A Grammar of Love

Abstract

Recently researchers in the family therapy field have encouraged a focus on aspects of therapy common across all models that are important to therapeutic change. The purpose of this study was to build on the “common factors” literature by exploring clients' perspectives of what was useful to their therapeutic experience. Quantitative and qualitative measures were used to collect data from 41 clients who participated in therapy at a university-based family therapy clinic. Quantitative results indicated that therapeutic relationship, client motivation, extratherapeutic factors, and hope and expectancy accounted for 49% of the variance of clients' perception of change and 73% of the variance of clients' perceptions of therapy helpfulness. Qualitative results indicated the therapeutic relationship to be the most helpful aspect of clients' therapeutic experience.     

Psychological Time in Later Life: Implications for Counseling

Psychological time consists of cognitive constructs, images, and symbolic representations. It has different dimensions such as the experience of time, time perspective, attitudes and beliefs toward time, and the individual's behavior relating to time. Psychological time undergoes changes throughout the life span and is an integral part of the psychological developmental processes. In later life, it may be particularly dissonant with environmental rhythms and require re‐integration of the individual's past, present, and future. This article suggests several guidelines for counseling practice that address the many facets of psychological time in later life and their implications for the mental health and well‐being of older people.     

Time Perspective Therapy: A New Time-Based Metaphor Therapy for PTSD

Time perspective therapy (TPT) is a new time-based therapy that focuses on clients' perceptions of their past, present, and future. Based on Zimbardo's temporal theory and the utilization of the Zimbardo Time Perspective Inventory, the authors have developed this new narrative therapy approach for the purpose of treating clients diagnosed with posttraumatic stress disorder. The goal of TPT is to identify clients' six time perspective factors and then work with and balance these perspectives to promote a more positive future orientation, replace their traumatic past negativity, and thereby create a more responsive and healthier individual.     

A Japanese Perspective on Client Inaction: Removing Attitudinal Blocks Through Morita Therapy

Seven self-defeating attitudinal factors contributing to client inaction and procrastination are discussed from the Morita therapist's perspective. Morita therapy is briefly described, and ways of facilitating desirable action and reducing self-preoccupations are suggested. The suggested approach challenges the client's assumption that resisting and removing the unwanted feelings and imperfect psychological conditions is a prerequisite for implementing necessary action. The counselor's reinforcement of clients' mood-governed action style is also discussed as a factor contributing to the client's inaction.     

The transcendent function in adolescence: miracle cures and bogeymen

Abstract: This paper proposes that Damasio's mental images, Stern's moments of meeting and Tronick's dyadically expanded consciousness refer to different aspects of the same psychological process as Jung describes in the transcendent function. This proposition is illustrated with two case vignettes of adolescents who functioned on a pre‐symbolic level, but who through a transformative experience were catapulted into new developmental trajectories and the beginning of symbol formation.     

Clients' experiences of online therapy in the early stages of a COVID-19 world: A scoping review

The emergence of the COVID-19 pandemic in 2019 forced an abrupt shift in the modality through which psychotherapy was delivered and online therapy became the only viable option for clients. Research regarding experiences of online therapy during the early stages of the COVID-19 pandemic is minimal, however, and has largely focussed on therapists' experiences of delivering online treatment, as opposed to clients' experiences of receiving it. A scoping review was undertaken to establish what is known from the existing literature about clients' experiences of online therapy during the initial stages of the COVID-19 pandemic and identify gaps in the current knowledge. Searches were conducted across four academic databases: Scopus, EBSCO CINAHL Complete, EBSCO MEDLINE and OVID PsycInfo; the literature was excluded based on established PICOS criteria. Data were summarised through data charting and synthesised by way of inductive content analysis. A total of five articles were identified. All articles focussed on online therapy using video or audio conferencing, and four of the five studies examined clients with eating disorders. Inductive content analysis identified seven categories, as follows: preference for face-to-face therapy; appreciation of accessibility and convenience; online format hindered connection; positive experience of online therapy; individual client differences impacted experience; strong therapeutic alliance indicative of positive experience; and gratitude for continuation of treatment. Future research could explore clients' experiences of online therapy in a “post-pandemic” world and include a broader range of client populations and online therapy approaches in the COVID-19 context.     

Movies on the couch: The MOVIE model of film therapy

Film therapy, the therapeutic use of movies in psychological therapies, is a growing area of interest to therapists and researchers. This paper discusses the benefits of film therapy and presents a method, the MOVIE model of film therapy, a widely applicable, trauma-informed framework for individual or group therapy, counsellor education and self-help. Film or cinema therapy is a highly accessible and relatable method for many diverse groups. The benefits identified include emotional processing, greater ease of dialogue, increased empathy, interpersonal learning, new perspectives and learning skills. Following the model's reflective steps, clients mindfully observe and voice their emotional and psychological responses to movie-watching; identify how the imagery, characters, themes and story symbolise personal experience; and consider any new possibilities that emerged for their own lives. The model is informed by a practice-focussed review of literature and draws on methods from mindfulness and experiential and narrative therapies. The steps are widely applicable in a range of settings and can be adapted across counselling modalities. Further research to consider the outcomes of using the model, alongside qualitative research on clients' experiences of working this way with film, is recommended.     

