Novice therapist,the client and therapy: Integrating the triad

Therapy process research focuses on understanding how therapy is conducted by professionals in the field. It is a nascent field of psychotherapy enquiry in India. This paper explores how novice therapists in India perceive their clients, and how this influences the process of therapy. In depth interviews were conducted with ten novice therapists, with less than six years of practice experience, from Mumbai, India. The data was thematically analysed. The data revealed that therapists' perceptions of their clients were defined by socio-demographic features of age and gender, along with presenting complaints and personal attributes. Participants had defined beliefs about good clients as contrasted with difficult ones. Distinct preferences for particular client types were identified. The antecedents to these beliefs were attributed to the therapist's worldview, their training and the supervision received. These views, and the conceptualisation of the client, influenced the choice of client, the process of therapy and how they proceeded with sessions, and their methods of referral. The data from the study has implications for therapist training, supervision and further research.     

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.     

Immigration: going home or going to pieces

Immigration may constitute a family crisis. Because of its lengthy duration, this crisis may be an unrecognized factor in the problem which brings patients into therapy. The immigration crisis may bring an individual into renewed contact with past unresolved emotional issues. It also affects the structure, hierarchies, and values of the family as a system. The therapist who relates only to presenting symptoms and ignores the context of the immigration crisis may lose credibility with patients and miss important therapeutic opportunities. Case studies are given to illustrate the statement.     

Why Don't People Change? A Psychoanalytic Perspective

From a psychoanalytic perspective, a central reason that people do not easily change is their fear of the dangers that they believe, at some level, change entails. These dangers include relinquishment of infantile wishes and fantasies, anxiety that would be experienced were defenses weakened, guilt, fantasies that change would harm a parental figure or threaten a vital relationship. Other factors that prevent change and maintain the sameness of behavior include defenses, unconscious pathogenic beliefs, devotion and loyalty to early figures, stable internal working models of self, other, and prototypic interactions, and emitting cues that elicit responses from others that confirm these working models. Finally, 1 discuss some selective psychoanalytic research on therapeutic change.     

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.     

让智慧插上创造的翅膀：创造动力系统的激活及其条件

创造力是一个集个人、团体、社会、文化相互交织的系统, 因此创造力的培养也需要综合考虑。本文在融合以往创造力研究的基础上, 建构了一套系统创造力培养的“蝴蝶理论”, 创造力培养需要抓住核心来统领全局, 同时兼顾创造力培养所需要统筹兼顾的各个部分。动力系统的激活是创造力培养的核心。新颖、适用的创造性成果的产出, 需要社会文化中的个体或团体在创造性心理动力的基础上来完成。创造性心理动力有效的激活则需要一些基本条件, 如在认知层面, 需要具备一定的能力, 如一般认知能力、思维方法的掌握、元认知以及高效的资源整合能力等; 在非智力因素方面, 基本心理需要的满足, 个性心理的健康发展等是创造力得以发挥的必要条件, 推而广之还包括：合理的社会支持、互动以及文化的包容等等。除了理论方面的整合, 本文还从实践的角度分析如何激活学生的动力系统, 重点分析了什么是兴趣以及如何激发个体的兴趣, 因为以兴趣爱好为核心的内部动机是自主性最高的动力来源。本文从理论(创造力培养的蝴蝶理论)与实践(创造力培养的兴趣激发)两个角度为创造力培养提供了支持。     

Reflections on a wounded and bleeding temenos

COVID-19, Black Lives Matter, and financial and political turmoil have uprooted our sense of personal and collective safety and predictability. Analysts are faced with professional and personal challenges, as well as a charge to help make sense of this new normal. This reflective piece focuses on the author’s thoughts on a wounded and bleeding temenos. She grapples with the new reality of analysis carried out via technology (e.g. Zoom or telehealth). The article interweaves personal experiences with theoretical and professional reflections on two Jewish myths that relate to creating temenos or sacred space in the face of ancient disasters. Specifically, she discusses Choni HaMagel, a first-century BCE Jewish scholar and miracle-maker who prays for relief from a drought from inside a sacred circle. She also tells the tale of four Chassidic Rebbes who face crisis from a sacred space in the forest. The author frames this piece with two personal and numinous dreams dreamt during the pandemic; one offering scenes of destruction and one offering hope for a future transformation.     

Effects of pay resets following drug use on attendance and hours worked in a therapeutic workplace

This secondary data analysis examined effects of an abstinence contingency on participation in a therapeutic workplace. Participants exposed to a pay reset after drug use did not differ in overall attendance from participants who were not exposed to a pay reset after drug use; however, they initially worked less after a pay reset than participants who did not receive a pay reset, and their attendance increased as their pay increased. Overall participation was not influenced by the abstinence contingency, but transient decreases in attendance occurred.