Should your lips be zipped? How therapist self‐disclosure and non‐disclosure affects clients

Is therapist self‐disclosure a therapeutic technique or a therapeutic mistake? Is it useful? Is it ethical? This study attempts to address this controversy among therapeutic modalities by asking clients about their perceptions of self‐disclosure and non‐disclosure. Eighteen people (16 women, two men), currently in therapy in two Canadian cities, generated 157 incidents of both disclosure and non‐disclosure. The incidents were first coded as helpful or unhelpful. Cross‐tabulation of the results showed that disclosures were more than twice as likely to be experienced as helpful; non‐disclosures were twice as likely to be unhelpful (χ² (3, N=157) = 14.439, p≤0.002). One‐quarter of these incidents was coded by two independent raters; inter‐rater reliability was high (Pearson corr. ranged from 0.755 to 1.0, p≤0.01). The data was then sorted, using the Constant Comparison method, into themes, starting with, but not limited to, the themes suggested by the literature. The greatest single effect was on the therapeutic alliance, both positive and negative. Clients’ perceptions of helpful disclosures and non‐disclosures generally supported therapists’ rationales. There was also some evidence that when clients found disclosures unhelpful, the reasons also supported theoretical rationales against disclosing. Rather than simply supporting either position in the controversy, this study suggests that skill, or lack of it, was the intervening variable that affected the perceptions of both techniques. Further research on the effects of skill on both disclosure and non‐disclosure are warranted. This study has implications for both researchers and practitioners.     

Video interaction guidance inviting transcendence of postpartum depressed mothers' self‐centered state and holding behavior

By sometimes evoking self‐absorbed and avoidance behaviors in new mothers, postnatal depression affects the quality of mother–infant interaction, which in turn may invoke distress and avoidance in the infant and cause even more lasting impairment in the child's development. Three depressed mothers, A, B, and C, are reported upon after having been offered counseling in accordance with the Marte Meo approach through jointly watching with the therapist video replays of themselves interacting with their newborns. Clinical vignettes are offered which indicate how empathic and positive support of a sensitive therapist can be helpful in inviting the mother's recognition of her importance to her infant and facilitating mutually gratifying interaction between mother and child. Protocol analyses of select sessions of video‐related therapy reveal that two of the mothers sometimes complete the therapist's unfinished statements in an other‐centered manner, thereby transcending their initial self‐centered state. This is most dramatic in the case of Mother A, who starts out in the first session almost incapable of speech, merely nodding or shaking her head. In addition to other indications of improved mother–infant interaction, comparison of pre‐ and postguidance windows regarding the three mothers' holding behaviors reveals a shift from an avoidance or anxious stance to closer and more secure holding.     

The experiences of therapy from the perspectives of carers of people with dementia: An exploratory study

Design: Interviews were conducted with six carers of people with dementia about their experience of receiving counselling/psychotherapy. Interviews were conducted in the carer's own home, and data were analysed thematically using a narrative approach. Findings: Three themes were identified from the data: ‘Still doing the best I can’ (identified as losses and processes of personal growth); ‘Feeling connected and being understood’ (identified as attributes believed to be important within the therapeutic relationship); and ‘Wanting to share information’ (identified as sharing information with someone ‘neutral’). Carers placed emphasis on the age of the therapist and the amount of therapist self‐disclosure. Attending counselling and/or psychotherapy also helped the carer to find a ‘safe space’ to disclose and share concerns. Discussion: Carer loss and personal growth are explored, together with the importance of building therapeutic relationships and, for the therapist, seeking supervision when managing personal self‐disclosure. The theme of therapist self disclosure is explored together with the importance of therapists seeking supervision when managing personal self‐disclosure.     

A Microanalytic Case Study of the Utilization of ‘Solution-Focused Problem Talk’ in Solution-Focused Brief Therapy

Abstract

Solution-focused therapy (SFBT) is a popular therapeutic approach among family therapists. However, disputes about SFBT still arise, especially on problems. This study examines the function of problem talk in SFBT by using a microanalytic case study method. As a result, three categories were found: Eliciting, clarifying, and acknowledging problems. The problem talks initiated by the SF therapist showed a pattern associated with the solution talk and served as preliminary steps to be connected to the following solution talks. The results indicate that solution building is constructed not only through solution talk, but also through ‘solution-focused problem talk.’     

