Therapist homophobia, client sexual orientation, and source of client HIV infection as predictors of therapist reactions to clients with HIV.

Four hundred twenty-five psychologists received vignettes depicting a male client who was either gay or heterosexual and whose source of HIV infection was sexual contact, a blood transfusion, intravenous drug use, or unspecified. Respondents' homophobia and reactions to the client in the vignette were measured. Canonical correlation analyses revealed that therapist attributions of client responsibility for problem cause were predicted by the source of HIV infection and therapist homophobia. In addition, therapists responded with less empathy, attributed less responsibility to the client for solving his problems, assessed the client's functioning to be worse, and were less willing to work with the client when the client's source of HIV infection was other than drugs, when the client was gay, and when therapists were more homophobic. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The therapeutic alliance in adolescent substance abuse treatment: A one-with-many analysis.

Studies of the therapeutic alliance typically use a one-with-many (OWM) design in which each therapist (the one) treats multiple clients (the many). This study used Kenny, Kashy, and Cook's (2006) OWM method to examine the composition of the therapeutic alliance and to analyze the association between alliance and outcome in a sample of 398 adolescents treated for substance abuse by 14 therapists. Both the client and therapist alliance ratings yielded large relationship variances, with limited consensus among clients treated by the same therapist about the quality of the alliance. If a client reported an especially strong alliance with his or her therapist, the therapist was likely to also report an especially strong alliance with that client (dyadic reciprocity). The association between the components of the alliance and treatment outcome was complicated, with different levels of measurement and different components of the alliance (perceiver, partner, or relationship) derived from different informants (therapist or client) relating to different outcomes. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The real relationship in psychotherapy: Relationships to adult attachments, working alliance, transference, and therapy outcome.

The purpose of this study was to understand how the real relationship (RR) relates to important process and outcome variables from both the clients’ and therapists’ perspectives. Using a sample of 31 therapist/client dyads at a university counseling center, the authors examined the RR at the 3rd session of therapy and at termination. The results revealed that client adult attachment avoidance was negatively correlated with client RR, while client adult attachment anxiety was uncorrelated. Therapists’ ratings of negative transference were negatively correlated with therapist-rated RR and were uncorrelated with client-rated RR. Hierarchical linear modeling analyses were conducted to predict postintervention outcome from client and therapist perceptions of the RR. Therapists’ ratings of the RR accounted for a significant amount of variance in client posttreatment symptoms while controlling pretreatment symptoms. Client-rated RR total scores and client and therapist 3rd-session alliance scores were not significant predictors of postsymptom ratings. Implications of the usefulness of measuring the RR in psychotherapy are discussed, as are recommendations for future study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship formation and relational control as correlates of psychotherapy quality and outcome.

This study examined the nature of therapist–client interactions within and across seven psychotherapy cases (a) to test whether therapeutic outcome is a function of a transition from relational incongruence to relational congruence (S. Strong, 1982), and (b) to investigate the relation of relational congruence and control to qualitative aspects of the therapy relationship and to therapy outcome. Measures of therapist and client response patterning served as indices of relational congruence and of relational control. Relationship quality was assessed in terms of therapist and client ratings of their working alliance and of therapy session depth and smoothness. Outcome was operationalized in terms of symptom reduction. Results showed limited support for a relationship between relational congruence and therapy outcome and suggested that relational control is not a significant factor in client or therapist evaluations of relationship quality or therapy outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client and therapist session satisfaction over the course of psychotherapy.

Examined the patterns of therapist and client session-by-session satisfaction (SSS) over the course of psychotherapeutic treatment as they varied by eventual outcome. The theoretical literature proposes 1 of 2 models for SSS evaluation patterns over the course of therapy for successful dyads: either linear increase over time or a curvilinear pattern. These models were examined using 23 therapist–client dyads at a university counseling center. The highly successful dyads demonstrated the curvilinear pattern for both the client and therapist evaluations and the linear pattern for the therapist, while the least successful group did not. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

When do people believe that alcohol treatment is effective? The importance of perceived client and therapist motivation.

Respondents read a narrative depicting a drunk-driving offender seeking help for alcohol problems and were randomly assigned to receive 1 of 3 types of client motivation (autonomous motivation, compulsory treatment, or impression management) and 1 of 2 types of therapist motivation (autonomous vs. controlled motivation). Maximal treatment efficacy was expected when both client and therapist were autonomously motivated. Minimal treatment efficacy was expected when the client entered treatment only to manage impressions and when the therapist exhibited controlled motivation. Compulsory treatment undermined beliefs about client interest in treatment. Finally, autonomously motivated therapists were expected to be able to reverse expected negative outcomes for compulsory treatment and impression management clients. It was found that expectations about the efficacy of alcohol treatment were affected by the perceived motivation of clients and therapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Male counselors' discomfort with gay and HIV-infected clients.

