ObjectiveTo explore how clients in clinical settings experience the process of opening up and sharing their inner experiences in the initial phase of therapy.MethodsTwo psychotherapy sessions of clients were videotaped and followed by interviews. Interpersonal process recall was used to obtain in-depth descriptions of clients’ immediate experiences in session. A follow-up interview was conducted 3 months later. The interviews were analyzed using thematic analysis.ResultsThe data revealed how and why clients distanced themselves from inner experiences in the initial phase of therapy. (...) The overarching theme was “Holding back and struggling to open up,” which included four subthemes: fearing the intensity and consequences of negative emotions; experiences of being incapable and bodily stuck; being insecure about one’s worthiness and right to share inner experiences with the therapist; and struggling with feeling disloyal to loved ones.ConclusionThe participants held back because they feared different consequences of opening up. A range of concerns led participants to distance themselves from their inner experiences and/or to refrain from openly talking about them to the therapist. Concerns related to appropriate interpersonal conduct as client were especially important. This knowledge is highly relevant to clinicians when building safety for psychotherapeutic work. (shrink)

The unexpected death of a child is one of the most challenging losses as it fractures survivors’ sense of parenthood and other layers of identity. Given that not all the bereaved parents who have need for support respond well to available treatments and that many have little access to further intervention or follow-up over time, online interventions featuring therapeutic writing and peer support have strong potential. In this article we explore how a group of bereaved mothers experienced the process of (...) participating in an online course in therapeutic writing for the integration of grief. Our research questions were: How do parents who have lost a child experience being part of an online course in therapeutic writing? What are the perceived benefits and challenges of writing in processing their grief? We followed an existential phenomenological approach and analyzed fieldwork notes (n= 13), qualitative data from the application and assessment surveys (n= 35;n= 21), excerpts from the journals of some participants (n= 3), and email correspondence with some participants (n= 5). We categorized the results in three meaning units: (1) where does my story begin? The “both and” of their silent chaos; (2) standing on the middle line: a pregnancy that does not end; (3) closures and openings: “careful optimism” and the need for community support. Participants experienced writing as an opportunity for self-exploration regarding their identities and their emotional world, as well as a means to develop and strengthen a bond with their children. They also experienced a sense of belonging, validation, and acceptance in the online group in a way that helped them make sense of their suffering. Online writing courses could be of benefit for bereaved parents who are grieving the unexpected death of a child, but do not replace other interventions such as psychotherapy. In addition to trauma and attachment informed models of grief, identity informed models with a developmental focus might enhance the impact of both low-threshold community interventions and more intensive clinical ones. Further studies and theoretical development in the area are needed, addressing dialogical notions such as the multivoicedness of the self. (shrink)

Background: Perfectionism is increasing over time and associated with various mental health problems. Recent research indicates adverse childhood experiences may play a role in the development of perfectionism. In addition, perfectionism is marked by interpersonal problems with implications for treatment outcome.Aim: This study aimed to fill an important gap in the predominantly quantitative literature field by exploring how individuals with perfectionism understand the relationship between painful experiences and how they relate to others.Method: Nine individuals with perfectionism were interviewed using McAdam's (...) life-story interview. Thematic analysis was used to analyze the interviews.Results: Four themes emerged: “A childhood with big responsibilities,” “I am still the responsible one,” “Keeping others at a distance to protect the inner self,” and “Achieving physical distance to get a fresh start.” These themes are grouped into two overarching themes: “You can't always trust people” and “A distancing from others.”Conclusion: Findings highlight taking responsibility and social distancing serve an important function for perfectionistic individuals in response to painful relational events. We discuss how themes of control and agency impact individuals' relationship to mental health and turning toward others for help. The findings provide greater complexity to understanding perfectionism as a “barrier to treatment.”. (shrink)