The use of touch in psychotherapy: Ethical and clinical guidelines.

With the emergence of humanistically oriented therapies, and given recent developments, a different view of the therapist–client relationship has evolved. Although touch has long been associated with healing in most cultures, Freud and other psychoanalysts established a no-touch rule in the therapist–client relationship. Critics of the touch taboo argue that the blank screen stance of therapists recreates the cold and distance environment that contributed to the client's dysfunction, and it ignores the value of touch as a powerful therapeutic ingredient, one which emphasized a more open and intimate relationship between client and therapist. Today there is a lack of consensus about the use of touch and the complex ethical and clinical issues surrounding its use. This article review the clinical and research literature and explores views for and against using touch in therapy. Given the powerful effect of touch and the legal climate in our society, ethical and clinical guidelines are presented to assist the therapist in using touch appropriately, with sensitivity and skill. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Myers-Briggs Type Indicator personality dimensions and perceptions of quality of therapy relationships.

Examined associations between perceived quality of therapy relationships and therapist and client scores on the Myers-Briggs Type Indicator (MBTI). 35 experienced therapists and 53 adult outpatients involved in long-term personal therapy completed the MBTI and measures of therapy relationship quality and pretherapy adjustment. More positive client ratings of the quality of the therapy relationship were associated with similarity of therapist and client in overall MBTI profiles and in the thinking–feeling and judging–perceiving dimensions of the MBTI. When therapists had higher extroversion and feeling scores, both therapists and clients rated the relationship more positively. The MBTI may be valuable in determining optimal therapist–client matches and in guiding therapists to better understand their impact on clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexualité, intimité et relation d'aide.

Examines sexual relationships in terms of their impact on the client, therapist variables, and the basic features of the helping relationship. Even though ethical formulations unanimously condemn sexual relationships between clients and therapists, it is suggested that the clients' interests require the articulation of an integrative and practical model of sexual interaction in therapeutic relationships. (English abstract) (34 ref) (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)     

Empathy.

Empathy is defined, and its measurement is discussed. We then present the results of a new meta-analysis of the relation between measures of empathy and psychotherapy outcome from three perspectives (client, therapist, and observer). Variables that mediate this relationship also are discussed. The processes of change that empathy is posited to facilitate, as well as the different roles and forms that empathy may take in therapy are discussed. Results indicate that clients' and observers' perceptions that therapists understand their clients' internal experiences relate to outcome. This suggests it is important that therapists make efforts to understand their clients, and that this understanding be demonstrated through responses that address the needs of the client, as the client perceives them, on an ongoing basis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

More than a mirror: The ethics of therapist self-disclosure.

Perspectives on the ethical implications of self-disclosure differ widely. Many authors warn that self-disclosure by a therapist can be exploitative. Some authors also highlight beneficent reasons for disclosing in therapy. The ethicality of a particular self-disclosure is likely to depend on the content of the disclosure, the therapist's rationale for the disclosure, the personality traits of the client to whom the disclosure is made, and the specific circumstances surrounding the disclosure. Research suggests that clients experience both positive and negative consequences as a result of their therapists' self-disclosures. Because of the ambiguity and complexity of this ethical issue, therapists must take into account numerous ethical principles when using interventions that involve self-disclosure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparing therapist and client perspectives on reasons for psychotherapy termination.

Examines the extent of agreement on the reasons for psychotherapy termination given by therapists and their clients. 194 client files in a psychology training clinic were reviewed to obtain reasons for termination cited by therapists in treatment termination reports. Telephone interviews were conducted with 87 of these former clients to determine their perspectives on reasons for termination. Consistent with previous research, there was little concordance among the reasons cited by therapists and by clients regarding clients' decisions to terminate therapy. Of the clients identified by therapists as terminating because of the successful attainment of therapeutic goals, three-quarters reported this reason as important in their termination decision; of those clients reporting termination because of attaining therapeutic goals, only half were identified by therapists as having achieved their goals. Dissatisfaction with therapy and/or the therapist were reported by many clients as important in their termination decisions; such factors were rarely cited by therapists as reasons for termination. Attention to discrepancies between client and therapist expectations of therapy and therapy termination is necessary to reduce the high rate of premature termination in psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The clinical management of client dynamics and fees for psychotherapy: Implications for research and practice.

