‘The bereaved therapist speaks’. An interpretative phenomenological analysis of humanistic therapists' experiences of a significant personal bereavement and its impact upon their therapeutic practice: An exploratory study

Aim: The aim of the research was to explore the under‐researched area of therapists' personal bereavement and its impact upon their therapeutic practice. Method: Data were collected via semi‐structured interviews with four humanistic therapists and were analysed using Interpretative Phenomenological Analysis (IPA). Findings: Four master and eight subordinate themes emerged from the rich data collected that exemplified both convergence with and divergence from the small body of extant literature on therapist bereavement and current thinking in thanatology. The findings suggest that bereavement is a unique experience that can affect the individual's personal and social identity and worldview. It can also be a transformative experience resulting in personal growth and a renewed sense of self and agency. In terms of professional practice, the findings suggest that the lived experience of the grieving process, mediated by supportive supervision, enabled participants to experience deeper levels of empathy and connectedness within their therapeutic relationships. Conclusion and implications: Bereavement is an experience that can profoundly impact upon therapists' personal identity and assumptive world. Such an experience can have an equally profound impact upon their therapeutic practice. There are therefore implications for students, trainers, therapists and supervisors particularly in terms of self‐care and the use of the ‘self’ in therapy. Further research needs to be undertaken in order to explore in greater depth the intersection between personal bereavement and therapists' evolving personal and professional identity development.     

Psychodynamic therapists' dilemmas in providing personal therapy to therapists in training: An exploratory study

Aim: This study explores dilemmas facing psychodynamic therapists who provide personal therapy to therapists in training. Method: Eight experienced psychodynamic psychotherapists were interviewed using a semi‐structured interview format during which they were asked about the importance of personal therapy, if they encountered any dilemmas and, if so, how they resolved those dilemmas. Their responses were analysed using a qualitative form of content analysis. Findings: Two categories of dilemma emerged: clinical and personal. Clinical dilemmas arose out of the mandatory requirement for therapy, boundaries, fitness to practice and the suitability of trainees. Personal dilemmas included pressure to model, sense of responsibility, therapeutic narcissism, countertransference reactions, over‐use of self and stressful involvement. The therapists' strategies for resolving the dilemmas are described. Conclusion: The results show participants considered personal therapy to be essential for trainees and thought it should be mandatory even though it led to difficulties in the therapy. Questions arose about the suitability of some trainees, the person of the therapist and stressful involvement. Further research into these important areas is recommended.     

Does Depression Affect Clinical Practice?

Abstract

While recent autobiographical accounts of women psychotherapists with depressive illnesses have provided vivid and compelling portraits of therapists' experiences in therapy (e.g., Jamison, 1995; Manning, 1995), further research is needed to clarify the impact that depression and its treatment have upon both collegial relationships and clinical practice. A subset of the membership of the Association for Women in Psychology (AWP) was surveyed concerning therapists' experiences with depression and its treatment. Of 220 respondents, 76% reported some form of depressive illness. Eighty-five percent of respondents indicated that they participated in personal therapy. When evaluating their clinical work, respondents reported both positive and negative consequences resulting from their depression. While some respondents noted improvement in collegial relationships, many felt judged and avoided.     

Women counsellors' experiences of personal therapy: A thematic analysis

Background: Following recent moves to relax the requirements for clinical mental health trainees to undergo personal therapy, this qualitative project explored the effects of personal therapy on volunteer counsellors. Method: Interviews were conducted with 19 volunteer counsellors at a women's community centre, and the data were analysed using thematic analysis. Findings: Emerging themes included the importance of personal therapy for trainee development, key elements of personal therapy and the idea that personal therapy is ‘a double‐edged sword’. Discussion: Allowing for evident methodological difficulties in evaluating the impact of personal therapy on trainees, this study suggests that close consideration should be given to the potentially adverse effects of reducing requirements for personal therapy in clinical trainings.     

