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.     

Journal File

The Internet can be a problematic place for relationship development. As popular as these approaches are, none apprise the therapist of specific dilemmas critical to the outcome of treatment. The purpose of this paper is to outline the therapeutic dilemmas faced by therapists in treating Internet infidelity. It is the first article of its kind to outline the key dilemmas: (a) seven factors that increase a couple's vulnerability to Internet infidelity, (b) self-of-the-therapist issues, and (c) divisive issues in treatment. A case example demonstrating how to address the dilemmas in a couple experiencing Internet infidelity is included.     

Feminist Issues in Couple Therapy

Abstract

The authors reviewed the feminist couple therapy literature from 1995 to 2006. They summarized this large body of work into several key themes. The first revealed that feminist couples therapists are continuing to discuss and deconstruct gender issues in couple therapy. The second showed that feminists believe that therapists should be educated both academically and personally about culture and diversity so as to support couples in their therapy around their own issues of diversity as well as learning to deal with issues of social justice as a couple. In the third theme, the authors introduced readers to feminists' emphasis on connection and empathy within couple and sex therapy. And, in the fourth, the authors explored feminists' work with power in couple therapy as they applied to couple therapy in general as well as around the specific topics of: balancing family and work and therapy for familial violence.     

Beyond the Frying Pan: Addressing Work Issues with Women in Therapy

In recent years, mental health practitioners have been exploring how women are balancing work and family. Given how this issue affects womens experiences in the corporate world and at home, marriage and family therapists are attempting to consider this concern as they treat female clients individually and within relational systems. Few articles and studies have examined the issues female employees face in the workplace and how the issues influence the therapeutic process. In this article, the authors examine the organizational, sociological, and cultural challenges women deal with at work and apply these areas to the therapeutic context. The authors present a case study of a female client enduring a difficult work situation, discussing how to view and approach this case from a feminist family therapy perspective.     

Male Cross-Dressers in Therapy: A Solution-Focused Perspective for Marriage

This paper offers techniques on how to work with male cross-dressers using solution-focused therapy. An overview about issues crossdressers often face is addressed which shows they have many of the same concerns as other clients seeking therapy. Solution-focused therapy is discussed as a way to work with male-cross dressers and their partners. A case study of a male cross-dresser and his wife is presented and possible directions are suggested for marriage and family therapists.     

Ecosystemic epistemology: an alternative paradigm for diagnosis.

An alternative paradigm for diagnosis based on cybernetics, ecology, and systems theory is proposed. This paradigm, termed "ecosystemic epistemology," suggests that diagnosis focus on knowing problematic situations in an ecological and systemic way. Theoretical statements concerning this approach are delineated with specific references to major family therapists. This discussion provides a foundation for an ecosystemic epistemology for diagnosis that addresses the following issues: (a) the meaning of system; (b) the symptom's presence in the system; (c) the therapist's presence in the system; (d) the ecological relationship system that emerges in diagnosis; and (e) the relation between ecosystemic epistemology and the process of diagnosis. In effect, this paper attempts to formally describe the underlying epistemology inherent in the work of therapists who approach diagnosis in an ecological and systemic way.     

Therapist in Distress: Team-Supervision of Social Workers and Family Therapists Who Work and Live Under Political Uncertainty

This article describes and analyzes a 2-year supervision process with social workers and family therapists who live and work under conditions of uncertainty on the West Bank. The systemic orientation used in this specific approach to supervision emphasizes the double role of the therapist: one as part of the therapeutic system, and the second as a member of the same community that is living in political uncertainty. The analysis revealed that a long-term supervision process, in which the supervisor encouraged a containing context, was meaningful to the group. As a result of this secure atmosphere, the group was ready to talk about painful issues like loss as the result of war and terrorist attacks, loss as a result of immigration, and loss of ideals. Furthermore, the members of the group were ready to confront the possibility of relocation and their role in such a situation. The techniques used in the process, such as narrative and metaphors, were implemented by the members in their daily professional interventions. The flexibility between working on regular professional issues and issues related to stress and uncertainty seemed useful to the supervision, as well as the political dialogue that was created between the supervisor and the group.     

Unerwünschte und schädliche Wirkungen von Psychotherapie

Unwanted effects or even damage due to psychotherapy are largely neglected issues within psychotherapy research as compared to other fields. On the other hand, it is reasonable to assume that unwanted effects of a treatment which intends to influence patients into a positive direction are very likely. The rate of negative effects of psychotherapy (the deterioration effect according to Bergin) is consistently estimated to be 10% of all cases and shows this same rate in a variety of studies. This review highlights side effects of psychotherapy both on the part of the patients and of the therapists. It reports unwanted effects related to different psychotherapeutic methods, i.e. psychoanalysis, cognitive behaviour therapy, client-centered psychotherapy and – beyond these basic orientations – group psychotherapy. The paper also reports on negative effects of psychotherapy on an untreated partner. Finally, some proposals are given on how negative effects of psychotherapy could be diminished. The authors especially highlight the possibilities of changing the therapist, the treatment technique, or the theoretical treatment approach as a way to reduce negative effects.     

A Systems Approach to Sex Therapy with Gay Male Couples

SUMMARY

Sex therapy with gay male couples is difficult for many family and relationship therapists. Family therapists lack knowledge of the nature of sex therapy, gay male culture and sexuality, the dynamics of gay male couples, and the sexual issues gay male couples are likely to bring to sex therapy. Countertransference also makes sex therapy with gay male couples difficult for some family and relationship therapists. This paper addresses those issues and then explains a systems approach to sex therapy with gay male couples.     

