The Missouri Psychoanalytic Counseling Research Project: Relation of changes in counseling process to client outcomes.

A short-term psychoanalytic counseling model was used to identify process dimensions and client outcomes. Six counselors saw 16 clients over the course of 2 semesters. Clients responded to measures at pre- and posttest and after each session, and counselors filled out measures following each session. Sessions were audio- and videotaped and viewed by trained raters. P-technique factor analysis identified 4 dimensions: Psychoanalytic Technique, Working Alliance, Client Resistance, and Client Transference. Results of hierarchical linear modeling indicated that counselor use of psychoanalytic technique and the working alliance increased steadily across the sessions, whereas client resistance steadily decreased. The alliance dimension also changed in a quadratic fashion. The process dimensions also influenced each other and were related to better client outcomes. Implications are discussed and suggestions for future research are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gay and bisexual male clients' perceptions of counseling: The role of perceived sexual orientation similarity and counselor universal-diverse orientation.

A recurring question in multicultural counseling is whether client–counselor similarity on sociodemographic characteristics benefits counseling. A related issue is how counselor orientation to diversity relates to counseling process and outcome, both as a main effect and in interaction with counselor–client sociodemographic match. This cross-sectional study investigated these questions in relation to gay and bisexual male clients' counseling experiences by examining clients' perceived similarity to their counselor in sexual orientation, as well as counselors' self-reported orientation to diversity (assessed in terms of level of universal-diverse orientation [UDO]). Data were from 83 male–male client–counselor dyads recruited from lesbian/gay/bisexual-affirming counseling practices, where clients identified as gay or bisexual and counselors identified as gay, bisexual, or heterosexual. Counselor UDO was positively and uniquely associated with client ratings of the working alliance, session depth, and session smoothness. Perceived sexual orientation similarity was not directly related to any of the counseling-related criterion variables. Moreover, when counselors reported low levels of UDO, perceived similarity was negatively associated with the client-rated alliance and perceived improvement. Client religious commitment—a control variable in all analyses—was uniquely and negatively associated with client ratings of perceived improvement in counseling. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Memory for therapeutic events, session effectiveness, and working alliance in short-term counseling.

Relationships among participants' assessments of the working alliance, effectiveness of counseling sessions, and memories for important therapeutic events were investigated in 10 counseling dyads. Results indicated that counselors exhibited greater specificity of recall of important events for sessions rated as more effective and showed greater specificity of recall than did clients. Counselors evidenced a statistically reliable increase in the bond aspect (quality of counselor–client relationship) of the working alliance over time, but there was no relationship between specificity of recall and the working alliance. Implications of these results for therapeutic work are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client self-terminations after one counseling session: Effects of problem recognition, counselor gender, and counselor experience.

From a pool of 758 clients seen individually by 1 of 34 counselors at a large university counseling center, 533 clients were identified as having self-terminated from counseling after their initial session or as having continued in counseling for at least 3 sessions. The authors investigated potential relationships between continuation in counseling and the variables of counselor experience, counselor gender, and counselor recognition of clients' problem definitions. As predicted, the results of logit analyses indicated that clients were more likely to self-terminate after 1 session when problem recognition was absent. This relationship was more pronounced for experienced counselors than it was for trainees, suggesting a possible explanation for the lack of a direct relationship between counselor experience and continuation in counseling in recent studies. Female counselors had higher rates of early premature terminations than male counselors. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Moderating effects of client attachment on the counselor experience–working alliance relationship.

The authors predicted that client attachment status would moderate the relationship between counselor experience and client-perceived working alliance. Forty clients from 2 university counseling centers completed measures of attachment and the working alliance. Their counselors were classified according to experience level. Client comfort with intimacy was related to a stronger alliance with the counselors. However, counselor experience was unrelated to client-rated working alliance. Client attachment, specifically comfort with intimacy, moderated the relationship between counselor experience and working alliance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship of trainee self-efficacy to the process and outcome of career counseling.

This investigation examined the role of counselor trainees' self-efficacy on measures of career counseling process, "small o" outcome, and outcome with actual clients. Twenty-four counselor trainees saw 55 clients in 3 to 12 individual sessions. Results indicated that (a) career counseling self-efficacy increased by a standard deviation from prepracticum to postpracticum; (b) client scores significantly improved from pretest to posttest across multiple career outcome measures; (c) clients' working alliance, goal attainment, and decidedness indicated significant growth; (d) the significant growth on the process variable and small o outcome variables did not appear to be related to career counseling self-efficacy; and (e) career counseling self-efficacy apparently related to certain career counseling outcome measures in a manner suggesting much greater complexity than the "more self-efficacy is better" philosophy would imply. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of Client Expectation for Counseling Success, Client-Counselor Worldview Match, and Client Adherence to Asian and European American Cultural Values on Counseling Process With Asian Americans.

