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 Dimensions of Culturally Sensitive Clinical Styles with Latinos

Abstract

This study sought to identify dimensions of culturally sensitive clinical practice by comparing the personal clinical styles of Latino and non-Latino clinicians, and their clinical decisions in respect to Latino immigrant clients. A combination of qualitative and quantitative methods were used. Sixty Latino American clinicians and 47 non-Latino (White) clinicians in Northern California completed the Achieving Styles Inventory (ASI) which yields information on direct, instrumental and relational styles. Demographic data were obtained as well as information on language proficiency and years of clinical experience. Statistical analysis included uses of t-test, ANOVA, and multiple regression analysis and revealed significant differences between the two groups in personal achieving styles within all three domains. There were no significant differences on the demographic variables. Nine clinician members of each ethnic group were interviewed in-depth through non-directive interviewing styles to assess their clinical decision making via use of a case vignette. Content analysis pointed to similarities and differences in proposed assessment and intervention strategies. The Latino group displayed more culturally relevant interpretations. The non-Latino clinicians were more directive and instrumental than the Latinos who put more emphasis on self disclosure, case management, use of Spanish with the client, and crisis intervention. This finding is consistent with both the quantitative data analysis of ASI hypotheses and the expected linguistic/cultural findings of the qualitative content analysis. Bilingual non-Latino White clinicians showed more cultural sensitivity and competence than the monolingual non-Latino clinicians. These findings suggest that linguistic/cultural match and linguistic/cultural compatibility are important in cross-cultural clinical practice.     

Psychotherapy with Lesbian and Gay Clients from an Adult Life Course Perspective

Abstract

A life course perspective of gay and lesbian adulthood enriches our understanding of clinical presentations and modifies our conception of psychotherapy. The author describes shifts in his psychotherapeutic orientation characterized by an increasing recognition of the importance of social, cultural, and historical forces that shape gay and lesbian mental health. Given the uncharted nature of many gay and lesbian lives across adulthood, existential questions about the meaning of life choices are often present in the consulting room. Therapists working with gay and lesbian clients embark on an empathic journey informed by treatment skills as well as our joint participation in a world of significant social change.     

Examining Psychotherapeutic and Psychosocial Factors in Working with Immigrant Families

In spite of the fact that the United States has been historically associated with immigrants, little is still known about the process of assimilation that immigrant families go through, and a lack ofsensitivity to the cultural diversity of immigrant families persists. Some mental health workers still suggest that the same techniques employed in working with American families can be applied to immigrant families. Through years of research, behavioral scientists have come to realize that a different approach to tutelage and psychotherapy is needed if immigrant families are to acculturate smoothly in American society. This paper addresses some problems associated with acculturation, the process of acculturation, immigrant families in transition and perspectives on the effectiveness of psychotherapeutic interventions. Some rudimentary guidelines are presented for understanding immigrant families via a comprehensive assessment battery which can assist in detemzining the stages of acculturation, the client’s social and emotional functioning, as well as any cultural transitional conflicts the client may be experiencing as a result of migration. Moreover, a model for treating immigrant families is suggested.     

Barriers and Promoters of Mental Health Services Utilization in a Latino Context: A Literature Review and Recommendations from an Ecosystems Perspective

ABSTRACT

This article focuses on the problems of disparities in mental health service utilization in the Latino population in the United States. It begins with an overview of the Latino population within the United States, an exploration of the diversity within this group, and shared cultural values and traits with a particular focus on the problems of Latino poverty. A review of the literature follows, including identified barriers to and promoters of mental health services utilization. These are contextualized in a Latino perspective using an ecosystems framework. Recommendations are made for future practice, research, and policy regarding mental health and mental health services utilization in the Latino community.     

Students at St. Joseph's College: Why they are Survivors

Abstract

The 1985–86 academic year was the year of the ACHA Task Force on AIDS, and it also was the first year in which the Northwestern University mental health staff conducted psychotherapy with students wherein AIDS was an issue. We might consider this a “baseline year.” In order to document the first step along what is certain to become a long road ahead, the author reviews the 21 out of 800 cases where the issue of AIDS was discussed, even minimally. Seven cases were summarized to illustrate the spectrum of AIDS concerns and therapist interventions. The review of cases revealed a tendency to split the knowledge of risk from the apprehension of the meaning and emotional significance of one's behavior. This disavowal tended to occur in therapists also.

The psychological, medical, and psychiatric literature on AIDS was reviewed in order to provide a context for the case review. The author examines some of the psychotherapeutic and psychoeducational issues faced by therapists in their work with students during this developing epidemic and the concomitant consciousness raising that is occurring.     

Ethnicity and psychotherapy with HIV-infected patients: Three case studies

Nationwide, demographic changes have led to an increased awareness of the impact of cultural diversity on the delivery of medical and psychological care . Due to the over-representation of minority and socially stigmatized groups among those affected by HIV, understanding the effects of psychosocial, linguistic and cultural membership on treatment relationships is crucial. In the psychological treatment of HIV-infected patients, psychotherapists can enhance the lives of their patients and support their involvement and compliance with medical treatment planning. Case studies are presented in which psychotherapy helped resolve difficulties in the medical care of three HIV-positive women that were due to cultural misunderstanding between doctors and patients.     

