The Therapeutic Use of Humor With Clients Who Have Schizophrenia

A positive worker/client relationship contributes greatly to a mental health client’s achievement of intervention goals. Practitioners who work with clients who have schizophrenia sometimes face challenges in developing positive relationships with them when the cognitive impairments characteristic of that disorder make verbal communication difficult. The purpose of this article is to review the indications for using humor with clients in general and then consider the potential for practitioners to use humor as one means of developing constructive working relationships with clients who have schizophrenia. This article does not address the use of specific humor techniques, but considers whether practitioners with a natural sense of humor can use it to their advantage in working with members of this population. Seven principles for the use of humor, and seven client examples, are included.     

The empathic use of sarcasm: Humor in psychotherapy from a self psychological perspective

A case is made for the therapeutic benefits of well-timed, prudently ventured sarcastic comments directed at persons in the patients'llives, including the therapist, who are experienced as failing them. Literature on use of humor in therapy is reviewed. The circumstances under which humor may be experienced empathically are suggested, as well as instances in which it may be contraindicated.     

A new nursing medium: computer networks for group intervention.

The PLWAs and the caregivers of persons with AD were similar in their adaptation to this new technology as a communication medium with nurses. Both groups availed themselves of the resources, both technological and personal, on the computer network. Although different in demographics, they also were similar in their ability to form and work in a traditional group structure. Nurses have historically intervened with groups, and this article demonstrates that nurses can intervene on a computer network with groups. Yalom's therapeutic factors exist in both non-face-to-face groups and traditional groups. The benefits of this technology to nurses are numerous: they can access clients in an efficient yet supportive manner; they can respond to multiple levels of need in multiple clients; and they can attend to emotional as well as more concrete needs of clients. The benefits to clients are also numerous: they can use the system at a time, frequency, and duration of their choice; they have the opportunity to be supported in self-care efforts versus being in a more dependent role; and they can engage in a normalization of their experiences. Computer networks can enhance nursing's ability to intervene with clients experiencing clinical problems.     

The nurse's role in neuroleptic medications.

1. A questionnaire study of schizophrenia sufferers' (N = 132) views on medication, contrary to expectations, revealed generally favorable attitudes. Clients seemed to understand the fine balance between costs and benefits better than many health-care professionals imagine. 2. Because nurses spend more time communicating with clients than physicians, they are ideally placed to find out how patients perceive neuroleptic therapy, and to provide information, advice, and counseling support. 3. There is a strong case for asserting that mental health nurses should extend their role in monitoring the effects of medication on their clients.     

Dual-Career Marriages: Implications for the Clinician*

This paper discusses the unique characteristics of dual-career marriages/families. These familial units are identified as a high stress group presenting unusual challenges to the clinician. Specific implications for the clinician include (1) values of therapist and clients; (2) critical issues; and (3) assets and liabilities. It is concluded that while dual-career couples may be demanding clients, the therapist can be sure he/she will have an intriguing, eventful, and meaningful experience along the way.     

How Do the Professional Lives of Family Therapists Affect their Private Relationships: A Qualitative Study

This article is based on a qualitative research project about how the professional lives of family therapists affect their private relationships. The overarching research question was: How does your professional work as a family therapist affect your private relationships? To answer this question, semi‐structured qualitative interviews were conducted with four therapists from two different Family Counseling Services. Through the use of interpretative phenomenological analysis, three main findings were identified: (1) family therapists’ knowledge and values are a basis for interpersonal encounters; (2) participants describe resonance in relation to clients’ stories; and (3) therapists can be challenged in managing confidential knowledge particularly where they belong to the same communities as clients. The study also explores societal expectations and discourses that accompany the role of therapist, which can affect therapists’ freedom of movement in their private lives. These issues are discussed in relation to family therapy theory and relevant research.     

More than ‘information provider’ and ‘counselor’: Constructing and negotiating roles and identities of nurses in genetic counseling sessions

This paper contributes to research on genetic counseling by exploring the complexity of this activity from the angle of identity construction. We argue that an analysis of the processes through which healthcare providers construct and negotiate their roles and identities in these encounters may contribute to a better understanding of the complexities of genetic counseling. Drawing on more than 150 video‐recorded genetic counseling encounters between nurses and clients in Hong Kong, we illustrate that the discursive processes involved in the construction of the nurses' identities are complex, overlapping and at times contradictory as the nurses respond to the (sometimes) competing norms and expectations of their institution, their clients and their own. They manage to solve these tensions by drawing on the roles traditionally assigned to nurses in these encounters such as information provider and counselor, as well as creating the new roles of co‐decision maker and cultural broker/mediator.     

DO WE REALLY UNDERSTAND? AN EXPERIENTIAL EXERCISE FOR TRAINING FAMILY THERAPISTS

This paper presents an experiential exercise for training beginning marriage and family therapists, as well as several adaptations of the format. The basic exercise consists of role playing a therapy session in which the people playing the clients speak a language that is not understood by the therapist-in-training. Although the therapist cannot understand the clients, the clients can understand the therapist. This exercise assists students to become more cognizant of the need to be cautious and curious in the cocreation of meaning in therapy. In addition, this exercise builds confidence and clinical skills, such as learning about nonverbal communication while observing 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.     

WHERE RELATIONAL THEORY AND ATTACHMENT THEORY INTERSECT: A REAL RELATIONSHIP AND A REAL ATTACHMENT

This paper demonstrates the importance of understanding the client’s early attachment patterns and of promoting a real attachment in the therapeutic dyad. A review of relational theory reinforces current acceptance of therapist self-disclosure as a tool for engaging difficult clients. Additionally, therapists can identify clients’ early attachment experiences and promote growth in fragile clients by allowing them judicious access to their inner world, thereby encouraging the formation of a real attachment. Case examples illustrate how to identify early attachment patterns and one therapist’s creative use of self in developing real, therapeutic attachments with her clients.     

