Transference,triangles and trajectories

In this article the author addresses the issue of the need to lessen the likelihood of a regressive transference neurosis in short-term therapy. He examines the role that active interpretation of the transference can have in shaping the transference so that it remains at the level of the transference that is ubiquitous. He explores the relationship between such an active interpretative approach and the need for the therapist to be empathic and sensitive to the patient and to allow space for a patient's independent discoveries. The author describes the role of the Central Therapeutic Focus, as a constellation of the Triangles of Insight, in guiding the therapist to select those manifestations of the transference to interpret, and in enabling the therapist to retain a stance that is sensitive and empathic. The Central Therapeutic Focus is contrasted with the concept of the Central Issue, and with the latter's more specific attention to the contribution that it makes to the therapist's communication of their empathic understanding of the patient's difficulties. The nature of the relationship between the therapist and the patient in short-term therapy is explored further and the connections between companionable interaction, ego-relatedness and the matrix of the transference are outlined. The author proceeds to consider the nature of the process of working through in short-term therapy and of the need to attend to the patient's external world as the place in which this can occur. The contribution of the Central Therapeutic Focus in shaping the trajectory through which the patient and therapist attend to the external world is examined. This in turn is linked to the identification of a patient's ordinary solution to their problem as a means of resolving their Dilemma. The article concludes with a case example that illustrates these themes.     

Developing the therapeutic relationship: from 'expert' professional to 'expert' person who stutters

This article looks back over the years and identifies some of the most influential thinkers, writers, and researchers who have had a profound effect on the way the therapy at the Michael Palin Centre for Stammering Children in London has evolved. It tracks the changes that have occurred in theoretical perspective, treatments offered, and the delivery of therapy. In particular this author is interested in the changing nature of the therapeutic relationship between professionals and people who stutter (PWS), and describes the way it has developed from the “expert professional” towards a more collaborative relationship that recognises the “expert patient”. It was inspired by a book written in 1902 by Mr Beasley, a person who stammered. After several unsuccessful attempts to find a ‘cure’ he found his own solution to his stuttering and then used what he had learned to help many others. Much of what he wrote was well ahead of his time and reminds us, the professionals, of the importance of listening to and taking account of the views of PWS in therapy and designing treatment that meets the needs of the individual. This article also looks briefly at evidence based practice (EBP) and the issues involved in measuring outcomes that reflect the complex and individual nature of the problem. Finally the importance of the research in developing the knowledge and skill base of clinicians as well as PWS is acknowledged and discussed and the way ahead signposted.Educational objectives: The reader will learn about (1) the early history and development of stuttering therapy, (2) the influence of a variety of psychotherapeutic approaches, (3) the relevance of designing therapy to meet the needs of the PWS, and (4) discuss the role of ‘common’ factors in EBP.     

Development of a therapists’ self-report measure of pluralistic thought and practice: the Therapy Pluralism Inventory

This study aimed to develop a self-report measure of pluralistic thought and practice. Following pilot development, a 23-item inventory was placed on an online survey site, and 474 participants satisfactorily completed the measure. Respondents were trainee or qualified therapists, predominantly female, based in the UK, and of a humanistic or integrative/eclectic orientation. A principal components analysis resulted in two scales, Pluralistic Philosophy and Pluralistic Practice, which had good internal consistency (Cronbach’s α?=?.72 and .80, respectively). Confirmatory factor analysis showed good model fit for this two factor solution. The Therapy Pluralism Inventory (TPI) has potential for use in training and research, although additional validity and normative data are needed.     

Counsellor conflict in managing the frame: Dilemmas and decisions

An essential feature of psychodynamic counselling is a secure frame for the work that holds boundaries as sacrosanct, both to ensure ethical practice and to provide a vehicle through which unconscious processes can be recognized and understood. Conscious or unconscious attacks on the frame are inevitable in any therapeutic relationship, and provide an opportunity for exploration and insight. However such incidents also have an impact on the therapist who must decide how to respond. In order to understand more about the therapist process when there is an attack on the frame, an investigation was carried out into ways in which psychodynamic counsellors manage the difficulties and dilemmas that arise as they try to hold a secure therapeutic frame. Ten counsellors were interviewed using a semi‐ structured interview format during which they were asked about an instance when the frame was challenged and the process by which it was resolved. The resulting dilemmas were categorized using grounded theory. Three categories of dilemmas emerged a) prior to making a decision about how to deal with it, b) after making a decision, and c), as a result of the outcome of the action taken. The nature of the dilemmas and the process of resolving them are reported and discussed.     

Resourceful Dialogues: Eliciting and Mobilizing Client Competencies and Resources

Within the social constructionist (narrative, solution-focused and collaborative language systems) therapies, therapists have increasingly focused on identifying and mobilizing clients’ resources and competencies. How such client resources and competencies are identified and elaborated can be considered empirical matters for analysts of therapeutic discourse. The present paper examines resourceful sequences of dialogue in 12 single session lifestyle consultations for how counsellors conversationally engaged consultees, and for what transpired within these sequences of dialogue. These sequences were micro-analyzed using conversation analysis and retrospective comments from consultees and therapists involved in these sequences were solicited using a videotaped replay procedure known as comprehensive process analysis [Elliott (1989). In M. Packer & R. B. Addison (Eds.), Entering the circle: Hermeneutic investigation in psychology (pp. 165–184). Albany, NY: SUNY Press]. The combined conversation analyses and related comments for three of the 23 videotaped passages analyzed are reported with the aim of enhancing therapists’ conversational practices in hosting resourceful dialogues with clients.

Human‐Animal Bonds I: The Relational Significance of Companion Animals

The importance of human‐animal bonds has been documented throughout history, across cultures, and in recent research. However, attachments with companion animals have been undervalued and even pathologized in the field of mental health. This article briefly surveys the evolution of human‐animal bonds, reviews research on their health and mental health benefits, and examines their profound relational significance across the life course. Finally, the emerging field of animal‐assisted interventions is described, noting applications in hospital and eldercare settings, and in innovative school, prison, farm, and community programs. The aim of this overview paper is to stimulate more attention to these vital bonds in systems‐oriented theory, practice, and research. A companion paper in this issue focuses on the role of pets and relational dynamics in family systems and family therapy ( Walsh, 2009a ).     

Walking in sacred spaces in the therapeutic bond: therapists' experiences of compassion satisfaction coupled with the potential for vicarious traumatization

The therapeutic bond is at the heart of effective therapy, yet few studies have examined therapists' experience of this bond. Using a qualitative study design, this exploratory study examines the experiences of couple and family therapists in relation to their perceptions of the satisfactions and risks involved in the therapeutic bond. The research was conducted using grounded theory methodology and eight in-depth interviews were conducted with therapists working in five counseling agencies in Sydney, Australia. Therapists described the importance of the 3 component parts of the therapeutic bond: the empathic connection between therapist and client; the role investment of the client; and the mutual affirmation experienced by both therapist and client in the therapeutic process. Walking in sacred spaces with the client was seen as both enriching and challenging for the therapist. The therapeutic bond gave therapists intense satisfaction and posed risks for them, especially when working with traumatic client experiences. However, the findings suggest that the experience of compassion satisfaction and the development of vicarious resilience counter-balanced the intense difficulty of bearing witness to clients' traumatic experiences and the potential for vicarious traumatization. The implications for sustaining couple and family therapists in their work are discussed.