Using client feedback in psychotherapy training: An analysis of its influence on supervision and counselor self-efficacy.

Tracking client outcome and the therapeutic relationship across treatment (i.e., client feedback) has become a recommended practice for clinicians. This study investigated whether the utility of this practice would extend to trainees if the data gained from clients was provided to their supervisor for use within supervision. Trainees (N = 28) were assigned to a continuous feedback condition or no-feedback condition for 1 academic year. Results indicated that trainees in both conditions demonstrated better client outcomes at the end of their practicum training than at the beginning, but those in the feedback condition improved more. However, those in the feedback condition did not rate the supervisory alliance or satisfaction with the supervision process differently. The relationship between counselor self-efficacy and outcome was stronger for trainees in the feedback condition than for those in the no-feedback condition, perhaps indicating that feedback may facilitate a more accurate assessment of one’s skills. Implications of how counseling self-efficacy, the supervisory alliance, and satisfaction with supervision are related to effective supervision are addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The secure-base hypothesis: Global attachment, attachment to counselor, and session exploration in psychotherapy.

This study explored J. Bowlby's (1988) secure-base hypothesis, which predicts that a client's secure attachment to the therapist, as well as the client's and the therapist's global attachment security, will facilitate in-session exploration. Volunteer clients (N = 59) and trainee counselors (N = 59) in short-term therapy completed the Experiences in Close Relationship Scale (K. A. Brennan, C. L. Clark, & P. R. Shaver, 1998) as a measure of adult global romantic and peer attachment orientations; the Client Attachment to Therapist Scale (B. Mallinckrodt, D. L. Gantt, & H. M. Coble, 1995) as a measure of attachment to counselor; the Working Alliance Inventory (A. O. Horvath & L. Greenberg, 1989) as a measure of working alliance; and the Session Evaluation Questionnaire-Depth Subscale (W. B. Stiles & J. S. Snow, 1984) as a measure of session depth. In line with Bowlby's hypothesis, the findings suggest that session depth is related to the client's experience of attachment security with the counselor and that counselor global attachment moderates the relationship between client global attachment and session exploration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of psychotherapy supervision on client outcome: A critical examination of 2 decades of research.

The supervision of counselors-in-training has become an important area of psychotherapy research. Through supervision, one expects that trainees will gain the knowledge and clinical skills needed to work effectively with clients. Much research has been dedicated to understanding trainee skill development through supervision, but relatively few studies in the literature have addressed whether clinical supervision leads to improved client outcome. The current article presents a review of 2 decades of research into the question of whether clinical supervision improves client outcome. Ten studies conducted between 1981 and 1997 are reviewed in detail. Caveats and criticisms, as well as suggested directions for future research, are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clients' emotional processing in psychotherapy: A comparison between cognitive-behavioral and process-experiential therapies.

The authors compared clients' emotional processing in good and bad outcome cases in cognitive behavioral therapy (CBT) and process-experiential therapy (PET) and investigated whether clients' emotional processing increases over the course of therapy. Twenty minutes from each of 3 sessions from 40 clients were rated on the Experiencing Scale. A 2 × 2 × 3 analysis of variance showed a significant difference between outcome and therapy groups, with clients in the good outcome and PET groups showing significantly higher levels of emotional processing than those in the poor outcome and CBT groups, respectively. Clients' level of emotional processing significantly increased from the beginning to the midpoint of therapy. The results indicate that CBT clients are more distant and disengaged from their emotional experience than clients in PET. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors associated with acceptance and decline of client gift giving.

Client gift giving is an interesting interpersonal event, and scholars have considered the ethical and clinical complexities involved in receiving gifts from clients. Attention to the cultural relations of client gift giving invites a more nuanced discussion of psychologists' decisions to accept or decline client gifts. In recognition of how cultural issues affect the therapeutic relationship, the American Psychological Association has instituted guidelines regarding multicultural competence and has urged psychologists to practice in a culture-centered manner. This article reviews the ethical decision making of 40 licensed psychologists to accept or decline gifts from clients. Results indicated that psychologists were more likely to accept gifts from clients when the gift was inexpensive, informed by cultural context, and presented with gratitude for good work at the end of psychotherapy treatment. Psychologists were more likely to decline gifts that were expensive, were presented during treatment rather than at the end of treatment, and had sentimental or coercive value. Two psychologists indicated they would not accept client gifts because they perceived gift acceptance to be a violation of their code of ethics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The value-congruence model of memory for emotional experiences: An explanation for cultural differences in emotional self-reports.

