Therapeutic Style Research Articles

Therapeutic Identity among Clinical Psychology Professionals in India

This study explored the therapeutic identity among clinical psychology professionals in India with objectives of assessing therapeutic style, attitudes, orientation, values and its relationship with work experience, age and gender. Out of 79 clinical psychology professionals contacted, 50 gave written informed consent for participation in study. The data obtained from Psycho-Therapeutic Identity Questionnaire (ThIdQ). Cluster analysis of the responses on attitude scales revealed broad themes of therapeutic identity in the form of three cluster profiles: Vague psychodynamic assumptions with high self-doubt and low optimism about change (n = 9); Entangled in their own strong feelings of limitations and doubts as a therapist (n = 16); and Eclectic approach with low self-doubt and high optimism about change(n = 25). A lack of synchrony was seen between assessed and reported therapeutic orientation with overuse of the cognitive behavioural therapy (CBT) orientation. Correlation findings indicated that increased work experience in the field and higher age were associated with low self-doubt and high optimism about change in therapy. Findings on therapeutic identity provide mixed bag of results, positive as well as negative, with equal number of participants on each side.

The relationships between therapeutic alliance and internalizing and externalizing symptoms in Trauma-Focused Cognitive Behavioral Therapy

Therapeutic alliance has been considered an important factor in child psychotherapy and is consistently associated with positive outcomes. Nevertheless, research on alliance in the context of child trauma therapy is very scarce. This study examined the relationships between child therapeutic alliance and psychopathology in an empirically supported child trauma therapy model designed to address issues related to trauma with children and their caregivers. Specifically, we examined the extent to which the child's psychopathology would predict the establishment of a positive alliance early in treatment, as well as the association between alliance and outcome. Participants were 95 children between the ages of 7 and 12 and their caregivers, who went through a community-based Trauma-Focused Cognitive Behavioral Therapy program in Canada. Caregivers filled out the CBCL prior to assessment and following treatment. Children and therapists completed an alliance measure (TASC) at three time points throughout treatment. Symptomatology and child gender emerged as important factors predicting alliance at the beginning of treatment. Girls and internalizing children developed stronger alliances early in treatment. In addition, a strong early alliance emerged as a significant predictor of improvement in internalizing symptoms at the end of treatment. Our findings indicate that symptomatology and gender influence the development of a strong alliance in trauma therapy. We suggest that clinicians should adjust therapeutic style to better engage boys and highly externalizing children in the early stages of therapy.

Critical Distinctions Between Positionless and Positioned Spaces

This article offers a series of distinctions, not always made by Avdi and Winslade, to clarify my argument that persons can find themselves outside of workable subject positions, but that they are inherently predisposed to actively seek out positioning. First, I distinguish between the study's theoretical aims and the “data” used in its service, highlighting that I am neither supporting nor especially critiquing Bugental's therapeutic style. Second, the interactive “dance” of therapy stressed by Avdi and Winslade must be distinguished from, because it does not fully determine, the experiences of one of the dancers. Laurence is not merely a function of the therapeutic relationship, or of the therapist's power. To see him in that way effectively erases the integrity of his personal experience. Third, we should be careful not to conflate persons’ experiences with the culturally derived stories we want to tell about them. I wonder if Avdi's theorizing entails an imposition of psychoanalytic discourse on Laurence's experience of meaninglessness. Fourth, in response to Winslade, I suggest that it is useful to distinguish between language and narrative, and I argue that Laurence's use of language does not automatically qualify his words as narratives or discourses, as Winslade claims. Finally, Avdi's suggestion that one can stand “in the spaces” between positions creates an image of stranding before a feast of buffet options. But experience is not always like this, and so I suggest that occupying such liminal spaces can also be experienced as more akin to a discursive famine.

