Building and Handling Therapeutic Closeness in the Therapist-Client Relationship in Behavioral and Cognitive Psychotherapy

The present study unpacks an important dimension of clinical practice from the therapists’ vantage point. We interviewed 26 therapists in private practice about how the personal relationship with the client works from their perspective and conducted a grounded theory analysis. Three categories emerged. One refers to scope, aims and corollaries of the connection with the client; a second to preventing harm and managing drawbacks; and a third to taking therapeutic advantage of challenges related to closeness. Together, these categories form a model that describes how the close connection modifies therapeutic effects and generates challenges the therapist needs to deal with. The closer the dyad, the easier therapists will affect and be affected by the client. Therapists try to direct closeness to where it can nourish client process without harming the relationship, the client or themselves, and when closeness backfires, they may still try to harness uninvited effects for the benefit of therapy. This model concerning therapists’ lived experience is offered to inform research on the therapist-client relationship and as a contribution to clinical competency models.     

Conversational perspective of therapeutic outcomes: The importance of preference in the development of discourse

Major theme: Evaluation of therapeutic outcome. Logical development of the theme: We suggest a way for practitioners and researchers to assess if they are on track in conversing towards client preferred goals. We offer a critique of more conventional approaches to studying therapeutic progress, suggesting how a discursive (i.e. focused on interaction and language use) lens can address these limitations. Through this lens we examine therapeutic progress evident in ‘preference work’, where clients demonstrably indicate, imply, agree and disagree with where the therapeutic conversation is heading. Such ‘preference work’ offers a form of evidence of within‐session outcomes in a process of reaching larger client preferred outcomes. Authors’ point of view: We present the results of conversation analysis – a qualitative approach to the study of therapy – to illustrate our discursive perspective on therapy progress and change. Implications: we suggest a way for practitioners to assess if they are on track in conversing towards client preferred goals. We propose that our interactional perspective may significantly contribute to bridging practice and research in therapy.     

A brain-inspired cognitive support model for stress reduction based on an adaptive network model

Stress is often seen as a negative factor which affects every individual’s life quality and decision making. To help avoid or deal with extreme emotions caused by an external stressor, a number of practices have been introduced. In the scope of this paper, we take three kinds of therapy into account: mindfulness, humor, and music therapy. This paper aims to see how various practices help people to cope with stress, using mathematical modelling. We present practical implementations in the form of client–server software, incorporating the computational model which describes therapy effects for overcoming stress based on quantitative neuropsychological research. The underlying network model simulates the elicitation of an extremely stressful emotion due to a strong stress-inducing event as an external stimulus, followed by a therapy practice simulation leading to a reduction of the stress level. Each simulation is based on user input and preferences, integrating a parameter tuning process; it fits a simulation for a particular user. The client–server architecture software which has been designed and developed completely fulfills this objective. It includes server part with embedded MATLAB interaction and API for client communication.     

In a search for meaning: challenging the accepted know-how of working with suicide risk

This opinion piece considers the current predominance of assessment tools and strategies in working with people at risk of suicide, and questions their efficacy and how they are privileged in day to day mental health practice. While such tools and an evidence-based ‘scientific’ approach to assessment clearly has its place, the author instead asserts that the modus operandi of therapy – a discursive based exploration – has much more to offer and should be the primary intervention in understanding suicide potential. Helping the client to gain insight into the meaning of their suicidality helps position the client – and practitioner – in the best possible place to reduce risk.     

少数民族双语者的语言表征和语言联系

我国少数民族学生一般掌握本民族语言、汉语和英语。少数民族双语者的语言的认知特点, 是语言学和心理学共同关心的问题, 也是了解少数民族学生语言认知机制的重要途径。已有研究围绕少数民族学生的语言表征、语言联系方式以及言语理解与言语产生的加工特点展开。本文系统地介绍了已有研究, 并提出未来研究应关注少数民族学生的语言认知加工的异同比较、少数民族文字的加工特点、少数民族学生加工汉字词的特点,以及少数民族学生第三语言的加工特点及其影响因素。     

(Re)Searching for a client in two different worlds: Mind the research‐practice gap

