Just for Women? Feminist Multicultural Therapy with Male Clients

Feminist multicultural therapy is an integrative approach to psychotherapy that emphasizes a systems-level understanding of psychological distress and the process of therapeutic change. In the present exploratory study, the experiences of feminist multicultural therapists working with male clients were studied using Consensual Qualitative Research (CQR) (Hill et al. 1997). Phone interviews were conducted with eight female practicing licensed or license-eligible therapists who had worked with at least one male client in the past 6 months. Consistent with the theoretical approach, all of the therapists interviewed expressed their belief that psychological symptoms can be seen as a reaction to a loss of power or related to the effects of an oppressive system. Additionally, the therapists believed that this theoretical model is broad enough to be used with varying types of intersecting social identities. The findings illustrate the ways in which the counseling approach may work similarly across genders, as well as ways in which one’s therapeutic approach may be altered when working specifically with men. Implications for therapists who work with male clients (both the rewards and the challenges) as well as for researchers who wish to study the application of therapeutic interventions with men are discussed.     

Death of a Clinician: The Personal, Practical and Clinical Implications of Therapist Mortality

Death is inevitable and yet in US culture the discussion of death is somewhat taboo. Marriage and Family therapists are trained in the implications of grief and loss for clients who lose loved ones and yet examination of the impact of therapist mortality on clients is lacking in the clinical literature. This article examines ways that private practice therapists can both protect their client’s confidentiality and mitigate the impact of therapist sudden death on their clients with planning and forethought. In addition, the factors influencing the lack of empirical research on this topic is discussed in the context of social mores on death and how therapists’ own denial of mortality may impact their ability to connect with clients through the pain of grief and loss. Recommendations are made for therapists to evaluate their own attitudes towards mortality and develop a plan for client care in the event of their death.     

Therapist Perceptions of Client Reactions

This study examined therapist ability to identify client-reported reactions. Sixteen therapists each saw two volunteer clients for single counseling sessions. In postsession reviews, clients rated the helpfulness of, and indicated their reactions to, each therapist intervention. Therapists also rated the helpfulness of, and indicated their perceptions of client reactions to, each therapist intervention. In 50% of the instances therapists matched clients, that is, reported the same reaction cluster as the clients did. There were higher match rates on the reaction clusters of therapeutic work (62%), supported (54%), and no reaction (46%) than negative reaction (27%) and challenged (14%). When therapists matched on therapeutic work, helpfulness ratings for the following intervention were higher than when therapists did not match. In contrast, when therapists matched on negative reactions and no reaction, helpfulness ratings for the following intervention were lower than when they had not matched. Thus, therapists' ability to match client reactions was related to their ability to generate helpful interventions. Implications for practice and future research are discussed.     

Qualitative meta-analysis of insight events in psychotherapy

Purpose: This study reports on a qualitative meta-analysis examining the phenomenon of insight into psychotherapy. Method: Studies (n?=?7, covering 15 insight events of 15 clients) were selected that examined significant events in psychotherapy leading to insight using session recordings and Interpersonal Process Recall interviews with clients and therapists. A conceptual organization of the data using a matrix grid consisting of three domains according to data origin (client process, therapist process, and their interaction) and three domains according to events’ sequence (context, event and key intervention, and impact) was established. Results: Key processes were identified that lead to insight events in psychotherapy. Two distinct types of events according to their main impacts as reported by the clients were identified: Painful/Poignant Insight where clients realized something that was painful, often evoking feelings of sadness or undifferentiated upset containing sadness and hurt; and Self-Asserting/Empowering Insight that led to an impact characterized by a sense of self-assertion and empowerment on the client’s part. A reasonably good alliance and vulnerability on the client’s part represent the context for insight events as does the client’s quest for self-understanding. The therapists’ key interventions in the event leading to poignant/painful insight contain either empathic reflection or collaborative interpretation. In empowerment/self-assertive insight events the therapists offer supportive, validating reframing promoting positive experience. In both types of events the therapist and the client work on consolidating insight. In some events, therapists emphasized cognitive or problem solution focused impacts, while clients emphasized emotional impacts. Some events contained emotional avoidance on the part of the client or therapist thus not realizing the full potential of the event.     

