Sedlakova and Trachsel (2023) discuss the ethical concerns associated with employing what they term conversational artificial intelligence as therapist substitutes. Given their apprehensions, they...

Based on conversations between 10 Chinese children with Autism Spectrum Disorders and five therapists in the context of Naturalistic Intervention, this study investigated the therapists’ agreement expressions in this typical setting. The study found that the therapists mainly used four agreement strategies: acknowledgment, positive evaluation, repetition and blending. These four strategies could be used individually or in combination. The first three strategies and their combinations were used frequently during the therapeutic conversation. With the major occurrences in the (...) post-expansion position, the agreement expressions in the therapeutic conversation mainly performed three functions, namely, creating a supportive therapeutic relationship, serving as positive reinforcers and implementing interventions pertinent to communication skills. This study proposed that the therapists’ preferred use of agreement expressions in the intervention process could be explained by the features of Naturalistic Intervention. (shrink)

This paper is based on a study of therapists’ experiences of working with suicidal clients. Using a hermeneutic-phenomenological methodology informed by Heidegger, the study provides an understanding of the meaning of therapists’ experiences from their perspective as mental health professionals in New Zealand. In this regard, the findings of the study identified three themes: Therapists’ reaction of shock upon learning of the suicide of their client; Therapists’ experience of assessing suicidal clients as a burden; and finally, (...) Therapists’ professional and personal crises as a result of their experiences and struggling to come to terms with events.The study sheds light on how the experiences of therapists whose clients have committed suicide can be understood. The findings show how mainstream prevention and intervention strategies result from the misrepresentation and misinterpretation of our traditional way of knowing what it means to be human. When therapists discover that phenomena are not necessarily what they appear to be, they feel unsettled and confused about their responsibilities and what it means to live and die as a human being. The study reveals that therapists experience a profound legacy of guilt, doubt and fear when a client commits suicide. Finally, the study proposes that the time has come for the profession to care for its own in order to allow therapist, in turn to care for (and about) the vulnerable other. (shrink)

This book provides an accessible comprehensive exploration of phenomenological theory and research methods and is geared specifically to the needs of therapists ...

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)

The question of what works in psychotherapy has been a subject of debate in the recent years, occupying both clinicians and researchers. In this study, we aimed to assess the current perspectives held by clinicians regarding the processes which produce changes in psychotherapy, as well as the predictors of specific views. Licensed therapists, consisting mainly of psychodynamically and integratively oriented psychologists, were asked to write in their own words what they think works in psychotherapy. Thematic analysis was employed to (...) assess the main mechanisms of change as perceived by the therapists. Differences in the prevalence of specific themes were assessed using Friedman and Wilcoxon signed-rank tests. Univariate logistic regressions were employed to assess the factors that predict the probability of reporting a specific mechanism of change. The results indicated that the therapeutic bond was the most highly reported mechanism of change, followed by theory-driven mechanisms of change, therapist characteristics, therapist professionalism, and client motivation. Male therapists were more likely to indicate the professionalism as a mechanism of change compared to female therapists. Higher education was associated with lower reports of therapists’ characteristics as the mechanisms of change. These results suggest that therapists acknowledge the importance of the working alliance, and that the perception of the mechanism of change is associated with various factors which comprise therapist orientation. Limitations and directions for future research are discussed. (shrink)

Although racism has always been present in the therapy room, the recent political climate and flood of news stories highlighting racist narratives and behaviors have made race and racism more salient in our society. For white therapists who align with antiracism in their self-identity and practice, this may present a difficult ethical dilemma when race and racism enter the therapy office. Therapists have a duty to protect client autonomy and self-determination as much as possible. However, therapists also (...) have a responsibility to the communities in which they work and to not willingly condone activities of others that hold prejudice, both of which are threatened with unacknowledged racism. This article addresses the issue of whether to work with racism as a clinical and ethical concern with white clients who hold racist ideas and narratives, and then offers a concise clinical model for therapists to help guide their practice. (shrink)

