Measuring client fears.

Describes the development of a 15-item instrument to measure client fears. 91 clients (mean age 22.6 yrs) and 104 nonclients (mean age 21.2 yrs) in a university setting were asked to rate possible fears about psychotherapy with regard to how much they had been (or would be) concerned about those issues. Analyses revealed 2 factors: Therapist Responsiveness and Image Concerns. Validity of the factors was supported by a multiple analysis of variance (MANOVA) that showed significant differences between clients and nonclients. Clients reported significantly less fear for each factor. (7 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expectations and preferences of clients for a university student counseling service.

Investigated the relation between preferences and expectations about counselors in a university student counseling service in a population of 100 student clients before their initial intake session. Compared with results from an earlier study on nonclients, preferences and expectations were more congruent in clients. Both clients and nonclients, however, preferred a more active counselor who promotes cognitive and behavioral change and expels symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stigma of psychological therapy: Stereotypes, interpersonal reactions, and the self-fulfilling prophecy.

Investigated stereotypes of counseling center clients and examined how these preconceptions influence social interaction. 136 undergraduates, told they were participating in a study of the acquaintance process in social interactions, were randomly assigned to be perceivers or targets. Ss engaged in a brief getting-acquainted conversation. Targets were randomly assigned to conditions in which perceivers were told that their conversational partner, the target, had been recruited either from among students seeking psychological therapy (clients) or from students in introductory psychology courses (nonclients). As was predicted, perceivers rated clients less favorably than they did nonclients before they interacted. Futhermore, consistent with previous research on the self-fulfilling prophecy, judges' ratings of the interactions revealed that perceivers behaved more negatively toward clients than toward nonclients, and clients came to behave in a less socially desirable manner than did nonclients. It is suggested that fear of rejection that makes people reluctant to seek psychological therapy appears to be justified. (30 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The client's perspective: Ethical judgments and perceptions of therapist practices.

In response to a questionnaire, 96 adults, both with and without experience as clients in therapy, judged the ethical appropriateness of 60 therapist practices. In addition, those who had been clients indicated whether the practices had occurred in their own therapy. The practices were organized into 6 groups that corresponded to major areas of professional ethics in psychology: confidentiality, dual relationships, informed consent and business practices, competence, sensitivity to differences, and interventions. Clients and nonclients alike showed a general understanding of ethical principles but uncertainty about many specific points. Some uncertainty stemmed from a misunderstanding about the nature, and particularly the risks, of therapy. Practices judged clearly appropriate were not reported to have occurred universally by the clients in the sample, and practices judged clearly inappropriate were reported to have occurred with some, albeit low, frequency. The results are discussed with regard to implications for ethics research and ethical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Counseling expectations of clients and nonclients for group and individual treatment modes.

A questionnaire that measured expectations about counseling was completed by 40 male and 40 female undergraduates under group or individual counseling expectation conditions, 18 males and 27 females who had sought group counseling, and 20 males and 20 females who had sought individual counseling. An additional 22 males and 28 females indicated their attitudes toward the acceptability of group and individual counseling. Results indicate significant differences between the 2 modes, the sexes, and the 2 populations (clients and nonclients); however, no interaction effects were noted. Results are discussed in terms of how differential beliefs about group and individual counseling may affect participation rates and behaviors and how professionals may better promote counseling services. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Helping Clients Heal: Does Forgiveness Make a Difference?

Broken trust, broken hearts, and broken spirits: these are all potential issues facing clients who have been hurt by others. Some have claimed that helping clients explicitly forgive those who have hurt them is a legitimate therapeutic intervention. However, do clients need explicit forgiveness interventions? Do clients want them? After they are received, are these interventions helpful? For the majority of 59 clients from 3 university counseling centers the answers were mostly affirmative. They had experienced a hurt that they wanted to forgive and wanted to talk about in therapy. Those who talked explicitly about forgiveness reported more overall improvement in their presenting symptoms. Implications for using explicit forgiveness interventions with clients are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists' knowledge of their states' laws pertaining to Tarasoff-type situations.

