Facilitating the client's experience of relational depth in counselling and psychotherapy: A thematic review

Aim

There is increasing interest in relational depth and its relevance and benefits for clients receiving therapy in a number of different therapeutic orientations. This research set out to draw together the available evidence from a wide range of therapies about clients' experiences of relational depth. The aim was to identify approaches that create the conditions where relational depth is more likely to be facilitated. The research focused on clients' views, given the increasing emphasis on their experiences in therapy.

Methodology

A systematic search of papers published in English between January 1996 and September 2022 was conducted using EBSCO Host, Google Scholar and citation chaining. Twenty-seven papers met the inclusion criteria, and a thematic analysis was conducted on these papers.

Findings

Six themes were identified: (1) establishing dialogue with the client's inner world, (2) working with attachment in therapy, (3) responding sensitively to the client's beliefs and values, (4) deepening the client's understanding of the therapist, (5) addressing ruptures in therapy and (6) the client's role in meeting at relational depth.

Conclusion

Facilitating the client's experience of relational depth can support and enhance many aspects of therapeutic practice and in itself may contribute to healing. Therapists who offer warmth and genuine engagement are more able to build confidence and trust, as long as these conditions are received by their clients. It is the clients who ultimately decide whether or not to share their deepest feelings.     

The impact of dialectical behaviour therapy training on therapists in Singapore: A mixed-methods study

Background

While dialectical behaviour therapy (DBT) has much empirical support for treating borderline personality disorder (BPD) and other conditions, little research has examined the dissemination of DBT in Southeast Asia.

Aims

This study evaluated training outcomes following a 5-day intensive DBT training programme in a group of psychologists in Singapore, who were in the process of implementing DBT as part of the training's objectives.

Methodology

A mixed-methods design was employed. Fourteen psychologists from a public psychiatric hospital in Singapore were recruited. Seven self-selected into DBT training, and the remaining were matched controls who were not attending the training programme. The latter served as a nonrandomised control group. Prior to and 3 months after training, all participants completed measures of stigma towards BPD patients, burnout and therapeutic alliance. DBT training participants additionally attended a focus group discussion assessing their experiences and challenges implementing DBT in Singapore's context.

Findings

Quantitative analyses using mixed ANOVA showed that, compared with controls, DBT-trained participants demonstrated significantly greater increases in acceptance towards BPD patients. No between-group differences were found on changes in burnout or therapy alliance with patients. Analyses of qualitative data using thematic analysis revealed that DBT training impacted the way participants conceptualised and delivered therapy for BPD patients, and highlighted several challenges in implementing DBT in the local hospital context.

Conclusion

The findings demonstrate the potential of DBT training in improving clinicians' attitudes towards BPD patients and support a need for policymakers to prepare organisations for DBT implementation to ensure programme sustainability.     

Impact evaluation of the family expectations program and moderation by sociodemographic disadvantage

The federal government, through the Administration for Children and Families (ACF), has funded community-based relationship education programs for couples, individuals, and families, with a strong focus on serving economically disadvantaged and racially diverse families. This study evaluated the impact of a 36-hour, workshop-based couple relationship education program that was funded by ACF using a randomized controlled trial (RCT) design and intent-to-treat (ITT) analyses. Participants were 1320 couples who were either expecting a baby or had a baby within the past 3 months, at the time of enrollment. Follow-up surveys were administered 12 months later. Analyses evaluated program impacts on relationship stability, constructive communication, and destructive conflict compared to a no-treatment control group. Analyses showed a statistically significant impact of the program on destructive conflict (d = 0.10) but not on constructive communication (d = 0.06) or stability (d_Cox = 0.10). Based on findings from previous evaluations, we also examined whether participants’ levels of sociodemographic disadvantage moderated these effects. There was significant moderation by sociodemographic disadvantage on constructive communication and destructive conflict, but not on stability. Effects were observed for those at higher levels of sociodemographic disadvantage.     