In 3 studies, the authors found support for the value-congruence model that accounts for cultural variations in memory for emotional experiences. In Study 1, the authors found that in the made-in-the-U.S. scenario condition, European Americans were more accurate than were Asian Americans in their retrospective frequency judgments of emotions. However, in the made-in-Japan scenario condition, European Americans were less accurate than were Asian Americans. In Study 2, the authors demonstrated that value orientation mediates the Culture×Type of Event congruence effect. In Study 3 (a daily event sampling study), the authors showed that the congruence effect was explained by the importance of parental approval. In sum, emotional events congruent with personal values remain in memory longer and influence retrospective frequency judgments of emotion more than do incongruent events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of extratherapeutic encounters: Individual reactions to both hypothetical and actual incidental contact with the therapist.

Participants (N = 763) responded to a hypothetical scenario in which they imagined encountering their therapist outside of the therapy setting. The intimacy of the setting (i.e., anonymous vs. intimate encounter) and the perceived success of the therapy (i.e., helpful vs. unhelpful) were manipulated between subjects. Based on a principal components analysis of participant reactions to these hypothetical scenarios, 4 subscales were derived: “Acknowledgement,” “Violation of Expectations,” “Awkwardness and Discomfort,” and “Professional Responsibility.” Results indicate that reactions to the hypothetical encounter on these subscales were related to both the setting and the success of therapy. In general, participants indicated that they preferred acknowledgment from their therapists, especially in less intimate settings. However, Asian Americans, in contrast to European Americans, indicated less desire for acknowledgment and greater perceived expectation violations. Implications for psychotherapy process and training of clinicians are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Behavioral and emotional disorders in adolescents: Nature, assessment and treatments.

Reviews the book, Behavioral and emotional disorders in adolescents: Nature, assessment and treatment by David A. Wolfe and Eric J. Mash (see record 2005-16249-000). The primary goal of this edited volume is to capture the current state of knowledge about the important behavioural and emotional adjustment problems and disorders of adolescence. Through 20 chapters by foremost experts, the reader is apprised of the unique features of these disorders in adolescents in comparison with children and adults, and of the importance of developmental issues and a developmental perspective. Any thought that adolescent disorders are adequately addressed by upward extension of knowledge of child disorders and downward extension of knowledge of adult disorders is compellingly dispelled. The unique compilation of empirical findings specifically for adolescents is a boon to those pursuing research, teaching or evidence- based practice with this age group. This book will be mandatory reading for any mental health professional, including academics, graduate students, and clinicians working with or teaching about troubled adolescents. As a text, it is excellent for a graduate course on the subject, and an essential reference source for those teaching abnormal development at the undergraduate level or providing clinical service to adolescents and their families. The book will be a classic in the field and a mandatory starting point for any professional interested in a detailed overview of the state of the art in Western societies, including researchers interested in an overview of areas outside their own specific expertise. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Relating emotional abilities to social functioning: A comparison of self-report and performance measures of emotional intelligence.

Three studies used J. D. Mayer and P. Salovey's (1997) theory of emotional intelligence (EI) as a framework to examine the role of emotional abilities (assessed with both self-report and performance measures) in social functioning. Self-ratings were assessed in ways that mapped onto the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT), a validated performance measure of EI. In Study 1, self-ratings and MSCEIT scores were not strongly correlated. In Study 2, men's MSCEIT scores, but not self-ratings, correlated with perceived social competence after personality measures were held constant. In Study 3, only the MSCEIT predicted real-time social competence, again, just for men. Implications for analyzing how emotional abilities contribute to social behavior are discussed, as is the importance of incorporating gender into theoretical frameworks and study designs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of written emotional expression: The role of positive expectancies.

