Clients as Teachers: Reciprocal Influences in Therapy Relationships

The value of the continuing education industry for therapists is questioned, as is the usefulness of therapy books and journal articles, as a means of engaging therapists in life‐long learning. Instead, it is argued that our clients are our best teachers and that therapists learn most effectively from their clients. Drawing on research studies with prominent theoreticians and therapists, and on case studies from clinical work, a number of important themes are identified as ways in which therapists are influenced by their therapeutic encounters with their clients. The themes explored in this article include: (1) intimacy and high emotional arousal with clients as we witness profound change; (2) being challenged by clients; and (3) allowing for boundary ‘crossings’ in order to develop more flexible ways of working with clients. The implications for professional development are discussed.     

Strategies Used by Foreign‐Born Family Therapists to Connect Across Cultural Differences: A Thematic Analysis

With the growing diversity in the United States among both clinicians and clients, many therapeutic encounters are cross‐cultural, requiring providers to connect across cultural differences. Foreign‐born therapists have many areas of differences to work through. Thus, exploring how foreign‐born family therapists in the United States connect to their clients can uncover helpful strategies that all therapists can use to establish stronger cross‐cultural therapeutic connections. A thematic analysis was conducted to understand strategies 13 foreign‐born therapists used during therapeutic encounters. Four themes were identified: making therapy a human‐to‐human connection, dealing with stereotypes, what really matters, and flexibility. Findings suggest that developing a deep therapeutic connection using emotional attunement and human‐to‐human engagement is crucial for successful cross‐cultural therapy. Clinical and training implications are provided. Video Abstract     

Secondary Trauma: How Working with Trauma Survivors Affects Therapists

Secondary trauma, a relatively recent topic that has emerged in the field of social work, includes the emotional and psychological effects that working with traumatized clients has on therapists. Secondary trauma can seriously impact therapists' personal and professional well-being. Trauma therapists face major ethical dilemmas if their reactions to being traumatized enter into the therapeutic relationship, exposing clients to psychological harm or possibly re-traumatization. As many graduate programs in social work and social service agencies are still unaware of this phenomenon, recommendations are made for how to introduce the topic as priority and how to cope with and prevent secondary trauma.     

Nurturing Life with Dreams: Therapeutic Dream Work with Cancer Patients

This paper describes the use of dream work as a component of individual counseling for cancer patients. Motivated by the work of experts in the field, who use dream work with their clients facing life-threatening illness and corroborated by a review of the literature, this therapeutic modality was introduced with cancer patients at a social service agency. The clinical work seems to indicate that the use of dreams helps create a safe environment for therapy by encouraging clients to discuss the emotional aspects of their disease and introducing topics, like death and dying, which are normally difficult to discuss.     

A new nursing medium: computer networks for group intervention.

The PLWAs and the caregivers of persons with AD were similar in their adaptation to this new technology as a communication medium with nurses. Both groups availed themselves of the resources, both technological and personal, on the computer network. Although different in demographics, they also were similar in their ability to form and work in a traditional group structure. Nurses have historically intervened with groups, and this article demonstrates that nurses can intervene on a computer network with groups. Yalom's therapeutic factors exist in both non-face-to-face groups and traditional groups. The benefits of this technology to nurses are numerous: they can access clients in an efficient yet supportive manner; they can respond to multiple levels of need in multiple clients; and they can attend to emotional as well as more concrete needs of clients. The benefits to clients are also numerous: they can use the system at a time, frequency, and duration of their choice; they have the opportunity to be supported in self-care efforts versus being in a more dependent role; and they can engage in a normalization of their experiences. Computer networks can enhance nursing's ability to intervene with clients experiencing clinical problems.     

Triads in Equine-Assisted Social Work Enhance Therapeutic Relationships with Self-Harming Adolescents

Despite an increasing number of studies, there is still a lack of knowledge about the unique features that underlie the process in equine assisted social work (EASW). This study aimed to reveal, through qualitative methods, the dyads within the triad that become stronger during the process of EASW, as well as the effect of the participation of the horse on the relationship between the counselor and client. Data were collected through in-depth interviews with nine female self-harming clients aged 15–21 years and eight staff members. The interviews, together with video-recorded human–horse interactions with three staff members and four clients were analyzed, resulting in additional issues answered by these three staff members and four clients in a second interview. Critical dialogues between patterns and fragmentations in the narratives and video-recordings, as well as a dialogue with the participants while they were viewing videos of their own EASW sessions, led to the conclusion that adding a horse qualitatively changes therapeutic relationships in EASW. The different triads consist of different liaisons between actors in the triad, giving rise to unique combinations. The quality of the relationships depends on both the staff and the clients’ attachment orientations. Further research is needed to investigate how the degree of emotional connection to the horse affects the impact that horses have on triads in EASW.     

