Using client feedback in training of future counseling psychologists: An evidence-based and social justice practice

Training in counseling psychology has evolved to emphasize both evidence-based practice (EBP) and social justice, though these two dimensions have often seemed disconnected, or even at odds in the practice of psychotherapy. The Partners for Change Outcome Management System (PCOMS), an EBP that monitors treatment outcomes and the therapeutic alliance across treatment (often called “client feedback”), may offer a means to connect evidence-based and socially just practices. The purpose of this article was to outline how the use of PCOMS in psychotherapy and supervision can serve as a useful training tool that is a form of EBP and also promotes a socially just paradigm in psychotherapy. We also offer an implementation example from a counseling psychology doctoral program to demonstrate how PCOMS can be used with clients in psychotherapy and included within the supervisory process.     

Self psychology in pastoral counseling

This article provides a general explication of how a pastoral counselor might use the self psychology perspective in conjunction with theological and ethical approaches. A particularly appropriate structure for this explication is self psychology's theory and practice of psychoanalytic psychotherapy as a two-phase process: an observation-understanding phase, in which empathic introspection is the central method, and an explanation-interpretation phase, in which by these empathic means the therapist hopes to consolidate further and mobilize developmentally an individual or group's self-cohesion. Each of these phases and the self psychology theory behind them provide an organizing rubric by which we can discuss how theological and ethical approaches might be carried out in a working alliance with the self psychology framework.     

A call for dialogue: psychotherapists and psychologists specialising in psychotherapy

The development of psychotherapy as an independent discipline in many countries in Europe has stimulated debate within the field of psychology as to what constitutes psychotherapy as a specialism of psychology. The authors, both clinical psychologists who pursued further training in psychotherapy, offer a reflection in this paper on the historical battle between psychiatry and psychology for ‘ownership’ of psychotherapy, describe recent developments in Europe to clarify this specialism within psychology and discuss the distinctive contributions that psychologists offer in developing psychotherapy as a specialism within the discipline. The aim of the paper is to begin a dialogue both within the profession of psychology and outside the profession, with our psychotherapy colleagues, that can develop into an interdisciplinary discourse and a more mutually respectful professional environment.     

An Indicator of Suicidal Ideation on the Rorschach Test

We examined the impact of patient- and therapist-rated alliance developed during psychological assessment on the subsequent alliance measured early and late in formal psychotherapy. We hypothesized that a working alliance developed during psychological assessment conducted from a collaborative therapeutic model of assessment (TMA; Finn &; Tonsager, 1992, 1997; Fischer, 1994) between the patient and therapist would carry into formal psychotherapy. We also hypothesized that alliance for those patients receiving a TMA would be significantly greater than patients receiving psychological testing as usual. To test this hypothesis, we administered the Combined Alliance Short Form-Patient Version (Hatcher &; Barends, 1996) and the Combined Alliance Short Form-Therapist Version (Hatcher, 1999) to a sample of outpatients and their therapists at the end of the assessment feedback session, early, and late in psychotherapy. The hypotheses were supported as alliance scales rated at the assessment feedback session demonstrated positive and significant relationships with alliance throughout formal psychotherapy and in relation to a control group. The clinical utility and research implications of these findings are discussed.     

The development of therapeutic alliance during psychological assessment: patient and therapist perspectives across treatment

We examined the impact of patient- and therapist-rated alliance developed during psychological assessment on the subsequent alliance measured early and late in formal psychotherapy. We hypothesized that a working alliance developed during psychological assessment conducted from a collaborative therapeutic model of assessment (TMA; Finn & Tonsager, 1992, 1997; Fischer, 1994) between the patient and therapist would carry into formal psychotherapy. We also hypothesized that alliance for those patients receiving a TMA would be significantly greater than patients receiving psychological testing as usual. To test this hypothesis, we administered the Combined Alliance Short Form-Patient Version (Hatcher & Barends, 1996) and the Combined Alliance Short Form-Therapist Version (Hatcher, 1999) to a sample of outpatients and their therapists at the end of the assessment feedback session, early, and late in psychotherapy. The hypotheses were supported as alliance scales rated at the assessment feedback session demonstrated positive and significant relationships with alliance throughout formal psychotherapy and in relation to a control group. The clinical utility and research implications of these findings are discussed.     

