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This paper discusses the inclusion of ideas from mindfulness, embodiment, and associated brain research in poststructural family therapies. Connecting research and practice across diverse fields is presented as enriching therapeutic work, increasing clinical effectiveness, and broadening options for families seeking our assistance. Ways of incorporating mindfulness and embodiment are described and offer distinctively novel practices not typically used in traditional forms of poststructural therapies. These innovative practices are illustrated by clinical work with a mother and her five-year- daughter who survived a dangerous health crisis and an extremely painful hospitalization. Therapeutic work with this family exemplifies how traumatic experiences are not always accessible through linguistic means alone. Working with interpersonal mind-body practices can uniquely contribute to relaxing the sympathetic nervous system and activating the social engagement branch of the parasympathetic nervous system. The inclusion of such practices can provide valuable opportunities to facilitate the emergence of preferred experiences of self for all family members.Este artículo trata de la inclusión de las ideas de conciencia plena y personificación, y de la investigación neurológica asociada en las terapias familiares posestructurales. La conexión de la investigación y la práctica entre áreas diversas se presenta como un trabajo terapéutico enriquecedor que aumenta la eficacia clínica y amplía las opciones para las familias que buscan nuestra asistencia. Se describen las maneras de incorporar la conciencia plena y la personificación y se ofrecen prácticas distintivamente innovadoras que normalmente no se usan en las formas tradicionales de las terapias posestructurales. Estas prácticas innovadoras se ilustran mediante el trabajo clínico con una madre y su hija de cinco años que sobrevivieron a una emergencia de salud peligrosa y a una hospitalización sumamente dolorosa. El trabajo terapéutico con esta familia ejemplifica cómo no siempre es posible acceder a las experiencias traumáticas por medios lingüísticos solamente. El trabajo con prácticas interpersonales centradas en el cuerpo y la mente puede contribuir de manera única a relajar el sistema nervioso simpático y a activar la rama de la participación social del sistema nervioso parasimpático. La inclusión de dichas prácticas puede brindar oportunidades valiosas de facilitar el surgimiento de experiencias preferidas del yo para todos los miembros de la familia.本文讨论了如何综合后结构家庭疗法中来自正念、具体化和相关大脑研究的观点。将不同领域的研究和实践联系起来，可以丰富治疗工作，提高临床效果，并为寻求我们帮助的家庭提供更多选择。本文描述了如何结合正念和具身化的方法到具体操作中去，并提供了在后结构疗法的传统形式中不太典型使用的独特新实践。一位母亲和她五岁的女儿经历了一场危险的健康危机和极其痛苦的住院治疗，针对她们的临床工作证明了这些创新做法。对这个家庭的治疗工作证明了创伤性的经历并不总是通过语言手段来获得。工作与人际身心练习可以独特地有助于放松交感神经系统和激活副交感神经系统的社会参与分支。把这些实践纳入治疗的措施中可以提供宝贵的机会来促进所有家庭成员偏好体验的出现。.

Purpose This paper outlines the concept of the 'Compassionate Kitbag', a novel multi-sensory-based means of helping draw together the various elements of compassionate mind training and processes within compassion-focused therapy (CFT), to help clients cultivate and facilitate their capacities for compassion. Building on the work of Lucre and Corten (2013, Psychology and Psychotherapy: Theory, Research and Practice, 86, 387), this is the first published work exploring this concept and the theoretical underpinnings, with a specific focus on how this can be used to support people with attachment and relational trauma. Methods A narrative review of the literature on multi-sensory stimulation in facilitating people's capacities for compassion was conducted, coupled with a review of the literature of the use of non-human and transitional objects as explained by attachment theory and the broader scientific research underpinning the CFT model. Results Clinical examples of how to use the Compassionate Kitbag to help stimulate compassionate therapeutic processes demonstrate the benefits of and how to begin utilizing this approach in compassion-focused work with clients with complex needs. Conclusions The Compassionate Kitbag's potential therapeutic value lies in offering multifarious creative and tangible means of accessing compassion to a wide range of individuals whom are typically fearful of, blocked, and/or resistant to compassion. Further research into the wider application of the concept of the Compassionate Kitbag is needed. Practitioner points Many patients with ruptured and/or traumatized early attachment relationships can find more traditional talking therapies difficult to access. Compassion-focused therapy (CFT) can offer an evolutionary-based understanding of interpersonal difficulties which can be helpful for such patients. Creatively harnessing and utilizing multi-sensory and non-linguistic social signals in CFT is key to exercising the care-giving and care-receiving social mentalities that facilitate compassionate flow. There is considerable evidence to support the use of a multi-sensory component to the therapeutic work to help patients cultivate and facilitate their capacities for compassion. The Compassionate Kitbag can be a way of supporting patients to create concrete representations of compassion in the context of the compassionate mind training component of the therapeutic work. Some of these objects can become transitional objects which can aid the therapeutic work.

