Captured by the Game: Might a Focus on the ‘Therapeutic Relationship’ Diminish the Attention We Give to the Client's Intimate Network?

A recent project sought to clarify how psychotherapists and mental health workers understand psychosocial health and pathology. In this enquiry, I paid particular attention to the client's interpersonal networks: did the professionals actively consider, and if so to what extent, ‘intimate social and family relationships’ in constructing their understanding of the presenting problem and in the process they used for goal setting. Twenty‐two semi‐structured interviews were undertaken, eleven with psychotherapists and eleven with mental health workers. Across both groups, interviewees tended not to see their clients as embedded, relational entities, but primarily, often quite exclusively, as autonomous beings. Second, interviewees accorded a high value to the importance of ‘the therapeutic relationship’. Is it possible that the emphasis practitioners place on ‘the therapeutic relationship’ has the effect of marginalising the attention that is given to the client's significant‐other network?     

‘Just what is there now,that is what there is’—the effects of theater improvisation training on clinical social workers’ perceptions and interventions

Flexibility, Therapeutic Presence (TP), and collaborative tendency are core capacities in clinical social work as well as in theater improvisation. This mixed-methods pilot study studied the effects of theater improvisation training on 35 graduate-level social work students, who participated in an experiential, semester-long ‘theater improvisation skills for clinicians’ course, compared to a control group of a similar cohort. These variables were measured before, after, and at a three-month follow-up to the course. Additionally, Follow-up semi-structured interviews were conducted with 17 course graduates. Quantitative results showed a significant increase in flexibility and TP immediately following the course compared to the controls, which was not maintained at the three-month follow-up. The qualitative findings indicated an increase in flexibility, open-mindedness, TP, and self-awareness following the training. Triangulation of both sets of data suggests that improvisation training contributed to changes in participants’ general attitudes and perceptions regarding their clinical work. However, longer training is needed in order for these skills to effectively impact their clinical work. The findings suggest that improvisation skills can help clinical social workers increase their flexibility and TP, as well as other important alliance abilities. Implications for teaching and research are discussed.     

The Structure of Empathy in Social Work Practice

This article presents a detailed theoretical framework demonstrating how empathy is used in the practice of social work. This consists of affective, cognitive, and behavioral dimensions of empathy and delineates six latent constructs that make up these dimensions. These constructs are (1) caring, (2) congruence, (3) interpersonal sensitivity, (4) perspective taking, (5) altruism, and (6) the therapeutic relationship. Evolutionary, sociological, and neuroscience theories are used to describe empathy's origins as a historically adaptive and interactional process, and social work theories emphasize empathy as an interpersonal helping strategy and organizing principle essential to the practice of social work.     

Is Managed Mental Health Treatment Psychotherapy?

The corporate takeover of mental health treatment has dramatically affected mental health treatment. Two essential constituents of psychotherapeutic process, the relationship between patient and therapist and the special communicative process associated with a talking treatment, have been significantly compromised. Therapists and patients are being forced to consider whether in the absence of confidentiality, self determination, and a secure treatment partnership managed mental health care can be called psychotherapy. Drawing on several detailed sessions from the managed treatment of a young woman, the writer concludes that the answer is no.     

AN EXPLORATION OF THE THERAPEUTIC RELATIONSHIP AND COUNSELLING OUTCOMES IN A PROBLEM GAMBLING COUNSELLING SERVICE

This study examined the relationship between a number of counselling process variables thought to influence counselling outcomes in a sample of 150 clients undertaking short‐term counselling in the state‐wide government funded Gambler's Help problem gambling counselling services in Victoria, Australia. Factors measured included psychosocial well‐being of clients prior to and after counselling, client readiness to change, self‐reported gambling activity levels before and after counselling, self‐assessment of current gambling behaviour, strength of therapeutic alliance, self‐reported counselling outcomes achieved in the area of symptoms, life matters, and related problems and a measure of client satisfaction with the service. The therapeutic alliance was found to have the strongest predictive power with respect to the level of problem resolution achieved by clients across all but one of the problem areas. The implications of these findings for clinical social work practice and education of practitioners are noted.     

