Person‐centred counsellors' experiences of working with clients in crisis: A qualitative interview study

Aims: This study aims to explore and understand person‐centred therapists’ experiences and work with clients at the pivotal point of crisis. Specifically: how do person‐centred therapists experience working with clients in crisis? Do they identify differences in crisis intervention compared to non‐crisis work? What do they perceive as helpful to crisis clients? How relevant are therapists' own experiences of crisis? Method: Participants were all experienced person‐centred therapists. Qualitative, semi‐structured interviews were conducted and the data were analysed qualitatively using person‐centred/phenomenological methodology. Results: Respondents identified differences in their experiences. Typically, therapists described polarity in their experience of danger and opportunity, also heightened energy levels within themselves, perceived higher levels of engagement, faster pace of work, experiences of reaching ‘relational depth’ earlier, and the importance of assisting symbolisation of clients' experience in awareness. Clients were experienced as vulnerable, unable to access previous coping mechanisms, in a state of breakdown and disintegration, but also as wide open, having dropped their usual defences, and more available to engage in therapy and enter the process of change and potential post‐crisis growth. Discussion: The findings are discussed in relation to prevailing models of crisis intervention, person‐centred theory and theoretical developments in post‐traumatic growth in the aftermath of crisis.     

Helpful processes in psychological therapy for patients with primary cancers: A qualitative interview study

Aims: The purpose of this study was to identify what patients with primary cancers found helpful in therapy. Method: In‐depth qualitative interviews were conducted with eight patients who had completed a course of psychological therapy within an NHS psychology service for cancer patients. Data were analysed using thematic analysis. Results: The participants identified a range of helpful processes in therapy: talking and expressing their feelings to someone outside of the family; forming a relationship with their therapist; normalisation through the therapists' expert knowledge; problem‐solving and CBT. Limitations: As with all qualitative studies, the small sample and size and dependence on participant recall limits generalisability of the findings. Implications: The findings of this study are consistent with a pluralistic perspective: that multiple therapeutic processes ‐ aligned to a range of different orientations ‐ can be of value to patients with primary cancers. This supports the provision of a range of therapeutic interventions and strategies for this patient group.     

Living with a pituitary tumour: A narrative analysis

This study aimed to synthesise the illness narratives of individuals living with a pituitary tumour. Eight adults with a pituitary tumour were recruited from an endocrinology service in the north-west of England. A narrative methodology was adopted which investigated elements of the individual narratives such as metaphor and structure but which also aimed to produce a joint account of experience in this particular illness context by extracting themes across the stories; these are presented as part of a chronological narrative. However, the resulting group story was also analysed in terms of different types of narrative plots. The group narrative started from the recognition of symptoms and then diagnosis though treatment to post-treatment and future plans. In terms of narrative plots, one notable element of the joint narrative was the flow between the culturally dominant restitution narrative, where participants focused on treatment and recovery and the chaos narrative when recovery did not seem possible. The findings contain many elements consistent with previous research; however, the use of a celebrity figure to communicate about the illness experience and a perception that objects or individuals should not be taken at face value emerged as more novel findings.     

Narrative vignettes and online enquiry in researching therapist accounts of practice with children in schools: An analysis of the methodology

Aims: This article reviews a research methodology that uses an Internet mediated qualitative, narrative approach to provide in‐depth analysis of vignettes. The research sought to investigate the ways in which dramatherapists, based in different countries, understood the nature of therapeutic change in their work with children. Method: The article describes a qualitative approach to the generation of data by a combination of therapist‐authored vignettes, live, synchronous Internet mediated communication (aMSN Messenger) and email. Participants kept a diary of their response to the research and the article draws on this data within its analysis of the methodology. Findings: Samples of the data are used to analyse how such innovative, online methodology can develop effective access and relationships with geographically dispersed participants and as an effective way of investigating therapist practitioners' understanding of their practice.     

A theory of clinical practice: the cognitive and the narrative

Today the extent of the difference between theoretical models of therapy is under discussion. There have been proposals to abandon such models altogether, or to create others, such as integrative or meta‐ theoretical models. This article proposes, through the analysis of a clinical situation, the possibility of building a theory of practice which could account for most of the aspects of the therapeutic process that remain tacit and implicit. Such a theory could help us explain what concretely happens when a therapist is doing therapy, and also how theoretical models interact with the everyday practice of therapists.     

Change process in systemic therapy: A qualitative investigation

This study addresses the process of therapeutic change in individuals who received systemic therapy. This study is an exploratory qualitative study based on the client's perceptions and therapeutic experiences. The sample included 10 clients who had completed their therapy with systemic therapists. The method used for the collection of the data was semi‐structured interviews (Change Interview; Elliott, Slatick, & Urman, 2001). The interviews were analysed using grounded theory analysis. The results showed that both specific and common factors in therapy function in a co‐occurring mode, hence suggesting a synergy effect between common factors and specific techniques or therapist factors in psychotherapy. The core category ‘experience of therapeutic change, within the secure frame of therapy, is a process of deconstructing and reconstructing the house you live in: Yourself’ emerged based on self‐exploration and self‐discovery and is then discussed in a theoretical constructivist framework. Implications for research on the issue of the process of therapeutic change are discussed.     

Fitting a square peg in a square hole: Using metaphor in narrative therapy

This paper examines the assumptions of the narrative mode of therapy and the assumptions of therapeutic metaphors. The premise is that the use of metaphor fits the assumptions of narrative therapy and can enhance and expand narrative therapy. This paper examines the structure and types of metaphor, explores their fit within the narrative model, and gives three case examples which illustrate the use of metaphor in narrative therapy.Kevin Lyness, MS, is a doctoral candidate, MFT Program, 1269 Fowler House, Purdue University, West Lafayette, IN 47907-1268, and a doctoral candidate in the MFT Program, Purdue University. Volker Thomas, PhD, is assistant professor, Marriage and Family Therapy Program, 1269 Fowler House, Purdue University, West Lafayette, IN 47907-1269. Reprint requests should be sent to the first author.     

