Therapeutic control in family therapy

This article emphasizes the importance of establishing therapeutic control in family therapy. Therapeutic control is viewed as similar to conducting an orchestra or directing traffic. Problems that interfere with its implementation are related to the limited appreciation by the therapist of understanding the requirements and responsibilities of a leadership role, the lack of knowledge and experience of the therapist, the difficulty in establishing the relationship between presenting problems and family conflicts, being overwhelmed by the perception or expression of strong feelings, discomfort in presenting options. A therapist who is in control of the therapeutic process is able, comfortably and gently, to lead family members, who initially are often in chaos or resistive, to discuss hidden feelings and conflicts. Often, through the therapist's initiative and articulation of understanding of the problems, the family, more relieved than threatemed, is able to focus on major issues.     

The Effects of Suicide on the Private Practitioner: A Professional and Personal Perspective

A patient's suicide has a profound effect on the therapist and psychotherapy with a chronically suicidal patient is particularly troubling. Guilt over one's failure to recognize the warning signs, fear of one's incompetence or irresponsibility, shame that one has failed, and fear of being blamed by the patient's loved ones and by colleagues are feelings that frequently surface and that can result in isolating a practitioner from the very sources of peer support that are necessary in order to resolve the trauma. This article explores the effects of suicide on the private practitioner. It discusses how burnout and vicarious traumatization impact upon the therapist who treats the chronically suicidal patient. Two clinical examples illustrate the impact of working with imminent suicide and the aftermath of a patient's death from a personal perspective. Recommendations are made to help private practitioners maintain equilibrium when working with these overwhelming case situations.     

Frozen in Time: Idealization and Parent-Blaming in the Therapeutic Process

Contemporary theory and culture can lead a therapist to view a client’s positive feelings towards parents as defensive idealization, while negative or hostile feelings may be seen as “deeper” and more important. This article suggests that both idealization of and critical feelings about parents can serve as defenses against other painful emotions and both are developmentally necessary. Contemporary neurobiological and attachment research indicate that “talk therapy” helps individuals manage emotions. This work can be derailed if anger is privileged over idealization. Clinical examples illustrate these ideas and show how unpacking both critical and overly positive attitudes can encourage development. Clients increase their capacity to tolerate a wider range of feelings, maintain a consistent and cohesive sense of self, and build meaningful relationships. Therapists’ countertransferential identification with clients’ parent-blaming and a not uncommon desire to reduce complex and confusing experiences to a more manageable subset of emotions are also addressed.     

Issues in Psychotherapy with Clients Affiliated with the Opposing Side in a Violent Political Conflict

The therapeutic dyad of clinician and client affiliated with rival groups in a violent conflict shares many features that complicate psychotherapy with persons of different ethnic, racial, and cultural groups, including lack of knowledge, negative stereotyping, differences in fundamental values and world views, and power differentials. Although a great deal has been written about these matters, very little has been written about the therapeutic dynamic where therapist and client are affiliated with different sides of a violent political conflict. Based on the sparse literature on the subject and on the clinical experiences of the author and her colleagues, this paper discusses three features that characterize this dynamic, which do not appear in the same way in therapy involving dyads of different races, ethnic groups, or cultures. These are the presence of the “enemy” in the consulting room, the therapist’s feelings of mistrust towards the client as a representative of the opposing group, and the client’s feelings of guilt towards the therapist as a representative of the injured group. The impacts of each feature on the therapist, client, and the therapeutic encounter are explored and suggestions are made for dealing with them. The hope is that professionals’ awareness of these issues will help improve the quality of psychotherapy with persons on the rival side of a violent political conflict.     

The celebration of death in group process

This paper discusses the mobilization of group resources in facing death. It delineates the evolvement of group process when patients and therapist learned of the oldest member's terminal illness. It deals with the group's commitment to his request for help in dealing with his last life crisis by being actively with him through his hospitalization and last rites; the commitment to death with dignity; the group's responses to the therapist as role model in dealing with death and seeing a facet of her which had not been evident to them within the confines of the office, the working through of the patients' and therapist's feelings of loss of loved ones particularly the father; and the countertransference resistance which resulted and its effect on group process.     

Countertransference issues for the consultant when a colleague is critically ill (or dying)

This report illustrates how countertransference issues emerged for a consultant therapist whose guidance about practice was sought by an ill and dying colleague. The detechment necessary for consultation was difficult to maintain. Denial, avoidance, and isolation operated for both. Ambivalence about directive behavior developed. Unexpressed grief, shock, feelings of inadequacy, and identification with the colleague intruted but were managed. The occurrence of such countertransference phenomena can be anticipated and understood in a consultation process that represents one valuable, underutilized, and important means of encouraging quality clinical practice under extremely painful circumstances.     