Therapeutic relationship and progress in the first six sessions of individual psychotherapy: A panel analysis

The temporal nature of the associations between client-rated therapist empathy and acceptance, and both client-and therapist-assessed therapeutic progress at sessions 2 and 6 were examined pairwise with cross-lagged panel correlatation (CLPC) and linear structural relationships (LISREL) analyses in 37 clients treated in weekly individual sessions of long-term psycoanalytic and person-centred therapy by 37 experienced therapists. Although none of the cross-lagged differences in the three CLPC analyses which met the necessary conditions for interpretation were significant, two of them approached it, suggesting that session 2 client-rated progress was a stronger determinant of session 6 therapist empathy and acceptance than vice versa. However, the LISREL analyses indicated that while session 2 client-rated progress was unrelated to session 6 therapist acceptance, session 2 therapist empathy was negatively correlated with session 6 client-rated progress. furthermore, both session 2 therapist empathy and acceptance were positively associated with session 6 therapist-rated progress, thereby providing some support for the therapeutic role of these two therapist variables as postulated by person-centred theory.     

Session helpfulness and session evaluation in short‐term counselling

The relationship between perceived session helpfulness and session evaluation was examined in 11 dyads during eight sessions of short‐term counselling. Results based on the Session Evaluation Questionnaire (Stiles, 1980) showed that, for clients, while depth, arousal, and positivity correlated with perceived session helpfulness, only depth and positivity entered a stepwise regression, yielding a multiple correlation of 0.76. For counsellors, while depth and positivity correlated with session perceived helpfulness, only depth entered the stepwise regression analysis, with a correlation of 0.70. Session depth also consistently correlated with change in perceptions of helpfulness from one session to another. Clients had higher depth scores for sessions that both participants rated as helpful. They had lower depth scores for sessions rated as less helpful by both participants or for sessions where participants disagreed in their helpfulness ratings. The centrality of counselling depth in affecting experiences of counselling helpfulness is discussed.     

Teaching mindfulness to psychotherapists in clinical practice: The Mindful Therapy Programme

Introduction: Initially proposed as a treatment modality for psychological disorders, mindfulness is now being promoted as a means of enhancing both therapist self care and therapeutic efficacy. The degree to which mindfulness can be learned by therapists to manage their own and clients' processes in therapy is as yet unknown. This study examines training outcomes of a standardised introductory mindfulness programme for mental health professionals. Methods: Forty-seven mental health professionals completed an eight-week mindful therapy (MT) training programme and associated measures. Results: Compared with baseline scores, participants demonstrated knowledge acquisition on all measures, including increased mindfulness in clinical work, increased capacity to intentionally invoke mindful states of consciousness, and higher participant ratings of well-being over the course of training sessions. Discussion: This research provides preliminary evidence that a brief, standardised mindfulness training programme can achieve acceptable knowledge and skills outcomes for therapists that can aid their therapeutic practice. Of note, increased ‘therapeutic mindfulness’ in this study resulted from changed mindfulness ‘attitudes’ (i.e. a more accepting and equanimous orientation within therapeutic work) as opposed to a clear demonstration of increased attention-regulation skills. The implications of these and other results for programme development and wider research are discussed.     

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.     

CONVERSATION ANALYSIS AND PSYCHOANALYTIC PSYCHOTHERAPY RESEARCH: QUESTIONS,ISSUES, PROBLEMS AND CHALLENGES

Understanding the talk of the ‘talking cure’ remains a central goal of researchers in psychoanalytic psychotherapy. Here, we consider whether conversation analysis (CA) can provide techniques to understand better the conduct of the psychoanalytic therapeutic interaction. Following discussion outlining the participant‐oriented nature of this qualitative methodology we consider reasons for the emergence of CA‐informed studies of psychoanalytic psychotherapy. Amongst other aims, CA focuses on uncovering the process and procedures which make the therapy encounter a distinct form of ‘institutional life’. For psychoanalytically‐oriented researchers, CA can refine their skills of attention and engender sensitivity to understanding material in sessions. Using examples from segments of talk between a training therapist and client we highlight both the advantages of, and constraints on, employing CA as an aid to understanding psychotherapeutic sessions by considering contrasting conceptions of temporality in conversation analysis and psychoanalysis. In the former participants are oriented towards the ongoing production of sequential understandings and local ‘context’ in an unfolding present, in the latter participants aim to enhance the emergence of the remote past into the present of the therapeutic interaction. While recognizing the research benefits of CA methodology concluding comments raise questions regarding the potential complementarity between our dispositions towards the close monitoring of the activity and the feelings of fellow humans.     

Engaging reluctant adolescents in family therapy: an exploratory study of in‐session processes of change

Informed by a trans‐theoretical model of the therapeutic alliance in conjoint family therapy, this exploratory study was the initial stage in a task analysis of critical shifts in adolescent engagement. Specifically, we compared sessions in which a resistant adolescent either did or did not shift from negative to positive engagement during the session. Two successful and two unsuccessful change events were selected from an archival data set based on SOFTA ratings of the therapeutic alliance. The results suggested that one parent element (support) and five therapist elements (structuring therapeutic conversations, fostering autonomy, building systemic awareness, rolling with resistance and understanding the adolescent's subjective experience) seemed critical for successfully facilitating adolescent engagement. The qualitative results were informed by the adolescent's self‐reported target complaints pretreatment, which suggested varying reasons for the teenagers’ active or passive disengagement. Implications for practice and recommendations for future research are offered to continue this line of inquiry.     

