Integrating clients' moment‐to‐moment ratings into psychotherapy research: A novel approach

Counselling and psychotherapy researchers have considerably advanced the field's understanding of psychotherapy processes and how they relate to treatment outcomes. Despite these advances, little is known about the client's perspective of changes in psychotherapy processes that occur throughout a given session (i.e. micro‐processes). To address this gap, this article describes the novel application of methods that assess participants' moment‐to‐moment ratings to psychotherapy research. This method entails recording psychotherapy session content that clients and other potential raters (e.g. therapists, researchers) later review while simultaneously providing continuous ratings of psychotherapy processes (e.g. helpfulness, alliance). In addition, moment‐to‐moment ratings can facilitate significant events research by prompting researchers to elicit client feedback about the moments that are rated the most and least positively. However, few studies have used these methods in the context of psychotherapy research. Studies incorporating these methods may yield findings that advance psychotherapy research, training efforts and clinical practice. For example, studies may examine how the magnitude and timing of clients' moment‐to‐moment ratings of psychotherapy processes are associated with treatment outcomes, therapist ratings and physiological processes (e.g. heart rate variability). Trainee therapists and their supervisors may also use clients' moment‐to‐moment ratings to facilitate attunement to verbal and non‐verbal indicators of moments perceived more positively and negatively. Last, these methods can produce findings that are highly relevant to clinical practice, where therapists routinely navigate fluctuations in psychotherapy processes (e.g. alliance ruptures) that can be assessed using moment‐to‐moment ratings.     

Adverse adolescence experiences,feeling lonely across life stages and loneliness in adulthood

Background/ObjectiveLoneliness is a mental health issue emerging over the life course. This study examines the latent structure of adult loneliness in a non-Western society and its association with adverse adolescence experiences (AAEs) as well as feeling lonely during middle school, high school, and college. Method: A cohort sample living in Northern Taiwan (N = 2,289) was analyzed from adolescence to adulthood. The de Jong Gierveld Loneliness Scale operationalized loneliness by a three-cluster model to present the latent structure of loneliness: emotional, serious emotional, and severe emotional/social loners. AAEs (e.g., abuse, neglect, and dysfunctional family) were measured by seven items. Multivariate multinomial logistic regression models were used to explore the longitudinal effects of AAEs and feeling lonely reported during middle school, high school, and college on adult loneliness. Results: AAEs and feeling lonely during adolescence were significantly associated with serious emotional loneliness and severe emotional/social loneliness during adulthood, even after adjusting for the individual’s characteristics. Attendance at a 4-year college was associated with decreased odds of serious emotional loneliness and severe emotional/social loneliness. Conclusions: Adults with AAEs and feelings of loneliness over life stages are more likely to report loneliness in the emotional and social domains.     

A taxonomy for scenes

Tomkins [Tomkins, S. (1979). Script theory: Differential magnification of affects. In: C. Keasey (Ed.), Nebraska Symposium on Motivation, Vol. 26 (pp. 201–236). Lincoln: University of Nebraska Press; Tomkins, S. (1987). Script theory. In: J. Aronoff, A. Rabin, & R. Zucker (Eds.), The Emergence of Personality (pp. 147–216). New York: Springer] proposed that personality is built from the experience of scenes, which minimally consist of an emotion and an event evoking that emotion. This study sought to identify a taxonomy of emotion-eliciting events. Examples of specific events eliciting love, joy, sadness, anger, and fear were collected from 200 participants, another 120 participants independently sorted these examples for similarity, and a hierarchical cluster analysis was run on these similarity sorts. The resulting tree diagram displayed categories of events at varying levels of abstraction. Individual differences were found in the types of events offered for each of the five emotions.     

