Therapist multicultural competency: A study of therapy dyads.

[Correction Notice: An erratum for this article was reported in Vol 44(1) of Psychotherapy: Theory, Research, Practice, Training (see record 2007-04278-014). The fifth author's name should be spelled as follows: Alexa Mislowack.] This study examined the role of therapist multicultural competence (TMC). Fifty-one therapy dyads completed measures of therapist multicultural competency, working alliance, and their satisfaction with therapy. Clients also completed measures of therapist attractiveness, expertness, trustworthiness, and empathy. Results showed strong associations between clients' ratings of TMC and ratings of the working alliance, therapist empathy, and satisfaction. Clients' combined rating of therapist expertness, attractiveness, and trustworthiness were not associated with their TMC ratings but were significantly associated with therapists' self-appraised TMC ratings. Therapists' ratings of their TMC were associated with their ratings of the working alliance and satisfaction with their work. Results are discussed in the context of the relevant literature, as are implications for training and research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multicultural approaches in psychotherapy: A rejoinder.

In this rejoinder, the authors address several issues raised by R. L. Worthington and F. R. Dillon (see record 2010-26150-001) and C. R. Ridley and M. Shaw-Ridley (see record 2011-00622-001) regarding (a) the measurement of multicultural competencies (MCCs), (b) sampling considerations in multicultural research, and (c) the conceptual frame of multicultural psychotherapy research. The authors challenge the wisdom of exploring MCCs in psychotherapy research and provide a different framework to understand therapists' multicultural effectiveness with clients based on their cultural race/ethnicity. Additionally, the concept of therapists' multicultural orientation or approach is introduced to illuminate the process of aligning with clients about salient cultural issues in psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Collaborative "expertise" after the discursive turn.

Given recent developments in discursive psychology, and a growing number of postmodern and collaborative therapies, it is time to revisit what it means to be competent or expert as a therapist. This article takes the view that competence (instead of "expertise"), for therapists who practice from a discursively informed perspective, involves a therapist's ability to reflectively and resourcefully engage in different forms of discourse with clients--lexibly. This includes the therapist's ability to engage clients within their own discursive forms, discern with clients the possibilities and constraints afforded by those forms, and transcend the limitations of those forms with credible invitations into other, more resourceful discourses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Multicultural counseling competencies: An analysis of research on clients' perceptions: Comment on Owen, Leach, Wampold, and Rodolfa (2011).

J. Owen, M. M. Leach, B. Wampold, and E. Rodolfa (see record 2010-24976-001) tested the hypotheses that (a) some therapists express more multicultural competencies (MCCs) more than other therapists and (b) clients' perceptions of their therapists' MCCs are a function of specific client or therapeutic factors. In the present analysis, the authors critiqued 3 major components of the study: conceptual and methodological underpinnings, interpretation of research findings, and implications for future research. Although the authors agree with the importance of this line of research, the authors also believe that some of the researchers' underlying assumptions are worthy of examination; alternate interpretations of the findings are possible, and several recommendations for future research are imperative. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist adherence/competence and treatment outcome: A meta-analytic review.

Objective: The authors conducted a meta-analytic review of adherence–outcome and competence–outcome findings, and examined plausible moderators of these relations. Method: A computerized search of the PsycINFO database was conducted. In addition, the reference sections of all obtained studies were examined for any additional relevant articles or review chapters. The literature search identified 36 studies that met the inclusion criteria. Results: R-type effect size estimates were derived from 32 adherence–outcome and 17 competence–outcome findings. Neither the mean weighted adherence–outcome (r = .02) nor competence–outcome (r = .07) effect size estimates were found to be significantly different from zero. Significant heterogeneity was observed across both the adherence–outcome and competence–outcome effect size estimates, suggesting that the individual studies were not all drawn from the same population. Moderator analyses revealed that larger competence–outcome effect size estimates were associated with studies that either targeted depression or did not control for the influence of the therapeutic alliance. Conclusions: One explanation for these results is that, among the treatment modalities represented in this review, therapist adherence and competence play little role in determining symptom change. However, given the significant heterogeneity observed across findings, mean effect sizes must be interpreted with caution. Factors that may account for the nonsignificant adherence–outcome and competence–outcome findings reported within many of the studies reviewed are addressed. Finally, the implication of these results and directions for future process research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treating "the Poor"--Classism or a Rigid Loyalty to Theory?: Comment.

