Psychotherapy Clients Research Articles

Sources of meaning and hope and associated well‐being among psychotherapy clients: A practice‐based mixed method study

AbstractBackgroundDespite the recognition of meaning and hope as salient for many individuals in mental health treatment, little empirical attention has been given to patient perspectives. Research has primarily looked at the presence—or absence—of meaning and hope, and associations with symptom distress and suicidality.AimsThese constructs are multi‐faceted and influenced by social, cultural and spiritual/religious contexts. Understanding where clients draw meaning and hope from can provide valuable information to inform case formulation, treatment planning and intervention.Materials and MethodsThis mixed method practice‐based study (N = 233) in an outpatient community clinic (a) elucidated key areas that fuel clients' sense of meaning and hope and (b) explored associations with well‐being.ResultsQualitatively, we identified six domains through thematic analysis: interpersonal, action‐based, transcendent, intrapersonal, environmental/contextual and lacking/searching. A sub‐set of clients also emerged who were lacking in and/or searching for meaning or hope. Quantitatively, one‐way ANOVA results indicated that source diversity was associated with greater well‐being.DiscussionFindings illustrate that patients draw from culturally and spiritually embedded sources to construct meaning and hope in their lives, with distinctions between areas most salient for meaning, hope and both. Furthermore, having fewer sources of meaning and/or hope may represent a well‐being liability.ConclusionTherapists should pro‐actively explore and consider ways to bolster patients' sources of meaning and hope, considering evidence of implications for well‐being outcomes.

„Miręs asmeniniame gyvenime tampu išmintingesnis pagalboje kitam“: psichoterapeutų artimųjų netekčių patyrimo reikšmė darbe su psichoterapijos klientais

The article presents the significance of the experience of bereavement for psychotherapists in their therapeutic work. This issue has not been studied much in the world and has not been raised in Lithuania yet. Paradoxically, the „psychotherapist working on his/her own“ has not been an interesting object of research so far, and so far researchers are mainly interested in the effectiveness of the psychotherapy, the question how psychotherapist feels after the crisis experience and how it affects his/her work remains in the shadows. Thus, the aim of the research presented in this paper is to uncover and systematically describe the implications of psychotherapists’ experience of bereavement for their work with psychotherapy clients. A qualitative research strategy was chosen for the study, data were collected using in-depth semistructured interviews, and analysed using Thematic Analysis. Seven psychotherapists who had experienced the loss of a loved one during the course of their psychotherapeutic work participated in the study. Three themes and seven subthemes were identified in the study, revealing the multilayered nature of experiences in their psychotherapeutic work. Although all the psychotherapists had integrated the loss of a loved one in one way or another and felt personally grown up, this had undoubtedly left traces in their therapeutic work and was experienced as a personal and professional challenge.

Direct retrospective measurement of therapeutic changes: an example using the Czech version of the Questionnaire of Personal Changes (Q-PC)

Objective: The study aimed to test the psychometric properties of the Czech translation of the Questionnaire of Personal Changes (Q-PC), a measure designed for retrospective (direct) measurement of change in psychotherapy. Methods: A sample of group psychotherapy clients (N = 222) and a nonclinical sample (N = 167) sample were used. Clients in the clinical sample were administered the Q-PC in addition to several pre–post outcome measures. Confirmatory factor analysis, correlational analysis, and structural equation modeling were used to test the Q-PC’s factor structure, longitudinal measurement invariance, reliability, convergent validity, sensitivity to change, and other psychometric properties. Results: The Q-PC demonstrated a unidimensional structure that was strictly invariant between two follow-up measurement waves. The measure also demonstrated excellent reliability and sensitivity to change and good convergent validity. Furthermore, it demonstrated a similar relationship to baseline severity as the pre–post outcome measures. Conclusions: The retrospective measurement of change is a promising approach that has the potential to complement the traditional pre–post measurement of change.

