Goal consensus and collaboration.

This article updates our previous article in this journal (Tryon & Winograd, 2001) by examining via meta-analyses results of recent studies, published from 2000 through 2009, that relate goal consensus and collaboration to treatment outcome. Specifically, 15 studies with a total sample size of 1,302 yielded a goal consensus-psychotherapy outcome effect size of .34 (SD = .19, p SD = .17, p     

Patient collaboration as a criterion for the therapeutic alliance.

In this article we show that a focus on patient collaboration, as a marker for the therapeutic alliance, is advantageous not only for theory and research but also for clinical practice. This point of view in no way minimizes the importance of the therapist's activity or the clinical significance of the interaction between patient and therapist. Rather, it focuses attention on how the therapist's personality, skill, and technique interact with the problems the patient brings to psychotherapy. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Introduction to special issue.

Recent years have witnessed the emergence of two powerful, and seemingly contradictory, visions of what most fundamentally causes change in psychotherapy. One of these visions emphasizes the primacy of therapist technique. According to this viewpoint, it is the specific methods used by the psychotherapist that account for, by far, most of the variance in treatment outcome. This viewpoint is seen most notably in what have been termed the empirically supported treatments (EST) and evidence-based practices (EBP) movements. The second vision instead focuses on the patient-therapist relationship and so-called therapist-offered relationship qualities as the sine qua non of therapeutic effectiveness. Advocates of this viewpoint underscore research on the importance of relational qualities such as the therapeutic working alliance (or cohesion in groups) and therapist-offered conditions. While acknowledging the value of both visions noted above, this special issue of Psychotherapy is based on the notion that what matters most in psychotherapeutic treatments is the interplay of the two, of techniques and the therapeutic relationship. Technical factors and relational factors are indelible elements in each and every psychotherapy encounter, and the articles in this special issue explore and seek to uncover why this is so. The articles, in addition, seek to describe the complex ways in which technique and relationship interact with one another in different treatments, at different points in treatment, and in conjunction with still other variables. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Repairing alliance ruptures.

In this article, we review the existing empirical research on the topic of therapeutic alliance ruptures in psychotherapy. Ruptures in the therapeutic alliance are defined as episodes of tension or breakdown in the collaborative relationship between patient and therapist. Two meta-analyses were conducted. The first reviewed studies examining the relation between rupture-repair episodes and treatment outcome (r = .24, z = 3.06, 95% CI [.09, .39], p = .002, k = 3, N = 148). The second meta-analysis reviewed the research examining the impact on treatment outcome of training therapists in the use of alliance rupture intervention principles (prepost r = .65, z = 5.56, 95% CI [.46, .78], p k = 8, N = 376). Both meta-analyses provided promising evidence regarding the relevance of alliance rupture-repair processes to therapeutic outcome. The limitations of the research reviewed are discussed as well as practice implications for repairing the inevitable alliance ruptures in psychotherapy. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Goal directedness and decision making in infants.

The term goal directed conventionally refers to either of 2 separate process types—motor processes organizing action oriented toward physical targets and decision-making processes that select these targets by integrating desire for and knowledge of action outcomes. Even newborns are goal directed in the first sense, but the status of infants as decision makers (the focus here) is unknown. In this study, 24-month-olds learned to retrieve an object from a box by pressing a button, and then the object’s value was increased. After the object’s subsequent disappearance, these children were more likely to press the button to try to retrieve the object than were control 24-month-olds who had learned to retrieve the object but for whom the object’s value was unchanged. Such sensitivity to outcome value when selecting actions is a hallmark of decision making. However, 14- and 19-month-olds showed no such sensitivity. Possible explanations include that they had not learned the specifics of the action outcome; they had not acquired the necessary desire; or they had acquired both but did not integrate them to make a decision. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Research summary on the therapeutic relationship and psychotherapy outcome.