Background: This article presents key findings of two major empirical studies of psychotherapist and counsellor development. Both aimed to advance knowledge of variations in professional development and better understand the complexity of formative influences. Methodology: The Minnesota Study of Therapist and Counsellor Development and the International Study of Development of Psychotherapists (ISDP) combined qualitative and quantitative research. Results: In the “Minnesota study,” qualitative analysis of data from 100 psychotherapists (172 interviews) at different experience levels led to formulating five phases of practitioner development: the Novice Student Phase, Experienced Student Phase, Novice Professional Phase, Experienced Professional Phase and Senior Professional Phase. Results were integrated in a model describing three developmental trajectories—Continued development, Exhaustion and Disengagement—suggesting a developmentally sensitive approach to supervision. In the ISDP study, the Development of Psychotherapist Common Core Questionnaire was used to survey approximately 5,000 psychotherapists from countries throughout the world from 1991 to 2003 (currently about 12,000 therapists). Multi‐level quantitative analysis yielded two broad dimensions of therapeutic work experience, Healing Involvement and Stressful Involvement, based on therapists’ clinical skills, difficulties in practice, coping strategies, manner of relating to clients and in‐session feelings. Analysis of therapists’ experiences of current professional development showed two dimensions (Currently Experienced Growth and Currently Experienced Depletion). These were predicted, respectively, by Healing Involvement and Stressful Involvement and in turn predicted different levels of Overall Career Development. Implications: Implications for supervison were drawn from the findings of The Phase Model and the Cyclical Trajectories model of the Minnesota‐study, while the ISDP study results were integrated in a Cyclical‐Sequential Model with implications for clinical training, supervision and practice.

Drawing on ethnographic fieldwork and interviews at a major metropolitan art museum and botanic garden, this article considers the practical accomplishment of American museums' 'health turn' by tracing how museum staff develop therapeutic programmes for visitors with disabilities. In doing so, it considers one of medical sociology's fundamental theoretical questions - how ideologies of health order social life - in an unconventional empirical setting. Acknowledging contemporary arguments for both the relative merits and unintended consequences of this policy trend, I focus instead on the particular institutional arrangements, professional norms, and material cultures of art and nature that shape museums' therapeutic work, so as to reveal its effects. Data reveals ideological similarities, but practical differences, between museological and medical understandings of wellness. Extending a 'medical sociology of practice' to new contexts ultimately foregrounds the contingencies, and diversity, of therapeutic mechanisms and meanings, thereby broadening sociological research on healing and healthism.

Mental health practitioners of varied orientations experience somatic phenomena in therapeutic work with clients. Understanding embodiment from the body psychotherapist's viewpoint can illuminate its nature for mental health counselors who experience the phenomenon but question how to channel it to inform their work. Findings from a heuristic inquiry using creative, relational, and reflexive approaches illuminate the experiences of 6 body psychotherapists and perceived impact of embodiment on clients.

The paper explores an interdisciplinary whole person approach to healing from trauma that conserves our rich inheritance from Jung but also takes on board insights from research in the areas of attachment, trauma and the neurobiology of emotion. It is now over 20 years since insights from neurobiology began to be used to inform clinical practice. The paper reviews key insights which have emerged, along with the ways they enable therapists to help mind, brain and body to heal and the ways in which they clarify why, in clinical practice, we do what we do. Traditionally the emphasis has been on words, interpretations, and meaning-making. Currently there is greater appreciation of the affective, relational, embodied aspects of therapeutic work and the way in which these relate to traumatic early interactive experience that is held outside of human awareness. The ways in which knowledge of particular systems of connectivity inform understanding of the whole mind-brain-body relationship are examined. The way forward for clinical practice to become more focused in order to help clients to heal in mind and body is reviewed.

