Exploring How Parents Make Sense of Change in Parent-Child Psychotherapy

Understanding how change occurs in psychotherapy is imperative in informing clinical practice. Increasing attention has been given to the role that qualitative research could play in enhancing our understanding of therapeutic change. Although quantitative research suggests that parent-child psychotherapy is effective in facilitating change, no research to date has focused on how parents make sense of their change experience. In this study, interpretative phenomenological analysis was used to analyze semi-structured interviews of eight parents who had completed parent-child psychotherapy about their understanding of change. Five master themes emerged that encapsulated participants’ understanding of change. These included constructing a survivor narrative, the experience of being understood enabling further understanding, adjusting expectations and practicing acceptance, and feeling empowered to relinquish control. The final theme summarized how despite psychotherapy being conceptualized as a “precious” resource, there was a sense that its limitations could negatively impact participant’s well-being.     

Group Therapy for Loss: Attachment,Intersubjectivity, and Healing

Loss is a fundamental human experience that can impact a person’s mental health in diverse ways. While this experience is potentially formative, harmful manifestations can fracture one’s sense of self and undermine relational health. In this article, we present a rationale for process-oriented group therapy focused on healing relational injuries associated with loss. We draw on attachment, self-psychology, intersubjectivity, and Yalom & Leszcz’s (2005) model of group psychotherapy to explore how group processes allow clients to work through losses and relational frustrations in the here-and-now. A case vignette and discussion offer practical insight on the ways in which loss manifests in the room and demonstrate the uniqueness of the group setting for reparative processing.     

Frank in mind: a journey to self

Abstract

This paper describes two years’ intensive psychotherapy with an 11 year old boy I shall call Lou, who as a result of traumatic experiences in his early life, struggled to integrate a robust sense of self and in particular to find accord with a sense of himself as male. The impact of maternal depression, paternal gender dysphoria and domestic violence are discussed in relation to this young boy’s capacity to resolve the ordinary Oedipal challenge and find narcissistic value in a male body image to consolidate his gender identity. Concomitant difficulties with separation from his mother and aggression towards himself and others significantly impacted his ability to manage in a mainstream school environment and he was excluded at the time the therapy began. A clinical narrative is presented which illustrates Lou’s journey in psychotherapy, where he began to engage and allow links to be made. He sought to understand his position in a world that did not make sense to him, to face a hitherto ‘unthinkable’ past and to integrate disparate aspects of himself including a male gender identity. Notably Lou’s creation of ‘Frank’ constructed from dead, lost and reanimated objects is described and the actual and symbolic functions of this therapy object are discussed in relation to his internal development and the progress of the work. Parallels are drawn with Mary Shelley’s novel Frankenstein, where the creature strives for psychological birth and understanding. Lou and I struggled in the paradox of the themes of his narrative; a male/female father; potency and castration; corruption and repair and how to be a boy, held and helped in part through the paternal function of a female therapist.     

Die Wiederherstellung der Zeit in der ambulanten Psychotherapie mit Psychosekranken

In psychoanalytic psychotherapy with psychotic patients, a disturbance in time experience quite frequently turns out to be central to the psychotic experience as a whole. These patients experience disruptions in the flow of time that lead to a loss of temporal continuity. This loss of temporal structures causes damage in thinking functions: Relations like causality, finality and others which imply a temporal dimension, cannot be established any more. Parts of treatment histories serve to demonstrate the reconstruction of temporal continuity by the patient in psychotherapy. Object-relation-theory and Piaget’s experimental psychology provide the frame of reference for the understandig of the mental processes involved. At the beginning of the psychotherapy the patient experiences being together with the therapist and being separated from him as two discrete conditions of existing which have no links. The periodical reappearance of being together in combination with the awareness of the therapist’s continuous ongoing care encourages the patient to remember and to envisage the meetings with the therapist. The reliability of the alternation seems to stimulate a specific mental activity which creates connections allowing for transitions between the different conditions — in the sense of Winnicott’s transitional phenomena. Transitional phenomena which sometimes are quite concrete things bridge the gap between presence and future. Narrating serves as a link to the past. Through these creative ego-activities temporal continuity is regained providing the basis for strucured thinking and — very important — for the perception of one’s own personality and its continuity over time, thus generating a sense of identity. This process of reconstructing time is interesting in itself, because it sheds light on the psychodynamics of the restitutional processes after a psychotic illness. Moreover, it allows for hypotheses about the development of the inner time dimension in early childhood.     

