The Relation Between Therapeutic Alliance and Treatment Motivation in Residential Youth Care: A Cross-Lagged Panel Analysis

This study investigated the longitudinal relation between therapeutic alliance and treatment motivation in a sample of 174 adolescents receiving residential treatment in the Netherlands. Structural equation modeling with a cross-lagged panel design was used to examine the relation between therapeutic alliance and treatment motivation up to 9 months of treatment. Results revealed that autoregressive associations between initial therapeutic alliance and alliance at subsequent time points were significant, whereas for treatment motivation a significant association was found after 6 months, but not after 9 months. Results also showed that a higher level of therapeutic alliance after 3 months was predictive of a higher level of treatment motivation after 6 months. Furthermore, a higher level of therapeutic alliance after 6 months was predictive of a higher level of treatment motivation after 9 months. Implications for research and clinical practice are discussed.     

Using Football Metaphor to Engage Men in Therapeutic Support

This paper is an account of a small scale exploratory study about the use and value of football metaphor as a device for facilitating therapeutic work. It is based on an evaluation which used a range of qualitative and quantitative approaches. In this paper, we selectively draw on the qualitative data to provide examples to inform our discussion. We illustrate various ways in which football metaphor can support therapeutic change: by aiding initial engagement, facilitating mutual support, enabling self-understanding and motivating change. We relate our analysis to the literature about the therapeutic value of metaphor and highlight the salience of using football metaphor in a group-based setting for men who are often seen as ‘hard to engage’ in therapeutic support. With some caveats, we argue that football metaphor offers a potentially rich and flexible therapeutic resource.     

The Therapeutic Pyramid: A Common Factors Synthesis of Techniques,Alliance, and Way of Being

Common factors in therapy such as the therapeutic alliance and client motivation have been found to account for more change than therapy models. But common factors have been critiqued as only lists of variables that provide little practical guidance. Some researchers have demonstrated that certain common elements (e.g., the therapeutic alliance) account for more variance than others (e.g., techniques), suggesting that some factors should be emphasized over others. Such findings suggest the need for alternatives to model‐based therapy, with one alternative being meta‐models, or “models of models,” that focus on how therapeutic factors interact with each other to produce change. The purpose of this article is to propose a meta‐model describing the relationship between two specific common factors—the therapeutic alliance and interventions. We also propose a new factor—a therapist's way of being—that we believe is foundational to effective therapy. The model is proposed in pyramid format, with techniques on top, the therapeutic alliance in the middle, and therapist way of being as the foundation. The hierarchical relationships between these three concepts are discussed, along with implications for training, research, and therapy.     

Way of being and the therapeutic pyramid: Expanding the application of a common factors meta‐model

Common factors proponents have suggested the need for principle‐based meta‐models to explain how various factors interact with each other to produce change. The therapeutic pyramid is a common factors meta‐model that outlines how therapeutic skills and techniques, the therapeutic alliance, and a therapist's way of being interactive to produce therapeutic change. Skills and techniques occupy the smallest top portion of the pyramid, with the therapeutic alliance in the middle and a therapist's way of being forming the foundation of the pyramid. The success of any layer rests on the quality of the immediately underlying layer. This study illustrates the broad applicability of common factors meta‐models by applying the therapeutic pyramid to couples therapy, family therapy, training and supervision, and professional ethics.     

A Refracted Reality of Everyday Life: The Constructed Culture of a Therapeutic Community

Focusing on the charismatic authority of its Founder/ Director, the ideology, and formal social structure of a holistic therapeutic community for schizophrenics, this paper examines the process of reality construction in an alternative therapeutic milieu. Data was provided from a field work study involving Intensive participant observation over a two year period and open-ended interviews. Within a phenomenological perspective, therapeutic work is viewed as a cognitive activity that not only redefines and transforms the meanings of everyday life but also one that in the process of redefining produces a peculiar cognitive style—a specific tension of consciousness—through a specific epochs. By virtue of this sustained bracket and a self-consciously created culture the therapeutic community is seen as constructing its own version of reality and a peculiar social world.     

