Pub Date : 2022-04-16DOI: 10.1080/09515070.2022.2065664
Hsiu-Lan Cheng
ABSTRACT Informed by objectification theory’s tenet that sexual objectification and racism are powerful sociocultural forces that perniciously impact women of color’s mental health, the present study examined the longitudinal links of sexual objectification and three forms of internalized racism (i.e. self-negativity, weakness stereotype, appearance bias) with body shame among Asian American college women (N = 146). Ethnic identity strength, a theorized protective factor in body image literature, was examined as a moderator for the hypothesized longitudinal links. Results indicated that sexual objectification and self-negativity measured at Time 1 had significant and positive bivariate associations with body shame measured at Time 2. However, these variables no longer predicted body shame when body mass index (BMI) was included as a covariate. A significant interaction between appearance bias and ethnic identity strength emerged in predicting body shame. Specifically, high ethnic identity strength exacerbated the detrimental effect of appearance bias on Asian American women’s body shame, whereas low ethnic identity strength buffered this effect. This finding contradicts theoretical views of ethnic identity strength as a protective factor in women of color’s body image development. Practice implications and future research directions are discussed.
{"title":"Body shame among Asian American college women: the roles of sexual objectification, internalized racism, and ethnic identity strength","authors":"Hsiu-Lan Cheng","doi":"10.1080/09515070.2022.2065664","DOIUrl":"https://doi.org/10.1080/09515070.2022.2065664","url":null,"abstract":"ABSTRACT Informed by objectification theory’s tenet that sexual objectification and racism are powerful sociocultural forces that perniciously impact women of color’s mental health, the present study examined the longitudinal links of sexual objectification and three forms of internalized racism (i.e. self-negativity, weakness stereotype, appearance bias) with body shame among Asian American college women (N = 146). Ethnic identity strength, a theorized protective factor in body image literature, was examined as a moderator for the hypothesized longitudinal links. Results indicated that sexual objectification and self-negativity measured at Time 1 had significant and positive bivariate associations with body shame measured at Time 2. However, these variables no longer predicted body shame when body mass index (BMI) was included as a covariate. A significant interaction between appearance bias and ethnic identity strength emerged in predicting body shame. Specifically, high ethnic identity strength exacerbated the detrimental effect of appearance bias on Asian American women’s body shame, whereas low ethnic identity strength buffered this effect. This finding contradicts theoretical views of ethnic identity strength as a protective factor in women of color’s body image development. Practice implications and future research directions are discussed.","PeriodicalId":51653,"journal":{"name":"Counselling Psychology Quarterly","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2022-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48452221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-18DOI: 10.1080/09515070.2022.2029349
U. Kramer, Hélène Beuchat, Loris Grandjean, J. Despland, A. Pascual-Leone
ABSTRACT In-session emotional processing is a central component of psychotherapy, but little is known about the types and the quality of emotional processing individuals engage in daily life. An ecological momentary assessment (EMA) schedule has been validated to assess distinct emotional experiences as they emerge in daily life. It remains an open question whether changes observed in distinct emotional experiences over a week of assessment are related to in-session self-esteem. In total, N = 42 university students participated in a one-week assessment of emotions using ecological momentary assessment, as well as in a one-session experiential task of resolving self-criticism (using a two-chair dialogue from emotion-focused therapy). The emotions in daily life were self-reported by the participants on a regular basis, and self-esteem was assessed three times during the two-chair dialogue. Two-level hierarchical linear models reveal emotional changes in daily life, and in-session self-esteem is introduced as predictor at level 2. In-session self-esteem was correlated with symptom levels. The results showed that changes in primary maladaptive emotions in the one-week assessment were predicted by state and trait components of in-session self-esteem, which took place at the outset of the EMA. Trait-components of self-esteem were linked with the level of symptoms, whereas state-components of self-esteem were not. The present study underscores the importance of extending research from within-session observations of emotional processing towards daily life. .
