Working alliance for clients with social anxiety disorder: relationship with session helpfulness and within-session habituation

It has been suggested that a strong working alliance encourages clients to take risks during therapy (Raue, Castonguay, & Goldfried, 1993). This encouragement may be important for clients who fear negative evaluations as they engage in risk-taking elements of therapy. This study examined the relationship between working alliance, session helpfulness and measures of emotional processing in 18 clients undergoing cognitive behavior therapy (CBT) for social anxiety disorder. Results indicate a positive correlation between client-rated, but not observer-rated, working alliance and session helpfulness. Moderate levels of working alliance were associated with higher initial anxiety and deeper within-session habituation. Overall, a strong alliance was associated with clients engaging with the session and finding the session helpful. Implications for the use of CBT for social anxiety are discussed.     

Some Consequences for Helpers Who Deliver “Cold Comfort”: Why it's Worse for Women than Men to be Inept When Providing Emotional Support

Two experiments were conducted to assess whether responses to helpers who used insensitive emotional support vary as a function of the interaction between sex of participant and helper. We hypothesized that women would evaluate an insensitive female helper and her behavior more negatively than they would an insensitive male helper. In Experiment 1, participants (N = 137) read conversations in which male or female helpers sought to comfort emotionally distressed friends. In Experiment 2, participants (N = 87) engaged in face-to-face interactions in which they were comforted by either a male or female helper who used insensitive comforting messages. Overall, the results imply that women with deficient emotional support skills may be at high risk of rejection by same-sex peers. A preliminary report of Experiment 1 was presented at the biennial meeting of the International Association for Relationship Research, Madison, WI, July, 2004.     

Session helpfulness and session evaluation in short‐term counselling

The relationship between perceived session helpfulness and session evaluation was examined in 11 dyads during eight sessions of short‐term counselling. Results based on the Session Evaluation Questionnaire (Stiles, 1980) showed that, for clients, while depth, arousal, and positivity correlated with perceived session helpfulness, only depth and positivity entered a stepwise regression, yielding a multiple correlation of 0.76. For counsellors, while depth and positivity correlated with session perceived helpfulness, only depth entered the stepwise regression analysis, with a correlation of 0.70. Session depth also consistently correlated with change in perceptions of helpfulness from one session to another. Clients had higher depth scores for sessions that both participants rated as helpful. They had lower depth scores for sessions rated as less helpful by both participants or for sessions where participants disagreed in their helpfulness ratings. The centrality of counselling depth in affecting experiences of counselling helpfulness is discussed.     

Peer counseling in an online chat service: a content analysis of social support

In a recently launched one-on-one chat service for young people with psychosocial problems, young peer volunteers (ages 16-23) have a leading role in the conversations, comparable to the role of counselors in web-based and telephone-based child help-line services. A content analysis of the chat conversations showed that the contribution of the peer counselors in the confidential chat sessions satisfied the various quality criteria of the service. Moreover, the peer counselors offered the young people who visited the site varied types of social support. The variety of types of social support appeared a stronger predictor of the quality ratings than the length of the conversation or the quantity (instead of variety) of social support, which emphasizes the importance of multidimensional social support in online conversations.     

Writing characteristics of suicidal people on the Internet: a psychological investigation of emerging social environments

Three studies were carried out to investigate the writings of suicidal people on the Internet, hypothesizing consistent findings to equivalent research of offline writing. In Study 1, suicidal persons' (n = 34) attributions as the cause of their condition, as expressed in their free online writing, were compared to those of emotionally distressed, nonsuicidal (n = 16) and to nondistressed (n = 15) individuals. Results showed that suicidal persons have significantly more stable and global attributions than do the other groups. In Study 2, expressions of self-focus in online written messages were compared among suicidal, two levels of nonsuicidal but distressed, and nondistressed individuals (200 messages in each group). With the use of various expressions of self-focus, findings showed that suicidal people were distinctively self-focused in their writing, unlike their counterparts. In Study 3, psychologically relevant themes in the online writing of suicidal (n = 39) and highly distressed, nonsuicidal persons (n = 24) were compared. Results revealed that the former expressed significantly more unbearable psychological pain and cognitive constriction than did the latter. The findings of the three studies are consistent with those found in examinations of offline writing. The research has important implications for the use of online environments for psychological research and means for assessment, as well as for understanding suicidality.     

