Individual differences in misremembering pre-psychotherapy distress: personality and memory distortion

In 2 studies, clients were asked, after terminating psychotherapy, to complete a measure of symptomatic distress exactly as they had in their pre-therapy assessment. Most clients overestimated their pre-therapy distress, which may lead to an illusion of positive change. A 3rd study found no overestimation of previously reported distress in a control sample. The degree of overestimation for psychotherapy clients was positively correlated with anxiety, depression, and neuroticism, and negatively correlated with ego strength, self-deception, and lying. Distress levels at termination mediated these effects of individual differences. Individual differences were also correlated with specific types of recall error, such as adding to, exaggerating, omitting, and minimizing previously reported symptoms. Misremembering prior emotions may both reflect and create individual differences.     

Integrating Spirituality and Religion Into Psychotherapy: Persistent Dilemmas,Ethical Issues,and a Proposed Decision-Making Process

Religion and spirituality are important aspects of the lives of most psychotherapy clients. Unfortunately, many psychotherapists lack the training to effectively and ethically address these issues with their clients. At times, religious or spiritual concerns may be relevant to the reasons clients seek treatment, either as areas of conflict or distress for clients or as sources of strength and support that the psychotherapist may access to enhance the benefit of psychotherapy. This article reviews persistent ethical issues and dilemmas relevant to providing psychotherapy to clients for whom issues of religion and spirituality are clinically relevant. Ethical considerations include assessment, advertising and public statements, informed consent, competence, boundary issues and multiple relationships, cooperation with other professionals, and how to effectively integrate religious and spiritual interventions into ongoing psychotherapy. A decision-making process is presented to guide psychotherapists in their clinical work with clients for whom religious and spiritual issues are salient or clearly linked to their presenting problems.     

Simulated situations in group psychotherapy training revisited

A simulated group training model serves as the modality which best captures a balance of didactic and experiential elements, en vivo supervision and consultation, working with the trainees' most difficult clients in a therapeutic group. Limitations of this approach can be most appropriately addressed by personal psychotherapy outside of the training program.     

Toward making progress feedback an effective common factor in couple therapy

Systematic monitoring of individual therapy progress, coupled with feedback to the therapist, reliably enhances therapy outcome by alerting therapists to individual clients who are off track to benefit by the end of therapy. The current paper reviews the possibility of using similar systematic monitoring and feedback of therapy progress as a means to enhance couple therapy outcome, including what measures of therapy progress are most likely to be useful, how to structure feedback to be most useful to therapists, and the likely mediators of the effects of therapy progress feedback. One implicit assumption of therapy progress feedback is that clients unlikely to benefit from therapy can be detected early enough in the course of therapy for corrective action to be taken. As a test of this assumption, midtherapy progress was examined as a predictor of final couple therapy outcome in a sample of 134 distressed couples. Either a brief 7- or 32-item assessment of couple therapy progress at midtherapy detected a substantial proportion (46%) of couples who failed to benefit by the end of therapy. Given that failure to benefit from couple therapy is somewhat predictable across the course of therapy, future research should test whether systematic monitoring and feedback of progress could enhance therapy outcome.     

Qualitative meta-analysis of insight events in psychotherapy

Purpose: This study reports on a qualitative meta-analysis examining the phenomenon of insight into psychotherapy. Method: Studies (n?=?7, covering 15 insight events of 15 clients) were selected that examined significant events in psychotherapy leading to insight using session recordings and Interpersonal Process Recall interviews with clients and therapists. A conceptual organization of the data using a matrix grid consisting of three domains according to data origin (client process, therapist process, and their interaction) and three domains according to events’ sequence (context, event and key intervention, and impact) was established. Results: Key processes were identified that lead to insight events in psychotherapy. Two distinct types of events according to their main impacts as reported by the clients were identified: Painful/Poignant Insight where clients realized something that was painful, often evoking feelings of sadness or undifferentiated upset containing sadness and hurt; and Self-Asserting/Empowering Insight that led to an impact characterized by a sense of self-assertion and empowerment on the client’s part. A reasonably good alliance and vulnerability on the client’s part represent the context for insight events as does the client’s quest for self-understanding. The therapists’ key interventions in the event leading to poignant/painful insight contain either empathic reflection or collaborative interpretation. In empowerment/self-assertive insight events the therapists offer supportive, validating reframing promoting positive experience. In both types of events the therapist and the client work on consolidating insight. In some events, therapists emphasized cognitive or problem solution focused impacts, while clients emphasized emotional impacts. Some events contained emotional avoidance on the part of the client or therapist thus not realizing the full potential of the event.     

