"I apologize for being late": The courteous psychotherapist.

Psychotherapists may behave discourteously toward clients, often unconsciously and without being aware of it. The effort here is to alert therapists to the simplest ingredient of the positive therapeutic relationship--behaving courteously toward our clients. A limited number of pitfalls are discussed including: tardiness, tiredness and fatigue, in-session electronic interruptions, drinking alone in the presence of the client, checking the clock, and improperly addressing clients by name. This brief list encourages therapists to be alert to these as well as other behaviors that may have the potential to be offensive. When therapist discourteous behavior has taken place, it is important for therapists to do what they can to repair the damage, especially if a rupture has ensued. It is recommended that therapists encourage clients to discuss their feelings about the offending behavior in the presence of the nondefensive therapist. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measuring the Real Relationship in Psychotherapy: Initial Validation of the Therapist Form.

The development and initial validation of a therapist-rated measure of the real relationship in psychotherapy (the Real Relationship Inventory--Therapist Form [RRI-T]) is reported. Using a sample (n=80) of practicing psychotherapists and on the basis of prior theory, the authors developed a 24-item measure consisting of 2 subscales (Realism and Genuineness) and a total score. This 24-item version and other measures used for validation were completed by 79 additional practicing therapists and 51 counseling graduate students (n=130). The RRI-T was found to have high reliability and sound initial validity. As theorized, the RRI-T correlated significantly with measures of working alliance, session outcome (depth and smoothness), client intellectual and emotional insight, and client negative transference. Discriminant validity was supported by a nonsignificant relation to social desirability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Commentary on "The 'Ins and Outs' of Enactment: A Relational Bridge for Psychotherapy Integration" by Frank.

This commentary reviews and critiques Kenneth A. Frank's (2002) article, in which he discusses the concept and nature of enactment and its power as a tool for integrating action -oriented, cognitive-behavioral treatments and insight-oriented psychodynamic treatments. Frank convincingly shows how enactments-both in and out of therapy-are pervasive, play a central part in personality difficulties, and can be used to effect change. Additionally, the concept of enactment is a valuable tool for psychotherapy integration. Suggestions are given for further, increasing the power of the concept through incorporation of the family systems perspective. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy for depression in adults: A meta-analysis of comparative outcome studies.

Although the subject has been debated and examined for more than 3 decades, it is still not clear whether all psychotherapies are equally efficacious. The authors conducted 7 meta-analyses (with a total of 53 studies) in which 7 major types of psychological treatment for mild to moderate adult depression (cognitive-behavior therapy, nondirective supportive treatment, behavioral activation treatment, psychodynamic treatment, problem-solving therapy, interpersonal psychotherapy, and social skills training) were directly compared with other psychological treatments. Each major type of treatment had been examined in at least 5 randomized comparative trials. There was no indication that 1 of the treatments was more or less efficacious, with the exception of interpersonal psychotherapy (which was somewhat more efficacious; d = 0.20) and nondirective supportive treatment (which was somewhat less efficacious than the other treatments; d = -0.13). The drop-out rate was significantly higher in cognitive-behavior therapy than in the other therapies, whereas it was significantly lower in problem-solving therapy. This study suggests that there are no large differences in efficacy between the major psychotherapies for mild to moderate depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dialogical Encounters: Contemporary Perspectives on "Chairwork" in Psychotherapy.

This article looks at the use of "chairwork" (2-chair and "empty" chair) dialogues through the lens of 5 psychotherapies: Gestalt, process-experiential therapy, redecision therapy, cognitive-behavioral therapy, and schema therapy. Many clinical examples are provided, and they are organized into 4 overlapping groups: (a) internal in focus; (b) external in focus; (c) conflictual, that is, whether they involve the replaying of difficult or traumatic scenes from the past; or (d) corrective, which means that the emphasis is on replacing maladaptive cognitions or schemas with ones that are healthier. A potential foundation for Gestalt and cognitive-behavioral integration is proposed on the basis of the idea that gestalts are schemas (I. G. Fodor, 1996) and that chairwork is actually a form of cognitive restructuring (D. J. A. Edwards, 1989). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Active Ingredients in Individual Psychotherapy: Searching for Common Factors.

