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In this paper I examine two important issues for family therapy research. I attend to the concept of complaints, highlighting the conversational structure they take in a family therapy setting. I do this by outlining how clients construct their complaints and examining how the family therapist receives them. Data is taken from a corpus containing four different families and two different therapists, and is subjected to discursive analysis in order to provide a rich analysis of not just what is happening in the talk but how it is happening. I conclude that complaints are not received as useful to the therapeutic process, despite their constructed importance to the client, and therefore there are wider implications for therapy and professionals more generally, particularly implications for multi-agency communication. [ABSTRACT FROM AUTHOR]

Bilingualism has risen dramatically due to increased migration patterns all over the world. This paper offers an overview of the current literature dealing specifically with bi- and multilingualism, and identifies a gap in systemic and family therapy literature about the subject of bilingualism. In the light of this, the author proposes a working definition of bilingual families. Some case examples illustrate different aspects of working systemically with a bilingual family and highlight potential challenges for a therapist, such as the assumption of more knowledge and expertise. The tools suggested relate to a rethinking of some modernist ideas regarding hypothesizing, and both the use of a social constructionist perspective and of self of the (bilingual) family therapist. A case is made for the exploration of meanings of difference including the lingua-cultural one. The author ends with a plea to start including more specific cultural issues such as bilingualism in systemic therapy practice. [ABSTRACT FROM AUTHOR]

This paper considers the female anorexic's use of space by reviewing her spatial practice as demonstrated in her clinical presentation upon starting therapy. Two categories of concept about space underpin the paper: the notion that space is produced as conceived in a Marxist perspective by Lefebvre, and psychoanalytic concepts of mental space derived from the work of Bick (1968), Meltzer (1975) and Rey (1994). Beginning psychotherapy with an anorexic patient shows how particular spatial phantasies (phantasy is here construed as an unconscious configuration of the mind which affects how we think, feel and act (see Isaacs, 1943) as opposed to a conscious fantasy such as a daydream) and practises structure the intersubjective relationship between therapist and patient and between patient and aspects of her own experience. In this paper anorexia is considered as a defence against consuming desire for the object (the word ‘object’ is used to represent the earliest relationship the infant has to someone else whom he or she has yet to recognize as a whole autonomous person in their own right. Object is thus used as a category word and not in a denigratory sense) (Sohn, 1985). Copyright © 1999 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper describes a training intervention to develop students' conceptual and observation skills relating to the therapeutic alliance (TA) in family therapy. An evaluation methodology was developed and piloted. The knowledge and observation skills of family therapy students pre- and post-training were assessed in comparison to a non-intervention group of experienced clinicians. Students' mean scores on the knowledge measure improved significantly from 43 per cent to 74 per cent (p<0.001) and on the observation test from 43 per cent to 65 per cent, although this failed to reach statistical significance (p=0.08). There were no significant changes in the clinicians' scores over the same period. The clinicians' knowledge was higher initially, but the students had caught up after six months. In conclusion, training students in conceptual and observational skills relating to the therapeutic alliance may have a measurable effect. A ‘stepwise’ methodology for demonstrating the relationship between training in TA and outcomes for families is proposed. [ABSTRACT FROM AUTHOR]

The London Depression Intervention Trial (LDIT) was set up in the early 1990s by Professor Julian Leff ( , and in this issue) to compare the relative efficacy and costs, in work with depressed adults, of systemic couple therapy, drug treatment and individual cognitive behaviour therapy (CBT). The research found that systemic therapy compared favourably with the other modalities in respect of fewer drop-outs, improvement in measured depression at the end of therapy and on follow-up after a second year without therapy, and was not – contrary to the usual assumptions – more expensive. I was one of the two therapists, together with Eia Asen ( , and Asen in this issue) practising systemic therapy with diagnosed depressed patients and their partners. In this paper I will discuss the experience of being the object of research scrutiny, and the reflections that have come to me during and subsequent to the research period. To put it more challengingly: What are the consequences for systemic psychotherapists of co-operation with researchers? Can a circular epistemology survive being scrutinized through a lineal grid? [ABSTRACT FROM AUTHOR]