{"title":"Change in emotional processing in daily life: relationship with in-session self-esteem","authors":"U. Kramer, Hélène Beuchat, Loris Grandjean, J. Despland, A. Pascual-Leone","doi":"10.1080/09515070.2022.2029349","DOIUrl":"https://doi.org/10.1080/09515070.2022.2029349","url":null,"abstract":"ABSTRACT In-session emotional processing is a central component of psychotherapy, but little is known about the types and the quality of emotional processing individuals engage in daily life. An ecological momentary assessment (EMA) schedule has been validated to assess distinct emotional experiences as they emerge in daily life. It remains an open question whether changes observed in distinct emotional experiences over a week of assessment are related to in-session self-esteem. In total, N = 42 university students participated in a one-week assessment of emotions using ecological momentary assessment, as well as in a one-session experiential task of resolving self-criticism (using a two-chair dialogue from emotion-focused therapy). The emotions in daily life were self-reported by the participants on a regular basis, and self-esteem was assessed three times during the two-chair dialogue. Two-level hierarchical linear models reveal emotional changes in daily life, and in-session self-esteem is introduced as predictor at level 2. In-session self-esteem was correlated with symptom levels. The results showed that changes in primary maladaptive emotions in the one-week assessment were predicted by state and trait components of in-session self-esteem, which took place at the outset of the EMA. Trait-components of self-esteem were linked with the level of symptoms, whereas state-components of self-esteem were not. The present study underscores the importance of extending research from within-session observations of emotional processing towards daily life. .","PeriodicalId":51653,"journal":{"name":"Counselling Psychology Quarterly","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2022-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45604850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-13DOI: 10.1080/09515070.2022.2050676
Vicky Hennissen, K. Van Nieuwenhove, R. Meganck, Dries Dulsster, Juri Krivzov, M. Desmet
ABSTRACT Self-critical perfectionism has been linked to alliance impairments due to patients’ distancing attitudes. However, systematic research on therapists’ emotional experiencing when working with self-critical patients is scarce. This qualitative study explores how therapists perceive, emotionally experience, and react to self-critical patients’ interpersonal dynamics. We studied narrative data from clinical supervisions where psychodynamic psychotherapists discussed self-critical patients (N = 7) within the context of an RCT on Major Depressive Disorder. Consensual Qualitative Research was applied to identify recurrent patterns in the data. As a global impediment to treatment, therapists observed a pattern of non-engagement. Patients’ superficial and avoidant way of communicating, hostility or aggressiveness in the alliance, and low or inaccurate treatment expectations emerged as main obstacles to the therapeutic process, evoking negative affect in therapists. More vulnerable aspects of the patient and case formulation emerged as having a mitigating effect on unfavorable therapist reactions. Our findings confirm longstanding clinical and theoretical accounts associating therapeutic work with self-critical patients with negative affect in therapists. Our study suggests that negative responses may be enacted in therapy which can reinforce poor alliance. We discuss the role of supervision in helping therapists to become aware of and manage negative responses, engage in case conceptualization, and advance clinical work.
