Psychotherapeutic Relationship Research Articles

The Role of Safety in Change-Promoting Therapeutic Relationships: An Integrative Relational Approach.

The significance of the psychotherapeutic relationship in promoting psychotherapeutic change is widely recognized. In this paper, we contribute to the relational orientation of psychotherapy through a transtheoretical exploration of safety. We aimed to identify and integrate those relational and change-promoting principles and aspects of safety that are school-independent. We conducted an overview and synthesis of the clinical-theoretical and empirical literature that we believe has significantly addressed the role of safety in regulating change-promoting therapeutic relationships. The relational and change-promoting aspects of safety form a dynamic system involving the therapist, the client, and the relationship. These interact, influence each other, and perform multiple homeostatic functions: they allow to resist change, assimilate small changes that do not disrupt the client's way of functioning, regulate major changes that disrupt and alter the client's way of functioning, and regulate adjustments in the way the therapist and client work together. From an integrative-relational perspective, a safe therapist is a precondition for co-creating a safe environment. This establishes trust and fosters an affective bond that provides additional sources of safety for the therapeutic relationship and the client. To promote change, however, the relational aspects of safety need to be fine-tuned (calibrated and personalized) for each therapy in terms of intensity, duration, timing, scope, and sources, accommodating developmental, individual, and situational differences. Crucially, the safety of the therapist, the client, and the relationship must be neither perfect, steady, or static, but rather safe enough, adaptive, and dynamic, leaving space not only for self-discovery and self-awareness but also for the co-regulation of tolerable frustrations, disappointments, and insecurities that facilitate the client's resilience and adaptation. Focusing on school-independent, safety-based relational principles and understanding how they evolve and adapt over time and across circumstances can make a significant contribution to the current relational orientation in psychotherapy. This has important implications for psychotherapy practice, training, and research.

Listening to the conversations of our bodies: Somatic intersubjectivity in psychotherapy

ABSTRACT This article explores the opportunities for client and therapist when somatic therapies and psychotherapy are brought together. Through a case study I illustrate how understandings and interventions from Intersubjective Self Psychology, Somatic Experiencing®, and Integral Somatic Psychology™ all supported the client’s emergence from profoundly somatised childhood traumatic loss, allowing them to restore thwarted developmental processes, rebuild affect tolerance, process their grief, and inhabit their life in new ways. I explicate how a deeply embodied psychotherapeutic relationship, where the conversations between the client and therapist’s bodies are held at the centre of the therapeutic relationship, can support reducing client re-traumatisation in therapy, meet early developmental needs, re-link affective layers allowing somatic and psychological (re)integration. I also explore the impact on, and possibilities for, the therapist of combining somatics and psychotherapeutic principles and techniques.

Do we see you? A systematic review of diversity representation in art therapy research conducted between 2010-2020

Art therapy is a mental health profession that enriches the lives of individuals, families, and communities through active art-making, creative process, applied psychological theory, and human experience within a psychotherapeutic relationship. Cultural diversity refers to the differences that exist among groups of people with definable and unique cultural backgrounds. Inclusion puts diversity in practice by respecting and valuing diverse individuals and groups. Diversity representation in art therapy is “seeing” people and ensuring that their viewpoints can be found and represented. Cultural competence in art therapy research is the ability to take culture into account as a central variable that affects every aspect of a study; this fosters the interest, integrity, and dignity of participants and the diverse cultural context of their lives. A systematic review of art therapy research was conducted to provide a critical evaluation of data on diversity representation within existing studies conducted between 2010 – 2020. The ADDRESSING acronym, which evaluates nine aspects of cultural identity, is utilized as a guide for assessment and data collection. The results indicate that diversity representation within the studies was either minimal or non-existent and suggest a need for intentionality about including diversity representation to create a more inclusive art therapy environment.

