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In Western culture, "hearing voices" is often considered a symptom of mental illness. After reinterpreting this phenomenon from perspectives that emphasise the socio-cultural aspects of the construction of these voices, this paper describes a case report involving a psychological intervention divided into six phases. The aim is to challenge the dominant narratives that stigmatise the experience of hearing voices, and propose alternative meanings that can improve the hearer's ability to manage the voices by converting them from a disease into a personal and relational resource. Using the metaphor of an "inner dialogue", we show how changes in the client's interpretation of the voices, and way of relating to them, can be co-constructed by the client and the therapist. The paper concludes with some critical reflections on the medicalisation of mental distress, highlighting the importance of expanding our understanding of the experience of hearing voices, not only in clinical terms, but also on a social and cultural level. [ABSTRACT FROM AUTHOR]

This paper explores core adaptive emotions, both negative and positive, and investigates their respective roles in the transformation of emotional suffering into flourishing. We do so through the lens of Accelerated Experiential Dynamic Psychotherapy (AEDP), a mind/body, emotion-focused, healing-oriented model of psychotherapy that has articulated a four state phenomenology of the transformational process. Through such a transformational process, energy-consuming negative emotions are transformed into energy-enriching positive emotions, thus describing an arc that organically links the negative emotions of emotional suffering with the positive emotions of flourishing. AEDP achieves this through (i) amplifying the vitality affects that identify positive neuroplasticity through therapist transformance detection; (ii) experientially processing to completion the "gut-wrenching" emotions of trauma, and then, (iii) "turbocharging" the innate affects of healing to expand transformation through metatherapeutic processing, a technique for working with positive emotions to maximize their therapeutic impact. We conclude with thoughts on how metatherapeutic processing might be used by therapists of different orientations to systematically bring flourishing into psychotherapy sessions and on how AEDP's descriptive phenomenology of affective states can function as a trans-theoretical vehicle of communication to further the exploration of the neurobiological mechanisms underlying change processes in psychotherapy. [ABSTRACT FROM AUTHOR]

The science of well-being has catalyzed a tremendous amount of research with no area more robust in application and impact than the science of character strengths. As the empirical links between character strengths and positive outcomes rapidly grow, the research around strength imbalances and the use of strengths with problems and conflicts is nascent. The use of character strengths in understanding and handling life suffering as well as emerging from it, is particularly aligned within second wave positive psychology. Areas of particular promise include strengths overuse and strengths underuse, alongside its companion of strengths optimal use. The latter is viewed as the golden mean of character strengths which refers to the expression of the right combination of strengths, to the right degree, and in the right situation. This paper discusses these constructs, maps out each across 24 universal character strengths, and deliberates on reasons for overuse and underuse. Practical strategies for counselors to support clients in the pursuit of optimal strengths use and the management of overuse and underuse are outlined. These include thoughts on wise interventions, the tempering effect, the towing effect, direct questioning, mindfulness, strengths-spotting, the use of a leading strengths model (aware-explore-apply), and eliciting feedback from others. [ABSTRACT FROM AUTHOR]

Objectives: The diagnosis of schizophrenia does not feature prominently in counselling psychology literature, and there is a distinct lack of empirical research pertaining to how counselling psychologists construct this diagnosis, as well as accounts of their experiences of working with this client group. This study aimed to explore how counselling psychologists in working with schizophrenia, experience the work and construct the diagnosis. Design: A social constructionist branch of discourse analysis known as critical discursive psychology was adopted as the researchers were interested in the organisation of talk, as well as the social and culturally resonant interpretative resources the participants draw upon in research. Method: A version of discourse analysis known as ‘critical discursive psychology’ is used to analyse how eight counselling psychologists talk about and around the diagnosis of schizophrenia in semi-structured interviews. Results: Three main interpretative repertoires will be expanded on in relation to the analysis; Relating to the Individual's Experience; The Therapeutic Relationship – The Contrarian Subject Position and Normalising the Experience – The Egalitarian Subject Position. Conclusion: These findings suggest that although counselling psychologists construct their experiences of working with individuals diagnosed with schizophrenia in a ‘relational’ way (e.g. through relating to the individual's experience and normalising the experience), the dangers of using language that pathologises is always present. This paper concludes with noting the inroads that have been made into an area where counselling psychology has been traditionally underrepresented, and what type of influence this will have on counselling psychology in the future. [ABSTRACT FROM PUBLISHER]

