Special Section: On Learning from Experience: Personal and Private Experiences as the Context for Psychotherapeutic Practice
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Auteurs : Per JensenSource :
- Clinical Child Psychology and Psychiatry [ 1359-1045 ] ; 2007-07.
Abstract
The central idea in evidence-based practice is that it is the therapy that works and not the therapist. However, this article seeks to show how both our private and personal lives are an area for reflection when we are working as psychotherapists, and that personal and private experience can be an important framework for practising psychotherapy. Through looking at elements of the personal and private lives of three different therapists in the light of a therapy session conducted by each, I will try to demonstrate how personal and private experiences may influence clinical practice. The article builds on an ongoing grounded theory research project at the Tavistock Centre, London.
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DOI: 10.1177/1359104507078468
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However, this article seeks to show how both our private and personal lives are an area for reflection when we are working as psychotherapists, and that personal and private experience can be an important framework for practising psychotherapy. Through looking at elements of the personal and private lives of three different therapists in the light of a therapy session conducted by each, I will try to demonstrate how personal and private experiences may influence clinical practice. The article builds on an ongoing grounded theory research project at the Tavistock Centre, London.</bold></p></abstract><kwd-group><kwd>evidence-based practice</kwd><kwd>experience</kwd><kwd>private and personal</kwd><kwd>psychotherapy</kwd><kwd>resonance</kwd></kwd-group><custom-meta-wrap><custom-meta xlink:type="simple"><meta-name>sagemeta-type</meta-name><meta-value>Journal Article</meta-value></custom-meta><custom-meta xlink:type="simple"><meta-name>search-text</meta-name><meta-value>375 SPECIAL SECTION On Learning from Experience: Personal and Private Experiences as the Context for Psychotherapeutic Practice SAGE Publications, Inc.200710.1177/1359104507078468 PerJensen Diakonhjemmet University College, Oslo, Norway, jensen@diakonhjemmet.no A B S T R A C T The central idea in evidence-based practice is that it is the therapy that works and not the therapist. However, this article seeks to show how both our private and personal lives are an area for reflection when we are working as psychotherapists, and that personal and private experience can be an important framework for practising psychotherapy. Through looking at elements of the personal and private lives of three different therapists in the light of a therapy session conducted by each, I will try to demonstrate how personal and private experiences may influence clinical practice. The article builds on an ongoing grounded theory research project at the Tavistock Centre, London. evidence-based practice experience private and personal psychotherapy resonance KEYWORDS W H E N W E T A L K about therapists' experience we most often refer to their training background and professional life. Personal and private experiences are often left out or overlooked in discussions of clinical competence. This is in line with the central idea in evidence-based practice that it is the therapy that works and not the therapist. The therapist's task is to deliver the therapy in the same way as the physician delivers an effective medicine to the patient. 376 In this article I will illustrate how it is possible to think about the living of personal and private life as a part of building competence as a psychotherapist. This article seeks to show how our private and personal lives are an area for reflection when we are working as psychotherapists, and that personal and private experience can be an important framework for practising psychotherapy. Family of origin forms one important context for understanding the family therapist's experience. Others include the therapist's political and cultural background, the social and economic setting and the religious commitments and values that have formed the therapist. I will look at three different therapists (Adam, Elisabeth and Eric)1 and show how elements from their personal and private life can appear as a framework for under- standing three different therapy sessions. Method The cases presented here are some of the findings from a grounded theory research project whose primary purpose was to explore in depth, with eight therapists, the patterns that connect their own personal experiences and life with their clinical family therapy practice. Each therapist is treated as a separate case study within a grounded theory design. Two interviews were conducted with each therapist, punctuated by watching a video of a first family therapy session conducted by that therapist in between the research interviews. Paradigm cases Adam's personal history from acting as a go-between in his family of origin will be used here as a paradigm case. The concept of `paradigm case' is used in many different frames of reference (law, philosophy, nursing). According to Benner (1985) a paradigm case is `a clinical episode that alters one's way of understanding and perceiving future clinical situations. These cases stand out in the clinician's mind; they are reference points in their current clinical practice' (p. 296). A paradigm case is a case that is based on experience and that is a part of the clinician's clinical experience. This may be considered good or bad, wanted or unwanted. Paradigm cases can show content, meaning, intentions, expectations, context, structure, process and results without taking the knowledge out of its context. In this way, they