A Commentary on “Gender Perspectives in Cross-Cultural Couples”

This commentary expands on Kellner’s article by discussing clinical practice with Asian and Euro-American couples. Differences in Western and traditional Asian cultural expectations around intimacy and styles of emotional expression can often lead to misunderstanding among couples. Therapy can also be a challenge for couples when they do not share the same first language. A therapist who only speaks English can inadvertently create an alliance with the partner whose first language is English. On the other hand, bilingual therapists who use both English and an Asian language in the session can face challenges differentiating their roles as a therapist versus a translator. Case illustrations are presented to illustrate these challenges.

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.     

FEMALE CAREGIVERS’ REFLECTIONS ON ETHICAL DECISION-MAKING: THE INTERSECTION OF DOMESTIC VIOLENCE AND ELDER CARE

As our population ages, increasing numbers of social workers and other therapists will provide counseling to women who are caregivers of frail elders. These female caregivers often face complex ethical dilemmas in caring for a frail elder. Furthermore, these dilemmas are compounded by domestic violence in the caregiver/frail elder relationship initiated before the onset of caregiving. Illustrated with case examples, this article presents an ethical decision-making model based on an empowerment framework for helping practitioners work with caregivers who face difficult dilemmas impacted by domestic violence. Implications for strengthening clinical practice with these caregivers are discussed.     

ETHICAL DILEMMAS IN FAMILY THERAPY

A review of the literature in the area of ethical dilemmas facing family therapists revealed that there were a number of issues facing family therapists which are not included in the Principles for Family Therapists (1984) of the American Association for Marriage and Family Therapy. Seventy-five family therapists from across the nation responded to a questionnaire which asked what ethical dilemmas they face and how helpful the ethical guidelines are with these dilemmas. Results indicate that family therapists are encountering dilemmas which are not included in the Principles, significantly more often than those that are included. The ethical principles were found to be helpful for those ethical dilemmas attended to by the Principles.     

Boundary Issues in Gay and Lesbian Psychotherapy Relationships

Abstract

Gay and lesbian psychotherapists face unique challenges when working with clients who also identify as gay or lesbian. Of particular importance are the roles professional boundaries play in working with sexual minorities. For example, clinicians must decide whether it is in the client's best interests to know the therapist is gay. Issues of contact outside of the therapy hour also become important, particularly when the therapist lives in a small community, or otherwise risks the possibility of seeing the client in the community. This chapter addresses some of these issues, and poses options for therapists on how to minimize professional boundary or ethical violations.     

Cybersex and the E‐teen: What Marriage and Family Therapists Should Know

Adolescents who use the Internet regularly (the “e‐teen”) present a new set of challenges for marriage and family therapists. This article introduces marriage and family therapists to (a) the basic technological concepts and unique psychological characteristics of the Internet important in understanding and addressing adolescent online sexual behavior, (b) the appropriate developmental expectations for teens online, including risk‐taking behaviors and critical decision‐making skills, and (c) suggested strategies for assessment, prevention, and intervention when dealing with problematic online sexual behavior in adolescents. Marriage and family therapists cannot ignore the role the Internet plays in adolescent sexual development and its implication for the family. This article will serve as a primer for the marriage and family therapist when presented with adolescents who engage in online sexual behaviors.     

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.     

AN ALTERNATIVE TO MANAGED CARE: A "GUILD" MODEL FOR THE INDEPENDENT PRACTICE OF PSYCHOTHERAPY

As health care is reconfigured by HMOs and managed care organizations, family therapists often have to decide whether or not to cooperate with the new power structures and their ways of doing things. The chief concern of many therapists is the ehtical bind created when the managed care orgranization demands breaches of confidentiality or makes decisions about the course of treatment that may not, in the therapist's opinion, be in the best interest of the family. Associations of independent, nonmanaged care psychotherapists are springing up in response to these dilemmas. This paper describes the philosophical evolution and organizational development of one such association.     

RESOLVING ETHICAL CONCERNS IN CLINICAL PRACTIVE: TOWARD A PRAGMATIC MODEL*

A pragmatic model is proposed for use in resolving ethical concerns and dilemmas in clinical practice. It encompasses five decision bases that therapists may draw on for the kind of comprehensive analysis that is necessary for reaching a defensible decision. The decision bases are: (a) theories of ethics; (b) professional codes of ethics; (c) professional theoretical premises; (d) the sociologal context; and (e) the personal/professional identity. The model is applied to five actual cases offered by several therapist who experienced ethical concerns with them. The case analyses demonstrate the model's utility for decision making and for prevention of ethical problems.     

