Sudden Death of the Therapist: The Effects on the Patient

While the termination phase of psychoanalytic psychotherapy has been discussed in the literature, the effects on the patient of a forced termination following the therapist's death have seldom been investigated. In this paper, two groups of patients (N = 35) were compared: those who experienced a planned termination and those who experienced a sudden termination as a result of their therapist's death. Data were gathered by means of detailed questionnaire and formal psychological assessment (i.e., the Grief Experience Inventory). Responses were also solicited from therapists who treated patients subsequent to the original therapist's death. Results indicate that patients forced to terminate due to the therapist's unexpected demise experienced significantly more intense grief reactions with regard to feelings of anger, despair, depersonalization, and somatization. The nature of the transference relationship with the original therapist at the time of the latter's death appeared to influence the subsequent therapeutic relationship as well. The authors present recommendations and practical guidelines concerning therapists' responsibility to their analytic patients to make reasonable accommodations in the event of their unexpected death.     

The Role of the Occupational Therapist as a Community Consultant

Concern for health development has been in the forefront of occupational therapy practice and training for many years. However, consultation in this area to community agencies and grass roots programs is a relatively new endeavor for occupational therapists. This article describes community consultation in a demonstration project emphasizing the concept of preventive mental health. Steps in establishing the consultation role are discussed using the theoretical constructs of systems consultation. Discussion of the educational objectives for field training in community mental health, community experience during the field training, and the supervisory and communication networks essential to such a program are presented as a model in developing the role of the occupational therapist as a community consultant.     

Creating a Safety Net: Transferring to a New Therapist in a Training Setting

Transferring clients to new therapists is a common necessity in training settings, agencies, and private practices. However, there is a paucity of empirical studies that examine the process of client transfer and its impact on the client. This qualitative study explored the experience of clients who had successfully transferred from graduating practicum students to incoming practicum students in a COAMFTE accredited MFT master program in the southeastern region of the US. The resultant grounded theory consisted of a central category (Creating a Safety Net), a paradigm (Professionalism), and two main categories (Structure and Trust). Clients described an overall process of initial disclosure of the pending transfer, their affective response, the therapist’s response, a period of co-therapy with incoming and outgoing therapists, and continuation of therapy with the new therapist.     

Interviewing a Therapist in the Presence of a Couple: A Description of the Therapeutic Process

A therapy research team interviewed a therapist in the presence of a couple. Following each of six consecutive sessions with a couple, an interviewer posed questions to the therapist and couple. While one question was standard to each interview, other questions were generated by team members who tracked the entire process via live observation. These questions were directed first at the therapist, then at the couple, and then focused on therapeutic process and outcome. Findings of this process for the therapy system included decreasing the hierarchy within the client/therapist relationship; increasing the client ownership and energy in the therapy process; discovering the presence of parallel processes between the systems; and informing the direction of future therapy sessions. Practical, clinical implications are discussed for a variety of therapy settings.     

The Soul of Therapy: The Therapist’s Use of Self in the Therapeutic Relationship

This paper is based on the premises that the conscious, active and purposeful use of self by the therapist in the therapeutic process is an essential aptitude in establishing an effective therapeutic relationship, and that this therapeutically purposeful use of self can and should be incorporated in the training of all therapists in a explicitly systematic manner. The paper will attempt to identify the contributions of the “what and how” the use of self by therapists contributes to the therapeutic process. First of all, therapists’ use of self is meant to be viewed as a Common Factor as defined by Sprenkle, Davis & Lebow (2009), which is a perspective about the effectiveness of therapy that “asserts that the qualities and capabilities of the person offering the treatment are more important than the treatment itself” (p. 4). Secondly, the use of self by therapists emphasizes developing the skill set of the therapist in the conscious, active and purposeful use of self as is in the moment of the therapeutic engagement with clients, and does so without denying the importance of therapists working to resolve personal issues of theirs that may interfere with the therapist's professional effectiveness. Therapists’ use of self gives particular emphasis to the purposeful use of self as is in therapy’s relationship, assessment and interventions whatever the therapy model (Aponte & Kissil, 2016). Thirdly, the use of self represents an aptitude that can be developed and refined through well elaborated structures for schooling therapists in the therapeutic use of all they bring of their personal selves to the therapy relationship including through the use of their human vulnerabilities as they exist at the moment of empathic engagement with clients.

