This article examines how therapists and patients start building and managing relationships and pursue institutional goals at the same time. Based on a corpus of 6 audio-recorded therapies (client-centered therapy and psychodynamic therapy), I investigate first encounters between therapists and patients as the starting points of any therapeutical process and the place where a relationship between the interactants is established for the first time. Following a microlinguistic qualitative approach and applying methods from conversation analysis and discourse analysis, I (...) show how therapists, on the one hand, try to align with patients to build a positive working alliance and, on the other hand, work to fulfill specific interactive tasks of therapeutic discourse which demand disaligning with the patients’ communicative activity and their interactive expectations. Specific interactive “jobs” that need to be fulfilled in psychotherapy are identified, namely the performance of institutional roles by the interactants, the establishment of an interaction structure and the pursuit of helpful change in the patient. I show at which places in the interaction therapists (dis-)align with the patients’ projected communicative activity and how aligning and disaligning are related to the interactive process and the establishment and performance of these interactive jobs. The analysis shows that, at the beginning of therapy, alignment and disalignment are both important processes for the following reasons: Aligning with the patient contributes to a positive relationship, which has been shown to be vital for successful psychotherapy, while disaligning introduces the patient to the specific discursive mechanisms that characterize therapeutic discourse and constitute the basis for its effectiveness. Overall, the paper argues that reducing therapy to a dichotomy between relationship and “technique” seems overly simplistic, as both aspects need to be handled and managed at the same time. (shrink)

Explores the theoretical and ethical implications inherent in Freudian psychoanalysis, Rogerian client-centered therapy, and Existentialist psychotherapy, under the premise that these are essentially ideologically motivated utopian statements. Because each of these 3 traditions privileges an idyllic conception of mental health and well-being, achievable only through strict adherence to restrictive codes of prescribed beliefs and behaviors, they ultimately reduce human freedom and possibility. In contrast to these traditional approaches, an alternative which seeks to radically reunderstand psychotherapeutic theory and (...) practice in light of writings of the French philosopher E. Levinas is explored. In this alternative approach, psychotherapeutic praxis is seen to break from its absorption in an imaginary order so as to fulfill an ethical obligation to "dwell-with" an Other in the here-and-now immediacy of their suffering. 2012 APA, all rights reserved). (shrink)

Since the emergence of psychology, its relation with religion has been inconsistent. Their different sources and methodologies but common aims made them close or distanced. Today these disciplines acknowledged and learned to benefit from each other. The affect of religion/spirituality on human’s lives raised the attention of psychology and required the integration of these into psychotherapy. In order to approach the psychology-religion relation via the traces of religion within psychotherapy the paper deals with the necessity, the knowledge needed, (...) the principles when integrating religious/spiritual principles and practices into psychotherapy; finally the religious traces in psychotherapy. The paper comprises few Turkish examples together with the huge body of theoretical and practical examples on the topic. These theories and practices should be important examples for Turkey. By addressing the religious traces in psychotherapy the aim of the paper is to show that the cliff between psychology and religion is in fact not that deep.SummaryIt can be argued that psychology and religion have common interests relating the well-being of individuals. There is a huge body of research that emphasizes the implementation and necessity of cultural, religious, spiritual principles in professional psychology. The proprium of these models is to integrate the client’s religious/spiritual sources into therapy. Especially religious clients benefit from therapies that define their treatment goals around their religious views. However, it must be considered that if the disorder has a biological dimension and/or is severe psychopathologic pure religious interventions will not be sufficient. This paper traces the religious/spiritual principles within psychotherapies and shows that the cliff between religion and psychology is not that deep.At different places in the world therapy is done according to western standards. However, determining mental health or disorders according to western criteria might be problematic. In societies in which religious/spiritual life is an essential part of culture, religion plays a crucial role in people’s perception of disease and treatment. In mental health, spirituality is an important and primary source for coping. Empirical studies reveal the positive outcomes of religious practices such as personal prayer, repentance, meditation, and dhikir on mental and physical health. In light of this data it becomes clear that psychotherapies should be revised socio-culturally and culturally sensitive psychotherapies that cover belief and religious practices should be developed. Another need for the integration of religion, belief, and spirituality with psychotherapy is the significant effect of these experiences on individual’s lives. With regard to the broad impact of religion, psychological interventions solely might not be sufficient to fulfill human psychological needs. As studies show, religious clients expect religious practices in treatment as well as a therapist who is open and respectful to religious principles, ready to talk about own religious beliefs, willing to integrate religious matters into therapy. To fulfill these expectations therapists, need to be trained and educated in religious/spiritual matters. Additionally, the therapist must acknowledge and be conscious about her/his own worldview, religious commitment, and spiritual life. However, the therapist needs not to be religious him/herself or share the same religion as the client. It is sufficient that the therapist is open and receptive to the client’s beliefs so that these can be used as effective sources in therapy. Spiritual psychotherapy considers spirituality as one of the main sources of clients. Thus, it might be critical when the therapist has poor knowledge about religion when the client considers it as significant. This source might be helpful for the client in coping with his/her problems and limitations. Having knowledge about the client’s religion and culture might also be important to acknowledge his/her perceptions and beliefs. Because individuals’ understanding of disease, their beliefs about reasons for mental disorders, their expectations from the health system are important factors in seeking help and choosing therapy.Therapists who decide to integrate spiritual/religious principles into psychotherapy have to adhere to some ethical principles. The source and the degree of the psychological disorder are important, too. Even though the efficacy of religious rituals and spiritual interventions are extensive in each case it has to be investigated whether religiosity/spirituality is part of the problem or the solution. Certain aspects will guide the therapist in deciding whether to integrate religiosity/spirituality into the therapy process or not. Additionally, he/she has to gather information about the client’s religious/spiritual life (spiritual anamneses) in order to choose the most appropriate religious method and intervention. Today psychotherapy deals with coping, questions about the meaning, purpose, and way of life. Actually, these are issues with which religious traditions has dealt and proposed solutions for thousands of years ago. For example, ethical principles for mental health professionals correspond to those of religious teachings. The attitudes and the type of relationship recommended by the client-centered approach are also commended by religious teachings for all human relations. Beginning with the 1960’s an increasing interest in Buddhist teachings is observable among psychotherapists. Mental exercises (especially meditation) cause transformations in the self-perception and lead to enduring changes in consciousness. Religions such as Islam, Judaism, and Buddhism recommend meditation technics like contemplation, dhikr, and yoga. Confession in the Catholic Church has similarities with psychotherapeutic catharsis. Many cultures own one kind of forgiveness rituals of confessions. As studies report people benefit from these rituals. Forgiveness is a multifaceted issue with psychological and spiritual dimensions and involves cognitive, emotional, relational, and spiritual processes. Research indicates the religious and psychological functions of forgiveness. Many subjects such as personal prayer, hope, empathy, love, and tolerance are common issues of both, psychotherapy and religion/spirituality. Different psychotherapeutic approaches and especially positive psychology integrate these values that are valued by religion/spirituality into their theories and practices.In conclusion, the cliff between psychology and religion/spirituality is not that deep at it seems at first sight. They have many subjects in common. Individuals turn to religion and spirituality in times of crises. This makes it inevitable to include religion and spirituality into the therapeutic process. Because religions provide ways of coping, hope, and meaning in difficult times. This fact is recognized and accepted abroad and lead to the religious/spiritual psychotherapy movement, which will hopefully an inspiration for Turkish psychology as well. (shrink)

