Therapist-client sexual involvement has been shown to have damaging effects on clients, therapists and the mental health professions. As sexual attraction necessarily precedes sexual involvement, the incidence, experience and management of sexual attraction to clients was investigated in a sample of 485 South African clinical psychologists (return rate 23%). Evaluation of training and attitudes to sexual involvement with current and former clients and to other forms of touch in therapy were also investigated. Survey data from 111 psychologists reveal that 63.1% (79.1% of men and 52.9% of women) have been sexually attracted to clients, at least on occasion, while 97.1% have never become sexually involved with a client. Most (61.4%) do not feel anxious, guilty or uncomfortable about the attraction, although more women (50%) than men (26.5%) do. More than half (58.2%) felt that their sexual attraction had benefited the therapy process, while 76.1% believed that it had never been harmful. Men reported significantly more frequent benefit than women. In managing their sexual attraction, 60.8% sought support from supervisors, peers and their own therapists, while 31.9% worked through the feelings on their own. Ethical practice and welfare of clients were more important reasons for refraining from acting on sexual attraction than fear of legal or professional censure. Ethics codes consulted reflect the lack of nationally endorsed guidelines. Almost half (45.7%) had received no education about therapists' sexual attraction to clients, while only 10.6% had received adequate education. Education about the ethics of therapist-client sexual involvement was rated as significantly more adequate than training about therapists' sexual attraction to clients. Most (74.2%) said that their training was useful in helping them to make informed decisions about sexual involvement with clients. The majority (92.5%) felt that education on these issues should be a required part of training for clinical psychologists. Sexual involvement with former clients was considered less unethical than with current clients (65.2% vs 98.9%). 55.9% believe that there are circumstances in which sexual involvement with former clients might not be unethical, particularly depending on time since termination. Appropriate time between termination of therapy and sexual involvement ranged from immediately (1.8%) to never (44.1 %). Certain forms of touch are considered ethical, although attitudes varied depending on context and form. A handshake was rated to be always ethical by 66.3%, while 83.2% believe kissing is never ethical. There was lack of consensus about hugging and holding hands. Implications of findings and directions for future research are discussed. / Thesis (M.A.)-University of Natal, Pietermaritzburg, 1999.

This study utilized Strong's (1963) theory of counseling as a social influence process to investigate the effect of therapist's training, experience, and similarity on hearingimpaired subjects' perceptions of the therapist's expertness, attractiveness, and trustworthiness and their willingness to see the therapist. Increasing levels of therapists' training and work experience was hypothesized to increase subjects' perception of expertness and their willingness to see the therapist. Increasing levels of therapists' similarity to the client was hypothesized to increase subjects' perceptions of expertness, attractiveness, and trustworthiness and their willingness to see the therapist. Subjects' ratings of the therapist were hypothesized to change when therapists with different levels of similarity were seen in different orders of presentation.