Interdisciplinary Considerations in the Psychotherapy of Psychosomatic Patients

Abstract

Patients with psychosomatic conditions, who comprise a significant proportion of students seeking health care, demonstrate clearly the need for effective functioning of the health care team. These patients usually present themselves with problems of physical illness for practical, social, and psychodynamic reasons. Socially they seek to avoid the stigma attached to acknowledging psychological problems. Psychodynamically, such patients have transformed psychological problems into physical illness and need help in reversing this transformation. Attending only the physical illness or dismissing the patient because “it's all in your head” are inappropriate responses deeply embedded in popular culture. Case illustrations are used to show the need for careful diagnosis from physical and psychological standpoints, for skillful referral and interdisciplinary collaboration, and to show how psychotherapy can reverse the psychosomatic process and the underlying psychological determinants. The illustrations include cases of headache, asthma, ulcers, and disturbances of sleep and appetite. Both specific psychotherapeutic technique and overall theory are discussed.     

Development of a Short-Form Scale of Public Attitudes Toward Homelessness

Nationwide, demographic changes have led to an increased awareness of the impact of cultural diversity on the delivery of medical and psychological care. Due to the over-representation of minority and socially stigmatized groups among those affected by HIV, understanding the effects of psychosocial, linguistic and cultural membership or treatment relationships is crucial. In the psychological treatment of HIV-infected patients, psychotherapists can enhance the lives of their patients and support their involvement and compliance with medical treatment planning Case studies are presented in which psychotherapy helped resolve difficulties in the medical care of three HIV-positive women that were due to cultural misunderstanding between doctors and patients.     

Examining psychotherapeutic and psychosocial factors in working with immigrant families

In spite of the fact that the United States has been historically associated with immigrants, little is still known about the process of assimilation that immigrant families go through, and a lack of sensitivity to the cultural diversity of immigrant families persists. Some mental health workers still suggest that the same techniques employed in working with American families can be applied to immigrant families. Through years of research, behavioral scientists have come to realize that a different approach to tutelage and psychotherapy is needed if immigrant families are to acculturate smoothly in American society. This paper addresses some problems associated with acculturation, the process of acculturation, immigrant families in transition and perspectives on the effectiveness of psychotherapeutic interventions. Some rudimentary guidelines are presented for understanding immigrant families via a comprehensive assessment battery which can assist in determining the stages of acculturation, the client's social and emotional functioning, as well as any cultural transitional conflicts the client may be experiencing as a result of migration. Moreover, a model for treating immigrant families is suggested.     

Two accounts of the management of racial different in psychotherapy

Abstract

In this paper, the authors present material from their clinical work, in which racial difference impinges directly on the psychotherapeutic encounter. They examine the primitive origins of racism from a psychoanalytic view point and discuss their management of related issues within the framework of psychoanalytic psychotherapy.

Part of a session from a psychotherapy group is described by Sue Davison, in which one member is excluded as part of a dramatisation entered into by all the group members for defensive purposes. The therapist, by calling attention to the painful reality which was banished from awareness, enabled the group members to recover their capacity to think, rather than re-enact the trauma.

The case study by Fakhry Davids describes work with a woman whose struggle in life is against a racist, intolerant mother. This mother is projected onto her black therapist, and a session is described in which the dynamics of this projection begin to be unravelled. Her therapist is experienced as an intolerant, oppressive mother to whom the patient's own hatred and intolerance has become attached, and the patient is enabled to take back some of these projections. The defences she uses illustrate a common way in which so-called “liberals” disown their hidden racism.     

Toward a Better Understanding of the Use of Psychodynamically-Informed Treatment with Latinos: Findings from Clinician Experience

Latinos in the United States constitute a significant and sizable population that mental health professionals must serve appropriately. Therefore, the question of what types of mental health treatment approaches are useful in working with this population is of increasing concern. A strong sentiment against the use of psychodynamic treatment with Latinos persists in the literature in the absence of rigorous data that would support such a stance. Thus, it is important to examine systematically the use of psychodynamically-informed treatment with Latinos in order to address the question of its potential relevance and utility with this population. This article presents the results of a qualitative study of Latino therapists who employ psychodynamic approaches with Latino clients. Findings suggest that the clinicians interviewed have expanded the psychodynamic framework to include a flexible focus on the relationship, consideration of each client as an individual, and an acknowledgment and understanding of external reality and its impact on the client. Modifications these clinicians have made in technique, such as increased self-disclosure, support and maximize this expansion of the frame. Simultaneously, such modifications enhance the cultural sensitivity of these clinicians' work and are congruent with contemporary psychodynamically-informed relational theories.     

