Psychotherapy Clients Research Articles

Taking Steps along a Path: Full functioning, openness, and personal creativity / Schritt für Schritt einen Weg entlang: Volle Funktionsfähigkeit, Offenheit und persönliche Kreativität / Dando Pasos a lo Largo de un Camino: Funcionamiento pleno, apertura y creatividad personal / Une Démarche sur un Chemin: Fonctionner à son plein potentiel, ouverture et créativité personnelle

For Carl Rogers, living the good life was the equivalent of being fully functioning. This meant living a life of growth, flow and change. Change happened because the fully functioning person was open to experience, information, ideas, and others. I present an elaboration of Rogers' views. People are seen as constantly changing on a moment-to-moment basis as they creatively cope with life's challenges. This feeds into change in personality over time. I cite research supporting this view. I consider how a particular form of openness—receptive openness—and holding constructs tentatively and productive agency may contribute to productive change. I then consider obstacles to receptive openness and how blocks to openness relate to psychopathology. Finally I look at how clients in psychotherapy exhibit the kind of creativity I have been discussing.

Interpersonal relationships and irrationality as predictors of life satisfaction

This study examined the association among interpersonal relationships, irrational beliefs, and life satisfaction. Twenty-eight psychotherapy clients and 207 college undergraduates completed measures of interpersonal relations (Outcome Questionnaire; Lambert et al., 1996), irrationality (Rational Behavior Inventory; Shorkey & Whiteman, 1977), and life satisfaction (The Satisfaction with Life Scale; Diener, Emmons, Larsen, & Griffin, 1985). Results indicated that interpersonal relations predicted life satisfaction, whereas global irrationality was indirectly related to life satisfaction. Specifically, interpersonal relations mediated the association between global irrationality and life satisfaction. Clinicians aiming to foster life satisfaction in their patients are encouraged to carefully assess their social functioning and utilize relationship-enhancing treatments. Targeting irrational thinking may also be necessary to set the stage for and support such interventions.

Reflexivity and its Radical Form: Implications for the Practice of Humanistic Psychotherapies

Reflexivity has been defined as self-awareness, and radical reflexivity as awareness of self-awareness. Based on a qualitative research study of the client's experience of psychotherapy, clients’ reflexivity and radical reflexivity are applied to the concepts of moral evaluation and freedom of will. These concepts in turn are related to psychotherapy clients’ relationship with self and with the therapist. It is shown how the nature of these relationships provides a rationale for decisions on the appropriateness of the therapist's direction of the therapeutic process. In addition, specific interventions to offset the power differential between the client and therapist are specified. It is concluded that unconscious determinants of experience and action notwithstanding, clients’ self-aware agency plays a significant role in their engagement in therapy.

Affirmative Psychotherapy with Bisexual Men

SUMMARY This article describes the range of issues that are of concern to bisexual men seeking psychotherapy. In addressing these issues with bisexual clients, the therapist is well advised to recognize the diversity that exists within this population regarding the pathways that individuals take in the course of acknowledging and coming to terms with their sexual orientation. It is important for the therapist to recognize that for most bisexual clients, the presenting issues are those that are common to most psychotherapy clients, such as anxiety, depression, stress, and relationship issues. For others, however, there are questions about sexual identity, coming out bisexual, and the implications of their sexual attractions to both women and men. An individual may have concerns regarding whether or not to disclose his sexual orientation at the start of a new relationship, or regarding realizing for the first time that he has bisexual feelings within an already established same-sex or other-sex relationship or marriage. There may also be questions and concerns regarding HIV/AIDS. In these situations, the personal impact of living in a social context in which sexuality is thought of in dichotomous either/or terms will be a realistic concern. Current trends in the research and clinical literature regarding bisexual men will also be discussed. The variety of manifestations of bisexuality across racial, ethnic, and cultural groups will be examined, including the challenges that this may pose for clients and therapists who identify with dominant definitions of sexuality within their respective social communities. Finally, the practical value and shortcomings of the main therapeutic schools will be examined in terms of providing bisexual men with effective and affirmative psychotherapy.

