Therapist immediacy in brief psychotherapy: Case study I.

The authors examined immediacy (i.e., discussions about the here-and-now therapeutic relationship) in a 12-session case of individual interpersonal psychotherapy. Therapist immediacy during immediacy events most often focused on parallels between external relationships and the therapy relationship, encouraging expression of immediate feelings, processing termination, therapist expressing disappointment/sadness/hurt and inquiring about the client's reactions. Client involvement was slightly higher before and after than during immediacy events. On the positive side, therapist immediacy seemed to help the client express her immediate feelings about the therapist more openly, feel closer to the therapist, and become less defended. On the negative side, the client felt somewhat awkward and pressured when the therapist used immediacy. Limitations and implications for practice and research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist immediacy in brief psychotherapy: Case study II.

Immediacy was examined in a 17-session case of brief therapy with a bright, articulate, inner-city, African American female client seeing an interpersonally oriented, White, male therapist. The main types of therapist immediacy were reinforcing the client for in-session behavior, inviting the client to collaborate, inquiring about client reactions to therapy, and reminding the client that it was okay to disagree with him. An in-depth qualitative examination of the seven most extensive/salient immediacy events revealed that therapist immediacy enabled the therapist and client to negotiate the relationship, helped the client express her immediate feelings to the therapist, helped the client open up to deeper exploration of concerns, and provided the client with a corrective relational experience. Implications for practice and research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rejoinder: The what, when, and how of immediacy.

In this rejoinder, I respond to Muran and Samstag's (2008; see record 2008-13167-003) and Anchin's (2008; see record 2008-13167-004) reactions to the investigation of immediacy in two case studies (Hill et al., 2008; see record 2008-13167-001; Kasper, Hill, & Kivlighan, 2008; see record 2008-13167-002). In particular, I focus on theoretical and methodological issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comment: Can some interpersonalists be more different than alike? Implications for method in practice and research.

The paper provides a commentary on two qualitative case studies of therapist use of immediacy in two brief interpersonal psychotherapies involving two senior White male clinicians and two young female patients with diverse identities (Hill et al., 2008; see record 2008-13167-001; Kaspar, Hill, & Kivlighan, 2008; see record 2008-13167-002). The commentary proposes an alternative interpersonal model by which the data collected could be examined. The model suggests that therapist and patient interact in a complex process of power and affection toward mutual recognition, which is further shaped by their respective gender and cultural identities. Several implications for the study of the psychotherapeutic situation based on this interpersonal model are presented, including using observer-based measures that can assess power plays and therapist immediate awareness, as well as another qualitative strategy that would capture the richness of clinical process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special section on multivariate psychotherapy process research: Structure and change in the talking cure.

In response to the search for novel investigative strategies to apply in the study of psychotherapy processes, several investigators have turned to the use of factor-analytic methods of investigation. Four studies are presented that use such methods to investigate the structure of, and change in, aspects of the client and therapist discourse and symptoms over the course of treatments. The corpora of process data, culled from investigations taking place on three different continents, represent some of the largest samples of in-therapy behavior that have been analyzed in microanalytic detail. Providing both methodological advances and important substantive findings, the studies included were conducted to stimulate further use and development of factor-analytic methods to identify and track key processes over the course of psychotherapeutic treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The therapeutic relationship in the brief treatment of depression: Contributions to clinical improvement and enhanced adaptive capacities.

Using data from the National Institute of Mental Health Treatment for Depression Collaborative Research Program, the authors examined the impact on treatment outcome of the patient's perception of the quality of the therapeutic relationship and contribution to the therapeutic alliance. Shared variance with early clinical improvement was removed from these relationship measures. Multilevel modeling demonstrated that a perceived positive therapeutic relationship early in treatment predicted more rapid decline in maladjustment subsequent to the relationship assessment. This effect occurred equally across all 4 treatment conditions. A positive early therapeutic relationship also predicted better adjustment throughout the 18-month follow-up as well as development of greater enhanced adaptive capacities (EAC). Controlling a wide range of patient characteristics did not eliminate the effects of the therapeutic relationship on rate of improvement during treatment and on EAC. Thus, independent of type of treatment and early clinical improvement, the therapeutic relationship contributes directly to positive therapeutic outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient's and therapist's views of early alliance building in dynamic psychotherapy: Patterns and relation to outcome.

Patients and therapists have somewhat divergent perspectives of alliance. Usually in psychotherapy research, the focus is on the patient's view of alliance, predicting parts of outcome. This study questions this hypothesis by applying the shape-of-change procedure to patient's and therapist's view of alliance-building processes in dynamic psychotherapy. The results of this naturalistic study indicate that none of the 3 patient patterns is related to outcome at the end of psychotherapy, but a specific therapist's pattern--out of 2--is linked to positive symptom change. These results are discussed in the context of present research on therapeutic alliance, especially in terms of level and process, its measurement, and potential in predicting outcome in dynamic psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal subtypes and change of interpersonal problems in the treatment of patients with generalized anxiety disorder: A pilot study.

