Counselor and helpee perceptions of counselor intentions in relation to outcome in a single counseling session.

Determined whether counseling session could be predicted from different variables (i.e., counselor intentions, helpee's perceptions of counselor's intentions, match between counselor and helpee on intentions), focusing on counselors' and helpees' perceptions. Four 32–43 yr old experienced counselors each saw 4 undergraduate helpees for single 50 min counseling sessions. Counselors and helpees evaluated sessions and then reviewed videotapes during which counselors identified their intentions and helpees rated the helpfulness for each counselor turn. Results indicate that helpees perceived more intentions to support, focus, and clarify and less self-control and resistance than counselors had intended. The highest match between counselors and helpees occurred for getting information, setting limits, and clarifying. Helpees' ratings of helpfulness were highest for counselors' intentions involving needs, resistance, cognitions, and relationships, and lowest for setting limits, getting information, supporting, and focusing. Session outcome was related to different counselor and client perceptions, indicating that participants valued different events within sessions. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Case study of the process and outcome of career counseling.

The process and outcome of a career counseling case was studied. Across the course of the 7 sessions, the 43-yr-old client attained her career goals and increased both her career exploration and her exploration stress. She decreased exploration stress, maintained other changes, and crystallized her career goals by the 18-mo follow-up. Compared with her behavior in personal counseling, this counselor mostly used intentions of support, insight, and feelings but gave more information and set limits in career counseling. On the basis of 5 analyses, the most helpful counselor intentions were give information, support, clarify, feelings, insight, change, reinforce change, challenge, and relationship. The helpful ingredients of career counseling are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exploring a psychotherapeutic change sequence: Relating process to intersessional and posttreatment outcome.

Process was related to intermediate and posttreatment outcomes for 34 patients undergoing multimodal group therapy. Exploratory time series analysis suggested that process variable effects differed with the phase of the therapy. It appeared that an emotionally warm bond occurred between patient and therapist in the sessions prior to therapist-rated improvement. A patient rating of insight followed in subsequent sessions. A negative feedback loop between patient symptom levels and therapist negative patient-directed feelings was demonstrated. Patient dysphoria in later therapy sessions seemed to reflect an earlier therapeutic failure. Ego strength directly exerted its positive influence on outcome in later sessions. The relation between in-therapy process trends and overall outcome supported these findings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outcome effects of eclectic interpersonal-learning-based group psychotherapy with college student neurotics.

A focused 5-yr research program used a large number of clients (45), groups (10), and co-therapists (20) to assess group psychotherapy outcome in a homogeneous diagnostic population (severely disturbed college student neurotics) and therapist–treatment modality (eclectic, interpersonal learning based, with insight and behavior change goals). Analysis of self-report data (Group Therapy Evaluation Form and Illinois Personal Rating Form) for control and therapy periods and terminal behavior ratings yielded consistent, converging evidence of significant positive change in personality characteristics of self-esteem variables; anxiety; motivation and self-discipline; and activity, interest, and outgoing behavior levels in the 1st part (mean?=?10.3 sessions) of treatment. In contrast, poor interpersonal functioning and related feelings of distrustfulness, hostility, unassertiveness, and excessive status-achievement needs resisted change, but they did change by the end of treatment (mean?=?20.5 sessions). Such longer term therapy is suggested as critical to allow these clients to go beyond newly and more easily acquired changes, such as self-esteem, to an integration and extension of these changes via significant interpersonal risk-taking behaviors to resolve long-term patterns of distrust, hostility, and avoidance. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Methodological examination of videotape-assisted reviews in brief therapy: Helpfulness ratings, therapist intentions, client reactions, mood, and session evaluation.

Evaluations of sessions and videotape-assisted reviews in 24 cases were studied to better understand methods and measures used in therapy process research. Results show that helpfulness ratings, intentions, and reactions were consistent across sessions and reviews. Positive mood increased after sessions but decreased after reviews. Therapists evaluated sessions less positively after reviews than after sessions; Stability, predictive validity, and concurrent validity were found for helpfulness ratings, and stability was found for intentions and reactions. Presession mood was related to process judgments. Thus, using videotape-assisted reviews, helpfulness ratings, intentions, and reactions to study process seems justified, but researchers should be aware that mood may influence judgments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A-B therapist status, patient diagnosis, and psychotherapy outcome in a psychiatric outpatient population.