This paper introduces the development of, and the key assumptions and practices associated with, Brief Solution Focused Therapy (SFT). Therapist and client collaborate to clarify the best ways to build on existing strengths and resources in order to move toward a future that the client would prefer. The benefits of this approach for children, adolescents, their carers and teachers, are highlighted. Recent developments in the practice of SFT are outlined. [ABSTRACT FROM AUTHOR]

This article discusses the much-misunderstood Tarasoff decision that requires psychotherapists to protect third parties from patients' violent acts. Through a normative approach, the paper analyzes four important issues: what to do when potential victims are unknown; what to do about the fact that the patients' potential for violence may be incorrectly perceived; the value of warning potential victims; and, the problem of discharging potentially violent patients from the hospital. The author proposes that the courts adopt a more flexible substantial departure test in most cases that involve psychiatric negligence. [ABSTRACT FROM AUTHOR]

It is argued that current attempts to investigate the process of family therapy might benefit from the application of discursive and narrative analytic techniques. An example of such an analysis is given, taking the work of an experienced family therapist with one family seeking help in dealing with the aftermath of a marital separation. The theme of ‘how to deal with change’ as it materializes in the discussions during therapy is selected for detailed examination in this paper. It is argued that there are two main discourses on this theme evident in the family's discussions, one being that the separation has occurred and its consequences should now be left to arise naturally; the other being that the effects of the separation need to he actively managed. It is suggested that this analytic procedure can dramatize the subtle changes in family discourses during therapy; its limitations in terms of generalizability, and the difficulties of dealing with huge amounts of complex material, are also noted. [ABSTRACT FROM AUTHOR]

This paper poses questions about the nature of the therapeutic process in general. Using a holistic and integrative perspective, the author argues that therapy has been influenced by considerations of therapist expertise, techniques aimed at solving problems, and a paternalistic model of doing things to the client. The paper proposes a contrasting approach involving a shared, conversational experience with clients which respects personal autonomy and encourages creative solutions. Throughout the whole paper weaves the underlying theme of unresolved grief, reflecting the author's philosophy that loss is a covert agenda for many people seeking therapeutic help. The author's thesis is that in defining the emotions associated with unresolved grief, exploring the contexts in which the losses occurred, and investigating future options and directions, therapeutic change can be effected. Finally, a quandary that therapy as conversation presents is addressed: how can we research our dialogue to ensure effective outcomes? [ABSTRACT FROM AUTHOR]

This paper reports on the development, reliability, and validity of a self-report scale to assess from the recipient's perspective two factors derived from Expressed Emotion (EE) theory. The Family Emotional Involvement and Criticism Scale (FEICS) has two subscales: Perceived Criticism (PC) and intensity of Emotional Involvement (EI). These two factors are analogous to Critical Comments and Emotional Overinvolvement, the two main factors of EE that are assessed through the Camberwell Family Interview, the original direct observation measure of EE. FEICS was completed by 83 respondents who were a random sample of patients over 40 years of age receiving care at a Family Medicine Center. Cronbach's alpha was .82 for the PC subscale and .74 for the EI subscale. Confirmatory factor analysis showed that each item loaded on its proposed factor (all at ≥ .50) and not with the other factor (all at ≤ .15). The subscales exhibited expected correlations and partial correlations with FACES III subscales, ISEL subscales, the SCL-90 depression and anxiety subscales, and demographic variables. We conclude that the FEICS is a reliable instrument with preliminary evidence of its construct and criterion validity. [ABSTRACT FROM AUTHOR]

This paper describes four interventions frequently used by experiential therapists during the trial of labor to foster greater intimacy in the therapy relationship. A brief overview of the trial of labor stage of the therapy process is given, followed by a description of the four interventions. Case examples are included for clarification. [ABSTRACT FROM AUTHOR]

This paper addresses an intersubjective issue that arises out of our model of therapeutic change: Why do humans so strongly seek states of emotional connectedness and intersubjectivity and why does the failure to achieve connectedness have such a damaging effect on the mental health of the infant? A hypothesis is offered—the Dyadic Expansion of Consciousness Hypothesis—as an attempt to explain these phenomena. This hypothesis is based on the Mutual Regulation Model (MRM) of infant–adult interaction. The MRM describes the microregulatory social-emotional process of communication that generates (or fails to generate) dyadic intersubjective states of shared consciousness. In particular, the Dyadic Consciousness hypothesis argues that each individual, in one case the infant and mother or in another the patient and the therapist, is a self-organizing system that creates his or her own states of consciousness (states of brain organization), which can be expanded into more coherent and complex states in collaboration with another self-organizing system. Critically understanding how the mutual regulation of affect functions to create dyadic states of consciousness also can help us understand what produces change in the therapeutic process. © 1998 Michigan Association for Infant Mental Health [ABSTRACT FROM AUTHOR]

