Reflexivity and its Radical Form: Implications for the Practice of Humanistic Psychotherapies

Reflexivity has been defined as self-awareness, and radical reflexivity as awareness of self-awareness. Based on a qualitative research study of the client's experience of psychotherapy, clients’ reflexivity and radical reflexivity are applied to the concepts of moral evaluation and freedom of will. These concepts in turn are related to psychotherapy clients’ relationship with self and with the therapist. It is shown how the nature of these relationships provides a rationale for decisions on the appropriateness of the therapist's direction of the therapeutic process. In addition, specific interventions to offset the power differential between the client and therapist are specified. It is concluded that unconscious determinants of experience and action notwithstanding, clients’ self-aware agency plays a significant role in their engagement in therapy.

Client experience of gender in therapeutic relationships: an interpretive ethnography.

The purpose of this study was to explore clients' experiences of gender in therapeutic relationships in order to inform therapists of critical issues from clients' perspectives. To capture clients' views, the researchers chose an interpretive ethnographic design that used unstructured, collaborative interviews with clients who had worked with both female and male therapists. The interviews were analyzed using procedures developed by Kvale (1996), who emphasizes the importance of including the client's voice in data gathering, analysis, and final presentation. The results were reviewed with the clients to insure accurate presentation of their views. The final results were organized into six themes: client-therapist connection, male therapists, female therapists, topics discussed, effectiveness, and confounding factors. Researchers discuss the implications of gender-stereotyped behavior in therapy, the relationship between therapist gender and therapeutic alliance, and recommendations for practicing gender-sensitive therapy.     

Their home is their castle: learning to do in-home family therapy.

The client's home is emerging as a typical site in which family therapy is delivered, yet training programs tend to train students in an office-based model. This qualitative study examines the process that three student interns went through as they learned to do home-based therapy after having been trained in a clinic setting. All three found that the experience of working in the clients' homes challenged their beliefs about therapy as well as the models of a professional relationship; all reformulated their views on therapy because of this challenge. A model is proposed that describes the students' journey from being a clinic-based to becoming a home-based therapist.     

Healing elements of therapeutic conversation: dialogue as an embodiment of love

From our Bakhtinian perspective, understanding requires an active process of talking and listening. Dialogue is a precondition for positive change in any form of therapy. Using the perspectives of dialogism and neurobiological development, we analyze the basic elements of dialogue, seeking to understand why dialogue becomes a healing experience in a network meeting. From the perspective of therapist as dialogical partner, we examine actions that support dialogue in conversation, shared emotional experience, creation of community, and creation of new shared language. We describe how feelings of love, manifesting powerful mutual emotional attunement in the conversation, signal moments of therapeutic change.     

Client and therapist variability in clients' perceptions of their therapists' multicultural competencies

This study examined therapist differences in their clients' ratings of their therapists' multicultural competencies (MCCs) as well as tested whether therapists' who were rated as exhibiting more MCCs also had clients who had better therapy outcomes (N = 143 clients and 31 therapists). All clients completed at least 3 sessions. Results demonstrated that therapists accounted for less than 1% of the variance in their clients' Cross-Cultural Counseling Inventory–Revised (CCCI-R; T. D. LaFromboise, H. L. K. Coleman, & A. Hernandez, 1991) scores, suggesting that therapists did not differ in terms of how clients rated their MCCs. Therapists accounted for approximately 8.5% of the variance in therapy outcomes. For each therapist, their clients' CCCI-R scores were aggregated to provide an estimate of therapists' MCCs. Therapists' MCCs, based on aggregate CCCI-R scores, did not account for the variability in therapy outcomes that were attributed to them. Additionally, clients' race/ethnicity, therapists' race/ethnicity, or the interaction of clients'–therapists' race/ethnicity were not significantly associated with clients' perceptions of their therapists' MCCs.     

