Abstract
The present study unpacks an important dimension of clinical practice from the therapists’ vantage point. We interviewed 26 therapists in private practice about how the personal relationship with the client works from their perspective and conducted a grounded theory analysis. Three categories emerged. One refers to scope, aims and corollaries of the connection with the client; a second to preventing harm and managing drawbacks; and a third to taking therapeutic advantage of challenges related to closeness. Together, these categories form a model that describes how the close connection modifies therapeutic effects and generates challenges the therapist needs to deal with. The closer the dyad, the easier therapists will affect and be affected by the client. Therapists try to direct closeness to where it can nourish client process without harming the relationship, the client or themselves, and when closeness backfires, they may still try to harness uninvited effects for the benefit of therapy. This model concerning therapists’ lived experience is offered to inform research on the therapist-client relationship and as a contribution to clinical competency models.
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References
Brattland, H., Høiseth, J. R., Burkeland, O., Inderhaug, T. S., Binder, P. E., & Iversen, V. C. (2016). Learning from clients: A qualitative investigation of psychotherapists’ reactions to negative verbal feedback. Psychotherapy Research. https://doi.org/10.1080/10503307.2016.1246768.
Charmaz, K. (2017). Continuities, contradictions and critical inquiry in grounded theory. International Journal of Qualitative Methods, 16, 1–8.
Corbin, J., & Strauss, A. (2008). Basics of qualitative research: Techniques and procedures for developing Grounded Theory (3rd. edn.). London: Sage.
Cordoba, J. V., & Scott, R. L. (2001). Intimacy. A behavioral interpretation. The Behavior Analyst, 24, 75–86.
Dryden, W. (2012). The therapeutic relationship in CBT. In W. Dryden & R. Branch, The CBT handbook (pp. 83–100). London: Sage.
Fresno, D. M. (2013). Tending the garden and harvesting the fruits of behavior therapy. Behavior Therapy, 44, 177–179.
Geller, S. M., & Greenberg, L. S. (2012). Therapeutic presence: A mindful approach to effective therapy. Washington: American Psychological Association.
Gelso, C. J., Rojas, A. E. P., & Marmosh, C. (2014). Love and sexuality in the therapeutic relationship. Journal of Clinical Psychology, 70, 123–134.
Glaser, B. (2007). Remodeling grounded theory. Historical Social Research, 19, 47–68.
Hatcher, S. L., Kipper-Smith, A., Waddell, M., Uhe, M., West, J. S., et al. (2012). What therapists learn from psychotherapy clients: Effects on personal and professional lives. The Qualitative Report, 17(48), 1–21.
Henwood, K. L., & Pidgeon, N. (2006). Grounded theory. In G. Breakwell, S. Hammond, C. Fife-Shaw & J. Smith (Eds.), Research methods (pp. 342–365). London: Sage.
Holman, G., Kanter, J., Tsai, M., & Kohlenberg, R. J. (2017). Functional analytic psychotherapy made simple: A clinician’s guide to using the Awareness-Courage-Love (ACL) model in session. Oakland: New Harbringer.
Jeffrey, M. K., & Tweed, A. E. (2015). Clinician self-disclosure or clinician self- concealment. Lesbian, gay and bisexual mental health practitioners’ experiences of disclosure in therapeutic relationships. Counselling and Psychotherapy Research, 15, 41–49.
Kazantizis, N., Cronin, T. J., Dattilio, F. M., & Dobson, K. S. (2013). Introduction: Using techniques via the therapeutic relationship. Cognitive and Behavioral Practice, 20, 385–389.
Kelly, A. E., & Rodriguez, R. R. (2007). Do therapists self-disclose more to clients with greater symptomatology? Psychotherapy, 44, 470–475.
Kohlenberg, R. J., Kohlenberg, B. S., & Tsai, M. (2008). Intimacy. In M. Tsai, R. J. Kohlenberg, J. Kanter, B. S. Kohlenberg, W. C. Follette & G. M. Callaghan (Eds.), A guide to functional analytic psychotherapy (pp. 131–144). New York: Springer.
Levitt, H. M., Minami, T., Greenspan, S. B., Puckett, J. A., Henretty, J. R., Reich, C. M., & Berman, J. S. (2016). How therapist self-disclosure relates to alliance and outcomes: A naturalistic study. Counselling Psycholgy Quarterly, 29, 7–28.
