Psychotische übertragung

The paper examines the problems concerning psychotic transference that are discussed controversially, including what are the structural and dynamic features, what is the significance for the therapeutic process and what importance is placed on working through psychotic transference.     

Counselling students' views and concerns about weeping with clients: A pilot study

This study examines counselling students' concerns and views about a phenomenon that has received little attention in the counselling literature: the counsellor weeping during a session with a client. Over 20 per cent of the counselling students who were surveyed reported being concerned about weeping in session with clients. However, the majority of students believed, to varying degrees, that weeping with clients could facilitate the therapeutic process. This paper sheds light on this unexplored dimension of countertransference, and has implications for those involved in providing counsellor training.     

Outcomes in clients transitioning from in-person counselling to telehealth counselling with trainees

The onset of the 2020 COVID-19 pandemic necessitated a rapid transition of mental health services from in-person to telehealth counselling. Despite the far-reaching impact of this transition, we know little about the impact of this transition on outcomes for clients working with counsellor trainees. The present study utilised longitudinal data collected from a counselling training centre at a major U.S. university to compare client ratings of depression, anxiety and working alliance across 1) in-person services delivered (i.e. pre-pandemic) and 2) telehealth services delivered after the pandemic began (i.e. intra-pandemic) among the same group of clients. Results support our hypothesis that changes in clients' self-reports would be generally equivalent across in-person and telehealth services. Depression and anxiety symptoms decreased, and working alliance tended to increase during both in-person and telehealth care; however, these trends were only statistically significant during telehealth services. Limitations related to sample size (N = 15 clients; up to 17 sessions per client) and low statistical power are discussed. Nonetheless, this study supports the growing body of literature supporting the efficacy of telehealth counselling services. We provide suggestions for future telehealth research and discuss implications for counsellor training.     

Psychodynamic counselling for the borderline personality disordered client: A case study

Psychodynamic counselling for clients with borderline personality disorder is difficult and challenging because there are problems with the validity of the concept, diagnosing the disorder, managing disturbed behaviour and maintaining the treatment to successful completion. Nevertheless, counsellors are frequently called upon to provide assessment, management and treatment for this group. This article explores the application of psychodynamic principles of counselling to clients with borderline personality disorder, examines the history of the concept, the diagnostic process, and employs a case presentation to help describe aspects of character structure and treatment.     

Marriage and Family Therapists’ Perspectives on Treating Overweight Clients and Their Weight-Related Behaviors

Marriage and Family Therapists (MFTs), undoubtedly, will be working with clients who are overweight and are working on their weight-related behaviors (WRB). Yet, little is known about MFTs' approach with this population. Our purpose was to survey MFT students, faculty, and licensed clinicians about their current practices, training, beliefs, and theoretical perspectives of working with clients who are overweight and WRB. One-hundred eight participants completed an electronic mixed-method survey. Participants reported that they were not trained to work with overweight clients on WRB, but strongly believed they should be. Contextual differences, implications for training, and future research are discussed herein.     

‘Knowing all this just makes it harder’: Psychodynamic Ideas on the Frontline

This paper was given as the fifth Annual Ellen Noonan Counselling Lecture on 12 July 2011 and retains some of the spoken style of the lecture. The theme pursues an aspect of Ellen Noonan’s thinking, in that she always valued equipping students with learning they could take back into the workplace rather than purely training clinicians. The paper addresses both the usefulness and potential difficulties of providing front-line workers with psychodynamic insight. It might appear self-evidently worthwhile to offer staff in the caring and educational professions greater understanding of the roots and meaning of the difficulties faced by their clients and of the dynamics involved in working with them. This paper, while stressing the immense value of such awareness, looks at what can be problematic about it, both for staff and their employing agencies. It also describes ways of addressing such issues, both at an individual and organisational level.     

Blood brothers,ugly sisters: School counselling and sibling dynamics1

This article explores the particular relevance of sibling dynamics for counsellors working in schools. School, when viewed as a large ‘lateral’ organisation, both reflects and reactivates sibling dynamics. This thinking about school counselling is based on the ‘whole school’ approach, in which a school counsellor works with staff and students, and with organisational dynamics, seeking to understand the unconscious emotional life of the school system, as well as those within it. The initial sections of the article are concerned both with the place of siblings in psychodynamic theory, and with challenges which sibling dynamics present for a counsellor working in a school context. There follow three linked sections in which the invitation to ‘think sibling’ is illustrated with some clinical examples, drawn from the specific context of a boarding school. All identities have been changed and anonymised to protect confidentiality. The article concludes with a discussion of sibling dynamics in practice, within the context of schools.     

