Does the Therapeutic Relationship Matter? A Follow-up Study of Adherence and Improvement in Family Therapy

A follow-up study of 83 families treated by family therapy at a child guidance clinic was conducted and the relation of client/therapist interaction to (i) drop out from therapy and (ii) improvement was examined. Early terminators were found to differ significantly from continuers as to their ratings of their relationship with the therapist, and trends were found for therapists' feelings to be associated with adherence to therapy. Early terminators were not distinguished by diagnosis, severity of case, or improvement rating. Improvement, on the other hand, was not associated with therapists' or clients' attitudes to each other. It is suggested that these factors are of greater significance in “joining” therapy than in its course.     

Evaluation of Family Therapy: A Comparison of Therapists' and Clients' Views**

In this evaluation of therapy experience for 82 families by brief therapy at Bouverie Clinic to 1976–1977, therapists' and clients' rating of outcome were obtained. After termination of therapy both therapists and clients reported high improvement rates in the presenting problem(s) as well as in the quality of family relationships and in the family's ability to deal with further problems. High agreement was found between therapist’ and clients' ratings of outcomes. Therapists were more favorable than clients in their ratings of change in the presenting problem and in their ratings of change in the quality of family relationships, but not in assessing the change in family's further problem solving ability. At follow-up clients were predominantly satisfied with their therapy experience. In addition, therapists' ability to predict outcome accurately, after the second of therapy, was strongly supported by our finding.     

Significant Conversations or Reduced Relational Capacity? Exploring Couple and Family Therapists' Expectations for Including a Client Feedback Procedure

Little information exists on the specific reflective processes that precede therapists' choice of including or not including a structured feedback procedure in their established practice. In the present study, we aim to describe and explore experienced couple and family therapists' expectations for how the comprehensive therapy feedback procedure Systemic Therapy Inventory of Change might influence their practices. Through a thematic analysis of six focus group interviews, two main themes were elicited. The first main theme involved values embedded in current practice, with the following subthemes: (1) balance between the therapist's expert knowledge and the client's experience‐based knowledge; and (2) making time to build alliances. The second main theme concerned the presumed influence on current practice, with the following subthemes: (1) ‘Systemic Therapy Inventory of Change will disturb the therapist's capacity to stay present’; (2) ‘Systemic Therapy Inventory of Change will shape conversations’; and (3) ‘Systemic Therapy Inventory of Change will contribute to increased qualitative depth’. We discuss these results in relation to the notion of Systemic Therapy Invention of Change as a ‘third party in the room’. We also discuss the results in relation to implications for collaborative practices, and for client and therapist autonomy.     

The Meaning of Work and Love: Career Issues and Interventions

Examining concepts about work and love can help people increase their career success and life satisfaction. Career counselors may initiate this examination by eliciting clients' concepts about work and love. After hearing a client's ideas about work and love, counselors can compare this personal meaning to the social meaning of work and love. When this comparison reveals dysfunctional beliefs about work and love, counselors can link these beliefs to their client's career concerns. Such a linkage typically provokes a cognitive dissonance that motivates clients to modify their beliefs. Counselors can facilitate meaning modification by using client-centered and social influence techniques.     

Approaching drinking problems in single male clients receiving social assistance

How are drinking problems in single male clients receiving social assistance approached? This subject has been investigated in two studies. In Study I, 103 social workers responded to a questionnaire on how they would act towards a hypothetical client. The results suggest that there is no consensus among social workers as to how to act towards their clients' drinking problems and that personal values more than anything else are what seem to influence the choice of action taken. Study II is based on focus group interviews with social workers. The social workers' approach to the clients' problems is described as a mobile point within a two-dimensional system. One dimension concerns the client's right to equal treatment versus the right to have their application judged individually with special circumstances considered. The other dimension is related to the client's integrity versus the need for support and control. The results are contextualised mainly from three aspects: the demands on ‘knowledge’ in social work, the specific framework of social work, and changes in the public discourse regarding socially acceptable drinking habits.     

Predictors and Processes Associated with Home‐Based Family Therapists' Professional Quality of Life

This study examined whether home‐based family therapists' (HBFT) workload and clinical experience were associated with therapists' professional quality of life directly and indirectly through self‐care activities and frequency of clinical supervision. Hypotheses were tested using structural equation modeling with a sample of 225 home‐based therapists. Results suggested that therapists' workload and HBFT experience significantly predicted therapists' professional quality of life. These associations between therapists' workload and HBFT experience were partially mediated through participation in self‐care and frequency of clinical supervision. Implications for improving therapists' quality of life are discussed as a function of therapists' workload, clinical experience, self‐care, and supervision.     