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.     

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.     

Environmental Globalization,Organizational Form,and Expected Benefits from Protected Areas in Central America*

Abstract Environmental globalization has led to the implementation of conservation efforts like the creation of protected areas that often promote the interests of core countries in poorer regions. The creation of protected areas in poor areas frequently creates tensions between human needs like food and shelter and environmental conservation. Support for such conservation efforts partially depends on expectations of benefits by those impacted. This article considers the effects of different organizational models on local expectations of benefits to be derived from protected areas. Our analysis indicates that individuals are more likely to expect that benefits of the park go to other communities or the nation as a whole than to expect direct benefits for themselves. Forms of park organization also impact these expectations. Individuals exposed to the zoned park, as opposed to a conventional, strictly protected park, were more likely to expect benefits from the park regardless of the beneficiary considered. In addition, for those exposed to the zoned park, location of residence is related to expectation that individuals will benefit themselves. However, our interviews with park residents also indicate that the expectations of individual benefits are rarely met, creating potential dissatisfaction and sometimes animosity toward the park administration.     

Mastering group leadership. An active learning experience

Leading therapeutic groups is an underused but viable treatment role for nurses in all specialty areas. A dynamic psychoeducational group model provides structure as nurses invest and collaboratively participate to actively learn the group leader role. this article highlights the sequencing of instruction of group theory and skills with examples from a baccalaureate nursing curriculum. Samples from student journals reveal their growing assimilation of the group leader role as learners actively participated in groups, collaborated, and reflected on their learning. Examples of creatively adapted group exercises, as well as selected nursing group leader interventions, demonstrate group leadership as a skill that can increase nurses' repertoire of therapeutic responses. Therapeutic groups are both exciting and cost-effective treatment strategies for use with mentally ill clients. The skills of an accomplished group leader are transferable from within the psychiatric population to working with families, bereavement groups, and other client populations, ranging from people with diabetes to survivors of catastrophic crises. Group leadership ability complements the management and negotiation skills needed in professional nursing roles. When students and staff nurses grow in group leadership expertise, clients in various settings will be better served with this currently underused treatment option.     

“If I Can Grapple With This I Can Truly Be Of Use In The Therapy Room”: Using The Therapist's Own Emotional Struggles To Facilitate Effective Therapy

This study premises that self‐of‐the‐therapist work is pivotal in the development of effective therapists. However, therapy models vary in their goals for this work and the means of accomplishing them. This study presents the perspective of the person‐of‐the‐therapist Training (POTT) model that prioritizes the ability to consciously and purposefully use the self‐as‐is at the moment of contact with the client over the traditional goal of therapists working to resolve their issues. A key underlying assumption of the model proposes that therapists' core issues (referred to as “signature themes”) are potent resources that can be tapped into to connect, assess and intervene effectively with clients. The study presents the model and illustrates the use of signature themes in clinical work.     

A Pilot Use of Letters to Clients before the Initial Session

This paper explores the nature of engagement in the therapy process, and proposes that engagement may be facilitated when both client and therapist are able to develop an appreciation of each other's position within the therapeutic relationship. Some ways that a therapist can assist in this process are explored. An experiment is described in which information letters are sent to clients before the initial therapy session, as a possible way to enhance the engagement process.     

The therapist who is perceived as "spiritually correct": strategies for avoiding collusion with the "spiritually one-up" spouse

Marital and family therapists who are perceived by the community as having a strong spiritual orientation face unique and difficult challenges. Clients who seek their help often bring a mix of expectations that can create a situation in which the therapist may struggle with multiple roles, some not of his or her choosing. These expectations are especially challenging when one spouse views him-or herself as "spiritually one-up" and wants the therapist to form a spiritually based coalition against the other partner. This paper describes the various dilemmas that therapists may face when clients perceive them as having spiritual expertise and presents strategies that can be used for avoiding these dilemmas. A case study illustrates the use of these approaches.     

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.     

The Pregnant Therapist: A Qualitative Examination of the Client Experience

This article reports on the findings of a qualitative study that was designed to capture the clinical dynamics that emerge when a therapist becomes pregnant during treatment. While there have been some empirical studies that have captured the pregnant therapist’s perspective, it is a sparse amount in comparison to the vast number of women therapists who become pregnant, and there have been no studies that have actually interviewed clients of pregnant therapists. This study seeks to begin to redress that crucial missing perspective by interviewing the clients of pregnant therapists, as well as first-time, formerly pregnant therapists. This article will look at the coded results of this qualitative study and the emergent themes from the client perspective, as well as discuss their implications for clinical social work practice.     

Using culture and the intersubjective perspective as a resource: A case study of an African-American couple

In this article a White Jewish-American therapist shares what she learned from her work with an African-American couple using a semi-structured protocol for planned short-term marital therapy. Twenty-eight months after the original treatment, the author met again with the couple for an audiotaped follow-up interview. Marital satisfaction for both partners was tracked with an Index of Marital Satisfaction over the course of the treatment and the follow-up process. The empirical findings augment the story of the couple and the therapist. During the middle phase, the therapy reached an impasse. With the goal of creating a cognitive shift, the therapist used the couple's culture as a resource for therapeutic change. The cultural metaphor is considered as the vital step in overcoming the treatment impasse. The major finding is that cultural responsiveness does not end with the engagement and assessment of clients. The culture of the clients and the culture of the therapist provide powerful metaphors and rich resources to introduce change possibilities. With this couple, when culture was combined with an appreciation of the intersubjective meanings for both clients and therapist, culturally responsive and effective therapy became possible.