The meaning of eclecticism: New survey and analysis of components.

Among the many forms of psychotherapy mental health professionals practice, eclecticism has become the center of renewed interest. In a national survey, we identified the theoretical orientations of 423 mental health professionals. A majority of psychotherapists use an eclectic form of therapy. Our results are compared with other surveys in a review of 25 studies of psychotherapists, and differences between the surveys are discussed. We further examine eclecticism by analyzing its individual components; psychodynamic theory is apparently the most influential viewpoint. We also examine the differences between eclectics in 4 professional subgroups (psychologists, psychiatrists, social workers, and marriage and family therapists). Differences are noted in the content of the eclectic psychotherapy in each subgroup. Implications for practice and research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparing professional and lay expectations of psychotherapy.

Compared 25 mental health professionals whose primary duties involved psychotherapy with 52 laypersons aged 18–51 yrs to determine similarities and differences in their expectations of psychotherapy. Ss were administered the Therapy Expectations Scale. Differences between the 2 groups were found in degree of expected change, importance of self in problem-solving, financial emphasis, and expected duration of psychotherapy. Similarities were found in socioenvironmental areas and in emphasis on the early years of life. Laypersons tended to appreciate the active role of the client in psychotherapy and viewed therapists as experts in problem-solving. It is suggested that greater efforts be made to educate the general public as well as individual clients about the realities of psychotherapy. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Racial/ethnic disparities in therapist effectiveness: A conceptualization and initial study of cultural competence.

As a result of mental health disparities between White and racial/ethnic minority clients, researchers have argued that some therapists may be generally competent to provide effective services but lack cultural competence. This distinction assumes that client racial/ethnic background is a source of variability in therapist effectiveness. However, there have been no direct tests of the therapist as a source of health disparities. We provided an initial test of the distinction between general and cultural competence by examining client racial/ethnic background as a source of variability in therapist effectiveness. We analyzed cannabis use outcomes from a psychotherapy trial (N = 582) for adolescent cannabis abuse and dependence using Bayesian multilevel models for count outcomes. We first tested whether therapists differed in their effectiveness and then tested whether disparities in treatment outcomes varied across therapist caseloads. Results suggested that therapists differed in their effectiveness in general and that effectiveness varied according to client racial/ethnic background. Therapist effectiveness may depend partially on client racial/ethnic minority background, providing evidence that it is valid to distinguish between general and cultural competence. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Patterns of mental health service utilization

How many and which individuals, with which psychiatric disorders, receive (and do not receive) mental health services from which professionals in what settings? This question falls within the purview of mental health services research, which is a multidisciplinary field that brings together the methodologies of epidemiology, econometrics, and clinical research. First, in this article, we present an explication of what is known about those individuals in need of psychotherapy and how they access services. Next, we describe the numbers, professional affiliations, and service sites of professionals who are engaged in the practice of psychotherapy. We summarize our current knowledge about the actual utilization of psychotherapy services relative to the needs of patients and the professional background of therapists. Finally, we identify aspects of psychotherapy service utilization that are, as yet, unaddressed.     

Sex roles and psychotherapy: A current appraisal.

Reviews the current status of research on the effects of sex-role stereotypes on mental health judgments. Studies in this area have addressed (a) whether there are different sex-role-related standards of mental health for men and women, (b) if violations of sex role norms result in adverse mental health judgments, and (c) if therapists set sex-role-related goals for their clients. It is concluded that sex-role stereotypes are strong mental health cues for nonprofessionals, with violations of sex-role norms leading to adverse mental health judgments, but that while professionals share the sex-role stereotypes of their lay contemporaries, the professionals are unaffected by them in making mental health judgments and in setting therapeutic goals. This discrepancy between stereotypes and behavior may be due to any of 3 factors: the methodological limitations of the studies, actual differences in mental health between men and women, or normal attitude–behavior discrepancies. (2 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

National health insurance, psychotherapy, and the poor.

