Understanding Motivational Interviewing Effectiveness: Contributions From Rogers' Client-Centered Approach

The object of this article is to gain a better understanding of motivational interviewing (MI) effectiveness using the framework of Rogers' approach. Examining MI's common points and differences with Rogers' client-centered therapy can make it possible to identify some of MI's active ingredients and its underlying process of effectiveness, especially related to MI relational component. In return, MI, a strongly evidence-based approach, could provide empirical basis and support of effectiveness for Rogers' client-centred therapy. The review of literature on Rogers' therapy and MI shows strong links between the two approaches. MI applies most of Rogers' therapy attitudes and techniques such as empathy, acceptance, autonomy support, collaborative style, and confidence in the client's ability to change. The article further presents a review of research data related to the therapeutic effects of each of these attitudes. Finally, implications for clinical practice and further research are discussed. MI and Rogers' client-centered approach have much to offer each other. The strong process and outcome research tradition in MI could bring about evidence on Rogers' therapy effectiveness. Rogers' work provides a testable theoretical basis for the mechanisms of MI effectiveness. Further MI research should operationalize more than just empathy in the relational component.     

An Analysis of How Carl Rogers Enacted Client‐Centered Conversation With Gloria

This study analyzed Carl Rogers's session with Gloria in Three Approaches to Psychotherapy (E. L. Shostrom, 1965a) to determine how Rogers's conversational style functioned to enact his core conditions of empathy, genuineness, and unconditional positive regard. Rogers's conversational style was found to be congruent with his espoused theory as well as a catalyst for client‐centered counseling. The authors suggest that despite the film's popularity, the “client‐centeredness” of the therapeutic interaction between Carl Rogers and Gloria has been previously underrecognized.     

Stuttering: Training the therapist

In order to sensitize therapists in training to the dynamics of helping others change, eight members of a graduate seminar in fluency disorders were asked to develop and maintain a program of personal behavioral change for a period of 4 wk. Their reflections on several features of this experience are discussed under the following categories: (1) Selecting the behavior for modification; (2) developing the contract; (3) motivational factors; (4) personal reflections, and (5) implications for working with stutterers.     

Spontaneous Self‐Practice of Cognitive Behavioural Therapy (CBT) by Aboriginal Counsellors During and Following CBT Training: A Retrospective Analysis of Facilitating Conditions and Impact

Previous cognitive behavioural therapy (CBT) training studies have suggested that therapists who practice CBT strategies on themselves during training may experience professional and personal benefits. However, it has also been reported that some CBT trainees are reluctant to engage in self‐practice. The present study reports an incidental finding from a CBT training study with Aboriginal counsellors: all five counsellors reported that they practiced CBT techniques on themselves without specific encouragement by the trainers to do so. This paper therefore posed three questions: (a) Why—in contrast to some other trainees—did this group choose to apply CBT to themselves? (b) How did they apply it—with what purpose, in what contexts, and which skills? (c) What was the impact of CBT self‐practice? Data from the group's reflections were qualitatively analysed by two of the researchers, and “member checked” by the remainder. Results indicated that the counsellors were motivated to practice CBT on themselves for two principal reasons: the value they placed on CBT, and their personal need resulting from the high number of crises experienced while living and working in their communities. The counsellors reported practicing CBT in a wide variety of contexts as part of their learning. As in previous studies, the impact of CBT self‐practice was that it increased their confidence and competence as therapists. It also appeared to be a valuable burnout prevention strategy. If the results are generalisable, they suggest that self‐experiential training in CBT may be a culturally responsive and adaptive way for Aboriginal counsellors to enhance their learning of CBT skills.     

