The therapist's self in dialogical family therapy: some ideas about not-knowing and the therapist's inner conversation

In this article, the focus is on the therapist's self, which will be in line with Bakhtin's thinking, viewed as a dialogical self. First, the dialogical view of the self is situated in the context of psychology's traditional focus on the individual self. Then, leaning on Bakhtin and Volosinov, the self is described as a dialogue of multiple inner voices. Some of the implications of this concept for family therapy practice are examined, focusing especially on the therapist's participation in the therapeutic process and on the therapist's inner conversation. The author argues that not-knowing does not only refer to the therapist's receptivity and respect but also implies that the therapist is aware of his or her experience and reflects on how his or her inner conversation might inform and enrich the therapeutic conversation. Finally, these ideas are illustrated with a brief clinical vignette.     

The therapist's pregnancy: Evocative intrusion

This paper is concerned with addressing the complex impact of the therapist's pregnancy on the analytic treatment process. The pregnancy is seen as intensifying the transference and countertransference material so that the therapeutic work becomes more strenuous as well as more fluid, with the potential for significant therapeutic change. The paper is divided into two parts. The first section attempts to conceptualise the meaning of the experience for the therapist and patient within the framework of psychoanalytic theory. Problems of technique and management resulting from the pregnancy are examined. One of the issues considered is the manner and timing of the patient's recognition of the pregnancy. The second section of the paper contains extensive clinical material illustrating the enriched transference and countertransference processes, and the access these allow to psychotic pockets of the personality, hitherto largely unavailable for exploration.     

Bonding in group: the therapist's contribution

Bonding is an ongoing aspect of intersubjective experience, a type of mental relationship to oneself and others. As a behavioral mode, bonding utilizes verbal and nonverbal communication primarily to establish a basic feeling of connection between individuals. Bonding is the floor, a cognitive-affective state that precedes and prepares the way for the complex processes underlying identification. The concept relates to Bion's early theory of basic assumptions, and takes on new and different meanings according to his later ideas regarding social communication. Bonding is also a therapeutic posture or technique, an element in the establishment of group cohesion, the positive transference, and therapeutic and group alliance. Case examples illustrate how the therapist and other group members bring a complex of bonding needs and anxieties that must be negotiated to establish and maintain bonding, which is a necessary condition for successful therapeutic work.     

The excitement of science

The Science of Pleasure: Cosmos and Psyche in the Bourgeois World View, by Harvie Ferguson, London: Routledge, 1990, 364 pages, pb £12.99     

The role of money in the excitement of gambling

Many gamblers claim that gambling is intrinsically exciting, with money playing only a secondary role. To examine the effects of the expectancy of winning money, the authors randomly assigned 243 male college student gamblers to 1 of 6 experimental or 1 of 3 control conditions. Control participants either simply watched a videotaped horse race or they picked a horse, but without wagering; that horse later turned out to be either the winner of the race or the runner-up. Experimental participants wagered $1 on a horse for a chance of winning either USD 2, USD 7, or USD 15, with half winning and half losing their wagers. Wagering led to increased heart rates and subjective excitement as a function of the expected payoff and of winning as opposed to losing the wager. The study was replicated with 200 female college student gamblers with similar results. These findings support the notion that the excitement of gambling is tied to the expectancy of winning money.     

The group therapist's shame: a much undiscussed topic

The topic of shame in group therapy has received limited attention in the group therapy literature. When the topic has been addressed, the focus has been on the shame of the group members. The shame of the group leader and its effect on leadership efficacy and group process has received inadequate attention, given what seems to be its power and prevalence. In this article we examine shame and the group therapist with regard to (1) potentially shameful topics and (2) dynamics that evoke shame. Suggestions for both the mitigation of shame and the enhancement of the leader's self-esteem in dispatching the role and functions of group therapist are offered. In discussing this subject, we propose to normalize group therapist shame by emphasizing the challenges and complexity of group leadership. While the examples illustrate an array of emotions, our purpose is to focus on their shameful elements because they are (1) frequently ignored or overlooked; (2) not made explicit; or (3) discussed in other terms, such as narcissism. In doing so, we invite the reader to consider the clinical utility of the hypothesis that shame has a powerful presence and impact on our leadership image and effectiveness.     

