Client perceptions of therapists: A study of the therapeutic relation.

A study was designed to identify the main ways that clients perceive their psychotherapists. An inventory of 65 statements was constructed to measure 8 postulated interpersonal behavior patterns. The inventory was administered to 523 patients in treatment for at least 3 mo. A factor analysis disclosed 5 dimensions of perceived therapist behaviors. The dimensions were labeled Accepting, Understanding, Authoritarian, Independence-Encouraging, and Critical-Hostile. The findings were shown to be consistent with constructs proposed by Fiedler, Apfelbaum, and Rausch and Bordin. Patient and therapist ratings of improvement were found to relate significantly to therapist Acceptance and Understanding. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clients' internal representations of their therapists.

Thirteen adults in long-term individual psychotherapy were interviewed regarding their internal representations (defined as bringing to awareness the internalized "image") of their therapists. Results indicated that in the context of a good therapeutic relationship, clients' internal representations combined auditory, visual, and kinesthetic (i.e., felt presence) modalities; were triggered when clients thought about past or future sessions, or when distressed; occurred in diverse locations; and varied in frequency, duration, and intensity. Clients felt positively about their representations and used them to introspect or influence therapy within sessions, beyond sessions, or both. The frequency of, comfort with, and use of clients' internal representations increased over the course of therapy, and the representations benefited the therapy and therapeutic relationship. Therapists tended not to take a deliberate role in creating clients' internal representations, and few clients discussed their internal representations with their therapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assimilative integration and responsive use of the assimilation model.

The assimilation model offers a framework for clinically responsive decisions integrating different therapeutic approaches. The authors suggest that the assimilation model can guide assimilative integration by delineating clients' changing requirements over the course of psychotherapy and linking those requirements with techniques drawn from varied theoretical approaches. According to the model, an appropriate therapeutic response is one that meets client requirements at a given stage of assimilation and helps to shift the client's assimilation of a given problematic experience from 1 stage to the next. The authors offer guidelines and case illustrations of integration at 4 separate time frames of intervention: treatment assignment, treatment strategies, treatment tactics, and moment-to-moment responsiveness within an intervention. At each time frame, therapists monitor client requirements and respond with interventions most appropriate for the client's level of assimilation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assimilation of problematic experiences.

The assimilation model offers an approach to customizing the therapeutic relationship. Assimilation research has tracked problematic experiences (e.g., destructive relationships or traumatic memories) across therapy sessions and has described a sequence of 8 stages of levels of assimilation of the problematic experience, from being dissociated or unwanted to being understood and integrated. This article reviews some assimilation model research and discusses its limitations. Therapists can use the model in assessing a problem's current level of assimilation and facilitating its movement to the next level. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Some comments on the use of untrained therapists.

A study by Poser, where chronic schizophrenics received group psychotherapy from both untrained and trained therapists, is discussed. The experimental design of the study is questioned: the time factor, male patients treated by female untrained therapists, dropouts, and selection of untrained therapists. The term "group psychotherapy" is poorly defined in this study, since the term covers a variety of therapeutic goals and orientations. The question of criteria becomes obscured. There is no clarification of the motives that bring psychotherapists to work with patients. The lack of clarity confuses workers in the field of psychotherapy since "help" is an ambiguous term which represents everything from compassion to personality change. Motivations and value systems of both patients and therapists must be considered in the type of study Poser has conducted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical experiences of play therapists: Does race/ethnicity matter?

The authors describe racial/ethnic similarities and differences of a sample of 891 members of the Association for Play Therapy with regard to workplace variables, professional interests and activities, and supervision variables. Results indicate few differences between Caucasian and racial/ethnic minorities and few differences between the racial/ethnic groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clients' perceptions of therapists with high attrition rates.

