Couple and family therapists’ experiences with Telehealth during the COVID-19 pandemic: a phenomenological analysis

In designing this study, we aimed to obtain a rich, phenomenological understanding of the experiences of couple and family therapists who transitioned their practice to telehealth due to the COVID-19 pandemic. Twelve experienced therapists from the U.S., Spain and Australia were interviewed in depth about their experiences of this transition, particularly how they developed and maintained therapeutic alliances in a virtual context with couples and families suffering pandemic-related hardships. The qualitative analysis identified 40 themes reflecting participants’ initial impressions of telehealth and their positive and negative reactions and adjustments to practicing remotely. Upon overcoming some initial wariness about providing services virtually, many participants described advantages to this way of working with families. Indeed, participants were creative in adjusting to this novel therapy modality, finding new ways to connect emotionally with their clients, to work meaningfully with children, to assess in-session dynamics, and to ensure their clients’ privacy and safety. Notably, several participants commented on the relatively slower development of alliances with new cases and the challenge of repairing split alliances between family members. Many of these difficulties were described as due to having minimal access to their clients’ raw emotions and the inability to use typical systemic interventions, such as moving family members around physically. Participants also reflected on being a “participant observer” to the upheaval caused by the pandemic, a distressing experience they shared with the families in their care.

     

A grounded theory exploration of therapists’ experiences of somatic phenomena in the countertransference

Somatic phenomena in the countertransference have historically received minimal attention despite evidence of their occurrence in the therapeutic encounter. In the field of Counselling Psychology, there seems to be an apparent gap in the academic coverage and clinical utilisation of therapists’ somatic states. The purpose of this study was to explore therapists’ somatic experiences in the countertransference using a grounded theory methodology, based on a sample of 12 participants that was composed of psychotherapists, counselling and clinical psychologists. The results indicated that therapists made sense of their somatic experiences through a developmental process of ‘relating to the body’ that combined stages of defensive operations, intellectual reflections, attributions of somatic ownership and recognitions of various working patterns in the management of somatic experiences. This study addresses the factors that constituted therapists’ processing of the experience, and the findings suggest that therapeutic work may be affected when psychosomatic phenomena as such become undermined and ignored.     

A response to Nguyen’s article, ‘Identification: A qualitative study of the experiences of bilingual therapists with their monolinguals and bilingual clients’

Noticing a certain lack of reflections directly related to language per se, I emphasise and discuss the importance of language issues in any bilingual or multilingual therapy. I try to illustrate this both with some of the existing literature on the subject and by offering my own take on some of the comments made by the interviewees.     

‘It’s about having exposure to this’: investigating the training needs of therapists in relation to the issue of anomalous experiences

Two focus groups, consisting of six participants each, were conducted to explore the training needs of therapists when working with clients reporting anomalous experiences (AEs). AEs are those that ‘depart from our own familiar personal experiences or from the more usual, ordinary, and expected experiences of a given culture and time’ [Braud, W. (2012). Health and well-being benefits of exceptional human experiences. In C. Murray (Ed.), Mental health and anomalous experience (pp. 107–124). Hauppauge, NY: Nova Science Publishers.]. A thematic analysis revealed four themes: ‘Quite often we get taken by surprise because it’s a subject we don’t talk about’, ‘It’s just having this in our vocabulary’, ‘Demystifying and valuing AEs as normal human experiences’ and ‘To ask or not to ask?’. Most of the participants felt that they were unequipped to work with clients reporting AEs and suggestions were made for overcoming this.     

Being student leaders or ‘ordinary’ students: Children's emotional experiences of relationships with others in a Chinese school

The student leader system is commonly used in Chinese schools. Student leaders are children who are elected by classmates, then assigned by teachers, to be responsible for monitoring classmates' behaviour. Based on the data collected through an intensive ethnographic study in a rural primary boarding school in China in 2016, this article discusses emotional experiences in peer relationships reported by both student leaders and other ‘ordinary’ students, who were not student leaders. The article argues that China's student leader system is likely to create hierarchical relationships between student leaders and ‘ordinary’ students, and exposes ‘ordinary’ students to the potential risk of being exploited by student leaders. The article also argues that because of this student leader system and relevant student evaluation values, student leaders and ‘ordinary’ students all feel stressed when they are building up and maintaining peer relationships, such as friendships, with each other.     

