Bargaining With Time: An Interview With Helen Pavlin

Helen Pavlin is an accredited mental health social worker and family therapist and accredited family dispute resolution practitioner in private practice in Darwin. She has been involved in social work and family therapy since the early 1970s in Australia and internationally. In 1996 she received the 50th Anniversary Commemorative Medal from the Australian Association of Social Workers. She is one of the assessors and associate editors for the Australian and New Zealand Journal of Family Therapy. In 2007 Helen received the Journal Award for her outstanding contribution to the family therapy field in Australia. She is an accomplished writer and a member of the Australian Society of Authors. Her poems and book reviews have been published frequently in ANZJFT.     

On Learning and Teaching Family Therapy

This paper explores some ideas about the process of learning to be a family therapist. It considers the questions: how does one learn to think like a family therapist? How is family therapy best taught? How is it learned? The author's experiences in learning and teaching are described. It is argued that family therapy differs from other approaches to therapy in some fundamental respects, and that learning to ‘be’ a family therapist is a different kind of task than learning to be a practitioner of other therapeutic approaches. The paper examines some key theoretical constructs, especially the idea of ‘levels’ of thinking, which are seen as central to both the learning and practice of family therapy.     

Losing Ann: Countertransference Aspects of Altering the Frame with a Long Term Patient Facing Atypical Dementia

This paper chronicles the journey of a long term, suicidally depressed patient’s struggle of growth and survival, only to be struck down by a form of Dementia: Lewy Body Disorder. Focus of the paper highlights the myriad complications and struggles that developed in the countertransference as therapist, patient, family, and medical caregivers, try to ascertain: What is psychological and regressive? What is neuro-degenerative? How can the therapist cope with this confusion while maintaining the frame? The paper highlights how the frame as we know it, is altered to meet the medical and psychological crisis presented and how that alteration impacts the treatment and the therapist’s changing perception of what the work is about.     

Working With Families Within Inpatient Settings

This paper examines the family's experience of psychiatric hospitalization. It considers the ways in which the family therapist can help keep the family system intact and involve it in the inpatient treatment process. Family-related and hospital-related obstacles to family involvement are discussed, along with suggestions for dealing with them. Also presented are family problems characteristic of an adult hospitalization population and suggested treatment strategies .     

Therapy with Infertile Heterosexual Couples: It’s Not About Gender—Or is it?

In spite of medical data that show males are equal to their female partners as a source of a heterosexual couple’s infertility, therapists face many unanswered questions about the extent to which gender influences each partner’s infertility experience in American culture. How is “hers” different from “his?” To what extent should the therapist strive to help the couple define the infertility issue as “ours”? This article explores how the therapist can elicit and be sensitive to gender issues while fostering resilience in the infertile couple.     

A Great Leap Forward?

It is unusual for family therapists to employ a dance framework as part of the therapeutic process. What happens when you do? This article describes the work of a therapist interested in dance as a way to psychic discovery.     

Phenomenology and intersubjectivity: considerations for webcam-facilitated psychotherapy

ABSTRACT

The clearest distinction between webcam-facilitated versus face-to-face psychotherapy is the available sensorial information. The following questions guide this discussion: 1. How do our senses inform the psychotherapeutic process? 2. What are the implications for the therapeutic process when sensory information is different than during face-to-face therapy? This examination of the role of the senses in the creation of knowledge is grounded in phenomenology. Individual unity of consciousness and reciprocal understanding are applied to literature on webcam-facilitated therapy. An amalgam clinical example illustrates these phenomenological concepts and role of intersubjectivity. The core issues are involvement of sensory processes in the process of psychotherapy and co-construction of knowledge. By accepting the limitations of therapist knowledge, the client is encouraged to articulate and develop their own knowledge, and make conscious their unconscious. It is not necessary for therapist and client to share a physical space for co-creation of knowledge necessary for client transformation.     

Transnational Intersectionality in Family Therapy With Resettled Refugees

In this article, we discuss incorporating the transnational intersectionality framework in family therapy with resettled refugees. Transnational intersectionality is an extension of the framework of intersectionality which helps to better understand complexities of power and oppression across national contexts and their influence on refugees' lives. Adopting this framework alerts family therapists to: (a) develop critical awareness of refugee's transnational contexts; (b) understand differences in experiences of social identities across contexts; (c) acknowledge postmigration factors of oppression affecting resettlement; and (d) critically reflect upon therapist–interpreter–client intersectionalities. This shifts our conceptualization of therapy with refugees to actively consider transnational contexts which refugees uniquely occupy. We describe the framework and provide two case illustrations to highlight its usefulness.     

