The chaplain as therapist

Summary In this presentation I have explored the dynamics that go on in therapy, showing how similar dynamics occur in pastoral relationships primarily in terms of the transference and countertransference phenomena. I have also called attention to issues or areas of concern that arise in therapy, equating them with issues with which theology has historically dealt, i.e., the relation of the natural to the supernatural, the problem of authority, the place of values in life, and the importance of individual responsibility. Finally, I have noted the importance of the chaplain's utilizing of psychodynamics in his ministry and specifically those areas where he should become informed and skilled, i.e., in the area of personality development as a way of understanding himself and in the factors that promote change and growth in another person. I have briefly noted the value of psychodynamics at the time of grief or loss.I hope that the focus upon the theme the chaplain as therapist will stimulate us to look at our ministry again. For those to whom this subject is new, may there be an interest in exploring it as an enriching dimension of ministry. For those who are already familiar with the impact that psychotherapy can have upon their ministry, may there be further experimentation at greater depth and broader latitude of some of the areas suggested in this treatment of the topic.This paper was presented at a joint session of the Protestant and Roman Catholic Chaplains at the 41st annual convention of the Association of Western Hospitals, Las Vegas, Nevada, April 20, 1971.     

The family therapist as a system interventionist

Family therapists need to develop therapeutic strategies which can be effective in helping members of dysfunctional and crisis oriented families reconnect with additional sources of support and strength.The extended family and social system can serve as this source of support when it is convened, mobilized and reactivated to become involved with the concerns of the ailing members of the family. This paper describes the unfolding six network phases, and the roles undertaken by the team of therapists serving as system convenors, mobilizers, choreographers and resource consultants. The task of the therapists working with a dysfunctional family and its larger extended support system is seen as that of an effective clinical stategist mobilizing the resourcefulness and energies of himself and his team to reactivate a dysfunctional system to change.A modified version of this paper appears in the author's book Networking Families in Crisis, Human Sciences Press: New York, 1978.     

The transition from therapist to executive coach

A growing number of clinicians are making the transition from therapist to executive coach. High-powered executives are exceptionally receptive to the very straightforward and pragmatic approach of REBT. However, to be successful, even a REBT trained clinician had best adapt his approach to the executive client. The primary focus needs to be on more effective and efficient job performance, not on helping the client feel better. Although these executives believe many of the same irrational beliefs as one’s clinical clients, the REBT coach can effectively illustrate how each of these beliefs contributes to specific job related problems which the executive had best resolve. Teaching executives to challenge their ideas, then assigning work-related action plans, usually results in enhanced performance, which convinces even skeptical executives that coaching is a useful endeavor. Coaching has an advantage over therapy in that the coach can observe their client in numerous work situations (meetings, presentations, performance reviews) and give constructive feedback, and actually monitor additional progress. It is an exciting field that many clinicians find extremely challenging and stimulating. Dr. William D. Criddle, MBA is a managerial psychologist and executive coach in independent practice, based in Seattle, WA, USA. He is a Fellow of the Albert Ellis Institute in New York City.     

On self-disclosure: The vulnerable therapist

The therapist may stimulate the family's growth by sharing his personal experiences directly with them. This helps by providing the family with a model of a real (versus symbolic) person and encouraging them to respond in new and competent ways. As a result, the emotional commitment of the therapeutic system may deepen, while unconscious conflicts that have been causing impasses may surface and be resolved. The therapist hopes that his self-disclosure will benefit the therapy, but understands that there are risks involved. Specific guidelines can help in deciding when not to share, what kinds of problems can be revealed, and what attitudes best strengthen this endeavor. Self-disclosure is discussed here in an experiential frame-work. The author illustrates the above points with examples from his own personal clinical and supervisory experiences.The author would like to thank his wife, Linda Barth Garfield, MSS, without whose sustaining support this paper could not have been written, and his partner, Ellen Berman, MD, for her valuable comments and encouragement. The masculine pronoun is used in this paper for convenience, and because the author is often referring to himself.     

