Experiential Psychotherapy Research Articles

Preferences for e-Mental Health Interventions in Germany: A Discrete Choice Experiment

ObjectivesRecent evidence suggests that e-mental health interventions can be effective at improving mental health but that there is still a notable hesitation among patients to use them. Previous research has revealed that they are perceived by patients as being less helpful than face-to-face psychotherapy. The reasons for this unfavorable perception are, however, not yet well understood. The aim of our study was to address this question by eliciting preferences for individual components of e-mental health interventions in a discrete choice experiment. MethodsUsing a stepwise qualitative approach, we developed the following 5 attributes of eMHIs: introductory training, human contact, peer support, proven effectiveness, content delivery, and price. Additionally, we asked questions about respondents’ demographics, attitudes, and previous experience of traditional psychotherapy, as well as their distress level. ResultsA total of 1984 respondents completed the survey. Using mixed logit models, we found that personal contact with a psychotherapist in blended care, proven effectiveness, and low price were highly valued by participants. Participants were indifferent toward the mode of content delivery but showed a slight preference for introductory training via phone, as well as for peer support via online forum alongside coach-led group meetings on site. DiscussionOur results suggest a clear preference for blended care that includes face-to-face contact with a psychotherapist. This preference remained stable irrespective of sociodemographics, previous experience of psychotherapy, distress level, and the 2 context scenarios used in our discrete choice experiment. Further investigations looking at the potential benefits and risks of blended care are needed.

Proffering Connections: Psychologising Experience in Psychotherapy and Everyday Life.

Conversation analytic research has advanced understanding of the psychotherapeutic process by understanding how psychotherapy is organised over time in and through interaction between clients and therapists. This study progresses knowledge in this area by examining how psychological accounts of experience are progressively developed across a range of helping relationships. Data include: (1) approximately 30 h of psychotherapy sessions involving trainee therapists; (2) approximately 15 h of psychotherapy demonstration sessions involving expert therapists; and (3) approximately 30 h of everyday conversations involving close friends or family members. This article reports an analysis of techniques that are used to bring together two experiences that were discussed separately, to proffer a candidate connection between them. This proffering of candidate connections was recurrently used in psychotherapy. If confirmed by a client, a proffered connection could be used to develop a psychological account of a client’s experiences, which could then warrant some psychological intervention. In contrast, the proffering of connections was observed in only one of the everyday conversations included in the current study, where it was used to develop psychological accounts of experience. This shows that although proffering candidate connections is an everyday interactional practice, it appears to be used with greater frequency in psychotherapy, to advance its specific institutional aims.

Using artistic activities within experiential psychotherapy to alleviate the psychological consequences of female infertility

Female infertility is associated with a wide range of psychological consequences, including heightened depressive and anxiety symptoms, impaired quality of life, and self-esteem. Considering the paucity of data regarding psychological interventions tailored for female infertility, this case study is aimed at providing preliminary evidence related to the treatment protocol and outcomes of an experiential psychotherapy intervention that uses artistic activities tailored for female infertility. The Short Form Health Survey (SF-36), Fertility Quality of Life International (FertiQoL), Ways of Coping Questionnaire (WCQ), Dyadic Adjustment Scale (DAS), and California Psychological Inventory, Femininity Scale (Fe-CPI), were used pre- and post-treatment for assessing psychological correlates of infertility. The psychological treatment consisted of three psychological assessments and seven experiential psychotherapy group sessions. Experiential techniques, mindfulness techniques, and artistic activities were used during the group sessions, in order to modify psychological maladaptive mechanisms associated with female infertility. Self-report results showed that the experiential psychotherapy intervention enhanced the quality of life, coping strategies, and femininity personality trait. Throughout the experiential intervention, the participant redefined her perspective on infertility and motherhood. On the other hand, the participant reported lowered levels of dyadic adjustment at post-treatment. This case study illustrates the beneficial effects of using artistic activities in experiential psychotherapy for female infertility.

