Abstracts

Veevers, J. E. (1990) Traumas versus strens: a paradigm of positive versus negative divorce outcomes. Journal of Divorce and Remarriage Kiser, L.J., Pugh, R.J., McColgan, E. B., Pruitt, D. B. and Edwards, N. B. (1991) Treatment strategies for victims of extra-familial child sexual abuse. Journal of Family Psychotherapy Bloch, S., Sharpe, M. and Allman, P. (1991) Systemic family therapy in adult psychiatry. British Journal of Psychiatry Crisp, A. H., Norton, K., Gowers, S., Halek, C., Bowyer, C., Yeldham, D., Levett, G. and Bhat, A. (1991) A controlled study of the effect of the therapies aimed at adolescent and family psycho-pathology in anorexia nervosa. British Journal of Psychiatry Dunn, J. and Plomin, R. (1991) Why are siblings so different? The significance of differences in sibling experiences within the family. Family Process     

The nature and success of influence attempts in a four-party bargaining relationship

The functioning of a complex four-party bargaining system was subjected to experimental analysis. Two of the bargaining parties, A and B, were defined as having equal power, this power being greater than that of A and B's respective “allies”, X and Y—who also had equal power. The bargaining system was further structured so as to make it desirable for A and B to interact indirectly with each other, via X and Y as intermediaries. Within this paradigm, A and B's relationship with each other (cooperative vs competitive) and X and Y's counterpower vis-à-vis A and B (high vs low) were manipulated in a 2 × 2 factorial design. It was found, as predicted, that the system functioned most effectively (in terms of outcome levels and degree of positive affect among the four parties) when A and B were cooperatively oriented, and X and Y had low counter-power. The system functioned least effectively when A and B were competitive and their “allies'” counterpower was high. On the other hand, a number of unexpected findings emerged with respect to the kinds of influence attempts directed by A and B at X and Y. Among the more provocative of these was the fact that cooperative A and B's, in contrast with those receiving a competitive induction, made the most frequent use not only of promises but threats as well.     

Power imbalances in therapeutic and forensic relationships.

This article examines the ways that power imbalances affect relationships in the forensic mental disability system and between therapists and their clients. It considers the impact of the “dual loyalty” dilemma on forensic relationships, the manner in which courts deal with this dilemma, and suggests several points of commonality that arise around such power conflicts. It also examines recent litigation involving therapeutic relationships, and attempts to extract doctrinal threads from these cases. Finally, it recommends that, in order for the judicial system to attempt to correct any of the underlying imbalances, courts and jurors must openly come to grips with the psycho-dynamic issues that underlie these imbalances.     

Language as power in the therapy room: A study of bilingual (Arabic–English) therapists' experiences

The topic of language as power (LaP) in individual therapeutic encounters has thus far been overlooked, and as bilingual therapists have the ability to use more than one language in the therapy room, their experience of LaP is a compelling research area that this paper attempts to explore. This qualitative, inductive, phenomenological study used interviews and interpretative phenomenological analysis to explore five bilingual Arabic–English-speaking therapists' experiences of LaP in the therapeutic encounter. The study identifies two overarching themes: (a) the emergence of identity and power from language and (b) comparisons of power in the English and Arabic languages. Within these themes, the study finds that therapists experience LaP through multiple avenues: self-disclosure, intersectionality, being transported to different identities and expressions of power and power of expression in Arabic–English. These multiple avenues illustrate the complexity of LaP in the therapeutic encounter. The study sheds light on an underexplored area in psychotherapy, illuminating an important area for psychotherapists and training institutions to consider when working with clients.     

On second-order family therapy

If family therapists remain aware of the indivisible and recursive nature of their interactions with families, and if they use this awareness to form a collaborative rather than a hierarchical therapeutic system, and at the same time minimize their attempts to change persons or family structures in strategic or predetermined ways, then they may be said to be practicing a "second-order" family therapy. This article analyzes the development of the second-order position on therapist power and influence, concluding that it is inconsistent and possibly disingenuous.     

Polyamory: Experiences of Power from Without,from Within,and in Between

This article highlights the ways in which cultural, relational, and therapeutic power can affect polyamorous relationships and the therapeutic process. In therapy, focusing on the power narratives that polyamorous partners might experience can aid in challenging mononormativity while creating space for a variety of relational orientations. Power processes are presented as occurring on three levels: social discourse (without), relational meaning-making (within), and therapeutic practice (in between). A case study is used to evaluate these processes and implications are provided for clinicians working with polyamorous families.     

