Difficulties,skills and therapy strategies in interventions with court-ordered batterers in Spain

As a consequence of its coercive context, psychological interventions with men convicted of intimate partner violence in Spain involve a series of challenges in the design and development of the therapy program. This article reviews the main international contributions that have considered the difficulties produced by the context and analyzes the most important skills that the therapist can utilize in order to facilitate the therapeutic process. The difficulties have been grouped in accordance with origin: (a) difficulties derived from the context of the intervention; (b) the characteristics of the offender; (c) the therapist. The principal skills and strategies of the therapist seem to be related to the clear definition of the intervention context, the management of therapeutic relationship and the therapist's capacity for analysis and reflection. Finally, this work recognizes the need for research projects that focus on the therapist and aspects of the therapeutic process that could optimize the implementation of therapist training actions and improve treatment results.     

Session-Intersession Sequences in the Treatment of Chronic Anorexic-Bulimic Patients: Following the Model of "Family Games"

In this article, the author presents some technical aspects of a psychotherapeutic approach for treating chronic anorectic patients. Two basic principles underlie the approach. First, the main purpose of the treatment is to improve the patient's relational skills in order to enable her to cope with her family's "game". Second, the therapeutic relationship is considered hierarchically subordinate to her relationships outside the therapeutic context. Mastering the model of families with anorectics is essential if the therapist is to be consistent with these principles. Specialized training in verbal and nonverbal communication is considered a useful tool.     

Three modes of psychotherapy and their requisite core skills

The field of psychotherapy suffers from the lack of an integrative meta‐perspective on the large variety of existing psychotherapies and on the therapeutic skills involved. In the present paper, it is suggested that the development of a more comprehensive view of this field may be facilitated if we differentiate between three modes of psychotherapy, which require different therapeutic core skills: (a) an educational mode, which requires teaching skills; (b) a reparative mode, which requires analytic‐conceptualising skills to identify some kind of disordered functioning, in combination with specific relational‐technical skills to repair this dysfunction; and (c) a developmental mode, which involves engaging in a therapeutic relationship with patients to facilitate their personal growth, and which requires non‐directivity skills. In addition, some therapeutic skills (e.g., awareness and communication skills) may be more or less important in all modes of treatment. Concrete manifestations of the three different modes of psychotherapy are discussed in terms of five different theoretical perspectives on psychotherapy: the common factors, the humanistic‐experiential mindfulness cognitive‐behavioural (CBT) and psychodynamic perspective. The common factors model is criticised as being insufficient in several respects. Finally, it is argued that if personal therapeutic skills are essential to the effects of psychotherapy, then empirical research on psychotherapy needs to be re‐oriented towards a person‐oriented study of therapist skills in action, in the context of a study of the interaction between therapist and patient.     

A Functional Approach to the Assessment and Treatment of Non-Suicidal Self-Injury in Veterans: A Dialectical Behavior Therapy–Informed Perspective

Given that non-suicidal self-injury (NSSI) is related to increased odds of suicidal ideation and suicide attempts, treating NSSI in veterans is a key treatment priority to help reduce suicide risk and increase quality of life. Treating NSSI can be difficult for clinicians and training in addressing NSSI can enhance therapist empathy and decrease negative attitudes. The current paper describes prevalence of and risk factors for NSSI in veterans and presents a Dialectical Behavior Therapy (DBT)-informed approach for arriving at a functional understanding of NSSI in order to inform assessment and treatment. This DBT-informed approach is demonstrated with two case examples of veteran clients. While in many circumstances treatment of NSSI may be most effective in the context of full model DBT (i.e., individual therapy, group skills training, phone coaching, and therapist consultation team), many aspects of the functional approach discussed herein are not specific to DBT and could therefore be integrated into behavioral analyses and case formulations conducted within non-DBT therapeutic approaches.     

Utilizing artistry in a therapeutic relationship

Abstract

In many humanistic approaches, therapeutic change involves utilizing the relationship between the client and therapist as a tool for personal growth. Like any relationship, the therapeutic relationship is one that is co‐created between those engaged in it, namely, the client and the therapist. Utilizing this co‐created relationship requires a sense of artistry on the part of the therapist. A therapist must be willing to engage in this meaningful relationship with the client. A therapist must also be aware of the personal values that he or she brings into therapy, and how they influence the therapeutic relationship. Finally, a therapist must acknowledge the power that the therapist and the client possess in the relationship, and understand how that power can be used to validate and invalidate the therapist's and the client's personal meanings. These aspects of therapeutic artistry are discussed and the use of therapeutic artistry in Eron and Lund's (1996) narrative solutions approach is presented.     

