‘Do existential touchstones really cool?’ An exploration of therapists’ experiencing of significant personal loss and how this informs their ‘way of being’ with a client

The Lived Experience of Grief, Loss, and Coping Among Pediatric Oncology Nurses (733)

BackgroundMaudsley Family Therapy and its manualised version Family-Based Therapy for Anorexia Nervosa (FBT-AN) have accrued the most significant research evidence-base for the treatment of adolescent Anorexia Nervosa (AN). A tradition of seeking augmentations for this treatment has also been established to enhance efficacy. There exists, however, a gap in the uptake of this form of manualised treatment into the “real world” of clinicians who work with adolescent AN.AimsThis research study investigated the key experiences and identity negotiations of a group of nine Australian clinicians who were interested in contributing to research into ways that Maudsley and FBT-AN might be improved.MethodsNine clinicians, who at the time of the interview practised or had previously practised, FBT-AN participated in a semi-structured interview. A critical discursive analysis of interview transcripts generated a thematic map of these therapists’ experiences and identity negotiations in their practice of FBT-AN.ResultsThese therapists experienced the structure of FBT-AN as both a secure map for therapy, yet also constraining at times, in their work with adolescents and their families. Additionally, their professional identities were both invested and troubled by the identity position of themselves as evidence-based practitioners, particularly where evidence-based practice (EBP) meant strict fidelity to the manual and restrained them from tailoring a broader range of therapeutic interventions to an individual adolescent and their family. Within their narratives, these therapists refashioned alternative identity positions around what it meant to be an evidence-based practitioner through listening to and drawing on their clinical expertise of what works in therapeutic practice with an individual adolescent and their family.ConclusionsThese therapists narratives highlight the power of the dominant discourse of EBP that works to privilege the research evidence over other forms of evidence that include clinician expertise and client preferences. The dilemmas faced by these therapists questioned not only the strict application of FBT-AN for adolescent AN across diverse therapeutic contexts, but also the effects of supervisory practices that paralleled this strict fidelity to the model. Further research is needed into therapeutic interventions and supervisory practices that give greater scope for clinicians to draw on their expertise in the flexible tailoring of treatments to the unique needs and preferences of the individual adolescent and their family.

Aim: The aim of the research was to explore the under‐researched area of therapists' personal bereavement and its impact upon their therapeutic practice. Method: Data were collected via semi‐structured interviews with four humanistic therapists and were analysed using Interpretative Phenomenological Analysis (IPA). Findings: Four master and eight subordinate themes emerged from the rich data collected that exemplified both convergence with and divergence from the small body of extant literature on therapist bereavement and current thinking in thanatology. The findings suggest that bereavement is a unique experience that can affect the individual's personal and social identity and worldview. It can also be a transformative experience resulting in personal growth and a renewed sense of self and agency. In terms of professional practice, the findings suggest that the lived experience of the grieving process, mediated by supportive supervision, enabled participants to experience deeper levels of empathy and connectedness within their therapeutic relationships. Conclusion and implications: Bereavement is an experience that can profoundly impact upon therapists' personal identity and assumptive world. Such an experience can have an equally profound impact upon their therapeutic practice. There are therefore implications for students, trainers, therapists and supervisors particularly in terms of self‐care and the use of the ‘self’ in therapy. Further research needs to be undertaken in order to explore in greater depth the intersection between personal bereavement and therapists' evolving personal and professional identity development.

Pre- and perinatal loss and grief tend to be referred to as complicated grief denoting the experience of ongoing trauma. It is considered a burden for the affected parents, their families and the helping professionals alike. Yet this phenomenon remains an underrepresented field in analytical studies. Our aim is to systematically review the literature that deals with personal grief caused by pre- and perinatal loss - as experienced by healthcare staff. We shall present a comprehensive view of relevant international and national attitudes including existing grief management options. The above-mentioned complex issue deserves greater attention, which should result in the establishment of dynamic, up-to-date support programmes on all professional levels.