After assessing their expectation for counseling success, adherence to Asian cultural values, and adherence to European American cultural values, 88 Asian American volunteer clients with personal concerns engaged in single-session counseling with 1 of 11 female counselors who either matched or mismatched the client's worldview. Clients in the worldview match condition perceived stronger client-counselor working alliance and counselor empathy than those in the mismatch condition. Client adherence to Asian cultural values was positively related to client-counselor working alliance. Client adherence to European American values was positively associated with client-counselor working alliance and session depth. In addition, an interaction effect was observed such that high expectation for counseling success and strong adherence to European American cultural values were associated with increased perception of counselor empathy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Session impact, working alliance, and treatment outcome in brief counseling.

Examined associations among working alliance, session evaluations over the course of brief counseling, and counseling outcome. At a training clinic, 61 clients and student counselors from 41 dyads completed ratings of session depth, smoothness, positivity, and arousal after their 1st 12 sessions. Alliance ratings were completed after the 4th session and at termination. Clients and counselors also provided 5 measures of counseling outcome. Results indicated that session evaluations were significantly related to later alliance ratings, and positive alliance ratings predicted subsequent session evaluations. Both linear and curvilinear session effects were suggested. Associations for client ratings were generally stronger than for counselor ratings. Both alliance and session evaluations were significant unique predictors of client-related outcome, but only alliance predicted counselor-rated outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Racial microaggressions against African American clients in cross-racial counseling relationships.

This study examined the relationships among African American clients' perceptions of their White counselors with respect to (a) perceived racial microaggressions in cross-racial counseling relationships, (b) the counseling working alliance, (c) their counselors' general and multicultural counseling competence, and (d) their counseling satisfaction. Findings revealed that greater perceived racial microaggressions by African American clients were predictive of a weaker therapeutic alliance with White therapists, which, in turn, predicted lower ratings of general and multicultural counseling competence. Greater perceived racial microaggressions also were predictive of lower counseling satisfaction ratings. In addition, African American clients' perceptions of racial microaggressions had a significant indirect effect on these clients' ratings of White counselors' general and multicultural counseling competence through the therapeutic working alliance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Session evaluation and recall of important events as a function of counselor experience.

Session evaluation and type of participant-recalled important event were investigated in 25 novice counselor dyads and 9 experienced counselor dyads during 9 sessions of short-term counseling. Counselor experience was the independent variable and session evaluation was the dependent variable. Results based on the Session Evaluation Questionnaire (W. B. Stiles, 1980) showed a significant interaction effect between counselor experience and role of participant (client or counselor) for session depth. Clients also reported an increase in positive affect over the course of counseling. Experienced counselors recalled more important events involving insight, whereas novice counselors recalled more important events involving exploration of feelings or self-critique. The type of important event recalled by clients also changed over the sessions of counseling. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship of counselor self-talk and hypothesis formulation to performance level.

25 female and 15 male counselors across a range of skill levels (14 students in graduate-level counseling laboratory classes, 13 doctoral or advanced master's degree students who had completed at least 1 practicum experience, and 13 professional counselors working as therapists in community agencies) conducted 25-min counseling interviews with 1 of 4 female undergraduate clients and then completed instruments measuring the frequency of task-facilitative and task-distractive self-talk and the quality of clinical hypothesis formulation. It is hypothesized that these measures of counselor internal dialog would be predictive of counselor performance (clients' and trained raters' evaluations) once the effects of counselor gender, education level, and years of experience were accounted for. Cognitive variables were assessed, using standard multiple regression techniques, for their combined and unique contributions to the overall prediction equation. A positive relationship between higher quality clinical hypothesis formulation and higher levels of facilitative performance during counseling sessions was found. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mistrust level and its effects on counseling expectations in Black client-White counselor relationships: An analogue study.

Black clients' high dropout rates from counseling with White counselors are often explained by the clients' lack of trust for Whites. This analogue study examined the effects of cultural mistrust on counseling expectations for Black clients assigned to both Black and White counselors. Subjects completed the Cultural Mistrust Inventory (an inventory designed to measure Blacks' mistrust of Whites) and the Expectations About Counseling questionnaire. In a 2 (subject sex)?×?2 (subject mistrust level)?×?2 (counselor race) factorial design, client mistrust level interacted significantly with counselor race. When assigned to a White instead of a Black counselor, highly mistrustful Blacks expected the counselor to be less accepting, trustworthy, and expert; they also expected less in terms of counseling outcome. We discuss the possible implications of these findings for counseling practice and the need for White counselors to be sensitive to the cultural mistrust issue when working with Black clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal influence process in real-life counseling: Investigating client perceptions, counselor experience level, and counselor power over time.

Examined the interpersonal influence process within an actual counseling context over an average of 8 sessions. Counselors were either beginning or advanced practicum students or doctoral interns (n?=?27); clients were 31 students who sought counseling at a university center. Before and after counseling Ss completed the Counselor Rating Form, the Expectations about Counseling measure, and the Counselor Perceptions Questionnaire. Results indicate that (a) the actual counselor experience level did not affect client perceptions of the counselor; (b) perceived counselor expertness, attractiveness, and trustworthiness changed over time, but not in the same direction across counselors; (c) different levels of client need did not affect clients' perceptions of counselor characteristics; and (d) counselors rated as highly attractive indicated they had more therapeutic power over clients than counselors rated as moderately attractive. (46 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relation of counselor intention and anxiety to brief counseling outcome.