Psychotherapists' dreams about their patients

Abstract This study examines therapists’ dreams about their patients from the Jungian and the relational perspectives. Few clinical and empirical references to this subject are to be found in the literature. In the present study 31 dreams were collected from 22 therapists. Dreams were collected using anonymous self‐report inventory. The research focused on three theoretical research questions: 1. What themes appear in the manifest content of therapists’ dreams about their patients? 2. What contributions are made by Jungian interpretation of therapists’ dreams about their patients? 3. To what extent are masochistic contents present in the manifest content of therapists’ dreams about their patients? The first question was addressed using categorical content analysis of a) themes common to different dreams and b) pre‐determined themes for all dreams. The third research question was addressed using Beck's (1967) ‘Masochistic Dream’ measure. Results: Among the themes common to different dreams were: therapist‐patient role reversal; therapist and/or patient attends and remains in meeting, departs/doesn’t depart; cancellation of therapy session; sexuality between therapist and patient; aggression; presence vs. absence; non‐verbal relationship and communication; time; driving vs. stopping. With regard to pre‐determined themes it was found that in 20 of the 31 dreams, the therapist had a negative experience and was characterized as vulnerable. Likewise it was found that 26 out of 31 dreams took place in either a) a street, a road, a route, a corridor; b) en route to somewhere; c) a therapy room and/or building; d) a house. With regard to the contribution of Jungian interpretations of the dreams it was found that 17 of the dreams had diagnostic and prognostic elements, 4 of which were initial dreams, 9 of them were compensatory dreams and in 14 it was found that the patient represents the shadow of the therapist. With regard to the third question it was found that 18 of the 31 dreams met Beck's (1967) criteria for masochistic dreams. The theoretical discussion examines the findings from a Jungian perspective, with an emphasis on also understanding the dream in terms of its expression of relational aspects of the therapist‐patient relationship. The findings affirm the presence of the ‘wounded healer’ archetypes in therapists’ dreams about their patients. The results of the study indicate that therapists’ dreams about their patients can be a valuable tool for deepening understanding of the therapeutic relationship and process.     

A Pilot Study of Psychotherapist Trainees' Alpha-Amylase and Cortisol Levels During Treatment of Recently Suicidal Clients With Borderline Traits

Psychotherapists often experience stress while providing psychotherapy, in particular when working with difficult presentations such as suicidality. As part of a larger study on the treatment of recently suicidal college students with borderline traits, 6 therapists in training collected their own salivary samples for alpha-amylase (AA) and cortisol (C) analyses immediately before and after sessions with 2 selected clients. On average, samples were collected for the same therapist-patient dyad throughout the year-long study to ensure that data reflected therapist responses across stages of treatment. Therapists also completed a working alliance questionnaire and rated perceived session difficulty immediately after each selected session. Contrary to expectations, therapists demonstrated elevated levels of stress as measured by AA and C at presession relative to postsession levels. Greater session difficulty was related to more pronounced declines in AA, whereas a stronger working alliance was linked to more pronounced reductions in C. Results suggest that physiological stress responses while working with recently suicidal clients with borderline traits occur primarily in terms of session anticipatory anxiety, whereas AA and C changes may be affected differently by factors such as session difficulty and working alliance. This is a pilot study, limited by its sample size, but the design, findings, and inclusion of physiological measures present an initial step in an essential line of research.     

The role of community and narrative in the work of the therapist: A post-modern theory of the therapist's engagement in the therapeutic process

This article presents a theory which suggests that therapists engage in therapeutic relationships seeking the (re) formation of their client's self-narratives according to certain normative resources. The notion of therapy as a process of narrative (re)formation is discussed, and the nature of the resources that guide the therapist's work are described as macronarratives, beliefs and a vision of the good life. This theory is explored in relation to Carl Rogers' therapeutic encounter with the client Gloria, and the article concludes with a discussion of the wider implications of this theory for those interested in therapy.     

the nature and frequency of medicare/medicaid fraud and neutralization techniques among speech,occupational, and physical therapists

ABSTRACT

The current study examines the nature and frequency of Medicare/Medicaid fraud and the techniques of neutralization utilized by a purposeful sample of speech, occupational, and physical therapists working within the context of hospitals, nursing homes, and with home health agencies, in a southern state. Participant observations, surveys, and in-depth interviews were utilized to obtain data for this study. We identified two main fraudulent practices, cutting sessions short while charging for the entire session and charging individual session rates for group therapy sessions. We also identified three techniques of neutralization utilized by the therapists in our study, including: (1) everyone else does it, (2) denial of responsibility, and (3) denial of injury. The implications of our findings are discussed.     

Therapist perspectives on working with fears,blocks and resistances to compassion in compassion focused therapy

Objective

A core aspect of compassion focused therapy (CFT) is addressing fears, blocks, and resistances (FBRs) to compassion. How CFT therapists do this with clients remains unclear. This study aims to explore the perspectives of well-trained, experienced CFT therapists regarding how they work with FBRs in the context of CFT.