Person‐centred counsellors' experiences of working with clients in crisis: A qualitative interview study

Aims: This study aims to explore and understand person‐centred therapists’ experiences and work with clients at the pivotal point of crisis. Specifically: how do person‐centred therapists experience working with clients in crisis? Do they identify differences in crisis intervention compared to non‐crisis work? What do they perceive as helpful to crisis clients? How relevant are therapists' own experiences of crisis? Method: Participants were all experienced person‐centred therapists. Qualitative, semi‐structured interviews were conducted and the data were analysed qualitatively using person‐centred/phenomenological methodology. Results: Respondents identified differences in their experiences. Typically, therapists described polarity in their experience of danger and opportunity, also heightened energy levels within themselves, perceived higher levels of engagement, faster pace of work, experiences of reaching ‘relational depth’ earlier, and the importance of assisting symbolisation of clients' experience in awareness. Clients were experienced as vulnerable, unable to access previous coping mechanisms, in a state of breakdown and disintegration, but also as wide open, having dropped their usual defences, and more available to engage in therapy and enter the process of change and potential post‐crisis growth. Discussion: The findings are discussed in relation to prevailing models of crisis intervention, person‐centred theory and theoretical developments in post‐traumatic growth in the aftermath of crisis.     

The good,the bad and the uncertainty: Trainees' perceptions of the personal development group

Background: Views about the purpose and role of personal development groups (PD group) in the counsellor training process are varied. Some argue they enhance self‐awareness, self‐exploration, the ability to be congruent and, ultimately, that they make for better practitioners. Others argue there is no clear evidence for such benefits and that they can actually be damaging to trainees. Aims: This study aimed to explore the beliefs of 25 trainees enrolled on counselling diploma or counselling psychology doctoral courses. It looked in particular at their perceptions of the purpose of PD groups and their expectations regarding support, difficulties and the scope of their participation. Method: Data was collected using open‐ended questions in an anonymous survey and was subjected to a thematic analysis. Results: Trainees appeared to hold mixed – and sometimes conflicting – views about the PD group. For some it was a positive endeavour that facilitated learning about self and clients, and helped in the processes of developing counselling skills and keeping the training group healthy. For others it was a feared space, which could elicit negative emotional experiences, and impact negatively on both learning outside of the PD group and the health of the group itself. Still others were unclear about its purpose. Hope/idealisation (of the process, the facilitator and course tutors) were also evident in the trainees' responses. Implications: Implications of these findings for counselling training are discussed.     

How did compulsory personal therapy during counselling training influence personal and professional development?

Aim: This study explored the influence of personal therapy on professional and personal development in a qualitative investigation. Method: Six semi‐structured interviews were conducted and analysed using Interpretative Phenomenological Analysis (IPA). Findings: All participants recognised the important influence of personal therapy on personal growth. Influences on personal development were experienced in the physical, cognitive, emotional and spiritual worlds of participants. It was felt that skills, a better understanding of therapeutic relationships, and general support, enhanced professional development. Conclusion: In combination this can lead to an increase in self‐awareness and thus a more effective professionalism in counsellors.     

Therapists' positive emotions in‐session: Why they happen and what they are good for

Aim: The therapist's feelings play a remarkable role in contemporary models of psychotherapy. However, these models are biased towards negative feelings. The present study explores therapists' personal experience with positive emotion in‐session. Method: A grounded theory analysis was conducted of interviews with 26 Brazilian psychotherapists. Results: Clinicians derive positive affect from the client's input in treatment, from their own input, and from the personal relationship with the client. Therapist positive emotion adds to the material that can be worked on in‐session by providing interpersonal events in the relationship with the client. It can improve therapist input in treatment by increasing in‐session awareness, resourcefulness and daring and by cuing efforts for professional development. It enhances involvement in the relationship with the client by prompting compassion and closeness in the dyad. Its effects may spill over and contribute to the therapist's personal thriving. Discussion: These results are discussed in light of what positive psychology can add to current work on therapist effects in the treatment process.     

The path towards a professional identity: An IPA study of Greek family therapy trainees

Objective: Contemporary psychotherapy research has focused mainly on practitioners' training and education. The impact of training on professional development and the application of therapeutic skills have been the primary foci of the empirical literature. The aim of this paper is to present the experiences of seven family therapy trainees regarding their personal paths toward the development of professional identity as they underwent training in systemic psychotherapy. Method: In‐depth interviews were conducted and analysed using Interpretative Phenomenological Analysis. Results & Conclusions: Seven themes were identified: The Quest, Developing by Relating, Learnings, Personification of Training, Use of Self, Self‐Care and Empowerment, and Reflecting on the Role of the Therapist. The findings are discussed with regard to the development of the ‘therapist as a person’, gaining acknowledgement and autonomy, and the development of a community of therapeutic practice.     

