Suitability and context for brief therapy

Abstract

The main point of this paper is that a client's suitability for brief or time-limited therapy is determined by various factors, including context. There is still agreement on the validity of Malan's selection criteria, which included ‘mild illness, recent onset, high motivation and response to trial interpretation’, yet many additional issues have since emerged and need to be considered. For instance, the counsellor's suitability, training and work experience, the counsellor's assessment skills and ability to establish a dynamic focus, the clients' capacity for self-reflection, their ego strength and their response to a trial therapy in the first session. Then there is the importance of the various contexts in which nowadays much brief counselling is offered free to clients, whether in education, at the workplace, in primary healthcare settings or by charitable organizations. This means that issues of money and markets have come to the fore and an initial differential assessment needs to be carried out in order to decide which method or model of therapy is best for the client. Matching the counsellor's personality to the needs and to the pathology of the client, and matching the treatment to the client's developmental stage or life stage crises are other aspects of the work, which determine the issue of suitability. In the end as always there is much that remains unknown about what works for whom and how the client's decision to take up help is made.     

Effective Challenging Through Additive Empathy

Empathy is a counseling skill that is highly regarded by most practitioners. Constant reflection of only expressed surface feelings however, may perpetuate a limited view of a client's problem. The ability to extend a client's original understanding is a valuable resource for a helper to offer. Through additive empathy, a helper challenges a client to examine a deep and broad perspective for assessing problems and then to take action. The purposes of this article are to identify some elements of additive empathy and to describe practical guidelines for using the skill in counseling and in systematic skill training.     

Moments of empowerment: A qualitative analysis of positively experienced episodes in brief person‐centred counselling

38 positively experienced episodes in brief person‐centred counselling with six clients were analysed. The Interpersonal Process Recall (IPR) method was used as the prime research tool. Clients were asked to identify positively experienced moments in the counselling session during a post‐session review interview. Clients and counsellors were invited to report on the feelings, perceptions and intentions they recalled experiencing during these moments. Three analyses were used to categorise the meaning and feeling quality of these moments, and a taxonomy of types of positively experienced episodes was also created. The most frequently reported positive client experiences were associated with empowerment, safety and insight. Other significant themes emerging from the analysis included: freedom in the relationship, shortcomings of the relationship, assurance of the relationship, unfolding of the client's personal meaning, and the importance of the counsellor's presence. Taxonomy of episodes revealed nine categories: four of them focused on the strengthening of the therapeutic relationship, and five focused on the empowerment of the client's self. These findings are discussed, and implications for theory and practice explored.     

‘I never talked about,ever’: A comprehensive process analysis of a significant client disclosure event in therapy

Aims: The present study was intended to examine how a particular client disclosure came about and what made it important to the client. Method: A client‐identified significant therapy event involving disclosure of childhood abuse was analysed using Comprehensive Process Analysis (CPA), a qualitative interpretive method for examining the process, effects and context of significant events in therapy. Results: The analysis identified therapist invitation and client universalisation as the key elements of the disclosure event. The context analysis showed how the event linked to the client's symbolisation of her fear earlier in the session and in the previous session. The client gained insight into how the earlier abuse had affected her life, linking it to the victimisation that was her primary reason for seeking therapy, and to her relationship with her mother. The therapist facilitated the event by following up the client's hints, trusting the strength of the alliance, and staying close to the client's frame of reference. Conclusion: The findings suggest that the initial significance of an invited disclosure event may diminish for a client over the course of therapy.     

Second-class citizen? Contract workers' perceived status,dual commitment and intent to quit

Outsourcing of jobs to contract workers who work alongside a client's employees has changed the human resource landscape of many organizations. In this study we examine how a contract worker's perceived employment status similarity to the client's own standard employees influences his/her affective commitment to both the client and the employer and ultimately intent to quit the employer. Using a sample of 623 contract workers, we found strong support for our hypotheses. In particular, findings indicate an important role for perceived employment status at the client organization in driving contract worker's attitudes and that contract workers consider both the client and the employer when making decisions to leave the employer. Implications for managing contractor relationships are discussed.     