Bounded in a nutshell and a king of infinite space: the embodied self and its intentional world

This paper explores the implications of developments in phenomenological biology for a reconsideration of synchronicity and the self. The enactive approach of Maturana and Varela aims to reformulate the relation between biological organisms and the world in a non‐Cartesian way, breaking down the conceptual division between mind and world so that meaning can be seen as a function of the species‐specific way in which an organism engages with its environment. This leads to a view of the self as inherently embodied and engaged with the particularities of its material, cultural and social worlds, while being infinitely extended through the power of imagination; this enables humans to adapt to many different social and material environments. In order to understand these differences, we need to ‘enter into the world of the other’. Where understanding of other animals requires immersion in their environmental milieux, understanding other humans requires us also to recognize that differences in socio‐cultural milieux create significantly different worlds of meaning and experience.     

Bridging Conversations: Discussing the Intra‐professional Relationship between Medical Family Therapy and Family Therapy

This article examines the conceptual and practice relationship between medical family therapy (MedFT) and its parent field, family therapy, with MedFT viewed as the extension of relational sense‐making and understanding into a specific venue; that of medicine. The extension of this relational meaning system into medicine is typified by the ability of the therapist to negotiate and connect three main areas of conceptual difference that often account for conflictual relationships between mental and biomedical healthcare providers: (i) patient and provider conceptualizations of issues and goals, (ii) linear and circular understanding of issues and goals and (iii) consultative and expert positions on issues and goals. Two case examples are offered to describe how these three areas of tension are reconciled in practice.     

From Freudian narcissism to the Buddhist notion of anatman,via Jung's idea of identity

Starting from the question the youthful Carl Gustav pondered as he sat on ‘his’ stone – ‘Am I he who sits on the stone, or am I the stone on which he sits?’ – the author has attempted to show that, for Jung, the idea of identity is founded on a wilful non‐determination. This stance results in ethical and methodological repercussions that differentiate it both from the Freudian project and from Hindu and Buddhist thought, while at the same time having much in common with them. The paper refers to the notions of emergence and (Varela et al. 1992) enaction 2 2 According to the Wikipedia entry, the introduction of the term ‘enaction’ is attributed to Francisco Varela, Evan Thompson, and Eleanor Rosch (1992), who proposed the name to ‘emphasize the growing conviction that cognition is not the representation of a pre‐given world by a pre‐given mind but is rather the enactment of a world and a mind on the basis of a history of the variety of actions that a being in the world performs’.
and argues that the concept of the archetype, especially in relation to the self, merits a re‐evaluation in light of the new scientific paradigm.     

Heroes and Mentors: A Consideration of Relational-Cultural Theory and “The Hero’s Journey”

Derived from mythology around the world and over the ages, Campbell’s “The Hero’s Journey” provides a conceptual roadmap for confronting life’s challenges. The way in which clients navigate these challenges may also have a profound effect on their relational development. This article examines The Hero’s Journey through the lens of relational-cultural theory and illustrates ways in which counselors can aid clients in making sense of the struggles they face on their own personal journeys.     

Using Systems Theory to Organize Confusion

This paper represents an initial step in applying to complex clinical situations the symbolic logic developed by G. Spencer Brown and elaborated by Francisco Varela. This way of modeling turns out to yield an interesting mixture of rigidity, ambiguity, and paradox, perhaps inevitable at our present level of understanding of systems containing feedback. Applying the Brown-Varela concepts seems a useful transitional step toward the future use of more sophisticated quantitative models such as those of Powers and Forrester.     

The Right to be Desperate and Hurt and Anger in the presence of Carl Rogers: A racial/psychological identity approach

This paper attempts to establish the beginnings of a conceptual and theoretical framework for psychotherapists and counsellors to 'work with' racial identity psychologically and psychological identity racially in cross-cultural clients. Using the video presentation - of a black client in therapy with Carl Rogers (in the 1970s) - Right to be Desperate and Hurt and Anger as a case vignette, the paper argues that racial/psychological self understanding is possible in therapy. The therapy sessions are critiqued in terms of race and multi-cultural psychotherapy and counselling. Since the video was widely used in the 1990s and is currently used in counselling and multi-cultural therapy training, it was felt that an examination and analysis of some of its contents would offer clinical possibilities in terms of race, culture and ethnicity. Through the analysis of significant excerpts the paper attempts to show that the conflicts, confusions and tensions that arise between a white therapist and a black client can be used creatively to engender trust, openness and cross-racial therapeutic possibilities.     