Who's willing to lay on the virtual couch? Attitudes, anthropomorphism and need for human interaction as factors of intentions to use chatbots for psychotherapy

AbstractBackgroundThe rising demand for psychotherapy exceeds therapist availability, often due to financial or physical proximity constraints. Artificial intelligence (AI), particularly through chatbots, presents a promising solution, having shown efficacy in enhancing mental health.AimsThis study investigated the psychotherapeutic relationship in the context of using chatbots for psychotherapy, in which the intimate and emotionally involving nature of the relationship might render the need for human interaction a strong deterrent to people's acceptance of anthropomorphised chatbots.MethodsThis study included four hundred ninety‐four participants, aged 15 to 69 years (M = 22.77; SD = 8.43); 75.1% of them were females. They completed scales that measure attitudes towards the use of chatbots in psychotherapy, AI and seeking professional psychological help, need for human interaction in psychotherapy, importance of anthropomorphic qualities and intentions to use chatbots in psychotherapy.ResultsIndividuals' engagement in using chatbots in psychotherapy is related to their attitudes towards chatbots and towards AI in general, not only to the importance that they place on chatbots having anthropomorphic traits, but also to the strength of their needs for human interaction in the psychotherapeutic relationship.ConclusionTechnology can enhance the psychotherapeutic process, but should not replace therapists entirely for people who seek psychological assistance.

Interior Space Design for Psychotherapy Sessions

The purpose of the present paper is to analyze the elements that can bring a state of well-being to the client in the setting of psychotherapy sessions. Every element has its own effect on the client; according to Davies (2018), for example, windows that allow the passage of sunlight could bring about a state of calm and relaxation; plants, as they are a part of nature, can also contribute to mental well-being; the way therapist and client sit is also meant to improve their relationship, and establish it on equal and friendly terms; colors should also be chosen to suggest a soothing atmosphere, and, to this purpose, greens and blues are recommended. Psychological and cultural perceptions of the psychotherapy space design will be considered, together with the recommendations of psychoanalysts such as Sigmund Freud. By examining past and present trends and recommendations, we could draw general conclusions about the psychotherapeutic relationship and the way it can be facilitated by space design.

Open notes in psychotherapy: An exploratory mixed methods survey of psychotherapy students in Switzerland.

In a growing number of countries, patients are offered access to their full online clinical records, including the narrative reports written by clinicians (the latter, referred to as "open notes"). Even in countries with mature patient online record access, access to psychotherapy notes is not mandatory. To date, no research has explored the views of psychotherapy trainees about open notes. This study aimed to explore the opinions of psychotherapy trainees in Switzerland about patients' access to psychotherapists' free-text summaries. We administered a web-based mixed methods survey to 201 psychotherapy trainees to explore their familiarity with and opinions about the impact on patients and psychotherapy practice of offering patients online access to their psychotherapy notes. Descriptive statistics were used to analyze the 42-item survey, and qualitative descriptive analysis was employed to examine written responses to four open-ended questions. Seventy-two (35.8%) trainees completed the survey. Quantitative results revealed mixed views about open notes. 75% agreed that, in general open notes were a good idea, and 94.1% agreed that education about open notes should be part of psychotherapy training. When considering impact on patients and psychotherapy, four themes emerged: (a) negative impact on therapy; (b) positive impact on therapy; (c) impact on patients; and (d) documentation. Students identified concerns related to increase in workload, harm to the psychotherapeutic relationship, and compromised quality of records. They also identified many potential benefits including better patient communication and informed consent processes. In describing impact on different therapy types, students believed that open notes might have differential impact depending on the psychotherapy approaches. Sharing psychotherapy notes is not routine but is likely to expand. This mixed methods study provides timely insights into the views of psychotherapy trainees regarding the impact of open notes on patient care and psychotherapy practice.

Recognition: A Key for Understanding a Necessary Role of the Psychotherapist for the Successful Outcome of Psychotherapy

The purpose of this paper is to focus on an aspect of psychodynamic psychotherapy that includes psychoanalysis to illustrate the important element in the psychotherapeutic relationship called recognition. This involves an emotional sharing with the patient of the importance of particular life experiences that he has had and as such this not only cements the relationship but becomes the substrate of change and an internalization of the therapist that persists after the end of treatment. This interaction parallels the experience with a responsive mother able to echo the infant's experience. The experience of recognition is illustrated with 10 case presentations that demonstrate the power of this factor in a variety of patients ranging from brief consultations to psychoanalysis.