Modeling the Innovation–Decision Process: Dissemination and Adoption of a Motivational Interviewing Preparatory Procedure In Addiction Outpatient Clinics

Widespread adoption of empirically-supported treatment innovations has the potential to improve effectiveness of treatment received by individuals with substance use disorders. However, the process of disseminating such innovations has been complex, slow, and difficult. We empirically describe the dissemination and adoption of a treatment innovation—an alcohol-treatment preparatory therapeutic procedure based on motivational interviewing (MI)—in the context of Rogers' (2003) five stages of innovation–decision process (knowledge, persuasion, decision, implementation and confirmation). To this end, 145 randomly-chosen outpatient addiction treatment clinics in New York State received an onsite visit from a project trainer delivering one of three randomly-assigned dissemination intensities: a 15-minute, a half-day or a full-day presentation. Across these clinics, 141 primary administrators and 837 clinicians completed questionnaires assessing aspects of five innovation–decision stages. At each clinic, questionnaire administration occurred immediately pre- and post-dissemination, as well as 1 and 6months after dissemination. Consistent with Rogers' theory, earlier stages of the innovation–decision process predicted later stages. As hypothesized, dissemination intensity predicted clinicians' post-dissemination knowledge. Clinician baseline characteristics (including gender, pre-dissemination knowledge regarding the MI preparatory technique, education, case load, beliefs regarding the nature of alcohol problems, and beliefs and behavior with regard to therapeutic style) predicted knowledge and persuasion stage variables. One baseline clinic characteristic (i.e., clinic mean beliefs and behavior regarding an MI-consistent therapeutic style) predicted implementation stage variables. Findings suggest that dissemination strategies should accommodate clinician and clinic characteristics.

Using motivational interviewing to engage adolescents and young adults with diabetes

AbstractFor young people trying to keep diabetes under control the behaviours can appear simple; e.g. following a healthy diet, regular self‐monitoring and exercise. However, clinicians and parents are often frustrated by the gap between the ‘ideal’ and ‘reality’. Young people have conflicting motivations and pressures; a change in behaviour feels too big, the rewards too distant, the personal or financial costs too high, or maybe it was never their idea to change in the first place. Attention has turned to the potential of motivational interviewing in the paediatric setting, particularly with the adolescent age group. Motivational interviewing is a directive person‐centred therapeutic style that invites individuals to explore ambivalence and find solutions that fit for them if they identify the situation as a problem. Early trials support the use of motivational interviewing in type 1 diabetes in adolescents, either as a stand‐alone treatment or as an adjunct to other treatments where it can be a method of engaging patients in the programmes thus enabling the programmes to be more effective. This paper describes the core principles and key skills of motivational interviewing and offers clinical examples with young people and parents living with diabetes. Copyright © 2014 John Wiley & Sons, Ltd.

Diagnóstico de déficit de atención versus la familia como recurso terapéutico

This article is a reflection on the paradigm shift in the conceptualization of attention deficit disorder, having incorporated family assessment from a systemic perspective into the therapeutic approach, working not only with the patient exhibiting the symptoms, but also with the system within which the patient is embedded, that is, the nuclear family. The procedure done with a family who came to our office, desperate after years of enrollment in different treatments and therapeutic styles due to the illness of one of its members, will be analyzed.

Self-Reported Therapeutic Style in Occupational Therapy Students

Introduction: The client-therapist relationship has long been viewed as important for both the process and outcomes of occupational therapy. The recently developed Intentional Relationship Model introduced six therapeutic modes as different ways of relating to clients. Increasing students' awareness of modes, and increasing their skills in using them flexibly, has the potential of improving their subsequent practice as occupational therapists. This article aims to describe occupational therapy students' affiliation with the therapeutic modes in a variety of hypothesized practice situations. In addition, relationships between the students' affiliation with the different modes are explored. Method: The study had a cross-sectional design. Data were collected from 31 occupational therapy students in Norway, using the Self-Assessment of Modes Questionnaire. Descriptive analyses, repeated measures ANOVA tests, and correlation analyses were employed in the analytic procedures. Findings: The students identified the problem-solving mode to be their most preferred way of relating to clients, whereas the advocating mode was the least preferred. High affiliation with the problem-solving mode was significantly associated with low affiliation with the collaborating mode. Conclusion: Several limitations indicate that caution should be taken when comparing this study with previous research. Nonetheless, differences between the results of this study and previous work on the therapeutic modes are of interest. Possible explanations for differences are discussed, as are implications for practice and research.

