Heidi M. Levitt

What Clients Find Helpful in Psychotherapy: Developing Principles for Facilitating Moment-to-Moment Change.

Clients who had completed psychotherapy were interviewed about the significant experiences and moments they recalled within their sessions. These interviews were analyzed using grounded theory, creating a hierarchy of categories that represent what clients find important in therapy. From the hermeneutic analysis of the content of these categories, a list of principles was constructed to guide the moment-to-moment process of psychotherapy practice. The authors respond to the call for qualitative outcome studies and demonstrate how qualitative psychotherapy research can lead to empirically derived principles that then can become the foundation of future research and psychotherapy integration efforts.

The role of therapist self-disclosure in psychotherapy: a qualitative review.

Over 90% of therapists self-disclose to clients (Mathews, 1989; Pope, Tabachnick, & Keith-Spiegel, 1987; Edwards & Murdock, 1994), however, the implications of therapist self-disclosure are unclear, with highly divergent results from one study to the next. The goal of this paper was to review the empirical literature relevant to therapist self-disclosure, and provide the reader with a comprehensive understanding of the factors that affect, and are affected by, therapist self-disclosure. Findings are organized into an integrated model examining the who, what, when, why, and how of therapist self-disclosure. In addition, training implications and suggestions for future research are provided.

Coping responses by adults who stutter: part I. Protecting the self and others.

UNLABELLED Using a grounded theory approach, four clusters were identified that represent patterns of coping by adults who stutter. In order to understand the complexities within the coping responses of speakers to the experience of stuttering, this first of two companion papers summarizes the literature on the human coping response to stress and the nature of two of the four main findings identified. These findings describe a coping process that emphasizes strategies of protecting both the speaker and the listener from experiencing discomfort associated with stuttering. The companion paper describes the remaining two main findings that emphasize the characteristics of self-focused and action oriented coping responses. EDUCATIONAL OBJECTIVES The reader will be able to: (1) describe, from the perspective of a select group of adults who stutter, the themes associated with the process of coping with stuttering, (2) describe the basic rationale for the procedures associated with grounded theory methods, (3) describe the factors that influence the choice to use emotion-focused and problem-focused coping strategies, and (4) explain the factors that contribute to the use of methods of escape.

The misunderstood gender: A model of modern femme identity

Femme identity remains a highly controversial topic. It has been maligned in both heterosexual and queer contexts, and is rarely represented in empirical literature. In this study we examined how femme women experience their own gender identity. Interviews were conducted with femme-identified lesbians; the focus was upon 4 content areas: identity development, experiences in the lesbian community, heterosexual society, and romantic relationships. The interviews were analyzed using Grounded Theory (B. J. Glaser & A. Strauss, 1967), an empirical method of generating models of subjective phenomena. The core category in this model “Maintaining integrity: Upholding beliefs about sexual desire and gender representation” reflects the need to uphold their sense of integrity across a variety of contexts by confronting stereotypes about both women and lesbians.

A Quest for Authenticity: Contemporary Butch Gender

A model of contemporary butch identity has been constructed from the analysis of a series of semistructured interviews with butch-identified women who described their gender in relation to their own experiences and beliefs. The analytic process entailed a grounded theory approach (Glaser & Strauss, 1967). The results of the study describe how butch-identified women conceptualize their gender identity and how it affects their social relations within lesbian and heterosexual communities. The core category in this model (i.e., A Quest for Authenticity) frames butch identity as entailing an ongoing process of negotiation between an essential sense of lesbian gender and gender presentation demands that are understood in relation to the signification and meaning of genders across social contexts.

The Development of Wisdom: An Analysis of Tibetan Buddhist Experience:

This article presents a qualitative study that examined the development of wisdom in a Tibetan Buddhist culture. A grounded theory methodology was used to analyze interviews of 13 monks from a monastery in the Himalayan region of India. These interviews focused on five areas: definitions of wisdom, facilitative conditions for the development of wisdom, the teaching process, methods of developing wisdom, and personal experiences. Translators were used when required. Results include an emphasis on the need for others’ guidance in the process of development. The understanding of the Buddhist perception of reality and altruistic behavior were critical in this process. Motivation to become wise was heightened through techniques such as an interpersonal process of cost-benefit analysis and the relating of scriptural material to personal experiences. The Tibetan Buddhist approach to self-development is then discussed in relation to Western psychological approaches.

