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)     

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)     

Review of Supportive therapy for borderline patients—A psychodynamic approach.

Reviews the book, Supportive therapy for borderline patients—A psychodynamic approach by Lawrence H. Rockland (see record 1992-97952-000). In this book, the author addresses the supportive psychotherapy of clients with Borderline Personality Disorder (BPD). While there is an abundant literature on expressive and psychoanalytic treatments for the borderline client there is very little on supportive approaches in the psychotherapy literature. Rockland offers a guide to the therapist who, after careful assessment and treatment planning, decides that a primarily supportive psychotherapy is most appropriate for his/her client, either initially or throughout the treatment. Using a practical, how-to format, Rockland applies the principles of Psychodynamically Oriented Supportive Therapy (POST)—an approach that he formulated (Rockland, 1989)—to clients with BPD. This text will assist clinicians in conceptualizing interventions that are often already part of their "supportive" repertoire but are applied in an unorganized and unsystematic fashion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived effectiveness of psychotherapy: A function of suggestion?

Investigated the relationship between theoretical orientation and the perceived effectiveness of psychotherapy. 20 analytically oriented therapists and 20 behavior therapists listened to 2 taped excerpts of sessions labeled "early" and "late" sessions of either behavior therapy or psychotherapy and then rated the effectiveness of treatment. The interviews were constructed to be ambiguous and portray no personality change. Instructions to each group varied the suggestion of whether a behavior therapist or analytic therapist conducted treatment. Results indicated that suggestion of professional identification was ineffective in biasing therapeutic effectiveness ratings. Analytic therapists as a group judged therapeutic outcome more positively across both suggestions than did behavior therapists, which is interpreted as a greater predisposition to see change where none existed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conceptual, methodological, and ethical problems of placebo groups in psychotherapy research.

Psychotherapy researchers have long recognized the need to control for expectancy effects, therapist contact, and therapist attention and have generally subsumed these therapeutic factors under the placebo effect rubric. The authors suggest that the need to control for such factors must be distinguished from the necessity for a placebo group. A psychotherapy placebo group that meets the classic criteria (i.e., a theoretically inert procedure without specific activity for the condition being treated) may be unethical, impractical, or methodologically unsound in psychotherapy research of moderate or greater length. The authors suggest that the term placebo group be abandoned and that alternatives, such as "best available" therapies, component control conditions, neutral expectancy controls, and counterdemand manipulations, be used. The necessity for wait-list controls in psychotherapy research is discussed. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The psychotherapist's experience of interest and boredom.

Explores the clinical utility of conceptualizing the intensity and direction of psychotherapists' interest in their patients in terms of the interdependent aspects of the patient–therapist relationship. An evolving interpretive framework is presented that takes into account the affective, cognitive, and motivational properties and the object-relational nature of interests. Focus is on the therapeutic possibilities and limitations of the hypothesis that the ebb and flow of a therapist's interest in a particular patient occurs in the context of a complex interaction in which both patient and therapist play important roles. The origins, meanings, and management of boredom in the therapeutic situation are given special consideration. A clinical vignette illustrates the interactional nature of boredom in the therapeutic situation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Training implications of harmful effects of psychological treatments.

The goal of this article is to delineate training implications regarding harmful effects associated with psychotherapy. The authors strongly recommend that trainees be made aware of (and encouraged to examine carefully) the potentially harmful treatments that have been recently identified (Lilienfeld, 2007). Consistent with a broad perspective on evidence-based practice, it is also argued that additional guidelines for the prevention and repair of harmful impacts can be derived from psychotherapy research on process (technique and relationship) and participant (client and therapist) variables. For example, rigid adherence to the application of psychotherapy techniques can be a potentially harmful therapist behavior that necessitates careful training on the nature and flexible use of interventions. Furthermore, the authors suggest that trainers and supervisors tentatively consider training implications linked to clinical observations and theoretical assertions, such as the premature use of clinical interpretations, with the assumption that more confidence in such therapeutic guidelines can be gained when they are supported by multiple knowledge sources (empirical, clinical, conceptual). Finally, training implications related to the monitoring of harmful effects in terms of treatment outcome and process are demarcated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Demystifying the concept of ethnicity for psychotherapy researchers.

At a time when ethnic minority populations are increasing in the United States, few psychotherapy studies are including minorities in their samples. To include ethnic minorities in psychotherapy studies, the complex construct of ethnicity must be carefully measured. In this article, practical advice is offered for conceptualizing, measuring, and interpreting ethnic factors in psychotherapy studies. Also discussed are identifying pathways from ethnicity to psychotherapy outcomes. Pathways that may influence ethnic differences in psychotherapy outcome include cultural factors, minority status, socioeconomic status, acculturation, and immigration experiences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethical Practice of Group Experiential Psychotherapy.

Ethical issues related to the practice of group experiential therapy are discussed. Particular emphasis is given to ethical considerations associated with group psychotherapy versus individual psychotherapy, therapist competency in the use of experiential techniques, leader power issues, and aftercare. The "Ethical Principles of Psychologists and Code of Conduct" of the American Psychological Association (2002) and the "Association for Specialists in Group Work Best Practice Guidelines" (L. Rapin & L. Keel, 1998) are referenced to highlight ethical principles and guidelines as they relate to this discussion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of between-session homework in systems-oriented individual psychotherapy.

