Parents’ and psychotherapists’ goals prior to psychodynamic child psychotherapy

In order to explore goals of parents and psychotherapists prior to child psychotherapy, the following questions were asked: (1) How are goals for psychotherapy formulated? (2) How can similarities and differences between parents’ and psychotherapists’ goals be understood? Questionnaires regarding psychodynamic child psychotherapies (n = 33) with parallel parental work were analysed using qualitative methodology. The child psychotherapists’ goals were often connected to the intrapsychic and relational development of the child. The parental therapists formulated goals focused on providing support to parents. The parents’ goals, on the other hand, concerned to a great extent giving the child help and to a lesser degree receiving help for themselves. They expressed their expectations concerning the child’s psychological development with a more everyday use of language, often with an emphasis on general psychological wellbeing. The study also indicated that parents had limited knowledge about the therapy’s implementation and framework. Some clinical conclusions could be made. Negotiating goals prior to parental and child psychotherapy can help create realistic expectations and promote a beneficial therapy situation.     

Should psychotherapists disclose their own psychological problems?

Background: Self‐disclosures by psychotherapists can encompass a wide array of content, including information about the personal life of the psychotherapist. Aim: The goal of this study was to empirically assess reactions to psychotherapists disclosing their own personal problems to clients with similar problems. Methodology: This study explored participants' (n = 155) reactions to vignettes describing psychotherapists as either disclosing or not disclosing their own history of psychological problems to clients presenting with similar problems. Findings: Compared to otherwise identical vignettes featuring psychotherapists who did not self‐disclose, vignettes featuring psychotherapists who self‐disclosed were rated more positively in a variety of ways. Specifically, psychotherapists in the vignettes featuring self‐disclosure were perceived as possessing a higher level of favourable personal qualities and as more likely to establish strong working relationships with clients and achieve success in therapy. Limitations of the method and alternate explanations for the results are considered. Implications: Implications regarding the judicious use by psychotherapists of self‐disclosure regarding their own past psychological problems are discussed.     

Integrating Spirituality and Religion Into Psychotherapy: Persistent Dilemmas,Ethical Issues,and a Proposed Decision-Making Process

Religion and spirituality are important aspects of the lives of most psychotherapy clients. Unfortunately, many psychotherapists lack the training to effectively and ethically address these issues with their clients. At times, religious or spiritual concerns may be relevant to the reasons clients seek treatment, either as areas of conflict or distress for clients or as sources of strength and support that the psychotherapist may access to enhance the benefit of psychotherapy. This article reviews persistent ethical issues and dilemmas relevant to providing psychotherapy to clients for whom issues of religion and spirituality are clinically relevant. Ethical considerations include assessment, advertising and public statements, informed consent, competence, boundary issues and multiple relationships, cooperation with other professionals, and how to effectively integrate religious and spiritual interventions into ongoing psychotherapy. A decision-making process is presented to guide psychotherapists in their clinical work with clients for whom religious and spiritual issues are salient or clearly linked to their presenting problems.     

Revisiting ‘What works for whom?’: A qualitative framework for evaluating clinical effectiveness in child psychotherapy

This paper describes a framework for evaluating the effectiveness of child psychotherapy used by child psychotherapists in an inner city Child and Adolescent Mental Health Service (CAMHS). The Hopes and Expectations for Treatment Approach (HETA) involves using the assessment for psychotherapy that normally precedes treatment to derive a baseline from which to generate a set of hopes/expectations as regards the effects of the treatment on the part of parents and the psychotherapist, to be revisited one year after the start of the psychotherapy and/or at its completion. The Strength and Difficulties Questionnaire, for parents and schools, was also administered before and after the treatment. The characteristics of the first 30 children referred for psychotherapy over a particular time period are described. Of the first 15 children in this group to complete one year of individual psychotherapy, all showed change or significant change in the areas concerning parents' and therapists' hopes at the end-of-year review, as rated by parents and psychotherapists. A case of a child with conduct disorder is used to describe how the assessment generated a psychoanalytic formulation, how the therapist's understanding was fed back to the parents, and how the parents' and therapist's hopes and expectations were derived and recorded. This case illustrates powerfully the impact of trauma in the parents' backgrounds on the internal world of the child, and how the method provides a useful bridge between parent and child work. Feedback from the psychotherapists, the parents and the referrers using the framework is reviewed, and in conclusion the paper argues for the framework's value in promoting good practice in the treatment and management of complex cases and in enhancing awareness of the nature and scope of the psychotherapy process.     

