Acknowledging the Impact of Social Forces on Sexual Minority Clients: Introduction to the Special Issue on Clinical Practice with LGBTQ Populations

Over the last two to three decades, advances in clinical practice with lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals have been extensive. Many clinical social workers now incorporate LGBTQ-affirmative approaches into their practice, and a number of social workers have contributed to the literature on clinical practice with sexual minority clients. Despite these advances, we still require specialized knowledge to understand a number of LGBTQ-related mental health issues. The Clinical Social Work Journal’s first special issue on clinical practice with LGBTQ populations emphasizes psychotherapy techniques that acknowledge and also address social forces (e.g., transphobia, homophobia, and heterosexism) that affect the psychosocial functioning of LGBTQ clients. The special issue focuses on LGBTQ populations, such as transgender and bisexual individuals, sexual minority youth, and older adults, and psychotherapy modalities informed by a number of clinical and theoretical approaches. These in-depth articles offer guidance to clinical social workers who need to expand their knowledge of LGBTQ-related mental health issues and also provide those with existing knowledge an opportunity to refine their clinical skills and sharpen their thinking.     

Value orientations of clinical social work practitioners

Six hundred and forty-two of 1,218 randomly sampled social workers in Texas certified as Advanced Clinical Practitioners responded to a pretested, mailed questionnaire as part of a study of personal value systems and personality traits. Agency practitioners, combination practitioners and those in private practice only are compared on their rank ordering of eight statements corresponding to four value orientations: (1) entrepreneurial, (2) social, welfare/change, (3) low risk, and (4) providing psychotherapy. Kruskal-Wallis and Mann Whitney tests yielded significant differences between the three groups. Nonprivate practitioners and those in private practice only were found to have almost symmetrically juxtaposed personal value systems. Combination practitioners were found to be a distinct group with a unique value system different in important respects from both nonprivate practitioners and from those in private practice only. Comparisons with other studies and implications for future research are discussed.     

The analytic template: Help or hindrance in the conduct of psychotherapy?

This paper explores the impact of psychoanalytic theory and practice on the conduct of psychotherapy. A brief review of the origin of the interface between the two modalities begins the discussion and case examples are used to highlight differences and commonalities. While recognizing the vast contributions made by psychoanalytic theorists to the field of psychotherapy, an attempt is made to establish an arena of legitimacy for the pursuit of psychotherapy. The role of goals is proposed as defining of the psychotherapeutic enterprise.     

THE NEUROBIOLOGY OF AFFECTIVE INTERVENTIONS: A CROSS-THEORETICAL MODEL

The integration of information from neuroscience with the practice of psychotherapy presents with numerous challenges. However, neuroscience research can guide practitioners in the purposeful use of the therapeutic relationship to enhance clinical outcomes. This article reviews such research pertinent to mental health and psychotherapy, and presents an a-theoretical model of intervention, guided by this information that can be incorporated into various therapeutic orientations.     

The influence of the Milan approach—Part 2. The legacy of Boscolo and Cecchin and their Paduan connection: A conversation with Andrea Mosconi

The Milan approach, pioneered by Selvini-Palazzoli, Boscolo, Cecchin, and Prata, has significantly contributed to the field of psychotherapy, particularly in the realm of systemic and family psychotherapy. While rooted in systemic principles and concepts, over time the original Milan group demonstrated differences in their clinical orientations and practices which led to their regrouping into two teams. The paper explores the divergences in their views and directions on family dynamics and the role of symptoms within the system. It delves into the influence of Boscolo and Cecchin, two of the ‘Milan Four’ on the Centro Padovano di Terapia della Famiglia. Drawing from a conversation with Andrea Mosconi, a mentee and collaborator of Boscolo and Cecchin, the paper examines the reconfiguration of the original ‘Milan Four’ team and its impact on their clinical approach. Key Milan principles and concepts such as hypothesising, circularity, and neutrality are examined with particular emphasis on the work of Boscolo and Cecchin's systemic work. These principles, intertwined and interconnected, provide a fertile ground for the construction of multiple hypotheses and circular questioning. The paper also highlights the concept of reflexivity, which originates from Bateson's work and plays a crucial role in family relations and communication while explaining the birthplace of paradox taking place when two levels of meaning are ‘confused.’ The Milan approach continues to be highly regarded, as its early concepts and ideas have evolved and left a lasting impact on the field of family therapy. By reflecting on the distinct contributions of Boscolo and Cecchin, and using examples, Mosconi offers valuable insights into the rich legacy and ongoing relevance of the Milan approach to contemporary therapeutic practice.     

Counselling and Psychotherapy: Is There a Difference? Does It Matter?