The relatively high gender equality in the Swedish society is likely to exert an influence on gender role construction. Hence, the present research aimed to investigate Swedish women's perceptions of and conformity to feminine norms. A mixed methods approach with two studies was used. In Study 1, young Swedish women's gender role conformity, as measured by the Conformity to Feminine Norms Inventory 45 (CFNI-45), was compared to the results from previously published studies in Canada, the United States, and Slovakia. Overall, Swedish women displayed less conformity than their foreign counterparts, with the largest difference on the subscale Sexual fidelity. In Study 2, focus group interviews with young Swedish women added a more complex picture of feminine norms in the Swedish society. For instance the results indicated that Swedish women, while living in a society with a strong gender equality discourse, are torn between the perceived need to invest in their appearances and the risk of being viewed as non-equal when doing so. In sum, despite the fact that traditional gender roles are less pronounced in Sweden, gender role conformity is still a pressing issue. Since attending to the potential roles of feminine norms in women's lives previously has been proposed to be useful in counseling and therapeutic work, the present research also offers valuable information for both researchers and practitioners. [Correction added on 5 May 2017, after first online publication in April 2017: An incorrect Abstract was inadvertently captured in the published article and has been corrected in this current version.].

This paper develops the argument that a core skill needed to be an effective therapist is to have acquired an awareness of one’s own ontological and epistemological position in relation to one’s work as a therapist. In the same way that researchers need to develop reflexive awareness of their assumptions about what there is to know (ontology) and how they can come to know about it (epistemology), therapists need to be aware of their fundamental assumptions about human beings and the world they live in (ontology) as well as their beliefs about how best to develop an understanding of their clients and the meaning(s) of their experiences (epistemology). Regardless of which particular therapeutic model is adopted, the language used to talk about (and in) therapy, the kinds of questions asked of clients and the comments/interpretations offered, all presuppose and reinforce particular versions of human being and experiencing which are themselves not usually questioned or challenged during the course of therapy. In this paper it will be argued that it is essential that therapists are aware of their own fundamental assumptions about what it means to be human, and that they recognise their ontological and epistemological positions as positions that they are taking (rather than perceiving them to be self-evident truths). This is important for two reasons: i) if clients do not share the therapist’s assumptions (ie. their ‘model of the person’), the therapeutic work cannot proceed and be effective; ii) without such an awareness, therapists are at risk of unwittingly imposing their own model of the person upon the client which raises ethical issues.

Revisions to the posttraumatic stress disorder (PTSD) diagnostic criteria in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) clarify that secondary exposure can lead to the development of impairing symptoms requiring treatment. Historically known as secondary traumatic stress (STS), this reaction occurs through repeatedly hearing the details of traumatic events experienced by others. Professionals who work therapeutically with trauma victims may be at particular risk for this exposure. This meta-analysis of 38 published studies examines 17 risk factors for STS among professionals indirectly exposed to trauma through their therapeutic work with trauma victims. Small significant effect sizes were found for trauma caseload volume (r = .16), caseload frequency (r = .12), caseload ratio (r = .19), and having a personal trauma history (r = .19). Small negative effect sizes were found for work support (r = -.17) and social support (r = -.26). Demographic variables appear to be less implicated although more work is needed that examines the role of gender in the context of particular personal traumas. Caseload frequency and personal trauma effect sizes were moderated by year of publication. Future work should examine the measurement of STS and associated impairment, understudied risk factors, and effective interventions.

Background There is limited research on the subjective experience of therapists and their understanding of therapeutic process when working with people from refugee backgrounds. Objective This study provides a qualitative account of therapists’ conceptions of therapeutic practice and experiences of working therapeutically with refugee clients. Method Participants were 12 mental health workers who had worked therapeutically with people from refugee backgrounds, with an average of 7.6 years (range 1.5–16 years) of experience in this field. Participants completed a semi-structured interview and completed a brief quantitative survey. Findings Thematic analysis revealed a number of superordinate themes. Four key themes are explored in this study: principles of therapeutic practice; therapy as a relational experience; the role of context in informing therapeutic work with refugee clients; and the impact of therapeutic work on the therapist. Discussion The results revealed the complexity and demands of working with people from refugee backgrounds. Further, the lack of research evidence for the methods of therapeutic practice described in this study highlights the distinction between naturalistic therapeutic practice and the current state of the evidence regarding therapeutic interventions for refugee clients. The findings have important implications for training and supporting therapists to work with people who have fled their countries of origin and who have often been exposed to highly traumatic events.

