Ethical Considerations for Therapists Working With Demographically Similar Clients

The increasing emphasis on multicultural competence within psychotherapy continues to highlight the need for being sensitive to key differences between therapist and client. However, this attunement to the psychotherapeutic impact of therapist–client differences may obscure the equally critical need to evaluate ethical problems associated with therapist–client similarities. It will be argued that therapists treating clients who are demographically similar to themselves encounter a unique set of ethical challenges that warrant careful consideration and caution precisely because of therapist–client matching. The extant research on matching therapists and clients based on demographic similarities is discussed, with a particular emphasis on psychotherapeutic outcomes and client preferences. Attention then turns to the nonrational heuristics and biases that can often cloud therapists’ ethical decision making regarding the appropriate uses versus contraindications for demographically matching therapists and clients. Within the discussion of nonrational heuristics and biases, suggestions are offered for managing related challenges for ethical decision making.     

Sibling Death and Adult Maladjustment Indices: A Brief Report

While symptoms of grief pose the most immediate psychological concern in the aftermath of sibling death, emerging research suggests that distal correlates may include strained interpersonal relations and externalized forms of psychological distress. College students with a history of Sibling Loss (n = 36), Parental Loss (n = 32), or No Loss (n = 367) were compared on the Minnesota Multiphasic Personality Inventory (MMPI-2). Sibling Loss was associated with higher Psychopathic Deviate (Pd; d = .62) and Hypomania (d = .42) scores. The relative risk (RR = 2.96) of a Pd elevation (T > 65) was higher after sibling death.     

Interviewing a Therapist in the Presence of a Couple: A Description of the Therapeutic Process

A therapy research team interviewed a therapist in the presence of a couple. Following each of six consecutive sessions with a couple, an interviewer posed questions to the therapist and couple. While one question was standard to each interview, other questions were generated by team members who tracked the entire process via live observation. These questions were directed first at the therapist, then at the couple, and then focused on therapeutic process and outcome. Findings of this process for the therapy system included decreasing the hierarchy within the client/therapist relationship; increasing the client ownership and energy in the therapy process; discovering the presence of parallel processes between the systems; and informing the direction of future therapy sessions. Practical, clinical implications are discussed for a variety of therapy settings.     

Therapists' views of the relative benefits and pitfalls of group work and one-to-one counselling for bereavement

Aim: To explore therapists' perceptions of the relative benefits and pitfalls of group work and individual counselling for bereaved clients. Method: Semi-structured interviews with nine experienced bereavement therapists from a range of different contexts generated data which was analysed using grounded theory methodology. Findings: Groups were perceived as having a normalising influence, helping members make new social contacts and practice social skills. Individual counselling was seen as facilitating the initial telling of the story and the expression of extreme emotion. Discussion: The findings suggest that individual counselling may be useful as a primary intervention easing ‘emotional loneliness’ caused by the death of a spouse or attachment figure. Group work may be of more benefit later in the bereavement process, facilitating an engagement with the outside world and alleviating ‘social loneliness’. Implications for practice: This suggests that bereavement services might usefully combine group and individual provision. Initial assessment could help clients clarify their needs and facilitate their choice of service. This would be more cost effective and potentially ease clients' bereavement experience.     

Affect dynamics,bereavement and resilience to loss

This investigation applied Zautra and colleagues’ Dynamic Model of Affect (DMA; Zautra: 2003, Emotions, Stress and Health (Oxford University Press, New York); Reich et al.: 2003, Review of General Psychology 7(1), pp. 66–83) to help understand resilience among a sample of middle-aged participants coping with the recent death of a spouse or child. We replicated and extended this model by examining interaffect correlations (individual correlations between negative and positive affect over time) in resilient versus symptomatic bereaved people. As predicted by the DMA, resilient bereaved had weaker (or less negative) interaffect correlations than symptomatic bereaved even when controlling for self-reported distress. These findings suggest that resilient individuals possess a capacity for a more complex affective experience and that this capacity serves a salutary function in the aftermath of aversive life events. The research described in this article was supported by a grant from the National Institute of Health, R29-MH57274 (George A. Bonanno).     

Activity/nonactivity and the group therapist: “Don't just do something,sit there”

The abstinent stance of psychoanalytically-oriented clinicians is often confused with passivity or coldness toward the patient or the group. Given the current move toward more active, shorter-term treatment, this paper offers a reaffirmation of the value of the abstinent analytic stance. The theoretical rationale for the technique is reviewed, and some specific arguments are made to illustrate the continuing importance of the method in the treatment of patients in psychodynamic group psychotherapy.Reputed to be Adlai Stevenson's advice to President John F. Kennedy during the Cuban Missile Crisis.     

A support group for couples who have terminated a pregnancy after prenatal diagnosis: Recurrent themes and observations

Genetic Counselors are increasingly becoming involved in organizing and facilitating support groups for couples who have terminated a pregnancy because of an abnormal fetal diagnosis. This paper discusses recurrent themes which have emerged in the FATE (Feelings After the Termination Experience) support group which was founded in New Jersey in 1990. By becoming familiar with the issues we have observed in our support group, genetic counselors should be better able to understand and empathize with their patients who make the decision to terminate a much wanted pregnancy. They may also feel better prepared to become involved in organizing and facilitating such support groups.     

Reviews

H. Helfrich (ed.), Time and Mind
Hans Eysenck, Genius: The Natural History of Creativity     

Desire and the female analyst

The literature on erotic transference and countertransference between female analyst and male patient is reviewed and discussed. It is known that female analysts are less likely than their male colleagues to act out sexually with their patients. It has been claimed that a) male patients do not experience sustained erotic transferences, and b) female analysts do not experience erotic countertransferences with female or male patients. These views are challenged and it is argued that, if there is less sexual acting out by female analysts, it is not because of an absence of eros in the therapeutic relationship. The literature review covers material drawn from psychoanalysis, feminist psychotherapy, Jungian analysis, as well as some sociological and cultural sources. It is organized under the following headings: the gender of the analyst, sexual acting out, erotic transference, maternal and paternal transference, gender and power, counter-transference, incest taboo - mothers and sons and sexual themes in the transference.     

DISCRIMINATIVE CONTROL OF THERAPISTS' PERFORMANCE1

In order to examine therapists' discriminative responding to normal and idiosyncratic patient responses, naive subjects were presented with a simulated “patient” for treatment. The subjects were made to believe they were reinforcing normal verbalizations emitted by this patient In fact, they were listening to a tape on which normal and idiosyncratic verbalizations had been recorded. Different probabilities of normal and idiosyncratic “patient” verbalizations could be presented to the subjects by means of a digital programming unit. In one of a number of conditions, the subjects' accurate reinforcing responses were followed by an increased probability of the patient's normal verbalizations. Accurate reinforcing responses emitted by the subjects were brought under the control of normal and idiosyncratic patient responses, by use of contingent feedback, change in patient responding, and monetary reinforcers. When the patient's normal verbalizations increased in probability, so did the subjects' accurate reinforcing responses following the patient's normal verbalizations, and to a lesser degree, the subjects' inaccurate reinforcing responses following the patient's idiosyncratic verbalizations. When the patient's idiosyncratic verbalizations increased in probability, the subjects' accurate and inaccurate reinforcing responses decreased in probability. The clinical implications of these tendencies are discussed.