Previous research generally has supported the hypothesis that A therapists obtain better therapy outcomes with schizophrenics, while B therapists do better with neurotics. Based on recent evidence, a 2nd hypothesis (super A) has been advanced which predicts that A therapists do at least as well with neurotic patients as do B therapists and that As obtain significantly more positive outcomes with schizophrenics. To examine these hypotheses, the therapy outcomes of 7 A and 4 B therapists, differentiated by their scores on the 23-item Whitehorn and Betz (1957) A-B scale, with their 18 schizophrenic and 18 neurotic patients were examined. A multivariate ANOVA computed for the 2 outcome measures, therapists' ratings of patient improvement and number of therapy sessions, clearly supported the super-A hypothesis. Separate ANOVAs demonstrated further support for the super-A hypothesis with therapists' ratings as the dependent variable, whereas the interaction hypothesis received support with number of sessions attended as the dependent measure. Of considerable importance was the fact that the addition of ataractic medication to the treatment of schizophrenics did not attenuate the effect of the A-B therapist distinction on therapeutic outcome. (32 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of dream interpretation, event, interpretation, and unstructured sessions in brief therapy.

Twenty-five distressed adult clients received 2 sessions each of dream and event interpretation using the Hill model during 12 sessions of successful therapy. No differences were found in depth, insight, and working alliance among dream interpretation, event interpretation, and unstructured sessions, suggesting that dream interpretation is as effective as other therapist strategies. Dream and event interpretation may be equally effective because both lead back to relevant waking concerns and past memories. Pretreatment measures of client psychological mindedness, openness, and insight were generally unrelated to each other, to evaluations of insight within sessions, to therapist evaluations of client insight, and to pre- and posttherapy changes in insight. Cognitive complexity of client dialogue was related to the process and outcome of dream interpretation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of therapist-facilitated and self-guided dream interpretation sessions.

Twenty-five volunteer clients participated in both a therapist-facilitated and a self-guided dream interpretation session; sessions were randomly ordered and separated by approximately 1 week. Observer and therapist ratings indicated that therapists adhered to the C. E. Hill (1996) model during therapist-facilitated sessions. Clients reported achieving greater depth, mastery, and insight, as well as more dream exploration-insight gains and more action-related gains, from therapist-facilitated sessions than from self-guided sessions. In addition, 88% of the clients preferred therapist-facilitated over self-guided sessions. Implications for using both types of sessions are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acceleration of changes in session impact during contrasting time-limited psychotherapies.

Following the suggestion that therapeutic change is accelerated in time-limited psychotherapy, this study investigated the across-session patterns of session impact in the treatments of 117 depressed clients who were randomly allocated to 8 or 16 sessions of cognitive-behavioral (CB) or psychodynamic-interpersonal (PI) therapy. After each session, all clients completed the Session Evaluation Questionnaire and 75 of the clients completed the Session Impacts Scale. Session ratings indicated that sessions were perceived increasingly positively on most impact dimensions (e.g., session depth and smoothness, relationship with the therapist, feelings of understanding and problem solving, postsession positive mood) as treatment progressed. Early in treatment, PI therapy sessions were less smooth (i.e., more tense and uncomfortable) and less focused on problem solving, but PI sessions changed more rapidly than CB sessions on these dimensions, so that later in treatment, sessions of both treatments were equivalently positive. In both treatments, the trend toward more positive sessions was more rapid (i.e., the across-session slope was steeper) in 8-session treatments than in 16 session treatments. Such accelerated changes in session impact may reflect the suggested acceleration … (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist Alliance-Building Behavior Within a Cognitive-Behavioral Treatment for Anxiety in Youth.