The COVID-19-pandemic brought massive changes in the provision of psychotherapy. To contain the pandemic, many therapists switched from face-to-face sessions in personal contact to remote settings. This study focused on psychodynamic therapists practicing Guided Affective Imagery, Hypnosis and Autogenous Relaxation and their subjective experiences with psychotherapy via telephone and videoconferencing during the first COVID-19 related lockdown period in March 2020 in Austria. An online survey completed by 161 therapists produced both quantitative and qualitative data with the latter (...) being subject to a qualitative content analysis. Our research suggests that telephone and videoconferencing are considered valuable treatment formats to deliver psychodynamic psychotherapy. However, therapists’ experiences with remote psychotherapy are multifaceted and ambiguous. In particular, the findings raise questions concerning the maintenance of the therapeutic alliance, the development of the analytic process, the sensitivity to unconscious communication, and the indication for certain types of patients that still need further investigation. Our research indicates that the long-standing reticence toward remote treatments offers among psychodynamic therapists is becoming more differentiated and partially dissolves as therapists gain experiences in their use. Attitudes are becoming more open. At the same time, the way is being prepared to take a closer look at the specific processes and dynamics of remote psychotherapy and to examine them critically in future studies. (shrink)

Although therapist sexual attraction to clients is common, and therapist self-disclosure is an often-used intervention, therapist self-disclosure of sexual feelings to clients is an understudied phenomenon. In this article, I critically review the small base of literature on therapist self-disclosure of sexual feelings, including information on prevalence rates, empirical research, and case studies. By incorporating these findings with information from relevant sections of the American Psychological Association (2002) Ethics Code, my intent is to evaluate different aspects of therapist self-disclosure of (...) sexual feelings and arrive at conclusions regarding therapists' use of these disclosures. It appears that direct, explicit disclosures of sexual feelings can run the risk of harming clients and may therefore be unethical. Therefore, the use of this technique is discouraged. I discuss the issue of using less explicit interventions. (shrink)

The article draws from a personal clinical experience of two suicides, not far removed from each other in time. The first patient was a 33-year-old intellectual suffering from depression with narcissistic traits but no psychotic elements, while the second patient was a 21-year-old student with a manifest psychotic episode behind him and with characteristics of post-psychotic depression at the time of suicide. The two suicides had very different impacts on the therapist: the first left open some “space” for reflection, communication, (...) and working-through, while the second closed such a “space,” leaving only a tiny door to the existential roots of human beings and suffering. The therapist was able to find some “shelter” by talking to supervisors, colleagues, and friends in the first case; in the second, the only possible “shelter” was glimpsed in the philosophy of groundlessness (Ungrund) of the Russian existentialist Nicolai Berdyaev. The personal experiences of the therapist, along with some theoretical interpretations of the after-effects of both suicides, are presented using a psychodynamic and existential–phenomenological understanding of the therapeutic relationship with a psychotic and a non-psychotic patient. The main dilemmas exposed by a patient’s suicide, especially if the patient suffers from psychosis, are difficult to deal with in the usual clinical settings and call for resources beyond it. The authors propose that these can be found in philosophical and theological insights. (shrink)

An age-old dilemma in philosophy—think of Socrates and the Sophists—concerns the taking of money in return for wisdom. Or rather in return for a shared search; in return, that is, for philo-sophia. The core of this same dilemma re-emerges in psychotherapy. Can it be right to take money for providing the kind of love, support, wisdom etc. which therapists and counselors attempt to provide?