present knowledge at a higher level, because the therapists' contextual understanding and intentions are expressed (Benner & Wrubel, 1989). Some paradigm cases are simple and can be told as stories that students and clinicians can incorporate into their knowledge to deepen and expand their practice. `However, many paradigm cases are too complex to be transmitted through case examples or simulations' (Benner, 1985, p. 9). The case method is closely linked to qualitative research and represents a `non- experimental qualitative sociological method that employs an exhaustive examination of cases' (Vidich & Lyman, 1998, p. 74). In the three paradigm cases I present here, I report narratives that represent the therapists' points of reference when their personal life is linked to clinical practice and try to explain the connection between them. Adam brings with him some basic patterns of behaviour that he developed in his own family of origin when he was a young man. Elisabeth, who is a less experienced therapist, brings her current life situation into the therapy room by making her own concern central to the therapy session although the couple had decided not to talk about this. Erik, who is a very experienced therapist and who was educated within the scientific 377 practitioner tradition, includes some of his personal values in therapy, although this is not something he considers to be good practice. Adam:The mediator When Adam grew up he was the boy in the middle of three siblings. When I asked Adam what his background and his upbringing had meant for him as a context for becoming a therapist, he pointed out one particular period. He said, `I believe some of it is connected to the family situation I've grown up in . . . sort of (to) the role I had there'. The period he refers to is when he was between 14 and 17 years of age. When he started telling about his background in his family of origin, the picture of him functioning as a mediator soon emerged. His personal history contains an important sequence from when he was 14 or 15 years-old, where, for a long period, his family of origin was in a kind of a fight with the rest of the family. Actually he cannot remember what it was all about, but he is sure `it was a situation where there was a frus- trating break between our family and my parents, there on the one side, and the rest of the family'. He also clearly remembers his own role in it. This mediating function gave him a particular position and a special status in his family. He says, `I had a role where I was a bit like a middleman or mediator, sort of also between . . . also between us children and the adults'. To elaborate what this is about he says, For periods of time there was little conflict at home like between my parents and then . . . then I probably had a sort of damping affect on them, or what can I say one, one who . . . brought . . . things further or . . . in a way one who kept the conversation going, I think. Kept sort of the connection going. Both sort of inside the family and like outside the extended family, relatives and the like, grand- parents and that. Let's go on by looking at Adam as a therapist. He is a very experienced therapist with many years in the psychiatric field. This example emerged after interviews with him and after watching a first session he conducted with a client. After analysing the material these connections appeared between the therapist's private and personal life and the clinical practice. In the video of his first session he meets with a man who is in the middle of a `frustrating break-up' from his wife. They have been married for 15 years and have two children aged 11 and 14. He has fallen in love with a new woman and has moved away from home to a new apartment where he lives alone. He is not sure what to do and is afraid to end up with a broken heart if he does not try out this new relationship. When the client asked Adam about his experience with breaking up like this, the mediator seems to appear when Adam answered, `I have experience with both those who have regretted it and those who feel it has been a good thing'. The client shows a lot of doubt with what to do and is very concerned for his children and about raising them with divorced parents. Adam shows a particular interest in this aspect, and he returns to the children's situation over and over again. Adam underlines the situation when he says, `It is hard to choose in stressful situations. It isn't for nothing that one practices what one will do in stressful situations'. Through the entire session Adam goes slowly and introduces different questions and topics for the client to investigate. Along with his obliging attitude and kind manner he guides the client into several important question without suggesting any answers. 378 When, in the next interview, I ask him if it was his mediating skills I saw on the video he says, Yes, yes, mmm, I believe I'm more concerned with sort of taking in his story then and taking . . . maybe taking in his experience around it and . . . also in a bit sort of, what should I say, small steps or maybe not to bring in too big, what should I say, contrasts into the conversation. If that has to do with being a mediator, yes, that is maybe the case. Because a mediator, some of that is about maintaining a position, then . . . also maintaining a position in relation to him. In order to preserve the contact and then certainly I'm relatively careful with introducing sort of big, big leaps . . . When I ask him what he thinks about giving advice when a client like this asks for advice, he says that he never would offer any advice when clients struggle with existential questions like this. He would maybe give some advice if he asked about maintaining contact with his children or how he should deal with his wife, but never about whether it is right