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Publications

Features of Pathogenic Beliefs in the Context of Childhood Maltreatment: Implications for Therapeutic Empathy

by Jay Reid & David Kealy

Abstract

One reason why patients may seek therapy is to address constricting beliefs about themselves, others and the world that diminish the quality of their lives. These pathogenic beliefs interfere with the pursuit of personal goals and are often the source of considerable distress. In this paper, we discuss the perspective from Control-Mastery Theory that such beliefs were once adaptive in the context of earlier traumatic relational experience, and are often held in place by loyalties and attachment ties to important figures. Therapists can facilitate patients’ efforts to disconfirm these beliefs by empathically understanding the form and function of the patient’s pathogenic beliefs historically and in the present. Such understanding is termed “person empathy” and is found to contribute to positive therapeutic outcomes. With the aim of helping to facilitate therapists’ empathy regarding patients’ pathogenic beliefs, we describe in this paper some of the original functions and subsequent consequences of such beliefs in patients’ lives.

Reid, J., & Kealy, D. (2023). Features of Pathogenic Beliefs in the Context of Childhood Maltreatment: Implications for Therapeutic Empathy. Smith College Studies in Social Work.

Full-Text Available Here: Features of Pathogenic Beliefs

Understanding and Working with the Effects of Parental Pathological Projective Identification.

by Jay Reid & David Kealy

Abstract

The present paper outlines parental pathological projective identification as a form of childhood adversity that some patients attempt to address in psychotherapy. This phenomenon involves a parent’s unconscious relocation of an unbearable state of mind, combined with the interpersonal evocation of such in the child. A child’s effort to deal with this experience may involve the development of pathogenic beliefs about the self. These beliefs subsequently cause difficulties in living and considerable distress. Through understanding the dynamics of parental pathological projective identification, clinicians may help patients to develop insight into the origins of their pathogenic beliefs, along with appropriate corrective experiences. The integration of Control-Mastery Theory with the concept of parental pathological projective identification can facilitate such understanding. A clinical example is provided to illustrate these concepts and their relevance to psychotherapy with adult patients.

Reid, J., & Kealy, D. (2022). Understanding and Working with the Effects of Parental Pathological Projective Identification. Smith College Studies in Social Work, 1-18.

Full-Text Available Here: Understanding and working with effects of PPI


Identifying patient verbal coaching in psychotherapy

Abstract

According to control-mastery theory (CMT), patients enter therapy with a plan (often unconscious) for how to work on their problems and disconfirm pathogenic beliefs. Patients want therapists to understand their plans and help them master their problems. CMT proposes that patients frequently coach their therapist to get them oriented and attuned to critical aspects of their treatment plan. The theory views patients coaching their therapists as an important part of the therapeutic process. The present study represents the first empirical research on this concept of coaching. It was designed to assess whether trained clinical judges could reliably identify and rate instances of patients coaching their therapists from psychotherapy transcript material. Segments from the beginning sessions of three brief (16-session) psychotherapy cases were presented to clinical judges to rate on the following dimensions: the degree to which a patient communication is coaching; the degree to which a patient communication is intended to help the therapist understand the plan; and the degree to which a patient communication is intended to influence the therapist’s behaviour. The results provide empirical evidence that patient coaching communications can be reliably distinguished from non-coaching communications. Moreover, there was consensus among clinical judges on both the degree to which a coaching communication was intended to help the therapist understand the patient’s treatment plan, and the degree to which a coaching communication was intended to influence the therapist’s behaviour. Further research is necessary to better understand the vicissitudes of this coaching dynamic in therapy.

Bugas, J., McCollum, J., Kealy, D., Silberschatz, G., Curtis, J. T., & Reid, J. (2023). Identifying patient verbal coaching in psychotherapy. Counselling and Psychotherapy Research23(1), 247-257.