The effects of supervisory interruptions on therapists and clients

Abstract

The general acceptance of live supervision has not been without criticism, specifically that it is a disruptive intrusion into the therapeutic process. The present study attempted to determine what effect supervisory interruptions had on the participants in a therapy session. Using a within-subjects design, excerpts from a session were analyzed to determine differences between a no-interruption condition and conditions of supervisor-initiated, therapist-initiated, and telephone interruptions. While each of the participants were affected to varying degrees by the interruptions, there were no consistent effects. It was concluded that the act of interrupting a therapeutic session, in and of itself, is not sufficiently disruptive to negate it use. Implications for supervision and practice are discussed and recommendations are given for managing interruptions during supervision and daily clinical practice.     

Addressing multiple relationships between clients and therapists in lesbian, gay, bisexual, transgender communities

Therapists working in lesbian, gay, bisexual, and transgender (LGBT) communities are likely to experience the potential to engage in multiple relationships with their clients. Currently, the American Psychological Association's (2002) ethics code and the related literature base offer minimal direct guidance to therapists practicing in LGBT communities. In this article, the authors review current literature regarding multiple relationships in psychotherapy, considering how this literature addresses issues specific to practitioners working within LGBT communities, present a case study highlighting the negotiation of a multiple relationship between a client and therapist who both identify as lesbian, and offer recommendations for practitioners working within LGBT communities.     

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.     

Nonerotic dual relationships between therapists and clients: the effects of sex, theoretical orientation, and interpersonal boundaries

We surveyed 223 APA members to investigate the roles of therapists' sex, theoretical orientation, interpersonal boundaries, and clients' sex in predicting therapists' assessments of the ethicality of nonerotic dual relationships with their clients. Results indicated that therapists' sex, interpersonal boundaries, and theoretical orientation influenced ethical judgments of these relationships. Theoretical and practical implications of our findings are discussed.     

Taiwanese speech–language therapists’ awareness and experiences of service provision to transgender clients

Background: One of the most influential factors that affect the quality of life of transgender individuals is whether they can be perceived by others to “pass” in their felt gender. Voice and communication style are two important identifying dimensions of gender and many transgender individuals wish to acquire a voice that matches their gender. Evidence shows that few transgender individuals access voice therapy, and that this is caused by their concerns about stigmatization or negative past experiences within healthcare services. In order to address the negative experiences faced by transgender populations we need a better understanding of healthcare services’ current levels of knowledge and LGBT awareness. Some studies of Speech–Language Therapists’ (SLTs’) experience and confidence working with transgender individuals have recently been undertaken in the United States (US). However, little research has been carried out in Asia.

Aims: To investigate Taiwanese SLTs’ knowledge, attitudes and experiences of providing transgender individuals with relevant therapy.

Method: A cross-sectional self-administered web-based survey hosted on the Qualtrics platform was delivered to 140 Taiwanese SLTs.

Results: Taiwanese SLTs were, (i) more familiar with the terminology used to address “lesbian, gay, and bisexual groups” than with “transgender” terminology, (ii) generally positive in their attitudes toward transgender individuals, and (iii) comfortable about providing clinical services to transgender clients. However, the majority of participants did not feel that they were sufficiently skilled in working with transgender individuals, even though most believed that providing them with voice and communication services fell within the SLT scope of practice.

Conclusion: It is important for clinicians to both be skilled in transgender voice and communication therapy and to be culturally competent when providing services to transgender individuals. This study recommends that cultural competence relating to gender and sexual minority groups should be addressed in SLTs’ university education as well as in their continuing educational programs.     

Therapeutic change in couples' therapy: Critical change incidents perceived by therapists and clients

Contemporary Family Therapy - Clients' perceptions of change in therapy have been virtually ignored in research on therapeutic change. An initial study was conducted which examined client...     