Digital Collateral Information Through Electronic and Social Media in Psychotherapy: Comparing Clinician-reported Trends Before and During the COVID-19 Pandemic.

Patient clinical collateral information is critical for providing psychiatric and psychotherapeutic care. With the shift to primarily virtual care triggered by the COVID-19 pandemic, psychotherapists may have received less clinical information than they did when they were providing in-person care. This study assesses whether the shift to virtual care had an impact on therapists' use of patients' electronic and social media to augment clinical information that may inform psychotherapy. In 2018, we conducted a survey of a cohort of psychotherapists affiliated with McLean Hospital. We then reapproached the same cohort of providers for the current study, gathering survey responses from August 10, 2020, to September 1, 2020, for this analysis. We asked clinicians whether they viewed patients' electronic and social media in the context of their psychotherapeutic relationship, what they viewed, how much they viewed it, and their attitudes about doing so. Of the 99 respondents, 64 (64.6%) had viewed at least 1 patient's social media and 8 (8.1%) had viewed a patient's electronic media. Of those who reported viewing patients' media, 70 (97.2%) indicated they believed this information helped them provide more effective treatment. Compared with the 2018 prepandemic data, there were significantly more clinicians with>10 years of experience reporting media use in therapy. There was also a significant increase during the pandemic in the viewing of media of adult patients and a trend toward an increase in viewing of media of older adult patients. Review of patients' electronic and social media in therapy became more common among clinicians at a large psychiatric teaching hospital during the COVID-19 pandemic. These findings support continuing research about how reviewing patients' media can inform and improve clinical care.

Психоаналитический случай как нарратив и текстовая репрезентация пациента

In the article a special type (form) of clinical history – a psychoanalytic case is considered as a narrative genre that has developed in the discursive practice of psychoanalysis at the intersection of medicine and literature under the influence of S. Freud’s classical works. According to the narrative approach, author of the article discusses, how the narration is constructed within the framework of psychoanalytic cases; the functions of case-narratives are clarified. It is noted, that in practice these forms of narration serve as models for understanding and structuring the experience of dialogic interaction between the analyst and his patient (analysand). At the same time, a case narrative is a means of professional self-identification, self-presentation and positioning of a practicing specialist in his collegial environment, a way to maintain and strengthen a sense of belonging to the psychoanalytic community. Apart from this, a psychoanalytic theory also has a narrative basis, which is extremely heterogeneous. Behind any theoretical construct of classical psychoanalysis there are one key (basic) narrative and series of additional ones. These are not only clinical stories, but also myths, literary works, psychobiographies of outstanding personalities. In content, a psychoanalytic case is always an epistemological narrative, a story about self-knowledge and knowledge of each other; struc-turally, it is a double narrative that unites two stories correlated with each other: “raw” or primary, compiled from the words of the analysand and his / her relatives, and processed or secondary, formed as a result of the analysis and including the dynamics of the transformative psychotherapeutic relationships. It is also stressed, that a distinctive feature of the narration in the case is the use of embedded narratives, in particular, analysand’s dreams or fantasies. Two questions are discussed: what happens when analysand becomes the personage of his psychoanalyst, and how we can characterize the representation of patient’s personality in the text of a psychoanalytic case.

Transformation of psychotherapeutic relationships during the war

ABSTRACT In this essay, the author attempts to describe how the pressures of the crisis and the trauma created by the war in Ukraine have reshaped and transformed both her identity as a dynamic psychotherapist and her typical relationship with her patients. As both therapists and patients are grappling with their own safety and their contribution to the war effort, the therapeutic neutrality and anonymity the author had been trained to maintain are now making no sense. Through dramatic clinical vignettes illustrating these struggles, the author describes how certain feelings abound, guilt and shame for those who flee for the safety of other countries, and anger, envy and resentment for those who are left behind, and how these feelings are being played out in the therapeutic relationships. Ethical dilemma forces her to abandon her neutral stance with some patients and contribute to reshape her own sense of professional identity. In the end, through intense and anxious questioning, the search for human connection in the face of horrors seem to survive and support both patients and therapists.

