Considering boundaries when doing therapeutic work with people who are seeking asylum: a reflective case study

People who are seeking asylum often have lived experience of their personal boundaries and human rights being violated. For this reason, it is especially important that we consider the impact of boundaries in therapeutic work with this population. This paper explores work with a woman with a severe trauma history who was seeking asylum in England. Examples of perceived boundary crossings in the therapeutic relationship are examined. Considerations for other clinicians working with asylum seekers are discussed. These include: addressing socio-political factors; being sensitive to cultural differences; the importance of supervision and reflective practice; the personal impact of such work; and using critical thinking and warmth to manage boundaries rather than rigidly following rules.     

Therapist activities preceding therapy setbacks in a poor-outcome case

Progress in psychotherapy is typically irregular, as advances alternate with setbacks. This study investigated the therapist’s activities prior to two main types of setbacks, one involving the client following therapist proposals and one involving the client failing to follow from therapist proposals, in the case of a poor-outcome client treated with a linguistically-oriented kind of cognitive therapy. Setbacks were defined as decreases of at least one level on an index of therapeutic progress, the 8-level Assimilation of Problematic Experiences Scale (APES), in adjacent client passages. Therapist activities were coded in 361 setback episodes that each included a client pre-setback passage, a therapist passage, and a client setback passage; both client passages had been previously rated on the APES. The main categories of therapist activities showed distinctive patterns in relation to the two main types of setbacks, the therapeutic zone of proximal development and the balance strategy. The two main patterns were described as an exploratory and a challenging configuration. These patterns of therapist activities and setbacks showed how the therapist seemed to persevere with approach-guided interventions while this poor-outcome client continued to have setbacks to low APES levels.     

Five women talk about work‐related brief therapy and therapeutic writing

Therapeutic writing can play a valuable role in brief, workplace counselling. The present study explores the experiences of five women who used therapeutic writing in this context. Ethical and methodological dilemmas in carrying out this research are highlighted. The study also demonstrates the use of ‘fictionalist’ accounts as a way of overcoming some of the difficulties associated with the dual role of practitioner/researcher, especially confidentiality.     

Book Club Groups to Aid Relational Connection and Trust among Addicted Trauma Survivors

This is a secondary analysis of qualitative data from a literacy study, which examines Book Clubs as a creative approach to engage female addicted trauma survivors in developing psychologically safe, trusting therapeutic relationships. This approach is respectful of the participants’ experiences of relational trauma and diverse cultural contexts, in part because book clubs are ‘normal’ experiences in which the client is better able to have control over the level of vulnerability she engages in within the therapeutic milieu. Themes indicating increasing levels of vulnerability and psychological safety include use of book club discussions to identify with text, plot, or characters; to discuss escape coping and aggressive coping; and to discuss self as a victim and as a survivor.     

‘THERE IS A WAR ON! SOMEONE IS GOING TO GET KILLED’

This paper describes the first three years of work providing consultation at the interface between adult mental health and children's services. It suggests that significant numbers of children, living with parents whose mental illness may be ‘severe and enduring’, remain hidden from services. The author applies psychoanalytic theory in an attempt to understand the unconscious factors, for organizations as well as for individuals, which may contribute to making it so difficult for services to work co‐operatively to recognize these children's existence and their emotional needs. She reviews some of the related fields in which the application of psychoanalytic thinking has occurred and also describes the context in which the work takes place. A series of vignettes demonstrate some of the difficulties encountered and the ways in which the presence of a neutral third or ‘other’ can contribute to their resolution. She suggests working relationships between adult's and children's services are profoundly affected by the psychotic processes operating in the minds of these parents and that the consultant acts as a container enabling staff to manage the fragmentation and splitting which would otherwise be inevitable.     

Taming the Brain Weasels: Reducing Self-Criticism Through Externalization and Compassion

ABSTRACT

Self-criticism is a natural process occurring across mental health disorders. When self-criticism is excessive, vulnerability to mental health disorders such as depression and anxiety increases. Compassion-focused approaches can effectively address a variety of concerns; however, highly self-critical individuals might balk at the idea of self-directed compassion due to shame, self-blame, or discomfort with positive emotions, resulting in treatment resistance. The brain weasel is an intervention strategy that uses the Narrative Therapy technique of externalization as an intermediate step toward compassion-oriented work. Through creative externalization and therapeutic humor, self-critical individuals can decenter and explore their self-critical dialogue. This article contains several ways to introduce and use the brain weasel personification in counseling.     

“The Parallel Dialogue”: Parental experience of their role in the relationship with their child's counsellor/psychotherapist

The parent–therapist relationship is a central consideration in child counselling and psychotherapy, particularly in private practice where parents are typically financially, emotionally and practically invested in the process. The relationship, which can be ambiguous and anxiety-laden on both sides, has historically received scant attention in therapeutic discourse, leading to gaps in practitioner confidence and training. In this context, and seeking to centre parent voices, this study provides an interpretative phenomenological analysis of four mothers' experiences of their role in the relationship with their child's therapist. Key identified themes encompass parental expectation of involvement; the destabilising, disorienting nature of the relationship; the centrality of trust; and critical evaluations of value. Findings are discussed in relation to attachment theory and cultural expectations of parental responsibility. The study concludes that the relationship is a live and potent property with potential to impact the course of the intervention, and recommends that practitioners thoughtfully consider the potential benefits and drawbacks of meeting or frustrating parental involvement expectations.     

Impact of aggressive humor on dysfunctional resistance

The present study examined the mediating effects of negative affect at work between abusive supervision and dysfunctional resistance, considering aggressive humor as a moderator. Two hundred and thirty-five full time working employees participated in the study. Correlational results indicated that aggressive humor was related to dysfunctional resistance. However aggressive humor was not related to negative affect at work. Aggressive humor moderated the direct path (i.e., between abusive supervision and dysfunctional resistance), but it did not moderate the indirect paths. Finally, the study found support for negative reciprocity beliefs (Gouldner, 1960). Implications for practice include an emphasis on self-awareness training for managers.