Sándor Ferenczi's Ideas and Methods and Their Relevance to Group Psychotherapy

Over the last 20years, I have been attempting to translate Ferenczi's significant discoveries into contemporary clinical practice. There are five basic Ferenczian concepts upon which I have elaborated a contemporary version, relevant for the conduct of an analytic group. The presentation of group interaction illustrates these five dimensions: 1. Confusion of Tongues Theory and Trauma; 2. Compassionate Confrontation; 3. Judicious Self-Disclosure; 4. Reparative Therapeutic Experiences; and 5. Group as Therapist to the Group Analyst.     

A journey through languages: A systematic literature review on the multilingual experience in counselling and psychotherapy with children and adolescents

The purpose of this research was to address the gap in the existing literature on the multilingual aspect of language in psychotherapy with children and adolescents. This research aimed at interpreting possible meanings for clients of being multilingual in the therapeutic process as well as reflect on the influence of clients’ multilingualism in the therapeutic relationship. The researcher used a systematic literature review (PRISMA guidelines, 2009) to select articles based on empirical qualitative/mixed studies with participants up to 25 years old or adults referring to childhood/adolescence. The researcher used thematic synthesis (Thomas & Harden, 2008) to extract, analyse and interpret data. The rigour of this study was enhanced by the use of auto-ethnography as a source of evidence (McLeod, 2015). The auto-etnography documents self-reflections on personal experience of being multilingual contributing to deeper contextualised knowledge. The findings confirm previous research on the existence of a link between multilingualism and “identity” (Costa, 2020, p. 5). This research suggests that the meaning a client gives to bilingualism can be co-constructed within an attuned therapeutic relationship. In this co-construction journey, there is a significant opportunity for children and young people in finding their way through languages, hence reaching emancipation and affirmation in the world. The main limitation of this research relates to the fact that there are not many studies with children/young people. This led the researcher to also include studies based on a mixed sample and with adults referring to childhood/adolescence, which might have influenced the interpretation of findings.     

How talking therapists experience working with adult clients who have autism

This research aims to gain new insight by exploring the thoughts, feelings and experiences of therapists working with clients who have autism. Three professional talking therapists participated in the study. Unstructured interviews were conducted and analysed using interpretive phenomenological analysis. Six main themes and 13 sub-themes were found which include therapists’ validation of autism, how therapists integrated autism when addressing mental health problems, how their personal experiences of autism impacted on their work and how they experienced the situation in which autism emerges during the therapy. Helpful suggestions are made for clinicians, namely, to zoom-in and zoom-out of autism, hold the knowledge that people with autism process information differently, incorporate working with trauma, consider disclosing a personal connection to autism and consider carefully whether, or not, to tell a client that they may have autism.     

Supervisees' perspectives on the contribution of supervision to psychotherapy outcomes

Objective

The aim of this study was to examine supervisees' perspectives about the contribution of two predefined aspects of supervision, supervisory bond (SB) and didactic input of supervisor (DI), to their ascribed outcome of therapy.

Method

Supervisees anonymously assessed the SB, supervisors' DI and their contribution to therapy outcome. Assessment was quantitative and qualitative. The supervisory aspects were assessed using a questionnaire constructed for this study. Perceived contribution was evaluated by two scaled questions, and themes generated by an open question. Supervisees (n = 111) evaluated 16 supervisors and supervision’s contribution to psychotherapy outcomes of 111 clients.

Findings

Hierarchical regression showed that supervisees' age, supervisors' status and frequency of supervision accounted for 24% of the variance ascribed to outcome. SB and DI accounted for 51% of the variance. These values, which are higher than reported in the literature, may be attributed to the assessment of predefined aspects of supervision by the same assessor. Thematic analysis of the didactic input produced more themes than for the supervisory bond.

Conclusion

Sociodemographic variables and supervisory relationship variables determine supervisees' evaluations of supervision’s contribution to outcome.

Implications for practice

Training and supervision may benefit from information obtained from quantitative and qualitative measures regarding these and other predefined variables related to supervision. The in-depth look at views and experiences shared by supervisees may advance training, practice and research.     

