心理咨询中的会谈影响:来访者的视角

从来访者的视角探索心理咨询中单次会谈对来访者所造成的影响。采取方便抽样,在某高校心理咨询中心招募22名大学生来访者,通过质性研究的文本内容分析方法,对22名来访者的访谈文本材料进行类属分析,总结出来访者在心理咨询会谈中可能受到的影响。结果显示:心理咨询会谈影响的内容丰富,主要分为两大类:积极影响和消极影响。其中,积极影响包括:情绪获益、认知获益和行为获益;消极影响包括:咨询任务进展不顺和咨询关系建立不良。     

工作同盟和领悟对咨询效果的影响

为了解短程咨询中工作同盟和领悟对咨询效果的影响,以12个个案94次会谈为对象,考察工作同盟、领悟分别与会谈效果、治疗效果的关系,并考察二者共同作用于效果的方式。结果表明,咨访双方评定的工作同盟都可以正向预测会谈效果,但不能预测治疗效果;领悟与会谈有效性正相关,领悟正向预测治疗效果;咨询师评定的同盟的三个维度以领悟为中介影响其对会谈效果的评价。     

一例失恋心理的案例报告

本文是一例使用合理情绪疗法咨询一般心理问题的个案。咨询中综合使用各种技术方法,让来访者与其不合理信念进行辩论,帮助其识别自己的不合理信念并代之以合理的信念,同时协助来访者对咨询效果进行巩固。通过心理咨询,来访者的悲伤情绪得以缓解,社会适应能力及心理承受能力都得到了提高,人格进一步完善。     

一则高中生厌学案例的分析报告

这是一例因厌学而导致一般心理问题的案例。本文通过对这例一般心理问题的咨询,阐述了对求助者心理诊断和心理咨询的过程,并与求助者共同商定,采取了合理情绪疗法。咨询目的是帮助来访者改变不合理认知,发挥自己的潜能,达到人格完善。通过4次心理咨询,来访者厌学情绪缓解,能正确对待学习生活中所遇到的困难,学习效率显著提高,对生活抱有乐观的态度,达到了心理咨询的目标。     

心理咨询的LIWC语言特征对咨询效果的预测

语言是心理咨询的重要内容。语言探索和词频统计（Language Inquiry and Word Count, LIWC）被广泛用于分析语言使用的心理意义。本研究收集了28名当事人共144次有效咨询录音及每次会谈后当事人的症状自评结果。将录音转录成文本后,抽取当事人的LIWC语言特征,进行主成分降维,结果获得8个因子,解释了总体方差的75.11%。一般线性回归中,躯体感受、功能词、情绪、认知和口语赘词对当事人的症状水平具有显著的预测作用,进一步多层线性模型中,躯体感受和情绪用词显著预测咨询效果。LIWC文本特征能够呈现与当事人症状相关的信息,为未来计算机自动化监控咨询过程和结果提供了新视角。     

一例严重心理问题的精神分析治疗个案

李某,女,36岁,近期不满女儿学习,焦虑,身体焦虑紧张近4个月,通过摄入性会谈收集资料,应来访者要求,进行精神分析心理咨询,以自由联想的方法为主,通过分析移情和阻抗及日常中的失误,最终使来访者认识到自己当前的症状与幼年期心理发展过程中未满足的愿望之间的关系,使之能够从精神分析的视角看问题,从而改变其心理症状。通过来访者自己的反馈,基本达到了咨询的目标。     

当事人的投入与会谈效果、咨询效果的关系研究

本研究探索了当事人会谈时的投入与即时会谈效果的关系;当事人咨询初期的投入与整体咨询效果的关系。结果发现当事人会谈时的投入与即时会谈效果、在咨询初期的投入与整体咨询效果都呈现显著的正相关。进一步回归分析发现,当事人在咨询初期的投入与整体咨询效果呈现正U型的偏态分布,少数投入水平最低的当事人获得中等水平的咨询效果,中等投入水平的当事人咨询效果最差,投入水平最高的当事人的咨询效果最好。     