Tools for Change

Abstract

This paper discusses the ways in which one may incorporate political action into a client's therapy process so the client may incorporate it into her/his life. A framework for defining this as ethical, therapeutic and necessary to the client is presented. A number of suggestions for helping clients and therapists to become more politically active, as well as vignettes demonstrating how this might work with clients in the therapy process are provided.     

Fostering Client Creativity in Family Therapy: A Process Research Study

Creativity has been shown to enhance problem solving, and to increase flexibility and adaptability—qualities associated with positive therapeutic outcomes. Literature related to therapist and/or client creativity is primarily anecdotal. Empirical literature addressing how therapists can facilitate the creativity of their clients in family therapy is scarce. In this study, the researchers used process methodology to code the behavior of therapists and clients in 31 videotaped family therapy sessions. Results show a significant positive correlation between interventions that induce positive affect and the creative client behaviors of optimism and playfulness.     

A discourse analysis of power in relation to PSYCHLOPS (Psychological outcome profiles) in the context of CBT for psychosis

Aims: Outcome measures (OMs) and routine change measurement have developed dramatically in psychological therapies over the last two decades and some therapists have expressed concerns that this, depending on how it is handled by the parties involved, can markedly affect the therapy. However, little research has investigated this. It therefore seemed timely to explore discourses of OMs drawn upon by both parties in the therapy room. Method: PSYCHLOPS (Psychological Outcome Profiles) is a client‐centred measure which offered an opportunity to explore how therapists and clients receiving CBT for psychosis talked about OMs. A useful contrast was provided by the CORE‐OM (Clinical Outcomes in Routine Evaluation‐Outcome Measure). The discourses drawn upon by clients (n=4) and therapists (n=4) were analysed, informed by a Foucaultian framework. Results: OMs were constructed as empowering or disempowering of clients, as being able to do therapeutic work of engagement and containment, and as part of the apparatus of service power, positioning therapists as relatively powerless to question their use. Discussion: It is suggested that client‐centred measures like PSYCHLOPS, although partly aligned with a recovery framework, may become part of top‐down state and service power, and there is a need for more research into the different ways in which OMs are used in therapy and the impacts on therapists, clients and their relationships.     

Behaviour therapy for obesity: The role of clinicians in the reduction of overweight

Behaviour therapists are often required to help those who are unhealthily overweight to reduce. Unfortunately, these interventions are often ineffective in the long-term. Many clients never achieve reduced weight. Often, those who do reduce weight are unsuccessful in keeping the weight off. A review of the relevant literature suggests that most therapeutic approaches do not enable people to change their lifestyles in the ways likely to be necessary for permanent reduction of weight to a healthy level. Clinical support for weight reduction would be more effective if it were more culturally realistic and therapeutically sensitive in empowering clients to make informed choices for themselves among sustainable habits of eating and exercise that contribute to negative energy balance. Approaches which encourage client self-efficacy and self-assertion are likely to be more effective in facilitating lasting change.     

Managing Emotional Responses in Therapy: An Adapted EFT Supervision Approach

Therapists often encounter experiences in therapy that elicit emotionality, this could be in the form of self-of-the-therapist issues, compassion fatigue, or professional burnout. Whereas approaches to supervision for self-of-the-therapist issues recognize the need for accessing the supervisee’s emotionality, approaches have not focused on how the clinical and professional system could also be part of the cycle. We propose an adapted emotionally focused supervision approach that employs steps one through six of the EFT model. To display how this approach would work, we provide the example of work with longer-term clients. Working with longer-term clients can be a challenge for many therapists, and both the professional and client system come with factors increasing emotional risk to the therapist. Engaging the therapist’s emotionality through supervision has the potential to improve therapeutic outcomes, as well as reduce loss of good therapists in the field to professional burnout.     

Working with Families from the Indian Sub-Continent: An Indo-German Experience*

Whereas most Western European therapists and clients consider emotional distance and abstinence as desirable and conducive in the therapeutic process, this may not always be the case with clients from India. Cultural components such as the contrast between linear and cyclic world-views and the traditional view of the psychologist as an advisor in India present a challenge to professionals with a Western background. Some factors such as the situation of women in society and seemingly too close familiy ties can mean that a Western therapist fails to promote the changes an Indian client is desiring for his or her family. However, besides cultural awareness and caution, one of the most helpful tools in work across cultures is curiosity in its most positive sense and the readiness to be surprised by ones’ clients.I would like to thank all my Indian colleagues who supported and advised me in my work in India.     