Helpful and meaningful aspects of a psychoeducational programme to treat complex dissociative disorders: a qualitative approach

ABSTRACT Purpose: Complex dissociative disorders (CDDs) are prevalent among psychotherapy clients, and research suggests carefully paced treatment for CDDs is helpful. The purpose of the present study is to qualitatively explore helpful and meaningful aspects of the TOP DD Network programme, a web-based adjunctive psychoeducational programme for the psychotherapeutic treatment of clients with CDDs. Methods: TOP DD Network programme participants (88 clients and 113 therapists) identified helpful and meaningful aspects of their participation in response to two open textbox questions. Framework analysis was used to qualitatively analyze client and therapist responses. Findings: Participants found the TOP DD Network programme helpful and meaningful in nuanced ways. Three themes were created: (1) Components of the Programme (subthemes: content, structure), (2) Change-Facilitating Processes (subthemes: heightened human connection, receiving external empathy and compassion, contributing to something bigger, improved therapeutic work and relationship), and (3) Outcomes (subthemes: insight, increased hope, self-compassion, increased safety and functioning). The most emphasized theme was components of the programme, which captured its content and structure. Conclusion: Clients and therapists in the TOP DD Network programme described the programme’s components and processes as helpfully facilitating positive outcomes in the treatment of CDDs. Therapists may consider integrating the components and processes in the programme into their practice with clients with CDDs.

Child-Gendered Mental Spaces Triggered by Space Builders Reflect Art Psychotherapy Clients' Childhood Experiences

ABSTRACT
 The language behaviour of clients’ reflection journey on art psychotherapy in the final stage of art psychotherapy sessions entitled ‘Reflect Interview’ reflects their childhood experiences that become a lifetime memory. In this paper, the topic of how the clients can construct their conceptual ideas of childhood experiences is discussed under a cognitive approach to language study. This article argues that: 1) There are REFLECTION SPACE, REALITY SPACE, DEPICTION SPACE and POSSIBILITY SPACE of the child-gendered mental spaces in the reflection journey on art psychotherapy, 2) Subject-Verb combinations, connectives and adverbs as the space builder on the child-gendered mental spaces and 3) Intersection between gender and child has experienced by the psychotherapy clients are generally related to weakness, depression, struggle and difficulties that become children's memories during their lifetime. These results are supported by a few background cases and government role illustrations in Indonesia.
 Keywords: Art psychotherapy; child-gendered mental spaces; space builder.

The Behavioral Cost of Care: Changes in Maintenance Behavior during Equine-Assisted Interventions.

This study examined human-animal symbiosis in an animal-assisted intervention through observations of animal maintenance behaviors. The rise of psychotherapy, learning, and recreation incorporating animals warrants exploration of the welfare of the animals involved in these interventions. The analysis of welfare in multispecies engagements can be discussed in terms of symbiosis. Regarding an intervention's animal provider (e.g., therapy horse) and human recipient (psychotherapy client), the balance of cost and benefit is important. Research describing human and animal interactive behavior during interventions is limited, whether focusing on client outcomes or animal welfare. The present study adapted ethological methods to study humans and animals in an equine-assisted intervention, observing equine maintenance behaviors and equid-human interactive behavior. Maintenance behaviors were recorded before, during, and after equine-assisted (psychosocial) learning sessions with youth, providing 1600 observations. Equine alertness, eating behavior, and ambulation varied significantly before, during, and after the equine-assisted sessions. Such interruptions of typical behavior are an important aspect of welfare and unit of analysis when examining symbiotic relationships. A total of 267 sequences of equid-human approach-response behavior were also recorded, indicating that human-animal interaction was predominantly from humans toward equids. Equids' dominant response to human approach was no response, followed by avoidance, while humans' dominant response to equid approach was reciprocation. The findings are discussed in terms of symbiosis and animal welfare.

Typical Personal Prerequisites for the Problems of Clients in psychotherapy and its Purpose in the Works of S. Freud and A. Adler from the Perspective of an Integrative Approach

Typical Personal Prerequisites for the Problems of Clients in psychotherapy and its Purpose in the Works of S. Freud and A. Adler from the Perspective of an Integrative Approach

Psychotherapist perceptions of engagement-building behaviours with youth clients across developmental levels.

