Issues in the supervision of group psychotherapy: Countertransference and the group supervisor's agenda

Countertransference issues are of particular importance to the beginning group therapist. This paper describes the role of supervision in helping the beginning group therapist deal with counter-transference issues as they effect the formation of a group and the role that the group leader plays in facilitating therapeutic activity within the group. Particular problem areas and the countertransference they evoke and the role of supervision in working through are described.The author wishes to acknowledge the suggestions and support of Aaron Stein, M.D., and other members of the Division of Group Psychotherapy of the Department of Psychiatry of the Mt. Sinai School of Medicine.     

Video games: support for the evolving family therapist

Video games are a growing part of USA and world culture. Gaming may have addictive effects on some gamers and may foster violent thoughts and behaviour in children and adults. Conversely, there are documented positive outcomes from playing video games. Through this growing media, family therapists have a new gateway to better understand the experience of a younger generation of clients. To keep up with a changing client base, family therapists must learn about video games, their contextual impacts, addictive aspects and possible uses in the therapeutic setting while ignoring the myth that all gaming is harmful.     

Countertransference issues in psychotherapy with lesbian and gay clients

This article briefly reviews literature on responses towards same-sex (lesbian and gay) sexualities from psychoanalytic and ‘lesbian and gay affirmative’ psychotherapeutic perspectives. An analysis is presented of reports of countertransferential reactions to lesbian and gay clients, obtained from interviews with fourteen psychotherapists who work in a lesbian and gay affirmative manner and eighteen clients who had received affirmative psychotherapy. Data were subjected to grounded analysis. Participants consistently attended to the thoughts, feelings and values that therapists held in relation to lesbian and gay clients and how these affected the meanings and practices available to them. These were linked with the therapist's sexual identity among other factors. Negative countertransferential reactions were regarded as potentially occurring among heterosexual and lesbian and gay therapists and were seen as arising from therapists’ conscious and unconscious fears about same-sex sexualities. These findings indicate a need to continue debating these issues more widely in the professional arena.     

Perceptions of the therapist in family therapy

Thirty-five families completed ratings describing their perceptions of their therapists. These ratings were then correlated with measures of outcome to assess whether there was a relationship between experiences of the therapist and treatment outcome. Further, the study addresses whether some family members' perceptions are more influential in affecting the course of treatment. The results showed that family members' perception of the therapist does have an impact on treatment outcome, but not all members affect the outcome equally. Further results and their implications are discussed.     

Three techniques for the solo family therapist

Three techniques are described which may be used by family therapists working without the aid of a co-therapist or team. These are: (1 )the use of a 'ghost co-therapist', (2) the use of the Gestalt therapy 'empty chair' technique in developing a systemic hypothesis, and (3) the use of self, the opinions of significant others and research findings to allow conflicting views of the family's dilemma to be presented.     

Making family therapy easier for the therapist: burnout prevention

Burnout prevention for family therapists can be enhanced by careful consideration of the degree of responsibility taken by the therapist contrasted with responsibility placed on the family. Attention to issues of expectations, role definition, sharing of feelings, and therapeutic ambition can ease the strain on the therapist.     

For the new family therapist: A glossary of terms

Abstract

Traditional psychodynamic terms used in describing, diagnosing, and treating individual patients have proven less than helpful in working with families. In an attempt to alleviate this difficulty, and as an aid to the newcomer in the field of family therapy, this glossary of terms is presented. This glossary is not meant to be all-inclusive. Rather, its purpose is to provide the new family therapist with an introduction to the language of the field, an armamentarium from which to work, and to provide a basis of knowledge that is usually not accumulated by the new family therapist until he or she has worked with a number of families over a period of time.     

SYMLOG: Clinical technology for therapist family of origin and family system appraisal

SYMLOG, an acronym for Systematic Multiple Level Observation of Groups, reflects a technology for the quantification and graphic organization of subjective observational data. The SYMLOG field diagram-a graphic diagram which reflects relational interactions on three dimensions-provides the opportunity to analyze the admixture of therapist family of origin dynamics in conjunction with family relational behaviors. This article presents a sample SYMLOG clinician family of origin evaluation with accompanying elaboration surrounding SYMLOG field theory.     

Hunger Pangs: Transference and Countertransference in the Treatment of Foster Children

In working with children, clinicians are often confronted with physical as well as psychological hunger—demands for real along with symbolic feeding. Foster children, who have suffered actual neglect and deprivation, often stir powerful and primitive feelings about the place and importance of the real and the symbolic in psychotherapy. These parentless children explicitly and implicitly announce that they need a family, not a therapist. In response, the therapist, particularly the young and inexperienced clinician, may devalue the therapeutic relationship and unconsciously move into a parental role, feeling that without the protection of a family the child will inevitably fall into the enormous emotional, economic, and systemic cracks in the world of foster care. Clinical material illustrates these points.     

