Evidence-Based Relationships: Three New Case Examples

September has been quiet for this blog as it included family traveling as well as immersion into the 6th edition revision of Clinical Interviewing. While re-working Chapter 7 (Evidence-Based Relationships), we developed three new case examples. As with all case examples, these are inspired by real cases of our own or of other professionals, but also include plenty of fictional components. The fictional components allow for concise articulation of specific learning goals, while preserving anonymity.

On a related note, one highly-esteemed reviewer of the 5th edition commented—repeatedly—that the text was filled with “bloat.” This was helpful feedback, albeit difficult. Ouch! And so we are striving in the 6th edition to consistently de-bloat everything:). What fun! Don’t worry; we’re still hydrating (this is exactly the sort of commentary that gets us into bloating trouble)

Here are the Case Examples.

Case Example: 7.1

Congruence across Cultures

Cultural identity has many dimensions (Collins, Arthur, & Wong-Wylie, 2010). In this example, during an initial clinical interview with an African American male teenager, the clinician is using congruence or authenticity across several different cultural domains.

Client: This is stupid. What do you know about me and my life?

Clinician: I think you’re saying that we’re very different and I totally agree with you. As you can probably guess, I’ve never been in a gang or lived in a neighborhood like yours. And you can see that I’m not a Black teenager and so I don’t know much about you and what your life is like. But I’d like to know. And I’d like to be of help to you in some way during our time together.

This clinician is being open and congruent and speaking about some of the obvious issues that might interfere with the clinician-client relationship. It would be nice to claim that this sort of openness always results in clinician-client connection, but nothing always works. However, as researchers have reported, there’s a tendency for congruence to facilitate improved treatment process and it also appears to contribute to positive outcomes, at least in a small way (Kolden et al., 2011; Tao, Owen, Pace, & Imel, 2015).

Case Example 7.2:

Intermittent Unconditional Positive Regard and Parallel Process

Michelle is a 26-year-old graduate student. She identifies as a White Heterosexual female. After an initial clinical interview with Hugo, a 35-year-old who identifies as a male heterosexual Latino, she meets with her supervisor. During the meeting she expresses frustration about her judgmental feelings toward Hugo. She tells her supervisor that Hugo sees everyone as against him. He’s extremely angry toward his ex-wife. He’s returning to college following his divorce and believes his poor grades are due to racial discrimination. Michelle tells her supervisor that she just doesn’t get Hugo and that she thinks she should refer him instead of having a second session.

Michelle’s supervisor listens empathically and is accepting of Michelle’s concerns and frustrations. The supervisor shares a brief story of a case where she had difficulty experiencing positive regard toward a client who had a disability. Then, she asks Michelle to put herself in Hugo’s shoes and imagine what it would be like to return to college as a 35-year-old minority person. She has Michelle imagine what might be “under” Hugo’s palpable anger toward his ex-wife. The supervisor also tells Michelle, “When you have a client who views everyone as against him, it’s all the more important for you to make an authentic effort to be with him.” At the end of supervision Michelle agrees to meet with Hugo for a second session and to try to explore and understand his perspectives on a deeper level. During their next supervision session, Michelle reports great progress at experiencing intermittent unconditional positive regard for Hugo and is enthused about working with him in the future.

One way to enhance your ability to experience unconditional positive regard is to have a supervisor who accepts your frustrations and intermittent judgmental-ness. If the issues that arise in therapy are similar (or parallel) to the issues that arise in supervision, it’s referred to as parallel process (Searles, 1955). This is one reason why when you get a dose of unconditional positive regard in supervision, it may help you pass it on to your client.

Case Example 7.6

Mutual Empathy – A Feminist Relationship Factor

Chantelle, a 25-year-old woman attending community college, came to the student health service for counseling. She was intermittently tearful as she described her abusive childhood. Her counselor, a 25-year-old female counseling intern, listened, paraphrased, offered feeling reflections, and stayed connected with the client through the stories and tears. At one point, the client expressed hate for herself and then described repeated scenarios where she felt coerced into providing sexual favors for males in her household in order to have access to transportation and food. With tears of empathic resonance in her eyes the therapist said, “I have this image of you in prison and the men in control only hand you the keys to temporarily go out on leave if they shame you by giving them sexual gratification.”

The client noticed her counselor’s emotion. In response she had a powerful emotional outpouring. Later, when asked about what was helpful in her work with the counseling intern, the client identified her counselor’s tears. She said that her mother and sisters always minimized and humiliated her for “complaining” about living in a home where she had food and shelter. For the client, the whole idea and experience of someone else having an empathic emotional response to her shame and self-revulsion played a big role in her healing.

And this is the end of the case examples. Comments–excluding comments about bloating–are always welcome.

R and J in Field

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