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     

Relational dynamics between psychotherapy clients and clinic administrative staff: A pilot study

Extensive empirical research has established therapeutic alliance as one of the most stable predictors of psychotherapy outcomes. Nearly all the contemporary empirical literature on therapeutic alliance focuses on the therapist-client dyad without attending to the relational experiences many clients in outpatient clinics have with administrative staff. Literatures from the fields of social work, psychiatric nursing and milieu therapy suggest there are more systemic relational and environmental dynamics that impact treatment beyond the therapist-client dyad, although these issues have been considered primarily in inpatient settings. A relational ecology framework has been developed drawing upon relational psychoanalysis, attachment theory and symbolic anthropology to help conceptualise the broader relational dynamics beyond the therapist-client dyad that may impact a more systemic therapeutic alliance in certain outpatient contexts. In an initial cross-sectional pilot study with a sample of clients (N = 107) receiving psychotherapy at a community mental health clinic in the Northeastern United States, the present study found client ratings of both (a) the therapeutic alliance with their therapists and (b) their alliance with administrative staff each significantly positively predicted client ratings of treatment. Thus, ratings of administrative alliance predicted client ratings of treatment over and above the effects of the therapist-client therapeutic alliance. These findings provide preliminary support for further investigation of the relational ecology of outpatient psychotherapy and suggest that client experiences of relational and environmental dynamics with administrative staff may be important contributors to psychotherapy outcomes. Limitations of the present study and implications for future research and practice are discussed.     

Using a Creative Intervention to Increase Self-Disclosure Among Mandated Juveniles with Co-Occurring Disorders

Abstract

Counselors providing treatment within the juvenile justice system encounter numerous challenges that are inherent in working with this population. One of the challenges includes providing treatment to adolescents who are entering the juvenile justice system with co-occurring mental health and substance use disorders. Given the challenges, creative interventions that enhance client motivation and the therapeutic relationship are especially needed. The purpose of this article is to propose a creative intervention that may enhance the therapeutic relationship, increase client investment in treatment, and facilitate client self-disclosure. A case illustration will be used to illustrate the intervention.     

Legal and Ethical Issues in the Court-Mandated Treatment of Batterers

Summary

In the following article, we will explore the nature of the therapeutic relationship as it relates to batterers' treatment programs. We will consider the impact of obligations created by forces outside the relationship, such as those imposed by legal proceedings. We will discuss the concepts of confidentiality, privilege, and agency and their impact on the therapeutic relationship and the extent to which the therapists' understanding of the role these concepts play may be altered by court orders that impose treatment on a client/patient. Finally, we examine the issues and choices a therapist must make when engaging in court-ordered treatment of batterers, and the implications of those choices for both therapist and client; we will also suggest guidelines to help therapists sort through the often conflicting goals of therapy and the legal process.     

Using Relational Cultural Theory as a Pedagogical Approach for Counselor Education

ABSTRACT

In the article the authors will discuss core concepts of RCT in greater detail while relating these concepts to the counselor education classroom setting. There are many aspects of the counseling process that are open-ended due to the necessity of counselors needing to be responsive to the client’s needs in the moment. It is the assertion of the authors that using RCT in the classroom as a pedagogical framework may be beneficial to the growth of CITs. Through creating and maintaining an environment that supports growth fostering relationships, mutual empathy, authenticity, recognition and healing of disconnection, identification of central relational paradoxes, and processing relational images can all lead to developing relational competence in the CITs who will become the next generation of counselors. Additionally, the authors provide examples of the core concepts in action that are grounded in their experiences, blending RCT into their instructional delivery in their course.     

Languages of trauma; towards a phenomenological response

In this article, I explore the possibilities of a phenomenological perspective on trauma in psychoanalytic practice. I highlight the problem of interpretations that universalise experiences of trauma, provide explanations in terms of ‘causes’ and assume particular processes/stages of ‘recovery’ from it. The notion of trauma challenges dichotomies of ‘internal’ and ‘external’ worlds. Traumatic experiences always have a context – that of the immediate relational circumstances of the individual suffering from the trauma, including the wider social/relational context, and the person’s history. I argue for an attunement to the language and specificity of the meanings, verbal and non-verbal, conscious and unconscious, of the client’s suffering within the analytical relationship. This requires the therapist to avoid ‘ready-made’ interpretations from psychoanalytic theory and to be open to the poiesis of the speech, which emerges between therapist and client. My discussion of my reading of the Chilean documentary film, Nostalgia for the Light, which focuses on the traumatic experiences of those who survived Pinochet’s military regime (1973–1989), highlights how diverse responses to trauma are. The originality of the language of the film calls on us as therapists to discover new ways of listening and speaking to our clients’ suffering.     

