Biased reporting of therapist–patient sexual intimacy.

To investigate bias in reports of therapist–patient sexual intimacy, information about 559 patients who were sexually intimate with their previous therapists was collected via questionnaire from 318 psychologists who subsequently saw these patients in therapy. Psychologists, the experimental Ss in the present study, were predominantly aged 40–49 yrs, and 64% were male. It was found that Ss who reported that no harm occurred to patients as a result of therapist–patient sexual intimacy (SI) admitted twice the prevalence of SI between patients and themselves than did Ss in general. Those Ss who had experienced SI with patients were less likely to report adverse effects of SI either for patients or for therapy. Fewer Ss with a history of SI than those without reported anger toward offending therapists, and fewer recommended punishment. A higher percentage of female than male Ss reported anger toward offenders and recommended punishment, yet women did not rate the effects of SI as more harmful than did men. In general, anger toward offending therapists and recommendations for punishment were associated with the degree to which patients were thought to have been harmed. Ss who had been consultants to a greater number of other therapists about sexual contact with patients reported relatively more cases in which therapy ended soon after SI began than did Ss who were consulted by fewer therapists. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexualization of therapeutic relationships: The dual vulnerability of patient and therapist.

Contends that consumerism (a humanistic-egalitarian therapeutic orientation) and feminism have heightened awareness of the problem of sexual intimacies between patients and therapists. Evidence suggests that sexual intimacy between patients and their therapists has become a more common mode of experience than previously thought. Sexual abuse occurs when the relationship between the patient and therapist is violated, and the patient is victimized by the therapist; erotic involvement between patient and therapist has been likened to incest. Data from the 1970's show that the overwhelming majority of sexually abusive therapists are male. Education during therapists' training period and alternatives for therapists at risk for sexually abusive behavior, including avoidance, referral, treatment programs, and punishment, are suggested as ways to deal openly with this small but severe problem. Public education, in a nonalarmist manner, is also recommended. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attachment to the therapist.

This study examines the ways in which therapists function as attachment figures for patients. Patients in long-term psychoanalytic therapy answered questionnaires about their feelings about their therapists and their closest personal relationships. Components of attachment prominent in the therapeutic relationships were looking up to the therapist and feeling the therapist was responsive to emotional needs. Stronger attachment to therapists was associated with greater frequency and duration of therapy, a stronger working alliance, and greater security of the patients' attachment style, as well as with the gender of the patient and therapist. Using attachment theory to understand psychoanalytic relationships emphasizes the unique importance of a therapist to a patient and can offer new perspectives on both therapeutic and attachment processes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Developing a new narrative: The woman therapist and the male patient.

Discusses the impact of the participants' gender on the therapeutic dialog, in particular the relationship of women therapists to male patients, using data obtained in 13 interviews with female analysts, therapists, or students. Two issues were found to be distinctive to the woman therapist: the contradictory terrain of female authority and the meaning of intimacy with women, given the residues of the separation/individuation process. The preoedipal maternal transference, the possible defensive uses of the erotic transference (e.g., issues concerning power), and the merging of aggressive and sexual impulses are discussed vis-à-vis the dyad of the woman therapist and the male patient. Issues of fantasy and hostile transference are also discussed. (66 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors influencing lower-class Black patients remaining in treatment.

Studied early termination from individual therapy in a community mental health clinic with 43 lower-class Black patients assigned to therapists who were Black or White. The only significant correlate was the interaction between sex of therapist and sex of patient. Patients remained longer with therapists of the opposite sex. No significant correlations were found between remaining in treatment and Black patients' attitudes toward Whites, patients' perceptions of therapists' understanding and acceptingness, or patient–therapist discrepancies in their perception of therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender bias in therapy? An analysis of patient and therapist causal explanations.

Examined the causal explanations (CEs) of 58 female and 53 male depressed or nondepressed patients (aged 20–53 yrs) and 19 female and 20 male therapists to see whether S and stimulus biases related to gender would appear in therapy. Gender differences in CEs for patient experience were not brought into therapy by the male and female patients themselves. No significant therapist biases could be discerned in providing CEs for patient-presenting problems early in therapy. However, when therapists were asked to explain difficulties that might occur in the therapy relationship, significant effects of gender as both S variable and stimulus variable appeared. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of client-centered group play therapy on self concept.

