Transference and countertransference issues with sexually abused clients

Abstract

This paper explores some of the therapeutic issues which arise when working with sexually abused clients. It is suggested that both the client and the therapist may at moments take any of the three positions in the Oedipal triangle and that the mother, father and child status are interchangeable in the transference and counter-transference. It is also suggested that the Oedipus myth represents the failure of a family to contain sexual and murderous passions. I describe a Hindu myth which takes a similar triangle of passion but illustrates how containment is possible. It is proposed that this implies we need to re-evaluate the presence of the erotic in therapy in a more positive light. It is further suggested that the sexually abused client needs to experience the containment of passion if a healing process is to occur.     

Countertransference issues in psychotherapy with lesbian and gay clients

This article briefly reviews literature on responses towards same-sex (lesbian and gay) sexualities from psychoanalytic and ‘lesbian and gay affirmative’ psychotherapeutic perspectives. An analysis is presented of reports of countertransferential reactions to lesbian and gay clients, obtained from interviews with fourteen psychotherapists who work in a lesbian and gay affirmative manner and eighteen clients who had received affirmative psychotherapy. Data were subjected to grounded analysis. Participants consistently attended to the thoughts, feelings and values that therapists held in relation to lesbian and gay clients and how these affected the meanings and practices available to them. These were linked with the therapist's sexual identity among other factors. Negative countertransferential reactions were regarded as potentially occurring among heterosexual and lesbian and gay therapists and were seen as arising from therapists’ conscious and unconscious fears about same-sex sexualities. These findings indicate a need to continue debating these issues more widely in the professional arena.     

Group counseling in a different cultural context: Several primary issues in dealing with Chinese clients

To apply group therapy or counseling, a branch of helping methodology rooted in modern Western psychology, to a culturally different context, such as the Chinese cultural environment, group counselors need to increase their awareness, knowledge, and skills that are compatible with the group climate they encounter. A group counselor needs to understand the general characteristics of the culture. The counselor should use his or her leadership quality to deal appropriately with group clients' psychological dynamics, which bear unique cultural preferences with respect to thinking, feeling, and doing. While many group counseling communication skills from a Western theoretical framework can be helpful and applicable to the Chinese group clientele, some of these skills need to be contextually modified. The counseling goal is to properly integrate Chinese cultural and therapeutic norms into the group process.He also teaches as a Sessional-Instructor in the same department.     

Measurement of state and trait anxiety in elderly mental health clients

Anxiety in elderly persons is frequently discussed but rarely measured. Difficulties in measuring state and trait anxiety with mental health clients aged 55 and older using the Spielberger State-Trait Anxiety Inventory (STAI) led the authors to validate the use of the simpler, children's form of their scale. Four types of validity data were found: (1) the childrens' form was highly correlated with the adult form, (2) both scales were significantly correlated with objective ratings of anxiety made by staff, (3) the STAI measures were not correlated with behavioral ratings other than anxiety (discriminant validity), (4) the residential clients were significantly higher in A-trait than the day clients. The nonresidential clients were not more anxious than college students. Discussion emphasizes the necessity of distinguishing between and measuring both state and trait anxiety in order to understand anxiety in the elderly.     

When clients want to pay more for psychotherapy: ethical issues and implications

One ethical issue that commonly comes up in clinical practice is the negotiation of fees with clients. Although the APA Ethics Code provides standards regarding clients who are unable to or do not pay (Standard 6.04), little guidance is given pertaining to fee limits for clients who want to pay more. This issue is explored using a real case example, including the relevant ethical codes to be considered. The necessary “gray” areas of ethical decision-making are demonstrated through my own decision process. Implications for future scenarios are discussed.     

Correspondence with clients in therapy

Resistance to the therapy process, and the help of the therapist, may sometimes be bypassed or overcome through the substitution of written for verbal communication. Techniques and implications of this procedure are discussed in this paper.     

Treatment issues during pregnancy and lactation

The lifetime incidence of mood disorders is twice as great in women compared with men, with the highest risk occurring during the childbearing years. The management of mental illness during pregnancy and lactation is a particularly complex clinical situation. The cornerstone of such a clinical decision is a completion of an assessment of the risks of the illness vs the risks of treatment. The following article reviews the factors influencing infant outcome and outlines the essential elements of the process of determining risk for the use of psychotropics in women during pregnancy and lactation. As the available data rapidly change, the facets of the risk benefit assessment are consistent and often the issue of specific medication is decided by prior history and exposure.     

