Managing boundaries under pressure: A qualitative study of therapists’ experiences of sexual attraction in therapy

Aim: To identify therapists’ views on sexual boundaries and the strategies they employ to manage them in therapeutic practice. Method: In‐depth qualitative interviews were conducted with a sample of 13 accredited, experienced practitioners of psychotherapy or counselling. A grounded theory approach, informed by principles from Free Association Narrative methodology, was employed, in which team members used debriefing sessions for extending depth of understanding of the interviews. Findings: There is consensus about boundaries at the extremes, but variability about fantasy, flirtation and touch. A core process was generated from accounts of successful management of sexual attraction. We identified four problematic ways of reacting to boundary pressure, each with potential to harm clients and therapy. Discussion: A participant‐observer stance was conceptualised as essential for managing threats to boundaries, consistent with the empathic stance. Minor boundary crossings were viewed by interviewees as both potential precursors of more serious transgressions, and as opportunities for understanding the client's difficulties. Implications for practice: These span training, accrediting organisations, supervision and therapy practice.     

Psychosocial response to COVID‐19 pandemic in India: Helpline counsellors’ experiences and perspectives

The COVID‐19 pandemic presents a threat to physical and psychosocial health of individuals. In lieu of the subsequent lockdown and containment measures, helpline counselling becomes a viable method of accessing psychosocial services during the pandemic. The present paper describes experiences of counsellors working with a special COVID‐19 counselling helpline initiated by iCALL, a national‐level technology‐assisted counselling service of the Tata Institute of Social Sciences, India, which aims to address the psychosocial impact of the pandemic and the lockdown. The paper is based on two focus group interviews held with 11 counsellors during the initial two months of the helpline's functioning. Findings of the study highlight the diverse profile of the callers, with individuals belonging to different strata of society and to marginalised communities. The nature of concerns presented by the callers were often a mix of psychological, relational and practical issues. The resultant distress emanated from an interplay of these factors with the relational contexts, their social locations and social structures the individuals were embedded in. This highlighted the need for conceptualising and responding from a psychosocial lens, whereby interventions involved traditional counselling approaches and strategies for addressing determinants of distress by connecting callers to required ground‐level resources. Counsellors’ engagement with this process impacted their professional and personal selves, necessitating the need for structured and continuous training, supervision and support. At a larger level, the counsellors’ narratives asserted the need for adopting a psychosocial paradigm for conceptualising and addressing mental health concerns in India.     

Primary care counsellors’ experiences of working with treatment resistant depression: A qualitative pilot study

Treatment resistant depression (TRD) is a severe and enduring form of depression that does not respond fully to medication. Although the evidence base for effective psychological treatments is not yet established, it is inevitable that counsellors working in primary care will encounter patients with this presentation. This pilot study explores the experience of four primary care counsellors with this patient group using Interpretative Phenomenological Analysis (IPA) and considers the implications for training and practice.     

Teaching critical psychology of ‘race’ issues: problems in promoting anti‐racist practice

The aim of this paper is to illustrate the difficulties faced by teachers of issues related to ‘race’ and racism in psychology when trying to develop anti‐racist practice in their teaching. I argue that the promotion of anti‐racist practice can be impeded by the institutionalised cultures of some psychology departments and that such cultures have developed out of an over‐reliance on positivist ideas. Positivism obscures the fact that knowledge is constructed from positions of power and privilege, which in turn obscures the social and ideological construction of ‘race’. This is clearly a problem when trying to develop anti‐racist practice in teaching. It also leads to fixed ideas about what should be included in teaching content and what can be considered as good pedagogical practice, where notions of ‘balance’ and ‘neutrality’ are advocated, effectively overriding arguments for understanding the dynamics of knowledge production. It also obscures the power and privilege associated with workings of ‘whiteness’. I illustrate this by presenting examples from my own experiences of teaching ‘race’ issues on undergraduate degree courses. I conclude with suggestions for developing anti‐racist teaching by proposing a collective reflexive approach to changing institutional cultures that are currently at odds with anti‐racist practice. I also invite further discussion and suggestions on how best to achieve such collective conscientisation. Copyright © 2007 John Wiley & Sons, Ltd.     

Building Alliances with (In)Voluntary Clients: A Study Focused on Therapists’ Observable Behaviors

This study aimed to compare therapists’ observable behaviors to promote alliances with involuntary and voluntary clients during brief family therapy. The therapists’ contributions to fostering alliances were rated in sessions 1 and 4 using videotapes of 29 families who were observed in brief therapy. Using the System for Observing Family Therapy Alliances, trained raters searched for specific therapist behaviors that contributed to or detracted from the four alliance dimensions: engagement in the therapeutic process, an emotional connection with the therapist, safety within the therapeutic system, and a shared sense of purpose within the family. The results showed that when working with involuntary clients, therapists presented more behaviors to foster the clients’ engagement and to promote a shared sense of purpose within the family. However, in the fourth session, the therapists in both groups contributed to the alliance in similar ways. The results are discussed in terms of (a) the therapists’ alliance‐building behaviors, (b) the specificities of each client group, and (c) the implications for clinical practice, training, and research.     