Every serious school of psychotherapy has its own theory--often only vaguely formulated--concerning the active ingredients in psychotherapy. Many of these theories are presented as mutually exclusive. The author presents an overview of some of the important, primarily psychoanalytically founded, theories of the factors in individual psychotherapy that are responsible for inducing change. It is impossible to pinpoint any single factor that is crucial in every therapy. What is needed is a nondogmatic, multiple-factor model that successfully incorporates the knowledge obtained from the many existing theories of psychotherapy-induced change. In practice, it is often difficult to maintain the traditional distinction between specific and nonspecific factors, just as it is difficult to distinguish the roles played by purely therapeutic factors--relating to the technique of the therapist--and by extratherapeutic factors. The author also addresses the epistemological status of the various claims put forward, by the many different theories of psychotherapy, concerning the active ingredients in psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist Alienation: Foreseeing and Forestalling Third-Party Dynamics Undermining Psychotherapy With Children of Conflicted Caregivers.

The phenomena of impasse and rupture in the psychotherapy relationship have been discussed mostly in terms of the dynamics of the therapist-patient dyad. Therapist alienation identifies the disruptive impact of third-party contamination of the patient's therapeutic alliance with the therapist. Therapist alienation and its intrafamilial cousin, parental alienation, are examined here from an attachment perspective, emphasizing the role of the cognitive schemas underlying each relationship. Case examples are drawn from the author's experience conducting psychotherapy with children of highly conflicted caregivers. Specific recommendations are offered to minimize the likelihood of therapeutic rupture due to therapist alienation. How to respond when and if therapist alienation is suspected and future directions for clinical work, empirical research, and legal process are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treating "the Poor"--Classism or a Rigid Loyalty to Theory?: Comment.

Comments on "Psychotherapy, classism, and the poor: Conspicuous by their absence" by Laura Smith (see record 2005-11834-002). Smith suggested that social psychology theories might explain how a negative attitude toward the poor has reduced the interest of practitioners in poor patients. The current author was impressed by Smith's comments when she left the literature and began to describe her own experiences. However, the current author was not convinced that social psychology and the varieties of classism explain the phenomenon described. The current author believes that many practitioners avoid the poor because they do not enjoy failure. In this comment, the author discusses personal experiences that support this position. It does not elaborate a history of either a dislike of or class avoidance of the poor. Instead, it suggests that psychologists are trained to overgeneralize findings and to look down on less rigorously collected findings and observations. Thus, psychologists overlook information that might allow theories to be further formulated in more accurate and generalizable forms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Dialogues on difference: Studies of diversity in the therapeutic relationship.

Reviews the book, Studies of diversity in the therapeutic relationship by J. Christopher Muran (see record 2006-11731-000). This book has taken the opportunity to begin with dialogue among clinicians with different theoretical perspectives on issues of diversity, including psychoanalytic, cognitive– behavioral, and humanistic viewpoints. In introducing the book, Muran sets the stage for the dialogues with an open discussion of his own culturally diverse background. He also describes the diversity characterizing his professional training in cognitive– behavioral psychotherapy and psychoanalysis, which in part contributed to his recognition of a need for this dialogue across perspectives. The book is divided into eight dialogues consisting of one psychoanalytically oriented writer or set of writers, followed by comments on this essay by two theorists from different and overlapping theoretical points of view. The final component of each dialogue consists of the author’s reply to the comments. The dialogues address eight separate topics including race, social privilege and multiple identities, homosexuality, intersection of race and gender in psychotherapy with African American men, identity in psychotherapy with Latino clients, role of stereotypes in psychotherapy with Asian Americans, Middle Eastern identity and psychotherapy, and communication and metacommunication in psychotherapy. One of the intriguing features of this book is that the dialogue is in written form, giving the reader the advantage of reading it several times to better engage with each author’s point of view. Because the format resembles that of an oral presentation of a single paper followed by discussions of the paper, I found myself wanting to ask questions of each of the authors. Several of the authors appear to have been enriched through this dialogue,because the very nature of this exchange parallels the concept of mutual influence that lies at the heart of relational psychoanalysis. The quality of dialogue across the different sections of this book is rich and complex and highlights the critical need for ongoing dialogue on cultural difference and similarity in the discipline of psychology, not to mention our broader society. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Narratives and Culture: "Thickening" the Self for Cultural Psychotherapy.

The dominant framework for understanding selfhood in contemporary psychology has been one that privileges a highly individualistic conception of self. This is reflected in both the language and approaches of psychotherapy where the influence of contextual factors (factors outside of the individual) are given marginal consideration in order to maintain some type of 'objectivity' or 'neutrality' in counseling. We argue that an understanding of selfhood which does not take into account the 'relational' nature of selfhood as well as the cultural or historical context of the client, will likely alienate clients who do not view their self through the individualized lenses of (North American) psychology. In order to deal with this problem, we adopt an approach to cultural (and cross-cultural) psychology that views the self as a relational narrative. Such a narrative does not imply an unrestricted freedom to construct our self, but understands the limits to selfhood implied in the web of meanings constitutive of our culture and the web of relations from which our self emerges. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist Interpretations and Client Processes in Three Therapeutic Modalities: Implications for Psychotherapy Integration.