Refugee families: issues of systemic supervision

Families of refugees tend to evoke many powerful responses in all who come into contact with them. Loss and trauma, helplessness and victimhood, transition and change are some of the main themes that seem to dominate. In particular, in contact with mental health professionals, refugee families are more likely to be seen as 'traumatized' and their resilience less acknowledged. In this article I will endeavour to address some issues that contribute to this skewing of our perception of refugee families, especially in the context of supervision.     

Ethical issues in therapy: therapist self-disclosure of sexual feelings

Although therapist sexual attraction to clients is common, and therapist self-disclosure is an often-used intervention, therapist self-disclosure of sexual feelings to clients is an understudied phenomenon. In this article, I critically review the small base of literature on therapist self-disclosure of sexual feelings, including information on prevalence rates, empirical research, and case studies. By incorporating these findings with information from relevant sections of the American Psychological Association (2002) Ethics Code, my intent is to evaluate different aspects of therapist self-disclosure of sexual feelings and arrive at conclusions regarding therapists' use of these disclosures. It appears that direct, explicit disclosure of sexual feelings can run the risk of harming clients and may therefore be unethical. Therefore, the use of this technique is discouraged. I discuss the issue of using less explicit interventions.     

A guide to family/school interventions for the family therapist

When presented with a behavioral problem or symptom expression that involves two systems, such as a serious school-related problem, the therapist needs to design an approach that will intervene effectively and expeditiously in both systems. This paper offers a guide to stages of problem escalation and therapeutic intervention that is intended to aid the problem-solver's thinking processes in approaching a troubled situation that involves two systems, the school and the home.     

Family therapy and outcome: Relationships between therapist and family styles

This study examined therapeutic outcome for a group of 175 clinic families divided into levels of family competence and style, and, later, into seven clinical groupings. The division into these groups was based on the level of rated Competence and Style determined by using the Beavers Systems Model. Therapists also rated their level of Openness/Sharing Strategy, Power Differential, and Partnership with the family at the third session. Results indicate that more competent families who fared well in therapy had therapists who formed a partnership, disclosed strategy, and employed a minimal power differential with the family. The most disturbed families, and those with a Centrifugal style, did better with therapists employing a high power differential and lower levels of openness and partnership. The study also presented the distribution of individual diagnoses by family groups. Implications for family therapists, including the value of family assessment, are provided.     

The rescuing therapist: A duplication of the pathogenic family system

Abstract

Rescuing is a saving behavior occuring in pathogenic families which is often duplicated by family therapists. Rescuing, if not confronted and explored, leads to frustration and burn—out in families and therapists. This paper explores the dynamics of rescuing behavior in families, how it is replicated by a therapist's attempts to rescue, and how the impetus for these attempts are derived from the therapist's own family of origin. The value of exploring the need to rescue is demonstrated by use of a case example. Countertransference issues and their resolution through the conscious differentiation between rescuing and real help are also explicated.     

The effect of supervisor and trainee therapist gender on supervision discourse

The effects of supervisor and trainee therapist gender on supervision discourse were examined in this study. Forty episodes of supervision discourse, with ten drawn from each of four types of supervision systems were videotaped. The systems were (1) male supervisor and male trainee therapist; (2) male supervisor and female trainee therapist; (3) female supervisor and male trainee therapist; and (4) female supervisor and female trainee therapist. The episodes of supervision discourse were analysed using a supervision discourse coding system which showed adequate inter-rater reliability. For supervisors, the coding system allowed a directive discourse style and a collaborative discourse styled to be coded. A cooperative discourse style and a resistant discourse style could be coded for trainee therapists. Two statistically significant findings of considerable theoretical and clinical importance emerged. First, contrary to stereotypic expectations, discourse characterized by a directive supervision style and a resistant trainee therapist style was more common for systems containing a female supervisor than for those containing a male supervisor. Second, for same gender supervisor-trainee-therapist supervision systems, a collaborative systemic supervision style was correlated with both cooperative and resistant trainee therapist styles. This discourse pattern did not occur for opposite gender supervision systems, indicating that a collaborative supervision discourse style is consistently associated with trainee therapist parti-cipation (either cooperatively or resistantly) within same gender pairings of supervisors and trainee therapists. These results are discussed in light of relevant literature on gender, power and supervision process and the limitations of the study are considered.     

On becoming a family therapist: The first three years

The process of learning to conduct family therapy involves encountering and mastering specific issues which can be conceptualized as occurring in a hierarchy of stages. This article describes five stages in the development of a beginning family therapist: immobilization, collecting techniques, examination of self, in search of a theory, and maintaining energy.