Clinical and demographic features of the online counselling client population

The purpose of this research was to determine the demographics and characteristics of clients seeking online counselling over an eight‐month period of clinical online practice. Two hundred and seventeen clients seeking Internet counselling completed a Counselling Application and a Life History Questionnaire. The characteristics of the relatively new client population include the following categories: gender, age groups, martial status, education, primary reason for seeking online therapy, secondary issues, frequency of email exchanges, and online vs. face‐to‐face counselling preferences. Implications for online counselling practice are discussed.     

Relationship between therapist empathy and client-perceived working alliance in China: A multilevel modelling analysis

This naturalistic study examined the relationship between two types of therapist empathy, intellectual empathy and empathic emotion, and client-perceived working alliance (WA) in China. The study adopted the definitions and assessment methods of empathy recommended by Duan and Hill and used the theory of WA by Bordin and WA Inventory-Short by Tracey and Kokotovic. Eighty-six clients and 43 therapists from a university counselling centre at a comprehensive university in China participated in the study. Therapist intellectual empathy and empathic emotion and client-reported WA measured in six consecutive sessions from the second through the seventh session were assessed for each session. The results of multilevel modelling analyses showed that client-perceived WA increased significantly session after session, and therapist empathic emotion significantly predicted Tasks of WA. Moreover, there was significant therapist effect associated with Bond. In the context of empathy and WA research findings reported in the USA, some of the non-significant results of this study were intriguing. We discuss the study results with particular attention to the Chinese cultural context and present suggestions for future research.     

Basic psychological needs satisfaction,working alliance,and early termination in psychotherapy

The goal of this study was to evaluate the relationship between basic psychological needs satisfaction and working alliance in psychotherapy and to determine whether client ratings of basic needs and working alliance during psychotherapy were associated with early termination of therapy. Former psychotherapy clients (n = 87) completed a semi-structured interview regarding basic needs satisfaction in therapy, working alliance and dropout status. Participant ratings on the Basic Needs Satisfaction in Psychotherapy scale (BNSP) and the Retrospective Working Alliance Inventory – Short (RWAI-S) were significantly correlated (r = .77) in our sample. A comparison of intercorrelations between working alliance subscales and basic needs subscales indicated higher factorial distinctiveness within the basic needs measure. T-tests comparing those who terminated psychotherapy early with those who had planned endings on scores on the BNSP and RWAI-S were significant (Cohen’s d = .65 and 1.82, respectively). Results suggest that the basic needs measure might tap into a wider breadth of the therapist and client interaction than the RWAI-S.     

A crisis mental health intervention service: an innovative model for working intensively with young people on the edge of care

This paper describes the setting up and the first year of running of an innovative outreach service for adolescents on the edge of care that aimed at redressing family breakdown and preventing placements in the care system. It was a collaborative endeavour between social services and a child and adolescent mental health provision to facilitate the engagement of hard to reach young people and families that often presented high levels of risk. This article describes a distinctive model of applied psychoanalytic work with individuals, families and the networks of practitioners and agencies around the case. It focuses on the integration of two perspectives: the individual and the family on the one hand and the organisation on the other. Case examples illustrate how our psychoanalytic and developmental framework illuminated our understanding of frequently extreme acting out behaviour and parental difficulties in terms of underlying intergenerational trauma, which was often re-enacted. This framework also helped in understanding the difficulties that practitioners experienced and how these related to individual and family dynamics. The article describes the significance of containment in the treatment of adolescents and families in crisis as well as in supporting the professional network.     

Clinician experiences of homework in couples and family therapy: A survey of perceived impact on the working alliance

The process of engaging clients in homework assignments has been studied extensively in research settings, but rarely have the challenges in the implementation of the science been considered in couples and family therapy. A survey was conducted of 226 clinicians regarding (1) their experience of homework adherence (quantity and quality) with couple and family clients, and (2) their experience of the impact of homework non-completion (IHN) on the working alliance. Clinicians working with families reported less overall homework quantity and quality. However, across both couples and family clients, more negative IHN was reported among clinicians experiencing less homework quantity, both in terms of IHN bond (couple ρ = 0.71, p < 0.001; family ρ = 0.78, p < 0.001) and IHN agreement (couples ρ = 0.25, p < 0.001; ρ = 0.19, p = 0.006), and among clinicians with fewer years of clinical experience (r = 0.19, n = 136, p < 0.05). The present findings suggest that, in the context of couples and family therapy, there is a risk of perceived negative IHN on the working alliance. There would be merit to future investigations examining the processes of facilitating homework engagement within the context of a strong working alliance.     

Relationship between orientation toward multicultural competence,multicultural competent behaviors,and working alliance: Examining a multigroup mediation model

In this study, the researchers examined the relationship among an orientation toward multicultural counseling competence, multicultural competent behaviors, and the working alliance from the perspective of 574 client participants across various therapeutic dyads. There was a positive relationship between clients’ perspectives on counselors’ multicultural orientation, counselors’ multicultural competent behavior, and working alliance. Multicultural competent behaviors mediated the relationship between an orientation toward multicultural competence and working alliance. However, the mediated effect was inconsistent across cross and similar racial/ethnic therapeutic dyads. Implications for counselors, limitations of the study, and future directions for research are provided.     

