How a return to theory could help alliance research.

This report aims to clarify alliance theory and extend its role in psychotherapy research. Bordin's (1979) alliance theory concerns the nature and quality of participants' collaborative, purposive work. Alliance is actualized in therapist techniques, client participation, and the dyad's relational features. Alliance is a property of all components of therapy, a concept superordinate to these components and not a component itself. Viewing technique and alliance as equivalent components of therapy confuses 2 levels of thinking, as does conflating alliance with the overall therapy relationship. Examples from contemporary research reports illustrate these points. The logic of alliance measures is clarified, as are the limits of measures' ability to capture key features of collaborative work. This approach opens new avenues for alliance research. (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)     

Use of the focus in brief dynamic psychotherapy.

Describes the process of brief psychodynamic psychotherapy, which unfolds around a central therapeutic focus that is explored in a limited period of time. The collaborative process of searching for a focus during the assessment phase of treatment is described using technical detail and case material. Difficulties of staying with the focus as therapy progresses are discussed from the points of view of technique and of resistance in both patient and therapist. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical supervision from the standpoint of cognitive-behavior therapy.

This article presents an approach to supervising cognitive-behavior therapists that is closely related to the process and content of cognitive-behavior therapy (CBT). The goal of CBT is to help therapists adopt the philosophy of CBT as the basic approach for changing clients' cognitions, emotions, and behaviors. A secondary goal is to teach therapists specific techniques. The seven major features of CBT and their implications for supervision are described: therapy as a meaning-making process; systematic and goal directed therapy; practicing and experiencing; therapy as a collaborative effort; person-focused therapy; the therapists as a facilitator of change and development; and empowerment of the client with self-change skills. Some of the major dilemmas and constraints in CBT supervision that are derived from adapting the principles of therapy to supervision are discussed as well as the need for supervision outcome research and recommendations for its implementation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist perspectives on countertransference: Qualitative data in search of a theory.

A consensual qualitative research strategy was used to examine data from 127 interviews conducted with 8 psychologists immediately following their sessions of brief therapy with 8 clients. Analyses revealed 3 domains relevant to countertransference: origins (including categories of family issues, needs and values, therapy specific issues, and cultural issues), triggers (including categories of content of client material, therapist comparing client with others, change in therapy structure or procedures, therapist assessing progress of therapy, therapist perception of client, and emotions), and manifestations (including categories of approach, avoidance, negative feelings, and treatment planning). The frequency of categories within and across cases was classified, and relationships among categories from the 3 domains were detected, generating hypotheses for future empirical research. Implications for practice, training, and continued research are discussed. (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)     

Duration and outcome in psychotherapy: An integrative review.

Research and practice trends are fueling a strong interest in brief therapy, highlighting the question of the relationship between treatment duration and outcome. A number of investigations have reported a weak or nonexistent relationship between duration and outcome, yielding the possible conclusion that there are few differences between brief and longer term treatments. A finer-grained analysis, however, based on such methodological factors as the nature, source, and timing of outcome measures, reveals intriguing dose–effect linkages within particular helping modalities. Summarizing process and outcome research, this article identifies potential client, therapist, and contextual mediators of the brevity of treatment. Recent research concerning stages of change within psychotherapy is advanced as an integrative framework that yields researchable hypotheses concerning the factors that facilitate outcomes at various points in the helping process. (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)     

Review of Stress inoculation training.

Reviews the book Stress Inoculation Training (1985) by D. Meichenbaum. This relatively brief book provides a worthwhile and practical overview of stress inoculation training (SIT). The book is organized into seven chapters. In the first chapter, the conceptual basis of stress inoculation is presented and the transactional nature of stress is described. Chapter 2 presents clinical guidelines for stress management programs. Meichenbaum contends that mental health professionals often intervene without an adequate understanding of the client's problem and the process of change. Chapter 3 provides an overview of the SIT process. This includes three phases: (a) conceptualization, (b) skills acquisition and rehearsal, (c) application and follow-through. A summary of populations with which SIT has been used is also presented. Chapter 4 details the conceptualization phase of SIT. This phase focuses on establishing a collaborative relationship with the client, determining the nature of the client's problem, and helping the client to understand the nature and effects of stress. Chapter 5 focuses on the skill acquisition and rehearsal phase of SIT. The coping skills that are trained during this phase should appear to be a natural outgrowth of the reconceptualization process. Chapter 6 describes the application and follow-through phase of SIT. The goal of this phase is to help clients implement coping responses outside of the training sessions. In the last chapter, applications of SIT to varied populations are described and discussed. This book does not contain an in-depth critical review of SIT research. However, this book does provide an excellent overview of clinical, practical issues, and guidelines related to SIT training. It contains a variety of implementation tactics not found in other publications on SIT. In general, the book sets forth an excellent state-of-the-art presentation of SIT implementation issues and guidelines for use of SIT in professional practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A case of depression: Introducing David.