to go or to stay. Theory and practice We have a long tradition of making a division between the place where knowledge is applied and the place where knowledge is acquired. The distances between university on one side and working life on the other are growing. The kind of knowledge we can only acquire through practical work has little or no space in the academy today. This has pushed us towards a narrow definition of knowledge. At the same time this process has led to a rise in the status of formal education and the professions. One kind of knowledge that in many ways has lost priority, or perhaps never established its own domain, is personal knowledge. Michael Polanyi (1958) emphasizes this knowledge, working towards `an epistemology of personal knowledge' (p. 255). Jeff Faris (2002) refers to Donald Schön when he argues that `the relationship between the personal epistemology embodied in therapists' practice and the discourses of espoused theory about therapy seems central to this process' (p. 92). He stresses the importance of bringing it forth, so it can be examined, rather than `silently' informing practice. In recent years we have seen a shift in the view of knowledge and learning. Many alternatives to the logocentric model have emerged. Today we see examples of the pendulum swinging in the opposite directions in the discussion on education. Some emphasize the work place as the main field for learning. Others emphasize practice in a way that makes it the only field of knowledge that carries weight. From my point of view it is a huge challenge for the universities and the practical field to work together in an educational process to benefit the individual trainee. The significance of the therapist Psychotherapy outcome researchers have often tried to minimize the influence of the individual therapist when they study the efficacy of specific interventions. However, research also shows that variation in outcome across methods or therapeutic traditions is smaller than variation in outcome among therapists within methods or therapeutic traditions. `The conclusion is that it makes a bigger difference who the therapist is than which method is used' (Rønnestad & Skovholt, 2002, p. 3). This is one of the important starting points in developing an understanding of the links between family therapists' personal lives and their professional practices. 379 The significance of the therapist as a person is underscored by several researchers (Jennings et al., 2003). Interest in studying how therapists develop has been increasing (Wampold, 2001). In their article, Rønnestad and Skovholt (2002) sum up 10 years of research on the development of psychotherapists. Through summarizing the main findings and perspectives from a cross-sectional and longitudinal qualitative study of the development of 100 counsellors and therapists, they identify 14 themes that are important in this process. Some of them are `professional development involves an increasing higher order integration of the professional self and the personal self' and `the cognitive map changes: Beginning practitioners rely on external expertise, seasoned practitioners rely on internal expertise' (p. 40). Some of these themes deal with the fact that experienced therapists have most confidence in their own expertise, that their personal lives influence their professional work throughout their careers, and that inter- personal sources are the driving force in their development. Wampold (2001) claims that `ignoring therapists in design can lead to catastrophic errors' (p. 187). He describes how, for example, previous research acquires entirely new values if one takes the therapist into account when interpreting the results. In a study comparing the effects of cognitive therapy with those of analytic therapy, the former proved most effective. He uses a `nested design' and a `crossed design'2 to include the therapist in psychotherapy research. When Wampold and his colleagues examined the results and included the effect of the therapist as a part of the treatment, it was impossible to define one type of therapy as more effective than the other. His conclusion is that `the evidence is clear that the type of treatment is irrelevant' (p. 202) and it is pointless to try to follow a manual slavishly. But the therapist, who is an integral part of all forms of treatment, makes all the difference. Wampold closes by saying that it is now clear that what is absolutely decisive in treatment is which therapist is carrying out the therapy, and that this conclusion supports a contextual perspective of psychotherapy. Evidence-based practice According to the evidence-based practice perspective the therapist's job is to deliver the intervention. The principle is the same as when the physician gives the patient a pill. It is the active substance in the pill that works. It is believed it is the same in therapy, that it is the intervention that works and the therapist's competence is to deliver it the best way. From this perspective it is important that the therapist gets the necessary training to be a scientist-practitioner in order to make the right interventions. When we ask about `what works' in psychotherapy, we are reminded that psychotherapy is often compared with the effects of chemicals from the pharmaceutical industry. In other words, we are invited to use the same rhetoric about psychotherapy as we use to describe chemical effects. Alan Carr (2000) points out that among family therapists who base their work on constructivism and social constructionism, there is considerable opposition to uni- lateral evidence-based practice. He also points out that family therapy and systemic practice are based on a different basic viewpoint than is evidence-based practice. But we shall also see that the arguments against an evidence-based and medical model can