Soft Prosody and Embodied Attunement in Therapeutic Interaction: A Multimethod Case Study of a Moment of Change

This study focused on a moment of weeping in one psychotherapy case. The overall aim was to explore the role of “soft prosody” in psychotherapy interaction—that is, the participants’ use of pauses, a lower volume, slower rhythms, and softer intonation than in the surrounding speech. A mixed-method, micro-analytic perspective was applied to investigate (a) social interaction, including its verbal and nonverbal elements; (2) the participants’ bodily responses, including autonomic nervous system (ANS) measurements; and (3) the participants’ thoughts and feelings during the therapy session, as reported in subsequent individual interviews. Soft prosody was observed to be an important conversational tool. It was used in conveying affiliation and offering therapeutic formulations, and it appeared to contribute both to emotional attunement between the participants and to the therapeutic change that occurred during the interaction under study. Two differing bodily synchronization tendencies in the arousal levels were observed among the participants: (a) a complementary tendency—that is, when the client's arousal increased, the therapist's decreased (occurring during the active therapeutic processing); and (b) a tendency to concurrent decreased arousal in all of the participants.     

An interview study exploring clients' experiences of receiving therapeutic support for family estrangement in the UK

Many people experience estrangement from a family member, which is broadly understood to refer to negative relationships that are characterised by little or no contact. However, little is known about how people cope with family estrangement. To address this gap, interviews were conducted with 46 participants who identified as being estranged from a parent/sibling and/or child and having sought therapeutic support for this experience. The participants were recruited from a UK-based charity that supports individuals experiencing family estrangement. The participants had a range of experiences of therapeutic support, with most (N = 31, 67%) having paid for private therapy. The data were analysed using thematic analysis, and three themes were generated: (1) finding the missing qualities in estranged family relationships: warmth, validation and safety; (2) speaking the unspoken: addressing the causes and consequences of estrangement; and (3) learning relational skills: improving the relationship with oneself and with others. When the causes of estrangement were addressed in the context of a safe therapeutic relationship, participants learned strategies to improve the relationships they had both with themselves and with others. When participants experienced a cold or unresponsive therapeutic relationship, and the causes and consequences of estrangement were not adequately addressed or understood, counselling was experienced as unhelpful. Individuals who seek therapeutic support for family estrangement have specific needs. Training around these needs and the causes and consequences of estrangement could be beneficial to helping professionals and the clients with whom they work.     

Therapeutic Effects of Islamic Intercessory Prayer on Warts

The present study aimed to examine the therapeutic effects of Islamic intercessory prayer on warts. Forty-five participants who are mostly Muslims and infected with warts were randomized into three groups: Group-1 (uncertain, with intercessory prayer), Group-2 (uncertain, no intercessory prayer), and control group (informed, no intervention). Stress symptoms were also measured before and after prayer sessions for these three groups. The results revealed that there were no significant differences between the groups in terms of healing. Although participants believed in the therapeutic effects of prayer, when participants did not trust the intercessor, prayer had no effect on warts.     

Evaluating the therapeutic misconception

The "therapeutic misconception", described by Paul Appelbaum and colleagues more than 20 years ago, refers to the tendency of participants in clinical trials to confuse the design and conduct of research with personalized medical care. Although the "therapeutic misconception" has become a term of art in research ethics, little systematic attention has been devoted to the ethical significance of this phenomenon. This article examines critically the way in which Appelbaum and colleagues formulate what is at stake in the therapeutic misconception, paying particular attention to assumptions and implications that clinical trial participation disadvantages research participants as compared with receiving standard medical care. After clarifying the ethical significance of the therapeutic misconception with respect to the decision making of patients, we offer policy recommendations for obtaining informed consent to participation in clinical trials.     

Research as therapy, therapy as research: Ethical dilemmas in new-paradigm research

Ethical dilemmas are raised by changes in research paradigms which encourage the development of a relationship between researcher and participant. In such contexts it becomes increasingly difficult to tell the difference between a therapeutic relationship and a research interview. The rapid development of research within the therapeutic world of counselling and clinical psychology poses further ethical issues relating to the use of clients as participants in research studies. It is concluded that there must be an increased awareness of these issues and a need to accept responsibility for relationships with both participants and clients.     

Narratives of therapeutic art-making in the context of marital breakdown: older women reflect on a significant mid-life experience

This paper explores the narratives of three women aged 65–72 years. They reflected on an episode of therapeutic art-making in midlife, which addressed depression associated with marital crisis and breakdown. The narrative analysis focused upon on the ways in which participants narrated the events leading up to their participation in therapeutic art-making; the aspects of therapeutic art-making that continued to be given significance; the characters given primacy in the stories they told about their journey through therapy and marital breakdown; meanings, symbolic and otherwise, that participants ascribed to their artwork made during this turning point in their lives; and aspects of the narratives that conveyed present-day identities and artistic endeavors. The narratives revealed the complexity of the journey through marital breakdown and depression into health, and showed that therapeutic art-making could best be understood, not as a stand-alone experience, but as given meaning within the context of wider personal and social resources. Participants looked back on therapeutic art-making that occurred two decades earlier and still described this as a significant turning point in their personal development. Art as an adjunct to counselling/therapy was not only symbolically self-expressive but provided opportunity for decision-making, agency and a reformulated self-image.     

