Secular Psychotherapists and Religious Clients: Professional Considerations and Recommendations

Traditional psychotherapy has often failed to meet the needs of religiously committed clients. Because many potential clients have religious as well as secular concerns, secular psychotherapists must become more empathic and competent in treating religious individuals. In this article the author argues that efforts toward consciousness raising as well as fundamental changes in professional training programs are necessary to accomplish this goal. Recommendations are offered for counselor educators and mental health service providers.     

Nonsexual Relationships Between Psychotherapists and Their Former Clients: Obligations of Psychologists

This article examines the issue of nonsexual relationships between psychologists and their former therapy clients. What little research is available concerning nonsexual relationships with former clients suggests that psychologists have clear reservations about some of these relationships, especially personal ones and intentional social interactions. Relationships immediately following termination are seen as particularly suspect. Drawing on the literature dealing with multiple relationships in general, and sexual relationships with former clients in particular, a number of arguments are made outlining why psychologists should avoid significant nonsexual relationships with former clients for at least some period of time following termination.     

How Psychotherapists Address Hypothetical Multiple Relationships Dilemmas with Asian American Clients: A National Survey

This study examined how psychotherapists address hypothetical nonsexual multiple relationships dilemmas with Asian American clients and identified predictors of conservative decisions and the use of culture-based rationales. This survey of 787 Asian American and non-Asian American psychotherapists revealed that clinicians rely on mostly their personal policies and seldom focus on the clients' cultural backgrounds. Psychotherapists who consider their clients' Asian culture have more cultural knowledge and awareness, have been mental health providers longer, and are Asian American and female. Clinicians who avoid multiple relationships tend to cite formal policies as justification and are less likely to consider clients' cultural worldviews, the therapeutic relationship, or their own values. The results are discussed in terms of specific revisions needed in the American Psychological Association Ethics Code, the benefits of more frequent consultation with colleagues and supervisors about ethical dilemmas, and recommendations for psychotherapists.     

Counselors' Values Profile: Implications for Counseling Ethnic Minority Clients

The authors review the empirical literature on counselors' values, describe values salient to the 4 largest ethnic minority groups in the United States, identify similarities and differences between counselors' values and those of the minority groups, and discuss implications for counseling ethnically different clients. Understanding counselors' values can lead to an examination of how these values may affect the counseling process, particularly when clients are from ethnic minority groups that may espouse differing cultural values.     

Competent Counseling for Middle Eastern American Clients: Implications for Trainees

The authors used a factorial multivariate analysis of variance (MANOVA) to determine whether counselor trainees’ group differences on measures of multicultural competence, empathy, and multicultural counseling self‐efficacy (CSE) when working with Middle Eastern American (MEA) clients were moderated by trainee race. Two hundred and fifty‐six trainees responded to 3 different clinical vignettes that gave information on clients who had varying degrees of MEA characteristics. MANOVA results revealed a significant main effect for trainee race. Follow‐up analyses demonstrated that trainees of color reported higher multicultural competence and multicultural CSE than White trainees. Los autores usaron an análisis factorial multivariante de la varianza (MANOVA, por sus siglas en inglés) para determinar si las diferencias en grupos de consejeros en formación respecto a competencia multicultural, empatía y autoeficacia en consejería (CSE) multicultural al trabajar con clientes americanos con ascendencia de Oriente Medio (MEA) estaban moderadas por la raza del consejero. Doscientos cincuenta y seis consejeros en formación respondieron a 3 viñetas clínicas que ofrecían información sobre clientes que tenían diversos grados de características de MEA. Los resultados del MANOVA revelaron un efecto principal significativo para la raza del consejero. Análisis de seguimiento demostraron que los consejeros de color en formación comunicaron un mayor nivel de competencia multicultural y CSE multicultural que los consejeros blancos.     

Innovative Moments in Humanistic Therapy I: Process and Outcome of Eminent Psychotherapists Working with Bereaved Clients

This project entailed an intensive qualitative analysis of six-session psychotherapies conducted by three eminent humanistic psychotherapists working with bereaved clients. The Innovative Moments Coding System (IMCS), rooted in narrative therapy, is designed to measure change across therapy orientations. Research using the IMCS suggests that the psychotherapy change process occurs through the emergence, elaboration, and expansion of identifiable change moments for a client—innovative moments (IMs)—which present as exceptions to a client's presenting problematic narrative. There are five identified types of IMs: action, reflection, protest, reconceptualization (RC), and performing change (PC). The current study aimed to inform theory regarding the patterns of IMs across three humanistic approaches—constructivist, person-centered, and existential—when working with bereaved clients, while linking these patterns to observable change in each client's functioning. The alliance between each client and therapist was also assessed across the therapy process, showing consistently strong alliances across the three cases. Findings from the current study reinforce the salience of reflection, RC, and PC IMs in successful grief therapy cases, and also suggest the importance of meaning-making interventions in grief therapy. Clinical implications and suggestions for future research are also addressed.     

