Bias in psychotherapist ratings of client transference and insight.

The psychology literature at large considers rater bias to be a substantial source of error in observer ratings. Yet, it is typically ignored by psychotherapy researchers using participant (psychotherapist/client) ratings. In particular, interrater variability, or differences between raters' overall tendency to rate others favorably or unfavorably, has been a largely ignored source of error in studies that use psychotherapists and/or clients as raters. Ignoring rater bias can have serious consequences for statistical power and for interpretation of research findings. Rater bias may be a particular problem in psychotherapy research, as psychotherapists are often asked to rate subjective variables that require much rater inference. Consequently, we examined the extent to which rater bias is a factor in psychotherapist ratings of client transference and insight, by comparing psychotherapist variance from these ratings to psychotherapist variance in ratings of client-perceived emotional intelligence, using Hierarchical Linear Modeling. Results suggest that bias may be a substantial source of error in psychotherapist process and relationship ratings, accounting for, on average, 38% of the total variance in scores, and 30% after accounting for perceived emotional intelligence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Asymmetry of responsiveness in client-centered therapy.

Each utterance of a psychotherapy session conducted by Carl Rogers was transcribed on a separate card and presented to 15 undergraduates. Ss reconstituted client–therapist sequences significantly more accurately than therapist–client sequences. This result confirms that Rogers is more responsive to his client than vice versa and suggests that the dialogue-reconstruction task is a promising measure of responsiveness in psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rater bias in the EASI temperament scales: A twin study.

Under trait theory, ratings may be modeled as a function of the temperament of the child and the bias of the rater. Two linear structural equation models are described, one for mutual self and partner ratings, and one for multiple ratings of related individuals. Application of the first model to EASI temperament data collected from spouses rating each other shows moderate agreement between raters and little rating bias. Spouse pairs agree moderately when rating their twin children, but there is significant rater bias, with greater bias for monozygotic than for dizygotic twins. MLEs of heritability are approximately .5 for all temperament scales with no common environmental variance. Results are discussed with reference to trait validity, the person–situation debate, halo effects, and stereotyping. Questionnaire development using ratings on family members permits increased rater agreement and reduced rater bias. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dimensions of the relationship between the Black client and the White therapist.

Discusses the psychological issues involved in having White therapists treat Black clients. The topics examined are the importance of the White therapist understanding his or her own feelings, countertransference, the detrimental effect of therapist guilt, and the impact of the therapist's need to be powerful. Also explored are the need for awareness of client–therapist interpersonal similarity and the need for an understanding of our social system for effective psychotherapy. Concrete suggestions are offered for helping therapists deal more effectively with Black clients. The White therapist–Black client relationship is proposed as a paradigm of how people with differing values learn to help each other. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural competence: A new way of thinking about integration in therapy.

This article, based on a keynote speech delivered to the 2009 conference of the Society for the Exploration of Psychotherapy Integration, offers a model for understanding cultural competence as a strategy for psychotherapy integration. Paradigms for what constitutes cultural competence in psychotherapy are explored, and the development of an epistemology of cultural competence that includes understandings of therapist bias and both therapist and client intersectionalities of identity are examined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relation of the therapeutic alliance with outcome and other variables: A meta-analytic review.

To identify underlying patterns in the alliance literature, an empirical review of the many existing studies that relate alliance to outcome was conducted. After an exhaustive literature review, the data from 79 studies (58 published, 21 unpublished) were aggregated using meta-analytic procedures. The results of the meta-analysis indicate that the overall relation of therapeutic alliance with outcome is moderate, but consistent, regardless of many of the variables that have been posited to influence this relationship. For patient, therapist, and observer ratings, the various alliance scales have adequate reliability. Across most alliance scales, there seems to be no difference in the ability of raters to predict outcome. Moreover, the relation of alliance and outcome does not appear to be influenced by other moderator variables, such as the type of outcome measure used in the study, the type of outcome rater, the time of alliance assessment, the type of alliance rater, the type of treatment provided, or the publication status of the study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Magnitude and moderators of bias in observer ratings: A meta-analysis.

Bias in observer ratings compromises generalizability of measurement, typically resulting in attenuation of observed associations between variables. This quantitative review of 79 generalizability studies including raters as a facet examines bias in observer ratings in published psychological research and identifies properties of rating systems likely to place them at risk for problems with rater bias. For the rating systems studied, an average of 37% of score variance was attributable to 2 types of rater bias: (a) raters' differential interpretations of the rating scale and (b) their differential evaluations of the same targets. Ratings of explicit attributes (e.g., frequency counts) contained negligible bias variance, whereas ratings of attributes requiring rater inference contained substantial bias variance. Rater training ameliorated but did not solve the problem of bias in inferential rating scales. (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)     

Rater biases in genetically informative research designs: Comment on Bartels, Boomsma, Hudziak, van Beijsterveldt, and van den Oord (2007).

Rater biases are of interest to behavior genetic researchers, who often use ratings data as a basis for studying heritability. Inclusion of multiple raters for each sibling pair (M. Bartels, D. I. Boomsma, J. J. Hudziak, T. C. E. M. van Beijsterveldt, & E. J. C. G. van den Oord, see record 2007-18729-006) is a promising strategy for controlling bias variance and may yield information about sources of bias in heritability studies. D. A. Kenny's (2004) PERSON model is presented as a framework for understanding determinants of rating reliability and validity. Empirical findings on rater bias in other contexts provide a starting point for addressing the impact of rater-unique perceptions in heritability studies. However, heritability studies use distinctive rating designs that may accentuate some sources of bias, such as rater communication and contrast effects, which warrant further study. (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)     

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)     

Supervision: Its contributions to treatment efficacy.

