Partners in the spiritual dance: learning clients' steps while minding all our toes.

We present four case illustrations highlighting the complex interplay of therapists' and clients' spirituality in therapy. Complexity, in these cases, results from (a) degrees of similarity and difference, both real and perceived, between clients' and therapists' spiritual beliefs and practices; (b) degrees of spiritual disclosure; (c) characteristics of the therapeutic relationship; and (d) geographic and cultural influences. Practicing therapists and therapist training programs can benefit from addressing how therapist and client spirituality intersect and influence therapy, how both similarity and difference present obstacles and opportunities, and how ambiguity and assumptions can contribute to misunderstandings. We believe that both the therapist's and the client's spiritualities are key influences in therapy that can contribute to the frustration, and the growth, of clients and therapists alike.

A careful balance: multinational perspectives on culture, gender, and power in marriage and family therapy practice.

In this study, we examined how marriage and family therapists from various countries and diverse cultural backgrounds address the intersection of gender, power, and culture in therapy. Twenty participants from 15 countries responded to an Internet survey that included several hypothetical, clinical vignettes not associated with any one particular culture or nationality. Participants selected a vignette based on its similarity to clinical situations they face in practice within their cultural contexts, and provided information about their conceptualizations of gender, culture, and power, along with treatment recommendations. We analyzed data using analytic induction and constant comparison methods. Results indicate the careful balance with which the participants work to engage clients in therapy, respect cultural values and practices, and promote equitable gender relationships.

Externalizing problems through art and writing: experiences of process and helpfulness.

Externalization of problems as a component of narrative therapy has been well defined by such authors as Epston and White, and Freedman and Combs. This study reflects the voices and experiences of 17 participants who engaged in an innovative externalization exercise combining sculpture and journaling over a period of 4 weeks. In an attempt to better understand the experience of the participants, the principal investigator also engaged in the exercise. Findings indicated that the intervention helped participants express emotions, increased their awareness of personal resources and agency, helped separate problems from self decreased symptoms and problem behaviors, and fostered a sense of empowerment. This study reveals the potential usefulness of physically externalizing problems and interacting with them deliberately over time. Such interventions may be useful components of narrative therapy or augmentations to brief therapy. They may help reach populations who have limited access to therapy services or who are reluctant to present for therapy.