Moments In Therapy Research Articles

When the therapist's and the client's woundedness meet: Dialogical selves of Filipino self‐identified wounded healers

AbstractIntroductionThe dominant literature on wounded healers assumes that the healer must be healed of one's wounds to be an effective therapist and that countertransference, moments in therapy when a healer's wounds are activated, must be successfully managed. Lacking in the literature is an understanding of the internal dynamics of wounded healers as they navigate moments of countertransference. Veering away from a unitary and static view of the self, we argue for a shift in how we understand wounded healers using the lens of a multiple and dynamic self. Through Herman's dialogical self‐theory, we conceptualise the wounded healer as having multiple selves—the wounded self (WS) and the therapist self (TS). Each self is an I‐position with its own unique voices and narratives.MethodThrough in‐depth interviews with Filipino self‐identified wounded healers, we examine the internal voices of the WS and TS during moments of countertransference, as the WS meets the client's wounded self.FindingsResults show that the participants' characterisation of their WS, or where they are in their journey of healing or recovery, shapes their countertransference experience. Participants with recovered WS channelled the voices of calm recognition and differentiation. Voices of identification, re‐experiencing and differentiation surfaced among participants with recovering WS. Participants with emerging WS transitioned from a voice of not knowing to a voice of identification.ConclusionBeing aware of and listening to the voices of the WS alongside the TS is key in navigating countertransference. The implications of a dialogical understanding of wounded healers in clinical practice are discussed.

Key-in-session identity negotiations in a first line treatment for adult anorexia nervosa

BackgroundExploration of client identity negotiations during treatment for Anorexia Nervosa (AN) is a relatively new area of research. Research suggests that difficulties with identity negotiations may present as a barrier to treatment. This study sought to explore individuals’ identity negotiations during therapy sessions using Compulsive Exercise Activity Therapy (LEAP) combined with Cognitive Behaviour Therapy for Anorexia Nervosa (CBT-AN). Analysis focused on moments in therapy where individuals’ identities were dominated or defined by AN and where alternative identities could be generated.Method40 in-session transcripts from sessions at early, mid and end points of the CBT-AN (with LEAP) treatment were qualitatively analysed for nine of the 78 participants in the original randomised control trial. Through a constructivist framework, thematic analysis was used to identify surface and latent meanings and discursive material participants used to negotiate their identities in the context of therapy sessions.ResultsAnalysis of in-therapy transcripts generated two themes pertaining to identity negotiations: (1) troubled identities and (2) rebuilding identities and lives outside of AN. Early therapy sessions explored fragmented and AN dominated identities, including how AN was troubling to participants’ sense of self, contributed to conflicted identities, positioned them outside of normality, and was associated with isolated and othering identities. Within therapy sessions, participants engaged in a recursive process of shifting relationships with AN and themselves and building identities and lives outside of the AN identity. This included generating hopes for recovery and the future more frequently in mid- to late- therapy sessions.ConclusionIdentity negotiations evident in the therapeutic conversations aligned with the key components of the CBT-AN intervention, including addressing (1) the characterisation of oneself as ‘an anorexic’ and (2) the diversification of roles and activities to broaden and enhance self-concepts. Future developments of therapeutic interventions for AN would benefit from greater consideration of ways to assist individuals to more comprehensively address problematic identities, including uncovering identities hidden by the AN identity and generating preferred identities.Trial Registration: Ethics approval was obtained at the time of the initial study and for this embedded research by the HREC at the Western Sydney University (HR777332).

Idiopathic guttate hypomelanosis: Issues of differential diagnosis and therapy

Hypomelanosis is an idiopathic guttate process with the appearance of small struts of hypopigmented, rounded patches on the skin. Despite the high caution of diseases among the population, this dermatosis, as a rule, remains unrecognized throughout life, and it is also difficult to consider this moment of therapy, remaining a cosmetic defect throughout life. This article provides information on the epidemiology, pathogenesis, manifestations, differential diagnosis and therapy of idiopathic guttate hypomelanosis.

