Therapists’ experiences with internal representations of clients

Fourteen therapists were interviewed via telephone regarding their experience of “carrying around” their clients with them between sessions (i.e. internal representations, or IRs, of clients), a phenomenon about which little empirically based knowledge exists. Data were analyzed using consensual qualitative research. Findings indicated that overall, therapists have IRs infrequently, most often have IRs of clients struggling with severe or challenging presenting problems, and do receive some training about IRs. When describing a specific IR experience, therapists typically noted a strong therapy relationship, and stated that the IRs typically had specific triggers. The IRs generally consisted of feelings about the client, and typically consisted of thoughts about the client or the felt presence of the client. The IRs generally yielded positive effects, typically both personally and professionally, and were typically discussed with supervisors/consultants. Implications for research, training, and practice are presented.     

Therapists’ self-reported chronic strategies of disconnection in everyday life and in counselling and psychotherapy: an exploratory study

The aim of this study was to explore how therapists believe they may relationally disconnect from other people and their clients, with an overall objective of developing methods for enhancing relational depth in counselling and psychotherapy. Participants were 168 trainee and practicing therapists, who listed their chronic strategies of disconnections (CSoDs) in everyday relationships, and then rated the presence of these CSoDs in their therapeutic work. Thirty-nine categories of self-reported everyday CSoDs emerged, organised into seven domains. Most prevalent were behavioural, passive and intrapsychic strategies. Over half of the CSoDs were rated as being present in therapy to a minimal extent, most commonly passive CSoDs, disingenuous CSoDs and humour. Male therapists, and trainee therapists, were most likely to identify their CSoDs as present in therapy.     

Exploring Master Therapists’ Use of Power in Conversation

Various theoretical approaches to therapy place different emphases on the use of power in therapy. In this study, we explore six master therapists’ use of power via communicational control for theoretical consistency. Results indicate that all therapists, regardless of their stance on power, use the role of therapist to exert power in an initial therapy session. Master therapists, in general, did appear to be theoretically consistent with their stated philosophies of therapy. Suggestions for future studies exploring power therapists have are included.     

Towards a new way of healing: experienced counsellors’ perceived influences of ch’i-related experiences on counselling practice in Taiwan

This narrative study explored how the experienced counsellors utilised the idea and practice of ch’i during counselling sessions. The data were co-constructed between the researcher and 12 senior counsellors with substantial ch’i-related experiences using a semi-structured in-depth interview method and were analysed employing a narrative analysis approach. The core themes emerging from the study were (a) an embodiment, which included two sub-themes: ch’i as a way of expressing health and illness and ch’i-related exercise lived out as an embodiment, and (b) ch’i as a way of understanding. The findings pointed to ‘a new way of healing’, which involves perceiving, containing and conveying ch’i and requires counsellors to empty themselves, and remain in a state of non-action and wholeness.     

Therapists’ Perspectives of the Cotherapy Experience in a Training Setting

The experience of cotherapy has been sparsely addressed in the literature. This qualitative study’s goals were to explore (a) the usefulness of cotherapy as a training model (b) the impact of cotherapy on services provided; (c) the impact of being trained in a cotherapy model; and (d) factors that both facilitated and hindered the process of cotherapy. The authors conducted a focus group interview with seven participants who graduated from a COAMFTE accredited MFT master’s program. Participants unanimously reported they believed cotherapy impacted client outcomes and training. They also expressed that cotherapists’ unwillingness to address issues within the cotherapy team negatively impacted the cotherapy relationship and client outcomes. Data analysis yielded four main themes, including cotherapy as a vehicle for personal growth, accountability in the cotherapy relationship, need for safety in the cotherapy relationship, and cotherapy team’s need for supervision.     