Objective: Writing in an emotional way about stressful or traumatic experiences has beneficial effects on emotional well-being and physical health. Yet the mechanisms that underlie these effects still need to be explored. Integrating research on the effects of positive expectancies, the authors suggest that positive effects of written emotional expression may, in part, depend on expectancies induced by writing about emotional experiences. Design: Two studies were conducted to test this hypothesis. In both studies, participants wrote about either an upsetting event or trivial issues. After the writing period, participants rated their expectancies that the writing intervention would improve (or impair) their emotional well-being over time. Main Outcome Measures: Study 1 assessed the emotional impact of an upsetting event, whereas Study 2 assessed subjective reports of physical symptoms. In both studies, outcome variables were collected both before and 6 weeks after the writing intervention. Results: The results showed that (a) writing about upsetting experiences induced higher positive expectancies than writing about trivial issues and (b) expectancies associated with written emotional expression were related to a reduction in the emotional impact of an upsetting event (Study 1) and to a reduction in physical symptoms (Study 2). Conclusions: There may be 2 alternative ways to render written emotional expression effective in reducing negative emotions: (a) by rendering an emotional experience more meaningful and (b) by inducing positive affect regulation expectancies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An actor-focused model of justice rule adherence and violation: The role of managerial motives and discretion.

Research on organizational justice has focused primarily on the receivers of just and unjust treatment. Little is known about why managers adhere to or violate rules of justice in the first place. The authors introduce a model for understanding justice rule adherence and violation. They identify both cognitive motives and affective motives that explain why managers adhere to and violate justice rules. They also draw distinctions among the justice rules by specifying which rules offer managers more or less discretion in their execution. They then describe how motives and discretion interact to influence justice-relevant actions. Finally, the authors incorporate managers’ emotional reactions to consider how their actions may change over time. Implications of the model for theory, research, and practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hypnotic enhancement of cognitive-behavioral interventions for pain: An analogue treatment study.

Recent meta-analyses have shown that adding hypnosis enhances the effectiveness of cognitive behavioral psychotherapy. This hypnotic enhancement effect was evaluated in the analogue treatment of pain. Individuals scoring in the high (n=135) and low (n=150) ranges of hypnotic suggestibility were randomly assigned to 1 of 6 conditions: Stress Inoculation Training, the same treatment provided hypnotically, nonhypnotic analgesia suggestions, hypnotic analgesia suggestions, a hypnotic induction treatment, or a control condition. The 5 analogue treatments reduced experimental pain more than the control condition, but were not different from one another. Under circumstances optimized to detect an enhancement effect, neither Stress Inoculation Training nor analgesia suggestions produced more relief when delivered in a hypnotic context than identical treatments provided nonhypnotically. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reported exposure and emotional reactivity to daily stressors: The roles of adult age and global perceived stress.

A central goal of daily stress research is to identify resilience and vulnerability factors associated with exposure and reactivity to daily stressors. The present study examined how age differences and global perceptions of stress relate to exposure and emotional reactivity to daily stressors. Sixty-seven younger (Mage = 20) and 116 older (Mage = 80) adults completed a daily stress diary and measures of positive and negative affect on 6 days over a 14-day period. Participants also completed a measure of global perceived stress. Results revealed that reported exposure to daily stressors is reduced in old age but that emotional reactivity to daily stressors did not differ between younger and older adults. Global perceived stress was associated with greater reported exposure to daily stressors in older adults and greater stress-related increases in negative affect in younger adults. Furthermore, across days on which daily stressors were reported, intraindividual variability in the number and severity of stressors reported was associated with increased negative affect, but only among younger adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Single session therapy: Maximizing the effect of the first (and often only) therapeutic encounter.

Reviews the book, Single session therapy: Maximizing the effect of the first (and often only) therapeutic encounter by Moshe Talmon (1990). One of the rationales for the book is the claim that in the reality of the practical world, patients frequently attend only one session of therapy. According to the author, there is considerable evidence in more than thirty years of literature to indicate that the single session psychotherapeutic encounter is the most common length of treatment. The majority of the book (chapters 2 to 7) deals with specific issues in the application of planned single session therapy (SST). There are chapters on guidelines for effective SST, empowering your patient, learning from failures, attitudes that facilitate SST, and a detailed case example. These chapters, like the rest of the book, are clearly written, practical, and free of jargon. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relation between event processing and the duration of emotional experience.