     

The Therapeutic Advantage to the Family Therapist of Intervening in the Family-Clinician System

Attempting family therapy in the context of a family-clinician system poses extreme difficulties for the therapist. He cannot be effective if he diagnoses only the family system. He must broaden his analysis to include other clinicians' transactions with the family. Once he accomplishes this perceptual leap, he can intervene in the family-clinician system most effectively with paradoxical methods. He may find that a change in his own contribution to the system solves the family's problem.     

Cultivating the Therapeutic Alliance in a Telemental Health Setting

Contemporary Family Therapy - Telemental health services have broadened during the last decade (Choi et al. 2019; Pierce et al. 2020). More recently, Severe Acute Respiratory Syndrome Coronavirus...     

Death of a Clinician: The Personal, Practical and Clinical Implications of Therapist Mortality

Death is inevitable and yet in US culture the discussion of death is somewhat taboo. Marriage and Family therapists are trained in the implications of grief and loss for clients who lose loved ones and yet examination of the impact of therapist mortality on clients is lacking in the clinical literature. This article examines ways that private practice therapists can both protect their client’s confidentiality and mitigate the impact of therapist sudden death on their clients with planning and forethought. In addition, the factors influencing the lack of empirical research on this topic is discussed in the context of social mores on death and how therapists’ own denial of mortality may impact their ability to connect with clients through the pain of grief and loss. Recommendations are made for therapists to evaluate their own attitudes towards mortality and develop a plan for client care in the event of their death.     

The Powerless Therapist and the Helpless Borderline: Acceptance,Aloneness, and Dyadic Joining

The encounter between therapist and borderline patient brings with it a humbling experience of powerlessness. The therapist or helping agent must confront her or his own feelings of inability to change anything in the patient's mental or material life. With this comes a corresponding reality that the locus of therapeutic action remains very circumscribed indeed. Many therapists, particularly new ones to the field, may feel overwhelmed by anxiety, grief, guilt, and fear, tempting them to jump precipitously into interpretations or thinly veiled advice-giving—or, alternatively, to deflect emotion with hollow “empathic” mirroring. By actively getting in touch with and using his or her experience of powerlessness, however, the therapist can find a way forward that relies on dyadic joining and a more useful conception of the therapist/patient system (whose dynamics, as we will see, are also increasingly clarified thanks to emergent neuroscience findings). Central aspects of this approach have been present since borderline first appeared in the literature, continuing through more recent contributions, notably those of Marsha Linehan and the Dialectical Behavior Therapy (DBT) school.     

Psychological Reactance as a Factor in Patient Noncompliance With Medication Taking: A Field Experiment1

Patient noncompliance with medical recommendations is widespread. The theory of psychological reactance sheds light on the subject. Reactance theory posits that when an individual discems a threat to a valued freedom, a motivational state compels the individual to reassert that freedom. The present study sought evidence of reactance in the compliance behaviors of 101 patients. Participants were exposed to either an authoritative‐oriented or a partnership‐oriented advice‐giving tone, coupled with either an opportumity for the participant to select certain features of the regimen or no opportunity to do so. While neither manipulation produced the anticipated causal results, both quantitative and qualitative correlational data clearly revealed a connection between reactance and noncompliance. The investigators report findings and make suggestions for further research.     