The perceived helpfulness of rendering emotional first aid via email

The present research examined the perceived helpfulness of an increasingly widespread mode of psychological assistance, namely, emotional first aid via email. The sample comprised 62 naturally occurring email interactions between distressful clients and trained volunteers operating within the framework of the Israeli Association for Emotional First Aid. Data were gathered by means of a structured questionnaire and open-ended questions so as to examine the clients' motivation to seek help via email and evaluate their satisfaction with the responses obtained. The results revealed a preference for written communication and the accessibility of assistance to be the most frequent reasons for clients to choose the medium of email. Most clients found the responses to be helpful in providing emotional support, enhancing cognitive change and suggesting practical ways of coping. Women perceived the assistance to be more helpful than men did. The results are discussed in terms of the unique value of email as an agent of mental health assistance.     

web‐assisted vocational test interpretation

Despite the increasing availability of online counseling services, many questions remain unanswered. This study compared the effectiveness of a specific employment counseling activity, vocational interest inventory interpretation, across 3 delivery modalities: (a) online text chat; (b) online text chat with video cues; and (c) traditional, face‐to‐face interpretation. The difference in ratings of session value between text chat with video and face‐to‐face modalities was not significant; both were rated significantly higher than text chat alone. The results provide tentative support for online delivery of vocational test interpretation if video cues are available but suggest caution with use of text chat alone.     

Partners and Fellow Patients: Two Sources of Emotional Support for Women with Breast Cancer

This study examined the helping process that occurred when 26 breast cancer patients (the disclosers) talked about their illness-related concerns with their partner and, in a separate conversation, with a fellow patient (the volunteer helpers). The conversations were rated by trained observers and by the disclosers in terms of several process and outcome variables. From the observers' perspective, the volunteer helpers were more helpful, empathic, and supportive, less critical, and used more self-disclosure than the partners. Disclosers did not differentiate between the two types of helper, and gave generally high ratings to both conversations. Strengths and weaknesses of each type of helper were identified. Findings are discussed in relation to the literature on formal and informal helping, and implications for training nonprofessional helpers are suggested.     

The Relationship Between Momentary States of Therapist Self-Awareness and Perceptions of the Counseling Process

To investigate the role of momentary self-awareness, beginning therapists and their volunteer clients participated in a postsession process recall in which therapist helpfulness and momentary self-awareness were assessed along with client reactions. Therapist anxiety levels and strategies used to manage hindering self-awareness were also examined. Results suggest that momentary states of heightened therapist self-awareness may be hindering. Specifically, when therapists rated themselves as more self-aware from moment to moment during counseling sessions, they also rated themselves as more anxious before the session and their clients rated them as less helpful during the session. In addition, therapists reported using a variety of strategies to manage distracting self-awareness, including focusing on intervention planning and focusing on the client. Implications for therapist training are discussed.     

Dysphoria and Children's Processing of Supportive Interactions

This study examined the processing of supportive interactions by dysphoric and nondysphoric preteens and early adolescents. Seventy-two youngsters between the ages of 10 and 13 evaluated the supportiveness and helpfulness of standardized, videotaped interactions between a distressed preadolescent and a maternal figure. The tape presentations varied in terms of the level of depicted maternal support and instructional condition (degree of self-reference). The results indicated that dysphoric youngsters evaluated both the supportiveness and helpfulness of interactions less positively than nondysphoric agemates. Group differences in support evaluations were most pronounced in the self-referenced condition. The level of depicted support did not affect processing differences. Dysphoric subjects reported lower levels of emotional support in prior relationships and a greater tendency to view supportive behavior as ingenuine than nondysphoric peers. Variation in prior support experiences accounted for group differences in the evaluation of the supportiveness of new interactions.     