Protocol of HOTFy: randomised clinical trial to hyperbaric oxygen therapy in fibromyalgia

IntroductionFibromyalgia is a polysymptomatic syndrome with a prevalence between 0.2% and 13% of the population and causes work disabilities in approximately half of affected patients. Several treatments to fibromyalgia have...

Nepantla Moments in Therapy: A Clinical Example With Latinx Immigrants

Therapy can be a site of decolonization in which the traumatic experiences of individuals, couples, families, and communities can be transformed by liberation-based frameworks. In this essay I articulate how key concepts from De Sousa Santos Epistemologies of the South, such as the ecologies of temporality, recognition, and productivity, can be integrated within a Mujerista therapy framework to address trauma and resilience. Through a clinical example of a Latinx mother and daughter, I illustrate nepantla moments and the co-construction of testimonios involving experiential, narrative, and spiritual levels of experience.

A few session moments.

This communication presents three session vignettes with three different people. The three dialogues are (1) Wondering; (2) Evacuative Moments and a Wish for Something Better, (3) Not the Lord. An emphasis is the evocative richness of moments in therapy that involve speech yet run silently through different psychic dimensions opening possibilities of growth. So much life happens in ways hard to pin down; yet trying to speak from one's being and voice one's concerns gives rise to something one might call psychic resonance.

Intenzivna terapija u vreme pandemije 2020. i u budućnosti - akronimi nam mogu pomoći

In a busy working environment, with a shortage of healthcare workers and increased workloads since the beginning of the COVID-19 pandemic, the implementation of an easy-to-remember mnemonic can significantly help anesthesiologists and clinicians in conducting intensive therapy. One of the first mnemonics in critical care therapy was implemented by Jean-Louis Vincent in 2005. FAST HUG concept reminds clinicians of crucial moments in therapy - nutritional support(F-feeding), analgesia and sedation (A - analgesia, S - sedation), thrombosis prophylaxis (T - thrombolytic prophylaxis), head elevation in bed (H - head of the elevated bed), antiulcer therapy (U - stress ulcer prevention) and glycemic control (G - glucose control). This acronym has been modified and tested in several studies over the years for the treatment of different patient types. This concept is widely utilized in intensive care units, it is characterized with easy implementation, and proved to be useful in ventilator-associated pneumonia prevention. Therapy of critically ill patients with COVID-19 is based on elements of general intensive care therapy with some specific therapeutic guidelines. With the intention to ease and improve therapy of patients with COVID-19 in intensive care units, a new and comprehensive acronym is proposed: One Fast Hug Bids COVID.

Sparks of psychotherapeutic change: How therapists understand moments of meetings’ contribution to change in psychotherapy

Moments of Meeting (MoM) in psychotherapy are understood as shared moments between patients and therapists that allow a mutual implicit understanding about their relationship and create a new state of intersubjectivity that reconfigures the patient’s procedural knowledge of “being with others.” Despite ample theoretical and clinical descriptions of this phenomenon, little is known, from an empirical standpoint, about these kinds of moments in therapy. Objective : This study describes therapists’ experience of moments of meeting with their patients in psychotherapy, and how these moments relate to the patient’s change process. Method 13 in-depth interviews conducted with therapists from different theoretical backgrounds were analyzed using Grounded Theory. Results Four categories were established: (1) Characteristics of moments of meeting, (2) Triggers of moments of meeting (3) Enabling conditions, and (4) Main effects of moments of meeting. A conceptual model was developed around an axial phenomenon that provides understanding on how moments of meeting contribute to the change process in psychotherapy, through the construction of shared relational knowing. Discussion : The value of moments of meeting for the therapeutic process is discussed and reflected upon, as well as their effect on changes regarding implicit relational knowing.

Windows of cultural opportunity: A thematic analysis of how cultural conversations occur in psychotherapy.