Multiple family therapy for Chinese families of children with attention deficit hyperactivity disorder (ADHD): treatment efficacy from the children’s perspective and their subjective experiences

This paper reports the results of our study that assessed the treatment efficacy of multiple family therapy (MFT) from the perspective of participating Chinese children with attention deficit hyperactivity disorder (ADHD) and identified their subjective experiences. Forty‐three children with ADHD in the experimental group (EG) completed a forty‐two‐hour MFT, whilst forty‐five children with ADHD in the control group (CG) had attended two writing classes scheduled three months apart that were similar to those of the MFT. Data from the outcome study were gathered using standardized questionnaires and data from the qualitative study were drawn from thirteen children with ADHD who had completed the MFT and attended the focus group interviews (n = 5) or individual interviews (n = 8) conducted in the post‐treatment phase. The results of the Paired sample t‐test and MANOVA indicated no significant changes on the scores for the four measures adopted (perception of competence, hopefulness, parent‐child relationship and perceived social support) in the pre‐ and post‐treatment for the EG and the CG. Five themes emerged from the narratives of children with ADHD, which revealed the children’s subjective experiences with the MFT: (a) full of fun; (b) building friendships through common experiences; (c) a happy family time; (d) safe space; and (e) positive parental responses and communications.     

Couple‐based Intervention for Depression: An Effectiveness Study in the National Health Service in England

This study represents an effectiveness study and service evaluation of a cognitive behavioral, couple‐based treatment for depression (BCT‐D) provided in London services that are part of the “Improving Access to Psychological Therapies” (IAPT) program in England. Twenty‐three therapists in community clinics were trained in BCT‐D during a 5‐day workshop, followed by monthly group supervision for 1 year. The BCT‐D treatment outcome findings are based on 63 couples in which at least one partner was depressed and elected to receive BCT‐D. Eighty‐five percent of couples also demonstrated relationship distress, and 49% of the nonclient partners also met caseness for depression or anxiety. Findings demonstrated a recovery rate of 57% with BCT‐D, compared to 41% for all IAPT treatments for depression in London. Nonclient partners who met caseness demonstrated a 48% recovery rate with BCT‐D, although they were not the focus of treatment. BCT‐D was equally effective for clients regardless of the clinical status of the nonclient partner, suggesting its effectiveness in assisting both members of the couple simultaneously. Likewise, treatment was equally effective whether or not both partners reported relationship distress. The findings are promising regarding the successful application of BCT‐D in routine clinical settings.     

Synchronistic mind‐matter correlations in therapeutic practice: a commentary on Connolly (2015)

This commentary adds some ideas and refinements to the inspiring discussion in a recent paper by Connolly ( 2015 ) that makes use of a dual‐aspect framework developed by us earlier. One key point is that exceptional experiences (of which synchronicities are a special case) cannot in general be identified with experiences of non‐categorial or acategorial mental states. In fact, most exceptional experiences reported in the literature are experiences of categorial states. Conversely, there are non‐categorial and acategorial states whose experience is not exceptional. Moreover, the psychodynamics of a synchronistic experience contain a subtle mesh of interacting processes pertaining to categorial, non‐categorial and acategorial domains. We outline how this mesh may be addressed in particular cases of synchronicity described by Connolly.     

The future of Jungian analysis: strengths,weaknesses, opportunities,threats (‘SWOT’)

Using a methodology derived from management and organizational studies, the author reviews the future of Jungian analysis. The methodology is termed SWOT – strengths, weaknesses, opportunities, threats. A selected list in each of these categories is presented. The author is transparent in allowing for the fact that the paper not only derives from a public lecture on the topic, but also retains the immediacy and the contrarian and opinionated style of such a lecture.     

A practice-based exploration of therapeutic change in a charitable,community-based person-centred counselling service using routine outcome measures of anxiety and depression. I: Statistical and clinically significant change

Background

Establishing the value of differing treatments for depression and anxiety is crucial in a climate of delimited spending and increased demand. Drawing from a well-founded, diverse evidence base is salient to constructive evaluation and any subsequent recommendations being fit for purpose.

Design

This study employed a practice-based quantitative design to explore therapeutic gains in adult counselling clients attending person-centred therapy (n = 301), delivered in a charitable, community-based UK service.

Measures

Outcome measures PHQ-9 and GAD-7 were used from three time points: initial assessment (IA), first ongoing session and last or 6th ongoing appointment (whichever occurred first; T1, T2 and T3).

Analysis

Repeated measures ANOVA, CSI, RI and RCSI calculations were used to consider significant change in clients.

Findings

Reductions in PHQ-9 and GAD-7 outcome measures were observed over time (between T2 & T3 and T1 & T3) and were all statistically significant (p = <0.001). By T3: CSI was achieved by 48.1% of clients on PHQ-9 and 50.8% of clients on GAD-7, RI was achieved by 47.8% of clients on PHQ-9 and 60.5% of clients on GAD-7, and RCSI was achieved by 32.6% of clients on PHQ-9 and 41.2% of clients on GAD-7.

