Counseling Psychology has emphasized the importance of using multicultural and social justice frameworks in psychotherapy to avoid reenacting in session the privilege and oppression dynamics that exist in larger society. People of Color have historically underutilized psychotherapy services and have higher attrition rates when they do attend therapy, even though they have been more likely to face more sources of psychological distress (Kearney, Draper, & Baron, 2005; Sue & Sue, 2008). Additionally, White therapists have been over-represented in professional and training settings (Fouad & Arredondo, 2007; Hays & Chang, 2003). Add to that the fact that therapists have been trained in and practice psychotherapy theories developed primarily by White men and you have a system of counseling that works for some and not all. Thus, White therapists could be at risk for harming their clients of Color, and possibly their White clients as well, because of the utilization of these Euro-centrically biased ways of conceptualizing and treating clients (Mindrup, Spray, & Lamberghini-West, 2011). In this study, I examined the impact of therapist-reported White privilege attitudes on client-reported counseling outcomes and the therapeutic relationship. Participating therapists (N = 36) were recruited from a community mental health agency in the southeast and administered measures of White privilege attitudes, multicultural knowledge and awareness, and motivation to control prejudiced reactions. Outcome and therapeutic relationship data from clients of participating therapists, seen between fall 2012 and fall 2013 semesters, were provided by the agency. Therapist self-reported White privilege attitudes were not directly predictive of therapy outcomes and the therapeutic alliance. Therapists’ willingness to confront White privilege, White privilege remorse, and apprehension about addressing White privilege moderated the effects first session outcome scores and client gender had on number of sessions attended by clients. Client race/ethnicity was not directly predictive of therapy outcome scores or therapeutic alliance scores. However, client race/ethnicity varied significantly across therapists, suggesting that therapists were differentially effective. Results of this study indicate that therapist White privilege awareness has an effect on outcomes and the therapeutic alliance, although the relationship is complicated. Study limitations, strengths, and implication for future research are discussed.

Bakgrund: Ett stort antal patienter fullföljer inte sin behandling av ätstörningar på grund av att de känner sig missförstådda av vårdaren vilket kan leda till ett vårdlidande. Sjuksköterskors arbete är betydelsefullt då den vårdande relationen som hen fokuserar på anses vara mer läkande än den medicinska behandlingen. En väletablerad kontakt mellan vårdpersonal och patient är av stor betydelse för en god omvårdnad och en lyckad behandling. Syfte: Syftet med studien är att belysa sjuksköterskors erfarenheter av att vårda patienter som lider av ätstörningar. Metod: En litteraturstudie har gjorts med utgångspunkt i Evans (2002) analysmetod. Analys av 10 vetenskapliga studier som har svarat till studiens syfte. Resultat: Fyra teman framkom som belyser sjuksköterskors erfarenheter kring attityder och beteenden, en vårdande relation, kunskap och känslor. Slutsats: Relationen mellan patient och vårdare är mycket viktig men också mycket komplext. Det är vår uppfattning att alla sjuksköterskor försöker med bästa möjliga förmåga sträva efter att lindra patienters lidande däremot är kunskapen om hur detta ska uppnås inte tillräckligt tydlig. Att sjuksköterskor ibland frångår principer som formar omvårdnaden, så som empati, kärlek och förståelse; är ett faktum. Klinisk betydelse: Sjuksköterskorna sökte många gånger stöd och hjälp från andra mer erfarna kollegor för att ta del av deras erfarenheter och kunskaper för att kunna ge en bättre vård. Studien är därmed ett viktigt bidrag då det ger en översikt över erfarenheter i en större utsträckning än den samlade erfarenheten som kan finnas inom endast en avdelning. / Background: A large number of patients do not fulfill the treatment provided for eating disorders due to a feeling of misunderstanding from the nurse; this can lead to a suffering for the patient. The works of nurses are significant since the therapeutic relationship is seen as more healing than the medical treatment. A well-established relationship between care provider and caretaker is of great importance for a good quality care and a successful treatment of the patient suffering from an eating disorder. Aim: The aim of the study was to shed light on nurses' experiences of caring for patients suffering from an eating disorder. Method: A literature review was conducted with support of Evan's (2002) method of analysis. An analysis of 10 scientific studies which contributed to the aim of this study. Findings: Four main themes were identified that shed light on the nurses' experiences regarding attitudes and behaviors, a therapeutic relationship, knowledge and feelings. Conclusion: The relationship between patient and caregiver is very important but also very complex. It is our opinion that all nurses try to ease the patients suffering at the best of their ability although the knowledge of how to achieve this is not very specific. That nurses sometimes abandon core values like compassion, love and understanding; is a fact. Clinical impact: The nurses often sought support and help from other, more experienced colleagues to take note of their experiences and knowledge to be able to provide better care. The study is there for an essential contribution since it gives an overview of experiences on a greater scale than the collected experience that can be found in just one ward.

