A narrative social constructionist approach to therapeutic empathy

The concept of empathy has been a centrol conceptual element in approaches to counselling and psychotherapy that emphasise exploration of meaning in the context of a facilitative relationship. However, the existing literature on therapeutic empathy lacks theoretical coherence. a narrative social constructionist perspective represents a theoretical approach that enables the integration of diverse strands of clinical observation and research into the creation of empathic understanding in counselling. From a social constructionist position, therapeutic empathy can be understood as a relational process, a step-by-step co-construction by counsellor and client of the life-narrative of the client. In this paper, the Barrett-Lennard (1981) cyclical model of empathy is used as a fremework for examining the counsellor and client actions, strategies and tasks that constitute empathic engagement around the task of emploring and re-authoring life-narratives. Constructionist analysis of the cultural origins of the concept of empathy suggest some limitations of this way of conceptualising what happens in therapy. The implications of these ideas for theory, training and research are discussed.     

A Review of “Relational Competence Theory: Research and Mental Health Applications”

Within the Couple and Family Therapy literature, there are few articles directly linking theory to treatment within the lesbian community. Utilizing contextual theory, the author presents a gay affirmative therapeutic approach to work with lesbian couples. The fundamental concepts of contextual therapy are uniquely suited for work with lesbian clients; particularly the four dimensions of individual psychology, relational ethics, systemic interaction, and facts. A case study is presented to highlight this therapeutic process. This article is one step in a larger systemic change related to the challenge of adapting theoretical methodology and gathering evidence for effective treatment of marginalized groups.     

Family therapy ‘lite’? How family counsellors conceptualise their primary care family work

A number of current developments in the field potentially provide opportunities for preventative relationship and family interventions to be integrated into primary care. In this context, it is important to understand what family counselling is and how it might differ from family therapy. Thus, this paper investigates how the service of one low-intensity family counselling provider, Relate, is conceptualised and practised by counsellors on the ground. Questions about practice were posed to five focus groups of family counsellors and these were analysed using thematic analysis. The findings suggest that Relate family counselling is seen as ‘family therapy lite’, with a flexible, eclectic and integrative use of concepts and techniques within a systemic framework. Implications of this conceptualisation of family counselling for training, practice and research are discussed.     

Treatment outcomes for female offenders: relationship to number of Axis I diagnoses

This article describes a study that examined the relationship between multiple Axis I mental health diagnoses and treatment outcomes for female offenders in prison substance abuse treatment programs. Preliminary findings of the effectiveness of therapeutic community (TC) treatment, modified for female offenders, relative to a control cognitive behavioral treatment condition, are presented. The hypothesis--that participants who fit into multiple diagnostic categories have more dysfunctional symptoms and behaviors at baseline--was confirmed; however, a hypothesized relationship between the number of Axis I diagnoses and 6 month treatment outcomes across five domains (mental health, trauma exposure, substance use, HIV needle risk behaviors, and HIV sexual risk) was not supported. Across all Axis I mental health groups, TC treatment was significantly more effective than the control condition overall, as well as on measures of mental health symptoms and HIV sexual risk. These findings suggest that this TC treatment program, as modified, is an effective model for women with varied diagnoses and diagnostic complexities.     

Family-based treatment for adolescent substance abuse: controlled trials and new horizons in services research

This article provides an overview of controlled trials research on treatment processes and outcomes in family-based approaches for adolescent substance abuse. Outcome research on engagement and retention in therapy, clinical impacts in multiple domains of adolescent and family functioning, and durability and moderators of treatment effects is reviewed. Treatment process research on therapeutic alliance, treatment fidelity and core family therapy techniques, and change in family processes is described. Several important research issues are presented for the next generation of family-based treatment studies focusing on delivery of evidence-based treatments in routine practice settings.     

Effects of family therapy for substance abuse: A systematic review of recent research

One of the most serious psychosocial problems worldwide is substance abuse because of its repercussions not only on the physical and psychological health of the abuser but also on their relational functioning. Among the well-established therapeutic approaches for the treatment of substance abuse is family therapy, which, in addition to influencing personal variables, promotes changes in family dynamics. The main objective of this study is to review the scientific literature published from 2010 to the present on the efficacy and effectiveness shown by family-based treatment approaches for substance use problems both in adolescent and adult samples. In addition, the effect on secondary variables such as family functioning and behavioral problems is evaluated. The empirical evidence accumulated in the last decade and reviewed in the present study indicates that the incorporation of family members in the treatment of substance abuse produces benefits by diminishing consumption and improving family functioning. Limitations of this study and of the research reviewed are discussed and directions for future research are provided.     