V. M. Axline's (1969) basic principles for client-centered play therapists direct the therapist to create an environment in which clients are granted the basic freedoms that V. Satir (1976) has delineated as necessary for self concept enhancement. This relationship between client-centered play therapy and self concept enhancement is evident when comparing their histories. This study investigated the effects of client-centered play therapy on self concept in a 10 session client-centered play therapy group involving 3 male and 3 female 6-9 yr olds with a variety of clinical problems. Two individual case studies from the group are presented which indicate that client-centered group play therapy enhances self concept. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of therapist and patient mood on the therapeutic functioning of high- and low-facilitative therapists.

Determined the effects of presession moods of 12 therapists and their patients on level of therapist empathy, warmth, and genuineness. Results of an intensively designed study indicate that high- and low-facilitative therapists were differentially affected by therapist moods. High-facilitative therapists functioned more facilitatively under dysphoric moods than under positive, while the opposite was true of low-facilitative. There were no differences in tape-rated therapist facilitativeness under different patient moods for either group, yet patients of low-facilitative therapists did perceive such a difference. It is concluded that the therapist feelings preceding the facilitative therapy hour were not the same for high- and low-facilitative therapists. The use of the intensive design in psychotherapy process research is discussed. (44 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Myers-Briggs Type Indicator personality dimensions and perceptions of quality of therapy relationships.

Examined associations between perceived quality of therapy relationships and therapist and client scores on the Myers-Briggs Type Indicator (MBTI). 35 experienced therapists and 53 adult outpatients involved in long-term personal therapy completed the MBTI and measures of therapy relationship quality and pretherapy adjustment. More positive client ratings of the quality of the therapy relationship were associated with similarity of therapist and client in overall MBTI profiles and in the thinking–feeling and judging–perceiving dimensions of the MBTI. When therapists had higher extroversion and feeling scores, both therapists and clients rated the relationship more positively. The MBTI may be valuable in determining optimal therapist–client matches and in guiding therapists to better understand their impact on clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Feminist identity and feminist therapy behaviors of women psychotherapists.

Investigated whether (1) feminist identity development for women therapists was related to their use of feminist therapy behaviors (FTBs) and (2) feminist identity development and use of FTBs for women therapists were related to self-identification as a feminist therapist. 153 women psychologists (aged 30–77 yrs) were administered a women's issues in therapy questionnaire, which included a short version of the Feminist Identity Scale (FIS; K. M. Rickard, 1989, 1990). Ss were categorized into stages of feminine identity development according to their scores on 4 subscales of the FIS: Passive-Acceptance (PA), Revelation (REV), Embeddedness (EMB), and Synthesis (SYN). Ss scoring high on SYN and REV, and low on PA, reported greater use of FTBs; scores on the EMB were not related to the use of FTBs. All 4 subscales were predictive of women therapists who self-identified as feminist therapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitude similarity in marital therapy.

Measured the evaluative attitudes, before and after treatment, of 10 couples involved in marital therapy, and compared these with the initial attitudes of their therapists. Contrary to previous research, results indicate that improvement in marital therapy was associated with attitudinal convergence between the 2 marriage partners instead of between patient and therapist. However, a significant trend was noted for patients to acquire their therapist's attitudes during treatment regardless of their improvement. Results suggest that improvement in marriage therapy may be more efficaciously predicted by determining the parameters of the husband-wife relationship, that could result in their attitudinal convergence, than by the similarity between the individual patient and therapist. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Shame: Countertransference identifications in individual psychotherapy.

Shame is a universal experience felt by patients and therapists alike. Yet, the experience of shame, with its profound sense of inadequacy and worthlessness, is anathema to the competent and compassionate self-image of most therapists. In order to help therapists understand their own shame and their countertransference identifications to patient shame, this article first describes the nature of shame, its developmental progression within interpersonal relationships, and the defenses commonly employed to cope with shame. Because the experience of shame involves the activation of devalued and devaluing internal representations, therapists may develop concordant or complementary countertransference identifications. These countertransference identifications are influenced further by the patient's primary reaction to shame' which includes withdrawal, attacks on self, avoidance, and attacks on others. Each of these reflects a habitual reaction to shame that is displayed in the patient–therapist relationship. (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)     

Review of Psychotherapy with psychotherapists.

