Witnessing Clients’ Emotional Transformation: An Emotion‐Focused Therapist's Experience of Providing Therapy

Emotion‐focused therapy (EFT) is an integrative–humanistic, research‐informed, psychological intervention characterized by sustained focus on the client's emotional pain and its transformation. This article discusses the impacts on the therapist when encountering and transforming the client's vulnerability. It is organized around the different phases of the therapy process: meeting a new client, accessing the client's core emotional pain, transforming the client's emotional pain, and ending the therapeutic work. The article also contains personal experiences of the author and provides illustrations of impactful events from therapy sessions. The work, it is suggested, provides significant learning for the therapist on both a personal and a professional level, leading, for example, to the therapist's maturation, better connection with personal hurts and vulnerabilities, greater courage in regard to sharing such feelings, greater kindness toward others and the self, and greater determination to be braver when facing adversity or injustice.     

Lay theories of psychotherapy and perceptions of therapists: A replication and extension of furnham and wardley

This study examined laypersons' perceptions of psychotherapy, the experience of psychotherapy clients, and therapist credibility. Most of Furnham and Wardley's recent findings of positive and realistic lay views on psychotherapy and therapists were replicated. Age, sex, and psychological experience mediated some beliefs about therapy and clients' experiences. Although positive views were associated with higher ratings on some aspects of therapist credibility, only the modality of the therapy (behavior vs. client-centered vs. rational-emotive individual therapy) influenced perceptions of overall credibility. Neither the fee charged nor the participant's sex had any effect on perceptions of therapist credibility.     

Early psychotherapy processes: An examination of client and trainee clinician perspective convergence

Convergence in the therapist–client dyad has been hypothesized to play an important role in the development of the therapeutic relationship and in successful therapy outcomes. Further, understanding the client's views and opinions of treatment has been identified as a critical skill for therapists in training to learn in order to reach professional competency in conducting psychotherapy. This study assessed convergence for 151 trainee therapist–client dyads on the identification of goals and tasks of treatment and on ratings of the therapeutic relationship, effectiveness of therapy and the client's current coping ability with life stressors. Results indicated that trainee therapists' and clients' ratings were significantly correlated; however, trainee therapists were more negative in their ratings of the relationship and progress of treatment and matched their clients' goals for treatment only 31.1% of the time. Training and practice implications are discussed. Copyright © 2009 John Wiley & Sons, Ltd.     

THE DAWN OF A NEW IDENTITY: ASPECTS OF A RELATIONAL APPROACH TO PSYCHOTHERAPY WITH A TRANSSEXUAL CLIENT

The importance of developing a certain consciousness in which one is present and autonomous while being intimately interconnected with larger meaning is an important dimension of a relational approach to psychotherapy. Based on the premise that both client and therapist bring something of themselves and of their respective past emotional experience to the therapeutic relationship, a relational approach to therapy is very attentive to the dynamics in the therapy room. It stresses the co‐creation of the therapeutic relationship at conscious, explicit verbal levels and unconscious, implicit levels of functioning, and establishes the therapist's emotional behaviour as a significant factor in fostering change ( Aron, 1996 ). Therapist responsiveness to client's affective impact is discussed with emphasis on its centrality to clinical practice and its relationship to countertransference. A case study of the psychotherapeutic journey with ‘Dawn’ (previously ‘David’), a 53 year‐old client who was awaiting sex‐reassignment surgery, is presented which illustrates how the therapist's struggle in the countertransference represents part of a complex relational body/mind system of parallel processes, re‐enactment and potential for therapeutic change.     

Early working alliance in outpatient substance abuse treatment: Predicting substance use frequency and client satisfaction

Background: The study examined the effect of the early working alliance on outcome in outpatient substance abuse treatment. Methods: A total of 327 clients and 33 therapists participated in the study. Data were collected in southern and western Finland in outpatient treatment units (N = 7). The dependent variables were percentage of days abstinent and client satisfaction at six‐month follow‐up. The independent variables were both client and therapist alliance ratings of the first and third sessions. The client's percentage of days abstinent for the month preceding treatment was used as a covariate. Intra‐class correlation was used to measure between‐therapist variation. Results: The main finding was that there was considerable between‐therapist variation in both the frequency of clients’ substance use and client satisfaction at follow‐up. The client's earlier substance use frequency was a significant predictor of the substance use frequency at follow‐up. Client satisfaction was significantly predicted by the client's rating of the early alliance. Conclusions: More research on therapists is needed because between‐therapist differences seem to be associated with patient outcomes over differences within therapists. While the study confirmed that good early working alliance improves outcome during treatment without being linked to post‐treatment recovery, more research is needed also in that area.     

