Intimate boundaries: Therapists’ perception and experience of erotic transference within the therapeutic relationship

Aim: This study explored therapists’ understanding and experiences of erotic transference within therapeutic relationships. Method: A small‐scale qualitative research project was undertaken with six therapists working within different counselling contexts. Data was collected through semi‐structured face‐to‐face interviews, and an Interpretative Phenomenological Analysis used for analysis of individual perception and experience. Findings: All participants had experienced what they understood to be erotic transference and/or sexual and loving feelings within therapy. There was little differentiation between the two phenomena, and both were often referred to interchangeably. There were contradictory views as to whether using the phenomena would be beneficial to client work, but there was a strong motivation to learn more about it. Therapists who encountered sexual attraction within therapy experienced feelings including shame and embarrassment. Supervisory support was seen to be beneficial. Implications/conclusion: The importance for therapists to acknowledge a lack of clarity that exists around the understanding of erotic transference and its relationship to sexual attraction within therapy is noted. Also, a recognition that better access to training regarding erotic transference and sexual responsibility within client relationships might be helpful to therapists in their work.     

Energy psychology and psychotherapy: A study of the use of energy psychology in psychotherapy practice

Aim: The aim of the study was to increase understanding of how energy psychology informs and affects counselling/psychotherapy practice. By undertaking phenomenological interviews with experienced clinicians, the aim was to enrich and expand on the scientific approaches to energy psychology research. Method: This research is based on in‐depth semi‐structured interviews using interpretative phenomenological analysis (IPA). Five experienced psychotherapists who are also practitioners of energy psychology were interviewed. Findings: Four main themes emerged from the analysis: energy psychology as a potent intervention that facilitates shifts in emotions, cognitions, behaviours and physiology; the safety of energy psychology techniques; the role of the therapeutic relationship when using energy psychology techniques; and the challenges of integrating energy psychology into the work context, highlighting the need for more complex, systemic models to understand how people experience distress and how change is facilitated. Conclusion: Overall, participants in this study found energy psychology to be a valuable supplement to counselling and psychotherapy. The implications for current practice are discussed.     

‘Coming out’ in therapy? Perceived risks and benefits of self‐disclosure of sexual orientation by gay and lesbian therapists to straight clients

Primary objective: The study's primary objective was to investigate the experiences of gay and lesbian therapists, when considering self‐disclosure of their sexual orientation to straight (i.e. heterosexual) clients. This qualitative study set out to ascertain the key factors gay therapists take into account when considering this decision and to explore the effects this self‐disclosure may have on themselves, their clients and their therapeutic relationships. Research design: The research design was based on the use of semi‐structured interviews, undertaken with a non‐random, purposive sample of counsellors and psychotherapists (n=8) in current practice. The rationale for this method was to aid exploration of therapists' experiences of the process of self‐disclosure. Methods and procedures: Inclusion criteria were for therapists who self‐identified as being gay or lesbian, and who were experienced in clinical work with straight clients. Transcribed data was analysed using inductive thematic analysis. Main outcomes and results: Some therapists reported being confident with self‐disclosure relating to their own sexual orientation. However, a common theme related to the reportedly high levels of anxiety and vulnerability, which therapists identified. Key themes emerged around: respondents' fears of client judgement; a need for therapist self‐protection; self‐awareness of the potential impact of their own fears and prejudices on the therapeutic relationship; and the potential relevance of internalised homophobia, as an overall constraining factor. Conclusions: Self‐disclosure of their sexual orientation to straight clients is constructed, in this initial survey, as being potentially problematic and risky for some gay therapists.     