The Normal,Improving, and Productive Self: Unpacking Neoliberal Governmentality in Therapeutic Interactions

Psychotherapy might be seen as a site of reproduction of neoliberal capitalist ideology. Unpacking therapeutic discourse affords the opportunity to explore neoliberalism in operation. We present a theoretical case for exploring neoliberalism in the therapeutic context. Specifically, we identify and illustrate three neoliberal discourses: the normal self, the improving self, and the productive self. We discuss how therapists might orient to these discourses and identify ways to challenge neoliberal ideology. Doing so will not dismantle power systems that yield oppression; however, it may help clients reclaim and negotiate preferred subjectivities within this system while also working toward broader social justice.     

“… der Phantasieschlüssel bewährt sich“

In operationalized psychodynamic diagnostics (OPD) imagination is seen as a psychic resource (aspect of self) and as such integrated in the widely known thought system contrasting (inner) self-reflexivity and (outer) reality. In order to make better use of and profit by this resource therapeutically, the power of the imagination to generate structure needs to be conceptually included. The author proposes adding a further dual system comprising the imaginative and the rational to this known polarity of imagination and reality, thus widening the therapeutic scope through the dynamic versatility of the imagination. This system could also become part of future concepts of structural competences of the psyche.     

Therapeutic Document in Group Counseling: An Active Change Agent

In this article, the authors provide a therapeutic document model using language as an active change agent. The practice of the therapeutic letter has demonstrated substantial power in narrative therapy to foster client change. No literature, however, has applied this construct in group counseling. Grounded in social constructionism, re-authoring therapy and the power of written language, this model transforms the usually time-consuming and frequently nontherapeutic client documentation into a functional intervention. As a competency-based intervention, this model provides counselors with principles and procedures to enhance clients' self-agency and expedite the change process in group counseling.     

Utilizing artistry in a therapeutic relationship

Abstract

In many humanistic approaches, therapeutic change involves utilizing the relationship between the client and therapist as a tool for personal growth. Like any relationship, the therapeutic relationship is one that is co‐created between those engaged in it, namely, the client and the therapist. Utilizing this co‐created relationship requires a sense of artistry on the part of the therapist. A therapist must be willing to engage in this meaningful relationship with the client. A therapist must also be aware of the personal values that he or she brings into therapy, and how they influence the therapeutic relationship. Finally, a therapist must acknowledge the power that the therapist and the client possess in the relationship, and understand how that power can be used to validate and invalidate the therapist's and the client's personal meanings. These aspects of therapeutic artistry are discussed and the use of therapeutic artistry in Eron and Lund's (1996) narrative solutions approach is presented.     

Quelques réflexions sur l’incidence des valeurs éthiques sur le choix technique des interventions psychothérapeutiques

If we consider the evolution in the patterns of psychopathology during the 20th century, we discover the evolution of ethical values implicit in the theory and their implications as far as our technical choices are concerned. The therapeutic relationship is asymmetrical, not only because of different role positions but also because of an inherent power differential. The therapist is consciously recognized as occupying a superior role because of his or her professional status and at the unconscious level, too, through transfer and projection of different fantasies. Being in charge of the therapeutic process carries with it the professional responsibility for handling this asymmetry. The therapist's theoretical and technical decisions in this regard reflect his or her ideology about power and how it should be used to establish the therapeutic alliance.     

Honouring our great grandparents: towards a rhetorical analysis of family therapy

This paper argues that family therapy is an inherently and inescapably rhetorical activity, although its connections with rhetoric have remained largely ignored and the implications for practice unexplored. An uncritical acceptance of a range of postmodern ideas has led many family therapists to ignore the power of their therapeutic rhetoric. The paper offers rhetorical analysis as a tool to help family therapists to reflect on the rhetorical power of their practice and thereby to exercise this power more responsibly.     

Reconsidering therapeutic action: Loewald, cognitive neuroscience and the integration of memory's duality

Both Loewald's relational theory of memory and the Self-Memory System (SMS) of cognitive neuroscience describe a dual memory system, one system that is experience-near sensory-perceptual, and the other, symbolic and conceptual. In contrast to perspectives that locate therapeutic action in either altering implicit procedural memories or interpreting explicit historical content, we argue that psychological health emerges from effective integration of both memory systems, achieved through a combination of transference dynamics and analytic insight. We support this position by elaborating four key assumptions of the loewaldian and SMS perspectives, followed by application to a clinical example. We highlight the power of certain integrative autobiographical memories called 'self-defining memories' in assisting an understanding of transference dynamics and providing metaphoric touchstones to guide subsequent treatment.     