Janet Taylor Spence: Innovator in the Study of Gender

Janet Spence’s contributions moved gender researchers beyond a simple understanding of psychological gender in terms of individual differences in masculinity and femininity. In early work, she constructed the Personal Attributes Questionnaire, or PAQ, consisting of a masculine and a feminine scale, which she interpreted as assessing the core of psychological masculinity and femininity. Spence subsequently recognized that the masculine, or instrumental, scale reliably predicts only self-assertive, dominant behaviors and that the feminine, or expressive, scale reliably predicts only other-oriented, relational behaviors. Moreover, as her work developed, Spence came to understand this self-ascribed instrumentality and expressiveness, not as gender identity, but as two of the several types of psychological attributes that may become associated with individuals’ self-categorization as male or female. She then defined gender identity as the basic, existential sense of being male or female, which generally corresponds to one’s biological sex. Building on her ideas, we argue that gender identity instead encompasses both the sex categorization of oneself, usually as male or female, and self-assessments on gender-stereotypic instrumental and expressive attributes. These two levels of gender identity are linked by people’s self-stereotyping to the extent that they value their group membership as male or female.     

It is All Personal: Further Thoughts on Therapeutic Action: Commentary on Paper by Noelle Burton

This paper evolved from an earlier panel presentation on conceptual tributaries to relational thinking at the 2015 International Association for Relational Psychoanalysis and Psychotherapy Conference in Toronto. Representing the place of Object Relations theory in the DNA from which Relational Psychoanalysis emerged, I emphasized—and provide here an abbreviated review of—the contributions of Fairbairn, Klein, and Winnicott. Then, as now, believing in the communicative power of clinical examples, I offer an extended clinical narrative in which the medium is the message and clinical phenomena such as multiple self-states, enactments, negotiation, play, and the residue of internal object relations (in both patient and analyst) are brought to life. Also, as the Toronto Plenary overview paper by Jody Davies has developed into its current substantial elaboration of distinctly relational issues (multiple self-states, co-creation, and the interplay of process and insight) and serves as the capstone paper for this published version of our panel, I respond to Jody’s conceptual contributions and her perspective on Relational thinking.     

Empirical investigation of a postmodern model of spirituality within the population of Republic of Ireland

Spirituality is a phenomenon which continues to attract much interest in the Western culture. Throughout the years, it has changed in form and developed in understanding. It has become unprecedentedly broad and embraced by many people, even those who do not consider themselves to be religious. Indeed, spirituality is a subject of debate within academic and non-academic circles regarding its shape, place, function, and definition. This debate and the academic investigation reveals that as a field of study it is undergoing intense and vigorous development. However, there are a number of conceptual deficiencies which need attention, namely; identity and method. The aim of this study is to develop the concept of spirituality according to the current European population. The study applies Structural Equation Modelling (SEM) and finds current spirituality functioning as a three-dimensional model composed of transcendence, immanence, and purpose. This concept is predicted by 13 independent variables. The findings conclude that current spirituality is a person’s individual existential dimension, being subject to change through the influence of various psychological, religious and social factors. The findings of the research describe its practical implication within formational social fields such as education, counselling, and psychotherapy.     

Digital power: exploring the effects of social media on children’s spirituality

Digital culture is a prominent factor in the formation of children’s identity and relational experiences, with high percentages of children in many countries participating in gaming and social networking activities. Yet little scholarly work has addressed the ways in which various patterns of engagement in digital culture call into question current assumptions about childhood identity formation and relationality and the repercussions of formational and relational shifts on children’s spirituality. This essay explores ways in which digital culture functions as a spiritually enriching force in children’s lives, paying particular attention to the potential value of social networking for children’s spiritual well-being and the ways in which the internet’s positive aspects may mask other, more corrosive, elements.     

I,me, and mine—how products become consumers' extended selves

• Consumer research literature has recognized the consumers' use of products and brands as props to their self‐identity. While this literature has illuminated that products indeed serve to extend one's sense of self, the concept of ‘self’ itself is under‐identified. In this conceptual essay, we propose a set of components that make up one's sense of self. Then we identify processes through which possessions become associated with one's identity or self‐concept. We suggest the utility of using the proposed framework in practice for consumers' self‐concept profiles, and for linking brands to appropriate components of ‘self.’ Copyright © 2006 John Wiley & Sons, Ltd.

     

The Dream Sense,Emergent Clinical Process,and the Question of Symmetry: Reply to Brown and Colombo

In recent years I have become interested in Bion and neo-Bionian field theory, but the origin of my interest in dreaming does not lie in scholarly or clinical sources. The source of the idea of the dream sense is my own experience. After addressing that point, I reject what appears to be Colombo’s impression (this issue) that detailed inquiry is necessarily the basis of interpersonal and relational clinical practice, and then take issue with Brown’s understanding of expressive participation in relational thinking (this issue). Responding to Brown’s wish that I offer more detail about my own clinical process, I present an overview of my understanding of the way I work. I conclude by addressing the understandings offered by the discussants of symmetry in the analytic relationship, and offering more details of my own.     