The efficacy of supervision in training of psychotherapists is discussed in relation to (a) trainees' attitudes, beliefs, and skills, (b) trainee's performance in the therapist role, (c) interactional process events in supervision and psychotherapy, and, (d) client change. Although investigations to date suggest the potential of supervision for teaching advanced skills of psychotherapy, few studies exist that examine directly the relation of therapist performance and client change to supervision. There are virtually no studies that compare the efficacy of supervision to other training methods. If supervision is to remain an integral part of training, then standardized training manuals, analogous to those in psychotherapy, need to be developed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correlation between the Truax and Carkhuff scales for measurement of empathy.

Assessed the correspondence between the R. R. Carkhuff (1969) and the C. B. Truax (1967) scales for measurement of empathy. 42 undergraduates responded to 9 simulated client statements. Responses were rated on both scales by trained, independent raters. An overall correlation of .89 was found. Interrater reliabilities for both scales were high. It is noted that degree of correspondence between scales varied with the content–affect characteristics of the simulated client statement. Implications for research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empathic relational bonds and personal agency in psychotherapy: Implications for psychotherapy supervision, practice, and research.

Although psychotherapy researchers have become increasingly interested in identifying common factors that contribute to effective therapeutic practices, across psycho-diagnostic categories and treatment approaches, relatively little attention to date has been focused on the impact of these research findings for psychotherapy supervision and training programs. To address this gap, in this article we describe key components of an integrative psychotherapy supervision and training program that focuses on the development of a strong therapeutic alliance as an empirically supported, common principle of change in psychotherapy. We review empirical research evidence that addresses the contributions of therapist empathic engagement for the development of secure, relational bonds, heightened client agency, and the development of strong therapeutic alliances, and we discuss the implications of these findings for therapy practice and supervision training. We conclude with specific recommendations for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Real Relationship Inventory: Development and psychometric investigation of the client form.

The development and validation of a client version of the Real Relationship Inventory (RRI-C) is reported. Using a sample of clients (n = 94) who were currently in psychotherapy, a 24-item measure was developed consisting of two subscales (Realism and Genuineness) and a total score. This 24-item version and other measures used for validation were completed by 93 additional clients. Results of the present study offer initial support for the validity and reliability of the RRI-C. The RRI-C correlated significantly in theoretically expected ways with measures of the client-rated working alliance and therapists' congruence, clients' observing ego, and client ratings of client and therapist real relationship on an earlier measure of the real relationship (Eugster & Wampold, 1996). A nonsignificant relation was found between the RRI-C and a measure of social desirability, providing support for discriminant validity. A confirmatory factor analysis supported the two theorized factors of the RRI-C. The authors discuss the importance of measuring clients' perceptions of the real relationship. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Studying psychotherapy using the one-with-many design: The therapeutic alliance as an exemplar.

Most psychotherapy research uses a one-with-many design, in which each therapist (the one) treats multiple clients (the many), which raises the challenge of nonindependent data. We present a statistical model for analyzing data from studies that use a one-with-many design. This model addresses the problems associated with nonindependence and can address theoretically relevant questions. To illustrate this model, we analyzed data in which 65 therapists and their 227 clients rated their therapeutic alliance. The primary finding was that both therapist and client alliance ratings were largely relational (i.e., specific to the unique therapist–client combination). There was little consensus among clients treated by the same therapist about the quality of the therapeutic alliance, although some therapists reported forming stronger alliances than other therapists. There was substantial dyadic reciprocity, indicating that if a therapist reported an especially good alliance with a particular client (better than with his or her other clients), then that client was also likely to report an especially good alliance (better than those reported by the therapist’s other clients). (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)     

Multitrait–multimethod–multirater analysis of performance ratings for law enforcement personnel.

144 deputy sheriffs were rated on 9 job performance dimensions with 2 rating scales by 2 raters. Results indicate that the rating scales (the Multiple Item Appraisal Form and the Global Dimension Appraisal Form) developed in this study were able to minimize the major problems often associated with performance ratings (i.e., leniency error, restriction of range, and low reliability). A multitrait/multimethod analysis indicated that the rating scales possessed high convergent and discriminant validity. A multitrait/multirater analysis indicated that although the interrater agreement and the degree of rated discrimination on different traits by different raters were good, there was a substantial rater bias, or strong halo effect. This halo effect in the ratings, however, may really be a legitimate general factor rather than an error. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of the forced-choice rating scale technique.

Forced-choice (FC) rating scales came about because of dissatisfaction with conventional scales. Reliabilities and validities of FC methods compare favorably with other methods. Studies on the FC method show this scale is more resistant than other scales to effects of bias. Formats using 4 favorable items, from which the rater chooses the items most characteristic of the person rated, prove superior to other formats. This superiority appears in validities, reliabilities, and preferences of raters using the form. Conditions under which statement indices are obtained should be as similar as possible to conditions under which the final scale will be administered. Combining FC scores with other scale scores yields better results than using either instrument alone. Ample evidence exists that more research can fruitfully be done in the area. (54 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The present status of outcome studies: A reply to Frank.

J. D. Frank (see record 1979-29008-001) argued that therapy outcome depends more on client and therapist characteristics than on therapeutic methods. Based on this assertion, Frank suggested that researchers should direct their attention to the identification of relevant client and therapist characteristics. The aim of the present author is to challenge Frank's argument and to offer an alternative direction for clinical researchers that emphasizes the development of more potent psychological procedures. (30 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)