Building a positive therapeutic relationship is a challenging, yet critical, first step in conducting youth psychotherapy. A number of studies in the youth treatment literature have indicated that a positive therapeutic alliance is related to increased treatment attendance, participation, and outcome. Some research has examined therapist behaviours for engaging therapy clients; however, developmental differences in alliance formation have had limited exploration. The current study surveyed clinicians about their use of specific engagement strategies and the developmental stage of their youth clients. It was hypothesised that participants would differentially rate the importance of different aspects of therapeutic engagement based upon a youth client's developmental stage and that these would correspond with differences in specific engagement strategies. A total of 64 clinicians with experience treating youth completed the study. The participants completed a questionnaire administered online that asked them to rate the importance of developmental differences to forming a therapeutic relationship and provide example client behaviours from their clinical experience for each developmental stage. Results showed clinicians felt the relative importance of collaboration, advocacy, and trustworthiness increased with age. These differences were also evidenced in the specific strategies clinicians endorsed in relation to each engagement factor across developmental stages. This program of research will eventually aid in the development of new guidelines for engaging clients in youth psychotherapy. In addition, the results may be used to enhance psychotherapy training for those working with children and adolescents.

Detecting microaggressions toward a Muslim client in psychotherapy.

Detecting microaggressions toward a Muslim client in psychotherapy.

The meaning and feeling of the time and space between psychotherapy sessions and everyday life: Client experiences of transitions

Objective To explore how clients in psychodynamic or psychoanalytic psychotherapy, conducted in the traditional in-person setting, experience the transitions in time and space between psychotherapy sessions and everyday life. Method Twelve semi-structured interviews were analyzed with inductive experiential thematic analysis, focusing on how the participants experience and make sense of the phenomenon in focus. Results The participants described therapy as a sheltered space where they could be open, vulnerable, receptive, and present. Approaching and leaving psychotherapy sessions, the participants established different behavioral patterns and routines dealing with their anxieties and resistances. In this in-between area, the participants could handle interconnections and differences between therapy and everyday life. Participants stressed the clinical impact of transitions: transitions affect both therapy and everyday life; disturbed transitions have an adverse impact; transitions are insufficiently addressed in therapy. Conclusion Transitions between therapy and life appear to be an essential but seldom recognized part of the therapy process beyond the borders of therapy sessions. Implications of these findings for psychotherapy training and practice are discussed, and a tentative transtheoretical framework for further research is proposed.

Play in body psychotherapy

From a body psychotherapy perspective, clients are often seeking ways to cope with issues stemming from early traumas. Yet body psychotherapy is concerned with more than just helping people to become ‘untraumatised’; it endeavours to support the client’s reconnection with their essential nature, or core state, which is characterised by creativity, compassion, joy, curiosity, intuition, and playfulness. The purpose of this essay is to increase curiosity about, and contribute to the reflection on, the use of play in psychotherapy. By integrating theory, clinical vignettes, and the author’s personal reflections (as student, therapist and client), the author will explore how play can assist body psychotherapy clients with trauma-recovery, how it is implicit in a client’s progression towards vibrant wellbeing within body psychotherapy, and how (re)learning how to play can lead to radical change on both a personal and societal level.

Detecting symptom exaggeration in compensation-seeking individuals, psychotherapy clients, and individuals referred for job assessments: Psychometric features of the French and Dutch versions of the Self-Report Symptom Inventory.

Detecting symptom exaggeration in compensation-seeking individuals, psychotherapy clients, and individuals referred for job assessments: Psychometric features of the French and Dutch versions of the Self-Report Symptom Inventory.

The experience of closeness and distance in the therapeutic relationship of patients with different attachment classifications: an exploration of prototypical cases.

