Clients' pretherapy interpersonal attitudes and psychotherapy outcome.

Investigated whether 55 outpatient counseling clients' (aged 16–57 yrs) pretherapy scores on affiliation–hostility and dominance–submission dimensions of the Interpersonal Check List (ICL) would be related to outcome of therapy. Ss, who received an average of 24 sessions, completed the ICL both pre- and posttherapy. Ss whose therapy was successful, as rated by both therapist and client, were significantly more affiliative (less hostile) than were less-than-successful therapy clients both pre- and posttherapy. 21 of 29 Ss whose predominant pretherapy interpersonal stance was characterized as affiliative had successful outcomes, whereas only 10 of 26 Ss whose predominant pretherapy interpersonal stance was characterized as hostile had successful outcomes. No significant differences were observed between outcome groups on the dominance–submission dimension either pre- or posttherapy. However, as expected, a significant number of successful therapy Ss showed a pre- vs posttherapy shift in their interpersonal stances from submission to dominance. Results highlight the reported difficulty of short-term dynamic psychotherapy with hostile clients and suggest the importance of assessing clients' pretherapy interpersonal attitudes as 1 influence on therapeutic process and outcome. (28 ref) (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)     

Ambiguity tolerance of therapists and process changes of their clients.

Investigated the relationships between 18 student-therapists' tolerance for ambiguity in visual perception tasks and (a) the positive affect displayed toward them by their 22 student clients, (b) changes in proportions of clients' self-reference statements, and (c) measures of improvement in clients' "adjustment." Results show an increase in clients' positive affect toward the therapists but no relationship between changes in clients' affect toward their therapists or the number of their self-reference statements and the therapists' tolerance for ambiguity. Clients of ambiguity-tolerant therapists described themselves more negatively, but all but 2 clients described themselves more favorably later in therapy. No positive correlation was obtained between client and therapist affect toward each other. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clients', therapists', and judges' evaluations of psychotherapy.

Asked 41 patients and their 17 therapists to complete a questionnaire indicating problem areas and their severity before and after the 1st and last therapy session. 2 clinical psychologists served as independent judges rating the client questionnaires. The clients' evaluations were unrelated to their therapists' evaluations, but were highly related to the evaluations made by independent judges. Further analyses suggest that the disagreements between clients and therapists stemmed from the therapists' inaccuracy in perceiving the clients' problems and the therapists' tendency to overestimate the progress of therapy relative to clients and independent judges. The results and the broader issue of client-therapist disagreements are discussed in terms of the client as a "consumer." (l6 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Thinking about thinking in therapy: An examination of clients' understanding of their therapists' intentions.

Two therapists each provided 2 clients time-limited (10 sessions each) therapies. These were examined to discover relations between (a) clients' understanding of therapists' intentions and episode level outcome, (b) similarities and differences between the participants' valuing of different intentions, and (c) shifts in intentions valued from the beginning to the terminal phases of therapy. By using therapists' segmentation of sessions into episodes and a computerized Counselor Intention List, some positive relations between clients' understanding of counselor intention and episode impact were documented. Differences were found between therapists' and clients' valued intentions as were systematic shifts on valued intentions from beginning to end phases of therapy. (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)     

The relationship between clients' expected and actual treatment duration.

Investigated the relationship of clients' expected and actual treatment duration in 148 outpatients (mean age 27 yrs) treated by 20 therapists. Data from questionnaires suggest that clients expected and attended a relatively low number of visits; these patterns were discrepant with the therapists' duration preferences. A stepwise regression analysis indicated that clients' expected number of visits was the only variable that incrementally increased the predictability of client visits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client-initiated homework in client-centered therapy.

This article explains the way homework is integrated into client-centered therapy (sometimes called person-centered therapy). It first presents a summary of the theory based on Carl R. Rogers' therapeutic conditions (congruence, unconditional positive regard, and empathic understanding), emphasizing the importance of the nondirective attitude. It describes Rogers' change theory based on unconditional positive regard and illustrates the therapeutic interaction process with segments of a typical session conducted by Rogers. Homework is then described and explained as almost always initiated by the client, with therapists' responses that range from pure empathic following to occasionally providing suggestions and instructions. The results of a small survey of nondirective client-centered therapists concerning homework are summarized, and several client/therapist interactions relating to homework are described. Homework in client-centered therapy, when it does occur, is an outcome of clients' initiatives and is consistent with the way the therapy fosters and protects clients' autonomy, self-determination and their sense of self. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do therapists self-disclose more to clients with greater symptomatology?

This research investigated the links between self-reported therapist self-disclosure and (a) clients' initial symptom levels, (b) the working alliance, and (c) symptom change. Outpatients (N = 83) and therapists (N = 22) at a mental-health hospital completed confidential surveys after a session of ongoing treatment. Results revealed that therapists self-disclosed more to clients with lower initial symptomatology. Therapist self-disclosure was not significantly related to clients' or therapists' ratings of the working alliance; nor was it related to symptom change. We suggest that therapists might limit self-disclosure to particularly symptomatic clients because the therapists want to establish clear boundaries with them, but future studies will need to explore the reasons for this link. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of locus of control on counseling expectations of clients.

Investigated the relation between clients' locus of control and expectations of therapeutic outcome among 67 clients (mean age 29 yrs) with mild neurotic problems. Clients were asked to estimate their likely success with therapists presented in a series of videotaped role plays. The role plays depicted the locus of control, sex, and social class of therapists. Results indicate that there was a significant interaction between clients' and therapists' locus of control in relation to clients' judgment of clinical success: Internal clients anticipated greater success with internal therapists, and external clients expected greater success with external therapists. Implications for the counseling process are discussed. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapists' race and African American clients' reactions to therapy.

