Client and therapist variability in clients' perceptions of their therapists' multicultural competencies.

This study examined therapist differences in their clients' ratings of their therapists' multicultural competencies (MCCs) as well as tested whether therapists' who were rated as exhibiting more MCCs also had clients who had better therapy outcomes (N = 143 clients and 31 therapists). All clients completed at least 3 sessions. Results demonstrated that therapists accounted for less than 1% of the variance in their clients' Cross-Cultural Counseling Inventory–Revised (CCCI-R; T. D. LaFromboise, H. L. K. Coleman, & A. Hernandez, 1991) scores, suggesting that therapists did not differ in terms of how clients rated their MCCs. Therapists accounted for approximately 8.5% of the variance in therapy outcomes. For each therapist, their clients' CCCI-R scores were aggregated to provide an estimate of therapists' MCCs. Therapists' MCCs, based on aggregate CCCI-R scores, did not account for the variability in therapy outcomes that were attributed to them. Additionally, clients' race/ethnicity, therapists' race/ethnicity, or the interaction of clients'–therapists' race/ethnicity were not significantly associated with clients' perceptions of their therapists' MCCs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clients', therapists', and judges' evaluations of psychotherapy.

Asked 41 patients and their 17 therapists to complete a questionnaire indicating problem areas and their severity before and after the 1st and last therapy session. 2 clinical psychologists served as independent judges rating the client questionnaires. The clients' evaluations were unrelated to their therapists' evaluations, but were highly related to the evaluations made by independent judges. Further analyses suggest that the disagreements between clients and therapists stemmed from the therapists' inaccuracy in perceiving the clients' problems and the therapists' tendency to overestimate the progress of therapy relative to clients and independent judges. The results and the broader issue of client-therapist disagreements are discussed in terms of the client as a "consumer." (l6 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Thinking about thinking in therapy: An examination of clients' understanding of their therapists' intentions.

Two therapists each provided 2 clients time-limited (10 sessions each) therapies. These were examined to discover relations between (a) clients' understanding of therapists' intentions and episode level outcome, (b) similarities and differences between the participants' valuing of different intentions, and (c) shifts in intentions valued from the beginning to the terminal phases of therapy. By using therapists' segmentation of sessions into episodes and a computerized Counselor Intention List, some positive relations between clients' understanding of counselor intention and episode impact were documented. Differences were found between therapists' and clients' valued intentions as were systematic shifts on valued intentions from beginning to end phases of therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapists' race and African American clients' reactions to therapy.

This study examines the posttherapy reactions and attitudes of 44 African American clients seen at a university clinic in a midwestern city. Clients were randomly assigned to European American or African American therapists for 10 sessions of interpersonal or problem solving therapy. Therapy attitudes and reactions were assessed through clients' ratings of how well they understood and accepted the goals of therapy, their ability to accept and make use of therapeutic interventions, and perceptions of therapeutic benefit. The impact of European American therapists' efforts to cope with racial differences through therapist-initiated discussion of race in the first session or no therapist-initiated discussion of race were examined. African American clients' ratings of therapy indicated that there was a relationship between therapists' race and the understanding and acceptance of therapeutic interventions and perceived benefit of therapy. Clients rated therapeutic understanding and acceptance higher when assigned to an African American therapist. Therapists' initiation of or noninitiation of discussions of race had no affect on ratings of therapy. The clinical implications of these findings and suggestions for future research are discussed. (PsycINFO Database Record (c) 2011 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)     

Client retrospective recall of resolved and unresolved misunderstanding events.

Client retrospective recall of major misunderstanding events was studied in 19 cases of therapy. A qualitative methodology was used to describe the sequence of 11 resolved and 8 unresolved misunderstanding events. Results indicate that a good relationship, clients' willingness to assert negative feelings about being misunderstood, and therapists' facilitation of a mutual repair effort through maintaining a flexible and accepting stance typically led to resolution. In contrast, a poor relationship, therapists' unwillingness to discuss or accept clients' assertion of negative reactions to being misunderstood, or therapists' lack of awareness of clients' negative feelings led to unresolved misunderstandings and often to clients quitting therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between self-talk and therapy process variables for novice therapists.

