Client-therapist Interaction Research Articles

Youth-Therapist and Parent-Therapist Match and Mismatch on Internalizing and Externalizing Treatment Goals as Predictors of Treatment Engagement.

Therapist-client cognitive match upon key constructs such as treatment goals is purported to be an important component of culturally competent care. For adolescent clients, treatment may involve both youths and their parents, suggesting the need to consider both youth-therapist and parent-therapist perspectives. This longitudinal study examined broadband youth-therapist and parent-therapist treatment goal matching and mismatching in relationship to treatment engagement in a culturally diverse sample of 245 outpatient mental health service-using youth. Although goal matching/mismatching did not uniformly predict treatment engagement as measured by a total score, youth-therapist internalizing goal matching predicted better youth engagement, and parent-therapist externalizing goal mismatch marginally predicted worse parent engagement. When selected post hoc analyses examined relationships to four individual engagement dimensions, youth-therapist internalizing goal matches positively predicted youth Client-therapist interaction, Communication/Openness, Client's perceived usefulness of therapy, and Collaboration with treatment, while parent-therapist externalizing goal mismatch negatively predicted parent Collaboration with treatment. Findings support the importance of cognitive match on treatment goals as well as the consideration of both parent and youth perspectives, matched and mismatched goals, internalizing and externalizing goals, and examining individual dimensions in addition to total scores of engagement.

Doing-together with words: the sequential unfolding of a moment of meeting in a psychoanalytic therapy session.

Changes in psychoanalytic therapy have been traditionally attributed to self-knowledge (insight) in the client, provided by the therapist's interpretations. In recent years there has been growing realization that such changes can also be the consequence of the development of new forms of relatedness through client-therapist interaction, particularly through special intersubjective moments called moments of meeting. Drawing on the methods and findings of Conversation Analysis about the sequential organization of psychotherapeutic interaction, this single-case study examines the unfolding of a moment of meeting in the final session of a brief psychoanalytic therapy in Peru (in Spanish) with a female client victim of domestic violence. Our analysis shows that the moment of meeting, which resolves a challenge to the intersubjective relationship posed by a now moment, comes about interactionally through a sequentially accomplished shared practice of co-animation. In this sequence the client, who had previously assumed a passive role, exercises her own agency to assume an active role, which the therapist ratifies through his response. In this way, a momentary but significant transformation in the here-and-now relationship between client and therapist occurs. Thus, our analysis contributes to the understanding of how a transformation of relation-the transitory emergence of a new form of relatedness-can take place in and through sequentially organized talk and action in psychotherapy. Our study also sheds light on the role of language in moments of meeting, as the moment of meeting in our segment does not occur in parallel with the exchange of linguistic utterances between client and therapist, but through the exchange of such linguistic utterances and through the sequence of actions carried out by that exchange. In this way, the sequential doing-together with words leads to a moment of meeting, bringing about change, at least momentarily, in the implicit ways-of-being-with-others of the client.

Respiratory Sinus Arrhythmia as a Therapy Measurement Strategy: The Example of Functional Analytic Psychotherapy

Introduction: Respiratory sinus arrhythmia (RSA) may be a psychophysiological measure that can gauge change processes in psychotherapy. RSA is a cardiovascular marker of nervous system functioning and has been proposed as an index of social engagement. Given the emphasis on social relationships in Functional Analytic Psychotherapy (FAP), RSA may be useful for understanding the process of change in FAP. The current study details the logic of using RSA as a measurement tool and provides data to establish proof of concept. Methods: RSA data were collected from three participants in a multiple baseline experiment which involved a control condition of reading two-person plays and a FAP condition. Sessions were coded using the FAP Rating Scale. RSA was calculated for each session and each client-therapist interaction. Results: RSA higher during FAP sessions (P1Mean = 6.60, P2Mean = 6.41, P3Mean = 6.32) than the control condition (P1Mean = 6.29, P2Mean = 5.79, P3Mean = 5.96). Conclusions: Data are consistent with outcomes that might be anticipated during therapy and suggest RSA could improve as a function of treatment. RSA was able to be isolated for therapeutic moves when coded at the turn-by-turn level. Thus, data suggest RSA’s utility for measuring therapy processes and outcomes.

