FACTORS RELATED TO FAMILY THERAPISTS' BREAKING CONFIDENCE WHEN CLIENTS DISCLOSE HIGH-RISKS-TO-HIV/AIDS SEXUAL BEHAVIORS

This national survey of 309 marriage and family therapists examined what therapists do when their HIV-positive clients disclose that they are engaging in high-risk sexual behavior. The participants were given vignettes in which a fictitious client told the therapist about engaging in unprotected sex. Although the basic situations were the same, the client variables of age, gender, race, sexual orientation, and HIV status were systematically varied. The participants were more likely to break confidence regarding unsafe sex practices when their clients were male, young, gay, or African American. Moreover, therapists who were more likely to disclose were older, female, had less experience with gay/lesbian populations, were Catholic, were very religious, and were more likely to practice in urban areas. The authors discuss the implications of these and other findings.     

THERAPIST AND CLIENT BEHAVIORS IN THE FIRST INTERVIEW: EFFECGTS ON SESSION IMPACT AND TREATMENT DURATION

The first-session behaviors of therapists and clients in 38 cases were observationally codes and their relations to client ratings of session impact and treatment duration were examined. Results indicated that few first-session global types of behaviors of participants affect treatment durations. Clients may suspend judgement about continuing in therapy untill after they have attended more than one session, regardless of the first inverview's impact. Thus, the first interview may be less crucial than traditionally asserted. It also appears that first-session behaviors of therapists and clients that are associated with greater impact may vary as a function of client type, that is individuals as opposed to couples and families.     

‘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.     

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.     

Cost effectiveness of an integrated service delivery model as measured by worker retention

This study sought to examine the impact of housing child welfare ongoing teams in the community, near client neighborhoods, and in a setting that also co-locates other service providers that serve the same clients. The focus was the impact of location and service integration on perceptions of worker stress and actual worker turnover. Thirty four workers from this type of setting and from a more traditional setting in two urban cities in a Southern state were interviewed. In addition turnover rates were calculated and compared. It was found that those located near clients and with staff from other agencies had better morale, lower stress levels, more positive attitudes toward clients and client contexts, knew more about the communities the clients lived in and had more chances to collaborate to solve client problems than those in a more traditional setting with co-location only with family support staff. The turnover rate was lower in the integrated service delivery setting than in either the traditional setting or the state overall. Thus, integration of service delivery benefits not only the child welfare workforce participants, but also the clients who have greater access to other service providers and to the bottom line of the agency through the retention of workers. Implications are described.     

AAMFT Master Series tapes: an analysis of the inclusion of feminist principles into family therapy practice

Content analysis of 23 American Association for Marriage and Family Therapy Master Series tapes was used to determine how well feminist behaviors have been incorporated into "ideal" family therapy practice. Feminist behaviors were infrequent, being evident in fewer than 3% of time blocks in event sampling and 10 of 39 feminist behaviors of the Feminist Family Therapist Behavior Checklist. These eminent therapists most often dealt with empowerment of male clients and management of power differentials in the therapeutic relationship in a relatively feminist manner, but they tended to hold women responsible for family issues, endorsed traditional rather than egalitarian relationships, and overlooked how the social context affects families. Several of the therapists were blatantly sexist in their treatment of female clients, communicating disrespect of and pathologizing them. The few tapes portraying effective incorporation of feminist principles in family therapy indicate that a handful of behaviors are key to this approach.     

Partners in the Spiritual Dance: Learning Clients’ Steps While Minding All Our Toes

We present four case illustrations highlighting the complex interplay of therapists’ and clients’ spirituality in therapy. Complexity, in these cases, results from (a) degrees of similarity and difference, both real and perceived, between clients’ and therapists’ spiritual beliefs and practices; (b) degrees of spiritual disclosure; (c) characteristics of the therapeutic relationship; and (d) geographic and cultural influences. Practicing therapists and therapist training programs can benefit from addressing how therapist and client spirituality intersect and influence therapy, how both similarity and difference present obstacles and opportunities, and how ambiguity and assumptions can contribute to misunderstandings. We believe that both the therapist’s and the client’s spiritualities are key influences in therapy that can contribute to the frustration, and the growth, of clients and therapists alike.     

Therapists’ Assessment and Treatment of Internet Infidelity Cases

In this study, we investigated through an Internet survey of 508 practicing marriage and family therapists which treatment decisions varied by gender of the client and background variables of therapists. The subjects responded to several typical Internet infidelity scenarios. We varied the gender of the person initiating the infidelity for half of one sample. We also asked the family therapy participants to respond to how they might assess and treat each presenting problem. They also evaluated problem severity, prognosis of the case, number of sessions necessary for treatment, and the extent to which a therapist would focus individually or relationally. Results indicate that there were differences in how therapists assessed and treated clients based on client gender, therapists’ age, therapists’ gender, how religious therapists reported they were, and the extent of therapists’ personal experience with infidelity.     