Gentle Like the Dawn: A Dying Woman's Healing

This article recounts the author's counseling relationship with a client who was a nursing home resident. The article describes the client's spiritual experiences and their impact on both the client and the counselor.     

Assessment of Subjective Client Agency in Psychotherapy: A Review

Theoretical accounts of psychotherapy, especially of a constructivist or humanistic sort, often assert the importance of the client's active efforts in “making therapy work.” Psychotherapy research also supports the importance of the client's contribution to therapy outcomes. Research on subjective client agency, defined as a client's expectations for taking an active role in psychotherapy, is limited, however. This review describes and evaluates the psychometric qualities of six measures of this construct and provides recommendations for future research. Three of these measures are particularly suitable for further work by constructivist investigators of therapy process and outcome, a topic too rarely studied in the literature to date. Those studies that exist suggest that agency is positively related to the therapeutic alliance but does not directly affect therapy outcome. Additional process-outcomes studies in this area are warranted and could benefit from placing client agency in a broader framework that views therapy, and even therapy supervision, as an active process of mutual inquiry.     

Cognitive Templating: A Technique for Feminist (and Other) Counselors

A technique designed to provide an idiosyncratic representation of a client's personal socialization experiences and a reanalysis of these experiences from a social-learning-theory perspective reveals the interconnectedness of client cognitions, feelings, and actions that contribute to the client's self-image. These data are presented to the client visually in diagrammatic form and aid the process of restructuring the self-concept. A case study illustrating the use of the cognitive-templating technique is presented, and the advantages of the procedure are outlined.     

Utilizing artistry in a therapeutic relationship

Abstract

In many humanistic approaches, therapeutic change involves utilizing the relationship between the client and therapist as a tool for personal growth. Like any relationship, the therapeutic relationship is one that is co‐created between those engaged in it, namely, the client and the therapist. Utilizing this co‐created relationship requires a sense of artistry on the part of the therapist. A therapist must be willing to engage in this meaningful relationship with the client. A therapist must also be aware of the personal values that he or she brings into therapy, and how they influence the therapeutic relationship. Finally, a therapist must acknowledge the power that the therapist and the client possess in the relationship, and understand how that power can be used to validate and invalidate the therapist's and the client's personal meanings. These aspects of therapeutic artistry are discussed and the use of therapeutic artistry in Eron and Lund's (1996) narrative solutions approach is presented.     

Philosophical Counselling, Truth and Self-Interpretation

Philosophical counselling, Ran Lahav and others claim, helps clients deepen their philosophical self-understanding. The counsellor's role is the minimalist one of providing the client with the philosophical tools needed for reflective self-evaluation. Respect for the client's autonomy entails refraining from intervening with substantive moral criticism, theories, and methods; the client's ways of working out fundamental questions like ‘Who am I and what do I really want?’cannot be assessed by the counsellor in terms of their truth-value, but only in terms of whether they reflect the client's autonomous choice to express him/herself in a certain way. I argue that this view, which is informed by an anti-realist account of self and life-history, undermines the distinction between self-knowledge and self-deception. Once interpretive and criteriological free rein is given to the client, and once personal, pragmatic and aesthetic considerations take precedence over truth-value, then the way is left open to clients to generate the most morally convenient self-interpretation to suit their current needs. I defend the view that truth matters in philosophical counselling; more specifically, that there is a basic distinction between true and false forms of self-understanding. To do this, I offer a broadly realist account of self and reflective self-evaluation. If this is right, then philosophical counsellors shoulder a significant burden of responsibility in helping their clients achieve an accurate, defensible, action-guiding and truth-oriented self-understanding.     

Psychoanalytic Interpretation of Superego Functioning Following CS Readministration Procedures: Case Illustration

The Comprehensive System (CS; Exner, 2003) has specific procedures to address brief Rorschach protocols when the first administration yields fewer than 14 responses. These procedures involve the assessor's asking the client to retake the test by providing more responses on the second administration than the first administration. The request carries with it an implicit criticism of the client's initial effort and a mandate to improve performance on retake. The retake request, with its ambiguously worded demand for improved performance, engages the client's superego (i.e., the client feels judged) and makes it possible to study superego manifestations (e.g., guilt, shame) on the Rorschach test, using a model of (a) brief first record, (b) retake directive, and (c) second administration. We present a case that illustrates a clinical strategy, modeled on a psychoanalytic understanding of the CS retake procedure, for studying the client's superego functioning under retest conditions.     