{"title":"The self-critical patient in clinical supervision: a qualitative study of therapists’ alliance struggles and emotional reactions in short-term psychodynamic psychotherapy for depression","authors":"Vicky Hennissen, K. Van Nieuwenhove, R. Meganck, Dries Dulsster, Juri Krivzov, M. Desmet","doi":"10.1080/09515070.2022.2050676","DOIUrl":"https://doi.org/10.1080/09515070.2022.2050676","url":null,"abstract":"ABSTRACT Self-critical perfectionism has been linked to alliance impairments due to patients’ distancing attitudes. However, systematic research on therapists’ emotional experiencing when working with self-critical patients is scarce. This qualitative study explores how therapists perceive, emotionally experience, and react to self-critical patients’ interpersonal dynamics. We studied narrative data from clinical supervisions where psychodynamic psychotherapists discussed self-critical patients (N = 7) within the context of an RCT on Major Depressive Disorder. Consensual Qualitative Research was applied to identify recurrent patterns in the data. As a global impediment to treatment, therapists observed a pattern of non-engagement. Patients’ superficial and avoidant way of communicating, hostility or aggressiveness in the alliance, and low or inaccurate treatment expectations emerged as main obstacles to the therapeutic process, evoking negative affect in therapists. More vulnerable aspects of the patient and case formulation emerged as having a mitigating effect on unfavorable therapist reactions. Our findings confirm longstanding clinical and theoretical accounts associating therapeutic work with self-critical patients with negative affect in therapists. Our study suggests that negative responses may be enacted in therapy which can reinforce poor alliance. We discuss the role of supervision in helping therapists to become aware of and manage negative responses, engage in case conceptualization, and advance clinical work.","PeriodicalId":51653,"journal":{"name":"Counselling Psychology Quarterly","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2022-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44611835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-13DOI: 10.1080/09515070.2022.2049703
M. Perlman, T. Anderson, J. Finkelstein, Victoria K Foley, Scott Mimnaugh, Caroline V Gooch, Kevin C David, Shelby J. Martin, J. Safran
ABSTRACT Relatively little research focuses on the impact of therapeutic, relational skills training for untrained helpers. The current study is a randomized control trial, which tested a novel, research-informed training protocol that integrated elements of alliance-focused training (AFT) and facilitative interpersonal skills (FIS) in a sample of college undergraduates interested in social helping careers. The AFT/FIS training was compared to a time-matched video demonstration of cognitive therapy (CT video). All participants were assessed on their Facilitative Interpersonal Skills (FIS) and emotional reactions to FIS stimuli pre- and post-training. After controlling for baseline effects, participants in the AFT/FIS training saw a significant increase in post-training FIS, especially in the areas of empathy, alliance bond capacity, and alliance rupture repair responsiveness. AFT/FIS participants also saw increases in positive and affiliative emotional reactions to FIS clips compared to participants in the CT video training. Implications for future empirical investigations and training initiatives are discussed.
{"title":"Facilitative interpersonal relationship training enhances novices’ therapeutic skills","authors":"M. Perlman, T. Anderson, J. Finkelstein, Victoria K Foley, Scott Mimnaugh, Caroline V Gooch, Kevin C David, Shelby J. Martin, J. Safran","doi":"10.1080/09515070.2022.2049703","DOIUrl":"https://doi.org/10.1080/09515070.2022.2049703","url":null,"abstract":"ABSTRACT Relatively little research focuses on the impact of therapeutic, relational skills training for untrained helpers. The current study is a randomized control trial, which tested a novel, research-informed training protocol that integrated elements of alliance-focused training (AFT) and facilitative interpersonal skills (FIS) in a sample of college undergraduates interested in social helping careers. The AFT/FIS training was compared to a time-matched video demonstration of cognitive therapy (CT video). All participants were assessed on their Facilitative Interpersonal Skills (FIS) and emotional reactions to FIS stimuli pre- and post-training. After controlling for baseline effects, participants in the AFT/FIS training saw a significant increase in post-training FIS, especially in the areas of empathy, alliance bond capacity, and alliance rupture repair responsiveness. AFT/FIS participants also saw increases in positive and affiliative emotional reactions to FIS clips compared to participants in the CT video training. Implications for future empirical investigations and training initiatives are discussed.","PeriodicalId":51653,"journal":{"name":"Counselling Psychology Quarterly","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2022-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45070987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-08DOI: 10.1080/09515070.2022.2047614
