Emotions in solution-focused therapy: a re-examination

This article re-examines whether and how emotions are an aspect of solution-focused therapy. A major theme in the article focuses on the usual ways that therapists define and discuss emotions in solution-focused and other therapies. We argue that these discussions are a source of much confusion about emotions and about solution-focused therapy, including the confusing idea that emotions are neglected in solution-focused therapy. The second major theme describes an alternative approach to these issues, one that we believe better fits with the assumptions and concerns of solution-focused therapy. The approach is based on Wittgenstein's writings about language games, private experience, and how emotions are rule-following activities. Viewed from this perspective, solution-focused therapists take account of their clients' emotions by helping clients to create new emotion rules to follow.     

Solution-Focused Brief Therapy

A brief history on Solution-Focused Brief Therapy is given, followed by pragmatic assumptions, offering a new ‘lens’ for looking at clients. SFBT originated from social constructionism: reality is subjective and there are many realities, all equally correct. Outcome studies indicate that SFBT has a positive effect in less time and satisfies the client’s need for autonomy. Indications and differences between problem-focused psychotherapy and SFBT are outlined. SFBT can be seen as a form of cognitive behavior therapy. Instead of reducing problems, the solution-focused question is: ‘What would you rather have instead?’ A lot could change for the better for both clients and therapists.     

Making the case for using personalised outcome measures to track progress in psychotherapy

The practice-based evidence movement has become increasingly influential in the practice of counselling. One element of this approach is the recommendation that therapists regularly administer standardised or nomothetic measures to track the progress made by their clients. When this feedback indicates that therapy is off course (i.e. out of kilter with the projected course of effective treatment) therapists are alerted to the risks of potential dropout and encouraged to take some form of corrective action. Despite an expanding evidence base supporting this strategy for improving psychotherapeutic outcomes, there are also concerns that the generic measures adopted do not always possess the specificity and sensitivity required to capture the unique experiences of individual clients. The paper argues that personalised or idiographic assessments can be designed to match the language and priorities of individual clients and so provide a more nuanced measure with which to track the course of therapy and promote informed reflective conversations between client and clinician on when and whether a change in direction is needed. However the idiographic alternative is not an easy option and practical as well as theoretical challenges in adopting this approach to monitoring treatment outcomes are acknowledged and discussed. Finally the virtue of using a strategy that combines nomothetic and idiographic measures is considered.     

Honoring Protective Responses: Reframing Resistance in Therapy Using Polyvagal Theory

Therapists often conceptualize resistance as client behaviors that impede progress; this perspective threatens the therapeutic alliance, especially in couple and family therapy where increased resistance and multiple alliances are present. Polyvagal theory reframes and normalizes resistant behaviors as preconscious, protective responses emerging from our autonomic nervous system. The theory also explains how humans reciprocate safety cues to connect with each other; therapists can use concepts of polyvagal theory to manage their own emotional regulation and foster safety and connection in therapy. Polyvagal concepts deepen our understanding of protective behaviors presenting in couple and family therapy; therapists can help couple and family clients to recognize protective behaviors in their own relationships and facilitate safer connection and engagement. Clinical implications are presented: psychoeducation can help clients normalize and understand their protective processes; therapist presence and immediacy acknowledges and normalizes protective behaviors as they arise; therapist and client self-regulation skills support connection; therapist genuineness is a precondition to client safety; and understanding of polyvagal theory enhances assessment of conflict and enactments in couple and family therapy.

     

Vivid RET II: Disputing methods

Summary In this article, I have outlined a variety of ways in which therapists can make the disputing process more vivid and memorable for clients. I have underlined that tailoring interventions to fit clients' idiosyncracies is most important and have suggested ways of doing this. The point was made that what might work for one client may very well not work for another. In conclusion, I would encourage therapists to adopt an experimental attitude toward their interventions and to continually monitor the effect of them by requesting feedback from clients as Beck et. al. (1979) advocate. This would help therapists to construct, for each client, a profile of the types of disputing tactics that are effective and the types that prove ineffective.     

