Client and therapist variability in clients' perceptions of their therapists' multicultural competencies

This study examined therapist differences in their clients' ratings of their therapists' multicultural competencies (MCCs) as well as tested whether therapists' who were rated as exhibiting more MCCs also had clients who had better therapy outcomes (N = 143 clients and 31 therapists). All clients completed at least 3 sessions. Results demonstrated that therapists accounted for less than 1% of the variance in their clients' Cross-Cultural Counseling Inventory–Revised (CCCI-R; T. D. LaFromboise, H. L. K. Coleman, & A. Hernandez, 1991) scores, suggesting that therapists did not differ in terms of how clients rated their MCCs. Therapists accounted for approximately 8.5% of the variance in therapy outcomes. For each therapist, their clients' CCCI-R scores were aggregated to provide an estimate of therapists' MCCs. Therapists' MCCs, based on aggregate CCCI-R scores, did not account for the variability in therapy outcomes that were attributed to them. Additionally, clients' race/ethnicity, therapists' race/ethnicity, or the interaction of clients'–therapists' race/ethnicity were not significantly associated with clients' perceptions of their therapists' MCCs.     

Videotaped simulated families as a tool in family therapy outcome research

Twenty-two therapists who had treated 57 families in brief conjoint family therapy under supervision responded to a videotaped simulated family as if they were treating it. Their responses were audiotaped and coded on a system devised for this study. Positive relationships were found between the ratings of expertise based on the coding system, and independent ratings of the treated families' satisfaction with treatment and the status of the presenting symptoms 6 months after termination. Videotaped simulated families are potentially useful as standardizable methods of revealing individual differences in therapists for family therapy outcome research.     

Perceptions of the therapist in family therapy

Thirty-five families completed ratings describing their perceptions of their therapists. These ratings were then correlated with measures of outcome to assess whether there was a relationship between experiences of the therapist and treatment outcome. Further, the study addresses whether some family members' perceptions are more influential in affecting the course of treatment. The results showed that family members' perception of the therapist does have an impact on treatment outcome, but not all members affect the outcome equally. Further results and their implications are discussed.     

Functions of nonsuicidal self-injury among young women in residential care: a pilot study with the Swedish version of the Inventory of Statements about Self-Injury

Nonsuicidal self-injury (NSSI) refers to the direct and deliberate destruction of one's own body tissue in the absence of lethal intent. The Inventory of Statements about Self-Injury (ISAS) is a recently developed instrument that taps both the frequency of different forms of NSSI and the self-perceived functions of the behaviour. The purpose of the present pilot study was to use the ISAS to study the functions of self-injury in a group of women with severe forms of NSSI who were treated within Swedish residential care settings and also to compare the patients' views with their therapists' views concerning these functions. Consistent with previous research, the patients reported intrapersonal functions (e.g. affect regulation and self-punishment) as more relevant than interpersonal functions (e.g. interpersonal influence and peer bonding). The therapists' ratings differed little from the patients' self-reports, although significant differences were found for some functions: The patients rated self-care and toughness as more important than the therapists did; the therapists, on the other hand, rated interpersonal influence and the marking of distress as more relevant than the patients did. Although the present study did not contain a full validation of the Swedish version of the ISAS, the results showed good internal consistency for the interpersonal and intrapersonal factors of the Swedish version.     

Relatives' Perceptions of Their Interactional Behavior with a Schizop/hrenic Family Member

Relatives' (N = 77 ) perceptions of their recent interactional behavior with a schizophrenic family member (N = 51 ), as measured by an adjective checklist, were compared with outside observer ratings of the relatives' Affective Style (AS) and the patients' Coping Style (CS) during a family interaction task. Results indicated that, overall, the relatives in the present sample perceived their own interactional behavior toward the patient, as well as the patients' behavior toward them, in a way that paralleled their affective behavior as assessed by outside raters. Moreover, the relatives' rated their relationship with the patient in a fashion that was more predictive of the observed interactional behavior of both the relatives and the patients than were the outside observers' ratings of the relatives' Expressed Emotion (EE) measured either at the patients' index hospitalization (using the Camberwell Family Interview, CFI-EE) or during the post-discharge period (assessed with a brief Five-Minute Speech Sample method, FMSS-EE).     

The hidden meanings of metaphors in family therapy

This study investigates how two therapists' beliefs and practices influence the therapeutic process when they organize social interaction according to a metaphor of a royal family. The therapeutic process is described through the case of a boy called Pelle. He comes to therapy together with his family. It is shown how the therapists collaborate in the process of implementing the worldview of the predefined normative standard for family life. In the short term the therapists' use of the metaphor can be seen as an intervention to accomplish immediate change in a non-threatening way. In the long term the cost of using the metaphor was that the mother got a confirmation about herself as a less powerful parent and the child got an image of being a failure. This study points out that metaphors as therapeutic tools have to be analyzed critically before they are used or more specifically the therapists have to examine what kind of values and meanings are hidden in the metaphor and who will gain and loose if it is used as an intervention.     