Debate on psychotherapy coverage under national health insurance has centered around perceived inequitable service to different income groups. It has been argued that national health insurance coverage for psychotherapy would represent a subsidy to the affluent by poorer citizens. Four pertinent hypotheses were examined in a series of studies of 5,967 patients in community mental health centers. It has been maintained that the poor would not seek psychotherapy, would receive fewer sessions, would receive either less prestigious treatments or less trained therapists, and would benefit less than the more affluent. None of these hypotheses were supported. The implications of these findings are discussed in terms of psychotherapy coverage under national health insurance and the role of psychologists in a national system of service delivery. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of patient and therapist evaluations of time-limited psychotherapy.

Obtained empirical data regarding the degree of congruence between therapists' and patients' evaluations of brief psychotherapy on a session-by-session basis and posttreatment and compared these data with predictions derived from J. Mann's (1973) model of the process of brief psychotherapy. 28 17–34 yr old students who were seen in brief psychotherapy (6–22 sessions) by 6 university mental health staff served as Ss. Patients and therapists completed an evaluative questionnaire at the conclusion of each session and at 1–4 wks posttreatment. Sessions were treated as falling into the early, middle or final phase of treatment by dividing the total number of sessions into equal thirds. Without exception, patients' evaluations were higher than those of therapists, both session-by-session and posttreatment. Therapists gave evidence of appreciating this discrepancy but underestimated its magnitude. Results are viewed as largely consistent with predictions derived from Mann's model of brief psychotherapy and as lending support to the model's validity. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empirically certified treatments or therapists: The issue of separability.

Forms of psychotherapy treatment are not neatly separable from one another in actual practice. They differ behaviorally in what they emphasize, but nevertheless they overlap and so cannot be unambiguously compared for effectiveness. Furthermore, forms of psychotherapy are not separable in practice from the therapists who apply them, so apparent differences in effectiveness between forms of treatment are always confounded by differences in effectiveness between therapists. Therapists, however, are separable from one another, and it is therapists not treatment forms that actually treat patients. Therefore, what should primarily be given preference in practice is not treatments empirically certified on the basis of their results in randomized clinical trials but psychotherapists empirically certified to practice on the basis of their results in actual practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy in the real world.

Community or school-based services may be the answer to meeting the needs of disadvantaged or poor children and youth and their families. This article focuses on lessons learned in treating a special population of children and families and discusses how therapists in the real world often modify treatment protocols to address the specific needs of their patients. Office-based settings and traditional psychotherapy approaches may not be salient to meeting the mental health needs of a vast group of children, youth, and families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting outcomes of psychotherapy: A comparison of predictions from two attitude theories.

Compared social judgment and dissonance theory in their ability to predict the outcomes of psychotherapy on the basis of patient-therapist attitudinal similarity. 65 mental health clinic outpatients of 16 therapists were given attitude questionnaires before and after approximately 12 therapy contacts. It was found that dissonance theory was better able than social judgment theory to predict both those attitude changes that took place and the amount of similarity that a patient perceived between himself and his therapist. On the other hand, certain concepts from social judgment theory did prove efficacious in predicting certain kinds of outcomes among certain therapy conditions, but not in the manner predicted. Finally, certain outcomes of psychotherapy were found to be unpredictable from either theory studied. (15 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceptions of the psychotherapy relationship in long- versus short-term therapy.

Examined participant perceptions of therapy by comparing long- with short-term therapy dyads. 30 therapy dyads from 3 large midwestern community mental health centers were included. Therapists and clients (20–49 yrs old) completed the Therapy Session Report 4 times and the Survey of Interpersonal Values twice immediately following scheduled therapy sessions. Results indicate that therapists and clients in long-term therapy dyads were more phenomenologically congruent in their feelings toward psychotherapy and each other and in their perceptions of therapeutic goals and processes than were therapists and clients in short-term therapy dyads. Often these perceptions were shared at the very outset of therapy. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Developing culturally sensitive psychodynamic case formulations: The effects of Asian cultural elements on psychoanalytic control-mastery theory.

