Attitudes of clinical psychologists towards clients with personality disorders

Previous studies have found that a variety of mental health professionals hold negative attitudes towards clients diagnosed with a personality disorder. These negative attitudes may lead to clients receiving a lower quality of service. Specialist training has been found to improve attitudes towards personality disorders but no empirical studies in Australia have examined this among clinical psychologists. In this study, the attitudes of 81 clinical psychologists towards clients with personality disorders were examined. We were specifically interested in investigating the relationship between recency of specialist training and clinician's attitudes as well as the influence of percentage of personality disorder clients on the clinician's caseload. Results demonstrated that both recency of specialist training and percentage of clients seen were associated with more positive attitudes; however, a higher caseload of clients with personality disorders was the most important predictor of positive attitudes. The implication is that recent participation in specialist training for personality disorders appears to be valuable in improving clinician's attitudes but that more positive attitudes are associated with seeing a greater number of individuals with personality disorders.     

Investigating biases in trainee counsellors' attitudes to clients from different cultures

Two studies were conducted to explore the assumption that trainee counsellors who are members of the indigenous population will exhibit biased attitudes when they are confronted with the case-history of clients from other ethnic groups. Dependent measures included a structured methodology and free-response methods. This evidence indicates that respondents showed more favourable patterns of attribution for White clients than for clients from three other ethnic groups (Asian, Jewish and West Indian). There appeared to be discrimination in the biased attributions for particular out-group clients.     

Client Aggression Towards Therapists: Is It More or Less Likely with Transgendered Clients?

ABSTRACT

It is well known that clients occasionally threaten or assault their therapists. No studies to date have attempted to systematically measure client aggression by transgender patients towards clinicians. One of the major questions of this study was to determine if clients with gender dysphoria have greater levels of aggression towards therapists than non-gender dysphoric clients. One hundred and fourteen professional therapists who are members of the Harry Benjamin International Gender Dysphoria Association responded to a questionnaire that addressed aggression by both transgender and non-transgender clients. Transgender clients were shown to commit significantly less acts of aggression than did non-transgendered clients (p = 0.0094). Within the relatively small subgroup of transgender clients that did commit acts of aggression, male-to-female transgender clients were significantly more likely to do so than female-to-male clients (p = 0.002). While the transgendered client undergoes significant suffering in violating inviolable gender boundaries, this suffering, in general, does not translate into acting out behaviors directed towards their therapists.     

Incidence and impacts of psychotherapists' feelings toward their clients: A review of the empirical literature

The empirical literature examining the incidence and impacts of psychotherapists' feelings of fear, anger, and attraction toward clients is reviewed, including: (a) studies reporting the incidence of psychotherapists' feelings toward their clients; (b) studies investigating the measurable impact of psychotherapists' feelings on clients, psychotherapists, and the therapeutic process; and (c) examinations of the psychotherapist-factors that affect either the incidence or impact of psychotherapists' feelings toward their clients. Fear, anger, and attraction toward clients are common experiences for psychotherapists. Many psychotherapists report that they are confused, ashamed, and stressed by these feelings. These feelings, although occasionally an important therapeutic resource, were often reported to have a direct and negative impact on the therapeutic processes or cause behaviors that were destructive. Most psychotherapists feel that they were inadequately trained to acknowledge and successfully manage these common and stressful experiences. Recommendations for research and training are provided.     

Interventions in everyday lives: How clients use psychotherapy outside their sessions

The purpose of psychotherapy is to help clients address and overcome problems troubling them in their everyday lives. Therapy can therefore only work if clients include it in their ongoing lives to deal with their problems. Detailed, systematic research is needed on how clients do so in their everyday lives outside their sessions. A design of exploratory case studies on this topic is presented in this article. The main outcomes of such a case study on family therapy are then laid out in general terms. They highlight how treatment practices and clients’ ordinary everyday practices interact when clients change their everyday lives to overcome their troubles. They also highlight what it involves for clients to accomplish this. It is concluded that we need more research on how to understand intervention; on the interaction between interventions and clients’ conduct of their everyday life; on sessions as a particular, secluded part of clients’ ongoing everyday lives, and on how to consider therapists’ procedures and conduct of sessions accordingly.     

