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.     

Client Perceptions of Couples Therapy: Helpful and Unhelpful Aspects

This article describes a qualitative study that investigated client perceptions of helpful and unhelpful aspects of couples therapy. A thematic analysis of interviews revealed among other themes, that couple participants associated helpful therapy experiences with (a) being given choices regarding ideas and ways of working that fit for them, (b) working with a therapist they trusted, and (c) developing new ideas about the couple relationship. Implications of this study for future research, practice, and training are described.     

Transference and countertransference issues with sexually abused clients

Abstract

This paper explores some of the therapeutic issues which arise when working with sexually abused clients. It is suggested that both the client and the therapist may at moments take any of the three positions in the Oedipal triangle and that the mother, father and child status are interchangeable in the transference and counter-transference. It is also suggested that the Oedipus myth represents the failure of a family to contain sexual and murderous passions. I describe a Hindu myth which takes a similar triangle of passion but illustrates how containment is possible. It is proposed that this implies we need to re-evaluate the presence of the erotic in therapy in a more positive light. It is further suggested that the sexually abused client needs to experience the containment of passion if a healing process is to occur.     

Spontaneous Moments and the Domain of Non-Verbal Communication

Abstract

This paper investigates the impact of non-verbal interactions and spontaneous encounters on the therapeutic process and on a client's structural and behavioral patterns. The following case vignette concerns a client who presents with a pattern of non-verbal relational schemas based on his early traumatic experiences. The non-verbal and verbal role reenactments that unfold between client and therapist will be examined from an intersubjective, dialogical and self psychological perspective. Finally, the paper will explore how important therapeutic shifts may occur by attending to and working through these non-verbal aspects of the treatment, leading to new relational structures.     

Constructive Metatheory: II. Implications for Psychotherapy

Abstract

The implications of constructive metatheory for the conceptualization and practice of psychotherapy are briefly outlined. It is argued that the constructivist therapist construes the client as an active and developing process, and that psychological problems are approached not as piecemeal flaws or deficiencies, but as expressions of current discrepancies between an individual's adaptive capacities and the challenges she or he faces. Likewise, the process of psychotherapy is portrayed as one of trial-and-error experimentation with different (novel) ways of “being in the world.” Ideally, the client and therapist create an intimate and emotionally charged alliance in and from which the client can explore and experiment with self and world relationships. These practical features dovetail with many assertions of the major me-tatheories of psychotherapy, and it is argued that constructive metatheory may be uniauely suited to facilitating attempts at conceptual integration     

Occupational Therapy's Role with Victims of Domestic Violence

ABSTRACT

Occupational therapists encounter individuals who are victims of domestic violence in many different settings. The role of the occupational therapist with each client depends on that client's specific needs, the treatment setting, and the skills and beliefs of the therapist. This article presents a theoretical argument for why the occupational therapist should choose to be involved in the treatment of domestic violence. The Model of Human Occupation provides a framework for understanding functional issues related to domestic violence. Methods of assessment and treatment are presented using this model. A continuum of levels of involvement including referrals for resources or treatment, direct and indirect treatment and program consultation is offered. Each level is illustrated with case vignettes demonstrating the therapist's role. Issues related to the challenge of working in domestic violence and reasons that women may refuse intervention are also discussed.     

The application of self-psychology to short-term counselling

Abstract

This article explores how key aspects of Heinz Kohut's self-psychology can inform short-term counselling work. Initially a summary is offered of Kohut's developmental theory, his understanding of the nature and causes of psychopathology and his view of the analytic cure. The application of his ideas to short-term counselling is then discussed. Specifically, it is suggested that short-term therapeutic work based on self-psychology involves a stronger emphasis on the curative aspects of the selfobject transference between client and therapist, a more limited notion of the role of interpretation, and a different understanding of working through to that of long-term self-psychological analysis.     

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.     

One-person family therapy? An analysis of family therapy schools

Abstract

In this article, eight schools of family therapy (psychodynamic, intergenerational, contextual, experiential, structural, strategic, functional, behavioral) are examined regarding participation policies. Differences in schools' participation policies are compared and contrasted using comparative and content analyses. Schools' theoretical rationales and how they effect therapy practice are explored. Implications for therapy practice are presented. The study's goal is to provide information to increase therapist flexibility in working with varying client populations.     

Real relationship,working alliance,transference/countertransference and outcome in time-limited counseling and psychotherapy

Six client/therapist dyads (three therapists each working with two clients) were studied to determine how the real relationship unfolds over the course of time-limited treatment and how this unfolding relates to the development of the client/therapist working alliance, client transference, and therapist countertransference. We also examined how these indices of the relationship fluctuate as a function of treatment outcome. Results indicate that in general for all six dyads, therapists’ and clients’ ratings of the real relationship and working alliance were strong throughout treatment. However, patterns of real relationship and working alliance over the course of treatment varied between dyads categorized as more vs. less successful. Therapists’ countertransference was low, as was client transference, but differences in ratings were evident when the dyads were classified by outcome.     

