How do therapists enhance family alliances? Sequential analyses of therapist-client behavior in two contrasting cases.

To identify alliance-related behavior patterns in more and less successful family therapy, the authors intensively analyzed two cases with highly discrepant outcomes. Both families were seen by the same experienced clinician. Results showed that participants' perceptions of the alliance, session impact, and improvement at three points in time were congruent with the families' differential outcomes and with observer-related alliance behavior using the System for Observing Family Therapy Alliances. In this measure, therapist behaviors contribute to the alliance and client behaviors reveal the strength of the alliance on four dimensions: Engagement in the Therapeutic Process, Emotional Connection with the Therapist, Safety within the Therapeutic System, and Shared Sense of Purpose within the Family. In the poor outcome case, observer ratings and self-reported alliance scores revealed a persistently "split" alliance between family members; this family dropped out midtreatment. Only in the good outcome case did the clients follow the therapist's alliance-building interventions with positive alliance behaviors; sequential analyses showed that therapist contributions to Engagement significantly activated client Engagement behavior, and therapist Emotional Connection interventions significantly activated client Emotional Connection. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client resistance as predicted by therapist behavior: A study of sequential dependence.

This study examined the relation of client resistant behavior to therapist directive behavior in a sample of 10 prominent archival therapy sessions. Client and therapist speaking turns were coded, with the behavior being aggregated into 1st-order 2?×?2 sequential frequency matrices for each dyad: one set with therapist behavior as antecedent and another set with client behavior as antecedent. The dependency of client and therapist behavior on the behavior of the other was considered across different dyads. The results indicated an overall trend, with therapist directive behavior slightly increasing the probability of subsequent client resistance. No similar effect of client behavior on subsequent therapist behavior was found. Implications of the findings with respect to research and practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist strategies for building involvement in cognitive–behavioral therapy for adolescent depression.

This study examined predictive relations between 9 therapist behaviors and client involvement in manual-guided, cognitive–behavioral therapy for adolescent depression. Analyses included 42 adolescents who met criteria for a depressive disorder (major depressive disorder, dysthymic disorder, or adjustment disorder with depressed mood) and who were treated in school-based clinics. Therapist behaviors hypothesized to promote client involvement were coded from Session 1 audiotapes; client involvement was coded from Session 2. Unlike prior research, the current study examined associations between behaviors and involvement while controlling for initial client resistance to isolate the therapist contribution to involvement. Results show that 3 therapist behaviors from Session 1 (attending to teen’s experience, exploring teen’s motivation, and less structure) predicted greater client involvement in Session 2, controlling for initial resistance. Only exploring motivation and less structure uniquely predicted Session 2 involvement when the 3 behaviors were examined simultaneously. Session 1 therapist behaviors predicted significant variance in involvement at Sessions 2, 4, and 8. Client initial presentation as resistant was associated with more exploring motivation and praising, but initial resistance did not explain associations between therapist behaviors and involvement. Implications for implementing evidence-based treatments are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reciprocal models of child behavior and depressive symptoms in mothers and fathers in a sample of children at risk for early conduct problems.

Although much has been written about transactional models in the study of parenting practices, relatively few researchers have used this approach to examine how child behavior might be related to parental well-being. This study used latent growth curve modeling to test transactional models of age 2 child noncompliance, parental depressive symptoms, and age 4 internalizing and externalizing behaviors using a subsample of families in the Early Steps Multisite Study. In unconditional models, maternal depressive symptoms showed a linear decrease from child ages 2 to 4, whereas paternal depression did not show significant change. Observed child noncompliance at age 2 showed significant associations with concurrent reports of maternal depressive symptoms and trend-level associations with paternal depressive symptoms. For both parents, higher levels of initial depressive symptoms were related to increased age 4 child internalizing behaviors. The findings provide support for reciprocal process models of parental depression and child behavior, and this study is one of the first to present empirical evidence that fathers' depressive symptoms have bidirectional associations with their children's behavior in early childhood. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impressions of psychotherapists' offices.