Counselors' Evaluation of Rogers-Perls-Ellis's Relationship Skills

Twenty-two participants (12 employment counselors and 10 counselor supervisors) attended a three-week workshop on enhancing relationship skills, after which each participant evaluated the Rogers, Perls, and Ellis film, Three Approaches to Psychotherapy, on 15 skills. Results indicate that there was general agreement between the counselors and the supervisors when judging levels of therapist functioning by the relationship skills. However, they also show that within each group there is wide divergence of judgment. Neither counselors nor supervisors agree among themselves on their evaluation of the relationship skills of Rogers, Ellis, and Perls. Implications are drawn for the use of the film as a training/evaluation aid for employment counselors and supervisors.     

Divorce therapy: an in-depth survey of therapists' views

In-depth interviews were conducted with 21 highly experienced therapists on the criteria of a constructive divorce, the obstacles to achieving such a divorce, and the strategies and tactics of divorce therapy. The primary criterion of a constructive divorce was the successful completion of the process of psychic separation and the protection of the welfare of minor children. Therapy may focus on the decision to get divorced and/or the negotiation of the terms of a divorce settlement. Three types of therapeutic strategies were identified: reflexive intervention by which the therapist orients himself to the marital problems and attempts to gain the trust and confidence of the partners; contextual interventions by which he tries to promote a climate conducive to decision-making; and substantive interventions intended to produce resolution on terms the therapist has come to believe are inevitable or necessary. The nascent state of divorce therapy as an area of therapeutic specialization is noted. The problem of diagnostic criteria for divorce, the relationship between therapists and lawyers, the nature and consequence of therapist impartiality, and the degree to which therapists should mediate the terms of divorce are considered central issues meriting further study.     

Transforming negative parent-adolescent interactions: from impasse to dialogue

This treatment development, process research study focuses on resolving in-session, parent-adolescent conflicts characterized by negative exchanges, emotional disengagement, and poor problem solving. These processes have been empirically linked to poor developmental outcomes, and clinically linked to poor therapeutic progress. Specifically, we examined how a shift of therapeutic focus from behavior management to interpersonal relationship failures could resolve this impasse and resuscitate therapeutic momentum. A task analysis approach was used to verify the presence of the impasse, to illuminate its core features, and to define the therapist and client behaviors associated with resolving it. In Part 1 of this two-part series, we presented the final performance map that represented that family's cognitive, emotional and behavioral interactions necessary to resolve the impasse. This article, Part II, focuses on the theoretical foundation of the intervention strategies, the phenomenology of the impasse, and the therapist's skills needed to facilitate it.     

Teaching mindfulness to psychotherapists in clinical practice: The Mindful Therapy Programme

Introduction: Initially proposed as a treatment modality for psychological disorders, mindfulness is now being promoted as a means of enhancing both therapist self care and therapeutic efficacy. The degree to which mindfulness can be learned by therapists to manage their own and clients' processes in therapy is as yet unknown. This study examines training outcomes of a standardised introductory mindfulness programme for mental health professionals. Methods: Forty-seven mental health professionals completed an eight-week mindful therapy (MT) training programme and associated measures. Results: Compared with baseline scores, participants demonstrated knowledge acquisition on all measures, including increased mindfulness in clinical work, increased capacity to intentionally invoke mindful states of consciousness, and higher participant ratings of well-being over the course of training sessions. Discussion: This research provides preliminary evidence that a brief, standardised mindfulness training programme can achieve acceptable knowledge and skills outcomes for therapists that can aid their therapeutic practice. Of note, increased ‘therapeutic mindfulness’ in this study resulted from changed mindfulness ‘attitudes’ (i.e. a more accepting and equanimous orientation within therapeutic work) as opposed to a clear demonstration of increased attention-regulation skills. The implications of these and other results for programme development and wider research are discussed.     

