Conducting research with community agencies: meeting recruitment and collaboration challenges

Family therapy outcome research with community agencies has been challenging for various reasons. In two recent research projects, it was found that providing active feedback to agencies about their clinical services via a clinical report and a research-agency liaison were successful strategies to develop a collaborative atmosphere with agencies. Specifically, the two strategies improved agency and therapist recruitment, client and therapist motivation, and reduced therapist and client attrition.     

AN ETHNOGRAPHIC STUDY OF CLIENT AND THERAPIST PERCEPTIONS OF THERAPY EFFECTIVENESS IN A UNIVERSITY-BASED TRAINING CLINIC

The purpose of this study was to explor client and therapist evaluations of direct practice in a university-based training center using an ethnographic research methodology. Client and therapist perceptions about the strengths and limitations of ethnographic practice evaluation were also analyzed. A domain analysis was performed on postsession interviews with both clients and practitioners over a 4- month period. Six core categories of client and therapist perceptions of therapy effectiveness emerged from a domain analysis: (a) changes associated with counseling, (b) important practitioner qualities, (c) effective interventions or techniques, (d) ineffective interventions or techniques, (e) recommendations for future sessions, and (f) strengths and limitations of ethnographic practice evaluation. Implications of this study for clinical practice, training, and future research are discussed.     

Countertransference with adolescent clients of the same ethnicity

This article addresses countertransference in therapeutic relationships involving therapist and client from the same ethnicity. A case illustration of a Japanese adolescent and a Japanese therapist is used to develop the thesis that obvious similarities in race, or culture may lead to invalid assumptions about shared beliefs and values and subtle countertransference manifestations which have the potential to disrupt or prevent the development of a working relationship.in private practice.     

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.     

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.     

Issues in Psychotherapy with Clients Affiliated with the Opposing Side in a Violent Political Conflict

The therapeutic dyad of clinician and client affiliated with rival groups in a violent conflict shares many features that complicate psychotherapy with persons of different ethnic, racial, and cultural groups, including lack of knowledge, negative stereotyping, differences in fundamental values and world views, and power differentials. Although a great deal has been written about these matters, very little has been written about the therapeutic dynamic where therapist and client are affiliated with different sides of a violent political conflict. Based on the sparse literature on the subject and on the clinical experiences of the author and her colleagues, this paper discusses three features that characterize this dynamic, which do not appear in the same way in therapy involving dyads of different races, ethnic groups, or cultures. These are the presence of the “enemy” in the consulting room, the therapist’s feelings of mistrust towards the client as a representative of the opposing group, and the client’s feelings of guilt towards the therapist as a representative of the injured group. The impacts of each feature on the therapist, client, and the therapeutic encounter are explored and suggestions are made for dealing with them. The hope is that professionals’ awareness of these issues will help improve the quality of psychotherapy with persons on the rival side of a violent political conflict.     

The Role Of Empathy in Brief Therapy: The Overlooked but Vital Context

Brief therapy is widely perceived to be a very technique oriented and outcome focused endeavour, with limited interest in the fluidity of the relationship between the therapist and client. This perception exists despite the absolute priority brief therapy has always placed on building a cooperative relationship between therapist and client. Certainly, the brief therapy tradition has almost completely avoided talking about ‘empathy’ and the emotional realm, almost as if it is inappropriate for a brief therapist to discuss them. This paper suggests firstly that brief therapy is enhanced, rather than diminished, by engaging with both empathy and affect, and secondly, that the conception and practice of empathy can itself be enhanced by the rich tradition of skills and experience that brief therapy offers. Case material is used throughout this paper to illustrate the authors’ views.     

THE RELATIONSHIP AMONG SELECTED SUPERVISOR,THERAPSIT, AND CLIENT BEHAVIORS*

This study examined the extent to which supervisory phone-ins were related to change in both immediate therapist behaviors and subsequent change in resistant behaviors of client family members. Of specific interest was whether the congruence of supervisor and therapist behaviors (referred to as isomorphism by some family therapy authors) would be related to immediate change in client resistance. The quality of supervisor's Support and Teach behaviors was foundj to be significantly related to the change in the quality of the threrapists' Support and Teach behaviors. Moreover, in instances where both supervisors and their supervises demonstrated effective Support and Teach behaviors, clients generally tended to either remain cooperative or become cooperative more frequently than when both effective supervisor and supervisee behaviors where not present.     