Since 1999, youth have experienced an increase in HIV incidence. Gay male youth, in particular, are a priority sub-population because they accounted for the highest exposure category in 2008 among youth. Due to the lack of studies on gay male youth who are susceptible to HIV, and the reality that most previous research on stigma may no longer reflect the contemporary context, nursing based research was undertaken. Utilizing critical theory, stigma within the therapeutic relationship was investigated through eight semi-structured interviews with gay male youth who were recruited through a gay men’s sexual health clinic in Ottawa, Canada. The results of this research showed that while stigma, whether perceived stigma or the fear of stigmatization, was still felt by these participants in some interactions, overall, these youth had positive experiences with the health care system, particularly within the context of the gay men’s sexual health clinic.

Background and objectives: Despite the large amount of research around counselling psychology and working with culture, ethnicity and religion, literature has mainly focused on clients' experiences of therapy. We know little about trainee counselling psychologists and how they experience working with clients from different ethnic and/or religious backgrounds. The objective of this study was therefore to explore UK-based trainee counselling psychologists and their experiences of working with clients from different backgrounds and to also explore educational implications trainee counselling psychologists identify when working with clients from different backgrounds. Therefore, following the aim of this study the two research questions, which will be, explored area as follows: 1. How do trainee counsellingpsychologists experience working with clients from different ethnic/religious backgrounds? and 2. What educational implications are identified by trainee counselling psychologists when working with clients from different ethnic/religious backgrounds to themselves? Method and analyses: A qualitative design was used within project. Semi-structured interviews were conducted with twelve UK-based trainee counselling psychologists who had experiences of working with clients from different ethnic/religious backgrounds. A systematic review of the literature was conducted in order to inform the research and to also produce a coding template, which was used to analyse the findings of this thesis. The interview material was analysed using thematic analysis. Analysis: The findings from the first research question revealed eight major themes, which were extracted from the coding template, these themes included: challenges, exploration, relationship, client's perspective, appropriateness, competency, sense of self and emotional responses. These eight major themes were extracted via the coding template and expanded further as the interviews were analysed. The interviews provided a richer understanding ofthese themes and they are introduced and outlined in depth in turn. Following the first researchquestion, the second research question concentrates on educational implications identified by trainee counselling psychologists. These findings yielded a total of four main themes, which included: course input, practical experience, personal experience and reflectivity. These themes are also outlined and explored further in the discussion of this thesis. Conclusions: The research enabled, for the first time, an insight into trainee counselling psychologists' reported experiences of working with clients therapeutically who were from different ethnic/religious backgrounds. Some trainee counselling psychologists reported that rather than working with clients from different backgrounds, working with clients from similar backgrounds posed to be quite difficult as well. More importantly, the idea of reflectivity and personal growth were key elements identified when working with differences in therapy. Trainees expressed that their own sense of self and personal development were key factors when working with clients from different backgrounds. The Discussion of this thesis further expanded on the findings relevant in this thesis. Finally, the Conclusion explored the implications for counselling psychology and education, additionally future considerations for research are also mentioned.

Among the many researched outcomes of childhood sexual abuse (‘CSA’), relational difficulties have been well documented. However, male CSA survivors may experience several outcomes that are unique to their gendered experience and yet remain largely under-represented in the literature. A gap was identified in the research around the experience of the male survivor in therapy for childhood sexual abuse, particularly where it relates to relationship building. Therefore the research aimed to explore this from the perspective of the survivors, with a focus on trust within the therapeutic relationship. To achieve this, the researcher interviewed 6 male survivors of sexual abuse, all of whom had greater than one years’ experience in a therapy that focused on their abuse. The researcher adopted a semi-structured interview format which facilitates partial guidance by the new data introduced by the participant. Transcripts of the interviews were analysed using interpretative phenomenal analysis with a consistent curiosity stance that allowed the researcher to partially bracket their prior knowledge. The analysis resulted in four master themes emerging; i) Finding and Connecting; ii) Negotiating Masculine identity, iii) Accepting and Committing to the process; and iv) Trust. Findings highlighted the necessity of reducing epistemic vigilance in the early relationship and the importance of negotiating power dynamics with support for challenge by the client in order to facilitate trust. The experience of masculine social expectations in a male CSA survivor is explored with regards to the trust relationship and an unexpected finding was made in the importance of group work. These findings were linked to previous research in the area of male CSA, recommendations are made for future research and implications for practitioners were explored.

