A dictionary of psychotherapy 9781315810706, 1315810700

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A DICTIONARY ________ O F ________ PSYCHOTHERAPY

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A DICTIONARY ________ O F _________ PSYCHOTHERAPY S u e W a lro n d -S k in n e r

O

Routledge Taylor & Francis Croup

LON D ON AND NEW YORK

FOR DOROTHY LANGDALE-SMITH w ho know s a lot ab o u t all this

P a r t o fth e proceeds fro m the sale o fth is hook are dedicated to those m an y people o f the developing w o rld fo r w h om d a ily liv in g is a b a ttle fo r p h ysica l s u r v iv a l a n d f o r w h om psychotherapy o f any k in d is an irrelevant luxury!.

First published in 1986 by Routledge (5 Kegan Paul pic Published 2013 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon 0X14 4RN 711 Third Avenue, New York, NY 10017, USA Routledge is an imprint o f the Taylor & Francis Group, an informa business

S e t in E h rh ardt by C olum ns, R eading ©

S u e W a lro n d -S k in n e r 1 9 8 6

N o p a r t o f this book m a y be reproduced in a n y fo rm w ith o u t perm ission fro m th e publisher, except f o r th e quotation o f briefpassages in criticism

L ib ra ry o f Congress C atalogin g in P ublication D a ta W alro n d -S k in n er, Sue. A diction ary o f psychotherapy. Includes bibliographies. 1. Psychotherapy - D ictionaries. I. Title. [D N I .M : 1. P sychotherapy - entyclopedias. W M 13 W 221d] R C 4 7 5 .7 .W 3 5 1986 ' 6 1 6 . 8 9 '1 4 ' 0 3 2 1 8 5 -2 8 2 6 7 B ritish Library' C I P da ta also ava ila b le I S B N 9 7 8 - 0 -7 1 0 0 -9 9 7 8 -5 I S B N 9 7 8 - 0 - 7 1 0 - 0 9 9 7 8 - 5 (h b k ) P u b lis h e r ’s N o te The publisher has gone to great lengths to ensure the q u a lity o f this reprint but poin ts out th at som e im perfections in the original m a y be apparent.

Contents

Preface E N T R IE S from A to Z

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Preface

S. L esse ’s (1981) editorial to the 35th edition o f the American Journal o f Psychotherapy (no. 4) p ro d u c ed som e in te restin g figures re g ard in g the in fo rm a­ tion explosion o f the tw entieth century. H e re m a rk ed th at th ere are now m ore th an 62,000 scientific journals in existence so th at anyone w ho attem pts research into even a highly lim ited field o f enquiry — one a sp ect o f psychotherapy for exam ple - m u st scan h u n d re d s o f th o u sa n d s o f articles to obtain a reliable overview o f the given field. In term s o f h u m an re so u rce s tim e, effort and en d u ran c e -

the task becom es one o f m ind-boggling

p roportions. W e arc faced w ith the relen tless fact th a t the total volum e o f available p rin te d inform ation in the w orld now d oubles every ten years and by the year 2000 it is likely to double in ju st one year. In the field o f psychotherapy th ere are now literally th o u sa n d s o f journals in existence, each p ro d u cin g articles several tim es a year, w hilst the n u m b e r o f books p ro d u c ed in each su b-specialty o f the field every year ru n s into m any h u n d re d . T h is dictionary can th erefo re only be classed as a m o d est offering w ithin an already b u rg eo n in g grow th area o f encyclopaedia, com pendia and w ord books, all attem p tin g to b rin g som e o rd e r to the field and offer som e m aps to guide the serious stu d e n t o f psychotherapy over a rough and uneven terrain . Its raison d'etre stem s from the rapidity with w hich o u r field has developed w ithin the last ten years, m aking m any excellent w ord books and dictionaries already o u t o f date. N o t only have a b ew ildering array o f new th erap ies com e on to die scene (since, for exam ple, H .J. E ysenck’s Dictionary o f Psychology was p ublished in 1972), b u t the usage o f term s shifts subtly in the o lder psychotherapies as they are influenced by and seek to influence, in an im plicit two-way dialectic, the changing social, political and intellectual context in w hich they are e m b ed d ed . T h e private, specialised language o f o u r profession grows and develops with a life o f its ow n and new e n tra n ts need to be acquainted w ith the c u rre n t usage o f its term inology as well as the vertical co nnections w ith history and the lateral co n n ectio n s w ith term s currently u sed across the d iffere n t areas o f psychotherapy. It is m ainly for these th at this dictionary has b een p re p a re d b u t I hope too th at experienced p ractitioners who specialise in one or two form s o f tre a tm e n t will be intrigued and e nlightened, as I have b een , w ith the d iffere n t u n d e rstan d in g that can be gained from co n sid erin g how the sam e tec h n iq u e o r c o n cep t is

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used by theorists and practitioners from a range o f different approaches. Many problem s surround the compilation o f this sort o f book. Selection is the obvious first and I have no doubt been biased unconsciously in what I have chosen to include and what I have left out. Consciously I have wanted to ensure the inclusion o f many new ideas, forms and interventions that do not figure in older dictionaries. T h is m eans that less space has been devoted to classical concepts from the behavioural and psychoanalytic approaches. In any case, I would expect there to be less need to be com prehensive in these areas although I have tried to be representative. I have wanted to include the m ost im portant aspects o f behavioural and psychoanalytic theory and practice and whilst relying heavily on secondary' m aterial, I have returned as often as possible to the original sources and to the classic texts, new and old, in order to gain as accurate a picture as possible o f the current use o f the term . I have tried to refer to journal articles on each subject area published during the last five years as well as to primary source m aterial, beginning in m ost cases with the original w riter’s early work. T h is brings me to another problem . T erm s are used differently and often polemically by different theorists and practitioners. M any definitions may be held o f the same term - so how does one arrive at a statem ent which em bodies its crucial m eaning, without boiling down areas o f difference into a false consensus? Com m enting in 1958 on this problem in the preface to his Comprehensive Dictionary o f Psychological and Psychoanalytical Terms, H orace English wrote: ‘A particular art is required to phrase a definition that will represent, not just a single author’s m eaning, but the “centre o f gravity'” o f a whole cluster’ o f individual meanings. I have sought to deal with this problem by treating the work m ore as an encyclopedia and less as a dictionary in the strict sense. T h u s, although 1 do in the main attem pt a definition for each term , I have tried to elaborate, in an article o f varying length, on the different usages m ade o f the concept. I have provided a short bibliography for m ost items, to guide the reader towards the m ost recent specialist texts which will help him or her to study the concept m ore fully. W here a topic is discussed by many different w riters from widely different perspectives, I have used just a few examples from the m ethod literature with which I have been m ost familiar or which has been m ost easily accessible to me. Any book is a tem ptation to fly one’s own idiosyncratic kites; to shape and bend the ideas o f others to conform to one’s own predilections. I have tried to avoid these pitfalls - though undoubtedly not altogether successfully. I have, I admit, ‘censored’ some types o f interventions which I have stum bled across

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during the course o f my researches, if they have seem ed very short on supporting authorities other than their ‘inventor’s’ enthusiasm , but I have included a range o f ideas which practitioners from the m ore orthodox and longestablished areas o f the field are likely to find bizarre, distasteful or ‘unprofessional’. H ere I fall back on a lexicographical rationalisation and claim that it is the dictionary com piler’s duty to include what is in existence rather than only what ought to be! I considered calling the book a Dictionary o f the Psychotherapies in the hope o f bypassing the many wrangles about what does and what does not constitute psychotherapy. But ‘m ixedness and m uddle’ is part o f the core identity' o f psychotherapy in the m id-1980s and psychotherapy should be regarded and rejoiced in as a plural noun rather than excused and tidied up. N o doubt many will take issue with me as to what I have included and what I have left out. Purists would probably feel that this is a word book about psychotherapeutic interventions rather than psychotherapy proper, and even then they might quarrel with some o f the inclusions! I have m ade a particular point o f studying the many previous compilations of psychotherapeutic term s, and to these and to the many m ajor handbooks, reference books and glossaries that have already been produced, I bear a great debt. In the field o f psychoanalysis I have drawn particularly from the following: English and English (1958), Comprehensive Dictionary< o f Psychological and Psychoanalytic Terms', Rycroft (1968), A Critical Dictionary’ o f Psychoanalysis-, and LaPlanche and Pontalis (1980), The Language o f Psychoanalysis. In the behavioural field I have consulted in particular Eysenck, Arnold and Meili (1972), Encyclopaedia o f Psychology and W olman (1973), Dictionary o f Behavioral Science. For many entries in the dictionary I have consulted an outstanding work of great importance to the whole field o f psychotherapy, W olm an’s 12-volume International Encyclopaedia o f Psychiatry, Psychology, Psychoanalysis and Neurology (1977). I would com m end this massive work to the reader along with the recently published English Encyclopedic Dictionary o f Psychology’ (1983) edited by H arre and Lamb. F or many ideas and com parisons I have relied upon some o f the m ajor handbooks in the field, in particular, the Handbook o f Psychotherapy and Behavior Change edited by Garfield and Bergin (1978), and G urm an and Razin’s Effective Psychotherapy (1977). Many other invaluable reference and source books are far too num erous to pay tribute to here. Z usne’s (1975) source book o f biographies, Names in the History o f Psychology, was helpful in filling gaps in the short biographical entries on outstanding contributors to psychotherapy. I have followed usual practice and only included those who are dead.

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My thanks are due to innum erable people who have helped me in many different ways during eighteen m onths o f intensive work, to handle a vast am ount o f material in a short space o f time. First, I am trem endously grateful for the opportunities afforded by the University o f Bristol library and, latterly by the Bodleian Library, Oxford, and die library' o f the Tavistock Clinic, London. In particular I should like to thank the staff o f the Inter-L ibrary Loans Service at Bristol University, who have tracked down obscure item s for me from libraries all over Britain. W ithout them it would have been impossible to obtain essential resources. My second debt is to all those experts I have consulted, both formally and informally, regarding different subject areas. Especially I would like to thank D r C hristopher D are, C onsultant Psychiatrist, the Bethlem Hospital and the M audsley Hospital, L ondon, who gave extensive advice on the psychoanalytic entries; M iss Sally Box, Principal Social W orker in the Adolescent D epartm ent o f the Tavistock Clinic, L ondon, who advised on the Kleinian entries; D r G lin Bennet, C onsultant Senior L ecturer in the D epartm ent o f M ental H ealth, University' o f Bristol, who advised on the term s relating to Jungian psychotherapy; D r Dougal M cKay, D irector o f Psycho­ logical Services to the Bristol & W estern H ealth Authority, who advised on behaviour therapy, the cognitive therapies and social learning approaches; D r Andrew' T reacher, L ecturer in M ental H ealth at the University o f Bristol, who advised on personal construct theory, social influence theory, outcom e studies and many o f the entries relating to general psychology; and M r Philip Kingston, L ecturer in the D epartm ent o f Applied Social Studies, University o f Bristol, who advised on the entries relating to family, m arital and systems therapy. Tw o colleagues have m ade particular contributions to the specialist areas o f psychological tests and philosophical concepts. M r P eter G ardner, Principal Psychologist for the County o f Avon, has contributed the entry under personality tests and assessm ent and many o f the entries on psychological tests; and M r David W atson, L ecturer in the D epartm ent o f Social Adm inistration, University o f Bristol, has contributed m uch o f the opening descriptions o f the following entries: epistemology, causality, phenom enology, Cartesian and the theory o f types. I am particularly grateful to D r R.D . Hinshelw ood for his com m ents on the m anuscript as a whole and for his expert help with the psychoanalytic entries, to D r M alcolm Pines for his help with entries relating to group psychotherapy and to M r Andrew Sam uels for his assistance with entries relating to analytical psychology'. Any errors that rem ain in the text are o f course my own. I would also like to thank all the many friends and colleagues who have

PREFACE

loaned, advised about or given me books and articles from their own libraries. Next, I would like to thank M rs Sheila Salisbury for typing and word-processing the m anuscript with exceptional care and for taking such an interest in it, Philippa Brewster, editor at Routledgc & Kegan Paul, for keeping me sane in the early days with regular doses o f encouragem ent, and Elizabeth Taylor for her detailed work on the typescript. And finally, all my friends whom I mainly deserted for a whole year and especially Di, who put up with it all and only complained when every room in the house was covered with papers and books.