Just for Women? Feminist Multicultural Therapy with Male Clients

Feminist multicultural therapy is an integrative approach to psychotherapy that emphasizes a systems-level understanding of psychological distress and the process of therapeutic change. In the present exploratory study, the experiences of feminist multicultural therapists working with male clients were studied using Consensual Qualitative Research (CQR) (Hill et al. 1997). Phone interviews were conducted with eight female practicing licensed or license-eligible therapists who had worked with at least one male client in the past 6 months. Consistent with the theoretical approach, all of the therapists interviewed expressed their belief that psychological symptoms can be seen as a reaction to a loss of power or related to the effects of an oppressive system. Additionally, the therapists believed that this theoretical model is broad enough to be used with varying types of intersecting social identities. The findings illustrate the ways in which the counseling approach may work similarly across genders, as well as ways in which one’s therapeutic approach may be altered when working specifically with men. Implications for therapists who work with male clients (both the rewards and the challenges) as well as for researchers who wish to study the application of therapeutic interventions with men are discussed.     

正式反馈的发展与临床应用

摘要:正式反馈通过系统收集当事人的效果反馈来追踪其治疗进展,进而识别缺乏治疗进展的个案,并通过促进治疗策略的调整来阻止治疗失败。正式反馈是近20年来发展出的一种循证治疗手段,其目的为进一步提高当事人的咨询效果。正式反馈的发展大致经历了临床有效性检验和实用性发展两个阶段。正式反馈可用于促进个体、夫妻和团体咨询的效果,也可用于评估临床督导效果、确定督导个案和指导临床督导。未来研究可探讨咨询师对待正式反馈的态度,拓展正式反馈的使用价值,建立正式反馈系统的本土化常模。     

The Contributing Factors of Change in a Therapeutic Process

The clients’ and therapists’ perceptions about the degree to which each of four common factors in therapy—extra-therapeutic factors; model/techniques; therapeutic alliance; and hope/expectancy—contribute to change in the therapeutic process were investigated in this study. In addition, the perceptions about the percentage of change attributed to clients and therapists were also explored. Results revealed that the therapists and clients have different perceptions on what factors contribute the most to change and that clients and therapists believe that the client contributes the most to change in a therapeutic process.M. L. Thomas, MSW, is a doctoral student in Marriage and Family Therapy at Florida State University.     

Ambivalence and Alliance Ruptures in Cognitive Behavioral Therapy for Generalized Anxiety

Client ambivalence about change (or motivation) is regarded as central to outcomes in cognitive behavioral therapy (CBT). However, little research has been conducted to examine the impact of client ambivalence about change on therapy process variables such as the therapeutic alliance. Given the demonstrated limitations of self-report measures of key constructs such as ambivalence and motivation, the present study instead employed a newly adapted observational measure of client ambivalence. Client statements regarding change (change talk (CT) and counter-change talk (CCT)) were coded in early (session 1 or 2) therapy sessions of CBT for generalized anxiety disorder. The frequency of CT and CCT was then compared between clients who later experienced an alliance rupture with their therapist, and clients who did not. The results showed that clients in dyads who later experienced an alliance rupture expressed significantly more CCT at the outset of therapy than clients who did not later experience an alliance rupture. However, CT utterances did not significantly differ between alliance rupture and no-rupture groups. CCT may strain the alliance because clients expressing higher levels of CCT early in therapy may be less receptive to therapist direction in CBT. Consequently, it is recommended that clients and therapists work together to carefully address these key moments in therapy so as to prevent alliance rupture and preserve client engagement in therapy.     

Ontological and epistemological reflexivity: A core skill for therapists

This paper argues that a core skill needed to be an effective therapist is to have developed an awareness of one's own ontological and epistemological positions in relation to one's work as a therapist. In the same way that researchers need to develop reflexive awareness of their assumptions about what there is to know (ontology) and how they can come to know about it (epistemology), therapists need to be aware of their fundamental assumptions about human beings and the world they live in (ontology), as well as their beliefs about how best to develop an understanding of their clients and the meaning(s) of their experiences (epistemology). Regardless of which therapeutic model is adopted, the language used to talk about (and in) therapy, the kinds of questions asked of clients and the comments/interpretations offered, all presuppose and reinforce particular versions of human being and experiencing, which are themselves not usually questioned or challenged during the course of therapy. It is essential that therapists are aware of their own fundamental assumptions about what it means to be human and that they recognise their ontological and epistemological positions as positions that they are taking (rather than perceiving them to be self‐evident truths). This is important for two reasons: (a) if clients do not share the therapist's assumptions, the therapeutic work cannot proceed and be effective; and (b) without such an awareness, therapists are at risk of unwittingly imposing their own model of the person upon the client which raises ethical issues.     

