Measuring the impact of sessions in process€xperiential therapy of depression: The Session Impacts Scale.

The Session Impacts Scale (SIS) is a brief client-report measure of the experienced impacts of therapy sessions. Data were collected from depressed clients seen in short-term process-experiential treatment. Factor analyses were consistent with the expected hierarchical structure of the measure (Helpful Impacts and Hindering Impacts, with Helpful Impacts divided into Task Impacts and Relationship Impacts subscales). Internal reliabilities were excellent for the helpful impact scales, and the pattern of impacts was consistent with the treatment model. Helpful impact scales were most strongly correlated with client Session Evaluation Questionnaire Depth and Positivity scales and client global helpfulness ratings. A components of variance analysis suggested that client and therapist factors account for large amounts of variance in SIS ratings, some of which could be predicted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acceleration of changes in session impact during contrasting time-limited psychotherapies.

Following the suggestion that therapeutic change is accelerated in time-limited psychotherapy, this study investigated the across-session patterns of session impact in the treatments of 117 depressed clients who were randomly allocated to 8 or 16 sessions of cognitive-behavioral (CB) or psychodynamic-interpersonal (PI) therapy. After each session, all clients completed the Session Evaluation Questionnaire and 75 of the clients completed the Session Impacts Scale. Session ratings indicated that sessions were perceived increasingly positively on most impact dimensions (e.g., session depth and smoothness, relationship with the therapist, feelings of understanding and problem solving, postsession positive mood) as treatment progressed. Early in treatment, PI therapy sessions were less smooth (i.e., more tense and uncomfortable) and less focused on problem solving, but PI sessions changed more rapidly than CB sessions on these dimensions, so that later in treatment, sessions of both treatments were equivalently positive. In both treatments, the trend toward more positive sessions was more rapid (i.e., the across-session slope was steeper) in 8-session treatments than in 16 session treatments. Such accelerated changes in session impact may reflect the suggested acceleration … (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Counseling session impact as viewed by novice counselors and their clients.

The Session Evaluation Questionnaire (SEQ) was used to measure the perspectives of 17 graduate-student counselors and their 72 17–39 yr old clients on 942 individual counseling sessions along 2 evaluative dimensions—depth and smoothness—and 2 dimensions of postsession mood—positivity and arousal. A components-of-variance analysis showed that, from both perspectives, SEQ ratings varied greatly from session to session; ratings were only modestly predictable from differences among counselors or among counselor–client dyads. However, averages across 6–20 sessions permitted adequately reliable differentiation among dyads, for example, for comparisons with outcome measures. Correlations between corresponding counselor and client dimensions ranged from moderate to negligible, whether calulated across sessions, across clients, or across counselors, Novice counselors' judgments of session depth and value may have had little relation to their clients' evaluations. On the other hand, counselors' comfort in sessions and postsession positive mood were moderately predictive of client reactions. (32 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Session depth and smoothness in relation to the concept of engagement in counseling.

Investigated the relation of client-counselor evaluation of initial interview to client return for another session. At the end of the initial session, 5 professionals, 5 practicum trainees, and their 290 college-student clients completed the depth and smoothness indexes of the Session Evaluation Questionnaire (W. B. Stiles; see record 1980-12384-001). Clients also completed the Client Satisfaction Questionnaire, and counselors completed items from the Pre-Counseling Assessment Blank (C. J. Gelso and D. H. Johnson, 1983). The duration of the intake interview was recorded. Client return was positively related to: longer interviews; deeper interviews, as rated by both client and counselor; and greater client satisfaction, disturbance, and motivation. The results are discussed in relation to the concept that the initial session represents an engagement session when clients return for more sessions. (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)     

Environmental and pharmacological factors in the development of noncontingent tolerance to cocaine in pigeons.

Previous research with rats and monkeys has shown that tolerance to behavioral effects of cocaine developed if the drug was administered before behavioral test sessions but not if it was administered after sessions, a finding known as contingent tolerance. In contrast, a recent experiment using pigeons found that they showed tolerance resulting from postsession drug administration (noncontingent tolerance). The 4 experiments reported in this article were conducted to examine that result more fully. Experiment 1 found that immediate presession administration of cocaine to pigeons reliably led to tolerance to effects on food-reinforced operant key pecking and that immediate postsession administration of cocaine also led to tolerance in half the subjects, those whose key pecking was not suppressed by postsession dosing. Experiment 2 showed that eating in the home cage under the effects of postsession cocaine was not necessary for tolerance to develop to effects of postsession cocaine and that the majority of subjects developed tolerance from postsession cocaine administration. Experiment 3 found that mere drug exposure in the home cage without exposure to an experimental session did not reliably produce tolerance during the behavioral session. Experiment 4 showed that tolerance from postsession cocaine administration could be observed even when daily dosing was discontinued during dose–response curve assessment. Therefore, the combined results showed that pigeons often developed tolerance to effects of cocaine during the behavioral session when cocaine was administered postsession and that this tolerance was not the result of feeding under effects of the drug. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Session impact in counseling process research: Comment on Elliott and Wexler (1994) and Stiles et al. (1994).

