Black clients: Implications for supervision of trainees.

Presents a model to assist supervisors in training therapists with Black clients. Errors of beginning therapists (both Black and White) are described, including the trainee's language being full of slang, assuming an "us against the system mode," acting as a client controller, and acting as the self-effacing helper. It is suggested that racial identity is as much an issue for the Black helper as for the Black client and that the most difficult aspect of therapy with Black clients is establishing the relationship. (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)     

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)     

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)     

Self-disclosure, paranoia, and unaware racism: Another look at the Black client and the White therapist.

Suggests that C. R. Ridley (see record 1985-26063-001), in his attempt to dissuade the reader from maintaining stereotypic views of Black clients, may be unintentionally perpetuating some of those views. Ridley's use of the term healthy cultural paranoiacs and the language and terminology of the article are discussed in this context. The concept of unaware racism and its effects on the White therapist–Black client relationship are discussed. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of counselor and client racial similarity on the counselor's response patterns and skills.

To test the hypothesis that factors of racial differences may mediate counselor–client interactions in terms of the counselor's attending and expressive response style and the delivery and type appropriateness of responses, 60 graduate level Black and White counselor trainees were asked to counsel both Black and White clients. As hypothesized, Ss' delivery scores and the type appropriateness of responses were significantly better under conditions of racial similarity with the clients. Both Black and White Ss were rated as being more expressive than attending in their response patterns toward Black clients. Findings have implications for counselor–client relationships and professional training programs for psychological counseling in multiracial settings. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Discriminating the "good" from the "bad" therapy hour: A study of dyadic interaction.

Investigated whether better interviews could be discriminated from worse interviews, using (1) relative client–therapist activity levels and (2) the degree of structure implicit in the therapist's messages. Eight 22–58 yr old clients and their therapists whose professional experience ranged from 1 to 4 yrs had congruent perceptions of 2 sessions, one good and one bad. Group and case-by-case comparisons were made of the natural language in these interviews. Results show metacomplementary patterns in both good and bad sessions, but client–therapist activity tended to be more asymmetrical in the worse interviews. In the bad sessions, these therapists either participated even more actively than their clients or were passive, while in their good sessions client–therapist participation levels were more balanced. In the good interviews, therapists consistently provided a moderate degree of structure (significantly more reassurance/encouragement, information, and interpretation), as opposed to lower structure (notably reflection/restatement) or higher structure (information seeking and guidance/advice) in their bad interviews. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Same difference: Black therapists' experience of same-race therapeutic dyads.

Do Black therapists experience their work with Black clients differently than their work with other clients? A phenomenological study of 12 Black psychologists, social workers, and counselors working in college counseling centers examined these therapists' lived experience of same-race therapeutic dyads. The therapists described the unique aspects of their therapy with Black clients, as well as how they learned to perform that work. The implications of this study are vital not only to Black therapists, but also to educators and supervisors of Black therapist trainees. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Racial/ethnic disparities in therapist effectiveness: A conceptualization and initial study of cultural competence.

As a result of mental health disparities between White and racial/ethnic minority clients, researchers have argued that some therapists may be generally competent to provide effective services but lack cultural competence. This distinction assumes that client racial/ethnic background is a source of variability in therapist effectiveness. However, there have been no direct tests of the therapist as a source of health disparities. We provided an initial test of the distinction between general and cultural competence by examining client racial/ethnic background as a source of variability in therapist effectiveness. We analyzed cannabis use outcomes from a psychotherapy trial (N = 582) for adolescent cannabis abuse and dependence using Bayesian multilevel models for count outcomes. We first tested whether therapists differed in their effectiveness and then tested whether disparities in treatment outcomes varied across therapist caseloads. Results suggested that therapists differed in their effectiveness in general and that effectiveness varied according to client racial/ethnic background. Therapist effectiveness may depend partially on client racial/ethnic minority background, providing evidence that it is valid to distinguish between general and cultural competence. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

An experimental inquiry into transference roles and age.

In this psychotherapy analogue investigation, the effects of client age and therapist age on transference-like projections onto therapists were examined. Young (25–35) and older (60–70) pseudoclients compared paraprofessional therapists to significant figures in their own lives after a dyadic "helping" interview. The results provide empirical support for the phenomenon of reverse transference in therapy with older patients. Older clients were more inclined than young clients to view therapists, particularly younger therapists, as similar to their children. Young clients more willingly attributed parental qualities to older therapists. Both old and young clients may see therapists more as peers or friends than as family members. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rights of clients, responsibilities of therapists.