Application of Interpretative Phenomenological Analysis methodology in psychotherapy impact research: Experience of psychotherapy of a person with multiple sclerosis

Psychotherapy’s impact and effectiveness have been explored through the use of quantitative research methods such as standardised inventories and scales measuring mainly behavioural and overt aspects of the psychotherapeutic encounter and symptom reduction. Nonetheless, change in psychotherapy is a complex, multifaceted phenomenon, requiring open-ended investigation to reveal the beneficial factors that are part of the process. This paper will demonstrate how Interpretative Phenomenological Analysis (IPA) can be applied in studying the psychotherapy process’s favourable aspects from the client’s perspective. We argue that IPA’s epistemological underpinnings and methods for collecting and analysing data can contribute to the study of psychotherapy’s impact. A case of a woman confronting the challenges of multiple sclerosis and illness symptomatology by undergoing psychodynamic psychotherapy is presented and analysed drawing on IPA guidelines.

The Importance and Limits of Experiential Psychotherapy

Experiential therapy focuses on emotions - whether we are talking about negative emotions, such as anger, pain, shame - correlated with past experiences, but also emotions associated with success, self-esteem, or even responsibility. Unlocking already experienced emotions and their subjective experience is the central point of experiential therapy - whether we are talking about the experience of the immediate and the awareness of our own being, or we are talking about "frozen" experiences, to which we have no conscious access outside psychotherapeutic practices. It reconfigures our mental maps by generating behaviors that make sense only in correlation with the understanding of those emotions, that are present in the subconscious but of which we are unaware and are not effectively rationalized. The article aims to analyze the field of application and the therapeutic particularities of experiential psychotherapy as a form of existentialist-humanistic therapy, as well as the limits of the experiential paradigm in a postmodern context.

Termination in 16-session accelerated experiential dynamic psychotherapy (AEDP): Together in how we say goodbye.

This article explores key aspects of the termination process in a 16-session treatment protocol of accelerated experiential dynamic psychotherapy (AEDP). AEDP theory and its empirical support are described; interventions used throughout termination are demonstrated with verbatim clinical exchanges; and potential challenges faced during termination are addressed. Congruent with AEDP's healing orientation, termination is reframed as completion and launching: Although treatment ends, the change process begun in therapy can continue, as does the therapist's care for the patient. AEDP interventions during termination include (a) relational strategies to foster connection and undo aloneness; (b) the highlighting of patient resilience and the celebration of growth; (c) affirmative work with defenses around loss; (d) coregulation of patient's emotional experience; (e) experiential, bodily-rooted affective strategies to process and transform negative emotions; and (f) thorough exploration and processing of ensuing, vitalizing positive emotions and in-session experiences of change-for-the-better (i.e., metatherapeutic processing), to expand these and promote enhanced well-being and flourishing. Therapists aim to (a) elicit and process emotions related to the completion of treatment; (b) celebrate patients' affective achievements; and (c) convey trust and confidence in an ongoing transformational process, predicted to yield not only diminishment of symptoms and suffering but also upward spirals of flourishing. AEDP suggests that in providing patients a new, positive attachment experience of togetherness as therapy ends, termination offers a unique opportunity to disconfirm patients' earlier attachment-based expectations, revise inner working models, and help patients grow in self-confidence as they face, accept, and thrive in the wake of loss. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

How Graduate-student or Recent Graduate Psychotherapists Experience and Manage Errors in Psychotherapy

ABSTRACT We explored how graduate-student/recent graduate psychotherapists managed errors committed in psychotherapy, using consensual qualitative research (CQR) to analyze interview data. The 13 graduate-student/recent-graduate psychotherapist participants defined errors as something that leads to negative consequences or harm for clients or psychotherapy, identified inattention to important client factors as the most common error, and reported minimal/no formal graduate training regarding errors. When describing a specific psychotherapy error they had made, they noted a strong pre-error psychotherapy relationship, recounted a range of intrapersonal antecedents to the error, and described the error as their using an approach that was not helpful to the client/psychotherapy. Some realized the error in session via clients’ responses; others’ realization came post-session. The errors led to ruptures in psychotherapy and negative emotional responses in participants, as well as self-doubt; the errors also stimulated participant growth/learning. Participants used supervision to recover from the error and process their thoughts/feelings regarding the error. They also frequently discussed the error with clients, and advised others to be self-compassionate toward the inevitable errors that psychotherapists make. Implications for training, practice, and research are discussed.