‘My language thing … is like a big shadow always behind me’: International counselling trainees' challenges in beginning clinical practice

Background: While counsellor education becomes increasingly culturally diverse, little is known about international trainees' experiences of training. Objective: The present study explores one aspect of training, namely clinical practice from the perspective of international, non‐native speaking trainees. In particular, this paper focuses on the challenges this group encounters when practicing in a second language. Methodology: Semi‐structured interviews with four non‐native English‐speaking trainees were conducted and analysed following the principles of interpretative phenomenological analysis (IPA). Results: Findings suggest that participants encounter practical difficulties related to their non‐native/foreign identity in practice, such as problems with articulate self‐expression and understanding the client's speech. These difficulties generate anxiety and impact on the trainees' confidence. Conclusions and implications for counsellor training: This study elucidates language as a fundamental aspect of culture, and identifies second language use as a significant source of difference in counselling practice. This paper highlights the need for attention to linguistic diversity and for appropriate support during counsellor education. This will improve international trainees' experiences of training, but also enhance all trainees' understanding of difference, resulting in better service provision for the community.     

Reclaiming the Boundary Concept from Forensic Discourse: Response to Commentaries

The author argues that sexual misconduct is better referred to as ethical or sexual misconduct rather than combining a fragile metaphoric construct—boundary—with forensic jargon. His argument rests on a few points that intersect. One objection to the term “boundary violation” involves a matter of scale in which the notion of exploring psychic boundaries, the essential context for psychoanalysis, is obliterated by sexual misconduct. The enormous scale of sexual misconduct is better labeled with behavioral referents rather than a moniker that combines forensic violation and the subtleties of analytic process. The author would reserve the term boundary difficulties for analytic process related to more subtle problems in analysis and the use of boundaries embedded in the work. Another objection relates to our responsibility to those outside our community to refrain from using our sophisticated understanding of the play of boundaries in analytic work in ways that are too often unintentionally confusing and mystifying.     

Psychodynamic therapists' dilemmas in providing personal therapy to therapists in training: An exploratory study

Aim: This study explores dilemmas facing psychodynamic therapists who provide personal therapy to therapists in training. Method: Eight experienced psychodynamic psychotherapists were interviewed using a semi‐structured interview format during which they were asked about the importance of personal therapy, if they encountered any dilemmas and, if so, how they resolved those dilemmas. Their responses were analysed using a qualitative form of content analysis. Findings: Two categories of dilemma emerged: clinical and personal. Clinical dilemmas arose out of the mandatory requirement for therapy, boundaries, fitness to practice and the suitability of trainees. Personal dilemmas included pressure to model, sense of responsibility, therapeutic narcissism, countertransference reactions, over‐use of self and stressful involvement. The therapists' strategies for resolving the dilemmas are described. Conclusion: The results show participants considered personal therapy to be essential for trainees and thought it should be mandatory even though it led to difficulties in the therapy. Questions arose about the suitability of some trainees, the person of the therapist and stressful involvement. Further research into these important areas is recommended.     

‘Learning from research’: Therapist perspectives on the benefits and challenges of participating in a longitudinal,systematic case‐study

Objectives: In psychotherapy research we have often neglected to examine the impact of research procedures on therapy process and outcome. Such information is extremely important in helping us evaluate the validity of our findings, increase relevance of research for practice, and choose appropriate methods for future projects. The aim of this paper is to share the experience of six person‐centered therapists, who participated in a longitudinal, systematic study, and present their reflections about the impact of research on therapy process, therapeutic engagement and professional development. Methods: The findings have emerged from semi‐structured interviews that took place after the first, sixth (middle) and last therapy session. In total 18 interviews were conducted. These data were part of a much larger research protocol that included a number of outcome and process measures. Results & Conclusions: The analysis of therapist narratives revealed important benefits for those participating in systematic case study research. The use of Brief Structured Recall methods and qualitative interviewing was an important factor in promoting therapist reflexivity and professional development. The importance of a strong research alliance and the active involvement of the client in the research process is discussed.     

