The psychotherapeutic relationship.

This paper attempts an exhaustive review of the literature on the psychotherapeutic relationship. The nature of the ideal psychotherapeutic relationship is defined and approximations of this ideal are shown to correlate positively with various measures of patient progress in the therapeutic enterprise. Other correlates of good therapeutic relationships are then explored: patient variables, therapist variables, therapist-patient similarity, and technique variables. In all these areas, significant correlations are found, though not as often as one might expect. The research on therapist variables is especially disappointing, while patient variables seem to be quite good predictors of the quality of the ensuring patient-therapist relationship. Methodological issues are considered throughout the paper. (72 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Verbal communication level and anxiety in psychotherapeutic groups.

Hypothesized a linear relationship in psychotherapeutic groups between verbal behavior (defined as the level of communication) and experienced anxiety. However, trained judges' ratings of 6 2-hr tape-recorded group sessions revealed a curvilinear relationship between these 2 variables. The maximum level of anxiety occurred on the border of communication of private and unknown-self material. When communication increased above these levels, the anxiety tended to decrease. This is explained in terms of S. Epstein's 1967 finding that bodily arousal and experienced anxiety increase progressively to a certain stimulus intensity level. Then, with still increasing stimulus intensity, the bodily arousal and physiological anxiety will continue to increase while the experienced anxiety will tend to decrease because of the intervention of certain inhibitory mechanisms. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A model combining two psychotherapeutic approaches in group psychotherapy.

Describes a multidimensional model that combines Gestalt and psychoanalytically oriented approaches in group therapy to overcome problems of dropping out, resistance, and regression. Eight outpatients (aged 30–50 yrs) were treated using this model, which altered approaches, cotherapists, and meeting places. Four case illustrations are provided as demonstrations of improvement and success. The group's reactions to the model are discussed along with observations regarding group work and group therapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Erickson and Kierkegaard: Indirect communication in psychotherapy.

In the present paper, we will show that, in their complementary approaches to indirect communication, Erickson and Kierkegaard have something important to offer to one another's theories. While Kierkegaard developed a framework by which Erickson can be more profoundly understood, Erickson's accounts offer clinical cases which support what Kierkegaard described. This mutual trade of benefits not only broadens and deepens the notion of indirect communication, but also alerts us to the fact that it was recognized and developed in two relatively independent disciplines, almost a hundred years apart! This parallel implies that indirect communication is, at the very least, a phenomenon worth investigating from both perspectives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perspectives on response-able psychotherapy: Rebuttal to "Emotionality and irrationality in psychotherapeutic fads."

Addresses R. M. Jurjevich's (see record 1979-29031-001) confusion of bad therapy with therapies that may promote emotional release. Jurjevich's classical leanings are noted and addressed as an inadequate model or view of people. The present author believes Jurjevich's article was misleading, and in its failure to responsibly educate, was unfit for publication. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

If sex enters into the psychotherapy relationship.

This article was originally published by the Committee on Women in Psychology to inform the public about the harmful effects of therapist–patient sexual intimacy. The Committee points out that sexual contact between a therapist and his or her patient is prohibited by the Ethical Principles of Psychologists of the American Psychological Association, as well as by the ethics codes of most other associations representing the professions licensed to conduct psychotherapy. The Committee discusses how to tell whether a therapist's conduct is appropriate and the importance of discussing with the therapist anything that he or she does that leads to discomfort whether or not it is sexual in nature. It also points out the negative effects of ending therapy to have a personal relationship. The Committee presents a range of actions that might be taken if sexual intimacy does occur. Although originally published as a consumer-oriented brochure, the article provides information for psychotherapists, trainers of psychotherapists, and other individuals concerned with therapy ethics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A reevaluation of the relationship between psychotherapeutic orientation and perceived personality characteristics.

Evaluated the relationship between psychotherapeutic orientation and perceived personality characteristics in 64 Israeli psychotherapists who were psychoanalytic, eclectic, or behavioristic in approach. Ss rated themselves, a "typical" therapist of their orientation, and a typical therapist of the other 2 orientations on action-oriented (AOCs), insight-oriented, and authoritarian personality characteristics. Self-ratings differed significantly only on AOCs, with behaviorists rating themselves higher than psychoanalysts and eclectics. Differences between self- and typical therapist perceptions suggest a stereotypic acceptance of a connection between therapist's orientation and personality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Non-verbal affective communication as a factor in psychotherapy.