This qualitative study's objective was to understand how failure in psychotherapy develops from depressed patients' perspective. Forty-seven patients were interviewed after brief psychotherapy. Data analysis was conducted according to Grounded Theory. Patients evaluated their own psychotherapies' outcome according to their subjective criteria. Then, negative, positive and mixed-results evaluations were compared in the main categories. Results showed that patients reporting negative evaluations considered null or adverse outcomes as failure. Distrust in their psychotherapists (both as persons and professionals) developed in early stages of the process and was apparently hard to revert. This early onset of distrust led patients to a lack of collaboration and an unreceptive attitude. They perceived their psychotherapist as not understanding, distant, and uninterested, losing focus on relevant problems and not providing new information. The relationship was experienced as uncomfortable and distant, and sometimes became harmful. Therefore, distrust led patients to regard their psychotherapies as an unhelpful experience, in contrast to what occurred in patients with positive or mixed results evaluations. Conclusions contribute to a clarification of how patients conceptualize failure and suggest reevaluating the relevance of their perspective, which seems not to be fully reflected in current outcome measures. Clinicians should consider building trust as a baseline and encourage patients to disclose even the earliest negative feelings about treatment and psychotherapist [ABSTRACT FROM AUTHOR]

Shared decision-making about therapeutic methods has been proposed as a way of conceptualising, and assisting, collaboration in the therapeutic alliance. However, little is known about how psychotherapists actually create concrete, moment-by-moment opportunities for clients to share their ideas about what might be therapeutically helpful. We used conversation analysis to examine psychotherapists' questions about what might be helpful in audio-recordings of early sessions of a collaborative-integrative therapy. We examined forty-two sessions involving seven dyads and identified 28 cases of questions either inviting clients' ideas about helpful in-therapy methods or strategies outside the therapy room. Psychotherapists could invite clients' ideas by using simple questions, however clients could find such questions problematic. Alternatively, psychotherapists could add scaffolding: offering support to the client in terms of how they might respond. However, this could erode clients' autonomy to respond with their own ideas. We identified a conversational practice, de-specifying, which overcomes this dilemma: asking questions and providing scaffolding whilst also lessening the pressure on the client to go along with that scaffolding. A therapeutic style which includes scaffolding and de-specifying practices creates an opportunity for the client to contribute where clients are empathically supported, but not directed, in responding. [ABSTRACT FROM AUTHOR]

To gain insights into psychologists' experience of working with refugees in Brazil, semi-structured interviews with 14 psychologists were conducted and analysed using thematic analysis. Results showed that participants experienced operating in a novel, precarious and xenophobic context, which led them to move beyond classical psychological work, engage in practical assistance and become very close to clients. Psychologists reported lack of public structures, insufficient competencies and high levels of fatigue. At the same time, they described gaining new perspectives and benefiting from witnessing their clients' resilience. In terms of facilitators for the work with refugees, participants pointed to the importance of psychologists being flexible, authentic, of showing a high frustration tolerance and of making use of group-based approaches. Participants suggested that, in order to better refugees' mental health in Brazil, efforts should focus on adopting a more social perspective in psychology, developing anti-discrimination campaigns, building policies for refugee' inclusion and scaling up investments in mental healthcare in general. Suggestions for future research are made, as well as for psychologists who work with refugees, such as fostering a more collectivity-focused and contextual understanding of mental health. [ABSTRACT FROM AUTHOR]

