Psychotherapeutic work with refugees: Understanding the therapist's countertransference

Abstract

Most therapists are chosen to work with refugees because they speak the language or come from the same cultural or racial background and/or have had experiences which resonate with those of the client. They are often people who can easily understand the clients' experiences, which creates interesting and potent therapeutic dynamics. They can offer a great deal of support to the person, but often with the high risk of over-identification. This paper is an attempt to examine from the therapist's perspective the complex dynamics involved in working with refugee clients. It is a collection of thoughts and feelings expressed in psychotherapeutic and supervisory work by different types of refugee mental health workers. It is an attempt to understand the therapeutic relationship further by focusing on the therapist's psychological response to the client. The paper will outline briefly some of the common themes reported by refugees, but the primary aim is to focus on the therapist's countertransference feelings. Countertransference in this context is defined as a personal psychological response, as well as consisting of socio-political components.     

The rescuing therapist: A duplication of the pathogenic family system

Abstract

Rescuing is a saving behavior occuring in pathogenic families which is often duplicated by family therapists. Rescuing, if not confronted and explored, leads to frustration and burn—out in families and therapists. This paper explores the dynamics of rescuing behavior in families, how it is replicated by a therapist's attempts to rescue, and how the impetus for these attempts are derived from the therapist's own family of origin. The value of exploring the need to rescue is demonstrated by use of a case example. Countertransference issues and their resolution through the conscious differentiation between rescuing and real help are also explicated.     

Empathy as dialectic imagination

Abstract

The importance of relationship processes for humanistic and psychodynamic therapists makes empathy a critical concept in psychotherapy. Experimental work suggests that learning occurs only when the subject is actively and cooperatively engaged in the learning process. Similarly, psychotherapy is only effective when the client is willingly active in the therapeutic process. A crucial aspect of the therapist's activity is empathic imagination, defined here as the use of “dialectic” thinking capacities‐the recognition of conceptual alternatives in a given situation. These processes are at the heart of a humanistic view of agency. The therapist's use of this capacity allows imaginative projection into aspects of the client's experience, helping the client to feel understood in the relationship and emboldened to consider new possibilities in life.     

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.     

Saudi therapists' lived experience of self-awareness

Self-awareness and self-reflection in psychotherapeutic processes have been critical components for effective counselling and psychotherapy. However, little qualitative research in Saudi Arabia has been conducted that aims to explore the therapist's subjective experiences of the self in their professional work. Therefore, the purpose of this phenomenological study was to understand the therapist's self-awareness within psychotherapy, by focusing on the therapist's lived experience of self-awareness and exploring how therapists recognise themselves as an integral component of the therapeutic relationship. Semi-structured interviews were conducted with six experienced and accredited psychologists with at least three years of clinical experience, and the qualitative data were analysed using interpretative phenomenological analysis (IPA). Five superordinate themes emerged from the data; that is, development of the professional self, use of self, self-oriented, supervision and experience. This study provides an understanding of the therapist's self in psychotherapy, as it shows that self-awareness is important for therapists to manage their feelings, thoughts and behaviours in meeting with clients and that it is a valuable resource for a therapist to become aware of and reflect upon the process within oneself. This understanding is integrated into the training programmes in counselling psychology, especially in the areas of self-awareness and personal development.     

Research & clinical exchange

Abstract

Question: Family therapists are often called upon to do consultations to schools about children having social and educational difficulties. In what ways is the family therapist's role different when he or she is called in to consult as an “outsider’ to the school system about a particular child whom he or she does not know, compared to being called upon by the school for advice about a child who is already being seen in treatment by that therapist?     

Countertransference issues in psychotherapy with lesbian and gay clients

This article briefly reviews literature on responses towards same-sex (lesbian and gay) sexualities from psychoanalytic and ‘lesbian and gay affirmative’ psychotherapeutic perspectives. An analysis is presented of reports of countertransferential reactions to lesbian and gay clients, obtained from interviews with fourteen psychotherapists who work in a lesbian and gay affirmative manner and eighteen clients who had received affirmative psychotherapy. Data were subjected to grounded analysis. Participants consistently attended to the thoughts, feelings and values that therapists held in relation to lesbian and gay clients and how these affected the meanings and practices available to them. These were linked with the therapist's sexual identity among other factors. Negative countertransferential reactions were regarded as potentially occurring among heterosexual and lesbian and gay therapists and were seen as arising from therapists’ conscious and unconscious fears about same-sex sexualities. These findings indicate a need to continue debating these issues more widely in the professional arena.     