一例人际关系敏感的心理咨询案例报告

一位女大学生在由于人际关系敏感,不能与同学正常交往,出现焦虑情绪、睡眠障碍、学习效率下降等症状。咨询师通过摄入性会谈收集了资料,发现来访者之所以陷入困境与复杂的家庭关系有关。咨询师主要运用认知行为疗法,帮助来访者进行认知重建,通过5次咨询,来访者情绪趋于平稳,睡眠得到了改善,学习效率得以提高,社会适应能力及心理承受能力都得到了提高,人格进一步完善。     

考试引发焦虑情绪的咨询案例

这是心理咨询师对一名高三毕业生进行心理咨询的完整过程。以解决因考试引发焦虑情绪为主要内容,深入探讨来访者焦虑情绪背后的原因。采用认知疗法,帮助来访者学习自我调节的方式,改善其情绪状况。报告共分为八大部分:一、一般资料;二、主诉和个人陈述;三、观察和他人反映;四、评估与诊断;五、咨询目标的确立;六、咨询方案的制定;七、咨询过程;八、咨询效果评估。     

一例大学生演讲焦虑心理问题的咨询案例

本文是一例使用合理情绪疗法咨询由演讲焦虑引起的一般心理问题的个案。详细搜集、整理来访者Y的有关资料,对来访者Y的心理问题进行诊断归类,客观评价其心理问题的严重程度。依据认知疗法理论,运用合理情绪疗法对来访者Y开展咨询,让来访者Y与其不合理信念进行辩论,帮助其识别自己的不合理信念并代之以合理的信念,通过心理咨询,来访者Y上台讲话的焦虑、紧张情绪有明显缓解,恢复正常的生活和社会功能。     

Internalization of the therapeutic process: differences between borderline and neurotic patients

Intersession process in psychotherapy refers to the thoughts, memories, and feelings about each other and about their therapy sessions that participants experience during the intervals between sessions. This study compared the intersession process experienced by patients who had been diagnosed with severe borderline personality disorders (BPD) with others who had not. A total of 76 patients with neurotic disturbances and 20 patients with BPD were treated in a therapeutic day clinic and completed the Intersession Experience Questionnaire (IEQ) before sessions of individual psychotherapy and the Session Questionnaire (Stundenbogen) after those sessions. Comparison of the two groups on these measures of intersession process and postsession outcome showed markedly different patterns in patients' evaluations and internalizations of in-session therapeutic experiences: most prominently, that BPD patients internalize therapy sessions with much more negative and contradictory emotions.     

The manifestation of transference during early psychotherapy sessions: Exploring an alternate data source for therapist narratives in transference research

Introduction: Previous transference studies have compared in‐session client narratives about significant others to in‐session client narratives about the therapist, limiting data to the information that clients are willing to share with the therapist. Method: The first three sessions of 30 therapies with high‐functioning individuals were examined using the Core Conflictual Relationship Theme (CCRT) method. Client narratives about others were drawn from the psychotherapy sessions and client narratives about the therapist were drawn from a Participant Critical Event (PCE) interview conducted after the third session of therapy. Results: Factor analyses of the CCRT components indicated several relational patterns: a complementary pattern of relating characterised by a devaluation of the therapist and idealisation of others; a concordant relational transfer where clients feel bad with both the therapist and others; and as clients experience control issues with significant others, they wish to adopt a submissive stance toward the therapist. The results suggest that the source of therapist narratives may influence the results of transference research.     

Symptom reduction and termination: client change and therapist identified reasons for saying goodbye

Empirical efforts have focused on predicting whether or not clients prematurely terminate therapy, with nonattendance of last session equated to premature termination. However, this fails to explore the relationship between clients’ distress reduction and reasons for termination. With this study, we aimed to understand how clients’ distress change relates to premature termination and examine clients’ distress change in conjunction with therapists’ perceptions of termination reasons. We collected data from 797 clients who prematurely terminated or attended termination but completed therapy a minimum of three individual sessions provided by 38 therapists. Clients completed an assessment of psychological symptoms before each session. At the end of treatment, therapists identified the reasons they believed termination occurred for all clients in the sample. Results demonstrate that total sessions attended and missed predict premature termination, whereas distress change does not. Additionally, clients who were believed to accomplish goals do show greater change. However, therapists’ indicated that over half of clients did not reach goals at termination and they did not perceive nonattendance at last session to equate to drop out in all cases. Implications are discussed with respect to understanding why clients’ terminate, therapeutic goal conceptualization, and review of goals during termination in time-limited psychotherapy.     