Sacred Science will be of interest to all those who believe in the emergence of the self-determining human spirit within the field of religious belief and practice. It is written for the general reader, yet specialists in transpersonal studies will find that it addresses critical issues at a sophisticated level.

In the article is given to the analysis of the formation and development of the theory of client-centered therapy K. Rogers and detection of its humanistic content. The concept of k. Rogers provides an effective ìnstrementarìj that allows you to "collect the individual pieces together and garmonìzuvuati his relationship with those around the world. Based on the concepts of humanization. These methods of treatment of individual allow solving internal conflicts of man and give hope for the survival of (...) the human species. (shrink)

Psychotherapy clients read two consumer-oriented brochures: a general brochure on psychology and a brochure on the topic of client-therapist intimacy. Half of the participants read the general brochure first and the brochure on client-therapist intimacy second, and half the participants did the reverse. Participants reported favorable reactions to the brochures, indicating they thought both should be made available to psychotherapy clients; that neither were too long, too sensitive, or too difficult to read; and that the brochures (...) should be made available early during the therapeutic process. After reading the client-therapist intimacy brochure, participants also showed some changes in Likert-type scores measuring attitudes regarding intimate contact between clients and therapists. Although participants were more negative about issues of sexual misconduct after reading the client-therapist intimacy brochure, they did not indicate a decrease in trust of therapists, nor did they indicate a greater likelihood of filing a false complaint. We concluded that therapists' reservations about presenting clients with factual information regarding therapist sexual exploitation of clients are not empirically founded. (shrink)

Carl R. Rogers, the founder of client-centered therapy, contributed to the development of self-reliant learning in education. He applied such concepts of client-centered therapy as realness, prizing, acceptance, trust, and empathy to educational area, and called attention the importance of the authentic relationship between teacher and student with such books as Freedom to Learn, Becoming A Person, and A Way of Being. Besides, he also focused on teachers‟ attitudes in classrooms in his works. His views still (...) continue to influence the practices in both contemporary psychotherapy and education. The current study aims to introduce Rogers‟ views on teachers‟ attitudes facilitating students‟ learning, to discuss the views in the light of existentialist approaches and thus to make contributions to the development of educational environments. (shrink)

The purpose of this paper is to examine what heals and harms the client in the psychotherapeutic encounter, from the client's perspective. The experience of eight clients was explicated using a model based on Giorgi and Schweitzer. The counselling experienced as healing by clients has at its core a vibrantly warm and honest relationship where the client feels held in the safety of the good heart space of the counsellor. The counsellor is experienced as providing an intense (...) beingness for the client that embraces the client's suffering and provides solid ground created out of the crucible of the counsellor's own encounter with his or her shadow. The counsellor is emptied out of his/her own agenda and provides space for the client's experience. The counsellor can evoke the higher resources of the client. The counselling is experienced as renewing and reconnecting the clients to his/her sense of self, of other and the lifeworld. The counselling relationship experienced as harming is described as being drained of human presence and transforming power. There is no alive human connection. The counsellor is experienced as insubstantial, and has no ability to hold traumatic experience. The counsellor's cold reception to the client's vulnerabilities has the power to shatter, fragment and splinter the client. The counsellor is full of self. This fullness may be ego that manifests as dry intellectualising or playing manipulative games as a substitute for human presence. This may lead the client to terror, sickness and anxiety. The counsellor may be full of their own fears and are experienced by the client as chaotic, avoidant and overwhelmed. Their unavailability leads clients to experience emotional depletion, exhaustion and frustration. The counsellor's self-righteousness, judgement and critical disengagement are experienced by clients as being belittled, condemned and diminished. The therapeutic encounter results in a weakening of the human potential for recovery. Both client and counsellor emerge as lesser human beings, with weakened relationships to self, others and the world. Indo-Pacific Journal of Phenomenology , Volume 1, Edition 2 September 2001. (shrink)

