Saudi therapists' lived experience of self-awareness

Self-awareness and self-reflection in psychotherapeutic processes have been critical components for effective counselling and psychotherapy. However, little qualitative research in Saudi Arabia has been conducted that aims to explore the therapist's subjective experiences of the self in their professional work. Therefore, the purpose of this phenomenological study was to understand the therapist's self-awareness within psychotherapy, by focusing on the therapist's lived experience of self-awareness and exploring how therapists recognise themselves as an integral component of the therapeutic relationship. Semi-structured interviews were conducted with six experienced and accredited psychologists with at least three years of clinical experience, and the qualitative data were analysed using interpretative phenomenological analysis (IPA). Five superordinate themes emerged from the data; that is, development of the professional self, use of self, self-oriented, supervision and experience. This study provides an understanding of the therapist's self in psychotherapy, as it shows that self-awareness is important for therapists to manage their feelings, thoughts and behaviours in meeting with clients and that it is a valuable resource for a therapist to become aware of and reflect upon the process within oneself. This understanding is integrated into the training programmes in counselling psychology, especially in the areas of self-awareness and personal development.     

The therapist with her back against the wall

This clinical paper describes once weekly psychotherapy with two boys with traumatic histories. The way in which the trauma enters the consulting room and the relationship with the therapist is explored. Technical issues are discussed, particularly the understanding of the countertransference and its modulation in communication with the patient. The therapist's intense personal anxiety about failure and about management of the difficulties that arise is linked to the impact of trauma.     

Counting black sheep: Contextualizing therapeutic relations

In this paper we draw on feminist and post-colonial theory to situate an account of a six-month therapy between a black, Asian woman therapist and a woman patient of mixed parentage, within contemporary Britain. We draw on this analysis to further the debates between psychotherapeutics and social theory, challenging each in three ways. First, in relation to the literature on culture, class, gender and sexuality in psychotherapy, we indicate how these enter into the therapeutic relation in distinct and intersecting ways, which, second, challenge the separation between inner and outer worlds frequently maintained within psychotherapy circles. Third, in terms of the correlative challenge psychotherapeutic perspectives pose for social theorists and activists, we highlight how the therapist's constructive and explicit use of her power and socio-cultural position was central to the progress of this client's therapy. Finally, we reflect on the broader questions around the theorizing of culture and gender within psychotherapy, including the available positions and representations of black therapists as well as black patients.     

Values and the psychotherapist

One cannot live without encountering the problem of values. Certainly, one cannot go through psychotherapy without becoming involved implicitly and explicitly in the problem. Nor can one engage in psychotherapy as a therapist without bringing certain convictions about values into one's work. These convictions may or may not be specifically communicated to the patient, but they underlie the therapist's activity; they help determine the goal he sets for himself and his patient; and they are consciously or unconsciously reflected in his questions, statements or other reactions.“^1,p.1     

Process variables in the treatment of sexual offenders: A review of the relevant literature

The present review considers the relevance of process issues for the treatment of sexual offenders. The general literature on psychotherapy indicates that the therapist's style, the client's perceptions of the therapist, and the alliance between client and therapist, all influence treatment effectiveness. From our review of this literature, and the far less voluminous research on these issues by cognitive behavior therapists, we draw implications for enhancing the effectiveness of treatment of sexual offenders. We also make suggestions for research on process variables in the treatment of these offenders.     

Being there,experiencing and creating space for dialogue: about working with children in family therapy

While most authors agree that it is important to mobilize the active participation of children in the family therapy session, a lot of family therapists exclude children from participating because they do not feel comfortable with children. Teaching family therapists to feel more comfortable around children is a good idea, but perhaps it is not enough. In this article, the author reflects on the complexity of the issue of the comfort of the therapist in a session with children and families. In the discussion of the case story of Elly and her mother, practitioners are reminded that the therapist's experiencing in the session can help her to understand something of what goes on in the families she is working with.     