Fostering Client Creativity in Family Therapy: A Process Research Study

Creativity has been shown to enhance problem solving, and to increase flexibility and adaptability—qualities associated with positive therapeutic outcomes. Literature related to therapist and/or client creativity is primarily anecdotal. Empirical literature addressing how therapists can facilitate the creativity of their clients in family therapy is scarce. In this study, the researchers used process methodology to code the behavior of therapists and clients in 31 videotaped family therapy sessions. Results show a significant positive correlation between interventions that induce positive affect and the creative client behaviors of optimism and playfulness.     

Developing countertransference awareness as a therapist in training: The role of containing contexts

The psychodynamic literature suggests that countertransference is an inevitable part of therapy and a significant feature of the client-therapist relationship. However, countertransference is also considered to be a ‘double-edged sword’: when it is reflected on by the therapist, it can offer valuable insights into the therapeutic relationship, but when it remains outside of awareness and therefore unmanaged it can result in the therapist unwittingly acting out in the therapeutic relationship and responding in counter-therapeutic ways. The purpose of this research was to explore the factors involved in the development of countertransference awareness in therapists and to construct a grounded theory of the process. Fifteen qualified therapists were recruited and interviewed, either face to face or via Skype, using a semi-structured interview schedule. The grounded theory constructed from the data suggests that during training participants initially experienced countertransference as threatening and overwhelming. When this experience was contained in supervision and therapy, the organisational context and by participants’ theoretical framework, they could reflect on their countertransferential responses and make sense of their experience, which then developed their self-awareness and other insights to the benefit of the therapeutic relationship. Conversely, a lack of containment in these domains resulted in participants acting out their countertransference and becoming either over or under available in the therapeutic relationship. The findings offer a useful process model on the role containing contexts play in the development of countertransference awareness for therapists in training.     

Behind the scene: cognitive benefits of playing a musical instrument. Executive functions,processing speed,fluid intelligence and divided attention / Detrás de la escena: beneficios cognitivos de tocar un instrumento musical. Funciones ejecutivas,velocidad de procesamiento,inteligencia fluida y atención dividida

Abstract

The relationship between music training and cognitive performance has been much explored over the last decades. A variety of evidence shows a different neurological and cognitive processing in the population who have undergone instrumental music training compared to people who have not. A review of the literature shows the many advantages in cognitive skills musicians have gained from musical training, such as benefits to their executive functions and other aspects of cognition, in children as well as adults and the elderly. This study investigates in greater depth certain cognitive aspects associated with musical training in the adult population. Specifically, it explores its relationship with inhibition, working memory (verbal and visual-spatial), flexibility, processing speed, fluid intelligence and divided attention. Our results suggest that there is indeed a relationship between musical training and improvements in cognitive performance, both in executive functions and in other areas of cognition.     

When 2–3% really matters: The (un)importance of religiosity in psychotherapy

Previous research suggests that clients’ religious beliefs are commonly excluded from therapeutic practice. Often, this exclusion is attributed to practitioners’ lack of knowledge or appropriate skills. Such analyses, however, have little regard for the interactional aspects of the therapist/client encounter. Drawing upon work within discursive social psychology, we argue that the exclusion of religious beliefs does not reflect therapists’ lack of knowledge or awareness but can more usefully be seen as the discursive accomplishment of marginalizing clients’ beliefs. Six practising psychotherapists were interviewed about religious beliefs within the therapeutic process. Participants construct religious beliefs as important but relevant only to restricted categories of clients. They rework religious beliefs as compatible with accepted practice, or construct particular groups of clients as incompatible with the process. Training and other requirements are reformulated in terms of spiritual beliefs rather than religious beliefs. These constructions display awareness of religious beliefs while marginalizing their relevance in practice. Inclusion of clients’ religious beliefs to best effect will require more psychotherapy to engage more constructively with religion than it does at present.     

The multi-level approach: a road map for couples therapy

This paper presents a multi-level framework and road map to guide the therapeutic process. Starting with the couple's reactive pattern, the multi-level approach first orients the therapist on how to create a "holding environment." It then suggests how the therapist, in collaboration with the couple, can proceed to explore interactional, sociocultural/ organizational, intrapsychic, and intergenerational processes that might be fueling the couple's dynamics. Central to this approach is the construct of the vulnerability cycle, a nexus of integration that helps the therapist stay anchored while moving through the many layers of therapeutic work. The overall goal is to help the partners move from reactivity to responsibility for their own feelings and behavior; from impasse to a greater ability to reflect, express feelings, listen, negotiate, and make choices about how to be in the relationship. This paper describes a range of concepts and interventions from basic to complex; it is intended as an organizational tool for practice and clinical training.     