First-hand experience of being a client is regarded by many psychotherapists as making an essential contribution to professional development. Although research has not established any direct influence on client outcome, arising from therapist participation in personal therapy, qualitative studies have explored how therapists transfer learning from one context to the other. A group of six therapists-researchers engaged in a collective autoethnography in which we shared narrative accounts of our own experiences as clients. Together we covered a wide set of therapies, sought for varied purposes, and from different stages in the life-course. Different areas of learning were identified: negative experiences could strengthen own convictions for acting differently; positive experiences worked as inspiration and support; being in therapy early in life represented a significant formative experience; working through complex personal issues in therapy gave the courage to identify similar conflicts in phantasies and realities of clients. The link between having been a client and working as a therapist is a subjective, reflective process of reworking figure and ground in the search for professional sensitivity. [ABSTRACT FROM AUTHOR]

We investigated differences in negative indicators and topics discussed during intakes for one engager and one non-engager (i.e. dropout) client for each of 18 therapists in psychodynamic psychotherapy. Results indicated that engager clients had fewer negative indicators (patient-therapist interaction, errors in techniques) and more coverage of client goals for treatment than did non-engager clients. Engager and non-engager clients did not differ in terms of client pathology, therapist countertransference, or order in which they were seen in the clinic. Preliminary findings suggest that therapists should be educated about negative processes and encouraged to discuss client goals to lessen the likelihood of dropout. [ABSTRACT FROM AUTHOR]

Despite high rates of mental health difficulties, low-income individuals are less likely to access mental health services and show fewer improvements when they do compared to middle-income clients (Falconnier, 2009). A handful of studies have shown, however, that when interventions are altered to address poverty-related stressors, they become more effective (e.g. Miranda, Azocar, et al., 2003). Although this research is extraordinarily valuable, we know little about how mental health practitioners working in naturalistic settings think about and tailor their practices to meet the unique challenges of working with clients who are impoverished. Such grassroots, practice-based knowledge could contribute to efforts to adapt interventions. This qualitative descriptive study of experienced psychologists working with clients in poverty aimed to fill this gap. Results indicate that psychologists often develop unique practices specific to clients in poverty. These include practices for addressing power dynamics, managing boundaries, and working with the relationship between intrapsychic and contextual poverty-related stressors. Perhaps the most striking finding of this study involves how participants conceptualized and enacted boundaries in the context of work with this population. These findings are discussed in the context of feminist theoretical models and current research. Implications for research, practice, and training are highlighted. [ABSTRACT FROM AUTHOR]

The goal of this study was to evaluate the relationship between basic psychological needs satisfaction and working alliance in psychotherapy and to determine whether client ratings of basic needs and working alliance during psychotherapy were associated with early termination of therapy. Former psychotherapy clients (n = 87) completed a semi-structured interview regarding basic needs satisfaction in therapy, working alliance and dropout status. Participant ratings on the Basic Needs Satisfaction in Psychotherapy scale (BNSP) and the Retrospective Working Alliance Inventory - Short (RWAI-S) were significantly correlated (r = .77) in our sample. A comparison of intercorrelations between working alliance subscales and basic needs subscales indicated higher factorial distinctiveness within the basic needs measure. T-tests comparing those who terminated psychotherapy early with those who had planned endings on scores on the BNSP and RWAI-S were significant (Cohen's d = .65 and 1.82, respectively). Results suggest that the basic needs measure might tap into a wider breadth of the therapist and client interaction than the RWAI-S. [ABSTRACT FROM AUTHOR]

Progress in psychotherapy is typically irregular, as advances alternate with setbacks. This study investigated the therapist's activities prior to two main types of setbacks, one involving the client following therapist proposals and one involving the client failing to follow from therapist proposals, in the case of a poor-outcome client treated with a linguistically-oriented kind of cognitive therapy. Setbacks were defined as decreases of at least one level on an index of therapeutic progress, the 8-level Assimilation of Problematic Experiences Scale (APES), in adjacent client passages. Therapist activities were coded in 361 setback episodes that each included a client pre-setback passage, a therapist passage, and a client setback passage; both client passages had been previously rated on the APES. The main categories of therapist activities showed distinctive patterns in relation to the two main types of setbacks, the therapeutic zone of proximal development and the balance strategy. The two main patterns were described as an exploratory and a challenging configuration. These patterns of therapist activities and setbacks showed how the therapist seemed to persevere with approach-guided interventions while this poor-outcome client continued to have setbacks to low APES levels. [ABSTRACT FROM AUTHOR]