“Testing Times,Challenging Choices”: An Australian Study of Prenatal Genetic Counseling

In many countries pregnant women deemed to be at increased risk for fetal anomaly following a screening test may attend a genetic counseling session to receive information and support in decision-making about subsequent diagnostic testing. This paper presents findings from an Australian study that explored 21 prenatal genetic counseling sessions conducted by five different genetic counselors. All were attended by pregnant women who had received an increased risk result from a maternal serum screening (MSS) test and who were offered a diagnostic test. Qualitative methods were used to analyze the content and structure of sessions and explore the counseling interactions. Findings from this cohort demonstrate that, within these prenatal genetic counseling sessions, counselor dialogue predominated. Overall the sessions were characterized by: a) an emphasis on information-giving b) a lack of dialogue about relevant sensitive topics such as disability and abortion. Arguably, this resulted in missed opportunities for client deliberation and informed decision-making. These findings have implications for the training and practice of genetic counselors and all healthcare professionals who communicate with women about prenatal testing.     

Une comparaison des apports des modèles de la construction de la carrière et de la construction de soi au life designing counseling

Recent developments in Western societies and transformations in work organizations have made the vocational issues that people face more frequent, complex, and puzzling. With the individualization of the life course, people now more than ever before need to reflect and deliberate as they design their lives. To assist individuals cope with difficult issues in life-designing, counselors have devised a new approach to counselling dialogues that differs from traditional information and guidance interventions. This article briefly presents the theoretical model for life designing counseling and then compares two distinct life-designing intervention approaches. Both of them share the epistemology of social constructivism and concentrate on the client and counselor's co-construction of meaning. Each approach provides a rigorous and systematic foundation for counselling interviews yet they differ in the ways they tackle meaning-making. The major difference is that the first approach presents a highly-structured form of life-designing interview that highlights the counselor's role in reconstructing a client's meanings, identity, and intentions. In contrast, the second approach presents a form of life-designing interview that highlights the client's role in self-construction of meaning, identities, and future prospects.     

A Japanese Perspective on Client Inaction: Removing Attitudinal Blocks Through Morita Therapy

Seven self-defeating attitudinal factors contributing to client inaction and procrastination are discussed from the Morita therapist's perspective. Morita therapy is briefly described, and ways of facilitating desirable action and reducing self-preoccupations are suggested. The suggested approach challenges the client's assumption that resisting and removing the unwanted feelings and imperfect psychological conditions is a prerequisite for implementing necessary action. The counselor's reinforcement of clients' mood-governed action style is also discussed as a factor contributing to the client's inaction.     

Counselors' Perceptions of Spirituality in the Therapeutic Process

The authors investigated the attitudes of 147 Licensed Professional Counselors (LPCs) in 2 southeastern states concerning spirituality in the therapeutic process. Results indicate that LPCs recognize the importance of being aware of their own spiritual beliefs. Spirituality is also viewed as a universal phenomenon that can act as a powerful psychological change agent. Respondents believe that spirituality is not experienced differently by women and men, although spirituality is believed to be expressed differently as a function of gender. Age of the client emerged as a salient variable. One's place in the aging process and one's perception of the aging process were perceived to affect the client's spiritual search. The results have implications for the training of counselors.     

Parallel Process

Summary

This article addresses parallel processes between the author (a therapist) and client when each are mourning the death of their mother. Similarities and differences in their experience and reaction are discussed. The effect of the client's unexpressed grief from her early childhood loss is explored. The author also examines her own, more recent loss and develops a new perspective on its consequences. Tools are presented to help the client work on her grief, especially when the issue is “motherloss.” The impact of the therapeutic process on the client and author is delineated, and the client's reactions to ending her therapy are analyzed.