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ABRAHAM, KARL

A A -h isto ric a l A pproaches to psychotherapy which de-em phasise the use o f the patient’s history in either diagnosis or treatm ent or both. Most therapies which are described as a-historical use the term relatively, since some form of history taking is often found helpful even though perhaps not at the beginning o f contact with the patient. T h e term is used to distin­ guish those psychotherapics (psychoanalysis and the depth psychologies) which connect the patient’s psychopathology with the past and especially with his early experiences o f infancy; and those therapies which focus on the presenting problem (behaviour therapy) and on the here and now events o f current inter­ action with the therapist and with his significant others. T h e distinction is quite hard to m aintain since analysts would argue that the analysis of the transference and the focus on the patient’s free associations are both here and now emphases; and Jungians would want to claim a future-directed, tcleological aspect to their therapy which supersedes in im portance the historical exploration. However, these cannot be described as a-historical in the same way since the purpose o f both is to link the present with the patient’s past and to enable him to gain insight into the way he is im peded by its influence. Systemic therapies such as family therapy tend to be a-historical as they afford opportunities for exploring the ‘horizontal’ network o f current relationships in vivo which tends to reduce the need to examine ‘vertical’ networks of past relationships. T h is would not, however, be true o f transgencrational family therapy or psychoanalytic family therapy. Some forms o f strategic therapy, brief therapy and crisis intervention are almost entirely ahistorical, the best example being b rief symptom-focused therapy. Cooklin (1982) discusses some o f the issues involved in com ­ paring historical with a-historical approaches to the treatm ent o f systems. Any discussion of

the two is inevitably value-laden, as those who advocate an a-historical approach are often concerned to move away from what they perceive as the determ inistic framework o f history, whilst those who underline the need for using the patient’s historical context arc anxious to establish the logical and scientific status o f a deductively derived theory o f change. COOKLIN, A. (1982) Change in ‘here and now’ systems vs systems over time (in Bentovim, A., (jorell-B am es, G . and Cookling, A. (eds), Family Therapy: Complementary Frameworks o f Theory and Practice, Academic Press, London.) See also Behavioural analysis, Phenotype. A -s y m p to m a tic Having no symptoms. A b ra h a m , K a rl (1877-1925) O ne o f F re u d ’s earliest and m ost senior collaborators, Abraham holds a foremost place in the history ofpsychoanalysis. B om in Brem en o f Jewish parents, he studied m edicine at F reiburg and later joined the Vienna Psycho­ analytic Circle along with Jung, Adler, Fcrenczi and others. In 1910, he founded the Berlin Institute which becam e one o f the forem ost psychoanalytic training institutes. A braham was one o f F re u d ’s m ost stalwart supporters and the two m en engaged in regular correspondence over theoretical and technical issues. H e took an active part in trying to keep F re u d ’s circle free o f ‘dissent’, although Freud expressed concern at A braham ’s zeal, pointing out that it was easier for Abraham than for Jung, ‘because o f racial kinship’, to rem ain consistent in his accept­ ance o f F re u d ’s work. Abraham m ade im portant contributions to the theory of psycho-sexual developm ent, subdividing the oral stage into oral-dependent and oralaggressive; and the anal stage into analeliminative and anal-retentive. H e had a considerable influence on many psycho­ analysts whom he analysed him self at the Berlin Institute, including H elene D eutsch, K aren I lom ey and M elanie Klein. H e died in 1

A BREA C TIO N Berlin o f a lung complaint in 1925, leaving his major works to be collected together in 1948 and published as ‘Selected papers on psycho­ analysis’. H is daughter, H ilde, becam e a wellknown analyst in London.

A b re a c tio n 'I'he release o f em otional energy' which occurs either spontaneously or during the course of psychotherapy and which produces catharsis. Spontaneous abreaction usually occurs soon after a traum atic event and this has the effect o f mobilising the individual’s coping behaviour and hastening his re-adaptation to the new situation. If spontaneous abreaction docs not occur, the affect attached to the m em ory o f the loss is repressed and is likely to produce symp­ toms o f depression, withdrawal or other neurotic presentations. T h e term was intro­ duced by Breuer and F reud (189.1) to describe the release o f em otion attached to a previously repressed experience, and abreaction is still considered to be an im portant elem ent in the therapeutic process not only within psycho­ analytic therapies but also am ong many forms o f group psychotherapy, encounter groups, Gestalt therapy and those therapies that make use o f psychodrama and re-enactm ent to help the patient integrate repressed material. N ot all abreaction leads to catharsis how­ ever, and som etim es the patient may be left worse off than before following an abreaction. T h e therapeutic inducem ent o f abreaction needs to take place in a protected setting with the safeguards that the therapeutic relation­ ships can afford. Barber (1969) has discussed its use in hypnosis, and Wolpe (1973), in behaviour therapy. W olpe suggests that the therapeutic effects obtained during abreaction m ight be a special case o f the non-specificfactors that operate in a proportion o f cases receiving any form o f psychotherapy. BARBER, T . X. (1969), Hypnosis: A Scientific Approach (Van N ostrand, Reinhold & Company, New York). B r eu er , J. and F r e u d , S. (1893), ‘O n the psychical m echanism o f hysterical p h en ­ omena: prelim inary com m unication’ (in 2

S tudies on Hysteria, Standard Edition o f the Complete Psychological Works o f Sigmund Freud, vol. 2, H ogarth Press, London). JUNG, C. G . (1928), ‘T h e therapeutic value o f abreaction’ (Collected Works, vol. 16, Roudedge & Kegan Paul, London). W oi.PE, J. (1973), The Practice o f Behaviour Therapy (Pergam on Press, New York). See also Trauma. A b s e n t m e m b e r m a n o e u v re A form o f resistance identified by Sonne et al. (1962) in the context o f fam ily therapy. A key m em ber o f the family absents him self either from the first session so that treatm ent cannot begin or during a critical phase later on in the treatm ent process. Family therapists vary in their response. Som e refuse to see the family if the key m em ber is absent; others prefer to work with the resistance, using it as a m eans of understanding the roles taken by individuals and the way in which coalitions and alliances are formed. SONNE, J. et al. (1962), ‘T h e absent m em ber m anoeuvres as a resistance in family therapy o f schizophrenia’ (Family Process, vol. 1, pp. 44672).

See also Folie a deux. A c cc p tan c e A quality believed to be necessary for a therapist to display in relation to the client, in order to prom ote effective psychotherapy. Van der Veen (1970) defines acceptance as ‘valuing or prizing all aspects o f the client including the p a n s that are hateful to him self or appear wrong in the eyes o f society’. U sed in ter­ changeably with unconditional positive regard by client-centred therapists, the concept o f accept­ ance enables the therapist to distinguish betw een the client’s self and his behaviour - a distinction which other schools o f therapy, for example behaviour therapy, would find difficult to sustain. Acceptance involves the recogni­ tion by the therapist o f the client’s worth w ithout necessarily implying either approval of his behaviour, or an em otional attachm ent on the part o f the therapist.

AC T IN G O U T d e r VEEN, F. (1970), ‘C lient perception o f therapist conditions as a factor in psycho­ therapy’ (in H art, J. T . and Tom linson, T . M . (eds), New Dimensions in Client Centred Therapy, H oughton Mifflin, Boston).

V an

See also Accommodation, Core conditions, Empathy, Joining, Non-specificfactors, Relation­ ship factors. A c co m m o d atio n T erm used to describe the need for the therapist to adapt and harmonise his style and techniques with each particular family or client. T h e term is used mainly in the context o f family therapy but the process is relevant to all modalities and is fundamental to the creation o f a therapeutic alliance. T h e therapist responds to this need by developing joining techniques and creating the core conditions o f the treatm ent process. Both these enable him to move from a position o f accomm odation to a position o f challenge, prom oting change, insight and the acquisition o f new skills for problem solving interventions. In the context of family therapy, accomm odation lavs the groundwork and makes possible the restruc­ turing interventions by which the family system begins to change. MlNUCHIN, S. (1974), Families and Family

Therapy (Tavistock, London). A c cre d ita tio n See Regulation (o f psychotherapists). A c k erm a n , N a th a n W ard (1908-1971) Pioneer offamily therapy, Ackerman was born into a Jewish family in Bessarabia. H e was one o f five children that survived infancy, the family emigrating to the United States in 1912. I le studied medicine at Columbia University, New York, and later psychiatry. Between 1937 and 1942 he was a candidate at the New York Psychoanalytic Institute, working sim ul­ taneously as a psychiatrist for the Jewish Board o f G uardians. In 1937 he m arried Gwendolyn Hill and they had two daughters. I le becam c a m em ber o f the American Psychoanalytic Association in 1943, but in 1955 he helped

found the Am erican Academy o f Psycho­ analysis which becam c a principal alternative organisation for those who refused to confine psychoanalysis to being a medical speciality. I lis approach to psychoanalysis was unorthodox and creative and although he retained his links with, and use of, psychoanalytic theory throughout his life, his appreciation o f the wider social and cultural determ inants o f psychological disturbance began to lead him towards the treatm ent o f the family as a group. In I960 he founded the Family Institute, New York, and from then on he specialised in the practice and teaching o f family therapy. In the same year, he co-founded, with D on Jackson, the journal Family Process, which rem ains the foremost family therapy journal in the world. I Ie left behind a huge legacy o f books and articles and also film material o f his clinical work. I lis best-know n books are The Psycho­ dynamics o f Family Life (1958) and Treating the Troubled Family (1966). A ctin g in T erm som etim es used as a contrast to acting out to denote an interm ediate form o f expres­ sion, which lies midway between acting out on the one hand and verbalisation on the other. Body postures, facial expressions and the patient’s whole repertoire o f non-verbal communication, adopted during the therapeutic session, is thus described as acting in. T h e term is also used to describe any behaviour that occurs within the therapeutic session (as a substitute for the work o f verbalising repressed material), as contrasted with that which occurs outside the session. DEUTSCH, F. (1947), ‘Analysis o f postural behaviour’ (Psychoanalytic Quarterly, vol. 16, pp. 195-213). MAHL, G . F. (1967), ‘Som e clinical observa­ tions on non-verbal behaviour in interviews’ (J. o f Nervous and M ental Diseases, vol. 144, pp. 492-505).