Conceptualising ‘The Relationship’ in Intensive Key Worker Support as a Therapeutic Medium

Across various welfare and justice systems, intensive key worker support is a model of working considered effective for individuals and families identified as having multiple and complex needs. The high profile ‘troubled families’ programme in England is the most recent prominent example of such a model. The key worker role is to assess an individual’s needs, carry out support planning, provide and/or co-ordinate the delivery of supportive interventions and complete care plan reviews. This requires the key worker to work on a one-to-one basis with individuals which, in turn, demands the ability to form effective relationships. In this paper and using evidence from a number of studies, I look at how the key worker-client relationship is developed and maintained. I examine the skills, processes and communication strategies that allow key workers to engage clients, build relationships and drive change. I also explore the notion that the key worker-service user relationship is itself a ‘therapeutic’ medium and is therefore a productive practice in its own right. The paper suggests that while key workers might not be trained therapists or counsellors, they might be equipped to address some emotional challenges that individuals with complex needs face and build therapeutic relationships with them.     

THE NEUROBIOLOGY OF AFFECTIVE INTERVENTIONS: A CROSS-THEORETICAL MODEL

The integration of information from neuroscience with the practice of psychotherapy presents with numerous challenges. However, neuroscience research can guide practitioners in the purposeful use of the therapeutic relationship to enhance clinical outcomes. This article reviews such research pertinent to mental health and psychotherapy, and presents an a-theoretical model of intervention, guided by this information that can be incorporated into various therapeutic orientations.     

Micro Ruptures and Repairs in the Beginning Phase of Cross-Cultural Psychotherapy

The article discusses misunderstandings and misattunements that occur in the beginning phase of cross-cultural psychotherapy. Sources of micro ruptures are outlined, including client maladaptive patterns, therapist misunderstandings, cross-cultural misunderstandings due to cultural variations, and asymmetrical power relations involving the impact of prior experiences or current therapy practices. Multiple clinical vignettes illustrate the rupture/repair process, drawing on Safran and Muran’s (2000) list of direct and indirect techniques.     

The Power of Relationship: A study of key working as an intervention with traumatised young people

This paper explores the role of the key working relationship in helping traumatised and characteristically hard-to-reach young people. A grounded theory approach was used to analyse data from 18 semi-structured interviews carried out with both key workers and young users in a community-based, innovative project in Inner London, Kids Company. The following four codes emerged: titrating intimacy, the power of relationship, the therapeutic function of hope and ‘knowing your own ghosts’. As well as supporting the important therapeutic function of the key working relationship, this paper draws on the analysis of the data to outline a three-phase model of intervention (fostering place attachment–homeostatic attunement–disruptive attunement) when working with traumatised and often hard-to-reach young people.     

More than just pain?! A systemic compass for working with people with chronic pain

Over one in four people in Belgium experience severe physical pain. One in 10 people develop chronic pain every year worldwide. Treatment of chronic pain is based on the biopsychosocial model. Scientific views state, among other things, that pain is a threat to the social self, which is an interesting point of entry for (mental) health-care providers. Conversations with people with chronic pain are always about more than just their pain; they are interesting and cover a lot of ground. Talking about feelings of being hard done-by, clarifying the complexity of the situation, examining the body as an autonomous entity, offering psychoeducation as a hypothesis, and a general attitude of not-knowing form a compass that allows us to attune to the patient and not take up an advisory position. Living with chronic pain requires negotiating with the outside world, being allowed to care for and consider the body, and being allowed to differ from the norm and still fit in enough in a world where the body is just a background figure. An identity transformation and the effects of trauma are described. We meet Eddy and Anne, both dealing with chronic pain, who bring theory alive. The author gives an insight into her personal search and struggles as a psychotherapist introducing systemic psychotherapy in chronic pain patients.     

Developing Effectiveness in the Therapeutic Use of Self

Traditional technique guided the effective psychotherapist more toward restraint of self than active use of self. Contemporary trends in technique are moving more toward encouraging the therapist to be aware of and use his or her real self in the relationship with clients, in other words to loosen the rigors of anonymity and neutrality in service of genuine relating and its attendant growth-enhancing potential. The authors of this paper offer the argument that the application of what you know as a psychotherapist (that is the accumulation of knowledge and techniques from professional education and training) can only be helpful and effective if you are aware of how who you are as a person in the room with the client (that is the accumulation of your own personality traits, personal belief systems, and psychology in the relational matrix with the client) is influencing the therapy. Support for this argument from the clinical literature provides the theoretical bases for three processes outlined in the paper which will guide the effective psychotherapist in integrating the personal self with the professional and technical self: 1) inventory of self; 2) development of self-knowledge; and 3) acceptance of risks to self.