Emotion in an alliance rupture and resolution sequence: A theory‐building case study

Aims: Alliance rupture and resolution processes are occasions for the client to have his or her core interpersonal patterns activated in the here and now of the therapy and to negotiate them with the therapist. So far, no studies have been conducted on emotional processing, from a sequential perspective using distinct emotion categories, in alliance rupture and resolution therapy sessions. This is the objective of this theory‐building case study. Method: This client underwent a 34‐session long, psychodynamic psychotherapy within the context of an open trial. An alliance rupture‐resolution sequence of two subsequent sessions, along with a third control session, was selected from this case and these sessions were rated using the Classification of Affective‐Meaning States (CAMS), an observer‐rated method to classify distinct emotions, according to current emotion‐focused models. Results: The results indicate that the rupture session was associated, above all, with core maladaptive fear, evoked in the actual here and now of the therapeutic relationship, whereas the resolution session was associated with the expression and experience of adaptive hurt as regards biographical issues of the client. Discussion: These results are discussed with regard to the alliance rupture and resolution model and the exploration of integrating client's emotional processing in the model.     

Understanding Pamina's recovery: An application of the hermeneutic single‐case efficacy design

This article reports an effectiveness case study of the individual systemic therapy of a 22‐year‐old Portuguese woman with a diagnosis of paranoid personality disorder, conducted in a university‐based clinic in Lisbon, Portugal. Data were analysed using the hermeneutic single‐case efficacy design, a non‐experimental interpretive approach that aims to determine whether change occurred, whether change was due to therapeutic strategies, and what in therapy caused the change. Results indicate that the treatment was effective and that de‐pathologising Pamina's condition and genogram‐based exploration techniques played a crucial role in her recovery.     

‘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.     

Using eye movement desensitization and reprocessing to treat complex PTSD in a biracial client

A biracial client's recovery from posttraumatic stress disorder (PTSD) through the use of eye movement desensitization and reprocessing (EMDR) is discussed to illustrate the interaction between ethnicity and phenotype as well as diagnosis and treatment considerations. This case explores a woman's experience of discrimination in and out of her home and her vulnerability to complex PTSD, and it documents the importance of the therapy focusing on experiences of discrimination and prejudice as well as abuse. It shows how the client structures her environment in a personally creative fashion to include representative features of various aspects of her identity, by her choice of where and who she teaches as well as how and with whom she spends her free time.     

Using REBT in the Treatment of Restless Leg Syndrome: A Case-Study

This paper describes a case study of a middle-aged woman with restless leg syndrome (RLS) and the course of her treatment using rational emotive behavior therapy (REBT). Although the empirical support is somewhat limited, published literature suggests the potential effectiveness of cognitive-behavioral therapy in treating clients with RLS. This client sought treatment for chronic pain consistent with RLS which had affected her quality of life and daily functioning. She was assessed using a battery of quantitative measures. Conceptualization and treatment from an REBT perspective is discussed. The client was seen for six sessions. Treatment involved a combination of REBT disputing and cognitive restructuring techniques and behavioral interventions. Homework was given after each session. Between-meeting progress was assessed at each session using the Outcome Questionnaire and a scale measuring the client’s rational and irrational beliefs. The client reported a steady reduction in symptoms with associated improvements in sleep and daily functioning over the course of the six-session intervention. Therapeutic gains were maintained at 8-months follow-up.     

The application of solution‐focused work in employment counseling

The author explores the applicability of a solution‐focused therapy (SFT) model as a comprehensive approach to employment counseling. SFT focuses the client on developing a vision of a preferred future and assumes that the client has the talents and resources that can be accessed in the employment counseling process. The solution‐focused counselor enters the therapeutic relationship from a point of “not knowing” and works with the client in job transition to develop possibilities that evolve from the client's strengths and knowledge. Examples are given of how solution‐focused employment counseling could be practiced.     

A meditation on the nature of self‐healing and personality change in psychotherapy based on Gendlin's theory of experiencing

Abstract

From a humanistic point of view psychotherapy is a creative transformational process in which therapists assist clients’ intrinsic self‐healing tendencies. However the nature of the self‐healing process is poorly understood. I briefly consider two theories of self‐healing, Rogers’ self‐actualization theory and dialectical theory, but focus on Gendlin's theory of experiencing as providing a more complete explanation. I consider the fundamentally implicational nature of change and portray personal change as “paradigm evolution” rather than paradigm revolution. I conclude with an examination of the self‐healing process in therapies that provide minimal prosthetic assistance to the client: client‐centered therapy, eye movement desensitization and reprocessing, and focusing‐oriented therapy. I conclude that the self‐healing/self‐change process occurs when intellectual, “top‐down” cognitive and self‐critical activity is interrupted, and when clients adopt a receptive, listening attitude towards inner experience.     

