... As one extremely articulate analysand who was terrified of any strong emotion recently told m... more ... As one extremely articulate analysand who was terrified of any strong emotion recently told me, "It doesn't really matter if I've put a blanket over my head or if I'm blind from some physical disability. ... Having said this, I reiterate that Brisman has made an extremely important point. ...
Daydreams, long recognized as containers of unarticulated, unrecognized and/or unconscious materi... more Daydreams, long recognized as containers of unarticulated, unrecognized and/or unconscious material, can be subtle but powerful tools for introducing clients to the process of exploring internal experience. They offer a crucial, relatively non-threatening path to self-understanding for individuals who come into therapy without the capacity for introspection, tolerance of affect, and sense of agency that are requisite for the process
It sometimes seems that the college experience is tailor-made for the development of eating disor... more It sometimes seems that the college experience is tailor-made for the development of eating disorders. Overwhelmed and bombarded by their feelings, college students often turn to behavioral means, like eating disorders, to cope. Contemporary research (e.g., Christenson et al., 1994) has shown that good and bad emotions alike can be managed by starvation, bingeing, overeating, purging, and/or obsessive exercise. For
While most clinicians-even those in their late twenties-did not grow up with contemporary technol... more While most clinicians-even those in their late twenties-did not grow up with contemporary technology, including social networks and cyber media, our adolescent clients have never known a world without it. We therefore often struggle not only to understand the impact of these technological forums on these younger generations, but also whether or not they can be useful tools or destructive agents in the therapeutic process. In this article we will consider research on the impact of Facebook, texting and other cyber technology on psychological health in adolescents. The data is often somewhat contradictory (e.g. one study says that Facebook makes adolescents lonelier while another says that it makes them feel more socially connected), but one finding is consistent: technology seems to amplify emotions not only in adolescents, but also in adults. In this article we will address ways that the technological world can affect adolescent development and what we, as clinicians, can do to ameliorate the negative and support the positive aspects of this sometimes overwhelming but clearly permanent aspect of contemporary life.
Chapter 6: “Making Assessments and Choosing Interventions” looks at the question of assessments a... more Chapter 6: “Making Assessments and Choosing Interventions” looks at the question of assessments and choosing interventions. It begins with a discussion of the Mental Status Exam (MSE), which can be a useful integrative tool that asks for information about a variety of different aspects of a client or potential client’s current and past psychological, social, cognitive and developmental functioning. The importance of ongoing assessment is noted. Continuing to construct a detailed picture of a client’s condition, symptoms, and strengths over the course of the work with any client can help a clinician choose interventions that make sense for that specific client at that specific point in time. Research, evidence and clinical examples show clinicians how to draw from a variety of different perspectives to make a thorough clinical assessment of any client at any point in the work. Detailed inquiry and small steps towards change are both considered in relation to ongoing assessment.
An Integrative Approach to Therapeutic Relationships
Integrative Clinical Social Work Practice, 2014
Chapter 7: “An Integrative Approach to Therapeutic Relationships” addresses the question of thera... more Chapter 7: “An Integrative Approach to Therapeutic Relationships” addresses the question of therapeutic relationships from different perspectives. Data shows that a relationship between therapist and client can be a key factor in therapeutic outcome, no matter what type of therapy a clinician is practicing. This chapter will look at this material to discuss what types of relationships lead to change in clients with different diagnoses and presenting problems. Bringing together numerous theories, evidence from research, and clinical material, this chapter addresses the important and often confusing question of whether it will be more helpful to encourage a client talk about the therapeutic relationship or to allow it unfold, undiscussed, as a background presence. Further discussion of the key concepts of “detailed inquiry” and “small steps” is presented in this chapter.