Dreaming up the patient in supervision: from the concrete to the symbolic*

This paper discusses the importance of parallel processes within the therapeutic and the supervisory context of therapy with an eight-year-old boy diagnosed with Asperger’s syndrome. During the first months of the therapy, through powerful projective identification, the therapist found herself in the ‘clothes’ of the ‘dead mother’. She was unable to think and feel in the sessions. Deadness could not be symbolised – it was enacted in the sessions. The therapeutic encounter had to start elsewhere: the supervisor’s reverie brought to life the patient’s material in the context of the supervision, allowing thinking to occur, first within the supervisory relationship and only then in the therapeutic relationship. In the context of supervision, the encounter of two mentally alive people could contain anxieties, metabolise them and open the way to mental connections. This encounter facilitated the development of creative thinking of both the therapist and the young patient in the consulting room, which allowed the child to become the subject of his existence and to evolve.     

Mindful Deliberation About Exercise: Influence of Acute Positive and Negative Thinking1

The purpose was to examine if the acute thoughts that individuals have as a function of deciding whether to exercise influence subsequent motivated behavior. Two questions based on self‐efficacy theory were tested. Are immediate, retrospective, or anticipated thoughts predictive of self‐efficacy to adhere to regular exercise? Does self‐efficacy influence exercise intention and behavior? Participants were 82 healthy adults (M age = 24 years) enrolled in a 10‐week exercise program. Social cognitive measures were assessed after 1.5 months of experience, and 3 weeks of exercise were tracked. Multivariate analyses showed that participants who were more positive in their acute retrospective or anticipated thinking exhibited significantly higher self‐efficacy and attendance than did negative‐thinking counterparts. Multiple regression analyses revealed that acute retrospective and anticipated thoughts were predictors of self‐efficacy. In addition, self‐efficacy was predictive of future intention and exercise attendance.     

Clients’ experiences of dynamic interpersonal therapy (DIT): opportunities and challenges for brief,manualised psychodynamic therapy in the NHS

Dynamic interpersonal therapy (DIT) is a brief manualised psychodynamic intervention for depression. This is a first study exploring clients’ experiences of DIT specifically and brief, manualised psychodynamic psychotherapy (PP) in general. Interpretative phenomenological analysis was the methodology employed. Five participants completed a semi-structured interview, three weeks to ten months after completing DIT. The scores of pre- and post-therapy outcome measures of depression and anxiety were also available. Two emerging superordinate themes are presented here: (1) ‘The Distinct Features of DIT’, referring to how its therapeutic style and time limitations were experienced and (2) the ‘Impact of Therapy’, referring to perceived outcomes. While previous findings showed that therapist’s perceived limited activity in long-term PP was experienced as hindering/unhelpful, the perceived sense of direction in DIT appeared adequate to most participants. Secondly, the time limitations provoked complex responses. Reactions to the distinct elements of DIT are to be treated both as therapeutic opportunities and as challenges. Further, in line with psychoanalytic theory, most participants described relational changes that went beyond symptom relief and remained in progress after therapy ended. Intriguingly, there was no consistency between participants’ qualitative accounts of change and the scores of the outcome measures.     

Culturally sensitive therapy? Examining the practice of cross‐cultural family therapy

This article is drawn from a research project that examines cross‐cultural family therapy sessions in order to consider what constitutes culturally sensitive practice. A discourse analytic approach was adopted in the analysis of three sessions from two families where the family and the therapists originated from different ethnic backgrounds. This article is based around part of the research findings connected to one of the families, and focuses upon the ways in which ‘culture’ is talked about in therapy (the term ‘culture’ will be referred to in inverted commas in order to acknowledge its complexity as is emphasized in this article). This allows for an examination of the cultural assumptions that we hold as therapists, which are enacted in therapy with effects on all participants and upon the course of the therapy. The value of qualitative research methods in examining the cultural assumptions we bring to therapy is highlighted as one way of improving culturally sensitive therapeutic practice, especially with regard to therapist reflexivity.     