On (not) listening for theory: the trainee’s use of theory as defence against the stress of beginning psychodynamic practice

This paper offers reflections on the trainee’s relationship with, and use of, theory in the early stages of psychodynamic practice. It addresses the issues of ‘listening for theory’ in the face of the unsettling, yet inevitable, stress and insecurity of beginning psychodynamic practice and the daunting awareness of the work being assessed by the training institution. While theory makes psychodynamic work possible and applying theory is explicitly welcomed in psychodynamic training, the paper argues that the unexamined use of theory is problematic as it, albeit unconsciously, is used by the trainee as a defensive retreat into a private mental sanctuary from the intimate, relational space of the consulting room and from the felt incompetence and inexperience aroused in the immediate encounter with the client. Exemplified through accounts of working with a particular client during my training, the paper examines the trainee’s evolving relationship with theory, in the light of what impedes and promotes therapeutic progress, as a significant marker of the trainee’s development to work psychodynamically.     

Eyes wide open: Facilitating student therapists’ experiences with the unfamiliar

Psychotherapists and counsellors work increasingly with culturally different or unfamiliar clients in the context of global migration and relocation. This paper explores the learning processes of trainee therapists within a South African community clinic context which confronts trainees with cultural diversity and a range of complex and traumatic presenting problems. Learning within this context entails interfacing with the ‘unfamiliar’, a process which challenges students both culturally and personally. Drawing upon the ideas of Wilfred Bion we suggest the importance of supervisory reverie in helping students convert raw sensory data into reflective practice. We suggest that working within community clinic contexts prompts personal anxieties as well as context-related anxieties of persecution or annihilation, of narcissistic injury and of contamination. It is hoped that a psychodynamic understanding may prompt further debate regarding the training of therapists working with diverse populations and problems.     

Trainee psychotherapy effectiveness at a psychodynamic training clinic: a practice-based study

The degree to which clinical experience is a significant factor in predicting positive psychotherapeutic outcomes is an open question. Empirical studies comparing experienced and beginning practitioners on differences in client outcomes have yielded mixed results. While multiple sources have indicated that trainees are generally effective therapists, few of these studies have examined the effectiveness of graduate-level therapists in a psychodynamic training program. In this study, conducted in the United States, we use a practice-based research approach to examine the outcomes of clients working with trainees at a community mental health clinic in the northeast United States. The theoretical orientation identified by the clinic and training program is psychodynamic with an interpersonal and/or relational emphasis. Results indicated that clients working with trainees at this clinic demonstrated improvement across several indicators of symptoms and psychosocial functioning over the time they received treatment. Implications for training and service reimbursement are discussed.     

Clients' suitability for counselling: The perception of counselors working in general practice

This study investigated the attitudes of 112 counsellors in general practice towards various factors concernig the selection of clients. Response indicate that counsellors are influenced, not only by diagnostic criteria, and other factors relating to the client, but also issues relating to the counsellor and the setting in which she or he works. The diagnostic critreria whcih seem to be considered most important are desire for change, motivation for therapty and evidence of psychopathology, althoug there is no clear consensus about the criteria overall. Importance varied according to the age and sex of the counsellor, but not by the experience, training, model of working, desire for further training, or number of sessins available.     

Changes in meaning in life across the course of psychodynamic psychotherapy

Using the Meaning in Life Questionnaire (MLQ), we studied Presence and Search for meaning for 34 adult clients in psychodynamic psychotherapy. Clients completed the MLQ and Outcome Questionnaire (OQ) before intake and after every eight sessions. Variance in Presence scores was mostly attributable to clients; variance in Search scores was mostly attributable to clients and therapists. Clients initially high in Presence decreased and then increased back to initial levels; clients initially low in Presence increased and then decreased back to initial levels. Clients initially low in Search increased and then leveled off; clients initially high in Search decreased and then leveled off. In lagged cross panel analyses, when clients decreased in psychological distress during one eight-week time period, they increased in Presence during the next eight-week time period; when they increased in psychological distress during one eight-week time period, they increased in search in the next time period. Excerpts from post-therapy interviews illustrate the process of working with meaning in life in psychotherapy. Implications for practice and training are discussed.     

How do you see me? Coming out in counselling

Recent large-scale survey research has raised serious concerns in both the counselling community and the mass media about the ways in which counsellors work with lesbian, gay and bisexual (LGB) clients. The current questionnaire-based research focused on client experiences of their own, and their counsellor's, self-disclosures of sexuality. Most clients did not require counsellor disclosure. However, failure of the counsellor to disclose could result in problems and assumptions being made by the client. We conclude that LGB awareness is improving, but there is still much need for training in this area to challenge limiting assumptions by some counsellors and to avoid the need for clients to educate them.     

