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.     

The Psychiatrist's Role in Implementing an Open Dialogue Model of Care

The Open Dialogue approach is a family‐oriented early intervention model for mental health problems developed in the health district of Western Lapland, Finland. Since the 1990s the psychiatric service system in Western Lapland Health Care District has been organised according to Open Dialogue principles and applied to the treatment of any mental health concerns. The Open Dialogue approach considers the client and their family as active participants rather than as objects of treatment in its planning and implementation with a psychotherapeutic focus. In daily work, the responsibility for the treatment process is shared with the case‐specific team. The model of care requires a dialogical orientation from all staff members, psychiatrists included, to interact with the team and the client's network. In this article I describe the role of the psychiatrist in implementing an Open Dialogue model of care in psychiatric services leaning on my experiences of clinical work in the adolescent psychiatric team in Western Lapland.     

How Family Therapy Stole My Interiority and Was Then Rescued by Open Dialogue

This paper serves as a naive autoethnography, based on the effect of open dialogue training on my practice as a systemic family therapist. It follows a beginner's attempt at a newly recognised form of writing, one that reflects the messy, emergent links between people, voices, experiences, sensations, memories, theories, objects, friends, and other entities, one that is also, however, actually in my head and body and real, territorialised in place, cities, streets, and rooms. It is an autoethnography in that it serves as a narrated introspection, built on a barometric research machine that will be described.     

Resiliency in the Practicing Marriage and Family Therapist

Although burnout in the helping professions is well documented, few studies have examined the phenomenon of the resilient therapist. This study used a grounded theory methodology to construct a theory of therapist resilience. The participants were eight licensed marital and family therapists: five females, three males, all Caucasian, with an average age of 58.9 and an average of 22.6 years of experience who reported feeling energized by the practice of therapy. The theory that was constructed included a central category (Integration of Self with Practice), a paradigm (Trust in Self), and two main categories (Career Development and Practice of Therapy). The process involved an initial calling, a positive agency experience, career corrections, the influence of relationships, and a move to a more flexible environment.     

Raising the Stakes in Child-at-Risk Cases Eliciting and Maintaining Parents' Motivation

This paper, the third in a series concerned with family therapy in cases involving children at risk of abuse, describes an approach to maximising parents' interest and commitment to therapy. After overviewing the difficulties faced by therapists in working with parents who are notorious for their ‘resistance’, we provide guidelines for minimising the negative consequences of notification and for constructing therapeutic leverage in order to elicit and maintain parents' motivation throughout the course of therapy.     

Opening Up: Therapist Self-Disclosure in Theory, Research, and Practice

While most therapists report that they do disclose some information about themselves to their clients, therapist self-disclosure continues to be both controversial and nebulous in clinical theory, research, and practice. This article considers what makes therapist self-disclosure so challenging to define and study and provides an overview of the empirical and theoretical literature. It then concludes with a consideration of therapist self-disclosure in contemporary legal, ethical, and technological contexts of clinical work.     

Intracultural and Intercultural Dialogue in Psychoanalytic Psychotherapy and Psychoanalysis

This paper explores some of the history of psychoanalysis as it has been influenced by and has influenced the cultures in which it exists. There was a time when the profession was almost antagonistic to considering that which lay outside of the intrapsychic. Partly in response to a sense of crisis, today it is busy incorporating a 'fourth leg into its training programs: the sociocultural surround. Those who would bring about these modifications are moving from an individualist model toward one in which self is the product of relationships, that is, toward a universal model.     

Observational Stance as a Predictor of Subjective and Genital Sexual Arousal in Men and Women

Observational stance refers to the perspective a person takes while viewing a sexual stimulus, either as a passive observer (observer stance) or an active participant (participant stance). The objective of the current study was to examine the relationship between observational stance and sexual arousal (subjective and genital) across a range of sexual stimuli that do or do not correspond with a participant's sexual attraction (preferred or nonpreferred stimuli, respectively). Regression analyses revealed that, for men (n = 44), participant stance significantly predicted subjective and genital arousal. Women's (n = 47) observer and participant stance predicted subjective arousal but not genital arousal. Analysis of variance showed that participant stance was greatest under preferred sexual stimuli conditions for all groups of participants, while observer stance scores revealed a less consistent pattern of response. This was particularly true for opposite-sex-attracted women, whose ratings of observer stance were lowest for preferred stimuli. Observational stance does not appear to account for gender differences in specificity of sexual arousal; for men, however, participant stance uniquely predicted genital response after controlling for sexual attractions. Similarities in the relationships between men's and women's observational stance and sexual responses challenge previous claims of gender differences in how men and women view erotica.     