<b>Purpose: </b>There is a well-established relationship between hearing loss and psychological symptoms. To ensure audiological rehabilitation is provided appropriately for older adults with comorbid psychological symptoms, a greater understanding of their preferences and experiences is needed. This study sought to understand experiences of hearing loss and audiological rehabilitation from the perspective of older adults with comorbid psychological symptoms (e.g., depression, anxiety, psychosis).<b>Design: </b>A qualitative study using in-depth semistructured interviews was conducted with older adults who had attended audiological rehabilitation within the last year and scored above established cutoffs on measures of depression, anxiety, and psychosis. A thematic analysis generated themes that related to participants’ experiences of hearing loss and audiological rehabilitation.<b>Results:</b> Participants included 14 older adults (eight men and six women) with an average age of 70.5 years (<i>SD</i> = 4.45, range: 64–80) who received hearing aids or a cochlear implant. Three major themes emerged from the analysis of participant interviews. “The cumulative impact of hearing loss and psychological symptoms” theme describes the two-way, additive relationship between hearing ability and psychological symptoms. “The experience of loss throughout hearing loss and audiological rehabilitation” captures subjective losses, the impact they have, and how participants cope with them. In contrast, “The experience of gain throughout hearing loss and audiological rehabilitation” describes the participants’ reported gains, their related impacts, and coping strategies.<b>Conclusions: </b>The experiences of participants revealed that the presence of comorbid psychological symptoms can influence the experience of hearing loss and audiological rehabilitation. These findings have implications for how audiological rehabilitation is provided to ensure optimal outcomes for adults with hearing loss and comorbid psychological symptoms.<br><b>Supplemental Material S1. </b>Sampling matrix containing number of participants fulfilling criteria (gender, age, hearing device, psychological symptoms) to obtain maximum variation sampling.<br><b>Supplemental Material S2.</b> Interview topic guide containing initial and follow-up open-ended questions.<br>Laird, E. C., Bennett, R. J., Barr, C. M., &amp; Bryant, C. A. (2020). Experiences of hearing loss and audiological rehabilitation for older adults with comorbid psychological symptoms: A qualitative study. <i>American Journal of Audiology.</i> Advance online publication. https://doi.org/10.1044/2020_AJA-19-00123

In literature, depression is associated with cardiovascular diseases. From clinical experience, we observed that the psychological category 'experience of loss' was associated with the onset and development of coronary heart disease. The experience of loss caused by self-reported significant event(s) leads to grief and the psychosocial factors which predispose the patient to diseases.To study the impact of the experience of loss by investigating the relationship between mourning and depression, in hospitalized patients with coronary heart disease.44 inpatients (50% men and 50% women, aged 33 to 65 years), with a diagnosis of acute myocardial infarction or angina, were evaluated. Two instruments were used: a semi-structured interview, for investigating the experience of loss and evaluating the state of grief; and the Beck Depression Inventory, for measuring the severity of depression. The results were expressed using the computer program Statistical Package for Social Sciences version 11.0.66% of the patients were in mourning, the relationship between mourning and depression was significant (p<0,05), and we verified that 100% of the patients who had serious depression were in mourning. The most frequent self-reported significant event was death of a family member (47%) and death of a close person (13%), totaling 60% of the events, reported by 84% of the participants. According to the results of Beck Depression Inventory, 48% of them had depression.This study suggests that the psychological category 'experience of loss' should be used as an indicator of the existence of psychological factors that could predispose the patient to CAD, and also confirms the relationship between a state of mourning and depression.

The aim of this study was to explore how someone perceives the process of becoming a person-centered therapist, and if (and in what way) the person-centered approach changes their self-concept during this process. Six person-centered therapists were interviewed about the way they experienced their process of ‘becoming’, the way they perceive their self-concept with regard to this process, and how this perception changed during their training and practice. These semi-structured interviews were analyzed using Interpretative-Phenomenological Analysis. Four main themes were identified: perceiving themselves through the process of becoming a person-centered therapist, experiencing themselves as clients, relating to significant others, and comparing and differentiating person-centered therapy and other approaches.