Therapist Differentiation and Couple Clients' Perceptions of Therapeutic Alliance

Therapeutic alliance has been acknowledged as one of the catalysts for change within a therapeutic relationship. The contributions of therapists' characteristics to alliance are not often studied. From a Bowen System's Theory perspective, the therapist's level of differentiation would be highly relevant to the development of a therapeutic alliance. The hypothesis for this study was that therapists who are able to take a more differentiated stance in therapy will build a stronger therapeutic alliance. To test this hypothesis, multilevel modeling procedures were performed, using data from nine therapists and 93 couple cases collected at a large, Midwestern university. Therapist differentiation of self was found to be weakly associated with the clients' perception of therapeutic alliance across the early sessions of therapy, but not in the expected direction. Although the results were unexpected, this study provides an example of the potential of examining therapist characteristics from within one model of therapy, that can be applied across various clients and various models of therapy.     

LEAVING THE CONSULTING ROOM TO PROVOKE ENACTMENT IN MARITAL THERAPY*

Enactment of emotionally intense, intimate behaviors is often important in marital therapy. But clients' concerns for privacy and their dependence on the therapist as a facilitator of communication can deter them from exhibiting such behavior in the therapist's presence. By walking out of the consulting room, the therapist can stimulate the enactment that would have been inhibited otherwise. Three case examples illustrate the technique. Specific points of procedure are considered, and the technique's limitations and risks are noted.     

Vicarious resilience from attachment trauma: reflections of long-term therapy with marginalized young people

The concept of vicarious resilience captures the therapist's emotional growth occurring as a direct result of therapeutic engagement with traumatized clients. Three chronological case scenarios are presented for exploration of vicarious resilience in relation to attachment trauma. The purpose is to increase awareness and appreciation of the positive functions it serves for client mentalization, therapist skill and resilience factors for both parties. The reflective methodology considers the intrapsychic worlds of the client and the therapist and details how the therapist comes to experience the client's distressing projections. The potential for vicarious resilience begins from the outset of the therapist's actions of containment upon these projections. Advancing early ideas, it is advocated that vicarious resilience requires the therapist to have both the capacity and willingness to maintain a constant reflective stance.     

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.     

Expectations of Career Counseling and Their Effect on Client Satisfaction

Although there has been growing attention to clients' expectations of career counseling, more research is necessary to clarify the role of these expectations in shaping client satisfaction at the end of the intervention. On the basis of expectation confirmation theory, this study examined the indirect effect of clients' initial expectations on overall satisfaction through the perceived performance and final confirmation of expectations. We also explored whether this indirect effect is dependent on counselors' initial expectations. Longitudinal data were collected on 83 counselor-client dyads involved in a career counseling intervention in northeast Italy. Results confirmed that clients' initial expectations predicted overall satisfaction with the intervention through the subsequent mediation of perceived performance and confirmation of clients' expectations. The moderating role of the counselors' initial expectations was not confirmed. These findings imply that career counselors should invest their efforts in managing clients' expectations.     

Which therapist perceptions best predict client outcomes? A naturalistic examination

Examining associations between therapists' perceptions of therapy sessions and client-reported outcomes in naturalistic settings (real-life therapy settings) can provide valuable guidance for the assessment, treatment, and monitoring of clients. This study included data of 1334 sessions from 127 clients (86 individual and 41 couple cases) and 15 therapists, collected at a therapy training center. Clients reported their personal functioning and individual symptoms before each session. Therapists rated clients' participation, receptivity, session progress, goal progress, and therapeutic alliance at the end of each therapy session. Multilevel Structural Equation Modeling analyses revealed that therapist-rated client participation and goal progress predicted better personal functioning, beyond clients' previous personal functioning scores. In contrast, none of therapist-rated session variables predicted clients' individual symptoms, beyond previous symptom scores. Power analyses suggested sufficient statistical power to detect small effect sizes. Findings of the current study have clinical implications for treatment planning and progress monitoring.     

Persons and Hypotheses: The Use of the Therapist in the Hypothesising Process

Although hypothesising has been strongly criticised by postmodern and narrative theorists, it plays a major role in any therapy. This article aims to investigate the hypothesising process, first revisiting the concept of hypothesis in semiotics and Schön's theory of the professions, then examining some features of hypothesising within systemic therapy. The article takes into account the relationship between hypotheses and therapists' basic theories, to arrive, finally, at an examination of the role of the person (both therapist and client) in shaping hypotheses within the therapeutic interaction.     

Constructivist Counseling for Career Indecision

Twentieth-century vocational guidance has been an objective enterprise in which counselors have studied and treated career indecision by abstracting and objectifying it. This article describes how the logical positivist perspective on indecision as an objective phenomenon has evolved over the course of this century. Then, the article explains how constructivist counselors view indecision as clients' subjective attempts to give meaning to crisis points in their lives. This view permits a conceptualization of career counseling as a process of articulating a client's life theme. The article concludes with a case study that illustrates a life-theme approach to counseling for career indecision.     