Assessing the effectiveness of animal-assisted therapy on alleviation of anxiety in pre-school children: A randomized controlled trial

Objective & backgroundHuman-animal interactions are considered as being valuable and beneficial for the psychological health. Recently Animal-Assisted Therapy (AAT) has been included for client-therapist interaction. The purpose of the present study was to assess the effectiveness of animal-assisted therapy in alleviation of anxiety in pre-school children. MethodThe study was carried out as a randomized controlled trail with pre-test and post-test design and control group. The trial was registered in the Chinese Clinical Trial Registry with the registration id of ChiCTR2000034145. The study consisted of 33 anxious 5–7years old children (participated in a welfare anxiety screening plan held by Counseling Center, Tehran-Iran) between 2018 and 2019. The participants took part in the study voluntarily. The subjects were randomly divided into experimental and control groups (10 in each group). The experimental group was exposed to 8 sessions of animal therapy. The research instrument used in the present study was Spence Preschool Anxiety Scale (Parent Form) and the data were analyzed on SPSS 21 software. ResultsThe results showed that animal therapy had a significant effect on general anxiety after adjusting for post-test assessments (f = 32.49 and p = 0.001) with the effect equal to 0.70. In addition, the effect of animal therapy on anxiety of separation (f = 5.63, p = 0.03), generalized anxiety disorder (f = 8.56, p = 0.01), social phobia (f = 14.58, p = 0.002) and specific anxiety (f = 11.63, p = 0.005) was significant with effects equal to 0.30, 0.40, 0.53, and 0.47, respectively. The results also showed that the effect of animal therapy on obsession was not significant (p > 0.05). ConclusionTherefore, it can be concluded that Animal therapy is effective in alleviating anxiety in children. It supports for the inclusion of AAT in therapeutic practice with children having anxiety.

Musical interaction in music therapy for depression treatment

Music therapy is efficacious for the treatment of depression. Compared to other psychotherapeutic forms, it allows for the emergence of various modes of mutual interaction, thus enabling multiple channels for emotional expression and fostering therapeutic alliance. Although musical interaction patterns between client and therapist have been regarded as predictors of therapeutic outcome in depression, this has not yet been systematically investigated. We aim to address this gap by analyzing the possible linkage between musical interaction features and changes in depression score. In a clinical trial, digital piano improvisations from 58 Finnish clients and their therapists were recorded over 12 sessions of music therapy lasting 6 weeks. Subsequently, a variety of symbolic features describing pitch, rhythm, duration, and velocity were extracted from the improvisations. We observed a number of relationships between client–therapist interaction and clinical improvement. Clients with largest improvements displayed higher overall interaction, particularly more musical interaction in the middle of the therapy process than in the beginning and end. In contrast, clients with lower depression change score exhibited overall lower interaction and yielded other temporal profiles of interaction. The association between clinical improvement and an inverted U-shaped curve of musical interaction is discussed in the light of process-outcome literature.

A NIRS-based hyperscanning study of client-therapist interaction during sandplay therapy

A NIRS-based hyperscanning study of client-therapist interaction during sandplay therapy

Psychometric analysis of the Dutch language Facilitative Interpersonal Skills (FIS) video clips.

With the motivation of investigating the replicability and transferability of the findings employing the Facilitative Interpersonal Skills (FIS) performance task beyond Anglophone countries, a set of Dutch FIS clips have been scripted and recorded. In this study the psychometric properties of the Dutch clips was tested. Furthermore, an additional set of FIS clips portraying a non-challenging client-therapist interaction was tested. 369 psychology students rated the interpersonal impact (IMI-C) and the affect (positive and negative affect schedule) displayed by the hypothetical client. Thirteen out of sixteen FIS clips were located in the same IMI-C quadrant as the US clips, indicating good content validity for all sets of FIS clips. Inter-rater reliability was reasonable for one set of Dutch language FIS clips (k=0.416). Visual inspection of quadrants showed the different character of the non-challenging set of FIS clips. The Dutch FIS clips are directly applicable for educational and research purposes.

