Psychotherapist mindfulness and the psychotherapy process.

[Correction Notice: An erratum for this article was reported in Vol 47(2) of Psychotherapy: Theory, Research & Practice (see record 2010-13424-005). the order of authorship and the affiliations of the authors was incorrectly printed. The correct order and affiliations are as follows: Noah Bruce, Shauna L. Shapiro, Michael J. Constantino, and Rachel Manber; Kaiser Permanente, Santa Clara University, University of Massachusetts, Stanford University] A psychotherapist’s ability to relate to his or her patients is essential for decreasing patient suffering and promoting patient growth. However, the psychotherapy field has identified few effective means for training psychotherapists in this ability. In this conceptual article, we propose that mindfulness practice may be a means for training psychotherapists to better relate to their patients. We posit that mindfulness is a means of self-attunement that increases one’s ability to attune to others (in this case, patients) and that this interpersonal attunement ultimately helps patients achieve greater self-attunement that, in turn, fosters decreased symptom severity, greater well-being, and better interpersonal relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal psychotherapy with men who experience gender role conflict.

Although research on men's gender role conflict reveals that it adversely affects men's psychological health and interpersonal relationships, psychotherapists typically underuse knowledge of masculine gender roles in psychological assessment and treatment. Interpersonal psychotherapy is proposed as a useful framework for working with men whose rigid enactment of traditional male gender roles leads to intrapersonal and interpersonal conflict (i.e., gender role conflict). Thus, this article integrates knowledge of male gender role conflict and interpersonal psychotherapy to examine issues that men who experience gender role conflict bring to their important interpersonal relationships and the therapeutic relationship. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What are the benefits of mindfulness? A practice review of psychotherapy-related research.

Research suggests that mindfulness practices offer psychotherapists a way to positively affect aspects of therapy that account for successful treatment. This paper provides psychotherapists with a synthesis of the empirically supported advantages of mindfulness. Definitions of mindfulness and evidence-based interpersonal, affective, and intrapersonal benefits of mindfulness are presented. Research on therapists who meditate and client outcomes of therapists who meditate are reviewed. Implications for practice, research, and training are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Empirical search for psychotherapists' gender competence in psychotherapy.

Over the past half century, psychotherapy research has demonstrated that psychotherapy outcomes do not vary based on clients’ gender (Clarkin & Levy, 2004; Garfield, 1994; Wierzbicki & Pekarik, 1993). However, most studies assumed that all psychotherapists are equally competent to treat men and women, thus potentially missing essential information about variations in psychotherapy outcomes. In fact, there is a paucity of studies that have examined if psychotherapists’ gender competence truly exists. We propose that psychotherapists’ gender competence should be defined as the psychotherapist’s ability to achieve positive psychotherapy outcomes with either female or male clients. This study examined the relationship between clients’ gender and psychotherapy outcomes and if psychotherapists varied in their abilities to produce positive psychotherapy outcomes for female and male clients. The sample included 93 male and 229 female clients treated by 31 psychotherapists. Consistent with previous research, the results demonstrated that clients’ gender was not related to psychotherapy outcomes. However, compared to other psychotherapists, some psychotherapists were better at treating men, whereas others were better at treating women. The results of this study demonstrate that psychotherapists’ gender competence exists and relates directly to the psychotherapy outcomes (i.e., psychological well-being) of clients. Implications for psychotherapy practice, training, and research are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapists view their personal therapy.

Studied the long-term effects of intensive psychotherapy or psychoanalysis on a sophisticated group of patients—practicing psychotherapists who had previously been in treatment. A comprehensive questionnaire was distributed to 97 30–60 yr old psychotherapists preselected by having completed personal psychotherapy or psychoanalysis. The items focused on subjective experiences in psychotherapy, the elucidation of intrapsychic effects, and Ss' perception of outcome. Positive benefits of treatment involved improvements in self-esteem as well as interpersonal relations. Symptom alleviation was ranked as the least important benefit. Improvement in all areas (including self-esteem, work function, sex life, social relations, character change, and alleviation of symptoms) positively correlated with the feeling of being liked by and liking the therapist. The emotional "tone" of the treatment situation as exemplified by aspects of the patient–therapist relationship appeared to be critical to a positive outcome. 21% of the Ss reported that their treatment was also harmful in some fashion. Data suggested that unresolved transference issues were central to a negative effect. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapists’ attachment, patients’ interpersonal problems and alliance development over time in inpatient psychotherapy.

The focus of this study is the investigation of the relation between patients’ interpersonal problems, therapists’ attachment representations, and the development of the therapeutic alliance over time. The authors investigated weekly alliance ratings of 281 psychotherapy inpatients, treated by 12 psychotherapists. Alliance quality was measured with the Inpatient Experience Scale. Multilevel regression models showed that patients’ interpersonal problems were associated with the level of alliance quality. Therapists’ attachment security was not related to alliance development, but higher attachment preoccupation of therapists was associated with lower levels of alliance quality. In addition, an interaction effect between therapists’ degree of attachment preoccupation and patients’ interpersonal problems explained variations of the alliance development curve over time. Limitations of the study are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client attachment style and the psychotherapist's interpersonal stance.