The Shift from Monologue to Dialogue in a Couple Therapy Session: Dialogical Investigation of Change from the Therapists’ Point of View

As part of a larger research project on couple therapy for depression, this qualitative case study examines the nature of dialogue. Drawing on Bakhtinian concepts, the investigation shows how the conversation shifts from a monologue to dialogue. Among the findings are: first, the process of listening is integral to the transforming experience. That is, the careful listening of the therapist can evoke new voices, just as the experience of one of the partners’ “listening in” to the conversation between the other partner and the therapist can create movement and new trajectories. The latter is a qualitative difference between dialogic therapy with a couple and that with an individual. Second, the therapist not only acts as creative listener, but as the dialogue unfolds, actively contributes to meaning‐making. Third, the study upholds having a team of researchers as a polyphonic forum and the usefulness of Bakhtinian concepts in clinical research on dialogue in multi‐actor sessions.     

The Effect of Therapist–Client Racial Similarity on Client Satisfaction and Therapist Evaluation of Treatment

Client satisfaction with therapy services and therapists' perspectives of treatment evaluation were examined in relation to therapist and client racial similarity. Secondary data from a university marriage and family therapy clinic located in the southeast was used to pair therapists and clients on racial similarity or difference. Statistical analyses revealed no major differences in clients' perceptions of satisfaction based on similarity to therapists' race. Therapists indicated some differences in their perceptions of the success of services provided to clients based on similarity to client's race. Implications for researchers, clinicians, and educators are included.     

The importance of cultural sensitivity and therapist self-awareness when working with mandatory clients

Systemic therapy emphasizes the importance of understanding each relationship in the context of its ecosystem. Considerations such as the influence of social agencies, culture, and the therapist's self-awareness are described in the literature as amplifying lenses within the therapeutic relationship. When a minority client is caught in the web of larger system agencies and is mandated to family therapy, systemic family therapy, which incorporates multiple lenses and attends to the context of social background, may provide a better understanding of the client's reality. Clinical cases show that therapists may slip into veiled racist and discriminatory attitudes with minority clients. Self-awareness, "soul searching," and appropriate supervision may be of tremendous help in learning from such experiences. A case example illustrates the application of this approach.     

Clients' Experiences of Obstructive Silence: Integrating Conscious Reports and Analytic Theories

The psychodynamic literature has associated clients' silences in psychotherapy sessions with a variety of processes. These processes include wishes to merge with the therapist, to gain control in session, to communicate the unsayable, to express helplessness and, most frequently, the intertwined processes of resistance and regression. Experiences of obstructive silence—that is, moments in which clients detached from the process of therapeutic inquiry—were examined in this study. A grounded theory analysis was used to explore clients' experiences of silences in psychotherapy across psychotherapeutic modalities. Two types of obstructive pausing processes, Disengaged pauses and Interactional pauses, were identified. The implications of delineating conscious aspects of these complex experiences are stressed and techniques are suggested for therapeutic intervention in moments of experienced threat.     

Valuing clients' perspective and the effects on the therapeutic alliance: a randomized controlled study of an adjunctive instruction

The patterns of growth and development of the therapeutic alliance over the course of therapy have been of continued interest to psychotherapy researchers. The purpose of this study was to investigate whether a simple institutional metacommunication intervention with clients had an effect on the development of the alliance. This adjunctive instruction involved inviting therapy clients to take a proactive role in their treatment by encouraging feedback to their therapist about various aspects of the therapy process. In this randomized controlled study (N = 94), clients were assigned to 1 of 2 conditions: (a) an institutional adjunctive instruction condition in which patients were contacted by clinic personnel at the beginning of the remediation phase (Session 5) and encouraged to take a proactive role in their treatment and (b) a control condition that contained no institutional adjunctive instruction. Between-condition differences in the alliance were tested, controlling for baseline influences and the early therapeutic alliance. Clients' postsession reports from Sessions 1 to 24 indicated that the adjunctive instruction increased the alliance over the course of therapy vis-à-vis the control condition. The adjunctive instruction appeared to have fostered clients' evaluation of their therapists' interest in their welfare. The results indicate that interventions, even brief or subtle, can produce lasting benefits in the alliance when targeted at specific psychological processes. Systematic metacommunication from the institutional level appeared to reinforce clients' therapeutic alliance with their therapists in individual treatment.     