The client,the therapist and the paranormal: a response to the special edition on psychotherapy and the paranormal

Abstract

In this paper, I provide a published paper response to the papers in this special edition on the paranormal and psychotherapy articulated largely from my career as a parapsychologist. In the introduction I note the definitional differences between advocates and counter-advocates in terms of what might be ‘paranormal’, although I argue ultimately that definitional differences aside, the therapist’s relationship with the client’s unusual experiences is critical, taking a phenomenological stance which is echoed by at least two of the papers in the special edition. In broad review, the papers make a variety of welcome contributions; historical individually and small sample phenomenological and also more metaphorically in terms of articulations of the haunting nature of collective and intergenerational trauma in the social and cultural sphere. I review the papers from a parapsychological perspective, considering the evidence drawn from parapsychological studies where it supports or adds to the topics of each paper. In concluding this response, it seems clear that therapists often work from first principles when relating to clients’ anomalous experiences, and that the papers of the special edition each offer practising therapists some important evidential and practical insights into working with client presentations of ostensibly paranormal and anomalous experiences.     

Qualitative meta-analysis of insight events in psychotherapy

Purpose: This study reports on a qualitative meta-analysis examining the phenomenon of insight into psychotherapy. Method: Studies (n?=?7, covering 15 insight events of 15 clients) were selected that examined significant events in psychotherapy leading to insight using session recordings and Interpersonal Process Recall interviews with clients and therapists. A conceptual organization of the data using a matrix grid consisting of three domains according to data origin (client process, therapist process, and their interaction) and three domains according to events’ sequence (context, event and key intervention, and impact) was established. Results: Key processes were identified that lead to insight events in psychotherapy. Two distinct types of events according to their main impacts as reported by the clients were identified: Painful/Poignant Insight where clients realized something that was painful, often evoking feelings of sadness or undifferentiated upset containing sadness and hurt; and Self-Asserting/Empowering Insight that led to an impact characterized by a sense of self-assertion and empowerment on the client’s part. A reasonably good alliance and vulnerability on the client’s part represent the context for insight events as does the client’s quest for self-understanding. The therapists’ key interventions in the event leading to poignant/painful insight contain either empathic reflection or collaborative interpretation. In empowerment/self-assertive insight events the therapists offer supportive, validating reframing promoting positive experience. In both types of events the therapist and the client work on consolidating insight. In some events, therapists emphasized cognitive or problem solution focused impacts, while clients emphasized emotional impacts. Some events contained emotional avoidance on the part of the client or therapist thus not realizing the full potential of the event.     

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.     

Countertransference as an Ally in Sexual Therapy

SUMMARY

This paper illustrates a constructive use of a persistent countertransference response of a therapist towards a client in sexual therapy. The recognition that the transference resistance from the client had multiple motivations assisted the therapist's constructive use of the countertransference to facilitate the treatment process of the couple.     

Methods for Connectedness

SUMMARY

There are prerequisites that must be achieved developmen-tally before individuals are capable of co-creating healthy intimacy in adult relationships. Thus, therapists often have to work to help client systems overcome failures of maturation. In these kinds of therapeutic encounters the therapist acts as a developmental partner. By designing compensatory experiences, the therapist can help partners fill gaps in early development and education that operate to sabotage loving relationships. This paper offers examples of how levels of moral development and social-perspective taking can be utilized within a transpersonal approach to help couples achieve more satisfying intimate connections.     

Counsellors' perceptions of client progression when working with clients who intentionally self‐harm and the impact such work has on the therapist

Introduction: This paper describes a qualitative study focusing on counsellors' perceptions of client progression when working with clients who intentionally self‐harm and the impact this has on the therapist. Method: Semi‐structured interviews were employed and the constant comparative method utilised to analyse the data. Findings: Findings indicate that counsellors experience intense emotions in response to self‐harm including: shock; sadness; anxiety; anger; and frustration. Counsellors also struggled to manage the tension between multiple dualities, corresponding to professional opinions of a seemingly polar opposite nature. Although participants indicated a requirement to work in a client‐led way, they all had either an explicit or implicit agenda for change. These two conflicting states create a tension for a counsellor that is difficult to resolve. In addition there were various views of client progression, yet all participants agreed that progression was not simply about stopping self‐harm. Conclusion: There is a significant impact on the counsellor when working with clients who intentionally self‐harm and the complexity of the phenomenon appears to exacerbate their anxiety. Implications: Further research within the counselling field focusing on the ambiguous nature of the subject may increase understanding, which in turn may contribute to greater therapist efficacy when working with this client group.     

Diagnosing behavior-disordered early adolescents as a function of cultural differences

The tendency of non-Indian teachers to rate American Indian early adolescents (11-year olds) as behaviorally disordered more frequently than similarly behaving non-Indian children is examined. To test this hypothesis, the observed number of students rated as behavior-disordered by non-Indian teachers were compared with the expected number. A chi-square test revealed no significant tendency for this pattern to occur chi 2 = 2.04 less than .05, df = 1).     

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.     

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.     

Overcoming My Model of Goodness as a Psychotherapist

Summary

The case of Tina is presented to examine one therapist's countertransference issues with a female client who had features of a Borderline Personality Disorder. The therapist's emotional reactions to this client's raw expression of anger and frustration are explored. The discussion also emphasizes the struggle of the therapist in resolving her discomfort with this client and in setting therapeutic boundaries.