The Utility of Social Class,Race, and Gender in Clinical Practice: A Case Study Involving Intraracial Dyads

This article focuses on clinical work involving a male Black practitioner and a male Black client in which issues of social class, race, and gender were prominent in the treatment process. Three questions raised by the client early in the therapeutic encounter informed assessment, treatment, and the clinician's countertransference. Tenets from self-psychology, relational theory, intersubjectivity, and sociocultural factors relative to Black men are used to ground the discussion. Finally, the article illustrates why intraracial therapy should be understood in the context of the delivery of culturally competent services, highlighting how the intersection of a client's psychological issues, social class, race, and gender can emerge as functional features in psychotherapeutic work.     

Examining the Incidence and Clients’ Experiences of Single Session Therapy in Italy: A Feasibility Study

Single session therapy (SST) postulates that one session can be sufficient for a client to take charge of the process and work toward their own solutions. Research has been conducted worldwide corroborating SST assumptions with several mental health conditions, but not in Italy. For the first time in Italy, this paper aims to explore: (1) if the most frequent number of sessions in traditional psychotherapy (not SST) is one (Study 1); and (2) the satisfaction of clients who attend SST services and the number who consider one session sufficient to address their presenting problem (Study 2). In Study 1, the records of 476 voluntary clients referred to three different traditional (not SST) psychological services in the west-central region of Latium, Italy, were retrospectively screened, and the number of sessions attended by each client recorded. In Study 2, 85 consecutive clients who voluntarily asked for SST with seven mental health professionals across Italy received a link to an online ad hoc survey, 1–3 weeks after the consultation, evaluating their experience. Study 1 found that the most frequent number of traditional psychotherapeutic (not intentionally SST) sessions was one (124 out of 476 clients (26%). Study 2 found that 44 out of 85 clients (52%) considered one session to be enough, as they felt better or much better and chose not to attend further sessions. Of those who asked for a second session (41 clients), 33 clients (80.5%) indicated that the first session was not enough and 8 clients (19.5%) wanted to address a new problem. These results converge with previous international studies and provide encouragement for the use of SST in both private and public psychological services to address the demand for timely mental health services in Italy. Further research is needed to support the efficacy of SST and to evaluate its cost-effectiveness.     

Latino Children's Integration into American Society: The Dynamics of Bilingual Education

Abstract

The Latino population has grown in recent decades due to increased immigration. This group is largely urban, disproportionately young, and typically enters American society with a low socioeconomic status, which has implications for urban schools. Using data from a three-year investigation of the bilingual education program at Maya Angelou Elementary in Texas, this study examines the integration of Latino students into the educational system. More specifically, I utilize a sociological framework which incorporates structural and sociocultural factors of immigrant adaptation to investigate bilingual education at Angelou and the broader context of educating Latino English Language Learners (ELLs). At Angelou, I find evidence of commitment to bilingualism, yet structural constraints in the school undermine this commitment. However, these challenges are minimal in comparison to the broader policy environment concerning the ELLs' education. On this front, Angelou must confront teacher shortages, scarcity of materials, and high-stakes standardized testing. Conclusions indicate the treatment of Spanish language and Latino culture as subordinate despite the school's efforts to serve their students.     

Kinship Care: A Cultural Resource of African American and Latino Families Coping with Parental Substance Abuse

SUMMARY

This paper examines kinship care as a cultural resource used by African American and Latino families coping with substance abuse by a family member. Although there is a growing body of literature on kinship care, there are no conceptual or empirical studies that have drawn or built on cultural similarities between these two groups of ethnic minority families. A framework that prioritizes cultural assessment and relevance in using familial and cultural resources is proposed to assist practitioners confronted with the demographic realities of working with social, clinical and ethnocultural complexities when serving ethnic minority families. The framework is based on practice implications raised by recent studies on kinship care and from the perspective of pertinent cross-cultural and anthropological literature.     

The Psychology of the Psychopharmacology Triangle

Abstract

The psychopharmacological triangle generated by recent changes in mental health practices requires social workers to deepen their understanding of the psychological meanings of such treatment. Many clients receive concurrent psychotherapeutic and psychopharmacological interventions from different providers, creating a triangular treatment relationship. To facilitate a successful outcome, social workers will need to understand how meaning, transference and countertransference are stimulated by this arrangement. The literature on these issues as well as clinical experience will highlight specific issues requiring attention. By attending to these dynamics, the social worker can maximize the chances for a successful treatment outcome.     

Relationship-based thinking and practice in social work

Abstract

Relationships with the users of social work are increasingly seen in procedural, legal and administrative terms. However, research studies examining both client satisfaction and intervention effectiveness regularly find that the psychosocial qualities of the worker-client relationship are a major component in the success or otherwise of the service offered. The case is made that the psychological selves of both practitioners and users acquire many of their characteristics, including personality, esteem, efficacy and defensive behaviours, within relationships throughout the lifespan. The level of social understanding and social competence that people develop depends on the quality of their relationship history. If poor relationships are where psychosocial competences go awry, then good relationships are where they are likely to recover. This observation has major implications for the quality, character and skill of the relationship experiences offered to clients by social workers