Therapists’ experiences with internal representations of clients

Fourteen therapists were interviewed via telephone regarding their experience of “carrying around” their clients with them between sessions (i.e. internal representations, or IRs, of clients), a phenomenon about which little empirically based knowledge exists. Data were analyzed using consensual qualitative research. Findings indicated that overall, therapists have IRs infrequently, most often have IRs of clients struggling with severe or challenging presenting problems, and do receive some training about IRs. When describing a specific IR experience, therapists typically noted a strong therapy relationship, and stated that the IRs typically had specific triggers. The IRs generally consisted of feelings about the client, and typically consisted of thoughts about the client or the felt presence of the client. The IRs generally yielded positive effects, typically both personally and professionally, and were typically discussed with supervisors/consultants. Implications for research, training, and practice are presented.     

Therapists’ perspectives about working with meaning in life in psychotherapy: A survey

Of 212 practicing therapists who completed a survey about working with meaning in life (MIL) in psychotherapy, 129 (61%) had recently worked with MIL with at least one client and reported on their work with a client in this survey. Those therapists who had worked with a client on MIL as compared with those who had not were older, more experienced, more humanistic/existential/experiential in orientation; reported more MIL training; and felt more competent working with MIL. Clients reported on primarily had internalizing, interpersonal, and career issues. Only 12% of clients explicitly labeled MIL as an issue coming into therapy. The three most frequently used interventions involved offering support; helping clients examine thoughts, feelings, and behaviors to discover hopes and goals; and facilitating exploration of MIL cognitions and experiences. Therapists reported many positive consequences from working with MIL. Therapists reported minimal training in MIL and moderate competence in working with MIL. Implications for practice, training, and research are presented.     

Integrative Shifts for the Theory and Practice of Family Systems Therapy

This paper describes several disagreements among approaches to family therapy and proposes two conceptual shifts providing a more integrative perspective. The first shift focuses on the implications of different ways therapists orient themselves to the developing structures of the therapy system and to the disabled structures of the client system. The second shift reconsiders theoretical approaches in terms of the types of distance they require of the therapist and the types of information these distances provide and ignore. Finally, the paper also discusses a means for classifying the different types of goals therapists establish for their clients, emphasizing that these goals must be consistent with the clients' views of themselves and the world.     

Client attendance measures in counselling psychology trainees

Counselling supervisors and educators have yet to reach a consensus about standard measures for evaluating the performance of graduate student therapists. Compared to self‐reports and rater judgements, client attendance records provide low‐inference behavioural data partially reflective of clients’ engagement with therapists. This naturalistic study evaluates client attendance data using archival records of 92 doctoral students in beginning and advanced counselling practica who produced data for 771 clients, 3,949 scheduled sessions and 3,186 attended sessions. Providing evidence of the sample representativeness for clinicians, results indicated that the mean number of sessions attended per client for student therapists (5.65) was very similar to that reported in the literature for outpatient therapists (<6). As expected because of structural differences in client assignment, beginning and advanced students evidenced statistically significant differences on attendance variables such as number of clients and scheduled sessions. In contrast, attendance ratios were equivalent across counsellor experience, suggesting that these individual difference variables could be useful for evaluation of therapist competencies related to client engagement.     

Client Aggression Towards Therapists: Is It More or Less Likely with Transgendered Clients?

ABSTRACT

It is well known that clients occasionally threaten or assault their therapists. No studies to date have attempted to systematically measure client aggression by transgender patients towards clinicians. One of the major questions of this study was to determine if clients with gender dysphoria have greater levels of aggression towards therapists than non-gender dysphoric clients. One hundred and fourteen professional therapists who are members of the Harry Benjamin International Gender Dysphoria Association responded to a questionnaire that addressed aggression by both transgender and non-transgender clients. Transgender clients were shown to commit significantly less acts of aggression than did non-transgendered clients (p = 0.0094). Within the relatively small subgroup of transgender clients that did commit acts of aggression, male-to-female transgender clients were significantly more likely to do so than female-to-male clients (p = 0.002). While the transgendered client undergoes significant suffering in violating inviolable gender boundaries, this suffering, in general, does not translate into acting out behaviors directed towards their therapists.     

