Research regarding the experience of the psychotherapist in the therapeutic interaction is uncommon in scientific literature and rarer still in the literature of the U.S. When Freud recognized the therapist’s emotional experience in response to the client, he termed it countertransference and identified it as counterproductive to the analytic process. Later it was recognized as containing potentially useful information about the client. Despite a shift in academic concern away from the clinician’s experience, outcome studies have demonstrated the importance of the therapeutic relationship. If the therapist’s experience can help or hinder the relationship and, therefore, the process of therapy, it must continue to be explored. Some researchers have suggested that the field may be disproportionately populated by individuals who had excessive emotional demands placed on them as children (Miller, 1979/1990). Jurkovic (1997) proposed that, along with strengths endowed by this childhood responsibility, parentified therapists may find themselves more vulnerable to a sense of duty that they must help clients. Similarly, these therapists might feel compelled by their empathic concern to go above and beyond. The experience of a therapist in such a situation might be to “feel in too deep with a client” – the phenomenon of concern for this study. Ten practicing, doctoral level psychologists were asked to describe a specific experience in which they felt in too deep with a client. Selection analysis and situational descriptions were reviewed with each participant. Four core themes emerged. They revealed the participants’ experience of feeling in too deep as involving a variety of distressful thoughts and feelings. A specific cluster of feeling insecure, confused, or not in control was universal. The other three core themes were challenge in connection, altering personal style of therapy, and balancing the wants and needs of the different people in the therapy relationship. The unique experiences of participants relative to the core themes are discussed. Recent research on therapist-identified difficult situations provides a context for understanding these themes. Feeling in too deep is considered as a response to an ethical challenge.

Unga vuxna är en grupp som i allt större utsträckning söker stöd för sina psykiska svårigheter. Att hitta samtalsformer som är verksamma är därför av stor vikt för målgruppen. På S:t Lukas Stockholmsmottagning har man valt att erbjuda unga i åldrarna 18-29 år ”Upp till fyra samtal” – en form av problemformulerande samtal eller counselling. Genom att sätta sig mer in i hur terapeutens arbete gestaltar sig i den här typen av kortare samtalskontakt, kan stödet till målgruppen förhoppningsvis utvecklas ytterligare. Frågeställningar: Hur arbetar terapeuterna på S:t Lukas Stockholmsmottagning i counselling med målgruppen unga vuxna? Hur upplever terapeuterna arbetet med metoden och målgruppen? Metod: I undersökningen tillämpades en kvalitativ, deskriptiv metod där data samlades in med hjälp av bandinspelade, kvalitativa halvstrukturerade intervjuer. En tematisk analys användes som bearbetningsmetod. Resultat: Studien visar att terapeuternas arbetssätt till viss del skiljer sig åt, främst när det gäller hur de hanterar ramen och inriktningen på interventioner. I upplevelsen är terapeuterna eniga i att motöverföringen är stark och ofta konfliktfylld, men de uppger inget behov av handledning. Skillnader från den ursprungliga metoden framkom även i den yttre ramen, främst i avsaknaden av handledning. Diskussion: Terapeuternas olika arbetssätt diskuterades samt avvikelser från metodens ursprungliga form. Orsaker till terapeuternas avsaknad av behov av handledning diskuterades utifrån arbetet med den komplexa målgruppen och organisatoriska aspekter. / Young adults seek help for their psychological problems to an increasing extent. Finding effective forms of therapy is of great importance for this group. At the S:t Lukas office in Stockholm, young adults aged 18-29 are offered “Up to four sessions” – a problem focused form of counselling. By learning more about how the therapist works with and experiences this counselling, the support for the target group might be further improved. Research questions: How do the therapists at S:t Lukas office in Stockholm work in counselling with young adults? What are their experiences from working with the method and the target group? Method: A qualitative, descriptive method was used, where data was collected through recorded semi-structured interviews. When processing the data a thematic analysis was applied. Results: The study shows that the therapists’ ways of working differ in how they handle the frame and what kind of interventions they use. The therapists all experience a strong countertransference, often conflictual, but they do not express any need for supervision. Deviations from the original method were also found in the outer frame, mainly in the lack of supervision. Discussion: The therapists’ different ways of working were discussed and also how the method seems to have changed from its original model. The reasons why the therapists do not express any need for supervision were discussed in relation to the complex target group and organizational factors.