亲子关系和父母教育卷入对青少年抑郁、自伤和自杀意念的影响：挫败感和人生意义感的作用

基于生态系统理论和动机-意志整合模型,采用问卷法以930名青少年(年龄=15.24±1.66岁)及其父母为研究对象,构建一个有调节的中介模型,从家长与孩子双视角分析孩子体验到的亲子关系和父母教育卷入对青少年抑郁、自伤和自杀意念的影响路径。结果显示：(1)相比低亲子关系-低教育卷入一致的个体,高亲子关系-高教育卷入的青少年有着更低水平的挫败感,且相比于低亲子关系-高教育卷入的青少年,有着高亲子关系-低教育卷入的个体表现出更低水平的挫败感;(2)挫败感在亲子关系-教育卷入与青少年抑郁、自伤和自杀意念之间起部分中介作用;(3)人生意义感调节该中介模型后半段,即挫败感对青少年抑郁、自伤和自杀意念的影响,具体表现为随着人生意义感的增加,挫败感对抑郁、自伤和自杀意念的影响逐渐减小。研究从家庭关系中家长与孩子双视角,揭示了挫败感和人生意义感的中介与调节作用,为青少年抑郁、自伤和自杀意念的发生机制提供更多解释路径。     

同伴侵害与青少年抑郁:社会退缩的中介作用与师生关系的调节作用

研究表明同伴侵害是青少年抑郁的重要风险因素,然而其中介机制和调节机制仍有待进一步探究。本研究采用问卷法对834名青少年进行调查,考察了社会退缩在同伴侵害与青少年抑郁关系中的中介作用,以及师生关系在这一关系中的调节作用。结果发现：（1）社会退缩显著中介同伴侵害与青少年抑郁的关系;（2）师生关系显著调节中介路径“同伴侵害→社会退缩→青少年抑郁”,具体而言,相较于高水平师生关系的青少年群体而言,同伴侵害通过社会退缩影响抑郁的中介效应在低水平师生关系的青少年群体中更高。     

Hermeneutics and the Philosophy of Medicine: Hans-Georg Gadamer'sPlatonic Metaphor

Taking as our starting point Plato'smetaphor of the doctor as philosopher we reflect on some aspects of the epistemological status of medicine. The framework to this paper is the hermeneutics of Hans-Georg Gadamer which shows the paradoxical nature of Western medicine in choosing the body-object as its investigative starting point, while in actual fact dealing with subjects. Gadamer proposes a model of medicine as the art of understanding and dialogue, which is capable of bringing together its various constituent parts, i.e. knowledge, knowing how to do and knowing how to be, in medical practice and in the physician'straining. The paper concludes with a brief discussion of the dyadic figure of the physician as Platonic master of the living totality and wounded healer, capable of activating the patient'sself-healing capacity.     

Developing the Working Alliance in Marital Therapy; A Psychodynamic Perspective

A good working alliance in marital therapy is one in which the partners are actively collaborating with their therapist to work through conflicts. The therapist begins to develop the alliance by setting the frame of therapy and helping the couple understand the guidelines of treatment. The partners gradually identify with and emulate the therapist's working style and use of self as a reflective instrument. The working alliance can be weakened by empathic failures and strengthened by increased feelings of trust in the therapist and the process of treatment This paper looks at the development of the working alliance in marital therapy from a psychodynamic perspective. A clinical illustration is included.     

CAN NEUROSCIENCE PROVIDE A COMPLETE ACCOUNT OF HUMAN NATURE?: A REPLY TO ROGER SPERRY

Abstract. In a recent Zygon article (June 1991), Roger Sperry argues for the unification of science and religion based on the principle of emergent causation within the central nervous system. After illustrating Sperry's position with some current experiments, I suggest that his conclusions exceed his argument and the findings of contemporary neuroscience and propose instead a pluralistic, rather than unified, approach to the relations between religion and science necessitated by the incompleteness inherent in any strictly neurological account of human nature.     

Challenges and opportunities of a transactional world view: Case study of contemporary Mormon polygynous families

Summarized an ongoing research program on contemporary Mormon polygynous families. Husband-wife and wife-wife relations in plural families are examined from dialectical and transactional world views. Key research issues center on (a) how husbands and wives achieve viable dyadic and communal relationships, and (b) how dyadic and communal issues are managed in social and physical contexts through the life cycle of plural family relationships. I wish to express my appreciation and respect for the individuals and families who welcomed us into their lives and homes during the course of this research. Their honesty, forthrightness, and commitment to religious and family life is deep and honorable. We were personally enriched by having the opportunity to learn about a unique life-style, and hope that our portrayal of aspects of participants' lives is objective, responsible, and understanding.     

Animus and creativity in psychotherapy: a position statement

Calling attention to what the author calls the 'maternalization of our profession', a warning is sounded to psychotherapists, and women practitioners in particular, not to neglect their own creativity in the course of professional development undertaken to take better care of patients. Development of the animus, here reformulated as 'an archetype of the capacity for non-relationship', is seen as a balancing alternative to the usual training in the capacity to contain object relations. A literary parallel can be found in Ibsen's play, The Woman from the Sea. It is hoped, too, that through her own initiation into a creative life, the analyst will be better able to help the analysand find a connection with a 'creative centre'.