Client Attachment to Therapist, Depth of In-Session Exploration, and Object Relations in Brief Psychotherapy.

Two studies explored attachment in psychotherapy. In the 1st study, clients (N=38) in time-limited therapy completed the Experiences in Close Relationships Scale as a measure of adult attachment, the Client Attachment to Therapist Scale (CATS), Working Alliance Inventory (WAI), and measures of session depth and smoothness. Consistent with J. Bowlby's (1988) concept of a secure base promoting greater exploration, secure attachment to therapist was significantly associated with greater session depth and smoothness. Insecure adult attachment was associated with insecure therapeutic attachment. CATS subscales predicted unique variance in session experience not accounted for by the WAI alone. The 2nd study was a new analysis of data originally reported by B. Mallinckrodt, D. L. Gantt, and H. M. Coble (1995). Among women clients (N=44) who completed the CATS, WAI, and the Bell Object Relations and Reality Testing Inventory, 2 CATS subscales predicted unique variance in object relations deficits not accounted for by the WAI alone. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Satisfaction With Therapy and Therapist Scale--Revised (STTS-R) for group psychotherapy: Psychometric properties and confirmatory factor analysis.

Patients' level of satisfaction with their therapeutic experience is a concept that is important for understanding treatment efficacy; however, patient satisfaction has received little empirical attention. The Satisfaction With Therapy and Therapist Scale (STTS) developed for group psychotherapy by T. P. S. Oei and G. J. Shuttlewood (1999) was designed to assess patients' level of satisfaction with their therapeutic endeavor. This article aims to strengthen the STTS's psychometric properties by using confirmatory factor analysis (CFA) with a large sample of patients with mood and anxiety disorders. Outpatients (N = 344) took part in the study. Exploratory factor analysis indicated 2 conceptually coherent factors that accounted for 66.9% of the variance. The 2 factors, which were similar to those found in Oei and Shuttlewood (1999), namely, Satisfaction With Therapy and Satisfaction With Therapist, were replicated. CFA revealed a 2-factor solution to be the best-fitting model. Overall, this article demonstrated that the STTS-R has sound psychometric properties and would serve as a useful instrument in assessing a patient's level of satisfaction with both group therapy and therapist in research as well as in clinical settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client and therapist variability in clients' perceptions of their therapists' multicultural competencies.

This study examined therapist differences in their clients' ratings of their therapists' multicultural competencies (MCCs) as well as tested whether therapists' who were rated as exhibiting more MCCs also had clients who had better therapy outcomes (N = 143 clients and 31 therapists). All clients completed at least 3 sessions. Results demonstrated that therapists accounted for less than 1% of the variance in their clients' Cross-Cultural Counseling Inventory–Revised (CCCI-R; T. D. LaFromboise, H. L. K. Coleman, & A. Hernandez, 1991) scores, suggesting that therapists did not differ in terms of how clients rated their MCCs. Therapists accounted for approximately 8.5% of the variance in therapy outcomes. For each therapist, their clients' CCCI-R scores were aggregated to provide an estimate of therapists' MCCs. Therapists' MCCs, based on aggregate CCCI-R scores, did not account for the variability in therapy outcomes that were attributed to them. Additionally, clients' race/ethnicity, therapists' race/ethnicity, or the interaction of clients'–therapists' race/ethnicity were not significantly associated with clients' perceptions of their therapists' MCCs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factor structure of the Working Alliance Inventory.

The Working Alliance Inventory (WAI; A. O. Horvath and L. S. Greenberg [see PA, Vol 76:24600]) was completed after the 1st psychotherapy session by 84 university counseling center clients and 15 therapists rating their work with 123 clients. The factor structure of these responses was examined using confirmatory factor analysis. A model with 1 general factor, a model with 3 specific factors, and a bilevel model of the factor structure were examined. The bilevel factor structure, with a General Alliance factor as its primary factor and 3 secondary specific factors, fit the data best. The items most indicative of the 3 specific factors were selected to form a 12-item short form of the WAI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Two aspects of the therapeutic alliance: Differential relations with depressive symptom change.