'Stuckness' in live supervision: Expanding the therapist's style

'Stuckness' in the live supervision of family therapy trainees can be used creatively to affect their style and expand their use of self in therapy. Supervisors, after clarifying the contract with their trainees, need to examine how their therapeutic style is constrained by personal qualities. These personal constraints may be related to generic difficulties in their personal, professional and cultural context. These include anxieties generated by the situation oflive supervision, or learning to increase stress to a greater level than the trainees learned to tolerate in their families of origin. Observing an impasse that is influenced by these qualities, the supervisor, who also analyses his or her part in the process, can change the supervisory relationship.     

The function of the therapist's affect in therapeutic conflict in groups

Group psychotherapy theory and technique are presented with the goals of helping group practitioners working with difficult clients: 1) develop a treatment plan; 2) create a therapeutic alliance; 3) foster a responsive group climate; and 4) utilize the therapist's countertransferential reactions in dealing with therapeutic conflict. Historical modifications of the analyst's role in the development of group psychotherapy are noted. Emphasis is give to the recognition of therapist-client identifications in order to separate feelings induced in the therapist from countertransferential reactions, to enable the practitioner to respond appropriately to the affective and inspirational substratum of therapeutic groups.     

Development of the concepts of transference and counter-transference

SUMMARY

This paper traces the development of the concepts of transference and counter-transference over nearly a hundred years, from the origin of the concepts to current understanding of them. Clinical material will be given to illustrate some of the ideas held today.     

Guarding confidentiality in clinical groups: the therapist's dilemma.

This study examines the confidentiality practices of highly experienced, well-trained group psychotherapists. A provocative finding was that practitioners rarely inform prospective clients of confidentiality limitations. Their reluctance to do so appears to be based upon the belief that it might discourage persons from entering treatment, as well as having negative ramifications for the therapeutic process (e.g., members may be less likely to talk about unprotected topics). The prevalence and content of breaches in confidentiality are explored. Ethical, legal, clinical, and educational implications of these and other findings are addressed. Research recommendations are offered.     

The group therapist's absence and the substitute leader.

When a group is led by a single individual the therapist's absence creates a management problem. This article presents several options for the solo leader. The author has used a substitute leader, and this experience is presented and evaluated. Discussion includes selection of a substitute, group preparation, on-going use of the substitute, and benefits of this alternative for the management of the leader's absence.     

The first to know: A systemic analysis of confidentiality and the therapist's family

Abstract

One of the most common yet unrecognized breaches of confidentiality occurs when family therapists share confidential information with their own families. For many therapists, the boundaries between professional and private seem unclear, especially pertaining to disclosing clients' confidential information. Therapists are encouraged to examine their own practices concerning sharing confidential information with their families. Therapists' families have their own rules, patterns, boundary issues, and power struggles which affect therapists' behaviors. Therapists can discuss this issue with their families and develop postures that insure clients' privacy.     

The therapist's responsibility: a systemic approach to mobilizing family creativity

Three techniques, sculpting, geneograms, and family drawing are considered within a systemic approach to therapy. Frequently, emphasis is laid on either the activity of the therapist or the behaviour of the family in treatment. We focus on ways in which the therapist draws on the clients' creativity, relying for this on a correct assessment of their 'language' or 'idiom'. Certain assumptions are proposed, and case illustrations are used in their support. Our approach is that any material, or apparently no material, produced when using these techniques represents essential information which can be turned to therapeutic advantage by means of positive reframing. Although a framework within which to practise is viewed as essential, a 'game-plan' will almost certainly result in sterility and impasses in therapy. Therapist flexibility, it is proposed, is a prerequisite for creativity. We prefer to label resistance to treatment as failure by the therapist to recognize the clients' needs.     

Sanctuary and presence: An existential view of the therapist's contribution

Abstract

This inquiry endeavors to form an understanding of the summons to caring. The effort will expand upon the work of Milton Mayeroff and Martin Heidegger by way of incorporating an existential interpretation of the Buddhist concept of suffering.