59 adult clients assigned to high-dropout rate therapists and 51 assigned to low-dropout rate therapists rated the therapists on several demographic and therapy-process variables. Findings show that a number of the therapy-process variables significantly differentiated the 2 groups of therapists. It is advocated that researchers consider the role of the therapist and therapy-process dimensions in future studies of early psychotherapy termination. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changing concepts in the training of therapists.

Many professionals in the mental health field recognize the ability of nontraditional workers with relatively little training to produce good therapeutic results. The question is raised and discussed as to why the guardians of our present system are slow to use fully new resources, the effectiveness of which has been demonstrated. The suggestion is made that professionals with long traditional training should identify themselves with the advancement of knowledge and leave more of the practice of crafts to new categories of workers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preferences of therapists-in-training for client characteristics.

The preferences of 132 therapists-in-training for 16 client characteristics were investigated using a paired comparison methodology. Therapists most preferred to work with clients who were psychologically minded, shared similar attitudes and values, and had dissimilar personally troubling problems. They least preferred to work with clients who were not psychologically minded, had dissimilar attitudes and values, and were older. Order of preferences was not influenced by therapist sex, race, clinical experience, socioeconomic status, sexual orientation, or theoretical orientation. Limitations of this study as well as implications for further research and training are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Clients' perceptions of helpful experiences in counseling.

The question of what clients experience as helpful in counseling was examined via concept mapping, a methodological approach combining qualitative and quantitative strategies. The purpose of the study was to clarify the scope and interrelations among elements of the retrospective experience of helpfulness among 36 clients who had completed counseling after an average of 11 sessions. Five thematic clusters consistent with previous research were identified: Counselor Facilitative Interpersonal Style, Counselor Interventions Generating Client Resources, New Perspectives, and Client Self-Disclosure. Four new thematic clusters were also identified: Emotional Relief, Gaining Knowledge, Accessibility, and Client Resolutions. The structure of the concept map generated by the participants in this study was found to be consistent with an integrative, pantheoretical model of the counseling process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethical practices reported by play therapists: An outcome study.

Examined the responses of 240 members (aged 27–77 yrs) of the Association of Play Therapy to a questionnaire identifying ethical practices in play therapy treatment. The following areas were explored: nature of treatment, confidentiality, informed consent, treatment adequacy, referral, and training. Results indicate most play therapists are consistent in both their ethical beliefs and reported therapy practices. Noted areas of concern are who the actual client is and what topics should be addressed during treatment (i.e., discussion of fees, theoretical orientation, goals for treatment, confidentiality, and a child's need for treatment). Results and implications for the Association of Play Therapy Practice Guidelines are discussed. The ethical guidelines questionnaire to individual play therapy with children is appended. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Women therapists working with women: New theory and process of feminist therapy.

Reviews the book, Women therapists working with women: New theory and process of feminist therapy edited by Clair M. Brody (1984). As with other edited volumes on this topic, this book attempts to address a very broad range of issues confronted by a therapist holding a feminist theoretical perspective in her work. Where this is most original and successful is in the examination of the issues faced by the therapist as a woman and feminist in the social and emotional environment of therapy. This volume does not stand alone as a text on feminist therapy, and that was clearly not the editor's intention. It will probably be of most interest and use to therapists already familiar with other literature on feminist therapy, and serves to complement what has come before. I would not suggest it as any reader's first introduction to feminist therapy theory and practice. However, it is sufficiently introductory that it can be of use to any experienced psychotherapist seeking to enhance her or his consciousness of women's issues and sexism as they impact upon the process of psychotherapy. (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)     

Coping with client death: Using a case study to discuss the effects of accidental, undetermined, and suicidal deaths on therapists.