Nurses' personal grief and loss experiences can enhance their ability to comfort family members of seriously ill and dying patients. Spiritual care in these situations can include empathy, listening, and sharing of Scripture, when appropriate. Additionally, caring for emotional needs of patients in critical care situations also may enable a nurse to resolve personal grief experiences.

ObjectivesCoaches have an unclear role and the industry shares a complex border with therapeutic practices. This study explored the nature of the relationship between coaching and therapeutic practices, how coaching professionals experience, navigate and manage this boundary, and sought to identify what roles they adopt.DesignSeven International Coaching Federation Master Certified Coaches self-selected to participate. Sixty-minute semi-structured interviews were conducted using an initial interview schedule comprised of 15 questions.MethodA qualitative methodology was adopted to explore the social reality and operation of coaches within their professional context. A grounded theory method of data collection and analysis was utilised to explore gaps in the profession’s current understanding of roles and boundaries.ResultsA range of borders and boundaries were identified. The nature of the relationship between coaching and therapeutic practices appears to hinge on each coach’s self-selected boundaries. Such boundaries appear to be delineated most often by a coach’s feelings of competency and their client’s ability to process and move forward within coaching.ConclusionsFindings suggest that the main difference between coaching and therapeutic practice is driven by how coaches perceive the work they do as opposed to differences in the processes, content and roles.

ABSTRACTThe therapeutic contract is an important aspect of the counseling process. However, it has received limited research interest, especially in the person-centered community. The objective of this qualitative study was to examine the perceptions and use of therapeutic contracts of seven experienced, person-centered therapists in Greece. A grounded theory design was chosen to guide the analysis of the data that were collected through semi-structured interviews. The emergent theoretical model was conceptualized as a system organized around the core category of ‘Forming a Safe – Attuned Framework’, which included the key-categories ‘Coordination game’, ‘Boundary setting’, and ‘Equal relationship’. Data analysis also revealed the contextual input of the ‘Therapist’s characteristics’ and the contextual output of the ‘Client consequences’. The emergent theory suggests that experienced person-centered therapists utilize therapeutic contracts in the first session with a new client in order to create a safe environment in which they can work cooperatively and develop their relationship. This process is guided by specific characteristics of the therapists (e.g. their sense of professional identity), and leads to various positive consequences for clients (e.g. facilitating their personal freedom). The study has important implications for practicing professionals, as well as for the training of new person-centered therapists.

This article explores the effects of racial assumptions, biases and stereotyping in therapeutic practice and how drama therapeutic tools might foster resistance to racist socialization among therapists. A review of relevant literature reveals a pressing need for programs, supervision and curricula that specifically address the potentially detrimental and traumatic effects of ‘isms’ (e.g. racism, classism, sexism) and ‘phobias’ (e.g. homophobia, Islamophobia) in the therapeutic encounter. This article proposes three exercises that draw on the projective, embodied and relational foundations of drama therapy towards challenging bias and moving towards just practices.

