Co-therapy

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Co-therapy or conjoint therapy is a kind of psychotherapy conducted with more than one therapist present. [1] [2] This kind of therapy is especially applied during couple therapy. [3] [4] [5] Carl Whitaker and Virginia Satir are credited as the founders of co-therapy. [6] [7] Co-therapy dates back to the early twentieth century in Vienna, where psychoanalytic practices were first taking place. [8] It was originally named "multiple therapy" by Alfred Alder, and later introduced separately as "co-therapy" in the 1940s. [9] Co-therapy began with two therapists of differing abilities, one essentially learning from the other, and providing the opportunity to hear feedback on their work.

Contents

Advantages of co-therapy

An active support system

Co-therapy has recently been discussed more thoroughly, and its advantageous aspects have been analysed. Researchers, namely Bowers & Gauron, suggest that co-therapy provides each therapist with a "support system" in their partner. [10] This allows for appropriate communication and the ability to lean on each other when "in the face of the power of the group". [10] Bowers & Gauron are supported by other researchers in this aspect of co-therapy. Russell and Russell [11] also suggest that both therapists are sources of support for each other. This can be in the case of clients (either singular, couples, or families) who express delusional systems [11] or aspects of psychopathy that may be difficult to deal with alone. A co-therapeutic design is more beneficial in these situations as therapists act objectively in each others' aid. This situation highlights an additional advantage of the amount of emotional draining experienced by each therapist individually. [11] Support of both therapists is carried through - if one is absent, there will always be someone available to collect information and continue with the sessions. [10] [11]

An educational model

Additionally, researchers suggest that a co-therapy relationship is beneficial as an educational model. [11] [12] Cividini and Klain proposed three models of co-therapy education. These three designs all incorporated differing levels of skill in each therapist, for example: situation one, having one experienced and one inexperienced therapist; situation two, including two inexperienced therapists; and situation three, involving two experienced therapists. [12] All models are said to be advantageous, as they all provide educational benefits, such as an inexperienced therapist gaining confidence whilst alongside one with more experience, and in an inexperienced model, the likeliness of a therapist overruling a session is wildly reduced. Moreover, a co-therapist relationship can "compensate for individual weaknesses", [10] meaning that more rounded conclusions can be drawn from therapy sessions as research has shown that co-therapeutic relationships provide greater insight into a client's analysis. [10] [12] Russell & Russell add to this notion by mentioning that conjoint therapeutic relationships can be valuable within the realm of education in order to "role-model didactically", [11] suggesting that it is extremely beneficial for a more inexperienced therapist to learn in a conjoint environment.

A respected role model

Although therapists can and have been seen to role-model for each other, they are simultaneously acting as examples of good practice for the clients themselves. Researchers Peck & Schroeder suggested that co-therapists could act as alternative powers where necessary. For example, absent parents. [13] This would benefit clients greatly as they can relate to situations created by therapists and discover healthy ways to react and process. Bowers & Gauron furthered this by mentioning that a healthy relationship between co-therapists can act as an effective role model to patients. [10] This is extremely beneficial in situations such as couples therapy, for example. Therapists must also be actively aware of the notion that they are constantly being watched and act accordingly. Natalie Shainess described this situation as 'do as I tell you, but not as I do', [10] suggesting that clients need to also be aware of the imperfect representation that could occur, signalling that they should copy what is said, rather than what they see.

Disadvantages of co-therapy

Although advantages exist (as above), the disadvantages of co-therapy and the issues that may arise for both clients and therapists have also been explored. Dangers can impact clients, therapists and spouses of therapists alike. Fabrizio Napolitani described co-therapy as not only lacking advantages, but also not being free of hazards. [14] The requirement for therapists is ever-increasing, with some suggesting that using two therapists when not extremely necessary is a waste of resources and adds to the expense of therapy provision. [11] Therapists are less likely to be paired thoughtfully, and are usually randomly placed together. This could increase the likeliness of tension during sessions, and could create unnecessary competition. [11] Alternatively, if the therapists form an amicable relationship, there is also the risk of their attention being diverted from the client, which leads to a negative impact on the session where the treatment of the patient is compromised. [10]

Spouse involvement

A widely debated topic within co-therapy is the involvement of spouses. This could refer to both a spouse of a therapist or a co-therapy relationship that consists of spouses themselves. Many issues can arise as a result of this, for example, jealousy of a third-party relationship. Dickes and Dunn suggested that voyeurism was an intricate part of co-therapy, where therapists gain sexual attraction to their partner as a result of competition in diagnoses. [11] Bowers & Gauron go into more detail on the issue, describing how a therapist and their spouse may disagree about the amount of time one spends with their co-therapist, and how their spouse may become insecure about this as they feel they are not of primary importance. [10] Co-therapists are required to spend a lot of time together outside of therapy sessions to discuss diagnoses and analyses of patients which, although seen in one sense as an advantage, can cause issues in the personal relationships of the therapists themselves.