One ethical issue that commonly comes up in clinical practice is the negotiation of fees with clients. Although the APA Ethics Code provides standards regarding clients who are unable to or do not pay, little guidance is given pertaining to fee limits for clients who want to pay more. This issue is explored using a real case example, including the relevant ethical codes to be considered. The necessary “gray” areas of ethical decision-making are demonstrated through my own decision process. Implications (...) for future scenarios are discussed. (shrink)

Extra-marital affairs are common in theusand frequently result in difficulties for individuals, families, and society. The psychological literature, however, does not provide adequate client-centered treatment directions for those who have affairs and seek psychotherapy for this issue.In an attempt to begin to address this gap in the literature, a descriptive phenomenological psychological study, a method that has the goal of articulating the general structure of an experience, in a pretheoretical manner, was undertaken. Results suggest areas of further (...) inquiry and may imply directions for psychotherapeutic praxis with those who have had affairs. (shrink)

Reasoning can promote psychological development, so even if the role of philosophical counselor is defined strictly in terms of assisting the reasoning of the client, we can expect client-centered philosophical inquiry to yield psychological benefits. The practices of philosophical counseling and psychotherapy permeate one another to some degree while also diverging in characteristic focus. Philosophical counselors are particularly well suited to helping clients think through their situation in the world.

Within emotion-focused therapy, the client’s ability to express and reflect on core emotional experiences is seen as fundamental to constructing the self and to entering into a change process. For this study, we 1) examine storytelling contexts in which clients do not disclose the emotional impact of their narrative, and 2) identify the interactional practices through which EFT therapists subsequently call attention to what the client may have felt. In doing so, we examine client stories drawn from (...) video-taped individual psychotherapy sessions involving clinically depressed clients. Client stories and therapists’ responses to these stories were analysed using conversation analytic methods. Three different therapist response types were identified: eliciting, naming and illustrating the emotional impact of the client’s prior narrative. These responses also were found to differ in terms of how effectively they could display empathy and secure affiliation with clients. The implications of this work for therapeutic practice are discussed. (shrink)

BackgroundCurrently, most people who might need mental health care services do not receive them due to a number of reasons. Many of these reasons can be overcome by telepsychology, in other words, the use of ICT technologies for therapy ; given that it facilitates access to specialized interventions. In fact, telepsychology is currently offered as an active service in many psychotherapy centers. However, its usage, how it is perceived, and who uses it are still largely unknown.ObjectiveThe aim of this (...) study was to determine if any pattern exists in the usage of telepsychology and face-to-face psychology, to clarify people’s perception of telepsychology in terms of the advantages, barriers and efficacy of online psychotherapy, and to examine usage patterns in terms of individual characteristics and identify patients’ profiles.MethodsAn online survey was conducted on a convenience sample of 514 subjects recluted by using an online advertisement. The inclusion criteria were: to be older than 18 years old and to answer completely the questionnaire. Cluster analysis, ANOVAs, and discriminant analysis were performed to test our research objectives.ResultsThree usage clusters were found: face-to-face psychotherapy ; non-therapy ; and combined face-to-face psychotherapy and telepsychology. In addition, the perception of telepsychology varied among usage clusters, but a common perception emerged about the main telepsychology advantages, barriers and efficacy. Finally, the results showed that personal characteristics differentiated people in each of these clusters.ConclusionThe most common form of access to psychotherapy is the face-to-face form but the second way of delivery was a combination between face to face and online psychotherapy. People who combine face to face with online psychotherapy perceives this last as more efficient and with less barriers to access. Finally, some characteristic as eHealth experience and sociodemographic variables can help to identify people that will attend telepsychology initiatives. These clusters provide insight into opportunities for face-to-face and online patient engagement strategies. (shrink)

BackgroundRemotely provided psychotherapy due to the COVID-19 pandemic became common. One of the most significant changes related to providing online psychotherapy services is that clients no longer travel to their sessions.AimsIn the article we are interested in the narrated experience of the absence of journey to psychotherapy sessions. We study clients' stories of past journeys and how their absence, resulting from the change of the mode of therapy provision, is coped with and replaced by other activities in (...) their narratives.MethodsThe study takes a constructionist approach to discourse and focuses on the lexico-grammatical form of the notes. The data come from 12 semi-structured interviews with people who declared attending remote psychotherapy sessions after the national lockdown had been introduced.ResultsIn the collected data, the physical journey is constructed not only as travel time, solitude which can be used for reflection, but, importantly, as an active process which ends with a resolution. In contrast, in narratives of the time before an online session, constructions of unfettered agents are replaced with those of people whose actions are hedged and qualified.ConclusionWe argue that in the informants' narratives the journey to psychotherapy is meaningful and is part of the therapeutic process. We propose that it is a time of passing between two states—one before therapy and one in session. The journey therefore is experienced as a process of change, and not only a process of traveling. (shrink)

