Therapist activities preceding therapy setbacks in a poor-outcome case

Progress in psychotherapy is typically irregular, as advances alternate with setbacks. This study investigated the therapist’s activities prior to two main types of setbacks, one involving the client following therapist proposals and one involving the client failing to follow from therapist proposals, in the case of a poor-outcome client treated with a linguistically-oriented kind of cognitive therapy. Setbacks were defined as decreases of at least one level on an index of therapeutic progress, the 8-level Assimilation of Problematic Experiences Scale (APES), in adjacent client passages. Therapist activities were coded in 361 setback episodes that each included a client pre-setback passage, a therapist passage, and a client setback passage; both client passages had been previously rated on the APES. The main categories of therapist activities showed distinctive patterns in relation to the two main types of setbacks, the therapeutic zone of proximal development and the balance strategy. The two main patterns were described as an exploratory and a challenging configuration. These patterns of therapist activities and setbacks showed how the therapist seemed to persevere with approach-guided interventions while this poor-outcome client continued to have setbacks to low APES levels.     

Assimilation of Problematic Experiences in Linguistic Therapy of Evaluation: A Case Study

In this article the process of assimilation in the problematic experience of tiredness of one patient, María, is shown. María was treated with linguistic therapy of evaluation (LTE), a therapy midway between constructivist and cognitive therapies based on the theory of General Semantics, for 14 sessions. María was one of the most successful cases of LTE. Aims of the study were to show the process of assimilation in a case with good outcome and to explore if this process shows an irregular pattern, with setbacks or jumps between stages. This process is analyzed by the Assimilation of Problematic Experiences Scale (APES), an eight-stage scale that shows the process of assimilation from an experience being warded off, avoided, in vague awareness, clarified, understood, solutions applied, and finally resolved and integrated into the self. Results showed, first, that the process of assimilation reaches APES Stages 5 (application) and 6 (problem solution), and, second, that the process of assimilation showed a clear sawtoothed, irregular pattern.     

Application of The Assimilation Model in The Context of Family Therapy: A Case Study

In this case study the aim was to apply the APES (Assimilation of Problematic Experiences Scale) model to the analysis of the family therapeutic treatment process. This was done as a qualitative methodological triangulation in a case of the family of a 10-year old psychotic boy. The study suggests that assimilation model is suitable for many kinds of data in analyzing family therapeutic treatment processes, makes the change more comprehensible, and yields information about the effectiveness of experiential family therapy techniques.     

Is how it is said important? The association between quality of therapist interventions and client processing

This study examined the association between the quality of therapist interventions and client in‐session processing using the York Therapist Process Measure (YTPM; Toukmanian and Armstrong, 1998). The instrument's three dimensions — attunement, tentativeness and meaning exploration — were tested separately for their impact on clients' manner of processing and depth of experiencing. For each of the 20 mild‐moderately depressed clients, treated in short‐term experiential therapy, a high and a low client‐process segment was isolated from a session that was judged by an experienced therapist to manifest the greatest amount of “good therapy moments”. Therapist interventions within these segments were then rated on the YTPM. Results revealed significant differences in the quality of therapist interventions between high and low segments. Attunement and tentativeness were associated significantly with greater complexity in manner of processing, and meaning exploration with greater depth in experiencing. The implications of these findings for psychotherapy research and practice are discussed.     

心理咨询中好坏效果案例的同化水平对比:基于同化模型的视角

目的:通过对比心理咨询中4例好效果案例和4例坏效果案例同化水平的差异,对同化模型有关成功治疗改变过程的理论构想进行检验,并寻找区分好坏案例的关键点。方法:选用7位经过培训的评定者组成三个研究小组,采用同化分析这一用来追踪当事人问题经验发展进程的研究方法,对8个当事人完整的咨询逐字稿资料进行分析,并对涉及当事人问题经验的段落进行摘录。依据同化问题经验量表和同化标识手册对摘录的段落进行同化评定。结果:8个案例的核心问题得到一致确定,三组评定者评分的组内相关系数ICC(1,1)在.64~.86之间,ICC(1,K)在.84~.96之间。好效果案例结束时的同化水平均分(M=5.50)和同化进展均分(M=4.25)高于坏效果案例(2.13和-.13)。好坏效果案例的同化进程均出现前进中倒退的情形,但好效果案例能够在倒退中保持上升,而坏效果案例未能完成上升。好效果案例最终的同化水平均达到了4(理解/领悟)及以上,坏效果案例最终的同化水平均未达到4。结论:研究结果基本支持同化模型的理论设想,即症状强度的减少同更高的同化水平相联系;并初步确定区分好坏效果的关键点是同化水平4;但从同化进程来看,可考虑对模型的发展序列进行修改完善。     