MIRANDA, Carmen Silvia Nunes de. Ética radical e psicoterapia centrada na pessoa: uma investigação acerca da abertura à alteridade radical na relação terapêutica a partir de discursos de psicoterapeutas sobre o inusitado em sua prática clínica. 2012. 129f. – Dissertação (Mestrado) – Universidade Federal do Ceará, Programa de Pós-graduação em Psicologia, Fortaleza (CE), 2012. / Submitted by Márcia Araújo (marcia_m_bezerra@yahoo.com.br) on 2013-11-26T11:29:24Z No. of bitstreams: 1 2012-DIS-CSNMIRANDA.pdf: 1067246 bytes, checksum: 70313fc650d77dcb1a38b6929249161b (MD5) / Approved for entry into archive by Márcia Araújo(marcia_m_bezerra@yahoo.com.br) on 2013-11-26T14:17:24Z (GMT) No. of bitstreams: 1 2012-DIS-CSNMIRANDA.pdf: 1067246 bytes, checksum: 70313fc650d77dcb1a38b6929249161b (MD5) / Made available in DSpace on 2013-11-26T14:17:24Z (GMT). No. of bitstreams: 1 2012-DIS-CSNMIRANDA.pdf: 1067246 bytes, checksum: 70313fc650d77dcb1a38b6929249161b (MD5) Previous issue date: 2012 / This study constitutes of a qualitative research with a descriptive and exploratory character. It intends to contribute to a discussion of ethics in clinical practice, with reference to the radical ethics of Emmanuel Levinas and the Person-Centered Psychotherapy. The overall goal is to understand the possibilities of opening to radical alterity in the therapeutic relationship from discourses of person-centered psychotherapists about their clinical practice. Thus, we performed semi-structured interviews with five psychotherapists about the unexpected experiences in their clinical practice. The interpretation of the discourses was inspired in Derrida's hermeneutics, focusing on how the idea of deconstruction was proposed, allowing the arising of the difference in speech itself. In the deconstruction of the discourses we get closer to potential areas of openness to otherness in the therapeutic relationship, talking about the therapist vulnerability and responsibility against the unexpected. In a welcoming position the therapist would have to allow the use of his sensitivity and the intuition in their attendance, being with the client in its suffering, from the facilitative attitudes as enablers of a understanding of the client as an enigma. / Este estudo se constitui numa pesquisa de natureza qualitativa, de caráter descritivo e exploratório. Intenta contribuir para uma discussão ética no campo da prática clínica, tendo como referências a ética radical de Emannuel Lévinas e a Psicoterapia Centrada na Pessoa. O objetivo geral é compreender as possibilidades de abertura à alteridade radical na relação terapêutica a partir de discursos de psicoterapeutas centrados na pessoa sobre sua prática clínica. Para tanto, realizamos entrevistas semiestruturadas com cinco psicoterapeutas acerca de experiências com o inusitado em sua prática clínica. A interpretação dos discursos teve inspiração na hermenêutica derridiana, focalizando como proposta a ideia de desconstrução, por permitir a emergência da diferença advinda do próprio discurso. Na desconstrução dos discursos, pudemos nos aproximar de possíveis espaços de abertura à alteridade na relação terapêutica, discorrendo sobre a vulnerabilidade e responsabilidade do terapeuta frente ao inusitado. Numa postura de acolhimento, o terapeuta deveria permitir-se a utilização da sensibilidade e da intuição nos atendimentos, estando com o cliente em seu sofrimento a partir das atitudes facilitadoras como possibilitadoras de uma compreensão do cliente como enigma.