Methods

A qualitative study was conducted. Participants were asked five open-ended questions regarding (a) their experiences of working with FBRs to compassion, (b) how they understand and formulate FBRs, (c) specific ways they address FBRs, (d) how other therapists might learn about working with FBRs, and (e) their top recommendations. A total of 64 participants completed the online questionnaire, and the qualitative data were analysed using thematic analysis.

Results

The analysis produced four interrelated superordinate themes: (a) Getting “alongside” and “behind”: The central role of formulation, (b) “It's not your fault”: Psychoeducation, (c) “Get experiential”: An emphasis on experiential interventions, and (d) “Respect the wisdom”: The importance of therapeutic process.

Conclusions

Working with FBRs to compassion is critical in CFT. Understanding the wisdom in the client's FBRs, and validating and de-shaming the client's FBRs are crucial. We provide clinical recommendations regarding working with FBRs as part of CFT.     

Self-Other and Third-person Anchored Modes of Thinking in Psychological Expertise: Cognitive Concomitants of Behaviourist,Client-centred,and Psychoanalytic Concepts

Information about people (A and B) can be processed consistent with two alternative modes of thinking: (1) an SO-mode conceiving of A and B as “self” versus “other,” and (2) a 3P-mode conceiving of A and B as “he/she called A” versus “he/she called B.” Previous research showed strong SO-anchoring biases in laypersons' thinking, so the present study focused on psychological experts' thinking. SO- and 3P-modes were associated with the formation of personalized and depersonalized representations of A and B respectively, so it was hypothesized that thinking in psychoanalytic terms would involve both modes, whereas the use of client-centred and behaviourist terms would trigger the SO- and the 3P-mode respectively. Data obtained from experts in psychotherapy confirmed the hypotheses except that the SO-mode was not less but more dominant in thought shaped in the behaviourist way than in thought shaped in the client-centred way. The results shed light on the role of scientific language and discourse as a general instrument of professional thought and communication.     

Being there,experiencing and creating space for dialogue: about working with children in family therapy

While most authors agree that it is important to mobilize the active participation of children in the family therapy session, a lot of family therapists exclude children from participating because they do not feel comfortable with children. Teaching family therapists to feel more comfortable around children is a good idea, but perhaps it is not enough. In this article, the author reflects on the complexity of the issue of the comfort of the therapist in a session with children and families. In the discussion of the case story of Elly and her mother, practitioners are reminded that the therapist's experiencing in the session can help her to understand something of what goes on in the families she is working with.     

Therapists’ and clients’ perceptions of routine outcome measurement in the NHS: A qualitative study

Primary objective: This is the first qualitative study that elicited the perceptions of both psychological therapists and their clients in the use of Clinical Outcomes in Routine Evaluation with computer software (CORE‐Net), where instant visual feedback for session tracking was given on a computer screen in the therapy room at each therapy session. The study also examined how therapists viewed its potential value in supervision and provides suggestions for improving training. Research design: The study adopted a convenience sample of four therapists in a primary care counselling setting (PCC – General Practitioner referrals) who were experienced in using CORE‐Net, and five therapists in an NHS employee/occupational support counselling service (OH) who had just begun to use CORE‐Net for session tracking with 10 of their clients. Method: A qualitative methodology was used and interview data were collected from the therapists via focus groups; the clients were interviewed individually face to face. All data was analysed inductively. Findings: The study identified six overarching themes: (i) therapists were initially anxious and resistant; (ii) therapists adapt ‘creatively’; (iii) outcome measures help the client/therapist relationship; (iv) clients perceive visual measures as helpful; (v) CORE scores inform supervision; and (vi) proper and ongoing training/support of therapists is necessary. The main limitations are comparability of data and the generalisabilty of results. Conclusions: The implementation of routine outcome measurement (ROM) is a challenge but can be made easier with proper training and supervision. Clients appear happier than their therapists when routine outcome measurement is used.     

Therapeutic relationship and outcome seen by clients in first and third session of individual therapy

Rogers' assertion that therapeutic improvement results from clients seeing their therapist as genuinely empathic and unconditionally accepting was explored in the first and third session of individual therapy with 24 clients. This proposition was partly supported in that higher combined levels of these therapist qualities as seen by clients after session one was associated with higher self-esteem and lower need for approval after session three, when these two variables after session one were respectively controlled. However, no support for this assumption was found for depression and anxiety, in that lower depression and greater anxiety after session one was associated with higher levels of these therapist qualities after session three. These latter two findings imply that the subsequent therapist qualities may have resulted from earlier anxiety and depression.     

