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.     

The self-image in the therapeutic dyad: A case example of mutual growth

The therapeutic relationship is seen as a mutual experiencing of self and other which is growth-promoting for the therapist as well as the patient. Work with a borderline woman during a period of two years evoked strong countertransference reactions in the therapist who, at times, experienced the patient as a mirror. A beginning sense of cohesion in the patient's highly fragmented sense of self found a parallel in this beginning therapist's developing professional identity.     

The Use Of Shame and Dread in the Countertransference

Much has been written about paranoid anxieties as these occur in the patient. Less, however, has been written about primitive experiences as these occur in the therapist during the session. This paper recounts a patient's correct articulation of the therapist's self-perception, which, because of its accuracy, initially flooded the therapist with shame and dread. Nonetheless, the patient's perception was able to be used in a way that clarified, in the countertransferance, a piece of the patient's early experience in relation to her mother and strengthened the therapeutic relationship.     

To Tell or Not to Tell: The Disclosure of Events in the Therapist's Life to the Patient

Happy or disturbing events may occur in a therapist's life during the course of treatment that intrude on the therapeutic process whether or not their true nature is disclosed to the patient. Therapists are not immune from experiencing acute, chronic, and even terminal illnesses, divorce, remarriage, adopting a child, mourning the death of a parent or significant other, or major accomplishments. In many instances such events affect the treatment process by disrupting appointments, necessitating sudden absences, restricting a therapist's emotional availability and physical stamina, or altering the therapist's mood and affect. In other instances, patients may be aware of such events, at least unconsciously, because of subtle changes in the therapist. Drawing on self psychology and intersubjectivity this paper explores the reasons for therapist self-disclosure of these events based on an assessment of the patient's developmental needs and the nature of the transference. It will discuss ways of making such disclosures therapeutic.     

The futility of child therapy

Summary If one takes into consideration modern communication and family systems theory, it is apparent that the therapist's effectiveness may be greatly hampered in situations where she works with the child alone in a play therapy situation. Seeing a child alone in play therapy often tends to play into the already existing double bind situations in a family. The family aims at rejecting new behavior patterns which emerge because it has adapted to the problem behavior. By seeing the child and related family members, an open therapeutic contract can be established aimed at educating and preparing the family to be more receptive to new behaviors via new means of communication. The therapist becomes the active intervening agent in the system, available to all of the members. With the therapist serving as the nurturer which the family lacked, its members learn how to be available to each other in a new way. Once nurturance occurs, the family members feel strengthened to maturate and respond differently to each other.     

Spontaneous self disclosures in psychotherapy

The closeness and intensity of feeling that develops between therapist and patient raises complex issues related to the therapist's neutrality, the transference, the countertransference, the therapeutic alliance, and the very essence of the curative aspects of the relationship. The issue of the relationship of self disclosure and the evolving transference, countertransference complex is discussed. It is suggested that on some occasions, the pressure a therapist feels to spontaneously disclose something intimately personal is an indication that the therapeutic role has become reversed and the therapist is using the process to heal a vulnerability in himself or herself. The patient unconsciously participates in the interest of safeguarding the treatment process. In such instances the self disclosure need not interfere with the evolving transference. It may lead to great spontaneity in the process and to opening areas of affect previously unreachable. Self disclosures cannot be viewed as technical innovations to avoid stalemates in clinical practice. Rather, they are facts of our clinical life, facts that must be explained and understood rather than judged and condemned.     

Marital therapy with couples whose lack of self-sustaining function threatens the marriage

In the hierarchy of internal structures that contribute to a complete, mature sense of self, certain psychic functions are essential. In particular, adults who can maintain a sense of intactness of the self can, by-in-large, provide the following five psychic functions for themselves: self-security, self-realness, self-esteem, self-love and identity. Dr. Dan Buie (1989) has described the lack of these five self-sustaining psychic functions in certain clients and the consequences for the therapist/patient relationship. This paper will summarize Buie's contribution to understanding clients who lack the ability to provide these self-sustaining functions, then apply this conceptual framework to the understanding of certain marital conflicts, discussing aspects of the therapeutic process and the therapist's role with respect to these marital conflicts.     

WHERE RELATIONAL THEORY AND ATTACHMENT THEORY INTERSECT: A REAL RELATIONSHIP AND A REAL ATTACHMENT

This paper demonstrates the importance of understanding the client’s early attachment patterns and of promoting a real attachment in the therapeutic dyad. A review of relational theory reinforces current acceptance of therapist self-disclosure as a tool for engaging difficult clients. Additionally, therapists can identify clients’ early attachment experiences and promote growth in fragile clients by allowing them judicious access to their inner world, thereby encouraging the formation of a real attachment. Case examples illustrate how to identify early attachment patterns and one therapist’s creative use of self in developing real, therapeutic attachments with her clients.     