Related Research Articles

Counseling psychology is a psychological specialty that encompasses research and applied work in several broad domains: counseling process and outcome; supervision and training; career development and counseling; and prevention and health. Some unifying themes among counseling psychologists include a focus on assets and strengths, person–environment interactions, educational and career development, brief interactions, and a focus on intact personalities.

Art therapy

Art therapy is a distinct discipline that incorporates creative methods of expression through visual art media. Art therapy, as a creative arts therapy profession, originated in the fields of art and psychotherapy and may vary in definition.

Solution-focused (brief) therapy (SFBT) is a goal-directed collaborative approach to psychotherapeutic change that is conducted through direct observation of clients' responses to a series of precisely constructed questions. Based upon social constructionist thinking and Wittgensteinian philosophy, SFBT focuses on addressing what clients want to achieve without exploring the history and provenance of problem(s). SF therapy sessions typically focus on the present and future, focusing on the past only to the degree necessary for communicating empathy and accurate understanding of the client's concerns.

Couples therapy attempts to improve romantic relationships and resolve interpersonal conflicts.

Narrative therapy

Narrative therapy is a form of psychotherapy that seeks to help patients identify their values and the skills associated with them. It provides the patient with knowledge of their ability to live these values so they can effectively confront current and future problems. The therapist seeks to help the patient co-author a new narrative about themselves by investigating the history of those values. Narrative therapy claims to be a social justice approach to therapeutic conversations, seeking to challenge dominant discourses that it claims shape people's lives in destructive ways. While narrative work is typically located within the field of family therapy, many authors and practitioners report using these ideas and practices in community work, schools and higher education. Narrative therapy has come to be associated with collaborative as well as person-centered therapy.

The Internal Family Systems Model (IFS) is an integrative approach to individual psychotherapy developed by Richard C. Schwartz in the 1980s. It combines systems thinking with the view that the mind is made up of relatively discrete subpersonalities, each with its own unique viewpoint and qualities. IFS uses family systems theory to understand how these collections of subpersonalities are organized.

Online counseling is the provision of professional mental health counseling services through the Internet. Computer aided technologies are used by the trained professional counsellors and individuals seeking counselling services to communicate rather than conventional face-to-face interactions[17]. Online counselling is also referred as an e-therapy, cyber therapy, or web counselling[18]. Services are typically offered via email, real-time chat, and video conferencing. Some clients use online counseling in conjunction with traditional psychotherapy, or nutritional counseling. Increasing number of clients are using online counseling as a replacement for office visits.

Self-disclosure is a process of communication by which one person reveals information about themself to another. The information can be descriptive or evaluative, and can include thoughts, feelings, aspirations, goals, failures, successes, fears, and dreams, as well as one's likes, dislikes, and favorites.

Psychological resistance is the phenomenon often encountered in clinical practice in which patients either directly or indirectly exhibit paradoxical opposing behaviors in presumably a clinically initiated push and pull of a change process. It impedes the development of authentic, reciprocally nurturing experiences in a clinical setting. It is established that the common source of resistances and defenses is shame, further its pervasive nature in trans diagnostic roles are identified.

Emotionally focused therapy and emotion-focused therapy (EFT) are a family of related approaches to psychotherapy with individuals, couples, or families. EFT approaches include elements of experiential therapy, systemic therapy, and attachment theory. EFT is usually a short-term treatment. EFT approaches are based on the premise that human emotions are connected to human needs, and therefore emotions have an innately adaptive potential that, if activated and worked through, can help people change problematic emotional states and interpersonal relationships. Emotion-focused therapy for individuals was originally known as process-experiential therapy, and it is still sometimes called by that name.

Functional analytic psychotherapy (FAP) is a psychotherapeutic approach based on clinical behavior analysis (CBA) that focuses on the therapeutic relationship as a means to maximize client change. Specifically, FAP suggests that in-session contingent responding to client target behaviors leads to significant therapeutic improvements.

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Insight-oriented psychotherapy is a category of psychotherapies that rely on conversation between the therapist and the client. Insight-oriented psychotherapy can be an intensive process, wherein the client must spend multiple days per week with the therapist.

The mainstay of management of borderline personality disorder is various forms of psychotherapy with medications being found to be of little use.

Remote therapy, sometimes called telemental health applications or Internet-based psychotherapy, is a form of psychotherapy or related psychological practice in which a trained psychotherapist meets with a client or patient via telephone, cellular phone, the internet or other electronic media in place of or in addition to conventional face-to-face psychotherapy.

Family therapy, also referred to as couple and family therapy, marriage and family therapy, family systems therapy, and family counseling, is a branch of psychology that works with families and couples in intimate relationships to nurture change and development. It tends to view change in terms of the systems of interaction between family members.

Psychotherapy discontinuation, also known as unilateral termination, patient dropout, and premature termination, is a patient's decision to stop mental health treatment before they have received an adequate number of sessions. In the United States, the prevalence of patient dropout is estimated to be between 40–60% over the course of treatment however, the overwhelming majority of patients will drop after two sessions. An exhaustive meta-analysis of 146 studies in Western countries showed that the mean dropout rate is 34.8% with a wide range of 10.3% to 81.0%. The studies from the US had a dropout rate of 37.9%.