Examined the effects of traditional Asian cultural norms, family roles, and values upon the psychodynamic formulation of a 25-yr-old Asian American man. The main tenets of control-mastery theory (CMT; J. Weiss et al [1986]), a cognitive approach to psychoanalytic psychotherapy, are presented, and its plan formulation method is discussed. The need for a more comprehensive consideration of Asian culture, Asian-American identity formation, and acculturative stress in clinical case formulations is presented. Theory modifications are discussed that should help to reconcile differences between the Western values inherent in CMT and traditional Asian approaches to psychotherapy and mental health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The therapist as patient: Special problems and considerations.

Argues that despite the awareness among mental health professionals of the need for the care of fellow practitioners, with emphasis on professional burnout and occupational counseling, the difficulties encountered by therapists in the treatment of their colleagues have been noticeably neglected. Based on experience treating colleagues, interventions and insights designed to avoid pitfalls while facilitating treatment are offered. It is suggested that the choice of a therapist should permit the patient a reasonable degree of social life-space anonymity, a sense of compatible treatment values and philosophy, and knowledge of and respect for the therapist's professional expertise. Factors that motivate a therapist to seek personal therapy are often more complex in reality than for the general patient population. Therapists who become patients have apprehensions that feelings emerging in their own psychotherapy will erode the carefully honed sense of self-as-healer/patients-as-wounded paradigm. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diversity within African American, female therapists: Variability in clients' expectations and assumptions about the therapist.

Despite the presence of some literature that has addressed the characteristics of the African American female therapist, most psychotherapy training proceeds with the assumption that therapists are members of dominant groups, and most of the psychological and psychotherapy literature has been written by therapists and psychologists who come from dominant cultural perspectives. Not as much has been written about psychological paradigms or the process of psychotherapy from the perspective of the therapist who is not a dominant group member. This article explores both the common and divergent experiences that we, the authors, share as African American female therapists and the different reactions we frequently elicit in clients. We also explore how individual differences in our physical appearances, personal backgrounds, and different characteristics of our respective practices elicit distinct responses from clients that we believe are based on differences between us, despite the fact that we are both African American women. We believe that many of the stereotypes that affect perceptions of African American female clients also exist for African American female therapists. We will address how the intersection of gender, race, and sexual orientation of the client highlights the complexity of culturally competent practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of a client pretherapy orientation videotape.

Examined the effects of a videotaped psychotherapy orientation on clients' response to therapy, knowledge about therapy, utilization of services, and satisfaction with services and on therapist ratings of client attractiveness. 62 psychotherapy clients (mean age 29 yrs) at an urban community mental health center were randomly assigned to an oriented group, which viewed a pretherapy orientation videotape at admission, or to a control group. 14 therapists participated. The 11-min videotape described the relationship between client and therapist, encouraged clients to attend appointments, and stated that, although progress is rarely immediate, most clients find that therapy can lead to a reduction in anxiety and depression. Clients and therapists completed questionnaire and rating scales at intake and at 1-mo follow-up. It was found that oriented clients were able to understand and recall the information in the videotape, and the oriented group showed a greater decrease in self-reported symptoms than the control group after 1 mo. Client feedback regarding the videotape was favorable. In general, the 2 groups did not differ in their satisfaction with services, service utilization, or therapist ratings of client symptoms and functioning. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correction to Larsson, Kaldo, and Broberg (2009).

Reports an error in "Similarities and differences between practitioners of psychotherapy in Sweden: A comparison of attitudes between psychodynamic, cognitive, cognitive–behavioral, and integrative therapists" by Billy P. M. Larsson, Viktor Kaldo and Anders G. Broberg (Journal of Psychotherapy Integration, 2009[Mar], Vol 19[1], 34-66). The results of the post hoc tests were printed illegibly. In order to make it possible for the reader to understand which of the effect sizes belong to which of the comparisons, the tables are clarified in this erratum. (The following abstract of the original article appeared in record 2009-03150-003.) This study focuses on similarities and differences between Swedish psychotherapists of four orientations: psychodynamic, cognitive, cognitive–behavioral, and integrative therapy. The aim is to describe similarities and differences regarding (a) background factors, (b) focus in psychotherapy, (c) attitudes toward psychotherapy as art/craftsmanship, (d) scientific outlook, (e) what characterizes a good psychotherapist, and (f) how psychotherapy ought to be pursued. The therapists had very similar attitudes about the therapeutic relationship and rather similar attitudes about which effects psychotherapy ought to obtain. The greatest differences were related to psychotherapeutic techniques and science. The results are discussed with emphasis on the distance or proximity between the orientations. The conclusion is that there are differences between psychodynamic psychotherapy compared with cognitive and cognitive–behavioral therapies, which imply difficulties in integrating these orientations. However, the differences between the cognitive and cognitive–behavioral therapists are not of such a magnitude that they necessarily present an obstacle to integration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attachment patterns in the psychotherapy relationship: Development of the Client Attachment to Therapist Scale.

