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.     

Exercises in Marital Listening and Conversing

ABSTRACT

This brief article shares a few simple interventions for use with couples who are having trouble in the areas of listening or conversing. Easy to implement, the exercises are expandable to other populations with problematic communication behaviors in the two previously mentioned areas. These exercises use external monitoring processes to assist clients in problem awareness and positive change.     

Addiction,the addict,and career: Considerations for the employment counselor

Employment counselors have been resistant to working with persons in recovery from addiction except under the strictest of criteria. This article examines the relationship between this resistance and the concepts of addiction and addict. Following this is an examination of substance abuse recovery and practical suggestions on incorporating recovery knowledge into career counseling. The goals of the article are twofold: (a) to present a framework that highlights the necessity of employment counseling for the recovery process from substance misuse and (b) to affirm that many employment counselors have the skills needed to assist clients who have been labeled as addicts.     

The Sexual Orientation Matrix for Supervision

SUMMARY

The Sexual Orientation Matrix for Supervision (SOMS) was created in order to assist supervisors and trainers in preparing supervisees to work with lesbian, gay, and bisexual (LGB) clients. The SOMS was developed around two core concepts: (1) degree of heterosexual bias, and (2) degree of acceptance of LGB orientations and behavior. Supervisors can employ the matrix to explore both their own and their supervisee's levels of comfort, knowledge, and experience in working with LGB clients including same-sex couples. This article describes the development of the matrix, an exploration of the concepts underlying this tool, and an explanation of how to use the matrix, including suggested tasks for supervision of therapists working with same-sex couples.     

The Non-Indian Therapist Working with American Indian Clients

Abstract

The lack of success non-Indian therapists have had in working with American Indian clients has perpetuated a repetitive cycle of poor mental health services with this population. Although we cannot change the historic distrust that exists, we can begin to understand cultural differences and how they can impact treatment to obtain positive results. Acknowledgment of these differences can promote trust, a core ingredient that must be established between the client and therapist. This paper offers guidelines to assist the non-Indian therapist in working with the American Indian client.     

Restoration of Intimacy and Connection in the Treatment of Couples with Substance Abuse Issues

SUMMARY

Addictions destroy both individuals and in particular their intimate relationships. Couples remain together for many reasons and when one partner has an addiction, the spouse has the fantasy that when the addiction is addressed the couple relationship will return to ‘normal.’ This article focuses on couple issues that have not been addressed in addiction treatment facilities and examines the role of the couple therapist versus the addiction counselor. Techniques and clinical interventions with this population are discussed and illustrated by case examples.     

A Feminist Approach to Treating Alcohol and Drug-Addicted African-American Women

Abstract

African-American women remain a population that is both unlikely to receive adequate treatment and more likely to be punished for behavior associated with alcohol and drug use. These societal responses originate, in part, in the failure of traditional addiction models to take into account the environmental context of addiction. Guided by the medical model in particular, the treatment community continues to identify addiction as a unitary experience and to deny the realities of sexism and racism in the recovery efforts of African-American women. Recommendations for the practice of feminist therapy with these women are explored.     

Fieldwork Journal at F.E.G.S.

SUMMARY

The challenge of working with the mentally ill population on the first Level I fieldwork exposure is often experienced in a setting where the on-site supervisor is a therapist from another discipline. Many skilled mental health professionals can offer a rich learning experience and assist students in mastering generic clinical skills in relating to and understanding the psychiatric population. Occupational therapy students bring to this clinical relationship the opportunity to demonstrate the effectiveness of occupational therapy interventions through group work, and individual evaluation and treatment, which benefits both the clients and the larger program. This article recounts the journal of a Level I student's journey through a setting that provided a receptive environment for fostering growth in the process of becoming truly comfortable and effective in the skills and roles of an occupational therapist in a mental health environment.     