Resilience Factors and Suicide Risk for a Sample of Transgender Clients

This study explored how individual- and community-based resilience factors operated together in order to reduce risk of suicide for a sample of transgender therapy clients. We collected cross-sectional survey data from 106 transgender therapy clients at a local community center, including demographic information, experiences of relational support, participants' emotional stability, and risk for suicide. Results from our mediation analysis indicated that high levels of perceived relational support are related to reduced risk for suicide and that this happens by way of a person's emotional stability. Clinical implications for family therapists are discussed based on the significant indirect effect found in this study.     

Interorganisational Relationships in Times of Decline: Implications for Organisational Resilience

We seek to delineate the processes by which work relationships between employees from buyer and supplier organisations can enhance the supplier's resilience. A micro-foundations perspective is taken to study the effect of individual-level relationships on these higher-level processes in the context of a declining organisation—a supplier that has been experiencing a period of size decline, following the transition of some of its stronger competitors to a more advanced generation of products. The findings of a qualitative study indicate that the work relationships built between employees from the supplier and the customers around current product and services offerings can help a declining organisation to cope with setbacks and difficulties. Expanding on the three C's of hardiness (challenge, control, and commitment), we discuss the implications of our research for the study of resilience through the lens of interorganisational work relationships and highlight the different pathways that build these coping and adaptation qualities for the organisation. Specifically, the challenge of transitioning to new products can negatively influence these work relationships unless the supplier organisation provides supportive context by allowing employees to retain the necessary control over what it takes to serve their customers. Furthermore, the supplier should display strong commitment to integrate the new offerings while customers need to mirror this commitment by developing a willingness to adopt these new offerings by the supplier. The findings further suggest that these new offerings can be translated into higher levels of adaptation.     

Resilience and Health: Implications for Interventions and Policy Making

Resilience is a complex phenomenon which mediates in successful adaptation to adversity. Researchers are trying to understand its various trajectories, and this is evident in the growing literature relating resilience to health across the life span. This article intends to understand the nature of resilience, its characteristics and its various social, psychological and cultural sources. The research evidence presented provides a glimpse of the meaningful relationship that exists between resilience and health while unfolding the consequences of resilience on various health outcomes. While understanding the underlying reasons for the relationship between resilience and health, interventions at social, psychological, and clinical level have been suggested followed by recommendations for policy initiatives that will facilitate resilience and health.     

Legal and Ethical Implications of Refusing to Counsel Homosexual Clients

In 2001, a federal appeals court upheld the job termination of a counselor who requested being excused from counseling a lesbian client on relationship issues because homosexuality conflicted with the counselor's religious beliefs (Bruff v. North Mississippi Health Services, Inc., 2001). This article provides the facts of the case and the legal reasoning of the court. The authors also explore the legal and ethical issues related to this case.     

Family Resilience and the Management of Fibromyalgia: Implications for Family Therapists

Fibromyalgia Syndrome (FMS) is one of the most troubling rheumatic disorders for patients, significant others, and the health care providers who treat them. Responses from 150 participants provided valuable information on the relationship between family resilience and the management of fibromyalgia. Self reported family stressors, strains, and distress were significantly associated with an increase in health problems/functional disability, whereas family hardiness and family social support were associated with a decrease. Family stressors and family strains were also positively associated with the frequency of medication use. Medical family therapy interventions that consider the familial context are recommended for treatment. Additional implications for clinical practice and future research are discussed. J. Cameron Preece, PhD, Sage Health Care, PLLC, 339 Allumbaugh Street, Boise, ID 83704. Jonathan G. Sandberg, PhD, Department of Marriage and Family Therapy, Syracuse University, Syracuse, NY 13244. (jgandbe@syr.edu) Special thanks go to Linda Stone Fish, PhD, for her support and guidance throughout the study.     