Person‐Centered Emotional Support and Gender Attributions in Computer‐Mediated Communication

Without physical appearance, identification in computer‐mediated communication is relatively ambiguous and may depend on verbal cues such as usernames, content, and/or style. This is important when gender‐linked differences exist in the effects of messages, as in emotional support. This study examined gender attribution for online support providers with male, female, or ambiguous usernames, who provided highly person‐centered (HPC) or low person‐centered (LPC) messages. Participants attributed gender to helpers with gender‐ambiguous names based on HPC versus LPC messages. Female participants preferred HPC helpers over LPC helpers. Unexpectedly, men preferred HPC messages from male and gender‐ambiguous helpers more than they did when HPC messages came from females. Implications follow about computer‐mediated emotional support and theories of computer‐mediated communication and social influence.     

Mastery or mystery? Therapeutic writing: A review of the literature

Recent developments in online support and counselling suggest that the users of chat rooms, for example, or the Samaritans' e-mail 'listening' service, have already discovered the power of writing as a self-help vehicle. Developments in computer-mediated counselling and therapy are essentially text-based and client-driven. The therapeutic use of expressive and reflective writing is not widely recognised in British counselling and therapy circles. The empirical foundations for the therapeutic uses of the literary arts are, however, well established. This review aims to map the use of 'writing therapy' by drawing together cross-disciplinary research and practitioner reports which might support the place of writing as a creative therapy in its own right, whether as an adjunct to face-to-face counselling or as a self-help tool.     

Avatar‐based counselling for young people within school counselling. Qualitative analysis of client experience

Background

This study is a qualitative analysis of clients’ experiences of a new avatar based counselling intervention, based on the ‘ProReal’ software ( www.proreal.world ). The intervention was piloted in eight secondary schools in the UK in 2016.

Aims

Twenty‐nine participants (53% of the full sample) were interviewed about their use of the software, experience of the intervention, process of change and views about its helpfulness.

Materials and Methods

Interviews were semi‐structured and were analysed using thematic analysis.

Results

The analysis shows that the intervention was potentially attractive to these clients, particularly those enthusiastic about digital software and clients who found visual communication helpful. The software provided additional opportunities for clients to communicate their inner worlds to the counsellor and supported the development of insight. Male clients, in particular, commented on its helpfulness.

Discussion

There is an indication that digital imagery supported the process of change in counselling and the development of meaning bridges: both internally and with the counsellor (Stiles, 2011; Stiles et al., 1990). However, the software could be experienced as an obstacle when clients wanted to talk about specific problems or ‘vent’ their feelings. All clients who reported that they did not find the software helpful were female. There were a number of suggestions about developing the software to increase opportunities for expression as well as appropriateness for clients from different minority ethnic backgrounds.

Conclusion

Use of digital software in counselling has a potential to enhance communication and support a process of change, particularly with male clients, those who find visual communication helpful, and clients enthusiastic about digital technology. Further research is needed to develop the intervention and compare it to the use of other creative media in counselling.     

Cybertherapy or psychobabble? A mixed methods study of online emotional support

ABSTRACT

The provision of online counselling and emotional support is a subject of intense debate among service providers. The subject is explored here by triangulating data from a statistical analysis of data from a children's helpline, interviews with practitioners and a focus group. Despite practitioners' concerns relating to misinterpretation, misrepresentation and the lack of non-verbal cues, online conversations are shown to span a greater variety of topics and focus on more sensitive issues than verbal sessions. Online services have potential for reaching clients in accessible and meaningful ways. However, practitioners need to consider online-specific issues, undertake specialised training and become comfortable with these new communication formats.     