The use of self-disclosure among Swedish psychotherapists

Although self-disclosure, when handled with discretion, is often seen as an important intervention in many psychotherapy orientations, including psychodynamic as well as humanistic and cognitive-behavioral approaches, many psychotherapists seem reluctant to use it. The frequency and type of those interventions from psychotherapists of different orientations is less well known. In this study, a random sample of Swedish psychotherapists was asked about their use of different types of self-disclosing information. The results showed that therapists with CBT orientation told their clients more about their training and about their personal ways of handling affective-relational issues. It was apparent that the trend toward more use of self-disclosure in relational psychodynamic treatment has not been accepted among a large number of psychodynamic and psychoanalytic psychotherapists in Sweden. It is recommended that psychotherapists inform their clients more about their training and in appropriate ways share more with their clients about their own relational experiences. Doing so may help enhance clients’ hope and their ability to address their ongoing difficulties.     

Self-Qualities and Self-Leadership as Pathways Linking Childhood Maltreatment to Depression and Relationship Quality

Among adults, childhood maltreatment is widely known to increase depressive symptoms and reduce quality of adult’s intimate relationships. Considering the association between childhood maltreatment and adult depression and relationship quality from systemic theories may help clinicians conceptualize and intervene with their clients. Internal Family Systems is an evidenced based psychotherapy and is a trauma-informed model. Self is one of the core concepts of the Internal Family Systems model and it is theorized to reduce mental health problems such as depression and strengthen adult romantic relationships. Despite this theoretical proposition there is no supporting empirical research. To address this gap, the current study examined Self, specifically the qualities of Self (e.g., compassion) and Self-Leadership (e.g., staying calm in face of distress) as pathways linking childhood maltreatment to depression and relationship quality. Using a sample of adults in a romantic relationship, the current study examined Self-Qualities and Self-Leadership as mediators linking retrospective reports of child maltreatment to current depressive symptoms and relationship quality. Results indicate that the indirect (mediating) effects from childhood maltreatment to depressive symptoms and relationship quality were significant through Self-Qualities, but not Self-Leadership. Findings suggest that childhood maltreatment is associated with less frequent access to the qualities of Self, such as compassion and confidence which, in turn, were associated with fewer depressive symptoms and higher levels of relationship quality. For clinicians, the use of IFS and specifically helping clients increase the Self-Qualities may reduce depressive symptoms and strengthen romantic relationships.

     

Journeys through the valley of death: multimethod psychological assessment and personality transformation in long-term psychotherapy

The Psychodynamic Diagnostic Manual (PDM Task Force, 2006) is based on the assumption that an in-depth understanding of clients' underlying emotional, personality, and interpersonal patterns will facilitate their treatment. In this article I show how such an understanding can be achieved through multimethod psychological assessment, and how useful such information can be in long-term psychotherapy with high-achieving, successful clients who struggle with forming and maintaining intimate relationships. Such treatments are extremely difficult, because when these clients attach to their psychotherapists, many of them temporarily become more symptomatic. I illustrate these points with a detailed account of my long-term therapy with a resilient but highly traumatized young man. Repeated use of the Minnesota Multiphasic Personality Disorder-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) and Rorschach with my client helped guide us in our work, and also helped create an important therapeutic "opening" into the underlying traumatic material. This and other experiences have convinced me that it is extremely useful for psychologists to have training in both assessment and psychotherapy.     

Constructivist psychology of child abuse and implications for psychotherapy

Abstract

This paper reviews constructivist and related literature on child abuse and psychotherapy. Constructivist psychology, with its emphasis on the personal, socially embedded construction of meaning, is uniquely situated to contribute to humanistic psychotherapy for child victims and adult survivors. Conversely, work with abused clients deepens our understanding of developmental meaning‐making processes and the social ecologies of meaning within which they unfold.

Constructivist approaches to child abuse are inherently humanistic, focusing on the child victim's and adult survivor's attempts to make meaning of their experiences, including the often traumatic experiences of abuse and the relational contexts in which it occurs. This paper first discusses how constructivist psychology may deepen our understanding of the impact of abusive experiences, the reverberation of those experiences through subsequent living, and the role of constructivist therapies in the healing process. Secondly, this paper explores reflexive aspects of work with abuse survivors that may challenge our cultural and professional assumptions and deepen our commitment to constructivist, humanistic, and feminist psychotherapies.     

The Function of the Human Motor System in Processes of Storing and Retrieving Preverbal,Primal Experience

Because the development of selfobject relationships is intimately involved with the development of the motor apparatus from the day of birth, it is assumed that movement improvisation can bring about the freeing of archaic memory traces. The author has painstakingly pulled together examples from her practice to demonstrate the existence of emotive memory clusters, which encompass many of life's vicissitudes and store them. She builds a theoretical framework for her hypotheses by linking her clinical observations with modern child research. Clinical vignettes illustrate this highly original, useful work. Transference and resistance are viewed with the same vigilance as in psychoanalysis while movement improvisations are given importance as type of free association.     

