Therapists' anger, hate, fear, and sexual feelings: National survey of therapist responses, client characteristics, critical events, formal complaints, and training.

Therapists reported frequencies of experiencing 24 instances of feeling anger, hate, fear, and sexual attraction or arousal; encountering 16 client events (e.g., client orgasm, client disrobing, client suicide, client assault on therapist or 3rd party); and engaging in 27 behaviors (e.g., avoiding clients with HIV, kissing clients, massaging clients, using weapons or summoning police for protection from clients). Responses differed according to therapist gender (e.g., more male than female therapists experienced patient suicides and faced malpractice, ethics, or licensing complaints), client gender (e.g., more female than male clients were noticed as "physically attractive," hugged, and cradled in therapists' laps), and theoretical orientation. Many participants rated graduate training regarding anger, fear, and sexual arousal as inadequate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dual relationships between therapist and client: A national study of psychologists, psychiatrists, and social workers.

4,800 psychologists, psychiatrists, and social workers were surveyed (return rate?=?49%) to examine attitudes and practices regarding dual professional roles, social involvements, financial involvements, and incidental involvements. Half of the Ss rated the degree to which each behavior was ethical; the other half reported how often they engaged in each behavior. A majority believed dual role behaviors to be unethical under most conditions; most reported that they had rarely or never engaged in the behaviors. 10 factors (therapist gender, profession, age, experience, marital status, region of residence, client gender, practice setting, theoretical orientation, and practice locale) were examined for their relation to the beliefs and behaviors. A higher proportion of male than of female therapists were perpetrators of sexual and nonsexual dual relationships. The professions did not differ among themselves in terms of (a) sexual intimacies with clients before or after termination, (b) nonsexual dual professional roles, (c) social involvements, or (d) financial involvements with patients. 10 specific training implications are discussed in light of the exploitive and clinically harmful nature of dual relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Male therapists' clinical bias: Influence of client gender roles and therapist gender role conflict.

This study examined male therapists' gender role conflict, client sexual orientation, and client emotional expression as they interrelated with clinical judgments about male clients. Using a series of written clinical vignettes to manipulate the client variables of sexual orientation and emotional expression, 196 experienced male therapists completed a measure of male gender role conflict, read a clinical vignette varying the client's sexual orientation and emotional expression, and rated the client on several clinical dimensions. Canonical analysis revealed 2 roots indicating that therapist gender role conflict factors, in combination with client sexual orientation and emotional expression, were associated with therapists' ratings of the male client's prognosis and how much therapists liked, had empathy for, had comfort with, and had willingness to see the male client. Implications for counseling practice, limitations, and future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diversity within African American, female therapists: Variability in clients' expectations and assumptions about the therapist.

Despite the presence of some literature that has addressed the characteristics of the African American female therapist, most psychotherapy training proceeds with the assumption that therapists are members of dominant groups, and most of the psychological and psychotherapy literature has been written by therapists and psychologists who come from dominant cultural perspectives. Not as much has been written about psychological paradigms or the process of psychotherapy from the perspective of the therapist who is not a dominant group member. This article explores both the common and divergent experiences that we, the authors, share as African American female therapists and the different reactions we frequently elicit in clients. We also explore how individual differences in our physical appearances, personal backgrounds, and different characteristics of our respective practices elicit distinct responses from clients that we believe are based on differences between us, despite the fact that we are both African American women. We believe that many of the stereotypes that affect perceptions of African American female clients also exist for African American female therapists. We will address how the intersection of gender, race, and sexual orientation of the client highlights the complexity of culturally competent practice. (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)     

Sex bias in psychotherapy: An examination of the effects of client sex, pathology, and therapist sex on treatment planning.

