The association between global and specific measures of the therapeutic relationship.

[Correction Notice: An erratum for this article was reported in Vol 31(3) of Psychotherapy: Theory, Research, Practice, Training (see record 2009-17141-001). This article contained, as Figure 1, an SASB model. The authorship and copyrights for the model were not acknowledged. The following acknowledgement should have been included: "From Benjamin (1983), Intrex User's Manual. Intrex Interpersonal Institute, P.O. Box 581037, Salt Lake City, UT 84158. Reprinted by permission." An apology is offered to the author, Dr. Lorna Smith Benjamin. The particular version used in the article was developed in collaboration with Clinton W. McLemore.] Examined the association between global and specific measures of the therapeutic relationship in Sessions 3, 5, and 15 of 9 cases of time-limited psychodynamic psychotherapy. L. S. Benjamin's (see PA, Vol 53:2991; see also, 1984) structural analysis of social behavior (SASB) model provided the specific measure of relationship. There were more consistent associations between ratings of client contributions to the alliance and SASB ratings of client behaviors than there were for the same therapist variables. Additionally, analyses show that external (i.e., nonself) judgments of client and therapist contributions to the alliance, rather than therapist or client self-ratings of contributions to the alliance, were most frequently associated with the SASB behavior codes. Finally, different therapist and client behaviors seemed to be associated with quality of the therapeutic relationship at different points in the therapeutic process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of a paradoxical intervention with a couple: An interactional analysis.

Examined the immediate impact of a paradoxical intervention in couple counseling involving the couple and the therapist, using content analysis of discourse and sequential statistical methods. The therapist reframed the symptom of insomnia to include couple dynamics. Discourse before, during, and after intervention was coded, using the Penman Coding system. The proportion of message codes and critical interactional patterns changed among the 3 participants. By the end of the interview, the power struggle between the man and the therapist de-escalated. The woman's use of high-power, positive symmetrical behaviors with her partner emerged, and the symmetrical, negative involvement patterns between the partners were eliminated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The specific effects of a Gestalt intervention.

Reports 3 cases in which the effects on client depth of experiencing and voice quality of the Gestalt "2-chair" operation were investigated. In a design using the clients as their own controls, the effects on each client of 3 Gestalt operations, applied under experimental control to client statements of conflict, were compared with the effects of 3 active-empathy operations at similar points. Results confirm that following the Gestalt operation the depth of experiencing was significantly higher for each of the 3 clients selected as good prognosis clients for client-centered therapy. Two Ss used significantly more emotionally expressive voice after the Gestalt operation. The implications of the change in depth of experiencing on shifts in awareness and on the client's ability to cope with and resolve conflict are discussed. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The interpersonal relationship as a vehicle for therapeutic learning.

Responds to S. L. Garfield's (see PA, Vol. 51:Issue 6) paper, underscoring the fact that the operations of psychotherapists share important processes with those of other influencers. There is more to modern psychotherapy than the relationship, but the latter typically serves as a powerful framework for therapeutic change, within which framework various techniques are potentiated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The positive therapeutic relationship as accreditation.

In formal accreditation ceremonies, one person acts by virtue of his or her position to confirm another person in a new position in a community. The new position, or "status," is such that the confirmed individual now enjoys expanded eligibilities for participation in that community. This article explores the power inherent in viewing the positive therapeutic relationship as an ongoing, informal rite of accreditation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of a feedback intervention on group process and outcome.

The effects of a feedback intervention directed at both members and leaders was examined in psychotherapy groups held in a university counseling center. Feedback consisted of group climate information using scores from the Group Climate Questionnaire, completed by members after each group session. The direct effects of the feedback intervention were assessed using scores on the Curative Climate Instrument as well as Group Climate Questionnaire subscales. These instruments were administered after each group session. Distal effects of the feedback intervention were examined using member symptom improvement (Outcome Questionnaire) and group attendance. Members and leaders in the experimental condition were given weekly written and graphical feedback and contrasted against comparable groups receiving no feedback. Results indicate the feedback intervention had little impact on the therapeutic factors and outcome. However, for members who reported that the group was high in conflict, the feedback intervention had a significant negative effect on outcome. Implications and directions for future research are examined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Meta-analysis of psychological assessment as a therapeutic intervention.