Gender and conversational behaviour in family therapy and live supervision

The association between supervisors' and therapists' gender and the conversational behaviour of four supervisors, nineteen trainee family therapists and twenty clients before, during and after eighty-eight live supervisory phone in events were examined in this study. Clients' co-operation was not directly related to the gender of therapists and supervisors. The quality of supervisors' collaborative behaviour was highest for events in systems where male supervisors were supervising male therapists and lowest for events in systems where male supervisors were supervising female therapists. In systems containing female supervisors and male therapists, therapists engaged in frequent collaborative behaviour and less frequent teaching behaviour with their clients. The quality of therapists' collaborative and supportive behaviour was highest in these systems. The unexpected results of this study suggest that the way supervisors interact with therapists and therapists interact with clients does not conform to gender stereotypic conversational behaviour in which males are directive and females affiliative. It may be that individuals whose conversational behaviour does not conform to gender stereotypes decide to become family therapists or that family therapy training helps people develop alternatives to gender-stereotypical conversational behaviour.     

Family history and gender roles: Critical factors in practitioners' views of family interactions

This study examined practitioners' perceptions of family and individual family member functioning in relationship to family roles, gender of family leadership, beliefs about the consequences of maternal employment, and paternal division of responsibility in practitioner family of origin. Practicing counselors and mental health therapists rated two videotaped family interviews, one demonstrating a matriarchal style of family interaction and the second a patriarchal style. Findings indicated that practitioners were vulnerable to view a patriarchal style of family interaction as more healthy in comparison to a matriarchal style and that their perceptions of family members were related to personal beliefs about the consequences of maternal employment and to personal family history. These and other findings suggest that practitioners may be prone to errant perceptions and misguided intervention related to personal history and attitudes.     

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.     

Assessment of therapists' and patients' personality: relationship to therapeutic technique and outcome in brief dynamic psychotherapy

My first focus of this study was to explore therapists' personal characteristics as predictors of the proportion of interpretation in brief dynamic psychotherapy (N=39; maximum 40 sessions). In this study, I used data from the Norwegian Multicenter Study on Process and Outcome of Psychotherapy (1995). The main finding was that therapists who had experienced good parental care gave less interpretation (28% variance was accounted for). Therapists who had more negative introjects used a higher proportion of interpretation (16% variance was accounted for). Patients' pretreatment characteristics were not predictive of therapists' use of interpretation. The second focus was to investigate the impact of therapists' personality and the proportion of interpretation on the development of patients' maladaptive defensive functioning over the course of therapy. Better parental care and less negative introjects in therapists were associated with a positive influence and accounted for 5% variance in the reduction of patients' maladaptive defense.     

The Effect of Therapist–Client Racial Similarity on Client Satisfaction and Therapist Evaluation of Treatment

Client satisfaction with therapy services and therapists' perspectives of treatment evaluation were examined in relation to therapist and client racial similarity. Secondary data from a university marriage and family therapy clinic located in the southeast was used to pair therapists and clients on racial similarity or difference. Statistical analyses revealed no major differences in clients' perceptions of satisfaction based on similarity to therapists' race. Therapists indicated some differences in their perceptions of the success of services provided to clients based on similarity to client's race. Implications for researchers, clinicians, and educators are included.     

Attributions and affective reactions of family members and course of schizophrenia.

The authors tested an attribution-affect model of schizophrenic relapse attending to the role of families' positive affect (warmth) and negative affect (criticism). Coders listened to interviews of 40 family members taken from C. E. Vaughn, K. S. Synder, S. Jones, W. B. Freeman, and I. R. Falloon (1984) and rated their attributions of controllability for the symptoms and behaviors of their relatives with schizophrenia. For family members not designated as emotionally overinvolved, perceptions that their ill relatives' symptoms and behaviors were under the patients' control were related to family members' warmth and criticism and to patients' clinical outcomes. Of the affective reactions, only criticism predicted outcome. In addition, patients' use of street drugs was related to attributions, criticism, and outcome. Together these findings suggest that families' attributions and criticism are important in understanding the relationship between family factors and course of illness.     

Relationships among client and counselor agreement about the working alliance, session evaluations, and change in client symptoms using response surface analysis

Two studies explored how counselor and client agreement on the therapy alliance, at the beginning of treatment, influenced early session evaluations and symptom change. Unlike prior studies that operationalized alliance convergence as either a profile similarity correlation or a difference score, the present study used polynomial regression and response surface analysis to examine agreement. Study 1 explored the impact of working alliance congruence on session depth and smoothness at the 3rd session of treatment with 36 client-counselor dyads. Results revealed that session smoothness was greater when clients' and therapists' perceptions of the working alliance were in agreement and high compared with when they were in agreement and low. In addition, clients rated sessions less smooth when their ratings of the alliance were lower than their therapists' ratings of the alliance, and they rated sessions as more smooth when their ratings of the alliance were higher than their therapists' ratings of the alliance. The authors did not find a significant relationship with session depth. In Study 2, the authors explored the impact of working alliance congruence, at the 3rd session of therapy, on symptom change for 63 client-counselor dyads. Results revealed that as the therapist and client have more positive agreement on the perceived alliance at the beginning of the treatment, there is greater symptom change. The authors also found that the consequences of alliance disagreement are the same regardless of who rated the alliance higher than the other. Implications and recommendations for future research are discussed.     

