Therapists' Emotional Reactions to Patients as a Mediator in Cognitive Behavioural Treatment of Panic Disorder with Agoraphobia

The aims of this study were to examine whether therapists' emotional reactions to their patients mediate the effect of personality disorders and interpersonal problem behaviours on the outcome of treatment, focusing on an Axis I disorder; and whether therapists' reactions mediate the effect of personality disorders on the course of interpersonal problems. Therapists completed a checklist of emotional reactions to individual patients after the end of residential cognitive or guided mastery therapy for 46 inpatients with panic disorder with agoraphobia. The severity of DSM‐III‐R personality disorder was related to therapists' insecurity feelings, but not to interest and anger. A higher level of therapists' insecurity feelings was related to less reduction in self‐reported agoraphobic avoidance during treatment, whereas therapists' emotions were unrelated to symptomatic course after treatment. Therapists' insecurity feelings appeared partly to mediate the relationship between patients' severity of personality disorder and persistence of patients' interpersonal dominance and nurturance problems.     

Magical agents,global induction,and the internalism/externalism debate

Externalism is the view that facts about one's history or past in the external world that bear on the acquisition of one's responsibility-grounding psychological elements are pertinent to whether one's actions are free and, hence, pertinent to whether one can be morally responsible for them. Internalism is the thesis that the conditions of moral responsibility can be specified independently of facts about how the person acquired her responsibility-grounding psychological elements. In this paper we defend a position that navigates between externalism and internalism: moral responsibility does not require that one have a past but it does require that one not have certain kinds of past.     

Humanistic Psychology at York University: Retrospective: Focus on Clients' Experiencing in Psychotherapy: Emphasis of Radical Reflexivity

A retrospective is given of the contributions by York University psychologists to humanistic psychology as it is expressed in the theory, research and practice of humanistic psychotherapies. These contributions are contextualized in the history and mission of the University. Attention is then turned to the author's qualitative research on the client's experiencing in psychotherapy and the main understanding coming from it, namely that clients are aware of their self-awareness and are agential in terms of this capacity, called radical reflexivity. Implications of radical reflexivity for client-centered/experiential therapists' reduction of the person to an organism and for the psychotherapy practice and research are derived.     

When Midlife Therapists Treat Midlife Patients

Abstract

Empathic attunement is the bedrock of self psychological treatment. In the treatment of midlifers who show underlying narcissistic vulnerability, achieving such empathy is sometimes more difficult that one might imagine, particularly since therapists, who are midlifers themselves, are often vulnerable to the impact of midlife stresses. Potential stumbling blocks may arise that stem from therapists' identification with and anxiety about patients' struggles that are similar to their own; difficulties relating to patients' problems that seem unfamiliar or alien; and assaults to therapists' own sense of self or selfobject needs.     

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.     

Erotic Countertransference and Clinical Social Work Practice: A National Survey of Psychotherapists' Sexual Feelings,Attitudes, and Responses

Male and female social work psychotherapists were surveyed on sexual feelings toward clients, sexual behavior with clients, and utilization of erotic countertransference. Relationships between these variables and therapists' self-reports of training in erotic counter-transference, utilization of supervisory consultation, length of clinical experience, and theoretical orientation were also examined. Male therapists were significantly more likely than females to report sexual attraction toward clients, and to report using erotic countertransference to further treatment goals. The frequency of therapists' discussion of sexual feelings toward clients in supervision was related to the reported frequency of utilization of sexual feelings in treatment. The majority of therapists reported that their social work training did not prepare them adequately to work with erotic countertransference.     

Meeting Them “Where They're At”

Abstract

Child maltreatment is associated with serious psycho-social difficulties and enormous direct and indirect societal costs. As such, it is an area for which new and promising interventions are highly important. The purpose of this exploratory research is to examine intensive school-based psychodynamic therapy for severely maltreated children experiencing significant difficulties, by obtaining perceptions of therapeutic effectiveness by the children's parents, teachers and therapists. Themes include: therapists', parents', and teachers' perceptions of child's changes; parental perceptions of therapy and relationship with the therapist; therapists' perception of relationship with parents; school as the location of therapy; teacher-therapist relationship; and the child's academic status.     

Stay a Little Longer: Sustaining Empathy,Vulnerability, and Intimacy in Couple Therapy

In this paper, my main intent is to heighten therapists' awareness of the difficulties and opportunities inherent in “vulnerable moments” (Livingston, 2001) and the importance of enabling couples to prolong such moments of openness. Sustained empathic attention to patients' subjective and affective experience during these moments deepens the analytic process and facilitates a transformation of the relationship itself—which is the focus of couple treatment.     

Early Reminiscing in Cultural Contexts: Cultural Models,Maternal Reminiscing Styles,and Children's Memories

The present study examined conversations of 164 mothers from seven different cultural contexts when reminiscing with their 3-year-old children. We chose samples based on their sociodemographic profiles, which represented three different cultural models: (1) autonomy (urban middle-class families from Western societies), (2) relatedness (rural farming families from non-Western societies), and (3) autonomy-relatedness (urban middle-class families from non-Western societies). The results showed that mothers from the autonomous contexts predominantly adopted an elaborative-evaluative reminiscing style (variable-oriented approach) and pattern (person-oriented approach). Mothers from the relational contexts mainly adopted a repetitive reminiscing style and pattern. There was greater heterogeneity for style variables among mothers from autonomous-relational contexts; in addition, the person-oriented approach revealed that the majority of mothers from autonomous-relational contexts showed hybrid style patterns. Thus, the cultural models, and their respective orientations towards autonomy and relatedness, were reflected in the way mothers reminisced with their children. The children's provision of memory elaborations was high in the autonomous contexts, low in the relational contexts, and moderate in the autonomous-relational contexts. Across contexts, maternal evaluations prompted children to contribute memory elaborations. Maternal elaborations were an additional predictor for children's memory, but only for families from the relational cultural model.     