Discusses ways in which ethical principles can be put into practice in the client–therapist relationship. Historically, ethical codes for therapists were drawn up to protect the professions from regulation by external agencies. Implicit in the ethical codes, however, is a model for the client–therapist relationship that fosters the goals of mental health. It is suggested that just as ethical codes have been given specific content in standards for providers of psychological services in human service facilities, ethical codes can be given specific content in the client–therapist relationship. It is recommended that therapists take responsibility for incorporating ethical standards into their practices so that clients' rights will be an integral part of therapy. Four illustrative situations are presented: providing clients with information to make informed decisions about therapy, using contracts in therapy, responding to clients' challenges to therapists' competence, and handling clients' complaints. (63 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapists' attributions for client premature termination: Are they self-serving?

We conducted two studies of therapist responses to client premature termination from psychotherapy. In Study 1, we surveyed therapists' attributions for client premature termination from therapy using an open response format. Results suggested that therapists showed a self-serving pattern in their attributions (i.e., attributed causality to the client or environment) when considering their own clients compared to when they considered the premature terminations of clients in general. Study 2 was a vignette study in which therapists responded to one of two client presentations that varied relationship to client (your client vs. other's client). Using the attributional categories derived from Study 1, therapists rated the likelihood that each attribution caused the client's premature termination. Again, patterns across groups indicated that therapists are self-serving in their attributions for client premature termination. In addition, differences were found across gender and theoretical orientation; larger effects were found for men compared to women, and psychoanalytic therapists compared to cognitive–behavioral. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist self-disclosure.

Studied therapist self-disclosure in 8 cases of brief psychotherapy with anxious/depressed female clients (aged 32–60 yrs) and experienced therapists (aged 34–78 yrs). As predicted, reassuring disclosures were rated as more helpful by clients and therapists and led to higher levels of client experiencing than did challenging disclosures. However, no support was found for the hypothesis that self-involving (present tense) disclosures would be more helpful than self-disclosing (past tense) disclosures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Commentary on Dinger et al.: Therapist’s attachment, interpersonal problems and alliance development over time in inpatient psychotherapy.

This short article is a commentary on a research study investigating therapist and client attachment styles and their relationship to alliance development in a 12-week psychodynamic psychotherapy program for nonpsychotic inpatients. The relationship is complex; unsurprisingly, securely attached therapists with less distressed clients formed the strongest alliances. A significant proportion of therapists were insecure, almost entirely in the preoccupied or hyperactivating mode. It is argued that collusive relationships between such therapists and similarly overaroused clients may be common. Therapists need both to accommodate to their client’s attachment style and to confound it if positive change is to result. Therapist self-scrutiny is likely to be a precondition for such positive outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparing therapist and client perspectives on reasons for psychotherapy termination.

Examines the extent of agreement on the reasons for psychotherapy termination given by therapists and their clients. 194 client files in a psychology training clinic were reviewed to obtain reasons for termination cited by therapists in treatment termination reports. Telephone interviews were conducted with 87 of these former clients to determine their perspectives on reasons for termination. Consistent with previous research, there was little concordance among the reasons cited by therapists and by clients regarding clients' decisions to terminate therapy. Of the clients identified by therapists as terminating because of the successful attainment of therapeutic goals, three-quarters reported this reason as important in their termination decision; of those clients reporting termination because of attaining therapeutic goals, only half were identified by therapists as having achieved their goals. Dissatisfaction with therapy and/or the therapist were reported by many clients as important in their termination decisions; such factors were rarely cited by therapists as reasons for termination. Attention to discrepancies between client and therapist expectations of therapy and therapy termination is necessary to reduce the high rate of premature termination in psychotherapy. (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)     

Relation of nonverbal behavior to client reactions.

Sixteen therapists each saw a volunteer client for a single counseling session. During a videotape review the clients recorded their reactions and the therapists recorded their perceptions of client reactions to each therapist intervention. Client nonverbal behaviors (speech hesitancies, vertical and horizontal head movements, arm movements, leg movements, postural shifts, adaptors, illustrators, and smiles) were examined to determine whether they were consistently associated with client reactions. The results indicated that horizontal head movements were associated with client reports of supported and therapeutic work reactions and were also associated with therapist perceptions of therapeutic work reactions; vertical head movements were associated with client reports of supported reactions; and speech hesitancies were associated with therapist perceptions of therapeutic work reactions. The results are discussed in terms of implications for practice and further research. (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)