be found in psychotherapy research. The highest context? This paradigm case is with Erik who is a very experienced family therapist. He is also the therapist that most clearly makes his point about not using private and personal stories as part of his clinical work. However, he will not decribe himself as a scientific practitioner. Erik is careful to tell me that he does not know how people should live their 380 lives and that he would never try to give someone advice about how to organize their life. He says he would never `promote' any of his own ways of living either as a therapist or in general. His video of a first therapy session was with a young couple that came for therapy because they wondered if they should stay married. When he asked what had brought them to the Family Counselling Office the wife said, `It's not supposed to be so easy when one has children, to turn your back on each other'. At one point in the therapy session they talked about who, if anybody, knew that they were having problems in their marriage. The husband said that he had not told anybody, not his parents, nor any friends. The wife said that she is an identical twin and that she tells her sister everything. But she had not told anyone else, not her parents, nor friends. When they were reviewing the couple's situation, Erik asked what they thought about telling their parents about their situation. Then he offered them something that sounds like advice. He said, `You could say of course to parents and acquaintances, to family and friends that you are going to family counselling, so that they will understand that this isn't something you have done with a light heart, for example'. At first, I did not understand the inducement for almost giving this advice to the couple. But then I remembered one of his own private stories from when he was a young student. His girlfriend became pregnant and he decided not to marry her. She wanted to keep the child and that meant that he would be a father. That also meant that his father and mother would be grandparents and that his siblings would be uncles and aunts. He knew he had to go home to his parents and the rest of the family and tell them that they would be getting a new member in the family but that he would not marry the child's mother. In the early 1970s this would have been a strong message into a Christian, pietistic environment in eastern Norway. They `had to' include a new member in the family born outside marriage. In many families `had to' was viewed as terrible. But his family included the child as one of their own. They managed to be real grandparents for the child. In his home `it was possible to have an open dialogue about most topics', he says. I decided, in my second interview with Erik, to link this good, early experience from his private life to the intervention when he `advised' the couple to go home and tell their parents. When I met him I was prepared for the fact that he would reject this interpretation or that he would ignore it, or even that he might be angry with me trying to press this kind of unprofessional clinical attitude on to him. I presented my thoughts about this connection and said, You said that you thought it might have been an idea that they told their family and maybe their friends. And then I thought that that was something Erik also did when something dramatic happened with him and in his family. The first thing he did was to go home to his mother and father, his family, to say that there is actually a grandchild on the way. When he heard this, he was stunned, and obviously moved, with tears in his eyes and he remarked, `I can feel that I am moved'. He confirms that, to him, this kind of story repre- sents an important value linked to his understanding of his own background and family context. At the same time, he was surprised that he had really said what he said or given that advice. To give that sort of advice is contrary to his ideas about being a professional psychotherapist. He said that he would never do that again. 381 The therapeutic relationship Research does not tell us much about how we can train good psychotherapists. Høglend (1999) claims in his research that there is nothing that indicates that a psychologist or psychiatrist with many years of education, who has undergone therapy, and who has long experience, achieves better results than a social worker or psychiatric nurse with less training and experience. The American family therapists, Hubble, Duncan, and Miller (1999) claim, taking their point of departure in the works of Michael Lambert in 1992, that research has identified four `common factors' that are present in all forms of psychotherapy regardless of theoretical orientation (psychodynamic, cognitive, etc.), mode (individual, group, couples, family, etc.), dosage (frequency and number of sessions), or speciality (problem type, professional discipline, etc.). These four common factors are the following: (1) The therapeutic relationship (30%); (2) expectancy (placebo effects) (15%); (3) techniques (15%); and (4) extratherapeutic change (40%). They maintain that these proportions apply regardless of the therapy tradition and choice of methods. The weight of each sector is, however, not based on research, but is estimated by Lambert on behalf of experience and visual inspection (Beutler et al., 2004). It is remarkable to make the claim that only 15 per cent of the therapeutic effect can be ascribed to therapeutic techniques when the evidence-based practice model seeks to demonstrate which therapy techniques have the best effect on specific psychological disorders. If the common factors approach is the basis for education and clinical practice, then the therapist's personal and private backgrounds are important in understanding clinical practice. If the therapist as a person and the relationship