A c tin g o u t The making conscious o f unconscious impulses and conflicts through action. Freud 3

A C T IO N T E C H N IQ U E S (1940) used the term in the context o f psycho­ analytic treatm ent and in relation to the trans­ ference, suggesting that the patient ‘acts it before us, as it were, instead o f reporting it to us’. Freud (1914) had already used the term in contrast to rem em bering, to mean the com ­ pelling urge to repeat the forgotten past and then relive it in the analytic situation. In psychoanalysis the term is used to refer to all those actions which take place, both within the therapeutic session or outside, which relate to the breaking through into behaviour of repressed m aterial from the past. Acting out may be m anifested by aggressive or sexual responses, directed either towards the therapist or to others. In psychoanalytic treat­ m ents, acting out is viewed as a hindrance and a resistance since it acts as a substitute for words and prevents the patient from gaining insight into his feelings and behaviour. T echniques for its m anagem ent includc containment, inter­ pretation, prohibition and efforts to increase the patient’s ego strengths. S andler et al. (1970) point out that the term is now used in two main ways: first, in F re u d ’s original sense, and second, to describe habitual m odes o f behaviour which flow from the patient’s personality structure rather than from the treatm ent process. T h e term is also used in contrast to acting in. M any therapeutic approaches encourage m odified forms o f acting out through the m edium o f action techniques, and in these m ethods, insight is believed to be gained through engaging the body in symbolic behav­ ioural acts which can afterwards be expressed in words. A b t , L. E. and WEISMAN, S. L. (1965), out - Theoretical and Clinical Aspects (G rune & Stratton, New York). FREUD, S. (1914), ‘Rem em bering, repeating and working through’ (Standard Edition, vol. 12, H ogarth Press, London). F rf.u d , S. (1940), ‘An oudine o f psycho­ analysis’ (Standard Edition, vol. 23, Hogarth Press, London). G a d d in i , E. (1982), ‘Acting out in the psychoanalytic session’ (fnt.jf. ofPsychoanalysis, vol. 63, pp. 57-64). 4

J o h n s o n , A. M . and S zu r e k , S. A. (1952), ‘T h e genesis o f anti-social acting out in children and adolescents’ (Psychoanalytic Quarterly, vol. 21, p. 323). N e t s , B. B. (1973), ‘Acting out in psycho­ therapeutic groups’ (Group Analysis, vol. 6, pp. 12-17). SANDLER, J. et a!. (1970), ‘Basic psycho­ analytic concepts: acting out’ (Brit. J . o f Psychiatry, vol. 117, p. 329). S c h w a r t z , L. and S c h w a r t z , R. (1971), ‘T herapeutic acting o u t’ (Psychotherapy: Theory, Research and Practice, vol. 8, pp. 205-7). A ctio n te c h n iq u e s All those techniques which rely primarily on movem ent, bodily expression or non-verbal communication. T h ey may also make use of words alongside the action, but their potency resides in their non-verbal aspect. Examples are play therapy, psychodrama, fam ily sculpting, role play, music therapy, art therapy, dance therapy, etc. M any techniques which rely primarily on a verbal interchange with the client nevertheless often use action techniques in addition drawn from a variety o f sources. F or example, the use o f charts, drawings and diagrams such as the genogram, sociogram, lifespace drawing, and the use o f relaxation exercises in systematic desensitisation. T h e efficacy o f action techniques stem s from their use o f analogic communication and their recog­ nition o f the im portance o f the analogic m ode in describing and understanding relationships. A ctive an aly sis A technique introduced by Stekel to reduce resistance and shorten the duration o f psycho­ analysis. Stekel believed that Freud had exaggerated the im portance o f the unconscious. H e suggested that many o f the patient’s con­ flicts lie instead within the realm o f conscious­ ness, and that the patient chooses not to deal with them . Resistance is therefore seen as a defence against the treatm ent, which the analyst m ust overcome by ‘attacking the patient’s system by storm ’. Stekel advocated giving advice, treating symptoms, using frequent confrontation and interpretations and suggesting lines along which the patient m ight profitably develop free association. Originally a devoted

ACTU A LISIN G THERAPY pupil o f Freud, Stekel later broke away and developed his own theories through a prodig­ ious literary output. STEKEL, W. (1950), The Autiobiography o f Wilhelm Stekel: The Life History o f a Pioneer Psychoanalyst (I .iveright Publishing Company, New York). STF.KF.L, W. (1950), Technique o f Analytical Psychotherapy (I .iveright Publishing Com pany, New York). A ctive te c h n iq u e An approach to psychoanalysis introduced by Ferenczi. It took two contrasting forms. O rig­ inally Ferenczi suggested privation, whereby the patient was encouraged to reduce all sources o f gratification outside the analytic experience, so as to make all libidinal energy available to the therapeutic process and hasten the overcoming o f resistance. Later, however, he suggested that the analyst should offer love to the patient and that the ‘indispensable healing power [lying in] the therapeutic gift o f love’ (De Forest, 1954) should be the chief tool o f treatm ent. In other words, far from adopting neutrality and using interpretations as the main form o f therapeutic activity, the analyst’s task is to provide the patient with a form of corrective emotional experience with the analyst. T h e first approach arose out o f F reu d ’s conccpt o f abstinence but the second was directly opposed to many o f the basic assum ptions o f Freudian psychoanalytic method and Freud made his disapproval clear. A break betw een Freud and Ferenczi was avoided, however, probably because of Ferenczi’s early death in 1933. D e FOREST, I. (1954), The Haven o f Love (London). FERENCZI, S. (1920), ‘F urther developm ent o f an active technique in psychoanalysis’ (in Further Contributions to the Therapy and Tech­ nique o f Psychoanalysis, H ogarth Press, London). FERENCZI, S. (1955), Final Contributions to the Problems and Methods o f Psychoanalysis (Hogarth Press, London).

A c tu a lisin g th e ra p y A form o f hum anistic therapy designed to help an individual becom e aware o f his core con­ flicts, engage with them and use the energy w'hich is thus released for creative living. It developed as a synthesis o f ideas derived from M aslow’s (1954) self-actualisation and the writ­ ings o f other humanistic psychologists such as C arl Rogers, Rollo May, Alexander Lowen and Victor Frankl. Like client-centred therapy, this approach relies heavily on the belief that hum an beings possess an innate tendency towards self-realisation or self-actualisation. T h is appraoch is therefore subject to the same criticisms, because o f its underlying assum p­ tions, as client-centred therapy and other hum anistic therapies. Like other hum anistic approaches, actualis­ ing therapy emphasises the need to help the client to develop his full potential by over­ coming core conflicts, developing an awareness o f feelings and the ability to express them , accepting one’s weaknesses and lim ita­ tions, and discovering meaning and purpose in life. T h e polarities o f anger-love and strengthweakness are viewed as basic to developing a fully actualised personality. T h e approach is concerned with the growth and developm ent o f the whole personality, not with the cure o f a disease or the solution to an imm ediate presenting problem. T h e subject o f the therapy is called the client. Actualising therapy can be used in the oneto-one relationship or in a group and the two are often com bined. T echniques used in therapy include the reflection o f the client’s experience and feeling back to him; the thera­ pist’s self-disclosure-, interpretation; exercises to get in touch with feelings through body work; and the clarification o f values. Action techniques are used such as role play and role reversal; breathing exercises; the release o f aggression and the experience o f love and care through touch. Actualising therapy is useful mainly with mildly disturbed, neurotic clients or individuals who feel the need to develop different aspects o f their personality. Actualis­ ing tendencies are m easurable using the Personal Orientation Inventory (Shostrom , 5

A D A P T A B IL IT Y 1963) developed by Maslow and Shostrom , and the Actualising Assessment Battery (Shostrom , 1976). BRAMMER, L. M . and SHOSTROM, E. L. (1977), Therapeutic Psychology: Fundamentals o f Actualising Counseling and Therapy (3rd edn, Prentice-H all, Englewood Cliff's, N ew jersey). MASLOW, A. H . (1954), Motivation and Personality (H arper & Row, New York). S h o s t r o m , E. L. (1963), Personal Orientation Inventory (Edits, San Diego). SHOSTROM, E. L. (1976), Actualising Assess­ ment Battery (Edits, San Diego). SHOSTROM, E. I.. (1976), Actualising Therapy: Foundations fo r a Scientific Ethic (Edits, San Diego). A d a p ta b ility See Morphogenesis. A d le r, A lfred (1870-1937) F ounder o f individual psychology, Adler was born in Vienna and was one o f six children o f H ungarian-Jew ish parents. H e studied at the Viennese College o f M edicine and in 1902 joined the Vienna Psychoanalytic Circle founded by Freud. H e broke with Freud in 1911, to develop his own approach to psycho­ analysis. In 1897, he m arried Raissa, the politically sophisticated daughter o f a Russian m erchant, and out o f his relationship with her grew his interest in socialism and in Marxist ideas. H e was also influenced by her in his views on the im portance o f sexual equality. In 1913 Adler founded the Society o f Individual Psychology, a nam e which, considering the social and relational emphasis o f A dler’s thinking, seems som ewhat inappropriate. He founded several child guidance clinics and took a great interest in the education of children, lecturing once a fortnight to parents and teachers in different schools for many years. Adler held a variety o f teaching appoint­ m ents in E urope and the U nited States and continued his analytic practice and interest in the education and treatm ent o f children along­ side his teaching and writing. I lis own experiences o f feeling inferior and o f having to 6

carve out his own identity in a large family when a child contributed to the form ation of his view that the experience o f powerlessness, not sexuality, was at the root o f neurotic disturbance. Adler died whilst on a lecture tour in Scotland in 1937, leaving behind a considerable literary output. H is m ost im por­ tant books include The Practice and Theory o f Individual Psychology (1924), Understanding Human Nature (1927), and Social Interest: A Challenge to M ankind (1933). Although Adler rem ained com m itted to the treatm ent o f indi­ viduals, many o f his ideas foreshadowed the developm ent o f social and interpersonal approaches to psychotherapy. A d le ria n th e ra p y See Individual psychology. A dvice Opinion offered by the therapist to the client as to the action or direction he should take. Advice is considered to be inappropriate in the psychoanalytic and non-directive therapies. Freud (1917), for example, was clear that ‘advice and guidance in the affairs o f life plays no part in psychoanalysis’ except in the case o f the very young or with particularly disturbed or helpless individuals. Generally speak­ ing, the hum anistic approaches and all those m ethods which are concerned with the ‘whole’ person and thus with growth in all areas o f the client’s life try to avoid advice giving. By contrast, the directive therapies, such as behaviour therapy, cognitive therapy, strategic therapy, crisis intervention and brief therapy, rely heavily on advice giving o f a particular kind, though it is clearly different from the lay m eaning o f the term . In these m ethods, which arc all focused on specific and restricted aspects o f the client’s life, the advice offered relates to the problem s being exam ­ ined in therapy. M oreover, it is directed more to the m eans o f achieving the therapeutic goals than to the goals themselves. F or example, instructions will be given regarding practice exercises, homework assignments and other tasks to be accomplished inside or betw een sessions but not about major decisions such as the

AGENCY choice o f a job, a partner, children, etc. An exception to this is to be found in crisis intervention and some o f the brief therapies, when the worker may take over the m anage­ m ent o f the client’s life for a brief period while the client is not capable o f doing so for him self or herself. T h u s a further distinction can be m ade between advice about how the client’s life should be lived and instructions con­ cerning the client’s therapy. FREUD, S. (1917), ‘M ourning and m elan­ cholia’ (Standard Edition, vol. 14, Hogarth Press, London).