This study examined psychologists' knowledge of their legal and ethical responsibilities with imminently dangerous clients. We randomly surveyed 1,000 psychologists from four states and received 300 useable responses (30%). Most psychologists (76.4%) were misinformed about their state laws, believing that they had a legal duty to warn when they did not, or assuming that warning was their only legal option when other protective actions less harmful to client privacy were allowed. Moreover, in spite of the inaccuracy of their knowledge, many respondents were confident that they understood the duty to protect in their own state. Contrary to expectation, we found no significant association between legal knowledge and continuing education in legal and ethical issues, graduate training in ethics, or clinical experience with dangerous clients. These findings suggest that educational experiences during and after graduate school may not be meeting the needs of professionals to understand the complicated array of state laws and ethical duties regarding dangerous clients. We recommend several changes in the provisions of these experiences to better protect psychologists and clients from unintentional risks. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expectations and preferences of nonclients for a university student counseling service.

Investigated the relationship between preferences and expectations about a university student counseling sevice in a population of 100 student nonclients. In addition, differences between nonclients' self-perceptions and their perceptions of counseling-service clients were investigated. Nonclients were administered a 157-item questionnaire on an individual basis to investigate these variables. It was hypothesized that discrepancies between preferences and expectations, as well as between perceptions of self and of clients, might be indicative of nonclients' willingness to become future clients of the counseling service. Results indicate that nonclients wanted the counselor to be significantly more active than they expected him to be. In addition, they perceived clients of the service as suffering significantly more from psychological and interpersonal problems than they themselves were. In light of the findings, it is suggested that there is a need for dissemination of information with regard to the process and modes of treatment offered by the counseling service. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy and aging: Results of two empirical studies between psychotherapists and elderly people.

Reports results from 2 studies that investigated predictors of psychotherapists' interest in clients over age 65 and addressed elderly people's opinions and fears concerning psychotherapy. In Study 1, 82 (38%) practicing behavioral and psychodynamic or psychoanalytic therapists (mean age 50.6 yrs) returned questionnaires concerning their education and experiences with elderly clients and completed a test of gerontological knowledge. Contrary to common belief, neither gerontological knowledge nor therapist's age predicted interest in elderly clients. The only significant predictor was previous experience with elderly clients. Study 2 investigated the opinions and fears of 84 elderly persons (mean age 74.3 yrs) concerning psychotherapy, using a questionnaire that consisted of 3 scales: prejudices against psychotherapy, sharing problems with others, and fears of psychotherapy. Results show that prejudices and fears were higher in older elderly as compared to younger elderly but they were not as predominant as expected. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Knowledge and beliefs about confidentiality in psychotherapy.

Surveyed 200 high school students, 308 undergraduate psychology students, 34 former clients from a community mental health center, and 40 former clients from a university counseling center regarding their knowledge of and attitudes toward confidentiality in therapy. Overall results show that the vast majority of Ss viewed confidentiality as an all-encompassing, superordinate mandate for the psychology profession and that most Ss wanted to be told of the limitations to confidentiality but would have limited therapeutic communications when told. It is concluded that the general population, including those who have been in therapy, does not have an accurate perception of current ethical limitations regarding confidentiality in psychotherapy. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Affirmative psychotherapy for American Jews.

As psychotherapists have increasingly attended to issues of culture, race, and ethnicity in their clinical work, some groups have not received adequate attention in the professional literature. One such group is American Jews, who represent a small, culturally distinct group of people who have experienced a long history of oppression. Because of the substantial within-group variability, stereotypes are often used in the place of knowledge about or actual experience working with American Jews. To reduce reliance on stereotypes and assumptions about Jews, it is important to understand both Jews and Jewish culture, as well as how to provide culturally congruent and affirmative psychotherapy services to this community. To provide some guidance in working with American Jewish clients, this article presents (a) basic demographic information about American Jews, (b) information about Judaism and Jewish culture, and (c) aspects of culturally appropriate psychotherapy with American Jews. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental Health Professionals' Disability Competence: Measuring Self-Awareness, Perceived Knowledge, and Perceived Skills.