Neurotypical individuals fail to understand action vitality form in children with autism spectrum disorder

Any defects of sociality in individuals diagnosed with autism spectrum disorder (ASD) are standardly explained in terms of those individuals' putative impairments in a variety of cognitive functions. Recently, however, the need for a bidirectional approach to social interaction has been emphasized. Such an approach highlights differences in basic ways of acting between ASD and neurotypical individuals which would prevent them from understanding each other. Here we pursue this approach by focusing on basic action features reflecting the agent's mood and affective states. These are action features Stern named "vitality forms," and which are widely assumed to substantiate core social interactions [D. N. Stern, The Interpersonal World of the Infant (1985); D. N. Stern, Forms of Vitality Exploring Dynamic Experience in Psychology, Arts, Psychotherapy, and Development (2010)]. Previously we demonstrated that, although ASD and typically developing (TD) children alike differentiate vitality forms when performing actions, ASD children express them in a way that is motorically dissimilar to TD children. To assess whether this motor dissimilarity may have consequences for vitality form recognition, we asked neurotypical participants to identify the vitality form of different types of action performed by ASD or TD children. We found that participants exhibited remarkable inaccuracy in identifying ASD children's vitality forms. Interestingly, their performance did not benefit from information feedback. This indicates that how people act matters for understanding others and for being understood by them. Because vitality forms pervade every aspect of daily life, our findings promise to open the way to a deeper comprehension of the bidirectional difficulties for both ASD and neurotypical individuals in interacting with one another.

Ο ρόλος της βίωσης θετικών συναισθημάτων στην ψυχοθεραπευτική διαδικασία: ανασκόπηση της θεωρητικής και ερευνητικής βιβλιογραφίας

In this article we critically present the main theories, models and research findings regarding the role of positive emotions in psychotherapy. In the first part we present an overview of the role of the emotional presence, expression, and experience in psychotherapy and the role of emotions in different psychotherapeutic models. In the second part we focus on the role of humor, joy and love in psychotherapy, while in the last part we present and discuss the Broadenand- build model and its application to psychotherapy theory and practice.

Supplemental Material for Patients’ Crying Experiences in Psychotherapy and Relationship With Working Alliance, Therapeutic Change and Attachment Styles

Supplemental Material for Patients’ Crying Experiences in Psychotherapy and Relationship With Working Alliance, Therapeutic Change and Attachment Styles

Patient‐reported reasons for discontinuing psychotherapy in a low‐cost psychoanalytic community clinic

AbstractUsing data from an outcome study of adult individual psychoanalytic psychotherapy, conducted in a low‐cost Australian clinic, a mixed‐methods approach was employed to investigate patient discontinuation. This paper addresses the qualitative component of the discontinuation study, which explored patients’ reasons for leaving the clinic service upon assessment or in treatment proper. Of 205 patients commencing clinic contact, 41% discontinued during or shortly after the four‐week assessment period, while 40.5% of patients beginning psychotherapy withdrew before reaching the two‐year treatment limit. Across these two groups, former patients were interviewed about their therapy experience and decision to discontinue. Thematic analysis of 20 interview transcripts generated five descriptive categories of discomfort or dissatisfaction prompting discontinuation: clinic factors, therapist factors, patient factors, therapist–patient relationship factors and therapy factors. Findings suggest that experience of the clinic setting itself, together with negative patient perceptions of therapists and therapist interactional style, weres significant influences and that dissatisfaction with the psychotherapy process and outcome was more relevant than problematic patient factors in treatment withdrawal. A number of patients, mainly late discontinuers, reported positive experiences of psychotherapy and significant treatment gains. Implications of the findings, with specific emphasis on psychoanalytic treatment settings, are discussed.

Considerations for Providing Pediatric Gender-Affirmative Care During the COVID-19 Pandemic

Considerations for Providing Pediatric Gender-Affirmative Care During the COVID-19 Pandemic