Objective: This study examined alliance rupture and repair processes in borderline personality disorder (BPD) and how the content of sessions interacts with the quality of the alliance. Design: A mixed methods single case study design was employed incorporating quantitative and qualitative measures of process and outcome. Methods: This case study examined a 22-year-old female with BPD who received 16 sessions of Cognitive Analytic Therapy. Measures of alliance, symptoms and global functioning were taken across multiple time-points. Selected sessions were analysed using dialogical sequence analysis (DSA), a theory-driven method of psychotherapy research that analyses utterances according to their author, addressee and referential object. Results: Quantitative data indicated symptom reduction without functional improvement. DSA demonstrated that the first exchanges in therapy were reflective of key relational themes. The case suggests that, rather than simply negotiating tasks and goals, repairing ruptures involves systematically linking the manifest topic to the client’s core problems. Conclusions: This case study points to the mediating role that the content of sessions has on alliance quality. Results underline the importance of the therapist stance, the need for a shared formulation to make sense of relational processes and the use of responsively timed interventions to decrease desperation and improve self-reflection. [ABSTRACT FROM AUTHOR]

The components of a tripartite model of the therapeutic relationship, namely the working alliance, the transference configuration (transference and counter-transference), and real relationship, were examined in terms of how they relate to one another and to the outcome of a psychotherapy session, from the therapists' perspective. Although previous studies have examined these components separately, no study to date has examined the components together in their relation to session outcome. Licensed psychotherapists (n = 249) were recruited from two Divisions of the American Psychological Association. Therapists completed measures for the last session they had with a client. Results revealed that from the therapist's perspective the real relationship and working alliance related positively to session outcome, and countertransference behavior related negatively to session outcome. The components related to each other mostly as predicted by the tripartite model, and a principal-axis factor analysis revealed the presence of four distinct factors resembling the components theorized to comprise the tripartite model. The components together accounted for 27% of the variance in session outcome and only the real relationship and the working alliance predicted session outcome when all the components were looked at simultaneously in a regression model. [ABSTRACT FROM AUTHOR]

This study examined therapists’ self-disclosure within early sessions of a naturalistic database of 52 therapy dyads collected at a university counseling center. Therapist orientations and client issues varied. We identified both types and functions of therapist self-disclosure in order to explore how self-disclosures related to therapy alliance and outcomes. Findings indicated that the number of disclosures was not significantly correlated with outcome or alliance scores. Central findings regarding the function of self-disclosures included that disclosures that acted to humanize the therapist were associated with fewer clinical symptoms post-session than disclosures expressing appreciation or encouragement. Also, disclosures that conveyed similarity between the therapist and client were associated with fewer post-session clinical symptoms and interpersonal problems when compared to disclosures that conveyed neither similarity nor dissimilarity. As well, neutral therapist self-disclosures were associated with better client functioning than disclosures that relayed negative or positive information about the therapist. Suggestions are provided for clinical practice and future research. [ABSTRACT FROM AUTHOR]

This article explores how flow theory and the serious leisure perspective (SLP) can be integrated into mental health counseling. Although different counseling models have acknowledged the role of leisure in the counseling process, leisure is largely an unknown and superficial concept in the mental health counseling literature. Four broad-based pragmatic ideas regarding how flow theory and the SLP can be integrated into the counseling process include mental health counselors (1) understanding the concepts of serious leisure, casual leisure, project-based leisure, flow (enjoyment), and hedonistic pleasure; (2) becoming aware of various assessment instruments that measure flow and serious leisure; (3) using the provision characteristics of entering flow into the counseling process; and (4) empowering clients to becoming community change agents through serious leisure pursuit, resulting in flow experiences. [ABSTRACT FROM AUTHOR]

