Incidental encounters between therapists and their clients.

Data about incidental encounters with clients in public settings were provided by 573 college therapists (return rate?=?32%), using J. C. Flanagan's (1954) critical incident technique. Results indicated that many therapists experience feelings of surprise, uncertainty, and discomfort, as well as concern about possible violation of confidentiality and therapeutic boundaries during such encounters. Implications for future research are discussed in light of these findings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual and business relationships between therapists and former clients.

Examined the incidence of post-termination sexual (PTSRs) and business relationships (PTBRs) between therapists and former clients, as well as the legal, clinical, demographic, and professional judgment considerations related to both PTSRs and PTBRs. Among a sample of 348 therapists (aged 29–81 yrs; 52% male) who had been delivering psychotherapy services for an average of 14 yrs, it was found that 6.5% engaged in PTSRs and 29% engaged in PTBRs. Demographic comparisons showed that males were significantly more likely to engage in both PTSRs and PTBRs. PTSRs were always viewed as more inappropriate than PTBRs. Results provide considerable support for the inclusion of prohibitions against sexual intimacies with former clients as part of the Ethical Principles and Code of Conduct (American Psychological Association; see record 1993-19413-001). (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)     

Confidentiality with minor clients: Issues and guidelines for therapists.

Confidentiality is fundamental to the therapeutic relationship; however, minors' rights regarding confidentiality are not clear. Legal issues in minors' voluntary consent to treatment are discussed, and a review of the clinical and developmental literature regarding minors' ability to provide informed consent to treatment is provided. Professional attitudes and actions regarding the best interests of and confidentiality with minor clients are also reviewed. Guidelines for deciding when it is appropriate to maintain a confidential therapeutic relationship with a minor and strategies for how to do so are suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Incidental encounters between therapists and clients: The client's perspective.

A questionnaire concerning clients' feelings about incidental encounters with therapists was administered to 147 university counseling center clients. Results indicated that most clients had experienced brief incidental encounters with their therapists. Clients generally felt comfortable with their therapists' responses, but some wanted a more involved response from their therapist. The feelings that clients reported experiencing most frequently were confidence, surprise, awkwardness, enjoyment, curiosity, and anxiety. Implications for further research and training are discussed. (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)     

Harmful effects of posttermination sexual and romantic relationships between therapists and their former clients.

[Correction Notice: An erratum for this article was reported in Vol 25(4) of Psychotherapy: Theory, Research, Practice, Training (see record 2007-12032-001). Reference was made to the Minnesota law regarding reporting of "any sexual or romantic relationship in which the parties were once therapist and client" (p. 250). Upon further review by the author, it was determined that the law is more complicated than conveyed in the article. A detailed explanation of the law is provided in the erratum, although legal counsel is suggested for further interpretation.] Examines anecdotal evidence regarding the harmful effects of posttermination sexual or romantic relationships between therapists and clients, focusing on relationships between female therapists and former clients who are also women. The question of equality of power between therapists and former clients is addressed. The impact of these relationships on the community in which they occur is considered. It is concluded that posttermination relationships between therapists and clients have the potential to do as much harm as relationships initiated during therapy and that such relationships should be defined as unethical. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How therapists manage potentially dangerous clients: Toward a standard of care for psychotherapists.

We assessed the techniques that psychotherapists use in the treatment and management of potentially dangerous clients. A nationwide sample of professional psychologists was surveyed in order to determine what they perceived to be important therapeutic interventions for use with dangerous outpatients. From these responses, a 46-item rating scale was developed. Another sample (n?=?101) of practicing psychologists completed the scale by indicating the likelihood that they would use each of the 46 interventions. Data were analyzed with respect to nine rationally derived subscales. Indicators of therapist expertise were related to several of the subscales, but theoretical orientation of therapists generally was not. We discuss three areas of future research that will be necessary in developing an empirically based standard of care for dangerous clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological impacts of sexual contact between therapists or other health care practitioners and their clients.

14 females who had had sexual contact with their therapists/psychiatrists (Group 1), 7 females who had had sexual contact with their health care practitioners (principally physicians [Group 2]), and 10 females who had received counseling services but had not engaged in sexual contact with therapists (Group 3) were compared by administering a questionnaire on self-esteem, depression, attitudes, beliefs about sexual contact, emotional effects of treatment, sexual attitudes, and psychosomatic and psychological symptoms. In addition, data were obtained from Ss, who were primarily aged 26–45 yrs, on (1) history of sexual victimization, (2) marital status of therapist/physician, (3) who initiated sexual contact, and (4) frequency of sexual contact. Results show that Ss in Group 1 had greater mistrust of and anger toward males and therapists and a greater number of psychological and psychosomatic symptoms following the cessation of therapy than did Ss in Group 3. Ss in Groups 1 and 2 did not differ in psychological impacts. Severity of impacts were significantly related to the magnitude of psychological and psychosomatic symptoms prior to treatment, prior sexual victimization, and the marital status of the therapist or health practitioner. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Delayed recall of childhood sexual abuse: psychiatric nursing's responsibilities to clients

In no other area of psychiatric care is such suspicion being cast on clients as in the area of delayed recall of childhood sexual abuse. Adult survivors of childhood abuse are encountered in nursing contexts of all kinds. Psychiatric nurses should be the ones that other nurses and members of the public can look to for guidance and clinical wisdom about dissociative amnesia for childhood abuse. It is incumbent on psychiatric nurses, especially those who publish about clinical issues, to provide the most accurate and complete available knowledge, to prioritize clients' needs, and to recommend care that meets the highest standards.     