Using culture and the intersubjective perspective as a resource: A case study of an African-American couple

In this article a White Jewish-American therapist shares what she learned from her work with an African-American couple using a semi-structured protocol for planned short-term marital therapy. Twenty-eight months after the original treatment, the author met again with the couple for an audiotaped follow-up interview. Marital satisfaction for both partners was tracked with an Index of Marital Satisfaction over the course of the treatment and the follow-up process. The empirical findings augment the story of the couple and the therapist. During the middle phase, the therapy reached an impasse. With the goal of creating a cognitive shift, the therapist used the couple's culture as a resource for therapeutic change. The cultural metaphor is considered as the vital step in overcoming the treatment impasse. The major finding is that cultural responsiveness does not end with the engagement and assessment of clients. The culture of the clients and the culture of the therapist provide powerful metaphors and rich resources to introduce change possibilities. With this couple, when culture was combined with an appreciation of the intersubjective meanings for both clients and therapist, culturally responsive and effective therapy became possible.     

The “risky” intervention: Twinship selfobject impasses and therapist self-disclosure in psychodynamic psychotherapy

This article examines therapist self-disclosure from the perspective of self psychology. Resistance to therapist self-disclosure in the traditional psychodynamic literature is reviewed and recent research pertaining to therapist self-disclosure is discussed. Twinship selfobject needs and the impasses resulting from these in psychotherapy are examined. Therapist self-disclosure is proposed as an appropriate intervention for such impasses. Two cases are presented to illustrate such interventions and the potential dangers and gains inherent in therapist self-disclosure are discussed.     

Therapist pregnancy and maternity leave: Maintaining and furthering therapeutic gains in the interim

A therapist's pregnancy and maternity leave is a time of multiple transitions for both patient and therapist. This article reviews the literature on therapist pregnancy and its therapeutic implications. It discusses the treatment planning choices of: trial termination, therapeutic hiatus, and temporary transfer. The article further addresses the clinical and administrative issues of planning the maternity leave as well as the issues of time-limited treatment with the interim therapist. It included illustrative case examples based on the author's experience as an interim therapist during a six month maternity leave.This paper in its original form was presented as part of the requirement for The Hunter College School of Social Work: Post Masters Program in advanced Clinical Social Work.     

Transcultural Differentiation: A Model For Therapy With Ethno‐culturally Diverse Families

This article evolved out of the writer's experience of being an immigrant, a systemic thinker, and a therapist involved in working with individuals and families from many different cultures. It proposes a model of ‘transcultural differentiation’, drawing on Western notions of separation‐individuation (Mahler) and differentiation of self (Bowen), but arguing that these concepts may have equivalents within non‐Western philosophies (e.g. Indian cultural beliefs). The model suggests that families co‐existing with both a culture of origin and an adoptive culture must inevitably change, and that in this process, they necessarily evolve into entities which transcend both culture of origin and adoptive culture. Implications for therapy are explored; in particular, it is argued that the therapist's awareness of, and sensitivity to, the transcultural experience may be more crucial than whether or not she/he shares the client's culture of origin.     

Treating Trauma Through Three Interconnected Lenses: Body, Personality, and Intersubjective Field

The neuroscience of trauma in increasingly oriented to the importance of understanding right brain to right brain dynamics and helping the therapist to respond to implicit communication, which is discussed, as well as Porges’ polyvagal theory. The traumatized patient presents a variety of challenges to clinicians, including a dysregulated autonomic nervous system (ANS), compromised ability to self-soothe and diminished capacity for relatedness with others. Therefore, one effective approach to treating trauma (especially dissociation) includes conceptualizing and responding to our patients through three separate but interconnected lenses: (1) patient and therapist as human mammals—orientation to the ANS, (2) patient and therapist as personalities—orientation to the internal world and, (3) patient and therapist as inhabiting an intersubjective field together—orientation to shared, co-created body/psychological states. The capacity to be guided by countertransference is an especially valuable skill for therapists, as well as the ability to know when they are being experienced as helper or adversary by their patients. Different dynamics driving dissociation and different strategies for responding to the dissociating patient are discussed. Clinical examples are included.     