A brief overview of the client, David, is presented. David participated in a short-term emotion-focused therapy for the treatment of depression. In this paper the client’s presenting problems and history are described to provide a context for the brief excerpt that follows. The excerpt is taken from his first session of psychotherapy and was used by the four different therapists to develop a case formulation illuminating their specific orientation so that these could be contrasted and compared. (PsycINFO Database Record (c) 2010 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 practice of brief therapy.

Examined therapist, patient, and system attitudinal factors in brief therapy practice. Attitudinal factors in brief and long-term therapy are contrasted, and technical treatment issues, patient selection, dangers, and future issues in brief therapy are discussed. Salient technical issues in brief psychotherapy include the maintenance of a clear and specific focus, a high level of therapist activity, flexible use of interventions, and encouragement of client activities outside therapy. Rather than presenting brief therapy as a specific school or model of treatment, an attempt is made to integrate various approaches that can make therapy beneficial within a well-planned, limited amount of time. (58 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Some ethical concerns regarding the individual psychotherapy of the married client.

A brief review of the literature establishes the high potential for disturbance of a client's marital relationship following individual psychotherapy. Several problems possibly inherent in the conduct of therapy with only one member of a marital dyad are discussed, as well as some of their probable sources. The importance of informed consent to treatment is stressed with regard to ensuring that potential clients are aware of the possible negative effects of therapy on their marital relationship. The systemic view of the spouse as necessarily involved in the maintenance and modification of the client's complaints, provides an alternative to individual psychotherapy: The spouse must be a part of their therapy from the beginning. It is suggested that the ethical responsibility of the therapist is toward the greatest overall benefit for the client and should concern the interpersonal as well as the psychological environments of the clients they serve. (French abstract) (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Analysis of the development of the working alliance using hierarchical linear modeling.

The relation between the working alliance and therapeutic outcome was examined in 21 therapist–client dyads. This relation was analyzed in terms of the level of alliance at the 3rd counseling session, midpoint of treatment, and last session with linear and curvilinear models of the temporal development of the working alliance. Analyses were conducted with hierarchical linear modeling. Results revealed a significant association between the linear growth function on therapist ratings of the working alliance and therapeutic outcome. The use of hierarchical linear modeling in counseling psychology research and the need for conceptualizing the working alliance as a temporally variant as opposed to a static process are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Understanding and overcoming parent resistance to play therapy.

Explores the nature and sources of parent resistance to play therapy, questions the concept of resistance as it is often understood, and suggests ways the play therapist can prevent or overcome it, addressing common mistakes therapists make that actually increase client resistance. It is stated that play therapist's own attitudes and the therapist–parent relationship can be used to overcome resistance that might interfere with therapeutic progress. Showing respect and empathy for parents can go far in creating a trusting collaborative therapeutic relationship that is needed for optimum outcomes. Similarly, helping parents see the connections between their problems and the course of therapy being recommended can make it easier for them to engage as partners in the process of change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Values: The enfant terrible of psychotherapy.

Cites clinical examples, personal experience, and empirical research demonstrating that the values of psychotherapists affect diagnoses, as well as the process and goals of therapy. Some therapists believe that values should not influence therapy. Thus, indirect ways of dissemination of values may be used as shown by clinical illustrations. The author holds a value-determined image of psychotherapy, in which therapeutic schools are viewed as "perceptual houses" to which the client is being converted. The advantages of making the public aware of the role of values in psychotherapy are briefly discussed. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Elements of the Socratic method: I. Systematic questioning.

Describes the use of systematic questioning (SQ), one of the elements of the Socratic method (SM), in terms of its format, content, and process. The other 2 elements of SM are inductive reasoning and universal definitions. Although many psychotherapists allude to the SM, most refer only to the questioning style and few describe the process in adequate detail. An attempt is made to provide an intermediate level of structure so as to facilitate a shaping process during the interview. SQ involves a complex interplay of question format, content, and process issues. The format of SQ emphasizes higher level cognitive processes, the content focuses on developing independent problem-solving skills in the client, and the process emphasizes a collaborative interaction between therapist and client. SQ can be used to facilitate self-initiated discovery, helping clients realize the answers they already possess. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of a method for studying thematic content of psychotherapy sessions.

The authors developed a measure for categorizing the nature of the topic that clients and therapists discuss from moment to moment during psychotherapy. The Counseling Topic Classification System (CTCS) contains 55 topics and 8 emotional categories. It was used to code the thematic content of Donald Meichenbaum's and Hans Strupp's initial therapy sessions with a client named Richard. Our findings provided preliminary evidence that the CTCS is useful for coding the core topic of initial therapy sessions and that thematic content may be an important process and contextual variable. Methods are described for studying thematic content as a contextual variable and for presenting change process and discovery-oriented research findings so that they are more clinically meaningful. (PsycINFO Database Record (c) 2010 APA, all rights reserved)