This paper describes an inpatient treatment programme specifically designed for normal- weight bulimia nervosa patients who have a co-morbidity marked by alcohol and drug abuse, ’cutting’, repeated overdosing or stealing, or sexual disinhibition (multi- impulsive bulimia). The programme uses a rigorous ward regime and simple behavioural counselling, under the direction of a nurse-counsellor to bring control to the many addictive and self-damaging behaviours. The underlying emotional and personality issues are addressed by focal-interpretive (psychodynamic) and cognitive techniques in both group and individual sessions. Major use is made of creative therapies and reality-orientated therapies. General psychodynamic groups are mixed with focal groups using cognitive techniques. Patients respond well and the improvement in symptomatology is maintained during follow-up. Those patients who describe poor peer relationships in adolescence and who find engagement in psychotherapy difficult, do poorly. [ABSTRACT FROM AUTHOR]

This paper describes the process of "coaching" individuals in their efforts to change themselves in the context of their nuclear and parental family systems. Although this approach is regarded as one of the major modes of intervention in family therapy, the actual methods and techniques for intervention are not widely understood. Moreover, we have expanded the Bowen approach to address powerful cultural and family life cycle influences. The goal of coaching is to help clients define themselves proactively in relationship to others in their families without emotionally cutting off or giving in. Coaching begins by training clients to become observers and researchers of their own role in the family and of family patterns of behavior. Coaching then moves to help them bring their behavior more in line with their deepest beliefs, even if this means upsetting family members by disobeying family "rules." [ABSTRACT FROM AUTHOR]

This article talks about John Ronald Seeley, a sociologist. No one who knows him at all well could doubt its accuracy, its sincerity, or its relevance to the vision Seeley has maintained throughout his career. Although Seeley is best known for his work as senior author of "Crestwood Heights," which, after twenty years, remains the most penetrating study ever made of the life and values and, especially, the education, of a suburban community. In TAMOTU, Seeley often expresses his trust in the untrustworthy in the course of a masterful piece of social analysis which fully demonstrates that he knows better. does not mince words. Seeley is no courtier, but rather the contrary, a perceptive psychotherapist, tactfully but firmly letting the patient know that though his ruses have been detected, the therapist's faith in his basic goodness and capacity for growth remains intact. The relationship between social institutions and those on whom they bear has entered a new and harsher phase in which the role of the social scientist as mediator is no longer accepted-for reasons explicit in Seeley's text.

Background There are very few studies that investigate the qualitative experiences of people with a learning disability who have engaged in psychological therapy. Indeed, having a learning disability has traditionally been an exclusion criterion for good quality research about psychological treatments ( Psychotherapy and Learning Disability. Council Report CR116. London: Royal College of Psychiatrists, 2004; Journal of Applied Research in Intellectual Disabilities, 19, 2005 and 5). The current research was developed in response to a clinical psychology service recognizing the need to evaluate their psychological service and, as part of this evaluation, the importance of consulting with service users about their experience of psychological therapies. The overall aim of gaining this feedback would be to improve the service offered and to ensure that people receive the best psychological care. Methods Six service users with a learning disability were interviewed about their experience of individual psychological therapy. The interviews were analysed using interpretative phenomenological analysis. Results Themes were generated from the interviews which highlighted both positive and negative feedback on the psychological therapy process. The feedback covered areas such as access to therapy, feelings about therapy, preparing for therapy, skill development and collaborative working, accessibility and making therapy fun, challenges to confidentiality, positive feelings towards the therapist, aspects of the therapeutic relationship, therapy being challenging but helpful, and positive outcomes. Conclusions These results have contributed to the evidence base that people with a learning disability are able to meaningfully engage in research and provide essential feedback on the services that they receive. No longer can people be excluded from individual psychological therapy or research just because of their label. [ABSTRACT FROM AUTHOR]

