Fat Women’s Experiences in Therapy: “You Can’t See Beyond…Unless I Share It with You”

Abstract

This article reports the results of a qualitative exploration of fat women’s experiences with weight-related microaggressions in psychotherapy. We conducted semi-structured interviews with 15 women about their weight-related experiences as therapy clients and asked for their advice to therapists who work with fat women. We used a general inductive approach to code the data into themes and found that common microaggressions included therapists who overly focused on weight, therapists who appeared to be less interested in clients because of their weight, and dissatisfaction with waiting room seating options. Participants advised therapists to allow their clients to initiate conversations about weight. Results suggest the need for increased awareness of: (a) how clients’ weight may impact therapists’ attitudes and choice of interventions and (b) how weight might influence fat clients’ in-session presentations.     

Doing Therapy in a Foreign Land: When the Therapist Is “Not From Here”

The psychotherapy field has been paying closer attention to how therapists’ characteristics, history, and styles affect therapeutic encounters and contribute to successful therapy outcomes. Therapists have been encouraged to increase self-awareness of their own socio-cultural dimensions to optimally connect with clients. However, the experience of therapists’ own immigration has received little attention. This article highlights the experience of immigration as important for understanding the self of the therapist, describing core experiences related to immigration for immigrant therapists in the United States. This article additionally describes how these experiences can affect immigrant therapists’ clinical encounters. Finally, recommendations are provided for immigrant therapists, clinical supervisors, and training programs.     

‘It’s about having exposure to this’: investigating the training needs of therapists in relation to the issue of anomalous experiences

Two focus groups, consisting of six participants each, were conducted to explore the training needs of therapists when working with clients reporting anomalous experiences (AEs). AEs are those that ‘depart from our own familiar personal experiences or from the more usual, ordinary, and expected experiences of a given culture and time’ [Braud, W. (2012). Health and well-being benefits of exceptional human experiences. In C. Murray (Ed.), Mental health and anomalous experience (pp. 107–124). Hauppauge, NY: Nova Science Publishers.]. A thematic analysis revealed four themes: ‘Quite often we get taken by surprise because it’s a subject we don’t talk about’, ‘It’s just having this in our vocabulary’, ‘Demystifying and valuing AEs as normal human experiences’ and ‘To ask or not to ask?’. Most of the participants felt that they were unequipped to work with clients reporting AEs and suggestions were made for overcoming this.     

A Survey of the Attitudes and Practice Experiences of Home-Based Practitioners

This article reports on the findings from a study that assessed the attitudes and practice experiences of home-based therapists. Existing research in the field of couple and family therapy encompasses largely qualitative information detailing the experiences of this therapist population. We explored several hypotheses generated from the qualitative literature on home-based therapy. Study results corroborated much of the qualitative data on home-based therapists’ experiences and reveal the profile of today’s home-based therapists along with their attitudes and therapeutic practices. A surprising result was that various aspects of home-based therapy models seem incongruent with therapist attitudes about the delivery of home-based services.     

I’mprovisation – Therapists’ Subjective Experience during Improvisational Moments in the Clinical Encounter

Improvisational (or now) moments can serve as important change mechanisms in psychotherapy. Yet there is little understanding of the therapists’ subjective experiences during those Improvisation Experiences (IE). In this pilot study, 17 clinicians reported on their clinical IE following theater improvisation training. Reports were analyzed in relation to three constructs: peak experience, flow, and peak performance. Results show that during IE therapists experience dimensions of peak experience and flow, but not of peak performance. Additional unique dimensions of IE are discussed in relation to different constructs, leading us to name therapists’ IE as I’mprovisation. Recommendations practice and training are discussed.     

Feeling accepted: A phenomenological exploration of adolescent patients’ experiences of the relational qualities that enable them to express themselves freely

Objectives: The aim of this study was to explore adolescent psychotherapy patients’ experiences of the relational qualities that make it possible for them to express themselves freely and to continue their self-consolidation.Design: An interview-based study using thematic analysis based on hermeneutical–phenomenological epistemology.Methods: Semi-structured in-depth qualitative interviews with 14 adolescents.Results: The adolescents’ experiences were clustered around five themes: (1) receiving full and genuine attention; (2) not having to take care of and responsibility for the therapist; (3) being accepted and valued; (4) the therapist staying with them through emotionally painful moments; and (5) the therapist facilitating openness by sharing.Conclusions: The results from the current study suggest that there are particular ways that therapists can relate to adolescent patients which would make them feel more able to express themselves freely and that create an atmosphere which facilitates the consolidation of the adolescents’ sense of self.     