This study entails the use of meta-analytic techniques to calculate and analyze 18 independent and 52 nonindependent effect sizes across 17 published studies of psychological assessment as a therapeutic intervention. In this sample of studies, which involves 1,496 participants, a significant overall Cohen's d effect size of 0.423 (95% CI [0.321, 0.525]) was found, whereby 66% of treatment group means fell above the control and comparison group means. When categorical variables were taken into account, significant treatment group effects were found for therapy process variables (d = 1.117, [0.679, 1.555]), therapy outcomes (d = 0.367, [0.256, 0.478]), and combined process/outcome variables (d = 0.547, [0.193, 0.901]). These findings appear to be robust on the basis of fail-safe N calculations. Taken together, they suggest that psychological assessment procedures—when combined with personalized, collaborative, and highly involving test feedback—have positive, clinically meaningful effects on treatment, especially regarding treatment processes. They also have important implications for assessment practice, training, and policy making, as well as future research, which are discussed in the conclusion of the article. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Blushing: A modified behavioral intervention using paradoxical intention.

A case history is presented of a 27-yr-old male for whom blushing had become a significant problem. He was successfully treated over a 7-session period primarily by paradoxical intention therapy. Other treatment reports on therapies for blushing are called for, and paradoxical intention is recommended as an effective treatment. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward a theory for therapeutic intervention in families.

Family roles are categorized into 5 functional entities: solidarity, sexuality, internal instrumentality, external relations, and division of responsibility. Within any of these, discrepancy between role expectations and role enactments leads to self-devaluation and thus to sometimes extreme behaviors which are designed to reinstitute role patterns which allow for positive self-evaluation. This extreme "symptomatic" behavior can be eliminated by assisting the family to reorganize roles so as to allow role-expectation gratification. Such interventions are more effective in areas of daily routine duties and responsibilities than in areas of solidarity or sexuality; the latter appear to respond epiphenomenally and self-correctively when other role frictions are eliminated. 3 case studies are presented, and principles for therapeutic intervention are suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The short-term effects of a hostility-reduction intervention on male coronary heart disease patients.

This preliminary study examined the effects of a hostility-reduction intervention on patients with coronary heart disease (CHD). Twenty-two high-hostile CHD men were matched on age and hostility and then randomly assigned to a hostility intervention (N?=?10) or an information-control group (N?=?12). Patients were reassessed immediately and 2 months posttreatment on hostility (with self-report and structured interview) and resting blood pressure. The intervention's overall effect size was moderately strong (d′?=?.62). Intervention patients reported at both reassessments and were observed at follow-up to be less hostile than controls. At follow-up, intervention patients had significantly lower diastolic blood pressure (DBP) than controls. Finally, reductions in hostility were significantly and positively correlated with reductions in DBP. Replication with a larger sample and CHD outcomes is recommended. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The paradoxical consequences of revenge.

People expect to reap hedonic rewards when they punish an offender, but in at least some instances, revenge has hedonic consequences that are precisely the opposite of what people expect. Three studies showed that (a) one reason for this is that people who punish continue to ruminate about the offender, whereas those who do not punish "move on" and think less about the offender, and (b) people fail to appreciate the different affective consequences of witnessing and instigating punishment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of relationship and technique in therapeutic change.

This article discusses varying perspectives on the role of technique and the relationship in therapeutic change. The theoretical assumptions underlying the debate are briefly described, as are the positions of humanistic, behavioral, psychodynamic, and experiential orientations. Theory and research that consider the integration of relationship and technique are presented. It is then proposed that there are general principles of therapeutic change that are facilitated by both the relationship and technique. It is suggested that these principles of change should be seen as the active ingredients of therapy, thereby moving the field away from a debate about whether technique or the relationship is more important. Instead, an emphasis on studying general principles of change and the processes by which technique and relationship facilitate these principles is encouraged. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The importance of the therapeutic relationship in systematic desensitization.

To determine the importance of therapist warmth in effecting positive behavior change using systematic desensitization, 23 female snake-phobic undergraduates were assigned to 1 of 3 groups: warm therapist, cold therapist, or no-treatment controls. Ss in each group were matched on initial Snake Avoidance Test scores. Posttreatment evaluation on the Snake Avoidance Test occurred after 6 20-min desensitization sessions and follow-up scores were obtained 21/2 mo later. Results show that the warm therapist group improved significantly more than either the cold therapist or control group, with no significant differences between these latter 2 groups. Results suggest that therapist warmth is an important variable in systematic desensitization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The child's conception of confidentiality in the therapeutic relationship.