Nicolás Suárez-Delucchi, Alex Keith-Paz, Mahaira Reinel, Sofía Fernandez, Mariane Krause
ABSTRACT This qualitative study’s objective was to understand how failure in psychotherapy develops from depressed patients’ perspective. Forty-seven patients were interviewed after brief psychotherapy. Data analysis was conducted according to Grounded Theory. Patients evaluated their own psychotherapies’ outcome according to their subjective criteria. Then, negative, positive and mixed-results evaluations were compared in the main categories. Results showed that patients reporting negative evaluations considered null or adverse outcomes as failure. Distrust in their psychotherapists (both as persons and professionals) developed in early stages of the process and was apparently hard to revert. This early onset of distrust led patients to a lack of collaboration and an unreceptive attitude. They perceived their psychotherapist as not understanding, distant, and uninterested, losing focus on relevant problems and not providing new information. The relationship was experienced as uncomfortable and distant, and sometimes became harmful. Therefore, distrust led patients to regard their psychotherapies as an unhelpful experience, in contrast to what occurred in patients with positive or mixed results evaluations. Conclusions contribute to a clarification of how patients conceptualize failure and suggest reevaluating the relevance of their perspective, which seems not to be fully reflected in current outcome measures. Clinicians should consider building trust as a baseline and encourage patients to disclose even the earliest negative feelings about treatment and psychotherapist
{"title":"Failure in psychotherapy: a qualitative comparative study from the perspective of patients diagnosed with depression","authors":"Nicolás Suárez-Delucchi, Alex Keith-Paz, Mahaira Reinel, Sofía Fernandez, Mariane Krause","doi":"10.1080/09515070.2022.2047614","DOIUrl":"https://doi.org/10.1080/09515070.2022.2047614","url":null,"abstract":"ABSTRACT This qualitative study’s objective was to understand how failure in psychotherapy develops from depressed patients’ perspective. Forty-seven patients were interviewed after brief psychotherapy. Data analysis was conducted according to Grounded Theory. Patients evaluated their own psychotherapies’ outcome according to their subjective criteria. Then, negative, positive and mixed-results evaluations were compared in the main categories. Results showed that patients reporting negative evaluations considered null or adverse outcomes as failure. Distrust in their psychotherapists (both as persons and professionals) developed in early stages of the process and was apparently hard to revert. This early onset of distrust led patients to a lack of collaboration and an unreceptive attitude. They perceived their psychotherapist as not understanding, distant, and uninterested, losing focus on relevant problems and not providing new information. The relationship was experienced as uncomfortable and distant, and sometimes became harmful. Therefore, distrust led patients to regard their psychotherapies as an unhelpful experience, in contrast to what occurred in patients with positive or mixed results evaluations. Conclusions contribute to a clarification of how patients conceptualize failure and suggest reevaluating the relevance of their perspective, which seems not to be fully reflected in current outcome measures. Clinicians should consider building trust as a baseline and encourage patients to disclose even the earliest negative feelings about treatment and psychotherapist","PeriodicalId":51653,"journal":{"name":"Counselling Psychology Quarterly","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2022-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41647867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-11DOI: 10.1080/09515070.2021.2023467
Isabel Caro Gabalda, W. Stiles
ABSTRACT This case study addressed what therapists do after assimilation setbacks. Previous research has shown that most setbacks reflect the client switching between strands of the problem and that most setbacks can be classified as balance strategy setbacks (BS) or setbacks due to the therapist exceeding the client’s zone of proximal development (TZPD). Alicia was a 26-year-old woman diagnosed as depressed and treated with a directive kind of therapy for 26 sessions. Sessions were transcribed and rated with the Assimilation of Problematic Experiences Scale (APES). Almost all setbacks could be classified as BS or TZPD. The therapist's succeeding interventions were coded with the List of Therapist’s Activities after a Setback and qualitatively described and summarized. Alicia showed improvement on the outcome measures, and the APES. Therapist activities following setbacks showed that exploratory activities and supportive and clarifying intentions seemed relatively more common after BS setbacks, whereas directive activities and intentions were relatively more common after TZPD setbacks. Results tended to support the conceptualization of setbacks as a switch of strands and suggested elaborations. In this directive therapy, the therapist tended to pursue the intended line of work after setbacks, using systematically different activities depending on which type of setback occurred.
