Points of growth of the clinical centered psychotherapy

Little attention has been given to the resiliency process of family caregivers for older people hospitalized with congestive heart failure. The purpose of this study was to examine the influences of older peoples' activities of daily living dependency, family caregivers' spiritual well-being, quality of relationship, family support, coping and care continuity on the burden of family caregivers of hospitalized older people with congestive heart failure using the Resiliency Model of Family Stress, Adjustment, and Adaptation. DESIGN AND SAMPLE. A descriptive, correlational research design was used. There were 50 family caregivers and 50 older people diagnosed with congestive heart failure recruited from medical and surgical units of two Midwest medical centres. Data on activities of daily living dependence of older people, family caregiver burden, spiritual well-being, coping strategies, quality of older people-caregiver relationship and care continuity were collected using structured questionnaires. The findings indicated that there were significant positive associations between patients' activities of daily living dependence and family caregiver burden and between lack of family support and family caregiver burden. There were significant negative associations between quality of relationship and family caregiver burden, between care continuity and family caregiver burden, between coping and family caregiver burden and between spiritual well-being and burden. In hierarchical multiple regression, the model variables accounted for 66% of the variance in family caregiver burden. Patients' activities of daily living dependence, quality of relationship and lack of family support are significant predictors of family caregiver burden. The best predictors of family caregiver burden, using the resiliency model, were the older persons' activities of daily living dependence, family support, quality of relationship, care continuity, coping strategies and spiritual well-being. Implications for practice. It is vital for nurses to assess family caregivers' needs and resources and the quality of the older person-family caregiver relationship in developing a plan of care that reduces family caregiver burden.

This study examined the relationship between implicit and explicit levels of change in psychotherapy—the ability to shift between self-states, measured by the Two Person APES (TPA), a relational extension of the Assimilation of Problematic Experiences Scale (APES), and the emergence of exceptions to the problematic self-narrative, measured by the Innovative Moments Coding System (IMCS). The contribution of each of these dimensions of change to session outcome was also examined. Eighty sessions of eight psychodynamic treatments (10 sessions each) were sampled and coded according to the TPA and the IMCS. Session outcome was measured by the Outcome Rating Scale (ORS). A repeated measures correlation approach was used, revealing a positive association between IMs and client TPA. Also, IMs showed stronger correlations with session outcome compared to TPA. These results indicate that a growing ability to shift between self-states in the implicit level is related to the client’s ability to construct new meanings in the explicit level, and that these explicit changes have stronger correlations with functioning improvement at the session level than implicit processes concerning the renewal of dialogue between self-states.

Research suggests that the quality of care provided by family members may be influenced by the quality of relationship they have with the person living with dementia. The study investigated this in the context of assisting with daily activities. The quality of the relationship was assessed using the conceptual framework of relationship continuity/discontinuity which focuses on whether the carer experiences their relationship as continuous or discontinuous with the pre-dementia relationship. Thirty spousal carers completed the Birmingham Relationship Continuity Measure. Participants were also interviewed about how they provide care for their partner's daily activities. Passages consistent with a more person-centered approach were identified, and the total number of these in each transcript was used as the measure of care quality. There was a significant correlation between questionnaire scores and the number of person-centered passages: Those reporting greater continuity more frequently described using a person-centered approach. Findings were consistent with earlier research suggesting associations between the quality of the relationship and the quality of care. The concept of relationship continuity suggests ways in which relationship and care quality are connected, and these suggestions could be used to develop interventions to help family carers provide better care.