Clients' reasons for terminating psychotherapy: A quantitative and qualitative inquiry

Objective. To study private‐practice clients' perspective on reasons for psychotherapy termination and how these are related to demographic and treatment variables and to satisfaction with therapy. Design. Eighty‐four persons who had been in extended private‐practice psychotherapy which ended in the preceding three years participated in the study. Mean number of months in treatment was 27.70 (SD =18.70). Method. Assessment included rating scales and open‐ended questions assessing demographic variables, reasons for terminating therapy, and satisfaction with therapy. Results. Quantitative results revealed that the most frequent reasons for termination were accomplishment of goals, circumstantial constraints and dissatisfaction with therapy, and that client satisfaction was positively related to positive reasons for termination. Qualitative results revealed two additional frequently mentioned reasons for termination: the client's need for independence and the client's involvement in new meaningful relationships. Conclusions. Findings suggest that psychotherapy termination may at times be required to facilitate the pursuit of personally meaningful goals.     

Young people's experiences of individual psychoanalytic psychotherapy

Greater emphasis is currently being placed on user involvement in shaping the delivery of mental health services and the need for increasing the evidence base for psychotherapeutic interventions such as individual psychoanalytic psychotherapy (IPP). This qualitative study reports on the range of experiences of six young people aged between 16 and 21 years in undertaking IPP. Interpretative phenomenological analysis was used to develop an in‐depth understanding of their experiences. The themes identified the young people's initial expectations and concerns about starting psychotherapy, experiences of learning the ropes of therapy and the process and meaning of ending therapy. The affective relationship with the therapist was of particular importance to the young people concerned. Positive experiences of IPP included being listened to and being accepted, and talking and thinking in depth. The power differentials with respect to being a patient were also evident. The paper concludes by suggesting that paying greater attention to young people's views of psychotherapy may improve their initial engagement and help to develop services in more appropriate ways. Qualitative methodologies provide a useful adjunct to conducting process and outcome research in this context.     

Corrective Experiences of Psychotherapists in Training

Although the concept of corrective experiences (CEs) is usually linked to the process of change in psychotherapy patients, we investigated them in the professional development of therapists‐in‐training. Inasmuch as psychotherapy is a relational process, it is important to look closely at how therapists reach the position of a competent partner in corrective experiencing. In this study, we interviewed 10 therapists‐in‐training undergoing their own training therapy. Responses to these semistructured interviews were analyzed using a computer‐assisted grounded theory method. The 499 first‐level categories were grouped into 5 main themes: therapist characteristics, therapist technical interventions, therapist relational interventions, relationship experience, and outcome experience. Two core categories representing corrective experiencing were (a) unexpected unconditional support from and trust in their own therapist and (b) unexpected confrontation and limitation with their therapist as well as awareness of self–other boundaries. Results are discussed in the broader context of the CE literature, relational theory, and relational practice.     

“Yes,Of Course It Hurts When Buds Are Breaking”: Therapist Reactions to an Adolescent Client's Sexual Material in Psychodynamic Psychotherapy

This article focuses on the therapist's emotional reactions to a young female client's revelations about her fear of being raped that came up in the course of an open‐ended psychodynamic psychotherapy. The client suffered from depression and emotional disturbance related to the overwhelming developmental tasks of adolescence, including individuation and psychosexual development. The patient's fears and nightmares not only raised ethical dilemmas in the therapist regarding how to handle the implications of these revelations but also reactivated the therapist's own issues from her adolescent period. The fact that the material of the patient found a “hook” (Gabbard, 1995 ) in the therapist enabled a deeper understanding of the patient that helped resolve her inner conflicts and move on in her development.     

Using the primary process emotional–behavioural system to better meet patient needs in psychotherapy

In order to increase therapeutic impact by enhancing awareness of clients' nonverbal communications, this article operationalizes the therapeutic alliance as a needs‐satisfaction process. The client's competence as a needs seeker and the therapist assisting with the client's expression and satiation of basic social needs are proposed as being key mechanisms of change. Functional model of primary emotions derived from Panksepp's seven primary emotional systems (care seeking, caretaking, lust, fear and anxiety, anger, play, seeking, plus dominance and disgust) is integrated with Functional Analytic Psychotherapy's emphasis on in‐session contingent natural reinforcement of clients' target behaviours. By identifying in‐the‐moment cues of underlying emotional–behavioural functions drawn from a categorization of clients' nonverbal communication can bridge the gap between client private events and therapist observables, in order to maximize therapist attunement and responsiveness to clients, and to increase the effectiveness of clinical interventions.     

Frequent mistakes made with black patients in psychotherapy

This report reflects some insights derived from a decade of supervising psychiatric residents who engaged in dynamic psychotherapy with black patients. Of major interest was giving particular attention to what was said by black patients while remaining alert to the responses given by the therapist. From these observations some common mistakes have been identified and the conclusion is that rapport between patient and therapist was dependent upon a genuine regard for the patient''s race, culture, and life-style.     