Objective: The therapeutic alliance has been linked to symptom change in numerous investigations. Although the alliance is commonly conceptualized as a multidimensional construct, few studies have examined its components separately. The current study explored which components of the alliance are most highly associated with depressive symptom change in cognitive therapy (CT). Method: Data were drawn from 2 published randomized, controlled clinical trials of CT for major depressive disorder (n = 105, mean age = 40 years, female = 62%, White = 82%). We examined the relations of 2 factor-analytically derived components of the Working Alliance Inventory (WAI; Horvath & Greenberg, 1986, 1989) with symptom change on the Beck Depression Inventory—II (BDI–II; Beck, Steer, & Brown, 1996) that occurred either prior to or subsequent to the examined sessions. WAI ratings were obtained at an early and a late session for each therapist–patient dyad. Results: Variation in symptom change subsequent to the early session was significantly related to the WAI factor that assesses therapist–patient agreement on the goals and tasks of therapy but not to a factor assessing the affective bond between therapist and patient. In contrast, both factors, when assessed in a late session, were significantly predicted by prior symptom change. Conclusions: These findings may reflect the importance, in CT, of therapist–patient agreement on the goals and tasks of therapy. In contrast, the bond between therapist and patient may be more of a consequence than a cause of symptom change in CT. The implications of these results and directions for future research are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A comparison of the psychometric properties of three measures of dietary restraint.

A subscale of the Three-Factor Eating Questionnaire (TFEQ), a subscale of the Dutch Eating Behavior Questionnaire (DEBQ), and the Revised Restraint Scale (RS) were administered to 901 undergraduates. Test–retest reliability (on 34 Ss) was highest for the RS (r?=?.95) and roughly equal for the DEBQ (r?=?.92) and the TFEQ (r?=?.91). Internal consistency was highest for the DEBQ (α?=?.95), moderate for the TFEQ (α?=?.90), and lowest for the RS (α?=?.82). The DEBQ was the most homogeneous scale, with a single principle component accounting for 68.2% of the variance. A single factor accounted for only 39.1% and 34.6% of the variance in the RS and TFEQ, respectively. The DBEQ had the most stable factor structure across genders, weight categories, and random samples. The TFEQ had the greatest discriminant validity with respect to social desirability. Finally, the TFEQ was least susceptible to dissimulation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Convergent validy of the Agnew Relationship Measure and the Working Alliance Inventory.

The convergent validity of the Agnew Relationship Measure (ARM) and the Working Alliance Inventory (WAI) was assessed in samples drawn from 2 comparative clinical trials of time-limited psychotherapies for depression. In 1 sample, clients (n=18) and therapists (n=4) completed self-report versions of both measures after every session (n=198). In the other sample, clients (n=39) and therapists (n=6) completed the ARM, and observers subsequently rated selected audiotaped sessions (n=78) using the WAI. In both samples, the ARM's core alliance scales (Bond, Partnership, and Confidence) were correlated with the WAI's scales (Bond, Tasks, and Goals) strongly when assessed within client and therapist perspectives and, with some qualifications, moderately when assessed between client, therapist, and observer perspectives, supporting the assumption that the ARM and the WAI measure some of the same core constructs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factor structure of coping: Two studies of mothers with high levels of life stress.

Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to investigate the factor structure of coping in mothers with high levels of life stress. In Study 1, EFA of the Coping Orientation to Problems Experienced (C. S. Carver, M. F. Scheier, & J. K. Weintraub, 1989) in a sample of mothers of full-term or very low birth weight 2-year-old children yielded 7 reliable coping factors. Each factor accounted for significant variance in at least 1 of 6 outcomes measuring maternal-child well-being. In Study 2, CFA was used to cross-validate the EFA model on the basis of the responses of mothers of 2-year-old children with prenatal polysubstance exposure. CFA results revealed a moderately good fit, confirming the factor structure in a 2nd, independent sample of mothers with high levels of life stress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dimensions of psychotherapists' activity: A replication and extension of earlier findings.

