Single-Session One-At-A-Time Therapy: A Personal Approach

The terms ‘Single-Session Therapy’ (SST) and ‘One-At-A-Time’ (OAAT) therapy are both used to indicate a situation where the therapist and client set out with the expressed intention of helping the client in one session while acknowledging that additional sessions are available to the client. Both terms have their advantages and disadvantages and thus the author uses the blended term ‘Single-Session One-At-A-Time’ (SST/OAAT) therapy to highlight the advantages of both. It is a core feature of SST/OAAT therapy that it is client-centred especially where the session’s focus and goal are concerned. However, in an attempt to avoid SST/OAAT therapy being highjacked by therapists who operate from the ‘expert’ source of influence, the field has downplayed the contribution of the therapist’s expertise. In this paper, I make clear that the expertise of the therapist when allied to the expertise of the client can be a potent force for good in SST/OAAT therapy. My main task, however, is to outline my own approach to SST/OAAT therapy which is a blend of general principles that are likely to be held by the majority of SST/OAAT therapist and specific ideas that are derived from working alliance theory, pluralism and Rational Emotive Behaviour Therapy.     

‘My Child is Anxious Because We Might Get Deported’: Brief Therapy from MRI with an Immigrant Family in the United States

As we go to press in a COVID-19 world, the topic of anxiety is foremost on our minds. While each situation has to be considered in its own context, how to manage different anxieties has common denominators. There is currently a sharp increase in forced migration around the globe so mental health professionals must develop effective skills, like the ability to adapt services to different contexts and cultures, to manage the needs of immigrant people. Problem-Solving Brief Therapy, as developed at the Mental Research Institute in Palo Alto, is a systemic model of therapy, which aims at promoting change in the complaint the presenting client (the ‘talker’) cares about. The model’s roots in Constructivism foster integrating the clients’ beliefs and values into therapy to allow the therapists to adapt to the clients’ particular needs. This paper is the analysis of a single case where the therapist worked with an immigrant family because their child suffered from severe anxiety related to the parents’ threatened deportation. The paper focuses on premises and strategies that allowed minimising cultural barriers between therapists and family members, thus facilitating a strong therapeutic alliance conducive to improvement.     

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.     

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.     

Micro Ruptures and Repairs in the Beginning Phase of Cross-Cultural Psychotherapy

The article discusses misunderstandings and misattunements that occur in the beginning phase of cross-cultural psychotherapy. Sources of micro ruptures are outlined, including client maladaptive patterns, therapist misunderstandings, cross-cultural misunderstandings due to cultural variations, and asymmetrical power relations involving the impact of prior experiences or current therapy practices. Multiple clinical vignettes illustrate the rupture/repair process, drawing on Safran and Muran’s (2000) list of direct and indirect techniques.     

Reading European football,critiquing China: Chinese urban middle class fans as reflexive audience

ABSTRACT

This essay explores European football’s cross-cultural appeals in China by focusing on Chinese fans’ active readings of this globalized cultural text. Using analytical tools from both sport sociology and transnational reception studies, I understand Chinese urban middle-class supporters as a reflexive audience whose meaning-making of European football is contextualized in their local urban experience. The in-depth interviewing reveals that these fans’ interpretations of their favourite European football teams as symbols of ‘collective cooperation’ and ‘beautiful football’ produce critical reflections on the discourses of ‘competitive individualism’ and ‘utilitarian commercialism’ which are part of the rising ideology during China’s neoliberal reform. Through the comparison among European football, Chinese football, and popular ‘national’ sports in China, the participants further contest the prevalence of these discourses in China’s broader economic and social arrangements over which they are engaged in constant material struggles. I further discuss how the transnational consumption of European football offers the Chinese urban middle-class a symbolic space to project their reflexivity on the reforming process.     