Identity in Crisis: Spirituality and Homosexuality in Adolescence

Adolescents experiencing same-sex attraction are increasingly comfortable identifying themselves as gay/lesbian/bisexual. For at least a minority of these youth, that identification conflicts with their spiritual values, and they or their families seek conversion therapy. The efficacy of conversion and ethics of conversion therapy for same-sex orientation stirs significant debate. The complexities of an approach to same-sex issues with adults multiply when the client is an adolescent. This article uses three adolescent case studies to examine issues of identity, ethics, confidentiality, social expectations, and therapist role.     

Clients’ perceptions of marriage and family therapists’ way‐of‐being: a phenomenological analysis

Previous research highlights the influence of therapist factors on treatment outcomes. One therapist factor proposed as fundamental to the process of therapy is the therapist's way‐of‐being, a relational concept that refers to how the therapist regards a client—either as a person or object (Fife et al., [2014] Journal of Marital and Family Therapy, 40, 20–33). Although this case has been made conceptually, there is little empirical research on therapists’ way‐of‐being with clients. The primary purpose of this research is to investigate clients’ perceptions of their therapists’ way‐of‐being. Utilizing a common factors perspective, the study seeks to explore: (a) how clients experience their therapists’ way‐of‐being and (b) the influence therapists’ way‐of‐being has on clients’ engagement. Phenomenological methods were used to gain a nuanced understanding of the phenomenon. Qualitative data were collected through semi‐structured face‐to‐face interviews with clients (N = 10) who received individual therapy from a marriage and family therapist. Results were organized into two main themes: core tenets (attunement, congruency, and aligning with clients) and operational tenets (providing affirmation and validation, balancing flexibility and structure, and accomplishing goals). Findings are used to make a case for adding the concept of way‐of‐being as an overarching construct for several well‐established therapist factors. Clinical and training implications are discussed.     

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.     

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.     

Consumers’ Insights About Spirituality in Advertising

While the study of spirituality in advertising is an emerging area of scholarship, previous research tends to focus more on the spiritual message rather than on the consumer. Although some studies report on the meanings consumers derive from spiritual advertising messages, the definitions of spirituality as religion in these studies are not in alignment with the holistic approach applied here. In this article, we interview consumers and ask what meanings may emerge from their responses to spiritually dense commercials. (By spiritually dense we mean commercial messages rich with spiritual core ideas, as described in the Spirituality in Advertising Framework). Four themes have emerged from the data: authenticity, the journey, inspiration, and nature. We analyze these findings in light of both theory and practice. Consideration of ethical issues and the positive dimension of spirituality in advertising are also discussed.     

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.     

‘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.     

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.     

"I'm still swimming"

Treatment of bipolar affective disorder is often difficult and lengthy. Enabling participation in a return to work process is equally daunting, primarily due to the dramatic and oftentimes sudden shifts in mood and thought. The following case study attempts to illustrate the complicated process of return to [and stay at] work for an individual who has mixed bipolar affective disorder. Work has always played a significant role in Ray's life and remains a valued goal and accomplishment for Ray. Work has been a means to structure and routine, and it has been from this routine that wellness has become possible for Ray. The metaphor, "I'm still swimming" helps to illustrate the continual treading of water, which both Ray and his occupational therapist [first author] have experienced over the past 6 years. This case study illustrates the strategies employed in maximizing the person-environment-occupation fit for Ray, as well as the importance of collaboration and partnership in the return-to-work process. It is also meant to stimulate thought and discussion about what is important for occupational therapists, and other health professionals to consider, when attempting the task of return-to-work for an individual with mixed bipolar affective disorder.     

The Dilemma of "Authentic Self" Ideology in Contemporary Japan

This paper examines dilemmas inherent in the pursuit of the modern ideology of "authentic self", which first emerged in the 1960s and is now widespread in contemporary cultures. The ideology is exemplified, in a religious scene, as "self-transformative" religions wherein seekers seek to transform themselves spiritually in order to realize their authentic, or "sacred" selves. Through an examination of Aum Shinrikyo, which began as a typical "self-transformative" religion but later transformed into a destructive cult, I will explain the intrinsic moral imperatives of the ideology of "authenticity". This study of Aum explores the introverted lifestyle and extreme desocialization, which resulted in obsession with the central guru, being legitimated by the ideology. This search for "authenticity" resulted in the members cutting themselves off from the reality of the world. The final analysis suggests that possible consequences of the endless pursuit of the "authentic self" are a "vacuum" self and a loss of empathy with other people. The ontological conditions created by this bring about potential destructiveness, either internal or external.