Do therapists address ethnic and racial differences in cross-cultural psychotherapy?

Ethnic and racial differences between client and therapist affect therapy processes and outcomes, but little is known about the extent to which therapists have dialogues about their differences in therapy. A survey on this topic was completed by 689 APA-licensed psychologists with experience conducting cross-cultural therapy. Most psychologists reported having such discussions, but with less than half of their cross-ethnic/racial clients. Therapists and clients were equally likely to initiate discussions. Reasons for discussing differences varied greatly. Therapists consistently described themselves as comfortable with and skilled at these discussions, and reported that discussions facilitated therapy. Therapists who were female, older, nonminority, less experienced with diverse clients, and viewed training as an important factor were more likely to have discussions about differences. Results point to the need to better understand if, when, and how ethnic and racial differences should be addressed in therapy. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Effects of clinical experience and client emotion on therapists' responses.

In an Emotion by Therapist Experience design, actresses portraying angry vs sad clients interacted with "therapists" (graduate clinical psychology students) varying in prior therapy experience (high, medium, or low). Results indicate that therapists judged angry clients less favorably than sad clients. More experienced therapists showed greater tolerance of anger. Therapists intervened less with angry clients than with depressed clients, and angry clients received less supportiveness, less directiveness, and fewer requests for information. (4 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical and treatment correlates of access to Section 8 certificates for homeless mentally ill persons

OBJECTIVE: The study assessed how clients' housing preference and other variables were related to the acquisition of Section 8 certificates, facilitating independent living, for homeless persons with severe mental illness who were being served by an experimental assertive community treatment team. METHODS: For 77 clients, demographic and clinical differences between receivers and nonreceivers of certificates were examined, and correlates of time from referral to the team to completion of the Section 8 application were analyzed. Reasons clients did not receive certificates and housing outcomes were summarized in relation to client preference. RESULTS: The 34 clients who received certificates (44 percent) had significantly less psychopathology after three months than did nonreceivers and tended to have affective disorders rather than schizophrenia. Of the 43 nonreceivers, the two largest groups were 19 clients who did not want certificates and ten clients who wanted certificates but whom staff considered unable to live safely in an unsupervised apartment. The mean +/- SD length of time for application for a certificate was 5.7 +/- 5.8 months. Longer time to apply was significantly associated with having schizophrenia, having the team as a representative payee, and showing increased psychotic symptoms at referral and at three months. CONCLUSIONS: The study suggests that it is possible to honor the housing preferences of the majority of homeless persons with severe mental illness if adequate resources are provided. However, staff may view persons who have schizophrenia and more symptoms as needing more supervision than those clients prefer. Homeless mentally ill persons may also take longer than more symptomatic persons to pursue independent living through a Section 8 certificate.     

Training and dissemination of cognitive behavior therapy for depression in adults: A preliminary examination of therapist competence and client outcomes.

Objective: In this study, the authors examined the feasibility and effectiveness of training community therapists to deliver cognitive behavior therapy (CBT) for depression. Method: Participants were therapists (n = 12) and clients (n = 116; mean age = 41 years, 63% women) presenting for treatment of depression at a not-for-profit and designated community mental health center for St. Joseph County, Indiana. The training model included a 2-day workshop followed by 1 year of phone consultations. CBT competence ratings from the Cognitive Therapy Scale were obtained prior to training and at 6 and 12 months posttraining. Two different groups of clients, a treatment-as-usual (TAU) group (n = 74) and a CBT group (n = 42), were compared with respect to decrease in symptoms of depression (assessed with the Beck Depression Inventory) and anxiety (assessed with the Beck Anxiety Inventory). Results: Therapists showed significant increases in total scores from pretraining to 6 months posttraining, increases that were maintained at 12 months. The increase in the total score reflected gains on items that specifically measure CBT skills and structure. Although both TAU and CBT resulted in a significant decrease in depressive symptoms, the CBT clients showed significantly greater change than the TAU clients, F(2, 113) = 53.40, p     

Influence tactics in psychotherapy.