Book review

Voluntary or involuntary migration and international work patterns have made it necessary for many people to adopt a new country and with it, a new language. Some of these latter-acquisition proficient bilinguals may seek therapy in this country. A small scale qualitative study was conducted, informed by a constructionist epistemology, in order to explore the meanings that participants gave to their experience of working in English with a client or patient who used English, proficiently, as a second language. Interviews were conducted with 10 therapists who had been contacted through counselling and psychotherapy organizations, and professional networks. Results indicated that participants experienced varying degrees of separation and distance from their bilingual clients. They found it necessary to pay extra attention to their clients' communications on all levels in order to make a good connection. An awareness of the underlying psychodynamic implications of bilingualism is helpful for the assessment of bilingual clients, in supervision and training, and in the ongoing work.     

The challenge of prejudice: counsellors’ talk about challenging clients’ prejudices

This paper considers the implications for training and practice of counsellors’ responses to the notion of challenging clients’ prejudices. It explores tensions in counselling discourse between social responsibility, responsibility to the client and responsibility for one's self as counsellor. Three focus groups of counsellors were asked whether a counsellor should challenge clients’ prejudices. Responses were categorised as challenge, not-challenge or exit responses. Discursive themes identified in the responses are: managing congruence and being non-judgemental; self-care and self-respect; and social responsibility. Strategies for managing the discursive conflicts identified in responding to counsellor-identified client prejudices are summarised.     

The experiences of person-centred counsellors working with suicidal clients online through the medium of text

ABSTRACT

In this study, we attempt to provide an understanding of the experiences of four UK-based person-centred counsellors working with suicidal clients online using text-based therapies and the impact of their clients’ suicidal ideation upon their “way of being”. The counsellors were selected purposively; each was working as a person-centred counsellor online, was encountering suicidal ideation in their clients, and was a member of a professional organisation. A narrative approach was taken, using unstructured interviews and a stanza format of representation. We found that participants had developed a way of being online that may be distinct from their in-person practice. Challenges included being more directive, lacking physical presence, lacking confidence in assessing risk and questions about empathic understanding. Working online with risk raises specific challenges for person-centred practitioners in line with what is indicated in the little relevant research currently already available.     

Counselling immigrants: School contexts and emerging strategies

In light of the important roles school counsellors fulfil, and their relatively high status and involvement in the Israeli educational system, the strategies counsellors employ when dealing with immigrant pupils in their educational institutions were investigated. The study was based on in-depth interviews with 37 counsellors working in secondary schools with relatively high numbers of recently-arrived immigrant students from the former Soviet Union. The findings highlight the great importance counsellors attribute to the school context and its organisational culture when formulating and implementing their work with immigrant pupils. Four counsellor roles for work with immigrants emerged from the interviews: as culturally-encapsulated assimilators, as self-facilitators, as specialists, and as cultural 'translators'. These strategies provide counsellors with frameworks for determining the issues to be addressed, their timing, identifying their clients, and devising maximally-effective tactics and techniques for implementation. The implications of these approaches are discussed in relation to counsellors' roles in educational institutions with multicultural populations.     

Experiencing gay affirmative therapy: An exploration of clients' views of what is helpful

Gay affirmative therapy is a counselling approach that emphasises an affirming, non‐pathologising approach to therapeutic work with lesbian, gay and bisexual clients. In this study, lesbian and gay clients who had experienced counselling that they defined as affirming identified what they perceived to have been helpful. Questionnaires and interviews were used to collect the views of a sample of lesbian, gay and bisexual informants. The material gathered was analysed using a grounded theory approach, which generated six main categories: communicating a non‐pathologising perspective on homosexuality; the counselling relationship; the counselling space; what the counsellor brought to the relationship; humanity; and the counsellor adopting a holistic approach. Some of these identified affirming elements are unique to gay affirmative therapy and cannot be attributed to other factors. The possible significance of the findings for practitioners is discussed.     

The deep student: A thematic analysis of counsellor educators' perceptions and experiences

What does it mean when we say a person is “deep” or has a lot of “depth?” We asked counsellor educators to describe the concept of personal depth, how it manifests in counsellors' work, and whether or not it could be trained. Twenty counsellor educators responded, and we analysed their responses using thematic analysis. We unearthed seven major themes of the construct: nondual consciousness, emotions, cognitions, interpersonal attributes, self-awareness, attitude and life experiences. Participants also provided suggestions for training students to cultivate personal depth. Finally, we introduce a depth wheel to conceptualise our results and provide implications for counselling and training.