“Not-knowing stance”
A) not trying to provide clients with “insight”
B) focusing on and validating the clients experience in the here-and-now (vs. pointing out connections to the past, including early childhood experiences)
Collaboration
Between client and worker is the key (metaphor of sitting side-by-side)
“Elephant in the room”
Watch out for the feeling bored, perceiving clients statements as trivial, operating on autopilot, feeling flat, rigid, out of contact
“Quick fix thinking”
Wishing to DO something (lists, coping strategies), giving practical advice (to soothe workers own anxiety)
“Inside-out thinking”
Puzzlement, confusion, excessive nodding, not sure what to say, anger at the client
Mentalizing response
A) to be authentic
B) to openly admit ones own feelings and responses in the moment (Irwin- spirit of curiosity)
Realistic attitudes and responses
Fear, involuntary clients, effects of prior knowledge, expectations based on differences between client and worker, workers manner, workers reactions, diagnosis understanding, understanding suffering, counter therapeutic responses, sharing worker reactions, worker reactions as a diagnostic tool, hard to counter therapeutic slips, positive feelings
Unrealistic attitudes and responses
Early life transferences, displacement reactions, transference, counter transference, importance of worker self-awareness of own issues
Early life transferences
Clients unrealistic or transference reactions mean that the client displaces on to the worker feelings or attitudes originally experienced during early childhood toward a family member - usually a mother or father - and act as if he or she were the therapist.
Attachment Theory
Although attachment theory is not a theory of psychotherapy in and of itself it has several important implications
Secure and insecure attachments
The developmental consequences of biological differences at birth (temperament)
Parenting can over-ride temperament
Borderline disorders
Disorganized attachments
Conduct disorders, substance abuse, narcissistic, and anti-social
Dismissing attachments- cognitive/thought-related
Affective, OCD
Pre-occupied attachment- affective/feelings-related
Attachment issues in the therapeutic relationship
- pay particular attention to transference issues
- be aware of the therapists own attachment style on the therapeutic process
- be tuned in to any kind of attachment style in male and female clients, but very few gender differences found (secure, avoidant, ambivalent)
- very few wide ranging studies have been done on culture and attachment
Displacement reactions
Are you looking for me to tell you what you should do?
Identifacatory transfer
The client treats the therapist the way they were treated by a central figure in their early lives
Transference
Negative or positive feelings transference can play an important role in the treatment if addressed properly
Transference
- exists whenever there is a relationship
- expectational set derived from earliest experiences of the infant with the crackers
- it may be continuously enriched and strengthened so that the individual responds to new relationship with hope and the capacity for productive interchange or ..
- it may be based on deprivation and inconsistency, resulting in despair and distorted expectations leading to conflict and disruption
Transference and the client
“It is one thing that an individual to achieve increased awareness of his transference needs and wishes. It is another to be able to communicate these needs and wishes in place of responding to hurts and slights with feeling states and behaviors which distance him/her from others”
Countertransference
- the therapists reaction to the realistic and unrealistic transference of the client
- the playing out of intra-psychic conflicts in the therapeutic relationship constitutes the transference…
- the therapists reactions to being the target of expectations, wishes, and fantasies derived from past experiences constitute the countertransference
Importance of workers awareness of own issues
Irrational reactions can interfere in the therapeutic process. It is important to get supervision, consultation, peer support to find your issue areas. It may even be necessary to consider your own personal therapy.
10 things of which every social worker should be self-aware
Vulnerabilities, triggers, prejudices, urges to rescue, deny pain, over-identity with trauma, intolerance of the symbiotic urge to merge, irrational fear of clients, imposing own agenda, loss of interest when client progress is lacking or slow
Mentalizing
“Holding heart and mind in heart and hand” (Peter Fonagy); or being aware of ones own thoughts and feelings and another’s thoughts and feelings (Jon Allen) – and this is the foundation of all good human connection, including all good therapy.