Examined male counselors' reactions to gay and HIV-infected clients in light of counselors' homophobia and death anxiety. After completing measures of homophobia and death anxiety, 34 male counselors viewed a videotaped, male client–actor in 1 of 4 conditions: either gay or heterosexual and either HIV negative or HIV positive. The dependent variable, counselor discomfort, was assessed through (1) the ratio of avoidance to approach verbal responses to the taped client, (2) self-reported state anxiety, and (3) recall of certain words used by the client. As hypothesized, counselors experienced greater discomfort with HIV-infected than HIV-negative clients, and counselors' homophobia predicted their discomfort with gay male clients. However, client sexual orientation did not affect counselor discomfort, and death anxiety was unrelated to discomfort with HIV-infected clients. Implications regarding countertransference and counseling were discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is psychotherapy more effective when therapists disclose information about themselves?

Theorists have long debated the wisdom of therapists disclosing personal information during psychotherapy. Some observers have argued that such therapist self-disclosure impedes treatment, whereas others have suggested that it enhances the effectiveness of therapy. To test these competing positions, therapists at a university counseling center were instructed to increase the number of self-disclosures they made during treatment of one client and refrain from making self-disclosures during treatment of another client. Analyses revealed that clients receiving psychotherapy under conditions of heightened therapist disclosure not only reported lower levels of symptom distress but also liked their therapist more. Such findings suggest that self-disclosure by the therapist may improve both the quality of the therapeutic relationship and the outcome of treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Formation of a therapeutic relationship: Experiences during the initial phase of psychotherapy as predictors of treatment duration and outcome.

Studied the formation of a psychotherapy relationship using self-reports of clients and therapists. Items designed as measures of a set of dimensions considered salient to the process of therapy were incorporated into client and therapist report forms. These were completed separately by clients and therapists immediately following each of the initial 10 sessions. It was hypothesized that report-form dimension scores early in treatment would predict persistence in treatment, duration of treatment, and retrospective evaluations of outcome. Subjects were 91 students (36 males, 55 females) attending a large urban unversity and 19 therapists (10 females, 9 males) on the staff of the university student counseling service. A number of client and therapist dimensions predicted persistence in treatment as early as the 3rd session. Dimension scores failed to predict duration of treatment for remainers, however. A greater number of dimension scores correlated with therapist outcome ratings than with client outcome ratings. (38 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment outcome and follow-up evaluation based on client case records in a mental health center.

Assessed the outcome of treatment of 121 mental health center clients (11–70 yrs of age), using therapist and independent global improvement ratings and independent ratings of notes in case records based on a client-specific goal-oriented outcome technique (Goal Attainment Scaling; GAS). Telephone follow-up of 50 clients provided a 2nd GAS assessment, client global improvement ratings, and 3 consumer satisfaction ratings. Findings indicate that (a) independently determined GAS scores and therapist and independent global ratings converged significantly, (b) the GAS procedure provided some increase in accuracy as well as an increase in specificity of outcome, and (c) client global ratings may reflect satisfaction with treatment rather than outcome. In view of the intercorrelations among measures and the relationship between GAS scores determined from case records and telephone interviews, case records may provide for accurate assessment of client problems and treatment success. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expectations and preferences.

Client expectations and preferences have been thought by many to influence the client's willingness to engage in and be influenced by the therapist and the process of therapy. Definitions and methods of assessment are presented of clients' expectancy for therapeutic gain; expectations about the roles they and their therapists will play; and their preferences for therapy roles, type of psychotherapy, and demographic features of the therapist. Included is a review of the empirical evidence based on 76 studies of the relation between client expectations and preferences, on the one hand, and the outcome of psychotherapy, on the other hand. Clients' expectations for therapeutic gain are related to outcome in most studies, although no causal conclusions can be drawn. The literature on role expectations is equivocal, and the relatively few studies on client preferences yield primarily negative or mixed results. Finally, specific implications for therapeutic practices are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Democratic values and therapeutic efficacy: A construct validity study.

Studied the construct validity of the Democratic Values Scale (DVS), a measure of therapist authoritarianism, and of the relation of DVS scores to therapeutic outcome for 30 completed cases treated by 14 therapists. Results indicate that DVS scores are significantly related to other relevant therapist attitudes, to therapists' actual choice behavior at intake, and to therapeutic outcome. These findings, together with previous ones from the same investigation, suggest that therapist authoritarianism may play a more significant role in determining treatment outcome than client authoritarianism. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exploratory in-session process research in individual psychotherapy: A review.