The path towards a professional identity: An IPA study of Greek family therapy trainees

Objective: Contemporary psychotherapy research has focused mainly on practitioners' training and education. The impact of training on professional development and the application of therapeutic skills have been the primary foci of the empirical literature. The aim of this paper is to present the experiences of seven family therapy trainees regarding their personal paths toward the development of professional identity as they underwent training in systemic psychotherapy. Method: In‐depth interviews were conducted and analysed using Interpretative Phenomenological Analysis. Results & Conclusions: Seven themes were identified: The Quest, Developing by Relating, Learnings, Personification of Training, Use of Self, Self‐Care and Empowerment, and Reflecting on the Role of the Therapist. The findings are discussed with regard to the development of the ‘therapist as a person’, gaining acknowledgement and autonomy, and the development of a community of therapeutic practice.     

Exploring Decision Making Around Therapist Self‐Disclosure in Cognitive Behavioural Therapy

Background

Therapist self‐disclosure (TSD) usage varies greatly among different psychotherapy orientations. Anecdotal evidence seems to suggest that there are reasons for its judicious use, and a small number of researchers have proposed guidelines for how TSD should be used to help therapists across psychotherapy models make decisions around disclosure. However, there is almost no literature specifically exploring how cognitive behaviour therapy (CBT) practitioners make decisions around employing TSD within the CBT framework.

Objective

This study aimed to explore how experienced CBT practitioners make decisions around TSD.

Method

In‐depth qualitative interviews were conducted with six clinical psychologists who were trained and experienced in CBT, and the interviews were analysed thematically.

Results

There were two overarching themes in terms of how they made decisions to self‐disclose: (A) the rules for TSD use, which included sub‐themes (a) it must have a clear purpose, (b) it must fit, (c) the therapist must maintain boundaries, and (d) the therapist must always reflect on his/her use of TSD; and (B) how they use TSD, which included subthemes of (a) using it as a tool for change and (b) using it to manage the therapeutic relationship.

Conclusion

Participants’ decisions on whether or not to self‐disclose were strongly influenced by the CBT model, and this process went beyond what is suggested in the transtheoretical literature. Understanding this process may lead to the development of CBT‐specific guidelines for making TSD‐related decisions.     

Counsellors' experiences of changing their practice: Learning the psychodynamic‐interpersonal model of therapy

Seven counsellors were interviewed about their experiences of learning and applying a new approach to therapy: the psychodynamic‐interpersonal model. These interviews were analysed using grounded theory — a qualitative approach. Under the core category of ‘changing counselling practice: applying the PI model of therapy’, the material was organised into 10 major categories: difficult feelings; new awareness; therapeutic identity; identifying reasons for choosing how to work; experiencing difficulties in adherence; attributing causes of difficulties; ways through the difficulties; understanding how change in practice occurs; changing interventions; and specific other inputs. Examples from the interviews are used to cast light on the difficulties experienced by counsellors in the process of changing their practice.     

‘The bereaved therapist speaks’. An interpretative phenomenological analysis of humanistic therapists' experiences of a significant personal bereavement and its impact upon their therapeutic practice: An exploratory study

Aim: The aim of the research was to explore the under‐researched area of therapists' personal bereavement and its impact upon their therapeutic practice. Method: Data were collected via semi‐structured interviews with four humanistic therapists and were analysed using Interpretative Phenomenological Analysis (IPA). Findings: Four master and eight subordinate themes emerged from the rich data collected that exemplified both convergence with and divergence from the small body of extant literature on therapist bereavement and current thinking in thanatology. The findings suggest that bereavement is a unique experience that can affect the individual's personal and social identity and worldview. It can also be a transformative experience resulting in personal growth and a renewed sense of self and agency. In terms of professional practice, the findings suggest that the lived experience of the grieving process, mediated by supportive supervision, enabled participants to experience deeper levels of empathy and connectedness within their therapeutic relationships. Conclusion and implications: Bereavement is an experience that can profoundly impact upon therapists' personal identity and assumptive world. Such an experience can have an equally profound impact upon their therapeutic practice. There are therefore implications for students, trainers, therapists and supervisors particularly in terms of self‐care and the use of the ‘self’ in therapy. Further research needs to be undertaken in order to explore in greater depth the intersection between personal bereavement and therapists' evolving personal and professional identity development.     