My diploma work is theoretical. It consists of four chapters. First chapter deals with the area of social work, its goals and paradigms. Furthermore, it deals with the relationship of social work and other disciplines and theories relevant to social work. Second chapter is devoted to psychotherapy and its determination, to psychotherapy in the history of human thinking and also to goals. Third chapter examines the therapeutic relationship from the perspectives of major therapeutic doctrines. The last chapter deals with ethics, the code of ethics and ethics in the psychotherapeutic relationship. In the second half of this chapter are described more important concepts that are closely linked to both - ethics and psychotherapy.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Este estudo se constitui numa pesquisa de natureza qualitativa, de carÃter descritivo e exploratÃrio. Intenta contribuir para uma discussÃo Ãtica no campo da prÃtica clÃnica, tendo como referÃncias a Ãtica radical de Emannuel LÃvinas e a Psicoterapia Centrada na Pessoa. O objetivo geral à compreender as possibilidades de abertura à alteridade radical na relaÃÃo terapÃutica a partir de discursos de psicoterapeutas centrados na pessoa sobre sua prÃtica clÃnica. Para tanto, realizamos entrevistas semiestruturadas com cinco psicoterapeutas acerca de experiÃncias com o inusitado em sua prÃtica clÃnica. A interpretaÃÃo dos discursos teve inspiraÃÃo na hermenÃutica derridiana, focalizando como proposta a ideia de desconstruÃÃo, por permitir a emergÃncia da diferenÃa advinda do prÃprio discurso. Na desconstruÃÃo dos discursos, pudemos nos aproximar de possÃveis espaÃos de abertura à alteridade na relaÃÃo terapÃutica, discorrendo sobre a vulnerabilidade e responsabilidade do terapeuta frente ao inusitado. Numa postura de acolhimento, o terapeuta deveria permitir-se a utilizaÃÃo da sensibilidade e da intuiÃÃo nos atendimentos, estando com o cliente em seu sofrimento a partir das atitudes facilitadoras como possibilitadoras de uma compreensÃo do cliente como enigma. / This study constitutes of a qualitative research with a descriptive and exploratory character. It intends to contribute to a discussion of ethics in clinical practice, with reference to the radical ethics of Emmanuel Levinas and the Person-Centered Psychotherapy. The overall goal is to understand the possibilities of opening to radical alterity in the therapeutic relationship from discourses of person-centered psychotherapists about their clinical practice. Thus, we performed semi-structured interviews with five psychotherapists about the unexpected experiences in their clinical practice. The interpretation of the discourses was inspired in Derrida's hermeneutics, focusing on how the idea of deconstruction was proposed, allowing the arising of the difference in speech itself. In the deconstruction of the discourses we get closer to potential areas of openness to otherness in the therapeutic relationship, talking about the therapist vulnerability and responsibility against the unexpected. In a welcoming position the therapist would have to allow the use of his sensitivity and the intuition in their attendance, being with the client in its suffering, from the facilitative attitudes as enablers of a understanding of the client as an enigma.

A compreensão do cliente, considerando o cenário da psicoterapia, se dá não somente pelo que é enunciado em linguagem verbal, mas sim, por sua presença como um todo. Há uma atitude de cuidado que se dá especificamente na relação cliente-terapeuta que favorece essa compreensão. Defende-se que a compreensão sempre parte de uma compreensão prévia para interpretar o que se mostra articuladamente no discurso do cliente. Por isso, a teoria ou referencial clínico do terapeuta; a sua visão de homem e de mundo; e sua experiência são decisivos para tal compreensão. O objetivo é refletir e entender como se dá a compreensão do sentido do cliente por parte do terapeuta, admitindo que o terapeuta sempre parte de uma compreensão prévia. O desenvolvimento deste trabalho ocorreu com relatos de situações clínicas da pesquisadora, alinhavando o conhecimento aprendido pela experiência e, buscando em autores e principalmente em Heidegger, contribuições para ampliar a reflexão acerca do que se dá no acontecimento do encontro cliente-terapeuta. É trazido o conceito de téchne em oposição à técnica para apresentar o procedimento da psicoterapia. Noções básicas da fenomenologia existencial são apresentadas para situar o leitor de onde partem os pensamentos da autora e sua visão de homem e mundo. A apresentação dos existenciais de Heidegger disposição (Befindlichkeit), compreensão (Verstehen) e linguagem (Rede) fazem-se pertinente como abertura de mundo que oferecem a experiência na relação, fazendo assim, oposição à ideia de que o acesso ao conhecimento ao outro, e ao mundo, se dá via teórica. Dessa forma a linguagem verbal e não verbal como o corpo, o gesto, o tom de voz e tudo o que se apresenta são elementos fundamentais / The comprehension about the client, considering the psychotherapys scenario, is given not only by what is stated in verbal language but by his whole presence. There is a caring attitude that is given specifically in the client-therapist relationship that promotes such comprehension. It is argued that comprehension always came from a previous understanding to