"You think lots of love will heal the child, but it requires a lifetime of patience". Foster parents' intrapersonal and interpersonal struggles.

BACKGROUND: Foster parents can be placed under significant demands when caring for foster children with extensive needs. Coming to terms with the challenges they have to face can be a daunting prospect. To examine foster parents' experiences is vital with a view to enhancing their resilience amid sustained demands and improving the professional support offered to them. OBJECTIVE: This study explores foster parents' lived experience of caring for foster children with mental illness and attachment difficulties. PARTICIPANTS AND SETTINGS: Twenty-two foster parents, caring for foster children aged 2-17, were recruited from a mental health clinic providing assessment and treatment to children. METHODS: In this qualitative study, in-depth interviews were conducted and analyzed using a descriptive phenomenological psychological approach. RESULTS: Our analysis revealed four interrelated constituents describing the foster parents' experiences: 1) Wanting to help a child, 2) Adjustments were harder than expected, 3) Sacrifices and suppression of needs, and 4) Commitment and love mixed with ambivalence. CONCLUSION: The findings highlight that being a foster parent for children with mental illness and attachment difficulties demands heightened patience, knowledge and understanding. It also involves a substantial emotional investment. This underscores the importance of addressing feelings of love, shame, and guilt in this context. Balancing the needs of the foster child with the well-being of the foster family can be challenging. Foster parents may need extensive support from professionals who are familiar with their unique circumstances to increase their feeling of self-efficacy and reduce ambivalent feelings regarding their role as caregivers.

Are We Together in This? Relationship Experiences of Parents of Children with Craniofacial Anomalies.

OBJECTIVE: The birth of a child with a craniofacial anomaly (CFA) can have a profound psychological impact on the family and the parental relationship. The purpose of this study was to qualitatively investigate how a child's CFA condition affected parents' couple relationship. SETTING: All patients with a CFA are followed-up by the National Unit for Craniofacial Surgery, a specialized and multidisciplinary team. Hence, participants were recruited within a centralized treatment setting. DESIGN: We used a qualitative approach to explore the relationship experiences of parents of children with CFAs. The interviews were analysed using a hermeneutic-phenomenological approach. PARTICIPANTS: The study included 13 parents, nine mothers and four fathers of children with a range of different CFAs. At the time of the interview, 10 participants were married, one was cohabiting, and two were divorced. RESULTS: Most participants perceived their partners as committed and engaged in caring for their affected child and involved in the family's everyday life, and described a strengthened relationship to their partner after the child with a CFA was born. However, some participants struggled in their relationships with their partners, and did not receive the comfort and support they needed during this critical time, leading to feelings of distance and loneliness. CONCLUSIONS: Craniofacial teams should be mindful of the importance of the environment surrounding the child, such as parental relationship and family function. Therefore, a comprehensive approach should be included in team-based care, and couples and families in need of extra support should be referred to relevant specialists.

The need to belong: Subjective experiences of living with craniofacial conditions and undergoing appearance-altering surgery.

The purpose of this study was to better understand how individuals with craniofacial conditions experience living with visible differences and make sense of appearance-altering surgery. We conducted semi-structured qualitative interviews with 11 adults with Goldenhar or Crouzon syndrome. Interviews were analysed using a hermeneutic-phenomenological approach to thematic analysis. Our analysis revealed the following overarching theme, To see myself as other people see me, which encompassed three main themes: a) Striving to fit in, b) Altering the way I look and c) Support from family and friends. The participants' sense of their own appearance seemed to be connected to how they perceived others to evaluate their appearance. All had experienced negative reactions from others. They experienced themselves as different and had a desire to belong. All participants had undergone appearance-altering surgery, hoping that by changing appearance, they would reduce negative reactions and feel more connected to and accepted by other people. The process of undergoing appearance-changing surgery was experienced as challenging, and participants wished for a dialogue with surgeons which included psychological and emotional aspects of changing appearance. A better understanding of how to strengthen positive identity processes and feelings of belongingness should be a key focus of future research.

The embodied listener: a dyadic case study of how therapist and patient reflect on the significance of therapist's personal presence for the therapeutic change process.