The Influence of Payment Method on Psychologists' Diagnostic Decisions Regarding Minimally Impaired Clients

Are psychotherapy clients who pay via health insurance more likely to receive Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM–IV], American Psychiatric Association, 1994) diagnoses than identical clients who pay out of pocket? Previous research (Kielbasa, Pomerantz, Krohn, & Sullivan, 2004) indicates that when psychologists consider a mildly depressed or anxious client, payment method significantly influences diagnostic decisions. This study extends the scope of the previous study to include clients whose symptoms are even less severe. Independent practitioners responded to vignettes of clients whose profiles deliberately included subclinical impairment and a high level of functioning. Half of the participants were told that the clients would pay via managed care; the other half were told that the clients would pay out of pocket. As in the earlier study, payment method had a highly significant impact on diagnosis such that relative to out-of-pocket clients, managed care clients were much more likely to be assigned DSM–IV diagnoses. In addition, a noteworthy percentage of participants assigned diagnoses regardless of payment method. Ethical implications are discussed.

Different Ways of Knowing: The Complexities of Therapist Disclosure

ABSTRACT This article offers a discussion of complexities associated with the unintentional disclosure of a therapist's sexual orientation to a client in ongoing psychotherapy. A case involving a lesbian therapist and a heterosexually married woman with a female lover is described and discussed. The case highlights the distinction between overt and dialogic communications between a client and therapist. It also emphasizes how changes in the client's relationship with her therapist intersect with her therapeutic work, including both work specifically related and that only tangentially related to sexual orientation.

Expanding Agoraphobics' Horizons: An Investigation Of The Effectiveness Of A Personal Construct Psychotherapy Intervention

This article investigated whether a personal construct group intervention would enhance the effectiveness of graduated exposure therapy for agoraphobia more than a supportive group intervention. Fifty-four clients were randomly allocated to the treatment conditions. Personal construct and supportive therapy sessions were differentiated on process measures. Although clients in the personal construct psychotherapy plus exposure condition improved more on some outcome measures during treatment than while on the waiting list, there was no evidence of difference in outcome between the two conditions. However, correlations between repertory grid scores and questionnaire measures, and changes in grid scores during therapy, provided support for the personal construct model of agoraphobia.

Characteristics of participants in the Forum, psychotherapy clients, and control participants: A comparative study

'New age' activities, personality variables, symptomatology, and subjective well-being (SWB) among the Forum (F) participants, psychotherapy (P) clients, individuals who are both Forum and psychotherapy (FP) clients, and control (C) participants, who were never involved in either F or P were compared. A group of 64 Israeli men and 76 women (mean age = 38.55 years) completed a demographic questionnaire; the Internal-external, Sensation-seeking, Happiness, Affects balance, Satisfaction with life, and Anxiety and depression scales of the SCL-90. The FP and F participants used occult counsellors significantly more than the C participants, although gender differences were also found. All in all, the FP and P clients were more depressive and anxious, and less happy, less satisfied with their life, and affectively balanced than the F and the C participants. The rationality, personal responsibility, and mental health of the F participants are discussed in light of the results with considerations of short-versus long-term interventions.

Correction notice: Characteristics of participants in the Forum, psychotherapy clients and control participants: A comparative study. Rubinstein, G. (2005)

Correction notice: Characteristics of participants in the Forum, psychotherapy clients and control participants: A comparative study. Rubinstein, G. (2005)

Racist Incident–Based Trauma

Racist incidents are potentially traumatizing forms of victimization that may lead to increased psychiatric and psychophysiological symptoms in targets. The magnitude of the problem of racist incidents in the United States is difficult to estimate; however, data from several sources permit the inference that the prevalence of racist incidents, particularly among people of color, is high. This article (a) distinguishes traumatic stress from nontraumatic stress and (b) draws parallels between experiences of racist incidents and experiences that are acknowledged to be traumatic, such as rape or domestic violence. Conceptualizing the symptoms of some survivors of racist incidents as trauma responses may help inform treatment when these individuals are clients in psychotherapy.