Self-criticism and the therapeutic relationship

The relationship between self-criticism and the therapeutic alliance was examined in 169 clients attending counselling in a community clinic. Self-criticism was associated with lower client ratings of the working alliance, suggesting that clients with higher self-criticism had greater difficulties establishing and maintaining a therapeutic alliance. These findings extend previous studies on the working alliance and self-criticism from highly controlled clinical studies to a more ecologically valid community mental health setting. Regression analyses were conducted to examine the mediating effect of additional factors on the relationship between self-criticism and the working alliance. Sensitivity to a perceived subordinate role in therapy did not impact the working alliance, although a general resistance to subordination was related to self-criticism. Implications for counselling self-critical clients are discussed.     

Does neuroscience hold promise for the further development of behavior therapy? The case of emotional change after exposure in anxiety and depression

Over the last few years, the integration of biological and psychological models has become increasingly important in clinical psychology. This paper presents a neurobiological framework for exploring how neuroscience research may be valuable in the context of new developments in behavior therapy. The importance of the cortical-subcortical circuitry of emotion processing for investigating the working mechanisms of exposure therapy is illustrated by current neuroimaging research. The implication is that during exposure therapy the focus of attention must be fully directed towards the emotional content of the threatening situation to facilitate prefrontal control over the amygdala and that new contextual information, of emotional salience, must be added to create inhibitory projections from the hippocampus. In addition, some possible mechanisms of action for different therapeutic approaches to both anxiety and depression and the role of neuroimaging techniques in predicting treatment outcome are discussed.     

Family therapy as a rite of passage: play's the thing

Although there is a considerable literature about the nature of family problems and techniques of therapeutic change, little is known about how change in the family therapy setting can be maintained over time. The current paper suggests that important insights into the nature of family therapy can be gleaned by comparison with "naturally occurring" rites of passage. Anthropological analysis of these rites suggests several concepts that may guide the family therapist. These include: (a) the idea of a "therapeutic frame" that marks off the therapy setting; (b) the role of symbolic process and flexibility; (c) the concepts of liminal play and flow as explanations of therapeutic technique and potential; and (d) the relationship between the family in treatment and a wider community. Rites of passage can serve as an important source of comparison and insight into the nature of change in the family therapy setting.     

Creation as transformation: Parenting as a turning point in drug users’ lives

This paper is drawn from a narrative inquiry into how ex‐drug users understand the connection between childhood trauma and their subsequent drug misuse. The research was commissioned by a community drugs project. Eight participants were selected from respondents to an advertisement in a counselling journal, five of whom are qualified psychological therapists. The particular focus of this paper is on the interconnection of childhood trauma/abuse, drug misuse and parenting, by showing participants’ own experience of being parented and how the experience of becoming a parent helped them to transform their relationship with drugs. The paper draws attention to the therapeutic value of recognising the complex contextual factors that influence the parenting abilities of problematic drug users, and of building upon the positive attitudes, hopes, values and capabilities that underscore the ‘good parenting’ found in their stories. The work suggests that drug rehabilitation, treatment or counselling might usefully focus on parent–child relationships, which can become a turning point for identity transformation.     

Counselling psychology in primary health care: A review

This paper reviews the development of counselling psychology within the field of primary health care. Issues discussed include liaison between counselling psychologists and other professionals, evaluation of treatment in primary care, family therapy in general practice and general practitioners’ skills in counselling. The need for training and evaluation of counselling are discussed and suggestions are made for further research.     

The context of counselling: A neglected dimension of trainings research and practice

The context of counselling includes such factors as the physical environment of the counselling room, the emotional climate of the counselling agency, the relationship between the agency and the community it serves, and the cultural beliefs and values which inform both counsellor and client. It is argued that these factors can make a difference to the relationship between counsellor and client, and the process and outcome of counselling. It is suggested that contextual issues have been largely ignored in counselling theory, research and practice, and that increased attention to context has the potential to contribute to the creation of more responsive and effective counselling services.     

Rediscovering Nagy: What happened to contextual therapy?

Ivan Boszormenyi-Nagy, originator and leading proponent of contextual family therapy, has been addressing relational ethics for more than 40 years. During the 1980s there was a proliferation of contextual publications. Great interest in the approach seemed to peak and then ebb silently. What happened to contextual therapy? Why has contextual therapy not taken its place among the other widely used and recognized therapeutic models? This article addresses these questions through a review of family therapy literature.     