This research investigated therapist interpretations and subsequent client actions in 3 therapeutic modalities--client-centered therapy, gestalt/existential therapies, and rational-emotive behavior therapy-by employing the coding system of the consensual qualitative research method (C. E. Hill, B. J. Thompson, & N. E. Williams, 1997). By allowing conceptual categories to emerge from these qualitatively analyzed data, the authors found that each approach had its own specific pattern of interpretation content as well as style of delivering the interpretations. Client reactions to interpretations were mostly positive. The results suggest that interpretation is a common therapeutic element and that different therapies nonetheless accentuate different aspects of interpretation. Implications for psychotherapy integration are offered, and the findings are discussed with reference to theory and clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comment: Integrating methodologies in the scientific study of interpersonal psychotherapy: A reaction to "Therapist immediacy in brief psychotherapy: Case study I and case study II".

In this reaction article, the author concentrates on selected methodological components characterizing both Kasper, Hill, and Kivlighan's (see record 2008-13167-001) and Hill, Sim, Spangler, Stahl, Sullivan, and Teyber's (see record 2008-13167-002) respective case studies of therapist immediacy in brief psychotherapy. In tandem, the foci and methodology of these investigations break new ground in the scientific study of interpersonal psychotherapy, and more generally they serve as paradigmatic illustrations of the form that psychotherapy research can take if it is to be truly more meaningful and useful for practitioners. Emphasis is placed on the investigators' integration of single-case research, elements of change process research, and quantitative and qualitative methods in a way that enables highly intensive examination of this core intervention in interpersonal psychotherapy. Specific elements and implications of each of these methodological components are briefly discussed, which also creates a context for addressing the issue of discovery versus verification as this pertains to the present studies. Some underlying philosophical considerations are also briefly touched on along the way. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Skills training in affective and interpersonal regulation followed by exposure: A phase-based treatment for PTSD related to childhood abuse.

Fifty-eight women with posttraumatic stress disorder (PTSD) related to childhood abuse were randomly assigned to a 2-phase cognitive-behavioral treatment or a minimal attention wait list. Phase 1 of treatment included 8 weekly sessions of skills training in affect and interpersonal regulation; Phase 2 included 8 sessions of modified prolonged exposure. Compared with those on wait list, participants in active treatment showed significant improvement in affect regulation problems, interpersonal skills deficits, and PTSD symptoms. Gains were maintained at 3- and 9-month follow-up. Phase 1 therapeutic alliance and negative mood regulation skills predicted Phase 2 exposure success in reducing PTSD, suggesting the value of establishing a strong therapeutic relationship and emotion regulation skills before exposure work among chronic PTSD populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How to Cope With "Noise" in Social Dilemmas: The Benefits of Communication.

Interactions in social life may be seriously affected by negative noise, whereby actual or perceived behavior is less cooperative than was intended (e.g., arriving late due to an unforeseen traffic jam). The present research examines whether negative noise exerts detrimental effects on impressions and cooperation and whether such effects could be reduced by communication. Consistent with hypotheses, Study 1 revealed that negative noise exerts detrimental effects on both impressions of partners' benign intent and cooperation and that these detrimental effects could be effectively reduced by communication about noise. Study 2 replicated both findings but only for individuals with low trust. Mediation analysis revealed that impressions of benign intent and prosocial interaction goals underlie the positive effects of communication on cooperation. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Working With Patients Involved in the Mafia: Considerations From Italian Psychotherapy Experiences.

The authors report their main findings on the psychological characteristics of Mafia members studied in the past 10 years. Clinical data were collected, such as psychotherapy reports of therapists who treated patients belonging to the Mafia and clinical interviews of important Italian Mafia informers. The psychological profile of a Mafia member and his relatives is described. The importance of the process of identity construction that a mafioso must learn in order to join the Cosa Nostra organization is outlined. The psychological distress mafiosi suffer and the type of psychotherapy they require are reported, including brief excerpts from clinical sessions. Therapists and analysts always feel troubled working with these patients, and supervision is often required. Italian clinical work differs greatly from that represented in American movies, and specific theoretical and clinical training is necessary to treat the particular characteristics of these patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

CBT With Older People: Alterations and the Value of the Therapeutic Alliance.