Collaborative relationships and dialogic conversations: ideas for a relationally responsive practice

The author presents a set of philosophical assumptions that provide a different language for thinking about and responding to the persistent questions: “How can our therapy practices have relevance for people's everyday lives in our fast changing world, what is this relevance, and who determines it?” “Why do some shapes of relationships and forms of talk engage while others alienate? Why do some invite possibilities and ways forward not imagined before and others imprison us?” The author then translates the assumptions to inform a therapist's philosophical stance: a way of being. Next, she discusses the distinguishing features of the stance and how it facilitates collaborative relationships and dialogic conversations that offer fertile means to creative ends for therapists and their clients.     

Using Genograms Creatively to Promote Healthy Lifestyles

ABSTRACT

Family therapists have used Genograms as an assessment tool for years to examine the interactions and relationships of family members across generations. This article discusses how a therapist can use a genogram creatively to help clients examine the impact of family relationships on healthy and unhealthy lifestyle patterns and how those relationships may be influencing the manner in which clients are currently managing their lives. The integration of a creative genogram can assist clients in recognizing inherited health-disease risks, learned lifestyle patterns, and parental behavior modeling. This technique can assist clients in developing a healthier lifestyle.     

The Application of Therapists' Maternal Capacity in Prerepresentational Body-Based Transference and Countertransference

Abstract

The paper explores the maternal capacity of therapists in working with patients for whom developmental deficits render the traditional verbal tools of psychoanalytic treatment ineffective, particularly in the early phases of treatment. Viewed from the perspective of a mother in relation to an infant, the therapist's role is seen as providing a safe holding environment, often in non-verbal ways, for the patient. The capacity of male therapists to access their maternal capabilities is considered. The manifestation of preverbal transference and counter-transference is explored through the presentation of relevant clinical material.     

Abortion and Mental Health

Abstract

Unwanted pregnancy and abortion are common life events, and therapists are likely to work with clients who experience them. Legal abortion currently entails little physical or mental health risk; most women currently cope effectively with these life events without need of clinical intervention. But current abortion politics include efforts to make abortion a more threatening, stressful, and stigmatized experience and to create a “postabortion syndrome.” Using a stress and coping framework, we examine how antiabortion activists spread myths and misinformation aimed at women's appraisal processes, and discuss approaches therapists can use to enhance women's strategies for coping with abortion. We also discuss specific issues and useful techniques for counseling about abortion concerns, including cultural sensitivity and strategies for promoting positive sexual health.     

The dream of dreams

Abstract

This paper investigates the relationship between the therapist's use of the dream and the patient's use of the dream, both inside and outside the formal therapeutic setting.     

Addressing the Person of the Therapist in Supervision: The Therapist's Inner Conversation Method

In this study a method of retrospective case supervision is presented aimed at helping the supervisee to become a better self‐supervisor. The method pays special attention to the therapist's self‐reflection and has the therapist's inner conversation as a central concept. The starting point of the method is an assignment in which the supervisee reflects on a case using a tape‐assisted recall procedure. The method helps trainees to develop experiential expertise to become more flexible and effective therapists. A case example of one training group of novice family therapists illustrates the use of the method.     

The Cruelest Cure? Ethical Issues in the Implementation of Exposure-Based Treatments

Numerous studies have provided supportive evidence for the efficacy of exposure-based treatments for many psychological disorders. However, surprisingly few therapists use exposure therapy in the clinical setting. Although the limited use of exposure-based treatments may be partially attributable to a shortage of suitably trained therapists, exposure therapy also suffers from a “public relations problem” predicated upon concerns that it is cruel and at odds with some ethical considerations (e.g., first do no harm). This article provides an overview of ethical issues and considerations relevant to the use of exposure therapy. It is argued that the degree to which ethical issues become problematic in implementing exposure-based treatments is largely dependent upon the therapist's ability to create an adequately safe and professional context. Specific strategies that may be employed for avoiding potential ethical conflicts in the use of exposure-based treatments are discussed.     