Through one clinical example involving complex post-traumatic stress disorder, this paper explores the ways in which the psychoanalytic psychotherapist may need to find creative ways of working which incorporate findings from neuroscience whilst holding the basic frame and methods of the traditional psychoanalytic approach. This entails bringing knowledge of how the body (including the brain) works into the consulting room. In particular, the author describes ways of accompanying the patient during florid flashbacks to chronic and severe childhood abuse and of using grounding techniques afterwards, so that anxiety levels can be sufficiently contained for the necessary therapeutic work to take place. The role of supervision is also explored in terms of how the dynamic of rescuer/victim/persecutor may be played out in the supervisory relationship. Unusually, some of the patient's own reflections, written at the end of the therapy, have been incorporated into the paper. Consideration is given to whether departures from standard psychoanalytic technique constitute boundary violations or useful enactments, which can be seen as a form of creativity which enables the work to move on.

Recent decades have witnessed an extraordinary amount of conceptual and empirical work on attachment theory in psychology and psychotherapy. Attachment theory is discussed in the present article as a way of understanding and fostering therapeutic work with 2 other key relationship constructs that have been theorized to be elements of all psychotherapies: client transference and the real relationship existing between the therapist and patient. Fundamental features of attachment, transference, and the real relationship are summarized. Particular emphasis is given to the role of the therapist as a secure base and a safe haven within the real relationship, and to the patient's internal working model as it relates to transference. A case of long-term psychodynamic psychotherapy conducted by the first author is presented to illuminate the 3 main constructs. The case demonstrates both the usefulness of attachment theory and the fact that any single theory cannot explain all of the complex features of a given treatment.

Over the past decade, there has been an explosion of interest in clinical applications of attachment theory. In the present article, we briefly describe John Bowlby's model of therapeutic change, the therapeutic relationship, and the therapist's role in emotional healing. We then review empirical evidence for three key propositions in Bowlby's model. First, a client's sense of security during therapy is crucial for facilitating therapeutic work. Second, a therapist's own sense of security contributes to positive therapeutic outcomes. Third, attachment insecurities can be effectively reduced in therapy, and movement toward greater attachment security is central to achieving favorable therapeutic outcomes. In sum, research evidence confirms the importance of establishing what Bowlby called a safe haven and a secure base within a therapeutic relationship.

Aims: Outcome measures (OMs) and routine change measurement have developed dramatically in psychological therapies over the last two decades and some therapists have expressed concerns that this, depending on how it is handled by the parties involved, can markedly affect the therapy. However, little research has investigated this. It therefore seemed timely to explore discourses of OMs drawn upon by both parties in the therapy room. Method: PSYCHLOPS (Psychological Outcome Profiles) is a client-centred measure which offered an opportunity to explore how therapists and clients receiving CBT for psychosis talked about OMs. A useful contrast was provided by the CORE-OM (Clinical Outcomes in Routine Evaluation-Outcome Measure). The discourses drawn upon by clients (n=4) and therapists (n=4) were analysed, informed by a Foucaultian framework. Results: OMs were constructed as empowering or disempowering of clients, as being able to do therapeutic work of engagement and containment, and as part of the a...

Critics have noted a mode in Samuel Beckett's writing that can be characterised as the urge to purge. Obsessed with figuring language as both vomit and shit in the guts of an oral/anal textual system, many of his texts are constructed by an oscillation between force-feeding and the compulsive evacuations of emetic and enema. This article suggests that Beckett's persistent textual questioning of what it means to take in and process material from outside the self can usefully be understood in relation to psychoanalytic interpretations of eating disorders; it also suggests that it can be read alongside Beckett's desperate turn to psychoanalytic psychotherapy in the 1930s. Plagued by difficulties with ingestion and digestion (among other symptoms), Beckett sought treatment from Wilfred Bion – the man who would later become one of the most famous British psychoanalysts. Beckett spat out and abandoned the therapy relatively quickly; nevertheless, after his time with Bion there is a sense that the textual evacuations enacted in an uncontrolled fashion in the earlier writing could now be ruminated on, raised to the level of form, and consequently contained. Perhaps coincidentally, the later Bion insisted that what analysis offered, in the face of the patient's frantic desire to ingest and master the world by splitting off and evacuating parts of themselves, was a container – a container for thinking. He insisted that this capacity for thinking should be understood as a form of ‘digestion’ that might bear external material long enough for it to be used rather than purged. Quite properly, Bion never gave details of his therapeutic work with Beckett and there is no accessible archive of clinical material on Beckett's case. This article suggests, however, that an archive of Beckett's analysis can be found in his corpus – in the words and writing he used as food for thought.