Hearing visuo‐tactile synchrony – Sound‐induced proprioceptive drift in the invisible hand illusion

The rubber hand illusion (RHI) and its variant the invisible hand illusion (IHI) are useful for investigating multisensory aspects of bodily self‐consciousness. Here, we explored whether auditory conditioning during an RHI could enhance the trisensory visuo‐tactile‐proprioceptive interaction underlying the IHI. Our paradigm comprised of an IHI session that was followed by an RHI session and another IHI session. The IHI sessions had two parts presented in counterbalanced order. One part was conducted in silence, whereas the other part was conducted on the backdrop of metronome beats that occurred in synchrony with the brush movements used for the induction of the illusion. In a first experiment, the RHI session also involved metronome beats and was aimed at creating an associative memory between the brush stroking of a rubber hand and the sounds. An analysis of IHI sessions showed that the participants’ perceived hand position drifted more towards the body‐midline in the metronome relative to the silent condition without any sound‐related session differences. Thus, the sounds, but not the auditory RHI conditioning, influenced the IHI. In a second experiment, the RHI session was conducted without metronome beats. This confirmed the conditioning‐independent presence of sound‐induced proprioceptive drift in the IHI. Together, these findings show that the influence of visuo‐tactile integration on proprioceptive updating is modifiable by irrelevant auditory cues merely through the temporal correspondence between the visuo‐tactile and auditory events.     

The manifestation of transference during early psychotherapy sessions

Despite the clinical use of therapeutic transference across various schools of psychotherapy, there have been relatively few empirical studies of this phenomenon, none of which has examined transference with a non‐pathological population. In this study, the core conflictual relationship theme (CCRT) method was used to examine the manifestation of therapeutic transference in the first three sessions of 22 counselling contracts with high‐functioning individuals. Factor analyses of the wish (W) and response of other (RO) components of the CCRT indicate a complementary pattern of relating in which the therapist is idealised and others are devalued. Within the response of self (RS) component, clients exhibited a concordant relational transfer whereby they had a negative response to both the therapist and others. Additionally, control issues emerged in the W component for significant others and in the RS component for the therapist.     

‘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.     

A Comparison of Interactions Among Children,Parents, and Therapists in Cognitive Behavior Therapy for Anxiety Disorders in Australia and Japan

Despite growing attention to the efficacy of culturally adapted cognitive-behavioral treatment (CBT) programs for children and adolescents, there is still little empirical and practical information available to therapists who adapt original treatment protocols to suit clients of a specific culture. The current study aimed to compare therapeutic interactions across CBT treatment delivered with two different cultural groups. We developed an observational coding system to examine behaviors exhibited by child, parent, and therapist during CBT sessions conducted in Australia and Japan for children with anxiety disorders. Our results demonstrated significant differences between the two countries with respect to the treatment readiness of children, the proportion of talking during the sessions by parents and children, therapists’ laughter, length of silence during the first session, and parent indices of accommodation. In terms of transitions over time (i.e., first to last CBT session), parents in both countries tended to talk more during the last CBT session, whereas only Australian therapists talked less over time. The proportion of silence decreased over time during the Japanese sessions, and the amount of interruptions by parents increased over time for Australian sessions. Finally, our exploratory analyses demonstrated that a number of behavioral observations were correlated with anxiety treatment outcome at posttreatment. This study suggests that interactions between a child, parent, and therapist during CBT sessions may be affected by the culture in which the CBT session occurs, which could have implications for culturally adapted CBT programs.     

Does a short self‐compassion intervention for students increase healthy self‐regulation? A randomized control trial

The primary aim of this study was to examine the effects of a two‐week self‐compassion course on healthy self‐regulation (personal growth self‐efficacy and healthy impulse control) and unhealthy self‐regulation (self‐judgment and habitual negative self‐directed thinking) in university students. We also examined the effects on self‐compassion, anxiety and depression. Students (N = 158, 85% women, mean age = 25 years) were randomized to an intervention group and a waiting‐list control group in a multi‐baseline randomized control trial. Healthy self‐control was measured by the Personal Growth Initiative Scale (PGIS) and the Self‐Control Scale; unhealthy self‐control was measured by the Non‐judgement subscale from the Five‐Facet Mindfulness Questionnaire (reversed) and the Habit Index of Negative Thinking (HINT). Secondary outcomes were measured by the State‐Trait Anxiety Inventory (STAI‐trait), the Major Depression Inventory (MDI), and the Self‐Compassion Scale (SCS). A 2 × 3 repeated measures analysis of variance (ANOVA) showed gains for the intervention‐group in personal growth self‐efficacy and healthy impulse‐control and reductions in self‐judgment and habitual negative self‐directed thinking, as well as increases in self‐compassion and reductions in anxiety and depression. After all participants had completed the course, the groups were combined and repeated measures ANOVAs showed that changes remained at six‐month follow‐up for personal growth self‐efficacy, self‐judgment and habitual negative self‐directed thinking; as well as for self‐compassion, anxiety and depression. Concluding, a short self‐compassion course seems an effective method of increasing self‐compassion and perceived control over one's life for university students, as well as increasing mental health.