A cultural opportunity is 1 of 3 pillars within multicultural orientation framework; it is defined as a moment in therapy when aspects of a client's background emerge, which can be deeply explored to better understand the salient aspects of a client's cultural identities. Research on cultural opportunities provides evidence that clients desire cultural conversations. However, no study to date has examined what cultural opportunities sound like in therapy and how therapists and clients utilize these opportunities. Accordingly, the purpose of this study was to examine the ways in which cultural conversations emerge during the first psychotherapy session and how clients and therapists engage in these cultural conversations. Psychotherapy sessions from diverse therapist-client pairings at a university counseling center (n = 22) were analyzed using (reflexive) thematic analysis. Qualitative findings revealed 4 themes around how cultural opportunities emerge (e.g., windowpane of feeling) and 3 themes in how they are responded to (e.g., look out the same window: using client's language to explore culture). Implications for therapist training and supervision are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Listening to the opinista? Relational understandings of voice and silence in a multiperspective narrative study of child psychotherapy

AbstractThe concept of ‘child voice’ is examined through a longitudinal narrative case‐based analysis of interviews and drawings with an 8‐year‐old Chilean girl, who was in psychotherapy following sexual abuse, alongside interviews with her mother and therapists. Prompted by the child's description of herself through the neologism of the opinista—one who has opinions—the analysis encompasses diverse narratives of a critical moment in therapy, illuminating the complexity and entangled relationality of ‘child voice’. Moving beyond an individualizsed conception of ‘voice’ makes it possible to account for relationality without privileging adult articulations of children's experiences—allowing the opinista to be heard.

Commentary: Rupture repair as a transtheoretical corrective experience.

This commentary highlights common principles shared across the diverse clinical case examples featured in this In Session issue on Rupture Repair in Practice. We discuss the importance of therapists recognizing subtle signs of rupture and responding to ruptures with curiosity and compassion. We also consider how therapists can use repair strategies responsively to facilitate a corrective experience for the patient. We explore the ways in which the specific resolution strategy of linking a rupture to larger interpersonal patterns can benefit the therapeutic process, and the ways in which it can constitute a form of avoidance. We conclude by noting promising future directions and celebrating the generosity evidenced by these insightful authors' willingness to share and explore challenging moments in therapy.

Living under lockdown in the shadow of the COVID-19 pandemic in South Africa: anxious voices from the unplanned shift to online therapy.

This paper is a narrative, phenomenological description of the themes of experiences of some of my South African patients that collectively elicit anxious voices from the unplanned shift to online therapy while living under the world’s longest lockdown in the shadow of the coronavirus 2019 (COVID-19) pandemic. This paper thus presents a thematic description of moments in therapy, which illustrate the influence of lockdown on their sense of self, and the emergence of new anxieties not encountered before. Such themes are: i) new anxieties about death and dying; ii) new anxieties about loss of contact with friends and family and the emergence of existential anxiety; iii) new anxieties about current household relationships and the emergence of object loss; iv) new anxieties about the unplanned shift to online therapy and the threat of internet dis-connection, and finally; v) new anxieties about missing body parts of online therapy: Part-body-on-the-screen relating versus what-was-once-whole-body relating. As this paper is based on psychoanalytic theory, and the notion of intersubjectivity, my own experiences and thoughts are included in the therapeutic engagement. The core contribution of this paper is that it adds a voice to the other voices of other patients around the world who are also living under lockdown. Without this kind of narrative documentation, the world-wide therapeutic community may not know the extent of the anxieties of living under lockdown in the shadow of the COVID-19 pandemic.

Well-Being as a Precursor and Consequence of Micro-Processes in a Group Psychotherapy With Forensic Patients.