Fostering the therapeutic alliance: Recognizing autonomy’s dialogical antecedents

ABSTRACT

This paper presents a reconceptualization of autonomy as the iterative realization of one’s capacity for “effective self-definition,” that is, possessing a sense of clarity and coherence in “who I am,” and exercising the decisional and volitional ownership over my life that this engenders. This process is “Relational,” wherein people’s interpersonal interactions have a deep and pervasive influence on their ability to recognize and exercise their autonomous capacities. This Relational understanding of autonomy is contextualized within the field of addiction rehabilitative practice. Addiction is a pathology that progressively and insidiously undermines autonomy – producing a number of negative consequences that present themselves along a “continuum of pervasiveness.” In order to most fully foster rehabilitation, therapeutic alliances should to be attentive to facilitating autonomy’s dialogical antecedents. Here, interpersonal recognition can help clients to more fully recognize their own autonomous resources – enabling them to embark on their rehabilitative journey and achieve broader autonomous living. This paper concludes by proposing ways that practitioners can manifest their recognition of their clients’ autonomy within the therapeutic encounter.     

Tom Thumb in hospital: The fairy tale workshop in a paediatric oncology and haematology ward

Abstract

Definitions of and attitudes towards countertransference have changed throughout the twentieth century. From being seen as a contaminant in the analytical process, countertransference has come to be seen by many therapists as a potentially useful source of information about a client and his or her problems. There are dangers as well as benefits associated with analysis and utilization of countertransference. This article reviews these issues and proposes some guidelines that therapists may find useful when contemplating their countertransference reactions to clients, and when considering how best to utilize these.     

The role of ultrarunning in drug and alcohol addiction recovery: An autobiographic study of athlete journeys

PurposeThere is contentious understanding of the role of sport in adult recreational drug and alcohol addiction recovery. This study explored athlete autobiographies as cultural sites of analysis in relation to the role that one sport (i.e., ultrarunning) plays in addiction recovery capital pathways.DesignWorking at the intersection of an autobiographical approach grounded in relativist narrative inquiry, a social constructionist narrative thematic analysis was conducted of two autobiographies--Catra Corbett and Carlie Engle—about addiction recovery through ultrarunning (i.e., distances of 43 km or more). The narratives used to construct life transformation and recovery capital in relation to ultrarunning were centralized in the analysis using Frank’s (2013) work on illness narratives and the body.ResultsTwo narrative themes threaded athletes’ addiction recovery journeys: chaos narrative and quest narrative. Two sub-themes related to fluid identity transformation intertwined with ultrarunning were identified within these narratives: 1. ‘addict-runner’ (chaos) and 2. ‘addict runner to ultra-runner’ (quest). Nuanced meanings of suffering were connected to identity transformation and running and two forms of addiction recovery capital: human (e.g., psychological adjustment, life perspective) and social (e.g., family connection, community).ConclusionsThe research findings provide insight into the role of sport in psychosocial aspects of addiction recovery using an autobiographical approach grounded in narrative theory. This study also extends work in sport psychology focusing on autobiographies as research and pedagogical resources to learn more about athlete mental health.     

The law and lawyers: Through psychodynamic eyes

Abstract

This article looks at some of the unconscious processes that operate among solicitors in general practice. In particular it considers various defences against the anxiety felt by solicitors partly because of the nature of their work and partly because of what is projected onto them by their clients. It argues that these defences have become embodied in the legal system itself as ‘socially structured defence mechanisms’ (Menzies Lyth 1989).     

Constructing a Theory and Evidence-Based Approach to Promote and Evaluate Autonomy in Addiction

ABSTRACT

In this article we use theory and empirical evidence to synthesize a model for the analysis of autonomy in people with addictions. We review research on motivation and denial as accepted addiction constructs that need to be replaced with non-stigmatizing and autonomy-supportive language when seeking to ‘treat’ addicts. We present three main factors involved in relational autonomy in addiction (mentalizing, positive self-concept, and stigma), and illustrate our model by examining variations on these parameters in two case studies of heroin addicts. We conclude that a growth perspective is needed to assess functioning in populations believed to be ‘addicted’ and make suggestions for assessment.     