The Social Ecology of Parental Monitoring: Parent–Child Dynamics in a High‐Risk Peruvian Neighborhood

While parental monitoring is understood to protect adolescents from engaging in risk behaviors, little is known about how the family dynamics involved in parental monitoring differ across sociocultural contexts. We sought to gain an in‐depth understanding of parent–child relationship dynamics and parental knowledge of adolescents’ activities in an urban Peruvian neighborhood with high levels of crime and adolescent substance use. We conducted 15 in‐depth interviews and two focus groups with adolescents and 12 in‐depth interviews with mothers sampled from a secondary school in Callao, Peru. Our findings emphasize the importance of parent–child confianza (trust) as a foundation for parental awareness of adolescents’ lives and activities. Participants in our sample characterized confianza as encouraging adolescent disclosure and shaping how parental solicitation and rules were interpreted by adolescents. Participants described how confianza was rooted in features of the parent–child relationship, including shared parent–child time, parental affection, adolescent perceptions of parents’ ability to give good advice, and awareness of how parents would react to delicate topics. Participants linked these family dynamics, in turn, to economic hardship, parental feelings of sacrifice and stress, perceptions of neighborhood risk, and gender norms limiting fathers’ involvement in caregiving. Results have implications for the planning and adaptation of family‐based prevention programs for use in high‐risk contexts in Latin America.     

Politicizing Brandom's Pragmatism: Normativity and the Agonal Character of Social Practice

This paper provides an agonistic interpretation of Robert Brandom's social‐pragmatic account of normativity. I argue that social practice, on this approach, should be seen not just as cooperative, but also as contestatory. This aspect, which has so far remained implicit, helps to illuminate Brandom's claim that normative statuses are ‘instituted’ by social practices: normative statuses are brought into play in mutual engagement, and are only in play from an engaged social perspective among others. Moreover, in contrast to a positivist or conventionalist understanding of Brandom's work, it shows that the possibility of a critical stance toward existing practices is not only compatible with, but already implicit in this form of pragmatism. This can be made explicit with the notion of farcical practices: practices that are treated merely as if they institute genuine commitments and entitlements. Interpreting a practice as farcical is taking a critical stance toward it, and this possibility is inherent in Brandom's theoretical framework. This opens the way for a fruitful appropriation of Brandom's pragmatism for social and political philosophy.     

How did compulsory personal therapy during counselling training influence personal and professional development?

Aim: This study explored the influence of personal therapy on professional and personal development in a qualitative investigation. Method: Six semi‐structured interviews were conducted and analysed using Interpretative Phenomenological Analysis (IPA). Findings: All participants recognised the important influence of personal therapy on personal growth. Influences on personal development were experienced in the physical, cognitive, emotional and spiritual worlds of participants. It was felt that skills, a better understanding of therapeutic relationships, and general support, enhanced professional development. Conclusion: In combination this can lead to an increase in self‐awareness and thus a more effective professionalism in counsellors.     

Client perceptions of hindering experiences in counselling

The purpose of this study was to increase understanding of what clients perceive as hindering experiences in counselling. In‐depth interviews combined with concept mapping were used to gather, organize, and understand clients' perceptions of hindering aspects of therapy. In the initial data gathering stage, 8 adult client participants, aged 18 or older (average of 14.1 sessions) were asked to respond to the following open‐ended questions:

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The manifestation of transference during early psychotherapy sessions: Exploring an alternate data source for therapist narratives in transference research

Introduction: Previous transference studies have compared in‐session client narratives about significant others to in‐session client narratives about the therapist, limiting data to the information that clients are willing to share with the therapist. Method: The first three sessions of 30 therapies with high‐functioning individuals were examined using the Core Conflictual Relationship Theme (CCRT) method. Client narratives about others were drawn from the psychotherapy sessions and client narratives about the therapist were drawn from a Participant Critical Event (PCE) interview conducted after the third session of therapy. Results: Factor analyses of the CCRT components indicated several relational patterns: a complementary pattern of relating characterised by a devaluation of the therapist and idealisation of others; a concordant relational transfer where clients feel bad with both the therapist and others; and as clients experience control issues with significant others, they wish to adopt a submissive stance toward the therapist. The results suggest that the source of therapist narratives may influence the results of transference research.     