{"title":"Therapeutic activities after assimilation setbacks in the case of Alicia","authors":"Isabel Caro Gabalda, W. Stiles","doi":"10.1080/09515070.2021.2023467","DOIUrl":"https://doi.org/10.1080/09515070.2021.2023467","url":null,"abstract":"ABSTRACT This case study addressed what therapists do after assimilation setbacks. Previous research has shown that most setbacks reflect the client switching between strands of the problem and that most setbacks can be classified as balance strategy setbacks (BS) or setbacks due to the therapist exceeding the client’s zone of proximal development (TZPD). Alicia was a 26-year-old woman diagnosed as depressed and treated with a directive kind of therapy for 26 sessions. Sessions were transcribed and rated with the Assimilation of Problematic Experiences Scale (APES). Almost all setbacks could be classified as BS or TZPD. The therapist's succeeding interventions were coded with the List of Therapist’s Activities after a Setback and qualitatively described and summarized. Alicia showed improvement on the outcome measures, and the APES. Therapist activities following setbacks showed that exploratory activities and supportive and clarifying intentions seemed relatively more common after BS setbacks, whereas directive activities and intentions were relatively more common after TZPD setbacks. Results tended to support the conceptualization of setbacks as a switch of strands and suggested elaborations. In this directive therapy, the therapist tended to pursue the intended line of work after setbacks, using systematically different activities depending on which type of setback occurred.","PeriodicalId":51653,"journal":{"name":"Counselling Psychology Quarterly","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2022-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46788888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-06DOI: 10.1080/09515070.2021.2023098
Angie Chircop Coleiro, M. Creaner, L. Timulak
ABSTRACT . With qualitative studies increasingly published on different aspects of supervision, this qualitative meta-analysis synthesized existing qualitative research and explored what aspects therapy trainees find helpful and unhelpful in individual supervision. A sample of 29 studies (755 participants) was selected by conducting a systematic literature search and a critical appraisal process to ensure a suitable level of methodological rigor. Data analysis followed a descriptive and interpretative framework. Results yielded 6 main meta-categories: three in the helpful aspects domain (i) Supervisor establishes a secure learning environment, (ii) Supervisor demonstrates ability to facilitate learning, and (iii) Supervisor demonstrates willingness and ability to acknowledge and negotiate differences; and three in the unhelpful aspects domain (i) Supervisor demonstrates behaviour that lacks sensitivity, accountability, and ethical consideration, (ii) Supervisor fails to create a safe and supportive environment, and (iii) Supervisor demonstrates limitations in the appropriate maintenance and sharing of knowledge and skills. Influenced by the quality of the supervisory alliance, supervision can be helpful, but it may also be experienced as unhelpful and potentially harmful. Issues of power and diversity need to be negotiated in a manner that maintains ethical and professional standards of practice and care. Implications for supervision training, practice, and research are discussed.
{"title":"The good, the bad, and the less than ideal in clinical supervision: a qualitative meta-analysis of supervisee experiences","authors":"Angie Chircop Coleiro, M. Creaner, L. Timulak","doi":"10.1080/09515070.2021.2023098","DOIUrl":"https://doi.org/10.1080/09515070.2021.2023098","url":null,"abstract":"ABSTRACT . With qualitative studies increasingly published on different aspects of supervision, this qualitative meta-analysis synthesized existing qualitative research and explored what aspects therapy trainees find helpful and unhelpful in individual supervision. A sample of 29 studies (755 participants) was selected by conducting a systematic literature search and a critical appraisal process to ensure a suitable level of methodological rigor. Data analysis followed a descriptive and interpretative framework. Results yielded 6 main meta-categories: three in the helpful aspects domain (i) Supervisor establishes a secure learning environment, (ii) Supervisor demonstrates ability to facilitate learning, and (iii) Supervisor demonstrates willingness and ability to acknowledge and negotiate differences; and three in the unhelpful aspects domain (i) Supervisor demonstrates behaviour that lacks sensitivity, accountability, and ethical consideration, (ii) Supervisor fails to create a safe and supportive environment, and (iii) Supervisor demonstrates limitations in the appropriate maintenance and sharing of knowledge and skills. Influenced by the quality of the supervisory alliance, supervision can be helpful, but it may also be experienced as unhelpful and potentially harmful. Issues of power and diversity need to be negotiated in a manner that maintains ethical and professional standards of practice and care. Implications for supervision training, practice, and research are discussed.","PeriodicalId":51653,"journal":{"name":"Counselling Psychology Quarterly","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2022-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47339122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-04DOI: 10.1080/09515070.2021.2013162