Constructing Cultural Competence: Perspectives of Family Therapists Working with Latino Families

This article focuses on developing an understanding of how nine therapists working with Latino families construct the idea of cultural competence in the counseling room. In-depth interviews were conducted and analyzed yielding five themes in cultural competence from the therapists' perspectives: the use of language in therapy; the impact of social class, gender, and power on the therapeutic relationship; immigration and culture clash; definitions of family; and unique constructions of cultural competence. The therapists'narratives in this study are best understood through a postmodern paradigm suggesting that the field of psychotherapy needs to move beyond a “checklist” modernistic approach to developing cultural competency.     

Influence of Racial/Ethnic Membership and “Therapist Culture” on Therapists' Worldview

The authors investigated 2 competing hypotheses related to therapists' worldview and therapists' race/ethnicity: (a) whether therapists of different racial/ethnic groups differed on worldview reflecting group membership, and (b) whether therapists were similar to each other on worldview reflecting membership in a “therapist culture.” Results indicated that therapists shared similar worldviews regardless of group membership, and differences found between therapists based on racial/ethnic membership were minimal.     

Dispesitional Bias in Trained Therapists' Diagnoses: Does It Exist?1

Therapists have been charged with a dispositional bias in their diagnoses of clients' problems. While a, review of prior research revealed considerable evidence that at least some trained therapists were more dispositional in their diagnoses than nonprofessionals, there was no clear evidence that therapists' dispositional diagnoses were in error. Therefore, an experiment was conducted to try to detect error in trained therapists' diagnoses. Twelve trained therapists and 16 untrained nonprofessionals each conducted intake interviews with two clients (confederates). Employing a technique based on attribution theory, one client presented a problem that was relatively situational; the other presented a problem that was relatively dispositional. Consistent with previous research, trained therapists were more dispositional in their diagnoses than were untrained nonprofessionals, suggesting that some bias did exist. But there was no clear evidence that therapists were less sensitive than nonprofessionals to differences between situational and dispositional problems. It was concluded that, to the degree that bias implies error, the charge of bias in therapists' diagnoses remains unproven.     

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.     

Manual‐based cognitive behaviour therapy for chronic fatigue syndrome: therapists' adherence and perceptions

Several randomized controlled trials have indicated that cognitive behaviour therapy is an effective treatment for chronic fatigue syndrome. In 1 of these studies 13 therapists applied cognitive behaviour therapy for chronic fatigue syndrome in 83 chronic fatigue syndrome patients. In the present study therapists' adherence and perceptions of the manual are studied. Following completion of the study the therapists were asked to complete a questionnaire. Audiotaped sessions were conducted to verify the therapists' adherence. Analyses of the audiotapes showed that in 87% of the sessions this appeared to be the case. The questionnaire revealed that the therapists found it more difficult to treat patients with chronic fatigue syndrome than to treat patients with psychological or other physical problems. Treatment aspects posing the most problems were integrating individual problems into the standardized treatment, dealing with the patients' lack of confidence in the treatment and handling insufficient motivation.     

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.     

‘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.     

THE THERAPIST'S EXPERIENCE OF PSYCHOTHERAPY: SOME DIMENSIONS AND DETERMINANTS

Eleven dimensions of therapists' experiences during psychotherapy ses- sions were derived, factor analytically, for a sample of 17 therapists. These therapists completed a standard questionnaire after each of 8 or more sessions with 31 female patients. In general, the 11 dimensions reflected various experiences of (a) being helpful towards patients, (b) attempting to deal with difSicult patients, (c) making non-therapeutic responses to patients, and (d) entrapment in personally distressing situations with patients. Personal-social characteristics of patients and therapists were examined as possible determinants of therapist experience. Among other characteristics, patients' employment and marital status, diagnosis and previous treatment, influenced certain therapist experience dimensions-as did therapists' profession, marital status, and personal psychotherapy.     

Therapist Awareness of Client Resistance in Cognitive-Behavioral Therapy for Generalized Anxiety Disorder

Clients' resistance relates negatively to their retention and outcomes in psychotherapy; thus, it has been increasingly identified as a key process marker in both research and practice. This study compared therapists' postsession ratings of resistance with those of trained observers in the context of 40 therapist–client dyads receiving 15 sessions of cognitive-behavioral therapy for generalized anxiety disorder. Therapist and observer ratings were then examined as correlates of proximal (therapeutic alliance quality and homework compliance) and distal (posttreatment worry severity) outcomes. Although there was reasonable concordance between rater perspectives, observer ratings were highly and consistently related to both proximal and distal outcomes, while therapist ratings were not. These findings underscore the need to enhance therapists' proficiency in identifying important and often covert in-session clinical phenomena such as the cues reflecting resistance and noncollaboration.