Overcoming My Model of Goodness as a Psychotherapist

Summary

The case of Tina is presented to examine one therapist's countertransference issues with a female client who had features of a Borderline Personality Disorder. The therapist's emotional reactions to this client's raw expression of anger and frustration are explored. The discussion also emphasizes the struggle of the therapist in resolving her discomfort with this client and in setting therapeutic boundaries.     

Are family therapists listening to the young? A psychological perspective*

This paper sets out to examine the family therapist's relationship to young children from a psychological perspective. Earlier contributions to the literature regarding the involvement of children in family sessions are reviewed briefly. Aspects of attachment theory and Piaget's theory of cognitive development are considered in terms of their implications for family therapy. It is argued that family therapists should be mindful of parents’ responsibilities for meeting their children's needs, particularly their need to experience predictability and to have a coherent story about their lives. The importance of exploring the effects of adult choices on the children is also emphasized.     

The Soul of Therapy: The Therapist’s Use of Self in the Therapeutic Relationship

This paper is based on the premises that the conscious, active and purposeful use of self by the therapist in the therapeutic process is an essential aptitude in establishing an effective therapeutic relationship, and that this therapeutically purposeful use of self can and should be incorporated in the training of all therapists in a explicitly systematic manner. The paper will attempt to identify the contributions of the “what and how” the use of self by therapists contributes to the therapeutic process. First of all, therapists’ use of self is meant to be viewed as a Common Factor as defined by Sprenkle, Davis & Lebow (2009), which is a perspective about the effectiveness of therapy that “asserts that the qualities and capabilities of the person offering the treatment are more important than the treatment itself” (p. 4). Secondly, the use of self by therapists emphasizes developing the skill set of the therapist in the conscious, active and purposeful use of self as is in the moment of the therapeutic engagement with clients, and does so without denying the importance of therapists working to resolve personal issues of theirs that may interfere with the therapist's professional effectiveness. Therapists’ use of self gives particular emphasis to the purposeful use of self as is in therapy’s relationship, assessment and interventions whatever the therapy model (Aponte & Kissil, 2016). Thirdly, the use of self represents an aptitude that can be developed and refined through well elaborated structures for schooling therapists in the therapeutic use of all they bring of their personal selves to the therapy relationship including through the use of their human vulnerabilities as they exist at the moment of empathic engagement with clients.

     

Three Aspects of the Therapeutic Conversation in Couples Therapy

Abstract

Feminist scholars have revealed the importance of examining the influence of gender on the therapeutic process. Gender differences in the treatment of clients may reveal inequitable or traditionally Stereotypie treatment of clients by therapists. This study examined gender differences in three conversational strategies widely used by therapists: expressions of empathy or understanding, compliments or praise, and challenges or requests for change. Fourteen tapes of live therapy sessions conducted by “master” therapists were examined using an exploratory, qualitative methodology based on Conversation Analysis. Results of this exploration revealed that therapists who are not self identified as “feminist challenged female clients more than male clients, and complimented male clients more than female clients. Feminist therapists challenged male clients more than female clients, and complimented female clients more than male clients. Feminist therapists used more challenges designed to facilitate non-stereo-typic gender behavior in both male and female clients. Only male therapists used disrespectful challenges of female clients, and were more often disrespectful to female clients than to male clients. Implications for the therapist-client relationship and the feminist critique are provided.     

Occupational Therapy's Role with Victims of Domestic Violence

ABSTRACT

Occupational therapists encounter individuals who are victims of domestic violence in many different settings. The role of the occupational therapist with each client depends on that client's specific needs, the treatment setting, and the skills and beliefs of the therapist. This article presents a theoretical argument for why the occupational therapist should choose to be involved in the treatment of domestic violence. The Model of Human Occupation provides a framework for understanding functional issues related to domestic violence. Methods of assessment and treatment are presented using this model. A continuum of levels of involvement including referrals for resources or treatment, direct and indirect treatment and program consultation is offered. Each level is illustrated with case vignettes demonstrating the therapist's role. Issues related to the challenge of working in domestic violence and reasons that women may refuse intervention are also discussed.