When marriages and long-term relationships break down, parents may refer their children and adolescents to therapy for a variety of reasons. While the systemic therapist's preference may be to work with the family system/s, high conflict separation may prohibit such an approach. This article discusses family-focused child therapy that prioritises the needs of children while seeking to preserve a systemic approach. At a practice level this may involve: (a) individual child therapy, (b) engaging with smaller subsystems including siblings, (c) joint therapeutic work involving child/ren plus parent/s, and (d) any of these combinations; all while continuing to maintain a systemic understanding of the work. The article discusses the challenges of working with children from separated families, where there is restricted or no possibility of engaging with the broader family system.

This article describes a training exercise in which students who are new to systemic practice but have some experience in therapeutic work in other modalities were invited to experience reflecting practice. The students were asked to follow a role-played therapy session by offering reflections on the connections felt to a ‘family’ member. The students stood beside the ‘family member’, reflected on the problems and accounted for the connections felt in terms of particular resonances felt. The students thus experienced a therapeutic use of self congruent with the reflecting team approach and the therapeutic position adopted in reflecting practice.

There are many descriptions in the research literature of the onset of delusions in psychosis: it is still not clear however whether there is one specific pathway to delusions or in fact several, and the role of social difficulties remains controversial. In this research we wished to explore the first person perspective of participants who had developed delusions. Interpretative phenomenological analysis was used to interview and analyse themes from 28 participants. An additional matrix analysis of themes was used to examine the importance of social difficulties in relation to types of onset and diagnoses. Our results suggest 3 types of onset: an eruptive sudden transformation of self or world; a slow progressive onset characterised by interconnected changes in meaning and experience; and onset beginning in childhood experience. Social difficulties were mentioned spontaneously by 17 participants in describing onset and a further 9 discussed social difficulties when explicitly asked. One feature that appears to be present both in the progressive and childhood onset is negative emotion about, and preoccupation with, a difficult interpersonal topic over long periods of time. The descriptions given suggest that certain ideas or images could take hold of a person and become interwoven in his or her thinking and perhaps even begin to influence the way the person experienced the world or self. We suggest that it may be important for therapeutic work with delusions to articulate a narrative of onset. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message: Exploring the onset of delusions can lead to useful information about social and emotional difficulties. Most patients are able to give detailed accounts of onset, though some might only describe social and emotional difficulties if prompted. Reported changes in experience and/or social difficulties may have occurred for some patients over many years and may even begin in childhood. There may be a process of mutual influence between extreme negative ideas and experience over years for some patients.

In this paper the author describes clinical work with forensic and anti-social personality disordered patients where the clinician is placed in a countertransference situation where, in the course of what is good therapeutic work, he experiences an overwhelming sense of having failed the patient. The author utilizes Glasser's idea of 'identification with the neglector' and Hinshelwood's writings on patients with disordered relations to care, to examine this experience, and he differentiates it from the concept of 'identification with the aggressor'. Two clinical illustrations are used to highlight the issues discussed and show how with this patient group much of the clinical work is done in the countertransference.

In this paper the author shares some of his experiences of teaching in areas of ‘race’ and culture to mainly white middle-class family therapy and clinical psychology trainees. He presents a framework for a systemic teaching session on working interculturally. Specific exercises are described that trainers can use to design a new session or incorporate into existing ones. It is meant to increase the cultural awareness and sensitivity of trainees with limited experience of cross-cultural therapeutic work.

The first half of this paper reconsiders the therapeutic work with a patient who had a troubled relationship with her older sister (Coles 1998). In particular I explore the conflictual sibling transference and the countertransference anxieties I faced. In the second half of the paper I speculate about transgenerational conflicts between sisters and suggest that the patient's conflict with her sister, and her sense of lost identity when her sister died, may be linked to her mother's relationship with an older sister. I draw on literary sources which also illustrate the impact of sibling relationships.

Book reviewed in this article: Pauline Boss (2006). Loss, Trauma, and Resilience: Therapeutic Work With Ambiguous Loss.

This article is concerned with the experience of infants who endure long hospitalisations. It explores the concept of the baby as subject; that is, infants as active, psychic participants in their earliest relationships. It explores therapeutic possibilities with hospitalised infants from an infant mental health perspective. It advocates for family therapists to equip themselves for infant-parent therapeutic work.