39 6–15 yr olds who were involved in individual counseling at a comprehensive community mental health center were interviewed using a questionnaire designed to assess their conception of confidentiality in the counseling experience. A significant main effect for age was found. Four variables were examined as potential predictors of S's confidentiality score. Two of the variables, which involved Ss' perception of the maintenance or violation of their confidentiality in either a past or current counseling experience, were significantly related to their overall confidentiality score. Results suggest that children gradually evolve a conception of confidentiality consistent with professional guidelines. The importance of an atmosphere of trust in the counseling relationship and the child's perception of the actual maintenance of trust in his/her own counseling experience are emphasized. (43 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of a language and literacy intervention on Head Start children and teachers.

A language and literacy intervention was implemented in 10 Head Start classrooms. Teachers were trained in specific book reading and conversation strategies. The focus of the intervention was to train teachers how to increase opportunities for language and vocabulary development in young children. At the end of the year, children in the intervention classrooms performed significantly better than children in the control classrooms on the Peabody Picture Vocabulary Test-III and the Expressive One-Word Vocabulary Test (3rd ed.). In addition, teachers in the intervention classrooms used strategies that promoted language development during book reading and other classroom activities. Head Start teachers can be trained to implement strategies that have positive effects on children's language and literacy development. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of a voluntary summer reading intervention on reading activities and reading achievement.

The causal effects of a voluntary summer reading intervention on children's reading activities and reading achievement were assessed in a randomized experiment involving 331 children in Grades 1-5. Children were pretested in the spring on a standardized test of reading achievement (Stanford Achievement Test, 10th ed.), on the Elementary Reading Attitudes Survey, and on a reading preference survey. At the end of the school year, children were stratified by their grade level and classroom and were randomly assigned to receive 10 books matched to their reading levels and preferences during summer vacation or after the administration of posttests. Children in the treatment group received books through airmail in July and August. In September, children were readministered the reading test and completed a survey of their summer reading activities. Although the treatment group reported reading more books and participating in more literacy activities than did the control group, there was no significant difference in reading achievement. Recommendations for enhancing the effects of voluntary reading through teacher-directed instruction and for conducting a replication study are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Consensus in the therapeutic relationship.

Analyzes the concept of consensus between patient and therapist in psychoanalytic psychotherapy. This topic has emerged in both psychotherapy research and analytic theory as an important construct and possible curative factor in psychotherapy. These independent lines of investigation are synthesized by considering consensus as a broader construct than simple agreement. Consensus is viewed as a creation of the dyad, based on an explicit and mutual effort to define the unique elements of the conscious and unconscious perspectives of patient and therapist. A theoretical understanding of the curative mechanisms of this process is proposed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The use of paradoxical interventions within a prison psychiatric facility.

Describes inmate personality characteristics and paradoxical techniques used in 4 interventions in a prison psychiatric facility. The cases of male inmates involved malingering, possible suicide, parental problem behaviors, and manipulation of the system. It is suggested that in selected cases, paradoxical strategies tap the client's strengths, help avoid adversarial relationships and power struggles, and produce change quickly. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The adult client's conception of confidentiality in the therapeutic relationship.

50 outpatient psychotherapy clients, 26 inpatients, and 50 hospital employees completed a 20-item questionnaire concerning 4 areas relevant to privacy in psychotherapy. Scores on general attitudes revealed that Ss significantly valued confidentiality. Inpatients valued confidentiality significantly more than did the outpatient or nonpatient comparison groups. Data suggest that patients were generally unable to differentiate between privacy as an ethical concept and as a legal concept. Responses to casehandling questions revealed a low level of concern about these technical intrusions on privacy. Total scores for outpatients who perceived a violation in confidentiality in either a past or current therapy relationship were significantly lower than for Ss who indicated no history of past or current violations. Implications for client pretherapy preparation are discussed. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Focus on therapeutic alliance: The psychometric properties of six measures across three treatments.

The psychometric properties of six measures of therapeutic alliance (California Psychotherapy Alliance Scales; Penn Helping Alliance Rating Scale; Vanderbilt Therapeutic Alliance Scale; and the Working Alliance Inventory- therapist, client, and rater versions) were compared in a sample of 60 substance-dependent individuals participating in a randomized clinical trial of three psychotherapies. Internal consistency, interrater reliability, and intercorrelations among the instruments were evaluated. Results supported the construct validity of the therapeutic alliance and indicated that all six measures had acceptable reliabilities. Correlations between observer and participant measures were comparatively low. Reliabilities did vary, however, by treatment condition, suggesting that psychometric properties, and by extension alliance-process-outcome relationships, may vary across treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)