Developing countertransference awareness as a therapist in training: The role of containing contexts

The psychodynamic literature suggests that countertransference is an inevitable part of therapy and a significant feature of the client-therapist relationship. However, countertransference is also considered to be a ‘double-edged sword’: when it is reflected on by the therapist, it can offer valuable insights into the therapeutic relationship, but when it remains outside of awareness and therefore unmanaged it can result in the therapist unwittingly acting out in the therapeutic relationship and responding in counter-therapeutic ways. The purpose of this research was to explore the factors involved in the development of countertransference awareness in therapists and to construct a grounded theory of the process. Fifteen qualified therapists were recruited and interviewed, either face to face or via Skype, using a semi-structured interview schedule. The grounded theory constructed from the data suggests that during training participants initially experienced countertransference as threatening and overwhelming. When this experience was contained in supervision and therapy, the organisational context and by participants’ theoretical framework, they could reflect on their countertransferential responses and make sense of their experience, which then developed their self-awareness and other insights to the benefit of the therapeutic relationship. Conversely, a lack of containment in these domains resulted in participants acting out their countertransference and becoming either over or under available in the therapeutic relationship. The findings offer a useful process model on the role containing contexts play in the development of countertransference awareness for therapists in training.     

Possible psychosomatic hazards to the therapist: patients as self-objects

This speculative paper concerns certain fundamentals of healing and psychotherapy which we mistakenly tend to take for granted. I discuss our need for the feeling of harmony, wholeness, and oneness. I call this archetypal need our 'normal autistic expectation'. When met, we experience well-being and 'healing'. If not sufficiently and reliably met, this expectation becomes an omnipotent demand ('autistic demand'). Frustration then brings about angry destructiveness, either outwardly directed or inwardly directed, with bodily changes which must be processed if bodily damage is to be minimized. Bereavement, the loss of a person necessary for one's feeling of wholeness (a 'self-object'), is an extreme and well-researched example of such damage. Our selfobjects are 'healing' when they help us to complete our sense of self. Our patients-, our profession, our colleagues, our place of work and our financial security are normally all part of our self-object structure. I give examples where patients' own needs for survival or intactness mean that they have to externalize their own hurt and anger for long periods of their therapy. This often means that the therapist's own wholeness and health are under attack, and even damaged permanently, or at least until the damage can be processed. The nature of 'processing' in this sense is therefore in need of energetic research.     

Portrait of the therapist as a shaman

What follows will show that an understanding of the nature and purpose of shamanism contains a number of insights that bring to light some important, but often obfuscated, aspects of Western therapeutic practices. the point of departure of the argument is the theory of shamanism developed by the inventor of structural anthropology: Claude Lévi-Strauss. It will be argued, in particular, that his theory of shamanism provides a key to the therapeutic action of symbols upon the body as well as to the broader social function of therapy in general.     

The self in action: lessons from delusions of control

Patients with delusions of control are abnormally aware of the sensory consequences of their actions and have difficulty with on-line corrections of movement. As a result they do not feel in control of their movements. At the same time they are strongly aware of the action being intentional. This leads them to believe that their actions are being controlled by an external agent. In contrast, the normal mark of the self in action is that we have very little experience of it. Most of the time we are not aware of the sensory consequences of our actions or of the various subtle corrections that we make during the course of goal-directed actions. We know that we are agents and that we are successfully causing the world to change. But as actors we move through the world like shadows glimpsed only occasional from the corner of an eye.     

Understanding emotion: lessons from anxiety

We agree that conceptualisation is key in understanding the brain basis of emotion. We argue that by conflating facial emotion recognition with subjective emotion experience, Lindquist et al. understate the importance of biological predisposition in emotion. We use examples from the anxiety disorders to illustrate the distinction between these two phenomena, emphasising the importance of both emotional hardware and contextual learning.     

The value of life purpose: Purpose as a mediator of faith and well-being

This study investigated the relationship between faith, life purpose, and well-being, and the potential mediational effects of life purpose between faith and well-being. One hundred and three male and female college students completed a life purpose measure designed for the current study, the General Life Purpose Scale, as well as the Perceived Wellness Scale (Adams, T.B. (1995). The conceptualization and measurement of wellness (Doctoral dissertation, University of Texas at Austin, 1995). Dissertation Abstracts International, 56(6–B), 3111) and the Santa Clara Strength of Religious Faith Questionnaire (Plante, T.G., & Boccaccini, M.T. (1997). The Santa Clara Strength of Religious Faith Questionnaire. Pastoral Psychology, 45, 375–387). Results indicated that life purpose significantly mediated the relationship between faith and well-being. The importance of these findings for clinicians and educators is discussed.