Emotionally focused therapy for couples (EFTC) is an important framework for couples therapy. It provides an integrative model, drawing upon experiential, systems and attachment theory to understand the dynamics of the couple relationship and to describe the therapeutic process. The aim of this paper is to ask how EFTC uses attachment theory, and whether it draws as fully as it can upon the richness of that theory to inform the process of therapy. This is set in the context of the evolving importance of attachment theory for therapeutic work. (author abstract)

This article describes goals and strategies for family-focused counseling and therapy when children are alienated from a parent after separation and divorce. The confidential intervention takes place within a legally defined contract and is based on a careful assessment of the dynamics of the multiple factors that contribute to the alienation and how the chil?s development is affected. Strategies for forming multiple therapeutic alliances with often reluctant, recalcitrant, and polarized parents are discussed together with ways of helping the child directly.

In this article we report and reflect upon a service offered in one locality of the UK to children who have been abused. The evaluation shows the value of close working relationships between agencies, and the very positive way that such interventions are viewed by the children and those involved with their care. It is also evident that an eclectic style of therapeutic work is able to produce improvement in aspects of the children's behaviour, most particularly in the area of family life and relationships. Copyright © 2005 John Wiley & Sons, Ltd.

This article employs a set of concepts developed by Mikhail Bakhtin in analysing the significance of language in therapeutic work. Employing his theoretical constructs, sequences of a videotaped transcript of a therapy session are analysed by a multidisciplinary team. This is combined with the notion of co-texted ritual in working with a woman who attempted suicide prior to this session. The findings suggest that co-texting gives direction to the meaning of ritual as well as the outcome of the therapeutic process. Bakhtinian concepts are found to be helpful in guiding, analysing and widening therapeutic processes. The findings also indicate that there is a need for a closer examination of ritual both as a constitutive and expanding force in narrative therapy. Finally, it is suggested that current assumptions about egalitarian relationships between therapists and clients require rethinking.

There are few attachment-based measures designed for use by therapists to inform the clinical process of psychotherapy. The aim was to develop an attachment based interview schedule for use by mental health professionals. A draft interview schedule was developed through a review of the literature. Systematic analysis of case materials led to refinements of the schedule. Attachment formulations were developed for six patients. The clinical validity of these formulations was assessed through group discussion and via reports from the patients’therapists. The schedule provided information about patients’attachment histories, styles, issues and problems leading to an attachment formulation, possible foci for therapeutic work, and difficulties that might arise during therapy. The interview schedule allows a picture to be built up of how attachment patterns and behaviours have developed and how they are expressed in the present. It leads to hypotheses about what needs to change for the individual to have more secure, less distorted relationships and what problems may be encountered during therapy.

This paper is a qualitative family therapy process study which is part of a larger European-based outcome study comparing family therapy to child psychotherapy plus parent support for depressed children and their families. The family therapists and two clinical supervisors from the original study formed themselves into a research team to study the process of therapy with twelve families. Therapists selected the significant moments from fifty-nine sessions, and were then interviewed by the research team using a standard protocol to investigate the therapists' own thinking about they significant moments. Applying a thematic analysis, the significant moments were clustered into eleven themes. The paper discusses the rationale for this model of research, which is well suited for clinical teams, and the application of the themes to therapeutic work with depressed children and their families.

Gay affirmative therapy is a counselling approach that emphasises an affirming, non-pathologising approach to therapeutic work with lesbian, gay and bisexual clients. In this study, lesbian and gay clients who had experienced counselling that they defined as affirming identified what they perceived to have been helpful. Questionnaires and interviews were used to collect the views of a sample of lesbian, gay and bisexual informants. The material gathered was analysed using a grounded theory approach, which generated six main categories: communicating a non-pathologising perspective on homosexuality; the counselling relationship; the counselling space; what the counsellor brought to the relationship; humanity; and the counsellor adopting a holistic approach. Some of these identified affirming elements are unique to gay affirmative therapy and cannot be attributed to other factors. The possible significance of the findings for practitioners is discussed.

The purpose of this study was to ascertain the level of narcissistic injury among trainee counselling psychologists using the Narcissistic Injury Scale (Slyter, 1991). This 38-item Likert scale is based on Miller's (1981) definition of narcissistic injury; a specific type of psychological damage which focuses on feelings about the self and past relationships related to self-development. Theorists suggest that if untreated, narcissistic issues can interfere with client work and lead to a number of problems for trainees, influencing drop-out rates and increasing burnout. The results of the study indicate that a high degree of narcissistic injury may be prevalent among trainee counselling psychologists and furthermore, that narcissistic injury does seem to be related to the quality of the perceived parent-child relationship. Consequently, the study suggests that therapeutic work could be affected in those trainees who fail to address their own narcissism. The study provides some tentative support for the utility of the Narcissistic Injury Scale.