Helpful processes in psychological therapy for patients with primary cancers: A qualitative interview study

Aims: The purpose of this study was to identify what patients with primary cancers found helpful in therapy. Method: In‐depth qualitative interviews were conducted with eight patients who had completed a course of psychological therapy within an NHS psychology service for cancer patients. Data were analysed using thematic analysis. Results: The participants identified a range of helpful processes in therapy: talking and expressing their feelings to someone outside of the family; forming a relationship with their therapist; normalisation through the therapists' expert knowledge; problem‐solving and CBT. Limitations: As with all qualitative studies, the small sample and size and dependence on participant recall limits generalisability of the findings. Implications: The findings of this study are consistent with a pluralistic perspective: that multiple therapeutic processes ‐ aligned to a range of different orientations ‐ can be of value to patients with primary cancers. This supports the provision of a range of therapeutic interventions and strategies for this patient group.     

A systematic review of the literature on counselling and psychotherapy for the prevention of suicide: 2. Qualitative studies

Scope of review: The paper reports a meta‐synthesis of 13 qualitative studies of counselling and psychotherapy with people at risk of suicide. Publication time span: The studies considered were reported between 1997 and 2006. Publication origin: Seven studies were conducted in the UK, four in the USA, one in Canada, and one in Sweden. Findings: Themes in clients' and therapists' accounts of the process of counselling or psychotherapy were therapist qualities; therapy components; theoretical framework; and therapy techniques. Themes in their accounts of the effectiveness of counselling and psychotherapy were decrease in self‐destructive behaviour, and quality of life. Themes in clients' views of barriers to effective counselling or psychotherapy were therapist characteristics; therapy components; secrecy; and transferring to the real‐life situation. Secrecy was also identified as a barrier by therapists, as were responsibilities of the profession; training; and the nature of suicide and self‐harm. Facilitators of successful counselling and psychotherapy as identified by clients were responsibility; support; and teaching therapy skills to family members, the latter also being identified by therapists.     

Dutch adolescents' tolerance of Muslim immigrants: the role of assimilation ideology,intergroup contact,and national identification

This study set out to examine native Dutch adolescents' tolerance (N = 1,139) of Muslim immigrants in relation to the endorsement of assimilation, national identification, and contact with ethnic minority peers. The focus was on two dimensions of tolerance: the acceptance of practices by Muslim actors, and Muslims persuading co‐believers to engage in the same practices. Tolerance was found to be higher for the practices than for persuading others. Higher endorsement of assimilation was related to lower levels of tolerance, and this relation was stronger for higher compared to lower national identifiers. Assimilation mediated the positive relationship between intergroup contact and tolerance. These effects did not differ for the two dimensions of tolerance. The implications of these findings are discussed.     

心理咨询中当事人的改变过程：同化模型的视角

摘 要 目的：选用心理咨询中获得成功改变的中国当事人,验证美国学者William B. Stiles等提出的同化模型。方法：采用同化分析这一用来追踪心理治疗中当事人问题经验发展进程的研究方法,对案例的会谈逐字稿资料进行分析。结果：三位研究者追踪到了两个主题（两对声音）,摘录了68个段落。其对两个主题摘录段落的同化评分与三位独立评定者的评分具有较高的相关（0.90和0.85）,同化的评分随着会谈的进程而提高（相关分别为0.89和0.91）。当事人在心理咨询中的改变过程遵循同化模型有关治疗改变的发展序列。结论：中国当事人的心理咨询改变过程支持同化模型的理论构想。     

‘I never talked about,ever’: A comprehensive process analysis of a significant client disclosure event in therapy

Aims: The present study was intended to examine how a particular client disclosure came about and what made it important to the client. Method: A client‐identified significant therapy event involving disclosure of childhood abuse was analysed using Comprehensive Process Analysis (CPA), a qualitative interpretive method for examining the process, effects and context of significant events in therapy. Results: The analysis identified therapist invitation and client universalisation as the key elements of the disclosure event. The context analysis showed how the event linked to the client's symbolisation of her fear earlier in the session and in the previous session. The client gained insight into how the earlier abuse had affected her life, linking it to the victimisation that was her primary reason for seeking therapy, and to her relationship with her mother. The therapist facilitated the event by following up the client's hints, trusting the strength of the alliance, and staying close to the client's frame of reference. Conclusion: The findings suggest that the initial significance of an invited disclosure event may diminish for a client over the course of therapy.     