A criticism voiced by counsellors and psychotherapists is that research does not truly reflect the complexities of therapy. Researchers, on the other hand, accuse practitioners of not attending to research findings and suggest that as a result they engage in an ill‐informed process. This polarised understanding can give rise to the situation where the client is missed, falling into the research‐practice gap. In reality the research‐practice gap gets smaller and smaller every time a practitioner employs — which is often the case — a complex and sophisticated construct system in search of a client's psychological distress. The metaphor of the ‘search’ seems to become a point of connection between the practitioner's search and the researcher's (re)search. As a way of exploring this issue, the paper briefly considers the research‐practice gap and the critique of current research. It argues that counsellors and psychotherapists are themselves engaging in research when they practise therapy since every counselling and psychotherapy session is basically a (re)search process.     

Three fragments on trauma and time

How does trauma influence a client and a therapist’s experience of time in time-limited therapy? The therapist must first work to understand and remain responsive to the different registers of time now operative following the traumatic event. This paper contends that in the immediacy of trauma, hallucinatory wish-fulfilment oblivious to the structuring conditions of time and space appears to dominate. In chronic traumatic states, time appears to circle in a narrow compass, buffering between a cluster of moments surrounding and including the moment of traumatic rupture – as if struggling to re-establish a secure connection with linear time. The three clinical fragments presented attempt to describe different experiences of traumatic bereavement and the felt movement of time within them. The death of another confronts us not only with their loss but with our own mortality – the time we have lived and the time we have left. It is not surprising, therefore, that an individual's otherwise fluid transitions between different temporalities are disturbed in the aftermath of traumatic bereavement. The therapist’s capacity to regulate tempo when the client’s subjective experience of time is dysregulated offers an important means of containment. The aim of the therapist working with the traumatically bereaved client is to develop collaborative understanding to get thinking moving again and to gradually help the client unpin time, moving it beyond the confines that it occupies in trauma.     

Is touch a valid therapeutic intervention? Early returns from a qualitative study of therapists' views

Findings are reported from six semi‐structured interviews with experienced psychotherapists, focusing on the reasons for using touch and the sort of touch used. They suggest that there is a distinction being made by therapists between ‘social space’ and ‘therapeutic space’, and a different view of touch taken if it is judged by the therapist to be ‘out of the therapeutic environment’. Whether or not touch was initiated by the therapist or the client would also appear to influence its further discussion by the therapist, either in processing it with the client or in supervision. What also emerged from the interviews was the finding that an exploration of touch in supervision was unusual. The implications for practice, supervision and training are discussed as areas for further exploration in the main survey, which will be conducted in the second year of the research.     

Expression and interpretation of emotions in multilingual psychotherapy: A literature review

This review aimed at presenting the findings of 19 original studies that were published in the period from 2000 to 2022 in order to outline the current state of the art in the field of emotion communication (i.e., expressing and interpreting emotions) in multilingual psychotherapy. This analysis involves in particular the studies that investigate multilingual phenomena (e.g., code-switching and language-mixing) that occur during psychotherapeutic sessions when client and therapist can speak more than one language, as well as the articles that research emotion communication in this multilingual setting. With this in mind, the articles selected for this review are divided into two main categories: linguistic phenomena in multilingual psychotherapy and emotion communication in multilingual psychotherapy. Results of the studies in the current analysis reveal that code-switching remains one of the main linguistic phenomena that arises in the area of multilingual psychotherapy. Switching languages in therapy tends to be considered as beneficial for both client and therapist. Besides, findings suggest a connection between speaking L1/LX and one's identity (e.g., feeling different depending on the language). Additionally, studies that investigate emotion communication in multilingual psychotherapy show that an individual's first language (L1) is predominantly viewed as more emotionally charged than their language(s) learned later in life (LX). However, some studies also demonstrate that the relationship between L1 and LX is more fluid and context-dependent than it has traditionally been regarded. Propositions are given for future research in the field of emotion communication in multilingual psychotherapy.     

Use of profanity in the counseling interview

Although profane language is used in the counseling interview by both clients and counselors, past research has focused on the counselor's use of profanity without considering whether the counselor is matching the language of the client. This research examined 160 college students' impressions of an audiotape of a female counselor who used profanity with either a male or female client who did or did not use profanity. In general, when the female counselor swore she was less likely to be sought for help. Further research is recommended.     

