Congruence/genuineness.

Congruence or genuineness is a relational quality that has been highly prized throughout the history of psychotherapy, but of diminished research interest in recent years. In this article, we define and provide examples of this attribute of the therapy relationship and present an original meta-analytic review of the empirical literature showing its relation to improvement. Analysis of 16 studies (k), representing 863 patients (N), resulted in a weighted aggregate ES (r) of .24 (p = .003; 95% CI = .12 to .36). Moderators of the association between congruence and treatment outcome are examined, and limitations of the extant research are discussed as well. In closing, we advance several therapist practices that are likely to foster congruence and thus improve psychotherapy outcomes. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Therapist immediacy in brief psychotherapy: Case study II.

Immediacy was examined in a 17-session case of brief therapy with a bright, articulate, inner-city, African American female client seeing an interpersonally oriented, White, male therapist. The main types of therapist immediacy were reinforcing the client for in-session behavior, inviting the client to collaborate, inquiring about client reactions to therapy, and reminding the client that it was okay to disagree with him. An in-depth qualitative examination of the seven most extensive/salient immediacy events revealed that therapist immediacy enabled the therapist and client to negotiate the relationship, helped the client express her immediate feelings to the therapist, helped the client open up to deeper exploration of concerns, and provided the client with a corrective relational experience. Implications for practice and research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The therapeutic alliance in adolescent substance abuse treatment: A one-with-many analysis.

Studies of the therapeutic alliance typically use a one-with-many (OWM) design in which each therapist (the one) treats multiple clients (the many). This study used Kenny, Kashy, and Cook's (2006) OWM method to examine the composition of the therapeutic alliance and to analyze the association between alliance and outcome in a sample of 398 adolescents treated for substance abuse by 14 therapists. Both the client and therapist alliance ratings yielded large relationship variances, with limited consensus among clients treated by the same therapist about the quality of the alliance. If a client reported an especially strong alliance with his or her therapist, the therapist was likely to also report an especially strong alliance with that client (dyadic reciprocity). The association between the components of the alliance and treatment outcome was complicated, with different levels of measurement and different components of the alliance (perceiver, partner, or relationship) derived from different informants (therapist or client) relating to different outcomes. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The Myers-Briggs Type Indicator personality dimensions and perceptions of quality of therapy relationships.

Examined associations between perceived quality of therapy relationships and therapist and client scores on the Myers-Briggs Type Indicator (MBTI). 35 experienced therapists and 53 adult outpatients involved in long-term personal therapy completed the MBTI and measures of therapy relationship quality and pretherapy adjustment. More positive client ratings of the quality of the therapy relationship were associated with similarity of therapist and client in overall MBTI profiles and in the thinking–feeling and judging–perceiving dimensions of the MBTI. When therapists had higher extroversion and feeling scores, both therapists and clients rated the relationship more positively. The MBTI may be valuable in determining optimal therapist–client matches and in guiding therapists to better understand their impact on clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttherapy congruence on client symptoms and therapy outcome.

Examined whether therapists' accuracy on the level of clients' symptoms as perceived by the client (congruence of perception) was related to outcome in the cases of 50 adult clients. Clients completed a 90-item symptom check list, which was scaled on 9 symptom dimensions (e.g., depression, anxiety, hostility) and a global pathology index. Therapists rated clients directly on these dimensions. As hypothesized, posttherapy congruence correlated significantly with both client-rated and therapist-rated outcome. Congruence of perception at the beginning of therapy was unrelated to outcome. Better congruence was associated more with successful outcome than was either therapists' or clients' components of the congruence level. Findings suggest that therapists' posttherapy conceptual congruence of client functioning is highly associated with successful outcome. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The alliance.

Two decades of empirical research have consistently linked the quality of the alliance between therapist and client with therapy outcome. The magnitude of this relation appears to be independent of the type of therapy and whether the outcome is assessed from the perspective of the therapist, client, or observer. Although the strength of the connection between alliance and therapy outcome appears to be relatively uniform throughout therapy, the client's report of the early alliance may be the most clinically useful indicator. In successful treatments, the therapist's and client's assessments of the alliance tend to converge over time. Recent research suggests that the therapist's skills and personal factors both influence the likelihood of developing a good therapeutic alliance with the client. Though the relation between the therapist's level of training and the quality of the alliance is inconsistent, it is likely that the more trained therapists are able to form better alliances with severely impaired clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role expectations and symmetrical/complementary therapeutic relationships.