Análisis de la conducta verbal del cliente durante el proceso terapéutico

Title: Analysis of the client's verbal behavior during the therapeutic process. Abstract: In this paper we conduct an analysis of the client behavior focusing on the main activity that is performed in session: talking. Using observational methodology we performed a topographical study of clients' verbal behavior through the development of a measuring instrument by our research group: Categorization system of the interaction of clients verbal beha- vior during the session (SISC- CVC). 92 clinical sessions from 19 cases treated by 9 therapists were observed and recorded. The results show that, in general, the client mainly provides descriptive information relevant to therapy, shows acceptance and understanding to the therapist's verbalizations aiming to inform, motivate or instruct, and expresses more frequently contents related to clinical change compared to contents opposed to the objectives pursued. We can also conclude that the clients' verbal behavior varies depending on the therapeutic activity that is taking place and is independent of the problems treated, the personal characteristics of the client or the clinician's therapeutic style.

Community Mental Health Provider Modifications to Cognitive Therapy: Implications for Sustainability

This study identified modifications to an evidence-based psychosocial treatment (cognitive therapy) within a community mental health system after clinicians had received intensive training and consultation. A coding system, consisting of four types of contextual modifications, 12 types of content-related modifications, seven levels at which modifications can occur, and a code for changes to training or evaluation processes, was applied to data from interviews with 27 clinicians who treat adult consumers within a mental health system. Nine of 12 content modifications were endorsed, and four (tailoring, integration into other therapeutic approaches, loosening structure, and drift) accounted for 65% of all modifications identified. Contextual modifications were rarely endorsed by clinicians in this sample. Modifications typically occurred at the client or clinician level. Clinicians in community mental health settings made several modifications to an evidence-based practice (EBP), often in an effort to improve the fit of the intervention to the client's needs or to the clinician's therapeutic style. These findings have implications for implementation and sustainability of EBPs in community settings, client-level outcomes, and training and consultation.

Religion and psychology in the age of emotional capitalism: The case of the Master Academy of Love

The author presents the Master Academy of Love (MAL), a project conducted by Catholics in Warsaw, Poland. The initiative is shown as typical of emotional capitalism: it resonates with the therapeutic emotional style, bolsters the social impact of psychology by combining the psychological discourse with the language of belief, employs the narrative of self-help and the narrative of suffering, and focuses on increasing the emotional competence of its audience. At the same time, the paper demonstrates MAL’s dualistic nature, that is, its innovative and conservative components. MAL is thus a project that uses the power of the therapeutic discourse to reinforce traditionalist tendencies in the Church. Eva Illouz’s (2007) considerations on the role of psychology in contemporary Western culture underpin the paper’s theoretical framework, while its empirical component is based on participant observations conducted at MAL meetings.

Make New Friends but Keep the Old: The Sisterhood Bonds that Have Shaped Me

The relationships in an Asian American psychologist's life have helped to shape her as a person as well as a professional. Specifically, a review of significant female relationships indicates that they have contributed to the author's therapeutic style. In this article, the author explores some of the relationships with other women in her life and illustrates how they have informed her role as a therapist. She concludes with a case vignette illustrating how some of these concepts were applied to a long-term therapy client.

Therapeutic Drug Monitoring of Chelating Agent Deferoxamine for <i>β</i>-Thalassemia Major Patients

Therapeutic drug monitoring is used to prevent or decrease the risk associated with the toxic effects of medication. This study aims to evaluate the potential advantages of Therapeutic Drug Monitoring (TDM) of subcutaneous Deferoxamine injection and prevention of clinical problems in β-thalassaemia major patients. Patients & Methods: Fifty-four thalassemia patients were allocated into two groups; missing, and not missing deferoxamine dose. TDM of Deferoxamine injection and it clinical outcomes was critically studied under the following subheadings: assessment of the adequacy of Deferoxamine usage, serum peak and trough concentrations of Deferoxamine and ferroxamine with needed pharmacokinetics, cardiac parameters and biomarkers, biochemical and hematological indices, adverse effects/toxicity, urinary assessment of Fe, Zn, selenium, and copper levels, compliance to treatment, dose adjustment in correlation to therapeutic index and life style. Results: Demographic data showed no significant difference. Peak plasma concentrations were 144.83±69 and 43.54±39.16 μg/L, while trough concentrations were 33±26.32 and 31.13±21.58 μg/L of Deferoxamine and ferroxamine, respectively. The elimination rate constant was 0.0237±0.00029 min-1, half-life was 34 min, and distribution volume was 0.93±0.078. Although cardiac parameters showed no significant differences, there were significant differences in CK-MB, and hsCRP levels; troponin I value could not be detected. Biochemical and hematological studies showed significant differences in Ferritin B, urea, SGPT, SGOT, alkaline phosphatase, serum albumin and serum calcium. Assessment of adverse effects/toxicity showed significant differences. The correlation of serum ferritin to therapeutic index, and the life style including Vitamin C and/or E administration were assessed for the compliance to treatment. Conclusion: Therapeutic monitoring of chelation therapy by Deferoxamine in β-thalassemia patients is necessary to ensure effective treatment, compliance, and to avoid adverse side effects and toxicity.