with the client is a part of what `works', it will also be important to focus on this aspect in education, supervision and practice. The therapist in the therapy In connection with some remarks about communication, Løgstrup (1982) says that language must be both `reference and request' (p. 182; see also Buur Hansen, 2000). In this context, reference means that clinical practice must have an evidence-based content. Most people take it for granted that the therapist has a solid professional background and that his or her approach is based on such a background. But according to Løgstrup, reference is not enough. A clinical practice also needs request. This refers to therapy as an interpersonal approach, an approach that is perhaps more similar to an artistic activity than to an instrumental or technical approach. When we refer here to request, we mean entering into a relationship characterized by communication, reciprocity, co-operation and respect. This has to do with people who have contact with each other – who have entered into a relationship marked by empathy and a shared search for meaning and solutions. According to the two psychotherapy researchers Soldz and McCullough (2000), psychotherapy encompasses a complex interpersonal interplay that cannot be reduced to the `findings' in a scientific investigation. In daily experience in a therapeutic setting, people do not fit neatly into ready-made categories, and in this type of setting we must look further within science or beyond science if we are to establish an adequate under- standing of therapy. In this connection, it is often said that therapy is both an art and a science. Such a statement could indicate that some therapeutic techniques are located outside of what we would usually define as science, and outside of the areas that are encompassed by traditional research. If this is the case, then this applies to both quantitative and 382 qualitative research, which is both based on rational and logical analyses. In this context, I want to emphasize that analogue or creative aspects of therapy entail a different type of knowledge than the rational and analytical knowledge produced by research (Jensen, 1994). This type of knowledge can be seen in those aspects of communication that cannot be captured in digital language but that are nevertheless essential elements in determining how relations between people are experienced and can be understood. After many years of research, one of the most productive pioneers within family therapy research, Jay Haley, took a position in which he claimed that research and therapy could only be useful to each other to a limited degree. In his view, the therapy process is an endlessly complex tapestry woven of interactions, emotions and value judgements, which current methodology will never be able to capture totally (Dallos & Draper, 2000). Resonance between private life and therapeutic practice The Belgian family therapist, Elkaïm (1997), introduces the concept of resonance to help us understand the dynamics between how one part of life may influence another part of life. He says, `resonance occurs when the same rule or feeling appears to be present in different but related systems' (p. xxvii). This kind of dynamic could be used to under- stand both Adam and Erik's paradigm cases. When we now use the concept of resonance to shed light on Elisabeth's paradigm case it should be quite clear how a therapy session is influenced by the therapist's current private life. In this example it is not only the rule or feeling that appears, but these rules and feelings come to dominate most of the therapy session. Elisabeth: Alcohol abuse at home and in couples therapy The video from this first therapy session showed Elisabeth working with a couple who had made a clear and distinct request for help. The woman opened up and said that they had decided to divorce but since they had two children they needed help to communi- cate. At the moment their communication ends with quarrelling all the time. Initially Elisabeth asked about the family as a whole and they spoke about many severe problems for both the children and for themselves. The husband's alcohol abuse was among these problems. However, after these opening questions and answers, they used almost the whole session to talk about the husband's drinking. At the end of the therapy session the woman remarked that this was a strange reversal because they had decided before they came not to mention alcohol at all. Elisabeth seemed to be a little bit hectic and she looked around for some pamphlets about good communication that she wanted to hand over to the couple. When I was analysing the first interviews with Elisabeth the only link to alcohol was connected to her father (with whom she lived with as a small child) and she had remarked on one occasion that her husband `drank too much'. I therefore decided to ask more explicitly for an explanation for her choosing to concentrate almost entirely on the husband's drink problem in the first therapy session. I asked her, `How do you think about your . . . that alcohol emerged as it did and that you followed that thread of all the possible threads?'