The scientific status of unconscious processes: is Freud really dead?

Do Psychedelics Facilitate Emergence of Unconscious Psychological Processes?

Psychedelic substances have a long history of use in traditional healing and religious ceremonies worldwide and are increasingly being investigated for their possible therapeutic usage. However, there is still a lack of consensus regarding how best to characterize the psychological effects of psychedelics and how they bring about the positive therapeutic outcomes observed in clinical studies. The aim of this article is to review available evidence from quantitative and qualitative studies on psychedelic-assisted therapy, as well as neurobiological studies, in relation to the hypothesis that psychedelics facilitate the emergence of emotionally charged unconscious material, originally proposed by pioneering psychedelics researcher Stanislav Grof. The reviewed process studies of therapeutic mechanisms in psychedelic-assisted therapy and qualitative studies of treatment participants clearly indicate that the psychedelic experience is associated with the subjective experience of having increased access to and awareness of emotions, memories, and perceptions that are normally avoided or outside of conscious awareness. Brain-imaging studies point to several different neurobiological effects of psychedelics that might be related to these subjective psychological experiences. Available evidence also indicates that this process might constitute an important therapeutic mechanism in psychedelic-assisted therapy, worthy of further investigation.

In our own words: key terms and trends in psychoanalytic history

Inspired by the work of Fonagy (2008) and Dent and Christian (2019), this study applies a form of quantitative textual analysis to 300 terms of psychoanalytic interest in the PEP archives by tracking their historical prevalence in five-year increments using the aggregate number of articles featuring each term in the field's journals. Our results confirm some of the more well-known inflection points in the history and application of psychoanalytic theory, while also revealing some intriguing surprises. Psychoanalysis remains fundamentally a depth psychology, yet it has increasingly acknowledged the external causes of distress and trauma. Changes in the prevalence of terminology around psychopathology, defense mechanisms, development, gender and sexuality, and psychoanalytic technique are discussed.

Una revisione della teoria delle pulsioni

Questo contributo propone profonde revisioni della teoria freudiana delle pulsioni. Le principali revisioni sono le seguenti: (1) Le pulsioni sono coscienti e sono in effetti la fonte di tutta la co-scienza. (2) L'energia pulsionale è equiparata all'energia libera variazionale (variational free energy) ed è quindi quantificabile in linea di principio. (3) Non esistono solo due pulsioni: ve ne sono tante di cui, per la precisione, sette possono essere categorizzate come pulsioni "emotive"; tutte le altre possono essere descritte come pulsioni "corporee". (4) Tutte le pulsioni sono o auto-conservative o in funzione della preservazione della specie; non esiste invece una pulsione di mor-te all'opera nella mente. Ciò significa che, dal punto di vista del meccanismo funzionale, tutte le pulsioni sono omeostatiche e anti-entropiche. (5) Il grande compito dello sviluppo mentale è quel-lo di aggiungersi alle predizioni istintuali innate, permettendo così non solo di gratificare le nostre più diverse esigenze pulsionali ma anche di armonizzarle tra loro. Questo lavoro viene svolto apprendendo dall'esperienza, principalmente attraverso un comportamento volontario, che è gover-nato da sentimenti coscienti.

Questions Raised by the Controversy Over Recovered Memories of Incest

The controversy in the mental health community over recovered memory has been heated. The devastation to families falsely accused of incest has been profound. A fortunate consequence, however, has been the vigorous pursuit of answers to a variety of mind-behavior questions raised by the controversy. In this article I raise some of the important questions and in reply I review and summarize some of the data. Some questions deal with the nature of memory and of unconscious processes, especially the role of implicit memory; the techniques of recovered memory therapy and the evolution of pseudo-memories and its relevance to clinical practice; the effects, real and alleged, of trauma; the place of dreams, flashbacks, and repetitive patterns of behavior in the understanding of memory and behavior; and finally, questions dealing with the definition of reality. All of these are important issues for the psychoanalyst.

