Therapist Alliance-Building Behavior Within a Cognitive-Behavioral Treatment for Anxiety in Youth.

Explored the specific behavior of therapists contributing to a child client's perception of a therapeutic alliance with youth (n = 56) who received a manualized cognitive-behavioral treatment for anxiety disorders. The first 3 sessions were coded for 11 therapist behaviors hypothesized to predict ratings of alliance. Child, therapist, and observer alliance ratings were gathered after the 3rd and 7th therapy sessions. "Collaboration" positively predicted early child ratings of alliance, and "finding common ground" and "pushing the child to talk" negatively predicted early child ratings of alliance. Although no coded therapist behaviors predicted early therapist ratings of alliance, "collaboration" and "not being overly formal" positively predicted therapist alliance ratings by Session 7. Child, observer, and therapist ratings of alliance were significantly correlated. Results are discussed with regard to the identified behavior of the therapist as a step toward the identification of empirically supported strategies for building a stronger child-therapist alliance. (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)     

Relationship of the A-B variable to patient symptomatology and psychotherapy expectancies.

In previous research, therapists' A-B status has predicted differential therapist effectiveness with schizoid vs. neurotic patients, but patients' A-B status has not been studied. This study related the A-B scores of 60 male college clinic patients (As, controls, and Bs), to therapist ratings of presenting symptoms and S's own complaints and role expectancies. As exhibited turning against the self, intropunitive symptoms, whereas Bs showed extrapunitive tendencies. Role expectancy data suggested, surprisingly, that As enter therapy expecting to unburden themselves in active, productive manner, whereas Bs appear to seek rational guidance and correctives. With respect to these adjustive modes and role expectancies, therapist-patient complementarity, rather than similarity, may partially mediate the effectiveness of therapy interactions. (18 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acceptance, values, and therapeutic change.

Studied the role of therapist acceptance of patient values, patient acceptance of therapist values, and value persuasion on outcome among 13 psychotherapy dyads. Therapists consisted of 13 graduate students in clinical psychology, all of whom had been trained in relationship/insight-oriented therapy. The 13 17–25 yr old patients were randomly selected, 1 from each therapist's caseload. Before beginning therapy all therapists completed a series of value questionnaires; patients completed the same scales after the 1st and 12th therapy sessions. A priori assessment of value acceptance was related to patients' perceptions of their therapists and ratings of improvement, with outcome being enhanced by selective value rejection as well as acceptance. A significant relationship was found between the patients' acquisition of their therapists' values and their ratings of improvement. (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–therapist value similarity and psychotherapy outcome: A microscopic analysis.

Examined the association between patient–therapist pretreatment value similarity and subsequent improvement in 45 nonpsychotic psychiatric outpatients (aged 19–54 yrs) who were randomly assigned to 22 therapists. Pre-assignment assessment of similarity in 36 value dimensions on the Rokeach Value Survey was investigated to determine how the dimensions influenced symptomatic and global changes in the therapy process. Treatment outcome was assessed both by patient and therapist reports, and the SCL-90 was used to evaluate pre- to posttreatment symptom change on 9 symptom dimensions. In addition, therapists were asked to complete a subjective rating of improvement at the end of treatment. The results indicate that a complex pattern of similarity and differences in specific values promoted maximal improvement. Moreover, specific improvement measures were influenced differently by various patient–therapist value patterns. Generally, therapist ratings of outcome were enhanced by pretreatment dissimilarities in value placed on social ascendance and achievement and similar value emphasis being placed on humanistic and philosophical concerns. Patient ratings of outcome were also enhanced if patient and therapist shared philosophical and humanistic concerns, but were further facilitated if values relating to social attachment and independence were ranked differently for patient and therapist. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of a client pretherapy orientation videotape.