Over one-quarter of psychologists and psychiatrists will lose a client to suicide, and the impact of suicide on therapists is profound. Therapists report both personal (e.g., emotional) and professional (e.g., fears of litigation, doubts about competency) reactions to client suicide, and these reactions are thought to be pronounced for therapists-in-training. However, little is known about the effect of nonsuicidal client deaths on therapists, especially how the experience of a client suicide might compare with other forms of unanticipated client death, such as accidental injuries (e.g., car accidents) or deaths of undetermined intent. The current article reviews family members' bereavement responses based on differential death classification, as well as therapist reactions to suicidal deaths. A case study of undetermined death will be described in light of the extant literature on therapists' coping responses to suicide, including reflections on emotional and professional implications to a nonsuicidal death. A recent social psychological model of adaptation to emotional experiences (Wilson & Gilbert, 2008) will be used as a theoretical framework to discuss how death by suicide may be construed in comparison to undifferentiated and/or accidental deaths, with a focus on informing sorely needed future research in this area. (PsycINFO Database Record (c) 2011 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)     

Clients' sexually inappropriate behaviors directed toward clinicians: Conceptualization and management.

Sexually inappropriate behaviors in clinical settings are relatively common occurrences that may negatively affect the therapeutic process. For example, more than half of female psychologists have reported at least 1 incident in which a client responded in a sexually inappropriate manner. Thus, it is important for clinicians to understand inappropriate behaviors and respond in a manner that is both personally satisfying and helpful to the client. A framework for conceptualizing these behaviors is proposed, as well as components for, and examples of, therapeutic responses. Recommendations are provided for preventive measures to decrease the likelihood of inappropriate behaviors and for systemic approaches to benefit professional training in regards to these issues. Our aim is to stimulate further discussion of sexually inappropriate behaviors specifically by facilitating psychotherapists' ability to address clients' within-session sexual behavior, facilitating speculation of the antecedents of and motivations behind such behaviors, and facilitating discussion of such behaviors within supervision and, more broadly, within training programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preparing play therapists for disaster response: Principles and procedures.

In the wake of numerous recent natural disasters such as the 2004 tsunami and 2005 hurricanes, play therapists have been asked to provide disaster response. However, the role of disaster response interventionists is vastly different from the typical role of play therapists. In order for play therapists to be prepared for disaster response, an explanation of disaster response principles and procedures is needed. This article will help educate play therapists about how to use their play therapy skills and knowledge in a disaster response environment. Specifically, this article will (a) explain basic principles such as following the Incident Command Structure; (b) discuss the play therapist's role in disaster response in light of the phase of disaster; and (c) recommend disaster response procedures. Examples from APT members' response to the tsunami and Hurricane Katrina are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Information assimilation from updated alphanumeric displays.

The accuracy with which Ss could locate updated elements of information was studied as a function of use of coded vs. uncoded updates, number of elements of information presented, and number of elements of information updated. Selected findings demonstrate the value of coding as an information enhancement technique and the considerable effects of elements presented and updated. With uncoded displays a reduction in the percentage of responses as the number of updates increased may reflect a lessening of Ss' confidence in their ability to make correct responses even though their actual performance did not appear to suffer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preventing vicarious traumatization of mental health therapists: Identifying protective practices.

This qualitative study identified protective practices that mitigate risks of vicarious traumatization (VT) among mental health therapists. The sample included six peer-nominated master therapists, who responded to the question, “How do you manage to sustain your personal and professional well-being, given the challenges of your work with seriously traumatized clients?” Data analysis was based upon Lieblich, Tuval-Mashiach, and Zilber’s (1998) typology of narrative analysis. Findings included nine major themes salient across clinicians’ narratives of protective practices: countering isolation (in professional, personal and spiritual realms); developing mindful self-awareness; consciously expanding perspective to embrace complexity; active optimism; holistic self-care; maintaining clear boundaries; exquisite empathy; professional satisfaction; and creating meaning. Findings confirm and extend previous recommendations for ameliorating VT and underscore the ethical responsibility shared by employers, educators, professional bodies, and individual practitioners to address this serious problem. The novel finding that empathic engagement with traumatized clients appeared to be protective challenges previous conceptualizations of VT and points to exciting new directions for research, theory, training, and practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)