The purpose of this study was to examine the affect and focus of therapists' self-talk in relation to other therapy across process variables, specifically their perceptions of their own helpfulness and their clients' negative reactions, after taking into consideration the perceived strength of the working alliance. Participants included 31 therapists-in-training who listened to an audiotape of a therapy session while completing a thought listing procedure and process measures. Results indicated that self-talk was related to perceptions of the therapy process such that when therapists thought negatively about themselves, they perceived themselves as less helpful and thought their clients were reacting more negatively. The results suggest the importance of both the awareness and management of therapists' self-talk in relation to their perceptions of themselves and their clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Less Directiveness by Therapists Improves Drinking Outcomes of Reactant Clients in Alcoholism Treatment.

In this study, the authors examined the impact of the interaction between clients' trait reactance and therapists' directiveness on the effectiveness of psychotherapy treatment for alcoholism. Ratings of videotaped treatment sessions were used to measure clients' reactance (N = 141) and therapists' directiveness. Models tested for the interaction as a predictor of 1-year posttreatment drinking quantity and frequency. Results indicate that directiveness had a negative impact on outcomes for clients at medium and high levels of reactance but did not affect drinking among clients low in reactance. Increased therapist use of interpretation, confrontation, and introduction of topics was most predictive of more frequent and larger quantities of drinking among reactant clients. This study suggests that research on treatment process can yield significant theoretical and clinical benefits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rights of clients, responsibilities of therapists.

Discusses ways in which ethical principles can be put into practice in the client–therapist relationship. Historically, ethical codes for therapists were drawn up to protect the professions from regulation by external agencies. Implicit in the ethical codes, however, is a model for the client–therapist relationship that fosters the goals of mental health. It is suggested that just as ethical codes have been given specific content in standards for providers of psychological services in human service facilities, ethical codes can be given specific content in the client–therapist relationship. It is recommended that therapists take responsibility for incorporating ethical standards into their practices so that clients' rights will be an integral part of therapy. Four illustrative situations are presented: providing clients with information to make informed decisions about therapy, using contracts in therapy, responding to clients' challenges to therapists' competence, and handling clients' complaints. (63 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of locus of control on counseling expectations of clients.

Investigated the relation between clients' locus of control and expectations of therapeutic outcome among 67 clients (mean age 29 yrs) with mild neurotic problems. Clients were asked to estimate their likely success with therapists presented in a series of videotaped role plays. The role plays depicted the locus of control, sex, and social class of therapists. Results indicate that there was a significant interaction between clients' and therapists' locus of control in relation to clients' judgment of clinical success: Internal clients anticipated greater success with internal therapists, and external clients expected greater success with external therapists. Implications for the counseling process are discussed. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Same difference: Black therapists' experience of same-race therapeutic dyads.

Do Black therapists experience their work with Black clients differently than their work with other clients? A phenomenological study of 12 Black psychologists, social workers, and counselors working in college counseling centers examined these therapists' lived experience of same-race therapeutic dyads. The therapists described the unique aspects of their therapy with Black clients, as well as how they learned to perform that work. The implications of this study are vital not only to Black therapists, but also to educators and supervisors of Black therapist trainees. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Ambiguity tolerance of therapists and process changes of their clients.

Investigated the relationships between 18 student-therapists' tolerance for ambiguity in visual perception tasks and (a) the positive affect displayed toward them by their 22 student clients, (b) changes in proportions of clients' self-reference statements, and (c) measures of improvement in clients' "adjustment." Results show an increase in clients' positive affect toward the therapists but no relationship between changes in clients' affect toward their therapists or the number of their self-reference statements and the therapists' tolerance for ambiguity. Clients of ambiguity-tolerant therapists described themselves more negatively, but all but 2 clients described themselves more favorably later in therapy. No positive correlation was obtained between client and therapist affect toward each other. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Facilitating informed consent for outpatient psychotherapy: A suggested written format.

