Issues in Psychotherapy with Clients Affiliated with the Opposing Side in a Violent Political Conflict

The therapeutic dyad of clinician and client affiliated with rival groups in a violent conflict shares many features that complicate psychotherapy with persons of different ethnic, racial, and cultural groups, including lack of knowledge, negative stereotyping, differences in fundamental values and world views, and power differentials. Although a great deal has been written about these matters, very little has been written about the therapeutic dynamic where therapist and client are affiliated with different sides of a violent political conflict. Based on the sparse literature on the subject and on the clinical experiences of the author and her colleagues, this paper discusses three features that characterize this dynamic, which do not appear in the same way in therapy involving dyads of different races, ethnic groups, or cultures. These are the presence of the “enemy” in the consulting room, the therapist’s feelings of mistrust towards the client as a representative of the opposing group, and the client’s feelings of guilt towards the therapist as a representative of the injured group. The impacts of each feature on the therapist, client, and the therapeutic encounter are explored and suggestions are made for dealing with them. The hope is that professionals’ awareness of these issues will help improve the quality of psychotherapy with persons on the rival side of a violent political conflict.     

A Therapeutic Summer Weekend Camp for Grieving Children: Supporting Clinical Practice Through Empirical Evaluation

Through collaborative action-oriented community research, agency-based clinicians, and university-based researchers engaged in a two-year theory-driven evaluation of a therapeutic summer camp for grieving children. The evaluation examined the camp practice model and children’s engagement in therapeutic camp activities and psychosocial functioning based on the camp staff and parental caregivers’ assessments. The first year findings led to a synergistic decision-making process that strengthened one of camp therapeutic activities. The overall results reveal a high consistency among staff on assessments of engagement and psychosocial functioning, and parental caregivers’ satisfaction with the camp. Limitations of research evaluation and implications for practice are considered.     

A Pilot Use of Letters to Clients before the Initial Session

This paper explores the nature of engagement in the therapy process, and proposes that engagement may be facilitated when both client and therapist are able to develop an appreciation of each other's position within the therapeutic relationship. Some ways that a therapist can assist in this process are explored. An experiment is described in which information letters are sent to clients before the initial therapy session, as a possible way to enhance the engagement process.     

Recognizing and utilizing projective identification in brief psychodynamic therapy: A case example

Projective identification is a means by which clients unconsciously communicate their affective, and often intolerable, experiences. Being on the receiving end of a client’s projective identifications can be elusive, confusing, and intense; consequently, the information afforded by projective identification is often disregarded in the therapeutic process. This paper will provide a case example of the author’s personal affective and clinical experiences with a 19-year-old client to illustrate the process of recognizing and utilizing projective identification in brief psychodynamic psychotherapy. Implications and challenges for utilizing projective identification in brief therapy are discussed.This paper was presented at the Annual Convention of the American Psychological Association, Honolulu, Hawaii, July 2004.     

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.     

Woman Abuse and Conjoint Therapy: Therapists' Experiences of Engagement

ABSTRACT

Treatment approaches with couples in which woman abuse is a factor have been the subject of much attention and concern in the therapeutic community. We used focus groups to examine therapists' experiences of what they see as impeding or facilitating their ability to engage therapeutically with heterosexual couples when a man has used violence. Results were coded along four categories: contextual issues, the person of the therapist, client characteristics, and strategies for enhancing engagement. Results point to the difficulties therapist participants experienced engaging with males who have been violent with their partner. Strategies which therapists used to enhance engagement are illuminated. We discuss differences between the experiences of male and female therapists, and implications for clinical work and future research.     

Spiritual development in adolescence: toward enriching theories, research, and professional practice

The author notes that she finds the case for making spiritual development a priority surprisingly compelling-"surprisingly" because although she is an expert on adolescent development, she has not done research or previously written about spiritual development. She suggests that a systems analysis occur first, before engaging frontline youth workers in this realm, to identify the interests of key stakeholder groups and ways to unleash creativity and engagement in each of them. The key will be framing engagement of spiritual development in ways that include rather than divide sectors and groups.     

