Transference,relationship and the analyst as object: Findings from the North American Comparative Clinical Methods Working Party

Data from the North American Comparative Clinical Methods (CCM) Working Party a is used to 1) explore how psychoanalysts in North America conceive and address the transference and the relationship between analyst‐analysand and 2) to study what kinds of ‘objects’ psychoanalysts become, explicitly and implicitly, within psychoanalytic treatments. The North American CCM Working Party closely studied 17 clinical cases presented by North American psychoanalysts across the spectrum of analytic schools at their meetings. We found that the 17 analysts fell into three different groupings according to the internal consistency of their method and their approaches to transference, relationship and analyst‐as ‐object. We also found that analysts' individual work, while heavily influenced by their schools of thought, also involved unique interpretations of their particular paradigms.     

The reality of the other: Dreaming of the analyst1

The author discusses the obstacles to symbolization encountered when the analyst appears in the first dream of an analysis: the reality of the other is represented through the seeming recognition of the person of the analyst, who is portrayed in undisguised form. The interpretation of this first dream gives rise to reflections on the meaning of the other’s reality in analysis: precisely this realistic representation indicates that the function of the other in the construction of the psychic world has been abolished. An analogous phenomenon is observed in the countertransference, as the analyst’s mental processes are occluded by an exclusively self‐generated interpretation of the patient’s psychic world. For the analyst too, the reality of the other proves not to play a significant part in the construction of her interpretation. A ‘turning‐point’ dream after five years bears witness to the power of the transforming function performed by the other throughout the analysis, by way of the representation of characters who stand for the necessary presence of a third party in the construction of a personal psychic reality. The author examines the mutual denial of the other’s otherness, as expressed by the vicissitudes of the transference and countertransference between analyst and patient, otherness being experienced as a disturbance of self‐sufficient narcissistic functioning. The paper ends with an analysis of the transformations that took place in the analytic relationship.     

The Relationship Between Counseling Trainee Perfectionism and the Working Alliance With Supervisor and Client

The relationships between perfectionism, counseling self‐efficacy, and the supervisory and client working alliance were investigated among 143 counseling trainees and 46 supervisor–trainee dyads. Maladaptive perfectionism was negatively correlated with the supervisory alliance and working alliance. Counseling self‐efficacy moderated the relationship between adaptive perfectionism and the supervisory alliance (perspective of the counseling trainee) and maladaptive perfectionism and the supervisory alliance (perspective of the supervisor). The authors conclude that supervisors should consider perfectionism and counseling self‐efficacy as important factors in supervision.     

Clinicians’ Attitudes Toward Therapeutic Alliance in E-Therapy

Although therapeutic alliance is a crucial factor in face-to-face therapies, no data exist on clinicians’ attitudes towards alliance in E-therapy. The study explored clinicians’ perceived importance of alliance in E-therapy, clinicians’ confidence in their skills to develop alliance in E-therapy, and whether attitudes towards alliance in E-therapy are associated with intended E-therapy practice. Clinicians (n = 106) responded to an online survey. The majority of clinicians considered alliance to be extremely important in both face-to-face therapy and E-therapy. However, clinicians’ ratings of the importance of alliance in face-to-face therapies were significantly higher than their ratings of the importance of alliance in E-therapy. Clinicians reported less confidence in their skills to develop alliance in E-therapy than in face-to-face therapy. Intended E-therapy practice correlated with confidence in one's ability to develop alliance in E-therapy and with previous E-therapy practice.     

Microaggressions and Perceptions of Cultural Humility in Counseling

The purpose of this study was to explore how microaggressions affect counseling outcomes. Participants were 128 racial/ethnic minority individuals who had been in counseling within the past year. Results indicated that identity attributions were associated with counseling outcomes (i.e., working alliance and perceived improvement in counseling). Furthermore, perceptions of cultural humility mediated the relationship between negative emotion due to rupture and counseling outcomes (i.e., working alliance and perceived improvement in counseling).     

心理咨询中的突然获益：工作同盟及初始症状的影响

对82位当事人在咨询中的症状改变过程进行纵向研究,检验突然获益模式（Sudden Gain, SG）的发生及其与咨询效果的联系,并探索初始症状水平、工作同盟对SG的影响。结果表明,24.93%的当事人经历了SG,咨询效果显著好于其他当事人;SG组与对照组在初始症状水平和总体工作同盟水平上差异显著。结论：SG出现于本土心理咨询中,经历SG的当事人取得了更好的咨询效果,工作同盟与初始症状水平与SG的发生相关。     

The importance of choice in therapy: From the perspective of a,hopefully flexible,CBT practitioner

The main purpose of this paper is to present a personal account of my therapeutic journey and to show how my practice of CBT is informed not only by orientation-specific variables (e.g. emphases on 1) attitude; 2) perpetuation of disturbance as opposed to its acquisition; 3) specificity; 4) the development of client self-help skills; and 5) homework), but by more general, trans-theoretical variables (e.g. rooting therapy in the bonds, views, goals and tasks domains of the working alliance and dealing effectively with threats to this alliance). In doing so, I hope to show that when practised well CBT draws upon general principles that span different therapeutic approaches as well as on ideas specific to CBT.     