Multistakeholder Etiological Explanation Agreement and Adolescent/Parent Treatment Engagement

Client–therapist consensus has been hypothesized to be an important element of culturally competent care. However, little is known about the relationship between explanatory model agreement and treatment engagement, particularly for services involving adolescents, where both parent and youth perspectives may need to be considered. This longitudinal study collected youth, parent, and therapist survey data on etiological beliefs as well as therapist-rated treatment engagement related to a culturally diverse sample of 285 outpatient mental health service-using youth (aged 12–18, M = 14.06 at Time 1 interview; 40% female). Youth–therapist and parent–therapist agreement on beliefs about the etiology of the youth’s mental health problems were examined in relationship to later treatment engagement. Although parent–therapist agreement was unrelated to parent engagement, youth–therapist coendorsement of etiological beliefs predicted overall youth treatment engagement. In addition, youth–therapist agreement significantly predicted specific aspects of youth engagement: client–therapist interaction, communication/openness, and client’s perceived usefulness of treatment. Results speak to the importance of agreement between therapist and youth upon key issues related to the youth’s problems in mental health treatment settings and support facilitation of consensus as a component of culturally competent care. Differences between findings for youth and parents suggest that therapeutic relationships may vary for different stakeholders, indicating a need to consider individual perspectives and contributions separately.

Verbal Change and Cognitive Change: Conceptual and Methodological Analysis for the Study of Cognitive Restructuring Using the Socratic Dialog

In this paper, we will firstly delve in a behaviorally rooted theoretical analysis of the learning processes that could be involved in the employment of Socratic dialog as a means to achieve cognitive restructuring. Three observers analyzed the case of study attending to the client–therapist interaction during the cognitive restructuring using the Socratic method. Different types of Discriminative Stimulus–Response–Reinforcement interaction sequences were specified during the debate and after the client’s pro-therapeutic verbalizations. A progressive increase in the frequency of pro-therapeutic verbalizations was observed. Taking into account the limitations of a case study, our results seem to fit those obtained in previous studies and suggest a possible explanation of the therapeutic process in general and the Socratic method in particular (at least as it is employed here) in terms of verbal shaping and verbal chaining. These processes would lead to the learning of rational thoughts which, in turn, would guide the client’s overt behavior to make it more pro-therapeutic.

Knowing our ‘ABCs’: self-reflection using cognitive-behavioural formulation of client–therapist interaction in work with a survivor of torture

AbstractSelf-reflection can aid therapist development, particularly interpersonal skills. It can be achieved through using cognitive-behavioural therapy techniques, for example, formulations of the therapist's cognitions and behaviours have been used to aid self-reflection. As interpersonal skills may be an area that benefits from self-reflection, an approach to formulating the interaction between client and therapist may be beneficial. This study reports the use of simple ‘antecedent-belief-consequence’ (ABC) formulations for the client and therapist to conceptualize their interaction. This description of a treatment failure focuses on cross-cultural work with a survivor of torture, where self-reflection may be particularly indicated to promote cultural competence and address the impact of the content on the therapist. ABC formulations for the client and therapist were completed and through this structured self-reflection, the therapist was able to identify the impact of her own beliefs on the process of therapy. This method identified areas for further development and generated hypotheses for how to continue therapy with this client. Using ABC formulations then may provide a useful and structured way to conduct self-reflection with explicit focus on the interaction between client and therapist.

Student perceptions and understanding of client-therapist interactions within the inpatient acute care environment: qualitative study.

Physical therapists practicing in inpatient acute care settings in the United States work in a 21st century health care system that requires professional competence in clinical reasoning and decision making. For doctor of physical therapy (DPT) students, the development of confidence in the patient evaluation and the professional skills necessary for managing the inpatient environment can be challenging. The study's purpose was to understand whether the early exposure of students to inpatient settings informed their understanding of the thought processes and actions of experienced clinicians during client interactions. A qualitative design was used. Thirty-three DPT students working in inpatient settings were recruited from 15 unique inpatient hospital (acute care and rehabilitation) facilities with a convenience sampling technique. Reflective data were collected for 1 month with clinician-facilitated discussion boards. Four themes emerged: environment, communication, evaluation, and client-therapist interaction. The themes informed a conceptual model depicting the observation by DPT students of factors that influenced interactions between clients and experienced clinicians in inpatient settings. Reflection on the what, the how, and the why that informed clinical decisions enabled students to recognize the situated nature of evaluation and treatment approaches. The use of a sample from 1 year of a DPT program at one university reduced the generalizability of the results. Limited research has examined student perceptions of the interactions of experienced clinicians with clients in inpatient acute care settings. More research is needed to understand the impact of exposing students to the thoughts and actions of therapists working in such settings earlier within DPT curricula.