Racial/ethnic matching of clients and therapists in mental health services: A meta-analytic review of preferences, perceptions, and outcomes.

Across several decades the effects of matching clients with therapists of the same race/ethnicity have been explored using a variety of approaches. We conducted a meta-analysis of 3 variables frequently used in research on racial/ethnic matching: individuals' preferences for a therapist of their own race/ethnicity, clients' perceptions of therapists across racial/ethnic match, and therapeutic outcomes across racial/ethnic match. Across 52 studies of preferences, the average effect size (Cohen's d) was 0.63, indicating a moderately strong preference for a therapist of one's own race/ethnicity. Across 81 studies of individuals' perceptions of therapists, the average effect size was 0.32, indicating a tendency to perceive therapists of one's own race/ethnicity somewhat more positively than other therapists. Across 53 studies of client outcomes in mental health treatment, the average effect size was 0.09, indicating almost no benefit to treatment outcomes from racial/ethnic matching of clients with therapists. These 3 averaged effect sizes were characterized by substantial heterogeneity: The effects of racial/ethnic matching are highly variable. Studies involving African American participants demonstrated the highest effect sizes across all 3 types of evaluations: preferences, perceptions, and outcomes. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Misconduct by therapists.

Suggests that, in his retrospective review of malpractice claims against psychologists, R. H. Wright (see record 1982-22006-001) infers beyond the limits of the data he reports. Specifically, he suggests that, because there were so few complaints of sexual misconduct, stories of sex between psychologist and patient are substantially overstated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-talk of group therapists.

To identify group leader cognitions and the role experience may play in leader cognitive schemas, 60 participants were placed in 1 of 3 groups on the basis of group-leading experience and were exposed to a 20-min videotape of a group session, during which they completed a thought-listing instrument. Two judges free sorted the 1,299 collected thoughts and identified and defined 17 distinct thought categories. Three trained judges then placed 1,271 (97.8%) of the thoughts into these categories. Differences among experience levels were also explored through correlation and stepwise multiple regression analyses. Two thoughts, interpretation of group process and internal question regarding member, were found to account for 56% of the variance in experience level. Findings are discussed in terms of group leader cognitive processing, and suggestions for future research are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The education of therapists.

At a conference for female therapists in Canada, participants answered a questionnaire on issues and skills of therapists. Results indicate that the Ss were interested in (1) understanding themselves, their careers, and women's roles in society, and (2) a feminist approach to therapy. The responses suggest that the Ss' training as therapists was inadequate to the extent that it failed to address their own reality and that of women clients. (0 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The cognitive, emotional, and relational characteristics of master therapists.

Cognitive, emotional, and relational characteristics among 10 peer-nominated master therapists were identified through qualitative research methods. Results suggest that master therapists (a) are voracious learners; (b) draw heavily on accumulated experiences; (c) value cognitive complexity and ambiguity; (d) are emotionally receptive; (e) are mentally healthy and mature and attend to their own emotional well-being; (f) are aware of how their emotional health impacts their work; (g) possess strong relationships skills; (h) believe in the working alliance; and (i) are experts at using their exceptional relational skills in therapy. These findings suggest that researchers studying therapist expertise may want to explore emotional and relational characteristics in addition to an almost exclusive focus on the therapist's cognitive attributes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Limit setting practices of play therapists in training and experienced play therapists.

This study evaluated the effect of play therapy training on graduate students' limit-setting choices in play therapy and compared their reported choice of limits with the reported choice of limits of experienced play therapists. The results indicated a significant difference between pre-training and posttraining limit-setting choices of graduate students, with more limits being chosen after training. The limits selected by students after play therapy training were similar to those chosen by experienced therapists in past studies. After training, students selected limits most frequently in the areas of physical aggression against the therapist, physical aggression against equipment, and on behaviors which endangered the child's health and safety. After training, students chose the fewest limits in the area of socially unacceptable behavior, particularly in the expression of obscenity in the playroom. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Working with Mexican-American clients.

Addresses issues crucial in serving mental health needs of Mexican-American clients. Topics include demographics, language, acculturation, social support, etiquette, and other information useful in developing initial hypotheses and treatment goals. The various topics and possible interventions are discussed within the framework of 3 case vignettes. The author's goal is to increase the reader's sensitivity to cultural differences, help clinicians avoid potential stumbling blocks, and make existing programs more accessible by overcoming barriers which discourage or exclude potential Mexican-American clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy with hearing-impaired clients.

Discusses issues regarding communication with hearing-impaired persons in psychotherapy, such as the use of an interpreter or telecommunication devices and the need for an awareness of interactional strategies used by deaf patients. The appropriateness of several personality, intelligence, and projective tests with hearing-impaired patients is reviewed, and the value of a personal history questionnaire is emphasized. It is suggested that in treatment, the therapist must be prepared to modify stereotypes of hearing-impaired persons, theoretical approaches to psychotherapy, and methods of communication. (50 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)