Cognitive-behavioral therapy (CBT) is empirically supported for use with older people. Reasons for its efficacy are not fully understood--i.e., whether theory-driven techniques or nonspecific "common factors" (such as the therapeutic alliance) are responsible. In this article, the authors discuss age-related psychotherapy components. They address the difficulties of using CBT with older populations and the importance of the TA in therapy with the elderly. Finally, they identify 4 areas where the application of the TA may enhance CBT among older adults: philosophy or socialization, cognitive restructuring, resource building in the context of aging, and affect tolerance. The authors argue that a strong TA can facilitate each of these processes in the application of CBT to current cohorts of older people. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Association Between Patient Characteristics and the Therapeutic Alliance in Cognitive-Behavioral and Interpersonal Therapy for Bulimia Nervosa.

The therapeutic alliance is an established predictor of psychotherapy outcome. However, alliance research in the treatment of eating disorders has been scant, with even less attention paid to correlates of alliance development. The goal of this study was to examine the relation between specific patient characteristics and the development of the alliance in 2 different treatments for bulimia nervosa (BN). Data derive from a large, randomized clinical trial comparing cognitive- behavioral therapy (CBT) and interpersonal therapy (IPT) for BN. Across both treatments, patient expectation of improvement was positively associated with early- and middle-treatment alliance quality. In CBT, baseline symptom severity was negatively related to middle alliance. In IPT, more baseline interpersonal problems were associated with poorer alliance quality at midtreatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The therapeutic relationship in the brief treatment of depression: Contributions to clinical improvement and enhanced adaptive capacities.

Using data from the National Institute of Mental Health Treatment for Depression Collaborative Research Program, the authors examined the impact on treatment outcome of the patient's perception of the quality of the therapeutic relationship and contribution to the therapeutic alliance. Shared variance with early clinical improvement was removed from these relationship measures. Multilevel modeling demonstrated that a perceived positive therapeutic relationship early in treatment predicted more rapid decline in maladjustment subsequent to the relationship assessment. This effect occurred equally across all 4 treatment conditions. A positive early therapeutic relationship also predicted better adjustment throughout the 18-month follow-up as well as development of greater enhanced adaptive capacities (EAC). Controlling a wide range of patient characteristics did not eliminate the effects of the therapeutic relationship on rate of improvement during treatment and on EAC. Thus, independent of type of treatment and early clinical improvement, the therapeutic relationship contributes directly to positive therapeutic outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using the Marschak Interaction Method Rating System for Chinese families: Relationship between parent-child interaction pattern and child's social behavior.

This study investigated the use of the Marschak Interaction Method Rating System (MIMRS) in assessing parent–child interaction patterns and its relationship with preschool children's social behavior in a Chinese sample. Fifty-two preschoolers and their parents (either mother or father) participated in the study. The MIMRS demonstrated moderate to high internal consistency. There was also a moderate positive correlation between the MIMRS and the Kinship Centre Attachment Questionnaire (Kappenberg & Halpern, 2006). With reference to parent–child interaction and the child's social behavior, a negative relationship was identified between child anger/aggressive behavior and parent's nurturing toward his or her child. In addition, a child's demonstration of exploratory behavior, reciprocity with parent, and regulatory capacities were positively related to that child's social competence and negatively related to the child's anger/aggressive behavior. The practical uses of the MIMRS as a screening tool for working with parents and children in a non-Western culture are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The development of a couple-based treatment for PTSD in returning veterans.

Military personnel deployed in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) show high levels of emotional distress and posttraumatic stress disorder (PTSD), and these deployment-related problems may be expected to have a devastating impact on their relationships. It is urgent that researchers develop couple-based treatments to reduce PTSD in OEF/OIF veterans and to reduce PTSD-related relationship problems. This article describes the development of a novel couple-based treatment for PTSD, called Structured Approach Therapy (SAT), that uses empathic communication training and stress inoculation procedures to help couples improve their ability to cope with trauma-related anxiety and a multicomponent emotion activation program to help couples reduce emotional numbing. The theoretical basis of the SAT Treatment Model is described, and the various treatment components are presented. The authors recommend that couple-based interventions be used to provide OEF/OIF veterans and their partners with empathic communication skills to discuss their thoughts and feelings about deployment and with dyadic coping skills to confront trauma-related aversive emotions and emotional numbing and return intimacy to their lives. (PsycINFO Database Record (c) 2011 APA, all rights reserved)