Personhood of the Therapist in Couples Therapy

SUMMARY

Integrity Therapy (Lander, 1986; Lander & Nahon, 1992a, 1995a; Mowrer, 1961b, 1964a) views the personhood of the therapist as the very essence of therapy. By meeting the deepest part of the therapist with the deepest self of individuals in therapy, a healing process unfolds which opens up the healing potential of both the individuals and the couple. This article offers couple therapists and other mental health professionals an Integrity Therapy perspective of the personhood of the therapist and its therapeutic potential for helping couples in distress to reclaim their personhood. Two aspects of the Integrity Therapy approach which play a critical role in enhancing therapists' use of their personhood in the therapeutic process are explored: (a) the use of therapist self-disclosure, and (b) therapists' awareness and therapeutic use of counter-transference issues.     

Three Views of Artful Practice in Psychosocial Occupational Therapy

This qualitative study explored artfulness in the psychosocial practice of three occupational therapists through in-depth observation and interviews. Analysis focused on the therapist-client relationship, activity use, self-reflection, and the change process. Each therapist established an interpersonal connection while offering meaningful, engaging activities. In addition, each brought a distinct and unique personal view to treatment. Findings suggest that the art of practice in occupational therapy is constructed by the therapist's integrated balance of substance, form, and vision to achieve a coherent whole, which positively influences the personal views of substance, form, and vision in clients.     

More than meets the eye: a consideration of the influence of a counsellor's visual impairment upon his therapeutic relationships

Other than through personal reflection and anecdotal evidence, I have had little opportunity to explore the influence of my visual impairment upon my therapeutic relationships. In order to address this, I conducted three research conversations with former clients (participants), each of whom had expressed an interest in participating in the research. Potential participants also had to meet the inclusion criteria for the research and provide informed consent prior to their participation. Research conversations were conducted between March and July 2009 and were analysed qualitatively, using a method informed by Moustakas's heuristic inquiry. Participants demonstrated idiosyncratic responses to my visual impairment; their perception of their responses to my visual impairment sometimes differed from mine. Feelings identified included uncertainty, disappointment and relief. My visual impairment appeared to influence the therapeutic relationship in a variety of ways, including resonance with the inner world significance of disability to the participant and interaction with my personal process. While not the therapeutic agent, my visual impairment had the potential to act as a catalyst in therapeutic change. The potential for me to either under-estimate or over-estimate the significance of my visual impairment highlights the need for continued self-awareness and the maintenance of an open and non-defensive attitude.     

Where Grammar and Interaction Meet: A Study of Co-Participant Completion in Japanese Conversation

This article examines the practice of "co-participant completion" in Japanese conversation, and explores what kinds of resources are mobilized to provide the opportunity to complete another participant's utterance-in-progress. It suggests the following observations as potential characteristics of Japanese co-participant completion: (i) Syntactically-defined two-part formats (e.g. [If X] + [then Y]) may not play as prominent a role as in English; (ii) The majority of cases of co-participant completion take the form of 'terminal item completion;' (iii) Locally emergent structures like 'contrast' and 'list' as well as 'unprojected' features of turn construction often play an important role in enhancing the opportunity for completing another participant's utterance-in-progress. The article then discusses the implications of these findings for the investigation of the mutual bearing of grammar and social interaction. In particular, the discussion focuses on what we can learn from the practice of co-participant completion about how projection of turn-shapes is accomplished in Japanese conversation.     

医疗纠纷泛化原因多视角分析

随着社会的发展,医疗纠纷日趋增多,成为各卫生部门的最大难题,是继医疗改革之后的又一备受社会各界关注的热门话题,医患关系成为社会最不和谐的声音。医患关系是在社会政治、经济、文化、法律等因素共同作用,围绕“治病”所形成的道德、诚信、契约、经济利益关系,通过分析现代医患关系的变化,探讨医疗纠纷增多的原因。     

Narrative Process Coding System in Marital and Family Therapy: An Intensive Case Analysis of the Formation of a Therapeutic System

The aim of this study is to investigate whether the method (Narrative Processes Coding System) for studying the narrative sequences of individual psychotherapy developed by Angus and Hardtke (1994) can be applied in a family therapeutic process. According to the results narrative process coding system adds new dimensions and gives new depth in the narrative understanding of family therapeutic process. In micro-analytic interactional level it shows the complicated interactions between narration, plot, and narrative process type.     