A ffiliation Literally from the Latin ‘affiare’ m eaning ‘to adopt a son’. T h e process whereby an alliance is created between one or more m em bers o f a family or group which may or may not include the therapist. Affiliative behaviour stems from early attachm ent behaviour between the infant and its m other (act Attachment theory). Affilia­ tion may have the effect o f both increasing cohesion between those m em bers included in the alliance and encouraging a coalition against those who are not. Referring to stranger groups, Kellerman (1981) points out that ‘affiliation in the group implies that a set o f expectations on that affiliation has been m et’ and that m em bers who make an affiliation have concurred with basic group attitudes. T hus, as Yalom (1970) comments, group cohesion and affiliation arc very closely intertwined. T h e effect o f an affiliation is determ ined by its context and by the roles taken by those who are making the affiliation. F or example, the pairing affiliation in a group may have the effect o f mobilising basic assumption behaviour and stultifying the perform ance o f the group task. Affiliations that take place across genera­ tions in a family are usually dysfunctional if they create a coalition against other m em bers, though an exception to this would usually be an affiliation made betw een a single parent and parental child. O n the other hand, affiliations made within natural sub-systems in the family strengthen the cohesion o f the family group. T h e family and group therapist can use affilia­

tion as an unbalancing technique in his work with systems. Affiliation is always an essential part o f the joining process. Kf.I .LEHMAN, H . (1981), ‘T h e deep structures o f group cohesion’ (in Group Cohesion, G rune & Stratton, New York). M in u c h in , S. and F ish m a n , H. C. (1981), Family Therapy Techniques (1 larvard University Press, C am bridge, Mass.). S c h a c h t e r , S. (1959), The Psychology o f Affiliation (Stanford University Press, Stanford, Calif.). YALOM. I. D. (1970), The Theory and Practice o f Group Psychotherapy (Basic Books, New York). Sec also Triangulation. A fte r e d u c a tio n T erm used by Freud (1940) to describe the way in which the analyst helps the patient to move from his underlying childish attitudes towards the analyst to m ore m ature ones. Freud suggests that the whole healing process o f psychoanalysis involves the patient putting the analyst in the place o f his father or m other and thus giving him the power which his superego exercises over his ego. ‘T h e new superego now has an opportunity for a sort o f after education o f the neurotic; it can correct blunders for which his parental education was to blam e.’ T h e process enables the patient to gain a less distorted view o f others and a more realistic, m ature view o f the self. FREUD, S. (1940), ‘An outline o f psycho­ analysis’ (Standard Edition, vol. 23, H ogarth Press, London).

See also Corrective emotional experience, Trans­ ference. A gency T h e term is used in two ways. First, in psychoanalytic terminology, it is used to des­ cribe the three structures o f the psyche - the ego, the id and the superego. Second, it refers to the setting in which psychotherapeutic work is carried out, for example, hospital, clinic, resi­ dential hom e, school, social work departm ent, or general practice. T h e setting surrounds the 7

A L E X A N D E R , E R A N Z G A B R IE L psychotherapeutic treatm ent with particular opportunities and limitations. A le x a n d e r, F ra n z G a b rie l (1891 -1964) An im portant figure in the field o f psycho­ analysis, Alexander was born in Budapest, the youngest child following three sisters. Follow­ ing his father, he studied first philosophy and then later m edicine at the University of Budapest. In 1913 he was appointed to the Hygiene Institute o f Budapest and after the outbreak o f the First W orld W ar he becam e a military physician. In 1919 he went to study psychoanalysis at the new Berlin Psycho­ analytic Institute, receiving his persona! analysis from H ans Sachs. H e became an assistant at the Institute and began a series o f im portant contributions to the literature. In 1929 he was appointed the first ever professor o f psychoanalysis at the University of Chicago’s new D epartm ent o f M edicine. In 1931 he founded the Chicago Psychoanalytic Society and became its first director, rem ain­ ing there for the next twenty-four years. By then he had produced im portant studies o f the personality and applications o f psychoanalytic theory to criminality. H e had a major interest in psychosomatic m edicines and founded a journal by the same name. In 1946 his most im portant work was published, Psychoanalytic Therapy, in which he developed his ideas regarding the im portance o f the corrective emotional experience within analytic therapy and the possibility o f using briefer approaches to psychoanalysis. It was greeted by a storm of protest and he left Chicago for California, taking a professorship at the University of S outhern California. His last published work was The Scope o f Psychoanalysis. A le x a n d e r te c h n iq u e A physical and psychological approach to developing improved body/m ind integration. T h e technique was introduced by an Australian, Frederick M athias Alexander. It focuses on the reduction o f stress and rigidity in the m uscles and aims at breaking dow n the blocks that originate in em otional and psycho­ logical problem s and get expressed in bodily

rigidity, tension and pain. Relaxation guidance on posture and use o f the body are the basic techniques used. Barlow (1973) suggests that the Alexander technique is a useful adjunct to psychotherapy with depressed and narcissistic patients since better control and use o f the body increases self-confidence and self­ esteem and lessens the need to m anipulate others or to turn aggression against the self. A l e x a n d e r , F. M. (1932), The Use o f The S e lf (D utton, New York). B a r l o w , W. (1973), The Alexander Technique (Knopf, New York). JONES, S. P. (1976), Body Awareness in Action (Schocken Books, New York).

See also Autogenic training, Body therapies, Character armour, Meditation, Reichian therapy. A lg o rith m A problem solving device that enables a sequence o f operations to be undertaken in a step-by-step progression, the next step in the sequence being made dependent on the result o f the previous one. Algorithms are a relatively new' introduction within the therapeutic field. T hey enable clinical m aterial to be processed in a systematic way by breaking down complex procedures into their com ponent pans; placing these units in their appropriate sequence; expressing the units in the form o f questions a n d /o r statem ents and linking the units by using yes/no answers to the questions to indicate how to proceed with the material. Algorithms are being used m ore frequently for m atching diagnosis and treatm ent approach; and in training. Orsolitis and M urray (1982) discuss the use o f an algorithm in a psychiatric em ergency unit for the treatm ent o f dep res­ sion and Blechm an (1981) presents an algor­ ithm for m atching families and behavioural child-related interventions. BLECHMAN, E. A. (1981), ‘T ow ard com pre­ hensive behavioral family intervention: an algorithm for m atching families and interventions’ (Behavior Modification, vol. 5, pp. 221-37). O r s o l it is , M . and M urray , M . (1982), ‘A depression algorithm for psychiatric em ergen­

A M B IE N C E cies’ (J. o f Psychiatric Treatment and Evaluation, vol. 4, pp. 137-42). A lien atio n Alienation is an im portant them e in From m ’s writings. Deriving the concept from Marx, From m contrasts alienation with the ability to relate to others and to the natural world and hence to find meaning. T h e term is also used by F.rikson and by existential psychotherapists to signify the patient’s core problem o f m eaning­ lessness which has to be overcome. FROMM , E. (1974), The A rt o f Loving (H arper & Row, New York). FROMM, E. (1978), Anatomy o f Hitman De­ structiveness (Fawcett, New York).

A lig n m e n t See Pseudohostility, Pseudomutuality A lliance T h e product o f an affiliation betw een two or m ore m em bers of a family or stranger group which may or may not include the therapist. Alternatively, an alliance may be created by the therapist with one or more m em bers o f the family or group. An alliance is m ade for the positive purpose o f engaging in a m utual task or sharing common interests and in this sense should be distinguished from a coalition. Examining the alliances that exist in a family group or other natural network is an essential part o f the diagnosis in systems therapy; and the strengthening or weakening o f functional or dysfunctional alliances is an im portant part o f the treatm ent process. Since alliances build up cohesion they arc usually functional, except when they create a coalition against outsiders to the alliance; or when they lead to fusion or symbiosis so that growth and change betw een m em bers o f the alliance is stultified. Both sorts o f pathological alliance occur as a defence against threat from the outside or the inside, through, for example, a developmental crisis. T h e therapist’s task is to strengthen functional alliances within subsystems (between marital partners or siblings) and to weaken those that create coalitions against others or lead to symbiosis. See also Collusion, Therapeutic alliance.

A llp o rt, G o rd o n (1897-1967) Founder o f a hum anistic approach to therapy, Allport was one o f the 'third force' psycholo­ gists, along with Rogers, Maslow and G oldstein. H e was born in Indiana and studied psychology at H arvard University. H is personality theory em phasised the place o f traits and the part played by both physio­ logical and psychological processes in the developm ent o f personality. H e described the unifying core o f the personality as the proprium , equivalent to the ego or self, and he viewed propriate striving as all those forms of behaviour by which the individual tries to gain self-actualisation. After his studies at H arvard, he travelled in E urope and was gready influenced by the G erm an psychologist, W illiam Stern. In 1925, he m arried Ada, and had one son. After teaching social psychology and personality theory at D artm outh, he returned to Harvard in 1930 and rem ained there until his death in 1967. Allport was interested in social issues and he retained a strong interest in social psychology, editing the Journal o f Abnormal and Social Psychology for m any years. In 1939 he became president of the Am erican Psychological Association. His literary output was not great, but his major theoretical ideas were set out in Personality: A Psychological Interpretation (1937), The Nature o f Personality: Selected Papers (1950), Becoming (1955), and Personality and Social Encounter (1960). A lte r ego See Doubling. A m b ien c e T h e setting in which psychotherapy takes place. W innicott (1958) suggests that the therapist should provide a ‘holding environ­ m ent’, free from interruption, which allows the therapist to concentrate on what the patient is saying and the patient to relax and think about himself. Frank (1978) describes am bience as the provision o f ‘the aura o f a healing tem ple’. Privacy, structure, consistency and appro­ priate m aterial circum stances all contribute to the provision o f a setting which is conducive to 9