Zusammenfassung Increasing attention has been given to the Assimilation Model as an integrative framework for understanding the change process in psychotherapy. This paper contributes to the development of the model by identifying ways in which narrative and discursive practices are involved in the transition to the „problem statement“ stage of assimilation of a problematic experience. The study uses a method of qualitative narrative analysis to construct an interpretive account of the change process occurring in a single case of experiential psychotherapy. The overall process of change in this case is described in terms of two broad phases: building a storyworld and coconstruction of a new narrative. The shift to „naming“ the problem is discussed in terms of the operation of a number of narrative micro-processes, including positioning, symbolisation and the co-construction of metaphor themes. The implications of this analysis are discussed. Narrative Prozesse in der Assimilation einer problematischen Erfahrung: eine qualitative Einzelfallstudie Das Assimilation Model als integrativer Rahmen fur das Verstandnis von Veranderungsprozessen in der Psychotherapie stost zunehmend auf breites Interesse. Durch die Identifikation von narrativen und diskursiven Aspekten beim Ubergang zum Stadium der Problemerkenntnis im Verlauf der Assimilation einer problematischen Erfahrung tragt der vorliegende Aufsatz zur Weiterentwicklung dieses Modells bei. Die vorgelegte Einzelfallstudie nutzt die Methode der qualitativen Narrativanalyse zur Konstruktion eines interpretativen Ansatzes uber den Veranderungsprozess bei einer erfahrungsorientierten psychotherapeutischen Behandlung. Der Veranderungsprozess in diesem Fallbeispiel wird in zwei Phasen beschrieben: Explikation einer personlichen Geschichte und gemeinsame Konstruktion eines neuen Narrativs. Die Entwicklung zur „Namengebung” fur das Problem wird verstanden als Abfolge narrativer Mikroprozesse, einschlieslich Positionierung, Symbolisation und gemeinsamer Metaphernkonstruktion. Die Implikationen dieser Methodik werden diskutiert. 284 ZBBS Heft 2/2000, S. 283-302 The development of better ways of understanding the change process has comprised one of the primary goals of psychotherapy research in recent years. Although a substantial amount of research has been carried out into the process of therapeutic change (see, for example, Toukmanian/Rennie 1992), it can be argued that this body of work has been informed by a diversity of theoretical perspectives, and as a result may lacks conceptual cohesion. The fragmented and contested nature of much psychotherapy process has made it difficult for practitioners to make use of research findings in guiding practice. Stiles and colleagues (Stiles et al. 1990, 1992) have developed an integrationist model for understanding the process of change in psychotherapy. This model conceives of therapy as an activity through which the client becomes able to master or „assimilate“ problematic or difficult experiences. The „Assimilation Model“ comprises 8 stages through which the client moves in his or her efforts to explore and understand the problematic issue which has brought them to therapy: Stage 0: Warded off; 1: Unwanted thoughts; 2: Vague awareness/emergence; 3: Problem statement/clarification; 4: Understanding/insight; 5: Application/working through; 6: Problem solution; 7: Mastery. The basic structure of the Assimilation Model has been supported in series of research studies (Stiles 1999; Stiles et al. 1991, 1995; Varvin/Stiles 1999). Recently, Honos-Webb and Stiles (1998) have presented a reconceptualisation of the Assimilation Model in terms of voices. Typically, in therapy a „warded off“ or „unheard“ voice of the client, which expresses a painful or unconscious aspect of the experiential world of the person, struggles to be heard in the face of stronger, dominant voices. The process of assimilation involves this emergent voice coming to take its place in the „community of voices“ (Honos-Webb/ Stiles 1998). Notions of „voice“ and „assimilation“ provide integrationist conceptual tools which enable the contribution of a broad range of theoretical approaches to psychotherapy to be brought to bear on the task of producing a more differentiated, elaborated and practically useful understanding of the change process. The narrative social constructionist approach to psychotherapy (McLeod 1997, 1999a, b) is a theoretical perspective which may potentially represent a valuable means of extending the scope of the Assimilation Model. The narrative social constructionist perspective on psychotherapy has developed from the work of White and Epston (1990) and Gergen (1985, 1999). It is an approach to psychotherapy which emphasises the social, historical and cultural construction of identity, and the collaborative co-construction of meaning between therapist and client. Narrative social constructionist inquiry pays particular attention to the uses of language within therapy, with a specific focus on the ways in which the telling of stories creates and conveys meaning and locates teller and listener within a cultural context. Experiential psychotherapy can be defined as a contemporary rendering of an approach to therapy which originated in the work of Carl Rogers and other humanistic psychologists in the 1950s. There are many current versions of experiential therapy in use, for example process-experiential therapy (Greenberg/Rice/Elliott 1993) person-centred therapy (Mearns/Thorne 1999), „secondgeneration“ person-centred therapy (Rennie 1998) and Gestalt Therapy. A review of recent developments in experiential psychotherapy can be found in J. McLeod/S.Balamoutsou: Narrative processes 285 Greenberg, Lietaer and Watson (1998). Some of the basic features of all experiential approaches to psychotherapy are an emphasis on an accepting, respectful empathic relationship between therapist and client, therapist willingness to be congruent and authentic, and active engagement in processing of current emotions and feelings. The aim of the present paper is to identify some of the narrative processes which may be involved in the therapeutic co-construction of assimilation of a problematic experience. The paper forms part of a series of research reports based on analysis of narrative processes in single cases of experiential psychotherapy (McLeod/Balamoutsou 1996; McLeod 1997; Grafanaki/McLeod 1999). The methodological assumption underpinning this series of case reports is that the complexity of narrative process can only be appreciated within the context of a whole case. As in the work of Murray (1938), findings from a series of case studies are used as means of building towards a generalisable model.