A Cross-Contextual Construction of Clients' Therapeutic Practice

This study demonstrates how gathering data from a different context can significantly change how an object of study may be viewed. Data from a qualitative diary study of psychotherapeutic practice were used to construct a cross-contextual view of psychotherapy. Data about clients’ everyday lives as well as psychotherapy sessions were analyzed. Examples of how extra-therapeutic factors are significant to client change are presented. Six types of extra-therapeutic information sources that clients use to develop their personal stances while in therapy were identified. The case of one client's abundant use of extra-therapeutic sources of information offers a different construction of how psychotherapy works, emphasizing client activities outside sessions. The implications of the study for psychotherapy research are addressed.     

Coming to an end: A case study of an ambiguous process of ending psychotherapy

Aim: When the duration of therapy is not preset and the outcome is a matter for negotiation, the decision to end psychotherapy will be an experiential concern for the two participants. This case study draws attention to how ambiguities may be settled in a process where ending is initiated by the therapist and resisted by the client. Method and analysis: The actual case was strategically selected as exceptional owing to a combination of circumstances. The client and the therapist had developed a ‘good enough’ alliance (WAI) and reached a ‘good enough’ outcome (OQ‐45), and still the client felt she was far from finished. A close inspection of interactional data in sessions together with both clients' and therapists' reflections in post‐therapy interviews elicited information about both substantial content and structural aspects of this complicated process of ending. Findings and discussion: The discrepancy between therapist and client was not addressed, but rather postponed and revisited again later. Structural elements like preparations for a break for vacations and reducing the frequency of sessions were used to test experiential qualities, such as how the client managed life without therapy. Carefully preserving a ‘good enough’ emotional bond through the negotiations seemed important to both parties. Significantly, the client's autonomy was interpreted as the final proof of improvement and the client came to a point where she could affirm that she had got better only by accepting that treatment was coming to an end.     

Client process in short term dynamic psychotherapy1

In this study, a single case design was used to examine significant client events in a process of short-term dynamic psychotherapy. The Category System of Client Good Moments (Mahrer, 1988) was used as a measure of therapeutic process. Client speaking turns were rated for three sessions (early, middle, and late) of the complete sixteen session treatment conducted according to davanloo's (1978) model of short-term dynamic psychotherapy (STDP), and categories of good moments identified. The results showed that the salient client change-events were related to the client's (a) provision of significant information, (b) exploration of feelings, and (c) insight and understanding across the three sessions. Additionally, the results also showed a statistically significant increase in client-reported behavior change and sense of well-being for the late session. The results suggest that in-session report of behavior change is an important component of therapeutic process. The implications of these results for an atheoretical, data-driven understanding of therapeutic change processes are presented.     

The Intersession Report: Development of a Short Questionnaire for Couples Therapy

This article describes the Intersession Report, a short, easily administered nine-item questionnaire that clients complete at the beginning of each therapy session. This questionnaire was developed to enable clinicians and researchers to routinely collect standardized data on clients. Results showed that the Intersession Report has three subscales that represent Functioning, Symptoms, and Alliance. The subscales scores demonstrated multiple forms of validity and reliability. The Intersession Report provides clinicians a quick and easy way to assess clients. It also provides researchers information on clients who discontinue therapy and information that can be used in assessing attrition bias.     

Building Alliances with (In)Voluntary Clients: A Study Focused on Therapists’ Observable Behaviors

This study aimed to compare therapists’ observable behaviors to promote alliances with involuntary and voluntary clients during brief family therapy. The therapists’ contributions to fostering alliances were rated in sessions 1 and 4 using videotapes of 29 families who were observed in brief therapy. Using the System for Observing Family Therapy Alliances, trained raters searched for specific therapist behaviors that contributed to or detracted from the four alliance dimensions: engagement in the therapeutic process, an emotional connection with the therapist, safety within the therapeutic system, and a shared sense of purpose within the family. The results showed that when working with involuntary clients, therapists presented more behaviors to foster the clients’ engagement and to promote a shared sense of purpose within the family. However, in the fourth session, the therapists in both groups contributed to the alliance in similar ways. The results are discussed in terms of (a) the therapists’ alliance‐building behaviors, (b) the specificities of each client group, and (c) the implications for clinical practice, training, and research.