Barbara L. Paulson

The therapeutic alliance: Adolescent perspectives

This paper presents a conceptualisation of the therapeutic alliance from the adolescent perspective and discusses implications for practitioners. The main aim of the study was to focus on the factors that participants identified as important in relationship formation and maintenance. Eighteen individuals were interviewed using a semi-structured format. Three major themes were identified: therapeutic environment, uniqueness of the therapeutic relationship, and therapist characteristics. Participants identified both positive and negative aspects of the therapeutic relationship. A strong alliance was found to be necessary in that the perception of the therapist as accepting, supportive and trustworthy influenced the adolescents evaluation of the appropriateness of therapeutic tasks and goals. Participants stressed the importance of the supportive nature of the relationship in their willingness to collaborate in therapeutic interventions.

Being in the Safety Zone: Emotional Experiences of Suicidal Adolescents and Emerging Adults.

This study examined how previously suicidal adolescents and emerging adults perceived their emotional experiences while being suicidal. Forty-one females and 9 males previously suicidal between the ages of 15 and 24 were interviewed. Qualitative data were analyzed using a grounded theory approach. Three major themes were identified in participants’ perceptions of their emotional experiences: (a) overwhelming despair, (b) shame and self-loathing, and (c) alienation and personal isolation. These emotional states were viewed within the multidimensional process of responding to emotions. Participants’ inability to deal with intense negative emotions appeared to be related to their suicidal state.

The client as expert : Researching hindering experiences in counselling

This paper identifies the importance of valuing clients’ experiences when seeking to understand hindering experiences in counselling. Since the research literature reports that client perceptions of counselling are better predictors of outcome than counsellor ratings, client viewpoints are critical to furthering understanding of hindering experiences. Clients are generally reluctant to share negative experiences and a discussion regarding the difficulty in soliciting these experiences is presented. Examples of the process of conducting a client-oriented investigation into hindering experiences convey some of these difficulties. Several implications for counselling practice are addressed: (1) the need for counsellors to notice and repair hindering experiences, (2) the value of attending to the quality of the relationship, (3) the need for counsellors to cultivate flexibility and responsiveness, and (4) the use of methods to encourage clients to share their unspoken experiences.

Self-criticism and the therapeutic relationship

The relationship between self-criticism and the therapeutic alliance was examined in 169 clients attending counselling in a community clinic. Self-criticism was associated with lower client ratings of the working alliance, suggesting that clients with higher self-criticism had greater difficulties establishing and maintaining a therapeutic alliance. These findings extend previous studies on the working alliance and self-criticism from highly controlled clinical studies to a more ecologically valid community mental health setting. Regression analyses were conducted to examine the mediating effect of additional factors on the relationship between self-criticism and the working alliance. Sensitivity to a perceived subordinate role in therapy did not impact the working alliance, although a general resistance to subordination was related to self-criticism. Implications for counselling self-critical clients are discussed.