Dialogue and power: a critical analysis of power in dialogical therapy

This article explores the relationship between dialogue and power in the practice of dialogue-oriented, "not-knowing" forms of therapy. It is argued that power of a dynamic and reversible kind infuses much ordinary social dialogue, and that the joint processes of power and resistance work together to render an interaction dialogical. In contrast, in dialogical therapy, overt exercises of power threaten the interaction's dialogical status, and power is deferred and denied by the therapist through not-knowing practices. A case study of Harlene Anderson's (1997) is used to illustrate that it is precisely power's presence that informs the practices of not knowing and uncertainty that characterize dialogical therapies. It is suggested that the not-knowing therapist withholds aspects of his or her voice as a condition for dialogicity. Instead, special speaking arrangements are required, in which the therapist's not-knowing is continuously communicated to the client, for the therapeutic conversation to remain dialogical. Without these speaking arrangements, I argue that therapy moves toward monologue. Therapists inherit powerful speaking positions from the institutional and sociocultural context, and the rejection of power within therapy serves only to conceal this aspect of power, which nevertheless pervades the therapeutic relationship. Finally, it is suggested that power is a "common factor"--shared by all therapies--and that our status as "inheritors" of power needs to be included in our understanding of the therapeutic process. This expanded view of therapy requires the re-theorization of dialogue, such that it includes, rather than excludes, considerations of power.     

Voices of Dialogue and Directivity in Family Therapy With Refugees: Evolving Ideas About Dialogical Refugee Care

In this article, we reflect on our evolving ideas regarding a dialogical approach to refugee care. Broadening the predominant phased trauma care model and its engaging of directive expertise in symptom reduction, meaning making, and rebuilding connectedness, these developing dialogical notions involve the negotiation of silencing and disclosure, meaning and absurdity, hope and hopelessness in a therapeutic dialogue that accepts its encounter of cultural and social difference. In locating therapeutic practice within these divergent approaches, we argue an orientation on collaborative dialogue may operate together with notions from the phased trauma care model as heuristic background in engaging a polyphonic understanding of coping with individual and family sequelae of forced displacement. This locating of therapeutic practice, as informed by each perspective, invites us to remain present to fragments of therapeutic positioning that resonate power imbalance or appropriation in a therapeutic encounter imbued with a social context that silences refugees’ suffering. In a clinical case analysis, we further explore these relational complexities of negotiating directive expertise and collaborative dialogue in the therapeutic encounter with refugee clients.     

The Greek Chorus and Other Techniques of Paradoxical Therapy

This paper has described some of the interventions developed at the Ackerman Brief Therapy Project in treating the families of symptomatic children. The interventions are based upon a differential diagnosis of the family system and upon an evaluation of that system's resistance to change. They are classified as compliance-based or defiance-based, depending upon the family's degree of anxiety, motivation, and resistance. Paradoxical interventions, which are defiance-based, are used as a clinical tool in dealing with resistance and circumventing the power struggle between therapist and family. A consultation group acting as a Greek chorus underlines the therapist's interventions and comments on the consequences of systemic change. This group is also sometimes used to form a therapeutic triangle among the family, therapist and group, with the therapist and group debating over the family's ability to change.     

The therapeutic alliance in couples therapy: clinical considerations

This article presents clinical considerations about the therapeutic alliance in couples therapy, stimulated by pertinent new research findings reported in this issue. A loyalty dimension of the couple's relationship is described, as well as its influence on the therapeutic alliance in couples therapy. The therapist's establishment of a "meta-alliance" with the couple around their loyalty conflicts, avoidance of splits and disruptions, and prioritization of marital distress (versus individual symptoms) as the primary focus of treatment all serve to solidify the therapeutic alliance. In addition, identifying the partners' early family-of-origin distress can help predict and respond to strains in the therapeutic alliance that may occur later in therapy. Finally, the therapist helping the couple to balance their relational power differences in therapy and to address their concerns about the impact of the therapist's gender also strengthens their therapeutic alliance. A clinical case and vignettes are included to illustrate these issues.     

干扰素治疗慢性乙型肝炎管理策略初探

在慢性乙肝抗病毒治疗中干扰素作为一线治疗取得了一定的疗效。在治疗过程中通过选择合适的慢性乙肝患者、监测疗效、确立个体化的疗程和剂量、及时监测不良反应和恰当的处理和最大限度的提高患者的依从性可使干扰素的疗效达到最大化。     

The Towers of Silence: creative and destructive issues for therapeutic teams dealing with sexual abuse

Intra-familial sexual abuse of children is a peculiarly potent area for subsequent inter-agency responses and interventions to become inappropriate, irrational, and damaging. A major component of the damaging responses by the inter-agency system is the mirroring processes which occur between that system and the family.
A case example is presented in some detail to illustrate the ways in which such mirroring processes also effect therapeutic teams dealing with such families. Some therapeutic techniques from an experiential base are described. It is argued that productive therapeutic work can only occur if the mirroring processes within the inter-agency system, and the therapeutic team system, are considered systemically.