Class 10: The Therapist’s Experience

Question 1

What is the best predictor of the outcome of psychotherapy?

Answer 1

• The Therapeutic Alliance

Question 2

Therapeutic Moments

(Closeness)

Answer 2

• patient is revealing something about her/himself, and the therapist feels that s/he understands
• A sense of “immediacy”
• Powerful positive valence

Question 3

Therapeutic Moments

(Loss)

Answer 3

• Therapist feels the loss, too
• Therapist tolerates the shared feeling of loss
• Sometimes it can only be witnessed

Question 4

Therapeutic Moments

(Joy)

Answer 4

• Sharing strong positive feeling(s)
  
  • Joy, admiration, respect, love
  • Occurs in the here and now (“Immediacy”)
  • Distinct from transference

Question 5

Therapeutic Moments

(žDifficult Decisions)

Answer 5

• Patient is struggling
• Both are aware of the significance of the decision
• Therapist considers how active to be

Question 6

Therapeutic Moments

(žThe Absurdity of Life)

Answer 6

• The perfect storm
• Running out of kleenex

Question 7

Therapeutic Moments

(žAbout the therapy)

Answer 7

• Building a narrative together
• A sense of working together
• Even in a rupture
  
  • “When a patient feels hurt, then hurt has occurred.” (p. 243)

Question 8

Therapeutic Moments

(žEmotion about you)

Answer 8

• It’s not about “fishing for compliments”
• It is communicating in the “here and now”
  
  • Opening ourselves to criticism
  • Engage with the patient about their experience as it is happening
  • Attend to our own emotional response
    
    • Admiration, respect, empathy are the “filters” through which we listen
    • It is not about us, it is about the patient’s experience of us

Question 9

Therapeutic Moments

(Mistakes)

Answer 9

• Forgetting, being distracted, nodding off
• Does the “mistake” help us understand something about the patient?
• We need to be able to acknowledge our mistake and apologize
• Apology allows the dyad to explore patient’s experience in reaction to mistake

Question 10

Therapeutic Moments

(žSelf-Disclosures, Being Personal)

Answer 10

• Heuristic: “Being normal”
• How will this serve the patient?

Question 11

Therapist’s Strengths/Countertransference

(žBetter outcome with)

(check slide #14 on class 10 PP…the formatting was weird on the PP)

Answer 11

• Adherence to treatment manual
  
  • (moderate or high)?
  • –Mixed results
• Therapist self-disclosure
  
  • Statistically significant, clinically weak
• Therapist emotional well-being
  
  • Mixed
• Therapist racial attitudes
  
  • Consistently high
• Quality of the therapeutic relationship
  
  • Strong predictor of outcome

Question 12

Therapist’s Strengths/Countertransference

(Attention)

Answer 12

• The phone ringing
• “Evenly hovering attention”
• Pay attention to patient’s emotional state
  
  • Per Summers & Barber (2010), focus on emotional hotspot
  • At issue: expand patient’s awareness of her/his emotions
• Track the story
• “Flow”—connecting with the patient
• When attention wanders, what might that mean? (enactment?)

Question 13

Therapist’s Strengths/Countertransference

(žInner Experience)

Answer 13

• We are emotionally open (vulnerable?)
• We attend to our feelings without being controlled by them
• We feel, but try hard not to be judgmental about our feelings

Question 14

Therapist’s Strengths/Countertransference

(Strengths)

Answer 14

• Emotional flexibility
• Kindness
• Social intelligence
• Cognitive flexibility
  
  • Taking in new information, being open to changing our conceptualization, our style
• Curiosity
• Peterson & Seligman (2004; cited by Summers & Barber, 2010)
  
  • Creativity, open-mindedness, perspective, persistence, integrity, humility, humor

Question 15

Therapist’s Strengths/Countertransference

(What can we do to nurture our personal qualities)

Answer 15

• Supervision, openness to feedback
• Our own psychotherapy
• Self-care

Question 16

Managing Emotions (as a therapist)

Answer 16

• žUnderstanding (our education and training is important in this)
• Optimal distance (be a bridge between the patient’s experience and something better)
• Positive emotions (we hold the patient’s hope when the patient can’t)
• Empathy (our own experience can help, if used with caution)
• Personal painful feelings (managing our own)

Question 17

APPLICATION

(Countertransference (Gabbard, 2001))

Answer 17

• žFreud: CT = the therapist’s own transference
• Heimann, Winnicott: CT = response to the patient’s behavior
• Gabbard: CT = jointly created

Question 18

APPLICATION

(CT Phenomena)

(žProjective Identification: defense and communication)

Answer 18

• Patient disavows an aspect of self, coerces the therapist to experience or unconsciously identify with that aspect; therapist is like a detox system, that allows the patient to reclaim the aspect that is now less toxic
• Therapist needs to have a “hook” for projection to stick

Question 19

APPLICATION

(CT Phenomena)

(žCountertransference Enactment)

Answer 19

The therapist is pressured (unconsciously) to become the object of the transference, and the therapist acts that role out (in tone, movement, etc.)

Question 20

APPLICATION

(CT Phenomena)

(žRelational/Constructivist Theories)

Answer 20

• Subjectivity of therapist and patient interact
  
  • Mutually
• Therapist is vulnerable
• (for the pic…the word “patient” should be on the left and the word “therapist” is on the right)

Question 21

CT Phenomena

(who manages it)

Answer 21

žDespite both patient and therapist being involved in CT, therapist is responsible for management of CT