Building a therapeutic alliance with a patient with pathological narcissism or narcissistic personality disorder is a challenging process. A combined alliance building and diagnostic strategy is outlined that promotes patients' motivation and active engagement in identifying their own problems. The main focus is on identifying grandiosity, self-regulatory patterns, and behavioral fluctuations in their social and interpersonal contexts while engaging the patient in meaningful clarifications and collaborative inquiry. A definition of grandiosity as a diagnostic characterological trait is suggested, one that captures self-criticism, inferiority, and fragility in addition to superiority, assertiveness, perfectionism, high ideals, and self-enhancing and self-serving interpersonal behavior. These reformulations serve to expand the spectrum of grandiosity-promoting strivings and activities, capture their fluctuations, and help clinicians attend to narcissistic individuals' internal experiences and motivation as well as to their external presentation and interpersonal self-enhancing, self-serving, controlling, and aggressive behavior. A case example illustrates this process. [ABSTRACT FROM AUTHOR]

This study investigated helpful and disturbing factors in multi-family groups with hospitalized, depressed patients and their family members. Both patients and their partners reported the occurrence of different therapeutic factors such as the cohesion of the group, different observational processes, and guidance from the therapist. The frequency of the therapeutic factors seemed to increase for both the patients and their partners as the group sessions progressed and several differences in reported therapeutic factors were found between the patients and their partners. A number of therapeutic factors such as modelling and guidance from the therapist were found to be related with improvement of depressive symptoms of the patient. The results help to provide some insight into which processes are important in multi-family group therapy for depression. [ABSTRACT FROM AUTHOR]

The article describes a research study that explored the process of how change occurred for one distressed couple and a specific therapist in a naturalistic setting. Quantitative and qualitative data were collected on the couple at multiple points in the therapy. A research team comprised of five members met regularly to analyze the data and collectively they arrived at a theory of change for the couple posttherapy. Conclusions are made related to how change occurred for the couple with an emphasis on the role of extratherapeutic events, client motivational factors, the therapeutic alliance, hope and expectancy factors, therapist factors, specific techniques and interventions, and other surprise factors that contributed to change. [ABSTRACT FROM AUTHOR]

A trait approach to personality has many implications for psychotherapy. Given that traits contribute to the expression of symptoms of common psychiatric disorders, are moderately heritable, and relatively stable (yet also dynamic to some extent), long-term change in symptoms is possible but is likely to be limited. Analogous to the manner in which genes set the reaction range for phenotype, standing on certain traits may set the patient's “therapeutic range.” On the other hand, some of the same traits that may limit the depth of therapeutic benefits might also increase their breadth. In addition, taking the patient's standing on different traits into account can inform the choice of therapeutic strategy and targets and can affect the formation of the therapeutic alliance and compliance with self-help exercises. Finally, other aspects of personality beyond traits, such as ego development and narrative identity, also appear to have important implications for psychotherapy. [ABSTRACT FROM AUTHOR]

In this article, we discuss the role of the therapist in change in couple and family therapy. We argue that the therapist is a key change ingredient in most successful therapy. We situate our discussion in the common factors debate and show how both broad and narrow common factor views involve the therapist as a central force. We review the research findings on the role of the therapist, highlight the strengths and weaknesses of this literature, and provide directions for future research. We then use this review as a foundation for our recommendations for theory integration, training, and practice. [ABSTRACT FROM AUTHOR]

Some researchers have hypothesized that factors common across therapy models are largely responsible for change. In this study we conducted semi-structured, open-ended qualitative interviews with three different MFT model developers (Dr. Susan M. Johnson, Emotionally Focused Therapy; Dr. Frank M. Dattilio, Cognitive-Behavioral Therapy; and Dr. Richard C. Schwartz, Internal Family Systems Therapy), Dr. Johnson and Dr. Schwartz’s former students, and each of their former clients who had terminated therapy successfully. We examined possible common factors in our qualitative data analysis. Common factors fell into two main categories of model-dependent factors and model-independent factors. This article—the first of two—reviews the model-dependent common factors, common elements found across three distinct therapies. They include common conceptualizations, common interventions, and common outcomes, each with several subcategories. We discuss the clinical, training, and research implications of the results. [ABSTRACT FROM AUTHOR]