Breaking the race barrier

Through the reflective process of analyzing one's own feelings and reactions to the ethnic minority patient, the white therapist develops an inner clarity that serves as a resource to cope with the unique conflicts one must confront in interracial practice. Only when the therapist has come to some resolution of his or her own feelings about the plight of ethnic minorities in this country can this acumen develop. Although the therapeutic skills applied in psychotherapy with ethnic minorities are in no way different from overall therapeutic skills, certain techniques may be especially useful in interracial practice. For instance, a discussion of the meaning of race and ethnicity in the relationship may curtail racial distortion, prevent stereotyping, and lead to the creation of a therapeutic alliance. When dealing with transference and countertransference issues, the therapist must be particularly attentive to the representation of these same distortions and stereotypes. Formulating clinical problems from dual perspectives, theoretical and sociocultural, is an arduous, but necessary task. Finally, the white therapist must be able to view ethnic minority patients as individuals. Although these patients cope with special problems which must be acknowledged and dealt with in therapy, the therapist must realize there is a common ground on which to communicate. On this common ground, therapists discover the foundation of interracial clinical practice is the ability to accept and respect their patients and themselves as individuals who may have similar anxieties, problems, experiences, and goals. It is through the recognition and sharing of the fundamental human bond that ethnic and racial differences, which may have detrimental effects on interpersonal relationships, are transcended.     

Qualifications and tasks of the therapist in group therapy with children

The tasks of the therapist in group therapy with children are discussed on the levels of comprehension of the developmental norms and emotionality of children, the understanding of the dynamic uniqueness of individual group members, the capacity to deal with the group as an entity in terms of recognizing group themes, group and subgroup resistance, and the need for selfawareness in dealing with the feelings induced in the group therapist by the group. Material illustrative of these parameters is presented.Presented at the Fortieth Anniversary of Group Therapy at the Jewish Board of Guardians, January 13, 1975.     

Therapeutic Love and Its Permutations

Compensatory treatment theory rooted in object relations and self psychology is typically silent about issues of love in the therapeutic relationship, particularly the erotic and sensually infused affects and enactments that may permeate patient-therapist interactions, even in the treatment of preoedipal patients. This paper presents a series of case reports in which the therapist consciously or unconsciously experienced some permutation of love in response to the patient's loving and/or erotic feelings. The central thesis is that patients benefit when therapists recognize the sensual components in transference-countertransference interactions and use them to inform therapeutic interventions.     

Countertransference issues in the in-home treatment of child sexual abuse

Strong emotions are aroused in people in the presence of child abuse. For the therapist trying to help abusive families, these feelings can destroy any prospect of achieving a therapeutic process. This problem is particularly acute in the in-home situation.     

Does the Therapeutic Relationship Matter? A Follow-up Study of Adherence and Improvement in Family Therapy

A follow-up study of 83 families treated by family therapy at a child guidance clinic was conducted and the relation of client/therapist interaction to (i) drop out from therapy and (ii) improvement was examined. Early terminators were found to differ significantly from continuers as to their ratings of their relationship with the therapist, and trends were found for therapists' feelings to be associated with adherence to therapy. Early terminators were not distinguished by diagnosis, severity of case, or improvement rating. Improvement, on the other hand, was not associated with therapists' or clients' attitudes to each other. It is suggested that these factors are of greater significance in “joining” therapy than in its course.     

Thinking About the Emotional Interaction of Therapist and Family

The emotional interaction of therapist and family has been difficult to explore within the field of systemic family therapy. This paper looks at ways of thinking about this process. As a starting point, I take some feelings I had with three families in the course of therapy. These are used to illustrate some concepts from analytic therapy which address the emotional interaction of therapist and family. The kind of theoretical space and guidance offered within systemic family therapy is then explored, and it seems that the Milan frame gives some space for thinking about the process but offers little guidance as to exactly how this might be done. This is a paper about practice, though it's primarily a theoretical discussion. There is no aim of establishing a ‘correct’ way of understanding the emotional interaction of therapist and family.     

Attachment intervention through peer-based interaction: Working with Istanbul's street boys in a university setting

Street youths are a particularly vulnerable group because of early experiences of emotional and physical neglect and abuse which can make them difficult to approach. Traditional interventions such as 1 h weekly therapy sessions do not meet their needs. This article describes a creative and novel approach to the rehabilitation of street children implemented during the To-Gather with Youth Project (TYP) under the aegis of the Research and Application Center to Support Children/Youth Living and Working in the Streets (SOYAÇ) at Maltepe University in Istanbul, running in collaboration with state-run care institutions for boys since 2010. The approach consists of a peer-based supportive model that provides adolescent boys care with emotional and social security through attachment relationships that they develop with university students. The teaching staff and students of the psychology department constitute the core group running the program, which also includes workshops assisted by teachers and students from humanities departments such as philosophy, drama, and radio. These workshops are organized to promote the psychosocial and cognitive development of the participating street boys as well as to enable their direct access to the public through their art and photography. Based on a qualitative analysis of narrative interviews with boys and detailed observational reports by project volunteers, we identify several mechanisms that we believe contribute to change in the boys, including the development of secure attachment relationships with a trusted adult, a child-centered approach, and a socially safe environment created by peer-support in a university setting. The boys and volunteers also reported incidents and feelings that seem to suggest that the boys' have increased their capacity to regulate their emotions, sense of self-esteem and resilience, and desire to develop their lives in the future. This paper offers this intervention as a feasible service model for the rehabilitation of street boys in other cities.     