Individuals with different attachment classifications (Secure, Avoidant and Preoccupied) may experience emotional closeness differently, in their intimate relationships but also as clients in psychotherapy. However, evidence for this assumption almost exclusively comes from research with self-report questionnaires. In this paper, we use observer-rated measures to explore in depth how patients with different attachment classifications experience closeness and distance from the therapist in different phases of therapy. Three patients' and their therapists' narratives about the therapeutic relationship at three time points during therapy were extracted and analyzed with two transcript-based observational measures: The Patient Attachment Coding System (PACS), which classifies patients' attachment according to their discourse behavior, and the therapeutic-Distance Scale-Observer version (TDS-O), which assesses the therapeutic relationship in terms of closeness, distance, autonomy and engagement. Cases were chosen from a larger research project due to their different prototypical attachment classification on the PACS. The narratives were obtained from Relationship Anecdote Paradigm (RAP) interviews in which the patients and their therapists narrated separately about meaningful interactions with each other, at early, middle and late phases of therapy. In addition, we followed patients self-report of the alliance and symptoms (OQ-45). Although all patients reported experiencing discomfort with feeling distant from the therapist the therapeutic distance, the secure patient was able to reflect on his feelings and, in the therapist's recollection, was able to share them with the therapist. This allowed the therapist to harness these feelings for the benefit of the therapy. The avoidant and the preoccupied patients both experienced the therapist as distant, but the avoidant patient prevented closeness by a minimal expression of feelings, and the preoccupied described strong frustration with the therapist in a one-sided manner that prevented collaborative processing and left the therapist confused. It appears that patient discourse is a stable (trait-like) component of attachment, while the therapeutic-distance is a process (state-like) component that may change along therapy. The discourse of insecure patients may hinder therapists' ability to adjust the therapeutic-distance to patients' needs. Therapists' knowledge about the ways patients with different attachment classifications communicate their proximity wishes may improve their attunement.

Therapists who foster social identification build stronger therapeutic working alliance and have better client outcomes

BackgroundFor decades we have known that therapeutic working alliance is a key contributor to client engagement and positive outcomes in therapy. However, we have made little progress in narrowing down its determinants, which is critical in supporting trainees to optimize such alliance. We make a case for the value of incorporating social psychological frameworks into models of alliance and explore the role of social identity processes in the development of therapeutic alliance. MethodAcross two studies, over 500 psychotherapy clients completed validated measures of alliance, social identification with their therapist, positive therapy outcomes, and a range of client and therapist characteristics. FindingsSocial identification strongly predicted alliance in both samples, whereas client and therapist characteristics showed few such associations. Alliance mediated the relationship between social identification and positive therapy outcomes. In addition, we found evidence that (a) personal control is a key psychological resource in therapy that arises from social identification, and (b) therapists who engage in identity leadership (i.e., who represent and build a social identity that they share with clients) are more likely to foster social identification and its downstream benefits. InterpretationThese data show that social identity processes are key to the emergence of working alliance. We conclude with a discussion of how recent social identity and identity leadership interventions might be adapted to train therapists in relevant identity-building skills.

Diving deep: three experiential approaches to working with dreams and nightmares

ABSTRACT Dreams have the potential provide intimate access to psychotherapy clients’ inner lives. When therapists are able to help clients experience their dreams in a curious, open, focusing-oriented way, the client gains direct access the dream’s tendency to carry their life situation forward. This paper offers evidence of a paradigm shift away from analytic to experiential, client-centered approaches to dreams. It then describes three experiential dreamwork practices: finding the help in a dream (from focusing), re-entering a dream element (from Gestalt) and dreaming the dream onward (from Jung). Included are several clinical and personal examples which show how entering a dream experientially allows the dreamer to discover something new and how this often leads to a change-moment or, in focusing terms, a felt shift. Several clinical and personal examples illustrate that while dreams may be helpful in their own right, engaging deeply with them in an experiential way allows their fuller potential for personal growth and forward movement to be realized. Over time, this way of engaging with dreams can become a natural ongoing undercurrent, both in dreaming and waking, that is always available and evolving.

