Therapist Self Disclosure in Group Psychotherapy from an Intersubjective and Self Psychological Standpoint

The history of therapist self disclosure is traced from the early struggles of Ferenczi and Burrow to its valued, yet still ambivalent, contemporary status. The symmetry of self disclosure by therapist and group members is differentiated from the parity of their different roles and responsibilities. Using a case example, the process is discussed through which a therapist's self disclosure fosters task-appropriate satisfaction of selfobject needs as it also helps group members articulate and loosen archaic selfobject binds. The therapy group is described as a transitional space within which a therapist's disclosure offers members an intersubjective bridge to the therapist as well as a model for members' own active participation in the group's work.     

Group processes and the therapist's subjectivity: interactive transference in analytical group psychotherapy

Interactions among the group therapist, the group members, and the group as a whole, especially enactments, are conditioned by the therapist's identity, defenses, and present relationships within his or her social networks. It follows from these considerations that difficulties in a group process stem from the group therapist's inability to understand well-enough what the group members are acting out and that they can be overcome only if the therapist extends the limits of his or her identity. Therefore, it has to be taken into account that the leader of a group is always a member of other groups whose dynamics in turn determine one's capability to understand the interactions in the group in which he or she is a therapist.     

Saying goodbye: exploring attachments as a therapist leaves a group of chronically ill persons

This clinical report highlights some of the processes arising in a therapy group of persons with persistent and chronic psychiatric illnesses as they cope with the stress of their long-standing therapist's impending retirement. Members were initially disbelieving that the therapist would leave and were also concerned about their future care, particularly in terms of medications. Gradually they were more able to experience their feelings of loss and their genuine caring for the therapist and the group, using higher level defenses and increasing their ability to tolerate strong affects. They became increasingly able to demonstrate empathy, notably in their ability to consider the therapist's emotions. The clinical material also illustrates the therapist's personal involvement, countertransferences and expressions of concern.     

The therapist's self in dialogical family therapy: some ideas about not-knowing and the therapist's inner conversation

In this article, the focus is on the therapist's self, which will be in line with Bakhtin's thinking, viewed as a dialogical self. First, the dialogical view of the self is situated in the context of psychology's traditional focus on the individual self. Then, leaning on Bakhtin and Volosinov, the self is described as a dialogue of multiple inner voices. Some of the implications of this concept for family therapy practice are examined, focusing especially on the therapist's participation in the therapeutic process and on the therapist's inner conversation. The author argues that not-knowing does not only refer to the therapist's receptivity and respect but also implies that the therapist is aware of his or her experience and reflects on how his or her inner conversation might inform and enrich the therapeutic conversation. Finally, these ideas are illustrated with a brief clinical vignette.     

Treatment of the chronically mentally ill: an opportunity for the group therapist

This article focuses on the therapist's task of engagement in the group treatment of the chronic mentally ill. The dynamics of individual and group processes are reviewed with an emphasis on the contributions of social, interpersonal, and intrapsychic factors. Drawing upon the observations of Friedman (1988), the presentation explores therapists' efforts to restore their inner balance by (1) acting like a therapist, that is, according to their theory; (2) satisfying their curiosity; and (3) eliciting "something desirable," which is formulated as the therapist's search for interactive responses. Examples illustrate these elements as they emerge in group psychotherapy.     

The therapist's inner conversation in family therapy practice: some ideas about the self of the therapist, therapeutic impasse, and the process of reflection.

In this article, a distinction is made between the outer therapeutic conversation and the therapist's inner conversation. The therapeutic conversation is a circle of meaning in which both the therapist and the clients play a part. The therapist's inner conversation is described as a negotiation between the self of the therapist and his role. In this process of negotiation the therapist has to take seriously, not only his observations, but also what is evoked in him by these observations, that is, images, moods, emotions, associations, memories, and so on. Furthermore, therapeutic impasse is conceptualized as a paralysis of the circle of meaning and of the therapist's inner conversation. A process of reflection is proposed as a way out of the impasse. In that process, the inner conversation of the therapist is externalized with the help of an outsider. In the final part of this article, a case study illustrates the importance of these ideas for the family therapy practice.     