Examined the effects of a videotaped psychotherapy orientation on clients' response to therapy, knowledge about therapy, utilization of services, and satisfaction with services and on therapist ratings of client attractiveness. 62 psychotherapy clients (mean age 29 yrs) at an urban community mental health center were randomly assigned to an oriented group, which viewed a pretherapy orientation videotape at admission, or to a control group. 14 therapists participated. The 11-min videotape described the relationship between client and therapist, encouraged clients to attend appointments, and stated that, although progress is rarely immediate, most clients find that therapy can lead to a reduction in anxiety and depression. Clients and therapists completed questionnaire and rating scales at intake and at 1-mo follow-up. It was found that oriented clients were able to understand and recall the information in the videotape, and the oriented group showed a greater decrease in self-reported symptoms than the control group after 1 mo. Client feedback regarding the videotape was favorable. In general, the 2 groups did not differ in their satisfaction with services, service utilization, or therapist ratings of client symptoms and functioning. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Impressions of psychotherapists' offices.

For counseling settings, research suggests that softness, personalization, and order might affect the experience and the perceived expertness, trustworthiness, and social attractiveness of the therapist. This article discusses exploratory studies on college students' perception of the counseling office environment and whether the likely client experience was associated with the softness/personalization and order of the office. As stimuli, the studies used 30 color photographs of psychotherapists' offices viewed from the client's perspective. After obtaining ratings of the characteristics of each office, we obtained ratings from different groups of students of the quality of care and comfort expected in each office (Study 1) and how qualified, bold, and friendly the therapist in the office would be (Study 2). Additional studies examined the likelihood of choosing a therapist based on the office, and the first thought or feeling that came to mind about the office, the therapist, and the patient experience. There were strong correlations in response between groups (by whether they had experienced therapy; their level in school; their gender; and their major, location, and school size). The quality of care, comfort, therapist boldness, qualifications of the therapist, and the likelihood that one would choose a therapist based on the office improved with increases in the office's softness/personalization and order. Friendliness improved with increases in softness/personalization. The office choices, open-ended responses, and reported reasons for the ratings confirmed the importance of softness (comfort) and order. Research should test longer term exposure and behavior. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A semantic analysis of a normal and a neurotic therapy group.

"The purpose of the research… was to see if S's entering therapy can be differentiated from persons that have never been in therapy by meanings they associate with certain selected concepts and to test for areas where semantic changes followed therapy, especially as they may relate to parental identification… . The findings indicate that control S's can be differentiated from therapy S's prior to therapy by the meaning they attribute to the concepts of the self and of parents… therapy affects the self-estimate and not the judgment of parents… ." The research is related to the findings of Rogers and Dymond (1954), Greenspoon (see 30: 4488), and Verplanck (see 31: 2940) on verbal reinforcement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality variables affecting WAIS scores.

Assigned 32 undergraduate Es and 32 undergraduate Ss to 1 of 4 groups based on their scores on a hostility and a dominance scale. Each E interviewed 1 S for 10 min., rated the S on warmth and likability, and scored 4 WAIS verbal subtests completed by the S. Each S also rated the E for warmth and likability. Results indicate that (a) nonhostile Es gave more credit to hostile-dominant Ss and to nonhostile-nondominant Ss than to nonhostile-dominant Ss; (b) E's liking of S and rating of S's warmth were significantly related to total scores; and (c) S's ratings of E's warmth and likability were not positively related to S's test scores. It is concluded that E bias was present. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist multicultural competency: A study of therapy dyads.

[Correction Notice: An erratum for this article was reported in Vol 44(1) of Psychotherapy: Theory, Research, Practice, Training (see record 2007-04278-014). The fifth author's name should be spelled as follows: Alexa Mislowack.] This study examined the role of therapist multicultural competence (TMC). Fifty-one therapy dyads completed measures of therapist multicultural competency, working alliance, and their satisfaction with therapy. Clients also completed measures of therapist attractiveness, expertness, trustworthiness, and empathy. Results showed strong associations between clients' ratings of TMC and ratings of the working alliance, therapist empathy, and satisfaction. Clients' combined rating of therapist expertness, attractiveness, and trustworthiness were not associated with their TMC ratings but were significantly associated with therapists' self-appraised TMC ratings. Therapists' ratings of their TMC were associated with their ratings of the working alliance and satisfaction with their work. Results are discussed in the context of the relevant literature, as are implications for training and research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Examining the alliance using the Psychotherapy Process Q-Set.