Examines aspects of general and specific factors in psychotherapy as they relate to interpersonal variables identified in analytic literature and in empirical research. It is suggested that 1 of the reasons why interpretation of the research concerning the role of empathy and understanding in the successful patient–therapist relationship is difficult and the results unclear is that many aspects of the interpersonal environment are more subtle and complex than existing research implies. Therapists of many persuasions who wish to enhance the effectiveness of psychotherapy may need to examine some of the less obvious aspects of the therapeutic environment. Evidence suggests that nonverbal affective interactive states are important as change producing agents. Even when specific techniques are applied, emotional aspects of the therapeutic relationship may have a powerful effect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Two methods of assessing unconscious communication in psychotherapy.

Explores the relation between 2 quantitative measures of unconscious communication: (1) referential activity, which emerged from the dual-coding model of mental representation, and (2) newness of themes and extent of narrative/imagery, first identified as bearers of derivative material in the communicative approach to psychotherapy. The measures are applied to data from 2 female patients, each of whom was seen separately by 3 out of a group of 6 psychoanalysts in videotaped consultation interviews. Findings include significant correlations between referential activity and both newness of themes and extent of narrative/imagery. Newness of themes and extent of narrative/imagery also correlated significantly with each other. Scores on the measures tended to be lowest with the analysts who spoke most often. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal complementarity and the therapeutic alliance: A study of relationship in psychotherapy.

Examined the relationship between the therapeutic alliance and interpersonal complementarity during the early stage of psychotherapy. 36 pairs of patients (aged 18–57 yrs) and therapists from 14 outpatient settings recorded their perceptions of their therapeutic alliance, using a working alliance inventory, and rated each other's therapy behaviors on the Checklist of Interpersonal Transactions. There were positive associations between patient–therapist interpersonal complementarity and both patients' and therapists' perceptions of the alliance. The more extreme/abnormal the patient's interpersonal behavior, the more both patient and therapist perceived a less positive working alliance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The dose–effect relationship in psychotherapy.

Applied probit analysis to 15 sets of data to specify the relationship between length of treatment and patient benefit. Data were based on more than 2,400 patients, covering a period of over 30 yrs of research. The probit model resulted in a good fit to these data, and the results were consistent across the studies, allowing for a meta-analytic pooling that provided estimates of the expected benefits of specific "doses" of psychotherapy. Analysis indicated that by 8 sessions approximately 50% of patients were measurably improved, and approximately 75% were improved by 26 sessions. Further analyses showed differential responsiveness for different diagnostic groups and for different outcome criteria. Findings hold promise for establishing empirical guidelines for peer review and 3rd-party financial support of psychotherapy. (30 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Research summary on the therapeutic relationship and psychotherapy outcome.

Factors that influence client outcome can be divided into four areas: extratherapeutic factors, expectancy effects, specific therapy techniques, and common factors. Common factors such as empathy, warmth, and the therapeutic relationship have been shown to correlate more highly with client outcome than specialized treatment interventions. The common factors most frequently studied have been the person-centered facilitative conditions (empathy, warmth, congruence) and the therapeutic alliance. Decades of research indicate that the provision of therapy is an interpersonal process in which a main curative component is the nature of the therapeutic relationship. Clinicians must remember that this is the foundation of our efforts to help others. The improvement of psychotherapy may best be accomplished by learning to improve one's ability to relate to clients and tailoring that relationship to individual clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Components of the psychotherapy relationship: Their interaction and unfolding during treatment.

C. J. Gelso and J. A. Carter (see record 1986-09708-001) suggested that all counseling and psychotherapy relationships, regardless of theoretical orientation, consist of 3 components: a working alliance, a transference configuration (including therapist countertransference), and a real relationship. Drawing on theoretical and research literature and using clinical examples, this article offers 19 propositions about how these 3 relationship components interact with one another, how each operates across the course of psychotherapy, and how they affect the treatment in both brief and longer term therapies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between GSR and speech disturbances in psychotherapy.

"… the relationship between points of emotional arousal or anxiety as defined by the GSR and the occurrence of speech disturbances in psychotherapy [was investigated]. Synchronized GSR and verbal recordings… provided the basic data." Speech disturbances were maximal at times coincident with GSR deflections and decreased in frequency on either side of GSR deflections. Additional validity is provided for both speech disturbances and the GSR as measures of momentary changes in anxiety level in psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The contextual therapeutic relationship: Ecological considerations in psychotherapy research and practice.