Psychosynthesis: A Foundational Bridge Between Psychology and Spirituality

Pastoral psychologists have long tried to establish a working model that encompasses the seemingly conflicting disciplines of science and religion. Psychosynthesis, a transpersonal psychology and therapeutic approach, offers such a model of the human personality, in which the psychological and spiritual perspectives can converge. This article explores psychosynthesis psychology and therapy as a theoretical framework for pastoral psychology. Although psychosynthesis psychotherapy relies on an array of techniques, it fundamentally works with the clients’ will while emphasizing, exploring, and cultivating their relationships on all levels—intrapersonal, interpersonal, and with the Higher Self. In addition to the subconscious, psychosynthesis includes a higher psychological plane, called the superconscious, from which our higher ethical, aesthetic, scientific, and spiritual values are derived. This article begins by introducing psychosynthesis concepts and techniques. It then provides qualitative findings showing that psychosynthesis counseling helped to awaken spirituality in three out of eleven clients who had formerly identified themselves as atheists. In addition, testimonies are included that show that psychosynthesis counseling also helped all eleven clients to attain personal growth. Finally, the counselor describes her experience of psychosynthesis as a Christian in the therapeutic setting. The framework of psychosynthesis psychology and its techniques are viable methodologies for anyone searching to incorporate spiritual growth into a psychological working model.     

How Psychotherapists Address Hypothetical Multiple Relationships Dilemmas with Asian American Clients: A National Survey

This study examined how psychotherapists address hypothetical nonsexual multiple relationships dilemmas with Asian American clients and identified predictors of conservative decisions and the use of culture-based rationales. This survey of 787 Asian American and non-Asian American psychotherapists revealed that clinicians rely on mostly their personal policies and seldom focus on the clients' cultural backgrounds. Psychotherapists who consider their clients' Asian culture have more cultural knowledge and awareness, have been mental health providers longer, and are Asian American and female. Clinicians who avoid multiple relationships tend to cite formal policies as justification and are less likely to consider clients' cultural worldviews, the therapeutic relationship, or their own values. The results are discussed in terms of specific revisions needed in the American Psychological Association Ethics Code, the benefits of more frequent consultation with colleagues and supervisors about ethical dilemmas, and recommendations for psychotherapists.     

Developing Together: Parents Meeting Children��s Developmental Imperatives

It is well known that the parent influences the child, but few realize how much the child changes the adult. This paper reports research that explored how adults change when they learn to nurture their child??s developmental needs. It also explores how empathy with the child impacts an adult??s ability to move through his or her own unresolved childhood issues into new meaning and relationships. Using qualitative methods and quantitative measures, the research captures perspectives of 20 parents about their own development from using child development principles. Analysis resulted in the identification of five themes: (a) cognitive development in perspective, differentiation from past ways, and new meaning-making; (b) emotional development of trust, empathy, and affective complexity; (c) personal agency of intentional effort and use of critical self-inquiry; (d) adult well-being; and (e) emergence of wisdom. More research is needed to determine the association between child development competence and adult development.     

The Right to be Desperate and Hurt and Anger in the presence of Carl Rogers: A racial/psychological identity approach

This paper attempts to establish the beginnings of a conceptual and theoretical framework for psychotherapists and counsellors to 'work with' racial identity psychologically and psychological identity racially in cross-cultural clients. Using the video presentation - of a black client in therapy with Carl Rogers (in the 1970s) - Right to be Desperate and Hurt and Anger as a case vignette, the paper argues that racial/psychological self understanding is possible in therapy. The therapy sessions are critiqued in terms of race and multi-cultural psychotherapy and counselling. Since the video was widely used in the 1990s and is currently used in counselling and multi-cultural therapy training, it was felt that an examination and analysis of some of its contents would offer clinical possibilities in terms of race, culture and ethnicity. Through the analysis of significant excerpts the paper attempts to show that the conflicts, confusions and tensions that arise between a white therapist and a black client can be used creatively to engender trust, openness and cross-racial therapeutic possibilities.     

Mirror mirror on the ward: who is the unfairest of them all? Reflections on reflective practice groups in acute psychiatric settings

Consultant psychiatrists in medical psychotherapy, adult psychotherapists, child and adolescent psychotherapists and clinical psychologists increasingly complement their direct therapeutic activity with applications of their psychotherapeutic thinking in acute mental health work through facilitating reflective practice groups for staff working in mental health teams. The authors offer their reflections on facilitating National Health Service reflective practice groups using the metaphor of a mirrored dialogue between patient and professional, and professional and institution as a basis for informing the development of reflective practice for colleagues. Their reflections are based on working on three acute in-patient wards, in a crisis resolution team and in community mental health teams. They describe the practicalities of setting up and facilitating reflective practice groups, and offer insights into some of the issues that arise in reflective practice groups. They conclude that these groups are mutually beneficial in forging links between psychotherapy professionals and professionals working in other disciplines and areas of mental health. Facilitating these groups often requires a challenging adaptation of technique, which will not suit all psychotherapists, as well as a wider understanding of organisational dynamics and the interplay between clinicians and management.     