Psychotherapeutic issues with Asian American women

Although several authors have written of the unique needs and stresses encountered by Asian American women, little information is available about the culturally sensitive therapeutic approaches in working with them. This paper attempts to identify some of the issues relevant for work with various groups of Asian American women. Sources of stress are discussed considering a variety of economic, cultural, and historic factors. Therapeutic approaches for dealing with these stressors are also discussed. In addition to traditional therapies, feminist perspectives are considered and issues of gender roles are raised. Finally, case examples and suggestions for therapists are provided.Paper presented at the annual convention of Asian American Psychological Association, New York, 1987.     

The challenges and experiences of psychotherapists working remotely during the coronavirus* pandemic

The experiences and challenges of psychotherapists working remotely during the coronavirus pandemic were explored using a mixed‐methods approach. An online survey completed by 335 psychotherapists produced both quantitative and qualitative data with the latter being subject to a reflexive thematic analysis. Large numbers of therapists were using video‐link platforms and the telephone to conduct client sessions. A majority of therapists felt challenged by remote working, with reduced interpersonal cues, feelings of isolation and fatigue, and technical issues frequently cited concerns. At the same time, most therapists considered that remote working had been effective and that clients were comfortable with the process. Two‐thirds of therapists indicated that remote working would now become core business for them. The great majority of therapists thought that remote working skills should be part of formal therapy trainings.     

Can MFTs Address Spirituality with Clients in Publically Funded Agencies?

Many marriage and family therapy (MFT) trainees and therapists working toward licensure are accumulating hours in publically funded treatment centers. The increasingly diverse clientele in the U.S. likely will be served in the public sector, especially as many states are providing more funding for county agencies and increased tuition reimbursement and/or loan forgiveness for students and graduates who work for these organizations. MFTs may feel ill-equipped to address spiritual issues in therapy at these sites, especially when grappling with ethical concerns. This article delineates a case example in which an MFT attends to spiritual issues when working with a family in a county mental health center. The authors illustrate how a therapist can navigate the ethical dilemmas of this case when working from a Bowenian perspective.     

Conceptual and Application Issues: Emotionally Focused Therapy With Gay Male Couples

Therapists working with couples are likely to see gay male couples in their practice yet there is a lack of training to prepare therapists to work with gay couples. Emotionally Focused Therapy (EFT) is an empirically supported approach to couples therapy and offers a clear structure and map for working with gay male couples. This article reviews some of the issues that are specific to EFT work with gay men. Given the range of minority stressors that gay men contend with EFT is particularly appropriate for work with gay male couples because of the focus on the attachment bond. Building a secure relationship is an important source of resilience that can buffer against prejudice and discrimination and provide a secure base for individual and couple exploration.     

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.     

Family Therapy in Poland: Development and Current Perspectives

The authors of the present article describe the historical context of family therapy in Poland and current issues in the field. They highlight the fact that Polish therapists first began to develop the field after coming into contact with family therapy leaders from the United States and Western Europe. With the political breakthrough of 1989, there were new opportunities for multilateral cooperation, attendance at international conferences, and the exchange of experiences. Currently, the work of Polish family therapists, the place of family therapy among other forms of psychotherapy, and the related problems and challenges do not differ from other European nations.     

Recapturing the Person in the Therapist: An Exploration Of Personal Values, Commitments, and Beliefs

The authors encourage an approach to personal exploration that attempts to recapture the person in the therapist. Person in the therapist training is aimed at helping therapists discover or re-capture their own values, beliefs, and personal ethics. A personal approach to theory development and the practice of therapy is offered and discussed. Activities to recapture the person in the therapist focus on developing a personal theoretical orientation, exploring the values of family therapy theories, and exploring the values of the stance of the therapist in the therapy session. The authors offer their own personal beliefs throughout the article and encourage further development of these issues.Co-director of The Re-Authoring Center and a PhD student in Marriage and Family Therapy at Iowa State UniversityCo-director of The Re-Authoring Center and a PhD student in Marriage and Family Therapy at Iowa State University     

Navigating Critical Theory and Postmodernism: Social Justice and Therapist Power in Family Therapy

The family therapy field encourages commitment to diversity and social justice, but offers varying ideas about how to attentively consider these issues. Critical informed models advocate activism, whereas postmodern informed models encourage multiple perspectives. It is often not clear how activism and an emphasis on multiple perspectives connect, engendering the sense that critical and postmodern practices may be disparate. To understand how therapists negotiate these perspectives in practice, this qualitative grounded theory analysis drew on interviews with 11 therapists, each known for their work from both critical and postmodern perspectives. We found that these therapists generally engage in a set of shared constructionist practices while also demonstrating two distinct forms of activism: activism through countering and activism through collaborating. Ultimately, decisions made about how to navigate critical and postmodern influences were connected to how therapists viewed ethics and the ways they were comfortable using their therapeutic power. The findings illustrate practice strategies through which therapists apply each approach.     

The Props are Falling Down and We Want to Make Music: A Narrative Perspective on Organisations in Transition (Violins/Violence in Organisations)

While South African society finds itself in the throes of political changes, therapists working within organisations in transition find themselves challenged by the turbulence of transformation. The authors are a group of therapists attempting to understand, from a narrative perspective, the organisational context within which they work. This paper recounts the processes around the design, implementation, and outcomes of a workshop on this theme. The main body of the paper consists of a letter that was sent to participants after the workshop. The reader is invited to join collaboratively in our reflections so as to continue an open-ended, creative process.     

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.