Although the responsibility of psychologists to inform clients fully about psychotherapy is clear, an adequate procedure for doing so is not. We present a written format designed to facilitate the informed consent process. The format is a series of questions that clients have a right to ask and has several advantages over narrative forms: It preserves clients' rights to refuse information, it is less overwhelming, it fosters conversation between therapist and client, and it is readable. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Envisioning the representational world: The client's experience of metaphoric expression in psychotherapy.

Investigated the interactive nature of clients' and therapists' experiencing during the expression, apprehension, and elaboration of metaphors. Analysis of audiotaped inquiry interviews between 4 clients (in therapy for at least 12 sessions) and 4 therapists (1 psychoanalyst, 1 Gestalt therapist, and 2 eclectics within a person-centered and psychodynamic framework) was conducted. Metaphors emerged from the associated meaning context when participants attempted to verbally depict felt experiences during therapy sessions. Metaphors symbolized inner experience by (1) providing an associative link to the experience, (2) representing aspects of self-identity, and (3) symbolizing role relationship patterns. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Loss of self" in the narratives of people with traumatic brain injuries: a qualitative analysis

To discover how people with traumatic brain injuries (TBI) experience themselves, narrative data from ten individuals with TBI were analyzed. The findings suggest that people with TBI experience loss of self in various forms although they may successfully use strategies to avoid or minimize the sense of loss. First, people with TBI find it difficult to develop clear self-knowledge about how they have become as they are and what they can and cannot do. Second, loss of self is conspicuous when they compare their present status with their past in many aspects of their lives. Third, their senses of self are threatened by labels that they feel the society imposes upon them. This categorization of loss of self can serve for rehabilitation counseling of this population. It may assist counselors to enhance their understanding of emotional distress after TBI and to make use of their clients' narratives for the intervention.     

Incidental encounters between therapists and clients: The client's perspective.

A questionnaire concerning clients' feelings about incidental encounters with therapists was administered to 147 university counseling center clients. Results indicated that most clients had experienced brief incidental encounters with their therapists. Clients generally felt comfortable with their therapists' responses, but some wanted a more involved response from their therapist. The feelings that clients reported experiencing most frequently were confidence, surprise, awkwardness, enjoyment, curiosity, and anxiety. Implications for further research and training are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment duration prediction: Client accuracy and its relationship to dropout, outcome, and satisfaction.

The relationship of clients' expected and actual treatment duration was investigated for 230 clients in private practice settings. Clients both expected and attended a relatively low number of visits. These patterns were discrepant with therapists' duration expectations. A stepwise regression analysis indicated that clients' expected number of visits was the single best predictor of clients' actual number of visits and that history of eating disorder, therapist's degree, and client's years of education also contributed to actual number of visits. Clients who attended fewer sessions than expected had lower satisfaction, better outcome on two of six measures, and were more often identified as dropouts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between therapist and client social class and participation in psychotherapy.

Conducted a replication of a study by the 1st author and T. M. Namenek (see record 1970-21092-001) in which therapists' estimates of their typical clients' social class were significantly related to the therapist's own discipline and self-ascribed socioeconomic background. The relationship between the therapist's discipline and socioeconomic background was also significant. Based on independent estimates of the social-class background and present social class of 48 therapists (mean age 39 yrs) and 98 of their clients, the present study partially replicates only one of Mitchell and Namenek's findings, namely, that the relationship between the therapist's discipline and background status tended toward significance. There was, however, a significant difference between the social class of typical as opposed to actual clients for all therapists and for each discipline separately. This difference was primarily due to the preponderance of lower-class clients among the actual clients of all 3 therapist groups (psychologists, psychiatrists, and both groups together). (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)