For counseling settings, research suggests that softness, personalization, and order might affect the experience and the perceived expertness, trustworthiness, and social attractiveness of the therapist. This article discusses exploratory studies on college students' perception of the counseling office environment and whether the likely client experience was associated with the softness/personalization and order of the office. As stimuli, the studies used 30 color photographs of psychotherapists' offices viewed from the client's perspective. After obtaining ratings of the characteristics of each office, we obtained ratings from different groups of students of the quality of care and comfort expected in each office (Study 1) and how qualified, bold, and friendly the therapist in the office would be (Study 2). Additional studies examined the likelihood of choosing a therapist based on the office, and the first thought or feeling that came to mind about the office, the therapist, and the patient experience. There were strong correlations in response between groups (by whether they had experienced therapy; their level in school; their gender; and their major, location, and school size). The quality of care, comfort, therapist boldness, qualifications of the therapist, and the likelihood that one would choose a therapist based on the office improved with increases in the office's softness/personalization and order. Friendliness improved with increases in softness/personalization. The office choices, open-ended responses, and reported reasons for the ratings confirmed the importance of softness (comfort) and order. Research should test longer term exposure and behavior. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Commitment to collaboration as a prerequisite for existential commonality in psychotherapy.

Discusses the theoretical justification for commitment to collaboration (CTC) in behavior therapy. It is noted that psychotherapy for outpatient clients with problems of personal adjustment ordinarily requires the client to accept major responsibility for success. However, the importance of personal CTC with the therapist has not been adequately justified theoretically for behavior therapy in which treatment is nominally based on the learning theories of Thorndike and Pavlov. CTC helps establish existential commonality of awareness and thought between client and therapist, thus increasing the probability that later therapist behaviors will influence both client cognitions and adaptive responses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relation of nonverbal behavior to client reactions.

Sixteen therapists each saw a volunteer client for a single counseling session. During a videotape review the clients recorded their reactions and the therapists recorded their perceptions of client reactions to each therapist intervention. Client nonverbal behaviors (speech hesitancies, vertical and horizontal head movements, arm movements, leg movements, postural shifts, adaptors, illustrators, and smiles) were examined to determine whether they were consistently associated with client reactions. The results indicated that horizontal head movements were associated with client reports of supported and therapeutic work reactions and were also associated with therapist perceptions of therapeutic work reactions; vertical head movements were associated with client reports of supported reactions; and speech hesitancies were associated with therapist perceptions of therapeutic work reactions. The results are discussed in terms of implications for practice and further research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting Stability and Change in Toddler Behavior Problems: Contributions of Maternal Behavior and Child Gender.

This study examined the stability and continuity of early-identified behavior problems and the factors associated with this stability. Children and their mothers (N=125) were seen when the children were 2 and 4 years of age. Maternal reports of child externalizing behavior and laboratory observations of child noncompliance were stable from age 2 to age 4. Early externalizing behaviors decreased over time; however, child noncompliance in the laboratory did not. Although few associations were found between maternal positive behavior and child behavior problems, maternal controlling behavior was related to increases in child behavior problems, particularly at high levels of both prior noncompliance and prior maternal control. Child noncompliance was predictive of increases in maternal controlling behavior over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment and training of clinical interviewing skills: analogue analysis and field replication

Two studies were conducted to assess the train clinical interviewing skills. In Experiment 1, eight university practicum students ("therapists") and either role played or volunteer "clients" were audiotaped during simulated interviews. Following the collection of baseline data on both therapist and client responses, training was provided by way of written materials, classroom instruction and practice, and quizzes. Results of a multiple baseline design across subjects showed improvements in therapists' interviewing skills and subsequent increases in client responding. Experiment 2 replicated and extended the research to a hospital outpatient clinic, in which therapists interviewed the parents of children with behavior problems. In addition, four months following the completion of Experiment 2, follow-up data collected during a maintenance condition showed continued high levels of therapist and client behavior. Finally, a panel of expert peers indicated that each response category was judged highly relevant to the behavioral assessment process.     