Interpersonal problems are highly relevant to the treatment of generalized anxiety disorder (GAD) patients. Previous studies using the Inventory of Interpersonal Problems identified several interpersonal subtypes in GAD patients. In this study, we wanted to replicate earlier findings of interpersonal subtypes in GAD. We investigated whether these interpersonal subtypes are characterized by different types of interpersonal problems and different levels of interpersonal distress, and we further examined whether they differed with regard to improvement of interpersonal problems after short-term treatment. This study is based on results from a randomized controlled trial that investigated short-term treatments in GAD outpatients. For secondary analysis, interpersonal subtypes were identified by cluster analysis and Inventory of Interpersonal Problems profiles were calculated for both the total sample (N = 52) and the interpersonal subtypes using the Structural Summary Method for Circumplex Data. This study confirmed previous results demonstrating the existence of interpersonal subtypes in GAD. Four interpersonal subtypes were identified: Overly Nurturant, Intrusive, Socially Avoidant, and Nonassertive. Short-term treatment significantly improved interpersonal problems (d = 0.46) within the total GAD sample. Interestingly, the effect sizes of the four clusters differed considerably (d = 0.19–1.24) and the clusters displayed different changes in the two circumplex axes Dominance and Nurturance. Our study indicates that change of interpersonal problems needs to be specifically analyzed, even within homogenous diagnostic groups. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The "I," the "we," and the "when": A meta-analysis of motivational primacy in self-definition.

What is the primary motivational basis of self-definition? The authors meta-analytically assessed 3 hypotheses: (a) The individual self is motivationally primary, (b) the collective self is motivationally primary, and (c) neither self is inherently primary; instead, motivational primacy depends on which self becomes accessible through contextual features. Results identified the individual self as the primary motivational basis of self definition. People react more strongly to threat and enhancement of the individual than the collective self. Additionally, people more readily deny threatening information and more readily accept enhancing information when it pertains to the individual rather than the collective self, regardless of contextual influences. The individual self is the psychological home base, a stable system that can react flexibly to contextual influences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integrating play and family therapy methods: A survey of play therapists' attitudes in the field.

The researchers surveyed 295 members of the Association for Play Therapy on their attitudes related to working with families when treating children. The results indicated the majority of play therapists held attitudes conducive to involving families in their approaches with children. However, mixed findings were found in specific areas related to the implementation of play therapy with families, suggesting barriers may exist. These mixed findings included a decreased percentage of play therapists that felt like play therapy was effective in family therapy when compared with the high level who felt that play and family therapy approaches could be integrated. Moreover, the respondents were divided on issues such as parents' willingness to be involved in therapy with their children and if parents were actually resistant to being included in sessions with their children. These mixed findings suggest that a wide range of attitudes and experiences about parental involvement exist among play therapists in the field. The authors raise key questions for the play therapy field to consider in more depth and suggest improvements that may be needed in play therapy education to increase the efficacy of play therapists' skills in working with families. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Case studies within a mixed methods paradigm: Toward a resolution of the alienation between researcher and practitioner in psychotherapy research.

This article addresses the long-standing divide between researchers and practitioners in the field of psychotherapy, regarding what really works in treatment and the extent to which interventions should be governed by outcomes generated in a “laboratory atmosphere.” This alienation has its roots in a positivist paradigm, which is epistemologically incomplete because it fails to provide for context-based practical knowledge. In other fields of evaluation research, it has been superseded by a mixed methods paradigm, which embraces pragmatism and multiplicity. On the basis of this paradigm, we propose and illustrate new scientific standards for research on the evaluation of psychotherapeutic treatments. These include the requirement that projects should comprise several parallel studies that involve randomized controlled trials, qualitative examinations of the implementation of treatment programs, and systematic case studies. The uniqueness of this article is that it contributes a guideline for involving a set of complementary publications, including a review that offers an overall synthesis of the findings from different methodological approaches. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"The spacing effect: A case study in the failure to apply the results of psychological research": Comment.

F. N. Dempster's (see record 1989-03118-001) recommendation that distributed practice be implemented in the classroom fails to consider such impediments as costs and effects on educators' quality of work life. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A study of the logic of empirical arguments in psychological research: "the automaticity of social behavior" as a case study.

This article describes the logical structure of one type of empirical argument commonly used in psychological research. A characteristic flaw in its application is identified and illustrated with an analysis of a number of experiments. Intraindividual as well as social factors that contribute to the flaw's occurrence are discussed. The operation of the social factor is explored with an analysis of citation patterns in the literature. The citation analysis reveals the degree to which the flaw goes unnoticed, in deference to building a consensus of support for broad theoretical claims. The article closes with an outline of the decisions involved in choosing a research strategy and indicates the epistemic consequences of these choices. (PsycINFO Database Record (c) 2010 APA, all rights reserved)