Latino immigrant parents’ experiences raising young children in the absence of extended family networks in Canada: Implications for counselling

Latinos account for 10% of newcomers to Canada, and most are families with young children under the age of 10. In their homelands, Latinos are supported in the parenting process by extended family networks due to the cultural value of familism. Migration to Canada disrupts extended family care-giving, as only one’s spouse and dependent children are allowed to accompany the principal immigration applicant. The purpose of this qualitative study was to explore Latino immigrant parents of young children’s experiences of parenting in Canada in the absence of their extended families, and how they adjust to this new lived reality. An ethnically mixed sample of 10 parents (5 mothers and 5 fathers) participated in semi-structured interviews, which were analysed via thematic analysis. Emerging themes suggested a perceived “uploading” of parental responsibility after migration, producing fear, worry, sadness, loneliness and burnout. These experiences resulted in the negotiation of new parenting partnerships with unanticipated positive outcomes: increased nuclear family cohesion and increased father involvement in childrearing. Parents also described how new support networks were established in surprising ways, such as through interfaces with the health care system. Interventions for facilitating the successful adaptation of Latino parents in a similar predicament are discussed.     

‘A preparation for practice?’ Students experiences of counselling training within departments of higher education

The literature has identified a gap between the education and practice in the education and training for the practice based professions based within traditional Departments of Higher Education. In the education and training in counselling it is suggested that this gap is primarily between those who view practice as the rigorous application of formal ‘science’ and those who see it as more holistically embedded in ‘tacit knowledge’ and artistry of the practitioner. This paper reports on a small scale qualitative study (Scanlon, 1993) which investigated the experience of students undertaking Counsellor training courses within Departments of Higher Education. Analysis of interview data revealed three main categories of concern. The first categoy describes the adverse effects of the theory-practice gap on the students. The second catego y describes the importance of clinical supervision in acquiring practice skills and the third catego y describes the participants' concerns about the quality of outcome for such training, particularly in relation to the perceived lack of ngour in the assessment of clinical competence. In the light of these findings a number of suggestions about how the professional education and training of counsellors could be better integrated into a more ‘practice led’ curriculum model are discussed.     

Psychological type and counselling psychology trainees’ choice of counselling orientation

Clarifying the factors which influence choice of counselling orientation is important. This study investigated whether psychological type is associated with choice of orientation in counselling psychology trainees. Sets of questionnaires were sent to 210 counselling psychology trainees in four universities, which resulted in a sample of 84 participants. The measures were the Keirsey Temperament Sorter II and a short demographic questionnaire which also asked open-ended questions about chosen orientation. Participants who preferred SJ (Sensing-Judging) were more likely to choose the CBT model, NFJ (Intuition-Feeling-Judging) types the Psychodynamic model and NFPs (Intuition-Feeling-Perceiving) the Person-Centred model.     

Client as expert: A Delphi poll of clients’ subjective experience of therapeutic alliance formation variables

This study extends prior research that identified client-derived variables believed to contribute to therapeutic alliance development. Forty-two clients participated in a three-round-modified Delphi poll in which the subjective importance of 74 client-derived, common alliance formation variables was rated using a six-point scale. Participants consensually identified 23 variables as highly important, five as moderately important and three as low in importance to the formation of a strong alliance. Variables related to validation and asking about parts of the client’s life other than the presenting concern were considered as most important by at least one-third of the sample. Limitations of the study are presented and implications for theory, measurement, practice and future research are briefly discussed.     

Therapists’ Thought-Action Fusion Beliefs Predict Utilization of Exposure in Obsessive-Compulsive Disorder