How Therapists Discuss Causality with Families in an Integrated Family Management and Therapy Service, a Qualitative Study with Focus Groups

Family therapy (FT) and family management (FM) approaches to psychosis have been distinguished by their understanding of causality. FM holds a biological understanding which could have negative consequences for the person with psychosis. FT, with its focus on interactions, has been criticised for its potential for implying that families are to blame for their relative’s psychosis. Although these two approaches have been integrated, the manner in which causality is discussed in family sessions within an integrated approach has not been researched. Qualitative research was conducted with clinicians working in an established integrated family intervention service to explore how they discuss causality. Four focus groups were conducted and a framework approach to thematic analysis used. Four themes developed from the analysis: how a shared understanding of causality is constructed; the use of an ‘explorative conversational’ therapeutic style to discuss causality; factors that limited the exploration of causality; and the challenges of working with issues of blame. The stress-vulnerability model, genograms, interactional-cycles and formulation were identified as useful tools to develop a shared understanding of causality. The therapeutic style of ‘explorative conversation’–based in FT, integrated with the stress-vulnerability model–based in FM, was identified as key to the integrated model and clinicians felt these two aspects addressed the criticisms that have been levelled at each approach. Complex family problems, abuse and illicit drug use were factors that challenged causality discussions. Families feeling blamed/blaming themselves and attempts to transform blame made up a dominant theme of the research.

Turkish University Students’ Preference from Rogers, Perls, Ellis and Their Therapeutic Styles

Shostrom (1965a, b, c)’ profound studies “Three Approaches to Psychotherapy” (TAP) scrutinized by 410 Turkish university students. Three deferent programs from one department of fourth grade students evaluated their preference in 29 items Counseling Preference Inventory. There are significant deference between three programs of students in their counseling theories and theorist's preference in terms of gender, program, GPA, SES and worldview. Both genders preferred Ellis but male preference respectively more than female. Although preschool teacher students preferred Person Centered Therapy and Carl Rogers but primary school education students preferred Rational Behavioral Emotive Therapy and Albert Ellis. Preference of science educations teacher students is also towards to Rational Behavioral Emotive Therapy and Albert Ellis. Although low achievers preferred Rogers, middle and higher achievers preferred Ellis. The same sudation which held in GPA also seen in the socioeconomic status. Conservative and democratic students preferred Ellis, tendency of liberal students toward Rogers. This study seems to be very interesting in terms of it is first meet of Turkish university students with Rogers, Perls and Ellis.

On Tone, Play, and Healing: Commentary on Riordan's Case Studies

The clinical work reported by Riordan (2012) is discussed, with attention to prosody (tone) and other subjectively inferred aspects of his therapeutic style with narcissistically troubled clients. Consideration is also given to cultural contexts relevant to understanding the reported increase in narcissistic problems in contemporary patients, the personality and genuineness of the therapist as factors in psychological healing, and the role of play and playfulness in reducing the suffering of clients who rely on narcissistic defenses to compensate for a fragile, erratic, or unrealistic sense of self-esteem. The focus throughout is on the less specifiable, more artistic elements of the psychotherapy process.

Reasons of Turkish University Students Preference from Three Different Therapeutic Styles

When students’ fail in their reading and writing development it also affects their self-esteem and self-confidence. Too many students in Sweden fail in literacy development and therefore don’t reach the goal stated in the curriculum. Their future education will not be what students had wished, instead they are more or less forced to enter an individual program at high school or quit after nine year in compulsory school. Many of these students have low self-esteem and self-confidence and their self-efficacy are also low when entering high school. The aim of this part of a longitudinal Grounded Theory-study was to conceptualize and generate a theory about what four teachers and their students in high school actually do when working with reading and writing using a specific method. The results based on qualitative research interviews, observations, questionnaires, video recording, and analysis in the tradition of grounded theory, show how teacher and students strive to increase and ensure every student in their reading and writing skills through what is labelled didactic arranging. Teachers’ systematic work with reading and writing, their self-efficacy and beliefs in every student’s possibilities helps students to increase their self-esteem and self-confidence.