Psychotherapy is an important approach for the treatment of psychiatric disorders. Apart from treating disorders as such, psychotherapy aims at increasing patients' well-being. The Therapeutic Cycles Model (TCM) is a process-oriented theoretical model that makes predictions about the psychotherapeutic progress based on verbatim content. The model helps to identify therapeutic factors on a language level. The present study aims at analyzing transcripts of group therapy sessions with forensic psychiatric patients using the rationale of the TCM. Furthermore, the relationship between linguistic features of psychotherapy sessions and patients' well-being before and after therapy are investigated. In order to identify therapeutic factors, a group psychotherapy with nine drug addicted forensic psychiatric patients was videotaped and transcripts of N = 16 sessions were analyzed. Process-oriented measures were rated by the patients, their therapists, and an external observer. Patients' self-reported well-being before therapy was negatively related to Connecting (indicating emotional insight), and the frequency of therapeutic cycles, which are both thought of as key moments in therapy. Well-being of forensic patients is not necessarily a helpful precursor for insightful and productive events in therapy to occur. The findings help to better understand psychotherapeutic micro-processes throughout forensic therapies, and their relationship with patients' well-being. Implications for research and the forensic practice are discussed.

Language as Gesture in Merleau-Ponty: Some implications for method in therapeutic practice and research

ABSTRACT The unexpected invention of a game with my grandchildren provided a new way of thinking about the nature of such unpredictable moments in therapy. The experience brought together a number of ideas, considered through the view of language taken by Merleau-Ponty where the chaotic primitive layers that pervade language are seen as having primacy over the rules of linguistics such as those set out by Saussure. Saussure is seen as providing a way of understanding linguistic structure whilst at the same time opening a number of ambiguities that then allow a way for thinking about language differently through Merleau-Ponty’s emphasis on the usage of language (la parole) as opposed the structural aspects of language (la langue). Initially, Winnicott’s ideas around the ‘spontaneous gesture’ are utilised to help show how this kind of unpredictable expression appears as something alive. Merleau-Ponty then shows how language as gestural phenomena takes hold of us through our bodies. Further questions then arise about the method in therapeutic practice and research. Here, it is argued that when the method is given primacy over experience, we are in a position that seeks the already known, which will not, therefore, permit some new expression to break through.

Strengthening mentalizing in a depressed mother of an infant with sleep disorders

Parent-infant psychotherapy treats parents to reduce infants' symptoms and strengthen the quality of the parent-infant relationship. However, little is known about the change processes that are set in place in parent-infant psychotherapy and the therapeutic techniques that are most helpful. The aim of this study was to provide a comprehensive description of the course of one treatment with a depressed mother of an 8 months old infant who received focused parent-infant psychotherapy (fPIP), a brief psychological intervention that aims at fostering mentalizing in the parent. This study also aimed at examining the specific interventions that fostered mentalizing in this case. We assessed therapeutic interventions with the fPIP adherence scale and in-session mentalizing with the Reflective Functioning Scale, and we analyzed qualitatively the moments in therapy that were relevant for the treatment focus and during which the mother demonstrated an increase in reflective functioning. We discussed the results with regard to the processes in the course of treatment and the strengths and limitations of fPIP.

Phototherapy versus Adapalene 0.1% Gel in Treatment of Acne Vulgaris

Background: Phototherapy has been increasingly used for treatment of acne vulgaris. The targets of the action mechanism of each light treatment are generally thought to be P. acnes. Visible light has been proposed to work by decreasing P. acnes bacterial counts by activating endogenous porphyrins. Objective: To evaluate the effectiveness of phototherapy with Pulsed Light and Heat Energy (LHE) versus topical Adapalene 0.1% in the treatment of mild forms of acne. Method: During the period of 2 years were treated 99 patients with Acne vulgaris, 51 with mild form of Acne vulgaris were treated with Phototherapy and 48 patients with mild form were treated with topical Adapalene 0.1%.The effectiveness was based on the number of inflammatory and non-inflammatory elements in the beginning moment of therapy and in the intervals after two sessions, 4 sessions, 6 sessions, 8 sessions, one month after treatment with Phototherapy and after 2, 4, 6, 8, 10, 12 weeks treatment with Adapalene 0.1% Gel. Results: One month after the treatment with Phototherapy, the inflammatory and non-inflammatory elements cleaning reached 67.9 ± 6.2% in mild form and 68.4 ± 6.5% in moderate form of Acne vulgaris. Three months after the treatment with local treatment, the inflammatory and non-inflammatory elements cleaning reached 59.4 ± 5.8 in mild form and 71.4 ± 7.2 after treatment with local plus systemic in moderate form of Acne vulgaris. Conclusion: The treatment of Acne vulgaris with phototherapy LHE as mono-therapy is a medical alternative which gives good clinical results in a relatively short period of time (one month) and with minimal side effects.