Observing the therapeutic alliance in family therapy: associations with participants' perceptions and therapeutic outcomes

Positive and negative alliance‐related behaviours of thirty‐seven families seen in brief family therapy were rated from videotapes using the System for Observing Family Therapy Alliances ( Friedlander et al., 2006b ). Positive associations were found between in‐session behaviour and participants' perceptions of the alliance and improvement so far both early (session 3) and later in therapy (session 6). Binary logistic regression showed that successful outcomes (defined as consensus by therapist and all family members on general improvement and reduced problem severity) were significantly predicted by positive individual behaviour (Engagement in the Therapeutic Process, Emotional Connection with the Therapist, Safety within the Therapeutic System) in session 3 and productive within‐family collaboration (Shared Sense of Purpose within the Family) in session 6. Shared Sense of Purpose was the alliance indicator most consistently associated with clients' and therapists' perceptions of therapeutic progress; moreover, it was the only alliance indicator to improve significantly over time in treatment.     

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.     

The relationship between cognitive errors,coping strategies,and clients' experiences in session: An exploratory study

Aim: Cognitive errors (CE) and coping strategies (CS) can bear weight on how individuals relate to others and perceive interpersonal relationships. However, there is little research into how clients' erroneous beliefs and maladaptive coping strategies can interfere with the therapeutic process. This study utilised a sample of healthy clients to explore the relationship between their CEs and CSs and their evaluation of therapy. Method: Therapy sessions of undergraduate student clients (N =26) were rated using the Cognitive Error Rating Scale (CERS – 3rd edition), the Coping Patterns Rating Scale (CPRS;), the Session Evaluation Questionnaire (SEQ) and the Session Impact Scale (SIS). Results: Clients who engaged in dichotomous thinking endorsed problem solving less and were more likely to feel unsupported and misunderstood by the therapist. Clients who discounted the positive tended to feel more pressured and judged by therapists. Conversely, those who engaged in problem solving were more likely to find sessions deeper and more valuable as compared to those who reacted to stressful events by submission, escape, or opposition. Implications: Better understanding how and when a client's cognitive errors and coping mechanisms are at play during therapy can help clinicians to address them and intervene appropriately.     

Development of parenting self‐efficacy in mothers of infants with high negative emotionality

Maternal parenting self‐efficacy (PSE) is a potential target for infant mental health interventions because it is associated with a number of positive outcomes for children and mothers. Understanding the development of maternal PSE under conditions of increased parenting stress, such as parenting an infant who is easily distressed and difficult to soothe, will contribute to providing more effective interventions. This study examines the development of maternal PSE in mothers of infants with high negative emotionality (NE). The Neonatal Behavioral Assessment Scale (NBAS; T. Brazelton, 1973 ) was administered twice to 111 infants to select a sample of irritable (n = 24) and nonirritable (n = 29) infants for a prospective study comparing the development of PSE in mothers of infants differing in neonatal NE. Consistent with our hypotheses and previous research, at 8 weeks' postpartum, mothers of irritable infants have significantly lower domain‐specific PSE than do mothers of nonirritable infants. Contrary to our predictions, mothers of irritable infants exhibit a significant increase in domain‐specific and domain‐general PSE from 8 to 16 weeks' postpartum. The implications of these results for infant mental health screening, infant mental health interventions, and research on self‐efficacy theory are discussed.     