P108: Relational aspects in dementia family caregiving: exploring caregivers ́ self-perceived caring style and its correlates in the caregiving stress and coping process

PurposeThe continued prevalence of financial crime and the lack of effective commercial forensic interviewing strategies prompted the development, presented here, of a conceptual framework to explain the relational dynamics conducive to interactions during a commercial forensic interview (CFI). The purpose of this study is to present such a framework which may facilitate the process of obtaining admissible evidence in different forums.Design/methodology/approachA grounded theory approach was adopted to develop a conceptual framework, drawing on the findings of a scoping review, direct observations of interactions involving commercial forensic practitioners (FPs) and interviewees, and data obtained from semi-structured interviews, making use of critical realism as a meta-theoretical framework.FindingsData obtained from the review informed the integrated approach of the conceptual framework, thus combining the structure of the PEACE model and creating an optimal interpersonal context informed by the person-centred approach (PCA). Observational data were used to identify the relational qualities associated with the interpersonal styles (clusters of relational qualities) of FPs in the CFI context, thereby contributing to complex relational dynamics. Interview data were used both to describe effective and ineffective interpersonal styles and how they played out in the CFI with interviewees, yielding information that unfortunately proved not to be admissible in a legal context. The findings of the different phases indicated the need for an integrated conceptual approach, the Ponaletso CFI framework, which draws on the structure of the PEACE model and the PCA, as expressed in the relational qualities of interactional pattern analysis (IPA). The framework consists of the interview stage (before, during and after), the structure (phases) of the PEACE model, the type of questions (open- or closed-ended) according to the PCA, FPs’ interpersonal styles (clusters of relational qualities as explained by IPA) and the observable relational dynamics between FPs and interviewees. When FPs use the Ponaletso CFI framework, there is a greater likelihood of extracting admissible evidence because the interview is guided by a clear structure with a step-by-step questioning approach by FPs, while taking into consideration the relational dynamics to which they contribute.Originality/valueThe proposed conceptual framework considers relational dynamics and how FPs can navigate towards optimal relational dynamics in CFI contexts. FPs can apply the structure, ask appropriate questions at the relevant phases and observe the relational dynamics playing out in the interpersonal context of the CFI. To the best of the authors’ knowledge, this is the first attempt at creating an integrated interviewing framework for conducting CFIs aligned with the legal context in South Africa. Using the Ponaletso CFI framework may aid FPs in obtaining admissible evidence and facilitate an optimal interpersonal context during commercial forensic investigations while respecting interviewees’ constitutional rights.

The study aimed to investigate associations between psychopathic traits (disinhibition, boldness, and meanness) and indicators of relationship quality (satisfaction, commitment, feelings toward the partner, closeness, and relationship costs) using a variable-centred and a person-centred approach. A total of 1,292 participants completed measures assessing psychopathic traits and relationship quality. Correlation analysis indicated that boldness was positively, while disinhibition and meanness were negatively correlated with relationship quality. Subsequently, cluster analysis was conducted to identify groups of participants with different combinations of psychopathic traits. Three clusters were extracted: “disinhibited”, “callous”, and “brave-resistant”. The last cluster had an elevated level of boldness and was relatively “positive” regarding relationship quality. The results seem congruent with the presumption of a different role of boldness, compared to meanness and disinhibition, in the domain of close relationships.

This book has been concerned with interdisciplinary applications of the Person-Centered Approach (PCA) to substantiate its theories. The concluding chapter provides a meta-view aiming to capture meta-theoretical statements and to integrate and expand between disciplines to offer further generation of ideas, research, and applications. Central elements include an experiential, whole-person approach to integration and enhancement, the systemic nature of the PCA, the recognition of the PCA as a way of being that acknowledges life as a directional, changing, social process, and the quality of interpersonal relationships as decisive factors for the actualization of persons and the constructive forming of their social systems.

