How Does Change Occur Within the Psychoanalytic Encounter?

On November 6, 2002, Dr. James Fosshage delivered the following talk at a Clinical Training Conference held at the Blanton-Peale Institute. The Clinical Training Conference at Blanton-Peale provides experiential and conceptual resources to support the therapist-in-training in the context of his/her professional identity. The training conference is attended by candidates of all phases of the Psychoanalytic Program, the Pastoral Psychotherapy Program, and the Marriage and Family Program, as well as faculty members, administrators, staff, and interns of the institute. The residents were asked to review three articles written by Dr. Fosshage in preparation for his presentation: Toward Reconceptualising Transference: Theoretical and Clinical Considerations, International Journal of Psycho-Analysis (1994) 75 (2): 265–280; Countertransference as the Analyst's Experience of the Analysand: Influence of Listening Perspectives, Psychoanalytic Psychology (1995) 12 (3): 375–391; and Listening/Experiencing Perspectives and the Quest for a Facilitating Responsiveness, Conversations in Self Psychology: Progress in Self Psychology, (1997) 13: 33–55.     

Professional and Provider Perspectives on Family Involvement in Therapeutic Foster Care

Therapeutic foster care (TFC) offers a promising community-based treatment option for children with serious emotional and behavioral disorders in the child welfare system. Family involvement is believed to contribute to achieving the goal of family reunification in TFC, but there has been little attention to family involvement in TFC. I present findings of a qualitative study of child welfare professionals' and TFC providers' perspectives on family involvement. Respondents' views of parent-child contact, parent-professional communication and information sharing, and family involvement in decision making were examined. Values and attitudes toward family involvement, practices related to family involvement, barriers to involvement, and strategies to promote involvement emerged as themes. Professionals in this study believed in the value of family involvement, but there were challenges at the organizational level and related to some TFC providers' lack of training to work with families.     

Aha over Haha: Brands benefit more from being clever than from being funny

We examine whether the cleverness of a brand's humor attempt affects consumers' brand attitudes and engagement. A clever humor attempt is any humor attempt wherein the consumer feels she must make mental connections to solve the joke (e.g., understand a cultural reference, understand the dual meaning of a pun). Across five studies, we demonstrate that as the cleverness of a humor attempt increases, consumers report higher brand attitudes and are more engaged with the brand. This effect is mediated by perceptions of brand warmth and competence and moderated by consumers' need for cognition.     

Saudi therapists' lived experience of self-awareness

Self-awareness and self-reflection in psychotherapeutic processes have been critical components for effective counselling and psychotherapy. However, little qualitative research in Saudi Arabia has been conducted that aims to explore the therapist's subjective experiences of the self in their professional work. Therefore, the purpose of this phenomenological study was to understand the therapist's self-awareness within psychotherapy, by focusing on the therapist's lived experience of self-awareness and exploring how therapists recognise themselves as an integral component of the therapeutic relationship. Semi-structured interviews were conducted with six experienced and accredited psychologists with at least three years of clinical experience, and the qualitative data were analysed using interpretative phenomenological analysis (IPA). Five superordinate themes emerged from the data; that is, development of the professional self, use of self, self-oriented, supervision and experience. This study provides an understanding of the therapist's self in psychotherapy, as it shows that self-awareness is important for therapists to manage their feelings, thoughts and behaviours in meeting with clients and that it is a valuable resource for a therapist to become aware of and reflect upon the process within oneself. This understanding is integrated into the training programmes in counselling psychology, especially in the areas of self-awareness and personal development.     

Videoconferencing versus face-to-face psychotherapy: Insights from patients and psychotherapists about comparability of therapeutic alliance,empathy and treatment characteristics

Objective

Videoconferencing psychotherapy (VCT) is an effective treatment option. Yet, it is unclear whether a similar therapeutic alliance as in conventional face-to-face psychotherapy (F2F) can be achieved, since previous studies yielded mixed results. Furthermore, surveys about the attitudes towards VCT amongst patients have been missing until now. The current study gathered opinions from patients and psychotherapists about the perceived comparability of VCT and F2F regarding contextual factors and treatment characteristics, focusing on therapeutic alliance and empathy.

Method

An online survey amongst patients (N = 189) and practitioners (N = 57) taking part in cognitive behavioural therapy was conducted after the first lockdown in Germany due to the COVID-19 pandemic and a resulting transition from F2F to VCT for most participants.

Results

While patients experienced therapeutic alliance and empathy as comparable, psychotherapists indicated advantages of F2F. Both groups indicated advantages of F2F for the therapy contents and expressed advantages of VCT for flexibility regarding location and time. More than half of the participants expressed a preference for a combination of analogue and digital therapy.