Comments on "Psychotherapy, classism, and the poor: Conspicuous by their absence" by Laura Smith (see record 2005-11834-002). Smith suggested that social psychology theories might explain how a negative attitude toward the poor has reduced the interest of practitioners in poor patients. The current author was impressed by Smith's comments when she left the literature and began to describe her own experiences. However, the current author was not convinced that social psychology and the varieties of classism explain the phenomenon described. The current author believes that many practitioners avoid the poor because they do not enjoy failure. In this comment, the author discusses personal experiences that support this position. It does not elaborate a history of either a dislike of or class avoidance of the poor. Instead, it suggests that psychologists are trained to overgeneralize findings and to look down on less rigorously collected findings and observations. Thus, psychologists overlook information that might allow theories to be further formulated in more accurate and generalizable forms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist qualities preferred by sexual-minority individuals.

Psychotherapy research concerning lesbian, gay, and bisexual (LGB) individuals has focused on matching clients on gender and sexual orientation, yet has not considered how factors such as therapeutic skill, presenting problem, and cohort membership may influence preference for therapists. This study was designed to identify those therapist qualities that sexual-minority individuals prefer and to determine how the presenting problem influences therapist choice. Forty-two nonheterosexual adults between 18 and 29 years old ranked 63 therapist characteristics from "Extremely Uncharacteristic" to "Extremely Characteristic" when seeking treatment for a problem in which their sexual orientation was salient and one in which it was not. The analyses of both conditions yielded clusters of items reflecting therapist characteristics that participants considered unfavorable, neutral, beneficial, and essential. Participants valued therapists who had LGB-specific knowledge as well as general therapeutic skills, whereas they indicated that they would avoid therapists who held heterocentric views. Application of these findings to clinical practice and future directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Superblind": Supervising a Blind Therapist With a Blind Analysand in a Community Mental Health Setting.

This article describes the 3-year psychoanalytic treatment of a blind female client by a blind female therapist supervised by a sighted man. The author focuses primarily on issues tied to each party's personal experience of blindness. Interpersonal psychoanalysis, which was the modality of supervision and therapy, is considered a cultural approach to psychoanalytic treatment. The author (the supervisor in the triad) suggests that the individuals involved treated each other, and were treated, with regard to their shared visual problems in ways that were influenced by previous relationships and the way that the culture in which the members were embedded treats disability in general. In the present, these cultural and relational expectations, influenced by the past, were played out between patient and therapist, between therapist and supervisor, and in the decisions and policies of the clinic system. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multicultural experiences of U.S. military psychologists: Current trends and training target areas.

This study provides the first quantification of the multicultural experiences of U.S. military psychologists. The importance of multicultural competence cannot be overemphasized given that military psychologists now practice all over the world and are expected to treat active-duty personnel, their family members, and individuals encountered from many different countries. Additionally, a small, but significant portion of enlisted military members are not U.S. citizens. Provision of services to this diverse group can be improved through efforts to enhance the multicultural competence of military providers. To better understand the multicultural experience base of military psychologists, the authors sent a survey to all contactable active-duty U.S. military psychologists (i.e., 367). Eighty-six individuals responded to a survey regarding their experiences with active-duty personnel, U.S. civilians, and civilians from other countries. Also, respondents provided quantitative information regarding working with detainees, using interpreters, and interacting with patients from diverse religious backgrounds. Results indicated rich and varied multicultural experiences with definite trends, which can assist individual psychologists and military training program development. Recommended training target areas for military psychologists at all levels are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist competence in cognitive therapy for depression: Predicting subsequent symptom change.