Treating Depression During a Recession: Psychotherapy with Indigent Clients

During the last few years, the global economy has struggled and many clients have experienced significant financial hardship. It can be difficult to confront emotional problems when there are multiple life stressors impinging on clients and disrupting their daily functioning. Several recommendations are provided for helping clients to oppose their depressive tendencies when financial problems are real, significant, and lasting. First, therapists can provide a stable and supportive relationship that helps to ease the client’s emotional distress and lays the foundation for other aspects of treatment. Second, therapy can help to protect an optimistic attitude and instill hope for a better future. Third, behavioral activities can be used to encourage productive activity each day. Fourth, problem-solving skills can help many clients deal with stressors in a direct, constructive, and proactive manner. Fifth, therapy can examine ways to expand and improve the client’s social relationships. Finally, psychotherapists should collaborate with other health care professionals in order to ensure the optimal, integrated care for the client. It is hoped that these recommendations will be helpful for therapists who work with financially impoverished clients.     

Ethical Considerations for Therapists Working With Demographically Similar Clients

The increasing emphasis on multicultural competence within psychotherapy continues to highlight the need for being sensitive to key differences between therapist and client. However, this attunement to the psychotherapeutic impact of therapist–client differences may obscure the equally critical need to evaluate ethical problems associated with therapist–client similarities. It will be argued that therapists treating clients who are demographically similar to themselves encounter a unique set of ethical challenges that warrant careful consideration and caution precisely because of therapist–client matching. The extant research on matching therapists and clients based on demographic similarities is discussed, with a particular emphasis on psychotherapeutic outcomes and client preferences. Attention then turns to the nonrational heuristics and biases that can often cloud therapists’ ethical decision making regarding the appropriate uses versus contraindications for demographically matching therapists and clients. Within the discussion of nonrational heuristics and biases, suggestions are offered for managing related challenges for ethical decision making.     

Client concealment and self-presentation in therapy: comment on Kelly (2000)

The authors disagree with A. E. Kelly's (2000) conclusions that clients conceal things from therapists primarily for self-presentational reasons and that client concealment is positively related to positive therapy process and outcome. They also disagree with A. E. Kelly regarding the implications of self-presentation theory for therapy. Their review of the research suggests that clients do not conceal much from therapists, that what they do conceal involves many different kinds of information hidden for many different reasons, that therapists have wide variability in being able to detect hidden client material, and that the relationship of client concealment and therapist awareness of client concealment with therapy process and outcome is not clear. Finally, the authors discuss their views about implications of client concealment and self-presentation for therapy.     

The use of self-disclosure among Swedish psychotherapists

Although self-disclosure, when handled with discretion, is often seen as an important intervention in many psychotherapy orientations, including psychodynamic as well as humanistic and cognitive-behavioral approaches, many psychotherapists seem reluctant to use it. The frequency and type of those interventions from psychotherapists of different orientations is less well known. In this study, a random sample of Swedish psychotherapists was asked about their use of different types of self-disclosing information. The results showed that therapists with CBT orientation told their clients more about their training and about their personal ways of handling affective-relational issues. It was apparent that the trend toward more use of self-disclosure in relational psychodynamic treatment has not been accepted among a large number of psychodynamic and psychoanalytic psychotherapists in Sweden. It is recommended that psychotherapists inform their clients more about their training and in appropriate ways share more with their clients about their own relational experiences. Doing so may help enhance clients’ hope and their ability to address their ongoing difficulties.     

The client,the therapist and the paranormal: a response to the special edition on psychotherapy and the paranormal

Abstract

In this paper, I provide a published paper response to the papers in this special edition on the paranormal and psychotherapy articulated largely from my career as a parapsychologist. In the introduction I note the definitional differences between advocates and counter-advocates in terms of what might be ‘paranormal’, although I argue ultimately that definitional differences aside, the therapist’s relationship with the client’s unusual experiences is critical, taking a phenomenological stance which is echoed by at least two of the papers in the special edition. In broad review, the papers make a variety of welcome contributions; historical individually and small sample phenomenological and also more metaphorically in terms of articulations of the haunting nature of collective and intergenerational trauma in the social and cultural sphere. I review the papers from a parapsychological perspective, considering the evidence drawn from parapsychological studies where it supports or adds to the topics of each paper. In concluding this response, it seems clear that therapists often work from first principles when relating to clients’ anomalous experiences, and that the papers of the special edition each offer practising therapists some important evidential and practical insights into working with client presentations of ostensibly paranormal and anomalous experiences.