This study examines the posttherapy reactions and attitudes of 44 African American clients seen at a university clinic in a midwestern city. Clients were randomly assigned to European American or African American therapists for 10 sessions of interpersonal or problem solving therapy. Therapy attitudes and reactions were assessed through clients' ratings of how well they understood and accepted the goals of therapy, their ability to accept and make use of therapeutic interventions, and perceptions of therapeutic benefit. The impact of European American therapists' efforts to cope with racial differences through therapist-initiated discussion of race in the first session or no therapist-initiated discussion of race were examined. African American clients' ratings of therapy indicated that there was a relationship between therapists' race and the understanding and acceptance of therapeutic interventions and perceived benefit of therapy. Clients rated therapeutic understanding and acceptance higher when assigned to an African American therapist. Therapists' initiation of or noninitiation of discussions of race had no affect on ratings of therapy. The clinical implications of these findings and suggestions for future research are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Male therapists' clinical bias: Influence of client gender roles and therapist gender role conflict.

This study examined male therapists' gender role conflict, client sexual orientation, and client emotional expression as they interrelated with clinical judgments about male clients. Using a series of written clinical vignettes to manipulate the client variables of sexual orientation and emotional expression, 196 experienced male therapists completed a measure of male gender role conflict, read a clinical vignette varying the client's sexual orientation and emotional expression, and rated the client on several clinical dimensions. Canonical analysis revealed 2 roots indicating that therapist gender role conflict factors, in combination with client sexual orientation and emotional expression, were associated with therapists' ratings of the male client's prognosis and how much therapists liked, had empathy for, had comfort with, and had willingness to see the male client. Implications for counseling practice, limitations, and future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rights of clients, responsibilities of therapists.

Discusses ways in which ethical principles can be put into practice in the client–therapist relationship. Historically, ethical codes for therapists were drawn up to protect the professions from regulation by external agencies. Implicit in the ethical codes, however, is a model for the client–therapist relationship that fosters the goals of mental health. It is suggested that just as ethical codes have been given specific content in standards for providers of psychological services in human service facilities, ethical codes can be given specific content in the client–therapist relationship. It is recommended that therapists take responsibility for incorporating ethical standards into their practices so that clients' rights will be an integral part of therapy. Four illustrative situations are presented: providing clients with information to make informed decisions about therapy, using contracts in therapy, responding to clients' challenges to therapists' competence, and handling clients' complaints. (63 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of client preference and expectancy upon the initial interview.

Used a 2 * 3 design with 10 Ss per cell to show how initial counseling interview process and outcome are affected by (a) assigning clients to either more preferred or less preferred counselors; (b) giving clients either positive, nonexistent, or negative expectancy inductions regarding their counselor assignments; and (c) congruence and incongruence between clients' expectations and experiences. Process and outcome were assessed using client and counselor self-report measures and audiotape segment ratings. More preferred assignment conditions received more favorable tape ratings than did less preferred assignment conditions. Positive or no-expectancy conditions revealed a more favorable counseling outcome than did negative expectancy conditions. Most Ss showed increased preferences for counselors seen despite congruence or incongruence between their expectations and experiences. (39 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Counselor-client agreement on session impact.

We propose a new framework for understanding studies of counselor–client agreement about their counseling. The framework includes five factors: the scope of counseling being studied (process, impact, or outcome), the dimension (index) being rated (in this study, session Depth, Smoothness, Positivity, or Arousal), the measure used to assess agreement (correlations or absolute differences), the level at which the analysis is conducted (session, client, or counselor), and the type of agreement—(a) consensus, the similarity of counselors' own ratings to clients' own ratings; (b) counselor awareness, the similarity of counselors' perceptions of their clients to clients' own ratings; (c) client awareness, the similarity of counselors' own ratings to clients' perceptions of their counselors; and (d) matched awareness, the similarity of counselors' perceptions of their clients to clients' perceptions of their counselors. In a study of session impact (scope), degree of agreement was found to vary substantially with each of the other factors—type of agreement, dimension rated, measure of agreement, and level of analysis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Counseling session impact as viewed by novice counselors and their clients.

The Session Evaluation Questionnaire (SEQ) was used to measure the perspectives of 17 graduate-student counselors and their 72 17–39 yr old clients on 942 individual counseling sessions along 2 evaluative dimensions—depth and smoothness—and 2 dimensions of postsession mood—positivity and arousal. A components-of-variance analysis showed that, from both perspectives, SEQ ratings varied greatly from session to session; ratings were only modestly predictable from differences among counselors or among counselor–client dyads. However, averages across 6–20 sessions permitted adequately reliable differentiation among dyads, for example, for comparisons with outcome measures. Correlations between corresponding counselor and client dimensions ranged from moderate to negligible, whether calulated across sessions, across clients, or across counselors, Novice counselors' judgments of session depth and value may have had little relation to their clients' evaluations. On the other hand, counselors' comfort in sessions and postsession positive mood were moderately predictive of client reactions. (32 ref) (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)     

Treatment duration prediction: Client accuracy and its relationship to dropout, outcome, and satisfaction.

The relationship of clients' expected and actual treatment duration was investigated for 230 clients in private practice settings. Clients both expected and attended a relatively low number of visits. These patterns were discrepant with therapists' duration expectations. A stepwise regression analysis indicated that clients' expected number of visits was the single best predictor of clients' actual number of visits and that history of eating disorder, therapist's degree, and client's years of education also contributed to actual number of visits. Clients who attended fewer sessions than expected had lower satisfaction, better outcome on two of six measures, and were more often identified as dropouts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)