Making the Parents as Partners Principle a Reality: The Role of the Alliance

We explore the dimensions of the Parents as Partners principle, the widely touted, but somewhat elusive construct in the literature on treating children with serious mental illness, whose poorly defined boundaries, lack of empirical grounding, and overemphasis on instrumental dimensions attenuates its usefulness as a guide for practice and research. Four major barriers to the realization of this principle are outlined, all of which may impede actualizing partnership in practice and may also inhibit the early formation of a positive clinician/parent alliance, a neglected, though key dimension of true partnership practice. The alliance, which has a long clinical and research history in psychotherapy and behavioral research, and more recently, in a variety of community-based interventions, is a precursor to active client partnership with helpers and to treatment participation, as well as therapeutic in its own right. After reviewing relevant alliance research, we close with a beginning research agenda to incorporate the alliance as an integral component of future conceptualization and research about the Parents as Partners principle.     

The therapeutic alliance and the interface of career counseling and personal counseling

This article proposes a very specific pathway for bringing career counseling back into mainstream counseling psychology: more explicit research and clinical attention to the therapeutic alliance. The author hopes that this abbreviated review on the alliance serves as an impetus for increased attention to the alliance in career counseling theory, research, and practice as well as for including training in alliance formation and strengthening in career counselor education and supervision.     

Marginalisation Is Not Unbearable. Is It Even Undesirable?

Marginalised movements in psychology and psychotherapy tend to retain their identity, and the writings of their founders continue to exercise an influence. Once absorbed into the mainstream the identity is lost, and the founders are relegated to the forgotten past. Movements are kept marginalised when they are at odds with the central, untested assumptions (the hard core) of the mainstream. Many of REBT's insights have already been assimilated by the mainstream, which is currently an alliance between experimental psychology and CBT. But the mechanistic hard core of the mainstream is at odds with normative assumptions about self-worth held by REBT. As long as that continues REBT is likely to remain marginalised, but will keep its most significant insights.     

Trainee therapists’ views on the alliance in psychotherapy and supervision: a longitudinal study

The shape of alliance in psychotherapy and supervision using growth curve modeling was examined for clinically inexperienced trainee therapists, who were engaged in long-term cognitive behavioral - or psychodynamic individual psychotherapy at a Psychology Clinic in Sweden. Trainee therapists rated their view of the alliance with their clients and their supervisors on the Working Alliance Inventory at five time points. The alliance to the client show a consistent, positive development throughout the therapy. The alliance to the supervisors show initially a decrease, followed by an increase, and then again, the rate of increase in the supervisory alliance ratings slowed down indicating a more complex view of the supervisory alliance compared to the view of the alliance in psychotherapy.     

The Initial Psychotherapy Interview with Adolescent Clients

Initial psychotherapy sessions with adolescents can be very challenging due to the need to balance assessment, relationship building, caretaker/parent management, and case formulation with a client population that sometimes has little motivation for psychotherapy. This article combines empirical evidence, theoretical knowledge, and clinical experience to describe strategies for how psychotherapists can prepare themselves for initial psychotherapy sessions and manage tasks associated with five stages of the clinical interview: (a) the introduction, (b) the opening, (c) the body, (d) the closing, and (e) termination. Using case vignettes and short examples, there is an emphasis on how psychotherapists can develop and maintain a strong therapeutic alliance while simultaneously helping adolescent clients focus on psychotherapy tasks and goals. The overall goal of this article is to help psychotherapists smoothly navigate the potentially stormy stages of the initial clinical interview with adolescents.     

Evaluation of a Combined Cognitive Behavioural Therapy and Interpersonal Process Group in the Psychotherapy Training of Clinical Psychologists