The older client’s experience of counselling and psychotherapy

AbstractOlder people are less likely to be referred for psychological therapies, yet statistics show they tend to have good outcomes. Ageist attitudes and professional bias are evidenced as part of the problem. Although in recent years treatment for dementia has received much research focus, older people’s general mental health has not. It has often been argued that research into the development of such a specialist provision for older people is urgently needed, and this means research into how older people experience therapy is called for in order to determine the sort of provision with which they would most likely engage. The aim of this idiographic study of four people in their 60s and 70s is to explore how older people themselves make sense of their therapeutic experience. Interpretative phenomenological analysis (IPA) was used to analyse the data in order to get a deep sense of the participants’ lived life. Semi‐structured, individual interviews were audio‐recorded with the four participants, and interview transcripts were analysed. Three overarching themes emerged; personal agency, authenticity and narrative. Personal agency findings challenged the social concept that older people are less motivated to change. This study shows how each participant’s personal agency provided drive and direction in the therapeutic process. Further, the analysis shows that the participant’s authenticity with the therapist is a cornerstone to developing a relationship that encourages change. The study also demonstrates how the reconciliation of past experiences was facilitated when the therapist adopted strong elements of a narrative approach.

Experience-Dependent Counselor-Client Brain Synchronization during Psychological Counseling.

The role of the counselor’s experience in building an alliance with the clients remains controversial. Recently, the expanding nascent studies on interpersonal brain synchronization (IBS) using functional near-infrared spectroscopy (fNIRS) on human subjects have hinted at the possible neural substrates underlying the relationship qualities between the counselor-client dyads. Our study assessed the clients’ self-report working alliance (WA) as well as simultaneously measured IBS by fNIRS in 14 experienced versus 16 novice counselor-client dyads during the first integrative-orientation psychological counseling session. We observed that synchronous brain activity patterns were elicited from the right temporo-parietal junction (rTPJ) across counselor-client dyads. Furthermore, such IBS, together with alliance quality, was especially evident when counselors had more psychotherapy experience. Time-lagged counselor-client brain synchronization might co-vary with the alliance (goal component) when the client’s brain activity preceded that of the counselor. These findings favor the notion that the IBS between counselor-client associated with the WA is an experience-dependent phenomenon, suggesting that a potential adaptive mechanism is embedded in psychological counseling.

Disaster psychiatry and homelessness: creating a mental health COVID-19 response

Homeless individuals across the globe live in a constant state of crisis Yet, during times of societal crisis such as COVID-19 that affect all populations, disaster planning has rarely included this high-risk group The high burden of co-occurring physical, mental, and substance use disorders, absence of reliable shelter, scant access to health information, and scarcity of financial, transportation, and nutritional resources all create unique vulnerabilities for this population These factors restrict the ability of people experiencing homelessness to respond and adapt to public health recommendations before and during a disaster In particular, the mental health needs of people who are homeless during disasters have received minimal attention (PsycInfo Database Record (c) 2021 APA, all rights reserved)

What do laypersons believe characterises a competent psychotherapist?

AbstractAimAlthough research and clinical definitions of psychotherapeutic competence have been proposed, less is known about the layperson perspective. The aim was to explore the views of individuals with different levels of psychotherapy experience regarding what—in their views—constitutes a competent therapist.MethodIn an online survey, 375 persons (64% female, mean age 33.24 years) with no experience, with professional experience, or with personal pre‐experience with psychotherapy participated. To provide low‐threshold questions, we first presented two qualitative items (i.e. “In your opinion, what makes a good/competent psychotherapist?”; “How do you recognize that a psychotherapist is not competent?”) and analysed them using inductive content analysis techniques (Mayring, 2014). Then, we gave participants a 16‐item questionnaire including items from previous surveys and from the literature and analysed them descriptively.ResultsWork‐related principles, professionalism, personality characteristics, caring communication, empathy and understanding were important categories of competence. Concerning the quantitative questions, most participants agreed with items indicating that a therapist should be open, listen well, show empathy and behave responsibly.ConclusionInvestigating layperson perspectives suggested that effective and professional interpersonal behaviour of therapists plays a central role in the public's perception of psychotherapy.

What claims are made about clients and therapists’ experiences of psychotherapy environments in empirical research? A systematic mixed‐studies review and narrative synthesis

AbstractAimsTo synthesise and evaluate evidence about experiences of psychotherapy environments.MethodsStudies were identified from systematic literature searches of PsycINFO, ASSIA and Web of Science. Selected studies were published in English between 2002 and 2016. Fifteen studies met the inclusion criteria. A quality appraisal process indicated that the quality of evidence was 'moderate' across included papers.FindingsIn the narrative synthesis, we use the concept 'mereology' to underscore the mutually constitutive relationship between person, world and practice. In this context, themes of relating, containment and process each highlight the integral and nuanced influences of the environment on the therapeutic endeavour.ConclusionsIn therapeutic training, it would be beneficial to utilise the concept of a 'mereological system' (reflecting how a person and their environment shape each other and constitute a whole) to show how environmental features may affect clinical practice. Designers may also benefit from using this concept for the purpose of improving therapeutic environments. Further research that explores features of the therapy as part of a mereological system may pinpoint other aspects that facilitate beneficial therapy outcomes.