Clinical Mutual Attunement and the Development of Therapeutic Process: A Preliminary Study

Despite the identification of many factors that play a central role in the development of the psychotherapy process, there is still a lack of evidence about the basic relational mechanisms that pave the way to its working. In this pilot study, we focus on nonverbal microprocessual attunement as the basic mechanism grounding the displacing of discrete factors in shaping the clinical process. Two single sessions of two short-term psychodynamic treatments, selected respectively from a good- and a poor-outcome treatment, have been coded in terms of patient and therapist speech rate, coordination in ruptures, resolution of the therapeutic alliance, and patient's displayed thinking processes. Two dynamic structural equation models focusing on clinical attunement as a factor able to activate the interplay of the assessed clinical dimensions have been theoretically designed and tested in both cases. The driven theoretical structural equation models fit the data, suggesting a different role of nonverbal attunement as a moderating factor. The obtained results are consistent with the hypothesis claiming that a good-outcome psychotherapy session is characterized by a mechanism of clinical attunement that enforces the therapist–patient relationship and promotes the integration of formal thinking processes that affect emotional and cognitive domains.     

Therapist as Subject: A Review of the Empirical Countertransference Literature

This article presents a synthesis of the research on countertransference (CT) that has been conducted since the last major review of CT literature was published in 1977. The past quarter century has witnessed a growing body of research on CT marked by methodological improvements and increasing conceptual sophistication. In this article, the authors critically review this research, noting implications for counseling practice, making connections to relevant theory, and suggesting directions for future research on CT.     

Interventive Interviewing: Part I. Strategizing as a Fourth Guideline for the Therapist

A clinical interview affords far more opportunities to act therapeutically than most therapists realize. Because so many of these opportunities remain outside the therapist's conscious awareness, it is useful to elaborate guidelines that orient his or her general activity in directions that are liable to be therapeutic. The Milan associates defined three such basic guidelines: hypothesizing, circularity, and neutrality. Hypothesizing is clear and easy to accept. The notions of circularity and neutrality have aroused considerable interest but are not as readily understood. These guidelines may be clarified and operationalized when reformulated as conceptual postures. This process is enhanced by differentiating a fourth guideline, strategizing, which entails the therapist's decision making, including decisions about how to employ these postures. This paper, the first in a series of three, explores these four interviewing guidelines. The other papers will appear in a subsequent issue. Part II will focus on reflexive questioning, a mode of inquiry oriented toward mobilizing the family's own healing capacity. Part III will provide a scheme for analyzing and choosing among four major types of questions: linear questions, circular questions, reflexive questions, and strategic questions.     

Heidegger's Brightness as a Responsibility of the Therapist in Existential Family Therapy

The author reflects upon the Heideggerian concepts of thrown-ness, death imagery, arrogance and brightness and their usefulness in existential family therapy. The article describes and illustrates with clinical material the process of helping a couple or family to move from an arrogance response to thrownness and death imagery to the response of brightness as attendants of Being. The responsibilities of the therapist in facilitating such a process are also described.Director of the Worthington Logotherapy Institute, co-director of Lantz and Lantz Counseling Associates, and a professor at The Ohio State University. College of Social Work     

Early Termination from Couple Therapy in a Naturalistic Setting: The Role of Therapeutic Mandates and Romantic Attachment

Drawing on a series of 141 couple therapy cases, the main goal of the present study was to determine whether romantic attachment, pre-treatment relationship distress and therapeutic mandates (i.e., reduction of couple distress or ambivalence resolution) are prognostic indicators of early termination. Couples completed the Dyadic Adjustment Scale (Spanier 1976) and the Experiences in Close Relationships Questionnaire (Brennan et al. 1998) at intake, whereas therapists filled in the Classification of Therapeutic Mandates (Poitras-Wright and St-Père 2004) after the 4th session. Results showed that an ambivalence resolution mandate, elevated couple distress and higher levels of attachment anxiety were associated with early termination. The implications of these findings to further understand early termination in couple therapy are discussed.     

Traditionally Defined Client,Meet Feminist Therapist: Feminist Therapy as Attitude Change

This article explores feminist therapy within the framework of the social-psychological influence process, outcomes of feminist therapy, and some cautions about the influence process.