Is the Influence of Freud Declining in Psychology and Psychiatry? A Bibliometric Analysis

Sigmund Freud is occasionally perceived as outdated and his work no longer relevant to academia. The citing papers (CPs) that cited Freud works were collected from Web of Science and analyzed. The 10 most common research areas of the CPs were noted, and the overall volume of the respective bodies of literature were retrieved. I computed the annual percentage of the respective bodies of literature that cited Freud. On a separate note, I computed the annual percentage of citations coming from psychology and psychiatry. Results based on 42,571 CPs found that psychology accounted for over half of the citations to Freud. The percentage of psychology papers citing Freud declined gradually from around 3% in the late 1950s to around 1% in the 2010s, in an extent of −0.02% per year over the entire survey period spanning across 65 years from 1956 till 2020 (P < 0.001). In psychiatry, a similar decline was observed, from around 4–4.5% in the late 1950s to just below 0.5% in the 2010s, in an extent of −0.1% per year (P < 0.001). However, a reverse trend was observed for psychoanalysis literature, which generally increased from 10–20% before the 1980s to 25–30% since the 2000s, in an extent of +0.2% per year (P < 0.001). Meanwhile, the annual percentage of CPs coming from psychology and psychiatry was decreasing by 0.4% per year (P < 0.001). Bibliometric data supported the notion that Freud's influence was on a decline in psychology and psychiatry fields.

The Psychoanalyst's Resistance to the Task of Proof

Freud's letters and papers indicate that his emotions interfered with his endeavor to justify his theories to an unsympathetic public. His example suggests that a psychoanalyst who wishes to prove the validity of psychoanalysis to critics may experience strong and unpalatable emotions that in turn stimulate defense mechanisms, such as avoidance of proving activities. While Freud habitually observed the public's resistance to psychoanalytic ideas, he overlooked the possibility of his own resistance to presenting them. Those who are interested in pursuing scientific validation of psychoanalytic theories and efficacy may wish to consider whether psychoanalysts' emotional resistances have contributed to the psychoanalytic community's halting approach to validation and the presentation of proof.

Psicoanalisi e ricerca scientifica

Vengono riassunte le affermazioni centrali della psicoanalisi, e date sintetiche risposte alle seguenti tre domande: (a) Come funziona la mente emotiva, nella salute e nella malattia? (b) Cosa si propone di raggiungere il trattamento psicoanalitico? (c) Quanto è efficace il trattamento psicoanalitico? Viene argomentato che, mentre possono esservi differenti opinioni su dettagli specifici, vi è un accordo su alcune affermazioni centrali della psicoanalisi, o premesse di base, che sono scientifiche in quanto verificabili e falsificabili. Queste affermazioni centrali, che sono basate sulle evidenze (evidence-based), mostrano che il trattamento psicoanalitico è altamente efficace, e per alcuni aspetti superiore alla terapia cognitivo-comportamentale e ai farmaci.

Harm in Hypnosis: Three Understandings From Psychoanalysis That Can Help

Over 50 years of empirical data demonstrate unequivocally that psychotherapy can cause harm as well as good. Two therapist factors increasing harm risk are inadequate assessment of patients' vulnerabilities and certain attitudes/affects. Adding hypnosis as a technique within psychotherapy heightens risk for harm because: (a) trance can unexpectedly expose patient vulnerabilities (through loosening reality orientation, lessening structure, generating unfamiliar sensations and perceptions, and intensifying access to interior information such as emotions and imagery); and (b) trance can unexpectedly increase porousness to therapist's attitudes/affects (through heightening mental receptivity to the internal states of others). A century of clinical data from psychoanalysis offers guidance for protecting against such risks. Concepts of structure, interiority, and countertransference are explicated and translated into practical clinical suggestions for harm prevention.