Real relationship,working alliance,transference/countertransference and outcome in time-limited counseling and psychotherapy

Six client/therapist dyads (three therapists each working with two clients) were studied to determine how the real relationship unfolds over the course of time-limited treatment and how this unfolding relates to the development of the client/therapist working alliance, client transference, and therapist countertransference. We also examined how these indices of the relationship fluctuate as a function of treatment outcome. Results indicate that in general for all six dyads, therapists’ and clients’ ratings of the real relationship and working alliance were strong throughout treatment. However, patterns of real relationship and working alliance over the course of treatment varied between dyads categorized as more vs. less successful. Therapists’ countertransference was low, as was client transference, but differences in ratings were evident when the dyads were classified by outcome.     

Death of a Clinician: The Personal, Practical and Clinical Implications of Therapist Mortality

Death is inevitable and yet in US culture the discussion of death is somewhat taboo. Marriage and Family therapists are trained in the implications of grief and loss for clients who lose loved ones and yet examination of the impact of therapist mortality on clients is lacking in the clinical literature. This article examines ways that private practice therapists can both protect their client’s confidentiality and mitigate the impact of therapist sudden death on their clients with planning and forethought. In addition, the factors influencing the lack of empirical research on this topic is discussed in the context of social mores on death and how therapists’ own denial of mortality may impact their ability to connect with clients through the pain of grief and loss. Recommendations are made for therapists to evaluate their own attitudes towards mortality and develop a plan for client care in the event of their death.     

The Value of Curiosity and Naiveté for the Cross-Cultural Psychotherapist

Therapists today face a dramatic increase in the cultural diversity of their client populations. Cultural literacy, long the dominant model for preparing to do cross-cultural therapy, advocates study of the prospective client's history and culture. This model, however, poses logistical problems, emphasizes scholarship over the experiential and phenomenological, and risks seeing clients as their culture and not as themselves. In this essay, we argue that teaching culture alone can obscure therapists’ view of human diversity. To balance the cognitive model of preparation, a process-oriented approach is considered, whereby the therapists’ attitudes of cultural naiveté and respectful curiosity are given equal importance to knowledge and skill. We begin from a concern with clients’ vulnerability in the power distribution that inevitably exists in therapy, especially with immigrant and marginalized populations. The use of acculturation narratives, which the therapist explores with naiveté and curiosity, helps clients to find their voices.     

A Both-And Approach: An Application of Narrative Interventions from a Modern Perspective

A contentious debate between the modern and postmodern epistemologies continue to wage on since the rise of constructivism and social constructionism in the 1990s. This debate has led to both modern and postmodernists falling into an either/or mindset. Others have proposed a solution, the both-and approach, that emphasizes integration of different therapeutic camps. Intentionality is a core component of this approach, as therapists must understand how employed interventions flow from the epistemology and theoretical orientation under which they operate. Another core component of this approach is tailoring the integration to the specific context of the client case. With this understanding and tailoring, therapists can utilize methods across the modern/postmodern divide, as they will coherently flow from their original epistemology and theoretical orientation. Applying methods from both modernism and postmodernism, then, enhances therapists’ therapeutic repertoire, allowing for more opportunities to adapt treatment to each client case. Altogether, the quality of services improve and the amount of clients therapists can help increases as well. This paper will provide an application of the both-and approach to a case study to provide an example of how the said method can be employed in therapy.