A M B IV A L E N C E the execution o f the therapeutic task. Specific form s o f therapy have additional require­ m ents, for example, sufficient comfortable chairs and space for family or group treat­ m ents; access to play m aterial if children are involved; and to audio visual equipm ent if this is part o f the therapeutic m ethod. T h e need to create the right am bience also affects the choice o f w hether therapy should take place in the therapist’s office or in the patient’s / family’s home. CARPELAN, H . (1981), ‘O n the im portance of the setting in the psychoanalytic situation’ (Scandinavian Psychoanalytic Review, vol. 14, pp. 151-60). FRANK,J.(1978), Psychotherapy and the Human Predicament (Schocken Books, New York). WlNNICOTT, D . W. (1958), Collected Works (H ogarth Press, London). A m b iv ale n ce T h e co-existence o f opposing feelings or attitudes towards a person or situation. Freud (1905), in his discussion o f infantile sexuality, attributed the term to Bleuler and used it to describe the way in which ‘opposing pairs o f instincts are developed to an approximately equal extent’. Freud, and the psychoanalytic tradition generally, uses the term to describe the holding o f opposite feelings towards the same object, usually the feelings o f love and hate (Suttie, 1935). It is used to describe the opposing experience o f negative and positive transference towards the analyst and also the way in which the individual handles conflict engendered by other people, notably by the parents during infancy. F or the Kleinian school, the concept is central. First experienced acutely during the paranoid-schizoid position, the infant splits the two feelings by projecting them on to ‘good’ and ‘bad’ objects. D uring the integrative phase o f the depressive position he ‘realises m ore clearly that it is the same person - him self - who loves and hates the same person - his m other’ (Segal, 1973). It is generally agreed amongst psychotherapists that strongly experienced positive em otion contains within it an opposing negative. 10

Bleuler seem s to have used the term orginally in a m uch less restrictive sense to describe ambivalence o f the will and intellec­ tual ambivalence as well as the current psycho­ analytic m eaning o f ambivalence o f impulses and em otions. T h is broader definition foreshadows some behavioural concepts such as the approach-avoidance conflict and cognitive dissonance. T h u s the broader definition of ambivalence, to m ean a conflict o f the affec­ tive, behavioural or cognitive experience o f the individual or group, is a useful extension within the broad range o f psychotherapies. F r e u d , S. (1905), ‘T h re e essays on the theories o f sexuality’ (Standard Edition, vol. 7, H ogarth Press, London). HOLDER, A. (1975), ‘T heoretical and clinical aspects o f ambivalence’ (Psychoanalytic Study o f the Child, vol. 30, pp. 197-220). SEGAL, H . (1973), Introduction to the Work o f Melanie Klein (H ogarth Press, London). SUTTIE, I. (1935), The Origins o f Love and Hate (Penguin Books, Harm ondsworth). See also Repression, Resistance. A nal sta g e T h e second psychosexual stage o f hum an developm ent occurring betw een the ages of about 2 and 4 years and lying betw een the oral stage and the phallic stage. F reud (1905) first described the anal stage, whereby the anus acts as an erogenous zone by which sensual pleasure can be experienced and a relationship with the outside world conducted. Freud suggested that polarisaton o f activity and pas­ sivity are marked features o f this stage, shown by the instinct o f mastery and acceptance. Abraham (1924) subdivided the anal stage into anal-eliminative, characterised by destructive and sadistic feelings, and anal-retentive, characterised by the desire to possess and control. Because o f the im portance attached to object relations by M elanie Klein in the very earliest years, she followed F reud in seeing these two subdivisions as im portant prototypes for the ambivalence which the child and adult expresses towards objects in later life. T his, in K lein’s view, increases the pre-existing oral

A N A LO GIC tcndcncv to split them into ‘good’ and ‘bad’. Klein adds the urethral impulses, character­ ised by burning or drowning attacks. In his analysis o f the eight developmental stages o f man, Erikson (1950) suggests that the anal stage is characterised by the growth of autonomy leading to the will to be oneself. If this stage is not satisfactorily accomplished, the child experiences sham e and self-doubt. Erikson views the establishm ent o f law and order as the societal concom itant o f the anal stage. Developmentally, the infant is con­ cerned with the mastery o f his own body sphincters and the socialisation o f the impulses connected with them . Freud (1908) suggested that orderliness, parsimony and obstinacy were the noteworthy characteristics o f a person fixated at the anal stage, and these comprised the obsessional character. H e further suggested (1917) that symbolic m ean­ ings o f giving and withholding are developed at the anal stage so that faeces are viewed as a gift to the m other which in later life is equated with the giving and receiving o f money. Farrell (1981) and others have criticised F re u d ’s understanding of the erotic nature o f the anal stage and also the cultural and social extra­ polations made by Erikson. ABRAHAM, K. (1924), ‘A short study o f the

development o f libido as viewed in the light o f mental disorders’ (in Selected Papers, I logarth Press, London). ERIKSON, E . H. (1950), Childhood and Society (Penguin Books, Harm ondsworth). FARREI.L, B. A. (1981), The Standing o f Psycho­ analysis (Oxford University Press, Oxford). F r e u d , S. (1905),‘T h ree essays on the theory o f sexuality’ (Standard Edition, vol. 7 , 1logarth Press, London). FREUD, S. (1908), ‘C haracter and oral erot­ icism’ (Standard Edition, vol. 9, H ogarth Press, London). FREUD, S. (1917), ‘O n the transform ation of instinct as exemplified in anal eroticism ’ (Standard Edition, vol. 17, H ogarth Press, London). See also Stages o f development.

A nalogic A form o f communication w'hich depends on the use o f analogues to describe what is to be represented. T h e analogue m eans that which is represented (for example, a picture o f a horse), unlike the digital mode w here the word horse acts as a symbol to express what is m eant. U sed in contrast to digital com m unica­ tion, the concept is derived from two models: first, the biological model o f the hum oral system, whereby discrete quantities o f specific substances are released into the body; and second, the cybernetic model o f the analogue com puter, whereby data is m anipulated in the form o f discrete positive m agnitudes. Analogic com m unication is the non-verbal accom pani­ m ent o f speech, and takes the form o f gestures, facial expression, non-verbal phonations, body posture, voice inflection and the rhythm and tone o f the words themselves. Analogic com m unication is considered by comm unication theorists to convey the ‘rela­ tional aspect’ o f comm unication as distinct from the ‘content’ that is conveyed by the digital mode. It provides the rich, primitive m eans o f conveying the emotional, affective and contextual aspects o f the relationship in which verbal com m unications are em bedded. It suffers from a lack o f exactitude and is often ambiguous and illogical, with one sign being used to express several different m eanings. Its characteristics therefore reflect the qualities of the primary process o f the id and the unconscious both in term s o f its lack o f order and refine­ m ent and its potential for rich expressiveness and creativity. Com m unication problem s arise betw een individuals because hum an beings make use o f both comm unication m odes sim ultaneously and therefore the need for translation betw een the two m odes has to be addressed. Problem s o f compatibility between digital and analogue com m unication are dis­ cussed under Communication. BATESON, G . (1955), ‘A theory o f play and fantasy’ (Psychiatric Research Reports, vol. 2, pp. 39-51, reprinted in Steps to an Ecology o f Mind, Paladin, New York, 1972). BATESON, G . (1966), ‘Problem s in cetacean 11

ANALYSAND and other mammalian com m unication’ (reprinted in Steps to an Ecology o f M ind, Paladin, New York, 1972). WATZLAWICK, P. et al. (1967), Pragmatics o f Human Communication (W. W. N orton, New York). See also Causality, Non-verbal communication. A n a ly sa n d A patient or trainee who is undergoing psycho­ analysis. A nalysis See Psychoanalysis. A n aly st (or p sy c h o a n aly st) T h e nam e given to a therapist who is qualified to practice psychoanalysis, analytical psychology or child analysis. A naly tic p a c t See Therapeutic alliance. A naly tic th e ra p y See Psychoanalysis.

A nalytical psychology T h e approach to personality and to psycho­ therapy developed by Carl Gustav Ju n g (18751961). Ju n g (1929) him self defined analytical psychology' as ‘a general concept em bracing both psychoanalysis and individual psychology as well as other endeavours in the field o f “complex psychology1” Although he showed considerable awareness o f the wider problem s o f the outside world and o f other cultures, Ju n g believed that change interventions should focus on the individual. Ju n g ’s work was gready influenced by that o f F reud. M any o f the same problem s were discussed by both and they shared ideas through meetings and correspondence betw een 1906 and 1913. However, analytical psychology is distinctively different from Freudian psychoanalysis and Ju n g arrives at different conclusions regarding the uncon­ scious, the m eaning o f dreams, transference, the origins o f psychic disturbance and the psycho­ 12

therapeutic approach to the disturbed individual. Ju n g disagreed fundamentally with F re u d ’s exclusive em phasis on the sexual origins of psychopathology and this disagree­ m ent caused a lifelong rift betw een them . In analytical psychology, the therapeutic process involves four stages: confession, elucidation, education and transform ation. T h e goal o f therapy is to help the individual gain insight and journey towards individuation. T h e thera­ pist’s primary task, however, is to help the patient experience him self differently by facilitating a greater integration o f his conscious and unconscious com ponents. Ju n g was in ter­ ested in the transform ation o f the whole person and, like F reud, he believed that psychic disturbance often m anifested itself in physical symptoms. Dream s, however, are a m ore im portant m eans by which the individual reveals the contents o f his or her unconscious m ind and dream interpretation was used b y ju n g to understand the individual’s current prob­ lems and aspirations as well as to uncover past conflicts. Jung, like Freud, used free association and interpretation in his therapeutic approach but he also favoured a m ore active form o f analysis with m ore use o f the real relationship betw een patient and analyst. H e introduced some original concepts such as the various archetypes (notably the shadow, the persona, and the animus and anima, the collective unconscious, and a bi-polar understanding o f the person­ ality, described in his work on psychological types. Although Ju n g (1963) described analytical psychology' as ‘fundamentally a natural science’, his theories are greatly influenced by his interest in religion and a lifelong study of mysticism and parapsychology. Analytical psychology has not achieved the popularity o f the Freudian approach to psychoanalysis, chiefly because it places less em phasis on scientific credibility and allows for the existence o f the individual’s spiritual aspirations. Even so, Ju n g ’s ideas have becom e increasingly influential in the general field of psychotherapy, particularly at the interface betw een religion and psychology. Although Ju n g him self was sceptical about its value, a

A N G Y A L, A N D R A S recent development and application o f his ideas has been to the group work setting (W hitmont 1964). Analytical psychology as a discipline has developed greatly since Ju n g ’s death in 1961. Many o fju n g ’s ideas have been developed or challenged, and unofficial though persuasive new schools have grown up (Samuels 1984). In many centres, a rap­ prochem ent with psychoanalysis is under way. BENNET, E. A. (1961), C. G. Jung (Barrie & Rockliff, London). EVANS, R. (1964), Conversations with CarlJung (V an N ostrand, New York). FORDHAM, F. (1953), Introduction to Jung's Psychology (Penguin Books, Ilarm ondsw'orth). FORDHAM, M. (1978),Jungian Psychotherapy (Wiley, London). FORDHAM, M . et al. (1980a), Technique in Jungian Analysis (Academic Press, London). FORDHAM, M. el al. (1980b), Analytical Psychology (Academic Press, London). H a nn a h , B. (1976), Jung: His I.ife and Work (Putnam, New York). HOMANS, P. (1979), Jung in Context (University o f Chicago Press, Chicago). JUNG, C. G., Collected Works (18 volumes plus general index plus bibliography, Routledge & Kegan Paul, London). JUNG, C. G . (1929), ‘Problems o f m odern psychotherapy’ (Collected Works, vol. 16, Routledgc & Kegan Paul, London). JUNG, C. G . (1953), Psychological Reflections (ed.Jolande Jacobi, Routledge & Kegan Paul, London). JUNG, C. G. (1963), Memories, Dreams, Reflections (Fontana, London). JUNG, C. G. (1963), Analytical Psychology: Its Theory and Practice (Routledge & Kegan Paul, London). JUNG, C. G . (1964), M an and His Symbols (Aldus, London). M c GUIRE, W. (cd.) (1974), The Freud-Jung Letters (Routledge & K egan Paul/H ogarth Press, London). PAPADOPOULOS, R. K. and SAAYMAN, G. S. (1984), Jung in M odem Perspective (Wildwood House, London). SAMUELS, A. (1984), Jung and the PostJungians (Routledge & Kegan Paul, London). STORR, A. (1976), C. G. Jttng (Viking Press,

