Psychotherapists view their personal therapy.

Studied the long-term effects of intensive psychotherapy or psychoanalysis on a sophisticated group of patients—practicing psychotherapists who had previously been in treatment. A comprehensive questionnaire was distributed to 97 30–60 yr old psychotherapists preselected by having completed personal psychotherapy or psychoanalysis. The items focused on subjective experiences in psychotherapy, the elucidation of intrapsychic effects, and Ss' perception of outcome. Positive benefits of treatment involved improvements in self-esteem as well as interpersonal relations. Symptom alleviation was ranked as the least important benefit. Improvement in all areas (including self-esteem, work function, sex life, social relations, character change, and alleviation of symptoms) positively correlated with the feeling of being liked by and liking the therapist. The emotional "tone" of the treatment situation as exemplified by aspects of the patient–therapist relationship appeared to be critical to a positive outcome. 21% of the Ss reported that their treatment was also harmful in some fashion. Data suggested that unresolved transference issues were central to a negative effect. (11 ref) (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)     

The patient's search for safety: The organizing principle in psychotherapy.

This article presents the Control-Mastery view that patients organize the process of their psychotherapy in their search for psychological safety with the therapist. According to this theory, people unconsciously assess their social environments for signals of safety and danger, relaxing their defenses when it seems safe to do so. In therapy, patients test to find the safety with the therapist which would free them to be less defensive in that relationship and, ultimately, in all their relationships. Understanding how patients' activity in psychotherapy is organized by their search for safety can simplify the treatment process for the therapist and help to guide the therapist's interventions. Clinical examples are used to illustrate these ideas. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The context of therapist behavior and outcome prediction.

A review of the research on the relation between therapist behavior and psychotherapy indicates that outcome should include the context of therapist behavior. The context has been deemphasized by measuring therapist behavior alone, sampling the session nonintensively at random or fixed points, and using statistics that focus on proportions or averages of ratings within a given time. The context of therapist behavior can be examined by measuring patient behavior, studying critical incidents or whole sessions, and using statistical analyses that focus on the probabilities of transitions between behaviors. Further development of existing theories of psychotherapy may provide guidelines for studying context. In particular, more emphasis should be placed on the patient–therapist interaction. (54 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The evaluation of a "target problem" approach to outcome measurement.

Examined the agreement among 3 sources (patients, therapists, and independent judges) in their evaluation of psychotherapeutic improvement for 25 outpatients in group psychotherapy. Sources used a "target problem" approach that involved constructing an ideographic problem list for each patient before entering therapy. After 8 and 12 mo of therapy, they rated improvement on each of the individualized problems. Sources did not generally agree either on the content of Ss' problems or on Ss' improvement, even when assessment of agreement was limited to specific problem areas. Furthermore, mean target problem improvement ratings were highly correlated with simple global ratings made by each source, suggesting that the elaborate problem identification procedure was unnecessary. These findings, typical for psychotherapy outcome research, suggest psychometric weaknesses in ideographic assessment approaches that have been gaining popularity. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Goal consensus and collaboration.

There are differences in the extent to which patient and therapist agree on psychotherapy goals and work together in the helping relationship. This article reviews the empirical research on the relation between psychotherapy outcome and patient-therapist goal consensus and collaboration. Research results suggest that psychotherapy outcome is enhanced when agreement on therapeutic goals and collaborative involvement (often assessed by patient cooperation, role involvement, and homework compliance) are present during the course of therapy. When therapists and patients demonstrate cooperative and affiliative behavior, and when patients are actively involved in the patient role, better outcomes can be expected. We discuss therapeutic practices based on these findings, emphasizing the involvement of therapist and patient in a process of shared decision-making where goals are frequently discussed and agreed upon. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multidimensional measures of therapist behavior as predictors of outcome.

Examines recent findings on the relation between process and outcome in psychotherapy and suggests that the difficulty of predicting outcome from therapist behavior may be due in part to neglect of various dimensions of therapist behavior. Some relevant dimensions are type, skillfulness, and interpersonal manner of intervening. Problems created by neglecting dimensions of therapist behavior can be overcome by rating therapist behavior on multiple factors and relating the factors to outcome in a multivariate way. It is recommended that existing theories of psychotherapy be developed further to provide more adequate guidelines for research methods. (63 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Training in counseling and psychotherapy: An evaluation of an integrated didactic and experiential approach.