Coping responses by adults who stutter: part II. Approaching the problem and achieving agency.

UNLABELLED As with the first of two companion manuscripts, this investigation employed a grounded theory approach to identify patterns of coping responses by adults responding to the stress resulting from the threat of stuttering. The companion paper described emotion-based avoidant coping responses that were used to protect both the speaker and the listener from experiencing discomfort associated with stuttering. This paper describes two cognitive-based approach patterns that emphasize self-focused and problem-focused forms of coping. The first of the cognitive-based coping patterns involved speakers approaching stuttering with a broader perspective about themselves and the experience of stuttering, resulting in an improved self-concept and increased self-confidence. The second coping pattern involved speakers focusing on their own goals which results in increased agency and self-confidence. Participants described the development of more functional coping responses. They moved from emotion-based avoidant patterns of coping that focused on protecting the self and the listener from experiencing discomfort associated with stuttering to cognitive-based approach patterns that focused on the needs of the speaker. As the participants chose to approach rather than avoid or escape stuttering, they experienced many positive social, physical, cognitive, and affective results. EDUCATIONAL OBJECTIVES The reader will be able to: (1) describe, from the perspective of a select group of adults who stutter, the themes associated with the process of coping with stuttering, (2) describe the basic rationale for the procedures associated with grounded theory methods, (3) describe the factors that influence coping choices, and (4) explain the factors that contribute the use of approach-oriented and agentic coping strategies.

Butch Identity Development: The Formation of an Authentic Gender:

The present article explores the gender identity development of butch lesbian women, as conveyed in semi-structured interviews. A grounded theory (Glaser and Strauss, 1967) analysis of the women’s developmental experiences was performed. From these results, a model was formed that illustrated the process of their gender identity development, in interaction with the development of their sexual orientation. Butch gender identity development is posited as a healthy process complicated by the societal pressures to conform to gender roles, and is offered as an alternative to a diagnosis of gender identity disorder.

Being Transgender Navigating Minority Stressors and Developing Authentic Self-Presentation

In this interview-based study, we investigated the common social experiences and minority stressors related to being transgender. It is one of two articles that resulted from a grounded theory analysis of interviews with 17 participants who claimed a variety of transgender identities (e.g., cross-dresser, transman, transwoman, butch lesbian) and were from different regions in the United States. The interview was centered on how participants’ identities influenced their lives across different interpersonal contexts. Participants described developing a more complex understanding of gender because of the effect of their transgender status on others and the need to modify their gender presentation at times to secure their safety. In the workplace, their gender could overshadow their competence and, in the age of social media, was always at risk of becoming public. Seeking social support could be dangerous, and the process of transitioning was found to make safe spaces especially elusive. Also, open communication about sex and gender was found to be particularly important within successful intimate relationships. Our findings emphasized the tensions between a need to be respected and valued for oneself and one’s abilities with a need to mitigate the very real dangers of being visible or out as transgender in different contexts. Our research can be used to enhance health professionals’ understandings of transgender people’s life experiences, to identify salient minority stressors for further research exploration, and to advance advocacy.

Being Transgender: The Experience of Transgender Identity Development

This article is based on a grounded theory analysis of interviews with transgender-identified people from different regions of the United States. Participants held a variety of gender identities under the transgender rubric (e.g., crossdresser, transman, transwoman, butch lesbian). Interviews explored the participants’ experiences in arriving at their gender identity. This article presents three clusters of findings related to the common processes of transgender identity development. This process was made possible by accessibility of transgender narratives that injected hope into what was a childhood replete with criticism and scrutiny. Ultimately, participants came to their identities through balancing a desire for authenticity with demands of necessity—meaning that they weighed their internal gender experience with considerations about their available resources, coping skills, and the consequences of gender transitions. The implications of these findings are considered in terms of their contribution to gender theory, research, and clinical support for transgender clients.