interpret what is present, articulately, on client\'s speech. For this reason, the theory or clinical therapist reference, their vision of men and world and their experience are crucial to this understanding. The purpose is to meditate and understand how occurs the comprehension of the client\'s meaning by the therapist, admitting that the therapist always comes from a previous comprehension. The development of this research took place with reports of clinical experiences lived by the researcher, adding knowledge learned by the experience and seeking to authors and particularly in Heidegger, contributions to increase the reflection about what happens in the event of the client-therapist encounter. I introduce the concept of téchne as opposed to the technique to present the psychotherapy procedure. Basic concepts of existential phenomenology are presented in order to situate the reader about from where my thoughts and ideas about men and world came from. The presentation of existential concepts as disposition (Befindlichkeit), comprehension (Verstehen) and language (Rede) are relevant as world\'s opening and offer the experience inside the relationship, thus, opposed to the idea that the access to the knowledge about the other and about the world is given theoretically. Therefore, the verbal and non-verbal language and body gesture, tone of voice and everything that is presented are crucial elements

Abstrakt   Bakgrund: Rättspsykiatrin i Sverige vårdar psykiskt sjuka lagöverträdare. Våld är vanligt förekommande och ett stort problem inom den rättspsykiatriska vården. Vårdare som blir utsatta för våld trivs sämre med sitt arbete och har högre sjukfrånvaro. Inom rättspsykiatrisk vård beskrivs en god vårdrelation mellan vårdare och patient som en förutsättning för att kunna vårda.   Syfte: Studiens syfte var att belysa vårdares upplevelse av våldssituationer och hur dessa påverkar vårdrelationen inom rättspsykiatrin.   Metod: Studien har en kvalitativ ansats och utgår från livsvärldsteorin. Studien baseras på intervjuer med tolv vårdare. Intervjuerna har analyserats med hjälp av kvalitativ innehållsanalys.   Resultat: I intervjuerna framkom att våldsamma situationer mellan patienter och vårdare inom rättspsykiatrisk vård kan leda till att en patient flyttas eller att det uppstår en distans mellan vårdare och patient. Våld kan även leda till att vårdare blir sjukskrivna under en period, eller slutar sitt arbete. Erfarna vårdare beskriver att de ständigt har en mental beredskap för att våld plötsligt kan uppstå. De använder även en hård jargong som ett verktyg för att kunna hantera den påfrestande miljön.   Slutsats: Det kan upplevas kontraproduktivt att flytta en patient efter en våldsam situation och därmed omöjliggöra mötet mellan patienten och den vårdare som blev utsatt för våld. Ett undvikande av mötet riskerar att försämra vårdrelationen. Istället kan patienten bjudas in till ett samtal tillsammans med denne vårdare. Vårdare efterfrågar stöd ur ett längre tidsperspektiv efter en våldsam situation. För att skapa förutsättningar för ett stöd på mellanmänsklig nivå efter en våldsam situation behövs ett långsiktigt och strukturerat stöd. Det krävs ytterligare forskning för att bättre förstå den tidvis hårda jargongen och hur den påverkar vårdandet. / Abstract   Background: The forensic psychiatry in Sweden offers care to people who have committed a crime under the influence of a mental disorder. Violence against staff is a common and major problem in the forensic psychiatry. Caregivers who have been exposed to violence feel less satisfied in their work, and are more often staying at home on sick leaves, compared to other caregivers. A good caring relationship between caregivers and patients is described as a prerequisite for giving a good care in the context of forensic psychiatry.   Aim: The aim of the study was to highlight the health professionals' experiences of violent situations and how these affect the caring relationship in forensic psychiatric care.   Method: The study has a qualitative approach based on the lifeworld theory. The study is based on interviews with twelve caregivers. The interviews were analyzed using qualitative content analysis.   Result: The interviews revealed that violent situations between patients and caregivers in forensic psychiatric care can lead to a distance between the caregiver and the patient, or that the patient is being moved. Violence can also lead to sick leave for caregivers or a permanent quit from work. Caregivers with long experience of forensic psychiatry describe that they constantly have a mental preparedness for violence to suddenly arise. They also use a rough jargon as a tool to handle the stressful context.   Conclusion: It may be counterproductive to move a patient after a violent situation, thus making it impossible for the patient and the victim to meet each other after a violent situation. An avoidance of the meeting is likely to worsen the caring relationship. Instead of creating a distance, the patient can be invited to a conversation with this caregiver. Caregivers demand support for a longer period of time after a violent situation. In order to create the conditions for interpersonal support after a violent situation, long-term and structured support is needed. Further research is needed to better understand the occasionally rough jargon and how it affects caring.