Recognition of Abnormal Uptake through 123I-mIBG Scintigraphy Entropy for Paediatric Neuroblastoma Identification

Whole-body 123I-Metaiodobenzylguanidine (mIBG) scintigraphy is used as primary image modality to visualize neuroblastoma tumours and metastases because it is the most sensitive and specific radioactive tracer in staging the disease and evaluating the response to treatment. However, especially in paediatric neuroblastoma, information from mIBG scans is difficult to extract because of acquisition difficulties that produce low definition images, with poor contours, resolution and contrast. These problems limit physician assessment. Current oncological guidelines are based on qualitative observer-dependant analysis. This makes comparing results taken at different moments of therapy, or in different institutions, difficult. In this paper, we present a computerized method that processes an image and calculates a quantitative measurement considered as its entropy, suitable for the identification of abnormal uptake regions, for which there is enough suspicion that they may be a tumour or metastatic site. This measurement can also be compared with future scintigraphies of the same patient. Over 46 scintigraphies of 22 anonymous patients were tested; the procedure identified 96.7% of regions of abnormal uptake and it showed a low overall false negative rate of 3.3%. This method provides assistance to physicians in diagnosing tumours and also allows the monitoring of patients’ evolution.

In Visible Hands: The Matter and Making of Music Therapy.

This study explores the topics of matter and making in music therapy through embodied reflexive retrospection with six music therapists. The participants were asked to re-enact a hand position from their memory of a significant moment in therapy. In individual research meetings, they shared their thoughts about this moment while the researcher made a body cast of their chosen hand pose. A thematic analysis of the participant narratives, the hand casts, and existing literature was used to generate the following themes: The biographic hand, The body, space, place, and time, The plural hand, Matter of the hand, and The method in hand. The research procedure facilitated an exploration of epistemological, ontological, and phenomenological perspectives in understanding music therapy practitioner experiences. The study highlights the inseparability and multiplicity of matter, making, and narrating music therapy that transcends context or therapeutic approach.

Arts and health as an ecopsychological practice: Developing a conversation

Abstract What place does therapy have in a world that is facing an ecological emergency? Once we come to see ourselves as cells of the whole system that we call the environment, it becomes impossible to ignore the well-being of the planet as we work to improve our clients’ well-being and our own. Bernie Neville, client-centred ecopsychologist, explains to Helen Varney, public health sociologist, how therapy can be imagined in a larger context, locating it within the ecological way of thinking. For the ecopsychologist and for the sociologist too the experience of the powerful, shared moment in therapy is one that is shared with the wider human community and with the universe itself. If we are looking for evidence of the benefit of arts and health for individuals and their communities, we should look more deeply into such experiences.

A Study of a Network Meeting: Exploring the Interplay between Inner and Outer Dialogues in Significant and Meaningful Moments

The present study is part of a series of qualitative studies focusing on dialogic practice in southern Norway. In this article, we present a qualitative study of a network meeting focusing on the interplay between the participants' inner and outer dialogues. The network meeting is between an adolescent boy, his mother and two network therapists, the same adolescent case discussed previously in this journal by Bøe et al. (2013). The aim of this study is to explore how the interplay between inner and outer dialogues contributes to significant and meaningful moments for the interlocutors. A multiperspective methodology is used that combines video recordings of a network meeting and participant interviews with text analysis. Our research found the interplay has an important role in understanding the emergence of significant and meaningful moments in therapy. A one-sided focus on participants' utterances or inner dialogues was insufficient to explain their significance and meaning to the interlocutors. A dialogical approach provides a theoretical frame and concepts that are useful in investigations of therapeutic conversations.