Thesis (MA)--University of Stellenbosch, 2008. / ENGLISH ABSTRACT: Sometimes it is not entirely clear why certain clients improve. Critical clinical ingredients which may have led to this improvement or recovery are hard to identify and describe and decisions about therapeutic interventions often appear to be intuitive rather than following a strict modus operandi. This is true particularly if refractory or chronic cases start to improve and maintain this improvement. Refractory and chronic cases are the norm amongst clients suffering from complex, chronic trauma, also termed complex PTSD. Complex trauma is a multi-facetted, often multi-layered condition. It includes damage to the individuals’ self and to her ability to interpersonally relate, additionally to the DSM IV TR diagnosis of PTSD. Due to the manifold unique presentations of the syndrome, particular after long-term exposure and confounded by co-morbidities and rigid defenses, it is difficult to diagnose and treat the condition effectively. This study focuses on one such complex trauma case with an initially very poor prognosis, which improved significantly over a treatment period of eighteen months. The therapeutic intervention and progression of the case are closely examined, using the phenomenological method, with the aim of discerning and describing themes and patterns that could assist in understanding the healing process of this client during therapy and to promote further research in this regard. Integration of psychodynamic conceptualization, particularly self-psychology and intersubjectivity, and person-centered, supportive therapeutic methods were found helpful in the treatment of this case. The common factor to these approaches is their emphasis on the relationship between client and therapist. This therapeutic relationship was concluded to be the determining factor in the successful treatment of this client, because it addressed damage to self and to her relational ability. The research took place concurrent to the therapy with the client and this process led to a degree of integration on three levels: integration of the client’s self and interpersonal functioning, integration of the abovementioned approaches to form a creative synthesis in the therapist’s individual approach to trauma clients, and the integration of a phenomenological methodology with a psychodynamically conceptualized case study. It is noted that the theoretical explorations and therapeutic procedures described and explored in this study are but one way to conceptualize and treat complex trauma. / AFRIKAANSE OPSOMMING: Somtyds is dit nie duidelik hoekom sekere kliente se toestand verbeter nie. Dit is soms moeilik om die kritiese bestanddele wat tot hierdie verbetering of herstel gelei het, te identifiseer en te beskryf. Besluite met betrekking op therapeutiese intervensies blyk dikwels eerder intuitief, as die gevolg van ‘n streng modus operandi, te wees. Dit is spesifiek die geval wanneer chroniese en hardnekkige gevalle begin om te verbeter en die verbetering volhou. Hardnekkige en chroniese gevalle is nie ongewoon by kliente wat aan komplekse, chroniese trauma - ook genoem komplekse post-traumatiese stressversteuring - ly nie. Komplekse trauma is ‘n multi-fasettige toestand, wat dikwels ‘n verskeidenheid lae of vlakke van versteuring opwys. Dit sluit skade tot die individu se self in, asook verlies aan vaardigheid om met ander mense suksesvolle interpersoonlike verhoudings op te bou. Hierdie kenmerke is toevoegings tot die diagnose van die sindroom soos uitgevoer in die DSM IV TR. As gevolg van die meervoudige unieke voorstellings van die sindroom - in besonder na langtermyn blootstelling en verwarring deur co-ongesteldhede en rigiede verdedigings - is dit moeilik om die toestand korrek te diagnoseer en efektief te behandel. Hierdie studie fokus op die soort geval wat aanvanklik ‘n baie swak prognose gehad het, maar vervolgens oor ‘n tydperk van 18 maande ‘n beduidende verbetering getoon het. Die terapeutiese intervensie en die progressie van die geval is in hierdie studie noukeurig ondersoek, deur gebruik te maak van fenomenologiese ondersoekmetodes, met die doel om temas en patrone vas te stel en te beskryf wat die begrip van die genesingsproses van die klient gedurende terapie moontlik kan bevorder, en wat verdere navorsing op hierdie gebied kan stimuleer. Integrasie van psigodinamiese konseptualisering (spesifiek self-sielkunde en intersubjektiwiteit) asook persoongesentreerde, ondersteunende beradingsmetodes, is as waardevol bevind in die behandeling van hierdie geval . Die gemeenskaplike faktor tot hierdie benaderings is die klem op die verhouding tussen klient and terapeut. Die gevolgtrekking is gemaak dat hierdie terapeutiese verhouding die bepalende faktor in die sukkesvolle behandeling van hierdie klient was, omdat dit sowel die skade aan die self as die verlies aan die vaardigheid om verhoudings te bou, aangespreek het. Die navorsing en die terapeutiese intervensie met die klient het terselftertyd plaasgevind, en die proses het ten slotte tot ‘n mate van integrasie op drie vlakke gelei: integrasie van die klient se self en herstelling van interpersoonlike funksionering, integrasie van die bogenoemde benaderings wat tot ‘n kreatiewe sintese in die berader se benadering tot trauma behandeling gelei het, en die integrasie van fenomenologiese metodes en psigodinamies konseptualisering in ‘n gevallestudie. Dit is belangrik om in gedagte te hou dat die teoretiese navorsing en praktiese prosedures wat in hierdie studie beskryf en uiteengesit is, net een manier is om komplekse trauma te konseptualiseer en te behandel.