Rated 25 tape recorded initial therapy interviews taken from graduate and undergraduate students on the process variable of topic determination, which was indicative of the type of relationship (either complementary or symmetrical) between client and therapist. Topic determination was defined as the ratio of successful topic changes to topic change initiations. It was hypothesized that matched client–therapist role expectations would be related to a complementary relationship, as determined by a high degree of topic determination. Conversely, nonmatched client–therapist role expectations would be related to a symmetrical relationship, as determined by a low degree of topic determination. It is concluded that matched/nonmatched client–therapist role expectations are important variables in determining whether the subsequent therapeutic relationship will be complementary or symmetrical. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exploratory in-session process research in individual psychotherapy: A review.

The goal of exploratory process research is to describe what occurs within psychotherapy sessions, eventually leading to the development of theories based on the accumulation of replicated results. Several areas in which exploratory methods are currently being used are described: therapist techniques, client behavior, covert processes, process models, interactions between therapist and client, and therapy events. Additionally, several areas in which exploratory methods would be useful for future research are described: the links between client personality characteristics, therapy process, and outcome; the timing and quality of therapist interventions; and client readiness for the therapist interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship between behavioral marital therapy outcome and process variables.

This study was conducted to identify therapist and client behaviors with a positive response to social learning-based behavioral marital therapy. A sample of 32 couples receiving treatment was examined. Immediately after each therapy session, the therapist, husband, and wife independently completed process ratings forms that measured therapist and client behaviors during the session. Composite scales, derived from these ratings, were entered into multiple regression equations to examine their relationship with posttherapy marital satisfaction. After controlling for pretherapy marital satisfaction and the other predictor variables, therapists', husbands', and wives' ratings of positive client behavior (i.e., collaboration, active participation, and homework compliance) were positively associated with therapy outcome. Implications for marital therapy and suggestions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differential prescription for psychotherapy on the basis of client role preferences.

Reviews research on the effect of congruence between client role expectations and therapist behaviors that suggests that congruence may promote more positive therapy outcomes. However, few practical means of increasing congruence have appeared in the literature. Four types of client role preferences are defined: medical modelers, revelationists, problem-solvers, and explorers. Specific suggestions for techniques to be used in the initial phases of therapy to maximize congruence with each type of preference are presented. The rationale for the techniques and the anticipated benefits of matching are discussed. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived support and relational effects in psychotherapy process constructs.

Recent research has indicated that only a small portion of supportiveness reflects the objective properties of providers. Instead, supportiveness primarily reflects the unique relationships among specific recipients and providers (i.e., relational effects), thus suggesting new approaches to support interventions. The authors investigated the possibility that similar relational effects occur for therapy process constructs (e.g., working alliance). Isolating relational effects in psychotherapy requires that each client receive treatment from more than one therapist during the same period of time. Therefore, we conducted analog studies in which therapy clients and students viewed videos of therapists and then rated expected therapist supportiveness and expected therapy process constructs for each therapist. Two studies indicated very strong relational effects in therapist supportiveness and therapy process constructs. In addition, process constructs were correlated strongly with supportiveness (Study 1) and favorable affect (Study 2) for relational effects specifically. Implications for integrating research on perceived support and therapy process were discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Complementarity and symmetry in family therapy communication.

We examined relational control communication patterns in systemic family therapy sessions. Therapist interactions with each family member (N?=?29 families) were examined with the Family Relational Communication Control Coding System. Results showed significantly more complementarity, which reflects mutuality in the definition of a relationship, than symmetry, which characterizes relational control competition. Transitional probabilities showed that family members were likely to respond to therapists in a complementary manner (following therapist one-up, ↑, messages with one-down, ↓, messages and vice versa); therapists were likely to respond to client ↑ and ↓ messages in either a competitive symmetrical or complementary manner. Neither complementarity nor symmetry was predictive of family members' perceptions of the therapeutic alliance as measured by Couple and Family Therapy Alliance Scales (W. M. Pinsof and D. R. Catherall; see record 1987-23860-001). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is psychotherapy more effective when therapists disclose information about themselves?

Theorists have long debated the wisdom of therapists disclosing personal information during psychotherapy. Some observers have argued that such therapist self-disclosure impedes treatment, whereas others have suggested that it enhances the effectiveness of therapy. To test these competing positions, therapists at a university counseling center were instructed to increase the number of self-disclosures they made during treatment of one client and refrain from making self-disclosures during treatment of another client. Analyses revealed that clients receiving psychotherapy under conditions of heightened therapist disclosure not only reported lower levels of symptom distress but also liked their therapist more. Such findings suggest that self-disclosure by the therapist may improve both the quality of the therapeutic relationship and the outcome of treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The real relationship in psychotherapy: Relationships to adult attachments, working alliance, transference, and therapy outcome.