Chapter 2: “Contemporary Psychodynamic Models” introduces psychodynamic theory as a tool for unde... more Chapter 2: “Contemporary Psychodynamic Models” introduces psychodynamic theory as a tool for understanding and making meaning out of what lies behind some of a client’s behavior and experience. To some extent, such meaning-making is about articulating and mirroring a client’s personal story, or narrative. Research, evidence and clinical examples show how an integrative perspective provides flexibility of approach that makes understanding such meaning useful in almost any context. A psychodynamic approach does not necessarily mean offering insight as a therapeutic intervention. Using the concepts of detailed inquiry and small steps, the chapter helps clinicians think about what lies behind some of the thoughts, feelings, behaviors and symptoms that may not be immediately clear either to a person experiencing them or to an observer. Understanding unspoken, unarticulated or unconscious meaning can help a therapist determine what will be the best therapeutic approach to take.
Chapter 9: “Building and Working with an Integrative Team” returns to the idea of integrative tea... more Chapter 9: “Building and Working with an Integrative Team” returns to the idea of integrative teamwork. Using research, evidence and clinical examples, it shows how teams, whether formally structured or barely linked, can provide support and amplify the effects of any therapeutic experience. Team members can provide different perspectives on dynamics and behaviors, support one another through difficult situations, and provide backup so that a client is never without the support of a known and trusted professional. Research that underscores the importance of such backup, especially with fragile or difficult clients who need extra support or tend to fragment or de-stabilize when their primary therapist is unavailable, is discussed. Difficulties that can arise as a result of a team approach are also considered. Problems managing conflict are often part of clients’ struggles; engaging in and untangling problems that arise in both interpersonal and interdisciplinary aspects of a team can be part of any therapeutic process.
Chapter 8: “Small Steps and Manageable Goals” further explores the process of goal-setting and ev... more Chapter 8: “Small Steps and Manageable Goals” further explores the process of goal-setting and evaluation begun in earlier chapters. This chapter looks closely at one of the themes of the book, the idea of breaking large, often overwhelming problems and goals into smaller, more manageable components. This activity is presented not only as a tool but as an important part of a therapeutic process and captures an essential aspect of integrative work. Using material from research and clinical examples, this chapter shows clinicians how to help clients take small steps towards their goals. This process can address immediate symptoms and engage long-term change, whether using cognitive or behavioral tools, focusing on body-mind dynamics, or working psychodynamically. The chapter also helps clinicians break their own goals into manageable segments. We want to help our clients feel better immediately even as we help them make changes that will point toward a happier and more productive life in the future. In this chapter we will discuss the way that an integrative position can help us find a place to start that journey.
Eating disorders are no longer considered isolated or single symptom disorders. Numerous authors ... more Eating disorders are no longer considered isolated or single symptom disorders. Numerous authors have noted difficulties categorizing and treating these "refractory" disorders, and over the past three decades the number of techniques, ideas, and approaches available to address these issues has expanded exponentially. While this provides therapists with a wide range of possible interventions, it also leaves open the question of how to choose from this wide field of possibilities. In this discussion I offer some ideas about bringing together disparate, even contradictory, therapeutic ideas and techniques into a relatively cohesive frame which will enhance the work of any therapist with clients with eating disorders.
Psyche and Soma: The Body as Canvas. Discussion of "I Made a Picture of My Life—a Life from the Picture: The life of the body in the pictures and writings of Frida Kahlo" by Pirkko Siltala
The use of group therapy to help women with eating disorders differentiate and articulate affect
Group, 1994
In this discussion of eating disorders, symptoms are viewed as responses to unprocessed and unpro... more In this discussion of eating disorders, symptoms are viewed as responses to unprocessed and unprocessable affect—what Stolorow and Atwood, Krystal, and Sifneos have called “alexithymia.” The article explores ways in which a group experience can help to provide an arena for the articulation and exploration of this affect. The group can provide its members with the responsive milieu necessary for
K. Gentile: Creating Bodies: Eating Diorders as Self-Destructive Survival
Clinical Social Work Journal, 2009
... F. Diane Barth ... In a creative approach to the subject, Katie Gentile's book Creat... more ... F. Diane Barth ... In a creative approach to the subject, Katie Gentile's book Creating Bodies: Eating Disorders as Self-Destructive Survival captures some of the complexity of these symptoms, including their interpersonal and rela-tional impact and also their multiple functions on ...