Matching Patient and Therapist Anaclitic–Introjective Personality Configurations Matters for Psychotherapy Outcomes

Decades of psychotherapy research suggest that patient–therapist match accounts for outcome beyond single patient or therapist variables. This study examines the associations between different patterns of patient–therapist matching (in terms of orientation on relatedness or self-definition) and outcomes at termination of psychoanalytic psychotherapy with young adults. Thirty-three patients and their therapists were classified as predominately anaclitic or introjective at baseline. Patients in the convergent patient–therapist dyads (both anaclitic or both introjective) showed significantly greater symptom reduction and increased developmental levels of representations of mother than patients in the complementary dyads (opposite personality configurations). Moreover, convergent patient–therapist match was connected with larger effect sizes on all outcome measures and lower proportion of non-improved patients. These findings suggest the importance of the therapists’ early adjusting their orientation on relatedness or self-definition to their patients’ predominant personality configuration in order to enhance treatment outcomes.     

The Edge of Chaos: Enactment,Disruption, and Emergence in Group Psychotherapy

The author outlines his approach to the theory and practice of group psychotherapy. The emphasis is on therapy by the group rather than therapy in the group. The therapist's task is to help the group itself become the agent of change. The group is conceived as being composed of many multiple selves. The process of group psychotherapy unfolds through enactments that involve the whole group and the group therapist entering into the grip of repetitive and unmentalized self-states. These enactments are resolved when the group members, with the therapist's help and containment, can access alternative self-states that allow for new and unformulated experience to emerge. This dialectical movement between the rigid “familiar chaos” of enactment and the reflective and related working through is compared to the dynamic systems theory articulation of the tension between rigidity and chaos captured by Kauffman's notion that “life exists at the edge of chaos.” A group session is described that involves a painful enactment. It illustrates how the therapist allows the enactment to unfold by holding and containing intense affect and how the group members are helped to find their own meaning and new experience in interaction with each other.     

PRIVATE THEORIES AND PSYCHOTHERAPEUTIC TECHNIQUE

That if real success is to attend the effort to bring a man to a definite position, one must first of all take pains to find him where he is and begin there. This is the secret of the art of helping others (Kierkegaard [] 1962, p.?27)

The aim of this study is to explore the importance, to the therapeutic process, of the relation between the patient's and the therapist's problem formulations and private theories of pathogenesis and cure. Four cases of young adults in psychoanalytic psychotherapy were compared, two with unequivocally positive and two with more ambiguous outcome at termination. The patients and therapists were interviewed about their private theories initially and at termination of therapy, and a qualitative comparison was made between the cases. In the two more successful cases the therapists had early in therapy perceived obstacles for the therapeutic work in the patients' ways of thinking, feeling, and relating, and made interpretative interventions focusing on these. This was not observed in the less successful cases. In the more successful cases the patient's and the therapist's private theories were more similar at termination than initially, whereas the opposite development was found in the less successful cases. One hypotheses generated is that the therapeutic process can be facilitated by a therapist listening to the patient's private theories, making interpretative interventions focusing on obstacles to the therapeutic work, including contradictions between their private theories, and monitoring the patient's reactions to these interventions.     

Effects of the Gulf War: Identifying dangers to integrity of the psychoanalytic process

This paper deals with aspects of psychoanalytically-oriented psychotherapy taking place during a period of political and dangerous military events in the Gulf War. The situatiOn threatened the physical existence of the civilian population, including the therapist and the patient. Presented are number of potential dangers to the integrity of the therapeutic process. These military-oriented dangers produce in therapists an occasional inability to contain their own feelings. This may lead to therapists' unconscious use of patients for their own intrapsychic needs, and harm their patients. Another source of danger is the vagueness and ambiguity of the objective reality of the outside world. This may disrupt the ability to help the patient differentiate between inner and outer reality. Moreover, discussed are the ways in which therapy may facilitate personal growth in both the therapist and the patient. These external events may also serve to accelerate the course of therapy, as patients identify with their therapist' coping ability. Similarly, therapists may also gain and benefit by perceiving their patients' healthy growth and development.     