Lesbian Therapists and Lesbian Clients

Abstract

The authors, on the basis of their own experience, explore issues specific to therapists working openly as lesbians with lesbian clients. Their discussion covers the structure of a private practice, the therapeutic relationship between lesbian therapist and lesbian client, and personal challenges for the lesbian therapist. Questions are raised and direction given with the aim of facilitating congruence among the therapist's personal capacities, the therapeutic setting, and the psychological intention of the therapeutic work. The authors note the therapist's need to tolerate the exposure of her personal life and the pressure toward fusion that are both entailed in work with lesbian clients, and they suggest that these special challenges, when the lesbian therapist's engagement with them is conscious, offer rich material that can deepen the therapeutic relationship and the therapeutic work.     

Love,Stigma, and Resistance: “Therapeutic Microaggressions” in a Prisoners' Wives' Support Group

This article derives from ethnographies of therapeutic interventions in a support group for prisoners' wives in Israel. The study's main inductive findings reveal that love and the emotion work of prisoners' wives are constructed as the primary site for achieving the clinical objective: modifying the prisoners' wives' spoiled self and encouraging their adoption of a psychological self. The findings reveal a dramatic clash between the therapeutic emotion work of love that the group facilitators proposed and the collectivist emotion work to which the prisoners' wives subscribed. These forms of emotion work are associated with ethnic hierarchies and experiences of stigmatization by the prisoners' wives during the therapeutic sessions. In this context, the article suggests the concept of “therapeutic microaggressions” to describe how interactions in clinical sessions can reinforce inequality.     

Six Step Therapeutic Process to Facilitate Forgiveness of Self and Others

This theoretical article postulates a six step therapeutic process to facilitate forgiveness of self and others. The purpose of this article is to provide therapists with the therapeutic process that can be used to assist clients who are working through forgiveness and self-forgiveness. The combination of several therapeutic methods in a specific order might be effective in assisting clients to work through the forgiveness process in a systematic way. A case example that chronicles a client’s experience while working through forgiveness is provided. Lastly, a discussion of implications for practice and further research questions are presented.     

Media Production as Therapy: A Systematic Review

Abstract

The rapidly changing communication environment of the digital age has generated needed discussion regarding implications of media technologies for social work practice. Yet scarce research has considered the therapeutic value of media technologies for social work practice. This systematic review explores how media production is used as a therapeutic intervention in human services to identify the therapeutic value and potential challenges of its application in the field. Media Production as Therapy (MPT) affords a range of therapeutic outcomes, including self- and community-awareness, self-reflection and self-correction practices, self-expression and story-sharing, and processing trauma. Challenges confronted through MPT include time and resource constraints, logistical difficulties, issues of authenticity, and dissemination concerns. Despite limited research, this review provides needed guidance for social workers to harness technology for social good, operating in the digital space to implement MPT interventions that afford a range of therapeutic benefits to clients in an increasingly mediated world.     

Therapeutic alliance between youth and staff in residential group care: Psychometrics of the therapeutic alliance quality scale

Therapeutic alliance has been frequently studied in individual counseling sessions; however, research on therapeutic alliance in residential settings for youth with mental health diagnoses has been limited. This may be due, in part, to the presence of multiple service providers often in caregiving roles. The purpose of this study was to examine the psychometric quality of a widely utilized measure of therapeutic alliance used in psychotherapy with youth in residential care where the treatment is provided by a trained married couple. We also compared the relationship between youth ratings of their male and female service providers, as well as examined correlations in ratings between youth and staff on therapeutic alliance. Finally, we investigated the direction, magnitude, and trajectory of change in therapeutic alliance over a 12-month period following admission into residential care. The method was a longitudinal assessment of 135 youth and 124 staff regarding therapeutic alliance over the course of 12 months or discharge from services. Results indicated strong psychometric properties and high correlations for youth ratings of both their male and female service providers. However, the correlation was low between youth and service provider ratings of alliance. Longitudinal analyses indicated that rates of therapeutic alliance changed over time.     

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.     

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.     

Change and Paradox in Family Therapy

This paper shows that when the interpersonal context in a family alters, solutions which have previously been successful may paradoxically increase the family's difficulties rather than resolve them. Therapy minors this process, in that when the family system is flexible, “commonsense” interventions may be effective, whereas with a rigid dysfunctional family system therapeutic interventions may be necessary which, among other things, paradoxically imply that no change is required. Some concepts derived from Watzlawick, Weakland and Fish are redefined and the mathematical group theory used by these authors is replaced by system theory in combination with the theory of logical types. A “behaviour disorder” family is used to illustrate the paradoxical mode of symptom development and also the use of a number of paradoxical therapeutic interventions. Possible reasons for the therapeutic power of these interventions are discussed; the concept of first and second order therapeutic paradoxes is introduced.     