Reviews the book, Psychotherapy with psychotherapists edited by Florence W. Kaslow (see record 1990-98484-000). There has been little written about doing psychotherapy with patients who are themselves psychotherapists, despite the fact that many therapists have been in therapy and some have provided treatment for other therapists. This book presents a good overview of many of the issues involved when therapist treats therapist, although there are no real surprises or conceptual breakthroughs. Regardless of theoretical orientation or preferred treatment modality, several common problem areas emerge having to do with boundaries, confidentiality, pride, competition, and countertransference. There is still a clear need for research, including investigation of the supposed efficacy of treatment as training. More discussion and detailed case examples of treatment from the perspective of the therapist-patients would have been desirable. These relatively minor qualifications notwithstanding, therapists will find much here to stimulate and inform their work with therapist-patients. There are fewer "therapists' therapists" than there are therapist-patients, however, and this suggests an even larger readership: trainees and practicing clinicians in treatment. This book may not only help therapists to be therapists to their patients, but should also help therapists to be patients to their therapists. (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)     

Do Psychotherapists Have Better Marriages Than Nonpsychotherapists? Do Therapeutic Skills and Experience Relate to Marriage Adjustment?

Couples in which 1 or both members were psychotherapists were compared with nontherapist couples for marriage adjustment (MA). The authors predicted higher MA scores for the therapists and a positive correlation between the MA of therapists and years of therapy training, years of practice, rating of therapeutic ability, length of marital therapy training, number of marital therapy clients, experience as a marital therapist, and self-rating as a marital therapist. Therapist and nontherapist couples did not differ on MA. Only self-rated ability as a marital therapist correlated positively with MA. For men, ability as a therapist, as a marital therapist, and marital therapist experience correlated significantly with MA. For female therapists only self-rated ability as a marital therapist correlated significantly with MA. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Studying psychotherapy using the one-with-many design: The therapeutic alliance as an exemplar.

Most psychotherapy research uses a one-with-many design, in which each therapist (the one) treats multiple clients (the many), which raises the challenge of nonindependent data. We present a statistical model for analyzing data from studies that use a one-with-many design. This model addresses the problems associated with nonindependence and can address theoretically relevant questions. To illustrate this model, we analyzed data in which 65 therapists and their 227 clients rated their therapeutic alliance. The primary finding was that both therapist and client alliance ratings were largely relational (i.e., specific to the unique therapist–client combination). There was little consensus among clients treated by the same therapist about the quality of the therapeutic alliance, although some therapists reported forming stronger alliances than other therapists. There was substantial dyadic reciprocity, indicating that if a therapist reported an especially good alliance with a particular client (better than with his or her other clients), then that client was also likely to report an especially good alliance (better than those reported by the therapist’s other clients). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist retrospective recall impasses in long-term psychotherapy: A qualitative analysis.

Twelve experienced therapists completed a questionnaire, and 8 of the 12 were then interviewed about their experiences with a therapeutic impasse that ended in the termination of therapy. Data were analyzed using a qualitative methodology. Results indicated that most of the clients were anxious and depressed with personality disorders and interpersonal problems. Therapists perceived impasses as having a profound negative impact on both clients and therapists. Variables associated with impasses in a majority of the cases were a client history of interpersonal problems, a lack of agreement between therapists and clients about the tasks and goals of therapy, interference in the therapy by others, transference, possible therapist mistakes, and therapist personal issues. Implications for training, practice, and research are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changing what has gone before: The enhancement of an inadequate psychology through the use of an Afrocentric-feminist perspective with African American women in therapy.

African American women face a variety of mental health issues due to their racial, historical, cultural, and economic position in American society. The synergistic effect of these variables and their interaction with mental health correlates creates an atypical therapeutic situation for many therapists and clients. The heritage of racism and sexism found within traditional psychological concepts severely limits the effectiveness of therapy with this population. Effective therapy with the African American female client (1) identifies the therapist's world view based on developmental and sociocultural influences, (2) examines therapist and client differences that could affect the therapeutic process, (3) makes use of community and interagency resources, and (4) stresses an approach that synthesizes Afrocentric and feminist perspectives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)