Investigated the effects of therapist sex, client sex, and client pathology on treatment goals formulated by a pool of 32 male and 32 female practicing psychotherapists (psychiatrists, clinical psychologists, psychiatric social workers, and therapists from related disciplines). Each therapist recommended treatment goals for either 2 male or 2 female pseudoclients who differed in their presenting pathology, which was severe and clearly defined. Male therapists chose significantly more feminine treatment goals for all their clients, whereas female therapists chose significantly more masculine goals, regardless of client sex. Therapists responded to the client's pathology, rather than the client's sex, in formulating treatment goals. This suggested either that client sex is not important in determining treatment goals or that client sex may affect therapists' treatment goal choice only when pathology is vague or not severe. (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)     

Screening for Domestic Violence: Recommendations Based on a Practice Survey.

How do practicing psychologists identify female victims of domestic violence? When asking about harm to self and others, do they also ask if the client is in danger of being harmed by another in an intimate relationship? A national survey of practicing psychologists revealed that 95% agreed that it is their responsibility to assist victimized clients, but fewer than 19% routinely screen for domestic violence. Psychologists report several barriers to screening at intake, which coupled with low screening rates, suggest that psychologists are missing important opportunities to assist clients who are at risk for assault. Several recommendations designed to improve psychologists' screening rates for domestic violence are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors associated with acceptance and decline of client gift giving.

Client gift giving is an interesting interpersonal event, and scholars have considered the ethical and clinical complexities involved in receiving gifts from clients. Attention to the cultural relations of client gift giving invites a more nuanced discussion of psychologists' decisions to accept or decline client gifts. In recognition of how cultural issues affect the therapeutic relationship, the American Psychological Association has instituted guidelines regarding multicultural competence and has urged psychologists to practice in a culture-centered manner. This article reviews the ethical decision making of 40 licensed psychologists to accept or decline gifts from clients. Results indicated that psychologists were more likely to accept gifts from clients when the gift was inexpensive, informed by cultural context, and presented with gratitude for good work at the end of psychotherapy treatment. Psychologists were more likely to decline gifts that were expensive, were presented during treatment rather than at the end of treatment, and had sentimental or coercive value. Two psychologists indicated they would not accept client gifts because they perceived gift acceptance to be a violation of their code of ethics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists' Use of Touch in Individual Psychotherapy.

A national sample of 470 practicing psychologists responded to a survey regarding touch in adult individual psychotherapy. Results reflected a high degree of caution regarding physical contact with clients. Close to 90% of respondents never or rarely offered touch to clients during a session. The handshake, a socially stereotyped form of touch most likely to occur during greeting or parting, was the only form of touch that occurred with some frequency. Therapist and client gender, theoretical orientation, and touch experience of the therapist were related to the use of touch. Contrary to guidelines, touch was typically not discussed with clients when it occurred. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identifying and reducing risk factors related to trainee–client sexual misconduct.

Sexual misconduct involving therapists-in-training and their clients is addressed. Personal and situational factors that may constitute risk factors for the development of inappropriate sexual activity between trainees and their clients are identified. Although there may be certain characteristics that put particular students at risk for such involvement, the authors believe this risk is more strongly related to systemic, programmatic, and pedagogic characteristics of the environments in which students train. Examples include, respectively, the decline of concern over transference and countertransference, failure to include education about client–therapist sexual attraction and the consequences of sexual misconduct in graduate psychology curricula, and the reluctance of supervisors to deal straightforwardly with trainees' sexual feelings. Suggestions for reducing risks for client–therapist sexual misconduct are directed toward these situational factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist qualities preferred by sexual-minority individuals.

Psychotherapy research concerning lesbian, gay, and bisexual (LGB) individuals has focused on matching clients on gender and sexual orientation, yet has not considered how factors such as therapeutic skill, presenting problem, and cohort membership may influence preference for therapists. This study was designed to identify those therapist qualities that sexual-minority individuals prefer and to determine how the presenting problem influences therapist choice. Forty-two nonheterosexual adults between 18 and 29 years old ranked 63 therapist characteristics from "Extremely Uncharacteristic" to "Extremely Characteristic" when seeking treatment for a problem in which their sexual orientation was salient and one in which it was not. The analyses of both conditions yielded clusters of items reflecting therapist characteristics that participants considered unfavorable, neutral, beneficial, and essential. Participants valued therapists who had LGB-specific knowledge as well as general therapeutic skills, whereas they indicated that they would avoid therapists who held heterocentric views. Application of these findings to clinical practice and future directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managed mental health care: The client's perspective.