New York). STORR, A. (1983), Jung: Selected Writings (Fontana, London). VAN DER Po s t , L. (\97b), Jung and the Story o f our Time (H ogarth Press, L ondon). WHITMONT, E. C. (1964), ‘G roup therapy and analytical psychology’ {J. o f Analytical Psychology, vol. 9, no. 1). A n a m n e sis Literal G reek meaning ‘not forgetting’. T h e active process whereby the patient is helped to recall past events and the feelings associated with them. T h e term is used more specifically to describe the fairly lengthy, retrospective investigation into the patient’s past conducted prior to diagnosis in long-term treatm ents. See also History taking. Medical model. A n cclectic I .iteral G reek m eaning ‘not eclectic’. Practis­ ing a specialist m ethod o f psychotherapy. A ngyal, A n d ra s (1902-1960) A psychologist and psychiatrist who espoused a holistic view o f m an and was an adherent of humanistic psychology. Angyal was born in H ungary and studied at the Universities of Vienna and I’urin where he gained a PhD and M D respectively. In 1932 he emigrated to the U nited States and for twelve years he worked at the State Hospital in W orcester, M assachusetts. H is early research was con­ ducted into theories o f cognition and later into schizophrenia. I le noted that disturbance in his patients arose from their inability to define their relationship with the environm ent appropriately. I le developed a theoretical view o f life as a total biological process and of hum an beings as open systems. H is systemic (see Systemic therapies) view o f hum an functioning led him to view the exploration of causality as being m ulti-facctcd, rather than linear, although it did not lead him into the treatm ent o f systems in his practice. Angyal died in Boston, M assachusetts, in 1960, leav­ ing his ideas contained in his books, Founda­ tions for a Science o f Personality (1941) and Neurosis and Treatment: A Holistic Theory (1965). 13

A N IM A A n im a T h e latent feminine principle which, accord­ ing to Jung, exists in every m an and which forms one o f the major archetypes in the collective unconscious in a similar m anner to that o f the animus in women. T h e anima both influences and is derived from the parental imago, the m an’s relationship with his m other which is internalised when the Oedipus complex is resolved. T h e anim a often m anifests itself in dreams in which female figures may serve as guides, or perform other helpful functions. In so doing, they act as ‘gatekeepers’ for the unconscious. T h e anima unconsciously influ­ ences the m an in his attitudes, choices, and relationships with women. It has the potential to be either negative and disruptive or to contribute to the psyche’s wholeness and well­ being. According to Jung, the repression o f feminine traits causes these contrasexual dem ands to accum ulate in the unconscious and an im portant part o f the psychothera­ peutic process lies in helping the man to recognise and integrate the feminine aspect of himself. J u n o , C. G . (1951), ‘Aion’ (Collected Works, vol. 9, part 2, Routledge & K egan Paul, London). JUNG, C. G. (1953), ‘T w o essays on analytical psychology’ (Collected Works vol. 7, Routledge & Kegan Paul, London). JUNG, C. G. (1957) Animus and Anim a (Spring Publications, New York). See also Analytical psychology. A n im u s T h e latent masculine principle which, accord­ ing to Jung, exists in every woman and which forms one o f the major archetypes in the collective unconscious in a similar m anner to the anima in m en. T h e anim us both influences and is derived from the parental imago, intern­ alised at the resolution o f the Oedipus complex. It is often said that, unlike the anima, the anim us is usually represented in dreams by a plurality o f figures. Em m a Ju n g (1957) explained this by reference to the predom in­ antly personal attitude o f the wom an’s 14

conscious m ind, to which her anim us forms a contrast. T h e anim us colours a wom an’s relationship with m en and it can be negative and destructive unless she is able to recognise and integrate the masculine aspects o f herself - the latter being a major task o f the thera­ peutic process. JUNG, C. G . (1951), ‘Aion’ (Collected Works, vol. 9, part 2, Routledge & Kegan Paul, London). JUNG, C. G. (1953), ‘T w o essays on analytical psychology’ (Collected Works, vol. 7, Routledge & Kegan Paul, London). JUNG, E. (1957), Animus and Anim a (Spring Publications, New York). See also Analytical psychology. A n n ih ila tio n A particular anxiety that would seem to have its origin in very’ early stages o f developm ent. W innicott (1960) postulates that the original infantile state is om nipotent in that the infant does not recognise his dependence on his m other, but if the environm ent impinges on him in such a way that his dependence is felt by him, it is experienced as annihilation and leads to the developm ent o f a false self to cover over the sense that ‘the continuity o f being is interrupted’. Such im pingem ent is, according to W innicott, the underlying problem in the generation o f schizophrenia. W in n ic o t t , D. W. (1960), ‘T h e theory o f the parent-infant relationship’, in Alaturational Processes and the Facilitating Environment (I logarth Press, London). See also Death anxiety, Modes o f relatedness, Transitional object. A nxiety m a n a g e m e n t tr a in in g An approach to coping skills interventions developed by Suinn and Richardson (1971). As with the coping skills approach developed by G oldfried (1971), relaxation training is used as an active ingredient o f the program m e. Covert modelling is then introduced and the client is trained in coping responses to a variety o f anxiety-inducing events. T h e approach is

ARCH ETYPE based on counter conditioning principles. GOLDFRIED, M . R. (1971), ‘Systematic desensitisation as training in self control’ (J. o f Consulting and Clinical Psychology, vol. 37, pp. 228-34). SUINN, R. and RICHARDSON, F. (1971), ‘Anxiety m anagem ent training: a non-specific behavior therapy program for anxiety control’ (Behavior Therapy, vol. 2, pp. 498-510). See also Problem solving interventions, S e lf instructional training, Stress inoculation. A p p ro a c h -a v o id a n c e conflict A concept introduced originally by K urt Lewin and developed by M iller (1944, 1959) to explain the roots o f neurotic conflict. M iller suggests that conflict arises when two drives compete. T h e conflict can be exemplified in three different ways: approach-approach con­ flict, when the individual has to choose between two desirable alternatives; avoidanceavoidance conflict, when he has to choose between undesirable alternatives; and approach-avoidance conflict, when he has to choose betw een som ething that is both desirable but painful or awkward, such as entering therapy, engaging in a course of study, etc. T h e pain or hard work o f engaging in the enterprise conflicts with the attraction of the hoped-for rewards at the end. M iller suggests that there are four assum ptions about the way in which a goal is approached or avoided: the closer one gets to a goal, the more strongly the individual pursues it; the nearer he comes to a feared event, the stronger the tendency to avoid it; the avoidance tendency is stronger than the approach tendency; and the strength o f the drives govern the strength o f the tendency to approach or avoid. M oreover, in an approach-avoidance situation, the further the individual is from his goals, the stronger the tendency to approach; but the nearer he comes to it, the greater the tendency to draw back. T h u s, he becom es stuck between two com peting drives. An effort to resolve this impasse may motivate the indi­ vidual to enter therapy. M iller’s work in this area is an attem pt to provide a learning theory

explanation for the psychoanalytic concept o f conflicting drives. MILLER, N. (1944), ‘Experim ental studies o f conflict’ (in I iunt, J. (cd.), Personality and the Behavior Disorders, Rolland, New York). M il i .f.r , N. (1959), ‘Liberalisation o f basic SR concepts’ (in Koch, S. (cd.), Psychology-A Study o f a Science, M cG raw -H ill, New York).

A rc h c ty p c A term adopted by Ju n g (1959) to describe ‘patterns o f instinctual behaviour’, the poten­ tial for which, in Ju n g ’s view, is inherited in the sam e way that instinctual behaviour is inherited in animals. It is im portant to distin­ guish betw een the archetypical structure, a purely skeletal concept which is essentially unknowable, and archetypal images, them es and patterns (see Imagery) which are based on the structure. F or example, the potential for a powerful bond betw een m other and child exists in both, so that the m other archetype (which could also be called the ‘m other-child archetypal structure’) becom es activated in the form o f images during the early days o f their relationship. W hen a m an falls in love, images deriving from the archetype o f the anima are activated. Aggression may be the expression of the archetype o f the shadow, and Ju n g has m aintained that the rise o f Nazism in Germ any in the 1930s was an example o f the shadow being activated at a collective level. O ther manifestations o f archetypes are the animus, the hero and the self, and these m anifest them selves in dreams, myths and religious symbolism. It was the discovery that these symbols exist in widely disparate cultures which led Ju n g to form ulate his concept o f the collective unconscious. Archetypes are ‘pre-existent forms o f exper­ ience’ (Jung, 1959) and are constituted out of the basic hum an experiences o f life which have rem ained the same down the ages. T hese include the knowledge o f night and day; birth and death; the search for food and shelter; the flight from danger; the daily rhythm o f work and sleep; the search for a mate and sexual intercourse. T h e archetype constitutes the 15

