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.     

A Model for Peer Experiential and Reciprocal Supervision (PEERS) for Genetic Counselors: Development and Preliminary Evaluation Within Clinical Practice

A model for practising genetic counselors to obtain clinical supervision via reciprocal peer observation and feedback was developed and trialled. The model was developed in response to a perceived lack of opportunity for immediate observational feedback for practising genetic counselors. The aims reached by consensus were to facilitate learning new approaches and skills, to revitalise current ways of practising, and to enhance supervision skills in a two-way process, where the observer learnt from the counselor, and vice-versa. The genetic counselors agreed on a process of paired reciprocal observation whereby the observer was present in the room during the counseling session, and a reflective feedback discussion was arranged within 24 h of the session. Four main themes emerged from analysis of the recorded discussions were (i) “I wasn’t sure if I-”: voicing of doubts or internal questions that occurred during session for the counselor conducting the session, (ii) “I really liked that”: positive feedback and validation from the observer, (iii) “I wonder whether-”: offering of alternative views, insights and strategies by the observer, and (iv) “That’s a real thing for me to take away and think about”: evidence of learning by both observers and counselors.     

Empathy deficits and sexual offending: A model of obstacles to empathy

Theoretical models of the role of empathy in sexual offending agree on five components relevant to the experience of empathy: a respectful and compassionate orientation to others, perspective taking, affective responding, the ability to manage personal distress, and situational factors. We identify overlap between these components of the empathic process and established risk factors for sexual offending and create a model detailing potential blocks to the empathic process during sexual offending. The model has external consistency and useful implications for interventions with sex offenders. Viewed in the light of this model, we argue that current sex offender treatment programs spend a disproportionate amount of time examining empathy for past victims. We recommend, instead, that treatment aims to enhance offenders' abilities in relation to the components of the empathic process more generally, using creative and engaging techniques akin to those used to develop “victim empathy”.     

Emotion at Work: To What Extent are We Expressing,Suppressing, or Faking It?

Emotions and emotion management are a prominent feature of organizational life and the concept of emotional labour was coined to describe the effort required to fake or suppress an emotional display because of the demands of the work role. Although much qualitative work has been conducted to investigate emotional labour, no attempts have been made to measure the degree to which this emotion work occurs. This omission is partly due to the difficulties in defining the construct and dimensions of emotional labour and this article discusses previous attempts at definition and reconceptualizes the concept in order to allow the development of a measurement tool. The process of development and testing of the tool within 12 UK companies is the focus of the remainder of the article and leads directly to the first quantitative answer to the question, to what extent are we expressing, suppressing, and faking emotion at work? Results suggest that emotional labour is performed in almost two-thirds of workplace communications, both at and away from the frontline. Implications for practitioners and researchers are outlined.     

Long‐term Effects of Dieting: Is Weight Loss Related to Health?

“Success” in dieting interventions has traditionally been defined as weight loss. It is implicit in this definition that losing weight will lead to improved health, and yet, health outcomes are not routinely included in studies of diets. In this article, we evaluate whether weight loss improves health by reviewing health outcomes of long‐term randomized controlled diet studies. We examine whether weight‐loss diets lead to improved cholesterol, triglycerides, systolic and diastolic blood pressure, and fasting blood glucose and test whether the amount of weight lost is predictive of these health outcomes. Across all studies, there were minimal improvements in these health outcomes, and none of these correlated with weight change. A few positive effects emerged, however, for hypertension and diabetes medication use and diabetes and stroke incidence. We conclude by discussing factors that potentially confound the relationship between weight loss and health outcomes, such as increased exercise, healthier eating, and engagement with the health care system, and we provide suggestions for future research.     

Cognitive Alexithymia Mediates the Association Between Avoidant Attachment and Interpersonal Problems in Patients With Somatoform Disorder

Patients with somatoform disorder (SFD) are characterized by the presence of chronic physical complaints that are not fully explained by a general medical condition or another mental disorder. Insecure attachment patterns are common in this patient group, which are often associated with interpersonal difficulties. In the present study, the mediational role of two types of alexithymia and negative affectivity (NA) was examined in the association between attachment styles and interpersonal problems in a group of 120 patients with SFD. Patients were requested to fill out several self-report questionnaires for the assessment of attachment strategies, alexithymia, NA, and interpersonal problems. Cognitive alexithymia (i.e., the inability to identify and verbalize emotions) mediated the relationship between avoidant attachment patterns and interpersonal problems, even after controlling for NA. Preliminary findings also suggested that NA acted as a moderator of the mediator cognitive alexithymia. These results have important implications for clinical practice, as this study clearly shows that interpersonal problems do not automatically follow from insecure attachment strategies, but are contingent upon alexithymic features. It is recommended to target alexithymic features in patients with SFD, particularly in the context of negative emotions. Therefore, cognitive alexithymia may be an important therapeutic focus, specifically in the treatment of avoidant ptients with SFD.