Explorations of the effectiveness of a voluntary sector psychodynamic counselling service

This paper reports two studies of individual psychodynamic counselling provided by a voluntary sector service. The first study examines evidence of the effectiveness of counselling, as evaluated by the General Health Questionnaire and Personal Opinion Survey. Measures of the process of counselling indicated the improvements that clients attributed to counselling, the changes that occurred during it, and the factors that were most beneficial, as well as the approaches used by counsellors. The second study, using the CORE Outcome Measure and ratings of problem severity, found counselling to be equally effective with disadvantaged and non‐disadvantaged clients, as defined by British Department of Health criteria, but these clients differed somewhat in their perceptions of helpful aspects of counselling. Both studies also indicated predictors of positive outcome of counselling. The studies are used to illustrate some of the methodological issues around research in this area.     

Self-criticism and the therapeutic relationship

The relationship between self-criticism and the therapeutic alliance was examined in 169 clients attending counselling in a community clinic. Self-criticism was associated with lower client ratings of the working alliance, suggesting that clients with higher self-criticism had greater difficulties establishing and maintaining a therapeutic alliance. These findings extend previous studies on the working alliance and self-criticism from highly controlled clinical studies to a more ecologically valid community mental health setting. Regression analyses were conducted to examine the mediating effect of additional factors on the relationship between self-criticism and the working alliance. Sensitivity to a perceived subordinate role in therapy did not impact the working alliance, although a general resistance to subordination was related to self-criticism. Implications for counselling self-critical clients are discussed.     

COMPARISON OF STAFF TRAINING STRATEGIES TO PROMOTE GENERALIZED TEACHING SKILLS

Two studies compared the effectiveness of different strategies for promoting generalization of staff skills in teaching self-care routines to clients with developmental disabilities. In Study 1, 9 direct-care staff members of group homes were trained sequentially through four conditions: (a) the provision of written instructions, (b) performance-based training using a single client program exemplar and simulated clients (single case training), (c) performance-based training using actual developmentally delayed clients as trainees (common stimuli training), and (d) performance-based training using multiple client program exemplars with simulated clients (general case training). The results indicated that staff members did not reach all generalization criteria until general case training was provided. Because staff members had been trained sequentially through several conditions in Study 1, a second study controlled for potential sequence effects. In Study 2, 7 staff members were trained using only the general case strategy after baseline. All staff members reached generalization criteria with only general case training, replicating the findings of Study 1. Together, the two studies demonstrated that the general case training strategy was more effective at promoting generalized training effects across clients, settings, and client programs than other commonly used staff training approaches.     

Cultural Studies Methodologies and Narrative Family Therapy: Therapeutic Conversations About Pop Culture

Therapists recognize that popular media culture is an influential force that shapes identities and relationships in contemporary society. Indeed, people have serious relationships with the commodities and practices that emerge from pop culture. However, they often lack the conceptual and conversational resources to engage meaningfully with clients about pop culture's influence in their lives. Cultural studies is introduced as an interdisciplinary approach that provides frameworks for both theory and practice that position therapists and clients to critically examine the role of pop culture in their lives. Cultural studies and narrative therapy are discussed as praxis allies that share a populist political intention and counter‐hegemonic discursive practices. The integration of cultural studies methodologies into narrative therapy practice with a parent and her teenage daughter is illustrated through a case vignette.     