ARICA T R A IN IN G unconscious com ponent o f conscious acts and relationships and so gives them their power and numinosity. Archetypes can function creatively but they can also exert a negative influence if they rem ain inaccessible to con­ sciousness. T h e shadow, for example, represents the individual’s potential for evil. If this potential is m ade conscious, then due allowance can be m ade for it. If it is denied, Ju n g suggests that it may then take over and dom inate the individual because the archetype which is suppressed is liable to work destruct­ ively below the level o f consciousness. Ju n g ’s work on archetypes as innate and p redeter­ m ined forms o f inherited behaviour patterning is open to criticism but Stevens (1982) offers a careful critique which reveals the usefulness as well as the difficulties o f Ju n g ’s theory. JUNG, C. G. (1959), ‘T h e archetypes and the

collective unconscious’ (Collected Works, voi. 9, part 1, Routlcdgc & K egan Paul, London). NEUMANN, E. (1955), The Great Mother: A n Analysis o f the Archetype (Routlcdgc & Kegan Paul, London). STEVENS, A. (1982), Archetype - A Natural History o f the S e lf (Routledge & Kegan Paul, London). A ric a tra in in g See Psychocalisthenics. A rt th e ra p y T h e use o f art forms to enable the expression o f conflicts, problem s and aspirations, first as a substitute for neurotic symptoms and later as a way o f developing latent creative energy. T h e term art therapy was introduced by Adrian Hill in Britain during the 1940s and developed out o f his work with T B patients. Art therapy has both diagnostic and treatm ent potential. It is used either as an adjunct to other forms o f psychotherapy or, more fully, as a therapy in its own right. C hildren’s drawings made during play therapy or in a fam ily therapy session fall into the first category. M any individual thera­ pies encourage the patient to express him self through art and Jung, for example, viewed drawing and painting as im portant adjuncts to 16

analytical psychology, w’hich it still is. W ie n used as a therapy in its own right, the value o f the artistic production itself is the focus, with opportunities given to develop the picture or m odel over a longer period o f time. T h e art therapist may subscquendy discuss the latent m eaning and symbolism o f the picture with the patient and use a sequence o f pictures painted over some m onths to examine em er­ gent them es and changes in the patient’s feelings, fantasies, self-concept and his p e r­ ceptions o f the external world. Art therapists who use a psychoanalytic approach (e.g. N aum berg 1966) stress the need to interpret the artistic production alongside the patient’s associations to it, if unconscious them es and phenom ena such as transference are to be fully understood. O ther therapists put m ore em phasis on the healing processes o f catharsis and sublimation. Art therapy may be conducted on a one-to-one basis, in groups or with families, and Rhyne (1973) has shown how art therapy and Gestalt therapy can be com bined. G a n t t , L. and S c h m a l , M . S. (1974), Art T h era p y-A Bibliography: January 1940 toJune 1973 (National Institute o f M ental H ealth, Rockville, M aryland). K w ia tk o w sk a , 11. (1967), ‘Family art therapy’ (Family Process, vol. 6, pp. 37-55). LEV1CK, M . F. (1975), ‘Art in psychotherapy’ (in M asserm an, J., Current Psychotherapies, G rune & Stratton, New York). NAUMBERG, M . (1966), Dynamically Oriented A rt Therapy: Its Principles and Practice (G rune & Stratton, New York). NEUMANN, E. (1959), A rt and the Creative Unconscious (Routledge & Kegan Paul, I .ondon). R h y n e , J. (1973), The Gestalt A rt Experience (B rooks/C ole, M onterey, California). ULMAN, E. and D a c k in g er , P. (eds) (1975), A rt Therapy in Theory and Practice (Schocken Books, New York). A ssagioli, R o b e rto (1888-1974) Assagioli, the founder o f psychosynthesis, was born in Venice in 1888. H e studied m edicine at the University o f Florence and becam c an early student o f psychoanalysis, introducing his

A TTA CH M EN T THEORY professors to F re u d ’s thinking while he was still a medical student. H e was considered by F reud to be the representative and hope for the developm ent o f psychoanalysis in Italy. However, almost from the beginning, he was laying the groundwork for a critique of psychoanalysis, anticipating the insights and emphases o f humanistic psychology on the whole person by many years. I le saw the need for a theory that would encom pass the spiritual and creative aspects o f the individual as well as his drives and instinctual life. H e was thus one of the early exponents o f a transpersonal psychology. H e corresponded widely with clin­ icians o f different schools including Ju n g and Maslow, and in 1926 he founded the Instituto di Psicosintcsi in Rome. T his became the centre for his teaching and practicc until the hostility o f the Fascist regime forced the Institute to close. After the war, Assagioli began writing and teaching again and encour­ aged the growth o f new psychosynthesis centres throughout the world. A sse rtiv e n e ss tra in in g A procedure introduced by Salter (1949) for increasing the social skills and lowering the anxiety level o f unassertive individuals. Assertiveness is defined as a strong appro­ priate response to another hum an being that is neither submissive nor aggressive. Assertive­ ness is viewed as a way o f participating in interpersonal relationships which reflects a healthy self-concept and high self-esteem without infringing the rights o f others. In particular, the training, which often takes place in groups, makes use o f social skills training, modelling and behavioural rehearsal (which originated in assertiveness training programmes). Simulation o f feared situations, role play and other structured exercises are used to increase the individual’s repertoire o f skills; and systematic desensitisation and relaxation training may be used to decrease anxiety. T h e therapist may also try to change the patient’s cognitive view o f his social skills competency by self-instructional and anxiety management training.

A l b e r t i, R. E. (1977), Assertiveness: Innovations, Applications and Issues (Impact Publishers, San Louis, Obispo). B o w er , S. A. and Bowf.r , G. II. (1976), Asserting Yourself (Addision-W esley, Reading, Mass.). M c F a l l , R. M . and TWENTYMAN, C. T . (1973), ‘Four experim ents on the relative contributions o f rehearsal, modeling and coaching to assertion training’ (J. o f Abnormal Psychology, vol. 81, pp. 199-218). R ic h , A. R. and SCHROEDER, H. E. (1976), ‘Research issues in assertiveness training’ (Psychological Bulletin, vol. 83, pp. 1081-96). SALTER, A. (1949), Conditional Reflex Therapy, C apricorn Books, New York).

See also Coping skills interventions, Feminist therapy, Problem solving interventions, Role reversal.

A tta c h m e n t th e o ry A theory o f the relationship betw een the infant and his primary caregiver developed by Bowlby (1969, 1973, 1980) at the Tavistock Clinic, L ondon. U sing insights from psycho­ analysis, developm ental psychology and ethology, Bowlby revealed how the earliest relationship betw een the child and his chief caretaker forms the starting point for all later relationships. Attachm ent behaviour is defined by Bowlby (1975) as ‘any form of behaviour that results in a person attaining or retaining proximity to some other differen­ tiated and preferred individual, usually conceived as stronger a n d /o r wiser. It is developing during the second trim ester o f life and is evident from six m onths onward when an infant shows by his behaviour that he discrim inates sharply betw een his m otherfigure, a few other familiar people and every­ one else.’ Bowlby and his research collaborators, Ainsworth, the Robertsons, Parkes and others, have shown that attach­ m ent behaviour persists as an im portant part o f the person’s behavioural equipm ent not only during later childhood but during adolescence and adult life as well. In adults it is especially evident when a person is distressed, ill or 17

A TTA C H M EN T THEORY afraid. Ainsworth et al. (1978) have developed the ‘strange-situation’ test for m easuring the degree o f attachm ent to the m other figure in early childhood. T h e test m easures the differ­ ence in the child’s behaviour when m other is present, when m other is away and when she returns. Bowlby has shown how, by the second half o f the first year o f life, the infant is capable of organising his behaviour in term s o f goal setting and goal correction designed to m ain­ tain the proximity o f the caregiver. T h e primary attachm ent figure is associated with feelings o f security and he or she is especially needed when the infant experiences threat. W hen attachm ent is interrupted, separation anxiety is experienced and Robertson and Bowlby (1952) have shown that in these circum stances, the child typically passes through stages o f protest, despair and detach­ m ent. W hen m other returns, the child engages in avoidance/resistance as well as attachm ent behaviour. F urther studies o f responses to m ajor separations are sum m arised by Bowlby (1973). T h e quality o f the attachm ent experience is o f crucial im portance and Bowlby makes it clear that although there may be a hierarchy of attachm ent figures for the young child, there still needs to be one principal figure with which bonding, o f a warm and intim ate quality, can occur. T h is principal figure is normally, though not necessarily, the m other - a m other substitute can be satisfactory so long as the quality o f the relationship facilitates bonding and reduces as far as possible the experience o f separation anxiety. In his third volume, Bowlby (1980) shows how the processes o f readjustm ent after the loss o f significant figures in adulthood and the success with which new intim acies are forged are related to the degree o f security/anxiety present in the person’s early attachm ent relationship. However, as other researchers have pointed out (see Parkcs and StevensonH inde 1978), this docs not mean that the early relationship is such that later benign exper­ iences cannot effectively ameliorate earlier separation traum ata. 18

Bowlby’s work has been criticised by psychoanalysts because o f the introduction of work from other knowledge bases into his theoretical framework; by feminists because o f the apparent exclusive em phasis on the m other-infant tie; and by others who have felt that his theory implies that the effects o f early m aternal deprivation cannot be reversed (R utter, 1972; Clarke and Clarke, 1976; Schaffer, 1977). I.ater reworkings and m odi­ fications o f the theory have however taken note o f these criticisms. T h e literature on attach­ m ent theory is now vast and the area rem ains a fertile one for new developm ents. M any different aspects have been considered. F a r example, H erb ert et al (1982) have pointed to the growing interest in the process o f m otherto-infant bonding as being a complementary' process to attachm ent behaviour in the infant. T hey suggest that, as in the case o f infant attachm ent behaviour, what we currently know regarding the bonding process ‘suggests that a pessim istic view o f the irreversibility of early events or a nihilistic therapeutic stance with regard to m other-to-infant attitudes and behaviour are both m isplaced’. O ther researchers have directed increased attention to the role o f the father and other attachm ent figures (Lam b, 1977; Lam b, 1982). A ttach­ m ent theory has had im portant practical consequences for the organisation of children’s hospitals and other institutions and on child rearing practices; and in the way it has increased understanding o f the grief and m ourning processes, o f loneliness and detach­ m ent in later life and o f the cyclc o f em otional deprivation which results in the continuation o f m aternal deprivation in the next generation (Fraiberg 1980). Sroufe and W aters (1977) have described attachm ent theory as an organ­ isational construct which links individual difference to the different developm ent needs o f individuals in different environm ents. A in s w o r t h , M . D. S. etal. (1978), Patterns o f Attachment (John Wiley, Chichester). ATKINS, F. R. et al. (1981), Parent-Child Separation: A n Abstracted Bibliography (Plenum Press, New York).

A T T E M PT E D SO LU TIO N BOWLBY,J. (1969), Attachment and Loss, vol. 1, ‘A ttachm ent’ (Penguin, H arm ondsworth). BOWLBY, J. (197 2), Attachment and Loss, vol. 2, ‘Separation’ (Penguin, Harm ondsworth). B owlby , J. (1975), ‘Attachm ent theory, separation anxiety and m ourning’ (in Ham burg, D. A. and Brodie, H., American Handbook o f Psychiatry, vol. 6, Basic Books, New York). BOWLBY, J. (1977), ‘T h e making and breaking o f affectional bonds’ {Brit. J . o f Psychiatry, vol. 130, pp. 201-10). BOWLBY, J. (1980), Attachment and Loss, vol. 3, ‘L oss’ (Penguin, Harm onsworth). C larke , A. M . and C la rk e , A. D . B. (1976), Early Experience: M yth and Evidence (Open Books, London). F raib ERG, S. (ed.) (1980), Clinical Studies in Infant Mental Health (Tavistock, London). H er b ert , M. etal. (1982), ‘M other-to-infant “bonding” ’ (J. o f Child Psychol, and Psychiatry, vol. 23, pp. 205-21). H er d , D . H . (1978), ‘From object relations to attachm ent theory: a basis for family therapy’ (Brit. J . o f Med. Psychology, vol. 51, pp. 67-76). H in d e , R. A. (1979), Towards Understanding Relationships (Academic Press, London). L am b , M. E. (cd.) (1977), The Role o f the Father in Child Development (Wiley, New York). L amb , M. E. (1982), ‘Paternal influences on early socio-em otional developm ent’ (J. o f Child Psychol, and Psychiatry, vol. 23, pp. 185-90). PARKES, C. M . and STEVENSON-HlNDE, J. (eds) (1982), The Place o f Attachment in Human Behavior (Tavistock, London). R o b e r t s o n , J. and Bow lby , H . (1952), ‘Responses of young children to separation from their m others’ (Courrier du Centre Inter­ nationale de L 'Enfant, vol. 2, pp. 131 -42). R o b e r t s o n , J. and R o b e r t s o n , J. (1971), ‘Young children in b rief separations’ (in Eisslcr, R. K. etal., The Psychoanalytic Study o f the Child, vol. 26, Yale University Press, New Haven, Connecticut). RUTTER, M . (1972), Maternal Deprivation Re­ assessed (Penguin, H arm ondsworth). SCHAFFER, H. R. (1977), Studies in MotherInfant Interaction (Academic Press, London).

