An experimental inquiry into transference roles and age

In this psychotherapy analogue investigation, the effects of client age and therapist age on transference-like projections onto therapists were examined. Young (25-35) and older (60-70) pseudoclients compared paraprofessional therapists to significant figures in their own lives after a dyadic "helping" interview. The results provide empirical support for the phenomenon of reverse transference in therapy with older patients. Older clients were more inclined than young clients to view therapists, particularly younger therapists, as similar to their children. Young clients more willingly attributed parental qualities to older therapists. Both old and young clients may see therapists more as peers or friends than as family members.     

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。     

The lived experience of psychotherapists working with older clients: an heuristic study

This paper presents the results of an heuristic study based on the research question: ‘How do psychotherapists experience working with older clients?’ The question came from the researchers’ experience and interest in working with older clients in general practice. It started from the researchers’ desire to examine more closely feelings and elements present in their own experience in dialogue with seven other practising therapists who had an interest and experience of working with this client group. Qualities and elements identified were: perceptions of old age and ageism; boundaries and settings; changes to practice; culture and experiences; awareness of time; loss; decline and mortality; and parents and children. These are illustrated by material from each of the participants, a composite depiction of the experience, a creative synthesis and examples from the researchers’ experiences.     

Self‐Favoring Bias for Physical Activity in Middle‐Aged and Older Adults1

A self‐favoring bias for physical activity (PA) was examined in a community‐based sample of middle‐aged and older adults (N= 3,211). Participants' actual level of PA relative to peers was compared with their perceived PA relative to peers. It was estimated that 38% were realistic, 46% self‐favoring, and 16% other‐favoring in their perceptions. Among participants whose actual PA level was similar to peers, increasing age was associated with a self‐favoring bias. Among less and more physically active participants, however, age was not associated with this bias. Better self‐rated health and being male were also associated with a self‐favoring bias. These results suggest that a self‐favoring bias for PA exists in a significant proportion of middle‐aged and older adults, and it is more pronounced with increasing age, among those with better self‐rated health, and among men.     

Ambivalence and Alliance Ruptures in Cognitive Behavioral Therapy for Generalized Anxiety

Client ambivalence about change (or motivation) is regarded as central to outcomes in cognitive behavioral therapy (CBT). However, little research has been conducted to examine the impact of client ambivalence about change on therapy process variables such as the therapeutic alliance. Given the demonstrated limitations of self-report measures of key constructs such as ambivalence and motivation, the present study instead employed a newly adapted observational measure of client ambivalence. Client statements regarding change (change talk (CT) and counter-change talk (CCT)) were coded in early (session 1 or 2) therapy sessions of CBT for generalized anxiety disorder. The frequency of CT and CCT was then compared between clients who later experienced an alliance rupture with their therapist, and clients who did not. The results showed that clients in dyads who later experienced an alliance rupture expressed significantly more CCT at the outset of therapy than clients who did not later experience an alliance rupture. However, CT utterances did not significantly differ between alliance rupture and no-rupture groups. CCT may strain the alliance because clients expressing higher levels of CCT early in therapy may be less receptive to therapist direction in CBT. Consequently, it is recommended that clients and therapists work together to carefully address these key moments in therapy so as to prevent alliance rupture and preserve client engagement in therapy.     

Diagnostic judgments as a function of client and therapist race

The purpose of the present investigation was to examine the process of differential evaluation of clients as a function of client and therapist race. It was hypothesized that race of client and therapist would interact, influencing the judgments of client psychopathology, appropriateness for therapy, verbal facility, and likelihood of treatment success despite standardization of the clinical stimuli. Graduate students in clinical psychology and with varying levels of training (i.e., 1 to 5 years) were asked to rate videotaped interviews of clients in which race of the client and level of psychopathology (i.e., normal, neurotic, and psychotic) were systematically varied. There were significant differences in ratings as a function of race of client, race of therapist, and level of psychopathology observed. Black clients were not rated differently on degree of psychopathology but were rated as less verbally skilled and less appropriate for treatment but more likely to benefit from treatment than white clients. Contrary to expectations, white therapists tended to underrate the pathology of black clients. On the other hand, black therapists tended to overrate the pathology of white clients and made mixed judgments of black clients. The implications of these findings are discussed.This study was supported in part by NIMH Research Centers in Minority Institutions (RCMI) Grant G12RR03206-2.     