Attempted to replicate the 5 dimensions of therapists' activity (personal distance, activity, flexibility, therapist distance, and preference for goal-limited therapy) found by M. S. Wallach and H. H. Strupp (see record 1964-02091-001). Questionnaire responses (the Therapeutic Attitudes, Skills, and Techniques Scale) from 136 therapists were factor analyzed. Significant differences were found on 5 subscales (constructed to represent each of the 5 factors), due to characteristics of the therapist, including sex, having had personal psychotherapy, involvement in research, frequency of patient visits, and length of time spent working with a typical patient. Although there were some changes in endorsement of "preferred theoretical orientation" which reflected advances in the field in the intervening 16 yrs, findings indicate that the dimensions of therapist activity identified in the original study represent enduring issues a therapist of any persuasion must confront. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapists' view of therapeutic action in psychoanalytic psychotherapy with young adults.

Studying experienced therapists' implicit theorizing may contribute to our understanding of what is helpful and what hinders treatment with particular patient populations. In this study, 16 therapists' views of curative factors, hindering factors, and outcome were explored in 22 interviews conducted at termination of individual psychoanalytic psychotherapy with young adults. Grounded theory methodology was used to construct a tentative model of therapeutic action based on the therapists' implicit knowledge. The results indicated that developing a close, safe and trusting relationship was viewed as the core curative factor in interaction with the patient making positive experiences outside the therapy setting and the therapist challenging and developing the patient's thinking about the self. The therapeutic process was experienced as a joint activity resulting in the patient becoming a subject and acquiring an increasing capacity to think and process problems. The patient's fear about close relationships was seen as hindering treatment and leading to core problems remaining. The model is discussed in relation to major theories of therapeutic action in the psychoanalytic discourse and previous research focusing on young adults' view of curative and hindering factors in psychotherapy. Implications for practice and further research are suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of six measures of working alliance.

Compared 6 measures of working alliance: the California Psychotherapy Alliance Scales (CALPAS), the Penn Helping Alliance Scales (PHAS), the Vanderbilt Therapeutic Alliance Scale (VTAS), Working Alliance Inventory—Observer Form (WAI—O), Working Alliance Inventory—Client Form, and Working Alliance Inventory—Therapist Form. All measures had high internal consistency. Observers were able to reach high levels of interrater reliability on all the observer-rated measures (CALPAS, PHAS, VTAS, WAI—O). Evidence of construct validity was found for the CALPAS, VTAS, and WAI—O, given that they were all highly correlated with each other. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-concept and self-esteem as moderators of client transference.

Operationalized transference as (a) the similarity of clients' perceptions of their therapist and their perceptions of their parents and (b) therapists' ratings on a transference scale, Therapy Session Check Sheet (TSCS; H. Graff and L. Luborsky, 1977), and examined the moderating role of self-esteem and ego development on client transference. Ss were 62 clients (aged 19–63 yrs) who were already involved in therapy, and 29 therapists (aged 25–61 yrs). The Barrett-Lennard Relationship Inventory (G. T. Barrett Lennard, 1962, 1973) measured the facilitative conditions (regard, empathy, and unconditionality) and therapist–parent similarity and the TSCS measured the therapists' perceptions of transference. Additional measures were the Ego Identity Scale (A. L. Tan, et al, 1977) and the Rosenberg Self-Esteem Scale (M. Rosenberg, 1979). Results support the idea that self-esteem and ego development impact a client's view of the therapist and parental figures and are associated with therapists' views of transference. Persons with low ego identity and low self-esteem tended to see their therapists and parental figures more dissimilarly; and the more transference that a therapist perceived, the greater the tendency for the client to have low ego identity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient and therapist introject, interpersonal process, and differential psychotherapy outcome.

The Structural Analysis of Social Behavior (SASB [L. S. Benjamin; see PA, Vol 53:2991]) system was used to study the interpersonal process between patient and therapist in the 3rd session of 14 therapeutic dyads. Dyads were grouped into good and poor outcomes cases (n?=?7) on the basis of the amount of change in the patients' introject as measured by the INTREX Introject Questionnaire. Strong support was found for the following hypotheses based on interpersonal theory, linking therapists' introject state, interpersonal process in therapy, and outcome: (1) Poor outcome cases (no introject change) were typified by interpersonal behaviors by the therapist that confirmed a negative patient introject; (2) the number of therapists' statements that were subtly hostile and controlling was highly correlated with the number of self-blaming statements by the patients; (3) therapists with disaffiliative introjects tended to engage in a much higher level of problematic interpersonal processes that have been associated with poor outcome. Implications for future research and therapist training are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Common genetic risk factors for conduct disorder and alcohol dependence.

