The Relationship of the Self of the Therapist to Therapy Process and Outcome: are Some Questions Better Left Unanswered?

Gurman (1987) has challenged the field of marital and family therapy to answer questions concerning the relationship of the therapist to outcome. An examination of conceptual and empirical literature regarding the relationship of the self of the therapist to process and outcome in marital and family therapy discloses that empirical evidence for such relationship is not persuasive. The author constructs a crucible for the field of marital and family therapy.     

Ethical Considerations in Psychotherapeutic Systems

Theoretical Medicine and Bioethics - In the process of individual psychotherapy, the client and the therapist work together towards clarifying the client's problems, unlocking vicious circles,...     

Counselor performance in treating anxiety and depressive symptoms in integrated care: A client outcomes study

Depression and anxiety are two of the most common mental disorders treated in Integrated Primary and Behavioral Healthcare programs. We investigated the within and between performance differences of mental health counselors on anxiety and depressive symptomatology in an integrated service with a sample of 1573 clients and 10 licensed professional counselors. The results of growth curves within the framework of Multilevel Modeling showed significant within and between performance differences among counselors treating anxiety and depressive symptoms. Some counselors performed better in treating anxiety symptoms while others did better treating depression. Implications for counselor education, client care, and legislation are provided.     

Psychotherapists’ psychological well-being: The role of epistemic orientation and emotion regulation

Psychotherapists’ mental health has been traditionally associated with the harmful consequences of clinical practice. In contrast to this dominant model, a growing body of research in positive psychology has sparked an interest in therapists’ positive well-being. The main objective of this study was to examine the relations between therapists’ epistemic orientation modes, emotion regulation strategies and psychological well-being (PWB). This was a cross-sectional study in which participants were 674 therapists (78.5% women), with a mean age of 42.02 years (SD = 13.06). Therapists completed an online questionnaire containing self-report measures of all study variables. Structural equation modelling using latent variables was performed to test the study hypotheses. Results revealed no significant direct effects of epistemic orientation on PWB. Up- and downregulation strategies had the most substantial direct effects on total PWB. Furthermore, emotion regulation mediated the association between therapists’ epistemic orientation modes and PWB, accounting for 57% of the variance in the outcome variable. Implications for training, practice and therapist self-care are discussed.     

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.     

Finding focus in a difficult landscape: Therapists’ experiences with challenging video guidance processes for parent–infant dyads

Marte Meo video guidance uses filmed interaction of the actual parent–infant dyad in the guidance of caregivers. Exploring the challenges that therapists meet in the guidance of parent–infant dyads may illuminate important aspects of the method itself as well as the therapists’ role and requirements. This could lead to method development and improved practice, but is hitherto little addressed. In this paper, we explore how skilled therapists experience and handle challenging or failing guidance processes with parent–infant dyads. We analyzed interviews with 13 Marte Meo therapists/supervisors using team-based reflexive thematic analysis. Four main themes were identified: promoting relational growth in a coercive context, building an alliance that feels safe for the parents, looking at positive moments in difficult lives, and handling intense feelings as a therapist. Our findings show that therapists experience specific therapeutic and ethical challenges with a vulnerable subgroup of parent–infant dyads where child protective issues arise, where caregivers’ insecurities impede the therapeutic relationship, and where caregivers have unsolved relational or mental health problems. The therapists’ role becomes pivotal and demanding with regard to the therapeutic alliance, the therapeutic interventions in the guidance process, and their own need for regulation, supervision, and structure. Identification of these vulnerable dyads early in the process could facilitate a better adaptation and practice of video guidance. Our findings suggest a need for supporting structures, clinical supervision, and training that address these challenges.     

The facilitative interpersonal skills method: Difficult psychotherapy moments and appropriate therapist responsiveness

The Facilitative Interpersonal Skills (FIS) task is a performance test of therapists’ use of common relational skills (e.g. empathy, building expectations). The FIS method includes (a) materials that simulate difficult client moments on video, which are used to collect therapists’ responses to these situations; and (b) independent ratings of these responses. Many of the FIS items are informed by psychotherapy processes that have been linked to outcome and facilitative conditions that have been reframed as individual therapist skills (e.g. alliance bond capacity). Overall, the FIS has predicted psychotherapy outcome. A single study is described in which FIS predicted the therapist effect using multilevel modelling of a large sample of clients who were nested within therapists. We also summarise two additional outcome studies that used experimental designs. One future direction is to better understand how therapists form responses to these difficult moments. We conclude that forming an optimal therapeutic response during challenging, emergent in‐session situations involves responsiveness (Stiles et al., 1998), or finding a response that fits the clients’ needs within any moment.     

Honoring and Privileging Personal Experience and Knowledge: Ideas for a Narrative Therapy Approach to the Training and Supervision of New Therapists

This article discusses an approach for the training and supervision of new therapists built around social constructionist and poststructuralist ideas from a narrative therapy perspective. We briefly discuss some of the pitfalls of current training/supervision in marriage and family therapy (MFT) that are deficit based and/or that disproportionately grant privilege to expert knowledge. We articulate this emerging training approach which utilizes the rite of passage metaphor, centers relationalism, and incorporates the honoring and privileging of new therapists' lived experience, knowledges, skills, talents, ideas, morals, personal ethics, values, beliefs. Concrete practices of experience privileging, re-membering, and creating communities of concern are detailed, and illustrative examples from our supervision work are given.