R. Elliott and M. M. Wexler (see record 1994-27938-001) have introduced the Session Impacts Scale (SIS), and W. B. Stiles et al (see record 1994-27969-001) have undertaken a new factor analysis of the Session Evaluation Questionnaire (SEQ) with a British sample of clients. These 2 measures of session-level psychotherapy effects have great potential as research tools. In this comment on the 2 articles, issues of retest reliability, the connection of session-level measures to research strategies based on other units of analyses, and suggested uses of the SIS and the SEQ are discussed. The importance of context-sensitive session impact research and of a comprehensive theory relating session impacts to therapy outcome is also stressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client introversion and counseling session impact.

Tested the hypothesis that insofar as personal counseling is a social encounter, introverted clients may be expected to experience greater distress in sessions than extraverted clients. This expectation was confirmed in a total of 83 clients (aged 17–39 yrs) in a university clinic who completed the Minnesota Multiphasic Personality Inventory (MMPI) during their treatment and completed a session evaluation questionnaire immediately after their sessions. With differences among counselors statistically controlled, relatively introverted (higher MMPI Social Introversion) clients rated their sessions as relatively uncomfortable, unpleasant, tense, rough, and difficult and rated their postsession mood as relatively unfriendly, uncertain, sad, angry, and afraid. Conversely, relatively gregarious, overactive, extraverted (higher MMPI Hypomania scores) clients rated their sessions as relatively comfortable, pleasant, relaxed, smooth, and easy. It is suggested that client introversion should be incorporated explicitly into counseling theories and should be measured as a possible mediating variable in process and outcome research. (40 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client and Counselor Trainee Attachment as Predictors of Session Evaluation and Countertransference Behavior in First Counseling Sessions.

This study investigated client and counselor trainee attachment as predictors of session evaluation and countertransference behavior in 93 first counseling sessions. Results indicated that client attachment predicted aspects of session evaluation, whereas counselor attachment and the interaction of client and counselor attachment predicted aspects of countertransference. Specifically, client fearful attachment was negatively associated with client ratings of session smoothness and depth and with counselor ratings of session smoothness. Counselor dismissing attachment was positively associated with supervisor ratings of hostile countertransference. Furthermore, interactions between client and counselor attachment predicted hostile and distancing countertransference reactions, such that countertransference was highest when the client had a preoccupied attachment pattern and the counselor trainee had a fearful or dismissing attachment pattern. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship of patient and therapist-reported experiences of the initial session to outcome: An initial investigation.

Explored the impact of the initial psychotherapeutic session on outcome in 32 therapist–patient dyads. Ss were 18+ yrs old. Therapy consisted of a maximum of 8 sessions. The therapeutic interaction was assessed with selected portions of the Therapy Session Report, completed immediately after the first session by the participants. It was found that the patient's perception of the therapist's functioning during the first meeting related significantly to patient and therapist reports of symptom change subsequent to 4 sessions and length of treatment. In addition, there was a significant, linear decline in symptoms (reported by patient and therapist) after 8 therapy sessions. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Systematic effects of participant role on evaluation of the psychotherapy session.

This study identified systematic differences between therapists (n?=?114) and patients (n?=?119) in the process components that predict evaluation of psychotherapy sessions. The Comprehensive Scale of Psychotherapy Session Constructs was developed to measure 9 process variables and their relationships to session evaluation from the perspectives of therapist and patient. Regression equations predicting session evaluation from the process components for the 2 groups were significantly different. Therapist session evaluation was best predicted by therapist expertness, and patient session evaluation was best predicted by the therapist real relationship. The therapist real relationship negatively predicted therapist session evaluation when all process variables were considered simultaneously. Patient progress and patient involvement significantly and positively predicted both therapist and patient evaluation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nonverbal communication and counseling outcome.

Nonverbal abilities and behaviors and verbal–nonverbal (VB–NVB) congruence of both counselor and client were studied in relation to judgments by counselors and clients of counseling outcome. 40 university students were clients; 20 counseling or clinical psychology graduate students were counselors. 40 counseling dyads were videotaped during 30-min counseling sessions. NVB abilities were assessed by the Profile of Nonverbal Sensitivity and an encoding task. Raters judged the presence of 7 NVB behaviors for each 5-sec segment of the videotaped session. Congruence was measured through postsession recall by counselor and client of consistency of feelings expressed through VB and NVB channels of communication. Only VB–NVB congruence was significantly related to outcome, suggesting that the NVB dimension is important primarily as it interacts with the VB dimension. Recommendations are made for use of new methodologies in future research to examine the complex interactions involving NVB communication. (41 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Language and symbolic play in infancy: Independent or related abilities.