Eight Chinese counselors were interviewed about their use of directives in counseling. They typically believed that directives can be beneficial in counseling Chinese clients. They used directives to extend the influence of counseling beyond sessions, meet client needs and expectations, and fit their own personality and orientation. In terms of conditions that need to be met for directives to be helpful, they identified client factors such as readiness, communication styles, past experience, and insight; the counselor factor of ability to communicate directives; and the therapeutic relationship. They emphasized the importance of clients acquiring a new perspective as a result of directives. Cultural factors in using directives are discussed. [ABSTRACT FROM AUTHOR]

Understanding how assimilation develops is essential in promoting personal change. By attending to signs or indices of assimilation in the speech of clients, therapists can use this process to assess how the therapy is developing and to tailor intervention. The system of assimilation indices was developed to use assimilation to understand the process of change. This system signals five sub-processes of assimilation: external distress, pain, noticing, decentring, and action. This study consisted of a longitudinal mixed-method analysis, following a multiple cases embedded design. The system of assimilation indices was applied to the recordings of nine psychotherapies and contrasted with both the outcome of the therapy and the perspectives of the therapists and clients about their therapy process. The results show that the system of indices is useful in understanding multiple pathways for assimilation. The system of indices is seen as a useful tool for understanding assimilation and as having clinical value in anticipating challenges to the success of the therapy. This study also shows how the indices are sensitive to the nuances in the change process observed in clinical settings. [ABSTRACT FROM AUTHOR]

A significant proportion of the counselling that people receive takes place within informal, situated encounters between service users and practitioners in fields such as nursing, medicine, teaching and social work. However, almost all of the research that has been carried out into the process and outcomes of counselling consists of studies of formal, contracted counselling and psychotherapy based in therapy clinics and offices. The competent and effective delivery of counselling that is embedded in a primary professional role, such as that of nurse, teacher or social worker, presents considerable challenges for practitioners. Research evidence around the process and outcomes of embedded counselling represents a valuable resource that has the potential to enhance the quality of counselling conversations enacted by practitioners in health, education, social work and other professions. An overview is provided of different types of research that has been carried out into informal and embedded counselling, and of the main themes that have emerged from these studies. Suggestions are made for the further development of this field. [ABSTRACT FROM AUTHOR]

This naturalistic study examined the relationship between two types of therapist empathy, intellectual empathy and empathic emotion, and client-perceived working alliance (WA) in China. The study adopted the definitions and assessment methods of empathy recommended by Duan and Hill and used the theory of WA by Bordin and WA Inventory-Short by Tracey and Kokotovic. Eighty-six clients and 43 therapists from a university counselling centre at a comprehensive university in China participated in the study. Therapist intellectual empathy and empathic emotion and client-reported WA measured in six consecutive sessions from the second through the seventh session were assessed for each session. The results of multilevel modelling analyses showed that client-perceived WA increased significantly session after session, and therapist empathic emotion significantly predicted Tasks of WA. Moreover, there was significant therapist effect associated with Bond. In the context of empathy and WA research findings reported in the USA, some of the non-significant results of this study were intriguing. We discuss the study results with particular attention to the Chinese cultural context and present suggestions for future research. [ABSTRACT FROM AUTHOR]

This study extends prior research that identified client-derived variables believed to contribute to therapeutic alliance development. Forty-two clients participated in a three-round-modified Delphi poll in which the subjective importance of 74 client-derived, common alliance formation variables was rated using a six-point scale. Participants consensually identified 23 variables as highly important, five as moderately important and three as low in importance to the formation of a strong alliance. Variables related to validation and asking about parts of the client’s life other than the presenting concern were considered as most important by at least one-third of the sample. Limitations of the study are presented and implications for theory, measurement, practice and future research are briefly discussed. [ABSTRACT FROM PUBLISHER]

Six client/therapist dyads (three therapists each working with two clients) were studied to determine how the real relationship unfolds over the course of time-limited treatment and how this unfolding relates to the development of the client/therapist working alliance, client transference, and therapist countertransference. We also examined how these indices of the relationship fluctuate as a function of treatment outcome. Results indicate that in general for all six dyads, therapists’ and clients’ ratings of the real relationship and working alliance were strong throughout treatment. However, patterns of real relationship and working alliance over the course of treatment varied between dyads categorized as more vs. less successful. Therapists’ countertransference was low, as was client transference, but differences in ratings were evident when the dyads were classified by outcome. [ABSTRACT FROM PUBLISHER]