The therapeutic relationship as a paradoxical experience

The therapeutic relationship exists within multiple levels of reality—including that of ordinary life and that of the therapeutic frame. This interplay between these two levels of reality gives rise to paradoxical experiences for both participants. Certain “principles”; or “rules”; of technique can be understood as a means of enabling the therapist to cope with what is usually referred to as “boundary”; issues. It is essential that the analyst or therapist demonstrate capacity to shift playfully from one level of reality to another. The “rule”; of abstinence and the asymmetry of desire that exists between the two participants are discussed. Gratification within the therapeutic frame is paradoxical in that gratification at one level of reality leads to privation at another level of reality. These paradoxical experiences for both patient and analyst are examined in relation to projective identification and to the analyst's countertransference.     

Simulationspatienten in der Psychotherapieausbildung

Background

The development of therapeutic skills is an essential therapist-related variable that deserves special attention in the context of the currently increasingly discussed topic of therapeutic failures and discontinuation of therapy.

Aim

The study investigated whether the use of simulated patients (SP) in the training of psychotherapists can lead to an increase in therapeutic skills.

Material and methods

The use of SP (16 teaching units) was tested in a pre-post comparison with 29 training participants for child and adolescent therapy and analyzed from three perspectives: from the perspective of the SP, the training of participants and rater.

Results

The work with SP in psychotherapy training leads to a significant increase in therapeutic skills; however, it requires further research to see if this teaching method is more effective than other approaches to teaching, whether it contributes to long-term changes in therapeutic skills and to what extent the results can be transferred to other therapeutic contexts (except exploration).     

participating in a couples therapy outcome study: Participants' views

Discovering that participants who received therapy in a research project and were being debriefed in a therapy outcome study considered those assessment sessions therapeutic, the authors conclude that participants: (a) are aware of the research context, (b) have some idea about how it affected the treatment they got, and (c) see positive outcomes for taking part in the study. Assessment and treatment were not separated in the minds of some participants, as they had been in the mind of the researchers.This study was supported in part by National Institute on Drug Abuse grant #1R 18DA 1069232001.     

Treating family relational trauma: a recursive process using a decision dialogue

This article describes a therapeutic process that combines individual and family sessions to maximize therapeutic opportunities to bring forward, understand, validate, and empower children's experience as equal participants in family therapy. The aim is to strengthen relational bonds within the family. Drawing from earlier work with families where incest had occurred, the authors present a recursive process that utilizes a "decision dialogue" to link individual and family sessions. Clinical examples are provided.     

The therapeutic alliance: Adolescent perspectives

This paper presents a conceptualisation of the therapeutic alliance from the adolescent perspective and discusses implications for practitioners. The main aim of the study was to focus on the factors that participants identified as important in relationship formation and maintenance. Eighteen individuals were interviewed using a semi‐structured format. Three major themes were identified: therapeutic environment, uniqueness of the therapeutic relationship, and therapist characteristics. Participants identified both positive and negative aspects of the therapeutic relationship. A strong alliance was found to be necessary in that the perception of the therapist as accepting, supportive and trustworthy influenced the adolescent's evaluation of the appropriateness of therapeutic tasks and goals. Participants stressed the importance of the supportive nature of the relationship in their willingness to collaborate in therapeutic interventions.     

The Added Value of Studying Embodied Responses in Couple Therapy Research: A Case Study

This article reports on the added value of embodied responses identified through sympathetic nervous system (SNS) activity in couple therapy research. It focuses on moments of change and the timing of therapeutic interventions or therapeutic moves in a couple therapy session. The data for this single‐case study comprise couple therapy process videotapes recorded in a multi‐camera setting, and measurements of participants’ SNS activity. The voluntary participants were a marital couple in their late thirties and two middle‐aged male psychotherapists. The division into topic segments showed how the key issue of seeking help, which was found to comprise three separate components, was repeatedly dealt with in the session. SNS activity showed different degrees of synchronization between the couple, between the therapists, and between the couple and therapists during the dialogue pertaining to these three components. The issue of timing emerged as a complex, even ambivalent, phenomenon. Arousal in the therapists was in line with their therapeutic activity, whereas in the clients it was more anticipatory. The approach used here rendered visible some of the intensity that therapeutic dialogue can generate when dealing with issues of relationship change in the couple context and showed how this intensity can be dialogically regulated in the therapeutic system.     

The effects of supervisory interruptions on therapists and clients

Abstract

The general acceptance of live supervision has not been without criticism, specifically that it is a disruptive intrusion into the therapeutic process. The present study attempted to determine what effect supervisory interruptions had on the participants in a therapy session. Using a within-subjects design, excerpts from a session were analyzed to determine differences between a no-interruption condition and conditions of supervisor-initiated, therapist-initiated, and telephone interruptions. While each of the participants were affected to varying degrees by the interruptions, there were no consistent effects. It was concluded that the act of interrupting a therapeutic session, in and of itself, is not sufficiently disruptive to negate it use. Implications for supervision and practice are discussed and recommendations are given for managing interruptions during supervision and daily clinical practice.     