THERAPIST AND CLIENT BEHAVIORS IN THE FIRST INTERVIEW: EFFECGTS ON SESSION IMPACT AND TREATMENT DURATION

The first-session behaviors of therapists and clients in 38 cases were observationally codes and their relations to client ratings of session impact and treatment duration were examined. Results indicated that few first-session global types of behaviors of participants affect treatment durations. Clients may suspend judgement about continuing in therapy untill after they have attended more than one session, regardless of the first inverview's impact. Thus, the first interview may be less crucial than traditionally asserted. It also appears that first-session behaviors of therapists and clients that are associated with greater impact may vary as a function of client type, that is individuals as opposed to couples and families.     

A study of live supervisory phone-ins in collaborative family therapy: correlates of client cooperation

The behavior of five supervisors, 19 trainee family therapists, and 20 clients before, during, and after 88 live supervisory phone-in events was examined in this study to determine the correlates of client cooperation. Following supervisory phone-in conversations, client cooperation was associated exclusively with the presence and quality of the collaborative behavior shown by the therapist. Isomorphism between the behavior of the supervisor and therapist was not associated with subsequent client cooperation, nor was any particular category of supervisor behavior. Surprisingly, isomorphism between the quality of supervisor and therapist behavior preceded those events where client resistance occurred.     

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.     

The meeting of two narratives

The post-modern paradigms, particularly regarding the nature of reality, are fast coloring our ideas regarding our client's truths. We now have an expanded understanding about the flexibility and dynamic nature of truth, and therefore of clients' narratives. Another narrative, however, that must be taken fully into account is the narrative of the therapist. In fact, what we have in a clinical hour is the meeting and blending of two narratives, that of the client and that of the therapist. This paper summarizes some of the recent thinking regarding narrative, and the nature of truth, as well as pointing to implications for clinical practice.     

DIFFERENT AND SAME: FAMILY THERAPY WITH ASIAN-AMERICAN FAILIES

This paper is written for non-Asian family therapists who must deal with an increasing number of Asian-American client families. Unlike some writers in fthe field who advocate that client and therapist have the same ethnic background, the authors belive that cultural sensitivity can be learned. Several culturally important values are described, and suggestions on how to orient treatment to fit this client population are offered. A Detailed case example illustrates the treatment issues involued.     

Cross-Cultural Empathy and Training the Contemporary Psychotherapist

The diversity of today's client population has required that psychotherapy training confront the importance of cultural competence in graduates. Approaches in this area of education create dynamic tensions between stressing therapist openness to diversity and therapist knowledge of clients' cultures. This paper proposes that this attitude-knowledge dilemma in psychotherapy education can be reconciled by helping trainees develop an empathic response capable of transcending cultural differences. Cross-cultural empathy helps provide the therapist with a coherent and familiar means of maintaining affective receptivity in the therapeutic encounter with clients while making use of a repository of information about clients' cultures. Such empathy can also be a base for building the skills needed to develop collaborative relationships with clients who are often disempowered and distrustful. The paper examines approaches and resources for training psychotherapists in cross-cultural empathy.     

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.     

A qualitative study of intimate partner violence universal screening by family therapy interns: implications for practice, research, training, and supervision

Although a few family therapy researchers and clinicians have urged universal screening for intimate partner violence (IPV), how screening is implemented-and, in particular, client and therapist response to screening-is vaguely defined and largely untested. This qualitative study examined the dilemmas experienced by couples and family therapy interns when implementing universal screening for IPV in an outpatient clinic setting. Twenty-two graduate students in a COAMFTE-accredited program were interviewed using qualitative research methods grounded in phenomenology. Three domains, 7 main themes, and 26 subthemes were identified. The three domains that emerged in this study include (a) therapist practice of universal screening, (b) client response to universal screening, and (c) therapist response to universal screening. Implications for practice, research, training, and supervision are discussed.     

A Case of Enhancing Sexual Confidence: Both the Client and the Therapist Are the Experts

This case study demonstrates the challenges and possibilities of working on a sexual relationship with a single client and provides an example of integration of sex therapy within the ethical and theoretical framework of a collaborative systemic approach. It illustrates the author's view on the therapeutic relationship involving the expertise of both the client and the therapist. A model for integration of systemic approach and sex therapy is proposed.     

Resolving Therapeutic Impasses by Using the Supervisor's Countertransference

The traditional role-set of the clinical social work supervisor has grown to be much more complex. From the exclusive position of teacher, administrator, and overseer she is now an integral part of a system wherein she is influenced not only by the therapist, client, and her own promptings but is a prime source of feedback to the client through the supervisee.As clinical social workers have shifted their conceptualization of therapy to a two-person psychology, this perspective has emerged as part of the supervisory process. Now the supervisor's countertransference responses to the supervisee, to his client, and to their interaction have assumed importance in supervisory work. This article is an attempt to demonstrate through case illustrations how the supervisor's disclosure of countertransference responses to the supervisee can strengthen the supervisory alliance which then enables the client and therapist to resolve therapeutic impasses.