Self-criticism and the therapeutic relationship

The relationship between self-criticism and the therapeutic alliance was examined in 169 clients attending counselling in a community clinic. Self-criticism was associated with lower client ratings of the working alliance, suggesting that clients with higher self-criticism had greater difficulties establishing and maintaining a therapeutic alliance. These findings extend previous studies on the working alliance and self-criticism from highly controlled clinical studies to a more ecologically valid community mental health setting. Regression analyses were conducted to examine the mediating effect of additional factors on the relationship between self-criticism and the working alliance. Sensitivity to a perceived subordinate role in therapy did not impact the working alliance, although a general resistance to subordination was related to self-criticism. Implications for counselling self-critical clients are discussed.     

One-to-one support for crisis intervention using online synchronous instant messaging: evaluating working alliance and client satisfaction

Young people are increasingly turning to online support, especially when traditional mental health services are not immediately available. Using a cross-sectional design, sociodemographic information and self-reported perceptions of the strength of the working alliance and client satisfaction were collected from a sample of participants (n = 78) who were users of a service providing free online support using synchronous instant messaging. The results reported a significant positive relationship between the strength of the working alliance and client satisfaction, suggesting that the strength of the working alliance remains a key component in counselling, even online. Participants, however, scored significantly lower on both the strength of the working alliance and client satisfaction, compared to participants in offline settings as reported in past studies.     

Multiple intelligences and the therapeutic alliance: Incorporating multiple intelligence theory and practice into counselling

Many of the main theoretical traditions in the sociology of the emotions have limitations in their explanations of the institutionalized styles of emotional work, of the menu of emotions available to be felt in particular settings, and of the causal processes by which particular emotions are elicited in those settings. A promising way forward is to apply neo-Durkheimian institutional theory, which also overcomes some of the limitations of Durkheim's own theory of the emotions. Central to this approach is the distinguishing of affect styles and the identification of styles of social organization that elicit these affect styles. The theory puts great weight on ritual, understood in the post-Goffman sense which encompasses quotidian everyday forms as well as grand public ceremonial, as the principal causal process by which forms of social organization produce certain emotions and styles of managing those emotions within ‘affect styles’. The latent social function, in this tradition, of the elicitation of affect is to be understood in terms of the conflictual and rival mobilization of accountability. The theory meets, the article argues, the four key criteria by which sociological theories of affect should be judged.     

如何建立聊天机器人与用户间的数字治疗联盟：关系线索的作用

近年来,研究者们将“治疗联盟”(Therapeutic Alliance,TA)的概念与在线自助干预(Internet-based Self-help Interventions,ISIs)相结合,以解决ISIs中用户参与度较低的问题。这种在数字环境中形成的TA,被称之为“数字治疗联盟”(Digital Therapeutic Alliance, DTA)。随着人工智能的迅速发展,聊天机器人可模拟人类指导,相对于传统ISIs程序更易于与用户建立关系,可通过友好、尊重、倾听、鼓励、真诚、理解、信任这几个关系线索来促进DTA的发展,为解决用户低参与度的问题提供了一种新思路。未来的研究可从影响因素、ISIs技术迭代、测量规范、实验操纵等方面对DTA作进一步的探索。     

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.     

Narcissism, solitude, friendship: notes on the therapeutic alliance in the context of the Freud-Jung relationship

This paper deals with friendship and therapeutic alliance as a transformation of the libidinal love that structures the Oedipal complex. The author considers the relationship between Jung and Freud as a formidable test that may shed light on their personalities and on the relevance of the Oedipal complex for both of them and for their particular theories and practices. The author discusses the possibility that the Oedipal complex may be seen under a finalistic frame of reference and discusses which implicit goals it may express. Such a goal has not been reached by either Freud nor Jung, but might be the key to underline and recognize the fundamental importance of the 'therapeutic alliance' within the analytical situation, seen as a potential relationship between the selves of the patient and of the analyst springing from a transformation of libidinal love into 'friendship' as it was described by Friedrich Nietzsche.     

Videoconferencing versus face-to-face psychotherapy: Insights from patients and psychotherapists about comparability of therapeutic alliance,empathy and treatment characteristics

Objective

Videoconferencing psychotherapy (VCT) is an effective treatment option. Yet, it is unclear whether a similar therapeutic alliance as in conventional face-to-face psychotherapy (F2F) can be achieved, since previous studies yielded mixed results. Furthermore, surveys about the attitudes towards VCT amongst patients have been missing until now. The current study gathered opinions from patients and psychotherapists about the perceived comparability of VCT and F2F regarding contextual factors and treatment characteristics, focusing on therapeutic alliance and empathy.

Method

An online survey amongst patients (N = 189) and practitioners (N = 57) taking part in cognitive behavioural therapy was conducted after the first lockdown in Germany due to the COVID-19 pandemic and a resulting transition from F2F to VCT for most participants.