Factors that influence client outcome can be divided into four areas: extratherapeutic factors, expectancy effects, specific therapy techniques, and common factors. Common factors such as empathy, warmth, and the therapeutic relationship have been shown to correlate more highly with client outcome than specialized treatment interventions. The common factors most frequently studied have been the person-centered facilitative conditions (empathy, warmth, congruence) and the therapeutic alliance. Decades of research indicate that the provision of therapy is an interpersonal process in which a main curative component is the nature of the therapeutic relationship. Clinicians must remember that this is the foundation of our efforts to help others. The improvement of psychotherapy may best be accomplished by learning to improve one's ability to relate to clients and tailoring that relationship to individual clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Decision making and psychotherapy integration: Theoretical considerations, preliminary data, and implications for future research.

In recent years, a number of publications have called for investigation of how psychotherapists make treatment decisions in clinical practice. This recommendation is particularly salient for psychotherapy integration, as studies have consistently shown that a plurality of American clinicians consider themselves to be either "eclectic" or "integrative" in theoretical orientation. Yet, the research on clinician decision making in psychotherapy is in its infancy. This article examines the need for decision-making research in psychotherapy integration, as well as aspects of psychotherapy integration that are targets for research and possible theoretical frameworks for understanding decision-making processes of integrative psychotherapists. A preliminary study provides data from practicing psychotherapists to illustrate these points. Finally, implications and directions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist interpretation, patient-therapist interpersonal process, and outcome in psychodynamic psychotherapy for avoidant personality disorder.

[Correction Notice: An erratum for this article was reported in Vol 43(3) of Psychotherapy: Theory, Research, Practice, Training (see record 2006-12148-017). The correct legend for Figure 1 on page 500 should read as follows: Figure 1. The SASB circumplex model, cluster version, interpersonal surfaces. Adapted from Benjamin (1993), Interpersonal diagnosis and treatment of personality disorders. New York: Guilford Press, copyright Guilford Press, and from: Benjamin (1987), Use of the SASB dimensional model to develop treatment plans for personality disorders, I: Narcissism. Journal of Personality Disorders, 1, 43-70, copyright Guilford Press.] The authors examined the link between interpretive techniques, the therapeutic relationship, and outcome in psychodynamic psychotherapy. Two independent teams of judges each coded one early session from patients diagnosed with avoidant personality disorder. Results revealed (a) an inverse association between concentration of interpretation and favorable patient outcome; (b) that small amounts of disaffiliative patient-therapist transactions before, during, and after interpretations were reliably or meaningfully associated with negative patient change; and (c) concentration of interpretation was positively associated with disaffiliative therapy process before and during interpretation and negatively associated with affiliative patient responses to interpretation. The results suggest that therapists who persisted with interpretations had more hostile interactions with patients and had patients who reacted with less warmth than therapists who used interpretations more judiciously. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alliance in individual psychotherapy.

This article reports on a research synthesis of the relation between alliance and the outcomes of individual psychotherapy. Included were over 200 research reports based on 190 independent data sources, covering more than 14,000 treatments. Research involving 5 or more adult participants receiving genuine (as opposed to analogue) treatments, where the author(s) referred to one of the independent variables as “alliance,” “therapeutic alliance,” “helping alliance,” or “working alliance” were the inclusion criteria. All analyses were done using the assumptions of a random model. The overall aggregate relation between the alliance and treatment outcome (adjusted for sample size and non independence of outcome measures) was r = .275 (k = 190); the 95% confidence interval for this value was .25–.30. The statistical probability associated with the aggregated relation between alliance and outcome is p     

Correction to Schut et al. (2005).

