Intersecting losses: Working with the inevitable vicissitudes in therapist and client lives.

Therapists working with clients with severe trauma histories over long periods of time may find themselves managing traumatic events in their own lives—illness, divorce, death—at the same time as they are assisting their clients to live productively with their painful pasts. While a few accounts exist describing how therapists deal with single overwhelming events, very little has been written about how therapists manage ongoing or prolonged episodes of severe stressors with a busy clinical practice of clients with severe trauma histories. Yet, we know that support for therapists is crucial to longevity in the field and we also know that learning from the experience of others is a highly recommended form of support. This paper is an account by a senior clinician of how she has maintained a productive clinical practice despite personal losses. Therapists who struggle with personal losses probably deal with choices related to self-disclosure more than therapists who do not have such experiences; they have repeated opportunities to establish appropriate and effective levels of self-disclosure for them and the people with whom they work. The paper presents a template for thinking about the risks and benefits of self-disclosure while at the same time modeling a level of self-disclosure that may be beneficial to therapists looking for examples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapists' attitudes toward clients reporting mystical experiences.

Studied the proportion of therapy clients who report mystical experiences, the diagnostic attitudes of their therapists, and the influence of personal and professional factors on attitudes toward these clients by analyzing the survey responses of 285 32–82 yr old psychotherapists (primarily males). Of the 20,670 clients seen during a 12-mo period, 4.5% reported a mystical experience; 67% of Ss had seen at least one such client during that period. Psychodynamic and behavioral therapists attributed significantly more pathology to such clients than did humanistic/existential therapists. Responses suggested that some therapists were biased in their diagnostic attitudes toward clients reporting mystical experiences. 50% of Ss said they had personally had a mystical experience. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Same difference: Black therapists' experience of same-race therapeutic dyads.

Do Black therapists experience their work with Black clients differently than their work with other clients? A phenomenological study of 12 Black psychologists, social workers, and counselors working in college counseling centers examined these therapists' lived experience of same-race therapeutic dyads. The therapists described the unique aspects of their therapy with Black clients, as well as how they learned to perform that work. The implications of this study are vital not only to Black therapists, but also to educators and supervisors of Black therapist trainees. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Therapists' reactions to treatment of survivors of political torture.

Working with survivors of political torture and war trauma can trigger strong emotional responses in the therapist. As more survivors seek treatment, it is essential to identify and develop robust support systems for therapists who help their clients confront nearly unspeakable experiences. The emotional reactions of 6 psychotherapists who worked with traumatized survivors in a refugee treatment center were explored. The psychotherapists' reactions were compared with those of therapists who worked in different treatment settings with other presenting problems. The results of the study show that the strong level of responsibility therapists feel for their traumatized clients may hide an emotional strain and may lead to burnout. Suggestions are offered for supporting therapists in this difficult but important work. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Developing as a therapist: Stress-related growth through parenting a child in crisis.

Stress-related growth following a variety of highly stressful experiences is receiving increased attention. However, one area that has not yet been addressed is the growth that therapists may experience in their own personal life through encounters with trauma and personal struggles and how this growth might carry forward to the work that they do with their clients in the practice of psychotherapy. In the present article, the authors describe stress-related growth and use it as a framework to examine the stressful experience and ultimate growth of a therapist dealing with a family member's emotional crises. Three areas of her growth as a therapist are examined: strengthened understanding of the therapeutic process from the client's viewpoint, additional strategies for approaching the change process, and increased empathy for parents and clients. The article concludes with recommendations for therapists experiencing personal struggles. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assimilation of problematic experiences by clients in psychotherapy.

Presents an integrative model for a central aspect of change in psychotherapy. According to the assimilation model, clients in successful psychotherapy follow a regular sequence in processing their problematic experiences as these are assimilated into schemata developed in the therapeutic interaction. The model's principal concepts include schema, problematic experience, and assimilation and accommodation. Stages of assimilation are discussed, and case illustrations of a 37-yr-old man and a 37-yr-old woman illustrate this process. Advantages of the assimilation model for research, for clinicians, and for the therapeutic relationship are addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diversity within African American, female therapists: Variability in clients' expectations and assumptions about the therapist.