It has been asserted that an integrative psychotherapy can promote recovery from schizophrenia by helping clients develop and evolve a richer personal narrative of their challenges and abilities. Yet it is unclear what techniques such a therapy might employ, and how those techniques are related to the developing therapeutic relationship. To address these questions we have conducted blind qualitative and quantitative assessments of transcripts of an integrative psychotherapy over 22 months. Analyses suggest that over time the client evolved a more coherent account of his challenges and abilities, and experienced significant psychosocial improvements. The therapeutic alliance was observed to build slowly, with minimal intervention and care on the part of the therapist not to tell the story for the client. As the relationship grew stronger, the client began rapidly developing the narrative of his life, allowing for the introduction of greater levels of confrontation to enhance further the coherence and richness of that narrative. [ABSTRACT FROM AUTHOR]

Background. Previous research has reported large differences in treatment results between individual therapists practising the same type of psychotherapy, but little is as yet known about the factors explaining this variation. In previous studies the authors have found associations with therapeutic attitudes as measured by the TASC 2 scales. Methods. A sample of 160 therapists were clustered in a non-parametric latent class (LC) regression modelling of their patients' repeated self-ratings on the SCL-90 across stages in psychotherapeutic treatment. This classification was then explored in relation to the therapists' TASC 2 scores. Results. Five classes were identified differing widely in terms of the patients' outcome trajectories. Membership in these classes was significantly influenced by the therapists' scores on the TASC 2 scales. The adjustment, neutrality and artistry scales of the TASC 2 were found specifically discriminative. A discriminant analysis confirmed the findings in general. Collectively, the TASC 2 scales were able to assign 56% of the therapists to their correct latent class, in comparison with 20% by chance. Conclusions. Therapists with a psychoanalytic or eclectic orientation are systematically different in terms of the outcomes they tend to contribute to with their patients. This variation is partly accounted for by differences in their therapeutic attitudes. [ABSTRACT FROM AUTHOR]

Background. Alliance ruptures and premature drop out from psychotherapy are very common with patients who have a diagnosis of borderline personality disorder, limiting the clinical effectiveness of treatment. Aim. To test and refine a model of how therapists successfully resolve threats to the therapeutic alliance involving enactment of problematic relationship patterns in the cognitive analytic therapy of borderline personality disorder. Method. Task analysis (Greenberg, 1984a) of 107 enactments from 66 sessions in four good outcome cases, compared with 35 enactments from 16 sessions in two poor outcome cases. This systematically compares a rational model of process with empirically coded transcripts of therapy sessions where independent raters have identified an alliance threat event. Results. The process stages of the rational model were observed, and 20 refinements were made, including a new process stage, heuristic principles and 'when--then' steps. Therapists were found to cycle between stages. Therapists in good outcome cases recognized the majority of these enactments and focused attention to them in contrast to poor outcome cases where therapists usually failed to notice or draw attention to the alliance threat and did not adhere to the model. Conclusion. Competent resolution of alliance-threatening events is crucially dependent on therapists' ability to recognize them, and secondarily on their adherence to the principles in the refined model. The model is consistent with prior research and can be used in supervision and quality improvement strategies. [ABSTRACT FROM AUTHOR]

Evidence in the literature suggests that some groups have greater difficulty accessing psychological treatment than others. The present study set out to provide benchmarks from the CORE National Research Database, focussing on four primary outcomes following a client's first contact session – (1) accepted for therapy, (2) assessment only, (3) referred to another service, (4) unsuitable for therapy. Data from 34 primary care counselling services were collected which had used CORE-PC as a service resource for at least two years. For each of the four assessment outcomes, the mean, standard deviation and 25th, 50th and 75th percentiles were calculated. Across the 34 services, an average of 81% clients were accepted for therapy with 25th, 50th, and 75th percentile values of 74, 82 and 89% respectively. The results indicate that working with benchmarks is an area in need of further research. Implications for policy and practice are discussed and attention given to the client's experience of seeking therapy. [ABSTRACT FROM AUTHOR]

The article presents articles and related improvements readers can expect from "Journal of Family Therapy" for the year 2001. The expansion in the number of editors represents the continuing emphasis of one element of the Editorial Board's development policy for the journal. The theme of gender and men in therapy will be of interest to all the readers. In the general papers section, a therapeutic framework and a psychometric method for understanding and working with the interrelating of couples and family members is introduced. Although the theory that is presented does not conform in every way to the systemic template of most family therapists, it is a helpful integrative perspective on family work from another 'seat.' Increasingly, family therapy must see itself as one part of a broader range of therapeutic services offered to individuals and their families. It would be interesting if family therapists could put down their wariness about research and, resting on the innovativeness of work such as this, make their contribution to the investigation of multi-modal therapy packages.