Teachers' knowledge about adolescents: an interview study

This paper presents the results of an interview study of twelve high school teachers to ascertain their general knowledge about adolescents, as well as their knowledge of issues important to adolescents. The results were as follows: (a) teachers lacked knowledge about what adolescents in previous studies have referred to as important issues in their lives; (b) teachers' general knowledge about adolescents was mainly based on experiential, as opposed to theoretical, knowledge; and (c) teachers were not interested in theoretical knowledge about normal adolescent development. These results are discussed in relationship to the Swedish school system, as well as their relationship to teacher training, which traditionally has focused on the what and how aspects of teaching, not on the aspect of whom one is teaching.     

Psychodynamic therapists' dilemmas in providing personal therapy to therapists in training: An exploratory study

Aim: This study explores dilemmas facing psychodynamic therapists who provide personal therapy to therapists in training. Method: Eight experienced psychodynamic psychotherapists were interviewed using a semi‐structured interview format during which they were asked about the importance of personal therapy, if they encountered any dilemmas and, if so, how they resolved those dilemmas. Their responses were analysed using a qualitative form of content analysis. Findings: Two categories of dilemma emerged: clinical and personal. Clinical dilemmas arose out of the mandatory requirement for therapy, boundaries, fitness to practice and the suitability of trainees. Personal dilemmas included pressure to model, sense of responsibility, therapeutic narcissism, countertransference reactions, over‐use of self and stressful involvement. The therapists' strategies for resolving the dilemmas are described. Conclusion: The results show participants considered personal therapy to be essential for trainees and thought it should be mandatory even though it led to difficulties in the therapy. Questions arose about the suitability of some trainees, the person of the therapist and stressful involvement. Further research into these important areas is recommended.     

Talking to children about family therapy: a qualitative research study

In an exploratory study a number of children were interviewed some time after family therapy. Their responses were analysed using grounded theory methodology. Outcomes indicate that for children, family therapy is potentially a complex arena in which ambiguities and ambivalences are present. The children's position in the therapeutic session is discussed in terms of their role in the 'therapeutic circle'.     

Barriers and challenges in the practice of multicultural counselling in Malaysia: A qualitative interview study

Counsellors face a lot of problems and stressors in their daily lives. As a person, counsellors may face challenges to deal with their personal expectations and responsibilities in life, work, family and community. As a professional, counsellors may face difficulties in dealing with professional issues and ethical dilemmas in their professional practice such as countertransference and value conflicts. These raise issues concerning their perceived multicultural competence and the adequacy of their training. Informed by a multicultural counselling perspective and drawing on semi-structured interviews with 12 professional counsellors in Malaysia, this study discusses the types of barriers and challenges faced by Malaysian counsellors and how these challenges were manifested and addressed in the cross-cultural counselling sessions. Results revealed five emerging themes based on participant counsellors’ responses on the barriers and challenges encountered in their practice of multicultural counselling in Malaysia. These were challenges related to counsellors’, clients’, presenting issues’, third-party and specific contexts’ characteristics. Research implications for the education and training of counsellors in the specific Malaysian socio-political context are also discussed.     

Mentalization-based therapy with maltreated children living in shelters in southern Brazil: A single case study

This study describes the mentalization-based child therapy of a boy who suffered from early abuse and neglect, who was living in a shelter in southern Brazil. This single case study aimed at assessing whether this kind of psychotherapy contributes to reducing depressive symptoms and developing a greater capacity for reflection on the mental states of self and other, as part of developing a more coherent sense of self. Structured assessments were conducted before therapy and after six months of treatment, and the audio-recorded treatment sessions were analyzed using content analysis, in order to identify key themes in the treatment itself. The results suggested a significant improvement in depressive symptoms and some changes in mentalization with the beginnings of a movement toward a more cohesive and integrated self. We argue that mentalization-based child therapy could be a promising therapeutic approach for children who have experienced severe disruptions of emotional bonds, due to the way it focuses on the capacity to regulate affect and develop a more coherent sense of self.     

Therapist experiences of equine-assisted psychotherapy in South Africa: A qualitative study

This study examined therapists’ perceptions and experiences of equine-assisted psychotherapy (EAP). Participants were 14 practising EAP therapists (females = 86%; male = 14%; age range 20 to 69 years) from across South Africa. They were interviewed utilising electronic interview media. Thematic analysis revealed therapists perceived effectiveness of EAP in providing emotional and interpersonal growth for clients. They also identified training, safety and ethical concerns with this therapeutic modality. Therapists’ experiences with EAP were influenced by their prior interaction with horses as horse owners or horse riders.     

Experiential congruence: Qualitative analysis of client and counsellor narrative accounts of significant events in time‐limited person‐centred therapy

The concept of congruence represents a core theoretical construct in the development of client‐centred therapy, and remains fundamental to the practice of experiential approaches to psychotherapy. This study explores the ways in which congruence is experienced during significant moments of therapy. Client and counsellor accounts of moments of congruence/incongruence were collected from six cases of person‐centred counselling, and were analysed using a method of narrative analysis. It was found that participants experienced congruence in a variety of ways, suggesting that the construct does not describe a unitary phenomenon. Congruence was experienced as simultaneously intrapsychic and relational. The effective negotiation of episodes of incongruence comprised a necessary element of effective therapy. Further research into the nature of congruence may be valuable in contributing to new understandings of how therapeutic alliances are made, broken and repaired.