Developing the Working Alliance in Marital Therapy; A Psychodynamic Perspective

A good working alliance in marital therapy is one in which the partners are actively collaborating with their therapist to work through conflicts. The therapist begins to develop the alliance by setting the frame of therapy and helping the couple understand the guidelines of treatment. The partners gradually identify with and emulate the therapist's working style and use of self as a reflective instrument. The working alliance can be weakened by empathic failures and strengthened by increased feelings of trust in the therapist and the process of treatment This paper looks at the development of the working alliance in marital therapy from a psychodynamic perspective. A clinical illustration is included.     

Videoconferencing versus face-to-face psychotherapy: Insights from patients and psychotherapists about comparability of therapeutic alliance,empathy and treatment characteristics

Objective

Videoconferencing psychotherapy (VCT) is an effective treatment option. Yet, it is unclear whether a similar therapeutic alliance as in conventional face-to-face psychotherapy (F2F) can be achieved, since previous studies yielded mixed results. Furthermore, surveys about the attitudes towards VCT amongst patients have been missing until now. The current study gathered opinions from patients and psychotherapists about the perceived comparability of VCT and F2F regarding contextual factors and treatment characteristics, focusing on therapeutic alliance and empathy.

Method

An online survey amongst patients (N = 189) and practitioners (N = 57) taking part in cognitive behavioural therapy was conducted after the first lockdown in Germany due to the COVID-19 pandemic and a resulting transition from F2F to VCT for most participants.

Results

While patients experienced therapeutic alliance and empathy as comparable, psychotherapists indicated advantages of F2F. Both groups indicated advantages of F2F for the therapy contents and expressed advantages of VCT for flexibility regarding location and time. More than half of the participants expressed a preference for a combination of analogue and digital therapy.

Conclusion

The perceived disadvantages of VCT can be addressed, for example, with training programmes for psychotherapists targeting communication in VCT and adapting established psychotherapy methods to a digital format to further improve VCT.     

当事人眼里的工作同盟：质的分析

为了解中国当事人如何看待咨询中的工作同盟, 对工作同盟做初步的本土概念化, 采用协商一致的质的研究方法对来自1所大学心理咨询中心的20名当事人的访谈结果进行了分析。结果发现, 与工作同盟相关的域有6个, 分别是情感联结、任务、投入、合作模式、发展变化、影响因素。前三个域可以看作是工作同盟的构成要素, 而后三个域则是对其外部特征的描述。对每个域的含义及其与现有理论和研究的关系进行了讨论。     

工作同盟的结构：基于两种测量工具的检验

以大学心理咨询中心的当事人为样本,对国外两种广泛使用的工作同盟测量工具WAI-S和WAI-SR的结构和测量学指标进行检验。结果发现,WAI-S和WAI-SR的任务一致与目标一致两个维度的相关较高,分别为0.71和0.74;WAI-S和WAI-SR的一因素、二因素和三因素结构均没有得到充分支持;WAI-SR与咨询效果的相关不显著。WAI-S和WAI-SR的结构不能很好反映其所依据的理论假设,提示在对测量工具进行改进的同时,还需要对工作同盟的理论结构进行思考。     

心理咨询中工作同盟的发展模式与咨询效果

为了探索工作同盟在咨询过程中的发展模式, 采用Stiles等(2004)提出的4个变化特征参数(shape-of-change parameters)对30个个案的工作同盟在咨询过程中的发展变化进行描述。聚类分析的结果显示有3类工作同盟的发展模式, 分别是线性增长、线性下降和二次增长模式。不过, 3种发展模式、4个变化特征参数及同盟的破裂?修复片段对咨询效果均没有影响。比较咨询效果不同的当事人在工作同盟发展模式上的差异, 发现同一个发展模式对于不同的个案可能有着不同的含义, 咨询师在早期对同盟关系的处理与调控对咨询效果有着重要的影响。     

Cultural ruptures in short‐term therapy: Working alliance as a mediator between clients' perceptions of microaggressions and therapy outcomes

Aim: To determine whether or not clients' perceptions of microaggressions varied based on their own and the therapist's race/ethnicity and whether or not they would be negatively related to the effectiveness of therapy and if the working alliance would mediate this effect. Method: The study utilised a cross‐sectional, retrospective, methodology. Clients were recruited from a large university counselling centre in the United States (N=232 clients and 29 therapists). Results: Neither clients' race/ethnicity, therapists’ race/ethnicity, nor client‐therapist ethnic matching predicted perceptions of microaggressions. Clients' ratings of microaggressions were negatively associated with their psychological wellbeing; however, this effect was mediated by clients' ratings of the working alliance. Implications: Therapists should take into account the cultural messages they may be conveying to both white and racial/ethnic minority clients. Therapists should develop strategies that are consistent with a general therapeutic approach that promotes discussions about culture with their clients and, most importantly, should attend to the therapeutic relationship.     