Ethical and legal issues in conducting research involving elderly subjects

Older people are increasingly the focus of biomedical and behavioral research not only because the elderly constitute the fastest growing segment of our population but because there is a societal concern to improve the elderly's quality of life. The profound need to advance that research carries with it an equally profound obligation to protect the rights and welfare of elderly research subjects, and thus raises difficult ethical and legal issues. Against a background of foundational principles for the protection of human subjects, we discuss whether older subjects should be treated as a special class, the ethical and legal issues over informed consent, capacities for consent, and special problems related to cognitive impairment. We discuss surrogate/proxy consent procedures in research, recruitment of elderly subjects, conflicts of interest, special problems regarding institutional research, and risk/benefit analyses. We offer recommendations and practical guidelines for conducting current and future research involving elderly participants.     

Hypotheses are dialogues: sharing hypotheses with clients

The use of systemic hypotheses in therapy has been criticized on the ground that it promotes the expert position of the therapist and tends to underplay the role of the client in the therapeutic process. In this article, we propose to view the systemic hypothesis as a collaborative action, involving the dialogue between therapists and clients. This interactive hypothesis is created by the very interaction of all participants in the therapeutic dialogue, and as such it may be considered a dialogue in itself. The article articulates a way of hypothesizing that is consistent with both systemic and dialogic premises, and presents some examples of the process in action.     

Evaluation of crisis intervention services with anonymous clients

American Journal of Community Psychology -     

Employment counseling with clients who have eating disorders

To present the career issues of clients with eating disorders (EDs) from a more holistic perspective, the author gives an overview of EDs, describes the career challenges that such clients may experience, and identifies several theories that may be helpful in conceptualizing their career choices. Suggestions for practice are offered.     

It's not only clients: Studying emotion work with clients and co‐workers with an event‐sampling approach

A group of 78 young employees in service and non‐service professions reported 848 task related interactions at work over 1 week using a variant of the Rochester Interaction Record which measured emotion work requirements, emotional dissonance, and deviance. Multi‐level analyses showed that dissonance was more likely in interactions with customers, whereas deviance, that is, the violation of display rules by acting out one's felt emotion, was more likely in co‐worker interactions. Well‐being in the interaction was lower (a) for interactions with emotion work requirements, (b) for dissonance, even after controlling for felt negative emotions, and (c) for deviance. Negative emotion displayed partially mediated the relationship between deviance and well‐being. Regarding the relationship of more stable job related attitudes, psychosomatic complaints, and aggregated scores of social interactions, fewer effects were found than in questionnaire studies, which may be due to the fact that only interactions that lasted at least 10 minutes were assessed, as is customary in research with this instrument. Among the effects found, however, many involved proportions rather than frequency of interactions, which raises the possibility of balancing and legitimizing effects of non‐stressful interactions.     

Psychological test usage with adolescent clients: survey update

In 1991, Archer, Maruish, Imhof, and Piotrowski presented survey findings based on the responses of a national sample of psychologists who performed psychological assessment with adolescent clients. The current survey was designed to update their results by examining the test use practices reported by 346 psychologists who work with adolescents in a variety of clinical and academic settings. These respondents represented an adjusted survey return rate of 36% and predominantly consisted of doctoral prepared psychologists (95%) in private practice settings (51%). The survey respondents had a mean of 13.6 years of post-degree clinical experience, and spent an average of 45% of their clinical time working with adolescents. Survey results reveal a substantial similarity in test usage between the 1991 survey and the current investigation. For example, the Wechsler Intelligence Scales, Rorschach, Thematic Apperception Test (TAT), and Minnesota Multiphasic Personality Inventory (MMPI) remain among the widely used tests with adolescents. However, several changes were also noted including a reduction in the use of the Bender-Gestalt and increases in the use of parent and teacher rating instruments. The current findings are used to estimate the relative popularity of an extensive list of test instruments, compare current findings to 1991 survey results, and to examine several issues related to general effects of managed care procedures and policies on test usage with adolescents.