Don't Let the Doorknob Hit You: A Relational-Intersubjective Exploration of Leaving and Remaining within the Therapeutic Frame

“Doorknob comments” is a concept that is not well represented in the professional literature. Through three case examples the author develops the theory that doorknob comments can fall within the internal structure of the session or outside of such a structure. In the former case, giving the internal element precedence by extending the session length to address the comments may be warranted. In the latter case, helping a client by scaffolding their ability to structure experience may require that the comment be processed at a later session. In either case, the ability to structure experience, which is the process of elaborating meaning, is an important aspect of treatment.     

The Therapist’s Needs: Beyond Mutual Recognition

Abstract

As early as 1965, Harold Searles argued that therapists’ needs for healing and growth are part and parcel of their work with patients. Since then, the relational movement has corroborated this idea by articulating the healing function of treatment for both patient and clinician. In this article, the authors examine therapists’ needs that have been overlooked or those that have not been considered fully in the literature. Using various ideas related to the concept of what the authors call therapeutic freedom, this article argues that clinicians must strive to adopt a therapeutic vision that aims to loosen their own ties to safe, familiar modes of engaging with patients, particularly in moments of enactment or impasse. The authors elucidate these ideas with case material from their clinical work and show how embracing various forms of therapeutic freedom results in a type of mutual surrender on the part of both patient and therapist, creating opportunistic conditions that generate therapeutic action and new possibilities for the dyad.     

Attention Deficit Disorder,Anxiety Disorder,and Learning Disabilities

Abstract

This article details an individualized psychoeducational model designed to treat a child with interrelated psychological and developmental issues whose psychic functioning was deteriorating within the traditional educational system. The team had leeway to function outside of the educational system to create an individualized, remedial, psychoeducational program. At the time we began the program, her diagnostic picture included: Anxiety Disorder, Attention Deficit/Hyperactivity Disorder, and Learning Disabilities. The treatment team consisted of an education specialist, two additional part-time teachers, a clinical social worker, an occupational therapist, a consulting senior child psychoanalyst, and the child's mother. The results at the close of the first school year are examined. Perspectives informing the psychoanalytic aspects of this case include Winnicottian and Fairbairnian Object Relations Theory and therapeutic milieu model.     

Three Aspects of the Therapeutic Conversation in Couples Therapy

Abstract

Feminist scholars have revealed the importance of examining the influence of gender on the therapeutic process. Gender differences in the treatment of clients may reveal inequitable or traditionally Stereotypie treatment of clients by therapists. This study examined gender differences in three conversational strategies widely used by therapists: expressions of empathy or understanding, compliments or praise, and challenges or requests for change. Fourteen tapes of live therapy sessions conducted by “master” therapists were examined using an exploratory, qualitative methodology based on Conversation Analysis. Results of this exploration revealed that therapists who are not self identified as “feminist challenged female clients more than male clients, and complimented male clients more than female clients. Feminist therapists challenged male clients more than female clients, and complimented female clients more than male clients. Feminist therapists used more challenges designed to facilitate non-stereo-typic gender behavior in both male and female clients. Only male therapists used disrespectful challenges of female clients, and were more often disrespectful to female clients than to male clients. Implications for the therapist-client relationship and the feminist critique are provided.     

Therapeutic Use of Space

ABSTRACT

The project described in this article addresses the therapeutic use of physical space in an outpatient counseling facility. It was theorized that an improved facility environment could be used as a practice tool when working with a vulnerable population. The authors undertook the project with limited time and finances. The process of the change project is discussed in detail in an attempt to encourage other counseling facilities and social service agencies to consider such an effort. Related literature from varied fields is reviewed. The article also relays client and staff feedback regarding the redecorated space and addresses design considerations such as the relative strengths and drawbacks to involving clients and staff in the process.     

The Confluence of Technology and Narrative Approaches in Group Work

Abstract

This article illustrates procedures for using e-journals as a creative and adjunctive approach in group work. Incorporating e-mail based journaling as an ancillary form of group interaction allows members to communicate via written channels, and creates new ways for clients to relate in the group. This article outlines how leaders can use narrative theory to construct e-mail based writing exercises in group settings. Borrowing from established narrative techniques, specific interventions are provided for using interactive e-mails in each group stage. Finally, detailed instructions for establishing encrypted and confidential e-mail communications are provided, and implications and limitations for establishing e-mail based communication systems are overviewed.     

Countering Perfectionism in Research on Clinical Practice. III: Implications for Randomized Designs of the Presence of Uncontrolled Interactions and Spontaneous Changes

In a crossover study, we took pre-test, post-first-treatment, and post-second-treatment measures of self-expressiveness (assertiveness) and of acute emotional distress while we successively trained different groups of students in assertiveness and group therapy exercises. Our (unfulfilled) expectations were straightforward: We thought that assertiveness training would produce specific improvement in self-expression measures with little impact on overall distress and that group therapy would produce specific improvement in general distress with little impact on assertiveness. Both treatments improved assertiveness and decreased distress. The fact that our treatments had impure effects enhanced the likelihood of Type II statistical errors and compromised the effectiveness of our design. In addition, quite surprisingly, assertiveness training selectively improved the mental health of women students, and group therapy selectively improved the assertiveness of men students more than the alternative treatment did. This interaction between gender and randomly administered experimental treatment procedures raises serious, generally important questions about the logic of statistically controlled experimentation that relies on randomization to eliminate the effects of uncontrolled, but relevant, variables.     

Risk-Taking and Risk-Avoiding Behavior: The Impact of Some Dispositional and Situational Variables

The purpose of this research was to assess the ability of a decision making model to correctly predict subjects' preferences for one of two alternatives; one alternative was highly valued but risky, whereas the other was less valuable but more certain. The model was based on the assumption that an additive relationship exists among self-efficacy, self-worth, and parental expectations in influencing subjects' propensity to take risks. The results suggested that the model did not work as expected. Rather, self-efficacy emerged as the principle variable influencing the risk-taking and risk-avoiding decision-making behaviors of subjects when a variety of resources were involved.     

Discrimination of Visual Patterns Protracted in Time: A Preliminary Report on the VS Test

The present study, consisting of two experiments, was designed to examine the effects of list length and display time on the short-term retention of paired-associate material. In Experiment I, with 90 Ss, a three-by-three-by-five mixed analysis-of-variance design was used with three levels of list length (five, seven, and nine city-temperature pairs), three levels of display time (15, 30, and 60 seconds), and five trials per S. In Experiment II, with 20 Ss, four of the nine conditions involved in Experiment I were tested each week for 10 weeks, with 20 trials per week. The overall results indicate significant effects on storage-and-retrieval capacity as a function of list length, display time, and extended periods of practice.