There are not a lot of conceptual tools that can help a family therapy teacher to talk and teach about the importance of the therapeutic relationship in family therapy practice. The idea that family therapy can be conceived as a dialogue might offer a fresh and promising perspective. Mainly inspired by the work of Bakhtin, Voloshinov, and Shotter, the author considers if the concept of dialogue can help us to talk about something that is there all the time in our family therapeutic practices, although sometimes unnoticed, and that is hard to talk about because we lack the necessary conceptual tools. When we choose to conceptualize family therapy as dialogue, the focus of the therapist is not primarily on data collection, information processing or problem analysis. The therapist is not primarily concerned with knowing, or with not-knowing. Instead, the focus is on the idea that first and foremost therapy is a meeting of living persons, searching to find ways to share life together for a while. Clinical vignettes that feature children's drawings in family therapy are used as illustrations. [ABSTRACT FROM AUTHOR]

The aim of this case report is to illustrate how cognitive remediation therapy (CRT) can be used as part of the treatment programme in acute anorexia nervosa (AN) to stimulate mental activities and improve thinking skills and information-processing systems when other therapies, for example cognitive behavioural therapy (CBT), may be too complex and intense for the patient to engage in. Furthermore, we hypothesize that CRT may be an effective tool in improving flexibility of thinking in AN, as previous neuropsychological findings have proved that rigidity is one of the maintaining factors in AN. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

The purpose of this collaborative research was to reflect on one client's experience of using writing therapy during brief workplace counselling. The client/co-researcher used expressive and creative writing between counselling sessions, the benefits of which are reported. A brief review of the literature on writing therapy is provided. The focus of the study is on investigating the process of writing therapy from the client's point of view. The epistemological assumptions and research methods are influenced by narrative inquiry. Feminist values inform both the therapeutic practice and research. [ABSTRACT FROM AUTHOR]

Is therapist self-disclosure a therapeutic technique or a therapeutic mistake? Is it useful? Is it ethical? This study attempts to address this controversy among therapeutic modalities by asking clients about their perceptions of self-disclosure and nondisclosure. Eighteen people (16 women, two men), currently in therapy in two Canadian cities, generated 157 incidents of both disclosure and non-disclosure. The incidents were first coded as helpful or unhelpful. Cross-tabulation of the results showed that disclosures were more than twice as likely to be experienced as helpful; non-disclosures were twice as likely to be unhelpful (χ² (3, N= 157)= 14.439, p ≤ 0.002). One-quarter of these incidents was coded by two independent raters; inter-rater reliability was high (Pearson corr. ranged from 0.755 to 1.0, p ≤ 0.01). The data was then sorted, using the Constant Comparison method, into themes, starting with, but not limited to, the themes suggested by the literature. The greatest single effect was on the therapeutic alliance, both positive and negative. Clients' perceptions of helpful disclosures and nondisclosures generally supported therapists' rationales. There was also some evidence that when clients found disclosures unhelpful, the reasons also supported theoretical rationales against disclosing. Rather than simply supporting either position in the controversy, this study suggests that skill, or lack of it, was the intervening variable that affected the perceptions of both techniques. Further research on the effects of skill on both disclosure and non-disclosure are warranted. This study has implications for both researchers and practitioners. [ABSTRACT FROM AUTHOR]

