

Pointing Out Defenses against Phobic Affects

119

(3)

Validating Defenses

122

(1)

Pointing Out Strengths That Exist Alongside Defenses

123

(1)

Managing Difficult Defenses

124

(6)

Repeating Interventions until Defenses Are Recognized

130

(8)

Exercises

131

(7)

Defense Restructuring, Section 2: Defense Relinquishing

138

(29)

Overview of Defense Relinquishing

139

(4)

Identifying Consequences of Defensive Behavior: Costs and Benefits

143

(3)

Distinguishing the Origin of Defenses from the Maintenance of Defenses: Then versus Now

146

(2)

Grieving Losses Due to Defenses

148

(1)

Building Self-Compassion When There Is No Grief

149

(1)

Identifying the Secondary Gain of Defenses: Hidden Meanings and Rewards

150

(6)

Repeating Interventions to Enhance Motivation to Give Up Defenses

156

(11)

Exercises

158

(9)

Affect Restructuring, Section 1: Affect Experiencing

167

(40)

Overview of Affect Experiencing

167

(10)

Exposure to Phobic Feeling/the Feared Affect

177

(12)

Response Prevention: Defense Restructuring as Needed

189

(1)

Identifying Pitfalls in Affect Experiencing

190

(3)

Repeating Interventions until Affect Phobia Is Desensitized

193

(2)

Some Frequently Asked Questions

195

(12)

Exercises

196

(11)

Affect Restructuring, Section 2: Affect Expression

207

(30)

Overview of Affect Expression

208

(5)

Building Expressive and Receptive Capacities

213

(2)

Bearing Interpersonal Conflict

215

(1)

Integrating Feelings

216

(1)

Role Playing of Difficult Interactions

217

(1)

Providing Information to Aid Expression

218

(3)

Pitfalls in Affect Expression

221

(2)

Repeating Practice until Affect Expression Flows Naturally

223

(10)

Exercises

224

(9)

PART III. SELF- AND OTHER-RESTRUCTURING

Introduction to Part III

233

(4)

Self-Restructuring: Building Compassion and Care for Self

237

(28)

Overview: Restructuring for a Positive Sense of Self

238

(7)

Building Receptive Capacity to One's Own Feelings

245

(5)

Changing Perspectives on the Self: Encouraging Patients to Imagine How Others See Them

250

(4)

Finding and Encouraging the Lost Voice

254

(1)

Encouraging ``Parenting'' of the Self

255

(1)

Reducing the Externalization of Needs

256

(2)

Repeating Interventions until Phobias about Self-Feelings Are Desensitized and Self-Worth Improves

258

(7)

Exercises

259

(6)

Other-Restructuring: Building Adaptive Inner Images of Others

265

(28)

Overview: Restructuring Affect Phobias about Relationships with Others

266

(8)

Building the Receptive Capacity to Others' Feelings

274

(2)

Changing Perspectives: Viewing Others More Accurately and Compassionately

276

(3)

Identifying and Restructuring Addictive Attachments

279

(2)

Recovering ``Lost Loves'': Caring Persons in the Past

281

(3)

Repeating Interventions until Phobias about Relationships Are Desensitized

284

(9)

Exercises

285

(8)

PART IV. DIAGNOSTIC CONSIDERATIONS AND TERMINATION

Treating Specific Diagnoses: The Relationship between DSM Diagnoses and Affect Phobias

293

(15)

How Affect Phobias Underlie Diagnoses and Are Maintained by Primary and Secondary Gain

293

(1)

Integrating Nature and Nurture: The Biopsychosocial Model

294

(1)

Using Axis I Diagnoses to Inform Treatment of Affect Phobias

295

(6)

Using Axis II Diagnoses to Guide Treatment of Affect Phobias

301

(6)

Conclusion: Focusing on Affect Phobias That Underlie Diagnoses

307

(1)

Termination

308

(15)

Overview of Termination

308

(5)

Assessing What Changes Have Been Made

313

(3)

Assessing Why Changes Have Been Made

316

(1)

Celebrating Progress and Acknowledging What Needs More Work

317

(1)

Exploring the Full Range of Feelings for the Therapist

318

(3)

Replacing the Loss of Therapy

321

(1)

Conclusion and Commencement

322

(1)

Appendix Answers to Exercises

323

(30)

References

353

(4)

Index

357

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Treating Affect Phobia A Manual for Short-Term Dynamic Psychotherapy

9781572308107

1572308109

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