Influences on Member Assimilation in Workgroups in High‐Reliability Organizations: A Multilevel Analysis

This multilevel investigation examined the effect of group interaction and its influence on individual‐level membership variables and group assimilation. The study is based on a model of group socialization developed by Moreland and Levine (1982) and was modified in this study to investigate the development and maintenance of highly interdependent workgroups in a high‐reliability organization: a municipal fire department. Using hierarchical linear modeling, we examined individual‐ and crew‐level influence on four assimilation outcomes: involvement, trustworthiness, commitment, and acceptance. At the individual level, acculturation predicted all the four assimilation outcomes. Involvement also was a predictor of the latter sequences of assimilation: commitment and acceptance. The study also found that one crew‐level variable—crew performance—affected and modified the influence of tenure, proactivity, involvement, acculturation, and trust on members’ commitment. Implications are offered for the influence of group interaction on member assimilation and support for continuing group‐level research on assimilation. This study also underscores the utility of multilevel analysis in examining communication at the interpersonal and group levels.     

Self‐Monitoring and the Metatraits

Prior attempts at locating self‐monitoring within general taxonomies of personality traits have largely proved unsuccessful. However, past research has typically neglected (a) the bidimensionality of the Self‐Monitoring Scale and (b) the hierarchical nature of personality. The objective of this study was to test hypotheses that the two self‐monitoring factors are located at the level of the metatraits. Using data from two large multi‐informant samples, one community (Sample 1: N = 552, M_age = 51.26, 61% female; N_Peers = 1,551, M_age = 48.61, 37% female) and one online (Sample 2: N = 3,726, M_age = 24.89, 59% female; N_Peers = 17,868, M_age = 26.23, 64% female), confirmatory factor analysis was used to test the hypotheses. Results confirmed hypotheses that acquisitive self‐monitoring would have a strong positive relation to metatrait Plasticity, whereas protective self‐monitoring would have a moderate negative relation to metatrait Stability. In both samples, constraining the correlation between acquisitive self‐monitoring and Plasticity to unity did not alter model fit indices, indicating that the two putatively distinct constructs are identical. Findings have wide‐ranging implications, including integration of the construct of self‐monitoring into the mainstream of personality research, as the latter moves toward the development of broad explanatory theories.     

Does theoretical background influence therapists' attitudes to therapist self‐disclosure? A qualitative study

Aims: This study investigated therapists' attitudes towards therapist self‐disclosure over different theoretical orientations and to establish how classical theoretical background and training effected and informed practice. Classical theoretical background was intended to refer to traditional Psychodynamic understanding. Method: Participants were experienced therapists drawn from four groups by a recruitment screening measure. Three groups were from the students’ cohort within a university Masters programme in Psychological Therapies. Participants were practicing from CBT, Systemic and Psychodynamic orientations. A further group was drawn from Person‐Centred therapist/trainers at a further education College. Data was gathered using focus groups and analysed using thematic analysis. Findings: Three major and one lesser theme emerged. These revealed that there was a spectrum of willingness to disclose throughout all groups, classical training influenced all participants; total restriction of TSD was impracticable and attitudes were affected by concerns for the therapeutic relationship. Implications for practice: TSD needs to be more thoroughly explored within therapy training and supervision. A structured framework could help inform practice. Conclusions: The study supported the idea that Classical Training influenced TSD.     

Therapist orientation,supervisor match,and therapeutic interventions: Implications for session quality in a psychotherapy training PRN

Background: Theoretical orientation is a multifaceted construct that is integral to the process of psychotherapy and psychotherapy training. While some research has been conducted on personal identification with particular schools of psychotherapy, techniques used in psychotherapy sessions, and match between trainees and supervisors in training, there is insufficient information regarding how these may interact with one another. Aim: This study, conducted in a practice research network of trainee therapists, was designed to test whether these variables may be related to one another in predicting session quality. Method: The sample comprised 328 sessions from 26 clients and 11 therapists, with the clients completing session quality measures and therapists completing measures of technique immediately post‐session. Results: Using multilevel linear modelling, the data showed varied results. For behavioural therapy and person‐centred therapy, techniques and orientation were unrelated to session quality in the sample. However, process‐experiential, psychodynamic, and cognitive therapy techniques were all involved in interactions with therapist and/or supervisor orientations. Conclusions: These results suggest that the impact of specific psychotherapy techniques sometimes depends on the orientation of the therapist and/or supervisor. For instance, sessions high in cognitive therapy techniques were only associated with positive outcome when both the therapist and supervisor were highly cognitively oriented. Though preliminary, these results suggest that orientation may be an important variable to consider in training and supervision, especially in the context of other variables.     

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.