Although exposure and response prevention (ERP) is considered the gold standard for the treatment of obsessive-compulsive disorder (OCD), it is rarely used in clinical practice. Therapists’ beliefs about ERP affect its utilization, as previous research suggests, but the role of therapists’ cognitive biases is unclear. In particular, susceptibility to thought-action fusion (TAF) may be related to the underutilization of ERP in OCD.Therapists (N = 353) were divided into those recommending (ERP+, n = 228) and not recommending ERP (ERP−, n = 125) as treatment for an OCD case example. TAF in therapists was assessed using behavioral and self-report measures (TAFS).TAF was higher in the ERP− than the ERP+ group, with a small to moderate effect size (0.2 ≤ d ≤ 0.4). ERP− therapists showed more avoidance and neutralizing behavior and a stronger emotional response than the ERP+ therapists during the experimental task. Moreover, higher TAF as measured by the TAFS was associated at a small magnitude with lower likelihood of using ERP in the therapists’ actual clinical practices.Therapists’ cognitive biases should be addressed in their training in order to increase the dissemination of evidence-based treatment (i.e., ERP) and thus improve the treatment of OCD.     

Therapists’ Subjective Experience during Improvisational Moments in the Clinical Encounter-Discussion of I’mprovisation

With this discussion, I reflect on the limitations of this pilot qualitative research. These include how categories of observation are established and the generalizability of the reported results beyond the small sample of subjects studied. Additionally, the metaphor of theater used by the investigators for understanding improvisation is compared and contrasted with the metaphor of jazz improvisation. Jazz improvisation as a metaphor works well with the quantitative data coming from infant/caregiver video studies. These studies represent a more micro focus on embodied registrations of the emotional/behavioral interactive process and account for data which might be otherwise unconsciously overlooked or dissociated with a strategy valorizing I’mprovisation. I then visit the question of whether improvisation should be held as an ideal versus an ideal of continuous practice and vigilance for how theoretical biases, personal credos and habits of activity can become unreflective traps blocking spontaneous emergent possibilities for clinically relevant movement and growth.     

Learners’ perceptions and experiences of respect in educator-learner relationships

The aim of the study was to explore and describe secondary school learners’ perceptions and experiences of respect in educator-learner relationships within a high-risk South African neighbourhood context. A qualitative research design was used in this study. The 15 participants were high school learners (females = 33%, age range 17 to 21 years). Data on how learners perceive and experience respect in educator-learner relationships were gathered utilising written assignments, and through the application of the World Café technique. Thematic analysis was used to identify relevant relationship themes for learners: mutuality, various behavioural practices and emotional attitudes. All school communities should promote relational well-being practices amongst educators and learners.     

Explorations of participants’ experiences of a Personal Development Group held as part of a counselling psychology training group: Is it safe in here?

This paper aims to extend understanding of student counsellors’ perceptions of participation in personal development (PD) groups during training. PD participants were invited to record their experiences in relation to these groups over a three month period. The accounts were then subjected to thematic analysis. Safety was found to be a dominant theme–both in the sense of how the group felt safe for them and also how the safety was threatened. These concepts are discussed and lessons the data has offered in terms of good practice in facilitating PD groups during counsellor training programmes are elucidated.     

Student counsellors’ experiences of mindfulness as a component of their person-centred counselling training: An interpretative phenomenological analysis

Aim

Mindfulness is increasingly integrated into counselling and psychotherapy practices, as well as being introduced to students in academic institutes with the aim of supporting them to balance the responsibilities of academic study, placements and other commitments alongside university life. Despite mindfulness routinely finding its way into counselling settings and being incorporated into counsellor training, there has yet to be any research conducted to explore the experience of student counsellors who have received mindfulness as a part of their undergraduate person-centred training. This study explored the reflections of counsellors who had attended a mindfulness module during the first year of a counselling degree.

Design

Six students completing a university-based undergraduate degree in Counselling and Psychotherapy in the North-West of England, in the UK, participated in the research. The study consisted of two students from each of the three years of the programme. Participants individually attended a semi-structured interview to explore their experiences of mindfulness as a mandatory module of their training in person-centred counselling. Interpretative phenomenological analysis (IPA) was used to analyse the generated data.

Findings

Four superordinate themes were generated: 1) becoming a counsellor, 2) person-centred mindfulness, 3) time, and 4) learning and development.