The terms ‘counselling’ and ‘psychotherapy’ are often employed in a loosely interchangeable way, especially in Australia. Where distinctions are made, there has been little agreement on what each term should cover. This article examines several axes on which ‘counselling’ might potentially be distinguished from ‘psychotherapy’; the most promising basis for such a distinction seems to be whether or not the mode of work attempts to access the unconscious. On this basis, several modalities currently termed ‘therapy’ would in fact be classed as types of ‘counselling’, including those modalities of family therapy which aim to engage clients at the level of conscious behaviour change and restructuring. Consideration of how new professionals are trained lends support to a continuum, with short‐term, problem‐focused conscious‐oriented approaches at one end, and longer‐term, transference‐focused, unconscious‐oriented approaches at the other, the dividing line coming at the point where trainees learn the skill of ‘immediacy’.     

Psychotherapy,Architecture and the Postmodern Attitude. An Essay

For all its faddishness, postmodernism as a set of ideas and as an attitude has much to offer contemporary psychotherapy. These ideas and attitudes are briefly outlined and their application to psychotherapy practice elaborated and illustrated with reference to postmodern design.     

A Client Perspective on Therapist Self-Disclosure

Abstract

Options of “coming out” in differing therapeutic modalities are considered. Modalities considered include traditional psychotherapy, alternative therapies, and managed care systems. Therapist disclosure situations are discussed from the viewpoint of both client and practitioner. Vignettes describing therapy experiences of adult lesbian and gay clients in a variety of clinical settings are presented. Clinical issues pertaining to therapist disclosure of sexual orientation receive consideration in terms of client self-determination as well as in terms of the options or limitations imposed by different modalities. Distinctions are drawn between disclosure in predominately lesbian and gay practice settings and disclosure in predominately heterosexual settings.     

THE NEIGHBORING FIELD OF BRIEF INDIVIDUAL PSYCHOTHERAPY*

The author presents the field of brief individual psychotherapy as a coherent set of conventions, despite its diverse origins in the schools or traditions of dynamic, behavioral, interpersonal or cognitive, and strategic psychotherapy. He proposes the advantages of these shared conventions, but also their drawbacks. He proposes how this neighboring field could help the field of family therapy reduce its errors.     

Immigrant students and their teachers – exploring various constellations of acculturation orientations and their impact on school adjustment

ABSTRACT

The present study examined what impact various constellations of acculturation orientations of immigrant students and their teachers have on the students’ school adjustment. For this purpose, the study analysed the acculturation orientations of 1106 5th graders and their class teachers in Switzerland. Using multiple regression analysis, we found that immigrant students were more satisfied at school if their teachers had similar attitudes about cultural assimilation and cultural diversity and could, thus, be said to have congruent acculturation orientations. With respect to students’ academic self-concept, immigrant students with a minority orientation whose teachers value cultural diversity including the heritage culture of their students showed a lower academic self-concept despite matching acculturation orientations. We interpret this result as a dilemma of teachers between the endeavour to develop culturally sensitive attitudes and behaviours and the risk to create stereotype threat and its negative effects through addressing cultural differences. Furthermore, a mismatch between the students’ (bi-)national identification at school and the teacher’s perception of the student as an immigrant or a native-born student could be shown to have adverse effects on the academic self-concept in the group of students with older teachers (50+ years).     

Career Counseling With Black Men: Applying Principles of Existential Psychotherapy

Counselors may benefit from applying principles of existential psychotherapy to career counseling with Black men. Existential psychotherapy asserts that there are 4 issues that all people experience: death, freedom, isolation, and meaning. The life experiences of Black men, including difficulty with their careers, suggest that they may struggle with these existential concerns, particularly finding meaning in their lives. Because work and issues in other domains of life (e.g., family, community) often intersect, an existentially based career counseling approach may prove useful. An overview of existential psychotherapy is presented, followed by a discussion of its applicability to career counseling with Black men. In addition to suggestions for career counselors, recommendations for training and professional development are offered.     

Female sexual pain disorders and cognitive behavioral therapy

Female sexual pain disorders are prevalent and have a deleterious effect on women's well-being. Because there are psychological elements to this pain, cognitive-behavioral therapy (CBT) may be a viable treatment alternative, particularly when compared to more physically invasive treatments such as surgery or medication. This article provides a critical analysis of research studies in this area by evaluating each study in detail, identifying gaps in the research base, and providing directions for future study. For the most part, all of the studies reviewed in this article found CBT to be effective. However, CBT modalities with minimal therapist direction or interaction were found to be problematic. In addition, there may be other noninvasive treatment types that are equally or more effective, such as biofeedback or supportive psychotherapy.     

Intergenerational Transmission and the Formation of Cultural Orientations in Adolescence and Young Adulthood

In this article we wanted to shed light on the intergenerational transmission and the formation of cultural orientations in adolescence. The intergenerational transmission was analyzed in different age groups in a longitudinal design (orientations of parents and their adolescent children were measured twice, with a time lapse of 3 years). Results clearly revealed that late adolescence is the “formative phase” for the establishment of cultural orientations and suggested that psychological processes such as internalization are guiding this formation. This internalization was found for all investigated orientations. In addition, as adolescents grew older, their susceptibility to parental orientations diminished, but, in contrast, parents did not become more susceptible to their children's orientations. No age effects in sociocultural influences were found. It was concluded that the investigated sociocultural influences should be seen as providing a structural context within which the formation of orientations in adolescence takes place.     