Results

While patients experienced therapeutic alliance and empathy as comparable, psychotherapists indicated advantages of F2F. Both groups indicated advantages of F2F for the therapy contents and expressed advantages of VCT for flexibility regarding location and time. More than half of the participants expressed a preference for a combination of analogue and digital therapy.

Conclusion

The perceived disadvantages of VCT can be addressed, for example, with training programmes for psychotherapists targeting communication in VCT and adapting established psychotherapy methods to a digital format to further improve VCT.     

Client self-image,therapist acting,and the establishment of the therapeutic alliance in a training context

This study examined how clients’ self-image and perception of therapist’s behavior are related to the therapeutic alliance, as well as how these variables change in the psychotherapy process in trainee-led psychotherapy. A total of 164 participants (M = 28.9 years) who attended two semesters of treatment at the Psychology Clinic of Umeå University completed the Working Alliance Inventory (WAI) to evaluate their perception of their alliance with the therapist. They also completed two questionnaires based on the Structural Analysis of Social Behavior (SASB) model to give insight into their self-image patterns and to analyze their perceptions of the therapist’s behavior. The results show that a positive self-image and positive perceptions of the therapist’s actions increased significantly over the course of the therapy, with a corresponding decrease in negative patterns. The alliance scores show that the therapeutic alliance gains significance over time and that it is influenced more by the perception of the therapist’s behavior than by the self-image. The self-image becomes relevant after the mid part of therapy, underlining the role of the therapist in co-creating the treatment relationship. The implications of these results are discussed, and so are directions for future research in other trainee-led settings and samples.     

The experiences of person-centred counsellors working with suicidal clients online through the medium of text

ABSTRACT

In this study, we attempt to provide an understanding of the experiences of four UK-based person-centred counsellors working with suicidal clients online using text-based therapies and the impact of their clients’ suicidal ideation upon their “way of being”. The counsellors were selected purposively; each was working as a person-centred counsellor online, was encountering suicidal ideation in their clients, and was a member of a professional organisation. A narrative approach was taken, using unstructured interviews and a stanza format of representation. We found that participants had developed a way of being online that may be distinct from their in-person practice. Challenges included being more directive, lacking physical presence, lacking confidence in assessing risk and questions about empathic understanding. Working online with risk raises specific challenges for person-centred practitioners in line with what is indicated in the little relevant research currently already available.     

A qualitative investigation into the online counselling relationship: To meet or not to meet,that is the question

Background and aim: Online counselling, as a psychotherapeutic approach, provokes debate amongst practitioners and researchers concerning its efficacy and validity. This reflexive study extends existing research into the nature of the online counselling relationship when it is conducted asynchronously (by email) and explores the possibility this approach may facilitate both online and face‐to‐face therapeutic engagement. Method: Semi‐structured interviews were conducted electronically with ten former email counselling clients of a university counselling service and six counsellors delivering email counselling in other higher education settings, to explore, in depth, their experiences of the online therapeutic relationship and its impact on the counselling process and outcomes. These were analysed using Interpretative Phenomenological Analysis (IPA). Findings: Four areas of focus emerged relating to: (1) the importance of the structure and processes involved; (2) their impact on thinking and feeling; (3) their impact on self and relationships (within and outside counselling), and (4) changes that followed email counselling. Having ‘time to think’ within the asynchronous exchanges, the anonymity and disinhibition afforded by the online medium, the creation of transitional space and the rich use of metaphor, visualisation and imagery all contributed to a sense of empowerment and relational depth for individuals who might have otherwise avoided seeking help. This led to positive change in many cases and for some, facilitated subsequent face‐to‐face counselling. Implications: The findings support the provision of counselling and therapy online and particularly its integration within existing face‐to‐face services.     

The co-constructed therapy alliance and the technical and tactical quality of the therapist interventions in psychotherapy

This study sought to describe a brief review of studies conducted on the therapeutic alliance, taking into consideration therapeutic process and outcomes. We seek to reflect about the need to encourage the communities who engage in and conduct research on clinical practice not only to implement surveys of empirically validated measures of therapeutic outcomes, but also make them a regular practice among all clinical mental health psychotherapists. We therefore suggest the following paradigm – the Practice Based on Evidence of Results (PBER) – as a way to improve the quality of technical and tactical interventions of psychotherapists     

Clinical and demographic features of the online counselling client population

The purpose of this research was to determine the demographics and characteristics of clients seeking online counselling over an eight‐month period of clinical online practice. Two hundred and seventeen clients seeking Internet counselling completed a Counselling Application and a Life History Questionnaire. The characteristics of the relatively new client population include the following categories: gender, age groups, martial status, education, primary reason for seeking online therapy, secondary issues, frequency of email exchanges, and online vs. face‐to‐face counselling preferences. Implications for online counselling practice are discussed.     