Psychotherapy holds out the promise of help for people who are hurting and in need. It can save lives and change lives. In therapy, clients can find their strengths and sense of hope. They can change course toward a more meaningful and healthy life. They can confront loss, tragedy, hopelessness, and the end of life in ways that do not leave them numb or paralyzed. They can discover what brings them joy and what sustains them through hard times. They (...) can begin to trust, or to trust more wisely. They can learn new behaviors in therapy and how to teach themselves new behaviors after therapy ends. They can question what they always believed was a given. They can find out what matters most to them, and how to stop wasting time. They can become happier, or at least less miserable. They can become better able, as Freud noted, to love and to work. They can learn how to accept and love themselves just as they are and accept others who are different from them. Our ethics acknowledge and affirm our profession's responsibilities. This book was written to help strengthen, deepen, and inform ethical awareness and the sense of personal ethical responsibility. Its job is to help you hold onto the ideals-including ethical ideals-that called you into the profession to begin with, to help you develop and fulfill those ideals. There will be so much-trust us on this-that tends to dull ethical awareness, to make ethics drift out of focus, to create barriers between you and your ideals, to replace ethics with pseudo-ethics and ethics placebos. Fatigue, endless paperwork, unrealistic expectations, illness, family crises, not being able to make ends meet, burn out, threats of job loss, insurance coverage that doesn't come close to meeting the needs of our clients, biases that have not been addressed, and so many other forces can pressure us into cutting ethical corners. This book is intended to help you develop a strong and healthy resistance to such forces, to help you weather them without losing your ethical awareness and ideals. (shrink)

According to insight-oriented psychotherapies, the change clients undergo during therapy results from insights gained into the "true" nature of the self, which entail greater self-knowledge and self-understanding. In this paper, I question such claims through a critical examination of the epistemological and metaphysical values underlying such forms of therapy. I claim that such psychotherapeutic practices are engaged in a process that subtly "absorbs" clients into the therapist's philosophical framework which is characterized by a certain problematic conception of subjectivity, knowledge, and (...) reality. Through mechanisms which are intrinsic to the therapeutic encounter, such as suggestion and power, such therapies construct and reconfigure clients along the lines of socially accepted norms and values. Consequently, insight-oriented psychotherapy results in a deceptive form of social control. (shrink)

Psychotherapy style is conceptualized as the therapeutic method that a therapist employs while working with clients during treatment. It influences both the therapeutic process and results of therapeutic actions. The present study developed and validated the Psychotherapy Style Scale. By following a systematic psychometric development process, a three-factor structure of the PSS was identified. Exploratory factor analysis and confirmatory factor analysis provided evidence of multidimensional structure and validity of the PSS. Cronbach’s α suggested that the resulting scale was (...) highly reliable. Criterion validity was also satisfactory, demonstrated by correlations between the scale and criterion validity measures. The PSS has the potential to help better understand therapists’ behavioral characteristics and select the most appropriate therapists for clients who undergo psychotherapy. (shrink)

The area of psychotherapy has grown considerably in Ireland since the original edition of this book was published in 1993, and in this revised edition twelve leading practitioners of psychotherapy working in Ireland offer an overview of the approach or school of psychotherapy that is within their area of competence. Among the topics covered are: psychoanalysis, child psychoanalytic psychotherapy, Jungian analysis, psychosynthesis and transpersonal theory, constructivist psychotherapy, family therapy, cognitive-behavioral therapy, gestalt theory, the person (...) class='Hi'>centered approach, and an integrative approach to psychotherapy. (shrink)

This book takes the discursive and postmodern turn in psychotherapy a significant step forward and will be of interest to all those working in mental health who want to work wiht clients in ways that will facilitate challenges to oppression and processes of emancipation. It achieves this by: · reflecting on the role of psychotherapy in contemporary culture · developing critiques of language in psychotherapy that unravel its claims to personal truth · the reworking of a place (...) in the transforative therapeutic practice Deconstruction is brought to bear on the key conceptual and pragmatic issues that therapists and clinical psychologists face, and the project of therapy is opened up to critical attention and reconstruction. The book provides clear reviews of different viewpoints and will help readers to orient themselves on the complex terrain of debates. (shrink)

Despite a wealth of findings that psychotherapy is an effective psychological intervention the principal mechanisms of psychotherapy change are still in debate. It has been suggested that all forms of psychotherapy provide a context which enables clients to transform the meaning of their experiences and symptoms in such a way as to help clients to feel better, and function more adaptively. However, psychotherapy is not the only healthcare intervention that has been associated with ‘meaning’: the reason (...) why placebo have effects has also been proposed to be a ‘meaning response’. Thus, it has been argued that the meaning of treatments has a central impact on beneficial (and by extension, negative) health-related responses. In light of the strong empirical support of a contextual understanding of psychotherapy and its effects, the aim of this conceptual analysis is to examine the role of meaning and its transformation in psychotherapy – in general – and within three different, commonly-used psychotherapy modalities. (shrink)