Clients with borderline personality disorder: Exploring their experiences of dialectical behaviour therapy

This study explores clients’ experiences of Dialectical Behavioural Therapy (DBT). Five participants, all with a diagnosis of borderline personality disorder, were interviewed following a semi‐structured format about their experiences of an NHS regional DBT programme. The interviews were transcribed and analysed using Interpretative Phenomenological Analysis (IPA). Three superordinate themes were identified consisting of a number of sub themes: joining a DBT Programme (external and internal factors); experience of DBT (specific and non specific factors); and evaluation of DBT (change, evaluation and role of the past and future). The study provides an insight into clients’ experiences of DBT. The results are discussed in relation to clinical practice and future research.     

Combining experiences over time: the effects of duration,intensity changes and on-line measurements on retrospective pain evaluations

Two experiments were conducted to examine the effects of various factors on retrospective pain evaluation. The factors examined in Experiment 1 were the rate and pattern of change, the intensity (particularly the final intensity), and the duration of the painful experience. Experiment 2 manipulated these factors and, in addition, examined the effect of continuous (on-line) ratings on the overall retrospective evaluation. The two experiments utilized different pain modalities, heat in the first and mechanical pressure in the second. In addition, all subjects in Experiment 1 experienced stimuli with the same physical magnitude, while in Experiment 2 stimuli were individually tailored to make them subjectively equivalent. In both experiments, subjects were presented with a series of painful stimuli and evaluated the intensity of each stimulus immediately upon its termination. The stimuli themselves were composed of multiple intensity levels that differentially changed over time (Intensity-Patterns). Subjects' on-line ratings in Experiment 2 closely mirrored the physical patterns of the intensities. The main conclusion from both experiments is that the retrospective evaluations of painful experiences are influenced primarily by a combination of the final pain intensity and the intensity trend during the latter half of the experience. In addition, results indicated that duration has little impact on retrospective evaluations for stimuli of relatively constant intensity. However, when the stimulus intensity changes over time, duration does play a role. Finally, the task of continuously reporting the stimulus intensity had a moderating impact on the retrospective evaluations. © 1998 John Wiley & Sons, Ltd.     

An exploration of the mechanisms of change following an integrated group intervention for stuttering,as perceived by school-aged children who stutter (CWS)

PurposeTo explore the process of change and role of resilience following an integrated group intervention for children who stutter (CWS).MethodUsing an exploratory multiple case study design, this research sought to identify the most significant changes perceived by seven participants following therapy, the mechanisms of change, and the role of resilience in the process of change. Quantitative measurements of resilience were combined with qualitative analysis of semi-structured interviews.ResultsThematic analysis of qualitative data showed that cognitive and emotional change was a key driver for therapeutic change, enabled by the shared experience of the group and a positive therapeutic environment. These changes were generalised into clients’ real-world experiences, facilitated by their support network. Quantitative data demonstrated a statistically reliable positive change in overall Resiliency scores for four participants and reduced impact of stuttering scores on OASES-S for all participants, maintained at 12 month follow-up.ConclusionsThis study demonstrates the importance of adopting an integrated approach in therapy for CWS, which incorporates Cognitive Behavioural Therapy (CBT) as a key component, to facilitate change and build resilience. These results are unique to this cohort of CWS and further investigation into the use of CBT and the process of change may be warranted.Educational ObjectivesThe reader will be able to (1) describe the integrated intervention used in this study (2) define the most significant change following therapy for the participants involved (3) summarise the key factors that facilitated change during the therapy process (as perceived by the participants).     

Dissociative experiences and interrogative suggestibility in college students

The present study examined whether scores on the Dissociative Experiences Scale (DES) are related to interrogative suggestibility, as measured by the Gudjonsson Suggestibility Scale (GSS-1). In addition, an attempt was made to identify factors that may mediate this relationship. The DES and GSS were administered to a sample of 56 female undergraduate students along with self-report measures of cognitive failures and fantasy proneness. DES and cognitive failures were found to be related to total GSS scores. In contrast, fantasy proneness was not linked to total GSS scores. Correcting for the influence of cognitive failures attenuated the correlation between DES and GSS. This suggests that cognitive efficiency is one of the mediating factors operating in the connection between dissociation and interrogative suggestibility.