Beyond polyphony: Open Dialogue in a Women’s Shelter in Australia as a possibility for supporting violence‐informed practice

Open Dialogue is a family/social network‐centered psychotherapeutic approach to responding to people in crisis and distress. In 2017, Open Dialogue network meetings were implemented in an Australian inner‐city shelter for disadvantaged women. The aim of this study was to explore the experience of participating in these meetings from the perspective of service users and Open Dialogue practitioners. Qualitative interviews were completed with thirteen participants (six service users and seven practitioners) and analyzed thematically. The findings suggested that dialogical processes created safety by attending to multiple voices in nonviolent ways that reduced perceived hierarchies. Notions of expertise were renegotiated, which allowed the women to feel heard in significant ways that were different from their previous experiences with other social and healthcare services. Open Dialogue is an approach that can meaningfully attend to some of the power relations within which women live and within which social and health care services are provided.     

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.     

Authority and the pursuit of order in organizational performance

The paper seeks to examine the site of performance, the spatial context of the dramatic act, and to consider the various ways in which performance is regulated, ordered and sustained. In particular, the paper is concerned with the relationship between authority and propriety in the regulation of the performance site and with the transformational metaphors which sustain the trajectory of the performance. The basic premise on which the argument rests is that there is a equivalence of sign-imagery as appropriate to liturgical performance which is the basis of some forms of organisational behaviour and that this equivalence permits more than the mere playing out of ritualistic behaviour: it appropriates the image in the reproduction and re-presentation of its forms. Consequently, the significance of the elevation, for instance, of The Cross or the consecrated Host, the notion of ritualistic cleansing, of humiliation, of redemptive acts, of public confession, become emblematic means of achieving organisational incorporations and of achieving movement from the isolated “I” to the collective “We”.     

Global Governance Organizations: Legitimacy and Authority in Conflict

Global governance organizations (GGOs) are frequently malignedas both illegitimate and ineffective. With the growing prominenceof entities that promulgate global rules governing trade, communications,finance, and transport, these shortcomings take on greater importance.This essay presents a theoretical framework to understand thechallenge of legitimacy for GGOs. It argues that GGOs tend toface trade-offs between legitimacy and authority, but that widespreadusages of these important terms conflate or confuse them andthus obscure critical issues in GGO politics. Once these termsare more clearly defined, we see more easily that GGOs mustsometimes violate democratic norms, sacrificing equality andbureaucratic neutrality, to satisfy key constituencies and thusretain power. The argument lays the foundation for an empiricalstudy that demonstrates how the structure and processes adoptedby GGOs are intended to satisfy the conflicting demands of legitimacyand authority.     

I Am a Therapist and I Have Three Tennis Balls in My Office

There is wisdom in the saying that ‘To a person with a hammer everything looks like a nail’. As a therapist my hammer is talking, naturally and inevitably, and most things look like they need talking. But, there are times when I put my talking tool aside and select another tool and my three tennis balls are one of the tools for which I reach.     

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.     

Family of Origin Supervision in the Workplace: Impacts on Therapist and Team Functioning

The Adolescent and Family Unit at Redbank House carried out a trial of Bowen's Family of Origin Coaching that has prompted us to comment on the usefulness of this approach as a component of clinical supervision. This article will describe how this trial came about, the process adaptations required to make it possible and how some of the ethical dilemmas raised by this approach were addressed. Personal reflections from the team members will be shared, and our observations in terms of impact of this form of supervision on clinical functioning, team cohesion and service provision will then be discussed. In essence, we aim to provide an anecdotal account of our experience and ask the question, ‘Is supervision that focuses on the therapist's individual functioning as a product of their intergenerational patterns a valid use of resources in a clinical setting?’     

Dialogue and creativity: The generative dialogical perspective in therapy

The generative perspective in therapy understands relations and dialogue as a generative social space where participants can promote innovative resources and possibilities for themselves, and their relations and circumstances, along with new social ecologies. It focuses on the creative dimensions of human relationality. This epistemological and clinical perspective has a heuristic value that allows us to discern and work with micro dialogues—micro processes of creative, generative dialogues—in the ongoing dialogue, mindful of the opportunities for creativity and innovation they provide. The generative perspective promotes creative processes and transformations to help clients build possible and viable futures when faced with problems, conflicts and challenges. It involves the dialogical and relational co-creation of resources and possibilities, and actions for implementation. The perspective is illustrated with a therapy process involving a 3-year follow-up. The paper includes a section where differences and similarities between dialogical perspectives are presented.