Objective: To describe mental health professionals' self-reported competence when working with clients with disabilities. Study Design: Survey administered with a measure of social desirability. Participants and Setting: One hundred eight professionals in counseling offices, disability services offices, and doctoral counseling programs. Main Outcome Measure: Competence as self-reported on the Counseling Clients With Disabilities Survey (CCDS). Results: CCDS scores paralleled participants' disability experience. Participants reported most competence in awareness, less competence in knowledge, and least competence in skills. Neither socially desirable responding nor years of experience accounted for these results. Conclusions: Findings indicate the need for mental health professionals to develop (a) awareness/beliefs/attitudes toward disability, (b) knowledge of disability and disability-related issues, and (c) skills/behaviors working with clients with disabilities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influence of perceptions of personal control on reactions to stressful events.

To test the assumption that beliefs of high personal control predispose individuals to greater stress in the face of difficult life events, clients and nonclients holding high, moderate, and low perceptions of personal control completed measures related to the occurrence of stressful events. Ss were a sample of 46 clients and 2 samples of 67 and 145 nonclients, respectively, at a large university. Beliefs of personal control were measured by H. Levenson's (1972) Internality Scale (developed from a revision of Rotter's Internal–External Locus of Control Scale). Stress at the time of psychological help-seeking was assessed by comparing clients and nonclients on self-esteem and perceptions of control over recent life events. Ss also indicated the degree of stress they associated with experiences of social isolation and powerlessness. As predicted, high internals generally reported higher stress than moderate or low internals; and high internal clients, in comparison with nonclient controls, reported lower self-esteem, higher stress, and less control over recent events. Low internal clients generally did not behave as predicted. Implications for counseling goals and treatment plans are discussed. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pertinent consumer issues in choosing a counseling professional.

In Study 1, 43 counselors (with MAs and PhDs), psychiatrists, clinical psychologists, and social workers completed a questionnaire evaluating issues in the literature as to their pertinence to the consumer in choosing a counseling professional. The most and the least pertinent issues are presented, as assessed by counseling professionals and clients. Counselors and psychiatrists were compared in their rankings. A significant positive correlation was found between the 2 groups. Study 2 utilized 39 17–61 yr old clients of counseling professionals in 4 categories: counselors (MA and PhD), psychiatrists, clinical psychologists, and social workers. Clients also completed the same questionnaire as in Study 1. Five items that differed significantly among clients' responses in the 4 professional counseling groups are presented. Results from both studies indicate the presence of general unifying concepts pertinent to consumer evaluation of potential counseling professionals. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient-therapist boundary issues: An integrative review of theory and research.

Boundary issues, which regularly arise in therapy, can present difficult dilemmas for clinicians. The purpose of this article is to help clinicians resolve these dilemmas by integrating some of the theoretical positions with empirical evidence reported in the literature on boundary issues in counseling and psychotherapy. The authors review the concept of treatment boundaries and the ethical principles that underpin them. They also review common boundary violations and provide recommendations to attenuate harm done to clients when such boundary violations occur in therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Waiting list dropouts in a university counseling center.

Surveyed 59 clients at a university counseling center who had been placed on a waiting list and subsequently decided not to renew their request for counseling. Ss were asked why they did not renew their request and whether they were still interested in counseling. Responses were analyzed in terms of type of problem, time on the waiting list, and degree of urgency. Most Ss did not report negative reactions or effects from their placement on the waiting list, although Ss in the highest urgency category tended to report that the wait was too long. 30 Ss stated that the intake interview was enough or that the problem had been resolved, while 23 were still interested in counseling. It is suggested that (1) high-urgency clients should be given priority at university counseling centers, (2) directive crisis-intervention approaches can be used to resolve issues at intake sessions, (3) assessment should identify clients whose motivation for counseling is related to developmental issues that need to be dealt with immediately, and (4) alternative treatments such as groups or workshops should be made available to waiting-list clients. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Tolerance for ambiguity in female clients: A further test of the catharsis model for predicting early counseling dropout.