Typological features of eating disorder patients: A review of publications

Despite the fact that the development and course of various types of eating disorders, and therefore their treatment, largely depend on the typological characteristics of patients, this aspect has been understudied. The purpose of the study is to review the problem of providing psychological assistance to eating disorder patients with various typological features. Using methods of analysis, synthesis, and comparison, the paper emphasises the importance of typological features of eating disorder patients in providing psychotherapeutic care. Patients with certain personality traits, such as perfectionism, the need for control, and impulsivity, have been found to be prone to eating disorders, while these typological personality traits, along with many others, have been shown to help build treatment strategies for anorexia nervosa, compulsive overeating, and bulimia nervosa. The analysis showed that there are traits specific to certain eating disorders that can be reinforced in overcoming food addiction. The influence of personal characteristics on the choice of psychotherapy strategy and the possibility of forming psychotherapeutic relationships are covered. The importance of typological features of eating disorder patients in the provision of psychotherapeutic care is revealed. To enhance the effectiveness of selecting a psychotherapeutic care strategy and establishing psychotherapeutic relationships, this paper summarises the primary personal characteristics associated with different types of eating disorders. Attention is paid to typical behavioural manifestations in the presence of one of the types of eating disorders. The main prerequisites for the development of a personality prone to dependent behaviour are substantiated. The central perspective on the role of the family in the development of an eating disorder is established. The practical value of the study lies in the possibility of using the findings to expand the understanding of the typological features of patients with food addiction to provide effective psychotherapeutic care.

Increased functional connectivity in military service members presenting a psychological closure and healing theme in art therapy masks

Military service members (SMs) have an increased risk of developing posttraumatic stress symptoms. Art therapy is a promising intervention that allows SMs with posttraumatic stress to explore their trauma through art-making and reflection in a psychotherapeutic relationship. Thematic analysis of art products may lend itself as a description of visual indicators of an internal state of the brain. We hypothesized that specific neurobiological markers are associated with the theme of psychological closure and/or healing of traumatic memories as represented in the masks created during art therapy. Resting state fMRIs of a convenience sample of 104 SMs who received art therapy as part of the interdisciplinary Intensive Outpatient Program (IOP) at the National Intrepid Center of Excellence were examined. SMs depicting psychological closure and/or healing within their art therapy masks demonstrated greater resting state functional connectivity between regions associated with attention, memory, language, and pain processing. These findings are preliminary in nature therefore causal relationships cannot be assumed between art therapy and neuroimaging metrics, as both art therapy and neuroimaging measures were collected as part of a larger integrative IOP. Future work collecting neuroimaging metrics pre and post an art therapy intervention is warranted to further evaluate these associations.

Remote Psychotherapy during the COVID-19 Pandemic: A Mixed-Methods Study on the Changes Experienced by Austrian Psychotherapists

The outbreak of the COVID-19 pandemic and associated measures to contain the SARS-CoV-2 coronavirus required a change in treatment format from face-to-face to remote psychotherapy. This study investigated the changes experienced by Austrian therapists when switching to psychotherapy at a distance. A total of 217 therapists participated in an online survey on changes experienced when switching settings. The survey was open from 26 June until 3 September 2020. Several open questions were evaluated using qualitative content analysis. The results show that the setting at a distance was appreciated by the therapists as a possibility to continue therapy even during an exceptional situation. Moreover, remote therapy offered the respondents more flexibility in terms of space and time. Nevertheless, the therapists also reported challenges of remote therapy, such as limited sensory perceptions, technical problems and signs of fatigue. They also described differences in terms of the therapeutic interventions used. There was a great deal of ambivalence in the data regarding the intensity of sessions and the establishment and/or maintenance of a psychotherapeutic relationship. Overall, the study shows that remote psychotherapy seems to have been well accepted by Austrian psychotherapists in many settings and can offer benefits. Clinical studies are also necessary to investigate in which contexts and for which patient groups the remote setting is suitable and where it is potentially contraindicated.