Examined the process of psychotherapy within the context of social power theory. Therapist influence acts were classified in terms of the goals or reasons why therapists exercised influence and the strength of the influence attempt. The analysis was based on 22 tapes of psychotherapy sessions, provided by 5 female and 6 male therapists. Each therapist provided a tape of 1 male and 1 female client. Findings indicate that therapists were consistent in their use of tactics from one client to another. Male therapists, compared with female therapists, used significantly more influence tactics and interrupted their clients significantly more often. Therapists of both genders used significantly more passive forms of influence earlier in the session and more active forms later. Therapists of both genders told female clients what to do significantly more often than they did male clients, although they significantly more often explained thoughts, feelings, and behaviors to male clients than to female clients. Therapists used stronger influence attempts—those judged as demanding a response from the client—significantly more frequently with female clients than with male clients. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Informed consent: Therapists' beliefs and practices.

To assess the current status of informed consent among psychotherapists, a survey instrument was sent to 324 American Psychological Association members currently practicing therapy. 189 therapists returned completed surveys, yielding a response rate of 58%. Survey responses provided information on use, importance, reasons, communication, methods, and timing regarding 5 specific consent issues. These issues included confidentiality, risks, treatment length, treatment procedures, and alternatives. Results suggest similarity and variability in therapists' reported beliefs and practices. Therapists of a cognitive-behavioral orientation indicated they inform clients more often and consider the issues more important. These findings, along with the reasons given for not informing clients, highlight the complexity of applying ethical standards to practice contexts. Implications for practice and research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapists' sexual values for self and clients: Implications for practice and training.

Therapists may be confronted with clients whose sexual values and behaviors are different from their own. To understand more about therapists' sexual values and how these values may affect therapy, the current study assessed therapists' sexual values for both themselves and their clients in the areas of premarital, casual, and extramarital sex, open marriages, sexual orientation, and sex in adolescence and late adulthood. Therapists differed selectively in their sexual values depending on their gender, religious involvement, and political affiliation. Therapists appeared comfortable working with a variety of sexual issues in therapy, and it appears that training in sexual issues is helpful in clinical work. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender differences in psychotherapy dyads: Changes in psychological symptoms and responsiveness to treatment during 3 months of therapy.

This investigation examined the relationship between gender (client, therapist, and client/therapist dyad) and various psychotherapy-related variables for clients with mood and/or anxiety disorders. In several instances, both client and therapist gender predicted treatment retention and psychological symptom changes during 3 months of therapy. In general, female clients were more likely to advance beyond the initial intake assessment and also complete 3 months of therapy. Conversely, male clients were more likely to withdraw from therapy after the initial intake assessment. Specific client/therapist gender pairing predicted treatment retention in the mood disorder subsample and trait anxiety symptom severity in the anxiety disorder subsample. Some findings should be interpreted with caution, as there were small group samples in a few of the analyses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The therapeutic alliance and its relationship to alcoholism treatment participation and outcome.

The relationship between the therapeutic alliance and treatment participation and drinking outcomes during and after treatment was evaluated among alcoholic outpatient and aftercare clients. In the outpatient sample, ratings of the working alliance, whether provided by the client or therapist, were significant predictors of treatment participation and drinking behavior during the treatment and 12-month posttreatment periods, after a variety of other sources of variance were controlled. Ratings of the alliance by the aftercare clients did not predict treatment participation or drinking outcomes. Therapists ratings of the alliance in the aftercare sample predicted only percentage of days abstinent during treatment and follow-up. The results document the independent contribution of the therapeutic alliance to treatment participation and outcomes among alcoholic outpatients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Combined use of root conditioning, fibrin-fibronectin system and a collagen membrane to treat a localized gingival recession: a 10-case report

The relationship between the therapeutic alliance and treatment participation and drinking outcomes during and after treatment was evaluated among alcoholic outpatient and aftercare clients. In the outpatient sample, ratings of the working alliance, whether provided by the client or therapist, were significant predictors of treatment participation and drinking behavior during the treatment and 12-month posttreatment periods, after a variety of other sources of variance were controlled. Ratings of the alliance by the aftercare clients did not predict treatment participation or drinking outcomes. Therapists ratings of the alliance in the aftercare sample predicted only percentage of days abstinent during treatment and follow-up. The results document the independent contribution of the therapeutic alliance to treatment participation and outcomes among alcoholic outpatients.     

Therapists’ views on working with bilingual Spanish–English speaking clients: A qualitative investigation.

