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Self-critical perfectionism has been linked to alliance impairments due to patients' distancing attitudes. However, systematic research on therapists' emotional experiencing when working with self-critical patients is scarce. This qualitative study explores how therapists perceive, emotionally experience, and react to self-critical patients' interpersonal dynamics. We studied narrative data from clinical supervisions where psychodynamic psychotherapists discussed self-critical patients (N = 7) within the context of an RCT on Major Depressive Disorder. Consensual Qualitative Research was applied to identify recurrent patterns in the data. As a global impediment to treatment, therapists observed a pattern of non-engagement. Patients' superficial and avoidant way of communicating, hostility or aggressiveness in the alliance, and low or inaccurate treatment expectations emerged as main obstacles to the therapeutic process, evoking negative affect in therapists. More vulnerable aspects of the patient and case formulation emerged as having a mitigating effect on unfavorable therapist reactions. Our findings confirm longstanding clinical and theoretical accounts associating therapeutic work with self-critical patients with negative affect in therapists. Our study suggests that negative responses may be enacted in therapy which can reinforce poor alliance. We discuss the role of supervision in helping therapists to become aware of and manage negative responses, engage in case conceptualization, and advance clinical work. [ABSTRACT FROM AUTHOR]

Despite considerable scientific interest in the negative symptoms of psychosis, the subjective dimension of these experiences has barely been studied. This paper aims at addressing this shortcoming by means of an Interpretative Phenomenological Analysis of semi-structured interviews with 12 participants with a psychotic disorder. The analysis yielded three major themes: 1) negative symptoms can be conceptualized as a failure of narratives to account for perplexing experiences participants are confronted with in psychosis; 2) negative symptoms challenge participants to make sense of them with meta-narratives; 3) participants highlight a withdrawn attitude towards life after psychosis. The standard characterization of negative symptoms as a loss of normal functioning should be revised, as this does not match participants' subjective experiences. Negative symptoms rather represent hard to verbalize experiences. This difficulty of linguistic expression is not 20 a shortcoming of the person experiencing them, but characteristic of the experiences themselves. [ABSTRACT FROM AUTHOR]

Patients with functional somatic syndromes (FSS) often display troubled relationships with health care providers, psychotherapists, and significant others. Research shows that patients' history of trauma, attachment disturbances, and mentalization deficits may result in the emergence of maladaptive interpersonal patterns, which may later contribute to the onset and maintenance of FSS, "doctor hopping," and dropout in psychotherapy. As the nature and therapeutic consequences of such maladaptive interpersonal patterns in FSS cannot be understood sufficiently by quantitative methods alone, there is a need for in-depth qualitative research. To address this issue, we conducted a metasynthesis of 23 published case studies of patients with FSS from various psychotherapeutic orientations. Results show that patients with FSS from our sample perceived others as unreliable, that is, unavailable, overcontrolling, and overprotective. To adapt to such unreliable others, patients attempted to please and to control them. Patients also suppressed their emotional awareness and expression. Although alexithymia could also play a role, the primary reason for emotional avoidance seemed to be interpersonal in nature, that is, patients were avoiding negative emotions in order to please and control the unreliable others. The onset and worsening of FSS were associated with both interpersonal and physical triggers. Showing signs of physical or emotional distress led to more rejection, overcontrol, and overprotection from unreliable others, which could create a "vicious circle." Our results suggest that offering a more interpersonal perspective on emotion regulation difficulties would be beneficial for patients with FSS, counselors, psychotherapists, and other health care professionals. [ABSTRACT FROM AUTHOR]