Linehan, M. M. (2015). Cognitive-behavioral treatment of borderline personality disorder (2nd edn.). New York: Guilford.
Nissen-Lie, H., Rønnestad, M., Høglend, P., Havik, O., Solbakken, O., Stiles, T., & Monsen, J. (2017). Love yourself as a person, doubt yourself as a therapist? Clinical Psychology & Psychotherapy, 24, 48–60.
Pierson, H., & Hayes, S. C. (2007). Using acceptance and commitment therapy to empower the therapeutic relationship. In P. Gilbert & R. Leahy (Eds.), The therapeutic relationship in cognitive behavior therapy (pp. 205–228). London: Routledge.
Pietkiewicz, I. J., & Wlodarczyk, M. (2014). Crossing the boundaries of privacy in accidental encounters: Interpretative phenomenological analysis of therapists’ experiences. Clinical Psychology and Psychotherapy, 22, 708–721.
Pope, K. S., & Keith-Spiegel (2008). A practical approach to boundaries in psychotherapy: Making decisions, bypassing blunders and mending fences. Journal of Clinical Psychology, 64, 638–652.
Råbu, M., Moltu, C., Binder, P.-E., & McLeod, J. (2015). How does practicing psychotherapy affect the personal life of the therapist? A qualitative inquiry of senior therapists’ experiences. Psychotherapy Research, 26, 737–749.
Rupert, P. A., Miller, A. O., & Dorociak, K. E. (2015). Preventing burnout: What does the research tell us? Professional Psychology, 46, 168–174.
Safran, J. D., Muran, C., & Shaker, M. A. (2014). Research on therapeutic impasses and ruptures in the therapeutic alliance. Contemporary Psychoanalysis, 50, 211–232.
Schröder, T., Wiseman, H., H. & Orlinsky, D. (2009). “You were always on my mind”: Therapists’ intersession experiences in relation to their therapeutic practice, professional characteristics, and quality of life. Psychotherapy Research, 19, 42–53.
Stahl, J. V., Hill, C. E., Jacobs, T., Kleinman, S., Isenberg, D., & Stern, A. (2009). When the shoe is on the other foot: A qualitative study of intern-level trainees’ perceived learning from clients. Psychotherapy, 46, 376–389.
Swales, M. A., & Heard, H. L. (2007). The therapy relationship in dialectical behavior therapy. In P. Gilbert & R. Leahy (Eds.), The therapeutic relationship in the cognitive behavioral psychotherapies (pp. 185–204). New York: Routledge.
Tsai, M., Callaghan, G. M., & Kohlenberg, R. J. (2013). The use of awareness, courage, therapeutic love and behavioral interpretation in functional analytic psychotherapy. Psychotherapy, 50, 366–370.
Vandenberghe, L., & Silveira, J. M. (2013). Therapist self-as-context and the curative relationship. Journal of Contemporary Psychotherapy, 43, 159–167.
Villatte, M., Villatte, J. L., & Hayes, S. (2015). Mastering the clinical conversation: Language as intervention. New York: Guilford.
Wilson, K. G., & Merwin, R. M. (2008). Therapeutic relationship. In M. Hersen (Ed.), Encyclopedia of behavior modification and behavior therapy with adult clinical applications (pp. 586–590). Thousand Oaks: Sage.
Wilson, K. G., & Sandoz, E. K. (2008). Mindfulness, values, and the therapeutic relationship in acceptance and commitment therapy. In S. F. Hick & T. Bein (Eds.), Mindfulness and the therapeutic relationship (pp. 89–106). New York: Guilford Press.
Young, J. E., Klosko, J. S., & Weishaar, M. (2003). Schema therapy: A practitioner’s guide. New York: Guilford.
Zur, O. (2007). Boundaries in psychotherapy: Ethical and clinical explorations. Washington: American Psychological Association.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
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Vandenberghe, L., Coppede, A.M. & Bittencourt, M.V. Building and Handling Therapeutic Closeness in the Therapist-Client Relationship in Behavioral and Cognitive Psychotherapy. J Contemp Psychother 48, 215–223 (2018). https://doi.org/10.1007/s10879-018-9388-9
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DOI: https://doi.org/10.1007/s10879-018-9388-9