Humanistic Psychology at York University: Retrospective: Focus on Clients' Experiencing in Psychotherapy: Emphasis of Radical Reflexivity

A retrospective is given of the contributions by York University psychologists to humanistic psychology as it is expressed in the theory, research and practice of humanistic psychotherapies. These contributions are contextualized in the history and mission of the University. Attention is then turned to the author's qualitative research on the client's experiencing in psychotherapy and the main understanding coming from it, namely that clients are aware of their self-awareness and are agential in terms of this capacity, called radical reflexivity. Implications of radical reflexivity for client-centered/experiential therapists' reduction of the person to an organism and for the psychotherapy practice and research are derived.     

Therapeutic moments are the key: foster children give clues to their past experience of infant trauma and neglect

Foster parents often despair over the lack of information about the past experience of the children in their care, particularly with children who have experienced infant trauma and neglect. In the context of family therapy these unknowns pose both a challenge and an opportunity. The author proposes that foster children gives clues to their past experiences in therapeutic moments, which the therapist may recognize as a result of her own inner conversation. In conjunction with a sound theoretical knowledge of infant trauma and neglect, these moments have the capacity to open a dialogue in the relationships between therapist, child and foster family. This dialogical process offers an opportunity for the child's past experience of infant trauma and neglect to be expressed in silence, and the foster parent's present experience to be heard in stillness, opening for them a way to go on beyond the family therapy sessions.     

Micro‐analysis of a therapist‐generated metaphor referring to the position of a parentified child in the family

The purpose of this exploratory study is to develop a deeper understanding of the way in which the metaphorical language of therapists evolves in dialogue with a client over the course of a therapeutic session. We first briefly report on a study in which we categorized the metaphors used by therapists in twelve therapy sessions with a role‐played client. Then we focus on an intensive micro‐analysis of one particular metaphor that was introduced in the session by one particular therapist in the categorization study: the metaphor of a fireman in the family. Our analysis allowed us a detailed look at some of the ways in which metaphorical language opens dialogical space in the session to talk about the position of parentification of the client and about the price she has to pay for this position in terms of preoccupying worries and loneliness. Furthermore our analysis revealed the delicate dialogical nature of the therapeutic process in which, in talk, the therapist takes the client's experiencing into account all the time.     

A critique of the microcounselling approach to problem understanding

Microcounselling approaches involve teaching the component behaviours of effective counselling or interviewing within a problem-solving framework. Egan, Ivey and Carkhuff, as proponents of this view, stress that later action stages of the problem-solving cycle should be based on an adequate understanding of the client's problem. The relationship between the skills which comprise the microcounselling approach and the goal of problem understanding is examined. It is argued that the approach lacks any explanation of how problem understanding is reached, and that it concentrates instead on the communication techniques involved in the discovery and modification of the client's understanding. This omission leaves counsellors without a rationale for the modification of their clients' views and without a means to regulate their use of the various microskills. Information theory and recent research on complex problem-solving are introduced to explain the skills involved in reaching a high-quality understanding of a client's problem. Given that these complex cognitive processes are not addressed in the microcounselling approach, suggestions are made for its modification.     

The concept of boundaries in counselling and psychotherapy

Boundaries in the mind—the relative 'thinness' and 'thickness' of many kinds of boundaries—has been studied as a measurable dimension of personality. Persons scoring 'thin' overall on the Boundary Questionnaire can be described as open, trusting, vulnerable, and usually having a rich fantasy life; they are people in whom 'everything gets through'. People who score very 'thick' tend to be solid, well-organised, and sometimes rigid. The relationship of boundaries to other measures of personality, to dreams and nightmares, to clients' occupations and interests, and finally to the conduct of psychotherapists and counsellors, including the question of boundary violations, is discussed. Some boundary violators have very thin boundaries and are unable to maintain clear distinctions between the client's needs and their own; others have relatively thick boundaries which make them insensitive to the damage that boundary violations can cause. Awareness of the client's boundaries and one's own can be useful in 'matching' a client with a therapist and in the conduct of therapy, especially at stressful times. It is also useful at times to discuss boundaries with clients.     