Female Sexual Pain Disorders and Cognitive Behavioral Therapy

Female sexual pain disorders are prevalent and have a deleterious effect on women's well-being. Because there are psychological elements to this pain, cognitive–behavioral therapy (CBT) may be a viable treatment alternative, particularly when compared to more physically invasive treatments such as surgery or medication. This article provides a critical analysis of research studies in this area by evaluating each study in detail, identifying gaps in the research base, and providing directions for future study. For the most part, all of the studies reviewed in this article found CBT to be effective. However, CBT modalities with minimal therapist direction or interaction were found to be problematic. In addition, there may be other noninvasive treatment types that are equally or more effective, such as biofeedback or supportive psychotherapy.     

Psychotherapy and career counseling: toward an integration for use with college students

The authors suggest that psychotherapy and career counseling with college students can be identified as potentially concurrent and interactive processes. They seek to increase awareness of this connection and underscore the value of its application when it is appropriate to do so. Selecting a career is a crucial developmental task for young adults and is, to varying degrees, an integral part of their psychosocial adjustment. The literature is reviewed from five perspectives: the psychodynamic model of career counseling; case examples; integration of career counseling and psychotherapy; a review of the developmental theories of Erikson, Farnsworth, Chickering, and Medalie; and empirical justification. The authors discuss the rationale for merging student psychotherapy and career counseling and offer case examples.     

Time,Knowledge, and Power in Psychotherapy: A Comparison of Psychodynamic and Cognitive Behavioral Practices

Time has long been recognized as a marker of professional control and a tool for the organization of work. Yet we know less about how temporality intersects with experts’ epistemic goals. This article illustrates how the patterning of time in psychotherapy shapes the construction of knowledge about mental illness and how this relationship is mediated by patients’ own interventions. I focus on psychodynamic and cognitive behavioral therapeutic practices and draw on data from ethnographic observations in an outpatient psychiatry clinic and in-depth interviews with psychotherapists. The article details the constitutive relationship between two dimensions of temporality: first, clock time, namely the length of treatment, the length and frequency of sessions, and the flow of the therapy hour, and second, the temporal epistemics of illness, its construction as a phenomenon with a past, present, and future. Clinicians in the two orientations attempt to construct particular temporal landscapes by integrating these two facets of their work. Yet they must always do so in response to patients’ own temporal interventions. By attending both to the organization of professional work and the temporality of illness, this article brings together two largely distinct literatures within medical sociology, namely scholarship on the profession of medicine and social scientific understandings of the temporal dimensions of illness. It shows that temporality is constitutive of how knowledge and power are negotiated in expert work.     

Cultural Influences Upon Psychopathology: Clinical and Practical Implications

Information on the role of cultural factors in abnormal behavior and experience is selectively reviewed, and several conclusions are drawn about the nature, extent, and impact of such influence. Although a number of demonstrated universals exist in the manifestations of schizophrenia and depression, the scope of cultural variation in all aspects ofpsychopathology is vast. Both universalist and relativist positions in their pure or exclusive form are rejected and the view is espoused that psychological manifestations are the joint result of panhuman and culture-specific factors. Several conclusions concerning the operation and the results of such influences are presented and the issues that are as yet unresolved are identified. The self is introduced as the key concept in. explaining both the constancy and the variation of experience across cultures and four dimensions derived from Hofstede’s worldwide multicultural research are described. Their potential relevance is spelled out for systematically investigating the culturally preferred and/or characteristic modalities of psychotherapy.     

Advocating the Clinical Social Work Professional Identity: A Biographical Study

Aiming to portray the clinical social work (CSW) professional identity, the present biographical study examines the CSW knowledge and practice domain boundaries as they appear from the perspectives of three Greek mental health social workers who have advocated for the professionalization of CSW. The practitioners' perspectives are studied in relation to their demographic characteristics, education and training, and multidisciplinary relationships. A thematic analysis of the in-depth interviews revealed that these practitioners retained their nuclear social work identity and felt their skills and interests to be different from those endorsed by the present generic social work education and practice system. The study also revealed differences in the educational qualifications and routes that each of the three practitioners followed in order to be able to identify themselves as ‘clinical social workers’. Although the common denominator in the practitioners' perspectives was their training in psychotherapy, the type of psychotherapy training pursued and the experience of personal psychotherapy differentiated each practitioner's ability to theorize on the CSW practice identity. The research data were filtered through a psychodynamic lens to reveal the dynamics of the unconscious processes within the relationships formed between individuals and organizations.