Background This report describes a group intervention for men with an intellectual disability who have sexually offended or abused others. The group was in response to referrals to a psychology department. The majority of these individuals had not been subject to legal proceedings. Methods A number of assessments were conducted prior to the group, immediately after the group and at 3- and 6-month follow-up. Results Attitudes consistent with offending reduced after participation for most participants, however, these tended to revert to pre-group levels over time. Locus of control became more external after the group treatment, this was contrary to expectations and results obtained with interventions for individuals without an intellectual disability. Knowledge tended to increase after the group, however, problems with the questionnaire used made interpretation of the results difficult. No further incidents of sexual abuse have been recorded by any of the five group members who completed the group, since the start of the group (a period of 1 year to date). Conclusions This group should be seen as a pilot project. However, further therapeutic work is indicated as is theoretical and questionnaire development.

Adopting an existential perspective in counseling is often viewed as inapplicable or a luxury for most clients. The author challenges these commonly held misconceptions. The concept of existential authenticity is presented as an organizing ethic that can bring out the positive side of existentialism in counseling. Specific values and conditions that the counselor can adopt to create an existential foundation for counseling practice are presented. The author concludes that actively incorporating these existential values into the counseling process can deepen the impact of the therapeutic work.

The aim of this paper is to explore some interactive processes and constraints as adults and children develop new narratives post-divorce. It will look at how adults’ narratives can become more rigid or frozen over time as a result of battles within the legal system, and the effect this can have on children. Dilemmas and contradictions for therapists attempting to bring about change in the context of an assessment will be discussed, as will the challenge of introducing therapeutic ‘understanding-based’ language into an adversarial system organized around ‘evidence-based’ language. The therapeutic work described takes place in the context of court assessments of children whose parents are engaged in disputes over contact. Case vignettes will be used to illustrate the processes described, and dilemmas for therapists will be discussed as they position themselves in relation to conflicting narratives.

Systemic therapy is considered as a modality which may be well-suited to therapeutic work with lesbian and gay male populations, whether as individuals, couples or families of choice. Issues within systemic therapy and practice are discussed with reference to working with these populations. Copyright © 2002 John Wiley & Sons, Ltd.

Generalizing therapeutic gains made during therapy sessions to patients' daily lives is the most fundamental goal of psychotherapy. Assigning between-session homework is an efficient method to teach new skills and to generalize those skills to the patient's natural environment. Given the persistent, chronic, and pervasive nature of the problems presented by the individual with a personality disorder, homework is not merely recommended but is an important and essential part of the therapeutic work. This article discusses modifying homework for personality-disordered patients in the context of a literature review and case examples from the various Personality Disorder Clusters. Also offered are a number of techniques to overcome patient “resistance.” © 2002 Wiley Periodicals, Inc. J Clin Psychol/In Session 58: 513–524, 2002.

This article examines the therapeutic work in three cases (child, adolescent, adult) to study the impact of a supportive and nurturing parent early in life upon the development of resilience. The close analysis of the clinical material of each client's personal narrative is the primary source. The metaphor of "heroes in the nursery" is posited as a vehicle for enhancing understandings of the development of resilience. Each case provides additive meaning to recent studies that elevate the importance of the memories of parents to the development of resilient responses of children later in life. Each case reveals specific dimensions of the impact of heroes in the nursery which extend our understandings of resiliency in children and adolescents as a proactive response to stress, trauma, and loss.

In the experience of non-narratively trained therapists, as well as some narratively trained therapists, the 'protest metaphor' for framing externalising conversations retains signature status. Yet this metaphor does not adequately represent the breadth of narrative work. As therapist and client reflecting on our joint work, we explore what using a range of metaphors offers to narratively informed therapeutic work. The concept of 'resistance practices' from Stacey (1997) is revisited, alternative metaphors employed in externalising conversations are reviewed and power is re-examined. We then review the effects on practice that ensue from drawing on a range of alternative metaphors, illustrating our account with extracts from letters and comments on sessions. (author abstract)

Although there has been a fairly substantial focus in previous research upon understanding the characteristic of firesetters and incidents of firesetting; there is a dearth of published studies that focus upon treatment strategies for use with mentally disordered firesetters. The current research rectifies this shortfall by describing the development and content of a firesetting treatment package, designed for use with individuals who have a mental disorder. Wherever possible, the reported features of the package are ground in the previous published research. Issues concerning evaluation of this type of therapeutic work are also discussed. Copyright © 2001 John Wiley & Sons, Ltd.