Psychodynamic Couple Therapy: A Practical Synthesis

This essay reviews the most significant contributions of psychodynamic thought to the field of couple therapy. It distills the work of numerous clinicians and researchers who, though writing from diverse perspectives, share fundamental assumptions and concerns. Rather than emphasizing differences between schools of thought, this paper mines their best contributions in a discussion of five central therapeutic targets: underlying issues, divergent subjective experiences, transferences, projective identification, and acceptance. Two detailed cases illustrate the benefits and techniques for targeting these five therapeutic domains. Video Abstract is found in the online version of the article.

There Is an 'Unconscious,' but It May Well Be Conscious

Depth psychology finds empirical validation today in a variety of observations that suggest the presence of causally effective mental processes outside conscious experience. I submit that this is due to misinterpretation of the observations: the subset of consciousness called “meta-consciousness” in the literature is often mistaken for consciousness proper, thereby artificially creating space for an “unconscious.” The implied hypothesis is that all mental processes may in fact be conscious, the appearance of unconsciousness arising from our dependence on self-reflective introspection for gauging awareness. After re-interpreting the empirical data according to a philosophically rigorous definition of consciousness, I show that two well-known phenomena corroborate this hypothesis: (a) experiences that, despite being conscious, aren’t re-represented during introspection; and (b) dissociated experiences inaccessible to the executive ego. If consciousness is inherent to all mentation, it may be fundamental in nature, as opposed to a product of particular types of brain function.

Unconscious Fantasy and The Priming Phenomenon

This paper is the third in a series of investigations into (1) the nature and development of unconscious fantasy, (2) its place in a contemporary model of mind that, parenthetically, suggests a possible solution to the problem of theoretical pluralism, and (3) its mode of operation in the mind. The aim of these investigations is to update the notion of unconscious fantasy, an indispensable construct in psychoanalytic theories that assume out-of-awareness mentation, and to situate that construct within contemporary views of mental functioning in disciplines such as philosophy of mind, cognitive science, and developmental psychology. At the same time, data accessible only through psychoanalytic work challenge these fields with findings that indicate the need for further investigation. This paper argues that experimental evidence on the phenomenon of "priming" lends support to one of the seminal claims in our field, one frequently attacked as an outmoded shibboleth: that is, that the past matters, whether encoded in declarative or in procedural memory. In common parlance, we are "primed" to respond to some situations in predetermined ways; the past primes us to experience the present in often unique and personal ways. There is evidence too that the priming mechanism and the encoding of subjective experience in declarative and procedural memory operate from very early in life.

Interpreting "Personality" Taxonomies: Why Previous Models Cannot Capture Individual-Specific Experiencing, Behaviour, Functioning and Development. Major Taxonomic Tasks Still Lay Ahead

As science seeks to make generalisations, a science of individual peculiarities encounters intricate challenges. This article explores these challenges by applying the Transdisciplinary Philosophy-of-Science Paradigm for Research on Individuals (TPS-Paradigm) and by exploring taxonomic "personality" research as an example. Analyses of researchers' interpretations of the taxonomic "personality" models, constructs and data that have been generated in the field reveal widespread erroneous assumptions about the abilities of previous methodologies to appropriately represent individual-specificity in the targeted phenomena. These assumptions, rooted in everyday thinking, fail to consider that individual-specificity and others' minds cannot be directly perceived, that abstract descriptions cannot serve as causal explanations, that between-individual structures cannot be isomorphic to within-individual structures, and that knowledge of compositional structures cannot explain the process structures of their functioning and development. These erroneous assumptions and serious methodological deficiencies in widely used standardised questionnaires have effectively prevented psychologists from establishing taxonomies that can comprehensively model individual-specificity in most of the kinds of phenomena explored as "personality", especially in experiencing and behaviour and in individuals' functioning and development. Contrary to previous assumptions, it is not universal models but rather different kinds of taxonomic models that are required for each of the different kinds of phenomena, variations and structures that are commonly conceived of as "personality". Consequently, to comprehensively explore individual-specificity, researchers have to apply a portfolio of complementary methodologies and develop different kinds of taxonomies, most of which have yet to be developed. Closing, the article derives some meta-desiderata for future research on individuals' "personality".