Attachment style is proposed as an important client variable that psychotherapists may need to assess in order to tailor their interpersonal stance in psychotherapy. The authors draw on J. Bowlby's (1969, 1973, 1978) attachment theory and describe the therapeutic implications of 3 adult attachment styles: Anxious/Ambivalent, Avoidant, and Secure. Results are summarized from a psychotherapy research program, including the finding that attachment style was related to symptomatology and to therapists' perceptions of the therapeutic alliance. Case illustrations of clients displaying the 3 types of attachment style are presented to illustrate how therapists can productively alter their interpersonal stance to enhance treatment outcome. (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)     

Patient interpersonal impacts and the early therapeutic alliance in interpersonal therapy for depression.

The therapeutic alliance consistently predicts positive psychotherapy outcomes. Thus, it is important to uncover factors that relate to alliance development. The goal of this study was to examine the association between patient interpersonal characteristics and alliance quality in interpersonal therapy for depression. Data derive from a subsample (n = 74) of a larger naturalistic database of outpatients treated at a mood disorders clinic of a university-affiliated psychiatric hospital. Following Session 3 of treatment, therapists completed the Impact Message Inventory (Kiesler & Schmidt, 1993) to assess patients' interpersonal impacts on them. Also following Session 3, patients completed the Working Alliance Inventory (Horvath & Greenberg, 1989) to assess alliance quality. As predicted, patients' affiliative interpersonal impacts, as perceived by their therapists, were positively associated with alliance quality, controlling for baseline depression severity. Although unrelated to the initial hypotheses, patients concurrently taking psychotropic medications reported better alliances than patients receiving psychotherapy only. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of conducting psychotherapy on psychotherapists' interpersonal functioning.

Reviews the literature and presents several scenarios concerning the impact of practicing psychotherapy on the psychotherapist, focusing on the effects on their interpersonal functioning. Findings reveal such positive consequences of practicing psychotherapy as increased assertiveness, self-assurance, self-reliance, and self respect; negative consequences include increased anxiety and higher suicide and alcoholism rates. Ways to minimize or eliminate possible negative consequences are suggested, including alerting psychotherapists to the potential problems, more adequate screening and monitoring of allied mental health professionals at the pre- and postgraduate level, and monitoring of professionals in the field by postgraduate professional organizations. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists conducting psychotherapy: New findings and historical comparisons on the psychotherapy division membership.

481 American Psychological Association Division 29 psychologists engaged in psychotherapy returned a mailed questionnaire concerning their characteristics, activities, affiliations, theories, and satisfactions. Results are described and compared with findings of a similar study completed a decade ago. Among the most salient findings were (1) an aging profession that shows high career satisfaction and increased employment in independent practice; (2) 70% endorsement of psychodynamicism or psychoanalysis as a primary or secondary orientation; (3) an escalating proportion of female psychotherapists, whose employment in independent practice is more than 2.5 times greater than in 1981; and (4) a negligible increase in minority therapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The "ins and outs" of enactment: A relational bridge for psychotherapy integration.

Patients' enactments--their reflexive attempts to influence interpersonal interactions in particular ways based on their psychodynamics, both with the therapist and with others outside the psychotherapy setting--provide an important avenue for advancing the complex task of integrating action-oriented techniques with in-depth exploration. This article, written from a relational psychoanalytic perspective, shows how enactments create a valuable bridge for thinking about and practicing psychotherapy integration. To be most effective, psychotherapists must deal both behaviorally and psychodynamically with enactments, using integrative interventions that simultaneously encourage constructive new and adaptive behaviors, promote important new mutative relational experiences with therapists and with others, and facilitate deep insight. Acting together, these processes contribute to structural, including behavioral, personality reorganization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client perceptions of therapists: A study of the therapeutic relation.

A study was designed to identify the main ways that clients perceive their psychotherapists. An inventory of 65 statements was constructed to measure 8 postulated interpersonal behavior patterns. The inventory was administered to 523 patients in treatment for at least 3 mo. A factor analysis disclosed 5 dimensions of perceived therapist behaviors. The dimensions were labeled Accepting, Understanding, Authoritarian, Independence-Encouraging, and Critical-Hostile. The findings were shown to be consistent with constructs proposed by Fiedler, Apfelbaum, and Rausch and Bordin. Patient and therapist ratings of improvement were found to relate significantly to therapist Acceptance and Understanding. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outcomes in group psychotherapy: Using persuasion theory to increase treatment efficiency.

Attempted to predict the outcomes of group psychotherapy using attitude theory. 34 group therapy patients and their therapists were tested on a questionnaire designed to measure 7 attitudes varying in centrality. At the conclusion of 3 mo of therapy, it was found that among attitudes of medium centrality initial attitude difference between patient and therapist was more strongly related to attitude change than were either attitude similarity or acceptability. However, initial patient-therapist similarity and acceptability of attitudes were related more to patient-rated improvement than was attitude dissimilarity. Results are discussed as they relate to psychotherapy as an interpersonal influence process, predictable by persuasion theory. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correction to Castonguay et al. (2010).