THE ROLE OF VERBAL BEHAVIOR IN THE ANALYSIS OF THE THERAPEUTIC PROCESS

Over the last 50 years, the variables established by B. F. Skinner in his work, Verbal Behavior (Skinner, 1957), have been taken into account in both empirical and theoretical research. Although historically the initial impact of Skinner's work was lower than expected, even in the areas most closely related to verbal behavior (e.g., naming, equivalence classes, rule-governed behavior), only recently have efforts focused on the analysis of verbal behavior in the context of the therapeutic process and clinical change. This paper highlights the crucial role of verbal behavior in the clinical setting by maintaining operant terminology and drawing attention specifically to the analysis of the therapist’s verbal behavior during sessions. In addition, it analyzes the role of verbal behavior in the form of instructional control and rule-governed behavior in the client-therapist interaction. The article concludes that questions regarding the status, function and variables that influence the verbal behavior generated in therapy sessions cannot yet be answered clearly and remain key objects of study.

Efeitos de uma atividade de fantasia em medidas da interação terapêutica

Avaliou-se o efeito de uma atividade de fantasia em medidas da interação terapeuta/cliente. Dez sessões psicoterápicas de uma díade terapeuta/cliente foram registradas em vídeo, transcritas e categorizadas por observadores que atingiram os critérios de concordância estipulados. Estas sessões foram divididas em cinco condições – ABABA. Nas condições B, introduziu-se uma atividade de fantasia. Houve diminuição nas categorias da terapeuta de Solicitação de relato e Solicitação de reflexão e aumento das categorias Fornecimento de interpretações, Informações e Recomendações, durante as condições B. Para a cliente, nas condições B, houve aumento da categoria Estabelecer relações entre eventos e diminuição da categoria Relato de eventos. Discutiu-se o aumento do relato de metas e melhoras por parte da cliente nas sessões subsequentes às duas condições B. Estudos foram sugeridos para esclarecer o efeito de intervenções do terapeuta e o efeito de descrições acuradas de contingência nos relatos de melhora e de engajamento na mudança

Does engagement with an intensive outreach service predict better treatment outcomes in ‘high‐risk’ youth?

Engagement is critical in ensuring that the most 'at risk' clients receive care from psychiatric services, but the relationship between engagement and treatment outcomes remains unclear. This study investigated possible improvements in client engagement and the relationship between engagement and treatment outcomes in a group of difficult-to-engage, 'high-risk' young people seen by the Intensive Mobile Youth Outreach Service (IMYOS) in Western Metropolitan Melbourne, Australia. Data from standardized outcome measures on client engagement, suicidality, hostility, well-being and functioning obtained at referral, after initial assessment and at discharge, were analysed retrospectively. Improved engagement was achieved after initial assessment and remained steady at discharge. All outcome measures showed significant improvement at discharge. Higher overall engagement following assessment was associated with decreased hostility risk and greater well-being and functioning at discharge. The engagement dimensions 'collaboration', 'perceived usefulness' and 'client-therapist interaction' were most consistently associated with better treatment outcomes. Engagement at an early stage of treatment can be a useful predictor for later hostility risk, well-being and functioning. To promote better outcomes for difficult-to-engage youth, service delivery needs to focus on collaborative client involvement, the development of a 'strong' therapeutic alliance and individualization of treatment in regard to client needs.

Transitional probability analysis of two Child Behavior Analytic Therapy cases.