A Tape Recorder as a Therapeutic “Witness” in the Treatment of an 8‐Year‐Old Girl

A tape‐recorded session of an early moment in an 8‐year‐old girl's psychotherapy experience is presented. The use of the recording device is immediately taken up by the child as a means of creating a “witness” for her depiction of both intensely distorted experiences of her therapist and poignant portrayals of her life as miserable and despairing. A discussion of both the process and the content generated from the use of the tape recorder is described, with implications drawn as to its effectiveness in the therapeutic process.     

A grounded theory analysis of the therapeutic relationship with clients sexually abused as children and non‐abused clients

The objective of this study was to investigate whether clients with a history of child sexual abuse (CSA) and non‐abused clients differ in their views of the therapeutic relationship. Two groups of 17 clients receiving psychological therapy, those who reported a history of CSA and a matched group who had not reported abuse, were asked in a semi‐structured interview about what was important to the therapeutic alliance. The accounts of the two groups were analysed using grounded theory, and then compared. The qualitative analysis demonstrated that both groups identified many similar important issues. These included factors relating to the therapist, to therapy itself, and to the client's perception of the relationship. Women in the CSA group emphasized the interpersonal qualities of the therapist and how they felt about their relationship, while the other clients talked more about therapeutic techniques and progress in therapy. Important issues mentioned exclusively by the CSA group included the therapist's commitment, being believed, and the therapist not showing negative reactions. Copyright © 2001 John Wiley & Sons, Ltd.     

Migration as an Unconscious Search for Identity: Some Reflections on Language,Difference and Belonging

The author addresses some issues regarding patients who relocate and who struggle with adaptation to a new reality. She argues that emigration is a complex psychological phenomenon that requires a therapist to pay special attention to the issue of language, difference and identity, and suggests that the issues of different culture and language in analytic psychotherapy need to be considered as part of a wider cultural context to which we all belong, rather than a specialized area of interest. The paper illustrates, through the clinical example of an East European male patient, that the psychic work of emigration can be understood as a process of integrating splits between pre‐ and post‐migration selves. The author concludes that the analyst needs to let herself be involved as a ‘real person’ to reach the non‐interpretative aspects of the patient's psyche through a mutuality of shared experience to promote a change.     

Time in Motion: Qualities of Temporality Within Psychotherapeutic Psychodynamic Counselling

Our relationship to time is both a developmental and a relational one; an inter- and intra-psychic experience. Exploring how the theories of Freud, Klein, Winnicott, and their successors offer explanations of how the psychoanalytic subject develops and sustains a concept of time and the factors that may hinder this, this essay suggests that different qualities of time, such as continuity, rhythm, repetition and interruption, can reveal themselves through the client's transferential and countertransferential relationship with the therapist. Using fictionalized clinical examples it explores how a bodily felt experience of time was thought about by the therapist/author using Laban movement analysis to support a client in ‘working through’ early material that felt stuck. The exploration of a client's perspective is brought in through the writings of the activist Passerini on her psychoanalytic treatment (cited by Baraitser in Enduring Time) and her experience of trauma's capacity to stop time. The essay also looks at how psychoanalytic ideas of temporality challenge the ‘recruiting’ of time by the wider culture to create more time-efficient late-capitalist subjects but by using ideas from movement studies and a Lacanian influenced time register it is suggested that cultural attacks on subjective experiences of temporality could be challenged within therapy. It is hoped the essay encourages the therapist to become alert to the manifestations of different temporal experiences within the therapeutic relationship and to develop a creative, embodied language with which to explore it with the client.     

Focusing on Reflections: Mentalization and Mirroring in Brief Dynamic Therapy

The author begins by noting the growing recognition of the contribution that addressing a client's capacity to mentalize can make to therapeutic effectiveness in short‐term psychodynamic work. He outlines the developmental origins of the capacity for reflective function or mentalization in the earliest experiences of infancy and how the primary carer's changing levels of contingency to the infant's feeling states promotes the infant's development of a sense of his or her own mind as well as a sense of the minds of others as sources of the motivation of behaviour. The author compares and contrasts the concept of mentalization with that of mirroring and how the latter contributes to the realization of the self. The contribution that a focus which captures the aesthetic of a client's idiom can make to the experience of being mirrored and contained by the therapist is highlighted. The author also identifies ways in which working with the components of a focus, as it is tracked through a client's narrative, can enhance a client's capacity to mentalize. These themes are illustrated by a case example which involves complex loss and trauma resulting in unmet adult attachment needs and a diminished capacity to mentalize.