The increasing emphasis on multicultural competence within psychotherapy continues to highlight the need for being sensitive to key differences between therapist and client. However, this attunement to the psychotherapeutic impact of therapist–client differences may obscure the equally critical need to evaluate ethical problems associated with therapist–client similarities. It will be argued that therapists treating clients who are demographically similar to themselves encounter a unique set of ethical challenges that warrant careful consideration and caution precisely because of therapist–client matching. The (...) extant research on matching therapists and clients based on demographic similarities is discussed, with a particular emphasis on psychotherapeutic outcomes and client preferences. Attention then turns to the nonrational heuristics and biases that can often cloud therapists’ ethical decision making regarding the appropriate uses versus contraindications for demographically matching therapists and clients. Within the discussion of nonrational heuristics and biases, suggestions are offered for managing related challenges for ethical decision making. (shrink)

This essay is a reply to commentaries by Elin Danielsen Huckerby, Yvonne Huetter‐Almerigi, and Paul Showler on Tracy Llanera's Richard Rorty: Outgrowing Modern Nihilism (2020).

The Experiential Therapist steps outside of the medical model to explore alternative ways of thinking about mental health disorders. Peter D. Ladd argues that successful treatment results from an informed understanding of a patient’s experience, not an ability to name and categorize difficult experiences as classical disorders.

In these seven letters, practising psychiatrist Vincenzo Di Nicola offers wisdom to a young therapist from 25 years of experience conducting relational therapy. Ranging from what to read and how to begin therapy, the letters cover therapeutic temperaments and technique, how to create a relational dialogue, the myths of individual psychology and the need for relational psychology, the evolution of therapy in the past century and when therapy is over-all the while looking forward to the relational practices of the coming (...) community. This book complements Di Nicola's model of working with families presented in A Stranger in the Family: Culture, Families, and Therapy (New York and London: W.W. Norton). -/- Awarded the prestigious Prix Camille-Laurin of the Association des médecins psychiatres du Québec - the Camille Laurin Prize of the Quebec Psychiatric Association. -/- From the Foreword: -/- "It's a beautiful idea, this project of turning to young people... The relational dialogue offers an important new direction of study to discover the deep basis of the therapeutic alliance, in order to understand the still too-little known phenomenon of 'change'... This is what you have brought together in your book: the search for the whole regarding the person and, at the same time, the network of primary affective relationships that we call the family and of social relationships ..." --from the Foreword by Maurizio Andolfi, M.D. Director of the Academy of Family Psychotherapy Professor of Psychology, University of Rome -/- Advance Review: -/- "Di Nicola is a true master of constructive inquiry, synthesis, and brilliant creativity. Memorable aphorisms leap from every page of this very wise, thoughtful, and beautifully written book in which the healing process of discovering and making meaning to help reorder the lives of troubled persons is clarified. I highly recommend this book for all who are or would be therapists!" --Armando Favazza, M.D., M.P.H. Emeritus Professor of Psychiatry University of Missouri-Columbia Author of Bodies Under Siege. (shrink)

A good number of therapists have tumed to the antirealism of postmodern theory in general, and postmodern literary theory in particular, to justify their antitheoretical preferences. Does this turn make sense? Given what drives the antitheoretical agenda - the aspiration to individualize therapeutic practice so as to optimize each client’s unique potential for change - the answer is no. More specifically, I argue that it is the composition (i.e., the completeness) of the theoretical system that guides therapeutic practice, rather (...) than the therapist’s epistemological leanings, that does have considerable bearing on the recalcitrant problem of individualizing practice, otherwise known as the nomothetic/idiographic problem.Bon nombre de thérapeutes se sont toumés vers I’antiréalisme de la théorie postmoderne, en particulier de la théorie littéraire postmoderne, pour justifier leurs positions antithéoriques. Qu’en est-il de ce choix? Si l’on considère le moteur de l’idéologie antithéorique - à savoir l’aspiration à individualiser la pratique thérapeutique afin d’optimiser le potentiel de changement propre à chaque patient - il faut admettre qu’elle ne tient pas. De façon plus spécifique, je soutiens que c’est la composition (c’est-à-dire la complétude) du système théorique qui guide la pratique thérapeutique, non pas les inclinations épistémologiques du thérapeute, lesquelles ont par ailleurs une incidence considérable sur le problème tenace de I’individualisation de la pratique, connu aussi en tant que problème nomothétique/idiographique. (shrink)

In The Virtuous Therapist, authors Elliot D. Cohen and Gale Spieler Cohen provide a systematic, philosophical approach to mental health ethics. Their comprehensive model of ethical decision making is developed to a number of difficult ethical problems counselors will experience. The issues raised in the book are timely, ethically engaging, and of practical importance to those working in the field.