Exploring the meaning in meaningful coincidences: An interpretative phenomenological analysis of synchronicity in therapy

Synchronicity experiences (SEs) are defined as psychologically meaningful connections between inner events (e.g. thought, dream or vision) and one or more external events occurring simultaneously or at a future point in time. There has been limited systematic research that has investigated the phenomenology of SEs in therapy. This study aimed to redress this by exploring the process and nature of such experiences from the perspective of the practitioner. Semi-structured face-to-face interviews were conducted with a purposive sample of nine practitioners who reported SEs in their therapeutic sessions (three counsellors, three psychologists and three psychotherapists), and focused on how participants make sense of their experiences of synchronicity in therapy. Interpretative phenomenological analysis was used to identify three superordinate themes: sense of connectedness, therapeutic process, and professional issues. Findings suggest that SEs can serve to strengthen the therapeutic relationship and are perceived as useful harbingers of information about the therapeutic process, as well as being a means of overcoming communication difficulties, as they are seen to provide insights into the client’s experiencing of themselves and others, regardless of whether or not the SE is acknowledged by the client or disclosed by the therapist.     

Developing the Working Alliance in Marital Therapy; A Psychodynamic Perspective

A good working alliance in marital therapy is one in which the partners are actively collaborating with their therapist to work through conflicts. The therapist begins to develop the alliance by setting the frame of therapy and helping the couple understand the guidelines of treatment. The partners gradually identify with and emulate the therapist's working style and use of self as a reflective instrument. The working alliance can be weakened by empathic failures and strengthened by increased feelings of trust in the therapist and the process of treatment This paper looks at the development of the working alliance in marital therapy from a psychodynamic perspective. A clinical illustration is included.     

Discussion about the Triple Foundational Relationship between Intellect,Emotion, and Willing from the Perspective of the Phenomenology of Consciousness

There are at least three foundational relationships between the three conscious acts of intellect, emotion, and willing. Section 2 covers the structural foundational relationship (Brentano and Husserl in his early period): all conscious acts are intentional and can be divided into objectifying (intuition and representation) and non-objectifying acts (emotion and willing). Because a non-objectifying act cannot constitute an object, things must be based on objectifying acts and the object constituted by the latter; in this sense, a non-objectifying act is rooted in an objectifying one. Section 3 explains the genetic foundational issue with consciousness (Husserl in his later period, Scheler, and Heidegger): the stream of consciousness has its earliest origins and follows a process where it gradually unfolds. The earliest origin is the intentional willing, followed by nonintentional feelings, and, finally, the representation and thinking of willing. Intentional activity taking place afterward must be based on the conscious activity that has come already. Section 4 points out that, apart from the two aforementioned kinds of foundational relationships (i.e. structural and genetic), a third foundational relationship (i.e. dynamic) can also be found between the conscious acts of intellect, emotion, and willing in the Consciousness-only school (a Buddhist tradition in the East). In a continuous activity, the foundational relationship between the three aspects of intellect, emotion, and willing always remains encased in dynamic changes, and the change of primary and secondary roles (i.e. a change in the foundational relationship) could happen at any time. From this perspective, one can explain and resolve the confrontation and conflicts between the two former foundational relationships.     

Predicting Dropout in Counseling Using Affect Coding of the Therapeutic Relationship: An Empirical Analysis

This study used an observational research method to examine affective counselor–client exchanges during the initial session of counseling for clients who dropped out of counseling and clients who remained in counseling. Results confirmed significant differences in the affect codes of clients and counselors between the 2 groups. Discriminant function analyses classified 77% of counselors and clients in the correct groups and correctly classified over 94% of clients who returned for 4 or more sessions.     

A Conversation Analysis of the ‘Acquiescence’ of People with Learning Disabilities

Contrary to received wisdom, ‘acquiescence bias’ in the responses of people with learning disabilities to questioning is not a simple phenomenon, and certainly not one to be laid at the door solely of people with learning disabilities themselves. Rather, it is probably an artefact of the conversational organization of interviews as tests. Analysis of Quality of Life assessment interviews show, we argue, that there is probably no uniform ‘acquiescent’ motivation which accounts for all inconsistencies and agreements that might be produced under such circumstances. Rather, the interview's logic produces a range of pseudo-acquiescent responses in the face of interviewers reformulations, and their pursuit of plausible and acceptable answers. There is also evidence of ‘anti-acquiescence’, in which respondents resist pressure to change their answers. We conclude that the traditional notion of submissive, willing-to-please acquiescence is probably unsustainable on current evidence, and ought to be replaced by a more respectful account of the linguistic and interpersonal competence of people with learning disabilities.     