Expanded a catharsis model for predicting early counseling dropout in female clients by considering the relations between tolerance for ambiguity and indices of responsiveness to counseling. According to the model, females who leave insight-oriented counseling after experiencing cathartive relief from merely presenting their problems to a sympathetic counselor will be higher in ambiguity tolerance, since they are willing to leave counseling without resolving the uncertainties that accompany personal problems. Study 1, with 95 undergraduates who were administered the Adjective Check List, confirmed this prediction when female nonclient Ss showing high tolerance for ambiguity on a laboratory task were found to be lower on a validated scale of counseling readiness than low-tolerant females. This result was replicated in Study 2 on a sample of 228 actual female counseling clients. Higher tolerance for ambiguity in female clients was associated with earlier departure from counseling and with less improvement. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client preferences and anticipations in career counseling: A preliminary investigation.

Client expectations have been studied infrequently in career counseling. This study provides preliminary data about precounseling expectations, which were conceptualized as preferences and anticipations. 92 university students (22 men and 70 women) who sought career counseling completed an open-ended questionnaire. Results suggested the following conclusions: (1) Clients have fairly clear ideas about what they want (preferences) from career counseling and about what the experience should be like; (2) clients are somewhat less certain about what the career counseling experience will actually be like (anticipations) and less optimistic about it; (3) a number of mismatches exist between clients' preferences and anticipations; (4) clients do not have well-developed expectations about their dislikes in career counseling; and (5) few differences are evident between clients who have had previous counseling and those who have not. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does a continuous feedback system improve psychotherapy outcome?

Using outcome data on a continual basis to monitor treatment progress has been identified as a way to enhance psychotherapy outcome. The purpose of this study was to investigate the use of a continuous feedback assessment system, the Partners for Change Outcome Management System (PCOMS; Miller & Duncan, 2004). Findings from 2 client samples that attended individual therapy at a university counseling center (N = 74) or a graduate training clinic (N = 74) indicated that clients who used PCOMS with their therapists (feedback condition) demonstrated statistically significant treatment gains when compared to clients receiving treatment as usual (no-feedback condition). Clients using PCOMS were also more likely to experience reliable change and in fewer sessions. A survival analysis demonstrated that approximately 50% of the clients in the feedback condition demonstrated reliable change after the 7th (graduate training clinic) or 9th session (university counseling center). Further findings, limitations of the study and ideas for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sacred adolescence: Practical suggestions for psychologists working with adolescents' religious and spiritual identity.

This article explores the relevance of adolescents' spiritual, religious, atheist, and agnostic identity development in the therapy process and the potential difficulties that psychologists face in effectively working with adolescents around spiritual/religious issues. Psychologists' limited personal and professional opportunities for increasing their self-awareness around their spirituality and religion may impact their ability to adequately address issues related to the spiritual/religious identity development of their adolescent clients. Psychologists' limited knowledge, awareness, and skills in reference to the process of adolescents' spiritual/religious/nonreligious identity may result in their neglect of spiritual/religious issues in psychotherapy. In such cases, adolescent clients may feel unsure if therapy is a safe place to discuss spiritual, religious, atheist, agnostic questions or issues that arise for them. The article concludes with practical suggestions that are framed around six critical concerns that are relevant for adolescents: (a) the relationship between spirituality/religion and health and coping, (b) negotiating multiple social identities, (c) religious cults, (d) religious conversion experiences, (e) anti-religious sentiment or religious discrimination, and (f) ethical considerations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)