Studies have underscored the complexity of the encounter between ultra-Orthodox society and psychotherapy, as well as the challenges involved in developing a therapeutic relationship in cross-cultural therapy. However, there is scant research on therapy for ultra-Orthodox children, especially when it comes to arts therapies that take place in a cross-cultural setting. The current study examined the perceptions of 17 arts therapists who are not ultra-Orthodox, and who currently work or have previously worked with ultra-Orthodox children. Semi-structured interviews were conducted (...) with the therapists and analyzed using the principles of Consensual Qualitative Research. The study covered four domains: perceptions of the significance and objectives of arts therapy with ultra-Orthodox children; the influence of the cultural difference between therapist and client on the emotional experience and the therapeutic relationship; the use of arts in therapy; systemic aspects. The findings indicate significant perceptual and value-based disparities between therapists and clients, which pose difficulties and challenges to all participating parties and require therapists to be highly sensitive. Aside from the difficulties, the findings suggest that this cultural difference may also have certain advantages for clients as well as therapists. The findings likewise attest to the multifaceted process of change that is taking place within Haredi society in its attitude toward psychotherapy in general and arts therapy in particular. (shrink)

This article is about the philosopher as a potential therapist. It starts from tendencies exhibited by a group of contemporary philosophers involved in a so-called human enhancement. Drawing on the newest discoveries of genetics, genetic engineering and pharmacology, they offer a set of therapies aimed at the extensive ‘improvement’ of the human condition. In the second part of the paper, selected ideas concerning philosophical therapy by the Ancient philosophers are presented. They basically employed personal contact, conversation, and wise counselling. Then (...) these two approaches to this kind of therapy are compared and contrasted. The contemporary approaches offer novel, technical ways of intervention but are blind as far as far-reaching goals and the essential goods of human life are concerned. Despite serious cultural differences, the contemporary therapy can learn a lot from the ancients. If the human being is to be treated by philosophers, an integral picture of who the former is must be taken into account. This means that both his interiority and exteriority should be subjects to the therapy. (shrink)

We surveyed 223 APA members to investigate the roles of therapists' sex, theoretical orientation, interpersonal boundaries, and clients' sex in predicting therapists' assessments of the ethicality of nonerotic dual relationships with their clients. Results indicated that therapists' sex, interpersonal boundaries, and theoretical orientation influenced ethical judgments of these relationships. Theoretical and practical implications of our findings are discussed.

Growing demand for broadly accessible mental health care, together with the rapid development of new technologies, trigger discussions about the feasibility of psychotherapeutic interventions based on interactions with Conversational Artificial Intelligence (CAI). Many authors argue that while currently available CAI can be a useful supplement for human-delivered psychotherapy, it is not yet capable of delivering fully fledged psychotherapy on its own. The goal of this paper is to investigate what are the most important obstacles on our way to developing CAI (...) systems capable of delivering psychotherapy in the future. To this end, we formulate and discuss three challenges central to this quest. Firstly, we might not be able to develop effective AI-based psychotherapy unless we deepen our understanding of what makes human-delivered psychotherapy effective. Secondly, assuming that it requires building a therapeutic relationship, it is not clear whether psychotherapy can be delivered by non-human agents. Thirdly, conducting psychotherapy might be a problem too complicated for narrow AI, i.e., AI proficient in dealing with only relatively simple and well-delineated tasks. If this is the case, we should not expect CAI to be capable of delivering fully-fledged psychotherapy until the so-called “general” or “human-like” AI is developed. While we believe that all these challenges can ultimately be overcome, we think that being mindful of them is crucial to ensure well-balanced and steady progress on our path to AI-based psychotherapy. (shrink)

An age-old dilemma in philosophy—think of Socrates and the Sophists—concerns the taking of money in return for wisdom. Or rather in return for a shared search; in return, that is, for philo-sophia. The core of this same dilemma re-emerges in psychotherapy. Can it be right to take money for providing the kind of love, support, wisdom etc. which therapists and counselors attempt to provide?