Objective: The efficacy of cognitive therapy (CT) for depression has been well established. Measures of the adequacy of therapists' delivery of treatment are critical to facilitating therapist training and treatment dissemination. While some studies have shown an association between CT competence and outcome, researchers have yet to address whether competence ratings predict subsequent outcomes. Method: In a sample of 60 moderately to severely depressed outpatients from a clinical trial, we examined competence ratings (using the Cognitive Therapy Scale) as a predictor of subsequent symptom change. Results: Competence ratings predicted session-to-session symptom change early in treatment. In analyses focused on prediction of symptom change following 4 early sessions through the end of 16 weeks of treatment, competence was shown to be a significant predictor of evaluator-rated end-of-treatment depressive symptom severity and was predictive of self-reported symptom severity at the level of a nonsignificant trend. To investigate whether competence is more important to clients with specific complicating features, we examined 4 patient characteristics as potential moderators of the competence-outcome relation. Competence was more highly related to subsequent outcome for patients with higher anxiety, an earlier age of onset, and (at a trend level) patients with a chronic form of depression (chronic depression or dysthymia) than for those patients without these characteristics. Competence ratings were not more predictive of subsequent outcomes among patients who met (vs. those who did not meet) criteria for a personality disorder (i.e., among personality disorders represented in the clinical trial). Conclusions: These findings provide support for the potential utility of CT competence ratings in applied settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Deconstructing multicultural counseling competencies research: Comment on Owen, Leach, Wampold, and Rodolfa (2011).

The present article offers a commentary and critique of the research presented by J. Owen, M. M. Leach, B. Wampold and E. Rodolfa (see record 2010-24976-001). Given the complexity of the research methodology, findings, and conclusions, the authors provide a concise summary of findings, study limitations, and conclusions followed by a detailed critique of the study. The authors respect and appreciate the ambitious efforts made by Owen et al. to address gaps in the literature regarding outcome research using client ratings of counselors' multicultural counseling competencies (MCCs). The authors provide a critical analysis of some of J. Owen et al.'s specific conclusions and offer alternative conclusions based on conceptual and methodological bases. The authors use the opportunity to comment on this study as a means of advancing recommendations regarding future research on MCCs that might contribute to substantive revisions to the long-standing theoretical foundation in this area. (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)     

Ratings of Therapist Dynamic Activities and Alliance Early and Late in Psychotherapy.

The present study examines the concurrent and predictive relationships between therapist psychodynamic-interpersonal activity and therapist-rated alliance. Ratings from 45 patient and therapist dyads engaged in short term psychodynamic psychotherapy from a point early (3rd or 4th session) and late (the session at which 90% of the treatment was completed) in treatment were used. The results suggest that therapists who have positive views of the alliance early in treatment also have positive views of the alliance later in treatment. Therapists who used psychodynamic-interpersonal activities early in treatment also made use of psychodynamic-interpersonal activities later in treatment. Moreover, the use of psychodynamic-interpersonal activities early in treatment was positively related to both global and specific aspects of therapist-rated alliance late in treatment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Therapist effects in outpatient psychotherapy: A three-level growth curve approach.

Evidence suggests that a moderate amount of variance in patient outcomes is attributable to therapist differences. However, explained variance estimates vary widely, perhaps because some therapists achieve greater success with certain kinds of patients. This study assessed the amount of variance in across-session change in symptom intensity scores explained by therapist differences in a large naturalistic data set (1,198 patients and 60 therapists, who each treated 10-77 of the patients). Results indicated that approximately 8% of the total variance and approximately 17% of the variance in rates of patient improvement could be attributed to the therapists. Cross-validation and extreme group analyses validated the existence of these therapist effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Twelve Practical Suggestions for Achieving Multicultural Competence.

Multicultural competence can be defined as the ability to understand and constructively relate to the uniqueness of each client in light of the diverse cultures that influence each person's perspective. Because the complexity of culture is often overlooked, multicultural research often inadvertently strengthens the stereotypes that it is intended to thwart. To avoid stereotypic thinking, clinicians must critically evaluate cross-cultural research and be thoughtfully creative in applying it to clinical practice. Twelve suggestions are offered for the use of multicultural research as a source of questions that enhance respect for clients' cultural identities rather than as answers that foreclose it. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief Integrative Therapy Comes of Age: A Commentary.