Realism, Self-Deception and the Logical Paradox of Repression

Historically, repression has been considered a cornerstone of psychoanalytic theory. However, explaining how the ego maintains repression without knowing the repressed appears to create a logical paradox of knowing in order not to know. Maze and Henry's realist analysis of the problem provides an important new direction for framing possible solutions. However, their proposed explanation in terms of `affective blocking' is found to be limited with respect to explaining important features of repression, such as the clinical phenomenon of resistance. Alternatively, the present thesis proposes that a solution can be provided in terms of strong partitioning and neural inhibition. The resolution of the paradox hinges upon the recognition that repression inhibits knowledge of knowing the repressed. Implications of this position for understanding self-deception are discussed.

Model for understanding consumer textural food choice

The current paradigm for developing products that will match the marketing messaging is flawed because the drivers of product choice and satisfaction based on texture are misunderstood. Qualitative research across 10 years has led to the thesis explored in this research that individuals have a preferred way to manipulate food in their mouths (i.e., mouth behavior) and that this behavior is a major driver of food choice, satisfaction, and the desire to repurchase. Texture, which is currently thought to be a major driver of product choice, is a secondary factor, and is important only in that it supports the primary driver-mouth behavior. A model for mouth behavior is proposed and the qualitative research supporting the identification of different mouth behaviors is presented. The development of a trademarked typing tool for characterizing mouth behavior is described along with quantitative substantiation of the tool's ability to group individuals by mouth behavior. The use of these four groups to understand textural preferences and the implications for a variety of areas including product design and weight management are explored.

Unconscious learning processes: mental integration of verbal and pictorial instructional materials

This review aims to provide an insight into human learning processes by examining the role of cognitive and emotional unconscious processing in mentally integrating visual and verbal instructional materials. Reviewed literature shows that conscious mental integration does not happen all the time, nor does it necessarily result in optimal learning. Students of all ages and levels of experience cannot always have conscious awareness, control, and the intention to learn or promptly and continually organize perceptual, cognitive, and emotional processes of learning. This review suggests considering the role of unconscious learning processes to enhance the understanding of how students form or activate mental associations between verbal and pictorial information. The understanding would assist in presenting students with spatially-integrated verbal and pictorial instructional materials as a way of facilitating mental integration and improving teaching and learning performance.

Unconscious learning processes: mental integration of verbal and pictorial instructional materials

This review aims to provide an insight into human learning processes by examining the role of cognitive and emotional unconscious processing in mentally integrating visual and verbal instructional materials. Reviewed literature shows that conscious mental integration does not happen all the time, nor does it necessarily result in optimal learning. Students of all ages and levels of experience cannot always have conscious awareness, control, and the intention to learn or promptly and continually organize perceptual, cognitive, and emotional processes of learning. This review suggests considering the role of unconscious learning processes to enhance the understanding of how students form or activate mental associations between verbal and pictorial information. The understanding would assist in presenting students with spatially-integrated verbal and pictorial instructional materials as a way of facilitating mental integration and improving teaching and learning performance.

Personality psychology: lexical approaches, assessment methods, and trait concepts reveal only half of the story--why it is time for a paradigm shift