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)

The paper examines the roles of manager and therapist as formed by an emotivist culture, by a recognition of tragedy, and by a Christian narrative. The Christian story provides resources to resist an emotivist culture, to cope with tragedy, and to reform the roles of manager and therapist. The context for the examination is provided by reflection about the development of a mission statement for Pine Rest Christian Hospital.

Does the way we think about our personal self-complexity affect how we accept others? Researchers have offered various conceptualizations of how individuals manage their complex identities, while others have identified links between cognitive complexity and acceptance of outgroups. This paper integrates the two bodies of work by positing a route by which personal identity conflicts may lead to cognitive and cultural pluralism. For individuals committed to multiple identities perceived as conflicting, the intra-psychic experience of value conflicts may lead to a (...) recognition of self-complexity, which is then transposed from the personal domain to the social one and expressed as a pluralistic attitude towards others. This argument find support in a study of Israeli Jewish Orthodox psychoanalytic therapists who belong to what they perceive as non-pluralistic religious groups, yet express value pluralism, which they attribute to their complex identities. One of the educational implications of this study is that facilitating engagement with internal complexity, multiple identities and personal value conflicts may promote pluralistic thinking for individuals in religious societies. (shrink)

2021 Reprint of the 1960 Edition. Facsimile of the original edition and not reproduced with Optical Recognition Software. In this essay, delivered as an address at Haverford College, Pennsylvania in 1959, Rogers discusses man's purpose and goal in life. In his therapeutic work Rogers sees clients take such directions as: away from facades; away from "oughts"; away from meeting expectations; away from pleasing others; toward being a process; toward being a complexity; toward openness to experience; toward acceptance of others; toward (...) trust of self. Given a therapeutic climate of warmth, acceptance, and empathic understanding, the client moves from what he is not toward "being," toward becoming that which he inwardly and actually is. Quoting Kierkegaard, "to be that self which one truly is." A worthy goal indeed. (shrink)

Introduction Respecting the Patients’ Rights Charter leads to the demands of patients for their rights and the response of rehabilitation therapists by increasing their compliance. The present study aimed to compare the views of patients and rehabilitation therapists about the importance and extent of compliance with the Patients’ Rights Charter. Methods This cross-sectional study was conducted for 3 months on 114 patients and 55 therapists who were selected using the convenience sampling method. The data collection tools included (...) a demographic information form and the Justification and Practice of Patient Rights Questionnaire. The collected data were analyzed using descriptive statistics, independent t-test, paired t-test, and Pearson correlation coefficient. Results Mean scores of the importance of compliance with the Patients’ Rights Charter were 2.21 ± 0.40 and 2.31 ± 0.43 in the group of patients and therapists, respectively. Moreover, the mean scores of compliance with the Patients’ Rights Charter were 1.45 ± 0.48 and 1.53 ± 0.61 from the perspective of patients and therapists, respectively. There was no statistically significant difference between the views of patients and therapists on the importance and extent of compliance with the Patients’ Rights Charter. Discussion and Conclusion The importance of respecting the Patients’ Rights Charter from the perspective of patients and therapists was at a desirable level while the level of compliance with it from the perspective of both groups was moderate. It seems that more research is needed to explain the causes of this discrepancy and increase compliance with the Patients’ Rights Charter in rehabilitation clinics. (shrink)

One way to understand philosophy as a form of therapy is this: it involves a philosopher who is trying to cure himself. He has been drawn into a certain philosophical frame of mind—the ‘disease’—and has thus infected himself with this illness. Now he is sick and trying to employ philosophy to cure himself. So philosophy is both: the ailment and the cure. And the philosopher is all three: pathogenic agent, patient, and therapist.