Although music therapy work with families has been documented for many years, the focus has remained on techniques and client outcomes rather than therapeutic process. The purpose of this study was to gain understanding and knowledge of the lived experience of music therapists who practice family-based music therapy. This research was conducted within the interpretative phenomenological framework. Three subjects who provided family-based music therapy participated in semi-structured interviews about their experiences. Three main interpretative themes emerged from the analysis of the data relative to the therapists’ expressed experience of their work with families: perseverance, resilience, and faith in the process. Discussion of the results, strengths and limitations of the study, and implications for training and further research are presented. / February 2016

ISTDP (Intensive Short-Term Dynamic Psychotherapy) är en psykodynamisk behandling som intervenerar på ångest och försvar. Metoden innebär aktivering av starka känslomässiga processer hos patienten varför det är relevant att undersöka om detta kan uppnås i terapier som sker på distans - en särskilt relevant fråga i samband med covid-19-pandemin. Frågeställningarna undersökte hur ISTDP-terapeuter upplever terapi via digitala mötestjänster samt upplevda skillnader av distansterapi med sköra respektive motståndskraftiga patienter. Studien hade en concurrent, embedded mixad-metoddesign. Kvantitativa data med bekvämlighetsurval samlades från svenska, CORE-utbildade ISTDP-terapeuter [n=38] genom en webbaserad enkät. Inbjudan skedde via facebookgrupp. Frågorna eftersökte deskriptiv information såväl som upplevelser av digital ISTDP och besvarades på en likertskala 1-7. Kvalitativa data med bekvämlighetsurval samlades genom separata, semi-strukturerade intervjuer med fyra [n=4] terapeuter från samma målgrupp och bearbetades med tematisk analys. Inbjudan skedde via mejlkontakt. Korrelationsanalyser av kvantitativa data visade på ett samband mellan lägre upplevd digital kompetens och sämre upplevd funktionalitet av digital ISTDP. Upplevda svårigheter med digital ISTDP-terapi korrelerade med svårigheter i arbetet med både sköra och motståndskraftiga patienter. I den kvalitativa undersökningen framkom två huvudteman: möjligheter och begränsningar med digital ISTDP. Huvudtemat möjligheter innefattade undertemana: ett portabelt terapirum, terapeutens egenpåverkan samt patientens strukturerande jag. Huvudtemat begränsningar innefattade undertemana: ett sårbart terapirum, patientens konflikt mot plattformen och skärmen - en begränsning bland flera. Sammanfattningsvis tyder resultaten på att ISTDP-terapeuter upplever såväl fördelar som nackdelar med digital terapi. Upplevelser av det digitala formatets funktion hade också ett samband med upplevelser av arbetet med digital ISTDP. / ISTDP (Intensive Short-Term Dynamic Psychotherapy) is a psychodynamic treatment that addresses anxiety and defenses. The method’s reliance on in-session emotional processing raises the question whether this can be achieved remotely - especially in connection to the covid-19-pandemic. Research questions explored how ISTDP-therapists experience therapeutic work through video conferencing as well as their perceived differences of remote therapy between fragile and resistant patients. The study used a concurrent, embedded, mixed- methods design. Quantitative data, using convenience sampling, was collected from Swedish core-trained ISTDP-therapists [n = 38] through a web-based questionnaire. Invitations were made through a facebook group. Items explored descriptive information, experiences of digital ISTDP and could be answered on a likert scale between 1-7. Qualitative data, using convenience sampling, was collected separately through semi-structured interviews with four [n = 4] participants from the same target group and processed using thematic analysis. Invitations were made via e-mail. Correlation analysis of the quantitative data showed a relationship between low digital self-efficacy and experienced difficulty performing digital ISTDP. Difficulties with digital ISTDP therapy had same-size correlations with both fragile and resistant patient difficulty. In the qualitative study, two main themes were found: possibilities and limitations with digital ISTDP. The main theme possibilities included the underthemes: a portable therapy room, and effects on the individual therapist and the patient’s structured self. The main theme limitations included: a vulnerable therapy room, the patient’s conflict against the platform and the screen – a limitation among others. In conclusion, ISTDP-1therapists experience advantages as well as disadvantages with digital therapy. Experiences of the digital format function also had a relationship with the digital ISTDP working experience.

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