Professional Responsibility in Elder Law: A Synthesis of Preventive Law and Therapeutic Jurisprudence

This article focuses on the professional responsibilities that a lawyer owes to older clients. Specifically, this article proposes that when working with older clients, lawyers have a special responsibility to ensure that their clients have the capacity to manage their own affairs and to ensure their clients' legal, financial, and personal interests are protected in case of sudden future incapacity. Furthermore, a lawyer working with older clients has a responsibility to remain cognizant of the realities of ageing without giving in to the falsities of senior citizen stereotypes. Through an integration of Therapeutic Jurisprudence and Preventive Law, a proactive, client-centered, four-stage framework for advancing therapeutic goals through preventive lawyering is developed. The framework is then applied to a model lawyer/client interaction typical of elder practice. The advantages and limitations of the four-stage framework 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.     

Genetic Counseling for Personal Genomic Testing: Optimizing Client Uptake of Post-Test Telephonic Counseling Services

The field of genetic counseling faces a broad challenge: many potential clients may not be aware of the value and benefit of genetic counseling services, and therefore may not utilize those services. Navigenics is a personal genomic testing company that provides telephonic genetic counseling services for multifactorial diseases and pharmacogenetics. When first offered in 2008, utilization of the Navigenics genetic counseling service was less than expected. To explore the basis for under-utilization and potential mechanisms for increasing uptake, Navigenics initiated a quality improvement study, in which three different methods of engaging clients in the uptake of genetic counseling services were assessed over the course of 1 year. Outcomes showed significant differences in uptake rates between methodologies (7.5%, 24.6%, and 60.1%), yielding an 8-fold increase in service utilization when post-test telephonic outreach to all clients was performed. Further, utilization spanned all risk levels based on client results, evidence that not only clients with high-risk results were motivated to engage in the genetic counseling service. This research indicates that implementing strategies to educate clients about genetic counseling can positively impact client engagement and utilization of available services.     

Delivered as Described: A Successful Case of Cognitive Processing Therapy With an Older Woman Veteran With PTSD

Cognitive processing therapy (CPT) is a first-line, evidence-based treatment for posttraumatic stress disorder (PTSD). Little is known, however, about the use of CPT for older adults. As the United States population continues to grow and age, an understanding of the utility of CPT for older adults is vital. We present a case study describing the assessment and cognitive treatment of a 74-year-old woman veteran with PTSD secondary to military sexual trauma. CPT was associated with decreased PTSD symptoms as measured before and after treatment. Factors contributing to the veteran’s response, as well as contextual and environmental factors, are discussed. The case demonstrates that CPT may be effective for older adults without major modification.     

Client attendance measures in counselling psychology trainees

Counselling supervisors and educators have yet to reach a consensus about standard measures for evaluating the performance of graduate student therapists. Compared to self‐reports and rater judgements, client attendance records provide low‐inference behavioural data partially reflective of clients’ engagement with therapists. This naturalistic study evaluates client attendance data using archival records of 92 doctoral students in beginning and advanced counselling practica who produced data for 771 clients, 3,949 scheduled sessions and 3,186 attended sessions. Providing evidence of the sample representativeness for clinicians, results indicated that the mean number of sessions attended per client for student therapists (5.65) was very similar to that reported in the literature for outpatient therapists (<6). As expected because of structural differences in client assignment, beginning and advanced students evidenced statistically significant differences on attendance variables such as number of clients and scheduled sessions. In contrast, attendance ratios were equivalent across counsellor experience, suggesting that these individual difference variables could be useful for evaluation of therapist competencies related to client engagement.     

Counselor and client personality as determinants of counselor expectancy effects

Seventy-eight students enrolled in summer-session college courses were randomly assigned to serve either as counselors or as clients for a 20-min, role-played peer counseling session. All of the subjects completed a battery of standardized personality measures. Each counselor interacted with two clients. Prior to the sessions, the counselor was led to believe that one of the clients was especially introverted and that the other client was especially extraverted. Dependent measures were based on clients' change scores on a mood adjective rating scale administered before and after the peer counseling sessions. Analyses showed that counselors who were more successful at biasing their clients in the direction of their expectancies (a) scored higher on measures of Dogmatism, Nurturance, and Social Recognition, (b) scored lower on Impulsivity, and (c) were more likely to be women. Clients who were more susceptible to counselor bias scored higher on the Self-Monitoring Scale, the Self-Monitoring Other-Directedness subscale, and Social Recognition. These results are discussed in light of previous research and their implications for research on interpersonal expectancy effects.     