Through semistructured interviews, language switching in therapy was examined with 9 bilingual Spanish and English therapists. Therapists were asked about how and when they switched from one language to another during treatment, as well as the ways in which their clients’ switched languages. After the use of consensual qualitative research methods (C. E. Hill et al., 2005; C. E. Hill, B. J. Thompson, & E. N. Williams, 1997), the results revealed that therapists used language switching as a mechanism to establish trust, bond with clients, and promote disclosure through the use of specific phrases or specific words; particularly, the use of Spanish idiomatic expressions (dichos) served to engage, redirect, and increase client self-understanding and awareness. Therapists reported that their clients switched from English to Spanish when recounting experiences that involved certain emotions (e.g., anger) and represented themselves differently depending on the language they were speaking. Therapists also reported that their clients switched from English to Spanish to improve communication and to connect with them. Future directions for research and implications for training and practice are outlined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Experienced therapists’ approach to psychotherapy for adults with attachment avoidance or attachment anxiety.

Interviews were conducted with therapists (N = 12) nominated by peers as especially effective in working with clients with adult interpersonal problems. Open-ended questions asked how these therapists would approach 2 adult clients described in brief vignettes as having high attachment avoidance or anxiety. A coding team used a grounded theory approach to identify 8 higher order themes in the interviews: Conceptualization, Client Defenses, Managing Boundaries, Markers of Progress, Therapist Reactions, Targeted Interventions, Corrective Relational Patterns, and Internal Representations and Models. These themes were integrated into an inclusive theoretical model based on the core concept of therapists’ strategic management of therapeutic distance. The distance necessary to engage clients initially is adjusted later in therapy to create a corrective attachment in the psychotherapy relationship that facilitates change. Therapists described how, after engagement, they gradually increase therapeutic distance for clients with attachment anxiety who must then manage resulting frustration while learning to function more autonomously. Therapists gradually insist on decreased therapeutic distance to help clients with attachment avoidance overcome their fears of intimacy. Therapists discussed the specific techniques they use to manage therapeutic distance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outcomes and ocular growth rates after intraocular lens implantation in the first 2 years of life

PURPOSE: To evaluate the outcomes and ocular growth after intraocular lens (IOL) implantation in the first 2 years of life. SETTING: University-affiliated eye institute. METHODS: The medical records of consecutive children under 24 months of age who had cataract extraction with IOL implantation were reviewed. Change in axial length over time, postoperative complications, need for additional surgery, predicted versus actual postoperative refraction, and visual outcomes were recorded. Complication rates were compared with those in a similar group of age-matched patients who were left aphakic at the time of surgery. RESULTS: Twenty-two eyes of 17 patients aged 12 days to 22 months had IOL implantation. Length of follow-up ranged from 2 to 36 months (mean 14 months). Visual acuity measurement, limited to fixation-preference testing in most patients, revealed amblyopia in the operated eye in the majority of cases. Postoperative refractive error, predicted using the Holladay formula, showed a mean error in prediction of 1.5 diopters (D) (range -1.8 to 4.1 D). Serial axial lengths in 11 patients with a mean follow-up of 20 months showed no significant difference in growth in the fellow versus the operated eye. There was no significant difference in complication rates between pseudophakic patients and the age-matched aphakic group. However, in 14 of 32 aphakic eyes (44%), a notation in the chart indicated that the patient had stopped wearing glasses or contact lenses for at least 2 months. CONCLUSION: Intraocular lens implantation appeared to be a safe and effective alternative to contact lens or spectacle correction of aphakia in children younger than 2 years of age. It may aid amblyopia treatment by eliminating periods of uncorrected aphakia.     

Counselor theoretical orientation as related to intake judgments.

Investigated the relation between the predominant theoretical orientations (self-identified) of counselors and intake interview judgments by asking 12 senior staff counseling psychologists to rate the problems of 1,443 university students who presented themselves for an intake interview on a 5-point scale. Results show that counselors who were humanistically oriented judged that their clients presented more severe educational problems and characterized their clients as more anxious than did the cognitively oriented psychologists. The 2 groups of counselors did not differ in how they judged the severity of personal problems or predicted length of treatment. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of Cluster C personality disorders on outcomes of contrasting brief psychotherapies for depression.