Helpful processes in psychological therapy for patients with primary cancers: A qualitative interview study

Aims: The purpose of this study was to identify what patients with primary cancers found helpful in therapy. Method: In‐depth qualitative interviews were conducted with eight patients who had completed a course of psychological therapy within an NHS psychology service for cancer patients. Data were analysed using thematic analysis. Results: The participants identified a range of helpful processes in therapy: talking and expressing their feelings to someone outside of the family; forming a relationship with their therapist; normalisation through the therapists' expert knowledge; problem‐solving and CBT. Limitations: As with all qualitative studies, the small sample and size and dependence on participant recall limits generalisability of the findings. Implications: The findings of this study are consistent with a pluralistic perspective: that multiple therapeutic processes ‐ aligned to a range of different orientations ‐ can be of value to patients with primary cancers. This supports the provision of a range of therapeutic interventions and strategies for this patient group.     

How trainees develop an initial theory of practice: A process model of tentative identifications

Aim: The increasing importance of integrative practice highlights the need to explore how trainees develop their theoretical stance. This investigation explored the experiences of trainees to elaborate a model of how they developed their personal theories of practice. Method: Seventeen Masters level trainee counsellors kept weekly journals recording how they developed a working theory of practice. Grounded theory analysis of the journals was used to develop a model of the process. Findings: The resulting Process Model of Tentative Identifications illustrates how a personal theory developed through trainees' tentative identifications with theories of practice, and how factors such as reading, personal philosophy, practice, and supervision interact to produce the identifications. A diagram of the model highlights the relationships among a variety of personal and professional factors that ranged from highly abstract to concrete and practice-based. Discussion: The model is consistent with several factors identified in previous research and highlights how trainees develop working theories of practice.     

The challenge of counselling and psychotherapy research

Aims: The purpose of this commentary is to argue that the value of counselling and psychotherapy research lies, not only in what it teaches us as therapists, but also in its ability to challenge us and our assumptions. Method: The paper identifies eight beliefs that may be prevalent in sections of the counselling and psychotherapy community, and presents evidence that challenges them. Findings: While many of our beliefs may hold true for some clients some of the time, the research evidence suggests that they are unlikely to be true for all clients all of the time. Discussion: By questioning and challenging therapists' a priori assumptions, research findings can help counsellors and psychotherapists to be less set in their beliefs; and more open to the unique experiences, characteristics and wants of each individual client.     

Reflections of Authority in Psychotherapy

Abstract

This article examines how therapists' expressions of authority affect the psychotherapeutic relationship. The article is based on the proposition that the clinical practitioner is always in a position of authority, regardless of how the role of authority is conceptualized within treatment approaches. The article includes an investigation of power and authority differentials within and across therapeutic approaches that espouse both hierarchical and egalitarian authority relationships. Process material from these approaches is analyzed to identify therapists' exercise of authority within these two approaches. It is suggested that researchers and therapists might use a heuristic research design to study the conveyance of therapeutic authority to identify whether dimensions of authority are overtly or covertly expressed, and whether or how such expression might affect practice and a client's exercise of personal authority.     

Introduction to Group-Analytic Psychotherapy by S. H. Foulkes

This article will explore special leader issues that emerge in psychodynamically oriented therapy groups with adult children of alcoholics. Particular focus will be on countertransference feelings that get stirred up in group leaders and techniques for dealing with some of these special dilemmas. Specific issues include (a) assumption of sameness between the therapist and the patient (the therapist assuming that he or she “understands” because of having also grown up in an alcoholic family); (b) the “will to restore,” which may be destructive when the therapist, whose own self-esteem is dependent on the patient's progress in therapy, forces a “rush to recovery” on the patient; (c) other personal issues in the life of the therapist that may also resonate with experiences of the patient; (d) “countertransference goodness and availability” as it affects therapists' abilities to set reasonable limits on their patients, as well as reasonable expectations for themselves; and (e) special issues regarding therapist transparency and self-disclosure.     