... As one extremely articulate analysand who was terrified of any strong emotion recently told m... more ... As one extremely articulate analysand who was terrified of any strong emotion recently told me, "It doesn't really matter if I've put a blanket over my head or if I'm blind from some physical disability. ... Having said this, I reiterate that Brisman has made an extremely important point. ...
Daydreams, long recognized as containers of unarticulated, unrecognized and/or unconscious materi... more Daydreams, long recognized as containers of unarticulated, unrecognized and/or unconscious material, can be subtle but powerful tools for introducing clients to the process of exploring internal experience. They offer a crucial, relatively non-threatening path to self-understanding for individuals who come into therapy without the capacity for introspection, tolerance of affect, and sense of agency that are requisite for the process
It sometimes seems that the college experience is tailor-made for the development of eating disor... more It sometimes seems that the college experience is tailor-made for the development of eating disorders. Overwhelmed and bombarded by their feelings, college students often turn to behavioral means, like eating disorders, to cope. Contemporary research (e.g., Christenson et al., 1994) has shown that good and bad emotions alike can be managed by starvation, bingeing, overeating, purging, and/or obsessive exercise. For
While most clinicians-even those in their late twenties-did not grow up with contemporary technol... more While most clinicians-even those in their late twenties-did not grow up with contemporary technology, including social networks and cyber media, our adolescent clients have never known a world without it. We therefore often struggle not only to understand the impact of these technological forums on these younger generations, but also whether or not they can be useful tools or destructive agents in the therapeutic process. In this article we will consider research on the impact of Facebook, texting and other cyber technology on psychological health in adolescents. The data is often somewhat contradictory (e.g. one study says that Facebook makes adolescents lonelier while another says that it makes them feel more socially connected), but one finding is consistent: technology seems to amplify emotions not only in adolescents, but also in adults. In this article we will address ways that the technological world can affect adolescent development and what we, as clinicians, can do to ameliorate the negative and support the positive aspects of this sometimes overwhelming but clearly permanent aspect of contemporary life.
Chapter 6: “Making Assessments and Choosing Interventions” looks at the question of assessments a... more Chapter 6: “Making Assessments and Choosing Interventions” looks at the question of assessments and choosing interventions. It begins with a discussion of the Mental Status Exam (MSE), which can be a useful integrative tool that asks for information about a variety of different aspects of a client or potential client’s current and past psychological, social, cognitive and developmental functioning. The importance of ongoing assessment is noted. Continuing to construct a detailed picture of a client’s condition, symptoms, and strengths over the course of the work with any client can help a clinician choose interventions that make sense for that specific client at that specific point in time. Research, evidence and clinical examples show clinicians how to draw from a variety of different perspectives to make a thorough clinical assessment of any client at any point in the work. Detailed inquiry and small steps towards change are both considered in relation to ongoing assessment.
An Integrative Approach to Therapeutic Relationships
Integrative Clinical Social Work Practice, 2014
Chapter 7: “An Integrative Approach to Therapeutic Relationships” addresses the question of thera... more Chapter 7: “An Integrative Approach to Therapeutic Relationships” addresses the question of therapeutic relationships from different perspectives. Data shows that a relationship between therapist and client can be a key factor in therapeutic outcome, no matter what type of therapy a clinician is practicing. This chapter will look at this material to discuss what types of relationships lead to change in clients with different diagnoses and presenting problems. Bringing together numerous theories, evidence from research, and clinical material, this chapter addresses the important and often confusing question of whether it will be more helpful to encourage a client talk about the therapeutic relationship or to allow it unfold, undiscussed, as a background presence. Further discussion of the key concepts of “detailed inquiry” and “small steps” is presented in this chapter.
