Mutual Exploitation in Intimate Relationships

SUMMARY

This article describes a systemic intervention designed to empower women who present individually in therapy and who perceive themselves as victims of exploitation within an intimate relationship. While appreciating the difficulty in recognizing, understanding and altering ingrained problematic interactional patterns, attention is rendered to the unwitting participation of women in the perpetuation of undesirable behaviors. Central issues surrounding constraining client cognitions, inculcated gender stereotyping, mutual invitations and therapist ethical/legal responsibility are discussed.     

The stalking of psychotherapists by current or former clients: Beware of the insecurely attached!

Abstract

A survey of psychological therapists who worked in primary care showed that the incidence of psychotherapists being harassed or stalked by their current or former clients was more than twice the national average at 24%. The stalkers fell into three broad categories: those clients who were needy and made early attachments to their therapists; those experiencing erotic transference; and those with personality disorders, especially those with a narcissistic style. All of these are disorders of attachment. This paper discusses the neurobiological development of an insecure attachment and how that manifests during therapy in stalking behaviour. Psychotherapists who are aware of the dynamics within the therapeutic relationship can take preventative steps to inhibit the automatic fear response of a client who is insecurely attached and which may lead to stalking behaviour.

A survey of psychological therapists who worked in primary care showed that the incidence of psychotherapists being harassed or stalked by their current or former clients was more than twice the national average at 24%. The stalkers fell into three broad categories: those clients who were needy and made early attachments to their therapists; those experiencing erotic transference; and those with personality disorders, especially those with a narcissistic style. All of these are disorders of attachment. This paper discusses the neurobiological development of an insecure attachment and how that manifests during therapy in stalking behaviour. Psychotherapists who are aware of the dynamics within the therapeutic relationship can take preventative steps to inhibit the automatic fear response of a client who is insecurely attached and which may lead to stalking behaviour.     

Assessment,Treatment, and Rehabilitation for Interpersonal Violence Victims

Abstract

Psychotherapists who have received minimal training in neuropsychology do not consider cognitive rehabilitation among the treatment options for their clients who have mild traumatic brain injury (mTBI). Historical perspectives on mTBI did not acknowledge brain plasticity and/or rehabilitation, yet rehabilitation might provide a necessary foundation for a client to be able to benefit from traditional feminist psychotherapy. This article provides an overview of two treatment modalities, biofeedback and neuropsychologically-informed feminist psychotherapy, for women with mTBI who sought relief from interstitial cystitis and headaches. Assessment for neuropsychological treatment planning and monitoring is illustrated with employment of the Ackerman-Banks Neuropsychological Rehabilitation Battery. Clinical examples are provided to demonstrate a variety of manifestations of mTBI and responses to treatment.     

Witnessing stories: Definitional Ceremonies in Narrative Therapy with adults who stutter

BackgroundNarrative therapy (White & Epston, 1990) was developed as an approach to counselling, as a response to the power relations that influence people's lives. Its use with people who stutter has been documented. A basic tenet of narrative therapy is that the dominant problem-saturated narrative is challenged by externalizing the problem, in due course facilitating development of an alternative narrative. Within this process, the definitional ceremony involving outsider witnesses is a key procedure used to influence change.AimsThis paper describes definitional ceremonies, and their application within a narrative approach to therapy for stuttering. The analysis of a specific definitional ceremony is presented, leading to an exploration of identity as a public and social achievement.MethodsA definitional ceremony involving a woman who stutters and family members was recorded and analysed using two methods: interpretative phenomenological analysis and Heideggerian hermeneutic phenomenological analysis. Details of the clinical application of definitional ceremonies with this client are described.Results and conclusionsResults from both methods of analysis were found to be similar. Notable results include the fact that the stuttering per se was not presented as the problem; rather, the impact of stuttering, especially the experience of bullying, was a dominant theme. This paper shows how definitional ceremonies can open opportunities for clients to present themselves in a preferred way, forming the basis for a new story and revised identity. Emerging themes can be identified for reflection and discussion with the client for therapeutic benefit.Educational objectives: (1) to describe and explain to readers the process of narrative therapy, with special attention to the use of definitional ceremonies; (2) to provide detail regarding the clinical processes involved with a specific definitional ceremony with one client; (3) to have the reader appreciate the specific importance of involving outsider witnesses in the therapy process; (4) to discuss the outcomes of the use of this particular definitional ceremony.     

The Anne Sexton complex

Abstract

From Sylvia Plath to Virginia Woolf and Anne Sexton, artists have identified with the downward pull of the creative unconscious toward death. Death appears in images of a sexual, mystical, or ecstatic union with the ghostly lover or mother. This paper explores an alternative creative model for women which does not lead to death, by documenting the case history of a woman artist who attempted suicide, but who lived to tell her story. The case history is written as a narrative both in the words of the author and in the words of the client.     