Dancing Contact Improvisation with Luce Irigaray: Intra‐Action and Elemental Passions

This article takes as its point of departure Luce Irigaray's Elemental Passions, in which a woman‐speaker tries to make her lover and the discipline of philosophy understand that she is not how they have imagined her to be; that she is not at all but that she keeps becoming through perpetual movement. The article investigates Irigaray's investment in a form of materialist difference feminism that offers conceptual links to the posthumanist work of Karen Barad's agential realism, especially her theorization of intra‐action. The link between Irigaray and Barad is established via a diffractive reading that incorporates the dance/movement research practice of Contact Improvisation. Although expressed through written language, Elemental Passions creates the impression of the woman‐speaker dancing, of encountering herself, her environment, and her lover through moved and moving contact, searching for a practice of moving‐together, feeling‐with, and feeling‐between that can be experienced in an improvised dance duet. Exploring how touch and the sharing of weight in Contact Improvisation challenges boundaries and establishes ever‐changing configurations and entanglements between dancers, the article proposes that Irigaray's woman‐speaker envisions herself as a posthuman/ist woman and that improvised dancing offers a practice of intra‐action through which she can encounter the world in her becoming.     

The effects of torture‐related stressors on long‐term complex post‐traumatic symptoms in South Korean torture survivors

This study explored whether perceived distress from specific stressors during and after torture explain long‐term complex post‐traumatic symptoms of South Korean torture survivors. We conducted a cross‐sectional survey of survivors who had been tortured by the homeland regime from the 1970s to the 2000s. Data from 206 survivors were gathered by key informants using target sampling and snowballing techniques. Project staff designed scales to encompass the specific types of stressors related to torture techniques used in Korea. Frequencies and distress ratings of exposure to torture, post‐torture psychosocial stressors and physical damage related to torture were gathered. Psychological symptoms were assessed by the Impact of Event Scale‐Revised‐Korean version and subscales of the Symptom Checklist 90‐Revised‐Korean version. Perceived distress from torture stressors was mainly divided into factors representing physical, psychological and deprivation torture by adapting a principal axis factor analysis. Hierarchical regression analyses showed that distress from psychological torture explained post‐traumatic stress disorder (PTSD) and that distress from deprivation explained PTSD and anxiety after controlling for demographic variables, psychological preparedness, time span since torture and distress from trauma other than torture. Among post‐torture stressors, distress from physical damage related to torture and social exclusion were strong indicators of complex symptoms.     

Person‐Centered Counseling: The Culture Within

The variables most related to success in counseling outcome research are the client‐counselor relationship and the personal and situational resources of the client (extratherapeutic variables). When these variables are compromised, a “specificity myth” is endorsed purporting that there are specific treatments for particular groups of people. This myth is a direct result of a shift in focus from the client to the counselor as the expert who focuses on “doing” counseling rather than “being” a counselor. Person‐centered counseling cuts to the core of therapeutic success: the relationship of the counselor‐client and the utilization of the client's resources.     

Therapeutic challenges of multi‐being

This paper emerges from an attempt to shift the locus of understanding human action from the individual to relationship. In doing so we come to see persons as multi‐beings, that is, as constituted within multiple relationships from which they emerge with multiple, incoherent, and often conflicting potentials. Therapy, in this context, becomes a collaborative relationship with the aim of transforming the client's broader relational network. In this view, schooling in a singular practice of therapy artificially limits the therapist's potential, and thus the possible outcomes of the client–therapist relationship. Invited, then, is a reflective eclecticism, in which the myriad potentials of both the therapist and client are considered in tandem. This view is illustrated by contrasting three relational conditions in which clients find themselves, each of which invites a different form of self‐expression from the therapist.     

Containment,curiosity and consultation: an exploration of theory and process in individual systemic psychotherapy with an adult survivor of trauma

This paper describes an individual therapy from the author's private practice. On referral, the client came to therapy requesting help with her 8‐year‐old daughter. Within the assessment, a single episode of trauma was revealed. Further therapeutic conversations told of multiple memories of trauma. The main therapeutic work has now ended, the contract being left that the client can continue to request appointments if she wishes. I show how systemic therapy from Post Milan and Narrative models, including practices from other orientations, has been useful and name three key practices as being crucial to the work, containment, curiosity and consultation. I suggest parallel processes operating between myself and my client as well as between the therapy and consultation. Distinct phases in the therapy recovery are identified. The discussion will consider themes of containment, curiosity and consultation.     