Issues in Professional Training to Implement Evidence‐based Parenting Programs: The Preferences of Indigenous Practitioners

Indigenous children have elevated risk for poor health, behavioural, emotional, and social outcomes. Significant evidence exists that parenting programs can reduce family risk factors and improve outcomes for children and families; however, mainstream programs have had slower uptake in Indigenous communities than other communities. Culturally sensitive delivery of evidence‐based programs can enhance engagement of parents, yet the development of a workforce to deliver programs to Indigenous parents faces many obstacles. This project seeks to identify professional training processes that enhance Indigenous practitioners’ skills and confidence in delivering an evidence‐based parenting program. A survey of trained parenting practitioners via an online practitioner network assessed their views of the training and post‐training support processes they had experienced. Respondents were 57 Indigenous and 720 non‐Indigenous practitioners from 15 countries. Most training processes were rated equally helpful by Indigenous and non‐Indigenous practitioners. However, several training processes were identified as important for the delivery of culturally competent training, such as tailoring the pace of training and simplifying the language in teaching resources. Practitioners with higher ratings of the helpfulness of peer support following training reported higher program uptake and implementation. Qualitative themes also focused on the helpfulness of program resources, and having a peer support network and mentoring. Increasing access to appropriate, flexibly delivered training and post‐training support for Indigenous professionals will support the development of a skilled workforce with local knowledge and connections, and further increase the reach of evidence‐based services in Indigenous communities.     

心理咨询中领悟质量的评定依据——当事人和咨询师的视角

为获得当事人和咨询师对心理咨询中领悟质量的评定依据,采用协商一致的质性研究方法分别对13位当事人和15位咨询师的访谈材料进行分析。结果：当事人的评定依据包括影响力和特性;而咨询师的评定依据包括影响力、特性、类型、产生方式以及当事人对领悟的接纳程度。结论：领悟的影响力和领悟的特性是评定领悟质量的重要依据。     

The secure-base hypothesis: Global attachment, attachment to counselor, and session exploration in psychotherapy

This study explored J. Bowlby's (1988) secure-base hypothesis, which predicts that a client's secure attachment to the therapist, as well as the client's and the therapist's global attachment security, will facilitate in-session exploration. Volunteer clients (N = 59) and trainee counselors (N = 59) in short-term therapy completed the Experiences in Close Relationship Scale (K. A. Brennan, C. L. Clark, & P. R. Shaver, 1998) as a measure of adult global romantic and peer attachment orientations; the Client Attachment to Therapist Scale (B. Mallinckrodt, D. L. Gantt, & H. M. Coble, 1995) as a measure of attachment to counselor; the Working Alliance Inventory (A. O. Horvath & L. Greenberg, 1989) as a measure of working alliance; and the Session Evaluation Questionnaire-Depth Subscale (W. B. Stiles & J. S. Snow, 1984) as a measure of session depth. In line with Bowlby's hypothesis, the findings suggest that session depth is related to the client's experience of attachment security with the counselor and that counselor global attachment moderates the relationship between client global attachment and session exploration. (PsycINFO Database Record (c) 2010 APA, all rights reserved).     

Therapist Perceptions of Client Reactions

This study examined therapist ability to identify client-reported reactions. Sixteen therapists each saw two volunteer clients for single counseling sessions. In postsession reviews, clients rated the helpfulness of, and indicated their reactions to, each therapist intervention. Therapists also rated the helpfulness of, and indicated their perceptions of client reactions to, each therapist intervention. In 50% of the instances therapists matched clients, that is, reported the same reaction cluster as the clients did. There were higher match rates on the reaction clusters of therapeutic work (62%), supported (54%), and no reaction (46%) than negative reaction (27%) and challenged (14%). When therapists matched on therapeutic work, helpfulness ratings for the following intervention were higher than when therapists did not match. In contrast, when therapists matched on negative reactions and no reaction, helpfulness ratings for the following intervention were lower than when they had not matched. Thus, therapists' ability to match client reactions was related to their ability to generate helpful interventions. Implications for practice and future research are discussed.