Brief dynamic counselling: Making the right choice

Abstract

Brief dynamic counselling has become a frequently practised method of treatment. This paper examines the usefulness of short-term therapy for certain clients and describes the relevant selection criteria. However, it is argued that there exists a real danger to the client should they be inappropriately referred for this work. Demands upon therapy services often mean that therapists are under pressure to have a rapid ‘through-put’ of clients. This may lead to some clients being treated in a way that is unsuitable and inadequate for their needs. It is suggested that, more than being inadequate, such a situation could cause additional harm to the client. Professional assessment is considered to be of vital importance. Case material is included in order to illustrate the difference between clients who are likely to benefit from short-term counselling work and those for whom the longer time duration is an essential part of the therapeutic relationship and process. In terms of therapy service provision, the need for flexibility and the need for availability of a variety of treatments are discussed.     

Spiritual,Religious, Nonspiritual,and Nonreligious Narratives in Marginalized Older Adults: A Typology of Coping Styles

SUMMARY

Narrative therapy is an important tool in the phenomenological framing of life events with older clients. Seventy-nine older adults who lived independently in four subsidized high-rise housing facilities in Chicago were interviewed in a research project about managing life challenges. Cases represent four types in a spiritual-religious typology: religious and spiritual, religious only, spiritual only, and neither religious nor spiritual (Zinnbauer, 1997). This article explores how older adults managed adversity and maintained a sense of self-efficacy. Findings indicate that older adults use many references to religion and spirituality in their narratives, either embracing these domains or defining themselves in contrast to them. Narrative therapy suggests that the implications of religious and spiritual resources addressed in client stories may reinforce coping capacity and promote aging well.     

Bridging the Divide

Abstract

Women who consider themselves traditional or conservative in the context of religious practice often experience tremendous conflicts regarding the integration of same-sex emotional and sexual feelings with their religion and spirituality. Current religious teachings about homosexuality make this combination difficult as only heterosexual sexuality within marriage is permitted in most orthodox faiths. Further, the way that spirituality and sexuality are conceptualized as opposing dichotomous categories (e.g., body vs. soul) presents women with a framework where integration does not seem possible. Observant women who come to psychotherapy often experience tremendous distress, guilt, depression, and even suicidality due to the conflict between their sexual feelings and religious doctrine. Relieving the distress, and resolving the conflicts while honoring the emotional complexity of sexual feelings, spirituality, and religious orthodoxy can present tremendous dilemmas for the practitioner as well as the client. Using the example of psychotherapy of an Orthodox Jewish woman who integrated same-sex desire into her life, this article describes psychotherapy process and alternative ways of viewing spirituality and sexuality that permit possible resolutions for clients.     

Sizeism in Therapy: Fat Shaming in Supervision

Abstract

The author, a doctoral student therapist, discusses her experience with a clinical supervisor who fat-shamed a client during supervision. This incident is examined within a shame framework and addresses the experience of shame, the effects of shame and shame-proneness on mental health outcomes, and why discussions about shame are often avoided in therapy by both clients and therapists. Some of the real-world considerations that can impact treatment for fat individuals, including chair size and comfort of the client, implicit bias within therapy, and goals for treatment, are also discussed.     

Student clinicians’ and clients’ perceptions of the therapeutic alliance and outcomes in stuttering treatment

PurposeThe purpose of this study was to examine how the therapeutic alliances (TA) of graduate student clinicians and adult clients who stutter relate to perceived treatment outcomes.MethodsStudent clinicians (N = 42) and adult clients who stutter (N = 22) completed a survey assessing their TA strength and perception of treatment outcomes. Responses were analyzed to determine similarities and differences in how clinicians and clients relate the TA to perceptions of treatment effectiveness, progress, and outcome satisfaction.ResultsResults suggest that clinicians and clients who stutter both relate the TA to treatment outcome, but in different ways. While clinicians associate the TA most with treatment effectiveness and client progress, clients relate the TA most to outcome satisfaction.ConclusionClinicians should be aware that for adult clients who stutter, outcome satisfaction is related to the degree of shared understanding, agreement on daily tasks, and bond they experience with their clinician. To ensure a strong TA and client satisfaction, clinicians should actively seek their clients’ perspective regarding TA status.     

Parallel Process

Summary

This article addresses parallel processes between the author (a therapist) and client when each are mourning the death of their mother. Similarities and differences in their experience and reaction are discussed. The effect of the client's unexpressed grief from her early childhood loss is explored. The author also examines her own, more recent loss and develops a new perspective on its consequences. Tools are presented to help the client work on her grief, especially when the issue is “motherloss.” The impact of the therapeutic process on the client and author is delineated, and the client's reactions to ending her therapy are analyzed.     