Twenty-seven of 114 depressed clients, stratified for severity of depression, obtained a Diagnostic and Statistical Manual of Mental Disorders (3rd ed.; DSM-III; American Psychiatric Association, 1980) diagnosis of Cluster C personality disorder, that is, avoidant, obsessive-compulsive or dependent personality disorder (PD clients), whereas the remaining 87 did not (non-personality-disorder [NPD] clients). All clients completed either 8 or 16 sessions of cognitive-behavioral (CB) or psychodynamic-interpersonal (PI) psychotherapy. On most measures, PD clients began with more severe symptomatology than NPD clients. Among those who received PI therapy, PD clients maintained this difference posttreatment and at 1-year follow-up. Among those who received CB therapy, posttreatment differences between PD and NPD groups were not significant. Treatment length did not influence outcome for PD clients. PD clients whose depression was also relatively severe showed significantly less improvement after treatment than either PD clients with less severe depression or NPD clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Collaborative versus directive interventions in the treatment of eating disorders: Implications for care providers.

Given that individuals with eating disorders, are typically ambivalent about changing their eating patterns, what approach is most helpful in working with this challenging group? This research compared the responses of clients with eating disorders and those of care providers to written clinical vignettes. All participants rated collaborative interventions as more acceptable and more likely to produce positive clinical outcomes than directive interventions. In addition, clients who were least ready for change rated directive interventions as less acceptable and less likely to produce adherence than did clients who were more ready. Despite participants' clear preference for collaborative interventions, directive interventions were rated as equally likely to occur. The implications of participant preferences and reasons that these preferences may not be reflected in actual clinical practice are addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapists' anger, hate, fear, and sexual feelings: National survey of therapist responses, client characteristics, critical events, formal complaints, and training.

Therapists reported frequencies of experiencing 24 instances of feeling anger, hate, fear, and sexual attraction or arousal; encountering 16 client events (e.g., client orgasm, client disrobing, client suicide, client assault on therapist or 3rd party); and engaging in 27 behaviors (e.g., avoiding clients with HIV, kissing clients, massaging clients, using weapons or summoning police for protection from clients). Responses differed according to therapist gender (e.g., more male than female therapists experienced patient suicides and faced malpractice, ethics, or licensing complaints), client gender (e.g., more female than male clients were noticed as "physically attractive," hugged, and cradled in therapists' laps), and theoretical orientation. Many participants rated graduate training regarding anger, fear, and sexual arousal as inadequate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Criminal involvement of cocaine users enrolled in a methadone treatment program

This was a study of criminal activities of cocaine users versus non-users enrolled in a methadone treatment program in New York City. Of those 140 methadone clients studied, 100 (71%) were cocaine users. There were no demographic differences between the two groups except marital status. Married clients (including common-law married) were more likely than never-married single clients to be non-users. Cocaine users were significantly more depressed, using the subscale of the Symptom Checklist-90. Although numbers of lifetime arrests and criminal involvement (in the year immediately preceding the research interview) of cocaine non-users were distinctively lower than those of users, the differences were not significant. In a multiple regression analysis, length of stay in the methadone program was the strongest predictor of criminal involvement. Those who were retained longer in the treatment were significantly less likely to be involved in criminal activities, regardless of cocaine use.     

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)     

Therapists' experiences treating Asian American women with eating disorders.

How do psychologists treat eating disorders (EDs) and subclinical issues in Asian American women in a culturally competent manner? Disordered eating and body dissatisfaction are so common in women that most therapists work with the issues to some degree, and it is increasingly likely they will see women of color. Asian American women are at significant risk and yet little treatment literature exists. Twelve therapists with experience in ED treatment were interviewed about their work with Asian American women. Grounded theory and consensual qualitative analysis methods were used to analyze the data, resulting in two central domains of conceptualization within the cultural context and treatment approach. Therapists reported that their clients were mostly first- and second-generation Americans who experienced acculturation stress and cultural conflict, particularly with elders. Other results suggested therapists perceived a strong connection between clients' desires to be thin and successful, and clients' efforts to conform to traditional Asian cultural values and fit in with U.S. mainstream culture. Therapists emphasized the cultural contextualization of family dynamics, developmental processes (e.g., individuation), and intergenerational conflicts. They viewed EDs as providing clients with culturally congruent coping strategies to affectively disconnect and to express distress. Treatment themes centered on psychoeducation and the importance of including parents in the treatment of their adult daughters. Helping clients navigate autonomy within the family and cultural context, and challenging clients and parents on the cultural (both Asian and mainstream U.S.) pressures regarding achievement and beauty were particularly important. Implications for therapy are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)