SUSPECTED REPRESSED CHILDHOOD SEXUAL ABUSE

This article explores therapists' responses to clients' suspicions that they have repressed memories of childhood sexual abuse (CSA). Each participant was randomly assigned one of two vignettes, varied for gender, each concerning a client who suspects that he/she is a victim of CSA. Following the vignette, a series of questions regarding the client assesses the participants' ratings of diagnoses, treatment goals, treatment plans, appropriate responses, and validity of suspicions. Participants were significantly more likely to endorse a diagnosis of borderline personality disorder and endorse treatments focusing on present symptoms over treatments focusing on the client's past. Participants were unlikely to endorse controversial treatments, suggestive statements, or strong opinions regarding the client's suspicions of CSA. The client's gender had a significant effect on diagnoses only. These results do not support reports that many therapists neglect clients' current symptoms and instead focus on memories, use controversial techniques, make suggestive statements regarding abuse, or immediately assume that their clients have repressed memories.     

Talking about talking: Interpersonal process recall as an intersubjective approach to research

Research methods are often marked by inequalities between researcher and researched, maintained through dominant discourses that structure expectations of research. This study considers how therapeutic skills such as reflexivity can help to develop alternative discourses, raise awareness and challenge inequalities in research. An approach to the qualitative analysis of research interviews using interpersonal process recall (IPR) is outlined. By focusing attention on the dialogue and enabling researcher and research participant to review and explore their interaction reflexively, IPR offers an opportunity to understand interviews as intersubjective events. It thus facilitates the collaborative identification of processes and narratives as key moments for further analysis and increases awareness of the potential blurring of genres between therapeutic and research conversations. The contribution of IPR to an intersubjective lens and greater equality in research interviewing is discussed. Potential implications for both research and therapy practices are suggested.     

Dialogue and power: a critical analysis of power in dialogical therapy

This article explores the relationship between dialogue and power in the practice of dialogue-oriented, "not-knowing" forms of therapy. It is argued that power of a dynamic and reversible kind infuses much ordinary social dialogue, and that the joint processes of power and resistance work together to render an interaction dialogical. In contrast, in dialogical therapy, overt exercises of power threaten the interaction's dialogical status, and power is deferred and denied by the therapist through not-knowing practices. A case study of Harlene Anderson's (1997) is used to illustrate that it is precisely power's presence that informs the practices of not knowing and uncertainty that characterize dialogical therapies. It is suggested that the not-knowing therapist withholds aspects of his or her voice as a condition for dialogicity. Instead, special speaking arrangements are required, in which the therapist's not-knowing is continuously communicated to the client, for the therapeutic conversation to remain dialogical. Without these speaking arrangements, I argue that therapy moves toward monologue. Therapists inherit powerful speaking positions from the institutional and sociocultural context, and the rejection of power within therapy serves only to conceal this aspect of power, which nevertheless pervades the therapeutic relationship. Finally, it is suggested that power is a "common factor"--shared by all therapies--and that our status as "inheritors" of power needs to be included in our understanding of the therapeutic process. This expanded view of therapy requires the re-theorization of dialogue, such that it includes, rather than excludes, considerations of power.     

Transformations in Therapeutic Practice

In her training of therapists, Virginia Satir sought to change the way her trainees perceived themselves, their clients, and the therapeutic endeavor. The change she sought was a movement from hierarchical models of therapy where clients were diagnosed in terms of paradigms of how they ought to be to an organic model where the therapist attempts to understand the client by entering the client's internal context. Contemporary training in the Satir model attempts to bring about the same change. Research indicates that the trainers are succeeding.