Clients’ perceptions of marriage and family therapists’ way‐of‐being: a phenomenological analysis

Previous research highlights the influence of therapist factors on treatment outcomes. One therapist factor proposed as fundamental to the process of therapy is the therapist's way‐of‐being, a relational concept that refers to how the therapist regards a client—either as a person or object (Fife et al., [2014] Journal of Marital and Family Therapy, 40, 20–33). Although this case has been made conceptually, there is little empirical research on therapists’ way‐of‐being with clients. The primary purpose of this research is to investigate clients’ perceptions of their therapists’ way‐of‐being. Utilizing a common factors perspective, the study seeks to explore: (a) how clients experience their therapists’ way‐of‐being and (b) the influence therapists’ way‐of‐being has on clients’ engagement. Phenomenological methods were used to gain a nuanced understanding of the phenomenon. Qualitative data were collected through semi‐structured face‐to‐face interviews with clients (N = 10) who received individual therapy from a marriage and family therapist. Results were organized into two main themes: core tenets (attunement, congruency, and aligning with clients) and operational tenets (providing affirmation and validation, balancing flexibility and structure, and accomplishing goals). Findings are used to make a case for adding the concept of way‐of‐being as an overarching construct for several well‐established therapist factors. Clinical and training implications are discussed.     

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.     

Phenomenology and intersubjectivity: considerations for webcam-facilitated psychotherapy

ABSTRACT

The clearest distinction between webcam-facilitated versus face-to-face psychotherapy is the available sensorial information. The following questions guide this discussion: 1. How do our senses inform the psychotherapeutic process? 2. What are the implications for the therapeutic process when sensory information is different than during face-to-face therapy? This examination of the role of the senses in the creation of knowledge is grounded in phenomenology. Individual unity of consciousness and reciprocal understanding are applied to literature on webcam-facilitated therapy. An amalgam clinical example illustrates these phenomenological concepts and role of intersubjectivity. The core issues are involvement of sensory processes in the process of psychotherapy and co-construction of knowledge. By accepting the limitations of therapist knowledge, the client is encouraged to articulate and develop their own knowledge, and make conscious their unconscious. It is not necessary for therapist and client to share a physical space for co-creation of knowledge necessary for client transformation.     

Exploring emotional aspects of care and control in social work with children and families - a single case analysis of conversation

ABSTRACT

In this article, I explore how emotions are displayed and dealt with on a communicative level in face-to-face encounters between social workers and parents in a child welfare setting. The analysis draws upon detailed analysis of a whole encounter between a social worker and a parental couple who have recently had their new-born daughter placed in foster care. By examining the way emotional stances are expressed and responded to I discuss how orientations toward institutional tasks and goals create constraints for the display, recognition and validation of clients’ emotion displays. I consider the communicative challenges this poses for the parents and the social worker and the implications these may have for the client–worker relationship.     

The Discursive Performance of the Alliance in Family Therapy: A Conversation Analytic Perspective

Following the ‘discursive’ turn in family therapy, the attention of practitioners shifted towards understanding how culture and language shape meaning‐making in therapy. In this article, we demonstrate how conversation analysis (CA) can be used to examine the processes and outcomes of systemic/constructionist practice. We used CA to study collaborative interactions of a renowned constructionist therapist Karl Tomm and one client‐family. Viewing collaboration as a pivotal aspect of the therapeutic alliance, we demonstrate how the ‘split’ within‐system alliances were developed and sustained in the course of therapy and how they were discursively transformed into ‘intact’ alliances. The therapist's efforts to align with perspectives of family members (and subsystems) seemed pivotal in this process.     

The implications of ‘naming’ on Roma and Sinti right to education and social inclusion: an ethnography of education among a Sinti family network