Trauma focused cognitive behavioral therapy (TF-CBT) is an evidence-based psychotherapy or counselling that aims at addressing the needs of children and adolescents with post traumatic stress disorder (PTSD) and other difficulties related to traumatic life events. This treatment was developed and proposed by Drs. Anthony Mannarino, Judith Cohen, and Esther Deblinger in 2006. The goal of TF-CBT is to provide psychoeducation to both the child and non-offending caregivers, then help them identify, cope, and re-regulate maladaptive emotions, thoughts, and behaviors. Research has shown TF-CBT to be effective in treating childhood PTSD and with children who have experienced or witnessed traumatic events, including but not limited to physical or sexual victimization, child maltreatment, domestic violence, community violence, accidents, natural disasters, and war.

Eclectic psychotherapy is a form of psychotherapy in which the clinician uses more than one theoretical approach, or multiple sets of techniques, to help with clients' needs. The use of different therapeutic approaches will be based on the effectiveness in resolving the patient's problems, rather than the theory behind each therapy.

Sexual trauma therapy is medical and psychological interventions provided to survivors of sexual violence aiming to treat their physical injuries and cope with mental trauma caused by the event. Examples of sexual violence include any acts of unwanted sexual actions like sexual harassment, groping, rape, and circulation of sexual content without consent.

References

  1. ↑ MacLennan, Beryce W. (1965). "Co-Therapy". International Journal of Group Psychotherapy. 15 (2): 154–166. doi:10.1080/00207284.1965.11642823. PMID   14297642.
  2. ↑ Roller, Bill; Nelson, Vivian (1991). The Art of Co-therapy: How Therapists Work Together . Guilford Press. ISBN   978-0-89862-557-8. co-therapy or conjoint model.
  3. ↑ Bellville, Titus P.; Raths, Otto N.; Bellville, Carol J. (1969). "Conjoint marriage therapy with a husband-and-wife team". American Journal of Orthopsychiatry. 39 (3): 473–483. doi:10.1111/j.1939-0025.1969.tb00643.x. PMID   5783742.
  4. ↑ Leslie, Gerald R. (1964). "Conjoint Therapy in Marriage Counseling". Journal of Marriage and Family. 26 (1): 65–71. doi:10.2307/349379. ISSN   0022-2445. JSTOR   349379.
  5. ↑ Hogan, Peter D.; Royce, Jack R. (1975). "Four-way sessions: The co-therapy of couples in individual and conjoint treatment". Groups: A Journal of Group Dynamics & Psychotherapy. 7 (1): 7–11.
  6. ↑ Goleman, Daniel (25 April 1995). "Carl Whitaker, 83, Therapist Who Focused on Family Life". The New York Times.
  7. ↑ Keith, David V.; Whitaker, Carl A. (1983). "Co-therapy with Families". Handbook of Family and Marital Therapy. Springer US: 343–355. doi:10.1007/978-1-4684-4442-1_16. ISBN   978-1-4684-4444-5.
  8. ↑ Hoffman, Ludmila W.; Hoffman, Herbert J. (1981). "Husband–wife co-therapy team: Exploration of its development". Psychotherapy: Theory, Research & Practice. 18 (2): 217–224. doi:10.1037/h0086082. ISSN   0033-3204.
  9. ↑ Hadden, Samuel B. (1947-03-01). "The utilization of a therapy group in teaching psychotherapy". American Journal of Psychiatry. 103 (5): 644–648. doi:10.1176/ajp.103.5.644. ISSN   0002-953X. PMID   20295278.
  10. 1 2 3 4 5 6 7 8 9 Bowers, Wayne A.; Gauron, Eugene F. (1981). "Potential hazards of the co-therapy relationship". Psychotherapy: Theory, Research & Practice. 18 (2): 225–228. doi:10.1037/h0086083. ISSN   0033-3204.
  11. 1 2 3 4 5 6 7 8 9 Russell, Axel; Russell, Lila (1979). "The Uses and Abuses of Co-Therapy". Journal of Marital and Family Therapy. 5 (1): 39–46. doi:10.1111/j.1752-0606.1979.tb00552.x. ISSN   1752-0606.
  12. 1 2 3 Cividini-Strani, Eugenija; Klain, Eduard (August 1984). "Advantages and Disadvantages of Co-Therapy". Group Analysis. 17 (2): 156–159. doi:10.1177/053331648401700209. ISSN   0533-3164. S2CID   143133491.
  13. ↑ Peck, Bruce B.; Schroeder, Dianne (1976). "Psychotherapy with the Father-Absent Military Family". Journal of Marital and Family Therapy. 2 (1): 23–30. doi:10.1111/j.1752-0606.1976.tb00392.x. ISSN   1752-0606.
  14. ↑ Napolitani, Fabrizio (April 1979). "Co-Therapy By Alternate Conduction and Reciprocal Supervision". Group Analysis. 12 (1): 52–55. doi:10.1177/053331647901200114. ISSN   0533-3164. S2CID   144011667.
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