Theory and Practice of Systemic‐Dialogical Therapy

Systemic‐dialogical therapy originates from an evolution of Milan systemic therapy, through a reflection on Bakhtinian dialogue and on power and knowledge dynamics in therapeutic sessions. The model considers both emergent patterns in human interaction and the dialogical nature of human exchanges in which emotions play a relevant part. Such theoretical considerations prompted the creation of specific practices, such as emotional micro‐hypothesising, considering heteroglossia in the session, dialogue with the context, finding one's place in the relational network, and fostering relational responsibility in both therapist and clients. The practice of systemic‐dialogical therapy is illustrated by a clinical case study.     

Strengthening Support to Families: Basing a Family Support Worker at a Primary School in Melbourne,Australia

This mixed methods study examines the benefits of basing a family support worker (FSW) at a primary school in Melbourne, Australia. The school has a number of high needs families requiring extensive support from school staff. Pre and post intervention data was collected on the time spent on social problems in the school community. These included managing students with behavioural and emotional issues, providing support and practical assistance to parents with problems and liaising with agencies to access support for students and families. Pre and post intervention Strengths and Difficulties Questionnaires were completed by teachers whose students and families were clients of the FSW (n = 8) and compared with non clients (n = 10). Semi-structured interviews were held with FSW clients (n = 6), class teachers (n = 3) the assistant principal, principal and the FSW. Employing a FSW showed a reduction in the amount of time spent on welfare cases for teachers, and therefore a monetary saving for the school. Qualitative data collected from school staff and FSW clients was overwhelmingly positive. Having a FSW based at a primary school provides savings in teacher time, and expenses to the school. Teachers are freed to concentrate on education and the parents valued the relationship provided by the FSW.     

Transition from the hospital to the community: small group program.

1. Clients in a psychiatric hospital often experience loss of control over their lives and dissatisfaction with their quality of living. A small group rehabilitation program can counteract the effects of institutionalization and restore a sense of mastery to chronic psychiatric clients. 2. The therapeutic nurse-client relationship provides consistency and stability for clients who must cope with the stress of the mental health system and the transition to a community setting. 3. The program strives to restore individuals' self-confidence and dignity, improve their quality of life, and decrease the frequency and length of hospitalization.     

Psychotherapeutic Considerations for Working with Betrayed Spouses: A Four‐task Recovery Model

The treatment of infidelity is one of the most challenging and misunderstood aspects of marital therapy, with therapists frequently making treatment decisions based on faulty assumptions. By too quickly trying to ‘fix’ the marriage or by assuming that the betrayed spouse contributed to the unfaithful partner's infidelity, the therapeutic process can inadvertently re‐traumatise an already emotionally fragile client, while not addressing his or her emotional needs. This paper addresses therapeutic considerations for working with the betrayed partner, and provides practical guidelines for addressing the psychological and emotional needs of a betrayed client. A grounded theory model of the recovery path for betrayed partners is presented, as well as suggestions for further research.     

Cultural aspects of bipolar disorder: Interpersonal meaning for clients & psychiatric nurses

Bipolar disorder is a complicated mental illness to diagnose and treat. The symptoms of the disorder cause a multitude of fluctuations in mood and behavior, affecting the way individuals function and interact with others on a daily basis. Individuals diagnosed with bipolar disorder experience symptoms within a framework that is grounded in their cultural beliefs, values, and norms. Culture is a complex and personal biopsychosocial phenomenon that provides meaning within life for an individual, a group, or a community. It is essential that psychiatric-mental health (PMH) nurses understand the role of culture and integrate this knowledge into the biopsychosocial care of clients. The development and maintenance of the interpersonal therapeutic relationship between PMH nurses and their clients requires the use of a cultural framework, which refers to the connection of culture and cultural competence. The purposes of this article are to define culture and the process of cultural competence, provide a brief overview of bipolar disorder, propose the use of a cultural framework for bipolar disorder, and discuss the implications for PMH nurses who care for culturally and ethnically diverse clients.     

Re-Collections of Childhood Sexual Abuse: A Biopsychosocial Perspective

A number of theories—biological, psychological, and sociological—inform clinical practice with adults who report memories of childhood sexual abuse. However, each of these theories is inadequate in and of itself. This has several, potentially damaging clinical implications. Therapists might doubt the validity of their clients' reports of traumatic incidents, they may place too heavy an emphasis on the recollection of traumatic events, or they may shy away from discussing these events. Any of these responses can jeopardize the helping relationship, leaving clients without professional assistance in managing a most difficult emotional situation. This paper provides a review of the biological, psychological, and sociological perspectives that lie at the foundation of current practice. These perspectives are then integrated via social work's biopsychosocial perspective. This holistic view provides an empirical base for effective, ethical social work. Specific practice implications are discussed.     

Who are they? Identifying and treating adult children of alcoholics

1. Adult children of alcoholics are frequently found within the population of clients on inpatient psychiatric units. The percentage of this population is greater than the occurrence of ACoAs in the general population. 2. Nursing staff can assist these clients in a therapeutic way by becoming familiar with the types of issues these clients present and the behaviors they manifest. These issues should be reflected in treatment planning. 3. Anger, abuse, guilt, and grief form the core issues that ACoAs must deal with in therapeutic ways during psychiatric hospitalization.     