The goal of exploratory process research is to describe what occurs within psychotherapy sessions, eventually leading to the development of theories based on the accumulation of replicated results. Several areas in which exploratory methods are currently being used are described: therapist techniques, client behavior, covert processes, process models, interactions between therapist and client, and therapy events. Additionally, several areas in which exploratory methods would be useful for future research are described: the links between client personality characteristics, therapy process, and outcome; the timing and quality of therapist interventions; and client readiness for the therapist interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship between behavioral marital therapy outcome and process variables.

This study was conducted to identify therapist and client behaviors with a positive response to social learning-based behavioral marital therapy. A sample of 32 couples receiving treatment was examined. Immediately after each therapy session, the therapist, husband, and wife independently completed process ratings forms that measured therapist and client behaviors during the session. Composite scales, derived from these ratings, were entered into multiple regression equations to examine their relationship with posttherapy marital satisfaction. After controlling for pretherapy marital satisfaction and the other predictor variables, therapists', husbands', and wives' ratings of positive client behavior (i.e., collaboration, active participation, and homework compliance) were positively associated with therapy outcome. Implications for marital therapy and suggestions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Male client–male therapist: Issues in a therapeutic alliance.

Asserts that the confusion and pain resulting from the erosion of traditional male norms have led many men to seek assistance from mental health professionals. The gender-role strains and stressors experienced by men are reviewed, and the consequences of restrictive emotionality on males themselves and on fathering are discussed. It is argued that constraints of restrictive emotionality and homophobia limit many men's ability to benefit from the traditional therapeutic environment, and behavior therapy is recommended as a more suitable therapeutic model for men. Behavior therapy contains the major principles of new experiences, language, therapist feedback, and therapist interaction; responds to many of the male's developmental assets; and addresses the gender-cognitive schema. Issues for the male client and male therapist are addressed, and the needs among mental health professionals for greater awareness, discussion, and investigation focused on males in therapy are emphasized. (67 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural control in psychotherapy with minority clients.

Reviews the literature on mental health services for minority clients, suggesting that these persons experience special problems with the traditional mental health delivery system. Epidemiological and attitude studies have indicated that minority client and majority therapist expectations for psychotherapy are often discrepant. Counseling and psychotherapy outcome research on therapist–client racial pairing has yielded inconclusive results at present. It is hypothesized that the therapist–client racial pairing may interact with level of therapist dominance in affecting psychotherapy outcome. Dominant majority clinicians may manipulate minority persons toward majority values, which may comprise a form of cultural control. Highly dominant clinicians are posited to function more effectively with culturally similar clients than with culturally different clients in that domination may be appropriate to a certain degree in culturally homogeneous settings. Low dominant clinicians are posited as being more effective than highly dominant clinicians with culturally different clients in that they would be more likely to attempt to understand the client's cultural perspective in a nonmanipulative manner. (100 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

White therapist and female minority clients: Gender and culture issues.

Discusses ramifications of a White female therapist working with female minority clients. The personality of the therapist and the meaning of White and minority to him/her appear to be important variables for success with minority clients. It is argued that therapy with minorities must always be viewed in the context of one's own political perspective, attitudes, and biases and that racial homogeneity for client and therapist is less important than interpersonal trust in a situation of gender likeness and equality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender differences in psychotherapy dyads: Changes in psychological symptoms and responsiveness to treatment during 3 months of therapy.

This investigation examined the relationship between gender (client, therapist, and client/therapist dyad) and various psychotherapy-related variables for clients with mood and/or anxiety disorders. In several instances, both client and therapist gender predicted treatment retention and psychological symptom changes during 3 months of therapy. In general, female clients were more likely to advance beyond the initial intake assessment and also complete 3 months of therapy. Conversely, male clients were more likely to withdraw from therapy after the initial intake assessment. Specific client/therapist gender pairing predicted treatment retention in the mood disorder subsample and trait anxiety symptom severity in the anxiety disorder subsample. Some findings should be interpreted with caution, as there were small group samples in a few of the analyses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic alliance: Predicting continuance and success in group treatment for spouse abuse.

This study examined the role of the therapeutic alliance between client and therapist on group treatment outcome in 70 husband-to-wife violent couples. Strength of husbands' alliance assessed at Session 1 was positively associated with treatment outcome, as measured by decreased husband-to-wife mild and severe psychological and physical aggression. Strength of wives' alliance was unrelated to treatment outcome. Finally, although alliance was related to treatment, outcome, it was unrelated to treatment completion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)