Reports an error in "Therapist Interpretation, Patient-Therapist Interpersonal Process, and Outcome in Psychodynamic Psychotherapy for Avoidant Personality Disorder" by Alexander J. Schut, Louis G. Castonguay, Kelly M. Flanagan, Alissa S. Yamasaki, Jacques P. Barber, Jamie D. Bedics and Tracey L. Smith (Psychotherapy: Theory, Research, Practice, Training, 2005 Win, Vol 42(4), 494-511). The correct legend for Figure 1 on page 500 should read as follows: Figure 1. The SASB circumplex model, cluster version, interpersonal surfaces. Adapted from Benjamin (1993), Interpersonal diagnosis and treatment of personality disorders. New York: Guilford Press, copyright Guilford Press, and from: Benjamin (1987), Use of the SASB dimensional model to develop treatment plans for personality disorders, I: Narcissism. Journal of Personality Disorders, 1, 43-70, copyright Guilford Press. (The following abstract of the original article appeared in record 2006-03309-008.) The authors examined the link between interpretive techniques, the therapeutic relationship, and outcome in psychodynamic psychotherapy. Two independent teams of judges each coded one early session from patients diagnosed with avoidant personality disorder. Results revealed (a) an inverse association between concentration of interpretation and favorable patient outcome; (b) that small amounts of disaffiliative patient-therapist transactions before, during, and after interpretations were reliably or meaningfully associated with negative patient change; and (c) concentration of interpretation was positively associated with disaffiliative therapy process before and during interpretation and negatively associated with affiliative patient responses to interpretation. The results suggest that therapists who persisted with interpretations had more hostile interactions with patients and had patients who reacted with less warmth than therapists who used interpretations more judiciously. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Balancing confidentiality: Protecting privacy and protecting the public.

Confidentiality is a primary obligation for psychologists. Yet confidentiality has been subjected to legal and professional balancing tests, in which the need for a confidential relationship is balanced and then gives way to other societal or professional needs. The protection of children, prevention of violence, professional training, and treatment coordination have been given priority over maintaining confidentiality. In the process, psychologists seem increasingly inclined to disclose confidential information or seek opportunities to disclose confidential information even when there are other clinical or legal options. This article takes the position that any disclosure of confidential information should be a last resort and that psychologists must push back and limit the growing list of mandatory and permissible disclosures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Active Ingredients in Individual Psychotherapy: Searching for Common Factors.

Every serious school of psychotherapy has its own theory--often only vaguely formulated--concerning the active ingredients in psychotherapy. Many of these theories are presented as mutually exclusive. The author presents an overview of some of the important, primarily psychoanalytically founded, theories of the factors in individual psychotherapy that are responsible for inducing change. It is impossible to pinpoint any single factor that is crucial in every therapy. What is needed is a nondogmatic, multiple-factor model that successfully incorporates the knowledge obtained from the many existing theories of psychotherapy-induced change. In practice, it is often difficult to maintain the traditional distinction between specific and nonspecific factors, just as it is difficult to distinguish the roles played by purely therapeutic factors--relating to the technique of the therapist--and by extratherapeutic factors. The author also addresses the epistemological status of the various claims put forward, by the many different theories of psychotherapy, concerning the active ingredients in psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Boundary issues and multiple relationships: Fantasy and reality.

Psychologists regularly struggle with boundary issues and multiple relationships. Knowing which boundary crossings are acceptable, when a behavior becomes a boundary violation, and which multiple relationships are acceptable and which are not can present great challenges for practicing psychologists. Furthermore, for those who work with diverse populations, these challenges may become even more pronounced. A rational approach to addressing boundaries and multiple relationships is presented along with 4 expert commentaries that further elucidate these issues. Special attention is paid to the role of culture and other diversity factors as they affect how psychologists address boundaries and multiple relationships. Recommendations for ethical and effective practice that incorporate rational decision making and attention to individual differences are made. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cooperative outcome interdependence, task reflexivity, and team effectiveness: A motivated information processing perspective.

A motivated information processing perspective (C. K. W. De Dreu & P. J. D. Carnevale, 2003; see also V. B. Hinsz, R. S. Tindale, & D. A. Vollrath, 1997) was used to predict that perceived cooperative outcome interdependence interacts with team-level reflexivity to predict information sharing, learning, and team effectiveness. A cross-sectional field study involving management and cross-functional teams (N = 46) performing nonroutine, complex tasks corroborated predictions: The more team members perceived cooperative outcome interdependence, the better they shared information, the more they learned and the more effective they were, especially when task reflexivity was high. When task reflexivity was low, no significant relationship was found between cooperative outcome interdependence and team processes and performance. The author concludes that the motivated information processing perspective is valid outside the confines of the laboratory and can be extended toward teamwork in organizations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Barriers and enhancements to physician-psychologist collaboration.

