Is touch a valid therapeutic intervention? Early returns from a qualitative study of therapists' views

Findings are reported from six semi‐structured interviews with experienced psychotherapists, focusing on the reasons for using touch and the sort of touch used. They suggest that there is a distinction being made by therapists between ‘social space’ and ‘therapeutic space’, and a different view of touch taken if it is judged by the therapist to be ‘out of the therapeutic environment’. Whether or not touch was initiated by the therapist or the client would also appear to influence its further discussion by the therapist, either in processing it with the client or in supervision. What also emerged from the interviews was the finding that an exploration of touch in supervision was unusual. The implications for practice, supervision and training are discussed as areas for further exploration in the main survey, which will be conducted in the second year of the research.     

Sexuality,Intimacy, and Recovery

Human sexuality is an inseparable part of the yearning for intimacy, merging, and touch, both for people in general and for those with severe mental disorders. The exploration and acceptance of sexuality and the yearning for intimacy are vital to the recovery process of people with severe mental disorders. Despite this importance, therapists appear to disregard sexual issues in therapy with people with severe mental disorders. This article discusses the sexuality difficulties of these patients resulting from their personal history and examines the difficulties of therapists and therapeutic institutions in dealing with these patients’ sexuality-related issues.     

Ethical considerations in the use of nonerotic touch in psychotherapy with children

Although touch frequently occurs in psychotherapy with children, there is little written on the ethical considerations of therapeutic touch. Because physical contact does occur, therapists must consider if, how, and when it is used, for both their clients' safety and their own. In this review, I further develop the issues suggested by Aquino and Lee (2000) in the use of nurturing touch in therapy by considering many types of touch that occur in psychotherapy with children; the possible positive role of touch; clients' perception of touch in therapy; considerations related to the therapist, the child's safety, and any history of abuse in the child's and family's background; and other practical considerations. I list guidelines.     

“I’ve got you under my skin”: Relational therapists’ experiences of patients who occupy their inner world

The aim of this study was to conduct an in-depth exploration of therapists’ experiences of patients who affect them more than others and occupy their inner world beyond the context of therapy sessions. A phenomenological analysis was performed on semi-structured interviews with five relational therapists. All the therapists had a strong experience of a particular patient getting “under their skin.” In all these cases, the patient was a traumatized woman. The distinctive characteristic of the phenomenon was a sense of blurred or too permeable boundaries between the therapist and the patient. This was associated with fear and anxiety, but also with feelings of love. The therapists’ reactions to having a patient “under their skin” varied from resistance to symbiotic relatedness. The therapists’ ideas of their professional role influenced how the experience of carrying the patient’s suffering was interpreted. The phenomenon of the patient’s presence in the therapist’s representational world might be interpreted as a distinct countertransference phenomenon when working in a more “thin boundary” manner with particular cases. The therapists’ ability to effectively manage their vulnerabilities, activated in the countertransference, seems to be crucial for therapeutic progress. Implications for research, clinical practice, and training are discussed.     

Opioid Substance Abuse Among Occupational Therapy Clients

This study examined opioid substance abuse among clients of occupational therapists. A sample of 500 occupational therapists, representing five targeted clinical practice areas, was randomly selected from American Occupational Therapy Association membership. Of these, a total of 182 participants ultimately responded to postal surveys. Results found one third considered opioid substance abuse a problem at their facility, and over half reported having one or more clients known to be or suspected of abusing opioids. Moreover, one in five reported having a client exhibit symptoms of overdose. Recommendations for a concerted response by the profession of occupational therapy to this nationwide epidemic are presented.     

The experiences of therapists using a new client‐centred psychometric instrument,PSYCHLOPS (Psychological Outcome Profiles)

PSYCHLOPS (‘Psychological Outcome Profiles’) is a newly developed client‐generated psychometric instrument which can be used as an outcome measure. Uniquely, it asks clients to state their own problems, in their own words. As part of its validation, we used it alongside an existing measure, CORE‐OM (‘Clinical Outcomes Routine Evaluation – Outcome Measure’). Based on a qualitative methodology, we report here on the first‐hand experiences of four therapists using both instruments. The key themes that emerged from therapists’ responses were feasibility, validity and usefulness. Both questionnaires were perceived as complementing each other, the qualitative information from PSYCHLOPS balancing the quantitative information from CORE‐OM and that both could contribute to the therapist‐client interaction. The key features of PSYCHLOPS are likely to prove attractive to therapists and should increase acceptance and uptake of outcome measures.     

