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.     

Psychotherapy and schizophrenia: An analysis of requirements of an individual psychotherapy for persons with profoundly disorganized selves

Many emerging views of outcome from schizophrenia emphasize that persons must recover a sense of their own identity, agency, and personal worth. While this is intuitively appealing and consistent with a wide range of literature, it raises the issue of how best to facilitate this. In this article we explore how integrative psychotherapy might address issues of narrative and recovery from schizophrenia among persons experiencing more profound levels of disorganization. Illustrated with a case example we explore in particular the barriers posed to psychotherapy by a client's cacophonous self-presentations. We then describe techniques from an integrative perspective that might help therapists enter dialogue with persons so afflicted. Our claim is that psychotherapy can revitalize dialogues within the client and between the client and others that enable the reconstruction of a personal narrative from which a life plan might be articulated.     

The experiences of therapy from the perspectives of carers of people with dementia: An exploratory study

Design: Interviews were conducted with six carers of people with dementia about their experience of receiving counselling/psychotherapy. Interviews were conducted in the carer's own home, and data were analysed thematically using a narrative approach. Findings: Three themes were identified from the data: ‘Still doing the best I can’ (identified as losses and processes of personal growth); ‘Feeling connected and being understood’ (identified as attributes believed to be important within the therapeutic relationship); and ‘Wanting to share information’ (identified as sharing information with someone ‘neutral’). Carers placed emphasis on the age of the therapist and the amount of therapist self‐disclosure. Attending counselling and/or psychotherapy also helped the carer to find a ‘safe space’ to disclose and share concerns. Discussion: Carer loss and personal growth are explored, together with the importance of building therapeutic relationships and, for the therapist, seeking supervision when managing personal self‐disclosure. The theme of therapist self disclosure is explored together with the importance of therapists seeking supervision when managing personal self‐disclosure.     

Constructive Metatheory: II. Implications for Psychotherapy

Abstract

The implications of constructive metatheory for the conceptualization and practice of psychotherapy are briefly outlined. It is argued that the constructivist therapist construes the client as an active and developing process, and that psychological problems are approached not as piecemeal flaws or deficiencies, but as expressions of current discrepancies between an individual's adaptive capacities and the challenges she or he faces. Likewise, the process of psychotherapy is portrayed as one of trial-and-error experimentation with different (novel) ways of “being in the world.” Ideally, the client and therapist create an intimate and emotionally charged alliance in and from which the client can explore and experiment with self and world relationships. These practical features dovetail with many assertions of the major me-tatheories of psychotherapy, and it is argued that constructive metatheory may be uniauely suited to facilitating attempts at conceptual integration     

The Pre-reflective Situational Self

It is often held that to have a conscious experience presupposes having some form of implicit self-awareness. The most dominant phenomenological view usually claims that we essentially perceive experiences as our own. This is the so called “mineness” character, or dimension of experience. According to  this view, mineness is not only essential to conscious experience, it also grounds the idea that pre-reflective self-awareness constitutes a minimal self. In this paper, we show that there are reasons to doubt this constituting role of mineness. We argue that there are alternative possibilities and that the necessity for an adequate theory of the self within psychopathology gives us good reasons to believe that we need a thicker notion of the pre-reflective self. To this end, we develop such a notion: the Pre-Reflective Situational Self. To do so, we will first show how alternative conceptions of pre-reflective self-awareness point to philosophical problems with the standard phenomenological view. We claim that this is mainly due to fact that within the phenomenological account the mineness aspect is implicitly playing several roles. Consequently, we argue that a thin interpretation of pre-reflective self-awareness—based on a thin notion of mineness—cannot do its needed job within, at least within psychopathology. This leads us to believe that a thicker conception of pre-reflective self is needed. We, therefore, develop the notion of the pre-reflective situational self by analyzing the dynamical nature of the relation between self-awareness and the world, specifically through our interactive inhabitation of the social world.