SROUFE, L. A. and WATERS, E. (1977), ‘Attachm ent as an organisational construct’ (Child Development, vol. 48, pp. 1184-99).

A tte m p te d so lu tio n T h e m eans which the prospective client has already tried in order to gain relief from his problem , prior to com ing to a therapist. N eighbours, friends and family m em bers may have already given advice and the client is likely to have tried out the ‘comm on sense’ solutions to his difficulties. Failure to identify these will involve the therapist in repetitious and unproductive work with the client. T h e presenting problem or symptom itself may rep re­ sent one o f the client’s attem pted solutions. Fisch et al. (1982) describe five basic attem pted solutions commonly found when clients present themselves to a therapist: attem pting to force som ething to happen which can only occur spontaneously (this usually relates to the client’s own perform ­ ance, e.g. sexual perform ance, insomnia, m em ory blocks, stuttering, addictions, etc.); attem pting to m aster a feared event by post­ poning it (e.g. a variety o f phobias, anxiety states, shyness, public perform ance blocks, exam ination nerves); attem pting to produce com pliance in another by force (e.g. marital conflicts, behaviour problem s in children, etc.); attem pting to produce a voluntary agree­ m ent to a repudiated action or behaviour (e.g. suggesting that person A should want to do what person B requires); and confirm ing an accuser’s suspicions by defending oneself from his accusation (e.g. denying or explaining away behaviour which has provoked another’s accusations). T herapists working within strategic therapy or focused problem resolution regard the client’s attem pted solution to his problem as a major problem to be addressed in therapy. T hey view the attem pted solution as being the problem and a real solution may likewise reside in the acceptance o f the ‘prob­ lem ’ which the client has ineffectively tried to solve. FISCH, R. et al. (1982), Tactics o f Change: Doing

Therapy Briefly (Jossey-Bass, San Francisco). 19

A T T E N D IN G A tte n d in g T h e process whereby the therapist listens, takes in and receives the verbal and non-verbal responses o f the patient. Attending is a basic interviewing skill, and an essential therapist activity in all psychotherapeutic m ethods. As Ivey and A uthier (1978) point out, ‘without the ability to attend, the helping interview regardless o f theoretical orientation becom es an empty sham ’. It involves the therapist in being open to incom ing stimuli from the patient and it is an essential ingred­ ient in the creation of an effective relationship with him. Focused attending requires the use o f a kind o f free-floating attention to allow as m uch o f the patient’s responses as possible to penetrate the therapist’s consciousness. It involves too, a relative freedom from those conflicts which m ight lead the therapist to block o ff the patient’s m aterial and an ability to m anage his or her own anxieties so that he or she avoids anticipating or assum ing the con­ tents o f the patient’s comm unication. D isturbed attentiveness may arise from the therapist’s own physical or psychological crises or from his counter transference reactions to the patient. Bion (1970) suggests that the therapist should enter each session without desire, memory' or understanding. Following such advice gready enhances the therapist’s capacity to listen productively, but it clearly conflicts to some extent with other imperatives such as the need to maintain a clear focus on treatm ent goals, devise tasks, develop hypotheses, etc., in an ongoing way from session to session. T h e type o f listening described by Bion (1970) and Langs (1978) is primarily directed towards the psychoanalytic therapies but in a modified form, active and creating attending or listening by the therapist is the essential prerequisite in all therapeutic approaches. It enables him to experience empathy and acceptance-, to engage in reflection and to offer containment for the patient’s disturbing phantasies. Langs (1978) proposes that the patient has an urgent need to cure the therapist and that a person becom es a therapist out o f his own need to place his pathology into the patient. T h e listening process involves this 20

m utual interaction betw een patient and therapist. Chessick (1982) offers a critique o f L angs’s views. Because o f its im portance in creating empathy, effective listening is p a r­ ticularly em phasised in the humanistic approaches. But it is also essential in taskfocused directive therapies. It allows the therapist to form ulate effective working hypthoses, develop an appropriate treatm ent plan and provide a model for effective communication. T h e complexity o f the listening process is greatly increased in the systemic therapies and in group work, and co-therapy is often used to enable the listening process to be more effec­ tive. Ivey and A uthier (1978) identify six skills which they regard as the behavioural indi­ cators o f effective attending: closed question­ ing; open-ended questioning; minimal encouraging (see Tracking)', paraphrasing (see Clarification)-, reflection and sum m arisation. T h e therapist needs to convey the fact that he is listening and the therapist’s ability to convey this to the patient acts as a reinforcer for further self-disclosure by the patient. B io n , W. R. (1970), ‘Attention and interpreta­ tion’ (in Seven Servants, Jason Aronson, New York). CHESSICK, R. D. (1982), ‘Psychoanalytic lis­ tening with special reference to the views of L angs’ (Contemporary Psychoanalysis, vol. 18, pp. 613-34). IVEY, A. E. and AUTHIER, J. (1978), Micro Counseling (2nd edn, C harles C. T hom as, Springfield, 111.). LANGS, R. (1978), The Listening Process (Jason Aronson, New York).

A ttra c tio n T h e personal quality which draws a person to want to associate with a n d /o r be influenced by another. A considerable am ount o f social psychological research has exam ined the determ inants and consequences o f inter­ personal attraction and its m eaning in term s o f social influence. T hese studies suggest that cooperativeness, physical appearance, liking, similarity, perceived expertness, w arm th and

A T T R IB U T IO N T H E O R Y familiarity are important determ inants of attractiveness. Goldstein (1971) examined the determ inants o f client attraction to the th era ­ pist in the early stages o f therapy, suggesting that the m ore attracted the client is to the therapist, the m ore likely he is to return and to co-operate with the treatm ent. N o correlations have been found to exist betw een therapist attractiveness and positive therapeutic out­ come, except indirectly through its beneficial effect on m aintaining the client in treatm ent, increasing the therapist’s influence over him and enhancing his level o f self-disclosure. H ow ­ ever, some studies suggest that perceived counsellor expertness and trustworthiness contribute to the client’s attraction to the therapist and hence to his satisafction with therapy. BERSCHF.ID, E. and WALSTF.R, E. H . (1978), Interpersonal Attraction (Addison-W esley, Reading, Mass.). G o i .DSTF.IN, A. P. (1971), Psychotherapeutic Attraction (Pergamon Press, New York). IlEPPNER, P. P. and H f.ESACKER, M . (1982), ‘T h e interpersonal influence process in reallife counseling’ (J. o f Counseling Psycholog]' vol. 29, pp. 215-23). I IEPPNF.R, P. P. and HEESACKER, M . (1983), ‘Perceived counselor characteristics: client expectations and client satisfaction with counseling’ (J. o f Counseling Psychology vol. 30, pp. 31-9). 1 lUSTON, T . (ed.) (1974), Foundations o f Inter­ personal Attraction (Academic Press, New York). See also Affiliation, Alliance, Cohesion, Thera­ peutic alliance. A ttrib u tio n th eo ry A social psychological theory' concerned with the origins, nature and consequences o f the individual’s perception o f causality. Interest in this area stems mainly from the work o f I Icidcr (1958) who examined the way in which indi­ viduals m ade cause and effect analyses in everyday situations. Interest in the subject was extended by Jones and Davis (1965); by Kelley (1967) and by Laing (1961). Jones et al. (1971)

suggest three fundam ental propositions of attribution theory: people assign causes for im portant instances o f behaviour and seek causally relevant information to support their hypothesis; the attribution o f causes follow's systematic rules; and causal attributions have im portant affective and behavioural conse­ quences, since an im portant com ponent o f the m eaning attached to an event, behaviour, feeling or problem is the cause to which it is attributed. A comm on distinction that is m ade both by patients and therapists is w hether the cause o f a problem should be located inside the patient (intrapsychic causation) or outside the patient (interpersonal or environm ental causation). A variety o f studies have shown that m anipulat­ ing the patient’s attribution from internal to external causes can be beneficial, a fact that is m ade use o f by therapists who use reframing as a technique. O thers (e.g. reality therapists and logotherapists) suggest that it is more helpful if the patient can own responsibility for his situation rather than projecting responsibility on to others. Johnson and M atross (1977) suggest that ‘instead o f focussing upon the “tru th ” o f an explanatory definition o f the client’s problem s, attribution theory focusses the therapist upon providing explanatory systems which facilitate the client’s acceptance o f responsibility for positive change’. Laing (1961) points out how the attributions placed on an individual by others helps him form his sense o f identity. Attributions which are experienced as incongruent with self­ perception invalidate the sense o f self. M uch o f Laing’s work has been devoted to showing how the individual can be ‘driven crazy’ by the contradictory attributions of others. IlEIDER, F . (1958), The Psychology o f Inter­ personal Relations, Wiley, New York. HEWSTONE, M. (ed.) (1983), Attribution Theory (Blackwell, Oxford). J o h n s o n , D. W. and M a t r o s s , R. (1977), ‘Interpersonal influence in psychotherapy: a social psychological view’ (in G urm an, A. S. and Razin, A. E., Effective Psychotherapy, Pergam on Press, New York).

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A U D IO T A P E JONKS, E. E. and D a v is , K. E. (1965), ‘F rom

acts to dispositions: th e attribution process in person p erception’ (in Berkowitz, L. (ed.), Advances in Experimental Social Psychology, vol. 2, A cadem ic Press, N ew York). JONES, E. E. et al. (1971), Attribution: Perceiv­ ing the Causes o f Behaviour (G eneral L earning Press, M orristow n, N ew Jersey). K e l l e y , H . H . (1967), ‘A ttribution theory in social psychology’ (Nebraska Symposium on Motivation, vol. 15, pp. 192-210). LAING, R . D . (1 9 6 1 ), The S e lf and Others (Penguin Books, I Iarm ondsw orth). S ee also Communication, Diagnosis, Double­ bind, Labelling, .Mystification, Scapegoat. A u d io ta p e S ee Audio visual equipment. A u d io v isu a l e q u ip m e n t A wide range o f audio visual equipm ent is currently used in the practice and teaching o f psychotherapy. Predictably, the newer m ethods o f psychotherapy have been m ore enthusiastic in th eir use o f these techniques, b u t m any traditional approaches have been in­ creasingly p rep ared to exploit their potential, particularly as training tools. Audio visual equipm ent for present purposes is defined as including films, video tapes, audio tapes, tele­ phones and the ‘bug in e ar’ device. As training toots, the m ajor use o f au