Developing the Working Alliance in Marital Therapy; A Psychodynamic Perspective

A good working alliance in marital therapy is one in which the partners are actively collaborating with their therapist to work through conflicts. The therapist begins to develop the alliance by setting the frame of therapy and helping the couple understand the guidelines of treatment. The partners gradually identify with and emulate the therapist's working style and use of self as a reflective instrument. The working alliance can be weakened by empathic failures and strengthened by increased feelings of trust in the therapist and the process of treatment This paper looks at the development of the working alliance in marital therapy from a psychodynamic perspective. A clinical illustration is included.     

An alternative view of the spouse of the therapist

A therapist's relationship with a spouse, i.e., partner in living, has an important influence on the quality of his or her professional functioning as this relationship offers a vital source of personal support and renewal. This relationship may aid in counterbalancing the weight of the therapist's professional demeanor by focusing on aspects of the therapist's interpersonal relatedness not commonly experienced with other professionals or with clients. The concept of a support-power base from which a therapist extends him or herself toward clients provides a context within which to view the therapist-spouse relationship. If this relationship is approached by the therapist without reliance upon a well-practiced professional role, it can make available opportunities for self-exploration which lead to enhanced personal growth and more effective functioning both personally and professionally.     

Oppression, freedom, and recognition in an analytic therapy group: group and therapist interactions from relational and group analytic perspectives

Group analytic and relational writings point to the development of mutual recognition between individuals as a main treatment goal. To achieve this, it is necessary to face up to issues of control and oppression in the therapeutic relationship, particularly as enacted by the therapist. The relationship between the therapist and group members is a co-construction, shaped by their respective subjectivities. The therapist's willingness to enter into an open examination of his or her enactments can stimulate change in relationships with patients, resulting in freer and more spontaneous communication in the group. To illustrate, several sessions of an analytic therapy group are presented in which there were struggles between (1) the desire for equality and mutuality and (2) firm exercise of authority.     

Family therapist authenticity as a key factor in outcome

The authors explore various arguments for and against therapist self disclosure and relate these to theoretical school and therapist style and personality. Several case vignettes are used to highlight the appropriate and efficacious revelation of therapist's thoughts, feelings and reactions to the patients and their behavior. A review of the recent literature on this controversial topic is included. The theme is that in almost all therapies, except in psychoanalysis where it is counterindicated, the therapist's selective dynamic use of his own perceptions, experiences and values in a genuine and committed fashion contributes positively to the therapeutic outcomes.To thine ownself be true And it must follow as the night the day Thou canst not then be false to any man. (Hamlet, Act I)     

Complete psychotherapy: Healing the phenotype

The concept of the phenotype is presented here as an integrator for psychotherapeutic and psychopharmacological knowledge. Some criteria which the therapist may find useful in pursuing nature/nurture resolutions are suggested by exploring this concept and its implications in the context of the present state of knowledge. The goal of this paper is to help refine the therapist's judgement on the nature/nurture causal components of the client's difficulties, and to help the therapist to better distinguish between healing which is effected without pharmacology versus those forms of healing which are better realized with it. A concluding section digresses to the potential for psychomathematical models to help achieve resolution.     

Countertransference envy toward the religious patient

Four illustrations have been presented which demonstrate the uses and interpretations of envy in countertransference reactions to religious patients. To be sure, envy reactions to any patient are significant, whether they simply distort the therapist's perception or contribute to a deeper understanding of the patient. In the case of the religious patient, envy reactions in the therapist may serve as an additional instrumentality for under-standing the ways in which the dynamic determinants of religious behavior and metaphor become enmeshed in and also transform the pathology of the patient as well as the therapeutic process itself. Both the constructive and destructive object relational implications of envy must be borne in mind by the therapist in order to adequately explore the range of reciprocating forces between therapist and patient. Primitive mechanisms such as projective identification and psychotic transference are particularly prone to evoke envy reactions of surprising intensities, yet an empathic attitude will usually enable the therapist to differentiate the true source of his envy as he more carefully comprehends the quality of object relational and dynamic needs such envy serves.     