It is now widely acknowledged that both content and process elements of psychotherapy play a part in client treatment outcomes. Despite this, there are pressures on Australian clinical psychology training programs to teach evidence‐based approaches in a relatively short time frame. Producing clinical psychology graduates who have an adequate level of competence in evidence‐based practice and meeting the demands of professional accreditation requirements can mean that less time is available to teach the process elements of psychotherapy. The aim of this study was to conduct a preliminary evaluation of a clinical psychology psychotherapy training program that combines an interpersonal process group with a cognitive behavioural therapy training model that incorporates self‐reflection and self‐practice. Eleven participants who participated in the training in 2008 completed the Counseling Self‐Estimate Inventory at pre‐ and post‐training. Significant improvements on the majority of the subscales of this inventory were found. A separate sample of nine trainees and clinical psychology registrars who also previously completed the program attended individual interviews in 2010 aimed at gaining their perspective regarding various aspects of the program. Self‐practice of cognitive behavioural therapy techniques was found to be important in the identification and management of trainees’ own core beliefs, and to their appreciation of how challenging this process may be for clients. The interpersonal process group was described by participants as enhancing their competency as psychotherapists. Common themes included the experience of anxiety and a high level of emotion, and understanding how this experience might be similar for clients; increased self‐awareness; and increased competence in process issues. Many participants believed the process and content components of training were equally important to their development as psychotherapists.     

文化心理学视域下的心理治疗

近年来,心理治疗的文化取向日益为心理学界所关注。在概要分析文化心理学理论取向和传统心理治疗特点的基础上,重点对文化心理学取向下的心理病因观、医患关系、心理治疗方法、心理治疗效果评价观做了相应分析,并对未来文化取向下的心理治疗理论进行了展望,希望对我国心理治疗理论和实践有所帮助。     

Integrating clients' moment‐to‐moment ratings into psychotherapy research: A novel approach

Counselling and psychotherapy researchers have considerably advanced the field's understanding of psychotherapy processes and how they relate to treatment outcomes. Despite these advances, little is known about the client's perspective of changes in psychotherapy processes that occur throughout a given session (i.e. micro‐processes). To address this gap, this article describes the novel application of methods that assess participants' moment‐to‐moment ratings to psychotherapy research. This method entails recording psychotherapy session content that clients and other potential raters (e.g. therapists, researchers) later review while simultaneously providing continuous ratings of psychotherapy processes (e.g. helpfulness, alliance). In addition, moment‐to‐moment ratings can facilitate significant events research by prompting researchers to elicit client feedback about the moments that are rated the most and least positively. However, few studies have used these methods in the context of psychotherapy research. Studies incorporating these methods may yield findings that advance psychotherapy research, training efforts and clinical practice. For example, studies may examine how the magnitude and timing of clients' moment‐to‐moment ratings of psychotherapy processes are associated with treatment outcomes, therapist ratings and physiological processes (e.g. heart rate variability). Trainee therapists and their supervisors may also use clients' moment‐to‐moment ratings to facilitate attunement to verbal and non‐verbal indicators of moments perceived more positively and negatively. Last, these methods can produce findings that are highly relevant to clinical practice, where therapists routinely navigate fluctuations in psychotherapy processes (e.g. alliance ruptures) that can be assessed using moment‐to‐moment ratings.     

Relational ecologies of psychotherapy: The influence of administrative attachment on therapeutic alliance

There is now vast and multi-faceted empirical literature on the impact of relational dynamics in psychotherapy, and relationality is a central theme within contemporary psychoanalytic theories. Yet, there is virtually no literature addressing the relational dynamics around outpatient psychotherapy that influence the wider therapeutic alliance, that is the relational dynamics that unfold between clients and administrative office staff in making initial contacts and appointments, completing paperwork, negotiating payment, discussing insurance coverage, working through crisis calls, and the myriad of other forms of interaction which serve to form the relational ecology of psychotherapy. Milieu therapy or the use of supportive and structured therapeutic environments has been given significant attention in inpatient settings; however, administrative relational factors or administrative staff characteristics have seemingly been ignored in outpatient psychotherapy and psychoanalysis literatures. Many outpatient clinical practice settings involve multiple levels and dimensions of relationality between clients, administrative personnel, and therapists which shape the potential for secure continuous containment and various forms of attachment to psychotherapeutic space. In this paper, we describe several clinical illustrations of relational dynamics between clients and office staff which influence therapeutic alliance and outline the contours of our emerging idea of administrative hospitality based on relational psychoanalysis, attachment theory, symbolic anthropology, and stigma research. In doing so, we draw on our collective experience working in several outpatient clinics and insights from our current context in an urban outpatient training clinic which emphasises psychodynamic practice. Our goal is not a comprehensive analysis of the relational ecology of psychotherapy but to offer an initial exploratory account of some of the administrative relational dynamics in and around outpatient psychotherapy which go beyond the therapist-client dyad. The anthropological concept of liminality is connected to relational psychoanalytic theories to describe the important dynamics of transitional space in an overall process of relational transformation.     