Therapeutic interactions in a medication education group. Using the psychopharmacology RACE.

1. The Psychopharmacology RACE is an interactive, innovative game that emphasizes group teaching about psychiatric medications and disorders at the clients' levels of functioning. 2. Implementation of the Psychopharmacology RACE provides the opportunity to structure a medication group, impart information, and facilitate the development of therapeutic group factors. 3. Interactive group learning with the Psychopharmacology RACE can be a useful tool to enhance learning when clients are unable to read and understand written materials.     

Mastering group leadership. An active learning experience

Leading therapeutic groups is an underused but viable treatment role for nurses in all specialty areas. A dynamic psychoeducational group model provides structure as nurses invest and collaboratively participate to actively learn the group leader role. this article highlights the sequencing of instruction of group theory and skills with examples from a baccalaureate nursing curriculum. Samples from student journals reveal their growing assimilation of the group leader role as learners actively participated in groups, collaborated, and reflected on their learning. Examples of creatively adapted group exercises, as well as selected nursing group leader interventions, demonstrate group leadership as a skill that can increase nurses' repertoire of therapeutic responses. Therapeutic groups are both exciting and cost-effective treatment strategies for use with mentally ill clients. The skills of an accomplished group leader are transferable from within the psychiatric population to working with families, bereavement groups, and other client populations, ranging from people with diabetes to survivors of catastrophic crises. Group leadership ability complements the management and negotiation skills needed in professional nursing roles. When students and staff nurses grow in group leadership expertise, clients in various settings will be better served with this currently underused treatment option.     

Working with Contact Father Families: Insights from Therapy

The incidence of marital and relationship breakdown, in particular where children are involved, continues to increase across Australia. For the contact father, the psychological and emotional effects of separation are often experienced concurrently with many practical matters and can raise issues such as dealing with loss, identity development and constructive role restructuring. The adjustment period can also expose an increasing need to move on in developmental terms. This paper describes the effects of relationship or marital breakdown and ongoing adjustment issues upon those contact fathers who have not initiated separation, who have physically left the family home and in doing so, have left their children behind with the mother. The paper also considers the psychological and therapeutic implications for working with this often marginalised group of clients. A working model which addresses various coping styles is presented.     

The impact of therapist pregnancy on the treatment process

Therapist pregnancy is a powerful emotional stimulus and a real-life event that affects clients and the treatment process. In the present paper, previous literature is reviewed and clinical experiences of the author in a university counseling center are reported to address how therapist pregnancy influences clinical treatment. Although therapists often hesitate in emphasizing their pregnancy, evidence suggests that it is easy to underestimate the importance of the pregnancy for clients. Case examples are presented which demonstrate client responses and the significance of the pregnancy for four female clients. Gender differences in client reactions are not fully understood, and it may be particularly difficult to facilitate male clients in dealing with issues stimulated by the pregnancy. These clinical findings suggest that in a variety of settings, understanding and working with clients' reactions to the therapist's pregnancy can enhance treatment.     

The impact of initial factors on therapeutic alliance in individual and couples therapy

The study uses 457 clients to investigate the impact of initial client factors on the development of therapeutic alliance. Data were collected longitudinally over the early portion of treatment. Cases included both individual and couple clients, allowing for examination of differences by case type. The study used the Working Alliance Inventory-Shortened Version (Tracey & Kokotovic, 1989) to measure therapeutic alliance. Initial factors considered included age, differentiation levels, prior stress, and depression. Couple clients showed differences from individual clients, and the variability prompted further investigation into relationship satisfaction and commitment as factors influencing the development of therapeutic alliance. Results highlight the increased complexity of developing an alliance with couples, and recommendations are provided for clinicians.     

Simulated Clients in a Group Practice Course: Engaging Facilitation and Embodying Diversity

Social work students need to develop practice skills with racially and ethnically diverse clients. Previous research has found benefits to using individual simulated clients, and working with a group would not only provide facilitation opportunities, it could also increase students’ exposure to diversity. This article presents a social work group practice class that used simulated clients and the evaluation of the pedagogy using a mixed-methods design. Students’ scores on the Diversity and Oppression Scale significantly improved from pretest to posttest. Focus groups clarified the impact. The results of this exploratory pilot study suggest that this approach allowed students to learn to manage emotional responses, promoted student insights, and provided opportunities to challenge student assumptions.     

Art therapy. Enhancing psychosocial nursing

1. The creative process can be a means of reconciling conflicts and increasing awareness. 2. Art provides a permanent representation of clients' internal states and reflects the changes seen in the therapeutic progression. 3. Many psychological states lend themselves to a much greater extent to graphic representation, as opposed to verbalization. 4. Art holds the potential for enhancing the quality of therapy for clients by increasing expression and facilitating insight.