This paper describes therapeutic work with eating disordered adolescents and their families in a multiple family setting. Theory and practice of the multiple family approach are presented and details of the treatment programme outlined. Preliminary results show that this form of treatment is not only acceptable to patients and their families, but that there are also significant positive changes in the patients' symptomatology and recovery rates. Copyright © 2001 John Wiley & Sons, Ltd and Eating Disorders Association.

Subject. Urinary incontinence is a frequent disorder among adult females, but very few of the incontinent women have consulted a doctor.Discussion. This paper reviews and discusses the possible roles of the general practitioner in the diagnostic and therapeutic work with women with urinary incontinence. Some characteristics of general practice and the selection process from primary care to the specialist level are described. The selection process (gatekeeper function) of patients from community to hospitals may introduce bias into research and hamper the generalization of hospital-based research back to general practice. Recommendations and guidelines for diagnosis or therapy developed at secondary or tertiary care levels may be inappropriate at the primary care level, with a significantly different clinical picture of this condition.Results. Several studies show that most women seeking help in general practice can be satisfactorily treated at this level of care with fairly simple treatments, and that tre...

The concept of "culture" figured prominently in the development of family therapy. Recent conceptualizations, however, have tended to focus primarily on the ideational dimensions of culture. While not disputing that meanings and other ideas constitute significant features of group lifeways, this article proposes a return to earlier anthropological framings that incorporate material and ideational dimensions of cultures. To illustrate how his expanded concept may serve as a guide for therapeutic work, the article describes therapy with one family at a clinic in rural Scandinavia. We especially focus on the place of key symbols as historical links between the ideational and material dimensions of cultures. The perspective developed here is one of seeing cultures as sets of interpenetrating actions and ideas shaped by as well as shaping their practitioners.

Research suggests that clients need to be made aware of the relationship between thinking and emotional and behavioural reactions at the start of the therapeutic work. This paper looks at the clinical processes of educating the client about this relationship in a seven-step ABC model. Rationales for each of the seven steps are given. The model illustrates the process of generating alternative beliefs in relation to a negative event and shows consequences of holding helpful and unhelpful beliefs.

The authors describe African American cultural and spiritual traditions that are the bedrock for therapeutic work with this population. Through the use of a clinical case, they link African American women's emotional issues with healing interventions borrowed from their rich heritage of religious and spiritual rituals and practices.

The trauma of the past, the echoes of war - how do we become aware of these in our work with individuals who as children suffered the consequences of their parents’ war experiences, and how do we conceptualize the damaging effects of the parents’ emotional wounds inflicted on the second or third generation? Much work has been done with Holocaust victims and the second generation and there are revealing American studies of Vietnam War veterans. But it took 70 years and a work of fiction to remind us of the beginnings of therapeutic treatment for shell shock in World War I. On the basis of extensive clinical material this paper attempts to describe some pathogenic effects exerted by the transmission of war trauma from fathers to children, speculates about the legacy of this century's terrible war and wonders how we are dealing with this in our therapeutic work.

This paper discusses the relative neglect of the role of the father by researchers and parent–infant psychotherapists. It goes on to describe reasons why the father's role is of developmental significance. Using clinical examples, it is suggested that it is often critical to ensure that fathers are included if the therapeutic work is to have the best chance of success. Two particular aspects of the father's contribution are considered, namely the direct influence that his own “ghosts” may exercise on the parent–infant relationship, and a slightly more indirect role that he may play as the other half of the parental couple. © 1999 Michigan Association for Infant Mental Health

The authors are currently conducting a large randomized controlled trial of the effectiveness of brief psychodynamic-interpersonal psychotherapy with outpatients who have been unresponsive to conventional psychiatric treatment. In this paper we describe the study and the psychodynamic-interpersonal model of therapy employed in the treatment limb of the study. We also describe therapeutic work with three patients whose presentation is representative of the outpatients recruited into the study.

In this article we discuss some of the relevant theoretical, technical, and clinical issues in the treatment of depression with short-term psychoanalytic psychotherapy. When successful, we suggest that such psychotherapy results in changes involving aspects of the self. We believe that this is particularly likely to occur when the technique emphasizes the interpretation of the nature of the client's relationship to the therapist. To illustrate this approach, we present the case of a clinically depressed woman treated in time-limited, short-term psychoanalytic psychotherapy. We demonstrate the nature of the therapeutic work typical of this treatment using verbatim vignettes from two sessions. © 1997 John Wiley & Sons, Inc.