BackgroundInternational guidance on models of care stress the importance of good quality, continuous patient-provider relationships to support high quality and efficient care and hospital avoidance. However, assessing the quality of patient-provider relationships is challenging due to its experiential nature. The aim of this study was to undertake a systematic review to identify questionnaires previously developed or used to assess the quality of continuous relationships between patients and their provider in primary care.MethodsMEDLINE, PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and SCOPUS databases were searched for English language studies published between 2009 and 2017. Key terms used identified studies conducted in the primary care setting examining relationships between patients and providers. Studies that focused on the conceptualisation, development, testing or review of a questionnaire, or studies that used a questionnaire for assessing the quality of continuous relationships between patients and providers were eligible. Studies that did not assess quality via a questionnaire, only assessed single aspects of relationships, only assessed single encounters, assessed transitions between settings or assessed relationships using an index were excluded. Information on validity testing of each relevant questionnaire identified from articles was reviewed to inform recommendations for future research and evaluation.ResultsTwenty-seven studies met the eligibility criteria, including 14 unique questionnaires. The questionnaires were diverse in length, scope, focus and level of validity testing. Five questionnaires were considered not feasible for future use due to size and lack of development work. Three questionnaires were considered strongest candidates for use in future work based on being relevant to the topic and primary care setting, freely available in English and not needing additional pilot work prior to use. These three questionnaires were the Care Continuity Across Levels of Care Scale, the Nijmegan Continuity Questionnaire and the Patient-Doctor Depth of Relationship Tool.ConclusionsThis study provides an overview of 14 unique questionnaires that have been used to assess the quality of continuous relationships between patients and primary care providers. The decision to use one of the questionnaires in future work requires careful consideration, including the scope, length, validation testing, accessibility of the questionnaires and their alignment with the initiative being evaluated.

In this paper I want to explore some of the preconceptions that underpin what is frequently called ‘client-centred counselling’. My aim has been to discuss its theoretical foundations by referring to one of the most widely used current positions, i.e. the client-centred theory of Carl R. Rogers. Taking Rogers' theoretical position as a starting point I criticise this for certain inconsistencies and omissions. Then proceeding to his conception of interpretation I claim this also to be lacking. In attempting to reconstruct a more viable position the phenomenological foundation of his theory is examined. This, in turn, is shown to be problematical and an attempt is made to rectify it. I then return to the theory of interpretation to replace the one criticised earlier in Rogers' work.

In view of the resurgence of the narrative perspective in psychology and the experiential emphasis in the person-centered approach (PCA), the concept of the self underlying the PCA is discussed in terms of the geographical and cultural contexts, which influenced my pursuit of psychology as a human as well as a natural science. During this journey I have moved from a traditional Western approach, focusing on the person as an independent and self-sufficient unit of the social system, and the importance of the sub-cortical areas of the brain in behavior, to an awareness of the importance of the interrelatedness of the self, especially in African culture, and the implications it has for psychology. The focus on the individual as an autonomous entity has been found wanting in alleviating the globally growing mental health crisis – We've Had a Hundred Years of Psychotherapy and the World's Getting Worse (Hillman & Ventura, 1993). New paradigms are required to facilitate conflict resolution, not only at individual level, but also in a world that is becoming increasingly fragmented. In the new paradigm, room has to be found for an interdependent model of the self that transcends cultural boundaries.

The model of emotional support to students in Higher Education for over 40 years has been one of ‘person-centred therapy’. Factors now challenge the supremacy of this approach, including its delivery format in an environment of extra-curricular demands, academic timetabling, students' financial restrictions (often requiring them to take paid work alongside their studies), and the requirement for them to build an undergraduate portfolio of employability to supplement their degree attainment. Other influential factors include staff accountability to the institution clashing with professional protocols, and duty of care dilemmas for support staff. In 2003, an action research project exploring the quality of its student counselling resulted in a Scottish Ancient university1 replacing traditional student counselling with a mental wellbeing service for students, which came to be known as ‘Support Advising’. This revised approach brought together professional staff from diverse disciplines providing short-term, focused individual and group work; student-led and with shared information databases. This paper examines the project's success, with regard to it representing a paradigm shift. Thus we address the central concepts of institutional purpose and responsibility boundaries, renegotiate the interpretation of ‘professional confidentiality’, and look to the future evolution of a mental wellbeing service in the context of student support.

The impact of empathy on interpersonal communication is a very relevant topic, as empathy plays a fundamental role in the way we relate and communicate with others. When we are able to put ourselves in someone else's shoes and understand their emotions and perspectives, communication becomes more meaningful. Empathy helps us avoid conflicts, promote mutual understanding and strengthen interpersonal bonds. Analyzing existing studies on the impact of empathy on interpersonal communication is the objective of this research. To do this, we used a structured bibliographical research with criteria for the inclusion and exclusion of sources, focusing on the relevance to the topic of empathy and its influence on interpersonal communication. To theoretically clarify the study, we emphasize the theory of empathy, Carls Rogers' person-centered approach. The research results demonstrate that disorders associated with a lack of empathy significantly impair social interactions and the quality of interpersonal relationships. The study presented and challenged the current paradigm, since it is common to say that communication solves everything. However, in reality, communication without the ability to empathize is flawed and does not achieve the desired objectives.

Complex in situ stress states in a deep shale gas reservoir in the southern Sichuan Basin, China: From field stress measurements to in situ stress modeling

Building the patient–clinician relationship through conversation based on narrative approaches