In the first of the two studies reported here, we established that trained judges could reliably identify 18 therapist features that occurred with reasonable frequency. In the second study 17 of these features were examined to determine how well they related to changes in sexual offenders with treatment. Five videotapes from each of five different prison programs were rated for the presence of these 17 features and correlational analyses examined their relationship with changes in 44 measures of treatment targets. The primary findings indicated that empathy and warmth displayed by the therapists and their directive and rewarding behaviours, were the features that most strongly predicted therapeutic benefits. The results are discussed in terms of their clinical and research implications. Copyright © 2002 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This article focuses on children's and adolescents' views on family therapy. Family therapy has made a considerable contribution to our understanding of the experiences of children and families and especially how various symptoms can be understood as their response to distressing family dynamics. Although family therapists developed many ways of engaging and connecting with children, there has been surprisingly little research describing the children's experience of family therapy or how therapists achieve a therapeutic relationship or sense of connection with children. Consideration of the similarities and differences between these children indicate that those children who generally wanted to avoid difficult feelings found the other aspects of the sessions difficult, and two of the children spoke of wanting to leave the room. Only a few studies have sought to elicit whether children find family therapy helpful. The aim of the studies conducted was to explore the nature of children's experience of being in family therapy.

This article focuses on a study which examines the gaps between role expectations and perceived reality of therapists and clients in therapy. One hundred and forty-seven therapy sessions were studied. The Role Expectation and Preference Questionnaire was designed to assess therapists' and clients' role expectations, preferences, and perceptions of what happened in the therapy sessions. In the first sessions the difference between expectations and perceived reality was higher for clients than for therapists. Expectations were significantly higher than perceived reality. Expectations may be viewed as indicating the potential for certain behaviors.

This article examines the ways that power imbalances affect relationships in the forensic mental disability system and between therapists and their clients. It considers the impact of the "dual loyalty" dilemma on forensic relationships, the manner in which courts deal with this dilemma, and suggests several points of commonality that arise around such power conflicts. It also examines recent litigation involving therapeutic relationships, and attempts to extract doctrinal threads from these cases. Finally, it recommends that, in order for the judicial system to attempt to correct any of the underlying imbalances, courts and jurors must openly come to grips with the psycho-dynamic issues that underlie these imbalances. [ABSTRACT FROM AUTHOR]

Viewing therapy as a conversation among participants, rather than as an interview concluding with an intervention selected by an expert, allows one to consider the contributions of each member of the conversation in comparable terms. I propose a distinction between intimate interaction, in which meaning is co-created or shared, and non-intimate interaction, in which meaning is rejected, provided, or misunderstood. I suggest that intimate interaction between therapists and clients is therapeutic and that non-intimate interaction rarely is. However, it is in the acknowledgment and repair of the inevitable lapses of intimate interaction that occur between therapists and clients that there is an opportunity for a profoundly meaningful collaboration. [ABSTRACT FROM AUTHOR]

Compliments are often viewed primarily as a linear event in which one person expresses approval or admiration of another. Far less attention has been given to the circular nature of compliments and the manner in which they enhance the positions of both the giver and the receiver of the compliment. Therapeutic compliments have proven to be highly effective means of motivating clients, while at the same time increasing therapeutic leverage. This article proposes that compliments should be purposefully given, and that the type of compliment should vary with the stage of therapy and the intended response of the client to the compliment. [ABSTRACT FROM AUTHOR]

Sixteen patients with essential hypertension from the northwest of Spain were exposed to a three-four week baseline period and later divided into two groups of eight patients each. One of these groups was treated with a six-week cognitive behavioural programme based mainly on stress inoculation training and the other group was assisted to an attention-placebo condition based on individual regular contacts between the therapist and the patient, including discussions about the lifestyle of the latter but without any training on cognitive or behavioural strategies. After the six-week intervention period, and at a six months' follow-up, subjects treated with the cognitive behavioural programme showed a significantly higher reduction of diastolic blood pressure than patients exposed to the attention- placebo condition, considering measurements taken both at hospital and at patients' homes. Similarly, the group treated with cognitive behavioural therapy showed a significant within-group reduction over the measurement taken at hospital. [ABSTRACT FROM AUTHOR]