Understanding Symbols when Working with Anxious Religious Clients in Positive Psychotherapy

The article illustrates specifics of working with religious clients in the context of Positive and Transcultural Psychotherapy. The article touches upon important aspects of using metaphors which are close to the perception of a person’s spiritual and ideological characteristics. The use of metaphors, parables, and references to scriptures helps to establish a good contact with the patient, assisting the therapist to achieve a greater therapeutic success. A particularly significant effect is achieved in working with religious people with anxiety disorders. As noted below, it is extremely important to take into account clients’ cultural background and choose metaphors and images that are close to his/her worldview. This case clearly illustrates how well-chosen references to religious symbols improved the therapeutic effect of working with a psychologist.

Prediction of Chinese clients' satisfaction with psychotherapy by machine learning.

Effective psychotherapy should satisfy the client, but that satisfaction depends on many factors. We do not fully understand the factors that affect client satisfaction with psychotherapy and how these factors synergistically affect a client's psychotherapy experience. This study aims to use machine learning to predict Chinese clients' satisfaction with psychotherapy and analyze potential outcome contributors. In this cross-sectional investigation, a self-compiled online questionnaire was delivered through the WeChat app. The information of 791 participants who had received psychotherapy was used in the study. A series of features, for example, the participants' demographic features and psychotherapy-related features, were chosen to distinguish between participants satisfied and dissatisfied with the psychotherapy they received. With our dataset, we trained seven supervised machine-learning-based algorithms to implement prediction models. Among the 791 participants, 619 (78.3%) reported being satisfied with the psychotherapy sessions that they received. The occupation of the clients, the location of psychotherapy, and the form of access to psychotherapy are the three most recognizable features that determined whether clients are satisfied with psychotherapy. The machine-learning model based on the CatBoost achieved the highest prediction performance in classifying satisfied and psychotherapy clients with an F1 score of 0.758. This study clarified the factors related to clients' satisfaction with psychotherapy, and the machine-learning-based classifier accurately distinguished clients who were satisfied or unsatisfied with psychotherapy. These results will help provide better psychotherapy strategies for specific clients, so they may achieve better therapeutic outcomes.

Supplemental Material for Detecting Symptom Exaggeration in Compensation-Seeking Individuals, Psychotherapy Clients, and Individuals Referred for Job Assessments: Psychometric Features of the French and Dutch Versions of the Self-Report Symptom Inventory

Supplemental Material for Detecting Symptom Exaggeration in Compensation-Seeking Individuals, Psychotherapy Clients, and Individuals Referred for Job Assessments: Psychometric Features of the French and Dutch Versions of the Self-Report Symptom Inventory

A change in frame and countertransference experiences: Transitioning from face‐to‐face to telepsychotherapy

AbstractUnprecedented changes in traditional psychotherapeutic practice arose from the lockdown restrictions associated with the COVID‐19 pandemic. These changes to practice included the imposed change to the therapeutic frame when transitioning clients from face‐to‐face meetings to delivery of psychotherapy sessions via videoconferencing (defined here as telepsychotherapy). The current study conducted qualitative interviews with 16 Australian psychologists who transitioned their existing adult psychotherapy clients from face‐to‐face therapy to telepsychotherapy and explored their novel experiences associated with countertransference reactions during this period. Thematic analysis of the interviews revealed several unique findings. The type of countertransference reactions towards existing clients was consistent across both face‐to‐face and online meetings; however, the felt intensity of countertransference reactions was reduced. Psychologists reported an increased hesitance to work with intense emotions during telepsychotherapy sessions and felt increased pressure to work harder during online sessions when compared to face‐to‐face meetings. Exposure to their clients' personal and home environments during telepsychotherapy sessions elicited several novel reactions towards their clients. These findings on countertransference and telepsychotherapy are informative for future practice and training. Awareness of these unique countertransference experiences is recommended prior to engaging in telepsychotherapy or when transitioning clients to this modality.

Patterns of emotional schema endorsement and personality disorder symptoms among outpatient psychotherapy clients

Patterns of emotional schema endorsement and personality disorder symptoms among outpatient psychotherapy clients