Toward the re‐enchantment of psychotherapy: Stories as container

Abstract

Storytelling by a therapist to clients may serve to increase clients’ ability to bear pain, to increase self‐complexity, and expand clients’ senses of the allowable. A model delineating the therapeutic impact of therapist storytelling in psychotherapy is proposed. Stories may change clients’ selves so that they may accommodate traumatic experiences and internal complexity. Stories increase clients’ capacity to tolerate painful experience and therefore serve as a container of tragic life experiences. The artistry of therapeutic story selection is defined as choosing stories consonant with clients’ strengths, rather than with the nature of the trauma. The power of story‐listening to alter consciousness in pleasant ways (storystoned) increases its usefulness as an intervention that is neither anxiety provoking nor re‐traumatizing.     

Effects of Neuro-Linguistic Psychotherapy on psychological difficulties and perceived quality of life

Aims: The purpose of this study was to examine the effects of Neuro-Linguistic Psychotherapy on psychological difficulties and perceived quality of life of clients who came for psychotherapy during free practice. Method: A total of 106 psychotherapy clients were randomly assigned to a therapy group or a control group. The outcome was assessed by the Structured Clinical Interview for DSM-IV Personality Disorders (SCID II) with respect to clinical symptoms and by the Croatian Scale of Quality of Life (KVZ) with respect to Quality of Life. The therapy group received the measures at pre-, post- and five-months follow-up occasions, whereas the control group received them initially and after a period of three months. Results: In the therapy group, as compared to the control group, there was a significant decrease of clinical symptoms and increase in the quality of life. With respect to clinical symptoms, effect sizes were 0.65 at post-measurement and 1.09 at follow-up, indicating a substantial reduction of symptom strain, which is comparable to the well established effects of Cognitive Behavior Therapy. We also found a significant increase in perceived quality of life after therapy, as compared to the wait-list control group, with effect sizes between 0.51 and 0.73. Therapeutic improvements were still present five months after the end of therapy, showing further development in the same direction. Conclusions: Neuro-linguistic psychotherapy is an efficient intervention, which is on a par with other, well-established psychotherapeutic techniques.     

Symptomatic distress and effectiveness of psychological treatments delivered at a nationwide student counseling service

The aim of this study is to investigate the effectiveness of student counseling in Denmark and to compare the symptomatic distress among student counseling clients with that of Danish outpatients. The pre-intervention level of self-reported symptomatic distress among 1256 students closely paralleled that of psychiatric outpatients. Participants in the intervention study were the 739 student clients with two or more counseling sessions. For the 530 (71.7%) participants with both pre- and post-measurements, the mean pre–post Cohen’s d effect size (ES) was .76 on the Global Severity Index of the Symptom Check List-90-Revised. An intention-to-treat analysis of all 739 clients resulted in an ES of .59. The number of recovered clients according to the Jacobson and Truax criteria was 295 (68.8%) of the 429 (80.9%) clients above the clinical cut-off at pre-intervention, while 66 (12.5%) of the 530 clients reliably deteriorated. The mean number of sessions was 5.0. Individual counseling, number of sessions, and ending counseling in agreement predicted better outcome. In line with results from other countries, this study may indicate that in Denmark student counseling is an effective intervention for a highly needy clientele, even though a high proportion of clients deteriorated (12.5%) or dropped out (31.7%).     

Symptom reduction and termination: client change and therapist identified reasons for saying goodbye

Empirical efforts have focused on predicting whether or not clients prematurely terminate therapy, with nonattendance of last session equated to premature termination. However, this fails to explore the relationship between clients’ distress reduction and reasons for termination. With this study, we aimed to understand how clients’ distress change relates to premature termination and examine clients’ distress change in conjunction with therapists’ perceptions of termination reasons. We collected data from 797 clients who prematurely terminated or attended termination but completed therapy a minimum of three individual sessions provided by 38 therapists. Clients completed an assessment of psychological symptoms before each session. At the end of treatment, therapists identified the reasons they believed termination occurred for all clients in the sample. Results demonstrate that total sessions attended and missed predict premature termination, whereas distress change does not. Additionally, clients who were believed to accomplish goals do show greater change. However, therapists’ indicated that over half of clients did not reach goals at termination and they did not perceive nonattendance at last session to equate to drop out in all cases. Implications are discussed with respect to understanding why clients’ terminate, therapeutic goal conceptualization, and review of goals during termination in time-limited psychotherapy.     

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.     

Acceptance and commitment therapy (ACT) for people with dementia experiencing psychological distress: A hermeneutic single-case efficacy design (HSCED) series

Introduction

People with dementia have a high prevalence of psychological distress but are underserved with evidence-based psychological interventions. To promote choice and improve clinical outcomes, there is a necessity to test different psychological intervention options for this population.