     

Crisis Theory and Therapeutic Change in Small Groups: Some Implications for Community Mental Health Programs

Abstract

The role of sibling dynamics in group psychotherapy has received relatively little attention in the literature. Our clinical experience suggests that sibling issues regularly arise in the practice of group psychotherapy. This article provides an integrative view of sibling relationships from a family systems and self psychology orientation to group therapy. Special emphasis is placed on developmental and cultural differences as they affect sibling dynamics and the group leader’s role. A number of case examples are offered to illustrate ways to view clinical challenges in a manner consistent with the influence of sibling relationships on group members and group process.     

Tragedy and the art of questioning in depth psychotherapy

Abstract

This essay examines how the art of questioning is central to depth psychotherapy. Conceiving of depth psychotherapy as a tragic art suggests the kind of inquiry unique to psychotherapy is that oriented to pathos. To explicate the art of pathic inquiry, this essay draws upon Nietzsche's depiction of Greek tragedy as structured by the relations between the artistic deities Apollo and Dionysus. As a tragic art, the structure of pathic questioning is formed by the principles these gods embody: reason and passion. Their intertwining within a psychotherapeutic discourse stimulates a liberative self‐knowledge, exemplified here by the differing approaches of Eugene Gendlin and James Hillman.     

The Mutual Development of Intersubjectivity and Metacognitive Capacity in the Psychotherapy for Persons with Schizophrenia

While cognitive behavioral approaches have been shown to help some individuals with schizophrenia, these approaches may be limited when working with patients with impairments in the metacognitive abilities required to form complex and integrated representations of themselves and others. In response, this paper explores the possibility that a key to working with patients with relatively impaired self-reflectivity lies in explicitly focusing on a patient’s intersubjective experience within psychotherapy. We offer theoretical and empirical support for the assertion that the tolerance and capacity for intersubjectivity is a basis for the development of self-reflectivity in general. We also explore how the fostering of intersubjective processes in psychotherapy might enable some patients to form more complex ideas about themselves and so better ward off delusions in the face of the challenges of daily life. To illustrate these principles we present the case of a patient with tenaciously held delusions and limited capacity for self-reflection. We discuss when and how the therapist’s awareness and verbalization of intersubjective processes within session allowed her and the patient to develop more complex and consensually valid ideas about him as a being in the world, which then assisted the patient to achieve improvements in a number of domains in his life.     

A psycho-analytical approach to the assessment of a psychotic patient

SUMMARY

When approached from a psycho-analytic point of view, psychotic states reveal a wide variety of patterns. Some of these are so complex and so rigid in their organisation as to render the patient quite unsuitable for formal psychotherapy. Others are more benign and accessible to a psycho-analytic approach.

The attempt to assess whether a psychotic patient might benefit from psycho-analytic psychotherapy can be facilitated by the use of certain psycho-analytic concepts which provide “ground rules” for decoding psychotic communication, for understanding the psychotic patient's experience and how it has come about.

This paper represents an attempt to show how the psychoanalytic approach to such understanding can help in the management of the case and open the way for psycho-analytic psychotherapy within the N.H.S. Although extremely limited in its provision of skilled psychotherapy, the N.H.S. provides an extremely rich potential for effective understanding, care and treatment of the psychotic patient if the psycho-analytic approach is sufficiently well understood and implemented.     

Psychotherapy and Recovery from Schizophrenia: A Model of Treatment as Informed by a Dialogical Model of the Self Experience in Psychosis

Since the term schizophrenia was coined, the disorder has been linked to experiences of self-diminishment. This link calls for theoretical work that helps us understand experiences of diminishment wherein persons find themselves less than they once were but nevertheless able to recognize and describe their diminishment. In response this paper describes how dialogical psychology may help us both understand this feature of schizophrenia and inform the practice of psychotherapy. In particular, we suggest that some alterations in sense of self in schizophrenia may proceed from a range of losses in a person’s ability to sustain intrapersonal and interpersonal dialogues. Moreover, we suggest that these losses lead to at least three different forms of disturbed self experience: barren, monological and cacophonous selves. We then explore the unique challenges each poses to psychotherapy and suggest that attention to dialogical deficits may enrich self-experience if it attends to aspects of self-experience that emerge within session.     