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.     

An exploratory study of psychodynamic therapists’ working with people with multiple sclerosis

There is little published on working psychodynamically with chronic illness and even less on the clinical insights of therapists working with people with multiple sclerosis. The objective of this study was to consider therapists’ reflections on the impact of multiple sclerosis on the internal worlds of clients with multiple sclerosis. I would also like to think about the challenges multiple sclerosis presents and how these challenges are worked with therapeutically. Finally, the impact of my multiple sclerosis diagnosis upon the research interviews was considered. Twelve counsellors / psychotherapists who had experience of working with clients with multiple sclerosis were interviewed. Data was analysed thematically and the findings revealed a number of significant themes. Denial appeared significant both for those with multiple sclerosis and those therapists working with them. Therapists also identified that people with multiple sclerosis hold a range of conscious and unconscious feelings in relation to their multiple sclerosis. Also, the meanings and impact of multiple sclerosis are broad and idiosyncratic. Therapists also faced a number of challenges in their work with people with multiple sclerosis: powerful countertransference feelings which could disable the therapy, embodied countertransference, the tendency to make generalisations, the physical reality of multiple sclerosis and its impact upon continuity, therapists’ unconscious phantasy and associations which if unaddressed could impact their ability to work with illness and the pressure multiple sclerosis placed on therapeutic boundaries. Therapists within the study recognised the need to work with both the physical reality of multiple sclerosis, as well as its psychological impact while at the same time keeping themselves open to powerful countertransference feelings and using them in the service of the therapy. The study has implications for theory, practice and future research.     

Miracles in Sport: Finding the ‘Ears to Hear’ and the ‘Eyes to See’

Paralympic Games (PG), involving people with disabilities (PWD), are a manifestation of excellence in sport. They show that athletics performed by PWD counts as genuine sport. They also support a wider meaning of the term ‘health,’ understood not just like a utopian state of perfection, but like the ability to realize oneself in the projects and activities of one’s own choosing. Notwithstanding these virtues, PG—in their current form—may paradoxycally reinforce social prejudice against PWD. This is due to the fact that PG and Olympic Games (OG) are now two distinct events. In this article, I argue that PG should be integrated in the OG, just like women’s and ‘minor’ sports, because the separation of PG and OG indicates a morally arbitrary separation between people with and without disabilities. I also propose to remove the word ‘Para-lympic’ because it stigmatizes the sport performed by PWD as an appendix of ‘normal’ sport. Athletes with disabilities deserve special attention because they have special needs; but they also deserve an arena where their excellence is offered to the public, and this arena should not be different from that of normal-bodied athletes.     

“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.     

Recollection improves with age: children’s and adults’ accounts of their childhood experiences

ABSTRACT

Since the time of Freud, psychologists have drawn conclusions about children’s memory on the basis of retrospective research with adults. Here, we turn the tables by examining what prospective studies with children and adolescents can tell us about the retrospective memory accounts provided by adults. Adults were interviewed about recent events and events from different points during their childhood (Age 5, Age 10) and early adolescence (Age 13). Children (5- and 8- to 9-year-olds) and young adolescents (12- to 13-year-olds) were interviewed about recent events. When matched for age at the time of encoding, adults recalled more about the target events than did 5-year-olds, even though the retention interval for adults was substantially longer. We conclude that retrospective studies with adults may lead researchers to overestimate the content of the early childhood memories that survive. We discuss the theoretical implications of these findings for an understanding of memory development and the practical implications for the interpretation of adults’ retrospective accounts in the courtroom.     

Trainee therapists’ views on the alliance in psychotherapy and supervision: a longitudinal study

The shape of alliance in psychotherapy and supervision using growth curve modeling was examined for clinically inexperienced trainee therapists, who were engaged in long-term cognitive behavioral - or psychodynamic individual psychotherapy at a Psychology Clinic in Sweden. Trainee therapists rated their view of the alliance with their clients and their supervisors on the Working Alliance Inventory at five time points. The alliance to the client show a consistent, positive development throughout the therapy. The alliance to the supervisors show initially a decrease, followed by an increase, and then again, the rate of increase in the supervisory alliance ratings slowed down indicating a more complex view of the supervisory alliance compared to the view of the alliance in psychotherapy.     