The supervisory alliance: Comparison of measures and implications for a supervision toolkit

Background Clinical supervision lies at the core of the professional development of clinicians providing services within a range of service settings. The supervisory alliance is regarded as the most important construct in effective supervision which underlies the importance of metrics to assess this construct. Aims materials and Method A cross‐sectional self‐report questionnaire design was used to examine clinical supervision constructs. The study used two scales measuring the supervisory alliance (SRQ and SWAI‐T), a scale measuring supervision satisfaction (SSQ) and a scale measuring disclosure (TDS). The questionnaires were administered to 127 clinical psychology trainees who were undertaking a practicum placement. Results Both scales measuring the alliance were positively correlated with satisfaction with supervision and disclosure, with similar sizes of correlation for each alliance scale. There was also a large, positive correlation between the two scales of measuring the alliance. Discussion Both scales were designed for use in supervision and are related to supervision outcome measures in the expected directions. Conclusion The SRQ has some distinct advantages over the SWAI‐T that lend the SRQ to be potentially more useful in clinical and research settings.     

Social integration and social support in a life crisis: Effects of macrosocial change in east Germany

This process evaluation study examined what variables moderate and mediate treatment effects on days in stable housing and client satisfaction for homeless mentally ill clients. In general, demographic characteristics did not moderate either outcome variable. Housing contacts, entitlement contacts, mental health contacts, and supportive services were significant mediators of the treatment effect on days in stable housing. Program contacts, mental health contacts, and supportive services were significant mediators of client satisfaction. The authors thank the National Institute of Mental Health for their financial support (MH43248, MH42357) for this project, Dorothy Gano for word processing and editorial assistance, and Gitry Heydebrand, Melissa Dannelet, Betty Tempelhoff, Ruth Smith, and Laeeq Ahmad for assisting in the interviews of clients. We are also appreciative of the cooperation given to us by the staffs of Malcolm Bliss Mental Health Center, St. Patrick's Center, the Community Advocacy and Support Alliance Program, and the St. Louisemergency shelters. Finally, we thank all of the participants in this study; we hope that their homelessness has now ended. (The conclusions presented in this paper are the sole responsibility of the authors and do not necessarily reflect official National Institute for Mental Health policy.)     

The impact of the socio-economic crisis on intrapsychic and intersubjective processes within the therapeutic relationship: Implications for the ethical practice of counselling psychology and psychotherapy

Using attachment and mentalisation theories as a framework, the present paper aims to explore the impact of the current socio-economic crisis on the micro-processes and interpersonal dynamics that emerge between client and therapist as well as the ethical dilemmas that surface within the context of the therapeutic relationship. The first part of the paper focuses on the intrapsychic level and the subjective appraisal and experience of the crisis, as this may differ from individual to individual as well as the unique meaning-making processes that take place for clients and therapists alike. It is argued that the socio-economic crisis itself cannot be seen as an entity that is entirely independent and external to the individual but as a phenomenon that interacts in unique ways with the individual’s inner current and past experience. The second part focuses on the exploration of intersubjective processes that emerge between client and therapist, in particular the transference-countertransference dynamic, as this develops within conditions of increased arousal and anxiety. The role and responsibility of counselling psychologists in preserving reflexivity, empathy and a mentalising stance (through supervision and personal therapy) are highlighted in order to safeguard the ethical and competent practice of counselling psychology.     

抑郁症网络化自助干预的效果及作用机制——以汉化MoodGYM为例

抑郁症是全球性的重要公共健康问题,抑郁症的网络化认知行为治疗近年来备受关注。本研究采用随机对照组试验考察抑郁症网络化干预程序Mood GYM中文版对中国大学生抑郁患者的在线干预效果,并且使用多重中介模型同时探索了基于临床实践提出的认知歪曲(ATQ和DAS)与认知领域研究发现的解释偏差(SST)在抑郁症网络化认知行为治疗中的作用机制。结果发现:(1)相较之对照组,Mood GYM对中国大学生抑郁的网络化自助干预具有中到大的效果量(CES-D,d=0.93;PHQ-9,d=0.79);(2)Mood GYM也显著降低抑郁患者的负性自动思维(ATQ)、消极解释偏差(SST)和功能失调性态度(DAS);(3)自动思维(ATQ)和消极解释偏差(SST)二者的改变在抑郁症网络化认知行为治疗效果中起中介作用,功能失调性态度改变的中介效应不显著。抑郁症的网络化干预还存在着诸如脱落率较高等多种局限,推荐作为传统心理治疗的额外补充手段,也可作为梯度治疗模型的自助式初级干预。