The development of therapeutic attitudes during and after psychotherapy training

The aim of this study was to explore changes in psychotherapeutic attitudes of students during training in psychodynamic psychotherapy and the first few years after it. Forty-six students were asked to answer a therapeutic identity questionnaire at three times during training and at one time after it. Twenty-one students completed the questionnaire on all four occasions. The questionnaire assessed attitudes on nine scales relating to beliefs about curative elements in psychotherapy, therapeutic style, and basic assumptions about psychotherapy and human nature. At the beginning of training, students had a clear psychoanalytical orientation, similar to that of their supervisors. From the last year of training, after supervision had ended, and continuing during the post-training period, students distanced themselves from the psychoanalytical orientation and their supervisors toward a more eclectic position. This development may reflect the formation of an autonomous therapeutic identity.

The Use of the Telephone to Extend Our Therapeutic Availability

The popularity of the ongoing use of telephone sessions as a legitimate mode of conducting psychotherapy is a cause for concern. This article discusses its limitations as well as appreciates its effectiveness with a select group of patients. Embarking on psychotherapy by telephone requires the pre-existence of a good psychotherapeutic alliance and the development of some stability in the patient's life. Many patients do not take to communicating by telephone. The need of a more active therapeutic style will be commented upon. The workability and the quality of the telephone sessions need to be ever re-evaluated, as the patient and the circumstances will change.

Editorial: Taking risks (by examining our practice) — Encouragement to address the couple relationship

Working with couples in distress is notoriously difficult. The balance between empathic understanding on the one side and stretching constrictively and sensitively the boundaries of the familiar is a difficult task. A reason why this is experienced as rather challenging is the high intensity of emotions in the therapy room. There can be rapid escalations of emotional exchanges so that, as the clinician, one minute you can be listening to a couple that seem to be trying to be reasonable with and understand each other, and in the next the partners are metaphorically at each other’s throats. These negative spirals that distressed couples create, and are victimized by, can be rather overwhelming (Johnson, 2008). Salvador Minuchin was one of the earliest therapists to have developed a theoretical and practical framework of working with interactions that take place in the therapy room (Minuchin, 1974). He introduced some very powerful techniques such as “enactment”, “intensification” and “unbalancing”, as part of a therapeutic goal of bringing into the room the couple relational issues which needed to be addressed (Minuchin & Fishman, 1981). Often these required the clinician to be more directive at times than her/his usual therapeutic style. Contemporary use of these techniques can be difficult for trainees and newly qualified professionals, who may have been trained in more explicitly collaborative approaches to psychology and psychotherapy. Politically, it can often be a thorny issue when one declares the importance of the couple relationship, for example in relation to problems displayed by children. Many family therapists, for example, are more comfortable working with parenting issues than moving into what some perceive to be the more risky territory of exploring with a couple how their marital, including sexual, issues may be impacting on their children. The term “couple therapy” has taken over from the original, now more value-laden, and for most in the West, outdated term “marital therapy”. These changes in accepted terminology often reflect changes in cultural and societal norms. Changing patterns and expectations of family life, for example in Western cultures, have required psychotherapists and other clinicians to keep up with these changes in people’s relational lives. Robert E. Emery, in writing about “the changing family”, echoes this by reminding us that from different perspectives, such as historical or anthropological, it has been documented that the contemporary Western family is “a continually evolving system” (Emery, 1999, p. 6). He describes how the functions of families and their structures have been continuously changing. In her rich book entitled Family Therapy in Changing Times, Gill Gorell Barnes writes that family relationships need to be re-thought if we in the mental health professions want to keep up with the diversification of family life in the UK:

Snapshots: Moments in time with children and families

This paper describes a variety of ways of working briefly with children, within the context of the family court system, some of the complexities and difficulties that may be encountered and some of the ethical dilemmas which arise particularly those that result from trying to meet the expectations of instructing solicitors and the court system. It is also about my search for a distinctively counselling psychology approach which relies less on psychometric measurements and diagnostic criteria and uses a more qualitative and therapeutic style to assist the parents and families involved so that the child and family may benefit. Our legal system will only fund assessments and not therapy, but within that framework it is sometimes possible to bring about therapeutic change.