Person‐centred counsellors' experiences of working with clients in crisis: A qualitative interview study

Aims: This study aims to explore and understand person‐centred therapists’ experiences and work with clients at the pivotal point of crisis. Specifically: how do person‐centred therapists experience working with clients in crisis? Do they identify differences in crisis intervention compared to non‐crisis work? What do they perceive as helpful to crisis clients? How relevant are therapists' own experiences of crisis? Method: Participants were all experienced person‐centred therapists. Qualitative, semi‐structured interviews were conducted and the data were analysed qualitatively using person‐centred/phenomenological methodology. Results: Respondents identified differences in their experiences. Typically, therapists described polarity in their experience of danger and opportunity, also heightened energy levels within themselves, perceived higher levels of engagement, faster pace of work, experiences of reaching ‘relational depth’ earlier, and the importance of assisting symbolisation of clients' experience in awareness. Clients were experienced as vulnerable, unable to access previous coping mechanisms, in a state of breakdown and disintegration, but also as wide open, having dropped their usual defences, and more available to engage in therapy and enter the process of change and potential post‐crisis growth. Discussion: The findings are discussed in relation to prevailing models of crisis intervention, person‐centred theory and theoretical developments in post‐traumatic growth in the aftermath of crisis.     

A grounded theory exploration of therapists’ experiences of somatic phenomena in the countertransference

Somatic phenomena in the countertransference have historically received minimal attention despite evidence of their occurrence in the therapeutic encounter. In the field of Counselling Psychology, there seems to be an apparent gap in the academic coverage and clinical utilisation of therapists’ somatic states. The purpose of this study was to explore therapists’ somatic experiences in the countertransference using a grounded theory methodology, based on a sample of 12 participants that was composed of psychotherapists, counselling and clinical psychologists. The results indicated that therapists made sense of their somatic experiences through a developmental process of ‘relating to the body’ that combined stages of defensive operations, intellectual reflections, attributions of somatic ownership and recognitions of various working patterns in the management of somatic experiences. This study addresses the factors that constituted therapists’ processing of the experience, and the findings suggest that therapeutic work may be affected when psychosomatic phenomena as such become undermined and ignored.     

‘And when you were a child?’: how therapists working with parents alongside individual child psychotherapy bring the past into their work

When a child is offered psychotherapy, it is common that regular meetings will be offered to the parents. However, there are debates in the literature about the degree to which such parent work should include a focus on the parents’ own childhood experiences. This study aimed to examine the way that those offering parent work as part of a study evaluating the treatment of adolescent depression dealt with this issue in their work with parents, both in the study and in routine clinical practice. Design: five therapists were interviewed on the subject of working with parents’ childhood experiences within parent work parallel to child psychotherapy. Data were analysed qualitatively, using Interpretative Phenomenological Analysis. Findings: participants described the need to consider the different parameters of this work to individual adult therapy; in addition, participants felt that it was necessary to negotiate permission to work on the parents’ childhood experiences. They also spoke of making use of insight into the repetition of the parents’ history, the analysis of parental projections and offering containment within the relationship; this varies from the ‘transference work’ of individual therapy and a different style of interpretation was described. Conclusions: there is a need to give more attention to the neglected field of working with parents alongside individual child psychotherapy, especially at a time when such work is under threat within many public services. There are particular technical issues related to work with parents’ own childhood histories that are different to how one might work in individual therapy with a parent.     

How talking therapists experience working with adult clients who have autism

This research aims to gain new insight by exploring the thoughts, feelings and experiences of therapists working with clients who have autism. Three professional talking therapists participated in the study. Unstructured interviews were conducted and analysed using interpretive phenomenological analysis. Six main themes and 13 sub-themes were found which include therapists’ validation of autism, how therapists integrated autism when addressing mental health problems, how their personal experiences of autism impacted on their work and how they experienced the situation in which autism emerges during the therapy. Helpful suggestions are made for clinicians, namely, to zoom-in and zoom-out of autism, hold the knowledge that people with autism process information differently, incorporate working with trauma, consider disclosing a personal connection to autism and consider carefully whether, or not, to tell a client that they may have autism.     

A hermeneutic study of integrating psychotherapist competence in postnatal Child Health Care: Parents’ perspectives

A child's emotional and social development depends on the parents’ provision of optimal support. Many parents with perinatal distress experience difficulties in mastering parenthood and seek help from professionals within primary healthcare. A clinical project was launched in Stockholm, where psychodynamic psychotherapists provided short-term consultations at Child Health Centers. This study qualitatively explored parents’ experiences of perinatal distress and of receiving help by nurses and therapists in the project. Thirteen parents were interviewed, and their responses were analyzed with a hermeneutical method. Three main themes crystallized; accessibility of psychological help and detection of emotional problems; experiences of therapy at the Child Health Center; and the therapists’ technique. Parents were also clustered into three so-called ideal types: the insecure; parents in crisis; and parents with lifelong psychological problems. Parents experienced obstacles in accessing psychological care within primary healthcare. Psychotherapists with a holistic family perspective and who managed to oscillate between insight-promoting and supportive interventions were especially appreciated. Patient categories who benefitted from insight promotion and support, respectively, were identified.     