Born in ’47

Just like a personal ego, the zeitgeist of a practice such as psychotherapy is constantly changing, influenced by both internal and external events. As with the personal ego, not only is it changing but it is also resisting change, leading to a state of imbalance and potential conflict. A psychotherapeutic relationship can help an individual re-establish balance in the changing world and live more fully in the present, but the relationship with an organisation or group can be more challenging. Just as we can identify with our ego, so can we identify with a group: does the onus fall more on the individual or the group to adapt, both to change and to the resistance to change? What can help in this process of adaptation? With the Freudian concept of the erotic bonds of love and hate in the background, I will call on my personal story as a psychotherapist born in the year the New Zealand Association of Psychotherapists (NZAP) was founded, with the aim of exploring these questions with a focus on the changing zeitgeist of NZAP.

Trends in Adolescents' Satisfaction with Their Inpatient Psychiatric Treatment: A Panel Analysis over 7 Years

Trends in Adolescents' Satisfaction with Their Inpatient Psychiatric Treatment: A Panel Analysis over 7 Years Abstract. Because the German legislature is increasingly enabling adolescents' participation in their psychiatric treatment, we traced changes in satisfaction of 6,893 patients at the end of their stay in 10 hospitals using BEST-J. The treatments resulted in a fair overall satisfaction without any improvement over the 7 years studied. In seven hospitals, we calculated deviation from the overall satisfaction based on annual surveys. Satisfaction with the psychotherapeutic relationship was good from the beginning, whereas the relationship with caregivers improved during the sample period. When new legal standards were introduced, we measured an improvement in some items concerning patient participation (coercive measures information, goals of treatment discussed). Patients were less satisfied with the information about their illness than with medication information. Initially poor satisfaction with leave regulations significantly improved over time. Respect for privacy also improved. Satisfaction with the environment and service organization scored substantially worse than the other items. Peer relations within the ward were rated close to overall satisfaction. The results point to benefits from training in psychotherapy and a growing awareness of closeness-distance issues and patients' rights. Nevertheless, psychoeducation and leave regulations require improvement. Furthermore, patients stated unmet needs for refurbishing and renovating buildings.

OVERCOMING MENTAL TRAUMA IN CHILDREN USING FAIRYTALE THERAPY

The article deals with the problem of psychological help to children who suffered as a result of crisistraumatic events in Ukraine. These threats usually cause intense fear in situations where children witness or possibly become victims of brutal violence in their habitual living, witness the destruction of property (homes) and are forced to flee in panic. Psychotherapeutic work with a child who has experienced psychotraumatic events involves helping him to restore a sense of security, which is largely ensured by the appropriate construction of a psychotherapeutic relationship, and is also strengthened in connection with the opportunities that the child receives in the process of creating a safe environment with the help of visual materials . The article discusses typical behavioral reactions of children to mental trauma. One of the most effective means of preventing and overcoming mental trauma is the use of art therapy methods, among which fairy-tale therapy plays an important role. Fairytale therapy helps children get rid of complexes, find a way out of a difficult situation, not to lose their strength of spirit and faith in good, because evil is always defeated. Fairy tales cause an intense emotional reaction. Thanks to fairy-tale therapy, the child will be able to survive difficult psycho-emotional states and experience the process of observing military actions, forced escape from home, adaptation to a new place of living. The materials presented in the article are addressed to psychological and pedagogical workers and parents who work with children of preschool and primary school age or raise their own. An algorithm for creating a therapeutic fairy tale is provided, thanks to which specialists will be able to compose therapeutic fairy tales themselves and provide assistance to children. Informational material will help adults find the right words when communicating with a child to describe their feelings, explain some difficult things, and, most importantly, restore strength and resources for further feelings of peace, stability and joy.

Ruptures or Disruption: Identity Diffusion and the Therapeutic Relationship

In the psychotherapy of personality disorders, the limitations of the self and of interpersonal functioning that underlie all personality pathology are both a main treatment focus and a major obstacle in doing so. These limitations are most intensely manifested within the primary aspect of the psychotherapeutic relationship. The core of personality disorders–identity diffusion–refers to a self, tormented by insignificance and annihilation, and by disconnectedness and mistrust. The infant will have internalized a mental state called the alien self that persists alongside an agentive self. This split leads to two domains of primitive dyadic object relations: one dominated by projection of epistemic yearning onto an idealized object, the other by projection of self-rejection onto a demonized object. The therapist remains an alien object in this way, making cooperation within therapy momentarily or even structurally impossible, with a negative impact on the working relationship, and a greater role of the realistic relationship.

