"If those tears could talk, what would they say?" Multi-method analysis of a corrective experience in brief dynamic therapy.

We analyzed master theorist/therapist Hanna Levenson's six-session work with "Ann" in American Psychological Association's Theories of Psychotherapy video series to determine if and how this client had a corrective experience in Brief Dynamic Therapy. First, we identified indicators of a corrective experience in the therapist's and client's own words. Complementing this analysis, we used observational coding to identify, moment by moment, narrative-emotion markers of shifts in Ann's "same old story"; the frequency, type, and depth of immediacy; and the client's and therapist's behavioral contributions to the working alliance. Additionally, we qualitatively analyzed Levenson's session-by-session accounts of the therapy from two sources. Convergent evidence from these multi-method analyses suggested how the intertwined relational and technical change processes seemed to bring about this client's corrective experience. Through consistent attention to the alliance and increasingly deep immediacy, Levenson created a safe space for Ann to "bring down the wall"-by allowing herself to cry and be deeply understood and cared for in a way that she had never before experienced. Concurrently, Ann began seeing herself quite differently, signified by self-identity narrative change. Then, following Session 4, she took Levenson's suggestion to risk behaving more authentically with a friend and with her romantic partner.

When psychotherapy is indefinite and there is no final outcome: case study of a community mental health clinic.

Little is known about long-term patients for whom there is no anticipated endpoint to treatment. In this qualitative case study, we used a focus group methodology to understand how psychotherapists at a community mental health clinic work with low-income adult patients who are seen indefinitely. Narrative themes that emerged from the focus group discussion include the nature of these patients' diagnoses and life problems; the sociocultural contexts in which they live; the kinds of treatment goals and interventions; the internal and external barriers to termination; and how therapists recognize the need to work indefinitely with some patients to keep them alive or functioning in the community. Although a diagnosis of major mental illness was the foremost reason for not planning a termination, participants also mentioned working indefinitely with some higher functioning patients whose lives are perpetually in crisis. Participants emphasized the importance of having a compassionate clinical team and supportive administration for seeing patients indefinitely, even when third party payments end. Results are discussed in terms of their implications for service delivery as well as their implications for future investigations of psychotherapy that has no foreseeable endpoint.