Summary The article substantiates the possibility and meaningfulness of a coherent theoretical system for psychotherapy, as it is strived for in Gestalt Theoretical Psychotherapy and presented in several articles in this issue of the journal "Gestalt Theory". The necessity of consistency in the theoretical assumptions and concepts of a psychotherapy method is not derived from scientific considerations alone, but already arises from the elementary role of consistency in human life. This also results in the requirements for the (...) consistency of theoretical foundations of psychotherapy. It is not fulfilled in a mere internal, logical consistency of its models, but only in the actual fitting together with the critical-phenomenal and naive-phenomenal worlds of the therapists and their clients in the reality test of life. (shrink)

According to insight-oriented psychotherapies, the change clients undergo during therapy results from insights gained into the "true" nature of the self, which entail greater self-knowledge and self-understanding. In this paper, I question such claims through a critical examination of the epistemological and metaphysical values underlying such forms of therapy. I claim that such psychotherapeutic practices are engaged in a process that subtly "absorbs" clients into the therapist's philosophical framework which is characterized by a certain problematic conception of subjectivity, knowledge, and (...) reality. Through mechanisms which are intrinsic to the therapeutic encounter, such as suggestion and power, such therapies construct and reconfigure clients along the lines of socially accepted norms and values. Consequently, insight-oriented psychotherapy results in a deceptive form of social control. (shrink)

In psychotherapy, the norm and expectation is for clients to self-disclose, thus disregarding and discouraging self-disclosure by therapists. This study aimed to investigate clients’ subjective experience of therapist disclosure, and in particular how clients interpret, appraise and react to therapist disclosure, using semi-structured interviews to gather data from eight research participants. By means of Interpretative Phenomenological Analysis of the data three basic themes were revealed: perceived underlying conditions of the disclosure event, disclosure type and disclosure impacts. The findings indicate (...) that the underlying conditions surrounding the therapist’s disclosure are the determinant factor as to how clients experience therapist disclosure, regardless of either the disclosure type or the impact of the disclosure on clients’ lives. (shrink)

This exciting volume brings together leading figures across existential psychology in a clear-sighted guide to its current practice and therapeutic possibilities. Its accessible yet scholarly presentation dispels common myths about existential psychotherapy while demonstrating core methods and innovative techniques as compatible with the range of clinicians' theoretical orientations and practical approaches. Chapters review the evidence for its therapeutic value, and provide updates on education, training, and research efforts in the field, both in the US and abroad. Throughout, existential (...) class='Hi'>psychotherapy emerges as a vital, flexible, and empirically sound modality in keeping with the current-and future-promotion of psychological well-being. Highlights of the coverage include: Emotion, relationship, and meaning as core existential practice: evidence-based foundations. · Meaning-centered psychotherapy: a Socratic clinical practice. Experience processing as an aspect of existential psychotherapy: life enhancement methodology. Structural Existential Analysis (SEA): a phenomenological method for therapeutic work. Experiencing change: an existential perspective. Creating the World Congress for existential therapy. Clarifying and Furthering Existential Psychotherapy will spark discussion and debate among students, therapists, researchers, and practitioners in existential psychology, existential psychotherapy, and allied fields as well as the interested public. It makes a suitable text for graduate courses in existential therapy, psychological theories, and related subjects. (shrink)

Ethics and Values in Psychotherapy examines the ways in which the ethical convictions of both therapist and client contribute to the practical process of psychotherapy. Practitioners are increasingly focusing on the issue of their extensive--and often problematic--ethical influence on clients as they attempt to agree on guidelines and standards for professional practice. Alan C. Tjeltveit argues that any discussion of ethical practice in psychotherapy must be carried out in connection with traditional ethical theories. The author draws (...) on scientific, clinical, and philosophical approaches to address issues such as: the role of therapy in society; the goals and outcomes of psychotherapy; techniques and practices; the existence and operation of values; and the intellectual and social context in which therapy takes place. This comprehensive study is a significant contribution to the debate on the ethical character of psychotherapy. (shrink)

The comprehensive guide to ethics "An excellent blend of case law, research evidence, down-to-earth principles, and practical examples from two authors with outstanding expertise. Promotes valuable understanding through case illustrations, self-directed exercises, and thoughtful discussion of such issues as cultural diversity."--Dick Suinn, president-elect 1998, American Psychological Association "The scenarios and accompanying questions will prove especially helpful to those who offer courses and workshops concerned with ethics in psychology."--Charles D. Spielberger, former president, American Psychological Association; distinguished research professor of psychology, University (...) of South Florida The authors draw on their professional experience, empirical studies, and case examples to examine the ethical responsibilities that confront psychotherapists and counselors in their day-to-day practice. They offer insights into contending with the sometimes competing demands of clients' needs, formal ethical principles, personal values, and evolving legal standards in a range of areas--including fees, informed consent, sexual concerns, confidentiality, documentation, and supervision. (shrink)