Despite the presence of some literature that has addressed the characteristics of the African American female therapist, most psychotherapy training proceeds with the assumption that therapists are members of dominant groups, and most of the psychological and psychotherapy literature has been written by therapists and psychologists who come from dominant cultural perspectives. Not as much has been written about psychological paradigms or the process of psychotherapy from the perspective of the therapist who is not a dominant group member. This article explores both the common and divergent experiences that we, the authors, share as African American female therapists and the different reactions we frequently elicit in clients. We also explore how individual differences in our physical appearances, personal backgrounds, and different characteristics of our respective practices elicit distinct responses from clients that we believe are based on differences between us, despite the fact that we are both African American women. We believe that many of the stereotypes that affect perceptions of African American female clients also exist for African American female therapists. We will address how the intersection of gender, race, and sexual orientation of the client highlights the complexity of culturally competent practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

African American and European American therapists' experiences of addressing race in cross-racial psychotherapy dyads.

Using Consensual Qualitative Research, 12 licensed psychologists' overall experiences addressing race in psychotherapy were investigated, as were their experiences addressing race in a specific cross-racial therapy dyad. Results indicated that only African American psychologists reported routinely addressing race with clients of color or when race was part of a client's presenting concern. European American psychologists indicated that they would address race if clients raised the topic, and some reported that they did not normally address race with racially different clients. When discussing a specific cross-racial dyad, African American therapists more often than European American therapists addressed race because they perceived client discomfort. Only European American therapists reported feeling uncomfortable addressing race, but therapists of both races perceived that such discussions had positive effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Basic behavioral science research for mental health: Thought and communication.

The key to human intelligent behavior lies in the capacity for thinking, reasoning, and problem solving and an inability to communicate through language. These abilities are often seriously impaired in people with mental disorders, and their language may reveal delusions and scattered, incoherent thoughts as well as "word" salad and idiosyncratic words. Depressed and anxious individuals often reveal self defeating thoughts and inappropriate reasoning, such as regarding minor slip-ups as catastrophes and dwellling on the negative aspects of experiences that are generally positive. Cognitive research seeks to understand how thinking, reasoning, and using language develop and function nomally, how they are represented in the brain, and how they can break down in aging, brain injury, and various mental disorders. Aspects of this research inform the work of therapists as they challenge irrational beliefs and dysfunctional reasoning, encourage clients to re-evaluate their problems, and aid people in overcoming the aftereffects of brain injury and disease. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Studying psychotherapy using the one-with-many design: The therapeutic alliance as an exemplar.

Most psychotherapy research uses a one-with-many design, in which each therapist (the one) treats multiple clients (the many), which raises the challenge of nonindependent data. We present a statistical model for analyzing data from studies that use a one-with-many design. This model addresses the problems associated with nonindependence and can address theoretically relevant questions. To illustrate this model, we analyzed data in which 65 therapists and their 227 clients rated their therapeutic alliance. The primary finding was that both therapist and client alliance ratings were largely relational (i.e., specific to the unique therapist–client combination). There was little consensus among clients treated by the same therapist about the quality of the therapeutic alliance, although some therapists reported forming stronger alliances than other therapists. There was substantial dyadic reciprocity, indicating that if a therapist reported an especially good alliance with a particular client (better than with his or her other clients), then that client was also likely to report an especially good alliance (better than those reported by the therapist’s other clients). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A qualitative analysis of client perceptions of the effects of helpful therapist self-disclosure in long-term therapy.

Thirteen adult psychotherapy clients currently in long-term therapy were interviewed twice, with semistructured protocols, about their experiences with helpful instances of therapist self-disclosure. Data were analyzed with a qualitative methodology. Results indicated that helpful therapist self-disclosures (a) occurred when these clients were discussing important personal issues, (b) were perceived as being intended by therapists to normalize or reassure the clients, and (c) consisted of a disclosure of personal nonimmediate information about the therapists. The therapist self-disclosures resulted in positive consequences for these clients that included insight or a new perspective from which to make changes, an improved or more equalized therapeutic relationship, normalization, and reassurance. Implications for psychotherapy are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapists’ views on working with bilingual Spanish–English speaking clients: A qualitative investigation.