Purpose To quantify how often physical therapists from high-income countries (HIC) travelling to low- and middle-income countries (LMIC) practise outside their scope of practice, in what circumstances, and their likelihood of doing the same in the future. Methods An exploratory descriptive study using a survey. Results One hundred and twenty-six licensed physical therapists from around the world participated. Physical therapists typically spent less than a month (73.8 per cent) in LMIC; 67.5 per cent believed that physical (...) class='Hi'>therapists practise outside of their scope, and 31.7 per cent reported doing so. Reasons were believing that something is better than nothing (47.5 per cent ), a mismatch between the physical therapist’s and host’s expectations (40.0 per cent ), and preserving their relationship with the host (25.0 per cent ). It was deemed appropriate by 64.5 per cent to practise outside of their scope in some situations and 53.8% considered repeating the activity in the future. Half of the respondent’s first experience in LMIC occurred as a student or in their first decade of practice. Conclusions Working in LMIC requires a keen understanding of the risks and challenges associated with such experiences. To ensure best practice, a skill set that consists of critical self-reflection, systems thinking, and structural competency combined with clinical competency and accountability is imperative. (shrink)

Therapists and their patients must deal with the negative sequelae of short term mating strategies. Implications for therapy of Gangestad & Simpson's strategic pluralism theory are compared with those of Buss's sexual strategies theory and Eagly's social role theory. Naive theories held by therapists and patients, as well as prevailing societal views, are posited as influential in determining the course and outcome of therapy.

Radiation therapy therapists face challenging daily tasks that leave them prone to high attrition and burnout and subsequent deficits in performance. Here, we employed an accelerated alpha-theta neurofeedback protocol that is implementable in a busy medical workplace to test if 12 RTTs could learn the protocol and exhibit behavior and brain performance-related benefits. Following the 3-week protocol, participants showed a decrease in subjective cognitive workload and a decrease in response time during a performance task, as well as a decrease (...) in desynchrony of the alpha electroencephalogram band. Additionally, novel microstate analysis for neurofeedback showed a significant decrease in global field power following neurofeedback. These results suggest that the RTTs successfully learned the protocol and improved in perceived cognitive workload following 3 weeks of neurofeedback. In sum, this study presents promising behavioral improvements as well as brain performance-related evidence of neurophysiological changes following neurofeedback, supporting the feasibility of implementing neurofeedback in a busy workplace and encouraging the further study of neurofeedback as a tool to mitigate burnout. (shrink)

The primary means for psychotherapy interaction is language. Since talk-in-interaction is accomplished and rendered interpretable by the systematic use of linguistic resources, this study focuses on one of the central issues in psychotherapy, namely agency, and the ways in which linguistic resources, person references in particular, are used for constructing different types of agency in psychotherapy interaction. The study investigates therapists' responses to turns where the client complains about a third party. It focuses on the way therapists' responses (...) distribute experience and agency between the therapist and the client by comparing responses formulated with the zero-person to responses formulated with a second person singular pronoun that refers to the client. The study thus approaches agency as situated, dynamic and interactional: an agent is a social unit whose elements are distributed in the therapist-client interaction. The data consist of 70 audio-recorded sessions of cognitive psychotherapy and psychoanalysis, and the method of analysis is conversation analysis and interactional linguistics. The main findings are that therapists use the zero-person for two types of responses: affiliating and empathetic responses that distribute the emotional experience between the client and the therapist, and responses that invite clients to interpret their own experiences, thereby distributing control and responsibility to the clients. In contrast, the second person references are used for re-constructing the client's past history. The conclusion is that therapists use the zero-person for both immediate emotional work and interpretative co-work on the client's experiences. The study suggests that therapists' use of the zero-person does not necessarily attribute “weak agency” to the client but instead might strengthen the clients' agency in the sense of control and responsibility in the long term. (shrink)