It is increasingly apparent that “something more” than interpretation is needed to bring about change in psychoanalytic treatment. Drawing on clinical and developmental observations, we propose that interactional processes from birth onward give rise to a form of procedural knowledge regarding how to do things with intimate others, knowledge we call implicit relational knowing. This knowing is distinct from conscious verbalizable knowledge and from the dynamic unconscious. The implicit relational knowing of patient and therapist intersect to create an intersubjective field that includes reasonably accurate sensings of each person's ways of being with others, sensings we call the “real relationship.” This intersubjective field becomes more complex and articulated with repeated patient–therapist encounters, giving rise to emergent new possibilities for more coherent and adaptive forms of interaction. During a transactional event that we term a “moment of meeting,” a new dyadic possibility crystallizes when the two persons achieve the dual goals of complementary fitted actions and joint intersubjective recognition in a new form. We argue that such moments of meeting shift the relational anticipations of each partner and allow for new forms of agency and shared experience to be expressed and elaborated. © 1998 Michigan Association for Infant Mental Health [ABSTRACT FROM AUTHOR]

Several aspects of developmental change that are dependent on interactions between parent and infant are examined for their value in casting light on the processes of change in adult psychotherapies. First, the domain of implicit knowledge (where changes necessarily occur in nonverbal infants) is identified. The vast majority of therapeutic change is found to occur in this domain. We then examine the improvised, largely unpredictable, nonlinear movements toward mutual goals that characterize the processes of parent–infant and therapist–patient interactions. Finally, we provide a microdescription of these processes and provide a terminology for the “moments” that make up their flow. Of particular importance is the “moment of meeting,” in which the participants interact in a way that creates a new implicit, intersubjective understanding of their relationship and permits a new “way-of-being-with-the-other.” We view “moments of meeting” as the key element in bringing about change in implicit knowledge, just as interpretations are thought to be the key element in bringing about change in explicit knowledge. © 1998 Michigan Association for Infant Mental Health [ABSTRACT FROM AUTHOR]

To explore an alternative solution more appropriate to clinical standards than random assignment, 42 mothers consulting for a functional (sleep, feeding) or behavior problem of their infant were given the choice between two forms of mother–infant psychotherapy (Psychodynamic or Interaction Guidance). Clinicians, blind to mother's choice, followed a systematic indication procedure and provided a therapeutic recommendation. Results revealed a very high agreement between mother's choice and therapists' recommendation. Examination of patient and pretreatment variables showed no major differences between the two groups resulting from a choice of treatment procedure. This procedure proved to ensure internal validity of the data and was also able to guarantee external validity. Discussion focuses on the methodological and clinical implications of the findings that support the consideration of the patient as an active participant to his/her treatment. © 1998 Michigan Association for Infant Mental Health [ABSTRACT FROM AUTHOR]

The article focuses on the study conducted to examine the factor-analytic structure of patient internal states. The Therapy Session Report is a methodological procedure that allows such an examination of patient feeling states. The two samples agreed in reporting that in an intake session over half of the patients experienced the following feelings: serious, anxious, accepted, and hopeful. Analysis of the typical feelings of college student patients revealed that these patients experience a fairly wide range of affect during the initial interview. Therapists, on the other hand, tended to minimize their patients' feelings of relief and gratitude. The result was attributed to the experience level of the therapists, as the present study utilized only inexperienced therapists, whereas experienced therapists were used in previous analyses.

Some assumptions developed by Weitz, Hughes, Newbrough, Wallston, Armstrong, and Roback (1979) for their transactional model of therapy are of questionable necessity. The approach to practice that Weitz et al. present goes beyond their theory in its creative utilization of therapy as a "special" situation and in its attention to and use of the clients' environment. It is these aspects which require further theoretical and pragmatic development. [ABSTRACT FROM AUTHOR]

Mutuality of patient-therapist expectations for treatment can be attained by adapting treatment to the special characteristics and focusing treatment on the unique problems of client populations. Culturally sensitive treatment is defined as a treatment mode built on a set of therapeutic assumptions that complements the patients" basic value structure. The implications for treatment of the Cuban immigrants' preference for lineality in interpersonal relationships, a present-time orientation, a doing activity orientation, and subjugation to natural and environmental conditions are discussed. Acculturation problems facing Cuban immigrant families and their implications for treatment are also discussed. The authors conclude that Ecological Structural Family Therapy is a treatment of choice for acculturation-related dysfunctions of Cuban immigrant families. [ABSTRACT FROM AUTHOR]

Offers views on the relationship between a therapists and eating disordered patients. Impressions being given by patients to therapists concerning interventions; Importance of patient motivation; Negative aspects of eating disorders.