Through semistructured interviews, language switching in therapy was examined with 9 bilingual Spanish and English therapists. Therapists were asked about how and when they switched from one language to another during treatment, as well as the ways in which their clients’ switched languages. After the use of consensual qualitative research methods (C. E. Hill et al., 2005; C. E. Hill, B. J. Thompson, & E. N. Williams, 1997), the results revealed that therapists used language switching as a mechanism to establish trust, bond with clients, and promote disclosure through the use of specific phrases or specific words; particularly, the use of Spanish idiomatic expressions (dichos) served to engage, redirect, and increase client self-understanding and awareness. Therapists reported that their clients switched from English to Spanish when recounting experiences that involved certain emotions (e.g., anger) and represented themselves differently depending on the language they were speaking. Therapists also reported that their clients switched from English to Spanish to improve communication and to connect with them. Future directions for research and implications for training and practice are outlined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An experimental inquiry into transference roles and age.

In this psychotherapy analogue investigation, the effects of client age and therapist age on transference-like projections onto therapists were examined. Young (25–35) and older (60–70) pseudoclients compared paraprofessional therapists to significant figures in their own lives after a dyadic "helping" interview. The results provide empirical support for the phenomenon of reverse transference in therapy with older patients. Older clients were more inclined than young clients to view therapists, particularly younger therapists, as similar to their children. Young clients more willingly attributed parental qualities to older therapists. Both old and young clients may see therapists more as peers or friends than as family members. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Experienced therapists’ approach to psychotherapy for adults with attachment avoidance or attachment anxiety.

Interviews were conducted with therapists (N = 12) nominated by peers as especially effective in working with clients with adult interpersonal problems. Open-ended questions asked how these therapists would approach 2 adult clients described in brief vignettes as having high attachment avoidance or anxiety. A coding team used a grounded theory approach to identify 8 higher order themes in the interviews: Conceptualization, Client Defenses, Managing Boundaries, Markers of Progress, Therapist Reactions, Targeted Interventions, Corrective Relational Patterns, and Internal Representations and Models. These themes were integrated into an inclusive theoretical model based on the core concept of therapists’ strategic management of therapeutic distance. The distance necessary to engage clients initially is adjusted later in therapy to create a corrective attachment in the psychotherapy relationship that facilitates change. Therapists described how, after engagement, they gradually increase therapeutic distance for clients with attachment anxiety who must then manage resulting frustration while learning to function more autonomously. Therapists gradually insist on decreased therapeutic distance to help clients with attachment avoidance overcome their fears of intimacy. Therapists discussed the specific techniques they use to manage therapeutic distance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist retrospective recall impasses in long-term psychotherapy: A qualitative analysis.

Twelve experienced therapists completed a questionnaire, and 8 of the 12 were then interviewed about their experiences with a therapeutic impasse that ended in the termination of therapy. Data were analyzed using a qualitative methodology. Results indicated that most of the clients were anxious and depressed with personality disorders and interpersonal problems. Therapists perceived impasses as having a profound negative impact on both clients and therapists. Variables associated with impasses in a majority of the cases were a client history of interpersonal problems, a lack of agreement between therapists and clients about the tasks and goals of therapy, interference in the therapy by others, transference, possible therapist mistakes, and therapist personal issues. Implications for training, practice, and research are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Experience of client-centered psychotherapists in East Germany. Contribution fo the "International Study for Development of Psychotherapists"--Collaborative Research Network

The empirical study presented here states the conditions of the development and work of client-centered psychotherapists in East Germany. These are compared with those of West Germany (before and after the reunification in 1990). The CCQ data (collected) prove that therapeutically intended client-centered psychotherapy was practised under various conditions with clients with multivarious forms of disturbances of clinical relevance. East German client-centered psychotherapists have often experiences in a ward environment and in client-centered group-psychotherapy. In recent years changes became noticeable in the structure of age, and disorders of clients treated by client-centered therapists in East Germany as well in the overall conditions of their psychotherapeutical activity.