Currently there are several psychotherapy modalities utilising theory and research from neuroscience in treatment frameworks for mental health and recovery from trauma. In Australia this includes: the Conversational Model of Psychodynamic Psychotherapy, a contemporary psychodynamic approach used for treating Borderline Personality Disorder and other trauma-related disorders; Electroencephalogram Neurofeedback, a brain training therapy which has been used as an adjunct to counselling/psychotherapy in traumatic stress and developmental trauma; and Somatic Experiencing, an integrative mind-body approach based on body responses (...) to threat and fear, especially thwarted attempts to enact fight or flight in the face of threat. These modalities have a promising but still-limited evidence base. This paper explores the role of different types of evidence to frame a descriptive review of the current evidence base available for clinicians practicing in these three modalities. While large clinical trials can provide evidence of comparative effectiveness, case studies, observational, qualitative and practice-based enquiry can assist in discovering other aspects of therapy important for individual clients and practitioners. Existing frameworks of evidence- and ethics-informed health and clinical decision-making suggest an ethical approach can incorporate new, developing and evidence-building therapies. Recommendations include careful consideration of informed consent for therapy including disclosure of efficacy and safety, and specific to psychotherapies incorporating neuroscience, a need for practitioners to reflectively assess their own knowledge, competence, heuristic approaches and biases. (shrink)

While psychotherapy is helpful to individual clients, the slim cadre of therapists and the vast number of disturbed people precludes any hope that more than a relative few will receive help. Nowhere is the futility of psycotherapy as obvious as among the poor and powerless whose suffering, crowding, and dispair will yield only to social and political solutions. In the United States the expansion of the number of psychiatric diagnoses and the demographic changes in populations will only make larger (...) the gap in numbers between therapists and clients. Psychotherapy is an expensive oddity to the poor, but their taxes will help the affluent obtain prepaid care. Psychotherapy does reveal some of the social and economic factors, like bad parenting, homelessness and unemployment, that cause emotional disturbances. But one-to-one treatment, medical or psychological, does not, and cannot, affect incidence. The rightward movement of American psychiatry, supported by political conservatives and by activist parent-groups, espouses an organic explanatory model for all mental disorders and for a wide range of human problems. Only effective primary prevention leading to social change will reduce future incidence. (shrink)

Proponents of empirically supported treatment have argued that psychotherapists have an ethical obligation to make an EST the first choice in clinical practice. This paper challenges this idea. The EST program assumes a model of therapy as technology or applied science that poorly fits the reality of psychotherapeutic practice. The problems brought to therapy implicate fundamental questions regarding what constitutes a good life. A therapeutic response to such problems is not a technical means to change a circumscribed disorder, but an (...) engagement with the client that has relevance to broader moral concerns. Further, the picture of therapy as technology of change implicitly proposes views of a good life, while not acknowledging that it is doing so. 2012 APA, all rights reserved). (shrink)

Conversation analysts have noted that, in psychotherapy, formulations of the client's talk can be a vehicle for offering a psychological interpretation of the client's circumstances. But we notice that not all formulations in psychotherapy offer interpretations. We offer an analysis of formulations that are diagnostic: that is, used by the professional to sharpen, clarify or refine the client's account and make it better able to provide what the professional needs to know about the client's (...) history and symptoms. In doing so, these formulations also have the effect of shepherding the client's account towards subsequent therapeutic interpretation. In a coda, we notice that sometimes the formulations are designed discreetly. We examine one such discreet formulation in detail, and show how its very ambiguity can lead to its failure as a diagnostic probe. (shrink)

This book takes Edmund Husserl's phenomenology and applies it to help psychotherapy practitioners formulate complex psychological problems. The reader will learn about Husserl's system of understanding and its concepts that point to first-person lived experience, and about the work of Husserl scholars who have developed a way to be precise about the experiences that clients have. Through exploring the connection between academic philosophy of consciousness and mental health, themes of biopsychosocial treatment planning, psychopathology of personality and psychological disorders, and (...) the treatment of complex psychological problems become clear. The author shows that Husserlian phenomenology can be used in the design of interventions for clients in a process called formulation. Once the intentionality of consciousness is understood, by asking simple questions, it becomes possible to define problematic experiences. This is a means of creating informed consent for treatment and it makes it clear to clients what is happening for them, so helping them understand themselves and how they see the world. We also see how Husserl's phenomenology is a vehicle for psychotherapists to present their knowledge about the research literature of what has been found to be effective care. This volume applies the concepts and practices of phenomenology in a concrete way, relating them to the practice of therapy and showing the value of a qualitative approach to understanding mental processes and the nature of human beings as motivated by values, meanings and other conscious experiences. This is a readable text in simple language that condenses key aspects of Husserl's thinking in relation to the theory and practice of psychotherapy, and it is suitable for philosophers and practitioners of psychology, psychiatry, and the psychotherapies, including psychoanalysis. (shrink)

Many therapists can attest to the fact that adolescents can be difficult and frustating clients-problems are seldom well defined, clearly delineated symptoms are more exception than the rule, and troubling situations often involve the entire family. Gestalt therapist Mark McConville draws on his more than twenty years of professional experience to offer clinicians an effective model for understanding and treating adolescents. He outlines the Developmental Tasks Model, which describes adolescents' struggles, "temporary insanity," and ultimately, triumph of development. He clearly demonstrates (...) that the Gestalt therapeutic model bridges the theoretical and clinical gap, and offers an indepth exploration of the various aspects of clinical work. _Adolescence_ offers valuable nuts-and-bolts advice on initiating therapy with adolescents who are not yet ready to do the self-reflective, exploratory work. In addition, the book examines the therapeutic method of engaging and cultivating the adolescent's emerging inner world. With perception and sensitivity, McConville explains how the clinician can guide the adolescent in the very personal and subjective process of birthing and existential self. The book details the process of the creative reorganization of the self during adolescence and explores the changes that take place in the adolescent's relationships with peers, parents, and others in the adult world. The author also tracks the interplay of intrapsychic and interpersonal boundary development and shows how this interplay manifests itself in relationships and evolves from early through late adolescence. The Gestalt model of therapy allows the clinician to make sense of the confusion of the adolescent world and map out the multiple possibilities of clinical interventions. (shrink)