This article develops a comprehensive philosophy-of-science for personality psychology that goes far beyond the scope of the lexical approaches, assessment methods, and trait concepts that currently prevail. One of the field's most important guiding scientific assumptions, the lexical hypothesis, is analysed from meta-theoretical viewpoints to reveal that it explicitly describes two sets of phenomena that must be clearly differentiated: 1) lexical repertoires and the representations that they encode and 2) the kinds of phenomena that are represented. Thus far, personality psychologists largely explored only the former, but have seriously neglected studying the latter. Meta-theoretical analyses of these different kinds of phenomena and their distinct natures, commonalities, differences, and interrelations reveal that personality psychology's focus on lexical approaches, assessment methods, and trait concepts entails a) erroneous meta-theoretical assumptions about what the phenomena being studied actually are, and thus how they can be analysed and interpreted, b) that contemporary personality psychology is largely based on everyday psychological knowledge, and c) a fundamental circularity in the scientific explanations used in trait psychology. These findings seriously challenge the widespread assumptions about the causal and universal status of the phenomena described by prominent personality models. The current state of knowledge about the lexical hypothesis is reviewed, and implications for personality psychology are discussed. Ten desiderata for future research are outlined to overcome the current paradigmatic fixations that are substantially hampering intellectual innovation and progress in the field.

An operational analysis of the clinical goals of psychoanalytic technique

An operational description is presented of the clinical goals of analytic technique shared by various analytic orientations. This operational schema of their similarities is then used to organize their differences. In this schema, analytic schools differ from one another in three areas: the kind of unconscious content looked for in uncovering; aspects of the process considered subject to direct intervention; and the most effective stance and interventions with which to pursue their shared analytic goals. Organizing the differences between approaches in the context of shared analytic process goals makes it possible to clarify implicit clinical assumptions and to develop empirical rather than theoretical clinical discussions between analytic orientations. Understanding the intent or purpose of an intervention is useful in comparing approaches, exploring clinical controversies, clarifying implicit clinical assumptions, and understanding approaches more deeply in their own terms.

On neuropsychoanalytic metaphysics

Neuropsychoanalysis focuses on the neural counterparts of psychoanalytically interesting phenomena and has left the difference in the metaphysical presuppositions between neuroscience and psychoanalysis unexamined. The authors analyse the logical possibilities concerning the relation between the brain and the mental unconscious in terms of the serial, parallel, epiphenomenalist and Kantian conceptions, and conclude that none of them provides a satisfactory ground for neuropsychoanalysis. As far as psychoanalytic explanations refer to the mental unconscious, they cannot be verified with the help of neuroscience. Neither is it possible to form a picture of how a neuro-viewpoint might be of help for psychoanalytic theorizing. Neuropsychoanalysis has occasionally been seen as a reductionist affair, but the authors suggest that neuropsychoanalysts themselves lean on the hybrid conception, which combines neuroscientific and psychoanalytic viewpoints. The authors state arguments in favour of the interfield conception of neuropsychoanalysis that takes seriously the metaphysical tensions between neuroscience and psychoanalysis.

Development of Instruments and Evaluative Procedures on Contributors to Illness and Health

Instruments available for a person-centered assessment of the causes of well-being and ill-being are described. Monitoring at the level of symptoms of illness and past lifestyle behavior has failed to promote change in well-being in a strong and consistent way. Therefore, we illustrate a way of assessing the interactions among multiple aspects of the causes of well-being. For example, at least three distinct aspects of human well-being are known to interact synergistically to promote health - neurobiological plasticity, self-regulatory functioning and virtue. The neglect of any one of the ternary aspects of well-being impedes understanding and treatment of the whole person. Each aspect can be reliably measured using quantitative and qualitative techniques to facilitate treatment planning and analysis of their interactions as a complex adaptive system, although further work is needed to clarify the content and structure of each aspect.