Freedom and struggling openly in psychotherapy: A qualitative inquiry with LGBQ young adults from religious families.

Lesbian, gay, bisexual, and queer (LGBQ) young people from religious families are at increased risk of family rejection, poor mental health outcomes, and are overrepresented in mental health services. This article describes a two-part qualitative study aimed at exploring the experiences of LGBQ young adults from religious families in psychotherapy, identifying positive and negative psychotherapy experiences, and understanding the influence of family and religion on the psychotherapy experience. Data were collected through a web-based survey (n=77) and interviews (n=7) with LGBQ young adults (ages 18-25) from religious families. The study followed an interpretative phenomenological approach. Integrated results found often invisible, relational therapy processes, and religious discourses as significant to LGBQ young people who seek psychotherapy. Implications for future research, effective systemic family therapy practices with LGBQ young people from religious families, and a critique on ethical and legal limits of confidentiality with policy implications are outlined.

Transformative Life Experience as a Glimpse Into Potentiality

Many clients cope with the consequences of transformative life experience (TLE) in psychotherapy. TLE often involves a radical, profound reorganization of or change in one’s life because of resulting formative, life-changing choices. Yet the essence of the mechanism people use to process and make sense of a TLE is unclear. This study is a phenomenological exploration of such experiences that aims to offer a heuristic theoretical view of how such change is constructed and played out. Data were collected through in-depth interviews with 120 adults who had coped with the consequences of a TLE. Data analysis was guided by a hermeneutic phenomenology paradigm that postulates that people account for their experience within the four existentials of temporality, spatiality, corporality (embodiment), and relationality. Those lifeworld existentials were utilized as a framework and lens through which to organize the data. This procedure was followed by a hermeneutical interpretation to identify common features of lived experience along all four domains of analysis with the purpose of constructing a conceptual model that illustrates the essence of change during TLE. Implications are considered for utilizing theoretical and applied insights from the model.

"We Just Did Not Get on". Young Adults' Experiences of Unsuccessful Psychodynamic Psychotherapy - A Lack of Meta-Communication and Mentalization?

In order to avoid suboptimal psychotherapy, research needs to highlight and analyze obstacles in such treatments. This clinically oriented article brings together empirical material of unsuccessful psychotherapy with young adults; empirical material on the therapists’ views of the same therapies; and theoretical perspectives on mentalization, therapeutic alliance, and young adulthood. Through a secondary qualitative analysis, it presents a tentative process model of how suboptimal psychotherapy with young adults develops, how it could be handled clinically, and possibly prevented. In three studies, experiences of young adult patients (aged 18–25; n = 27), in psychoanalytic therapy at an outpatient clinic, who did not improve from therapy (defined as no reliable and clinically significant symptom reduction) and/or were dissatisfied, and their therapists, were analyzed. Patients described experiences of not being understood and not understanding therapy, whereas therapists described patient non-commitment. These results were compared from the developmental perspective of mentalization in young adulthood. The primary grounded theory analyses and secondary analysis resulted in a tentative process model of the development of suboptimal psychotherapy with young adults. Suboptimal therapy is described as a vicious circle of therapist underestimation of patient problems, therapeutic interventions on an inadequate level, and diverging agendas between therapist and patient in terms of therapeutic alliance, resulting in pseudo-mentalizing and no development towards agency. A benign circle of successful therapy is characterized by correct estimation of patient problems, meta-communication, and the repair of alliance ruptures. One clinical implication is that therapists of young adult patients need to establish verbal and nonverbal meta-communication on therapy progress and therapeutic alliance. The importance of the patients’ present mentalization capacity and adjusted interventions are demonstrated in an example. Research in the field should be process-oriented and investigate the effect of meta-communication and interventions targeted to foster therapeutic alliance based on this theoretical model, particularly for young adults.