Metacognitive Reflective and Insight Therapy for a Person Who Gained Maximal Levels of Metacognitive Capacity and Was Able to Terminate Therapy

Schizophrenia often involves a loss of metacognitive capacity, or the ability to form a complex and integrated sense of self and others. Independent of symptoms and impairments in neurocognition, metacognitive deficits are a barrier to the formation and sustenance of goal-directed activities of daily life and ultimately to recovery. Metacognitive reflective and insight therapy (MERIT) is a form of psychotherapy intended to assist patients to recover metacognitive capacity through intensive individual therapy. This paper presents a case illustration of how MERIT assisted a patient with prolonged schizophrenia and significant metacognitive deficits to develop a robustly complex understanding of himself and others and then to use that knowledge to agentically monitor his own experiences and effectively respond to life challenges. The eight elements of MERIT that stimulate and promote metacognitive capacity are presented with an emphasis on how they were implemented when the patient had reached some of the higher levels of metacognitive function.     

Passion,Containment, and Commitment—Essential Elements of Groups Across the Lifespan in Bruce Springsteen’s Work

Abstract

The group, with its intensity, interaction, roles and dynamics, is an important unit of experience in everyday life, in psychotherapy groups, and in Bruce Springsteen’s music. This paper explores experiences of and ideas about real life groups throughout the lifecycle through Springsteen’s music, framed in concepts from a broad group literature including clinical psychology, social psychology, group psychotherapy, sociology, anthropology, and organizational psychology. The lifecycle includes adolescence and the role of the group to contain all its passions; the work world with its excitements and disillusionments; encounters with loss, and the holding power of the group; experiences of dissolution of the group, and possibilities for recommitment; and the passion and support of the group during celebrations. Themes of passion, containment, and commitment weave throughout the narrative.     

Narratives of trauma,recovery, and growth: The complex role of sport following permanent acquired disability

ObjectivesThe purpose of this study was to explore how participation in sport may assist an individual in working through experiences of physical trauma.DesignAn instrumental, collective case study was used to illustrate the experiences of two men with acquired disabilities.MethodBoth men participated in sport at a high level and suggested that participation was a central feature of their recovery from trauma. Interviews invited participants to describe their lives pre-trauma, the trauma experience, and the recovery process. A narrative analysis was used to focus on the progression of the plot outlined in each participant's story.ResultsOur results exemplify two narrative types: assimilation and positive accommodation. The narrative of positive accommodation demonstrates how sport provided mastery experiences, enhanced relationships, corporeal understanding and enhanced life philosophies. The alternative narrative of assimilation was associated with resilience to trauma. Our case illustrates that such a narrative may be focused on re-capturing previous life meanings and creating an athletic identity using past definitions of sport.ConclusionWhile the narrative of positive accommodation is most frequently associated with posttraumatic growth, our case outlines the occurrence of synchronous positive and negative experiences, even within the same dimensions of growth. The narrative of assimilation demonstrates the challenges presented by the rehabilitation and sporting environments for an individual who aimed to restore their pre-trauma self and pre-trauma beliefs.     

Linking Developmental Experiences to Leader Effectiveness and Promotability: The Mediating Role of Leadership Self‐Efficacy and Mentor Network

We developed and tested a model linking developmental experiences to leadership effectiveness and promotability through 2 mediating processes based on social cognitive and social capital theories. We hypothesized that a manager's exposure to 3 types of developmental experiences (formal development programs, developmental job challenges, and developmental supervision) would positively relate to supervisor's assessment of the manager's leadership effectiveness in the current job role and promotability within the organization through the manager's leadership self‐efficacy and size and quality of the manager's mentor network. Results based on a sample of 235 retail managers showed that leadership self‐efficacy and mentor network fully mediated the relationship between job challenges and promotability, whereas leadership self‐efficacy also fully mediated the relationship between job challenges and leadership effectiveness. Developmental supervision was indirectly related to promotability through mentor network. In addition, a 3‐way interaction analysis revealed that participation in formal development activities had a positive indirect relationship with leadership effectiveness and promotability mediated by leadership self‐efficacy when a manager experienced either lower levels of job challenge and developmental supervision, or higher levels of both. Our findings contribute to leadership knowledge by examining how both formal and informal developmental experiences relate to leadership effectiveness and promotability through social processes.     