The alliance between therapist and patient was investigated using the Psychotherapy Process Q-Set (PQS), an instrument that quantitatively describes therapy sessions in a manner that captures the complexity of the therapy process. More specifically, the PQS was used to examine the treatment processes being assessed by observer ratings on the California Psychotherapy Alliance Scales (CALPAS). Using data from 30 brief psychodynamic psychotherapy treatments (patients aged 20–81 yrs), three PQS factors were found to be associated with alliance: Patient–Therapist Interaction, Patient Capacity/Commitment, and Therapist Countertransference. In multiple regression analyses with scales constructed from these three factors, Patient–Therapist Interaction was found to predict alliance ratings, while the other two aspects of the treatment process did not account for any significant additional variance in the alliance ratings. Results suggest that Patient–Therapist Interaction plays a defining role in the alliance construct, as assessed by the observer version of the CALPAS. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist sexual orientation, gender, and counseling practices as they relate to ratings on helpfulness by gay and lesbian clients.

Three hundred ninety-two lesbian and gay volunteers described their experiences with 923 therapists, reporting therapist sexual orientation, therapist gender, and perceived helpfulness of the therapist in each case. Gay, lesbian, and bisexual therapists of both genders and heterosexual female therapists were all rated more helpful than heterosexual male therapists. Participants also reported whether each therapist exhibited 9 negative and 4 positive practices. Relative risk ratios indicated that 8 of the 9 negative therapist practices were significantly associated with (a) client designation of a therapist as unhelpful and (b) termination after 1 session. All 4 of the positive practices were inversely associated both with unhelpful ratings and with termination after 1 session. Therapist practices accounted for more of the variance in ratings of helpfulness than did therapist demographic characteristics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relation between specific and general dimensions of the psychotherapy process in interpersonal psychotherapy of depression.

This article examines the relation between general dimensions of the psychotherapy process, rated with the Vanderbilt Psychotherapy Process Scale (VPPS), and a type of manual-guided psychotherapy, Short-Term Interpersonal Psychotherapy of Depression (IPT). With the use of data from a training program in IPT, two types of analyses were performed. First, VPPS factors were correlated with IPT therapist competence ratings. This analysis showed that all VPPS-rated dimensions of patient and therapist behaviors were significantly correlated with IPT competence ratings. Especially strong correlations occurred between IPT competence ratings and the VPPS therapist factors of (a) Exploration and (b) Warmth and Friendliness. Second, to evaluate whether the general process features that influenced IPT competence ratings were also related to the therapy's effectiveness, correlations between VPPS process dimensions and patient outcome were performed. This analysis indicated that VPPS-rated therapist behaviors were significantly predictive of patient outcome, whereas patient behaviors were generally not significantly related to outcome. Taken together, the findings indicate the importance of general aspects of the psychotherapy process in therapist evaluation and efficacy of manual-guided psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationships among therapist empathy and authoritarianism and a therapist's prognosis.

Administered the Rokeach Dogmatism Scale (Form E), the Hogan Empathy Scale, and a therapy prognosis scale to 25 therapists (PhD psychologists). A positive relationship was found between therapist empathy and the prognosis variables dealing with perception of degree of disturbance and overall prognosis. Multiple regression analysis revealed that (a) empathy, number of years of experience, and age (in that order) are of greatest importance in predicting a therapist's perception of degree of disturbance of an individual; and (b) empathy and number of years of experience (in that order) are most important in predicting a therapist's overall prognosis for an individual. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A-B therapist perceptions and preferences for schizophrenic and psychoneurotic clients.

Administered an extended version of the a-b scale to 141 experienced, practicing psychotherapists. Ss also completed scales designed to assess therapist attitudes toward working with schizophrenic and psychoneurotic clients, personal liking for specific schizophrenic and psychoneutrotic clients, and orientation toward interpersonal relationships. Analysis of variance results revealed no evidence suggesting that a and b therapists differentially perceive or prefer schizophrenic or psychoneurotic clients. There was evidence suggesting that a therapists initially like both schizophrenic and psychoneurotic clients as individuals more than b therapists. By the time therapy had ended, these differences between a and b therapists tended to dissipate with schizophrenic clients. However, b therapists' personal liking of their psychoneurotic clients actually declined during therapy. (18 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)