This work proposes a revolutionary therapeutic framework that integrates Carl Jung’s shadow psychology with both orthodox and heretical streams of Kabbalistic thought to address the fundamental presence of evil and suffering in illness and existence. Drawing upon the scholarship of modern scholars, this study demonstrates how Jung’s recognition that Kabbalistic writings “anticipated my entire psychology” opens pathways for therapeutic approaches that can hold the tension between light and dark, creation and destruction, presence and absence. The theoretical foundation rests upon the Lurianic Kabbalistic insight that divine light becomes trapped within kelipot (shells of evil) through the cosmic catastrophe of Shevirat HaKelim (Breaking of the Vessels), paralleling Jung’s understanding that rejected shadow material contains essential life energy requiring integration rather than elimination. The concept of tzimtzum (divine contraction) provides a framework for therapeutic spaces that can hold both divine presence and absence, while heretical movements like Sabbateanism and Frankism reveal how “redemption through sin” anticipates contemporary insights about the necessity of engaging rather than avoiding difficult psychological material. The controversial figure of Jonathan Eybeschutz, accused by Jacob Emden of harboring secret Sabbatean beliefs while maintaining orthodox authority, exemplifies the profound tension between orthodox containment and heretical breakthrough that characterizes both authentic mystical development and therapeutic transformation (Ungar-Sargon, 2025). Clinical applications demonstrate how therapeutic encounters can become sacred containers for the coincidence of opposites (coincidentia oppositorum), allowing both healer and patient to recognize divine sparks hidden within psychological suffering. This approach transforms symptoms from pathology to be eliminated into sacred texts requiring hermeneutical sophistication, moving beyond conventional models that split healing and wounding, light and dark, therapist and patient. The framework extends to collective healing, revealing how individual shadow integration creates immunity to political manipulation through projection and scapegoating. Analysis of war and peace through this lens demonstrates how collective shadow projection creates “political kelipot” that imprison the divine sparks present in designated enemies, while conscious resistance based on tikkun olam (repairing the world) offers pathways for transforming rather than perpetuating cycles of violence. Elie Wiesel’s testimony about maintaining faith through ultimate darkness provides a model for therapeutic work that can hold the “tragedy of the believer”—remaining open to sacred encounter even within experiences of divine absence. The integration of personal healing with cosmic repair suggests that therapeutic practice becomes a form of political action, creating possibilities for what Hillman terms “archetypal democracy” based on conscious relationship to collective energies. This synthesis offers hope for therapeutic approaches capable of addressing the fundamental spiritual dimensions of suffering while maintaining clinical sophistication, suggesting that the integration of ancient wisdom with contemporary psychology may be essential for healing the individual and collective wounds of our time.

In this article, we reflect on our evolving ideas regarding a dialogical approach to refugee care. Broadening the predominant phased trauma care model and its engaging of directive expertise in symptom reduction, meaning making, and rebuilding connectedness, these developing dialogical notions involve the negotiation of silencing and disclosure, meaning and absurdity, hope and hopelessness in a therapeutic dialogue that accepts its encounter of cultural and social difference. In locating therapeutic practice within these divergent approaches, we argue an orientation on collaborative dialogue may operate together with notions from the phased trauma care model as heuristic background in engaging a polyphonic understanding of coping with individual and family sequelae of forced displacement. This locating of therapeutic practice, as informed by each perspective, invites us to remain present to fragments of therapeutic positioning that resonate power imbalance or appropriation in a therapeutic encounter imbued with a social context that silences refugees' suffering. In a clinical case analysis, we further explore these relational complexities of negotiating directive expertise and collaborative dialogue in the therapeutic encounter with refugee clients.

This article explores the application of Deleuze and Guattari to the practice of psychotherapy and attempts to consider how Deleuzoguattarian theory might inform a therapeutic understanding of the ways in which the digital —that is, social media platforms, mediated communication devices, smartphones, and so forth—influences subjectivity and interrelationality in the networked age. A review of the relevant literature explores historical approaches to case formulation and highlights the field’s limited acumen towards the interplay between online technologies and the therapeutic encounter. Following a brief overview of Deleuze and Guattari’s philosophy, a four-stage analytical model is put forward and applied to a case vignette taken from my own therapeutic practice, the analysis of which demonstrates the possibility of understanding the contemporary therapy meeting—and the contemporary “digital” subject—through a Deleuzoguattarian lens.

This article addresses the issue of engaging client diversity in therapeutic practice by elaborating a dialogical model of engagement that is sensitive to and inclusive of the spiritual dimension in the therapeutic encounter. Drawing on Martin Buber’s writings on the ‘I–Thou’ relationship, the concept of intersubjectivity, research on spirituality in therapy, and the authors’ clinical experiences of collaboratively engaging the spiritual dimension in therapy, strategies of engagement are critically examined. Treatment benefits of practices that facilitate the inclusion of client spiritual values and beliefs in the therapeutic conversation are explored and potential therapeutic pitfalls are identified.