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.     

Clients’ experiences of dynamic interpersonal therapy (DIT): opportunities and challenges for brief,manualised psychodynamic therapy in the NHS

Dynamic interpersonal therapy (DIT) is a brief manualised psychodynamic intervention for depression. This is a first study exploring clients’ experiences of DIT specifically and brief, manualised psychodynamic psychotherapy (PP) in general. Interpretative phenomenological analysis was the methodology employed. Five participants completed a semi-structured interview, three weeks to ten months after completing DIT. The scores of pre- and post-therapy outcome measures of depression and anxiety were also available. Two emerging superordinate themes are presented here: (1) ‘The Distinct Features of DIT’, referring to how its therapeutic style and time limitations were experienced and (2) the ‘Impact of Therapy’, referring to perceived outcomes. While previous findings showed that therapist’s perceived limited activity in long-term PP was experienced as hindering/unhelpful, the perceived sense of direction in DIT appeared adequate to most participants. Secondly, the time limitations provoked complex responses. Reactions to the distinct elements of DIT are to be treated both as therapeutic opportunities and as challenges. Further, in line with psychoanalytic theory, most participants described relational changes that went beyond symptom relief and remained in progress after therapy ended. Intriguingly, there was no consistency between participants’ qualitative accounts of change and the scores of the outcome measures.     

Family Assisted Contingency Management within the Context of Evidence-Supported Treatment for Child Neglect and Drug Abuse

Contingency management (CM) has extensively been shown to be effective in reducing substance use disorders, but its effects in reducing child maltreatment have yet to be determined. The current study provides preliminary support for the utilization of an innovative family-assisted CM component in 18 mothers who were referred to an evidence-supported behavioral treatment for concurrent child neglect and drug abuse by Child Protective Service caseworkers. In the examined CM, participants were invited to indicate from a list of common actions incompatible with child neglect (i.e. positive parenting actions), the extent to which these actions had been experienced utilizing a 3-point scale (almost never, sometimes, almost always). For each item that was indicated to be almost never or sometimes experienced, the participants were queried to indicate if the neglect incompatible action should be targeted as a therapeutic goal. Contingencies were subsequently established in which the participants were rewarded by involved family members for their completion of therapeutic goals. At baseline, results indicated that there was a negative association between the number of neglect incompatible parenting actions that were infrequently experienced and child abuse potential. A hierarchical multiple regression analysis showed that the number of neglect incompatible actions targeted as therapeutic goals at baseline, but not the number of positive parenting actions experienced infrequently at baseline, predicted reduced child maltreatment potential following treatment. These findings suggest the examined CM may assist evidence supported behavioral treatment specific to child neglect and drug abuse.     

Practitioners' accounts of religious and spiritual dimensions in bereavement therapy

This study explores religious and spiritual dimensions in bereavement therapy through in-depth qualitative interviews with 12 therapists for whom bereavement work constituted a major part of their therapeutic role. Information was gathered on the conceptualization of religious and spiritual issues, the perceived influence of therapists' beliefs on their practice and the therapeutic processes that occur in work with religious and spiritual issues. Interpretative Phenomenological Analysis was used to analyse the data, examining associations between these areas as well as highlighting the diversity of experiences and viewpoints. The multi-dimensional role of the therapeutic relationship was highlighted by participants as well as the perceived limitations of many theoretical models of therapy and bereavement in working with religious or spiritual issues. Some therapeutic processes were described in terms of the exploration of belief systems that have been challenged by bereavement and the re-creation of personal meaning. Implications for therapeutic practice and further research are discussed.     

The role of expectation and memory‐retrieval techniques in the construction of beliefs about past events

This study assessed social factors affecting the elicitation of false reports for events occurring the day after birth. High, medium and low hypnotizable participants (N=170) were randomly assigned to hypnotic, guided imagery (non‐hypnotic), expectancy or control conditions. Participants were led to believe that they had experienced a specific event on the day after birth. Hypnotic and guided imagery participants were age regressed, while participants in the expectancy condition were provided with cues suggesting access to this memory was feasible. Relative to controls, these participants recalled higher levels of day‐after‐birth reports, although age‐regressed participants reported significantly more event specific details than expectancy participants. Furthermore, high and medium hypnotizables were more likely than low hypnotizables to recall events occurring the day after birth. Implications of this study within the therapeutic setting are discussed. Copyright © 2000 John Wiley & Sons, Ltd.     

Prevention Rather Than Cure? Primary or Secondary Intervention for Dealing With Media Exposure to Terrorism

The authors examined the efficacy of primary versus secondary intervention in moderating state anxiety and state anger from media‐based exposure to terrorism. Two hundred participants, allocated to a terrorism or nonterrorism media exposure and to antecedent or subsequent therapeutic or control intervention, were assessed for state anxiety and state anger responses. Results confirmed that higher postexposure response in the terrorism media exposure group was successfully moderated by primary but not by secondary therapeutic intervention. Findings illuminate the need in this domain for intervention that is sensitively assessed for content and sequencing.