The Impact of Racial Microaggressions on Mental Health: Counseling Implications for Clients of Color

This study examined the relationship between racial microaggressions (subtle and unintentional forms of racial discrimination) and mental health. Results from a large sample (N = 506) indicated that higher frequencies of racial microaggressions negatively predicted participants' mental health and that racial microaggressions were significantly correlated with depressive symptoms and negative affect. Differences in the types of microaggressions experienced by various racial groups (Asian, Latina/o, Black, White, and multiracial) and counseling implications are discussed.     

The Search to Be Real: Why Psychotherapists Become Therapists

This paper argues that one receives the calling to become a therapist to experience feeling real. Stated differently, therapists become therapists to heal themselves. Drawing on object relations theory, the author identifies five wounds therapists may consciously and unconsciously address by entering a therapeutic profession. The wounds are located in the capacity to believe, the capacity to imagine, the capacity for concern, the capacity to be alone, and the capacity of object usage. Achieving these capacities provides the therapist with a sense of wholeness, health, and holiness.     

Attachment Theory and Religiosity: A Summary of Empirical Research With Implications for Counseling Christian Clients

The authors summarize the growing body of empirical research literature in the area of psychology of religion that has been guided by attachment theory and indicate implications for counseling, including practical suggestions for case conceptualization, possible spiritual interventions, and ethical guidelines for practice. Attachment theory provides a fertile framework whereby counselors may conceptualize the religious experiences of Christian clients whose spirituality involves the belief in and relationship with a personal God.     

National Survey of Social Workers' Sexual Attraction to Their Clients: Results,Implications, and Comparison to Psychologists

A survey form sent to psychologists (Pope, Keith-Spiegel, & Tabachnick, 1986) was adapted and sent to 1,000 clinical social workers (return rate = 45%). Most participants reported sexual attraction to a client, causing (for most) guilt, anxiety, or confusion. Some reported having sexual fantasies about a client while engaging in sex with someone other than a client. Relatively few (3.6% men; 0.5% women) reported sex with a client; training was related to likelihood of offending, though the effect is small and complex. An analysis of eight national studies (data from 5,148 therapists) found significant effects for gender (more male offenders) and year of study (about 10% annual decrease in reported offenses since 1977) but not profession (i.e., no difference among psychiatrists, psychologists, and social workers). Most social workers reported no graduate training whatsoever about sexual attraction; only 10% reported adequate training.     

Legal and Ethical Implications of Using Religious Beliefs as the Basis for Refusing to Counsel Certain Clients

This article addresses potential legal and ethical implications of lawsuits that have been brought when counselors and counseling students have used their religious beliefs as the basis for refusing to counsel lesbian, gay, bisexual, and transexual clients. Four lawsuits are reviewed, issues relevant to the cases are identified, and implications for counselor educators and counseling students are discussed.     

Increasing Our Sensitivity to the Implications of Similarities and Differences Between Therapists and Clients

Women therapists are similar and dissimilar to our clients in a variety of ways. Previously, we have focused on and celebrated our similarities. Both similarities and differences can be disruptive to the psychotherapy process, however, when not recognized. This paper attempts to delineate and to describe in a preliminary way some of the dimensions, both obvious and subtle, along which we may be similar and different from our clients. The greatest difficulty appears to arise from similarities and differences in values. Using examples, the paper disusses problems which can occur with similarity and with difference.     

How to Choose a Measure of Resilience: An Organizing Framework for Resilience Measurement

Existing measures of resilience include disparate content that is based on qualitatively different conceptualizations of the construct. Consequently, there is confusion and inconsistency regarding the measurement and application of resilience. To promote clarity, the authors conduct an examination of resilience measurement approaches. This was accomplished by elaborating on three fundamentally distinct conceptualizations of resilience that can serve as an organizing framework for measurement; (1) attribute/resource-focused; (2) process-focused; and (3) outcome-focused. To verify the utility of this framework, qualified and trained subject matter experts (SMEs) completed a content analysis categorization task by sorting 227 items from 11 scales into these categories. Frame-of-reference (FOR) training was used to prepare the SMEs. Results were largely supportive of the three category framework, as overall SME agreement was 86.76 percent and only 10 of 227 items (4.41%) were categorized as “unclear” with regard to the categories. At the same time, SME agreement varied across the scales and sub-dimensions examined, suggesting that some scales/sub-dimensions are more conceptually clear than others in terms of the three categories. Based on the results, the authors provide guidance for how to choose a measure of resilience and discuss different workplace applications that are aligned with the aforementioned categories.