. First, she said that she wanted to get out of it and then she said that he needed to talk about it but she did not give me any explanation. Therefore, I was still curious and after a while, I asked her if she thought I was overdoing the topic of alcohol, asking too much about it. Then she said, `It is no more than 1 or 2 years ago that I sat in a Family Consultation Office and said, “I'm 383 leaving if this doesn't get sorted out”'. She then said that she thought her husband drank too much and `he was only angry, angry, angry'. They were recently in therapy because of this situation. I asked her if she was aware of this parallel when she was conducting the session. She said yes and that when she came home she told her husband that she had met a challenge at work that was a bit like their relationship. The couple continued to come to therapy and Elisabeth was in a dilemma whether she should go on working with the drinking problem or if she should refer them to some specialists. From the first session, she really felt she had made a good contact with them and they had been eager to come for more therapy. She also said that this was the first time the husband told a professional about his drinking problem. When I asked her how she would evaluate her parallel life situation with the couple, she said that although it was a parallel, there were also huge differences between the couples and that she felt she could manage the situation. This paradigm case illustrates how a personal and private situation may form and organize a therapy session. It shows how a therapist may lose her curiosity and openness and let her own private situation govern the therapy session. The therapist's personal and private situation also gives her a particular understanding of this couple's situation and that may give her a special capacity to connect with them. Summary and conclusion The research on the development of therapists and how therapists of different gender, ethnicity, age and experience develop, are numerous, (Beutler et al., 2004; Protinsky & Coward, 2001; Rønnestad & Skovholt, 2002, 2003; Skovholt & Jennings, 2004). However, during the last two decades, interest in therapists' characteristics has decreased due to the focus on manual-driven treatments and randomized clinical trials. Psychotherapeutic treatments are often evaluated as entities that work regardless of the therapists who deliver them. Eventual effects of the therapist as a person are often viewed as a `source of error' (Beutler et al., 2004, p. 227). Interest in doing research on the possible connections between the therapist's personal and private life and their psychotherapeutic practice is even smaller. I find, however, that it is valuable to try and understand how professionals have found their way into becoming family therapists and how their private and personal backgrounds have played a part in their development as psychotherapists. Adam, Elisabeth and Eric are three very experienced family therapists. They are experienced both in terms of their backgrounds as professionals and as human beings with eventful private and personal lives connected to their daily psychotherapeutic practice. In addition, their family and cultural backgrounds have contributed to their formation as therapists. In the three paradigm cases described here they show us how experiences from outside their professional training influence in different ways their psychotherapeutic practice today. Their personal and private experiences can be viewed as different from and more then `a source of error'. The three paradigm cases indicate that more research on the links that connect psychotherapists' personal and private experiences with their psychotherapeutic practice might offer us new ideas and insight in the nature of psychotherapy. This personal and private perspective may also have important con- sequences for the education and training of psychotherapists. The inclusion of a personal and private perspective on psychotherapists' competence may influence the entire way we view psychotherapy. 384 Notes The article builds on an ongoing research project at the Tavistock Centre, London, UK. 1. Pseudonyms. Permission has been obtained to use their examples. 2. About `nested design' and `crossed design' in psychotherapy research, see Wampold (2001). References Benner, P. (1985). From novice to expert. Melno Park, CA: Addison-Wesley. Benner, P., & Wrubel, J. (1989). The primacy of caring. Melno Park, CA: Addison-Wesley. Beutler, L.E., Malik, M., Alimonhamed, S., Harwood, M., Talebi, H., Noble, S., & Wong, E. (2004). Therapist variables. In M.J. Lambert (Ed.), Handbook of psychotherapy and behavior change (pp. 227—306). Chichester: Wiley . Buur Hansen, N. (2000). Pêdagogikkens treklang. Copenhagen : Gyldendal Uddannelse. Carr, A. (2000). Family therapy: Concepts, process and practice . Chichester: Wiley. Dallos, R., & Draper, R. (2000). An introduction to family therapy. Buckingham: Open University Press. Elkaïm, M. (1997). If you love me, don't love me. London: Jason Aronson. Faris, J. (2002). Some reflections on process, relationship, and personal development in supervision. In D. Campbell & B. Mason (Eds.), Perspectives on supervision (pp. 91—113). London: Karnac. Hubble, M.A., Duncan, B.L. , & Miller, S.D. (Eds.). (1999). The Heart and soul of change: What works in therapy . Washington, DC: American Psychological Association. Høglend, P. (1999). Psychotherapy research: New findings and implications for training and practice. Journal of Psychotherapy Practice and Research, 8, 257—263. Jennings, L., Goh, M., Skovholt, T.M., Hanson, M., & Banerjee-Stevens, D. (2003). Multiple factors in the development of expert counselor and therapist. Journal of Career Development, 30(1), 59—72. Jensen, P. (1994). Ansikt til ansikt: System- og familieperspektivet som grunnlag for klinisk sykepleie. Oslo: Ad Notam Gyldendal. Løgstrup, K.E. (1982). System og symbol. Copenhagen : Gyldendal. Polanyi, M. (1958). Personal knowledge: Towards a post-critical philosophy . London: Routledge & Kegan Paul. Protinsky, H., & Coward, L. (2001). Developmental lessons of seasoned marital and family therapists: A qualitative investigation. Journal of Marital and Family Therapy, 27, 375—384. Rønnestad, M.H., & Skovholt, T.M. (2002). Learning arenas for professional development: Retrospective accounts for senior psychotherapists. Professional Psychology: Research and Practice, 32, 181—187. Rønnestad, M.H., and Skovholt, T.M. (2003). The journey of the counselor and therapist. Journal of Career Development, 30, 5—44. Skovholt, T.M., & Jennings, L. (2004). Master therapists: Exploring expertise in therapy and counseling. Boston, MA: Pearson . Soldz, S., & McCullough, L. (2000). Reconciling empirical knowledge and experience: The art and science of psychotherapy. Washington, DC: American Psychological Association . Vidich, A.J., & Lyman, S.M. (1998). Qualitative methods: Their history of sociology and anthropology. In N.K. Denzin & Y.S. Lincoln, Y.S. (Eds.), The landscape of qualitative research (pp. 195—220). London: SAGE. Wampold, B.E. (2001). The great psychotherapy debate. London: LEA.