Mariana: A MS Patient in My Office

Theory appears variously in these clinical vignettes. Sometimes it is addressed as such, in the cases of Hartman, Lobban, and Guralnik. In other instances, it is seamlessly woven in, as in Sheehy's account or in the deftly written narrative by Olga Pugachevsky, a therapist in private practice. She recounts her work with Mariana, a patient who, precociously accommodating and accomplished in projective identification, had acquired a chronic and progressive illness readily interpellatable by others—including the analyst—such that the patient is rendered an invalid, a subjectivity that both compels and repels her.     

Responsive Persistence Part I: Therapist Influence in Postmodern Practice

Feminist and social constructionist developments in family therapy highlighted the importance of attending to therapist–client power relations and incorporating clients' understandings and preferences as a part of therapy. Significantly, less attention has been given to how postmodern therapists do use their power and influence. This is an important topic because it is therapists who have the major responsibility for guiding the interaction with clients and persisting in this so that change is facilitated. Therapist persistence in various forms and across dimensions of therapy process is examined to expand understanding of therapist influence in postmodern and collaborative work. An analysis of responsive persistence in a session with Karl Tomm as the therapist is presented to illustrate this conceptual framing.     

“Basically it's the Usual Whole Teen Girl Thing”: Stage‐of‐Life Categories on a Children and Young People's Helpline

This article explores the practices of membership categorization in the interactions of clients and counselors on a national Australian helpline (Kids Helpline [KHL]) for children and young persons. Our focus is on membership categories drawn from three membership category devices (MCDs): stage‐of‐life (SOL), age, and family. Analysis draws on data across different contact modalities—email and web‐counseling sessions—to examine how category‐generated features are relevantly occasioned, attended to, and managed by the parties in the course of interaction. This shows clients' use of MCDs in presenting their trouble and building a relevant case for their grievance. By examining counselors' subsequent receipts of the clients' complaints, we are able to trace some of the cultural knowledge that the clients' categorizations make relevant to the counselors. Moreover, the analysis demonstrates how the inherent flexibility of MCDs allows counselors to exploit these same categorial resources and to re‐specify the clients' trouble in a more positive fashion to accomplish counseling work. In explicating how taken‐for‐granted notions of the lifespan as well as of family relations are mobilized by participants in KHL's sessions, the findings contribute to previous studies of social interaction in counseling, and to research on social identity and categorization more broadly.     

An Individual Mixed‐Evaluation Method for Career Intervention

Economic issues linked to career counseling are a cause for concern to policy makers in developed countries because they expect career practitioners to provide evidence of the efficiency of career counseling interventions. The aim of this study was to test an individual evaluation method mixing time series (outcomes) and life narrative (processes). The method used 5 items related to 1 client's career decision self‐efficacy and studied the evolution of those items throughout the intervention of 1 career counselor (43 days). Changepoint analysis helped in identifying the changes that have to be taken into account for time series and which are contextualized in the client's verbatim analysis. This mixed method highlighted that the career counselor's intervention increased the client's career decision self‐efficacy. Practitioners could use the methodology proposed in this article to evaluate their interventions. They could also report their practice to clients, employers, and decision makers.     

A culturally relevant measure of client satisfaction in child welfare services

Child welfare professionals increasingly recognize the importance of the client's perspective in evaluating service outcomes, but there is a dearth of well-developed instruments that meet the needs of service providers and planners. This article describes the implementation of a measure of primary caregivers' satisfaction with mandated child welfare services. This measure is significant for its flexibility regarding the nature of the child welfare population to be surveyed and for its attention to cultural aspects of the clients' experience. The instrument is an adaptation of Harris, Poertner, and Joe's (2000) client satisfaction measure and includes selected items from related instruments in the field. The measure was developed with the help of an Aboriginal child welfare agency and piloted with that agency's clients. The adapted instrument also includes items requested by the pilot testing agency to reflect high quality child welfare practice including specific attention to the clients' racial, ethnic, and cultural identity. This project furthers Harris et al.'s (2000) prior work by using the instrument in another country (Canada) and with diverse populations, thereby adding to the body of evidence supporting the development of this measure. Future research with larger samples could further enhance the validation of the measure and its usefulness to policy makers and practitioners.     

Five-Way Experiential Learning Model for Social Work Education

Social workers exercise their practice skills by helping clients find strengths and solutions. In order to comprehensively practice skills for diverse client situations, it is crucial to practice and fine-tune the applications of various therapeutic approaches through clinical drills. This paper presents an experiential learning model, expanded from Kolb's Learning Cycle, which fits the dynamic pedagogical needs of the social work profession. It examines the implementation of the use of the ‘Five-Way Experiential Learning Model’ based on practice learning through personal reflections and professional evaluations. This practice learning study helped 79 MSW students define their ‘five-way learning’ and to analyze its impact on their acquisition of social work skills and clinical practice competencies. This process demonstrates the importance of the transtheoretical connection to achieve a better understanding of clients' situations through the process of change and peer input. Discussions will focus on the model elements, results on experiential learning, and ethical considerations.