Strengthening the Strengths Perspective

Abstract

This article revisits the strengths perspective as conceptualized in social work practice. Although we find this perspective has value and utility for practitioners, we identify areas where the strengths perspective could be enhanced and augmented by integrating the contemporary relational approach exemplified by Paul Wachtel's cyclical psychodynamics. Specifically, we explore his concepts of therapeutic communication and use of language, including interventions that affirm client strengths such as reframing, searching for variations and exceptions, and reconceptualizing how transference impacts the therapeutic action. We illustrate our view with a case vignette, advocating that Wachtel's integrative approach provides a new context for psychodynamics in current social work practice.     

Using Narrative Therapy in the Treatment of Adult Survivors of Childhood Sexual Abuse in the Context of Couple Therapy

Abstract

Childhood Sexual Abuse (CSA) is a prevalent social issue. Many theoretical approaches have been applied to the treatment of CSA, these approaches predominately focus on the treatment of children and adolescents, failing to address adulthood and couples’ relations. This limited focus fails to address long-lasting relational implications CSA survivors face. This paper proposes the application of a systemic therapeutic modality, Narrative therapy when treating adult survivors of CSA in couple therapy. The treatment of CSA in the context of couple therapy will be discussed. Clinical vignettes will be used. Implications for clinical practice and future research will be discussed.     

Psychotherapeutic work with refugees: Understanding the therapist's countertransference

Abstract

Most therapists are chosen to work with refugees because they speak the language or come from the same cultural or racial background and/or have had experiences which resonate with those of the client. They are often people who can easily understand the clients' experiences, which creates interesting and potent therapeutic dynamics. They can offer a great deal of support to the person, but often with the high risk of over-identification. This paper is an attempt to examine from the therapist's perspective the complex dynamics involved in working with refugee clients. It is a collection of thoughts and feelings expressed in psychotherapeutic and supervisory work by different types of refugee mental health workers. It is an attempt to understand the therapeutic relationship further by focusing on the therapist's psychological response to the client. The paper will outline briefly some of the common themes reported by refugees, but the primary aim is to focus on the therapist's countertransference feelings. Countertransference in this context is defined as a personal psychological response, as well as consisting of socio-political components.     

Interpersonal Perceptions and Metaperceptions in Dialogic Action Therapy: A Relational Methodological Approach to Theory Construction

Abstract

Two forms of understanding in theories of therapy are identified: empathic understanding rooted in individualism, and reality-based understanding that acknowledges the relational character of human existence. We argue for regarding these two forms of understanding as complementary. This requires a paradigmatic shift from methodological individualism to methodological relationalism, which asserts that the analysis of role relationships precedes that of individuals and situations. Informed by methodological relationalism, dialogic action therapy accords prominence to the creation of a therapeutic relationship between therapist and client, between whom bidirectionality of perceptions is inherent. We develop a formal analytic scheme for theory building. Six major constructs, degrees of perception, directionality, agreement, reciprocity, accuracy, and congruence, are employed to facilitate the analysis of therapist and client perceptions and metaperceptions of trust in depth. The implications for therapy and methodology of measurement are discussed.     

How Therapy Helps When the Culture Hurts

SUMMARY

The purpose of psychotherapy is movement toward relational healing. However, the practice itself is embedded in a culture where relational disconnection and power-over arrangements are normative. The purpose of this article is to examine the impact of cultural disconnections on the therapy relationship. Because they embody multiple social identities within a power-over paradigm, both client and therapist are “carriers” of cultural disconnections. The article examines the shifting vulnerabilities associated with those identities that may lead to impasse and violation or contribute to possibilities for growth. Scenarios from clinical practice illustrate how conflict becomes a pathway to deeper connection when embraced with such processes as empathic attunement, authentic responsiveness, and mutuality.     