Investigated 3 hypotheses: that language and symbolic play are positively related in infancy, that the 2 are unrelated, and that early symbolic play predicts later language ability. 25 infants were observed in 2 free play sessions, at 12–14 mo (Session 1) and 20–22 mo (Session 2). Three symbolic play and object use measures were significantly and positively interrelated. Three language variables, measured at Session 2, were significantly and positively interrelated. There were no significant correlations between the language and play variables from either session, and a principal-components analysis confirmed this independence. The results best support the hypothesis that language and symbolic play abilities are unrelated in infancy. (French abstract) (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A pilot study of psychotherapist trainees' alpha-amylase and cortisol levels during treatment of recently suicidal clients with borderline traits.

Psychotherapists often experience stress while providing psychotherapy, in particular when working with difficult presentations such as suicidality. As part of a larger study on the treatment of recently suicidal college students with borderline traits, 6 therapists in training collected their own salivary samples for alpha-amylase (AA) and cortisol (C) analyses immediately before and after sessions with 2 selected clients. On average, samples were collected for the same therapist–patient dyad throughout the year-long study to ensure that data reflected therapist responses across stages of treatment. Therapists also completed a working alliance questionnaire and rated perceived session difficulty immediately after each selected session. Contrary to expectations, therapists demonstrated elevated levels of stress as measured by AA and C at presession relative to postsession levels. Greater session difficulty was related to more pronounced declines in AA, whereas a stronger working alliance was linked to more pronounced reductions in C. Results suggest that physiological stress responses while working with recently suicidal clients with borderline traits occur primarily in terms of session anticipatory anxiety, whereas AA and C changes may be affected differently by factors such as session difficulty and working alliance. This is a pilot study, limited by its sample size, but the design, findings, and inclusion of physiological measures present an initial step in an essential line of research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A format for Individual Psychotherapy Session Notes.

Describes a format for individual case notes, termed the Individual Psychotherapy Session Note (IPSN) form, which is designed to focus the clinician's attention on certain relevant aspects of the psychotherapy process and to facilitate the formulation of inferences and hypotheses on the basis of clinical data. It also encourages the therapist to examine his/her own behavior in sessions as well as to observe the therapist–client interaction. The form is designed to be used flexibly, in accordance with the practitioner's needs at different points during therapy. The implications of the IPSN form for training and supervision are also discussed. (2 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of training in dream recall and dream interpretation skills on dream recall, attitudes, and dream interpretation outcome.

Forty-two volunteer clients with below-average dream recall and attitudes toward dreams participated in training sessions focusing on either improving dream recall and attitudes toward dreams, building dream interpretation skills, or educating about counseling. After training, individual dream interpretation sessions were conducted. No significant differences were found among the 3 conditions in regard to dream recall, attitudes toward dreams, or client- or therapist-reported session outcome, but effect sizes suggested that participants in the skills condition gained more from sessions than did participants in the dream recall–attitudes condition. Session outcome for all volunteer clients was equivalent to those in previous studies of volunteer clients with no training, suggesting that training was not necessary and that these participants were able to benefit from single-session dream interpretation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physical attractiveness and counseling skills.

80 college students assumed the role of a client with social skill problems during 3 counseling sessions. Videotaped interchanges between a male client and a female counselor during an initial intake session were presented, and audiotapes with background slides of the counselor were presented during 2 subsequent therapy sessions. Physical attractiveness had an impact on perceived effectiveness independent of the counselor's skillfulness. In contrast, analyses of future expectancy data revealed that only in the good skills condition did attractiveness augment impressions about the desirability of the counselor in treating other social and behavioral problems. Correlational analyses suggested that clients in the good skills condition, who were most influenced by attractiveness in Session 1, judged the counselor most favorably following Session 3 in terms of her potential effectiveness in treating new problems. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acute and chronic hormonal responses to resistance training designed to promote muscle hypertrophy

Acute and chronic hormonal responses to resistance training were evaluated in 11 college men who completed 12 weeks (33 sessions) of high volume resistance training. No differences in resting concentrations of growth hormone (GH), insulin-like growth factor-I, testosterone, or sex hormone-binding globulin occurred from pre- and posttraining in the trained vs. nontrained control group. However, cortisol (c) decreased 17% for both groups (p < 0.05). There were no differences in exercise-induced responses between Sessions 10 and 20, with all hormone concentrations increasing (p < 0.05) from pre- at mid- and post exercise session. However, after correction for plasma volume decreases, only C and GH showed differences, with C increased from mid- to postsession (48% 10th; 49% 20th), and GH increased from pre- at mid- and postsession for both sessions 10 (0.16 +/- 0.42 pre; 4.77 +/- 6.24 mid; 6.26 +/- 5.19 post; microg x L-1) and 20 (0.33 +/- 0.85 pre; 5.42 +/- 9.08 mid; 8.24 +/- 7.61 post; microg x L-1). Significant correlations (p< 0.05) existed only between absolute mean GH increases from presession and the degree of muscle fiber hypertrophy for type I (r = 0.70 mid, 0.74 post) and type II (r = 0.71 post) fibers. In conclusion, resistance training had no effect on resting serum hormone concentrations, whereas similar acute exercise responses occurred between the 10th and 20th training sessions.