Research indicates that there is no clear relationship between fees and therapy effectiveness, although fees do impact the therapeutic process. By integrating E. Fromm's (1947) personality theory with a typology of client dynamics in response to fees, it is suggested that therapists are aided in the conceptualization of client dynamics and are able to develop proactive treatment interventions. For example, receptive clients may use fees to get attention, to foster helplessness, or to maintain ties with the therapist in the therapeutic relationship. Dynamics of exploitative, hoarding, and marketing clients are also outlined. A major benefit of the typology is that therapists can assess, evaluate, and interpret clients' dynamics in terms of goals, needs, feelings, and behavioral expressions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Getting the picture: The use of imagery to clarify therapeutic impasses.

Contends that imagery can be used to disclose the nature of the client–therapist relationship and to resolve therapeutic impasses. The most common forms of impasses in the relationship are the result of therapist's misperceptions, the pacing of therapy dealing with acting-out behavior, difficulties induced by transference and countertransference, and difficulties in making alliances with severely disturbed patients. To uncover latent images in the therapist–client interaction, therapists imagine a metaphoric meeting place with a client, what they become to each other there or what other forms they take, the activity both might be engaged in, what a dance between the 2 might look like, what might be done differently, and what translations can be made from the imaginal to the actual therapeutic relationship. Case illustrations with 4 female and 2 male clients are given. It is suggested that images clarify the symbolic and affective elements of the internal world. (45 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between clients' perceptions of therapist–parent similarity with respect to empathy, regard, and unconditionality and therapists' rating of client transference.

The authors studied the similarity between clients' perceptions of their therapists and their perceptions of their parents (or early parental figures) in terms of the relationship qualities of empathy, positive regard, and unconditionality of regard and how those perceptions compared with their therapists' ratings of transference. Participants were 62 actual therapy dyads. The results failed to support a hypothesized positive association between the similarity of the therapist and parents or parental figures on the relationship dimensions of empathy, regard, and unconditionality and therapist ratings of transference. Instead, the clients' relationship ratings of their parents and therapists suggested that therapists' perceptions of transference may more accurately reflect perceptions of their clients' nontransferential (i.e., real relationship) reactions to the therapist. (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)     

Effectiveness of a client pretherapy orientation videotape.

Examined the effects of a videotaped psychotherapy orientation on clients' response to therapy, knowledge about therapy, utilization of services, and satisfaction with services and on therapist ratings of client attractiveness. 62 psychotherapy clients (mean age 29 yrs) at an urban community mental health center were randomly assigned to an oriented group, which viewed a pretherapy orientation videotape at admission, or to a control group. 14 therapists participated. The 11-min videotape described the relationship between client and therapist, encouraged clients to attend appointments, and stated that, although progress is rarely immediate, most clients find that therapy can lead to a reduction in anxiety and depression. Clients and therapists completed questionnaire and rating scales at intake and at 1-mo follow-up. It was found that oriented clients were able to understand and recall the information in the videotape, and the oriented group showed a greater decrease in self-reported symptoms than the control group after 1 mo. Client feedback regarding the videotape was favorable. In general, the 2 groups did not differ in their satisfaction with services, service utilization, or therapist ratings of client symptoms and functioning. (29 ref) (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)     

Expectations and preferences.

Client expectations and preferences have been thought by many to influence the client's willingness to engage in and be influenced by the therapist and the process of therapy. Definitions and methods of assessment are presented of clients' expectancy for therapeutic gain; expectations about the roles they and their therapists will play; and their preferences for therapy roles, type of psychotherapy, and demographic features of the therapist. Included is a review of the empirical evidence based on 76 studies of the relation between client expectations and preferences, on the one hand, and the outcome of psychotherapy, on the other hand. Clients' expectations for therapeutic gain are related to outcome in most studies, although no causal conclusions can be drawn. The literature on role expectations is equivocal, and the relatively few studies on client preferences yield primarily negative or mixed results. Finally, specific implications for therapeutic practices are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-concept and self-esteem as moderators of client transference.