This article focuses on the use of between-session homework assignments in Unified Therapy, an individual psychotherapy approach that integrates psychodynamic, cognitive-behavioral, and family systems therapies. Unified therapy theory posits that, in clients with personality disturbances, ongoing and recurrent interpersonal behavior patterns within their family of origin serve as both behavioral triggers to and reinforcers of self-destructive or self-defeating behavior. Family behavior is believed to be the most powerful such environmental factor and is believed to have far more influence on patients than a therapist. Homework assignments are geared toward implementing strategies by which dysfunctional family patterns are altered. Strategies are designed by the patient and therapist, using role-playing techniques, which are described. A case example is presented to demonstrate the use of such homework throughout the arc of psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural factors and social influence techniques in Naikan therapy: A Japanese self-observation method.

In light of an increasing interest in different forms of psychotherapy across cultures, a discussion is given of cultural factors and social influence techniques in Naikan therapy, a Japanese self-observation method. The goal of Naikan therapy is to restore the person's positive interpersonal relationships within a hierarchical Japanese social structure. The Naikan therapist arranges the physical and social environment to maximize the client's attention on self-observation and gives specific instructions to recollect the favors given to the client by significant others, especially by the mother. The client engages in self-observation of past interpersonal events for over 100 hrs continuously. The roles of therapist and client are discussed against the Japanese cultural background. Problems in Naikan therapy and its efficacy are reviewed from an empirical standpoint. It is concluded that the goal of Naikan therapy meets the Japanese value system and that cross-cultural studies of psychotherapy should consider various social influence techniques as they are applied in different cultures. (46 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 temporal relation of adherence and alliance to symptom change in cognitive therapy for depression.

This study attempted to replicate an earlier study (R. J. DeRubeis & M. Feeley, 1990) of the prediction of symptom change from process variables in cognitive therapy for depressed outpatients. Measures of in-session therapist behavior and therapist–patient interactions were correlated with prior and subsequent symptom change. One of the positive findings was confirmed, but the other received only marginal support. A "concrete" subset of theory-specified therapist actions, measured early in treatment, predicted subsequent change in depression. The therapeutic alliance was predicted by prior symptom change in 1 of the 2 later assessments, but only at a trend level. Several negative findings were similar to those obtained in the earlier study. Specifically, the alliance, an "abstract" subset of theory-specified therapist actions, and facilitative conditions did not predict subsequent change. Implications for causal inferences in psychotherapy process research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Critical interventions in psychotherapy, from impasse to turning point.

Reviews the book, Critical interventions in psychotherapy, from impasse to turning point by Haim Omer (see record 1994-98362-000). In his opening sentence the author postulates that, "Prolonged impasse is probably the toughest and most ubiquitous ordeal of psychotherapy." This relatively short volume is directed at the development of a technique, which the author calls "Critical Intervention(s)" for the resolution of such impasses. It also, very directly, makes a case for the psychotheapeutic pluralism rampant on the contemporary psychotherapeutic scene. The first seven of the eight chapters are devoted to the philosophy and then the actual technique of the critical intervention. There are case histories to make each point, and the histories consist of dialogues between patient(s) and therapist as well as dialogue between therapist, the consultant, and a group of colleagues who are part of the consultation statement developed out of this consultation. The therapist, then, is to present this statement to the patient(s). While the apparent focus of this book is the critical intervention, it is also clearly a platform for the author's views and feelings about both the pluralistic approach to psychotherapy and the "older" single frame of reference psychotherapies. While this book will have some interest for the solo practicing clinician, the utilization of the technique would be, at best, quite difficult given the necessity of calling together a consultant and group. For those with a single theory orientation to treatment the book will be of no value (other than as an interesting idea) since the technique depends upon pluralism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychoanalytic therapy: A subset of healing.

Argues that dynamic psychotherapy has 2 sets of factors in common with techniques of healing practiced over thousands of years: contextual factors that transcend designated healing procedures and the technology of healing itself. It is suggested that a helpful healing context involves a kind of controlled regression in the service of the therapeutic ego resembling the psychoanalytic definition of orality. Thus, the healing relationship is characterized as being derived from the early mother–child relationship. The major technology of therapeutic change discussed is insight. It is concluded that conceptualizing therapeutic change requires the ability to think in multivariable terms. (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)     

How do graduate student therapists incorporate diversity factors in case conceptualization?

Researchers interviewed 17 psychotherapists in training in an analogue study of psychotherapists' use of broadly defined diversity factors in conceptualizing clients and cases. Each therapist watched two 5-minute staged videotapes of clients who varied along dimensions of race and ethnicity, age, and gender. Each acting client described problems in an initial psychotherapy interview, and then participant therapists responded to questions. Participants demonstrated varying levels of multicultural competence. Many exhibited knowledge in the areas of culture-specific values, and family and gender roles; awareness of their own cultural background and its effects on the therapeutic relationship; and skills in treatment planning, including assessment of levels of acculturation and culturally appropriate treatment methods. (PsycINFO Database Record (c) 2010 APA, all rights reserved)