Mozambican immigrants to South Africa: Their xenophobia and discrimination experiences

We explored Mozambican immigrants’ lived experiences of xenophobia and discrimination in South Africa. Informants were 15 Mozambican immigrants (female = 7, male = 8) living in an informal settlement in Zandspruit, Gauteng Province. They completed open-ended written narratives on xenophobic and discriminatory experiences. Following thematic analysis, we identified three themes to characterise the Mozambican immigrants’ experiences of xenophobia and discrimination: (i) abusive attitudes, (ii) ethnic discrimination, and (iii) scapegoating. The Mozambican immigrants’ experiences of xenophobia and discrimination are consistent with findings from the extant international literature on ingroup/outgroup social strife with real or perceived scarcity of resources.     

Encounter group counsellor training with pre-service industrial psychologists: A pilot study

This study explored the efficacy of an encounter group counsellor training protocol to prepare pre-service industrial-organisational (I-O) psychologists as workplace counsellors. The participants included 48 master’s degree students enrolled for I-O professional education at a South African university over the span of two years (female = 59%, aged 23 to 30 years, white = 79% and Afrikaans speaking = 70%). They were engaged in an encounter group training process as part of their professional preparation. Qualitative impressions on the students’ experiences impacting on their intra-and interpersonal awareness were gathered after the training using a structured observation design. The data were thematically analysed and the findings indicated the participants portrayed a higher sense of inter-and intrapersonal awareness following the encounter group training. Encounter group experiences might be of added value in the training of future I-O psychologists for interpersonal awareness.     

People with severe and profound intellectual disability: Nurse carer experiences in a South African setting

We explored nurse carer experiences with people with severe and profound intellectual disability in a care and rehabilitation centre in South Africa. Informants were a convenience sample of 10 nurses (females = 7; males = 3; mean years of service = 7.8, SD = 4.8 years). They completed an unstructured interview on their care provision experiences. The data were thematically analysed using Tesch’s method of open coding. Findings resulted in the following three themes to characterise the nurse carer experiences: compassion, person-centred care, and importance of parent involvement. Compassionate and person-centred care is fundamental to the establishment of a therapeutic relationship between nurse carers and people with severe and profound intellectual disability.     

Inviting passage to new discourse: ‘Alive moments’ and their spiritual significance

Some social constructionists assert that therapeutic change occurs when clients' meanings for problems and solutions shift from those found in resource‐impoverished discourses to those affording resourceful and preferred possibilities. Referred to as ‘positioning theory’, our research examined this assertion by inviting clients and therapists to speak of a significant, but ambiguous, experience in unfamiliar discourse: spiritual discourse. Clients were asked to review videotapes of their sessions, selecting moments that felt most ‘alive’ to them for discussions with the researcher, including inquiries as to whether ‘alive’ moments held any spiritual significance. The outcomes are portrayed as a ‘poetic collaboration’ between the researcher, clients and therapists — while clients' and therapists' reported experiences for changes in discourse and meaning are highlighted. Implications regarding sensitivities required when co‐constructing meanings for ambiguous but significant experiences in therapy are discussed. Possibilities for more research examining poetic practices and processes in therapy are also considered in terms of positioning theory.     

Therapists’ Thought-Action Fusion Beliefs Predict Utilization of Exposure in Obsessive-Compulsive Disorder

Although exposure and response prevention (ERP) is considered the gold standard for the treatment of obsessive-compulsive disorder (OCD), it is rarely used in clinical practice. Therapists’ beliefs about ERP affect its utilization, as previous research suggests, but the role of therapists’ cognitive biases is unclear. In particular, susceptibility to thought-action fusion (TAF) may be related to the underutilization of ERP in OCD.Therapists (N = 353) were divided into those recommending (ERP+, n = 228) and not recommending ERP (ERP−, n = 125) as treatment for an OCD case example. TAF in therapists was assessed using behavioral and self-report measures (TAFS).TAF was higher in the ERP− than the ERP+ group, with a small to moderate effect size (0.2 ≤ d ≤ 0.4). ERP− therapists showed more avoidance and neutralizing behavior and a stronger emotional response than the ERP+ therapists during the experimental task. Moreover, higher TAF as measured by the TAFS was associated at a small magnitude with lower likelihood of using ERP in the therapists’ actual clinical practices.Therapists’ cognitive biases should be addressed in their training in order to increase the dissemination of evidence-based treatment (i.e., ERP) and thus improve the treatment of OCD.