Acknowledging the European political commitment to Roma education and the research in this field, my article deals with the experience of education of a Sinti ‘minority’ (The terms ‘minority’ and ‘majority’ will be used in this article, according to the meaning that is given to them within Anthropology and Education studies (cf.). The inverted commas are used to note that they are categories, used with the aim of a clearer explanation for the present text but not necessarily showing the complexity of the social and cultural contexts observed) in northern Italy. The study presents an interpretation of the observations collected during 21 months of ethnographic research among a Sinti family network and in a multicultural middle school, attended by their teenage children in Trent. The ethnographic interpretations point out how the languages and communication codes used within schools partly reproduce the asymmetric power relationships that exist between Roma and Sinti ‘ethnic minorities’ and the Italian so-called majority society. The process of ‘naming’ the ‘other’ plays a crucial role in this analysis, as it shows how meanings are imposed and handled in the relationship between institutions, ‘groups’ and individuals. Consequently, this process highlights the important role of anthropologists in pointing out the ‘emic’ and ‘etic’ (The concepts of ‘emic’ and ‘etic’ were coined in 1954 by the linguist Kenneth Pike and then used by anthropologists. ‘Emic’ refers to the ‘insiders’ points of view on their cultures, and ‘etic’ refers to the ‘outsiders’ accounts on cultures that are not their own) dimensions of every culture. Furthermore, the study’s methodology testifies to the author’s choice of pursuing an ‘engaged anthropology’. Finally, the relevance of the concept of propriospect will be stressed as a means to interpret educational and cultural processes in which the subjects actively take part, with particular attention to young Sinti and their peer groups.     

We Don't Need Your Help,But Will You Please Fix Our Children

A Bowen Family Systems therapist employs concepts of triangles and the family projection process to view a child's symptoms as embedded in the broader family patterns. This article will examine the dynamics of two family therapy cases where parents anxiously asked for their children's symptoms to be fixed. These cases will be used to explore the common presentation in child and adolescent mental health, where the parents are concerned for their children but are also keen not to open their own ‘can of worms’. The presenting problem in the first case was violent hostility between adolescent sisters and in the second case was an adolescent's anorexia. Drawing on client feedback, I reflect on the therapy process behind the divergent outcomes. In case one, the parents were willing to address their own troubled relationship and family of origin, while in case two, the parents discontinued therapy when family of origin dynamics began to be explored. The article suggests how the therapist can evoke parents' curiosity about their role in anxious family patterns, without them feeling blamed.     

Systemic alliance in individual therapy: factor analysis of the ITAS-SF and the relationship with therapy outcomes and termination status

Clients providing systematic feedback to therapists via self-report measures of psychological distress and working alliance have been shown to increase therapy outcomes. However, there are few systemic-based measures that are feasible for therapists to use. Recently, Pinsof et al. (Family Process, 2008, 47, 281) developed a brief systemic alliance measure (ITAS-SF) for individual therapy. The current study tested the factor structure of this measure and examined whether the subscales related to clients' therapy outcomes and termination status (N = 570). The results demonstrated supported a 3-factor model for the ITAS-SF (as compared to the seven factors proposed by Pinsof et al.). In the first factor, content combined the goals for therapy, the tasks or methods to reach those goals and bond between the client and therapist. The second factor reflected how clients perceive the relationship with the therapist (i.e., interpersonal dimension-self/therapist), and the third factor reflected how clients perceive the alliance between their social network and the therapist (i.e., interpersonal dimension others/therapist). The two interpersonal factors were related to therapy outcome and termination status.     

Un-imagining the local/future: cinematic engagement with the absence of hope

ABSTRACT

With reference to the 2014 Umbrella Movement and Hong Kong’s uncertain fate come 2047, I ask how one un-imagines the cultural future of inhabiting the locality. As people take prompts from the present predicament to cope with real possibilities about the future, they realize that a strong embodiment of local consciousness permeates the sociocultural space. I discuss how such engagement takes place through cinematic experience, and examine tactics of the spectator’s critique centring around the erosion of hope at the core of everyday, intellectual and affective imagination. I trace the ways in which postcolonial subjects engage with hope and with the shock of hopelessness in a lived social imaginary. Examining in detail three differently representative recent films, namely, The Midnight After (2014. Dir. Fruit Chan, The Midnight After Film and One Ninety Films), Overheard 3 (2014. Dir. Alex Mak and Felix Chong, Sil-Metropole, Bona Film and Pop Movies) and Ten Years (2015. Dir. K. L. Ng (‘Local Egg’, Boon-deh dan), J. Au (‘Dialect’, Fong-yin), K. Chow (‘Self-Immolator’, Jee-fun jeh), F. P. Wong (‘Season of the End’, Dong sim), and Z. Kwok (‘Extras’, Fau gua), Ten Years Studio), I depict the modes in popular imagination that invoke people’s engagement with the ‘local’, albeit in its affective state. Accordingly, in the context of ‘externalized’ social realities, I identify three interlocking modes of cultural engagement, which I characterize as figurative, performative and prefigurative, respectively. In their ‘future’ imaginary, I look for ordinary people’s ways to face the absurdity of the status quo and the performativity of local struggles with the self.     