The evolved function of the oedipal conflict

Freud based his oedipal theory on three clinical observations of adult romantic relationships: (1) Adults tend to split love and lust; (2) There tend to be sex differences in the ways that men and women split love and lust; (3) Adult romantic relationships are unconsciously structured by the dynamics of love triangles in which dramas of seduction and betrayal unfold. Freud believed that these aspects of adult romantic relationships were derivative expressions of a childhood oedipal conflict that has been repressed. Recent research conducted by evolutionary psychologists supports many of Freud's original observations and suggests that Freud's oedipal conflict may have evolved as a sexually selected adaptation for reproductive advantage. The evolution of bi-parental care based on sexually exclusive romantic bonds made humans vulnerable to the costs of sexual infidelity, a situation of danger that seriously threatens monogamous bonds. A childhood oedipal conflict enables humans to better adapt to this longstanding evolutionary problem by providing the child with an opportunity to develop working models of love triangles. On the one hand, the oedipal conflict facilitates monogamous resolutions by creating intense anxiety about the dangers of sexual infidelity and mate poaching. On the other hand, the oedipal conflict in humans may facilitate successful cheating and mate poaching by cultivating a talent for hiding our true sexual intentions from others and even from ourselves. The oedipal conflict in humans may be disguised by evolutionary design in order to facilitate tactical deception in adult romantic relationships.

Workplace Discrimination and the Perception of Disability

This article documents the employment discrimination experienced by Americans “regarded as” disabled (but not medically verified as such), using the Integrated Mission System of the U.S. Equal Employment Opportunity Commission (EEOC). Claimants who were perceived as disabled, as contrasted with those with documented disabilities, were more likely to file charges of discrimination based on the issues of discharge or hiring. Decisions by the EEOC in favor of claimants perceived to have disabilities disproportionately exceeded those in favor of claimants with documented disabilities. This finding lends support to the assertion that unconscious/implicit bias is persistent in the workplace.

One hundred years after Sigmund Freud's lectures in America: towards an integration of psychoanalytic theories and techniques within psychiatry

The impact of Sigmund Freud's lectures in America in 1909 is discussed. Some of the roots of psychoanalysis and their contemporary relevance are addressed: neurological ideas, the discussions of the sexologists, and the degeneration theories at the turn of the twentieth century. Factors which led to the dominance of psychoanalysis in psychiatry included, in particular, its arguments against the hopelessness of degeneracy theories;yet,by isolating itself from mainstream academic psychiatry and psychology,organized psychoanalysis itself contributed to its own subsequent marginalization. In order to re-integrate itself with mainstream psychiatry, psychoanalysis needs to appreciate the importance of systematic demonstrations of the therapeutic power of psychodynamic/psychoanalytic concepts and techniques when caring for individuals.

Psychoanalytic lexicography: notes from two "harmless drudges"

The co-Editors in Chief of the American Psychoanalytic Association's new edition of Psychoanalytic Terms and Concepts (previously edited by Moore and Fine and last revised in 1990) recount their lexicographical adventures. Editing a dictionary at the turn of the twenty-first century is a daunting, some might say foolhardy, undertaking. The most obvious challenge faced by the editors was the growing pluralism within psychoanalysis. However, a more fundamental challenge was that the object of psychoanalytic study, the mind and its processes, can be known only by putting words to our observations, inferences, and interpretations. Psychoanalytic thinkers, starting with Freud, have wrestled with this challenge in ways that define the history of psychoanalysis itself. Long gone are the days when Freud could commend the "correctness" of Sterba's lexicographical efforts. Today postmodern critics, at the opposite extreme, argue that terms and concepts are best understood as "verbal gestures" in the "language-game" of psychoanalysis. Some go so far as to assert that dictionary-writing is obsolete. The co-Editors in Chief of Psychoanalytic Terms and Concepts have not succumbed to such nihilistic views, but have instead struggled to establish a reasonable stance within contemporary debates over the nature of psychoanalytic language.

Mind-brain and consciousness in psychoanalysis

Understanding how the brain produces conscious mentation is vital to the prospective integration of psychoanalytic and neuroscientific study of the mind-brain relation. This essay explores some of the current opinions, based on recent neuroscientific research, regarding origins of consciousness in the brain. Areas explored include levels of consciousness, waking versus dream consciousness, and issues of consciousness and self-organization in split-brain studies. Some tentative suggestions are made regarding clinical implications of this perspective.