If you go down to the woods today you are in for a big surprise: seeing the wood for the trees in online delivery of career guidance

Arguments about online delivery of career development are too frequently couched in polarising terms setting traditional face-to-face guidance practice against online systems. The focus has been on the alleged dehumanising impact of technology and the speed, economy and efficiency of online systems. The possible synergies delivered by the appropriate integration of online systems into career development need exploring. The potential of eguidance, elearning, social media and online information and assessment systems has been insufficiently explored. The user experience has been overlooked, despite evidence that user-interface issues and usability are critical factors in the effectiveness of online systems. The application of artificial intelligence remains largely under-researched in career development. The potential for online systems to assist individuals respond to their chaotic careers has yet to be adequately addressed.     

Metatherapeutic communication: an exploratory analysis of therapist-reported moments of dialogue regarding the nature of the therapeutic work

The purpose of the study was to investigate the nature of metatherapeutic communication (MTC), defined as dialogue between therapists and clients on the nature of the therapeutic work and the means by which it can be of greatest help to clients. Twelve counselling psychologists, working pluralistically with 35 clients experiencing depression, described on post-session forms moments of negotiation and collaboration around the therapeutic work. Two main dimensions of MTC were identified: the subject matter of the MTC and the temporal focus of the MTC. In addition, MTC varied by the time at which it took place. These findings provide a framework for understanding the nature of MTC in counselling and psychotherapy, and the opportunities for implementing it in practice.     

The Value of Research Methods in Psychotherapy Research: A Reply to the Commentary of Dr Norton

Norton's commentary on our article has prompted us to think further about the purpose of psychotherapy research. We agree with his suggestion that researchers have much work to do to understand when and for whom interventions are most efficacious. We hope that our field will make progress in this regard. In this reply, we further describe why we believe careful attention to research methods, such as those highlighted in our article, is key to making progress in psychotherapy research.     

Understanding the context of suicide in master's level counselling programmes in Australia

The purpose of this study was to understand the context of suicide in master's level counselling courses in Australia. The sample comprised courses accredited by the Australian Counselling Association (ACA) and the Psychotherapy and Counselling Federation of Australia (PACFA). A mixed methods content analysis was used to identify the explicitness of suicide in these courses and identify themes that emerged during the analysis. The sample consisted of 405 units of study contained in 26 courses. Suicide was explicit in 23 units in 17 courses. Suicide content was overshadowed by cultural diversity, ethics, morality and philosophy, research and self-awareness, which was explicit in all 26 courses.     

Beyond the therapeutic hour: an exploratory pilot study of using technology to enhance alliance and engagement within face-to-face psychotherapy

In this paper we introduce and investigate the capacity for a novel, technologically advanced system (goACT) to enhance face-to-face psychotherapy. Specifically, we explore the capacity for goACT to enhance therapeutic alliance (TA) and engagement, and reduce distress. Using a mixed-methods, multiple-baseline design we present the first study to examine the utility, effectiveness and user experience of goACT in a university psychology clinic setting. The introduction of between-session goACT use was staggered across patients (N = 7). Patients completed weekly measures of mood, patient-rated TA and clinician-rated engagement. Semi-structured interviews were used to qualitatively understand user experience of the system. Methodological limitations impacted the generalisability of multiple-baseline findings, yet qualitative results provide a significant contribution to the literature and groundwork upon which further study can be built. Results indicated that goACT built engagement and TA via novel change processes that were associated with expanding the parameters of the therapeutic encounter beyond the one-hour session. Change processes that underpin the qualitative success of goACT are discussed in terms of their theoretical implications. goACT is likely to be a useful tool for enhancing the quality and quantity of traditional face-to-face psychotherapy.     

Things online social networking can take away: Reminders of social networking sites undermine the desirability of offline socializing and pleasures

People are beginning to develop symbiotic relationships with social networking sites (SNSs), which provide users with abundant opportunities for social interaction. We contend that if people perceive SNSs as sources of social connection, the idea of SNSs may reduce the desire to pursue offline social activities and offline pleasures. Experiment 1 demonstrated that priming with SNSs was associated with a weakened desirability of offline social activities and an increased inclination to work alone. Felt relatedness mediated the link between SNS primes and reduced desire to engage in offline social activities. Experiment 2 showed that exposure to SNS primes reduced the desirability of offline socializing and lowered the desire for offline pleasurable experiences as well. Moreover, heavy users were more susceptible to this detrimental effect. We provide the first experimental evidence that the idea of online social networking may modulate users’ engagement in offline social activities and offline pleasures. Hence, online social networking may satisfy the need for relatedness but undercut the likelihood of reaping enjoyment from offline social life.