Anna Mylona, Evrinomy Avdi, Evangelos Paraskevopoulos
ABSTRACT This exploratory single session-study presents a multimodal, mixed-method description of a session of psychoanalytic psychotherapy and illustrates an in-session “failure”, defined in terms of rupture in the therapeutic alliance and the process of its repair. It aims to enhance our understanding of the mechanisms implicated in therapeutic change. The research materialcomprises session’s video-recording, transcript, and measurements of participants’physiological arousal, as reflected in their heart rate in the session. The analysis consisted of an iterative, multi-layered process that combines observations from verbal and nonverbal modalities of interaction for the identification of significant in-session moments. We applied quantitative descriptive analysis on participants’ physiological arousal and synchronization, qualitative analysis of the clinical dialogue, and coded the in-session fluctuations in the therapeutic alliance,using the Rupture Resolution Rating System. The detailed analysis of specific interactive events in the session illustrates the shift from a “failure” in therapeutic collaboration to gradual repair; this shift entailed increased relatedness and physiological synchronization, and on a semantic level, co-created, reflective meanings in the here-and-now of the therapeutic interaction. The findings highlight ruptures as important in-session events and suggest that the therapist’s empathic oscillation between interpretative and metacommunication strategies can be mutative during moments of relational rupture. Practical Implications Negotiation and resolution of in-session therapeutic ruptures may provide opportunities for therapeutic growth in terms of increased relatedness and reflectiveness. The therapist’s flexible shifts between using interpretative interventions and immediate collaborative explorations in the here-and-now, in the form of metacommunication, seem to facilitate the repair of alliance rupture. Multimodal methodologies and multi-layered analyses, integrating verbal and nonverbal, physiological data in the study of therapeutic interaction can shed light on significant in-session events and mechanisms of the change process.
{"title":"Alliance rupture and repair processes in psychoanalytic psychotherapy: multimodal in-session shifts from momentary failure to repair","authors":"Anna Mylona, Evrinomy Avdi, Evangelos Paraskevopoulos","doi":"10.1080/09515070.2021.2013162","DOIUrl":"https://doi.org/10.1080/09515070.2021.2013162","url":null,"abstract":"ABSTRACT This exploratory single session-study presents a multimodal, mixed-method description of a session of psychoanalytic psychotherapy and illustrates an in-session “failure”, defined in terms of rupture in the therapeutic alliance and the process of its repair. It aims to enhance our understanding of the mechanisms implicated in therapeutic change. The research materialcomprises session’s video-recording, transcript, and measurements of participants’physiological arousal, as reflected in their heart rate in the session. The analysis consisted of an iterative, multi-layered process that combines observations from verbal and nonverbal modalities of interaction for the identification of significant in-session moments. We applied quantitative descriptive analysis on participants’ physiological arousal and synchronization, qualitative analysis of the clinical dialogue, and coded the in-session fluctuations in the therapeutic alliance,using the Rupture Resolution Rating System. The detailed analysis of specific interactive events in the session illustrates the shift from a “failure” in therapeutic collaboration to gradual repair; this shift entailed increased relatedness and physiological synchronization, and on a semantic level, co-created, reflective meanings in the here-and-now of the therapeutic interaction. The findings highlight ruptures as important in-session events and suggest that the therapist’s empathic oscillation between interpretative and metacommunication strategies can be mutative during moments of relational rupture. Practical Implications Negotiation and resolution of in-session therapeutic ruptures may provide opportunities for therapeutic growth in terms of increased relatedness and reflectiveness. The therapist’s flexible shifts between using interpretative interventions and immediate collaborative explorations in the here-and-now, in the form of metacommunication, seem to facilitate the repair of alliance rupture. Multimodal methodologies and multi-layered analyses, integrating verbal and nonverbal, physiological data in the study of therapeutic interaction can shed light on significant in-session events and mechanisms of the change process.","PeriodicalId":51653,"journal":{"name":"Counselling Psychology Quarterly","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2022-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48657114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01Epub Date: 2021-11-11DOI: 10.1080/09515070.2021.1997916