Facilitating Family Communication About Predictive Genetic Testing: Probands’ Perceptions

The responsibility of informing relatives that predictive genetic testing is available often falls to the proband. Support is required during this process, however the perceived utility of genetic counseling and other strategies to facilitate communication have not been explored. We investigated the experiences of 12 individuals with hereditary nonpolyposis colorectal cancer (HNPCC) in a semistructured telephone interview. Respondents informed their immediate family about the availability of genetic testing, however many more-distant relatives were not directly informed. Respondents were mostly satisfied with the way they told family members about testing and had mixed views about the usefulness of genetic counseling. Gender differences were observed, with most men expressing a need for guidance or support in communicating to relatives. Letters and booklets were thought to enhance the quality of information but the provision of further aids is unlikely to increase the number of relatives made aware of predictive testing by the proband.     

Life stories managing chronic illness: Young adults’ lived experiences with type 1 diabetes

This study aimed to characterise diabetes management experiences of South African young adults living with well-controlled type 1 diabetes (n = 8, female = 5, male = 3, age range = 20–25). The young adults told life stories managing their type 1 diabetes. Thematic analysis revealed the young adults to construct personal identities as people living with type 1 diabetes, to mostly utilise emotion-focused management strategies and social support for successful living with type 1 diabetes. Behavioural health strategies appear important for living well with this chronic insulin deficiency condition.     

“Weathering the storm:” Mothers’ and fathers’ experiences of parenting a preterm infant

Parenting preterm infants is a unique experience distinct from parenting full-term infants, characterized by a delayed transition to parenthood and limited caregiving opportunities. This study explored mothers’ and fathers’ lived experiences of parenting during infancy in the context of preterm birth. Semistructured qualitative interviews were conducted with 13 parents (6 fathers, 7 mothers) of preterm infants. Data were analyzed using interpretative phenomenological analysis. Four superordinate themes emerged: (a) An unnatural disaster: The traumatic nature of preterm birth, (b) The immediate aftermath: Disconnected and displaced, (c) Breaking the ice: Moving from frozen to melted, and (d) Aftershocks: Transitioning home. Both parents experienced preterm birth as traumatic. Similarities and differences in mothers’ and fathers’ experiences were identified. Preterm birth posed challenges for nurturant and social caregiving and resulted in anxiety, hypervigilance, and overprotective parenting behavior. The results highlight the need for trauma-informed care and further research developing and testing empirically based interventions.     

Early childhood mental health consultation: Care providers’ experiences of the consultative relationship

This article presents findings from a qualitative research study exploring child care teachers’ experiences receiving early childhood mental health consultation (ECMHC). As an emerging intervention in early childhood education, ECMHC is already yielding promising results, namely in helping teachers better address challenging behaviors in their classroom and promote a more nurturing classroom environment. However, there remains a lack of personal testimony from teachers who receive this intervention. Considering that teachers are the primary focus of most ECMHC interventions, the purpose of this study was to examine child care teachers’ personal experiences receiving consultation. Eight child care teachers were interviewed for this study. Results from this study illuminate key interpersonal processes in the development of the consultant–consultee relationship, indicate what teachers consider to be the most helpful components of consultation, and speak to the challenges that teachers experience in consultation. By examining the personal testimony of child care teachers who have received ECMHC services, consultants and researchers can consider ways to expand and improve future implementation of ECMHC.     

Redefining unforgiveness: Exploring victims’ experiences in the wake of unforgiven interpersonal transgressions

This study explored victims’ experiences in the aftermath of unforgiven offenses. Semi-structured interviews with 13 individuals discussing two unforgiven offenses revealed considerable variability in the experiences of unforgiveness, suggesting that unforgiveness may be more multifaceted than previously believed. In addition to the negative emotions and rumination previously posited to characterize unforgiveness, novel themes emerged describing unforgiving cognitions (e.g., the offense is unforgiveable) and construals of the offender. Participants varied along each dimension, resulting in a range of outcomes (e.g., forgiveness, lingering personal distress, finding peace without forgiving). Implications for conceptualizing unforgiveness and counseling those who struggle with unforgiven offenses are discussed.