Facilitating intercultural education in majority student groups in higher education

ABSTRACT

The present article critically analyses the pedagogical efforts of two teachers to promote values education and intercultural reflection in their own educational practice. They teach in higher education in Norway and most of their students have majority backgrounds. Based on their teaching experiences with VaKE (Values and Knowledge education), the article discusses opportunities and challenges when working with values education in majority student groups. It concludes that discussing values is difficult but can be eye opening. It also raises the question of which dilemmas can prevent stereotyping and foster more complex intercultural thinking and shows that intercultural education requires a discussion of one’s own cultural position. The article highlights the teacher’s crucial role in the VaKE-process regarding the aims of intercultural values education.     

Engagement: Who's Engaging Whom?

A definition of ‘engagement’ in therapy is developed, based upon the proposition “the client engages the therapist”. Engagement is then distinguished from ‘joining’, and a consideration of the relational power between client and therapist, implied by this definition, shows it to be consistent with systemic theory for therapy.     

The Impact of Family Therapists’ Adult Attachment Styles on Their Career Choice and Approach to Therapy: An Interpretive Phenomenological Analysis

Attachment theorists have highlighted the role of the therapist in providing a ‘secure base’ for therapy. This raises the question of how therapists with insecure as well as secure attachment styles manage the integration of their personal experience and their therapeutic work. This study explored the relationship between family therapists’ adult attachment styles, influences on their career choice and their approach to therapy. Participants’ (n = 11) attachment styles were previously assessed using the self-report Experiences in Close Relationship questionnaire. Three participants were assessed as having a ‘secure’ attachment style; three were ‘preoccupied’, three ‘fearful’ and two ‘dismissing’. They were interviewed about their practice and the impact of past or current relationships on their development as therapists. Interpretive Phenomenological Analysis was used to analyse the verbatim accounts into cluster of master themes and subthemes. The analysis identified two master themes: understanding one’s self and the impact of family of origin experiences, and the integration between personal experiences and therapeutic work. There were differences in responses relating to the therapists’ attachment styles. Therapists with ‘secure’ adult attachment styles were aware of their challenges and able to utilise their experiences in their practice and respond sensitively to their clients. Conversely, those with ‘insecure’ styles have difficulties in mentalisation and in using counter-transference responses in their practice. We suggest that family therapists, social workers and others engaged in therapeutic work with families should undertake an exploration of the ‘self’ of the therapist in the context of their own family relationships and adult attachment styles as part of their training and continuing professional development.     

The Clinician's Cultural Countertransference: The Psychodynamics of Culturally Competent Practice

The purpose of this paper is to define the presence of the clinician's cultural countertransference in the cross-cultural therapeutic dyad, and describe its impact on the delivery of culturally competent services. The recognition of the contributing role of the therapist's own subjectivity in psychodynamically oriented practice cannot be more vital than in the treatment of patients whose culture, race, or class markedly differ from that of the therapist. The cultural countertransference is viewed as a matrix of intersecting cognitive and affect-laden beliefs/experiences that exist within the therapist at varying levels of consciousness. Within this matrix lie: the clinician's American life value system; theoretical beliefs and practice orientation; subjective biases about ethnic groups; and subjective biases about their own ethnicity. The author proposes that these countertransference attitudes are often: disavowed by the clinician; exert a powerful influence on the course of treatment; and though unspoken, are frequently perceived by the client.