Family therapist comfort with and willingness to discuss client sexuality

Limited empirical information exists on whether or not marriage and family therapists are having sexuality-related discussions with their clients. When helping professionals ignore client sexuality, the potential for unintended negative outcomes increases. The researchers surveyed 175 clinical members of the American Association for Marriage and Family Therapy to assess how their clinical training and education, their perceived sexual knowledge, and their comfort with sexual material influenced their willingness to engage in sexuality-related discussions with their clients. The results indicate that sexuality education and supervision experiences are the cornerstone for a therapist's base level of comfort. It is through sexuality education and supervision that sex knowledge is acquired and comfort levels are increased. Once comfort with sexual discussions increases, then therapists are more likely to engage in sexuality discussions with their clients.     

Practices of psychotherapists: cultural mutuality,ideologies, and work settings*

Quand on mit en comparaison la culture et l'idéologie professionnelle des psychothérapeutes d'une région métropolitaine avec les affiliations religieuses de leurs clients, on constata que l'affinité culturelle entre thérapeute et client était plus grande dans les clientèles privées que dans les clientèles d'hôpital, ce qui suggère que le thérapeute et le client privé se choisissent plus souvent selon leurs formations religieuses. L'affinité culturelle est la plus grande parmi les protestants, moins grande parmi les catholiques, et encore moins parmi les juifs. Il y a aussi un rapport important entre l'affiliation religieuse du client et l'idéologie professionnelle du thérapeute, surtout dans deux cas: les clients catholiques sont le plus souvent en thérapie chez des thérapeutes de l'analyse existentielle de Rogers, et les clients juifs le plus souvent chez des thérapeutes psychanalytiques. Dans une comparaison entre la culture et l'idéologie professionnelle du thérapeute et la religion du client, on trouva dans les clientèles privées moins d'affinité culturelle parmi les protestants et les juifs, et plus d'affinité culturelle parmi les catholiques; dans les clientèles d'hôpital, il y a une diminution d'affinité culturelle et une augmentation concomitante de l'importance de l'idéologie professionnelle. En général, on constate que l'affinité culturelle entre le thérapeute et ses clients explique la dynamique des rapports mieux que le font les relations entre l'idéologie professionnelle du thérapeute et les affiliations religieuses de ses clients. When the attributes of cultural affinity and ideology of psychotherapists were related to the religious affiliations of their patients in a metropolitan area, it was found that there was higher cultural mutuality (shared culture) of therapists and patients in private practices than in organizational practices, which indicates that therapists in private practice and their patients more often mutually select each other on the basis of religious backgrounds. Cultural mutuality is highest for Protestants, followed by Catholics and then by Jews. Treatment ideologies of therapists are also importantly related to religious affiliations of patients, especially in two cases: Catholic patients are more often in therapy with Rogers-existential practitioners and Jewish patients in therapy with psychoanalytic practitioners. When cultural affinity and ideology of therapists are simultaneously considered in their relation to their patients' religions, private practices exhibit reduced cultural mutuality of Protestants and Jews and increased cultural mutuality of Catholics; in organizational practices, there is a reduction of cultural mutuality for Jews, with a concomitant increase in the importance of the ideologies. In general, it was found that cultural mutuality of therapists and their patients more importantly explains the structural patterns of the practices than the relation of the mental health ideologies of therapists and the proportions of patients' religious affiliations in the practices.     

DOES ACADEMIC TRAINING BACKGROUND MAKE A DIFFERENCE AMONG PRACTICING MARRIAGE AND FAMILY THERAPISTS?

Using a national sample of practicing marriage and family therapists (MFTs) and their clients, this study investigated whether academic training background is associated with differences in pracice patterns and client outcomes. Clinical members of the American Association for Marriage and Family Therapy with academic training in psychology, social work, counseling, and marriage and family therapy were compared on a wide range of clinical practice variables, and their clients were surveyed about thier satisfaction and outcomes. Results showed highly similar practice patterns and client outcomes across all four disciplinary groups. Although the findings showed little evidence for the uniqueness of academic marriage and family therapy training among experienced MFTs, they also refute the notion that therapists trained in MFT degree programs practice in unusual or inferior ways compared to MFTs trained originally in other mental health disciplines.     

Therapist-worldview matching: not as important as matching to clients

In this essay, we respond to Simon's article (2012). We discuss our view that therapy works best when therapists can match therapeutic interventions to the worldview of clients. We see this matching to client worldview as rooted in research evidence, and we suggest that therapists can practice authentically and effectively using more than one divergent therapy approach. We conclude the paper by pointing out points of disagreement we have with Simon's use of Davis and Piercy's (Journal of Marital and Family Therapy, 2007a; 33, 298; Journal of Marital and Family Therapy, 2007b, 32, 515) study, a study Simon uses to ground his arguments.     

