Working with unrealistic or unshared hope in the counselling session

Hope has long been identified as an important therapeutic factor in counselling. Further, research evidence for the importance of hope to counselling practice and outcome is abundant. However, the field is only beginning to explicitly consider how hope can be effectively and intentionally practised. One of the most challenging dilemmas encountered by counsellors committed to working with this important therapeutic factor is that of so-called unrealistic hope. In this paper, we outline two real-life counselling vignettes illustrating unrealistic hope, and consider these scenarios alongside relevant scholarship and practice experience. Guiding principles and practices for conceptualising and working with unrealistic hope are offered as a means of beginning the conversation about this complex aspect of working with client hope.     

Understanding the context of suicide in master's level counselling programmes in Australia

The purpose of this study was to understand the context of suicide in master's level counselling courses in Australia. The sample comprised courses accredited by the Australian Counselling Association (ACA) and the Psychotherapy and Counselling Federation of Australia (PACFA). A mixed methods content analysis was used to identify the explicitness of suicide in these courses and identify themes that emerged during the analysis. The sample consisted of 405 units of study contained in 26 courses. Suicide was explicit in 23 units in 17 courses. Suicide content was overshadowed by cultural diversity, ethics, morality and philosophy, research and self-awareness, which was explicit in all 26 courses.     

The function of language in parent‐infant psychotherapy

Parent‐infant psychotherapy, a rather new field in psychoanalysis, raises questions of how to conceptualize the clinical process. Previous publications have used semiotic concepts to account for the therapist's non‐verbal communication and investigated the countertransference, including what the baby might grasp of its variations. The present paper focuses on another argument for using verbal interventions to a baby in therapy; they present him with a symbolic order that differs from that of the parent. The qualitative difference between the parent's and the analyst's address is conceptualized by Dolto's term parler vrai. The therapeutic leverage is not the analytic interventions' lexical content but their message that words can be used to expose conflicts. Thereby, one can transform warded‐off desires into demands that can be negotiated with one's objects. The reasons why this address catches the baby's attention are discussed. A prerequisite for such attention is that the infant brain is prewired for perceiving words as a special communicative mode. Relevant neuroscientific research is reviewed in regard to this question. The presentation relies on concepts by Dolto, Lacan and Winnicott and findings from neuroscience and developmental psychology. It also briefly discusses Chomsky's linguistic concepts in relation to these therapies.     

Existential psychotherapy and the therapeutics of activism*

This paper considers the socio-political perspectives of Sartre, de Beauvoir and Fanon and their relationship to existential psychotherapy practice. It argues that their existential analyses of oppression must play a greater part in informing existential psychotherapeutic practice and pedagogy. In this current neo-liberal political age, in which therapy is increasingly being utilised as a form of psychological coercion and mystification, an understanding of the structures and systems of alienation and oppression that construct experience must translate to a broadening therapeutic concern beyond individual to social change. The author suggests that engaging with a politics of alienation and actively responding to the oppressive social conditions which generate distress and marginalisation should be intrinsic to existential psychotherapy practitioners and their representing institutions.     

Support groups for parents with an adult child suffering from bipolar disorder

Confronted with the disconcerting behaviour exhibited by their children, parents of bipolar patients are in severe distress. Research focuses on the study of the ‘burden’ that the pathology puts on caregivers, owing to their experience of depression, sometimes combined with the presence of hostile attitudes and negative affects. In France, parents of adult patients encounter an initial specific difficulty: they are not systematically included in the care management system. Thanks to the initiative of an association of psychiatrists and psychoanalysts, the authors set up a psychoanalytic support group for the parents of ‘bipolar’ adults. The diagnosis of a bipolar disorder is established by a psychiatrist within a medical structure. Support groups for parents do exist in France, but their experiences have not led to scientific publications on this specific topic. Existing publications focus on other types of pathology and other therapeutic approaches. In this article, we will highlight how this type of psychoanalytic support group, with operating rules based on the theoretical work of Anzieu, can help parents of patients with bipolar disorders. Group participants accepted the principle of a research study that maintained their anonymity. We collected and analysed qualitative data from the first year of the group, so we highlight the specific difficulties of these parents, faced with chronic disease. The relevance of our qualitative study also resides in the data collected over a period of time, enabling us to see the progress made, and encouraging us to reflect on the place of psychoanalytic groups for parents, as well as on the care management of this pathology.     

Pathways to Help-Seeking and Mental Health Service Provision for African Female Survivors of Conflict-Related Sexualized Gender-Based Violence

ABSTRACT

African migration to Canada is a relatively new development. There is a dearth of literature on the mental health of this newer immigrant population, especially those from the conflict zones of Sub-Saharan Africa. Our exploratory study examined the experiences of African female survivors of conflict-related sexualized violence based on the insights of six community mental health professionals. Guided by interpretive inquiry, semi-structured interviews were analyzed thematically and interpreted in light of multicultural feminist and transnational perspectives. Findings highlight refugee women’s resilience in the face of threats of social isolation and stigma. Their prioritization of assistance with practical needs, parenting, community/social supports, and education attainment in the context of counseling raises questions about agency and identity in understanding the relationships between female survivors, what they identify as important to their recovery, and their pathways to accessing mental health services.     

Patient preference as a predictor of outcomes in a pilot trial of person-centred counselling versus low-intensity cognitive behavioural therapy for persistent sub-threshold and mild depression

The aim of this analysis was to explore whether pre-treatment intervention preferences were related to outcomes for patients with persistent sub-threshold and mild depression who received one of two treatment types. Thirty-six patients took part in a two-arm, parallel group, pilot randomized controlled trial that compared short term (3 month and 6 month) outcomes of person-centred counselling (PCC) compared with low-intensity, CBT-based guided self-help (LICBT). Patient preferences for the two interventions were assessed at baseline assessment, and analysed as two independent linear variables (pro-PCC, pro-LICBT). Eight out of 30 interactions between baseline treatment preferences and treatment type were found to be significant at the p < .05 level. All were in the predicted direction, with patients who showed a stronger preference for a treatment achieving better outcomes in that treatment compared with the alternative. However, pro-LICBT was a stronger predictor of outcomes than pro-PCC. The findings provide preliminary support that treatment preferences should be taken into account when providing interventions for patients with persistent sub-threshold and mild depression. It is recommended that further research analyses preferences for different treatment types as independent variables, and examines preferences for format of treatment (e.g. guided self-help vs. face-to-face).     

Positive psychotherapy: A strength-based approach

Positive psychotherapy (PPT) is a therapeutic approach broadly based on the principles of positive psychology. Rooted in Chris Peterson’s groundbreaking work on character strengths, PPT integrates symptoms with strengths, resources with risks, weaknesses with values, and hopes with regrets in order to understand the inherent complexities of human experiences in a way that is more balanced than the traditional deficit-oriented approach to psychotherapy. This paper makes the case of an alternative approach to psychotherapy that pays equal attention and effort to negatives and positives. It discusses PPT’s assumptions and describes in detail how PPT exercises work in clinical settings. The paper summarizes results of pilot studies using this approach, discusses caveats in conducting PPT, and suggests potential directions.     

Countertransference as object of empirical research?

Abstract

The concept of countertransference as a robust cornerstone of psychoanalytic work has gained momentum over the last five decades. It is a prime example of elastic concepts covering the range from microprocesses to global clinical phenomena. Empirical research on the treatment process has for a long time – and for good reasons – avoided even trying to measure countertransference. We report here on various efforts for approaching a methodology for measuring it. The paper organizes the various approaches in terms of stages of research.