The Three Fallacies: Evaluating Three Problematic Trends in Clinical Practice

In an era of condensed treatment and managed care, three trends are gaining prevalence in some graduate training programs and in some circles of the practicing community, limiting clinicians from utilizing the therapeutic techniques needed to help a client achieve long-standing intrapsychic change, a precondition for maintaining therapeutic gains post treatment. The first trend, the equation of empathy with sympathy, hinders the therapeutic dyad from truly understanding a client’s internal experience and implicitly conveys the message that anxiety-provoking material is less welcome in the consulting room. The second trend, prizing cognition over affect, results in a primary focus on secondary thought process, discounting the affective experience that unconsciously steers behavior and thought. This trend is, in large part, due to the widespread dissemination of cognitive-behavioral therapy efficacy research and the belief by some individuals that psychodynamic forms of treatment lack empirical support. The last and most problematic trend, the rigid utilization of treatment manuals, tends to result in a reductionistic approach to treatment, limiting psychotherapy to a set of techniques while also overlooking salient aspects of treatment that can predict positive outcomes. Treatment manuals oversimplify the process of therapy; as a result, the therapeutic dyad is less likely to uncover and discover the multiple origins of one’s suffering, contributory factors that are not always readily available to conscious awareness. This paper discusses each trend and the therapeutic implications that result.     

Reconceptualizing Substance Abuse Treatment in Therapeutic Communities: Resiliency Theory and the Role of Social Work Practitioners

ABSTRACT

Although therapeutic communities (TC) have achieved promising results in the treatment of substance abusers, several areas have been identified which might further enhance TC treatment effectiveness. Two of these, resiliency theory and the role of social work practitioners, are discussed. Resiliency theory provides a framework for re-conceptualizing interventions as they apply to therapeutic communities. Resiliency is explicated and illustrated via a case study of a therapeutic community TROSA (Triangle Residential Options for Substance Abusers), a non-profit TC in Durham, North Carolina. A number of contributions that social work practitioners can make to TCs are described.     

Strategies Used by Foreign‐Born Family Therapists to Connect Across Cultural Differences: A Thematic Analysis

With the growing diversity in the United States among both clinicians and clients, many therapeutic encounters are cross‐cultural, requiring providers to connect across cultural differences. Foreign‐born therapists have many areas of differences to work through. Thus, exploring how foreign‐born family therapists in the United States connect to their clients can uncover helpful strategies that all therapists can use to establish stronger cross‐cultural therapeutic connections. A thematic analysis was conducted to understand strategies 13 foreign‐born therapists used during therapeutic encounters. Four themes were identified: making therapy a human‐to‐human connection, dealing with stereotypes, what really matters, and flexibility. Findings suggest that developing a deep therapeutic connection using emotional attunement and human‐to‐human engagement is crucial for successful cross‐cultural therapy. Clinical and training implications are provided. Video Abstract     

Bodywork Boundaries: Power,Politics and Professionalism in Therapeutic Massage

In the last decade or so, complementary and alternative medicine generally, and therapeutic bodywork in particular, has been attempting to enhance its professional status and standing. By focusing upon the sex/gender dimensions of therapeutic massage and the wider historical, cultural and legal contexts in which such work is situated, this article explores and analyses the discursive formations and practices which women therapeutic massage practitioners deploy in the course of their attempts to achieve professional recognition. Drawing upon both primary and secondary data, it is argued that particular difficulties pertain in the case of the professionalization of therapeutic massage. Because of the widespread elisions between massage and sex work, women therapeutic massage practitioners have to mark out their professional distance from clients by deploying professional identifications and by using boundary‐setting devices or techniques which act to distinguish them from sex workers. This article explores these discursive formations and practices and argues that they act to create near‐intractable problems for women massage practitioners. The article concludes that, because these issues are not commonly acknowledged in much of the academic, policy or practitioner‐orientated literature, the neglect of sex/gender in the case of therapeutic massage has consequences not only for the professionaliza‐tion project of this particular therapeutic modality but for the ways in which various body work occupations in which women predominate tend to be seen as marginal and illegitimate ‘professions’.