The Relationship Between Perceptions of Neighborhood Characteristics and Substance Use Among Urban African American Adolescents

Although the neighborhood microsystem is recognized as an important domain for adolescent development, relative to the family and peer contexts, neighborhood factors have been understudied in relation to adolescent substance abuse. In addition, recent research suggests that risk factors for adolescent substance use may differ for African Americans when compared to Caucasian youth. This study investigated the association between perceived neighborhood disorganization and later substance use, as well as possible mediators of that association, among a community sample of urban African American adolescents. Perceptions of neighborhood disorganization (i.e., violence/safety and drug activity) in grade 7 were associated with increased tobacco, alcohol, and marijuana use in grade 9. For females, this association was mediated by attitudes about drug use and perceptions of drug harmfulness. Findings highlight the importance of neighborhood contextual variables for African American substance use. Implications and directions for future research are presented.     

Couple therapy in a therapeutic community setting†

An account is given of couple therapy offered as part of a comprehensive treatment programme in a unit run as a therapeutic community. The additional therapeutic force provided by couple or family therapy is important in dealing with adult patients who may not be highly motivated for change or who may not initially present their difficulties as springing from marital or family relationships. A combined approach with these kinds of patients may succeed where either group therapy or couple therapy alone is likely to fail.     

Personality characteristics of substance abusers: an MCMI cluster typology of recreational drug users treated in a therapeutic community and its relationship to length of stay and outcome.

The purpose of this investigation was to define homogeneous personality subtypes among substance abusers treated in a long-term, inpatient, drug-free therapeutic community and to determine how the resulting typology was related to length of stay and treatment outcome. A hierarchical agglomerative cluster analysis was performed on the Millon Clinical Multiaxial Inventory (MCMI) scale scores of 235 admissions to a therapeutic community. Five cluster types emerged, which were similar to typologies found in studies with alcoholic inpatients. A concordant solution evolved when a different clustering algorithm was used with the same sample and when clustering was done with a different group of substance abusers. As hypothesized, clusters of patients with average MCMI elevations that indicated avoidant, schizoid, and antisocial qualities tended to stay in treatment fewer days and relapsed earlier during the 1-year follow-up. The implications for substance abuse treatment are discussed.     

Personality Characteristics of Substance Abusers: An MCMI Cluster Typology of Recreational Drug Users Treated in a Therapeutic Community and Its Relationship to Length of Stay and Outcome

The purpose of this investigation was to define homogeneous personality subtypes among substance abusers treated in a long-term, inpatient, drug-free therapeutic community and to determine how the resulting typology was related to length of stay and treatment outcome, A hierarchical agglomerative cluster analysis was performed on the Millon Clinical Multiaxial Inventory (MCMI) scale scores of 235 admissions to a therapeutic community. Five cluster types emerged,, which were similar to typologies found in studies with alcoholic inpatients. A concordant solution evolved when a different clustering algorithm was used with the same sample and when clustering was done with a different group of substance abusers. As hypothesized, clusters of patients with average MCMI elevations that indicated avoidant, schizoid, and antisocial qualities tended to stay in treatment fewer days and relapsed earlier during the 1-year follow-up. The implications, for substance abuse treatment are discussed.     

Taking the Bull by the Horns: A Family Therapy Case of an East Indian Adolescent Substance Abuser

The cultural clash between traditional East Indian cultural values and US values often leads to parent–child conflicts, which increases East Indian adolescents’ risk for substance abuse. This is demonstrated in theory and through a case presentation of an East Indian adolescent substance abuser who was treated through an approach that coincided with the core principles of multi-dimensional family therapy. Family therapy interventions that coincided with East Indian cultural values were generally effective and resulted in decreased parental substance abuse, decreased family conflict, and improved parenting skills. Family therapy interventions that conflicted with East Indian cultural values were not effective. Further study is needed to ascertain the extent of parental and adolescent substance abuse in East Indian immigrant families and the effectiveness of a multi-dimensional family therapeutic approach to treatment.     

Resolving the trauma organized system of sexual abuse by confronting the abuser: A focal family therapy approach with a woman who was a childhood victim of sexual abuse

The longer-term emotional and interpersonal effects of sexual abuse in childhood are reviewed and approaches to treatment discussed. The notion of a 'trauma organized system' to account for the long-standing effects of abuse is described. A major potential issue in creating therapeutic change is confronting the abuser, and a case is described where a woman brought her family for therapy when it was feared that the father, who had abused her in childhood, might abuse his grandchildren. A focal family therapy approach was used: this takes into account the traumatic nature of abusive events and their long-term organizing effects on individual and family functioning. The process of therapeutic work is described, including the resolution of traumatic effects by confronting the abusive act.