The Negotiation of Values in Therapy

Values are integral to all social systemic operations and therefore to the heart of the therapeutic process. For the therapist, values are an essential component in defining and assessing a problem, determining goals, and selecting therapeutic strategy. Therapists do not have a choice about whether they need to deal with values in therapy, only about how well. The training of therapists about their values needs to be integrated with the training about their own emotional and family issues. This training should be carried out in the context of treating families and have as its primary focus the relationship of the therapists' personal issues to the conduct of their therapy with families. Personal insight and mastery over handling their own values and family issues will maximize therapeutic effectiveness.     

Transformational education for psychotherapy and counselling: a relational dynamic approach

ABSTRACT

An evolving relational dynamic approach to psychotherapy and counselling education is described. Key themes integrated within the approach are the learning community and transformational relationships. Learning is a reciprocal change process involving students, teachers, supervisors and therapists in overlapping learning communities. Drawing on evidence that effective outcomes in therapy correlate with effective aspects of the therapeutic relationship, the relational dynamic approach emphasises the findings of attachment and intersubjectivity theorists. The intersubjective matrix of infant/caregiver and client/therapist is mirrored and embodied in the relational ethos of training and actively engaged in group supervision. An emphasis on embodied relating is discussed, drawing on infancy studies and recent neuroscientific findings     

Therapeutic Groundhog Day – exploring the impact of the theory/approach on the self of the therapist

The ‘use of self’ of the therapist is a concept that can be considered from numerous directions. An underrepresented aspect of ‘the self of the therapist’ is the influence of the theoretical orientation and associated skills. As part of a recursive process, the theory and techniques shape the therapist's emergent self in the therapeutic relationship. This teaching event was designed to provide an opportunity for trainee therapists to experience contrasting ‘selves’. This is developed through role play where ‘family’ and ‘therapists’ attempt to reproduce the same episode but each is responded to with a different model and skill.     

Clinical Mutual Attunement and the Development of Therapeutic Process: A Preliminary Study

Despite the identification of many factors that play a central role in the development of the psychotherapy process, there is still a lack of evidence about the basic relational mechanisms that pave the way to its working. In this pilot study, we focus on nonverbal microprocessual attunement as the basic mechanism grounding the displacing of discrete factors in shaping the clinical process. Two single sessions of two short-term psychodynamic treatments, selected respectively from a good- and a poor-outcome treatment, have been coded in terms of patient and therapist speech rate, coordination in ruptures, resolution of the therapeutic alliance, and patient's displayed thinking processes. Two dynamic structural equation models focusing on clinical attunement as a factor able to activate the interplay of the assessed clinical dimensions have been theoretically designed and tested in both cases. The driven theoretical structural equation models fit the data, suggesting a different role of nonverbal attunement as a moderating factor. The obtained results are consistent with the hypothesis claiming that a good-outcome psychotherapy session is characterized by a mechanism of clinical attunement that enforces the therapist–patient relationship and promotes the integration of formal thinking processes that affect emotional and cognitive domains.     

Structural Effects of Poverty on Children

This paper evaluates the perceived benefit to a group of thirty caring professionals of a brief training in Child-centred play therapy. Play therapy enables a child to create fictional worlds and in this way make sense of the real world. By playing in the presence of the therapist, who provides a trusting relationship and at times shares the play, the child is able to obtain relief from the negative effects of distress, sadness, anger or shame. All course participants had adult counsellor qualifications and worked with vulnerable children (n= 25, age range = 56, mean years of experience = 10). The course was delivered in Nairobi, Kenya, East Africa via theory presentations; case presentations; practical skills demonstrations and instruction with tutor feedback and self-development awareness group teaching methods. Questionnaires provided qualitative data for consideration and analysis. Key findings included: pre-training prevalent feelings of inadequacy to meet the therapeutic needs of vulnerable children using adult style counselling; post-training perceived raised awareness of the therapeutic power of play with positive impact on professional and personal lives; perceived increase in therapeutic play skills and increased ease in establishing therapeutic rapport. Training was largely beneficial increasing the confidence, knowledge and skills of the course participants.