Carl Rogers: Body‐Centered Counselor

The fundamental construct of C. R. Rogers's (1961, 1980a) person‐centered approach is organismic experiencing. This thesis is examined in the context of person‐centered theories of personality and counseling. Similarities between Rogers's thinking and that of W. Reich (1942, 1945), pioneer in body‐oriented psychotherapy, are identified. Rogers's activities as counselor are shown to be body‐centered.     

Repurposing process measures to train psychotherapists: Training outcomes using a new approach

Aims: First, this paper presents the rationale for a novel approach to training counsellors in which measures for psychotherapy process research are taught to students before moving on to teaching basic empathic reflections and interventions. The rationale for this is that client process measures can be re‐purposed to help orient and sensitise trainees to key in‐session moments. Second, we present a training outcome study that assesses the effectiveness of this approach. Method: Using an experiential‐integrative therapy approach, a 13‐week training program was used to teach psychotherapy skills and process research measures to22 clinical graduate students taken from two cohorts. As part of the course, trainees conducted several single sessions with volunteer clients on four separate occasions. Training outcomes were measured using both trainee and client reports. Results: Compared to baseline, therapists reported significant and steady gains (all p's<.05) in session management, reducing their anxious self‐awareness, and in improved sense of self‐efficacy, with the latter having the largest effect (partial Eta Sq.=.381). Discussion: While the findings provide some support for a new training strategy, a dismantling design is needed next to more closely examine the process‐measure approach to training.     

Clinical Guidelines for Working With Stepfamilies: What Family,Couple, Individual,and Child Therapists Need to Know

This article draws on four decades of research and clinical practice to delineate guidelines for evidence‐informed, clinically sound work with stepfamilies for couple, family, individual adult, and child therapists. Few clinicians receive adequate training in working with the intense and often complex dynamics created by stepfamily structure and history. This is despite the fact that stepfamilies are a fundamentally different family form that occurs world‐wide. As a result many clinicians rely on their training in first‐time family models. This is not only often unhelpful, but all too often inadvertently destructive. The article integrates a large body of increasingly sophisticated research about stepfamilies with the author's four decades of clinical practice with stepfamily relationships. It describes the ways in which stepfamilies are different from first‐time families. It delineates the dynamics of five major challenges stepfamily structure creates: (1) Insider/outsider positions are intense and they are fixed. (2) Children struggle with losses, loyalty binds, and change. (3) Issues of parenting, stepparenting, and discipline often divide the couple. (4) Stepcouples must build a new family culture while navigating previously established family cultures. (5) Ex‐spouses (other parents outside the household) are part of the family. Some available data are shared on the impact of cultural and legal differences on these challenges. A three‐level model of clinical intervention is presented: Psychoeducational, Interpersonal, and Intrapsychic/Intergenerational Family‐of‐Origin. The article describes some “easy wrong turns” for well‐meaning therapists and lists some general clinical guidelines for working with stepfamily relationships.     

ASSESSING AND TRAINING TEACHERS IN THE GENERAUZED USE OF BEHAVIOR MODIFICATION WITH AUTISTIC CHILDREN1

This study investigated the feasibility of developing reliable, valid criteria for measuring and training the skills necessary to teach autistic children. The behaviors of 11 teachers and 12 autistic children were recorded in a series of different teaching situations. Teacher-training was initiated at different times for different teachers. The results showed: (1) it was possible to assess empirically whether a teacher was correctly using defined behavior-modification techniques; (2) generally, for any given session, systematic improvement in the child's behavior did not occur unless the teacher working in that session had been trained to use the techniques to a high criterion; (3) all 11 teachers were rapidly trained to use these techniques; and (4) the teachers learned generalized skills effective with a variety of children and target behaviors.     

Rogers Redux: Relevance and Outcomes of Motivational Interviewing Across Behavioral Problems

Very little work regarding C. Rogers's (1961) client‐centered counseling has been published in the counseling discipline's journals over the last 20 years. However, during this time there has been an impressive output of empirical research using motivational interviewing (MI) in which C. Rogers's theory and approach are foundational. A review of MI's basic theoretical premises and applications for a multitude of behavioral problems are presented. Justification for integrating MI into counseling practice, training, and research is offered.