Opening Up: Clients’ Inner Struggles in the Initial Phase of Therapy

Kleiven, Gøril Solberg; Hjeltnes, Aslak; Råbu, Marit; Moltu, Christian

doi:10.3389/fpsyg.2020.591146

Cited by 14 publications

(8 citation statements)

References 44 publications

(46 reference statements)

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“…In this study, overwhelming fear and shame fueled relational distance. Our findings resonate with other qualitative research, confirming that feelings of fear and shame are common during initial sessions and need to be dealt with to successfully reach a real relationship and a collaborative working alliance ( Lavik et al, 2018 ; Radcliffe et al, 2018 ; Kleiven et al, 2020 ). Further, serious ruptures or a lack of relationship became fatal when not addressed, as in dyads 4, 9, and 11.…”

Section: Discussionsupporting

confidence: 87%

“…IPR is a qualitative research method utilizing video or audio recordings to support the interviewee’s recollection of every moment in the session. While IPR was originally developed for supervision, the method has increasingly been used in recent years for the purpose of studying psychotherapy micro-processes ( Elliott, 1986 ; Kleiven et al, 2020 ; Solstad et al, 2021a , b ). In psychotherapy research, IPR typically entails video recording the therapeutic interaction; the recording is then viewed by the client and/or therapist shortly afterward, at the same time as the research interview.…”

Section: Methodsmentioning

confidence: 99%

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Relationship and Alliance Formation Processes in Psychotherapy: A Dual-Perspective Qualitative Study

et al. 2022

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ObjectiveTo explore how therapists and clients act dyadically to establish a therapeutic relationship during the first five sessions of psychotherapy. The study aimed to identify both relational facilitative and hindering processes occurring in routine care.MethodsUsing the method ‘interpersonal process recall’ (IPR), we videotaped the third and fifth session of 12 psychotherapy dyads, and conducted video-assisted interviews with each therapist and client separately. In total, the data material consist of 47 IPR interviews. Data were analyzed using a thematic approach.ResultsThe analysis process revealed two main groups. The first group consisted of dyads with a positive relational outcome, and the second group consisted of dyads with a troubled or frail relational outcome. During the initial phase of therapy, clients described feeling overwhelmed by fear and shame. Positive relational development occurred when these emotions were successfully accommodated and replaced with a growing sense of safety with the therapist. However, the relationship became troubled when the client experienced an increase in shame and/or fear during the first sessions. When forming a therapeutic relationship, it is vital that the client experience the therapist as genuine and skilled, and that the therapist is able to engage and connect deeply with the client on a person-to-person level. The article further provides a discussion on how these dyadic experiences align with the working alliance and real relationship, and how the two consolidate during the first sessions of psychotherapy.ConclusionThe current study explored the complex relational processes underlying the formation of the therapeutic relationship. Core aspects of the real relationship are prerequisites to forming a collaborative working alliance in which both therapist and client are actively engaged. Facilitating a positive relationship is crucial in the early phase of psychotherapy, and therapists can actively identify and repair ruptures at this time.

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Section: Discussionsupporting

confidence: 87%

Section: Methodsmentioning

confidence: 99%

Relationship and Alliance Formation Processes in Psychotherapy: A Dual-Perspective Qualitative Study

et al. 2022

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“…Three of the five participants expressed specific concerns that their photographs might be laughed at or criticised. Self-disclosure is a challenging yet important process in psychological therapy, and it is natural for participants to experience vulnerability fears at the start of a group intervention (Farber, 2003;Kleiven et al, 2020). It is unclear whether the current participants were particularly fearful of others' responses, but this would make sense in terms of some of their difficulties as emotional instability typically develops as a result of an early environment characterised by invalidation (Linehan, 1993).…”

Section: Discussionmentioning

confidence: 97%

‘Showing people part of your life’: service-user experiences of taking and sharing photographs in a DBT-informed emotional coping skills group