Clinical commentary by David Trevatt,Clinical Manager of ‘Hear and Now’ Adolescent Counselling Service,Redbridge and Manager of Open Door's Parenting Teenagers Project,Haringey

Leading the charge to link intervention research with clinical practice is the development of process research, which involves a detailed analysis of specific therapeutic processes over the course of treatment. The delineation of interaction structures – repetitive patterns of interactions between patient and therapist over the course of treatment – can inform therapists of what may be expected from patients with particular patterns of symptoms or behaviours in their clinical practice and how interactions change over time. Using the Child Psychotherapy Q-Set, this study aims to compare the different interaction structures that emerged in the two-year psychotherapy of a six-year-old child conducted, for one year each, by two doctoral-student therapists in a university-based community mental health clinic. The study allows for exploration of the independent role of the therapist in the psychodynamic therapy of a child diagnosed with Asperger's disorder. The results suggest that four distinct interaction structures between child and therapist could be identified in this psychotherapy and that the interaction structures differed between the two therapists and also differed over time within each treatment. The implications of these findings for training and clinical practice are discussed.     

Dissatisfied psychotherapy patients: A tentative conceptual model grounded in the participants' view

Usually, between 5% and 20% of psychotherapy patients are dissatisfied with their treatments. This naturalistic study explores seven clearly dissatisfied patients' view of the therapeutic process and outcome. Interviews at termination of psychoanalytic psychotherapy and at a 1.5-year follow-up were analysed to create a tentative conceptual model of patient dissatisfaction using grounded theory approach. At the core of the model is an experience of abandonment by a therapist felt to be insufficiently flexible, a therapy lacking intensity, and links missing between therapy and everyday life. Dissatisfied patients lacked confidence in their relationship with the therapist, described their therapists in negative terms and concluded that their therapies lacked direction. They wanted more response from the therapist. Paying greater attention to the patient's emerging dissatisfaction may prevent lasting disappointment, unnecessary continuation of fruitless treatment, and probably increase efficiency.     

The fear of the body in psychotherapy

This paper identifies the fear of attending to and engaging with the patient's body and the therapist's body, regardless of therapeutic orientation, as a topic rarely explored in books and articles but pervasively experienced because of the cultural norms brought to the consulting room. It explores how we might name the constituent parts of this fear and describes how they inter-link. A case study then exemplifies learning about and transforming such fear in both patient and therapist. Finally, the paper offers suggestions of how therapists might increase their awareness and turn this fear into a tool which extends their range of skills.     

The function of the therapist's affect in therapeutic conflict in groups

Group psychotherapy theory and technique are presented with the goals of helping group practitioners working with difficult clients: 1) develop a treatment plan; 2) create a therapeutic alliance; 3) foster a responsive group climate; and 4) utilize the therapist's countertransferential reactions in dealing with therapeutic conflict. Historical modifications of the analyst's role in the development of group psychotherapy are noted. Emphasis is give to the recognition of therapist-client identifications in order to separate feelings induced in the therapist from countertransferential reactions, to enable the practitioner to respond appropriately to the affective and inspirational substratum of therapeutic groups.     

Therapist specific communication styles and patient resistance: An analogue study

Two contrasting pairs of verbal therapist communication styles were covaried with three areas of communication loci and were studied in relation to subjects' choices of resistant or resonant ‘patient responses’. Thirty medical students, serving as vicarious patients, observed a videotape of a simulated psychotherapy session and made response choices in relation to 12 therapists' well-specified communications. Contrary to expectations, subjects chose fewer resistant responses following engaged styles of communication than with disengaged styles. Collaborative style of communication, as hypothesized, was followed by less resistant responses than was unidirectional style. Communications that were cast in terms of transferential relationships were generally followed by significantly lower resistant choices than were those relating to past and current relationship loci. No gender differences were observed. Rationale, findings and possible inferences were in relation to dyadic interpersonal influences. Experimental manipulation of variables within psychotherapy sessions is encouraged.     