Many therapists can attest to the fact that adolescents can be difficult and frustating clients-problems are seldom well defined, clearly delineated symptoms are more exception than the rule, and troubling situations often involve the entire family. Gestalt therapist Mark McConville draws on his more than twenty years of professional experience to offer clinicians an effective model for understanding and treating adolescents. He outlines the Developmental Tasks Model, which describes adolescents' struggles, "temporary insanity," and ultimately, triumph of development. He clearly demonstrates (...) that the Gestalt therapeutic model bridges the theoretical and clinical gap, and offers an indepth exploration of the various aspects of clinical work. _Adolescence_ offers valuable nuts-and-bolts advice on initiating therapy with adolescents who are not yet ready to do the self-reflective, exploratory work. In addition, the book examines the therapeutic method of engaging and cultivating the adolescent's emerging inner world. With perception and sensitivity, McConville explains how the clinician can guide the adolescent in the very personal and subjective process of birthing and existential self. The book details the process of the creative reorganization of the self during adolescence and explores the changes that take place in the adolescent's relationships with peers, parents, and others in the adult world. The author also tracks the interplay of intrapsychic and interpersonal boundary development and shows how this interplay manifests itself in relationships and evolves from early through late adolescence. The Gestalt model of therapy allows the clinician to make sense of the confusion of the adolescent world and map out the multiple possibilities of clinical interventions. (shrink)

The Tidal Model represents a significant alternative to mainstream mental health theories, emphasizing how those suffering from mental health problems can benefit from taking a more active role in their own treatment. Based on extensive research, The Tidal Model charts the development of this approach, outlining the theoretical basis of the model to illustrate the benefits of a holistic model of care which promotes self-management and recovery. Clinical examples are also employed to show how, by exploring rather than ignoring a (...) client's narrative, practitioners can encourage the individual's greater involvement in the decisions affecting their assessment and treatment. The Tidal Model 's comprehensive coverage of the theory and practice of this model will be of great use to a range of mental health professionals and those in training in the fields of mental health nursing, social work, psychotherapy, clinical psychology and occupational therapy. (shrink)

Mental health professionals face many complex questions in the course of their work with clients and patients. Among the most difficult are dilemmas that involve ethical issues. This book presents a forthright exploration of these dilemmas and the ethical considerations they raise. Drawing on extensive interviews, the author identifies common ethical problems that practitioners encounter. What happens, for example, when personal interests intrude into therapy? How can the therapist make an accurate assessment of his or her appropriateness as a care (...) provider for a particular patient? What about confidentiality? How are problematic financial arrangements best addressed? The author goes on to show how these dilemmas may be intensified by the unique assumptions of different therapeutic orientations--individual, group, family, marital, and organizational--and how professionals can learn from such experiences to better understand and apply their particular approach. This analysis--and the words of the therapists themselves--provide both a guide to practice and a unique store of experience for the growing number of researchers and students concerned with ethical problems in psychotherapy. (shrink)

The Revisions Task Force of the Ethics Committee of the American Psychological Association (APA) has proposed that prohibition of sexual intimacies with clients after termination of therapeutic relationships be made an explicit part of the new code. This decision was based on much careful deliberation and input from various individuals and groups. This article supports the proposed change and provides a rationale based on emerging theoretical positions and research findings regarding risks to clients, risks to professionals, and risks to the (...) various mental health professions. The revision would read, "Psychologists do not engage in sexual intimacies with current or former psychotherapy clients" (see "Ethical Principles Revised", 1990). (shrink)

_Using Art Media in Psychotherapy_ makes a thoughtful and contextual argument for using graphic art materials in psychotherapy, providing historical context for art materials and their uses and incorporating them with contemporary practices and theories. Written with an analytic focus, many of the psychological references nod to Jung and post-Jungian thought with keen attention to image and to symbolic function. This book jettisons the idea of reductionist, cookbook approaches and instead provides an integrated and contextual understanding of the origins (...) of each art form as well as an insightful use for each in its application in mental health healing practices. _Using Art Media in Psychotherapy _gives clinicians and students alike the tools they need to offer psychologically minded and clinically astute choices that honor their clients. (shrink)