Objective: There is a need to understand more of the dyadic processes in therapy and how the therapist's ways of being are experienced and reflected upon by both patient and therapist. The aim of this dyadic case study was to investigate how the therapist's personal presence was perceived by the patient and the therapist as contributing to change.Method: From a larger project on collaborative actions between patient and therapist, a dyadic case involving in-depth interviews of the therapist and patient was selected to examine the research question. Interpretative phenomenological analysis of four interviews with the therapist and one interview with the patient was conducted.Results: The analyses indicated that the therapist's way of being, as perceived by both therapist and patient, was expressed at a superordinate level through the concept of embodied listening, which was of particular help for the patient, and influenced by the therapist's theoretical orientation, as well as being rooted in his own personal history. Three sub-themes emerged from the analysis, each illustrating how embodied listening contributed to the therapeutic relationship and process. Our findings flesh out how the underlying phenomena of emotional attunement, presence, and genuineness are observable in therapeutic encounters.

Therapists' Experiences of Psychodynamic Therapy with and without Transference Interventions for Adolescents with Depression.

Psychodynamic therapy is an effective treatment for depression. However, a large number of adolescent patients with depression do not respond and/or drop out of therapy and little is known about what therapists actually do in therapy with adolescents. Thus, more research is needed to explore the various actions that therapists do in therapy, so that therapists can tailor their therapy more specifically to each individual adolescent. The present study aimed to investigate how the experience of psychotherapists differs between two treatment modes for adolescents with depression: psychodynamic psychotherapy with and without transference interventions. In-depth interviews were conducted with six therapists. The data, which were analyzed using thematic analysis, generated three key themes: (1) The therapists experienced that transference interventions are often useful in therapies with adolescents with depression, (2) therapies without transference interventions can be challenging for therapists, but still helpful for patients, and (3) the experience contributed to the deepening recognition of therapists that they always need to adapt their techniques to the particular patient. The results enhance our knowledge of the significance of therapists' actions in therapy with adolescents. The therapists highlighted issues that are important for identifying barriers to incorporating new knowledge into clinical practice.

Subjective experience of the origin and development of avoidant personality disorder.

OBJECTIVE: To better understand how persons diagnosed with avoidant personality disorder (AVPD) make sense of the origin and development of their current everyday struggles. METHODS: Persons with AVPD (N = 15) were interviewed twice using semi-structured qualitative interviews, which were analyzed through interpretative-phenomenological analysis. Persons with the first-hand experience of AVPD were included in the research. RESULTS: The superordinate theme, "a story of becoming forlorn," encompassed three main themes: "it goes all the way back to when I was little," "there was a distance between others and me," and "transitions made it worse." CONCLUSIONS: Though the results are not necessarily specific to AVPD, the findings clarify how people with AVPD can make sense of their current struggles by constructing developmental life stories in the interplay between themselves as persons and the growing demands of their social world. Furthermore, childhood relational vulnerabilities may challenge the ongoing development of social cognition and skills.

Opening Up: Clients' Inner Struggles in the Initial Phase of Therapy.

OBJECTIVE: To explore how clients in clinical settings experience the process of opening up and sharing their inner experiences in the initial phase of therapy. METHODS: Two psychotherapy sessions of clients (N = 11) 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. RESULTS: The 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: (a) fearing the intensity and consequences of negative emotions; (b) experiences of being incapable and bodily stuck; (c) being insecure about one's worthiness and right to share inner experiences with the therapist; and (d) struggling with feeling disloyal to loved ones. CONCLUSION: The 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.

Struggling to be a person: Lived experience of avoidant personality disorder.

OBJECTIVE: To better understand the subjective lived experience of persons diagnosed with avoidant personality disorder (AVPD). METHODS: Persons with an AVPD (N = 15) were interviewed twice with semistructured qualitative interviews and analyzed through interpretative-phenomenological analysis. Persons with first-hand experience of AVPD were included in the research process. RESULTS: The superordinate theme, "struggling to be a person," encompassed two main themes. The first, "fear and longing," incorporated the subthemes "longing for connection," "dreading to get close" and "being alone, for better or for worse." The second main theme, "a doubting self," included the subthemes "feeling insecure" and "searching for a sense of self." CONCLUSIONS: The findings shed light on how the reflexive selves of people with AVPD might struggle with sense-making, sense of agency, and identity. This study underscores how impaired tacit knowledge of social behavior can hamper the process of being a person in relation to others.