Experiences of Countertransference: Reports of Clinical Psychology Students

While historically linked with psychoanalysis, countertransference is recognised as an important component of the experience of therapists, regardless of the therapeutic modality. This study considers the implications of this for the training of psychologists. Fifty‐five clinical psychology trainees from four university training programmes completed an anonymous questionnaire that collected written reports of countertransference experiences, ratings of confidence in managing these responses, and supervision in this regard. The reports were analysed using a process of thematic analysis. Several themes emerged including a desire to protect or rescue clients, feeling criticised or controlled by clients, feeling helpless, and feeling disengaged. Trainees varied in their reports of awareness of countertransference and the regularity of supervision in this regard. The majority reported a lack of confidence in managing their responses, and all reported interest in learning about countertransference. The implications for reflective practice in postgraduate psychology training are discussed.     

An Inter-Rater Reliability Study of Parental Alienation Syndrome

The dual purpose of this study was to first test the acceptance of the concept of parental alienation among therapists, and secondly, to assess the validity of parental alienation as a syndrome among therapists who are familiar with this phenomenon. The study measured the independent variable, symptoms of parental alienation syndrome, and the dependent variable, therapists' perception of the syndrome.

The respondents analyzed five cases using Dr. Richard Gardner's differential diagnosis chart built into a questionnaire for the potential alienator and the child. For the measurements of reliability and inter-rater reliability, the researcher used Microsoft Excel and Kendall's coefficient of concordance.

The findings showed a significant level of concordance among raters in all five cases except in Case 2, where there was a lower consensus on the presence of parental alienation syndrome or meeting Dr. Gardner's criteria due to the complexity of the case presentation. Similarly, findings also reflect the relatively recent discovery of this phenomenon, evidenced by some level of apathy from the general population of therapists to get involved.

The completed surveys were from therapists familiar with parental alienation syndrome, which indicated their level of understanding of the phenomena and how their views differed from other therapists who were unfamiliar with PAS. The data gathered from the completed surveys was sufficiently reliable to suggest a wider study for the purpose of classification in the next edition of the DSM.     

The effects of clinical supervision on supervisees and patients in cognitive behavioral therapy: a systematic review

Clinical supervision is a central part of psychotherapist training but the empirical support for specific supervision theories or features is unclear. The aims of this study were to systematically review the empirical research literature regarding the effects of clinical supervision on therapists’ competences and clinical outcomes within Cognitive Behavior Therapy (CBT). A comprehensive database search resulted in 4103 identified publications. Of these, 133 were scrutinized and in the end 5 studies were included in the review for data synthesis. The five studies were heterogeneous in scope and quality and only one provided firm empirical support for the positive effects of clinical supervision on therapists’ competence. The remaining four studies suffered from methodological weaknesses, but provided some preliminary support that clinical supervision may be beneficiary for novice therapists. No study could show benefits from supervision for patients. The research literature suggests that clinical supervision may have some potential effects on novice therapists’ competence compared to no supervision but the effects on clinical outcomes are still unclear. While bug-in-the-eye live supervision may be more effective than standard delayed supervision, the effects of specific supervision models or features are also unclear. There is a continued need for high-quality empirical studies on the effects of clinical supervision in psychotherapy.     

Therapists' Use of DBT: A Survey Study of Clinical Practice

The purpose of this study was to examine how therapists conduct Dialectical Behavior Therapy (DBT) individual psychotherapy with clients, focusing on clinical factors that could account for decisions regarding modifications of DBT (e.g., client diagnosis, therapist theoretical orientation, and intensity of DBT training). Additionally, the study investigated how therapists integrate DBT into their primary approach to therapy. Greater adherence to the DBT protocol was reported by therapists who described using DBT with a client with a diagnosis of borderline personality disorder. More frequent use of DBT components (i.e., group skills training, consultation teams, and telephone consultation) was reported by therapists who viewed their therapy as being guided by an applied behavior analysis/radical behavioral theoretical orientation and by therapists who had received intensive DBT training. Most therapists reported using DBT skills in their non-DBT work, with non-cognitive-behavioral therapists more likely to introduce mindfulness skills.     