Conclusions

The treatment observed resulted in effective outcomes equivalent to other therapies reviewed in the literature for clients' symptoms of anxiety and depression as measured by GAD-7 and PHQ-9.     

Intrahippocampal administration of A beta(1-40) impairs spatial learning and memory in hyperglycemic mice

Age-related neurodegenerative dementia, particularly Alzheimer's disease (AD), may be exacerbated by several interacting risk factors including genetic predisposition, beta amyloid (A beta) protein accumulation, environmental toxins, head trauma, and abnormal glycolytic metabolism. We examined the spatial learning and memory effects of A beta(1-40) administration on hyperglycemic mice by their performance in the Morris water maze. Chronic hyperglycemia was induced in male C57BL/6J mice to mimic diabetes mellitus by intraperitoneal injection of streptozotocin (STZ), which specifically destroys pancreatic beta-islet cells. Ten days after STZ treatment, intrahippocampal infusion of vehicle, monomer, or oligomer A beta(1-40) was given to these hyperglycemic mice. Our results demonstrate that in comparison with vehicle or monomer A beta(1-40), oligomer A beta(1-40) induced significant deficits of spatial learning and memory in hyperglycemic mice. Apoptotic signals were identified in the CA1 and dentate gyrus of hippocampus in hyperglycemic mice. A beta accumulation, oxidative stress, and apoptosis in the CA1 region were more intensive in hyperglycemic mice than that in normoglycemic mice after acute treatment with oligomer A beta(1-40) peptide treatment. These results indicate that CA1 apoptosis was enhanced by oxidative stress resulting from accumulation of A beta. Considered together, these findings suggest that hyperglycemic mice are more vulnerable to the A beta-induced-oxidative stress than normal subjects. We therefore propose that A beta accumulation would be enhanced by hyperglycemia, and the oxidative stress caused by A beta accumulation would in turn enhance the AD symptoms.     

A revolution of the mind: some implications of George Hogenson's ‘The Baldwin Effect: a neglected influence on C.G. Jung's evolutionary thinking’ (2001)

George Hogenson's 2001 paper ‘The Baldwin Effect: a neglected influence on C.G. Jung's evolutionary thinking’ developed the radical argument that, if archetypes are emergent, they ‘do not exist in the sense that there is no place that the archetypes can be said to be’. In this paper, I show how Hogenson's thinking has been seminal to my own: it is not just archetypes but the mind itself that has no ‘place’. The mind is a dynamic system, emergent from the cultural environment of symbolic meanings to which humans are evolutionarily adapted. Drawing on the work of philosopher John Searle, I argue that symbols constitute the realities that they bring forth, including the imaginal realities of the psyche. The implications for clinical work include a rejection of structural models of the psyche in favour of the emergence of symbolic realities in the context of psychoanalysis as a distributed system of cognition.     

Children's and Parents’ Well‐Being in Joint Physical Custody: A Literature Review

Joint physical custody (JPC), a parental care arrangement in which a child lives with each parent for at least 25–50% of the time after separation or divorce, is increasingly common in many Western societies. This is a major shift from the standard of sole physical custody, with mostly mothers providing primary childcare after a parental separation or divorce. The increasing share of separated or divorced parents who practice JPC, which in some countries, US states, and regions reaches 30% and more, results from increasing gender equality due to mothers participating considerably in the labor force and fathers being actively involved in their children's daily lives. This review focuses on the effects of JPC on children's and parents’ well‐being, based on 40 studies from North America, Australia, and Europe published between 2007 and 2018. In sum, there is empirical evidence from different countries that suggests that JPC arrangements can have positive effects on the well‐being of children and of parents. However, the existing studies are conceptually, methodologically, and contextually very heterogeneous. In addition, self‐selected highly educated parents with a high socio‐economic status, a low conflict level, and children between the ages of 6–15 practicing JPC dominate the samples. Thus, the risks and benefits of JPC are not clear yet and are heavily debated by advocates and academics. The review concludes with suggestions for future research.     

The associations between insecure attachment,rooming‐in,and postpartum depression: A 2 months’ longitudinal study

Postpartum depression (PPD) is the most common complication of childbearing, and recent studies have attempted to examine risk factors associated with it. The main study hypothesis was that a protective situational factor at a sensitive time period (full rooming‐in postpartum) would moderate the associations between insecure attachment dimensions and PPD. Three hundred twelve women, in either full or partial rooming‐in, participated in a longitudinal study at the maternity ward of a tertiary healthcare center. A Demographic questionnaire and the Experiences in Close Relationships Scale were administered at 1–4 days postpartum, and the Edinburgh Postnatal Depression scale at 2 months postpartum. PPD was significantly associated with both anxious and avoidant attachment dimensions, but not with rooming‐in conditions. In addition, women in partial rooming‐in showed a positive correlation between insecure attachment dimensions and PPD, whereas no such correlation was found for full rooming‐in women. A situational factor such as full rooming‐in, which occurs at a critical time point for the mother–infant relationship, can moderate the association between maternal avoidant or anxious attachment dimensions and the mother's PPD levels. Postpartum practices, such as rooming‐in, can be personalized and thus beneficial in moderating personal risk factors for PPD.