The future of psychotherapy outcome research: science or political rhetoric?

Although the relationship between research and clinical psychology has at times been conflicted, it has also been productive. Psychologists from both specialties have benefited from each others' work. The area of psychotherapy outcome research represents an important interface between the fields of clinical and research psychology. In an era of scarce resources and demands for accountability, there is pressure for researchers to justify the value of clinical practices. Recently, numerous articles have appeared recommending changes to the way psychotherapy research is conducted. The authors of these articles emphasize with urgency the importance of conducting and reporting research in a manner that will influence the decisions of policymakers and sanction funding for psychotherapy services. This article is an exploration of the impact of these recommendations, whose objective appears to be the promotion of psychological techniques for inclusion in clinical practice guidelines. It is argued that such recommendations may be in conflict with the philosophy and methods of science and may adversely affect public perception, perhaps leading psychologists to be seen as political lobbyists rather than clinicians and researchers.     

The Supervisory Alliance as Quintessential Integrative Variable

The concept of alliance in psychotherapy supervision is now a half century old. But over the course of its first 50 years, how has the supervisory alliance come to generally be viewed by supervision scholars and practitioners? and What is its specific place now within different visions of supervision? In this paper, I would like to consider those two questions by: (a) describing the two enduring perspectives on the supervisory alliance that have dominated and continue to dominate the supervisory scene; and (b) examining the ways in which the alliance appears to currently be conceptualized and implemented across several distinct views of supervision. Each view of supervision is also presented as containing and actuating its own message and meaning about the role of alliance in supervision, and those messages and meanings are accordingly identified. The supervisory alliance appears to now be widely regarded as being a transtheoretical common factor that binds by means of: (a) bond/rapport; (b) supervision goals; and (c) supervision tasks. Much like the therapeutic alliance in psychotherapy, the supervisory alliance has increasingly come to be seen as the very heart and soul of supervision itself and may indeed be the quintessential integrative variable in psychotherapy supervision.     

Integrating Religion and Psychology in Therapy: Issues and Recommendations

This article explores the history of the relationship between religion and psychology, integration difficulties within psychotherapy, and recommendations for problem resolution. Two religious frameworks psychologists can use to reduce conflicts and enhance psychotherapy with regard to religious concerns are provided2.     

Der ausreichend gute Therapeut

Psychotherapists show a great variation in their ability to achieve positive outcomes in therapy. Specifically, they vary in terms of their ability to identify and repair ruptures in the therapeutic alliance. Alliance ruptures are a frequent phenomenon but often go undetected; however, repairing alliance ruptures represents a great opportunity to improve the psychotherapy process and therapy outcome. Empirical research suggests that patient feedback should be included in the psychotherapy process to be able to detect alliance ruptures better. From a psychodynamic point of view, a “sufficiently good” therapist is a therapist who can acknowledge the countertransference-based limitations in evaluating the therapeutic alliance with patients and the need to use feedback in order to detect and repair inevitable alliance ruptures. The consequences for research, practice and psychotherapy training are considered.     

Humanistic Psychology at York University: Retrospective: Focus on Clients' Experiencing in Psychotherapy: Emphasis of Radical Reflexivity

A retrospective is given of the contributions by York University psychologists to humanistic psychology as it is expressed in the theory, research and practice of humanistic psychotherapies. These contributions are contextualized in the history and mission of the University. Attention is then turned to the author's qualitative research on the client's experiencing in psychotherapy and the main understanding coming from it, namely that clients are aware of their self-awareness and are agential in terms of this capacity, called radical reflexivity. Implications of radical reflexivity for client-centered/experiential therapists' reduction of the person to an organism and for the psychotherapy practice and research are derived.     

Psychology of Religion: What One Needs to Know

This essay is an introduction to systematic nonsectarian psychology of religion—its nature and scope, and its history. Among major issues, the study of motivation for being religious and stages of religious development are discussed, as well as counseling and psychotherapy. I summarize current trends.