A Grammar of Love

Abstract

Recently researchers in the family therapy field have encouraged a focus on aspects of therapy common across all models that are important to therapeutic change. The purpose of this study was to build on the “common factors” literature by exploring clients' perspectives of what was useful to their therapeutic experience. Quantitative and qualitative measures were used to collect data from 41 clients who participated in therapy at a university-based family therapy clinic. Quantitative results indicated that therapeutic relationship, client motivation, extratherapeutic factors, and hope and expectancy accounted for 49% of the variance of clients' perception of change and 73% of the variance of clients' perceptions of therapy helpfulness. Qualitative results indicated the therapeutic relationship to be the most helpful aspect of clients' therapeutic experience.     

An Integration of Feminism into Experiential Psychotherapy

Abstract

Feminist therapy altered how marriage and family therapists conceptualized their clients’ realities and psychopathology. Upon an extensive search of the literature, there is a sparse amount of literature regarding the integration of feminist therapy with experiential therapy. The authors discuss feminist and experiential therapy models, propose a model of feminist-experiential therapy, and highlight the need and fit of these theories. A discussion on giving space to silenced voices, establishing an egalitarian relationship, expanding the definition of deviance, and exploring the importance of language will be done to aid the experiential therapist in their work and expand their client’s experience.     

Fat Women’s Experiences in Therapy: “You Can’t See Beyond…Unless I Share It with You”

Abstract

This article reports the results of a qualitative exploration of fat women’s experiences with weight-related microaggressions in psychotherapy. We conducted semi-structured interviews with 15 women about their weight-related experiences as therapy clients and asked for their advice to therapists who work with fat women. We used a general inductive approach to code the data into themes and found that common microaggressions included therapists who overly focused on weight, therapists who appeared to be less interested in clients because of their weight, and dissatisfaction with waiting room seating options. Participants advised therapists to allow their clients to initiate conversations about weight. Results suggest the need for increased awareness of: (a) how clients’ weight may impact therapists’ attitudes and choice of interventions and (b) how weight might influence fat clients’ in-session presentations.     

Using Medical Family Therapy with Parents of an Adult Child with Traumatic Brain Injury

Abstract

Acquired traumatic brain injury (ATBI) is a public health concern causing approximately 2.5 million emergency room visits in the United States annually. Medical family therapy (MedFT) displays how biological issues impact each area of a client’s life. This paper highlights how MedFT can be utilized with parents of an adult child with ATBI; the case is presented as treatment occurred with benefits of the inclusion of MedFT. Researchers propose a call to the field of marriage and family therapy to increase access of MedFT to afford more opportunities to help families who experience medical conditions.     

Tools for Change

Abstract

This paper discusses the ways in which one may incorporate political action into a client's therapy process so the client may incorporate it into her/his life. A framework for defining this as ethical, therapeutic and necessary to the client is presented. A number of suggestions for helping clients and therapists to become more politically active, as well as vignettes demonstrating how this might work with clients in the therapy process are provided.     

Suicide and the Law

SUMMARY

The purpose of this chapter is to delineate how mental health professionals can prevent their clients from acting in a suicidal manner while protecting themselves against potential liability when a client attempts or completes suicide. In our increasingly litigious society mental health professionals can apply their understanding about the elements of legal liability in cases involving client suicidal behaviors to structure their services in a manner to meet their responsibility in treating potentially suicidal clients.     

Gender Biases and Therapists’ Conceptualization of Couple Difficulties

In spite of the fact that gender issues have played an important role in many family therapy training programs, little research has been developed to explore the effects of gender and gender biases in therapists’ conceptualizations of client problems. This study explores beginning and advanced marriage and family therapy (MFT) student’s inclusion of gender in the conceptualization of a clinical case. To examine clinician’s thinking, 32 therapists (18 beginning MFT students and 14 advanced MFT students) were asked to 1) view the first 20 minutes of an intake interview conducted by a sex therapist, and 2) identify the couple’s central issues. Qualitative and quantitative analyses were used to explore constructs associated with therapists considerations and inclusion of gender and cultural issues in their conceptualizations of marital difficulties. Results revealed that trained MFT students who considered gender may have analyzed gender issues more extensively than untrained MFT students. In addition, results of qualitative analysis of participant critiques revealed subtle forms of gender and cultural biases. Discussion focuses on how these biases, some of which are linked to clinical theory, can lead to differential expectations and inequality in the treatment of men and women in couple therapy. Implications for clinical training, curriculum development, and future research are also discussed.     

Experiential personal construct therapeutic artistry: The therapy relationship and the timing of interventions

Abstract

Experiential personal construct psychotherapy focuses on the intimate, interconnected, and evolving relationship between the therapist and the client as vital to therapeutic growth. Great creativity is demanded of the therapist who aspires to connect with clients in life‐changing psychotherapy. This article first describes the essential nature of the therapy relationship with its implicit and explicit demands for therapist creativity. These principles then are illustrated through a discussion of the critical issue of timing therapeutic interventions.