New and experienced psychotherapists alike can find themselves overwhelmed by an ethical quandary where there doesn't seem to be an easy solution. This book presents positive ethics as a means to overcome such ethical challenges. The positive approach focuses on not just avoiding negative consequences, but reaching the best possible outcomes for both the psychotherapist and the client. The authors outline a clear decision-making process that is based on three practical strategies: the ethics acculturation model to help therapists incorporate (...) personal ethics into their professional roles, the quality enhancement model for dealing with high-risk patients who are potentially harmful, and ethical choice-making strategies to make the most ethical decision in a situation where two ethical principles conflict. Throughout the decision-making process, psychotherapists are encouraged to follow four basic guidelines: Focus on overarching ethical principles Consider intuitive, emotional, and other nonrational factors Accept that some problems have elusive solutions Solicit input from colleagues and consultation groups Numerous vignettes illustrate how to apply positive ethics to many different ethical challenges that psychotherapists will likely encounter in practice. (shrink)

ObjectiveTo explore how clients in clinical settings experience the process of opening up and sharing their inner experiences in the initial phase of therapy.MethodsTwo psychotherapy sessions of clients were videotaped and followed by interviews. Interpersonal process recall was used to obtain in-depth descriptions of clients’ immediate experiences in session. A follow-up interview was conducted 3 months later. The interviews were analyzed using thematic analysis.ResultsThe data revealed how and why clients distanced themselves from inner experiences in the initial phase of (...) therapy. The overarching theme was “Holding back and struggling to open up,” which included four subthemes: fearing the intensity and consequences of negative emotions; experiences of being incapable and bodily stuck; being insecure about one’s worthiness and right to share inner experiences with the therapist; and struggling with feeling disloyal to loved ones.ConclusionThe participants held back because they feared different consequences of opening up. A range of concerns led participants to distance themselves from their inner experiences and/or to refrain from openly talking about them to the therapist. Concerns related to appropriate interpersonal conduct as client were especially important. This knowledge is highly relevant to clinicians when building safety for psychotherapeutic work. (shrink)

Secular and religious values of psychotherapists influence the process of psychotherapy. The psychologist Allen Bergin has pointed out several major antitheses between values of secular psychotherapists and their religiously oriented clients. The present essay is a response to Bergin's antitheses, on the one hand, and to humanistic psychology, on the other, from the point of view of a Christian humanism. Karl Rahner's theological anthropology is proposed as one possible foundation for an explicit articulation of the relationship between psychotherapy (...) and religion, and as a means to address apparently divergent values of psychotherapists and religious believers. (shrink)

While scientific interest in the relationship between psychotherapeutic praxis and spirituality is growing, there is still little knowledge on this topic, especially in an East Central European context. To explore how psychotherapists understand spiritual issues and experiences they encounter in their work and to learn what happens to these issues in the course of psychotherapy, this study analyses semi-structured interviews with 30 Hungarian psychotherapists. Applying a grounded theory analytical strategy, three main topics were identified: the therapist's attitude towards spirituality (...) leaves a discernible trace in the psychoterapeutic treatment; the therapist influences the way spiritual issues are treated; and the therapist may have a shared spiritual experience with the client. We present individual variations of these experiences as they appear in the code tree. Results are interpreted with reference to a systemic view of the psychotherapeutic process, the intersubjective space of patient and therapist, and the notion of the therapists’ mentalizational capacity. (shrink)

The experience of loss of agency is one of the reasons for clients to go for psychotherapy. Enhancing clients’ agency has been considered a fundamental factor for successful treatment in psychiatry and psychotherapy, yet few studies have investigated the interactional realization of how therapists do this in authentic psychotherapeutic encounters. Drawing on audio-recorded talk-in-interaction between clients and psychotherapists in cognitive behavioral therapy encounters at a mental health center in China, this paper uses the method of conversation analysis to (...) demonstrate how therapists ascribe agency positions to clients by issuing formulations of what the clients have just said. Two types of formulation were identified: affirmative formulations and challenging formulations. In the first type, the therapists highlight the positive aspect of the clients’ description of their experiences and ascribe an agentic position to the clients. In the second, the therapists challenge the clients’ implausible views and their non-agentic positioning of themselves. This study shows that the therapists’ formulation could be employed to manage the epistemic difficulties associated with claiming knowledge about the clients’ inner states and assessing their feelings. In this sense, the formulation is a robust interactional device in negotiating epistemic problems in addressing the clients’ experiences and promoting their agency in therapy. However, it is noteworthy that in the challenging formulation, therapists claim privileged access to the clients’ knowledge domain and challenge their prior epistemic status, which might run the risk of engendering clients’ resistance. (shrink)

PREFACE This volume is a sequel to yet independent of our Paranoia: A Study in Diagnosis, Reidel, Dordrecht and Boston, 1976. Whereas our first book centered on diagnosis, this centers on treatment. In our first volume, all discussions of nosology (theory of illness) and of treatment was ancillary to our discussion of diagnosis; similarly all discussion of this volume dealing with nosology - there is very little on diagnosis here - is ancillary to our discussion of psychotherapy. It (...) is still our profoundest conviction that to speak of treatment without diagnosis is meaningless, if not irresponsible, since otherwise one does not know what one is talking about. Hence, our present study, though it centers on theories of treatment, links psychotherapy with psychopathology. It is the rationale of psychotherapy which is of importance, and the rationale dwells in this link. We wish our present study to be self-contained and understood by readers who are not familiar with our first book - or with any specific literature. Our discussion of medicine in general, meaning the rationale of therapy in general, helps the uninitiated reader, as well as the initiated, we hope: it certainly has helped us. We did not see how else can we study a branch of medicine; we felt the need for some idea of how medicine is supposed to work. (shrink)