Chapter 2: “Contemporary Psychodynamic Models” introduces psychodynamic theory as a tool for unde... more Chapter 2: “Contemporary Psychodynamic Models” introduces psychodynamic theory as a tool for understanding and making meaning out of what lies behind some of a client’s behavior and experience. To some extent, such meaning-making is about articulating and mirroring a client’s personal story, or narrative. Research, evidence and clinical examples show how an integrative perspective provides flexibility of approach that makes understanding such meaning useful in almost any context. A psychodynamic approach does not necessarily mean offering insight as a therapeutic intervention. Using the concepts of detailed inquiry and small steps, the chapter helps clinicians think about what lies behind some of the thoughts, feelings, behaviors and symptoms that may not be immediately clear either to a person experiencing them or to an observer. Understanding unspoken, unarticulated or unconscious meaning can help a therapist determine what will be the best therapeutic approach to take.
Chapter 9: “Building and Working with an Integrative Team” returns to the idea of integrative tea... more Chapter 9: “Building and Working with an Integrative Team” returns to the idea of integrative teamwork. Using research, evidence and clinical examples, it shows how teams, whether formally structured or barely linked, can provide support and amplify the effects of any therapeutic experience. Team members can provide different perspectives on dynamics and behaviors, support one another through difficult situations, and provide backup so that a client is never without the support of a known and trusted professional. Research that underscores the importance of such backup, especially with fragile or difficult clients who need extra support or tend to fragment or de-stabilize when their primary therapist is unavailable, is discussed. Difficulties that can arise as a result of a team approach are also considered. Problems managing conflict are often part of clients’ struggles; engaging in and untangling problems that arise in both interpersonal and interdisciplinary aspects of a team can be part of any therapeutic process.
Chapter 8: “Small Steps and Manageable Goals” further explores the process of goal-setting and ev... more Chapter 8: “Small Steps and Manageable Goals” further explores the process of goal-setting and evaluation begun in earlier chapters. This chapter looks closely at one of the themes of the book, the idea of breaking large, often overwhelming problems and goals into smaller, more manageable components. This activity is presented not only as a tool but as an important part of a therapeutic process and captures an essential aspect of integrative work. Using material from research and clinical examples, this chapter shows clinicians how to help clients take small steps towards their goals. This process can address immediate symptoms and engage long-term change, whether using cognitive or behavioral tools, focusing on body-mind dynamics, or working psychodynamically. The chapter also helps clinicians break their own goals into manageable segments. We want to help our clients feel better immediately even as we help them make changes that will point toward a happier and more productive life in the future. In this chapter we will discuss the way that an integrative position can help us find a place to start that journey.
Eating disorders are no longer considered isolated or single symptom disorders. Numerous authors ... more Eating disorders are no longer considered isolated or single symptom disorders. Numerous authors have noted difficulties categorizing and treating these "refractory" disorders, and over the past three decades the number of techniques, ideas, and approaches available to address these issues has expanded exponentially. While this provides therapists with a wide range of possible interventions, it also leaves open the question of how to choose from this wide field of possibilities. In this discussion I offer some ideas about bringing together disparate, even contradictory, therapeutic ideas and techniques into a relatively cohesive frame which will enhance the work of any therapist with clients with eating disorders.
Psyche and Soma: The Body as Canvas. Discussion of "I Made a Picture of My Life—a Life from the Picture: The life of the body in the pictures and writings of Frida Kahlo" by Pirkko Siltala
The use of group therapy to help women with eating disorders differentiate and articulate affect
Group, 1994
In this discussion of eating disorders, symptoms are viewed as responses to unprocessed and unpro... more In this discussion of eating disorders, symptoms are viewed as responses to unprocessed and unprocessable affect—what Stolorow and Atwood, Krystal, and Sifneos have called “alexithymia.” The article explores ways in which a group experience can help to provide an arena for the articulation and exploration of this affect. The group can provide its members with the responsive milieu necessary for
K. Gentile: Creating Bodies: Eating Diorders as Self-Destructive Survival
Clinical Social Work Journal, 2009
... F. Diane Barth ... In a creative approach to the subject, Katie Gentile's book Creat... more ... F. Diane Barth ... In a creative approach to the subject, Katie Gentile's book Creating Bodies: Eating Disorders as Self-Destructive Survival captures some of the complexity of these symptoms, including their interpersonal and rela-tional impact and also their multiple functions on ...
Uploads
Papers by Diane Barth