Countertransference,resistance and frame management in the psychotherapy of a 15 year old anorexic and her mother

Countertransference is a rich source of understanding of client dynamics but can be difficult to detect. A case vignette is used to illustrate how changes in the arrangements of therapy should be viewed as red flags alerting the therapist to possible countertransference. By paying careful attention to the client's derivative response to the therapist's agreeing to a request for a change in appointment times, the therapist was able to understand the unconscious motive behind the request, as well as her own countertransference reasons for participating in the resistance expressed in the request. When, based on this under-standing, the therapist was then able to hold to the framework and maintain the previous appointment schedule, this furthered the treatment by providing a model for introjection and by promoting understanding rather than acting out. In complicated therapy situations where treatment of more than one family member by a single therapist is indicated, such careful attention to the framework and to the client's derivative response to the therapist's interventions is particularly important.An earlier version of this paper was presented before the Annual Conference of the Washington State Society for Clinical Social Work on May 14, 1984.     

A therapist's pregnancy: An opportunity for conflict resolution and growth in the treatment of children

A therapist's pregnancy is a unique event which holds profound implications for both patient and therapist in any therapeutic relationship, and it inevitably affects the course of the patient's treatment. A number of theoretical and clinical articles have been written over the past 15 years on the topic of the pregnant therapist, but very few have concentrated specifically on the child patient. This article explores the therapist's pregnancy and treatment implications in clinical work with children and offers an in-depth case vignette to illustrate how a child may effectively utilize the experience to work through previously unresolved feelings and conflicts. The therapist's pregnancy can, therefore, provide the child with an opportunity for conflict resolution and growth, if the process is handled in a therapeutically sound and sensitive way.The author would like to thank Ava Siegler, PhD and Jules Glenn. MD for their helpfül suggestions.     

The therapist's pregnancy: Impact on the treatment process

As soon as she becomes aware of her pregnancy, the therapist is confronted with a barrage of issues involving her identity, integration of roles, maternal identification, and redenfinition of important relationships, including those with her patients. While she works at becoming aware of and responding to the dramatic emotional and biological changes of pregnancy, and emerges with corresponding maturational adjustments, her patients enter an often stormy period of therapy in which they respond to the changes in the therapist's appearance, the threat of the growing infant, and the reality of the therapist's needs and inevitable absence for maternity leave. The special event of the pregnancy alters the therapeutic setting and affects both the transference and coun-tertransference, initiating reverberations in the therapeutic relationship which provide opportunities for marked advances in therapy.     

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.     

Therapist pregnancy and maternity leave: Maintaining and furthering therapeutic gains in the interim

A therapist's pregnancy and maternity leave is a time of multiple transitions for both patient and therapist. This article reviews the literature on therapist pregnancy and its therapeutic implications. It discusses the treatment planning choices of: trial termination, therapeutic hiatus, and temporary transfer. The article further addresses the clinical and administrative issues of planning the maternity leave as well as the issues of time-limited treatment with the interim therapist. It included illustrative case examples based on the author's experience as an interim therapist during a six month maternity leave.This paper in its original form was presented as part of the requirement for The Hunter College School of Social Work: Post Masters Program in advanced Clinical Social Work.     

DIRECT SUPERVISION: ADDING COMPUTER-ASSISTED FEEDBACK AND DATA CAPTURE TO LIVE SUPERVISION

This is a critical review of live supervision with emphasis on technical innovations such as earphones or bug-in-the-ear, Teleprompters, and computers. A computer-assisted approach is described that overcomes many criticisms of live supervision. Direct supervision uses a computer monitor to unobtrusively provide information to the therapist about the supervisor's perceptions of the clients' and therapist's behavior, the expected therapeutic behaviors, and the therapist's "on target" behavior. Direct supervision has the advantage over other forms of supervision by providing an immediate, continuous, and permanent record for postsession supervision and for research into the supervisor-therapist-client process. The paper provides several suggestions for research.     

Clinical supervision for psychiatric nurses

Supervision does not represent merely the acquisition of facts. It is an emotionally charged process that touches on therapists' affective problems, interpersonal conflicts, problems in being helped, and problems in helping (Ekstein). As such, it is a process similar to, but not the same as, psychotherapy. Supervision is necessary for continued professional growth, no matter how skilled the nurse may be. Other mental health disciplines have long accepted supervision as an essential component of professional work. A number of methods can be used to review the therapist's work, including case material discussion, conjoint interviewing, direct observation, and review of mechanical recordings. This can be done individually, in groups, or among peers. A supervisor can be a senior clinician from any of the mental health disciplines. The nurse should not be limited to receiving supervision only from other nurses. Periodic evaluations of the supervisory relationship as well as the therapist's skills are recommended. Supervision is a valuable tool that the nurse therapist should use fully to develop the professional self.     