Clinical behavior analysis (Dougher, 1993; Kanter & Woods, 2009) assumes behavior analysis as the fundamental science and Skinner's Radical Behaviorism as the philosophical foundation for clinical psychology. In Brazil, clinical behavior analytic ideas have produced Behavior Analytic Therapy (BAT; Meyer et al., 2010), and more recently, Child Behavior Analytic Therapy (CBAT; Del Prette, 2011). From these theoretical and clinical standpoints, a fundamental issue in therapy is that therapy may produce rule-governed or contingency-shaped changes in client behavior (Skinner, 1974). While much of talk therapy may be seen as the therapist providing rules for clients to follow to change their behavior, regarding contingency-shaped behavior when the client behavior to be targeted for change occurs in session the therapist can provide consequences, thus shaping it as already suggested by Krasner (1962) in therapist as a social reinforcing machine. This shaping process is specified in more detail in Functional Analytical Psychotherapy, or FAP (Kohlenberg & Tsai, 1991; Tsai, Kohlenberg, Kanter, Kohlenberg, Follette, & Callaghan, 2009). FAP's basic tenet is that the client's problem behaviors that appear in their daily relationships will also appear in therapy where the therapist can shape behavior through differential and contingent responding. The authors state that generalization occurs due to similarities between the therapy setting and the client's other environments, which implies that improvements achieved in session will generalize to the relationships that take place out-of-session. Therapist contingent responding is key to FAP and may start with general contingent reinforcement of broad classes of behavior relevant to simply to coming to therapy, and then reinforcement is funneled to focus more directly on clinically relevant behaviors relevant to the goals of treatment identified by the client and therapist (Follette, Naugle, & Callaghan, 1996). Recently, researchers have called for the identification of empirically supported principles of change (Rosen & Davison, 2003) and the development and use of novel methodologies in psychotherapy research, such as the direct observation of the therapeutic process instead of the use of randomized controlled trials or other group designs, to identify these change principles. Because contingent responding by definition is a change process that occurs in the turn-by-turn client-therapist interaction in session, it is a mechanism that is well suited to exploration by direct observation of the therapeutic process. It is important to note that contingent responding is a mechanism that is not specific to FAP but is fundamental to BAT and CBAT, broadly defined, and may be seen by behaviorists as occurring in, and potentially important to, all forms of therapy. For example, an early classic process study by Truax (1966) used direct observation of the therapeutic process to explore the use of contingent responding in sessions conducted by Carl Rogers, a therapist well known for espousing the belief that the therapist's behavior should be unconditional as per his humanistic theory (Rogers, 1957) rather than contingent on client behavior as per behavioral theory. Truax, using independent coders blind to the study hypothesis, found that Rogers in fact contingently responded to specific client behaviors with empathy and positive regard, and that these responses functioned as reinforcement as indicated by the fact that the client behaviors responded to in this fashion increased in frequency over the course of therapy. More recently, Busch, Kanter, Callaghan, Baruch and Weeks (2009) employed a similar micro-process analysis to explore the hypothesized change mechanism of FAP. They used the FAP Rating Scale (FAPRS; Callaghan & Follette, 2008) to code client clinically relevant behavior and therapist effective responding to in-session client behavior on a turn-by-turn basis over the course of therapy for a depressed adult client who received three phases of therapy: Assessment, Cognitive Behavior Therapy (CBT), and FAP. …

Efficacy of Neurofeedback Treatment in ADHD: The Effects on Inattention, Impulsivity and Hyperactivity: A Meta-Analysis

Since the first reports of neurofeedback treatment in Attention Deficit Hyperactivity Disorder (ADHD) in 1976, many studies have investigated the effects of neurofeedback on different symptoms of ADHD such as inattention, impulsivity and hyperactivity. This technique is also used by many practitioners, but the question as to the evidence-based level of this treatment is still unclear. In this study selected research on neurofeedback treatment for ADHD was collected and a meta-analysis was performed. Both prospective controlled studies and studies employing a pre- and post-design found large effect sizes (ES) for neurofeedback on impulsivity and inattention and a medium ES for hyperactivity. Randomized studies demonstrated a lower ES for hyperactivity suggesting that hyperactivity is probably most sensitive to nonspecific treatment factors. Due to the inclusion of some very recent and sound methodological studies in this meta-analysis, potential confounding factors such as small studies, lack of randomization in previous studies and a lack of adequate control groups have been addressed, and the clinical effects of neurofeedback in the treatment of ADHD can be regarded as clinically meaningful. Three randomized studies have employed a semi-active control group which can be regarded as a credible sham control providing an equal level of cognitive training and client-therapist interaction. Therefore, in line with the AAPB and ISNR guidelines for rating clinical efficacy, we conclude that neurofeedback treatment for ADHD can be considered "Efficacious and Specific" (Level 5) with a large ES for inattention and impulsivity and a medium ES for hyperactivity.

Note on optimization of individual psychotherapeutic processes

Individual psychotherapy typically involves a sequence of recurrent sessions of client–therapist interaction. Accordingly, the psychotherapeutic process can be conceived of as evolving at least at two different time scales: a fast time scale pertaining to the on-going interaction within each session and a slow time scale associated with sequential regularities occurring between consecutive sessions. It is possible to exploit the sequential regularities between sessions in order to assess and optimize an ongoing individual psychotherapeutic process in real time. In this note a computational paradigm is outlined according to which this can be implemented and applied in flexible ways. Illustrations are given with simulated data. A heuristic summary is provided in the closing section.