Suitability and context for brief therapy

Abstract

The main point of this paper is that a client's suitability for brief or time-limited therapy is determined by various factors, including context. There is still agreement on the validity of Malan's selection criteria, which included ‘mild illness, recent onset, high motivation and response to trial interpretation’, yet many additional issues have since emerged and need to be considered. For instance, the counsellor's suitability, training and work experience, the counsellor's assessment skills and ability to establish a dynamic focus, the clients' capacity for self-reflection, their ego strength and their response to a trial therapy in the first session. Then there is the importance of the various contexts in which nowadays much brief counselling is offered free to clients, whether in education, at the workplace, in primary healthcare settings or by charitable organizations. This means that issues of money and markets have come to the fore and an initial differential assessment needs to be carried out in order to decide which method or model of therapy is best for the client. Matching the counsellor's personality to the needs and to the pathology of the client, and matching the treatment to the client's developmental stage or life stage crises are other aspects of the work, which determine the issue of suitability. In the end as always there is much that remains unknown about what works for whom and how the client's decision to take up help is made.     

Dropping Out of Couple Therapy

Abstract

Current literature on dropouts in marriage and family therapy includes few studies that focus exclusively on couple therapy and only a limited number of qualitative studies. Clients' perceptions of premature termination are seldom considered. This qualitative case study describes, from both the clients' and the therapist's perspectives, one couple's experience of dropping out of couple therapy after three, sessions. Findings from this case study are compared with existing literature and a fourfold typology of dropouts is proposed. We offer recommendations for future research of dropouts in couple therapy.     

Enclothed cognition

We introduce the term “enclothed cognition” to describe the systematic influence that clothes have on the wearer's psychological processes. We offer a potentially unifying framework to integrate past findings and capture the diverse impact that clothes can have on the wearer by proposing that enclothed cognition involves the co-occurrence of two independent factors—the symbolic meaning of the clothes and the physical experience of wearing them. As a first test of our enclothed cognition perspective, the current research explored the effects of wearing a lab coat. A pretest found that a lab coat is generally associated with attentiveness and carefulness. We therefore predicted that wearing a lab coat would increase performance on attention-related tasks. In Experiment 1, physically wearing a lab coat increased selective attention compared to not wearing a lab coat. In Experiments 2 and 3, wearing a lab coat described as a doctor's coat increased sustained attention compared to wearing a lab coat described as a painter's coat, and compared to simply seeing or even identifying with a lab coat described as a doctor's coat. Thus, the current research suggests a basic principle of enclothed cognition—it depends on both the symbolic meaning and the physical experience of wearing the clothes.     

Family Consulting: A New Role for Therapists

A new model for psychological practice entitled, "Family Consulting" is proposed. It is defined as a long-term, intermittent approach to working with families based on a developmental/non-pathological perspective. The specific format of intervention is described in detail. A brief review of the life-span perspective of development, the family life-cycle literature, and object relations family therapy, which serve as the building blocks of the model is provided. The role that family consulting can play in today's managed mental health care environment is discussed.     

Experiences in difference: An exploration of the usefulness and relevance of psychoanalytic theory to transcultural mental health work

Abstract

This paper presents accounts of work with mental health service users in a multicultural residential setting and, explores some of the difficulties involved in working from a psychodynamic perspective in such a setting. It argues that a psychoanalytic understanding of the role of phantasy in the experience of difference, upon which ideas of culture and identity are constructed, can be helpful to practitioners concerned with addressing the consequences of their clients' experience of racism and other forms of discrimination. Particular reference is made to Winnicott's writings on play, transitional space and the location of cultural experience.     

Cultural ruptures in short‐term therapy: Working alliance as a mediator between clients' perceptions of microaggressions and therapy outcomes

Aim: To determine whether or not clients' perceptions of microaggressions varied based on their own and the therapist's race/ethnicity and whether or not they would be negatively related to the effectiveness of therapy and if the working alliance would mediate this effect. Method: The study utilised a cross‐sectional, retrospective, methodology. Clients were recruited from a large university counselling centre in the United States (N=232 clients and 29 therapists). Results: Neither clients' race/ethnicity, therapists’ race/ethnicity, nor client‐therapist ethnic matching predicted perceptions of microaggressions. Clients' ratings of microaggressions were negatively associated with their psychological wellbeing; however, this effect was mediated by clients' ratings of the working alliance. Implications: Therapists should take into account the cultural messages they may be conveying to both white and racial/ethnic minority clients. Therapists should develop strategies that are consistent with a general therapeutic approach that promotes discussions about culture with their clients and, most importantly, should attend to the therapeutic relationship.     