The COVID‐19 Pandemic: An Evolving Story. Professional and Personal Insights using Self and Culture as Agents of Calm and Healing after a Year of Co‐habitation with Imminent Threat

Being a cross‐cultural systemic therapist, clinical supervisor, and educator means that culture and language are central to my work. They provide a scaffold to develop deeper understanding, increased trust, and connection between myself and my supervisees, students, and clients and facilitate a process for the latter to connect to their own selves and values. Given the fear and uncertainty generated by the COVID‐19 pandemic, there exists a pervasive activation of the sympathetic nervous system in the community. In this article, I present two case studies as examples of a cross‐cultural/cross‐linguistic approach that facilitates two clients to find a place of comfort and calmness and consequently a balancing activation of the para‐sympathetic nervous system. First is a client who, due to the overwhelming pandemic chaos, suddenly exhibited a host of signs and symptoms of a functional neurological nature, which she experienced as a lack of control and disconnection from her body, her primary language, and herself. Within a trusted therapeutic relationship that draws on the culture and primary language of the therapist, the client regains connection with language and enhances her ability to communicate and connect with her body. Second is an international student who is encouraged to use her culture of origin and primary language to induce calmness, reconnect with herself, and return to the familiar as a ‘known’ collectively inclusive, comforting, and nurturing environment.     

A Philosophic Stance,Ethics and Therapy An Interview with Harlene Anderson

Harlene Anderson is director of the Houston Galveston Institute. With her late colleague Harry Goolishian she challenged family therapy theory, proposing that as therapists we consider theoretical metaphors based on language and social constructionism, and in effect has moved family therapy in a new direction. The physical and conversational context of interview was the Lofoten Islands, 300 km inside the Arctic circle, Far Northern Norway on the night after Mid Summer's Night, 24th June 1993. Tom Andersen was the host for several days to a gathering called Constructed Realities; Therapy Theory and Research. The aim of the gathering was to explore the concept of Knowledge in the fields of psychiatry, psychology, teaching and social work. The focus was to provide a bridge between the ‘practical’ and the ‘theoretical’ discourses around knowledge and the creation of the knowledge. There were eight main issues around which the conversations revolved — 1) Knowledge: One or Many? 2) Multiple Realities and the Therapeutic Process 3) Human Understanding 4) Language and the Construction of Self 5) Research Alternatives 6) Qualitative Research in Clinical Work 7) Feminist Issues in Theory and Research 8) Power, Ethics and Practice. Harlene Andersen has written extensively on many of these subjects taking a constructivist position and was central to the numerous conversations. She was also one of the prime movers in putting together such a challenging and multi-disciplinary conversation. In conjunction with Harry Goolishian, Harlene Andersen has proposed that what we call ‘problems' are created in language and are dissolved in language. Her interests are in the multiple realities that come to an intersection in a therapeutic conversation and how a therapist can engage with a client to open the possibility for the client to create and find some changes in his/her life. She takes the position that in order for a therapist to be helpful to his/her client, conversational space needs to be created that makes room for the exploration of the client's beliefs and realities. An essential element in this process of creating conversational space is the therapist taking a position of not knowing, of uncertainty, of exploring and making room for the client to talk about what is important for him/her to talk about and not for the therapist to lead from a position of knowing what is best for the client. Harlene Andersen is regarded as a leading theorist and clinician in the therapeutic community who is exploring the broad concept of therapy as a collaborative process at many levels. She is one of the major presenters at the forthcoming New Voices in Human Systems conference hosted by Lynn Hoffman in Northampton, Massachusetts in October 1994.     

A therapist's pregnancy: An opportunity for conflict resolution and growth in the treatment of homosexual men

The author discusses the impact of a therapist's pregnancy on the therapeutic process, adding her experience with homosexual patients to the growing literature on this subject. Clinical illustration and a discussion of theoretical conceptualization related to a therapist's pregnancy specifically dealing with issues of the arousal of the maternal transference, infantile and sexual conflicts, competition and identification with the creative process, are presented. The author shows how the reality of her pregnancy seemed to facilitate rather than hinder the therapeutic process when she could openly deal with the patient's reactions.This article is submitted in partial fulfillment of the requirements for certification in The Post Masters Program in Advanced Clinical Social Work at Hunter College (1986). The Author thanks Dr. Lucille Spira for her contributions to this paper.     

The Therapist's Imagination of Self in Relation to Clients: Beginning Ideas on the Flexibility of Empathic Imagination

The therapist's capacity to imagine is one specific part of the endeavour of empathy which lies at the heart of the processes of the therapeutic relationship. This article offers beginning ideas about the significance of therapist's imagination of self in relation to her/his clients in the task of trying to understand their experience. In seeking to ‘understand’ the experience of others, the therapist is able to move between an imagination of sameness/identification with the client/s, and an imagination of difference/‘foreignness’. The family therapy orientation of curiosity and ‘not‐knowing’ relies on the imagination of self as different to our clients; more traditional understandings of empathic connection rely more heavily on the imagination of sameness/identification with clients. This article argues that flexibility in the therapist's use of self in moving between these positions allows an expanded capacity for therapeutic connectedness. These ideas have special valence in the practice territories of impasse and intercultural therapy.