</meta-value></custom-meta></custom-meta-wrap></article-meta></front><back><notes><p><list list-type="order"><list-item><p>1. Pseudonyms. Permission has been obtained to use their examples.</p></list-item><list-item><p>2. About `nested design' and `crossed design' in psychotherapy research, see Wampold (2001).</p></list-item></list></p></notes><ref-list><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Benner, P.</surname></name> (<year>1985</year>). <source>From novice to expert</source>. <publisher-loc>Melno Park, CA</publisher-loc>: <publisher-name>Addison-Wesley</publisher-name> .</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Benner, P.</surname></name> , & <name name-style="western"><surname>Wrubel, J.</surname></name> (<year>1989</year>). <source>The primacy of caring</source>. <publisher-loc>Melno Park, CA</publisher-loc>: <publisher-name>Addison-Wesley</publisher-name> .</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Beutler, L.E.</surname></name> , <name name-style="western"><surname>Malik, M.</surname></name> , <name name-style="western"><surname>Alimonhamed, S.</surname></name> , <name name-style="western"><surname>Harwood, M.</surname></name> , <name name-style="western"><surname>Talebi, H.</surname></name> , <name name-style="western"><surname>Noble, S.</surname></name> , & <name name-style="western"><surname>Wong, E.</surname></name> (<year>2004</year>). <source>Therapist variables</source>. 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Lambert</surname></name> (Ed.), <source>Handbook of psychotherapy and behavior change</source> (pp. <fpage>227</fpage>—<lpage>306</lpage>). <publisher-loc>Chichester</publisher-loc>: <publisher-name>Wiley</publisher-name> .</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Buur Hansen, N.</surname></name> (<year>2000</year>). <source>Pêdagogikkens treklang</source>. <publisher-loc>Copenhagen</publisher-loc> : <publisher-name>Gyldendal Uddannelse</publisher-name> .</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Carr, A.</surname></name> (<year>2000</year>). <source>Family therapy: Concepts, process and practice</source> . <publisher-loc>Chichester</publisher-loc>: <publisher-name>Wiley</publisher-name> .</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Dallos, R.</surname></name> , & <name name-style="western"><surname>Draper, R.</surname></name> (<year>2000</year>). <source>An introduction to family therapy</source>. <publisher-loc>Buckingham</publisher-loc>: <publisher-name>Open University Press</publisher-name> .</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Elkaïm, M.</surname></name> (<year>1997</year>). <source>If you love me, don't love me</source>. <publisher-loc>London</publisher-loc>: <publisher-name>Jason Aronson</publisher-name> .</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Faris, J.</surname></name> (<year>2002</year>). <source>Some reflections on process, relationship, and personal development in supervision</source>. In <name name-style="western"><surname>D. Campbell</surname></name> & <name name-style="western"><surname>B. Mason</surname></name> (Eds.), <source>Perspectives on supervision</source> (pp. <fpage>91</fpage>—<lpage>113</lpage>). <publisher-loc>London</publisher-loc>: <publisher-name>Karnac</publisher-name> .</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Hubble, M.A.</surname></name> , <name name-style="western"><surname>Duncan, B.L.</surname></name> , & <name name-style="western"><surname>Miller, S.D.</surname></name> (Eds.). (<year>1999</year>). <source>The Heart and soul of change: What works in therapy</source> . <publisher-loc>Washington, DC</publisher-loc>: <publisher-name>American Psychological Association</publisher-name> .</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Høglend, P.</surname></name> (<year>1999</year>). <article-title>Psychotherapy research: New findings and implications for training and practice</article-title> . <source>Journal of Psychotherapy Practice and Research</source>, <volume>8</volume>, <fpage>257</fpage>—<lpage>263</lpage> .</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Jennings, L.</surname></name> , <name name-style="western"><surname>Goh, M.</surname></name> , <name name-style="western"><surname>Skovholt, T.M.</surname></name> , <name name-style="western"><surname>Hanson, M.</surname></name> , & <name name-style="western"><surname>Banerjee-Stevens, D.</surname></name> (<year>2003</year>). <article-title>Multiple factors in the development of expert counselor and therapist</article-title> . <source>Journal of Career Development</source>, <volume>30</volume>(<issue>1</issue>), <fpage>59</fpage>—<lpage>72</lpage> .</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Jensen, P.</surname></name> (<year>1994</year>). <source>Ansikt til ansikt: System- og familieperspektivet som grunnlag for klinisk sykepleie</source>. <publisher-loc>Oslo</publisher-loc>: <publisher-name>Ad Notam Gyldendal</publisher-name> .</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Løgstrup, K.E.</surname></name> (<year>1982</year>). <source>System og symbol</source>. <publisher-loc>Copenhagen</publisher-loc> : <publisher-name>Gyldendal</publisher-name> .