Adelya A Urmanche, Lauren M Lipner, Sarah Bloch-Elkouby, Elaine Hunter, Jerzy Kaufmann, Jonathan T Warren, Gregory T Weil, Catherine F Eubanks, J Christopher Muran
About one in five clients drops out of treatment prematurely. Premature termination has been found to correlate with patient, therapist, and treatment factors, as well as complex interpersonal processes, including ruptures in the therapeutic alliance. This study examines the therapeutic alliance using a qualitative approach to patient-, therapist-, and observer-based data. The sample includes five trainee therapists, each of whom worked with one patient who terminated after the first or second session, and one who completed a cognitive-behavioral therapy protocol. The session(s) preceding premature termination in the drop case and the corresponding session(s) in the completer case were examined. Rupture resolution process was prevalent in both groups, though confrontation ruptures seemed more prevalent with completers and withdrawal ruptures were more clinically impactful with dropouts. Therapist awareness of process and responsiveness or contribution to rupture were identified as potential factors contributing to patient retention.
{"title":"The beginning of the end: A comparison of treatment completers and early dropouts in trainee-provided time-limited Cognitive Behavioral Therapy.","authors":"Adelya A Urmanche, Lauren M Lipner, Sarah Bloch-Elkouby, Elaine Hunter, Jerzy Kaufmann, Jonathan T Warren, Gregory T Weil, Catherine F Eubanks, J Christopher Muran","doi":"10.1080/09515070.2021.1997916","DOIUrl":"10.1080/09515070.2021.1997916","url":null,"abstract":"<p><p>About one in five clients drops out of treatment prematurely. Premature termination has been found to correlate with patient, therapist, and treatment factors, as well as complex interpersonal processes, including ruptures in the therapeutic alliance. This study examines the therapeutic alliance using a qualitative approach to patient-, therapist-, and observer-based data. The sample includes five trainee therapists, each of whom worked with one patient who terminated after the first or second session, and one who completed a cognitive-behavioral therapy protocol. The session(s) preceding premature termination in the drop case and the corresponding session(s) in the completer case were examined. Rupture resolution process was prevalent in both groups, though confrontation ruptures seemed more prevalent with completers and withdrawal ruptures were more clinically impactful with dropouts. Therapist awareness of process and responsiveness or contribution to rupture were identified as potential factors contributing to patient retention.</p>","PeriodicalId":51653,"journal":{"name":"Counselling Psychology Quarterly","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9856216/pdf/nihms-1766986.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10666981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.1080/09515070.2021.1895724
Carly A Hunt, Rachael D Goodman, Alexander J Hilert, Wilson Hurley, Clara E Hill
We investigated the impact of a 1.5 hr workshop based on mindfulness-based compassion practices (MBCP) for 6 doctoral student therapists, followed by these therapists engaging in pre-session preparation for each of their clients in one of 3 randomly assigned conditions (MBCP, self-supervision, preparation-as-usual) over a 1-month period. State mindfulness and meditation self-efficacy increased following the workshop. Therapist ratings of session effectiveness were higher following pre-session meditation relative to preparation-as-usual, although there were no client-rated differences in session outcome. In a focus group, therapists reported that the workshop was generally helpful, and noted that pre-session MBCP led to a positive state of being and increased selfcare. However, they felt rushed to fit in the exercises and some doubted their meditation self-efficacy. They suggested that longer, at-home practice might be more beneficial than pre-session exercises. We encourage replication in larger samples varying the amount and format of meditation training for improving outcomes.
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