The deep poetic soul: An alternative vision of psychotherapy

Abstract

This is the presidential address of David N. Elkins, who served as president of Division 32 in 1998–1999. Current mechanistic models of psychotherapy are criticized as failing to honor the complexities of human growth and the therapeutic process. The article presents an alternative vision of psychotherapy, grounded in an artistic perspective, that focuses on the deeper, more complex processes of clients’ growth and becoming. Four major pillars of this alternative vision are discussed: (a) the “more,” (b) the phenomenological experience of the emergence of the new, (c) the duende, and (d) destiny.     

Fat Women’s Experiences in Therapy: “You Can’t See Beyond…Unless I Share It with You”

Abstract

This article reports the results of a qualitative exploration of fat women’s experiences with weight-related microaggressions in psychotherapy. We conducted semi-structured interviews with 15 women about their weight-related experiences as therapy clients and asked for their advice to therapists who work with fat women. We used a general inductive approach to code the data into themes and found that common microaggressions included therapists who overly focused on weight, therapists who appeared to be less interested in clients because of their weight, and dissatisfaction with waiting room seating options. Participants advised therapists to allow their clients to initiate conversations about weight. Results suggest the need for increased awareness of: (a) how clients’ weight may impact therapists’ attitudes and choice of interventions and (b) how weight might influence fat clients’ in-session presentations.     

Relational-Cultural Practice: Working in a Nonrelational World

SUMMARY

While more and more clinicians are practicing a relational-cultural approach to therapy, many work in settings that continue to reinforce the normative values of separation and disconnection. Consequently, practitioners face the challenges of helping clients heal and grow-through-connection while navigating work settings that are all too often professionally disempowering, disconnecting, and isolating, i.e., “cultures of disconnection.” This article begins a conversation about the complexities of practicing Relational-Cultural Theory in nonrelational work situations and explores new possibilities for creating movement and change in these settings.     

The common sense of counseling psychology: introducing the Common-Sense Model of self-regulation

Abstract

The goal of therapy is typically to improve clients’ self-management of their problems, not only during the course of therapy but also after therapy ends. Although it seems obvious that therapists are interested in improving clients’ self-management, the psychotherapy literature has little to say on the topic. This article introduces Leventhal’s Common-Sense Model of Self-Regulation, a theoretical model of the self-management of health, and applies the model to the therapeutic process. The Common-Sense Model proposes that people develop illness representations of health threats and these illness representations guide self-management. The model has primarily been used to understand how people self-manage physical health problems, we suggest it may also be useful to understand self-management of mental health problems. The Common-Sense Model’s strengths-based perspective is a natural fit for the work of counseling psychologists. The model has important practical implications for addressing how clients understand mental health problems over the course of treatment and self-manage these problems during and after treatment.     

Addiction and Responsibility: A Survey of Opinions

ABSTRACT

This article reports the result of a survey about causal beliefs, normative conceptions and moral evaluations of addicts and addiction in the general population. Specifically, we focused on four issues: To what extent are the normative conceptions of addiction current in the philosophical and scientific literature reflected in laypersons' conception of addiction? How do laypersons rate addicts on perceived responsibility? Which factors influence laypersons' responsibility attributions in the context of addiction? What feelings and attitudes (anger/sympathy/help-giving intentions) do laypersons have toward addicts? We found that, although laypersons seem to assume a weakness view of addiction, their patterns of responsibility attributions vary depending on type of drugs combined with perceived severity of outcome, where the latter even overrides the attributional effects of the actor's perceived control over events. Some explanations of the data are suggested, and various consequences with respect to help-giving behavior, are discussed.     

Promoting Clinical Knowledge,Skills, and Empathy via a Creative Self-Suicide Assignment

Abstract

Suicide is a leading cause of American deaths. Given suicide's overall frequency and negative effects, specialized suicide training is warranted. This article describes a creative self-suicide assignment designed to enhance doctoral students? suicide assessment and intervention knowledge and clinical skills, and promote greater counselor empathy for clients presenting with suicidal ideation. Doctoral students who participated in the assignment reported increased suicide assessment and intervention knowledge and skills, and enhanced empathy toward clients presenting with suicide-related issues. Student summarizations related to their assignment experiences are included.