On the need for structurally competent counselling and psychotherapy: Neoliberal ideology,disability and the psy disciplines

This article highlights and problematises the psy disciplines' articulations with neoliberalism, with a particular focus upon disability and upon counselling and psychotherapy. Recent years have witnessed burgeoning scholarly interest in the potential complicities of the psy professions in a neoliberal agenda of individualisation, pathologisation and responsibilisation of human suffering. Such complicities are, in state therapy settings, driven by a growing need for these professions to offer cost-effective, evidence-based interventions to secure funding in an increasingly competitive market. Whilst the entwining of neoliberal ideology with therapy practices may be innocuous for some, it is contended that disabled people may be at particular risk of harm. A case is then made for training and practice to foreground structural competency, an awareness of how therapy encounters and client concerns are shaped by socio-structural factors, including, but not limited to, politics and political ideology. This would require not only an appreciation of the sociopolitical context in which therapy unfolds and its indubitable shaping of subjectivities, but also greater recognition of disability as a source of social inequity and oppression, as opposed to an individual phenomenon. Moreover, structural competency would require theoretical and demographic diversity in training and practice, which, in turn, would necessitate identifying and addressing barriers to inclusion for disabled people. Points raised are deemed of particular importance given the emergence of long COVID.     

The use of augmentative alternative communication in psychotherapy

The use of augmentative alternative communication (AAC) in psychotherapy is particularly important for psychotherapists who may have a disability related to speech-language production. The aim of our study was to examine the perceptions of using AAC in psychotherapy. We recruited 186 participants and randomly assigned them to either watch a video of a therapist using AAC or employing traditional talk psychotherapy. Subsequently, we asked participants to complete the Counsellor Rating Form-Short (CRF-S), respond to a question about behavioural intention to seek psychotherapy and complete the Working Alliance Inventory-Observer form (WAI-O). Most participants perceived the use of AAC to be related to the therapist having a disability. The use of AAC had higher ratings on the CRF-S and higher scores on the WAI-O. There were no significant differences in behavioural intention between the therapist using AAC or traditional talk psychotherapy. The use of AAC is a viable option for psychotherapy and is beneficial. Psychotherapists with a disability affecting speech-language production may opt to use AAC as others perceive the therapist positively, the alliance is rated higher and therapists do not need to be concerned with patients not wanting to seek out their services.     

Effective—and Tolerable: Acceptance and Side Effects of Intensified Exposure for Anxiety Disorders

Despite striking empirical support, exposure-based treatments for anxiety disorders are underutilized. This is partially due to clinicians’ concerns that patients may reject exposure or experience severe side effects, particularly in intensive forms of exposure. We examined acceptance and side effects of two randomly assigned variants of prediction error-based exposure treatment differing in temporal density (1 vs. 3 sessions/week) in 681 patients with panic disorder, agoraphobia, social anxiety disorder, and multiple specific phobias. Treatment acceptance included treatment satisfaction and credibility, engagement (i.e., homework completion), and tolerability (i.e., side effects, dropout, and perceived treatment burden). Side effects were measured with the Inventory for the Balanced Assessment of Negative Effects of Psychotherapy (INEP). We found treatment satisfaction, credibility, and engagement to be equally high in both variants of exposure-based treatment, despite higher treatment burden (β = 0.25) and stronger side effects (β = 0.15) in intensified treatment. 94.1% of patients reported positive effects in the INEP. 42.2% reported side effects, with treatment stigma (16.6%), low mood (14.8%) and the experience to depend on the therapist (10.9%) being the most frequently reported. The mean intensity of side effects was low. We conclude that prediction error-based exposure treatment is well accepted by patients with different anxiety disorders and that patients also tolerate temporally intensified treatment, despite higher perceived treatment burden and stronger side effects. Clinicians should be aware of the most frequent side effects to take appropriate countermeasures. In sum, temporal intensification appears to be an acceptable strategy to achieve faster symptom reduction, given patients’ well-informed consent.     

Raising Fees in Group Therapy: Some Ethical and Clinical Implications

Of all money matters in group psychotherapy, one of the most neglected in the literature is the issue of raising the fees. The premise of this paper is that there are ethical and clinical considerations to group fee increases. One consequence of the lack of attention to the subject of raising of fees is that many neophyte group leaders do not learn about its complexity. It will be argued that the raising of fees is not merely a straightforward matter of informing groups about an impending change in the amount of money that they will pay but rather, it is a knotty, emotionally charged issue with both realistic and subjective components for members and leaders alike. Further, it will be argued that the issue of raising fees in group therapy is dissimilar, in significant ways, from raising fees in individual treatment. When leaders use subjective criterion to decide an increase, then the group process may be disrupted. Suggestions for reform will be offered.