Aims: This study explores trainee counselling psychologists’ erotic feelings towards their clients and their responses to those feelings. The influences that help shape trainees’ reactions as well as the support systems they utilize to deal with the erotic are examined.︣Design: The participants’ narratives were analysed using Smith’s (1995) Interpretative Phenomenological Analysis.︣Procedure: The data were collected in semi-structured interviews with six trainee counselling psychologists who were attracted towards a client at least on one occasion.︣Results: A total of 29 themes were deemed of particular importance and relevance to the topic under investigation. The emergent themes were organized into 3 master themes: (i) attributes of erotic attraction; (ii) impact or erotic attraction; (iii) management of erotic attraction.︣Conclusions: The results of this study emphasize the need for increased awareness, comprehensive training and systematic research on matters of the erotic within therapeutic encounters. Erotic attraction seemed to have a profound impact on the participants’ intrapersonal and interpersonal being as it touched upon their feelings, thoughts, personal identity, professional identity, everydayness, and clinical work. The majority of trainees believed that their inability to deal with their attraction appropriately had a marked negative impact upon therapeutic relationship, process, and outcome. All participants considered their experience, however, a major learning point as it allowed them to an extent to redefine their intentions, motives, and expectations as professionals and human beings. All participants used supervision, personal therapy, peer consultation, literature, and theoretical constructs to process and understand their attraction with varying degrees of success. Training programs and clinical placements seem to contribute to mismanagement of attraction by failing to lift the taboo off the erotic, by neglecting to address these issues explicitly in their curriculum, and by nurturing unrealistically high standards of conducting therapy. This study suggests that the erotic has an ontological and ontic significance which could be fully explored by adopting an existential counselling psychology paradigm or by adding an element of existential observation and understanding to any other approach.

This study aimed to explore the countertransference responses of psychoanalytically informed psychotherapists working with religious patients. By elucidating the various responses that devout patients may provoke in psychoanalytically oriented psychotherapists, it also sought to investigate how differences in religious orientation - which referred to atheistic, agnostic, theistic, or a combination of these metaphysical views – between patient and therapist may influence the nature of psychoanalytically informed psychotherapists’ countertransference responses to their religious patients. Thirdly, it endeavored to understand how psychoanalytically informed psychotherapists manage religiously influenced countertransference responses. A sample of six psychoanalytically informed psychotherapists participated in a self developed, semi-structured interview. A thematic content analysis of the psychotherapists’ interview transcripts revealed that the therapists’ countertransference responses to their religious patients were broadly negative, and primarily took the form of feelings of paralysis and frustration. Concerning the extent to which the therapists perceived that differences in religious orientation between themselves and their patients influenced the nature of their countertransference reactions, a key finding was that, while the theistic therapists generally noted these responses, the agnostic therapists seemed to give more attention to them during the interviews, while reflecting on the extent to which their agnosticism may partially account for the intensity of their countertransference paralysis and frustration. Most of the agnostic therapists, moreover, were able to identify early personal experiences that may have contributed to these responses. Thirdly, regarding the management of these countertransference responses, all the therapists alluded to the significance of supervision, colleagues and their own therapy. It was also found that the therapists’ countertransference reactions to their religious patients were partly a consequence of the therapists’ perspectives on what constitutes healthy and pathological religion, and perceived similarities between certain religio-mystical concepts and aspects of psychoanalytic thought. The study elucidates the complex interaction between various factors that conceivably influence the nature of psychoanalytic psychotherapists’ countertransference reactions to religious patients, as well as the necessity for therapist self-awareness when working with religious patients, with the broader aim of offering an example of an increasingly applied and relevant form of psychoanalytic praxis in a country with a diverse and inherently religious population.

It is well understood that psychoanalysis began with Freud’s encounter with hysteria and his work with illnesses of the mind which manifested in bodily terms. However, despite its close connection to the body and the understanding that psychoanalytic theory and practice develop hand-in-hand, psychological conflict that expresses itself in physical terms and more especially the role of the two bodies in the therapy room has received relatively little attention. The topic of this research project is captured in its title: “Minding the Body”, and the four journal articles it presents interrogate the relationship between the mind and body of both the patient and therapist. The thesis begins with two published papers which focus on the body of the patient, rehearsing and extending the psychoanalytic theory of bodily psychopathology and the implications that the different understandings of the relationship between body and mind in different forms of psychosoma have for clinical interventions. The second two papers examine what the analyst’s interpretation of her somatic responses to the patient, and the patient’s engagement with the analyst’s body, can reveal about the dynamics of the therapeutic dyad. The project concludes with a discussion of the clinical implications of a greater focus on the two bodies in the room, suggesting that the techniques developed to make sense of the patient’s physical symptoms can be usefully applied to decode the somatic countertransference as it manifests in a particular therapeutic dyad. That process, coupled with an awareness of the patient’s engagement with the therapist’s body, can create conditions under which the analyst’s body may become an analytic object and this can add significantly to the analytic repertoire.