Client perspectives: The therapeutic challenge of domestic violence counselling – a pilot study

Aims: This qualitative pilot study explored the perceptions of four female domestic violence clients regarding counselling they had concluded in order to identify a preliminary client‐preferred domestic violence counselling approach. Method: Semi‐structured interviews asking about significant events during counselling were held. An adapted grounded theory and narrative methodology was used. Results from the analysis were reviewed with two of the participants. Participants were offered additional counselling support if required after the research interview. Results/Findings: Domestic violence clients found starting counselling particularly difficult after years of keeping the abuse to themselves. Participants actively withheld and managed information for several sessions and needed to know they had time to explore their experiences. The counsellor being consistent and non‐judgemental, and understanding domestic violence and its effects was helpful. Having a clear ending was appreciated by the participants. Discussion: The initial development of the therapeutic relationship benefited from active discussion of how domestic violence could affect behaviour and emotions. Good early therapeutic relationships showed elements of the three main psychological schools. Participants benefited from a pro‐active discussion of endings. A key limitation of this research is the small sample size. Implications for practice: The research suggests that counsellors would benefit from knowledge and skills from different psychological schools and specific training in domestic violence. Allowing flexibility on the number of sessions available to clients may be helpful. Conclusions: Further work is required to explore these preliminary findings. However, early indications suggest that domestic abuse clients may benefit from non‐time‐limited specialist counselling services.     

Helpful processes in psychological therapy for patients with primary cancers: A qualitative interview study

Aims: The purpose of this study was to identify what patients with primary cancers found helpful in therapy. Method: In‐depth qualitative interviews were conducted with eight patients who had completed a course of psychological therapy within an NHS psychology service for cancer patients. Data were analysed using thematic analysis. Results: The participants identified a range of helpful processes in therapy: talking and expressing their feelings to someone outside of the family; forming a relationship with their therapist; normalisation through the therapists' expert knowledge; problem‐solving and CBT. Limitations: As with all qualitative studies, the small sample and size and dependence on participant recall limits generalisability of the findings. Implications: The findings of this study are consistent with a pluralistic perspective: that multiple therapeutic processes ‐ aligned to a range of different orientations ‐ can be of value to patients with primary cancers. This supports the provision of a range of therapeutic interventions and strategies for this patient group.     

An exploration of the therapeutic process while using computerised cognitive behaviour therapy

Background: Modern technologies that offer an alternative to face‐to‐face therapy have gained ground in the NHS. Critics have argued that some of the important elements of the therapeutic change process necessarily require a human therapist. Yet, the traditional understanding of the change process in psychotherapy is challenged by evidence that some computerised cognitive behaviour therapy (cCBT) programs may be as effective as face‐to‐face therapy, suggesting that in certain cases the interaction between user and a cCBT product satisfies sufficient criteria for personal change without the need for actual human contact. Aim: This study used the cCBT package Blues Begone as a means of investigating the process by which a computer‐mediated program helped adults with mild depression help themselves. Method: Seven qualitative interviews were conducted with mildly depressed users who had completed Blues Begone in their own homes without any additional human help or support. Findings: Interpretive phenomenological analysis (IPA) was performed with four main themes emerging. These were: the meaningful relationship; shape from confusion; stimulation and empowerment. This study illustrates some of the ways that some depressed users make use of cCBT self help.