Physical therapists' nonverbal communication predicts geriatric patients' health outcomes.

Two studies explored the link between health care providers' patterns of nonverbal communication and therapeutic efficacy. In Study 1, physical therapists were videotaped during a session with a client. Brief samples of therapists' nonverbal behavior were rated by naive judges. Judges' ratings were then correlated with clients' physical, cognitive, and psychological functioning at admission, at discharge, and at 3 months following discharge. Therapists' distancing behavior was strongly correlated with short- and long-term decreases in their clients' physical and cognitive functioning. Distancing was expressed through a pattern of not smiling and looking away from the client. In contrast, facial expressiveness, as revealed through smiling, nodding, and frowning, was associated with short- and long-term improvements in functioning. In Study 2, elderly subjects perceived distancing behaviors of therapists more negatively than positive behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Creeping dispositionism: The temporal dynamics of behavior prediction.

Four studies tested the hypothesis that temporal distance increases the weight of global dispositions in predicting and explaining future behavior. Study 1 found that the correspondence bias was manifested more strongly in predictions of distant future behavior than of near future behavior. Study 2 found that participants predicted higher cross-situational consistency in distant future behavior than in near future behavior. Study 3 found that participants sought information about others' more global dispositions for predicting distant future than near future behavior. Finally, Study 4 found that participants made more global causal attributions for distant future outcomes than for near future outcomes. The results were interpreted as supporting the assumption of construal level theory that perceivers use more abstract representations (higher level construals) to predict and explain more distant future behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship between behavioral marital therapy outcome and process variables.

This study was conducted to identify therapist and client behaviors with a positive response to social learning-based behavioral marital therapy. A sample of 32 couples receiving treatment was examined. Immediately after each therapy session, the therapist, husband, and wife independently completed process ratings forms that measured therapist and client behaviors during the session. Composite scales, derived from these ratings, were entered into multiple regression equations to examine their relationship with posttherapy marital satisfaction. After controlling for pretherapy marital satisfaction and the other predictor variables, therapists', husbands', and wives' ratings of positive client behavior (i.e., collaboration, active participation, and homework compliance) were positively associated with therapy outcome. Implications for marital therapy and suggestions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapists' attributions for client premature termination: Are they self-serving?

We conducted two studies of therapist responses to client premature termination from psychotherapy. In Study 1, we surveyed therapists' attributions for client premature termination from therapy using an open response format. Results suggested that therapists showed a self-serving pattern in their attributions (i.e., attributed causality to the client or environment) when considering their own clients compared to when they considered the premature terminations of clients in general. Study 2 was a vignette study in which therapists responded to one of two client presentations that varied relationship to client (your client vs. other's client). Using the attributional categories derived from Study 1, therapists rated the likelihood that each attribution caused the client's premature termination. Again, patterns across groups indicated that therapists are self-serving in their attributions for client premature termination. In addition, differences were found across gender and theoretical orientation; larger effects were found for men compared to women, and psychoanalytic therapists compared to cognitive–behavioral. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A new method for assessing the interpersonal behavior of psychopathic individuals: Preliminary validation studies.

Two studies examined whether increased attention to interpersonal behaviors would improve assessments of the personality core underlying psychopathy. After item analysis, 21 items measuring interpersonal interactions and nonverbal behaviors associated with psychopathy were retained as the Interpersonal Measure of Psychopathy (IM-P). Federal prison inmates (Study 1, N?=?98) and undergraduates (Study 2, N?=?92) were rated on occurrence of these behaviors during an interview conducted to complete either Hare's Psychopathy Checklist—Revised (PCL-R) or Psychopathy Checklist: Screening Version (PCL: SV). In both studies, IM-P scores correlated more highly with PCL Factor 1 than with PCL Factor 2 scores. Regression analyses indicated that, after controlling for demographic variables and PCL factor scores, IM-P scores predicted interviewer emotional responses and participants' adult fighting (Study 1) and ratings of participants' interpersonal dominance (Study 2). Thus, measurement of interpersonal behavior appears to permit improved prediction of several criteria linked to the personality core of psychopathy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The association between global and specific measures of the therapeutic relationship.