An approach to training in counseling and psychotherapy integrating the didactic-intellectual approach which emphasizes the shaping of therapist behavior with the experiential approach which focuses upon therapist development and growth was successfully implemented with both a group of graduate students in clinical psychology and a group of lay hospital personnel, including 3 attendants, a volunteer worker, and an industrial therapist. The program relied heavily upon scales which in previous and extensive research had been predictive of positive patient outcome in estimating levels of therapist empathy, positive regard, and congruence and patient depth of self-exploration. It was found that the trainees could be brought to function at levels of effective therapy quite commensurate to those of more experienced therapists in less than 100 hours of training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Untangling the alliance-outcome correlation: Exploring the relative importance of therapist and patient variability in the alliance.

Although the therapeutic alliance is a consistent predictor of psychotherapy outcomes, research has not distinguished between the roles of patient and therapist variability in the alliance. Multilevel models were used to explore the relative importance of patient and therapist variability in the alliance as they relate to outcome among 331 patients seen by 80 therapists (therapist average caseload was 4.1). Patients rated both the alliance and outcome and all models adjusted for baseline psychological functioning. The results indicated that therapist variability in the alliance predicted outcome, whereas patient variability in the alliance was unrelated to outcome. Reasons why therapist variability as opposed to patient variability predicted outcome are discussed. Clinical implications include therapists monitoring their contribution to the alliance, clinics providing feedback to therapists about their alliances, and therapists receiving training to develop and maintain strong alliances. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward the validation of the California Therapeutic Alliance Rating System.

The California Therapeutic Alliance Rating System, CALTARS, was used by judges to rate four therapy sessions for each of 52 subjects treated in brief dynamic psychotherapy for pathological grief. A principal-components analysis provided support for the theoretically proposed domains of alliance. The interrater reliability at the treatment level was satisfactory for the five component-based scales. As hypothesized, scores reflecting positive contribution to the alliance were positively related to educational attainment, motivation for psychotherapy, pretreatment interpersonal functioning, patient experiencing in therapy, symptom improvement, and gains in interpersonal functioning but negatively associated with stressful life events and greater therapist emphasis on addressing patient resistances. As further hypothesized, scores reflecting negative contribution to the alliance were positively associated with greater therapist emphasis on addressing resistances. Alliance ratings were largely independent of pretreatment symptomatology. These findings build toward the construct validity of the CALTARS. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Matchmaking in psychotherapy: Patient-therapist dimensions and their impact on outcome.

Patient–therapist matching was investigated using recent theoretical and methodological developments to overcome some of the limitations that have hindered similar past efforts. Two hypotheses were tested: (a) Therapeutic outcome is affected by the interaction between patients' and therapists' self-concepts, and (b) increasing anticomplementarity between therapist self-concept and therapists' perceptions of patients' behavior is negatively associated with patient improvement. Data from the first 2 cohorts of the Vanderbilt II Psychotherapy Project (H. H. Strupp et al; see record 1989-10009-001) were analyzed. They included the therapies of 16 experienced therapists, who saw a total of 48 patients (38 women and 10 men) in time-limited psychotherapy. Patients' ages ranged from 24 to 65 years (M age?=?40). Outcome was measured from the perspective of the patient, therapist, and evaluating clinician. Each hypothesis was supported, but not across all 3 outcome perspectives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The prediction of child psychotherapy outcome: Factors specific to treatment.

Examined the prediction of child psychotherapy outcome from client, parent, and process factors specific to the therapeutic relationship. 31 children (mean age 11 yrs) were assessed by some independent and therapist ratings, as were parental behaviors, at admission and at discharge from a community mental health center. The primary diagnoses were adjustment disorder (89%) and functional enuresis (11%). Process was evaluated by therapist ratings on the Psychotherapy Process Inventory by P. E. Baer et al (see record 1981-11629-001). Results support the importance of treatment dosage and client participation to global change in impairment and are consistent with findings of B. Gomes-Schwartz (see record 1979-26509-001). Change (decrease) in the severity of Ss' primary problem through treatment was predicted by less frequent parental psychological punishment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Defensive style in the families of schizophrenics and controls.

Biological parents of groups of Good and Poor Premorbid schizophrenics and neurotic controls were administered the Rorschach test in order to evaluate the relative level of ego maturity between parental groups. A rating schedule designed to reflect styles of defensive behavior was devised in an effort to objectify the dimension of ego maturity. It was found that this scale correlated significantly with age, intelligence, and Rorschach response total of the parents employed in the sample. The level of maturity of defensive behavior manifested by the parents was found to differ significantly. Parents of Poor Premorbid schizophrenics produced a greater amount of immature defensive behavior than parents of Good Premorbids, with the parents of neurotic controls falling intermediate between the schizophrenic groups. The difference between parents of "Poors" and neurotics approach significance, while the difference between parents of "Goods" and neurotics was clearly unreliable. (27 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An interpersonal model of psychotherapy: Linking patient and therapist developmental history, therapeutic process, and types of outcome.