Beginning Struggles with Families*

Beginning treatment with families is marked by a sense of struggle between the family and the therapist. The family is seen as testing the therapist and as asking through their behavior questions about the therapeutic process. The therapist is advised to focus intently on the beginning interviews, working toward the point where the family relaxes and decides on an intuitive level to enter therapy. The major hurdle is in dealing with the family's anxiety as the therapist attempts to shift the focus from the individual patient to the family as a whole. Strategy in establishing this shift is outlined     

‘Bad Therapy’ as a Training Technique: An Empirical Analysis

The purpose of the present study was to gather empirical data to examine the usefulness of an intriguing training technique called “bad therapy”. The technique, developed by Lang (1980, 1982), is utilized in a role-play setting for experienced therapists who are having difficulty with specific clients showing little improvement. The therapist is instructed to disregard his or her usual style of treatment, and instead, within a role-play format with a colleague who plays the part of a client, to try an alternative style of treatment. This new treatment, termed “bad therapy”, instructs the therapist to try to make the client worse rather than better. Interestingly, reports from both the role-play therapist and client indicate that the “bad therapy” session was considered more beneficial than the therapist's usual mode of treatment. As well as empirically investigating Lang's assertion, the present study also attempted to look at different perspectives of bad therapy. Is “bad therapy” a directive to be harmful and destructive, or is it a suggestion to be more daring and to take more risks? Subjects were 56 therapists who formed twenty eight pairs of therapist-client dyads. First, each pair conducted a “session” where the therapist performed his or her typical therapy. Then, therapists in one group (N= 11) were given directives to try to make their clients worse rather than better (“destructive” set), while therapists in another group (N=11) were told to say and do things that they wished to, but never dared (“daring” set). Finally, six therapists were told to simply repeat their usual type of therapy (“control” set). Results indicated that clients perceived the destructive and daring groups differently with the daring group being perceived more favourably, yet more authoritarian. Similarly, therapists perceived the daring and control groups more positively than the destructive group. The results are discussed in terms of training techniques and current trends in psychotherapy.     

Therapy of the Expectant Family: The Foetus as a Force to be Reckoned With

Over the past 30 years, there has been increasing recognition that pregnancy constitutes a crisis, not only for the pregnant woman, but also for the expectant father and siblings. The tasks facing the “expectant family” and the associated stresses are outlined. Expectant families present when one or more members find the stresses overwhelming, and a range of presenting problems is described. Guidelines for the therapist working with the expectant family are developed, highlighting the importance of acknowledging the existence of the foetus as a “family member” who can already exert a powerful influence on family system dynamics.     

Toward a mini-theory of the blamer softening event: tracking the moment-by-moment process

In this article we present the results of a discovery-oriented task analysis research study identifying specific therapist behaviors that facilitate softening events in emotionally focused therapy (EFT) for couples. Therapy sessions conducted by an expert EFT therapist were examined. Six therapist content theme shifts were identified and specific interventions were delineated within each using an EFT coding scheme (EFT-CS) created for this study. This study extends the theoretical understanding of the softening process--a key change event in an empirically validated couples therapy approach--and provides a detailed clinical map for the training of therapists.     

Challenges,Speculations, Risks: Differentiating From Israel

What is it like to differentiate from a country, a culture? Is it even possible? This paper describes my struggle to differentiate from Israel. I share both the emotional and intellectual dimensions of my journey. The emotional plane is illustrated with a journal entry, and the intellectual through the meaning that I give to my experiences and the conclusions that I draw from them as a therapist. This paper is not a political statement but it does illustrate, I believe, the close and complicated relationship between what is public and what is personal.     

Marital Therapy — The Therapist

This article applies systems principles to an appreciation of the couple therapist. It offers an overview of the changing role of therapists and addresses the philosophical debate of the therapist as scientist or artist. It demonstrates how the worldviews, beliefs and values of clients and therapists are influenced by, and in turn influence, the therapeutic and wider social contexts to which they belong. The question of how a therapist simultaneously maintains personal values and neutrality is considered. The implications of examining the therapist's role from a systems framework are discussed. It is concluded that research needs to adopt a more holistic methodology and that impasses need to be analysed by examining beliefs at different levels within the systems involved. Finally, a personal account of the effect that therapy has on the therapist is offered.     

How Do the Professional Lives of Family Therapists Affect their Private Relationships: A Qualitative Study

This article is based on a qualitative research project about how the professional lives of family therapists affect their private relationships. The overarching research question was: How does your professional work as a family therapist affect your private relationships? To answer this question, semi‐structured qualitative interviews were conducted with four therapists from two different Family Counseling Services. Through the use of interpretative phenomenological analysis, three main findings were identified: (1) family therapists’ knowledge and values are a basis for interpersonal encounters; (2) participants describe resonance in relation to clients’ stories; and (3) therapists can be challenged in managing confidential knowledge particularly where they belong to the same communities as clients. The study also explores societal expectations and discourses that accompany the role of therapist, which can affect therapists’ freedom of movement in their private lives. These issues are discussed in relation to family therapy theory and relevant research.