Filmic Therapeutic Encounters and Resistance: Silence, Forgetting, and Guilt in the Face of Historical Violence

Mental disorder and therapeutic encounters are central aspects of three films that were groundbreaking in addressing collective trauma in the aftermath of slavery, colonialism, or genocide: Peele’s GET OUT (USA), Ruhorahoza’s GREY MATTER (Rwanda) and Mhando and Mulvihill’s MAANGAMIZI—THE ANCIENT ONE (Tanzania/USA). Recurring to theories of collective memory and trauma, the article assumes that asymmetric historical violence causes a crisis of reason among the victims, and that the affective dream-like technique of film has the potential to make unutterable mental conditions explicit and relatable without trivializing their complexities. Oppression is usually perpetuated by an alliance of domination with forgetting, silencing, and a sense of guilt, inflicted on the victims who are thereupon labeled as overly sensitive, moronic, or insane. The films depict mental conditions caused by collective trauma which are expressed by haunting memories, ancestral visions, or victims being possessed by their oppressors. A central element is the depiction of problematic therapeutic encounters which may be abusive, manipulative or turn the patient–therapist relation upside down. By challenging notions of therapy and critically addressing its potential embeddedness in power relations, it is argued, the films themselves serve as a form of postcolonial therapy and empowerment.

Experiences of Compassion in Adults With a Diagnosis of Borderline Personality Disorder: An Interpretative Phenomenological Analysis

The study explored experiences of compassion in adults with a diagnosis of Borderline Personality Disorder (BPD) to further the development of the construct of compassion in relation to BPD. Interpretative Phenomenological Analysis was used to develop themes from the narratives of six adults with a diagnosis of BPD. Five themes emerged: Emotional Connection to Suffering, Empathic Understanding, Prioritisation of Needs, A Model of Genuine Compassion and Developing Acceptance and Worth. Participants described the role of compassion in their difficulties, including the adverse impact of experiences of incompassion upon their sense of self. The themes were integrated into a model that highlighted a process of recovery through therapeutic encounters with others in which genuine compassion was modelled. In addition, barriers to compassion and factors facilitating the development of compassion emerged from the analysis and have implications for clinical practice.

Insidious Trauma, Heteronormative Steeping, and Help-seeking: Exploring the Rural Non-Heterosexual Experience

Non-heterosexual (NH) individuals are often exposed to stressors based on their non-heterosexual status and, therefore, may have unique needs related to help-seeking for mental health, especially in rural areas where residents are more likely to identify as religious or conservative, groups that have historically been opposed to NH individuals. This study was completed to explore the lives of 10 non-heterosexual individuals in rural northern Michigan related to their daily encounters with minority stress and their experiences with help-seeking for mental health symptomology. In-depth semistructured interviews were conducted, and transcriptions were analyzed to identify the occurrence of traumatic experiences at a systemic/interpersonal level, subsequent internalization of those experiences, how that prompted the need for counseling, and the individual experiences within those therapeutic encounters. Thematic analysis identified three themes: (a) experiences of distal stressors and proximal stress reactions related to environmental and interpersonal interactions, (b) heteronormativity and heterosexism within the help-seeking process, and (c) suggestions for improving the help-seeking process. The results of this study include increasing awareness of, and focus on, the NH population in rural northern Michigan, which may have increased negative experiences based on minimal community acceptance, few affirming and diversity-educated mental health provider options, and negative provider reactions. The knowledge generated from this study could lead to increased awareness of the insidious environmental trauma experienced by NH individuals in rural conservative areas and reduce the disparities for this population by improving provider awareness and services.

A Paradigm Shift for Acute Rehabilitation of Stroke

Current best practice standards for rehabilitation after stroke call for increasing the dose and intensity of interventions for optimal therapeutic benefit. Despite this, those within inpatient rehabilitation during the acute phase are often sedentary, and they receive a lower dose and intensity of therapy than recommended. This may be due to the lack of therapeutic opportunities outside of therapies, program structure characteristics, or a lack of efficiency in therapeutic encounters, all of which have the potential to reduce therapeutic outcomes. Circuit class therapies and group therapies provide a method of increasing the dose and intensity of therapy provided, and may reduce redundancy and inefficiency within programs, but do not satisfy the 3-hour rule under the current Prospective Payment System in the United States. The Centers for Medicare and Medicaid Services require that individual therapy be the primary mode of intervention provision, which limits programs from providing these evidence-based interventions, at a higher volume in a group or circuit format. Providing an enriched environment outside of structured therapies should be mandated to maximize benefits experienced by patients and reduce sedentary time. Empirical study is required to determine which interventions may be effectively delivered when provided via a nonindividual basis, and to explore the feasibility and fiscal implication of alternative models of care. Reform of regulatory standards may be required to align with best practice standards.

Going Online: The Affordances of Online Counseling for Families Affected by Alcohol and Other Drug Issues

Online counseling can overcome barriers families face when accessing support services for issues such as a relative’s alcohol or other drug use. However, little research has explored how online counseling platforms assist family members to improve their well-being and support their relative. We thematically analyzed 90 transcripts of online counseling sessions with family and friends of people who use alcohol, opioids, and amphetamines in Australia between 2015 and 2016. In our analysis, we drew on the concept of affordances to articulate how online platforms afford or constrain potentially therapeutic encounters with families. We found online counseling enabled families to make first contact, relieve distress, plan appropriate action, improve communication, regain direction, and connect with local services. Sessions were constrained by Internet access, web-chat communication, counselors’ focus on referral, and limitations in addressing the wider concerns of families. The findings present opportunities for improving online services for families.

Therapeutic encounters

When individuals experience distress, they try to make sense of this and, in the first instance, may seek help from personal, folk, or social sectors. If these interventions do not work, they will contact the professional sector. It is likely that the healthcare system will direct their help-seeking behaviour. In addition, the explanatory models they have will direct them into help-seeking accordingly. Once therapeutic interaction has started, the explanatory models of the individuals, their families, carers, and those of the clinician will affect therapeutic engagement. Race, gender, social status, education, and economic status will all affect explanatory models and where individuals seek help. If different from that of the patient, the culture of the clinician will affect therapeutic alliance. Working with interpreters requires training if the primary language of the patient differs from that of the healthcare professional.