Therapists’ and clients’ perceptions of routine outcome measurement in the NHS: A qualitative study

Primary objective: This is the first qualitative study that elicited the perceptions of both psychological therapists and their clients in the use of Clinical Outcomes in Routine Evaluation with computer software (CORE‐Net), where instant visual feedback for session tracking was given on a computer screen in the therapy room at each therapy session. The study also examined how therapists viewed its potential value in supervision and provides suggestions for improving training. Research design: The study adopted a convenience sample of four therapists in a primary care counselling setting (PCC – General Practitioner referrals) who were experienced in using CORE‐Net, and five therapists in an NHS employee/occupational support counselling service (OH) who had just begun to use CORE‐Net for session tracking with 10 of their clients. Method: A qualitative methodology was used and interview data were collected from the therapists via focus groups; the clients were interviewed individually face to face. All data was analysed inductively. Findings: The study identified six overarching themes: (i) therapists were initially anxious and resistant; (ii) therapists adapt ‘creatively’; (iii) outcome measures help the client/therapist relationship; (iv) clients perceive visual measures as helpful; (v) CORE scores inform supervision; and (vi) proper and ongoing training/support of therapists is necessary. The main limitations are comparability of data and the generalisabilty of results. Conclusions: The implementation of routine outcome measurement (ROM) is a challenge but can be made easier with proper training and supervision. Clients appear happier than their therapists when routine outcome measurement is used.     

The use of altruism and forgiveness in therapy

This study investigates the relative likelihood of psychotherapists promoting altruism and forgiveness as therapeutic agents as compared with other techniques. One hundred and five therapists were asked to rate the relative likelihood of fostering altruism, forgiveness, direct expression of feelings, vicarious ventilation of feelings, and self-reinforcement in response to treating four presenting problems where a fictitious client had been hurt by another. Results indicated that, for the most part, altruism and forgiveness were likely to be promoted significantly less often than the other three therapeutic alternatives by the therapists sampled. The association of altruism and forgiveness with religious values and their disassociation from selftheory are posited as possible explanations for the findings.     

Suicide of a Patient: Gender Differences in Bereavement Reactions of Therapists

Emotional reactions of therapists who experienced the death by suicide of one or more of their patients were investigated. Data were collected by a questionnaire containing both objective and open-ended items from 27 men and 36 women, psychiatrists and psychologists, working in psychiatric hospitals in Slovenia. The most frequently reported reactions by the therapists were of increased caution in the treatment of their patients and an increase in conferring with colleagues, partners, and supervisors. About two thirds reported experiencing strong guilt feelings along with other commonly reported survivor feelings of grief, depression, and loss. Gender differences were apparent (women more often felt shame and guilt, sought consolation, or doubted their professional knowledge). No significant differences appeared between disciplines and years of work experience. Agreement was general that support was important both professionally and personally. Suggestions are offered to help the therapist work through the trauma of a patient's suicide.     

Questioning the “Slippery Slope”: Ethical Beliefs and Behaviors of Private Office-Based and Church-Based Therapists

Counselors and other mental health professionals whose primary office is in a church building often face unique challenges in maintaining appropriate client-therapist boundaries. A sample of 497 Christian counselors responded to an 88-item survey of their ethical beliefs and behaviors. Of the respondents, 148 reported a church as their primary work setting and 162 reported a private office as their primary work setting. Survey results were factor analyzed, then church-based therapists were compared with private office-based therapists regarding their views of ethical behaviors. Although church-based therapists take greater liberties with multiple-role relationships than private office-based therapists, they appear similar with regard to other ethical beliefs and behaviors. Results suggest that church-based therapists who take liberties in nonsexual multiple-role relationships are no more likely than other therapists to violate other ethical standards.     

消费者触摸渴望的形成机制解析——基于认知体验视角

对消费者触摸渴望形成机制的探讨, 有利于线上和线下企业制定如何补偿和满足消费者触摸渴望的营销战略。迄今, 关于消费者触摸渴望形成机制的探讨主要从信息加工视角、动机视角、决策视角以及先天观视角着手。但这些视角均不能解释为何同一消费者在不同认知体验下在触摸行为反应上的差异。本文提出个人控制受威胁感这一认知体验是消费者触摸渴望形成的前因变量。具体而言, 本文发现, 个人控制受威胁感这一负性认知体验会导致消费者触摸渴望的增加, 内在机制是为了满足对环境的控制需求(实验1, 2)。本文进一步发现, 当强化消费者的自我价值后, 他们对环境的控制需求下降了, 因此消费者的触摸渴望将不再受个人控制受威胁感的影响(实验3)。最后, 本文还发现, 强化自我价值对个人控制受威胁感与消费者触摸渴望间关系的调节作用仅在高自尊者(vs.低自尊者)身上出现(实验4)。论文结尾讨论了本文所关注的个人控制受威胁感这一认知体验视角对已有触觉研究、已有个人控制感研究等的理论贡献。     