Explored the specific behavior of therapists contributing to a child client's perception of a therapeutic alliance with youth (n = 56) who received a manualized cognitive-behavioral treatment for anxiety disorders. The first 3 sessions were coded for 11 therapist behaviors hypothesized to predict ratings of alliance. Child, therapist, and observer alliance ratings were gathered after the 3rd and 7th therapy sessions. "Collaboration" positively predicted early child ratings of alliance, and "finding common ground" and "pushing the child to talk" negatively predicted early child ratings of alliance. Although no coded therapist behaviors predicted early therapist ratings of alliance, "collaboration" and "not being overly formal" positively predicted therapist alliance ratings by Session 7. Child, observer, and therapist ratings of alliance were significantly correlated. Results are discussed with regard to the identified behavior of the therapist as a step toward the identification of empirically supported strategies for building a stronger child-therapist alliance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Erratum to Matthews and Burkhart.

Reports an error in the article "A-B Therapist Status, Patient Diagnosis, and Psychotherapy Outcome in a Psychiatric Outpatient Population" by Jerry G. Matthews and Barry R. Burkhart (Journal of Consulting and Clinical Psychology, 1977, Vol. 45, No. 3, pp. 47S-482), the next to last sentence of the abstract is incorrect. The sentence reads: "Separate analyses of variance demonstrated further support for the super-A hypothesis with therapists' ratings as the dependent variable, whereas the interaction hypothesis received support, with number of sessions as the dependent measure." The sentence should read: "Separate analyses of variance demonstrated further support for the super-A hypothesis with number of sessions attended as the dependent measure, whereas the interaction hypothesis received support, with therapists' ratings as the dependent variable." (The following abstract originally appeared in record 1978-03783-001) Previous research generally has supported the hypothesis that A therapists obtain better therapy outcomes with schizophrenics, while B therapists do better with neurotics. Based on recent evidence, a 2nd hypothesis (super A) has been advanced which predicts that A therapists do at least as well with neurotic patients as do B therapists and that As obtain significantly more positive outcomes with schizophrenics. To examine these hypotheses, the therapy outcomes of 7 A and 4 B therapists, differentiated by their scores on the 23-item Whitehorn and Betz (1957) A-sub( scale, with their 18 schizophrenic and 18 neurotic patients were examined. A multivariate ANOVA computed for the 2 outcome measures, therapists' ratings of patient improvement and number of therapy sessions, clearly supported the super-A hypothesis. Separate ANOVAs demonstrated further support for the super-A hypothesis with therapists' ratings as the dependent variable, whereas the interaction hypothesis received support with number of sessions attended as the dependent measure. Of considerable importance was the fact that the addition of ataractic medication to the treatment of schizophrenics did not attenuate the effect of the A-sub( therapist distinction on therapeutic outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist behavior as a determinant for client noncompliance: A paradox for the behavior modifier.

Examined the immediate impact of therapist behavior on client noncompliance in 2 studies involving 12 3.8–13.1 yr old socially aggressive children and their families. One family participated in both studies. Observation systems describing client and therapist behavior were used to code videotaped therapy sessions. In Study 1, the therapist behaviors teach and confront were associated with significant increases in the likelihood of client noncompliant reactions. Therapist behaviors facilitate and support were followed by reliable decreases in client noncompliance. In Study 2, the therapist behaviors teach and confront were manipulated in a series of single-S ABAB reversal designs. Results demonstrate that changes in therapist behaviors produced increases in client noncompliance. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Affective experience in psychotherapy.

118 patients and 17 therapists in individual psychotherapy completed structured-response questionnaires after each of from 5-66 consecutive sessions. Analyses focused on the frequency, structure, and correlates of reported affective experiences. Typical patient feelings included both positive and negative affective states, i.e., serious, accepted, confident, and anxious. Typical therapist feelings were predominantly positive, including interested, alert, thoughtful, and sympathetic. Dimensions were defined in the separate domains of patient and therapist feelings by means of factor analysis. Correlational analysis indicates that the affective tone of a session tended to be shared and mutually perceived by both participants. Fluctuation in patient feelings was related to variation of their reported problematic concerns; e.g., dysphoric affect accompanied concerns with isolation and with anger. (20 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived effectiveness of psychotherapy: A function of suggestion?