Reports an error in "Psychotherapists, researchers, or both? A qualitative analysis of psychotherapists' experiences in a practice research network" by Louis G. Castonguay, Dana L. Nelson, Mary A. Boutselis, Nancy R. Chiswick, Diana D. Damer, Neal A. Hemmelstein, Jeffrey S. Jackson, Marolyn Morford, Stephen A. Ragusea, J. Gowen Roper, Catherine Spayd, Tara Weiszer and Thomas D. Borkovec (Psychotherapy: Theory, Research & Practice, 2010[Sep], Vol 47[3], 345-354). The first sentence of the second paragraph of the author note on page 345 was incorrect. The corrected sentence is as follows: “The study was conducted with funding provided by the Pennsylvania Psychological Association and the Committee for the Advancement of Professional Practice of the American Psychological Association”. (The following abstract of the original article appeared in record 2010-20923-008.) This paper describes the experiences of psychotherapists who, as part of a practice research network (PRN), collaborated with researchers in designing and conducting a psychotherapy study within their own clinical practices. A qualitative analysis of interviews conducted with these psychotherapists led to the delineation of several benefits (e.g., learning information that improved their work with clients and feeling that they were contributing to research that would be useful for psychotherapists) and difficulties for them and their clients (e.g., time and effort required to integrate research protocol into routine clinical practice) that psychotherapists associated with their participation in the PRN. Also identified were a number of strategies used by psychotherapists to address obstacles that they encountered, as well as general recommendations for future PRN studies. As a whole, the experiences of these psychotherapists are likely to provide valuable lessons for the survival and growth of what is viewed by many as a promising pathway for building a stronger bridge between practice and research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mending the gap: Introduction to the invited commentaries on Dinger, Strack, Sachsse, and Schauenburg (2009).

Introduces several commentaries on an article by U. Dinger et al (see record 200913603-002) entitled “Therapists’ attachment, patients’ interpersonal problems and alliance development over time in inpatient psychotherapy.” This article represents an ambitious effort on the part of the researchers to map a number of interrelated relational variables, over the course of treatment, in a relatively understudied patient population. “Attachment,” “interpersonal problems,” and “alliance” are variables that capture core components of the therapeutic relationship and psychotherapy process that have been reliably linked to patient improvement in many previous studies of mostly outpatient psychotherapy. Jeremy Holmes (see record 2009-13603-003) and George Silbershatz (see record 2009-13603-004) were invited to comment on this study while wearing their clinical hats. They were asked about how they made sense of the research results as practicing psychotherapists, the ways in which the findings were useful to them as clinicians, and where they considered the research to be of more limited value from a clinical point of view. Following the commentaries is a final word from the authors of the study (see record 2009-13603-005). It is hoped that this format of dialogue will have an impact on how clinical research is presented in the future. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Decision making and psychotherapy integration: Theoretical considerations, preliminary data, and implications for future research.

In recent years, a number of publications have called for investigation of how psychotherapists make treatment decisions in clinical practice. This recommendation is particularly salient for psychotherapy integration, as studies have consistently shown that a plurality of American clinicians consider themselves to be either "eclectic" or "integrative" in theoretical orientation. Yet, the research on clinician decision making in psychotherapy is in its infancy. This article examines the need for decision-making research in psychotherapy integration, as well as aspects of psychotherapy integration that are targets for research and possible theoretical frameworks for understanding decision-making processes of integrative psychotherapists. A preliminary study provides data from practicing psychotherapists to illustrate these points. Finally, implications and directions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomised controlled assessment of non-directive psychotherapy versus routine general-practitioner care

BACKGROUND: We compared the efficacy of and patients' satisfaction with general-practice-based psychotherapists with those of general practitioners in providing treatment to people with emotional difficulties. METHODS: We carried out a prospective, randomised, controlled trial of brief, non-directive psychotherapy and routine general-practice care. Therapists adhered to a non-directive Rogerian model of psychotherapy. Between one and 12 sessions of psychotherapy were given over 12 weeks in 14 general practices in north London, UK. Of 136 patients with emotional difficulties, mainly depression, 70 patients were randomly assigned to the therapist and 66 to the general practitioner. Depression, anxiety, other mental-disorder symptoms, and social adjustment were measured by self-report at baseline, 3 months, and 9 months. Patients' satisfaction was also measured by self-report at 3 and 9 months. FINDINGS: All patients improved significantly over time. There were no significant differences between the groups receiving brief psychotherapy and routine general-practitioner care. Patients assigned brief psychotherapy were more satisfied with the help they received than those assigned to the general practitioner at both 3 and 9 months' follow-up (mean scores on satisfaction scale 50.9 [SD 7.9] vs 44.4 [9.8] and 45.6 [9.4] vs 37.1 [11.2], respectively). INTERPRETATION: General-practitioner care is as effective as brief psychotherapy for patients usually referred by doctors to practice-based psychotherapists. Patients with emotional difficulties prefer brief psychotherapy from a counsellor to care from their general practitioner.