This study empirically evaluated a 3-stage causal model based on interpersonal theory that relates patient and therapist early parental relations, the therapeutic alliance, and outcome. Data were from the Vanderbilt II database and encompassed 64 psychodynamic psychotherapies. Interpersonal variables were assessed using the Structural Analysis of Social Behavior. Initial support for the model was found, suggesting a direct effect of patient early parental relations on process and outcome, a direct effect of therapist early parental relations on process, and a direct effect of process on outcome—and thus indirect effects of both patient and therapist early parental relations on outcome mediated by the process. The psychotherapy process was assessed from 3 perspectives: patient and therapist self-report and reports by independent observers. Little convergence was found between the 3 perspectives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-disclosure and expectations for psychotherapy in repressors and sensitizers.

Identified 2 groups of 49 university students as repressors and sensitizers based on scores on Byrnes's Repression-Sensitization Scale. Ss completed the Jourard Self-Disclosure Questionnaire and a Likert-type scale rating dimensions of psychotherapy to assess effects of defensive orientation on expectations for a psychotherapy relationship. Repressors indicated significantly more willingness than sensitizers to self-disclose during the 1st 4 hrs of therapy. Repressors expected more planned than spontaneous activity by the therapist, felt therapist personality less important than sensitizers in facilitating change, and rated themselves significantly less likely than sensitizers to enter psychotherapy in the future. Results are discussed within the framework of repressing and sensitizing defensive styles. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic Alliance and Treatment Adherence in Two Interventions for Bulimia Nervosa: A Study of Process and Outcome.

The relationship between therapeutic alliance, therapist adherence to treatment protocol, and outcome was analyzed in a randomized trial of cognitive-behavioral therapy (CBT) and interpersonal psychotherapy for bulimia nervosa. Independent observers rated audiotapes of full-length therapy sessions. Purging frequency was the primary outcome variable. There were no significant therapist or Therapist × Treatment effects on outcome. Although results showed high levels of alliance and adherence across treatments, CBT was associated with greater adherence. Across treatments and time points, better adherence was associated with enhanced alliance. Treatment condition and baseline purging frequency, but not adherence, predicted outcome. Early alliance predicted posttreatment purging frequency. In temporal analyses, prior symptom change assessed early in treatment was significantly related to subsequent adherence at midtreatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exploring minors' reluctance and dissatisfaction with psychotherapy.

Among 42 10–19 yr olds with learning and associated behavioral or emotional problems who had been referred for counseling, 79% manifested some form of reluctance or dissatisfaction, as demonstrated by refusal to participate, expressions of ambivalence, avoidance, or premature termination. The most frequent reasons for negative attitudes toward psychotherapy were perceived negative attributes of therapy, Ss' feeling that they did not need therapy, and lack of choice in the decision. Ss' mothers and therapists tended to attribute their resistance to therapy to defensiveness, rebellion, or other negative attributes of the Ss. Ss who were reluctant to enter therapy rated it as less important and were rated by their therapists as less committed than Ss who were not reluctant to begin therapy. A 1-yr follow-up of 25 Ss showed a high degree of consistency in Ss' attitudes toward and decisions regarding psychotherapy. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy length of stay and outcome: A meta-analysis of the effect of therapist sex.

This meta-analysis combined results from 64 published and unpublished studies that sought to determine the effect of therapist sex on the outcome of psychotherapy. The articles were obtained using PsychLit and PsychInfo and spanned the years 1930–2000. Results show that therapist sex was found to be a poor predictor of outcome for both male and female clients. Level of therapist training, theoretical orientation of treatment, quality of study, age of clients, and number of treatment sessions did not moderate the minimal effect of therapist sex on the outcome of psychotherapy. The authors conclude that the sex of the therapist has little overall effect on the outcome of psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The alliance as mediator of expectancy effects in short-term individual therapy.

The authors investigated the hypothesis that the therapeutic alliance mediates the relationship between pretherapy expectancy of improvement and psychotherapy outcome. Data were drawn from a comparative trial of 2 forms of short-term, time-limited individual psychotherapy (W. E. Piper, A. S. Joyce. M. McCallum, & H. F. Azim, 1998). Measures of expectancy and outcome were based on an individualized assessment of target objectives; outcome was considered from 3 perspectives (patient, independent assessor, therapist). Using the R. M. Baron and D. A. Kenny (1986) procedure, the authors, found evidence in support of the hypothesized mediation effect. The effect was evident when the alliance was rated from the perspective of either patient or therapist, and it accounted for one third of the direct impact of expectancy on outcome. Clinical implications and limitations of the study are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)