The “Other” Effects of Psychotropic Medication: Social Workers’ Perspectives on the Psychosocial Effects of Medication Treatment on Adolescent Clients

This study explores social workers’ perspectives on the psychosocial effects of psychotropic drug treatment of their adolescent clients. Using a mail survey, we asked a national sample of experienced clinical social workers to answer questions about their perceptions of the effects of such treatment on the sense of self and social well-being of an adolescent client. The survey questions also explored associations between perceived psychosocial medication effects and characteristics of the client and the treatment. The findings suggested that social workers viewed medication treatment as having greater beneficial than harmful psychosocial effects on their adolescent clients, but that both effects existed simultaneously. The most important factors associated with the perceived effects of medication that emerged from social workers’ reports included the etiology of the disorder, the type of drug treatment and its effectiveness in addressing symptoms, the client’s “competence,” and the quality of the relationship between the client and the treating social worker. This study provides direction for future research on a neglected but important question. It would be helpful to broaden the scope of professional discourse on the advantages and disadvantages of psychopharmacologic treatment for youth beyond the effectiveness or safety of the treatment to include questions concerning clinicians’ perceptions of the effects of drug treatment on youths’ sense of self and social well-being.     

Pathways to the Clinician’s Experience of Empathy in Engaging Single Mothers at Risk for Physical Abuse of their Children

Based upon an analysis of interviews from a qualitative study with twelve agency-based clinical social workers, this paper recounts three “situational pathways” through which these workers were able to experience empathy in the process of engaging low-income single mothers whose presenting picture involved physical aggression toward their symptomatic children who the workers were also seeing for therapy. The paper describes and utilizes self-psychological and intersubjective concepts to understand the therapeutic contexts that may enhance the worker’s potential for experientially understanding the client’s viewpoint. The relevance of the findings for practice and training is discussed.

‘One and a Half Dimensional’ Preferences and Majority Rule

I examine a model of majority rule in which alternatives are described by two characteristics: (1) their position in a standard, left-right dimension, and (2) their position in a good-bad dimension, over which voters have identical preferences. I show that when voters’ preferences are single-peaked and concave over the first dimension, majority rule is transitive, and the majority’s preferences are identical to the median voter’s. Thus, Black’s (The theory of committees and elections, 1958) theorem extends to such a “one and a half” dimensional framework. Meanwhile, another well-known result of majority rule, Downs’ (An economic theory of democracy, 1957) electoral competition model, does not extend to the framework. The condition that preferences can be represented in a one-and-a-half-dimensional framework is strictly weaker than the condition that preferences be single-peaked and symmetric. The condition is strictly stronger than the condition that preferences be order-restricted, as defined by Rothstein (Soc Choice Welf 7:331–342;1990).     

How a Therapist Responds to Cultural Versus Noncultural Dialogue in Cross-Cultural Clinical Practice

A therapist's capacity to respond appropriately to a client is crucial in fostering positive therapeutic relationships and outcomes in general but it is even more important in cross-cultural therapy. Given the clinical significance of the dyad-specific and dynamic nature of the therapist's responsiveness, our study explores one white female therapist's responsiveness with three racial/ethnic minority clients in the beginning phase of therapy sessions. Using the structural analysis of social behavior and conversation analysis, the turn-by-turn intensive analysis of culturally relevant and nonrelevant talk in therapy illustrates how a therapist, who is appropriately and positively responsive to clients in other contexts, becomes disengaged and even negatively oriented during culturally relevant talk. This finding illustrates the challenges involved in maintaining positive engagement and responsiveness in cross-cultural therapeutic communication. Our findings also highlight the usefulness of focusing on moment-to-moment interactions in cross-cultural clinical practice.     

Opening Space for Clients' Religious and Spiritual Values in Therapy: A Social Constructionist Perspective

SUMMARY

Although spirituality is foundational in many peoples' lives, this dimension is often excluded from therapeutic discussions. This article explores how a social constructionist frame may alleviate the tension created by traditional beliefs concerning spirituality in therapy and foster an open, trusting, climate in which spiritual topics can be discussed. Some of the implications for training therapists in the social constructionist perspective also are considered.     