Promoting Relational Competencies in Counselor Education Through Creativity and Relational-Cultural Theory

Abstract

This article addresses the need to identify requisite relational competencies that professionals providing creative and innovative counseling services must hold when facilitating responsible, growth-fostering connections between service providers and others. This article also includes a discussion on how the relationally responsible use of power must be included in any forum that examines relational dynamics and competencies. Although subsequent writings will discuss creativity-related competencies in greater depth, the focus of this paper rests on some relational challenges that students and professionals in the counseling and related fields face and on the need to identify relational competencies that can facilitate successful resolution of these challenges.     

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.     

Validity of the Global Assessment of Relational Functioning (GARF) When Used By Community-Based Therapists

Construct validity of the Global Assessment of Relational Functioning (GARF) was assessed using a health services research approach, a mode of study that captures the naturalistic practice of health service providers. A sample of 395 couple/family cases with GARF scores assigned pre- and post-therapy by 222 community-based marriage and family therapists yielded these results: 1) pretreatment GARF scores were negatively correlated with severity of client problems; 2) GARF change scores were positively correlated with client reported changes in functioning; 3) GARF change scores were positively correlated with therapist-reported client change; 4) GARF change scores were positively correlated with client satisfaction; 5) pretreatment GARF scores were negatively correlated with number of therapy sessions; and 6) pretreatment GARF scores and client diagnoses showed no relationship. Given these results the GARF appears to have construct validity in community settings, and is a promising brief assessment tool for relational functioning.     

Clinical strategies to promote compliance

Abstract

This article focuses on the need for effective client management throughout the therapeutic process. The appropriate and astute use of clinical strategies can promote client compliance with treatment and counteract the possibility of client dissatisfactions and ethical/legal complaints. This article offers a systemic explanation of compliance, identifies five major clinical strategies to foster treatment adherence, and discusses the need for clinical judgments that fulfill ethical/legal obligations while promoting quality care.     

From relation to the field: Modes of unconscious fantasy elaborations1

Abstract

Relational and field theories have much in common, despite divergent foundations. In this paper, several areas of divergence are selected, including the structure of the field as a relational matrix or as an unconscious joint fantasy of the couple; the fate and form of insight; and the nature of the unconscious as relational or ubiquitous. Differences in cognitive and attentional sets are identified and linked to different modes of insight. Using a clinical vignette, these divergences will be illustrated with an attempt to compare and contrast the two approaches through a discussion of how each lens highlights, expands, or forecloses different features of the analytic process. A mode of conceiving the unconscious as unstructured and multiple in potential is offered to reconcile divergent assumptions in therapeutic action. A consideration of Sandor Ferenczi’s clinical emphasis on relaxed technique, elasticity, and especially mutuality suggests that he would have been a field theorist were he among us today.     

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.     

A psychodynamic perspective on early childhood trauma in an adult: A case study

Abstract

This paper uses a long-term case to illustrate, from a psychodynamic perspective, a number of issues arising in working with an adult survivor of early childhood trauma. The paper takes an overview of the case study, identifying issues which are inextricably interwoven in the client's experience of trauma, and which impact on the working alliance. The therapeutic relationship forged with the client is discussed in terms of its intrinsic successes and failures together with the implications of early traumatic experiences for the termination of counselling.     

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.     

Editorial

Abstract

This paper is an attempt to address the issue of trust in the therapeutic relationship from the counsellor's perspective, with a particular reference to working with drug addicts. It is a personal reflection on previous work with drug addicts in which a cognitive-behavioural approach was used. The comparison will be made, in a post hoc, reflective manner, on the issue of trust from a very different perspective; namely psychodynamic. It is suggested that the counsellor's trust in their own ability to contain the patient's often projected anxiety, is a central element or variable that can be seriously disrupted by the process of projective identification. And, moreover, it may have some explanatory power for the choice of method of working with this particular client population, that the issue of trust and its containment says as much, if not more, about us as counsellors, as it does about the client. It is argued that our anxieties may lead us to adopt a certain course of action in the therapy, rather than to address the possible meaning of these anxieties in terms of the relationship regarding the clients' needs.