The prevalence of stalking of psychological therapists working in primary care by current or former clients

The prevalence of being a victim of harassment or stalking among the general population of the UK is held to be 11.8 per cent. There has been speculation that the prevalence rate would be higher for psychological therapists, as they could be at risk from their own clients. This study analysed the prevalence of job‐related experiences of harassment or stalking in a postal survey of psychological therapists who worked in primary care. The results showed a prevalence rate of more than twice the national average at 24 per cent. The stalkers, who were equally male or female, fell into three broad categories: those clients who were needy and made early attachments to their therapists; those experiencing erotic transference; and those with personality disorders. The implications of these findings for training and practice are discussed.     

Racial/ethnic matching of clients and therapists in mental health services: a meta-analytic review of preferences, perceptions, and outcomes

Across several decades the effects of matching clients with therapists of the same race/ethnicity have been explored using a variety of approaches. We conducted a meta-analysis of 3 variables frequently used in research on racial/ethnic matching: individuals' preferences for a therapist of their own race/ethnicity, clients' perceptions of therapists across racial/ethnic match, and therapeutic outcomes across racial/ethnic match. Across 52 studies of preferences, the average effect size (Cohen's d) was 0.63, indicating a moderately strong preference for a therapist of one's own race/ethnicity. Across 81 studies of individuals' perceptions of therapists, the average effect size was 0.32, indicating a tendency to perceive therapists of one's own race/ethnicity somewhat more positively than other therapists. Across 53 studies of client outcomes in mental health treatment, the average effect size was 0.09, indicating almost no benefit to treatment outcomes from racial/ethnic matching of clients with therapists. These 3 averaged effect sizes were characterized by substantial heterogeneity: The effects of racial/ethnic matching are highly variable. Studies involving African American participants demonstrated the highest effect sizes across all 3 types of evaluations: preferences, perceptions, and outcomes.     

Family therapists, community, and civic renewal

In this article, we review family therapy's history regarding community concerns and broader societal issues; offer a model of levels of therapists' involvement with communities and community systems; and propose that family therapists join the citizen activation movement by becoming catalytic partners with families in communities. We call for a new kind of community practice that is driven less by therapist-defined problems and professional expertise, and more by community-defined problems and families' own expertise.     

Ethnic variations in the initial phase of mental health treatment: a study of Sami and non-Sami clients and therapists in northern Norway

Several studies indicate that mental health and mental health service vary with ethnicity. Ethnically linked social differences affect these results. We examined the multiethnic population in northern Norway where social inequalities between the Sami and the non-Sami population are not prominent. Clients (N=347) and therapists (N=32) in outpatient treatments reported demographics, ethnicity and the therapeutic alliance. Clients also reported pretreatment psychosocial status, service utilization and the type of help requested. Therapist recorded clinical and diagnostic assessments and treatment plans. The Sami and non-Sami client groups were similar in demographics and pretreatment psychosocial characteristics. However, the therapists prescribed more sessions and more socially focused interventions when clients were Sami. Verbal therapy was more often used by the non-Sami therapists. Alliance ratings were positively correlated only between Sami therapists and their clients, and Sami therapists rated the largest initial clinical improvement. Clinics located in the high Sami density areas offered their clients more therapy sessions, than in clinics in the high non-Sami density areas. Ethnic similarity between client and therapist were associated with more frequent use of medication and less frequent use of verbal therapy.     

Ethical decision making among family therapists and individual therapists

In this study, we investigated the ethical decision making of 30 individual and 30 family therapists in order to detect the types of decision making used by practicing therapists. Informants responded to three ethical dilemmas. Two of the situations were hypothetical. The third dilemma was a situation the informant had experienced in practice. Each interview was assessed for decision-making style, using content analysis. Kohlberg's justice reasoning and Gilligan's care reasoning provided the conceptual foundations for this analysis. The results suggest that both family and individual therapists prefer care reasoning on all dilemma types. There was significantly more care reasoning demonstrated on the personal dilemma than on the hypothetical dilemmas. Characteristics of informants did not provide clear explanations for the differences found in reasoning.