In the eye of the beholder: subjective and observer ratings of middle-class African American mother-adolescent interactions

Middle-class African American mothers and adolescents (n=81) participated in a dyadic interaction task in early adolescence (M=13.06 years, SD=1.27) and then again 2 years later (M=15.01 years, SD=1.27). Following the task, mothers and adolescents rated their own and their partner's support and involvement in the task; observers rated videotaped interactions for the same dimensions. African American mothers perceived adolescents' behavior in the interactions more positively than did observers, and both mothers and observers viewed mothers' behavior as more positive than adolescents' behavior. With observers' ratings controlled, early adolescents' more negative perceptions of their mothers' interactions led to less trust and communication with mothers 2 years later, but subjective understanding did not influence later ratings of conflict intensity.     

Self-esteem and perceptions of conveyed impressions: is negative affectivity associated with greater realism?

Two studies examined the notion that negative affectivity (Watson & Clark, 1984) is associated with more accurate perceptions of conveyed impressions in social interactions. In Study 1 (n = 160), low self-esteem (LSE) and high self-esteem (HSE) subjects were paired with either an LSE or an HSE partner. After a 15-min interaction, they rated themselves, their partners, and how they believed their partners would rate them on 20 adjectives related to social competence. Study 2 (n = 40) was identical except that each interaction was observed by 2 observers who rated each participant, and participants also rated how they believed an observer would rate them. LSE subjects exhibited greater accuracy only with respect to the elevation component of observers' ratings; HSE subjects overestimated the positivity of observers' evaluations, whereas LSE subjects were relatively accurate. However, LSE subjects exhibited less overall accuracy with respect to their partners' ratings. We argue that when these results are considered with earlier research, there is no support for the notion of depressive realism in assessing conveyed impressions.     

Supervisors' and Supervisees' perceptions of the effectiveness of family therapy supervisor interpersonal skills

Abstract

This study surveyed a randomly selected group of Approved Supervisors of the American Association for Marriage and Family Therapy (n=318) and their supervisees (n=299) on their perceptions of the effectiveness of several supervisor interpersonal skills. Both supervisors and supervisees had high ratings for the majority of the interpersonal skills and rated “respects the supervisee” most effective. Trends in supervisors' and supervisees' responses were assessed for (a) theoretical orientation, (b) supervision setting, (c) gender, (d) number of years supervising family therapists (for supervisors), and (e) number of years practicing family therapy (for supervisees).     

Conversational skill and locus of perception

The present study attempted to identify behavioral skills associated with global perceptions of communication competence and to determine if the relationship between competence and skills varies as a function of perceptual locus. Fifteen dyadic conversations were videotaped. Each interactant rated self and partner and was rated by four observers who viewed each tape. Results indicated that subjects' perceptions of their partners' skills accounted for 87% of the variance in subjects' ratings of partners' competence and 80% of the variance in subjects'self-perceived confirmation. Observers' ratings of subjects' skills predicted 83% of the variance in observers' ratings of subjects' competence. Observers'ratings of subjects'skills were unrelated to subjects' self-rated competence.     

Retrospective self-reports of therapist flexibility in a manual-based treatment for youths with anxiety disorders

Evaluated retrospective therapist ratings of the flexibility used when applying the procedures and strategies prescribed in the treatment manual. Flexibility ratings were collected from 18 therapists who had treated 148 children with anxiety disorders (ages 9 through 13). Analyses revealed strong reliabilities for a flexibility questionnaire and that flexibility was used by therapists; however, significant relations between therapist-rated flexibility and treatment outcome were not found. Discussion focuses on the role of flexibility in manual-based psychological treatments and future directions for study.     

Contrasting four major family therapy paradigms: implications for family therapy training

Four major paradigms of family therapy are contrasted: affective-experiential, structural, strategic and Milan. The differences are defined according to the way in which therapists think and behave in relation to their premises about change, and they are discussed under the following headings: historical roots and understanding of symptom formation; therapists' stance and techniques used in change; focus, goals and locus of change; and time perspective in change. Some suggestions are made with regard to training family therapists based on the differences that emerge when contrasting these models of family therapy.     

Manual-based cognitive behaviour therapy for chronic fatigue syndrome: therapists' adherence and perceptions

Several randomized controlled trials have indicated that cognitive behaviour therapy is an effective treatment for chronic fatigue syndrome. In 1 of these studies 13 therapists applied cognitive behaviour therapy for chronic fatigue syndrome in 83 chronic fatigue syndrome patients. In the present study therapists' adherence and perceptions of the manual are studied. Following completion of the study the therapists were asked to complete a questionnaire. Audiotaped sessions were conducted to verify the therapists' adherence. Analyses of the audiotapes showed that in 87% of the sessions this appeared to be the case. The questionnaire revealed that the therapists found it more difficult to treat patients with chronic fatigue syndrome than to treat patients with psychological or other physical problems. Treatment aspects posing the most problems were integrating individual problems into the standardized treatment, dealing with the patients' lack of confidence in the treatment and handling insufficient motivation.