What Kind of Doing is Clinical Ethics?

This paper discusses the importance of Richard M. Zaner’s work on clinical ethics for answering the question: what kind of doing is ethics consultation? The paper argues first, that four common approaches to clinical ethics – applied ethics, casuistry, principlism, and conflict resolution – cannot adequately address the nature of the activity that makes up clinical ethics; second, that understanding the practical character of clinical ethics is critically important for the field; and third, that the practice of clinical ethics is bound up with the normative commitments of medicine as a therapeutic enterprise.     

'This is our life': strong evaluation in psychotherapy narrative

This paper examines the relevance of both client and counsellor conceptions of the ‘good life’ in relation to a narrative analysis of the first session of a case of successful client-centred therapy.In this opening session, the client embeds her ‘problem’ story within contrasting cultural narratives of what it means to live a good life. The therapist discourse also consistently draws upon a therapeutic meta-narrative that conveys an implicit story of how to live life well. This material is discussed from the perspective of the concept of ‘strong evaluation’ offered by the philosopher CharlesTaylor.Implications for research and practice are discussed.     

The arms of the chimeras

This article seeks to compare the approach developed in 1974 by Michel de M'Uzan to the concept of the ‘chimera’ with Thomas Ogden's ( 1995 , 2005 ) reflections on ‘the analytic third’. This comparison shows that in spite of the different theoretical approaches, unconscious to unconscious communication – a subject of interest in contemporary psychoanalytic research – makes it possible to grasp the intersubjective data deployed in the field of the session. After reviewing M. de M'Uzan's conception of the ‘chimera’ – a product of the unconsciouses of patient and analyst alike, and which emerges during a process of depersonalization in the analyst – the author proposes her hypothesis of the chimera as a particular intersubjective third whose creation, in a hallucinatory state, makes it possible to gain access to the bodily and emotional basis of the trauma. The author describes the chimera as a mental ‘squiggle’ between the two members of the pair which finds expression in different forms; further, she considers that the chimera that seizes the analyst is underpinned by the unconscious affinities of traumatic zones in both protagonists, which permit the grounding, configuration and sharing of the territories of suffering, as apprehended in this paper.     

Providing a Transcultural Genetic Counseling Service in the UK

This paper uses a broad definition of culture to explore the practice of transcultural genetic counseling through three case studies. The first case involves a White genetic counselor seeing an Asian family, the second, an Asian genetic counselor seeing an Asian family and the third, a hearing genetic counselor seeing a culturally Deaf client. Boundaries, transference and countertransference reactions are considered within each transcultural encounter and the author of each case reflects in detail on their role in the client interaction and their impact on the transcultural dynamic. The cases are used to illustrate some cultural beliefs or characteristics that may challenge the genetic counselor’s expectations. The value of identifying and interpreting these differences to facilitate useful clinical work is considered. The paper debates, where possible, whether it is helpful to culturally match genetic counselor and client.     

Therapeutic action in psychoanalytic therapy with toddlers and parents

Psychotherapy with toddlers and parents can focus on promoting attachment, facilitating development and improving interactions. Some techniques provide guidance to the parents, whereas others interpret to them their unconscious fantasies or ‘ghosts’ contributing to the child’s disorder. A recent paper introduced a psychoanalytically oriented technique, which emphasised the therapist’s interaction with the child in the presence of the parent(s). The child was addressed about his/her unconscious motivations in the session and the feelings towards the therapist. Also, the parent’s transference onto the therapist was seen as a vehicle that might further the therapeutic process and was accordingly addressed. The present paper analyses the therapeutic action in such treatments. Whereas work with the parents resembles that of ordinary psychodynamic therapy, therapeutic action is more difficult to conceptualise regarding the toddler, whose understanding of verbal interpretations and the therapist’s dialogues with the parent is more limited than that of an adult. However, a clinical vignette demonstrates a toddler’s precise and swift reactions to communications from mother or therapist. The paper investigates evidence from neuroscience and psychological research as to which communicative channels – beyond words – toddlers might perceive and comprehend. In addition, it is claimed that the countertransference is key to explaining how the therapist understands such communication.