Background and objective: Caring for critically-ill and dying patients is widely recognised as a central stressor in oncology and palliative-care staff. Past research in this area has mostly focused on medical staff, and the impact of patient deaths on other professionals has received only limited attention. This study aimed to explore how psychotherapists experience and cope with the death of the cancer patients in their care, and whether these experiences promote personal and/or professional growth. Methods: an exploratory sequential mixed-methods design was adopted. Participants were psychotherapists working with adult cancer- and palliative-care patients within UK hospices. In the qualitative phase, seven semi-structured interviews were conducted and examined using thematic analysis. In the quantitative phase, 28 participants completed an online questionnaire designed to evaluate the incidence within the target population of the themes identified in the qualitative phase. Findings: Grief appeared as hospice psychotherapists' main immediate response to client deaths. Participants used coping strategies aiming to facilitate emotional closure, and to foster emotional and cognitive processing. These strategies included conducting personal rituals, receiving support from colleagues and clinical supervision. Several factors hindering these coping strategies were identified, but the vast majority were shared by only a small minority of participants (e.g. feeling disenfranchised in their grief for clients). Repeated exposure to client death caused participants to feel emotionally and physically drained (and for some leading to greater fear of illness and dying). It also affected their outlook on life positively, leading to personal growth. Participants managed the negative long-term impact of their work using self-care strategies, which included working in cancer- and palliative-care settings on a part-time basis, and engaging in creative and future-oriented activities promoting a sense of hope, possibilities, and growth. Conclusion and implications: Although many hospice psychotherapists repeatedly experience grief following the deaths of their clients, most appear able to manage the immediate and long-term impacts of their work. Working in proximity to illness and death is seen as deeply challenging but at the same time as promoting personal growth, and to enhance and bring meaning to hospice psychotherapists' lives. Furthermore, the mixed-methods design adopted here provides evidence that while the qualitative methods employed produced rich data, the addition of a simple quantitative survey allowed to put these in perspective about the wider group of hospice psychotherapists. I argue that this finding supports the call, prevalent in the mixed-methods research literature, to question the segregation of qualitative and quantitative methods.

This hermeneutic phenomenological study explores eight psychotherapists' and counsellors' experiences and understandings of 'inexplicable' phenomena that sometimes occur when working with clients.The purpose of the study is to stimulate thinking about these experiences and bring them into conversation within the psychoanalytic community.The findings emerging from this research reveal that inexplicable phenomena may occur when therapists and counsellors are in an 'open', meditative state in which the boundaries between self and the world seem lessened and time and space are experienced differently. The phenomena may take many forms, including the apparent knowing about events that are later reported by clients, which it would not have been possible to 'sense' in the usual way, and the seeing of semi-solid forms, which may be static or moving.The meanings made of the experiences vary according to different spiritual and theoretical worldviews but, invariably, the experiences are interpreted as receiving a communication from, or being attuned to, the unconscious mind or a spiritual intelligence or source of knowledge. This is discussed in relation to psychotherapeutic, phenomenological and spiritual literature. Occultism is another field we shall have to conquer There are strange and wondrous things in these lands of darkness. Please don't worry about my wanderings in these infinitudes. I shall return laden with rich bounty for our knowledge of the human psyche (Jung to Freud 1911: Mc. Guire, 1991, p. 223).I advise against. Don't do it. By it you would be throwing a bomb into the psychoanalytical house, which would be certain to explode. (Freud's letter to Ferenczi, (1919) when the latter wanted to present his telepathic experiments to the next IPA conference (Jones, 1957, p. 42).Freud wrote to psychic researcher , Hereward Carrington, that: "If I had my life to live over again, I should devote myself to psychical research rather than to psychoanalysis" (Jones 1957, p. 32). In 1929, Freud denied having said this but Ernest Jones tracked down the evidence of the letter (Farrell, 1983).

Thesis (M.Ed.)--Memorial University of Newfoundland, 2005. / Bibliography: leaves 113-149.

Thesis (Ph. D.)--University of Washington, 2001. / Vita. Includes bibliographical references (leaves 167-178).