The association between retrospectively reported childhood conduct disorder (CD) and a history of alcohol dependence (AD) was examined in a sample of 2,682 male, female, and unlike-sex adult twin pairs. There was a strong association between CD and AD in both men (tetrachoric r?=?.34, odds ratio?=?2.8) and women (tetrachoric r?=?.53, odds ratio?=?9.9). Genetic factors accounted for most of the association between CD and AD liability in men and women, with the remainder of the association being due to nonshared individual-specific environmental factors. Genetic influences common to CD and AD accounted for 17% and 35% of the genetic variation in AD liability in men and women, respectively, and accounted for 11% and 23% of the total variation in AD liability in men and women, respectively. The results suggest that there are common genetic risk factors for CD and AD or that CD itself is an important genetically influenced risk factor for AD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapists' emotional reactions to substance abusers: A new questionnaire and initial findings.

Developed and tested the Ratings of Emotional Attitudes to Clients by Treaters (REACT) scale. The REACT was administered to 52 therapists and 140 cocaine-dependent outpatients, at sessions 2, 5, and 24 of psychotherapy. It was found to have high internal consistency at each time point, moderately high convergent validity with therapists' (but not patients') therapeutic alliance ratings, and a factor structure that appeared to meaningfully derive 4 factors: "therapist in conflict with self," "therapist focused on own needs," "positive connection," and "therapist in conflict with the patient." Therapists' emotional responses were found to become more negative over the course of treatment, and, when compared by theoretical orientation, were found more positive for 12-step drug counselors than for cognitive or supportive-expressive therapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multivariate study of the patient-therapist system: A replication and extension.

Replicates and extends the work of R. H. Moos and S. R. Clemes (see record 1967-07395-001) and F. van der Veen (see record 1965-08090-001). Each of 6 patients saw each of 4 therapists twice. The variables total activity, feeling words, action words, reinforcements each was scored separately for patient and therapist for each interview. Patient problem expression and therapist accurate empathy were rated for each interview. Consistent differences between patients accounted for substantially more variance than consistent differences between therapists on all variables. Patient * Therapist * Session interactions generally accounted for large proportions of the total variance. Results indicate that the therapist behaviors studied were not the result of a trait, of a given tendency to be empathic, or of a consistently applied therapeutic technique, but rather were very substantially situationally or patient determined. (23 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The patient's contribution to the therapist's countertransference feelings

Countertransference feelings of psychiatric milieu therapists toward their patients were studied by using a self-report feeling word checklist. The feelings were scored on subscales of feeling states in a circumplex model. By using an analysis of variance model, comparisons between reactions to patients individually and reactions to patients with different personality organizations and with different Health-sickness rating scale scores could be made. A total number of 244 therapists at 21 small treatment homes were studied. It was found that approximately 15% of the therapists' countertransference feeling reactions could be accounted for by recurrent reactions to patients individually. Surprisingly, the personality organization and the Health-sickness rating scale score of the patient accounted for almost no variance in therapists' feelings. The results are discussed, and possible explanations are evaluated.     

The effect of anticipatory strategies on the first day of smoking cessation.

The authors tested a model hypothesizing the predictors and the effects of anticipatory strategy use on the 1st day of smoking cessation using data from 63 participants in an ecological momentary assessment study of smoking cessation. Remaining abstinent on the 1st day of cessation was not associated with mean level of urges to smoke during tempting situations but was associated with anticipatory strategy use, which accounted for 18% of the variance. Getting rid of cigarettes contributed the most to this effect (β?=?-.397). Getting rid of cigarettes was itself predicted by 2 variables, lower nicotine dependence (β?=?-.264) and attending a formal smoking cessation class (β?=?.305), which accounted for 15% of its variance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)