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.     

Trainee nondisclosure in supervision: What are they not telling you?

Aims: The purposes of this study were to examine: (1) the content of and reasons for trainee nondisclosure in supervision, and (2) the influence of trainee anxiety and perception of the supervisory working alliance on amount of nondisclosure and willingness to disclose. Method: As the focus of the study was a single supervision session, qualitative and quantitative data were collected from 204 trainees about their most recent supervision session. Results: Within the single supervision session on which they reported, 84.3% of trainees withheld information from their supervisors. Trainees reported an average of 2.68 nondisclosures occurring in the session, with the most common nondisclosure involving a negative supervision experience. Trainee perception of a better supervisory working alliance was related to less nondisclosure and greater overall willingness to disclose in supervision. Higher trainee anxiety was related to greater nondisclosure and lower overall willingness to disclose in supervision. Implications: The implications of the findings for the practice of supervision are discussed and areas for further research are suggested.     

Recording supervision: Educational,therapeutic, and enhances the supervisory working alliance?

Aims: To explore the impact of listening to an audio‐recording of their latest supervision session on supervisees. Method: Participants recorded a supervision session, listened to it and were interviewed about this experience of listening to it within seven days of listening to the recording. The phenomenological interviews informed by the researcher's knowledge were analysed using grounded theory. Participants: Fifteen participants with 0–20 years’ experience, representing person‐centred, CBT, psychodynamic and integrative approaches, and qualifications ranging from student to doctorate formed the theoretical sample. Findings: Listening to the audio‐recording allowed participants to re‐experience their thoughts and emotions. Participants recalled and re‐experienced events which had been forgotten, unnoticed or (arguably) repressed. This re‐experiencing was usually less emotive than in real‐time; but suppressed emotions could be more intense. As participants integrated both these noticed and unnoticed events, they were able to accept what had been unacceptable, gaining self‐awareness, which was potentially therapeutic. Noticing what had been unnoticed permitted insights into many aspects of therapy and supervision, which was more than just ‘reflection‐on‐action’. Conclusion: Listening to an audio‐recording of the latest supervision may be educational for any supervisee; it may be therapeutic by facilitating challenge of maladaptive beliefs and behaviours; and it also seems to strengthen the supervisory working alliance.     

阅读进度反馈信息对工作同盟和咨询效果的影响

进度反馈指将对当事人的标准化测量结果和解释反馈给咨询师的干预, 其目的在于矫正咨询师对咨询效果主观评估的偏差, 提高咨询效果。考虑到咨询师和当事人“面对面”的标准反馈程序不符合我国社会文化习惯, 采用多层结构方程模型, 分析了自然情境下非“面对面”的进度反馈对工作同盟和咨询效果的影响。结果发现, 在组间水平, 反馈组的工作同盟质量更好; 在组内水平, 工作同盟与症状是相互预测的关系。在结案时, 反馈组在抑郁症状和咨询的有帮助性上效果更好。结论是进度反馈对工作同盟和咨询效果有积极影响。研究从工作同盟和中国人的关系角度拓展了对进度反馈作用机制的认识, 为进度反馈的应用提供了基于实践干预有效的证据。     

One-to-one support for crisis intervention using online synchronous instant messaging: evaluating working alliance and client satisfaction

Young people are increasingly turning to online support, especially when traditional mental health services are not immediately available. Using a cross-sectional design, sociodemographic information and self-reported perceptions of the strength of the working alliance and client satisfaction were collected from a sample of participants (n = 78) who were users of a service providing free online support using synchronous instant messaging. The results reported a significant positive relationship between the strength of the working alliance and client satisfaction, suggesting that the strength of the working alliance remains a key component in counselling, even online. Participants, however, scored significantly lower on both the strength of the working alliance and client satisfaction, compared to participants in offline settings as reported in past studies.     

Bearing the unbearable: ancestral transmission through dreams and moving metaphors in the analtyic field

Abstract: This paper explores how untold and unresolved intergenerational trauma may be transmitted through unconscious channels of communication, manifesting in the dreams of descendants. Unwitting carriers for that which was too horrific for their ancestors to bear, descendants may enter analysis through an unconscious need to uncover past secrets, piece together ancestral histories before the keys to comprehending their terrible inheritance die with their forebears. They seek the relational containment of the analytic relationship to provide psychological conditions to bear the unbearable, know the unknowable, speak the unspeakable and redeem the unredeemable. In the case of ‘Rachael’, initial dreams gave rise to what Hobson (1984) called ‘moving metaphors of self’ in the analytic field. Dream imagery, projective and introjective processes in the transference‐countertransference dynamics gradually revealed an unknown ancestral history. I clarify the back and forth process from dream to waking dream thoughts to moving metaphors and differentiate the moving metaphor from a living symbol. I argue that the containment of the analytic relationship nested within the security of the analytic space is a necessary precondition for such healing processes to occur.