Investigated the relationship between theoretical orientation and the perceived effectiveness of psychotherapy. 20 analytically oriented therapists and 20 behavior therapists listened to 2 taped excerpts of sessions labeled "early" and "late" sessions of either behavior therapy or psychotherapy and then rated the effectiveness of treatment. The interviews were constructed to be ambiguous and portray no personality change. Instructions to each group varied the suggestion of whether a behavior therapist or analytic therapist conducted treatment. Results indicated that suggestion of professional identification was ineffective in biasing therapeutic effectiveness ratings. Analytic therapists as a group judged therapeutic outcome more positively across both suggestions than did behavior therapists, which is interpreted as a greater predisposition to see change where none existed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of a system for categorizing client reactions to therapist interventions.

We developed a measure of client reactions to therapist interventions. The 21 categories of the measure were divided into 14 positive and 7 negative reactions, which differed significantly from each other on client helpfulness ratings. Preliminary validity data indicated that therapist intentions were related to client reactions more for successful cases than unsuccessful cases, pretreatment symptomatology was highly predictive of which reactions the clients reported, there were some predictable changes in reactions across time in treatment, and within-case correlations of reactions with client-rated session depth and smoothness indicated some similarities across cases. We discuss the case-specific nature of client reactions, methodological issues, and the need for greater therapist awareness of client reactions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in the patient's level of insight in brief psychotherapy: Two pilot studies.

Describes 2 studies of the level of insight obtained in 16 sessions of brief time-limited psychotherapy. Four patients (aged 34–58 yrs) were examined using the Pro-plan Insight Rating Scale (PIRS) in Study 1, and 1 patient (aged 34 yrs) was examined using the PIRS—Revised in Study 2. All Ss initially demonstrated insight, but during the course of therapy their insight decreased. Toward the end of therapy their insight again increased. The average level of insight across each therapy was found to be related to outcome. Based on control mastery theory, the results reflect Ss' unconscious plans for working in therapy by testing their pathogenic beliefs in order to change them. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient-therapist identification in relation to both patient and therapist variables and therapy outcome.

18 patients in a counseling center completed (a) a battery of tests, including scales from the MMPI and Gibson's Acceptance of Self; and (b) rating scales measuring S's identification with and perception of the therapist. Results reveal that S's identification with the therapist significantly correlated with therapy improvement. Degree of identification was associated with both (a) subjective feelings of helplessness and weakness and (b) perception of a stronger therapist during therapy. S's perception of the therapist's strength was incongruent with external judges' ratings of therapist competence, indicating that S's ratings were based on subjective needs. (28 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dimensions of psychotherapy: A factor-analytic study of ratings of psychotherapy sessions.

Rated tape recordings of 60 early sessions of psychoanalytically oriented therapy on 110 process variables. The ratings of 3 Os were clustered and factor analyzed. 4 factors were rotated and interpreted as (a) patient health vs. distress, (b) optimal empathic relationship, (c) active directive mode, and (d) interpretive mode with receptive patient. For 27 of the 30 patients, outcome ratings were obtained from the therapist (patient improvement and success + patient satisfaction). Patient improvement was not predicted by any process ratings. Success + patient satisfaction, on which women scored higher than men, was predicted by patient health vs. distress. Patients rated in early sessions as healthy and low in distress had better prognoses. Optimal empathic relationship qualities related positively to success in therapies low in directive mode, but for relatively directive therapies, this relationship was negative. (31 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship of patient and therapist-reported experiences of the initial session to outcome: An initial investigation.

Explored the impact of the initial psychotherapeutic session on outcome in 32 therapist–patient dyads. Ss were 18+ yrs old. Therapy consisted of a maximum of 8 sessions. The therapeutic interaction was assessed with selected portions of the Therapy Session Report, completed immediately after the first session by the participants. It was found that the patient's perception of the therapist's functioning during the first meeting related significantly to patient and therapist reports of symptom change subsequent to 4 sessions and length of treatment. In addition, there was a significant, linear decline in symptoms (reported by patient and therapist) after 8 therapy sessions. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)