Healing Intergenerational Wounds: An Integrative Relational–Neurobiological Approach

Old resentments and unfinished business from the family of origin can constrain adults in current relationships with parents or siblings and negatively affect relationships with partners or children. This article explores how old wounds get reactivated in current relationships and contribute to the intergenerational transmission of painful legacies and trauma. Building on intergenerational family theory and interpersonal neurobiology, the dynamics of reactivity and pathways for growth are explored. While much of the time the human brain is on autopilot, driven by habits and emotional reactivity, we are capable of bringing prefrontal thoughtfulness and choice to close relationships. Rather than being victims of parents or our past, we can become authors of our own relational life. Interventions are offered to help adult clients “wake from the spell of childhood,” heal intergenerational wounds, and “grow up” relationships with family of origin. The damage caused by parent‐blaming in therapy is explored and contrasted with Ivan Boszormenyi‐Nagy's emphasis on rejunctive action and cultivating resources of trustworthiness in intergenerational relationships. The family is considered both in its cultural context—including stressors and resources for resilience—and in its life cycle context. Aging in the intergenerational family is discussed, focusing on ways adult children and their parents can grow and flourish with the challenges at this time of life. Throughout, the theme of relational ethics—how we can live according to our values and “reach for our best self” in intergenerational relationships—informs the discussion.     

Linguistic Reflections on Psychotherapy: Change in Usage of The First Person Pronoun in Information Structure Positions

Aim of present study was to understand changes in speech of clients with regard to certain linguistic features from 5th to 15th session of psychotherapy. First person pronoun use in information structure positions were analyzed in speech of clients. Participants of this study were 11 psychotherapists (clinical psychology master and doctorate students) and 16 clients (applicants to AYNA Psychotherapy Unit). In present study word count results of clinets’ speeches were analyzed by ANOVA method. According to results, use of first person pronoun changed significantly in preverbal position from 5th to 15th sessions of psychotherapy. Findings of this study suggest that, psychotherapy leads to certain linguistic changes, and these changes discussed to be means of understand change of clients during psychotherapy     

Common principles of psychotherapeutic change: patterns of use

ABSTRACT

Many authors have proposed the existence of common principles of counselling and psychotherapeutic change. However, little is known about how practitioners use these change principles. A sample of 373 Czech psychotherapists and counsellors participated in an online survey and rated their use of 10 psychotherapy change principles in their practice over the previous year. The frequency of the use of the 10 change principles is reported. Furthermore, three principal components of the change principles were identified: exploration, acceptance, and understanding of clients’ experience; attending to clients’ own resources; and furnishing clients with new skills and advice. The use of these components was mainly associated with the practitioner's theoretical orientation. The implications of the component structure for psychotherapist and counsellor training and practice are discussed.     

“Doc,There's Something I Have To Tell You”: Patient Disclosure to Their Psychotherapist of Unprosecuted Murder and Other Violence

The current investigation examines the incidence of clients telling their psychotherapists of committing violent crimes for which they have not been prosecuted. Thirteen percent of the psychologists surveyed indicated that on at least one occasion a client self-disclosed to them during a psychotherapy session that he/she had murdered someone, not including the killing of another person in the line of duty in the military or as a public peace officer. One third of the psychologists had clients self-disclose an unprosecuted incident of a sexual assault, and more than two thirds had clients self-disclose an unprosecuted incident of a physical assault during a psychotherapy session. Data are reported on psychotherapists' views of the impact of such disclosures on the psychotherapy relationship, adequacy of being informed regarding legal obligations after hearing such reports of violence, and adequacy of graduate preparation to deal with these clinical situations.     

Clients’ perceptions of personal psychotherapy or counselling for therapists

The purpose of this study was to examine clients’ opinions of therapists’ personal use of psychotherapy or counselling. Participants in this study, a nationwide sample of clients recruited through Amazon’s MTurk system, were asked to complete an online survey assessing their attitudes towards treatment use by therapists as well as their general attitudes towards psychological help-seeking and perceptions of stigma (social and self) with psychological treatments. In this study, we found that clients generally had positive views about therapists’ personal use of psychotherapy or counselling. Although overall positive attitudes were found, the results from repeated measures ANOVAs indicated that attitudes depended somewhat on whether the therapist had sought out treatment as part of a training requirement for self-enrichment, or for the treatment of a psychological problem. In addition, participating clients were less supportive of therapists disclosing a treatment use history with their clients. Regression analyses also indicated that attitudes towards treatment use by therapists were significantly predicted by general help-seeking attitudes and perceptions of stigma (social and self), but attitudes towards disclosure were not. The findings from this study have important implications regarding therapist treatment use and disclosure in practice.