Humanising forces: Phenomenology in science; Psychotherapy in technological culture

One of the concerns of the existential‐phenomenological tradition has been to examine the human implications of living in a world of proliferating technology. The pressure to become more specialised and efficient has become a powerful value and quest. Both contemporary culture and science enable us to have a view of human identity that focuses on our ‘parts’ and the compartmentalisation of our lives into specialised ‘bits’. This is a kind of abstraction, which psychology has also, at times, taken in its concern to mimic the natural sciences. As such, it may unconsciously collude with a cultural trend to view humans as objects, like other objects, and thus fit ‘normatively’ into the emerging world of specialised and efficient systems. This paper examines how the findings of a phenomenological study of psychotherapy reflect a movement by people in psychotherapy to recover their sense of human identity in ways that always transcend any form of objectification. Their human complexity is somewhat restored as they move back towards the concrete details of their lives where the human order has its life. In addition to considering the implications of these findings for restoring the uniquely human dimensions of human identity, the paper also considers the methodological role that an existential‐phenomenological approach can play in supporting a broader view of science. In wishing to be faithful to the human order, it champions the value of the human individual as a starting point in human science. This includes a return to concrete experiences, the balance between unique variations and the ground that we share, and the movement from the particular to the general. As such, a phenomenologically oriented psychology may have an important role to play in helping the broader sciences remember the ‘human scale’ of things.     

A narrative social constructionist approach to therapeutic empathy

The concept of empathy has been a centrol conceptual element in approaches to counselling and psychotherapy that emphasise exploration of meaning in the context of a facilitative relationship. However, the existing literature on therapeutic empathy lacks theoretical coherence. a narrative social constructionist perspective represents a theoretical approach that enables the integration of diverse strands of clinical observation and research into the creation of empathic understanding in counselling. From a social constructionist position, therapeutic empathy can be understood as a relational process, a step-by-step co-construction by counsellor and client of the life-narrative of the client. In this paper, the Barrett-Lennard (1981) cyclical model of empathy is used as a fremework for examining the counsellor and client actions, strategies and tasks that constitute empathic engagement around the task of emploring and re-authoring life-narratives. Constructionist analysis of the cultural origins of the concept of empathy suggest some limitations of this way of conceptualising what happens in therapy. The implications of these ideas for theory, training and research are discussed.     

Anorexia and the Trojan Horse: a reflexive review of written psychoanalytic encounters with anorexic patients

A selective and limited sample of clinical case studies of psychoanalytic psychotherapy with anorexic patients, focussing on the author/therapist’s experience of working with such patients, is examined. Patients’ depressive and often angry states of withdrawal, and projections, are frequently noted. A summary of more hopeful interactions, as selected from the literature reviewed, is offered. An understanding of anorexic defences is explored in relation to the ‘Trojan Horse’ mythology, in the sense that that which purports to be emotionally nourishing and sublime can be suspiciously viewed as seeking to enter and conquer, through subterfuge. Some existing challenges to traditional tenets of psychoanalytic clinical practice with anorexic patients are presented.     

Relational ecologies of psychotherapy: The influence of administrative attachment on therapeutic alliance

There is now vast and multi-faceted empirical literature on the impact of relational dynamics in psychotherapy, and relationality is a central theme within contemporary psychoanalytic theories. Yet, there is virtually no literature addressing the relational dynamics around outpatient psychotherapy that influence the wider therapeutic alliance, that is the relational dynamics that unfold between clients and administrative office staff in making initial contacts and appointments, completing paperwork, negotiating payment, discussing insurance coverage, working through crisis calls, and the myriad of other forms of interaction which serve to form the relational ecology of psychotherapy. Milieu therapy or the use of supportive and structured therapeutic environments has been given significant attention in inpatient settings; however, administrative relational factors or administrative staff characteristics have seemingly been ignored in outpatient psychotherapy and psychoanalysis literatures. Many outpatient clinical practice settings involve multiple levels and dimensions of relationality between clients, administrative personnel, and therapists which shape the potential for secure continuous containment and various forms of attachment to psychotherapeutic space. In this paper, we describe several clinical illustrations of relational dynamics between clients and office staff which influence therapeutic alliance and outline the contours of our emerging idea of administrative hospitality based on relational psychoanalysis, attachment theory, symbolic anthropology, and stigma research. In doing so, we draw on our collective experience working in several outpatient clinics and insights from our current context in an urban outpatient training clinic which emphasises psychodynamic practice. Our goal is not a comprehensive analysis of the relational ecology of psychotherapy but to offer an initial exploratory account of some of the administrative relational dynamics in and around outpatient psychotherapy which go beyond the therapist-client dyad. The anthropological concept of liminality is connected to relational psychoanalytic theories to describe the important dynamics of transitional space in an overall process of relational transformation.