Wet Cocker Spaniel Therapy: An Essay on Technique in Family Therapy

Wet Cocker Spaniel Therapy is a metaphor for the therapist's use of spontaneous techniques arising from the specific therapeutic situation rather than planned techniques from the therapist's training or allegiances. The paper proposes a problem-oriented, rather than technique-oriented, approach to family therapy. Most therapy can be performed in a calm, polite, rational, straightforward manner without any tricks or therapeutic razzle-dazzle. From time to time, the therapist may have to startle or jerk the family past a snag point and into change. Ideally, the therapist's techniques should arise from the content of the hour and the symbolism of the family and should be applied sparingly. I hope this paper will make therapists feel more comfortable being sane, polite, and practical, and unashamed when not being brilliant.     

Anonymity reconsidered

This paper questions the concept of the therapist's anonymity and offers as an alternative the concept of an anonymity/self-disclosure dimension along which the therapist can position himself depending on several criteria. These criteria pertain both to characteristics of the therapist, the patient, and the material to be disclosed.     

Sudden Death of the Therapist: The Effects on the Patient

While the termination phase of psychoanalytic psychotherapy has been discussed in the literature, the effects on the patient of a forced termination following the therapist's death have seldom been investigated. In this paper, two groups of patients (N = 35) were compared: those who experienced a planned termination and those who experienced a sudden termination as a result of their therapist's death. Data were gathered by means of detailed questionnaire and formal psychological assessment (i.e., the Grief Experience Inventory). Responses were also solicited from therapists who treated patients subsequent to the original therapist's death. Results indicate that patients forced to terminate due to the therapist's unexpected demise experienced significantly more intense grief reactions with regard to feelings of anger, despair, depersonalization, and somatization. The nature of the transference relationship with the original therapist at the time of the latter's death appeared to influence the subsequent therapeutic relationship as well. The authors present recommendations and practical guidelines concerning therapists' responsibility to their analytic patients to make reasonable accommodations in the event of their unexpected death.     

The therapeutic alliance in couples therapy: clinical considerations

This article presents clinical considerations about the therapeutic alliance in couples therapy, stimulated by pertinent new research findings reported in this issue. A loyalty dimension of the couple's relationship is described, as well as its influence on the therapeutic alliance in couples therapy. The therapist's establishment of a "meta-alliance" with the couple around their loyalty conflicts, avoidance of splits and disruptions, and prioritization of marital distress (versus individual symptoms) as the primary focus of treatment all serve to solidify the therapeutic alliance. In addition, identifying the partners' early family-of-origin distress can help predict and respond to strains in the therapeutic alliance that may occur later in therapy. Finally, the therapist helping the couple to balance their relational power differences in therapy and to address their concerns about the impact of the therapist's gender also strengthens their therapeutic alliance. A clinical case and vignettes are included to illustrate these issues.     

The effects of feedback self-consistency, therapist status, and attitude toward therapy on reaction to personality feedback

Individuals' reactions to interpersonal feedback may depend on characteristics of the feedback and the feedback source. The present authors examined the effects of experimentally manipulated personality feedback that they--in the guise of therapists--e-mailed to participants on the degree of their acceptance of the feedback. Consistent with Self-Verification Theory (W. B. Swann Jr., 1987), participants accepted feedback that was consistent with their self-views more readily than they did feedback that was inconsistent with their self-views. Furthermore, the authors found main effects for therapist's status and participant's attitude toward therapy. Significant interactions showed effects in which high-status therapists and positive client attitudes increased acceptance of self-inconsistent feedback, effects that were only partially mediated by clients' perceptions of therapist competence. The present results indicate the possibility that participants may be susceptible to self-concept change or to self-fulfilling prophecy effects in therapy when they have a positive attitude toward therapy or are working with a high-status therapist.     

Collaboration and a Self-Help Orientation in Therapy with Suicidal Clients

Working with suicidal clients historically has placed a heavy burden of responsibility on the therapist for a successful outcome. This orientation generally has left clinicians feeling stressed and in need of controlling their clients' behavior; clients, in turn, often have developed unrealistic expectations of therapy or resistance of the therapist's interventions. In this context, the chance for a potentially valuable collaboration between client and therapist is often lost. This paper builds on previous work that has introduced the notion of a collaborative working relationship with suicidal clients. It is argued that the therapeutic process ideally should not only utilize the therapist's knowledge and skills in treating suicidal clients, but also cultivate self-efficacy by encouraging the client to adopt a self-help orientation to therapy. Several general principles of a collaborative/self-help orientation to working with suicidal clients are discussed and a variety of specific therapeutic strategies consistent with this orientation are described.