Listening to Both Sides of the Therapeutic Dyad: Self-Disclosure of Gay Male Therapists and Reflections From Their Gay Male Clients

Clinicians vary as to their beliefs about the use of self-disclosure in psychotherapy depending on theoretical framework, experience level, and the problem focus. Given the limited number of studies examining therapeutic pairs (client and clinician), this study used qualitative methodology to interview gay male therapists and their gay male clients about how therapist self-disclosures affected their therapy. Results show that clients often felt aware of therapist self-disclosures, whether explicit or implicit, and believed the disclosures assisted them in feeling connected to their therapists and served to normalize the clients’ experiences. Limitations to the study are discussed.     

The dark figure of sexual offending: A replication and extension

Studies of the dark figure of sexual offending using federal correctional clients reported significant evidence of previously unknown or hidden sexual violence, often among clients with no official criminal history. Unfortunately, research has produced variable estimates of how large the dark figure is. The current study sought to replicate recent studies of federal sexual offenders about the dark figure of sexual offending. We also extended the knowledge base by providing additional correlational analyses to see whether self-reported and official sexual offending have shared or divergent correlates. Overall, 73.8% of federal sexual offenders reported prior contact victims, which is higher than, but generally consistent with, prior prevalence estimates of 55–69% in studies of federal correctional clients. In the current data, clients convicted of child pornography possession or receipt and who had no official record of sexual abuse nevertheless reported contact sexual offenses in more than 59% of cases.     

A naturalistic study of the effectiveness of time-limited counselling with low-income clients

The role of counselling and psychotherapy services in relation to the needs of economically disadvantaged individuals has been largely neglected in the recent research literature. Although a small number of theoretical papers and case analyses have been published, there is an absence of studies that examine the effectiveness of counselling with this client group. The present paper reports on a naturalistic outcome study of the effectiveness of time-limited counselling (seven sessions) with low-income clients. Analysis of pre-counselling, postcounselling and follow-up measures of mental health and problem ratings indicated levels of change equivalent to those achieved in controlled studies of counselling and psychotherapy with other client groups. Factors influencing the effectiveness of counselling included gender and employment status. Qualitative client reports suggested that the main benefits experienced by clients were in the areas of self-understanding and self-belief. For illustrative purposes, data from low-income clients are compared with results from employee counselling clients receiving a similar service. The implications of these findings for further research are discussed.     

The Effects of Modeling and Instructions on High and Low Verbal Family Members

This study attempts to generalize the findings of laboratory studies of modeling and instructions by comparing their effects for modifying verbal behavior of actual clients referred to a family service agency. The findings suggest that in a population with less homogeneous verbal skills than found in a typical college population, verbal fluency will influence response to these interventions. Specifically, when a rule is supplemented by either verbal examples (instructions) or behavioral examples (modeling), both interventions have utility. However, for highly verbal clients, verbal examples are appropriate. For less verbal clients, more elaborate audiotape or videotape examples represent the more useful strategy.     

Family Centred Brief Solution-focused Therapy with Chronic Schizophrenia: a Pilot Study

The purpose of the study was to pilot a family centred brief solution-focused therapy model (BSFT) with families and clients diagnosed with schizophrenia. A control group of clients and their families received traditional outpatient therapy, while an experimental group of clients and their families were treated with a BSFT model. All participants were pre-tested and then post-tested with the Family Environment Scale after five therapy sessions over a ten-week period. Significant differences between the groups were found on expressiveness, active-recreational orientation, moral-religious emphasis and family incongruence. The participation of families and clients with schizophrenia in family centred brief solution-focused therapy produced encouraging results and demonstrated the need for expanded studies using BSFT with other chronically mentally ill clients and their families.     

Dyslexia and the school counsellor: A Maltese case study

Aim: This paper seeks to understand whether Maltese school counsellors are equipped to deal with dyslexic clients, considers whether specific strategies need to be used, and what positive effects, if any, counselling has on these clients. Previous studies: A literature review on self-concept and techniques on how to improve the self-concept of children with Learning Disabilities (LD)/Specific Learning Difficulties (SpLD) will place the current study in context. Method: Questionnaires (available from the authors on request) were distributed to all school counsellors on the island and analysed using content analysis. Findings: Findings from respondents indicate a need for more training, evidence-based knowledge of specific techniques when dealing effectively and successfully with dyslexic clients, specific specialised training to understand dyslexic clients and that counselling has a positive effect on dyslexic clients.     