An emotional experience can last for only a couple of seconds up to several hours or even longer. In the present study, we examine to which extent covert intrapersonal actions (cognitions both related and unrelated to the emotion-eliciting stimulus) as well as overt interpersonal actions (social sharing) account for this variability in emotion duration. Participants were asked to report the duration of their anger, sadness, joy, and gratitude episodes on a daily basis during five days. Furthermore, information was collected with regard to their cognitions during the episodes and their social sharing behavior. Discrete-time survival analyses revealed that for three of the four emotions under study, stimulus-related cognitions with the same valence as the emotion lead to a prolongation of the episode; in contrast, both stimulus-related and stimulus-unrelated cognitions with a valence opposite to the emotion lead to a shortening. Finally, for the four emotions under study, social sharing was associated with a prolongation. The findings are discussed in terms of a possible process basis underlying the time dynamics of negative as well as positive emotions. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

An emotional exposure-based treatment of traumatic stress for people with chronic pain: Preliminary results for fibromyalgia syndrome.

Emotional trauma occurs in many patients with chronic pain, particularly fibromyalgia syndrome (FMS). Current cognitive-behavioral treatments for chronic pain have limited effects, perhaps because the trauma is not addressed, whereas emotional exposure-based treatments improve post-traumatic stress, but have not been tested on chronic pain. The authors present a novel, brief treatment protocol for people with chronic pain and unresolved trauma (Multi- Stimulus, Multi-Technique Emotional Exposure Therapy), which involves detecting avoidance of a range of emotion-related stimuli, implementing exposure techniques tailored to the patient's avoidances, and negotiating the process and therapeutic alliance. This treatment was pilot tested on 10 women with intractable FMS and trauma histories. Three months post-treatment, the sample showed moderate to large effects on stress symptoms, FMS impact, and emotional distress; and small-to-moderate improvements on pain and disability. Two patients showed substantial improvement, four made moderate gains, two showed modest improvement, and two did not benefit. This pilot study suggests that emotional exposure treatment for unresolved trauma may benefit some patients with FMS. Controlled testing of the treatment for FMS and other chronic pain populations is indicated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client experience of psychodynamic psychotherapy for bulimia nervosa: An interview study.

We examined 14 bulimic clients' experiences of individual psychodynamic psychotherapy through semistructured interviews, which were analyzed using qualitative methods. The results showed that the psychodynamic approach was a challenge to most of the clients. Yet, most clients profited from therapy both symptomatically and with regard to interpersonal relations and affect regulation. There were, however, marked differences in the clients' experiences. One subgroup rather quickly felt that the therapy met their needs, another initially felt challenged by the approach and the therapeutic attitude but ultimately succeeded in using this particular kind of therapy. A third group remained predominantly critical of their therapies. The clinical implications and possible explanations of the results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The emotional impact of loss narratives: Event severity and narrative perspectives.

Out of the complex influences of event, narrative and listener characteristics on narrative emotions, this paper focuses on event severity, narrative perspectives, mood, and dispositions for emotion regulation and empathy. Event severity and perspective representation were systematically varied in sad autobiographical narratives to study their influence on quantity and quality of readers' emotional response. Each of three stories were manipulated to contain elaborated perspectives, only the past protagonists' perspective (dramatic narration), and very little perspectives at all (impersonal narration). We predicted that event severity influences the quantity of emotional response, while degree of perspective representation influences plausibility and whether emotional responses are sympathetic or interactional, that is, directed against the narrator. Hypotheses were confirmed except for plausibility, and perspective representation had an effect only on anger against and dislike of the narrator. In a second study, impersonal narration evoked anger at and negative evaluations of the narrator which were related to blaming the narrator for showing too little emotional involvement. The generalizability of findings across emotions and implications for sharing of emotions in everyday and clinical settings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)