Succeeding at succession: the myth of Orestes

Although the myth of Oedipus seems an inevitable template for understanding succession in psychoanalysis, the myth of Orestes offers a more complex and promising view of the intergenerational transfer of leadership and authority, one that takes into account the entire community, not merely the individual leader. A closer look at the Aeschylus drama suggests three dimensions that need to be taken into account in managing succession: what are the mechanisms enabling the community to participate, what is the role of the unconscious irrational forces inevitably aroused in the process, and what are the wider social and economic issues that need to be addressed? This paper looks at the myth elaborated in the Greek drama, and then applies it to some of the current problems facing contemporary psychoanalytic institutions.

Does Repression Exist? Memory, Pathogenic, Unconscious and Clinical Evidence

The current dispute regarding the existence of repression has mainly focused on whether people remember or forget trauma. Repression, however, is a multidimensional construct, which, in addition to the memory aspect, consists of pathogenic effects on adjustment and the unconscious. Accordingly, in order to arrive at a more accurate decision regarding the existence of repression, studies relevant to all three areas are reviewed. Moreover, since psychoanalysis regards repression as a key factor in accounting for the development and treatment of neurotic disorders, relevant research from these two domains are also taken into account. This comprehensive evaluation reveals little empirical justification for maintaining the psychoanalytic concept of repression.

The Unconscious Mind

The unconscious mind is still viewed by many psychological scientists as the shadow of a "real" conscious mind, though there now exists substantial evidence that the unconscious is not identifiably less flexible, complex, controlling, deliberative, or action-oriented than is its counterpart. This "conscious-centric" bias is due in part to the operational definition within cognitive psychology that equates unconscious with subliminal. We review the evidence challenging this restricted view of the unconscious emerging from contemporary social cognition research, which has traditionally defined the unconscious in terms of its unintentional nature; this research has demonstrated the existence of several independent unconscious behavioral guidance systems: perceptual, evaluative, and motivational. From this perspective, it is concluded that in both phylogeny and ontogeny, actions of an unconscious mind precede the arrival of a conscious mind-that action precedes reflection.

E uno plurus: psychoanalytic psychotherapy in the age of pluralism

Until 1970 the dominant theoretical framework in American psychoanalysis was Freudian ego psychology. Since then a number of additional theories, such as object relations theory (including, but not restricted to, the Kleinian approach), self psychology, relational psychoanalysis, and attachment theory have evolved and compete with contemporary ego psychology in the current marketplace of psychoanalytic ideas. There is considerable controversy about whether it is advantageous to work from one theoretical model and apply it to all clinical situations, or whether to utilize all the available paradigms, making judgments about which model or combination of them is most useful in a particular clinical situation or at a particular clinical moment. The latter approach might be termed pluralistic. Though a pluralistic approach is not without its philosophic and practical difficulties, such a perspective is helpful in understanding the complexity of human behavior and in facilitating therapeutic growth. A pluralistic approach is familiar to contemporary psychotherapists, who must utilize multiple frameworks in constructing biopsychosocial formulations of their patients. A pluralistic perspective is advantageous in promoting a therapeutic alliance, since it lends itself to a collaborative therapeutic process with patients. A brief clinical vignette is presented to illustrate these ideas.

Resistance, reluctance, and readiness in perpetrators of abuse against women and children

Perpetrators of abuse and violence against women and children are often reluctant participants in intervention programs. They frequently fail to attend scheduled appointments, are sometimes openly hostile to intervention staff, and often judge program materials as irrelevant to their situation. Recognizing this problem, researchers and practitioners have begun to develop models and tools to more appropriately assess and intervene with reluctant clients. Unfortunately, the resulting proliferation and inconsistent application of terms and theories have led to considerable confusion in characterizing reluctant clients and have significantly hampered research on strategies that may be helpful to better meet the needs of this client group. The purpose of this review is to help standardize the definition and measurement of treatment reluctance as it applies to violence perpetration and to review evidence for the importance of these aspects of client reluctance to intervention. Recommendations for assessing reluctance in research and clinical practice are also provided.