Deconstructing heterosexism: becoming an LGB affirmative heterosexual couple and family therapist

The purpose of this article is to propose a three-step model to help heterosexual therapists become more aware of the influence of their own heteronormative assumptions, heterosexual privileges, and heterosexual identities on the therapy process. This article also provides definitions of concepts central to the practice of affirmative therapy with lesbian, gay, and bisexual clients and strategies that therapists and clients can use to deconstruct heterosexism in the context of therapy.     

Collaborative Influence

Collaborative therapists acknowledge their role in influencing clients and the outcomes of therapy. But the word ‘influence’, for many new to the collaborative therapies, can be mistakenly connoted as an undue exercise of therapist power. From a dialogic and social constructionist perspective, this article reflects on how therapists can be influential in collaborative ways. Negotiating ‘shared intentionalities’ with clients, while privileging their preferences in meaning‐making and change—as part of respecting their primary authorship over their lives—assists therapists to employ their influence in ways that stay collaborative. Furthermore, by regarding client ‘resistance’ and misunderstanding as instructive, therapists can enhance their efforts to stay collaborative.     

The Pregnant Therapist: A Qualitative Examination of the Client Experience

This article reports on the findings of a qualitative study that was designed to capture the clinical dynamics that emerge when a therapist becomes pregnant during treatment. While there have been some empirical studies that have captured the pregnant therapist’s perspective, it is a sparse amount in comparison to the vast number of women therapists who become pregnant, and there have been no studies that have actually interviewed clients of pregnant therapists. This study seeks to begin to redress that crucial missing perspective by interviewing the clients of pregnant therapists, as well as first-time, formerly pregnant therapists. This article will look at the coded results of this qualitative study and the emergent themes from the client perspective, as well as discuss their implications for clinical social work practice.     

Evaluation of high and equal status male and female touchers

Henley's theory of touch and status was explored in a study where male or female subjects spoke to a male or female interviewer with equal or higher status who either touched or did not touch them. Men were relatively less favorable toward equal status and female interviewers who touched them. Status and sex of the touching interviewer did not influence reactions of women. Female interviewers who touched were evaluated more favorably when they had high rather than equal status. Evaluations of touching male interviewers were not moderated by status. Ratings of interviewer status were not influenced by interviewer touch. This finding contrasts with results from studies showing that higher status was ascribed by observers to people initiating touch in photographs and videotapes. It will be necessary in future research to determine the conditions under which touchers can achieve status in the eyes of people they touch.The authors express appreciation to Bruno M. Kappes for his helpful suggestions on the study and to Susan Johnson for her assistance with graphics.     

Creative Solutions and Development for Social Workers Treating People with Serious Mental Illness - Contributions from Supervision

Social workers who are engaged in a therapeutic work with clients who have serious mental illness often face specific challenges and find themselves in crisis states in therapy, which stem from the return of the clients’ symptoms and their cognitive impairments as well as social stigma. These crisis states cause dramatic changes in the way social workers mentalize their clients and they are propelled to draw from covert, unformulated, and dissociated knowledge that they have about the client’s experience, which contributes to achieving new, surprising, and creative ways to mentalize the client. Such crisis resolutions enhance therapists’ personal and professional development and serve as an identification model for their clients.     

When Social Workers Are Stalked: Risks,Strategies, and Legal Protections

By virtue of their work, social workers are at risk of becoming victims of stalking. This is because social workers assist individuals who suffer from major mental health problems that may cause them to develop delusional beliefs about their therapists, and because social workers may need to exercise authority against individuals with personality disturbances that present a risk to others. Surveys suggest that 16% of social workers have been stalked at one point in their career by a client. Stalking of social workers by clients has far-reaching personal and professional implications, potentially affecting all aspects of an individual’s life. This paper reviews the nature and incidence of stalking of social workers, the legal remedies available to social workers who are victims of stalking, and strategies for protection.     

Lesbian Therapists and Lesbian Clients

Abstract

The authors, on the basis of their own experience, explore issues specific to therapists working openly as lesbians with lesbian clients. Their discussion covers the structure of a private practice, the therapeutic relationship between lesbian therapist and lesbian client, and personal challenges for the lesbian therapist. Questions are raised and direction given with the aim of facilitating congruence among the therapist's personal capacities, the therapeutic setting, and the psychological intention of the therapeutic work. The authors note the therapist's need to tolerate the exposure of her personal life and the pressure toward fusion that are both entailed in work with lesbian clients, and they suggest that these special challenges, when the lesbian therapist's engagement with them is conscious, offer rich material that can deepen the therapeutic relationship and the therapeutic work.