Purpose

This study aimed to investigate the effectiveness and acceptability of acceptance and commitment therapy (ACT) for people with dementia, considering carer-supported, remote delivery and necessary therapy adaptations.

Methods

A hermeneutic single-case efficacy design series was used to analyse the therapy process and change for three clients with dementia and psychological distress. A matrix of quantitative and qualitative data was collated (“rich case records”) and subject to critical analyses by three independent psychotherapy experts (“judges”) who identified change processes and determined the outcome for each client.

Results

Adjudication concluded that one client made positive changes, specifically reliable reductions in psychological distress, which were largely attributable to ACT. Two clients remained unchanged.

Discussion/Conclusion

Where change was achieved, the ACT-specific processes of values, committed action and acceptance, in combination with non-specific therapy factors, including a strong client–carer relationship, existing client interests and individualised therapy adaptations, were facilitative. Hence, ACT may be a feasible and effective vehicle for therapeutic change by helping carers to better meet the needs of their loved ones. Future research to optimise ACT delivery in this population may be beneficial. Furthermore, the assessment of carer factors (e.g., their psychological flexibility and the client–carer relationship) may strengthen the evidence base for systemic ACT use.     

Psychological Distress in Australian Clients Seeking Family and Relationship Counselling and Mediation Services

There is little published data on the prevalence of psychological distress among individuals and couples seeking counselling and mediation services from non‐government organisations (NGOs). This national cross‐sectional study establishes the prevalence of psychological distress among clients seeking family and relationship counselling and mediation services from Relationships Australia. A national sample of 1,365 clients attending services in April to May 2012 completed the 10‐item Kessler Psychological Distress Scale (K10) after their first counselling or mediation session. Individual counselling (M = 23.01, SD = 8.97, 95% CI [22.05–23.97]) and couple counselling (M = 21.63, SD = 8.10, [20.86–22.41]) clients reported a mean K10 score comparable to those reported by clinical studies of clients with anxiety or affective disorders. One quarter to one fifth of these clients reported very high psychological distress. Clients accessing mediation services had a mean score of 18.13 (SD = 7.76; [17.51–18.75]), and one tenth of clients reported very high distress. These elevated rates of very high psychological distress suggest that mental health issues may be a significant problem for a large proportion of clients accessing counselling and mediation NGO services provided under Family Support Programs (FSP) funding. Implications for screening for mental health and appropriate treatment planning are discussed.     

Changes in meaning in life across the course of psychodynamic psychotherapy

Using the Meaning in Life Questionnaire (MLQ), we studied Presence and Search for meaning for 34 adult clients in psychodynamic psychotherapy. Clients completed the MLQ and Outcome Questionnaire (OQ) before intake and after every eight sessions. Variance in Presence scores was mostly attributable to clients; variance in Search scores was mostly attributable to clients and therapists. Clients initially high in Presence decreased and then increased back to initial levels; clients initially low in Presence increased and then decreased back to initial levels. Clients initially low in Search increased and then leveled off; clients initially high in Search decreased and then leveled off. In lagged cross panel analyses, when clients decreased in psychological distress during one eight-week time period, they increased in Presence during the next eight-week time period; when they increased in psychological distress during one eight-week time period, they increased in search in the next time period. Excerpts from post-therapy interviews illustrate the process of working with meaning in life in psychotherapy. Implications for practice and training are discussed.     

Negative Treatment Effects in Dyadic Psychotherapy: A Focus on Prevention and Intervention Strategies

Therapy holds the potential to harm as well as help. This paper highlights approaches that may help prevent or decrease the incidence of negative effects in psychotherapy. These approaches include supervision, peer consultation, ongoing assessment of the therapeutic process, therapist-client matching, and referrals and transfers. We hope that this paper will serve as a stimulus for clinicians, psychotherapy researchers, and educators to put forth collabo-rative effort into identifying variables directly associated with adverse treat- ment outcomes and determining appropriate prevention and intervention strategies.     

Psychological Distress with Direct-to-Consumer Genetic Testing: A Case Report of an Unexpected <Emphasis Type="Italic">BRCA</Emphasis> Positive Test Result

We report a case of a client who discovered she had a BRCA mutation following direct-to-consumer (DTC) genetic testing in the absence of genetic counseling. After testing she presented for genetic counseling with anxiety, distress, and a deficit of knowledge about what the DTC genetic testing revealed. Genetic counseling helped alleviate distress while empowering the client to apply the results of testing to improve medical management. Despite recent studies demonstrating no negative psychological impact of DTC genetic testing on the consumer, this case illustrates that significant psychological distress and confusion can occur as a result of DTC genetic testing for highly penetrant single gene disorders. Pre- and post-test genetic counseling in conjunction with DTC genetic testing may alleviate consumers’ distress and empower clients to proactively utilize their result information.