Operationalized transference as (a) the similarity of clients' perceptions of their therapist and their perceptions of their parents and (b) therapists' ratings on a transference scale, Therapy Session Check Sheet (TSCS; H. Graff and L. Luborsky, 1977), and examined the moderating role of self-esteem and ego development on client transference. Ss were 62 clients (aged 19–63 yrs) who were already involved in therapy, and 29 therapists (aged 25–61 yrs). The Barrett-Lennard Relationship Inventory (G. T. Barrett Lennard, 1962, 1973) measured the facilitative conditions (regard, empathy, and unconditionality) and therapist–parent similarity and the TSCS measured the therapists' perceptions of transference. Additional measures were the Ego Identity Scale (A. L. Tan, et al, 1977) and the Rosenberg Self-Esteem Scale (M. Rosenberg, 1979). Results support the idea that self-esteem and ego development impact a client's view of the therapist and parental figures and are associated with therapists' views of transference. Persons with low ego identity and low self-esteem tended to see their therapists and parental figures more dissimilarly; and the more transference that a therapist perceived, the greater the tendency for the client to have low ego identity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gay and lesbian clients' selection of therapists and utilization of therapy.

Examined gay and lesbian clients' therapy utilization and therapist selection. Specifically the study examined whether clients' sexual orientation and gender relate to the total number of therapists seen and to the average duration of therapy, what the demographic characteristics of the therapists chosen by gay and lesbian clients are, the likelihood that gay men and lesbians prescreened potential therapists for gay-affirmative attitudes, the methods used to prescreen, and if the prescreening related to client satisfaction. 172 gay men and 220 lesbians (aged 22–71 yrs) who had seen at least 1 therapist participated in the study. A comparison group of 81 heterosexual individuals matched for demographic characteristics also participated in the study. Results show that 41% of the therapists gay and lesbian Ss saw in the 1990s were gay, lesbian, or bisexual. Of the therapists seen, 63% had been screened for gay-affirmative attitudes by respondents before being selected. Prescreening was associated with higher therapist ratings. Several methods for therapist screening were reported including seeking a referral. Results also show that gay and lesbian Ss reported seeing more therapists and seeing therapists for longer durations than heterosexual Ss. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Similarity between therapists' and clients' locus of control: Implications for therapeutic expectations and outcome.

Investigated the possible influence of locus of control (LOC) similarity between clients and therapists on therapeutic process and outcome with 21 practicing therapists (mean age 42 yrs) and 78 of their current clients (mean age 35 yrs). LOC was measured for both therapists and clients using Rotter's Internal–External Locus of Control Scale. Therapists self-administered questionnaires on their clinical expectations and therapy evaluations at the beginning and end of therapy, respectively. Questionnaires about the clients' characteristics and clinical expectations were administered at the initial stages of therapy, and questionnaires about the client's LOC and therapy evaluations were administered at the end of therapy. Results indicate that initial similarity in LOC between client and therapist significantly influenced clinical expectations, while the posttest similarity between client's and therapist's LOC significantly influenced evaluations of therapy outcome. Pretherapy matches on the LOC variable were insufficient to predict outcome; however, contemporaneous LOC scores appeared to have utility for client's and therapist's expectations and evaluations. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Formation of a therapeutic relationship: Experiences during the initial phase of psychotherapy as predictors of treatment duration and outcome.

Studied the formation of a psychotherapy relationship using self-reports of clients and therapists. Items designed as measures of a set of dimensions considered salient to the process of therapy were incorporated into client and therapist report forms. These were completed separately by clients and therapists immediately following each of the initial 10 sessions. It was hypothesized that report-form dimension scores early in treatment would predict persistence in treatment, duration of treatment, and retrospective evaluations of outcome. Subjects were 91 students (36 males, 55 females) attending a large urban unversity and 19 therapists (10 females, 9 males) on the staff of the university student counseling service. A number of client and therapist dimensions predicted persistence in treatment as early as the 3rd session. Dimension scores failed to predict duration of treatment for remainers, however. A greater number of dimension scores correlated with therapist outcome ratings than with client outcome ratings. (38 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)