A Process and Outcome Study Examining Career Indecision and Indecisiveness

Despite the abundance of research on undecided and indecisive students, there is a lack of literature on the actual change process of counseling these individuals. No published studies have applied advances in single-subject methodology to career research. This study uses both process and outcome measures to investigate the counseling process with an undecided and indecisive college student to examine (a) what specific events were the most significant in each session, (b) counselor intentions in the “best” versus “worst” sessions, (c) role of the working alliance with career clients, and (d) differential counseling outcomes. Participants were two female counselors, one male undecided student, and one male indecisive student. Results (a) support previous speculation about the differential utility of interventions for undecided and indecisive clients, (b) suggest that the relationship may be important to clients in career counseling, and (c) raise questions about previously assumed intervention strategies for career clients.     

Comparison of million personality profiles of chronic residential substance abusers and a general outpatient population.

Several theories and studies have suggested that particular personality disorders or psychiatric symptoms should be associated with substance abuse. The current study was done to clarify these relationships by comparing scale profiles on the Millon Clinical Multiaxial Inventory obtained by 144 inpatient residentially treated substance-abuse clients and 1000 general clinical outpatient clients in psychotherapy. A surprisingly large number of significant differences were noted. Substance-abuse clients displayed relative elevations on scales for Alcohol and Drug Abuse, Hypomania, Antisocialism, Narcissism, Schizoidism, Paranoia, Psychotic Thinking, and Psychotic Delusions. General clinical outpatients showed relative elevations on Anxiety, Somatoform, Dysthymia, Borderline, and Compulsive scales. Some possible meanings of these findings were explored and suggestions for research given.     

Pre‐treatment change in psychotherapy with adult children of problem drinkers: The significance of leaving home

In a qualitative diary study of four adult children of problem drinkers in psychotherapy, it transpired that all four clients had experienced significant changes before they entered psychotherapy. This study first addresses the issue of how pre‐treatment change may be conceptualised in psychological theory and research. Five ways of understanding pre‐treatment change are presented. Data from the case studies are then presented, highlighting how these clients experienced a diminishing sense of self‐control in relation to leaving the home they cohabited with their alcoholic parent. The dynamics of how leaving home affects the clients are analysed. It is suggested that change experienced in relation to leaving home is significant to the decision to enter therapy. The fit between the data and the theories of pre‐treatment change is discussed.     

Client perspectives and uses of psychotherapy

The present paper argues for the importance of studying user perspectives on ongoing psychotherapy. Four approaches to such studies are discussed. It is stressed that studies of user perspectives may allow us to develop a broader and more robust understanding of clients as the primary agents of their own change processes, and that if the studies focus on clients' everyday lives during the course of psychotherapy, they allow us a better understanding of how clients include their psychotherapy, give it a particular significance, fight over it, and transform it as a part of their changing everyday practice in other places than the session. the rationale and design of such a study is presented. It is a study of a small number of family therapies with the present author as a co-therapist. Some preliminary findings from this study are presented.     

Do Research Intermediaries Reduce Perceived Coercion to Enter Research Trials Among Criminally Involved Substance Abusers?

We examined the efficacy of including a research intermediary (RI) during the consent process in reducing participants' perceptions of coercion to enroll in a research study. Eighty-four drug court clients being recruited into an ongoing study were randomized to receive a standard informed consent process alone (standard condition) or with an RI (intermediary condition). Before obtaining consent, RIs met with clients individually to discuss remaining concerns. Findings provided preliminary evidence that RIs reduced client perceptions that their participation might influence how clinical and judicial staff view them. This suggests that using RIs may improve participant autonomy in clinical studies.