Being missed and missing: An interactional element of separation/individuation

The intent of this paper is to demonstrate as a therapeutic use of self the selective communication of the therapist's own feelings as enabling a patient to experiencemissing. I focus here on work with a patient who urgently and primarily presented unmourned (unintegrated) separation and loss in her history, in her self and object relations, and thus in her relationship with me. I propose that the therapist's feelings, in so far as they reflect an interactional aspect of the normal separation/individuation process may serve as a basis for expressive, interactive participation by the therapist.     

From action to reflection: New depths in psychotherapy with drug addicts

The continuously self-destructive behavior of some drug addicts may stir up in the therapist feelings of helplessness, hopelessness and anger. This article explores some of the dynamics of the addict's behavior and some of the pitfalls present in interventions on the part of the therapist which ignore the language of the acting out and which concentrate on crisis and behavior. Two case examples are presented to illustrate the therapist's dilemma and new depths of interventions.     

The RELATionship Evaluation (RELATE) with therapist-assisted interpretation: short-term effects on premarital relationships

This study assessed participant satisfaction with two interpretation formats and the effects of taking the RELATionship Evaluation (RELATE) on single young adults' premarital relationships. Thirty-nine engaged or seriously dating couples were assigned to one of three groups: (a) those who took RELATE and interpreted the results themselves, (b) those who took RELATE and participated in an interpretation session with a therapist, or (c) a control group. Results showed that taking RELATE with therapist assistance had a significant positive effect on perceived relationship satisfaction, commitment, opinions about marriage, feelings about marriage, and readiness for marriage. Positive effects also included increased awareness of strengths and challenges, improved couple communication, and the expectation of the prevention of future relationship problems. Taking RELATE without therapist assistance produced a small initial drop in relationship satisfaction followed by a marked improvement over time. Both genders approved of two interpretation formats-self-interpretation and therapist-assisted interpretation-with males slightly preferring therapist assistance. These results add to the literature on the usefulness of brief assessment techniques as effective interventions with premarital couples.     

Homosexualities in the Netherlands

Loving relationships between two men, or between two women, are by no means generally accepted in the Netherlands. Prejudices, mistrust, and aversion on the part of those surrounding them are the daily lot of homosexuals. Young people who are attracted to members of their own sex have understandable difficulties in dealing with this state of affairs. Becoming aware of their own homosexual feelings, looking for contact, building up relationships, developing a measure of self-esteem—all become especially difficult when there is little support, understanding, and no role models for homosexual lifestyles to be found in the immediate environment.In this article we will successively examine the attitudes of the Dutch population toward homosexuality and the living situation of homosexuals in the Netherlands. A more detailed report will be given of a comparative investigation of homosexual and heterosexual boys and girls carried out by the author.     

Relational Quandaries in the Treatment of Forensic Clients

This article examines the sources of relational difficulties inherent in clinical work with forensic clients. Left alone, common countertransference feelings, responses, and defense mechanisms can disrupt and ultimately derail treatment. Concepts relating to the management of countertransference offer a path with which to integrate therapists’ affective reactions as a mechanism of therapy. A relational framework utilizing the affective dynamics between client and therapist to develop and promote treatment goals is introduced and the process of formulating it is described. Practice examples are offered.     

THE EVALUATION PHASE OF SYSTEMIC FAMILY THERAPY*

The initial, evaluation phase of family therapy is of decisive importance within the systemic perspective. Contacting a therapist is always a complex action for a family. The therapist's evaluation must include the possibility that continued contact may influence the family negatively and limit their potential for change. If there appears to be a logical context in which continued therapy can be justified, it will be necessary to use the first three or four sessions to collect essential data and to organize them meaningfully. It is essential to clarify the circular interaction that is maintaining the symptom, as well as the presence of specific family structures and traditions, and the kind of relationships the family attempts to establish with the therapist. On the basis of this information, the therapist can build models of the family's functioning. These models, according to general system theory, make possible logical intervention in complicated, living systems, without distorting them by artificially splitting them into their component parts. Two models that are important to our treatment perspective—the phenomenological and the mythical—are presented.     

Family therapy: An orientation

Conclusion The family therapist is an active, involved therapist. He must be emotionally lithe and resilient, prepared to deal with, or deal out, the unexpected. His challenge is to learn to use his own impulses and reactions in a way that the family can use to understand themselves better. He makes use also of any people and resources in the family's environment which might be of help to them. There are some basic techniques and orienting principles available to the family therapist, and it is these which it has been the task of this paper to set forth. Beyond these, the responsibility rests with each family therapist to comprehend himself and his place in his own family, and then to use his creativity to transform what he knows and what he feels into a form which can be used by the families he treats in their development.