     

Managing Emotional Responses in Therapy: An Adapted EFT Supervision Approach

Therapists often encounter experiences in therapy that elicit emotionality, this could be in the form of self-of-the-therapist issues, compassion fatigue, or professional burnout. Whereas approaches to supervision for self-of-the-therapist issues recognize the need for accessing the supervisee’s emotionality, approaches have not focused on how the clinical and professional system could also be part of the cycle. We propose an adapted emotionally focused supervision approach that employs steps one through six of the EFT model. To display how this approach would work, we provide the example of work with longer-term clients. Working with longer-term clients can be a challenge for many therapists, and both the professional and client system come with factors increasing emotional risk to the therapist. Engaging the therapist’s emotionality through supervision has the potential to improve therapeutic outcomes, as well as reduce loss of good therapists in the field to professional burnout.     

A discourse analysis of power in relation to PSYCHLOPS (Psychological outcome profiles) in the context of CBT for psychosis

Aims: Outcome measures (OMs) and routine change measurement have developed dramatically in psychological therapies over the last two decades and some therapists have expressed concerns that this, depending on how it is handled by the parties involved, can markedly affect the therapy. However, little research has investigated this. It therefore seemed timely to explore discourses of OMs drawn upon by both parties in the therapy room. Method: PSYCHLOPS (Psychological Outcome Profiles) is a client‐centred measure which offered an opportunity to explore how therapists and clients receiving CBT for psychosis talked about OMs. A useful contrast was provided by the CORE‐OM (Clinical Outcomes in Routine Evaluation‐Outcome Measure). The discourses drawn upon by clients (n=4) and therapists (n=4) were analysed, informed by a Foucaultian framework. Results: OMs were constructed as empowering or disempowering of clients, as being able to do therapeutic work of engagement and containment, and as part of the apparatus of service power, positioning therapists as relatively powerless to question their use. Discussion: It is suggested that client‐centred measures like PSYCHLOPS, although partly aligned with a recovery framework, may become part of top‐down state and service power, and there is a need for more research into the different ways in which OMs are used in therapy and the impacts on therapists, clients and their relationships.     

Therapist Grief and Functional Analytic Psychotherapy: Strategic Self-Disclosure of Personal Loss

Functional Analytic Psychotherapy (FAP), a behavioral approach that focuses on the development of genuine and meaningful therapeutic relationships including the strategic use of disclosure, provides a framework for therapist self-disclosure during times of personal loss. This article briefly outlines FAP and provides an example of FAP in practice following the death of the first author’s mother. Qualitative data from a client questionnaire on the impact of this disclosure are presented, which suggest that the disclosure was a positive experience for most but not all clients. The article concludes with clinical guidelines that can enhance therapeutic effectiveness whether or not therapists choose to disclose loss to their clients and general precautions for treading in this emotionally intense territory.     

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.     

Therapieverläufe von Sexualstraftätern

Throughout the past decades evaluation studies on sexual offender treatment have led to controversies. While numerous studies examined the effectiveness of different interventions, the possible underlying mediating mechanisms have largely been neglected. This study took a multimethod approach to investigate the measurability of change processes in sexual offenders serving a sentence in the social therapeutic institution (SothA) of the detention center in Tegel, Germany (n?=?105). A longitudinal design with three groups (i.e. waiting group, treatment group and day release group) from four perspectives on change processes (i.e. external criminal prognostic assessment, therapists’ view, staff observation and clients’ perspective) was employed. Most criminal prognostic risk and protective factors improved over the course of treatment and this effect was smallest in the waiting group. While therapists reported increased therapeutic constraints in the course of treatment, they were more favorable in the criminal prognosis and detected more differentiated patterns of needs and resources of clients as conceptualized by the primary and secondary assets of the good lives model (GLM). In contrast, during the course of treatment the sexual offenders showed an increased awareness of the criminogenically relevant problems in the sexual domain. Nonetheless, the overall number of problems they identified as criminogenically relevant decreased. The internal problem attribution in the sense of internal causes (“It is my fault”) and capability of change (“Only I can solve the problem”) was increased. The stronger the clients’ perception of own problems in the sexual context increased over the course of treatment, the more positive the change in the staff’s view of their behavior became and the more their dynamic risk factors improved. Overall, this study found strong evidence that change processes in SothA might already be detectable during ongoing social treatment. It is currently uncertain whether these changes influence future recidivism. A comparison with recidivism data is necessary and in planning.