</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Polanyi, M.</surname></name> (<year>1958</year>). <source>Personal knowledge: Towards a post-critical philosophy</source> . <publisher-loc>London</publisher-loc>: <publisher-name>Routledge & Kegan Paul</publisher-name> .</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Protinsky, H.</surname></name> , & <name name-style="western"><surname>Coward, L.</surname></name> (<year>2001</year>). <article-title>Developmental lessons of seasoned marital and family therapists: A qualitative investigation</article-title> . <source>Journal of Marital and Family Therapy</source>, <volume>27</volume>, <fpage>375</fpage>—<lpage>384</lpage> .</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Rønnestad, M.H.</surname></name> , & <name name-style="western"><surname>Skovholt, T.M.</surname></name> (<year>2002</year>). <article-title>Learning arenas for professional development: Retrospective accounts for senior psychotherapists</article-title> . <source>Professional Psychology: Research and Practice</source>, <volume>32</volume>, <fpage>181</fpage>—<lpage>187</lpage> .</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Rønnestad, M.H.</surname></name> , and <name name-style="western"><surname>Skovholt, T.M.</surname></name> (<year>2003</year>). <article-title>The journey of the counselor and therapist</article-title> . <source>Journal of Career Development</source>, <volume>30</volume>, <fpage>5</fpage>—<lpage>44</lpage> .</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Skovholt, T.M.</surname></name> , & <name name-style="western"><surname>Jennings, L.</surname></name> (<year>2004</year>). <source>Master therapists: Exploring expertise in therapy and counseling</source>. <publisher-loc>Boston, MA</publisher-loc>: <publisher-name>Pearson</publisher-name> .</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Soldz, S.</surname></name> , & <name name-style="western"><surname>McCullough, L.</surname></name> (<year>2000</year>). <source>Reconciling empirical knowledge and experience: The art and science of psychotherapy</source>. <publisher-loc>Washington, DC</publisher-loc>: <publisher-name>American Psychological Association</publisher-name> .</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Vidich, A.J.</surname></name> , & <name name-style="western"><surname>Lyman, S.M.</surname></name> (<year>1998</year>). <source>Qualitative methods: Their history of sociology and anthropology</source>. In <name name-style="western"><surname>N.K. Denzin</surname></name> & <name name-style="western"><surname>Y.S. Lincoln</surname></name> , <name name-style="western"><surname>Y.S.</surname></name> (Eds.), <source>The landscape of qualitative research</source> (pp. <fpage>195</fpage>—<lpage>220</lpage>). <publisher-loc>London</publisher-loc> : <publisher-loc>SAGE</publisher-loc> .</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Wampold, B.E.</surname></name> (<year>2001</year>). <source>The great psychotherapy debate</source>. <publisher-loc>London</publisher-loc>: <publisher-name>LEA</publisher-name> .</citation></ref></ref-list></back></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Special Section: On Learning from Experience: Personal and Private Experiences as the Context for Psychotherapeutic Practice</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Special Section: On Learning from Experience: Personal and Private Experiences as the Context for Psychotherapeutic Practice</title></titleInfo><name type="personal"><namePart type="given">Per</namePart><namePart type="family">Jensen</namePart><affiliation>Diakonhjemmet University College, Oslo, Norway,</affiliation><affiliation>E-mail: jensen@diakonhjemmet.no</affiliation></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><originInfo><publisher>Sage Publications</publisher><place><placeTerm type="text">Sage UK: London, England</placeTerm></place><dateIssued encoding="w3cdtf">2007-07</dateIssued><copyrightDate encoding="w3cdtf">2007</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">The central idea in evidence-based practice is that it is the therapy that works and not the therapist. However, this article seeks to show how both our private and personal lives are an area for reflection when we are working as psychotherapists, and that personal and private experience can be an important framework for practising psychotherapy. Through looking at elements of the personal and private lives of three different therapists in the light of a therapy session conducted by each, I will try to demonstrate how personal and private experiences may influence clinical practice. The article builds on an ongoing grounded theory research project at the Tavistock Centre, London.</abstract><subject><genre>keywords</genre><topic>evidence-based practice</topic><topic>experience</topic><topic>private and personal</topic><topic>psychotherapy</topic><topic>resonance</topic></subject><relatedItem type="host"><titleInfo><title>Clinical Child Psychology and Psychiatry</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">1359-1045</identifier><identifier type="eISSN">1461-7021</identifier><identifier type="PublisherID">CCP</identifier><identifier type="PublisherID-hwp">spccp</identifier><part><date>2007</date><detail type="volume"><caption>vol.</caption><number>12</number></detail><detail type="issue"><caption>no.</caption><number>3</number></detail><extent unit="pages"><start>375</start><end>384</end></extent></part></relatedItem><identifier type="istex">F56FCC8B2401566B29A9786DB34038864E3D8793</identifier><identifier type="DOI">10.1177/1359104507078468</identifier><identifier type="ArticleID">10.1177_1359104507078468</identifier><recordInfo><recordContentSource>SAGE</recordContentSource></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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