The purpose of this study was to understand how the real relationship (RR) relates to important process and outcome variables from both the clients’ and therapists’ perspectives. Using a sample of 31 therapist/client dyads at a university counseling center, the authors examined the RR at the 3rd session of therapy and at termination. The results revealed that client adult attachment avoidance was negatively correlated with client RR, while client adult attachment anxiety was uncorrelated. Therapists’ ratings of negative transference were negatively correlated with therapist-rated RR and were uncorrelated with client-rated RR. Hierarchical linear modeling analyses were conducted to predict postintervention outcome from client and therapist perceptions of the RR. Therapists’ ratings of the RR accounted for a significant amount of variance in client posttreatment symptoms while controlling pretreatment symptoms. Client-rated RR total scores and client and therapist 3rd-session alliance scores were not significant predictors of postsymptom ratings. Implications of the usefulness of measuring the RR in psychotherapy are discussed, as are recommendations for future study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client behavior as a function of therapist style and client resources.

Examined the therapy career of 27 males and 21 females from pretherapy characteristics to outcome, focusing on the 3 issues: (a) degree to which each member of the dyad influenced the process level of the client at different stages, (b) interaction effects between therapist style and client personal resources, and (c) relationships between outcome and client process levels at different time points. The effect of client resources on client process level proved significant both early in therapy and at the midpoint. The therapist style effect was significant at the midpoint but not in early therapy. No significant Client * Therapist interactions were found. Client process in the 10th interview correlated significantly with outcome of therapy viewed from 3 perspectives: The client's, the therapist's, and that of a Rorschach diagnostician. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Formation of a therapeutic relationship: Experiences during the initial phase of psychotherapy as predictors of treatment duration and outcome.

Studied the formation of a psychotherapy relationship using self-reports of clients and therapists. Items designed as measures of a set of dimensions considered salient to the process of therapy were incorporated into client and therapist report forms. These were completed separately by clients and therapists immediately following each of the initial 10 sessions. It was hypothesized that report-form dimension scores early in treatment would predict persistence in treatment, duration of treatment, and retrospective evaluations of outcome. Subjects were 91 students (36 males, 55 females) attending a large urban unversity and 19 therapists (10 females, 9 males) on the staff of the university student counseling service. A number of client and therapist dimensions predicted persistence in treatment as early as the 3rd session. Dimension scores failed to predict duration of treatment for remainers, however. A greater number of dimension scores correlated with therapist outcome ratings than with client outcome ratings. (38 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Studying psychotherapy using the one-with-many design: The therapeutic alliance as an exemplar.

Most psychotherapy research uses a one-with-many design, in which each therapist (the one) treats multiple clients (the many), which raises the challenge of nonindependent data. We present a statistical model for analyzing data from studies that use a one-with-many design. This model addresses the problems associated with nonindependence and can address theoretically relevant questions. To illustrate this model, we analyzed data in which 65 therapists and their 227 clients rated their therapeutic alliance. The primary finding was that both therapist and client alliance ratings were largely relational (i.e., specific to the unique therapist–client combination). There was little consensus among clients treated by the same therapist about the quality of the therapeutic alliance, although some therapists reported forming stronger alliances than other therapists. There was substantial dyadic reciprocity, indicating that if a therapist reported an especially good alliance with a particular client (better than with his or her other clients), then that client was also likely to report an especially good alliance (better than those reported by the therapist’s other clients). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of therapist sex on the outcome of therapy.

Examines studies of the effects of therapist sex on the outcome of therapy. Most studies supported 1 of the following 3 viewpoints: Female therapists are more effective with both sexes of clients; matching therapist and client sex produces the greatest therapeutic benefit; therapist sex is a poor predictor of outcome in therapy. Strengths and weaknesses of these positions and some less commonly held views are discussed. Due to unimpressive statistical findings, conflicting evidence, and poor experimental control in prior research, it is cautiously concluded that a therapist's sex is a poor predictor of outcome in therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client concealment and self-presentation in therapy: Comment on Kelly (2000).

The authors disagree with A. E. Kelly's (see record 2000-08364-001) conclusions that clients conceal things from therapists primarily for self-presentational reasons and that client concealment is positively related to positive therapy process and outcome. They also disagree with A. E. Kelly regarding the implications of self-presentation theory for therapy. Their review of the research suggests that clients do not conceal much from therapists, that what they do conceal involves many different kinds of information hidden for many different reasons, that therapists have wide variability in being able to detect hidden client material, and that the relationship of client concealment and therapist awareness of client concealment with therapy process and outcome is not clear. Finally, the authors discuss their views about implications of client concealment and self-presentation for therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)