Lived Experience of Treatment for Avoidant Personality Disorder: Searching for Courage to Be.

Objective: To inquire into the subjective experience of treatment by persons diagnosed with avoidant personality disorder. Methods: Persons with avoidant personality disorder (n = 15) were interviewed twice, using semi-structured in-depth interviews, and the responses subject to interpretative-phenomenological analysis. Persons with first-hand experience of avoidant personality disorder were included in the research process. Results: The super ordinate theme emerging from the interviews, "searching for courage to be" encompassed three main themes: "seeking trust, strength, and freedom," "being managed," and "discovering the possibility for change and development." The main theme, "being managed," included the subthemes: "getting a diagnosis," "receiving medication," and "attending therapy." Conclusion: Although this may not be specific to avoidant personality disorder, the findings highlight the importance of being met inter-subjectively as a person with intentionality and agency, even when one does not feel like one. The importance of establishing an emotional bond and emergent trust for open therapeutic collaboration, learning, and becoming able to build courage to begin to approach that which one fears is emphasized.

"It's both a strength and a drawback." How therapists' personal qualities are experienced in their professional work.

Objective: The aim of this study was to gain knowledge about how the integration of personal and professional experiences affects therapeutic work. Method: Therapists (N = 14) who had been recommended by their leaders at their individual workplaces were interviewed twice with semi-structured qualitative interviews, which were then subjected to thematic and Interpretative Phenomenological Analysis. Results: All the therapists in the sample described their personal qualities as an experienced tension between their personal strengths and vulnerabilities in the therapeutic setting. This tension came to expression through four subordinate themes: (a) The tension between perceiving oneself as a helper while dealing with one's own needs for attention and care; (b) The tension between the ability for embodied listening to the patient while tuning into oneself; (c) The tension between staying present while handling aggression and rejection from clients; and (d) The tension in striving for a constructive balance between closeness and distance. Conclusion: The results point to ways in which the personal selves of the therapists may affect their professional role performance. Drawing upon previous research and literature on the topic, the paper discusses how therapists' personal qualities are experienced as affecting their work and suggests several implications for psychotherapy training and practice.

Wisdom in professional knowledge: Why it can be valuable to listen to the voices of senior psychotherapists.

OBJECTIVE: To explore the nature of professional wisdom, through learning from the experiences of a group of highly experienced senior therapists. METHOD: Twelve senior psychotherapists took part in qualitative in-depth interviews about their professional role and their views around a range of aspects of therapy theory and practice. Interview transcripts were subjected to thematic analysis. RESULTS: The analysis yielded nine wisdom themes, clustered within three domains. Each domain represented efforts to resolve dilemmas arising from the experience of being a therapist, around the use of theory in psychotherapy practice, the type of therapeutic relationship that is most helpful for clients, and the experience of therapeutic failure. CONCLUSIONS: Therapist wisdom can be viewed as a form of contextualized knowledge, which functions as a source of emergent insights that arise as responses to the limitations of prevailing ways of thinking. Research into the nature of therapist wisdom draws attention to sources of knowledge within philosophy and the humanities that have the potential to enhance therapy practice and contribute to our understanding of therapist expertise.

How does practicing psychotherapy affect the personal life of the therapist? A qualitative inquiry of senior therapists' experiences.

OBJECTIVE: To investigate how psychotherapists' lives and relationships are influenced by their work. METHOD: Twelve senior psychotherapists took part in qualitative interviews. RESULTS: Thematic analysis yielded four significant themes: (i) it has been a privilege to know and contribute, and to be allowed to grow personally; (ii) facing suffering and destructiveness has been a burden; (iii) being a therapist has had an impact on my personal relationships-for better and worse; and (iv) I have needed to construct a way of living that allowed me to continue to do the work. CONCLUSION: Working as a therapist seem to imply a potential for developing openness, tolerance, and creativity, while being vulnerable to becoming overwhelmed with responsibility and feelings of inadequacy, isolation, and despair.