THE THERAPIST'S EXPERIENCE OF PSYCHOTHERAPY: SOME DIMENSIONS AND DETERMINANTS

Eleven dimensions of therapists' experiences during psychotherapy ses- sions were derived, factor analytically, for a sample of 17 therapists. These therapists completed a standard questionnaire after each of 8 or more sessions with 31 female patients. In general, the 11 dimensions reflected various experiences of (a) being helpful towards patients, (b) attempting to deal with difSicult patients, (c) making non-therapeutic responses to patients, and (d) entrapment in personally distressing situations with patients. Personal-social characteristics of patients and therapists were examined as possible determinants of therapist experience. Among other characteristics, patients' employment and marital status, diagnosis and previous treatment, influenced certain therapist experience dimensions-as did therapists' profession, marital status, and personal psychotherapy.     

Marital Status and Gender Similarity in Marital Therapy

This analogue study was designed to examine the effects of therapists' marital status and therapist and participant sex on participants' perceptions of therapist and expectations for therapy. Each partner of 20 couples presenting for marital therapy at four outpatient counseling centers independently completed one of four protocols. The protocols differed only on the therapist's marital status and sex. Results revealed that neither therapist marital status nor therapist sex had an effect on participants' perceptions of therapists or therapy expectations. Female participants, however, perceived therapists as more trustworthy, attractive, and expert and had higher expectations for therapy than did male participants.     

Problem-oriented sessions: Presentation of a method for therapeutic work within a narrow time frame

Abstract

A method of problem-orientation has been developed as a delimited psychotherapeutic procedure comprising four sessions with a psychotherapist. The distinguishing feature of this method is the distinct time frame, within which the therapist grasps the patient's current situation and difficulties. The sessions are disengaged from considerations about the need for further treatment. The therapist appeals to die reflective part of the patient and attempts to awaken their curiosity about themselves in order to explore inner associations concerning core problems. The four problem-oriented sessions are offered during the initial telephone contact to the person who wishes to gain a greater understanding of their own part in their difficulties and who is able, already in the introductory telephone conversation, to embark upon an exploratory dialogue about these problems. The sessions are strongly characterized by this short-term perspective; the intensity increases and attention is sharpened. The stance adopted by the therapist during die sessions is one of balancing a non-appraising, empathic and confirmatory listening aimed at making connections with reality and a faith in the patient's resources and capacity to maintain a sense of responsibility for their life; an approach which limits the patient's tendency to regress. Transference is not interpreted explicitly but is used by the therapist to understand the patient. Supervision is an important and essential component, whereby the therapist receives help in increasing understanding of that which is played out during the sessions and also of their own counter-transference. This understanding constitutes the foundation of the therapist's tentative formulations of that which is central in the patient's problems.     

Psychotherapists' attitudes towards and observations of nonverbal communication in a greeting situation: II. Relationships to background variables.

An interview study of 79 Swedish psychotherapists was performed to investigate their attitudes towards and observation of nonverbal communication in a reference situation in relation to background factors such as gender, length of professional experience, and theoretical approach. The greeting situation, i.e., the first time a therapist and patient meet in a waiting-room, was chosen as the reference situation. Face communication in that greeting situation was significantly less achieved by male psychotherapists with relatively short experience than by female therapists. However, this sex difference was not significant among therapists whose psychotherapeutic experience was longer than 13 years. Attaching great importance to nonverbal communication in psychotherapy was related to an intention to be well-kept and to perform correctly in front of the patient, to establish direct communication in the greeting situation, and to background factors such as frequent work in psychotherapy and an eclectic psychotherapeutic approach.     

Novice therapist,the client and therapy: Integrating the triad

Therapy process research focuses on understanding how therapy is conducted by professionals in the field. It is a nascent field of psychotherapy enquiry in India. This paper explores how novice therapists in India perceive their clients, and how this influences the process of therapy. In depth interviews were conducted with ten novice therapists, with less than six years of practice experience, from Mumbai, India. The data was thematically analysed. The data revealed that therapists' perceptions of their clients were defined by socio-demographic features of age and gender, along with presenting complaints and personal attributes. Participants had defined beliefs about good clients as contrasted with difficult ones. Distinct preferences for particular client types were identified. The antecedents to these beliefs were attributed to the therapist's worldview, their training and the supervision received. These views, and the conceptualisation of the client, influenced the choice of client, the process of therapy and how they proceeded with sessions, and their methods of referral. The data from the study has implications for therapist training, supervision and further research.