On the basis of a review of 4 contemporary models of brief integrative psychotherapy-short-term restructuring psychotherapy, cognitive behavioral analysis system of psychotherapy, time-limited dynamic psychotherapy, and a therapy integrating cybernetic systems, existential-phenomenology, and solution-focused narrative approaches-a set of common factors is articulated and a distinction between unitary and dialectical common factors is introduced. That therapy is essentially experiential and that a necessary agent of change is the patient's experience, particularly of new, positive interpersonal experiences, is a major area of agreement among the models. The paper concludes with a discussion of a transformational model of mutual influence, which supports a therapeutic stance that goes beyond responsiveness, to explore therapist initiative in the co-construction of dyadic interpersonal patterns. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Client-therapist complementarity: An analysis of the Gloria films": Correction.

Reports an error in "Client-therapist complementarity: An analysis of the Gloria films" by Donald J. Kiesler and Chesley S. Goldston (Journal of Counseling Psychology, 1988[Apr], Vol 35[2], 127-133). The date of receipt indicated for the revision of this article was incorrect. The correct date of receipt is provided in the erratum. (The following abstract of the original article appeared in record 1988-36446-001.) In this investigation of Shostrom's (1966) psychotherapy demonstration films, we used a checklist inventory measure derived from the 1982 Interpersonal Circle to examine the interpersonal behavior of Gloria, her three therapists, and their respective transaction patterns. Groups of undergraduate raters observed the three films, after which they rated the interpersonal behavior of either Gloria or the therapist. Analyses of Interpersonal Circle axes and segment scores revealed significant differences in the interpersonal behaviors of the three therapists with Gloria and of Gloria with the three therapists. Analyses of transactional patterns showed departures of Gloria's behaviors from the perfect complementary fit predicted from each of the therapist's interpersonal profiles, especially for behaviors categorized on the hostile half of the Interpersonal Circle. Discussion emphasized the complex of dyadic mix and other contextual factors that need to be addressed in future interpersonal studies of psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measuring the Real Relationship in Psychotherapy: Initial Validation of the Therapist Form.

The development and initial validation of a therapist-rated measure of the real relationship in psychotherapy (the Real Relationship Inventory--Therapist Form [RRI-T]) is reported. Using a sample (n=80) of practicing psychotherapists and on the basis of prior theory, the authors developed a 24-item measure consisting of 2 subscales (Realism and Genuineness) and a total score. This 24-item version and other measures used for validation were completed by 79 additional practicing therapists and 51 counseling graduate students (n=130). The RRI-T was found to have high reliability and sound initial validity. As theorized, the RRI-T correlated significantly with measures of working alliance, session outcome (depth and smoothness), client intellectual and emotional insight, and client negative transference. Discriminant validity was supported by a nonsignificant relation to social desirability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Exploitation and inference: Mapping the damage from therapist-patient sexual involvement": Correction to Williams.

Reports an error in "Exploitation and inference: Mapping the damage from therapist-patient sexual involvement" by Martin H. Williams (American Psychologist, 1992[Mar], Vol 47[3], 412-421). On page 419, the sentence "In this case, the odds that a patient will become sexually involved with his or her psychoanalyst are 1 in 1,129 or a likelihood of 0.9%" should read "In this case, the odds that a patient will become sexually involved with his or her psychoanalyst are 1 in 1,129 or a likelihood of 0.09%." (The following abstract of the original article appeared in record 1992-25076-001.) A growing body of evidence documents a clinical pattern of harmful effects of therapist–patient sexual involvement. In addition, surveys suggest that 1 to 12% of all therapists may have engaged in this behavior at least once in their careers. In order to develop a more comprehensive research agenda, several of these studies are reviewed in terms of inferences that may or may not be drawn. Case studies and surveys may provide for inference of clinical harm and syndrome, but they are limited in terms of generalizations about incidence in the overall population. A population approach coupled with case sampling may provide a useful tool by which to approximate a minimum level of incidence and of effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)