Themes in Therapist Development During the First Three Months of Clinical Experience

The results of a qualitative research study designed to better understand the developmental processes active in beginning therapists during the first three months of clinical contact is reported. Thirteen beginning therapists were asked to complete a monthly log describing experiences impacting their clinical work and themselves as therapists during their first three months of client contact. Data analysis revealed that the primary developmental theme active during this period of time is the development of therapist confidence. Two additional themes, the development of an internal gauge on which to evaluate current experiences and the development of boundaries around the self as a professional, were also found to be active during this time. These additional themes support the development of therapist confidence. Implications for training and research are identified.     

Validity and temporal stability of the chimeric face technique for studying hemispheric processing asymmetries: Data from 6-through 14-year-old children

The validity and temporal stability of the chimeric face technique as a measure of cerebral hemispheric functioning in children were investigated. The method is based upon the observation that when a subject encounters a representation of the human face, the left side (from the observer's point of view) of the face dominates his or her perception of it. This bias was shown to be present in a majority of children ranging from 6 through 14 years old, and it was stronger for right-handers than for left-handers. The 1-month temporal stability of the bias was 67%, which is comparable to that of other surface methods. As in other split-message techniques, the typical left visual field bias was more reliable than the unusual right visual field bias. The implications of these data are discussed.     

Analytic practice: Convergences and divergences1

The author discusses current convergences and divergences concerning analytic practice. After presenting a clinical vignette that can be understood differently according to different theoretical approaches, he discusses Wallerstein’s proposal of a common ground in psychoanalysis and suggests that the present state of the art indicates that psychoanalysis is a pluralistic discipline, with different ways of training and practising it, and that the main challenge is to improve our ability to listen to and to learn from different approaches.     

Resistance and outcome expectations in cognitive‐behavioural therapy for generalised anxiety disorder

Greater client resistance has been consistently found to be negatively associated with outcome in psychotherapy. However, the pathways through which resistance impacts such outcomes are underexplored. Given that client outcome expectation (OE) has been identified as an important common factor in psychotherapy, the goals of the present study were to examine: (a) the impact of resistance on subsequent client and therapist OE (COE & TOE, respectively); and (b) whether COE and/or TOE mediate the relationship between resistance and outcome. These relationships were tested among 44 clients with severe generalised anxiety disorder treated with cognitive‐behavioural therapy in the context of a randomised controlled trial (Westra, Constantino, & Antony, 2016). Resistance was measured at a mid‐treatment session, and COE and TOE were assessed at baseline and immediately after the resistance session. Treatment outcome was measured via client‐rated worry severity at post‐treatment. As predicted, higher resistance was associated with lower subsequent COE and TOE; B = ?.73, p < .001 and B = ?.46, p < .001, respectively. In turn, lower post‐resistance COE predicted higher post‐treatment worry (B = ?.5, p < .001), indicating mediation. In contrast, TOE did not mediate the relationship between resistance and outcome (B = ?.02, p = .876). These results suggest that resistance can be demoralising to both clients and therapists. However, only lower client morale may be detrimental to therapy outcome. This study contributes to understanding outcome pathways through two common therapy processes.     

Between Wonder and Doubt: Psychoanalysis in the Goal-Free Zone

This paper examines the experiential dimensions of wonder and doubt as one way to articulate the creative and growth-promoting tensions between the medical/scientific model and the spiritual/mystical model. Both forms of experience, it is argued, function as necessary elements in a psychotherapy that integrates psychoanalysis and spiritual praxes. Fundamental differences between the medical/scientific model and the spiritual/mystical models are examined. The notion of the gap serves to illustrate these diametrically opposed, albeit compatible and necessary, points of view. The multifaceted layers of movement between Buddhism and psychoanalysis typify interacting dynamics between the two disciplines and provide a focal point for discussion. The paper then explores parallels between the Zen Buddhist notion of Satori as explicated in the writings of D. T. Suzuki and Wilfred Bion's notion of O. Theoretical aspects of the discussion provide a backdrop for exploring clinical experience regarding the relationship between acceptance and change, the clinical relevance of the Buddhist notions of gaining idea and basic goodness. The author also explores relationships between presence as actuality and ideal; knowing and not knowing; wonder and doubt. Clinical material supports the theoretical aspects of the discussion.     

In Experiential Sessions, There Is No Therapist or Client: There Is a “Teacher” and a “Practitioner”

In virtually every kind of psychotherapy, therapist and client attend mainly to one another throughout almost the entire session. If each experiential session is to be successful in enabling the person to become the whole new person that the person can become, and to become free of the painful feeling in the painful situation, the radical alternative is for the experiential teacher–therapist and the person to attend mainly to the third thing that is the important center of attention for the person. An even more radical glimpse into the future includes the person having one's own sessions by oneself, complemented by skill-development sessions with the experiential teacher.