Männer sterben früher, Frauen leiden mehr

Männer leben im Durchschnitt mehrere Jahre weniger als Frauen. Dies gilt in allen Kulturen. Aufgrund der Universalität des Phänomens wurden lange Zeit biologische bzw. genetische Ursachen als selbstverständlich erachtet. Erst mit den quasiexperimentellen Analysen der sog. Kloster- und Lebensstilstudien wurden Sozialisationsbedingungen als wesentlicher Grund für die geschlechtsspezifische Mortalität belegt. Geschlecht wurde damit dekomponiert, von einem auf genotypischen und phänotypischen Merkmalen beruhenden Dimorphismus hin zu einem auf der Interaktion zwischen „Sex“ und „Gender“, also den biologischen Grundlagen und der Identitätsbildung, beruhenden eher kontinuierlichen Konstrukt. Die Pole „männlich“ und „weiblich“ werden durch eine sich über die Zeit von traditionell nach modern wandelnde Auffassung von Geschlechterrolle in Bezug auf die Dimensionen Gesellschaft, Sexualität, Persönlichkeit und Körperbau charakterisiert. Auch wenn die Polung selbst heute durch die immer stärkere Bedeutung von Transidentität und Neubewertung der Störungen der Geschlechtsentwicklung möglicherweise in Auflösung begriffen ist, sind die tradierten Geschlechterrollen nach wie vor wirkmächtig – nicht nur im Hinblick auf die Mortalität, sondern auch unter Berücksichtigung der geschlechtsspezifischen Morbidität (Krankheitslast). Die Reflexion der Bedeutung von Geschlecht ist nicht nur als gesellschaftlicher Diskurs relevant, sondern kann auch einen wichtigen Beitrag für das Agieren in der psychotherapeutischen Beziehung vom Mann-Frau- oder Nonbinärsein zum geschlechtssensiblen Handeln mit dem Anspruch eines geschlechtsaufmerksamen Bewusstseins leisten.

Managing Romantic and Sexual Feelings Towards Clients in the Psychotherapy Room in Flanders (Belgium).

It is important that therapists manage adequately their romantic and sexual feelings toward clients as it can negatively affect the psychotherapeutic relationship and may even pose a risk of sexual abuse. This study explores how psychotherapists in Flanders (Belgium) manage such feelings, by conducting both a survey (using 105 of 786 respondents for analyses, as they reported romantic feelings) and focus groups (with a total of 36 participants). Results show that most therapists never consider starting a romantic relationship with a client. They reflect profoundly on their feelings, dwell on possible consequences, while maintaining strict boundaries. Although therapists themselves highly recommend referring the client to a colleague if feelings become too intense, this rarely happens in practice. Most therapists consider talking about their romantic and sexual feelings towards clients as something very important, but only a third have disclosed their feelings in supervision, peer-supervision, or in personal therapy. Therapists indicate there is still hesitance about this due to fear of condemnation.

The Use of Interpretive Dynamic Transactional Analysis Psychotherapy (IDTAP) in Facilitating Structural Integration When Working With Reenactments of Developmental Trauma in the Psychotherapeutic Setting

The author considers how through reenactments, early developmental trauma and potential impairments in personality functioning may manifest in the psychotherapeutic relationship and how such reenactments may be underpinned by the individual’s need to control the intrapsychic dynamics through the use and control of interpersonal relationships. Some of the common transference manifestations are considered along with how they present fertile ground for resolution of the underlying internal conflicts. The article addresses this mainly through the theory and clinical examples from clients presenting with some level of personality impairment. In terms of psychotherapeutic technique, the author falls back on what he refers to as interpretive dynamic transactional analysis psychotherapy (IDTAP). There is a particular focus on reenactments of the destructive internal parts embedded in the client’s attachment to the internal bad object. The dangers of the therapist’s intention to provide the reparative relational experience are addressed along with the importance of analysis and resolution of the idealizing transference. The importance of the therapist’s function to endure and contain the negative countertransference is also discussed. Some potential interventions aimed at improving personality functioning are considered as are the implications of working with extratransference.