Discussion

Experiential themes were explored including the process of professionalism, vulnerability, embodiment of person-centred theory and the core conditions and the conflict of approach.

Conclusion

Recommendations are made for mindfulness to be included in counselling training programmes with a person-centred focus. Suggestions for further research include longitudinal studies to follow the development of trainees over time.     

Student clinicians’ and clients’ perceptions of the therapeutic alliance and outcomes in stuttering treatment

PurposeThe purpose of this study was to examine how the therapeutic alliances (TA) of graduate student clinicians and adult clients who stutter relate to perceived treatment outcomes.MethodsStudent clinicians (N = 42) and adult clients who stutter (N = 22) completed a survey assessing their TA strength and perception of treatment outcomes. Responses were analyzed to determine similarities and differences in how clinicians and clients relate the TA to perceptions of treatment effectiveness, progress, and outcome satisfaction.ResultsResults suggest that clinicians and clients who stutter both relate the TA to treatment outcome, but in different ways. While clinicians associate the TA most with treatment effectiveness and client progress, clients relate the TA most to outcome satisfaction.ConclusionClinicians should be aware that for adult clients who stutter, outcome satisfaction is related to the degree of shared understanding, agreement on daily tasks, and bond they experience with their clinician. To ensure a strong TA and client satisfaction, clinicians should actively seek their clients’ perspective regarding TA status.     

Parents’ experiences of family food routines in adolescent elite-level swimming

ObjectiveParents have an important role in their child’s food routines and eating behaviour and face additional demands when that child is an athlete. Yet little is known about how parents manage providing food for their athletic child, in addition to the wider family, within the context of elite-level youth sport.MethodsSemi-structured interviews were conducted with sixteen parents (mothers = 11; fathers = 5) of elite level adolescent swimmers (i.e., competing at UK national level or above; child mean age = 15.4 years) to explore their experiences of family food routines and eating behaviour. Reflexive Thematic Analysis was used to analyse the data.ResultsParents outlined the importance of ‘optimal’ fuelling for their athletic child. Parents had an active role in their child’s eating behaviour and shaping their food choices but expressed uncertainty regarding the volume of food their child should consume and concerns regarding their child’s future relationship with food. Meticulous organisational and logistical strategies were employed to meet the extensive food requirements of their adolescent elite swimmer in the face of intensive training schedules. Such schedules also impacted food routines for the wider family (i.e., fewer family mealtimes), and on the quality of parents’ own diets.ConclusionThe findings highlight that clearer guidance is needed for parents of elite adolescent swimmers in relation to quantities of food intake and how to support a positive future relationship with food (specifically during any periods of transition in their training or out of the sport). The findings also identify a novel organisational stressor for parents in elite youth sport, in managing and prioritising their own diet. Further research is needed to explore the extent to which parental diet may be impacted by supporting an adolescent athlete.     

Gender Biases and Therapists’ Conceptualization of Couple Difficulties

In spite of the fact that gender issues have played an important role in many family therapy training programs, little research has been developed to explore the effects of gender and gender biases in therapists’ conceptualizations of client problems. This study explores beginning and advanced marriage and family therapy (MFT) student’s inclusion of gender in the conceptualization of a clinical case. To examine clinician’s thinking, 32 therapists (18 beginning MFT students and 14 advanced MFT students) were asked to 1) view the first 20 minutes of an intake interview conducted by a sex therapist, and 2) identify the couple’s central issues. Qualitative and quantitative analyses were used to explore constructs associated with therapists considerations and inclusion of gender and cultural issues in their conceptualizations of marital difficulties. Results revealed that trained MFT students who considered gender may have analyzed gender issues more extensively than untrained MFT students. In addition, results of qualitative analysis of participant critiques revealed subtle forms of gender and cultural biases. Discussion focuses on how these biases, some of which are linked to clinical theory, can lead to differential expectations and inequality in the treatment of men and women in couple therapy. Implications for clinical training, curriculum development, and future research are also discussed.