An analog study was conducted to examine differences in women’s preference for and anticipated comfort self-disclosing to hypothetical therapists of different sexes based on the type of hypothetical presenting problem. The impact of general level of self-disclosure was also examined. Participants included female college students (n = 187). Anticipated comfort self-disclosing to male or female therapist was rated by subjects when presented with therapists of each sex with the same qualifications. Women preferred and reported higher levels of anticipated comfort self-disclosing to a female therapist. The type of hypothetical presenting problem and general level of self-disclosure also impacted anticipated comfort self-disclosing. There was an interaction between general level self-disclosure and the sex of therapist on anticipated comfort self-disclosing. General level of self-disclosure only impacted anticipated comfort self-disclosing when the therapist was male. This information is relevant for therapists or organizations that provide psychosocial services to women. Organizations may want to inquire about a client’s preferences about sex of therapist beforehand and, if possible, cater to the client’s preference. [ABSTRACT FROM PUBLISHER]

Many religiously committed clients show concern to work on psychological problems with a professional who is similarly committed, and highly religious clients demonstrate resistance to engaging with professionals who are not. By exploring Christian clients’ constructions of their counselling experiences, the present study's aim was to understand something of the complexity behind such insistence, rather than leave it as a taken-for-granted aspect of a general therapist-client matching hypothesis. Adopting the view that Christians comprise a socio-cultural group, we employed discourse analytic techniques to explore the interpretative repertoires evident in transcript data from interviews with six Christian clients who had sought and received professional counselling from a counsellor who was a Christian. The ‘client discourse’ and the ‘Christian discourse’ and their component interpretative repertoires, are presented. We then discuss crucial issues for the Christian client by forming an intersection of the discourses and repertoires involved. Finally, acknowledging the small scale of this exploration, we highlight implications for further research and practice. [ABSTRACT FROM PUBLISHER]

There has been curiously little empirical investigation into the experiences of psychotherapeutic practitioners undertaking a mandatory training therapy. We present results from a qualitatively-driven mixed-methods study designed to explore the way in which counselling psychologists' attachment status and levels of reflective function intersect with how they experience the therapeutic relationship within their personal therapy. Participants were interviewed twice: once using Main and Goldwyn's (1998) Adult Attachment Interview (AAI) to explore representations of early childhood relationships; and subsequently using a semi-structured interview format, analysed via Interpretative Phenomenological Analysis (IPA), to explore experiences of personal therapy. Meshing results from both sets of data showed that insecurely-attached participants experienced their personal therapy differently from secure or earned-secure participants, and were more troubled by a perceived disparity of institutional and interpersonal power within the therapeutic relationship. Results are considered in terms of the power dynamics within training therapy. Implications for training and future research in this neglected field are briefly discussed. [ABSTRACT FROM AUTHOR]

Significant events research represents a specific approach to studying client-identified important moments in the therapy process. Significant events studies in some instances look at the relationship of the prevalent type of events and therapy outcome. However, they normally do not link significant events with the progress achieved in therapy. This study addresses the issue of whether therapeutic change in a successful therapy case is visible in helpful significant events throughout the course of therapy. For that purpose, 59 client identified helpful significant events from one therapy case were analysed, namely the session transcripts and transcripts from subsequent post-session interviews wherein the client and the therapist reflected on the events. The qualitative analysis of the discussed content, the therapeutic interaction within the events and the helpful impact in the events resulted in a taxonomy of 14 mutually exclusive types of events. Significant events were focused either on the building of the therapeutic relationship or on in-session changes potentially contributing to the outcome. Some of the events which contributed to the building of therapeutic relationship also provided corrective interpersonal and emotional experience. The therapeutic benefits reported by the client in post-session interviews seemed to conceptually fit client improvement as observed in the client stated presenting issues and the changes reported in the post-therapy interview. [ABSTRACT FROM AUTHOR]