Conclusion

The perceived disadvantages of VCT can be addressed, for example, with training programmes for psychotherapists targeting communication in VCT and adapting established psychotherapy methods to a digital format to further improve VCT.     

A qualitative study of the therapists' experiences of working with community reinforcement and family training

Community reinforcement and family training (CRAFT) was developed to help and support concerned significant others (CSO) of people with, for example, alcohol use disorder. The aim of this study was to investigate therapists' experiences of working with CRAFT and their experiences of the CSOs receiving CRAFT. The study has a qualitative design and is based on three focus group interviews with 17 therapists. Interviews were analysed using thematic analysis. The analysis revealed six themes and four subthemes: Concerned significant others—A special group; Help prior to CRAFT—Offering information and a shoulder; CRAFT as a new and specific method (The toolbox of CRAFT, Formats for delivering CRAFT, Introducing a diary as homework and Implementing self-help material—Alone or in combination with sessions); Moving from a lack of structure to structure; Change in CSOs from the therapists' point of view; and Change in the therapist's role (Dilemmas—Personalising the intervention). The therapists were generally satisfied with the method and found it easy to adapt to. Moreover, working using a manual was more structured than they were used to and increased feelings of working professionally with the CSOs. Specifically, most therapists found the self-help book useful and indispensable in their work with CRAFT, but also agreed that it could not be used as a stand-alone intervention for most CSOs. The therapists' experiences are relevant for implementation of manualised, structured approaches and group-based interventions more broadly.     

“In my own comfort zone”: Clients' experiences of relational aspects of online therapy for alcohol problems

Background

Therapists and counsellors increasingly use online video applications to offer treatment in place of face-to-face delivery. In the alcohol treatment sector, this offers a range of potential benefits for treatment providers. However, the impact of working remotely via video on the therapeutic relationship remains unclear and under-researched.

Aims

This study aimed to explore how alcohol treatment clients make sense of the relational aspects of therapy delivered remotely, and to examine how the use of remote therapy might disrupt existing ideas around the therapeutic relationship.

Methodology

This study utilised a qualitative design using thematic analysis, with 15 participant interviews with adult service users from a single treatment provider. All participants had previously undertaken at least four 1-h online therapy sessions.

Findings

The themes that were identified highlighted the significance of the participants' own homes as the site of therapy, with emphasis on the comfort of the home, and the presence of family members and pets. Participants stressed the importance of viewing the face of the therapist, the establishment of a therapeutic bond and specific therapist qualities. Participants also reflected on issues around denial and avoidance associated with self-image and identity.

Discussion

There are nuanced and potentially unforeseen consequences of undertaking therapy for alcohol problems via video, relating to the significance of the therapy environment and relationship between client and therapist. This may include issues of shame, denial and avoidance, which are of particular significance for clients experiencing difficulties associated with alcohol.     

Predictors of Placement Outcomes in Treatment Foster Care: Implications for Foster Parent Selection and Service Delivery

Treatment foster care (TFC) is a normalizing environment in which to treat those children whose particular needs are not addressed in traditional foster care and for whom an institutional setting is a restrictive and unnecessary alternative. However, when the foster care placements of these emotionally and behaviorally disturbed children fail, as they often do, the children are shifted from one home to another without the opportunity to experience permanence or emotional attachment, resulting in poor adjustment to foster care. Placement stability, which depends in part upon effective matching of foster children with potential foster families, is critical for achieving positive outcomes in TFC. Yet, there is a dearth of information to guide placement agencies in making decisions about matching foster children with families. Moreover, once a successful match has been made, it is equally vital that service delivery be of high quality so that permanence is maintained. We review research on the predictors of positive outcomes in foster care, focusing on studies involving emotionally or behaviorally disturbed children, and provide recommendations for selecting foster parents and for ensuring high quality foster care services and placement stability.     

The Relationship Between Client Emotional Expressions, Therapist Interventions, and the Working Alliance: An Exploration of Eight Emotional Expression Events

The relationship between client emotional expression and therapist interventions was studied in two working alliance conditions. An events-focused methodology was used to examine a total of 8 events taken from a variety of therapeutic orientations. Results indicated that, in the presence of a good client–therapist relationship, therapists showed higher levels of empathy and effectively focused on the immediately expressed feelings; in turn, their clients were engaged in exploration of feelings. In poor-relationship dyads, clients expressed negative feelings toward the therapists. Interventions rated as effective by clinical judges were characterized by accurate therapist understanding of clients' emotional expressions and working with strains in the therapeutic relationship. Ineffective interventions were associated with inaccurate assessments of clients' emotional states. Intensive analysis of these sessions led to three distinct models of in-session emotional expression events. Theoretical and practical implications of these models will be discussed.