Treatment‐seeking young adults from families with alcohol problems. What have they been through? What state are they in?

Aims: This study surveys the childhood experiences of treatment‐seeking young adult offspring of problem drinkers (AOPDs) and their psychological state at treatment baseline. Methods: Clients (N=502) entering a Danish nationwide treatment facility for young AOPDS completed the survey. Clients completed the Adult Children of Alcoholics Trauma Inventory, The Family Tree Questionnaire, the CORE–OM 34, Major Depression Inventory, and the Work and Social Adjustment Scale at treatment start. Results: A total of 48% of the clients' mothers and 75% of the clients' fathers were problem drinkers. Both parents were problem drinkers in 25% of cases, and 27% had at least one problem drinking stepparent. Mothers had on average drunk during 11.4 years of the clients' childhood (0–18 years). Fathers had on average drunk during 13.4 years; 46% knew or believed that at least one of their parents suffered from a psychiatric illness; 44% reported physical violence; 63% reported psychological abuse; and 38% had not spoken to anyone about their family's problem. A further 20% had only spoken to a parent or sibling. Conclusions/implications: The study highlights the high degree of variation in AOPD clients' childhood experiences and in their levels of distress, corresponding with studies of non clinical samples. The study offers a bleak image of the extent of parental drinking and of other negative factors in these clients' childhood homes, coupled with the finding that clients have often not spoken to others about their parents' drinking. Mentioning parental drinking to a counsellor is thus a potentially highly significant counselling event, demanding counsellor sensitivity and attention.     

Toward a Bahá'í Concept of Mental Health: Implications for Clinical Practice

The author highlights the emerging interest in understanding religious beliefs as a resource for more fully conceptualizing clients' psychological functioning. Although various authors have explored religious theories of mental health in an effort to increase understanding of clients' problems, there is a dearth of information on the Bahá'í client and how this particular religion conceives of mental health. The purpose of this article is to create an initial formulation for a Bahá'í concept of mental health and to discuss its clinical implications to aid in counseling Bahá'í clients.     

An investigation into the client at the heart of therapy

This paper reports on an exploration of the experience of the client at the heart of therapy. A grounded theory analysis of clients' experiences of therapy provided through a voluntary sector counselling service was undertaken, and generated four main categories: permission, engagement, transparency and restructuring. The results of the study are presented in a way that hopefully retains much of the richness of what people have reported about their experience of counselling. The findings of the study are discussed in terms of the idea that counselling can provide a setting where people can have common therapeutic requirements met.     

Shame as a Cultural Artifact: A Call for Self-Awareness and Reflexivity in Personality Assessment

It has become common for assessors to face therapeutic impasses and dilemmas when practicing within the Therapeutic Assessment (TA) model. This is due to the explicit goal of producing therapeutic changes in clients. In this article the author discusses the importance of assessors being aware of how their clinical practices relate to their assessment outcomes. To enhance such awareness, the author reviews the characteristics of psychological assessment practices as derived from 3 paradigms developed almost 1.5 centuries ago in Europe by the forefathers of psychology as a scientific discipline. Current assessment practices are deeply ingrained in specific cultural, social, and political frameworks originating in these paradigms. Being aware of such a historical and cultural background might help the assessor avoid blindly reenacting the values, norms, and latent relational schemas implied by different assessment methods, and instead use assessment tools as potent aids in the service of clients' change. Finally, the author illustrates how the experience of clients' shame in psychological assessment might also be understood as a by-product of the specific cultural and historical background of certain common assessment practices.     

Metaphor and Change in Counseling

Increased general interest among counselors in the way language, narratives, and stories influence clients' personal and social realities has drawn particular attention to metaphorical language and its facilitative role in counseling. In this article, the authors suggest that metaphors and metaphorical knowing may play a significant role in facilitating at least 5 developmental change processes in counseling: relationship building, accessing and symbolizing client emotions, uncovering and challenging clients' tacit assumptions, working with client resistance, and introducing new frames of reference.     

Inviting passage to new discourse: ‘Alive moments’ and their spiritual significance

Some social constructionists assert that therapeutic change occurs when clients' meanings for problems and solutions shift from those found in resource‐impoverished discourses to those affording resourceful and preferred possibilities. Referred to as ‘positioning theory’, our research examined this assertion by inviting clients and therapists to speak of a significant, but ambiguous, experience in unfamiliar discourse: spiritual discourse. Clients were asked to review videotapes of their sessions, selecting moments that felt most ‘alive’ to them for discussions with the researcher, including inquiries as to whether ‘alive’ moments held any spiritual significance. The outcomes are portrayed as a ‘poetic collaboration’ between the researcher, clients and therapists — while clients' and therapists' reported experiences for changes in discourse and meaning are highlighted. Implications regarding sensitivities required when co‐constructing meanings for ambiguous but significant experiences in therapy are discussed. Possibilities for more research examining poetic practices and processes in therapy are also considered in terms of positioning theory.