Explored the construct validity of counselor intention as conceptualized in the cognitive-mediational paradigm (Martin, 1984). Specifically, we examined the influence of clarity of counselor-stated intention, which is the quality of articulation of counselor statements of intention associated with counseling interventions, and counselor in-session anxiety as mediators of outcome in brief counseling. Counselors, clients, and independent judges rated the quality of counseling sessions. The clarity of counselor-stated intention was related positively to clients' and judges' ratings of counseling outcome. Counselor in-session anxiety was associated negatively with the outcome ratings of the counselors. The implications of these findings for the counselor intention construct and Martin's paradigm are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in counselor adherence over the course of training.

Following recommendations of S. F. Butler and H. H. Strupp (1993), novice counselors were used to examine the development of adherence and counselor interactional style over the course of manual-based training in time-limited dynamic psychotherapy (TLDP; H. H. Strupp & J. Binder; 1984). Adherence to TLDP was assessed with the Vanderbilt Therapeutic Strategies Scale. Counselor interactional style was assessed with the client version of the Working Alliance Inventory. Growth curve analyses showed a significant linear increase in TLDP adherence and in client-rated working alliance for the novice counselors across 4 supervised training sessions. Time-series analysis (cross-correlations) indicated there was a lead-lag relationship with (a) counseling sessions in which higher ratings of counselor interactional style followed sessions with more counselor adherence to a general psychodynamic interviewing style and (b) sessions with higher ratings on adherence to psychodynamic interviewing style preceded sessions with higher level of adherence to TLDP specific strategies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social psychology and counseling psychology: The history, products, and promise of an interface.

For 3 decades, counseling psychologists have drawn ideas from social psychology about the social process of counseling, integrated the ideas into counseling theories, and assessed them in research. This article traces the history of this interface, examines its products, and projects its future. Three propositions have guided and have been supported by much of the research: (1) Successful counseling relationships generate psychological convergence between counselor and client through a systematic developmental process; (2) ideas counselors introduce that are discrepant from clients' understandings stimulate change; and (3) clients' responsiveness to counselors is a function of their dependence on the counselors. These social influence dynamics underlie the processes and outcomes of counseling relationships regardless of the clinical theory that guides the counselors' work. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client perception of the counselor and orality.

Since previous research and psychoanalytic theory have demonstrated that orality is related to accurate perception of others, it was predicted that high-oral clients would be more accurate perceivers of their counselors than low-oral clients. A pilot study of 12 clients and graduate-student counselors found a trend in the expected direction; a larger study of 21 Ss using a revised Perception of Counselor Questionnaire confirmed the hypothesis. Accuracy of perceiving the counselor did not improve from the 1st administration of the questionnaire, which followed the 3rd counseling session, to that which followed the termination of counseling. The most accurate perceptions were made by female clients with male counselors. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relation between counselors' use of intentions and clients' perception of working alliance.

I examined the relation between counselor intention use and client-rated working alliance. Subjects were 42 volunteer clients paired with 42 counselor trainees for 4 counseling sessions. Ratings were obtained for client interpersonal attitudes, client-rated working alliance, and counselor intention use. Counselor intention use accounted for a moderate amount of variance in client-rated working alliance, after the variance in client interpersonal attitudes was removed. Specific counselor intentions (assessment, explore, support) were negatively related to strength of the working alliance. The implications of these findings for theoretical formulations of working alliance formation are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Three methods in measuring the therapeutic process: Clients' and counselors' constructions of the therapeutic process versus actual therapeutic events.

Explored 3 methods in examining the therapeutic process that (1) assessed how clients construct and interpret the change process and counselors' behavior over time, (2) assessed the content and valence of clients' and counselors' most memorable thoughts immediately after the session, and (3) compared the clients' and counselors' memorable thoughts with the actual content of the counseling sessions. A single-S design was used to examine 3 counselor–client dyads across 7 counseling sessions. The results provided preliminary but rather encouraging support of 2 methodologies, Guided Inquiry and thought listing, that assess how clients and counselors construct and interpret aspects of the therapeutic process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clients' pretreatment counseling expectations as predictors of the working alliance.

Because research suggests that counseling expectations are malleable and that alliance ratings predict clinical outcomes, the relationship between this pretreatment client characteristic (expectations) and the quality of the alliance early in treatment deserves further attention. This study examined the relationships between 57 clients' pretreatment role expectations and 3rd-session client-rated alliance in a naturalistic setting. Prior to intake, clients completed the Expectations About Counseling-Brief Form (H. E. A. Tinsley, 1982), and clients completed the Working Alliance Inventory-Short Form Revised (R. L. Hatcher & J. A. Gillaspy, 2006) following the 3rd therapy session. Results indicate that clients' expectations for personal commitment predicted the task, bond, and goal dimensions of the alliance. Expectations for facilitative conditions and counselor expertise did not predict clients' perceptions of the alliance. Clinical implications and research directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)