Contents: Volume 29

This paper describes our experience in treating nearly 200 eating disordered patients ages eleven to thirty-five in five ongoing, open groups combining inpatients and outpatients. A limited outcome study of 121 patients who attended group regularly is presented. Guidelines are offered for group formation, referral to group, function of the therapists, group themes, and management of specific problems arising during the group. Our experience suggests broader applicability of group treatment for eating disorders than previously reported. The age and developmental level of the patient is a more important consideration in group placement than the nature or severity of their eating disorder. More vigorous and longer term follow-up studies are necessary to determine the lasting benefits of group psychotherapy for this patient population.     

RELATIONAL MESSAGES ASSOCIATED WITH NONVERBAL BEHAVIORS

Based on the assumptions that relational messages are multidimensional and that they are frequently communicated by nonverbal cues, this experiment manipulated five nonverbal cues -eye contact, proximity, body lean, smiling, and touch - to determine what meanings they convey along four relational message dimensions. Subjects (N= 150) observed 2 out of 40 videotaped conversational segments in which a male-female dyad presented various combinations of the nonverbal cues. High eye contact, close proximity, forward body lean, and smiling all conveyed greater intimacy, attraction, and trust. Low eye contact, a distal position, backward body lean, and the absence of smiling and touch communicated greater detachment. High eye contact, close proximity, and smiling also communicated less emotional arousal and greater composure, while high eye contact and close proximity alone conveyed greater dominance and control. Effects of combinations of cues and sex-differences are also reported.     

Adolescent Patients’ Responses to Interpretations Focused on Endings in Short-Term Psychoanalytic Psychotherapy

Discussing endings is a crucial part of the work of short-term psychoanalytic psychotherapy with adolescents, but there are different views on how best this should be done and whether it is helpful or appropriate to link endings to interpretations of the transference. This study looks at how adolescent patients suffering from moderate to severe depression respond to interpretations around endings in a 28-session long, manualized psychoanalytic psychotherapy. Data come from a randomized clinical trial in which all sessions were audio-recorded. Purposive sampling was used to identify four sessions with four different adolescents in which therapists raised the issue of upcoming endings, explored the patients’ emotional responses, and linked these to the transference. The four extracts were transcribed and analysed using conversation analysis. Findings show that patients either emphasized or diminished the importance of their relationship to the therapists and the consequences of the separation from them in response to transference interpretations. They managed the conversational exchange by either “trouble-telling” or “story-telling.” The authors reflect on the implication of patients’ responses for treatment technique and consider whether transference work with adolescents should be paced and adapted more flexibly in short term psychoanalytic psychotherapy.     

Psychotherapy across languages: beliefs,attitudes and practices of monolingual and multilingual therapists with their multilingual patients

Aims: The present study investigates beliefs, attitudes and practices of 101 monolingual and multilingual therapists in their interactions with multilingual patients. Method: A mixed‐method approach was adopted using an online questionnaire with closed questions, and informed questions in interviews with one monolingual and two multilingual therapists. Results: A principal component analysis yielded a four‐factor solution accounting for 41% of the variance. The first dimension, which explained 17% of variance, reflects therapists' attunement towards their bilingual patients (attunement versus collusion). Further analysis showed that the 18 monolingual therapists differed significantly from their 83 bi‐ or multilingual peers on this dimension. The follow‐up interviews confirmed this result. Discussion: Recommendations based on these findings are made for psychotherapy training and supervision.     

The use and abuse of touch in therapy and counselling

Sexual exploitation within therapy is founded upon inappropriate physical contact. Yet the use of touch in therapy remains a contentious issue. Some therapists purport that touch is a primary source of communication of which many clients, as children, were deprived. They argue that refraining from the appropriate use of touch in the counselling situation can be damaging to the client. This article considers the argument for the use of physical contact in therapy and counselling and its potential therapeutic value.