A panel of 9 therapists generated items for an instrument designed to measure the psychotherapy relationship from the perspective of attachment theory. The initial version of the Client Attachment to Therapist Scale (CATS) contained 100 items that were administered at 4 counseling agencies in survey packets to 138 clients who had completed at least 5 sessions with their therapists. Factor analysis suggested that 36 items loaded on 3 subscales, labeled Secure, Avoidant–Fearful, and Preoccupied–Merger. CATS factors correlated in expected directions with survey measures of object relations, client-rated working alliance, social self-efficacy, and adult attachment. Cluster analysis identified 4 types of client attachment. Significant differences in social competencies (e.g., object relations) were evident across types of attachment. Implications of attachment patterns for the understanding of client transference are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Interpersonal psychotherapy of depression.

Reviews the book, Interpersonal psychotherapy of depression by Gerald L. Klerman, Myrna M. Weissman, Bruce J. Rounsaville, and Eve S. Chevron (1984). The authors state their intention to "describe the theoretical and empirical basis for interpersonal psychotherapy of depression," and also "offer a guide to the planning and conduct of the therapy." They do both, and waste no words. The book is organized into three parts. In the first part, the authors present an overview of the theory of the interpersonal approach of the use of interpersonal psychotherapy for depression, objectively offer both favorable and unfavorable findings from completed studies, and outline several studies in progress. The chapters in Part Two clarify how one conducts interpersonal therapy of depression. Part Three addresses the combination of psychotherapy with pharmacotherapy and the professional requirements of the therapist. This book is clearly written, well referenced, and easily understood by beginners who might not have the perspective, as well as by busy veterans who want to learn something new without plowing through mountains of theory and data. It would be useful for students in training, and extremely valuable to the legions of relatively inexperienced front-line mental health center therapists who are required to use time-limited approaches with depressed patients, often without having much structure for what they are doing. More experienced therapists who treat ambulatory depressed patients will add to their clinical skills and enjoy the process. The authors have turned their manual into a useful book that competes most favorably with other texts on short-term approaches to therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief psychotherapy and psychological assessments: Entering a relationship, establishing a focus, and providing feedback.

Brief psychotherapy is aimed at facilitating change within a circumscribed time frame. To do this, therapists in this specialty actively engage clients, establish a focus to the treatment, and provide ongoing feedback throughout treatment. The authors show how using these features of brief psychotherapy in the assessment process can enhance the clinical usefulness of an assessment. By also incorporating an emphasis on respect for the client, in line with existential/client-centered principles, psychological assessments can be made more personally relevant and meaningful for the client. The approach outlined has been useful within a hospital-based, adult inpatient and outpatient mental health service in which assessments are conducted before starting psychotherapy or as clinical activities in themselves (e.g., psychodiagnosis). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A relationship between childhood sexual abuse and professional sexual misconduct.

This article identifies specific factors that place therapists at risk for engaging in sexual activity with clients and provides guidelines to minimize the likelihood of such behavior. In a national, randomly drawn sample of 323 mental health practitioners, 3 of 5 men who reported severe childhood sexual abuse and whose psychological symptoms met the criteria for a high degree of psychological distress reported sexual boundary violations with clients. High-risk clinicians should avoid the isolation of private practice, closely monitor their boundaries with clients, obtain ongoing professional supervision, and seek personal psychotherapy to address any remaining abuse-related issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)