AGAINST RECORDING SESSIONS FOR SUPERVISION

The American Psychological Association’s (APA) 2014 injunction that supervisors must listen to recorded sessions of their supervisees’ work is based on a rich and thorough body of research, and yet it entails a narrative of psychotherapy as a discipline of Science. If psychotherapy is understood as an endeavor also of the Humanities, recording sessions may be anathematic to supervision and training. Developing ideas from Greenberg’s (2015) theory of “controlling fiction,” the writer presents a narrative of psychotherapy in which it is not wise to review recorded sessions in supervision.

     

Altruism and the Resolution of the Transference Resistance: Partners in Clinical Psychoanalysis

ABSTRACT

The article is devoted to the central place of altruism in clinical psychoanalysis and psychotherapy. Using an experiential-subjective perspective, I demonstrate how I overcame an inhibition in utilizing altruism in my theoretical and clinical work, which then reduced barriers against working with the experience of vitality, closeness, and creativity for my patients and myself. I then could follow the importance of resolving the transference resistance against consolidating the experience and functioning of the self or person. At this time, altruism has also become a subject of interest in several fields that deal with human and animal behavior such as evolutionary science, social biology, and anthropology. Psychoanalysis, with its special subjective and experimental perspectives, can make valuable contributions in these realms of knowledge and research.     

Positive Aging Through Reading Our Lives

The same turn toward ??narrative?? that has been making its way across psychology, sociology, and related disciplines is influencing how gerontologists view the inner experience of aging??inside aging, as it were: subjective aging or biographical aging. In sympathy with Kenneth and Mary Gergen??s vision of ??positive aging??, and in contrast to the biomedical paradigm that dominates societal perceptions of aging in general, a narrative gerontology appreciates that lives are in many ways ??texts?? that are socially constructed - and co-authored??amid our relationships with others within a wide range of narrative environments, larger stories, and master narratives??families, friendships, cultures, creeds, etc.. In this way, it opens up a theoretical space for appreciating the poetic complexity of later life and for seeing aging as a process, potentially, of growing old and not just getting old. This paper explores how a poetic or narrative perspective sheds light on the intimate links between memory, meaning, wisdom, and spirituality; moreover, how learning to ??read our lives?? can aid us in developing resilient, robust stories??of self, other, and world??with which to meet the many challenges of later life.     

The Supervisory Alliance as Quintessential Integrative Variable

The concept of alliance in psychotherapy supervision is now a half century old. But over the course of its first 50 years, how has the supervisory alliance come to generally be viewed by supervision scholars and practitioners? and What is its specific place now within different visions of supervision? In this paper, I would like to consider those two questions by: (a) describing the two enduring perspectives on the supervisory alliance that have dominated and continue to dominate the supervisory scene; and (b) examining the ways in which the alliance appears to currently be conceptualized and implemented across several distinct views of supervision. Each view of supervision is also presented as containing and actuating its own message and meaning about the role of alliance in supervision, and those messages and meanings are accordingly identified. The supervisory alliance appears to now be widely regarded as being a transtheoretical common factor that binds by means of: (a) bond/rapport; (b) supervision goals; and (c) supervision tasks. Much like the therapeutic alliance in psychotherapy, the supervisory alliance has increasingly come to be seen as the very heart and soul of supervision itself and may indeed be the quintessential integrative variable in psychotherapy supervision.     

Toward the re‐enchantment of psychotherapy: Stories as container

Abstract

Storytelling by a therapist to clients may serve to increase clients’ ability to bear pain, to increase self‐complexity, and expand clients’ senses of the allowable. A model delineating the therapeutic impact of therapist storytelling in psychotherapy is proposed. Stories may change clients’ selves so that they may accommodate traumatic experiences and internal complexity. Stories increase clients’ capacity to tolerate painful experience and therefore serve as a container of tragic life experiences. The artistry of therapeutic story selection is defined as choosing stories consonant with clients’ strengths, rather than with the nature of the trauma. The power of story‐listening to alter consciousness in pleasant ways (storystoned) increases its usefulness as an intervention that is neither anxiety provoking nor re‐traumatizing.