Qualitative Exploration of Client-Therapist's Interaction on Play Therapy

Qualitative Exploration of Client-Therapist's Interaction on Play Therapy

A quantitative and qualitative exploration of client‐therapist interaction and engagement in treatment in an alcohol service

Studies have suggested that differences in the effectiveness of therapists may be related to the therapist's ability to maintain a facilitative stance in the face of client resistance or hostility. The current study, examined a sample of audiotaped sessions from Hyams, Cartwright, and Spratley's (1996) study of engagement in an alcohol treatment service in an attempt to see whether the therapists' effectiveness at engaging clients in treatment was related to client-therapist interaction in assessment interviews. It was hypothesized that there would be (1) more overall negative interpersonal behaviour (2) more negative interpersonal behaviour by the therapist and (3) more negative interpersonal complementarity in interviews where the client failed to engage. Structural Analysis of Social Behaviour was used to assess the interpersonal behaviour of clients and therapists in three case comparisons, each of which focused on an engage and a non-engage case provided by one of three participating therapists. An additional series of follow-up qualitative case studies was carried out on the interviews where the client failed to engage. The results were mixed, with the qualitative analyses providing more support for the hypotheses than the quantitative analysis. It was concluded that problematic interpersonal processes might be harder to gauge in assessment sessions than later on in therapy and methodological recommendations were made for enhancing the likelihood of detecting problematic processes in future studies.

Review of The Mind in Therapy: Cognitive Science for Practice.

KATHERINE D. ARBUTHNOTT, DENNIS W. ARBUTHNOTT and VALERIE A. THOMPSON The Mind in Therapy: Cognitive Science for Practice Mahwah, NJ: Lawrence Erlbaum, 2006, 432 pages (ISBN 0-8058-5675-7, US$49.95 Paperback) Reviewed by DAVIDJ. A. DOZOIS Cognitive science has undoubtedly contributed importantly to our understanding of adaptive and maladaptive human functioning and will increasingly continue to do so. Basic cognitive science offers a tremendous wealth of knowledge about various processes and mechanisms that are fundamental to a client's functioning, a therapist's efficacy, and the client-therapist interaction. Among other forms of psychological interventions, cognitive therapy has explicitly adopted constructs and adapted methodologies from cognitive science and has evolved conceptually and clinically as a result of this empirical work (cf. Clark & Fairburn, 1997). As McFaIl and Townsend (1998) cogently argued, however, most clinical psychologists focus on idiographic solutions to a client's problems and pay less attention to the nomothetic solutions that pertain to a broader range of issues: It is as if the two worlds of psychology not only moved in independent orbits, but also occupied different corners of the universe. Many clinical psychologists seem unaware of and unaffected by developments and discoveries in the nomothetic world, even when these potentially could help them understand, assess, treat, predict, and prevent psychopathology and other suffering (p. 325). Clinical science and practice, they contend, would benefit from greater integration with cognitive science. In The Mind in Therapy: Cognitive Science for Practice, Arbuthnott, Arbuthnott, and Thompson attempt to bridge this gap by grounding in basic cognitive science. They do not intend to do so in the way that empirically based treatment does (i.e., by demonstrating what works for which particular psychiatric difficulties or by examining what are the effective ingredients of therapy) ; rather, their text applies the conceptual underpinnings of cognitive science, and its empirical findings, to particular practical issues. This book is thus timely, innovative, and interesting. In 16 chapters, the authors review different areas of cognitive research and emphasize findings relevant to the theoretical and applied aspects of psychotherapy. An overarching objective of the book is to better inform practitioners about some of the key cognitive variables that impact clients, therapists, and the therapy process. Each chapter begins with general definitions of key terms and explains how various cognitive constructs, and the research literature surrounding them, are important to psychotherapy. Many chapters also include case illustrations to translate these concepts into application. In Chapter 1, the authors make the case that cognitive processes are essential to all forms of in that they provide the pathways for treatment change or set up constraints to psychotherapeutic intervention. In the second chapter, Arbuthnott and her co-authors contextualize the processes and methods of within the framework of problem-solving. They review the literature on what facilitates effective problem-solving and how to overcome deficits and impasses. Chapter 3 provides a good review of memory retrieval and priming. The issue of how past memories are activated is described, vis-a-vis an associated network, and recommendations are made for how therapists might elicit and reframe a client's autobiographical memories in the most effective manner possible. The literature pertaining to autobiographical memory, the lifeblood of psychotherapy (p. 55) is further elaborated upon in Chapters 4 and 5. Common errors in autobiographical memory (e.g., overconfidence, schematic knowledge errors) are also described and the implications for therapists highlighted. In Chapter 6, prospective memory is discussed in the context of between-session extratherapy tasks. …