Therapists’ perspectives about working with meaning in life in psychotherapy: A survey

Of 212 practicing therapists who completed a survey about working with meaning in life (MIL) in psychotherapy, 129 (61%) had recently worked with MIL with at least one client and reported on their work with a client in this survey. Those therapists who had worked with a client on MIL as compared with those who had not were older, more experienced, more humanistic/existential/experiential in orientation; reported more MIL training; and felt more competent working with MIL. Clients reported on primarily had internalizing, interpersonal, and career issues. Only 12% of clients explicitly labeled MIL as an issue coming into therapy. The three most frequently used interventions involved offering support; helping clients examine thoughts, feelings, and behaviors to discover hopes and goals; and facilitating exploration of MIL cognitions and experiences. Therapists reported many positive consequences from working with MIL. Therapists reported minimal training in MIL and moderate competence in working with MIL. Implications for practice, training, and research are presented.     

CHARACTERISTICS OF SUCCESSFUL AND DROPOUT MDTA TRAINEES1

A study was designed to compare several variables of Manpower Development Training Act (MDTA) clients who dropped out of the program with those of clients who completed the program. A random sample of application cards was drawn for individuals enrolled in MDTA adult classes in Milwaukee, Wisconsin. Trainees who completed the program were more likely to be married, older, characterized by a more stable employment history prior to entering the program, and slightly more educated than were program dropouts. Clients who completed the program versus those who did not were not significantly different on the following variables: (1) sex; (2) counseling versus no counseling; (3) race; and (4) client reported physical disability.     

Exploring counsellor perceptions of the impact of counselling supervision on clients

This qualitative study explores counsellors' experiences and perceptions of how counselling supervision impacts their clients. The literature review highlights little research in this area. Data collection combined open-ended questionnaires and semi-structured interviews. Analysis was phenomenological incorporating participant validation. The findings indicate that supervision impacts client work both helpfully and unhelpfully. Areas that emerged as having the most direct impact on client work were: exploration of client-counsellor dynamics and raising counsellor self awareness, professional development, emotional support and the quality of the supervisory relationship. Benefits and dangers for clients not taken to supervision were highlighted. Congruence and confidence were the most direct link between supervision and client work.     

Counselor Bias in Working With Gay Men and Lesbians: A Commentary on Barret and Barzan (1996)

This article comments on R. Barret and R. Barzan (1996), who do well in exploring the spiritual experiences of gay men and lesbians but in the process set up a precedent of reverse discrimination against the client whose religious beliefs proscribe homosexual behavior. Suggestions are offered to sensitize counseling professionals to such bias so that therapists' values are not imposed on clients in an unreflected manner.     

A study of Muslim Asian women's experiences of counselling and the necessity for a racially similar counsellor

A survey of four Muslim Asian women of varying ages was carried out, for whom the author had previously acted as a counsellor. The survey was designed to explore the extent to which client and counsellor racial similarity affected the therapeutic alliance, as the counsellor/author was of a similar race to all four clients. It was the author's belief that racial similarity in itself would not procure positive counselling outcomes, and hence this study attempted to explore the clients' perceptions of qualities extrinsic to race, including interpersonal skills, styles and approach to counselling of the counsellor, in order to duduce whether in fact these factors were more singnificant to the outcomes than race. The majority of clients did not feel racial similarity was an essential quality, although one client expressed cultural awareness as being a preferable quality. This has suggested that it is not essential for client and counsellor to be racially similar in order to achieve successul counselling outcomes.     

An investigation of self-assessment bias in mental health providers

Previous research has consistently found self-assessment bias (an overly positive assessment of personal performance) to be present in a wide variety of work situations. The present investigation extended this area of research with a multi-disciplinary sample of mental health professionals. Respondents were asked to: (a) compare their own overall clinical skills and performance to others in their profession, and (b) indicate the percentage of their clients who improved, remained the same, or deteriorated as a result of treatment with them. Results indicated that 25% of mental health professionals viewed their skill to be at the 90th percentile when compared to their peers, and none viewed themselves as below average. Further, when compared to the published literature, clinicians tended to overestimate their rates of client improvement and underestimate their rates of client deterioration. The implications of this self-assessment bias for improvement of psychotherapy outcomes are discussed.     

会谈中的当事人阻抗及工作同盟的影响因素:一项过程研究

从心理咨询过程研究视角,以38个会谈为对象,考察咨询师指导和当事人特质逆反对当事人阻抗的影响,并检验三者对工作同盟的影响。结果:指导正向预测阻抗,特质逆反则不能,二者的交互作用也不显著;阻抗负向预测工作同盟,指导则不能,二者的交互作用和中介作用都不显著,但阻抗的中介效应相对更大。结论:咨询师指导增加当事人阻抗;当事人阻抗破坏工作同盟,并在咨询师指导对工作同盟的影响过程中可能起中介作用。