While the psychotherapeutic relationship has been assumed to be relatively free from external influence, we suggest that the therapeutic alliance develops within a larger environment, much of which is beyond the control of client and therapist. The reticence of practitioners and researchers to recognize and explore ecological issues is likely related to therapeutic tasks that are necessary for insight-oriented treatments (e.g., developing a therapeutic setting that protects clients from the intrusion of outside influences). Two sources of ecological disruption are discussed, managed care and psychotherapy research, and an illustrative case example of ecological disruption within a psychotherapy research setting is presented. We suggest that addressing ecological disruptions in the context of the therapeutic relationship may facilitate the establishment and maintenance of a positive therapeutic alliance. By doing so, the therapist can integrate the demands of the external world into the therapeutic relationship, thereby increasing the meaningfulness of interpersonal interventions and easing discussions about therapeutic alliance ruptures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Structure of psychotherapy: Role playing as a variable in dyadic communication.

42 Ss discussed personal experiences in dyads, with one S controlling conversation over a one-way intercom. All Ss acted as peers in Sessions 1 and 2. Experimental groups were then instructed to assume complementary patient and therapist roles in Sessions 3 and 4. Control Ss continued as peers. In Session 5 all Ss carried out unrestrained conversation. Under peer conditions, Ss distributed time for speaking approximately equally. Under psychotherapy roles, patients were allotted significantly more time, regardless of whether patient or therapist controlled the interaction. The same talk: listen ratio was maintained in Sessions 3 and 4 and continued in Session 5. The results suggest that the Ss perceived psychotherapy as a communication system in which relatively stable speaker roles are assigned to each participant. Implications of these findings were discussed. (15 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Individual psychotherapy with the nonvocal patient: A unique application of communication devices.

Followed 7 nonvocal patients with multiple handicaps in individual therapy for periods ranging from 1 to 10 yrs. Ss had been evaluated and their communication disabilities had been diagnosed as either anarthria or dysarthria. Several communication devices have been utilized in keeping with the particular ability of the S in question. The response of both anarthric and dysarthric Ss to therapeutic intervention by means of electronic devices generally has been positive. The course of therapy is similar to that observed in other persons with disabilities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dose–effect relationship in children's psychotherapy services.

Concerns about session limits imposed by behavioral health care organizations (BHOs) have prompted an examination of the dose-effect relationship in psychotherapy. This study of the dose-effect relationship in child psychotherapy used multiple outcome measures and standardized data-collection points and addressed the confound between dose, effect, and initial severity. Data obtained from 567 outpatient children who participated in the Fort Bragg Evaluation Project were used. Probit and longitudinal growth curve analyses found no evidence of a general dose-effect relationship. Implications of these findings are discussed, especially the need for BHOs to justify use limits and suggestions for clinicians to justify use requests. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceptions of the psychotherapy relationship in long- versus short-term therapy.

Examined participant perceptions of therapy by comparing long- with short-term therapy dyads. 30 therapy dyads from 3 large midwestern community mental health centers were included. Therapists and clients (20–49 yrs old) completed the Therapy Session Report 4 times and the Survey of Interpersonal Values twice immediately following scheduled therapy sessions. Results indicate that therapists and clients in long-term therapy dyads were more phenomenologically congruent in their feelings toward psychotherapy and each other and in their perceptions of therapeutic goals and processes than were therapists and clients in short-term therapy dyads. Often these perceptions were shared at the very outset of therapy. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nonverbal synchrony in psychotherapy: Coordinated body movement reflects relationship quality and outcome.

Objective: The authors quantified nonverbal synchrony—the coordination of patient's and therapist's movement—in a random sample of same-sex psychotherapy dyads. The authors contrasted nonverbal synchrony in these dyads with a control condition and assessed its association with session-level and overall psychotherapy outcome. Method: Using an automated objective video analysis algorithm (Motion Energy Analysis; MEA), the authors calculated nonverbal synchrony in (n = 104) videotaped psychotherapy sessions from 70 Caucasian patients (37 women, 33 men, mean age = 36.5 years, SD = 10.2) treated at an outpatient psychotherapy clinic. The sample was randomly drawn from an archive (N = 301) of routinely videotaped psychotherapies. Patients and their therapists assessed session impact with self-report postsession questionnaires. A battery of pre- and postsymptomatology questionnaires measured therapy effectiveness. Results: The authors found that nonverbal synchrony is higher in genuine interactions contrasted with pseudointeractions (a control condition generated by a specifically designed shuffling procedure). Furthermore, nonverbal synchrony is associated with session-level process as well as therapy outcome: It is increased in sessions rated by patients as manifesting high relationship quality and in patients experiencing high self-efficacy. Higher nonverbal synchrony characterized psychotherapies with higher symptom reduction. Conclusions: The results suggest that nonverbal synchrony embodies the patients' self-reported quality of the relationship and further variables of therapy process. This hitherto overlooked facet of therapeutic relationships might prove useful as an indicator of therapy progress and outcome. (PsycINFO Database Record (c) 2011 APA, all rights reserved)