Changes in psychotherapy services have been the focus of controversy between psychologists and the managed-care industry, yet too seldom have client preferences been directly heard in that debate. This study investigated consumer attitudes about the central elements of psychotherapy service delivery by 3 participant groups: self-pay clients, managed-care clients, and adults without therapy experience. Important differences of opinion were found among participant groups, yet results revealed that all 5 elements investigated were considered essential. Autonomy in treatment decision-making was ranked most important, followed by choice of therapist, copayment amount, limits to confidentiality, and ease of access to care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An analog study with beginning therapists suggesting bias against "activity" in women.

Investigated the effects of client sex and therapist attitudes toward women on treatment planning for an "active" client by having 28 social workers, 28 psychiatrists, 2 nurses, and 3 psychologists (aged 20–30 yrs) formulate a treatment plan for either a male or female client whose cases were identical except for client sex. The client was portrayed as active in work, sex, and interpersonal relationships. Results show bias against activity in women: The female client was seen as having an intrapsychic problem requiring individual insight-oriented therapy, while the male client, with the same presenting problem of marital conflict, was seen as having an interpersonal relationship problem requiring couples' therapy. Activity in a woman was viewed as neurotic. The conflict was conceptualized as unresolved issues about sexual identification, implying normal femininity had not been achieved. Therapists expected that the woman would make the concessions in the relationship and would compromise her career ambitions to achieve a more satisfactory balance of the roles of career woman and wife. It is suggested that therapists must reexamine their conceptualization of activity in men and women and the consequences of their beliefs in everyday clinical practice. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do Psychologists Adhere to the Clinical Practice Guidelines for Tobacco Cessation? A Survey of Practitioners.

Practicing psychologists are well positioned to provide at least minimal interventions for tobacco dependence among their clients. Because smoking covaries with psychopathology, a substantial proportion of psychologists' clients are likely to be smokers. Psychologists have expertise in motivating behavior change, and they have greater contact and stronger relationships with their patients than do most other health providers. Despite these advantages, the current study found that psychologists were less likely to intervene for tobacco use than for other client behaviors, such as alcohol or illicit drug abuse. Psychologists do not regularly ask their clients whether they smoke, advise them to quit, assess their willingness to quit, assist them with quitting, or arrange follow-up. Recommendations for additional training are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Practicing psychologists' knowledge of general psychotherapy research findings: Implications for science-practice relations.

If you are a therapist, how knowledgeable are you and how knowledgeable do you need to be about psychotherapy research findings? In this study, the authors examined practicing psychologists' knowledge of general psychotherapy research findings. Results revealed that some psychologists showed excellent familiarity with this body of outcome research, but many did not achieve this standard. Not infrequently, psychologists believed that research findings were less positive than is actually the case, perhaps explaining some of the negativity that practitioners sometimes express toward psychotherapy research. Research knowledge could not be predicted by years graduated, percentage of long-term clients, percentage of time conducting therapy, theoretical orientation, or perceived familiarity with research. The modest familiarity with research findings that therapists, in general, demonstrated may be understood, in part, through examination of the acquisition of research knowledge as a judgment task. The authors explore potential factors that may influence therapists' judgments about the research. In addition, they examine possible relations between research knowledge and therapy outcome and their potential practice implications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sex with therapy clients: Its prevalence, potential consequences, and implications for psychology training.

Reviews literature indicating the prevalence and clinical consequences of therapist–client sexual contact. Ethics complaints; administrative action; therapist rehabilitation: posttermination therapist–client sexual contact; and legal consequences in the US and Canada, including the Canadian Supreme Court's Norberg v. Wynrib (1992) decision, are discussed. Recommendations for psychology to prepare students to appropriately handle sexual attraction to clients and deal with related ethical issues are offered. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)