A qualitative study of the therapists' experiences of working with community reinforcement and family training

Community reinforcement and family training (CRAFT) was developed to help and support concerned significant others (CSO) of people with, for example, alcohol use disorder. The aim of this study was to investigate therapists' experiences of working with CRAFT and their experiences of the CSOs receiving CRAFT. The study has a qualitative design and is based on three focus group interviews with 17 therapists. Interviews were analysed using thematic analysis. The analysis revealed six themes and four subthemes: Concerned significant others—A special group; Help prior to CRAFT—Offering information and a shoulder; CRAFT as a new and specific method (The toolbox of CRAFT, Formats for delivering CRAFT, Introducing a diary as homework and Implementing self-help material—Alone or in combination with sessions); Moving from a lack of structure to structure; Change in CSOs from the therapists' point of view; and Change in the therapist's role (Dilemmas—Personalising the intervention). The therapists were generally satisfied with the method and found it easy to adapt to. Moreover, working using a manual was more structured than they were used to and increased feelings of working professionally with the CSOs. Specifically, most therapists found the self-help book useful and indispensable in their work with CRAFT, but also agreed that it could not be used as a stand-alone intervention for most CSOs. The therapists' experiences are relevant for implementation of manualised, structured approaches and group-based interventions more broadly.     

Searching for Prosociality in Qualitative Data: Comparing Manual,Closed-Vocabulary,and Open-Vocabulary Methods

Although most people present themselves as possessing prosocial traits, people differ in the extent to which they actually act prosocially in everyday life. Qualitative data that were not ostensibly collected to measure prosociality might contain information about prosocial dispositions that is not distorted by self-presentation concerns. This paper seeks to characterise charitable donors from qualitative data. We compared a manual approach of extracting predictors from participants' self-described personal strivings to two automated approaches: A summation of words predefined as prosocial and a support vector machine classifier. Although variables extracted by the support vector machine predicted donation behaviour well in the training sample (N = 984), virtually, no variables from any method significantly predicted donations in a holdout sample (N = 496). Raters' attempts to predict donations to charity based on reading participants' personal strivings were also unsuccessful. However, raters' predictions were associated with past charitable involvement. In sum, predictors derived from personal strivings did not robustly explain variation in charitable behaviour, but personal strivings may nevertheless contain some information about trait prosociality. The sparseness of personal strivings data, rather than the irrelevance of open-ended text or individual differences in goal pursuit, likely explains their limited value in predicting prosocial behaviour. © 2020 European Association of Personality Psychology     

A systematic review of the literature on counselling and psychotherapy for the prevention of suicide: 2. Qualitative studies

Scope of review: The paper reports a meta‐synthesis of 13 qualitative studies of counselling and psychotherapy with people at risk of suicide. Publication time span: The studies considered were reported between 1997 and 2006. Publication origin: Seven studies were conducted in the UK, four in the USA, one in Canada, and one in Sweden. Findings: Themes in clients' and therapists' accounts of the process of counselling or psychotherapy were therapist qualities; therapy components; theoretical framework; and therapy techniques. Themes in their accounts of the effectiveness of counselling and psychotherapy were decrease in self‐destructive behaviour, and quality of life. Themes in clients' views of barriers to effective counselling or psychotherapy were therapist characteristics; therapy components; secrecy; and transferring to the real‐life situation. Secrecy was also identified as a barrier by therapists, as were responsibilities of the profession; training; and the nature of suicide and self‐harm. Facilitators of successful counselling and psychotherapy as identified by clients were responsibility; support; and teaching therapy skills to family members, the latter also being identified by therapists.     

Heuristic research as a vehicle for personal and professional development

This paper reports one aspect of a more extensive narrative inquiry into how two counsellors experienced their involvement in heuristic research and the contribution it made to their personal development. The paper is located within stories of Becoming a Reflexive Researcher: Using Our Selves in Research (2004) and shows how reflexive conversations enabled participants to co‐construct meaning and create what Rosanna Hertz called ‘reflexive knowledge’ (1996).     

Guidelines for Reporting Information in Studies of Diagnostic Test Accuracy: The STARD Initiative

My first focus of this study was to explore therapists' personal characteristics as predictors of the proportion of interpretation in brief dynamic psychotherapy (N = 39; maximum 40 sessions). In this study, I used data from the Norwegian Multicenter Study on Process and Outcome of Psychotherapy (1995). The main finding was that therapists who had experienced good parental care gave less interpretation (28% variance was accounted for). Therapists who had more negative introjects used a higher proportion of interpretation (16% variance was accounted for). Patients' pretreatment characteristics were not predictive of therapists' use of interpretation. The second focus was to investigate the impact of therapists' personality and the proportion of interpretation on the development of patients' maladaptive defensive functioning over the course of therapy. Better parental care and less negative introjects in therapists were associated with a positive influence and accounted for 5% variance in the reduction of patients' maladaptive defense.