Maternal representations and emotional availability among drug‐abusing and nonusing mothers and their infants

Both negative and idealized maternal prenatal representations may constitute a risk for mother–infant interaction. This study analyzed the role of maternal prenatal representations and pre‐ to postnatal representational change in predicting mother–infant emotional availability (EA) among 51 drug‐abusing mothers and their infants who participated in either psychodynamic group therapy (PGT) or received psychosocial support (PSS) and among 50 nonusing comparison dyads. Maternal representations of her child, the child's father, her own mother, self‐as‐mother, and self‐as‐woman were measured during pregnancy and at 4 and 12 months' postpartum with the Interview of Maternal Representations (M. Ammaniti et al., 1992 ; M. Ammaniti, R. Tambelli, & P. Perucchini, 1998). EA was measured with the Emotional Availability Scales, fourth edition (Z. Biringen, 2008 ) at 4 and 12 months. The results showed that drug‐abusing mothers had more negative prenatal representations of the self‐as‐woman and of the child's father. Postnatally, PSS mothers tended to first idealize their child, but later to experience disillusionment of idealization. Both negative and idealized prenatal representations of the self‐as‐mother predicted mother–infant EA problems, but only among the PGT mothers. For all mothers, negative representational change was detrimental for the mother–infant EA whereas for drug‐abusing mothers, also increasing idealization from the prenatal period to the postnatal period was harmful. Clinicians working with drug‐abusing mothers should aim at supporting the development of a realistically positive view of motherhood.     

Treating Adults With Complex Trauma: An Evidence‐Based Case Study

This article presents an overview of complex trauma and a case study describing the evidence‐informed treatment of a 25‐year‐old woman with chronic complex trauma symptoms resulting from childhood sexual, physical, and psychological abuse from a caregiver. Treatment followed a relationship‐based, cognitive behavior therapy model across 3 treatment phases. Significant reductions in trauma and general distress symptoms occurred from pre‐ to posttreatment, although firm conclusions about cause cannot be drawn from case studies. Verbatim vignettes illustrate specific interactions.     

Career‐Community Development: A Framework For Career Counseling and Capacity Building in Rural Communities

The authors propose a framework for career counseling in rural communities that addresses the psychosocial and economic challenges of natural disasters and other catastrophic transitions. The career‐community development framework expands the notion of “client” to include a community‐as‐client approach within a capacity building orientation to supporting workers in the wake of large‐scale disruptions. Drawing on a case study of 2 communities recovering from a devastating forest fire, the authors outline an intervention approach that integrates elements from psychological‐trauma theory, career‐community capacity building models, and libratory educational practices. Implications of this framework for counselor training and practice are discussed.     

Social Achievement Goals and Social Adjustment in Adolescence: A Multiple‐Goal Perspective

Adolescents approach social situations with different social achievement goals (i.e., social development goals, demonstration‐approach goals, and demonstration‐avoid goals). Applying a latent profile analysis (LPA), a person‐centered approach, this study identified four groups of adolescents with distinct social goal profiles: approach‐oriented, undifferentiated high, demonstration‐oriented, and undifferentiated low. Observed differences in various indicators of social adjustment, including social anxiety, friendship quality, prosocial behavior as well as aggressive behavior, indicated that the approach‐oriented and undifferentiated high profiles showed most adaptive outcomes, whereas the demonstration‐oriented and undifferentiated low profiles showed maladaptive patterns of social outcomes. Profiles with high levels of social development goals showed the most adaptive social outcomes regardless of the level of demonstration‐oriented goals (i.e., demonstration‐approach and demonstration‐avoid goals). These findings suggest that focusing on high‐quality relationships and developing social competence leads to adequately contending with social challenges, and it provides protection against the negative effects of demonstration‐oriented social goals.     

Privileged Communication in the Counselor‐Client Relationship

Determining the status of privileged communications between counselors and clients is a complex task. The scope of counselor‐client privilege varies considerably across states, and several sections of state codes directly and indirectly influence its status. This article presents an analysis of state laws related to privileged communication in the counselor‐client relationship and discusses prevalent legal exceptions. The authors offer implications for practice to assist counselors in balancing their ethical and legal obligations.