Have you ever wondered why it is so difficult to establish and maintain good relationships with physicians who could be good referral sources for you? Physicians in 2 multispecialty practices that include psychologists reveal what they want from psychologists and what most concerns them about working with psychologists. Strategies are outlined that psychologists can adopt to promote physician-psychologist collaboration, including seeing physicians as their customers and marketing services with an eye toward customer satisfaction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Positive Reactions to Working in Groups in a Study of Group and Individual Goal Decision Making.

The authors explored group members' positive reactions to working in groups that performed a card-sorting task for which they set goals. They also tested predictions regarding observed differences between the goal decisions of groups and individuals for their own and others' performance. Consistent with predictions, group members had more goal commitment, more positive attitudes toward goal attainment, and greater satisfaction with their performance than individuals. Moreover, groups chose goals that were less difficult than the goals of individuals both for their own and for others' performance. The ways in which group decision processes and other factors may account for differences in group and individual goal decisions are considered. In addition, the social-emotional and task-related benefits members perceive of working in their groups are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapists, therapist variables, and cognitive-behavioral therapy outcome in a multicenter trial for panic disorder.

The relationship between therapists and treatment outcome was examined in 14 highly trained therapists who participated in the Multicenter Collaborative Study for the Treatment of Panic Disorder. Overall, therapists yielded positive outcomes in their caseloads; yet, therapists significantly differed in the magnitude of change among caseloads. Effect sizes for therapist impact on outcome measures varied from 0% to 18%. Overall experience in conducting psychotherapy was related to outcome on some measures, whereas age, gender, gender match, and experience with cognitive-behavioral therapy (CBT) were not. Therapists with above- and below-average outcomes were rated similarly on measures of adherence and competency. The results suggest that therapists make a contribution to outcome in CBT for panic disorder, even when patients are relatively uniform, treatment is structured, and outcome is positive. Implications for future clinical outcome studies and for training clinicians are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Feedback and the rationing of time and effort among competing tasks.

The study described here tested a model of how characteristics of the feedback environment influence the allocation of resources (time and effort) among competing tasks. Results demonstrated that performers invest more resources on tasks for which higher quality (more timely and more specific) feedback is available; this effect was partially mediated by task salience and task expectancies. Feedback timing and feedback specificity demonstrated both main and interaction effects on resource allocations. Results also demonstrated that performers do better on tasks for which higher quality feedback is available; this effect was mediated by resources allocated to tasks. The practical and theoretical implications of the role of the feedback environment in managing performance are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Treatment failures in private practice: How do psychologists proceed?

Very little is known about how psychotherapists proceed when patients fail to progress. Psychologists in independent practice (N = 591) were surveyed regarding their approach to treatment failures in an updated partial replication of P. C. Kendall, D. Kipnis, and L. Otto-Salaj (1992). Overall, practitioners reported seeing patients a median of 12 sessions before concluding no progress was being made and relying on colleague consultation and clinical experience to formulate their next steps. Practitioners of different orientations varied on treatment duration and ensuing strategies. Specifically, psychodynamic practitioners treated patients significantly longer than cognitive-behavioral and eclectic practitioners before concluding treatment failure. Cognitive-behavioral and eclectic practitioners were more likely than psychodynamic practitioners to utilize treatment materials informed by psychotherapy outcome research and to refer patients to other clinicians. The ethical and practical implications of handling treatment failures in private practice are considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient-therapist matching: A good start.

M. Horowitz (see record 2002-13441-001) has presented an account of self- and relational observation as a critical variable in the conduct of psychotherapy. This variable can be seen as an organizing basis for an approach to matching patient with therapist and for selectively choosing appropriate interventions. More clarity of definitions, techniques of assessment, and an empirical foundation are needed, but this is a fine first step. (PsycINFO Database Record (c) 2010 APA, all rights reserved)