Barrow,

Masterson,

Lee

2023

tCBT

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The added value of using photographs to explore experiences has been embraced in research methods such as photo-elicitation and Photovoice. Despite evidence that photographs aid communication and understanding, there is little research investigating photograph use within cognitive behavioural therapy. This project explores participant experiences of taking and sharing photographs within a dialectical behaviour therapy (DBT)-informed emotional coping skills group intervention. Five service users were recruited from groups that had implemented the taking and sharing of photographs as a feature of homework tasks and feedback. Semi-structured interviews were conducted, using the photographs taken for the group as prompts, and interpretive phenomenological analysis was used to develop themes. Group evaluation data were used to support the analysis. Participants were positive about the impact of the photographs, despite initially experiencing anxieties regarding sharing them. The task supported them to express themselves in ways that added value to verbal feedback, which had benefits for group relationships and for the therapeutic tasks such as mindful observing. Further research is indicated, given the small sample and participants all being white, working-age females. However, the findings suggest that using photographs as homework tasks could support communication and the exploration of experiences that may be difficult to express using words. Key learning aims (1) Photographs may be an excellent tool for the communication of meaning and emotion in therapy. (2) Photographs taken on smartphones are likely to be a user-friendly, familiar and effective addition to homework recording tools. (3) Sharing photographs may have particular benefit for service users who struggle to be open about or express their feelings. (4) Photographs can provide a prop to help service users share experiences in a non-verbal way, which may help when working with people who struggle to describe their emotional experiences. (5) Sharing photographs can lead to a deeper connection with others, although some negotiation about what types of images can be captured will need agreement in a group setting.

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“…We believe that triangulation of data sources from within the same epistemological position is valuable, as they may provide opportunity to develop and deepen knowledge. One way to do this in a qualitative interview study could be to use interpersonal process recall of treatment sessions to elaborate on the participants perspectives on their own evaluations, choices, and behaviors as they play out in practice (see, e.g., Kleiven et al, 2020 ). In this study, we do not have access to other data sources, which we consider a limitation.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Negotiating System Requirements to Secure Client Engagement – Therapist Strategies in Adolescent Psychotherapy Initiated by Others

et al. 2021

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Background: Many adolescent clients come to treatment reluctantly, at the initiative of others. Adolescents also quit therapy prematurely more often than adult clients do. This points to the value of finding good ways to engage adolescent clients in treatment and understanding more of what therapists do to achieve this task.Methods: We used focus group methodology to explore therapist strategies and behaviors to engage adolescent clients who come to therapy at the initiative of others. Ten focus group interviews with a total of 51 therapists were conducted with existing treatment teams from seven different clinics in community mental health care for children and youth. Reflexive thematic analysis was used as a framework to guide the analytical process.Findings: Navigating a position allowing the therapist and adolescent to meet and work toward a shared understanding of the situation and what could help was considered the main gateway to client engagement. To do this, therapists had to manage the pull between system requirements and their obligation to the individual adolescent client, represented by the theme Managing system requirements. The process of working with the adolescent to ensure engagement is represented by the four themes: Counteracting initial obstacles for client engagement – “You are not trapped here”; Sharing definitional power – “What does it look like to you?”; Practicing transparency – “I want you to know what I see”; and Tailoring as ideal – “I will design this therapy for you.”Implication and conclusion: Therapists want to understand their adolescent clients’ position better, and subsequently adjust the treatment goals and techniques to establish sufficient common ground to allow both the therapist and adolescent to find the therapeutic project worthwhile. However, system requirements and service organization were found to obstruct and influence these processes in several ways, pointing to the significance of exploring the interplay between system organization and therapeutic practice more thoroughly. There was also a variation between therapist behaviors described by different therapists within the same treatment teams, as well as systematic differences between treatment teams, pointing to the importance of future research differentiating wanted from unwanted variation in treatment.

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Opening Up: Clients’ Inner Struggles in the Initial Phase of Therapy

Cited by 14 publications

References 44 publications

Relationship and Alliance Formation Processes in Psychotherapy: A Dual-Perspective Qualitative Study

Relationship and Alliance Formation Processes in Psychotherapy: A Dual-Perspective Qualitative Study

‘Showing people part of your life’: service-user experiences of taking and sharing photographs in a DBT-informed emotional coping skills group

Negotiating System Requirements to Secure Client Engagement – Therapist Strategies in Adolescent Psychotherapy Initiated by Others

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