The Perceived Relative Strength of the Therapeutic Alliance

ABSTRACT

The association between the perceived relative strength of the therapeutic alliance in couples therapy and psychotherapeutic outcome was investigated. The perceived relative strength of the couples therapeutic alliance was classified into three categories: a balancedalliance (an individual perceives his/her own alliance and the partner's alliance as approximately equal in strength), a positively biasedor blessedalliance (an individual perceives his/her alliance as stronger than the perception of the partner's alliance) and a negatively biasedor just biasedalliance (an individual perceives his/her alliance as weaker than the perception of the partner's alliance). The impact of a consensus or non-consensus within each partner about the perceived relative strength of the alliance on outcome was also investigated. The Alliance Inventory for Couples was used as a measure of the alliance and outcome was assessed with the Family Environment Scale and the Marital Satisfaction Scale. No statistically reliable relation was found between perceived relative strength of the alliance and improved outcome. Consensus was also not predictive of outcome. These findings failed to confirm previous theoretical propositions and empirical research. Possible reasons for discrepancies between the current findings and previous research are provided. The distinction between perceived strength and strength based upon independent self-report measures; and the designation of biased, blessed and balanced alliances merit future research.     

‘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.     

Experiences of Altruism in the Therapeutic Relationship: Perspectives of Counselors‐in‐Training and Their Clients

The purpose of this phenomenological investigation was to explore experiences of altruism in the therapeutic relationship to better understand how counselors‐in‐training (CITs) and their clients mutually perceived the construct in sessions. Findings from interviews with clients (n = 14) included emotional–relational characteristics and cognitive–behavioral aspects of altruism by their counselors. Findings from interviews with CITs (n = 10) included explorations of the role of altruism in counseling, overall experiences of altruism in counseling sessions, and experiences of altruism with specific clients. Implications for practice and research are discussed.     

Interviewing a Therapist in the Presence of a Couple: A Description of the Therapeutic Process

A therapy research team interviewed a therapist in the presence of a couple. Following each of six consecutive sessions with a couple, an interviewer posed questions to the therapist and couple. While one question was standard to each interview, other questions were generated by team members who tracked the entire process via live observation. These questions were directed first at the therapist, then at the couple, and then focused on therapeutic process and outcome. Findings of this process for the therapy system included decreasing the hierarchy within the client/therapist relationship; increasing the client ownership and energy in the therapy process; discovering the presence of parallel processes between the systems; and informing the direction of future therapy sessions. Practical, clinical implications are discussed for a variety of therapy settings.     

我国古籍中“勇”的心理学探析

在830部古籍中检索“勇”,形成包含836个句段的语料库,对语料逐条进行内容分析。结果如下：“勇”的内涵主要体现为威猛强悍、临危不惧、坚定笃志、果敢决断、大义担当、知耻革新六个方面,大致分为义理之勇和血气之勇两类,具有维护国家安全、优化人格等功能。最后,对勇气的传统性与现代性、跨文化的一致性与差异性进行了讨论,并提出勇气是一种既继承了优秀的中国文化传统,又能适应当下心理学国际化需要的心理品质。     

疼痛治疗方法在晚期癌痛病人中的应用

癌症是当今严重威胁人类健康和生命的疾病之一。解除癌症疼痛对改善晚期癌症患者的生存质量、延长生存期都具有十分重要的意义。癌痛的诊断和合理的疼痛评估是治疗癌痛的基础。癌症疼痛的治疗方法虽有多种,但其目的就是使用最佳方法解除患者痛苦,消除疼痛,从而提高生存质量。因此本文从科学的角度对晚期癌痛的治疗方法进行评价和阐述。     

Competence in Delivering Cognitive Processing Therapy and the Therapeutic Alliance Both Predict PTSD Symptom Outcomes

Cognitive Processing Therapy (CPT) is efficacious in treating PTSD, but there remains a need to improve outcomes for individuals who do not fully respond to treatment. Differences between patient-therapist dyads in the fidelity (i.e., adherence and competence) of CPT delivery and the quality of the therapeutic relationship may partly explain differential levels of symptom improvement. Sessions were sampled from a randomized trial comparing different consultation conditions in training therapists new to CPT. Among 69 patients, one session from Sessions 1–3 and one session from Sessions 4–7 were reliably rated for adherence and competence using the CPT Therapist Adherence and Competence Scale, and for therapeutic alliance using the Working Alliance Inventory-Observer scale. Mixed models, including detrending using a fixed effect of session, predicted self-reported Posttraumatic Stress Disorder Checklist (PCL-IV) scores in one session using process scores from the previous session. The statistical interaction between fidelity and alliance scores to predict outcome was also examined. Alliance had significant, positive correlations (rs = 0.18–0.21) with same-session adherence and competence. Higher competence scores and higher therapeutic alliance scores in one session were independently associated with lower PCL-IV scores in the subsequent session. Adherence scores, which tended to be very high with relatively less variability, did not significantly relate to subsequent-session PCL-IV scores. Competence significantly interacted with alliance, such that sessions high in both competence and alliance predicted especially lower subsequent-session PCL-IV scores. A strong therapeutic alliance may have a synergistic, salutary effect with the competent delivery of CPT.