[Correction Notice: An erratum for this article was reported in Vol 31(3) of Psychotherapy: Theory, Research, Practice, Training (see record 2009-17141-001). This article contained, as Figure 1, an SASB model. The authorship and copyrights for the model were not acknowledged. The following acknowledgement should have been included: "From Benjamin (1983), Intrex User's Manual. Intrex Interpersonal Institute, P.O. Box 581037, Salt Lake City, UT 84158. Reprinted by permission." An apology is offered to the author, Dr. Lorna Smith Benjamin. The particular version used in the article was developed in collaboration with Clinton W. McLemore.] Examined the association between global and specific measures of the therapeutic relationship in Sessions 3, 5, and 15 of 9 cases of time-limited psychodynamic psychotherapy. L. S. Benjamin's (see PA, Vol 53:2991; see also, 1984) structural analysis of social behavior (SASB) model provided the specific measure of relationship. There were more consistent associations between ratings of client contributions to the alliance and SASB ratings of client behaviors than there were for the same therapist variables. Additionally, analyses show that external (i.e., nonself) judgments of client and therapist contributions to the alliance, rather than therapist or client self-ratings of contributions to the alliance, were most frequently associated with the SASB behavior codes. Finally, different therapist and client behaviors seemed to be associated with quality of the therapeutic relationship at different points in the therapeutic process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of attrition on studies of noncompliance.

Describes 2 studies that investigated past compliant behavior of volunteers and nonvolunteers in noncompliance research. In Study 1, past attendance compliance was examined for 87 Ss divided into 5 groups; Ss responded to 2 requests to participate. Participants were found to have been compliant and nonparticipants to have been noncompliant. Study 2, with 67 Ss, extended the research on the participants to determine that early dropouts were more noncompliant than those who remained to the end of the study. Taken together, the findings indicate that sampling bias exists in studies of noncompliance in volunteer samples. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Countertransference behavior and management with survivors of sexual assault.

Examined the impact of therapist gender on countertransference behavior toward rape survivors and tested a 2-step model of countertransference management. The model recommends awareness of countertransference feelings (ACF) followed by employment of theoretical framework to understand these feelings. 47 counseling and clinical psychology graduate students (aged 20–44 yrs) completed measures of ACF and of theoretical framework. 1 wk later, countertransferential "approach" and "avoidance" behaviors were assessed as Ss responded to videotapes of an actress portraying a client survivor of date rape. Based on hierarchical regression analysis, an interaction effect was identified between ACF and theoretical framework. A combination of high ACF and high theoretical framework yielded the least avoidance behavior. As hypothesized, male therapists provided significantly more avoidance responses to the rape survivor than did female therapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived support and relational effects in psychotherapy process constructs.

Recent research has indicated that only a small portion of supportiveness reflects the objective properties of providers. Instead, supportiveness primarily reflects the unique relationships among specific recipients and providers (i.e., relational effects), thus suggesting new approaches to support interventions. The authors investigated the possibility that similar relational effects occur for therapy process constructs (e.g., working alliance). Isolating relational effects in psychotherapy requires that each client receive treatment from more than one therapist during the same period of time. Therefore, we conducted analog studies in which therapy clients and students viewed videos of therapists and then rated expected therapist supportiveness and expected therapy process constructs for each therapist. Two studies indicated very strong relational effects in therapist supportiveness and therapy process constructs. In addition, process constructs were correlated strongly with supportiveness (Study 1) and favorable affect (Study 2) for relational effects specifically. Implications for integrating research on perceived support and therapy process were discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)