Clinical Writing of a Therapy in Progress: Ethical Questions and Therapeutic Challenges

Clinical implications and ethical dilemmas of the use of confidential case material in clinical writing are examined, including a review of the discourse among professionals who publish clinical work. This literature is applied to a clinical illustration of psychotherapy with a client who gave consent for publication and read the clinical write-up of her case material. It is suggested that clinical writing may increase client “self-reflection” if there is a “secure base” of attachment between therapist/author and the client. The impact on the client’s treatment process is examined, in addition to a discussion of ethical questions and professional recommendations. ²Dr. Susanne Bennett is an Assistant Professor, National School of Social Service of the Catholic University of America. Dr. Bennett is also a psychotherapist in private practice in Falls Church, VA.     

CLIENTS ROLE CHOICES: UNEXPLORED FACTORS IN INTERVENTION DECISIONS

The role of the client in social work interventions has not been extensively explored in the professional literature. However, the client role varies significantly in different models of care and carries vast differences in the expectations and behaviors required of clients in the process. Clients’ individual characteristics, preferences, and expectations make them better suited to some approaches than others. This paper explores the change in perspectives on consumers emerging in the field and analyzes client role factors in four intervention models. It will also discuss the “fit” between the client and the particular approach as well as implications for outcomes and evidence-based practice.     

Youth engagement and service dosage in a mandated setting: A study of residential treatment centers

Treatment theory in residential treatment centers (RTCs) is conceived as a two-stage process of first engaging the client and then delivering services or interventions aimed at presenting problems. This treatment logic has been criticized for “creaming clients” or reserving services for clients easier to engage or more amenable to treatment but less in need. The present study examines whether higher early levels of engagement by youth in RTCs leads to more intervention and compares the relative effects of engagement and seriousness of presenting problems on the quantity of services provided by the mid-point in the adolescents' stay. Data come from interviews with a clinical sample of 71 male and 59 female adolescents in two RTCs in an eastern state. Findings indicate that higher level of engagement predicts more treatment interventions. Treatment staff delivered higher dosages of services to youth with more current behavioral problems, not those with problematic behaviors at intake. Youth with positive peer group backgrounds also received more services. Findings extend knowledge of how treatment staff provide treatment to clients and the role engagement plays in RTC service delivery.     

The mass class and teaching assistants: A case for discussion exercises

Sociology courses, particularly introductory courses, with 200 or more students are increasingly being offered in U.S. colleges and universities. Within the “mass class” structure, teaching assistants are often utilized to instruct students in smaller discussion sessions. This creates unique conditions of instruction for both professors and teaching assistants. For instance, professors are faced with coordinating teaching assistants’ activities, while teaching assistants need to develop skills relating to provoking discussion. Both must deal with effects of a hierarchy of instruction. After discussing these conditions we present structured classroom exercises that focus on sociological concepts typically presented in introductory courses to help teaching assistants create an engaging learning experience, attain teaching skills, and facilitate the professor’s coordination of instruction.     

Explaining the motivational forces of (<Emphasis Type="Italic">dis</Emphasis>)Respect: How self-focused and group-focused concerns can result in the display of group-serving efforts

The current article explains the motives underlying respect-and disrespect induced group-serving efforts. Research showed that intra-group respect increases individuals’ engagement with their group and subsequent intentions to show group-serving efforts. We refer to this process as ‘the group-focused motive’. Based on a recent program of research on actual effort and performance evaluations, we conclude that respect-induced group-serving efforts are not only due to enhanced engagement with the group. In addition, we posit that behavioral motivations can also stem from self-focused concerns — we refer to these as ‘self-focused motives’. We argue that the perception of being respected boosts the self-evaluation of individual group members. Maintenance of this positive self-evaluation, together with respect-induced enhanced self-confidence, can cause individuals to show more contextual performance. Finally, when individuals are disrespected, this impacts negatively on their self-perception. As a result, these individuals show group-serving efforts in an attempt to re-establish their self-worth, and this occurs relatively independently of improvement concerns for the group. Dick de Gilder (TC.de.Gilder@fsw.vu.nl) currently is associate professor of organizational behavior at the VU University in Amsterdam. He studied at the University of Amsterdam and received his Ph.D. from the University of Groningen, The Netherlands. His research interests include organizational commitment, error management, and research management.