Academic journal article Journal of Marital and Family Therapy

What Novice Family Therapists Experience during a Session. . . a Qualitative Study of Novice Therapists' Inner Conversations during the Session

Academic journal article Journal of Marital and Family Therapy

What Novice Family Therapists Experience during a Session. . . a Qualitative Study of Novice Therapists' Inner Conversations during the Session

Article excerpt

A family therapeutic conversation is very complex and for family therapists it is not always easy to develop a strong working alliance with all the family members, with their different stories of pain and suffering and with their unspoken fears and conflicting interests (Friedlander, Escudero, & Heatherington, 2006). Family therapy sessions are tension-filled meetings with real-life consequences, and therapists are often in the eye of the storm. In particular, for novice therapists this may be difficult as strong emotions may be evoked when they are pushed and pulled by the dynamics of the session.

THE PERSON OF THE THERAPIST AS A COMMON FACTOR

The person of the therapist is a major contributing factor to therapy outcome (Lambert & Ogles, 2004; Wampold, 2001; Wampold & Imel, 2015). It is a consistent finding in psychotherapy research that some therapists are more effective than other therapists, irrespective of the model they practice. This is, for example, illustrated in the NIMH study about depression showing considerable differences in effectiveness between therapists, regardless of their psychotherapy model (Blatt, Sanislow, Zuroff, & Pilkonis, 1996; Elkin, Falconnier, Martinovich, & Mahoney, 2006; Elkin et al., 1989).

Further research posed the question what it is that makes certain therapists more effective than other therapists. Reviewing the literature on therapist variables, Beutler et al. (2004) conclude that certain therapist variables (e.g., therapist well-being, cultural attitudes, patient-therapist relationship) have an effect on outcome, but in most cases there is also an interaction with client factors. The effect of therapist directiveness is, for example, moderated by the level of the client's resistance: When the client is experiencing high levels of resistance, the client benefits more from a nondirective treatment (Beutler, Clarkin, & Bongar, 2000). Also self-reflective, introverted, and/or introspective clients seem to benefit more from insight-oriented interventions, whereas impulsive, aggressive, and/or undercontrolled clients tend to be more responsive to symptom-focused interventions (Beutler, Harwood, Alimohamed, & Malik, 2002). The therapist thus seems to be most effective when he or she is sensitive to the individual needs of the client and is able to attune his or her interventions to the unique client (Duncan & Miller, 2000). In other words, sensitivity and flexibility seem to be essential qualities of an effective therapist.

The studies mentioned above focus on the person of the therapist in terms of effectiveness and outcome. Another approach to studying the person of the therapist is to focus on the experiences of therapists. In this approach, the self of the therapist is not modeled by characteristics such as his or her training, experience, cultural attitudes, but by the feelings and emotions the therapist has during a therapy session. Although research has been scarce on the subject, a few conclusions can be drawn from this line of research: Most therapists experience anger, hate, fear, and sexual feelings (Pope & Tabachnick, 1993); both experienced and novice therapists encounter feelings of incompetence (Th^eriault & Gazzola, 2005, 2010); and therapists also experience positive emotions in the session, such as liking the client and personal involvement (Vandenberghe & Silverstre, 2013). Self-awareness is another topic within the domain of therapists' experiences that has received attention (e.g., Fauth & Williams, 2005; Williams, 2003; Williams & Fauth, 2005). These studies explore the effects of self-awareness on in-session processes and the strategies therapists use to manage distracting self-awareness. Experiences of novice therapists in particular are also not an unexplored topic. That novice therapists experience anxiety seems to be a consistent finding across these studies (Hill, Sullivan, Knox, & Schlosser, 2007; Melton, Nofzinger-Collins, Wynne, & Susman, 2005; Williams, Judge, Hill, & Hoffman, 1997). …

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