Smoking Cessation and Exercise Promotion Counseling in Psychologists Who Practice Psychotherapy

Little is known about health promotion within the context of psychotherapy. The present study assessed a sample of psychologists' attitudes and behavior with their psychotherapy clients regarding smoking cessation and exercise promotion counseling. This is a cross-sectional survey study. Surveys were mailed. Licensed psychologists (1000) in Massachusetts were randomly selected to receive surveys. Psychologists practicing psychotherapy at least 5 h/wk were invited to participate. Out of 496 responses, 328 completed surveys were analyzed. Two parallel surveys were developed for smoking (N = 154) and exercise (N = 174) assessing health promotion behaviors and attitudes. Approximately 43% of respondents inquire about smoking and 53% inquire about exercise with new clients. Over 45% advise smoking clients to quit and 50% advise sedentary clients to exercise. Over 80% of respondents felt smoking and exercise should be addressed in psychotherapy; however only 41% of smoking and 65% of exercise respondents felt confident in their counseling abilities. Lack of confidence, beliefs about relevance of smoking and exercise to psychological functioning, and beliefs that such personal choices should not be addressed in psychotherapy significantly predicted smoking cessation and exercise promotion behaviors. Many respondents are engaging in health promotion with their psychotherapy clients. Exercise promotion is occurring more frequently and is viewed more favorably compared with smoking cessation counseling. Health promotion attitudes are associated with counseling behaviors. Limitations include self-selection bias and small sample size.

Client Self-Disclosure as a Predictor of Short-Term Outcome in Brief Psychotherapy

ABSTRACT College students differ in their tendencies to self-disclose personal information. The goal of this study was to determine how differing disclosure tendencies among university counseling center clients affect psychotherapy outcomes. Among 22 clients in brief psychotherapy, client tendencies to self-disclose personal information predicted how relevant their in-session disclosures were to the therapy goals. Disclosure tendencies also predicted a decrease in symptoms and social-role concerns after only three to four sessions of psychotherapy. This study suggests that the early assessment of self-disclosure tendencies may be a useful way to clarify clients' expectations about disclosure in therapy and develop effective treatment plans.

A New Perspective on Women's Anger

Anger experience and expression have historically been framed dichotomously (anger held inside the person versus anger let out in overt expression) or in other ways that may be oversimplified and have limited applicability for women. A newer model, women's anger diversion, is applied to the case of a Caucasian woman psychotherapy client, presenting with stress-related physiological symptoms and marital dissatisfaction, to clarify its use in clinical conceptualization, using a descriptive and explanatory case study design. The procedure involved bringing the client into the process as an active participant, and employing her verbal and written feedback as a means of further developing the study. Anger diversion is illustrated in the participant's case history and verbatim reports of her anger experiences. The model is discussed with regard to related literature on women's anger, its therapeutic implications, and needs for further research in the area.

Predicting change for individual psychotherapy clients on the basis of their nearest neighbors.

This study extended client-focused research by using the nearest neighbor (NN) approach, a client-specific sampling and prediction strategy derived from research on alpine avalanches. Psychotherapy clients (N=203) seen in routine practice settings in the United Kingdom completed a battery of intake measures and then completed symptom intensity ratings before each session. Forecasts of each client's rate of change and session-by-session variability were computed on the basis of that client's NNs (n=10-50 in different comparisons). Alternative forecasts used linear or log-linear slopes and were compared with an alternative prediction strategy. Results showed that the NN approach was superior to the alternative model in predicting rate of change, though the advantage was less clear for predicting variability.

Complementary and Alternative Therapy Use by Psychotherapy Clients.

Complementary and Alternative Therapy Use by Psychotherapy Clients.

Here's Looking at Me: The Effect of Memory Perspective on Assessments of Personal Change.

Five studies manipulated the memory perspective (1st-person vs. 3rd-person) individuals used to visually recall autobiographical events and examined its effects on assessments of personal change. Psychotherapy clients recalled their first treatment (Study 1), and undergraduates recalled past social awkwardness (Study 2). Participants who were induced to recall from the 3rd-person perspective believed, and acted as though (Study 2), they had changed more since the events occurred. Subsequent studies revealed a crucial moderator: Third-person recall produces judgments of greater self-change when people are inclined to look for evidence of change, but lesser self-change when they are inclined to look for evidence of continuity. This pattern emerged when motivation (Studies 1 and 2), goals (Study 3), instructions (Study 4), and self-esteem (Study 5) determined participants' focus on change versus continuity. Results have implications for constructivism in memory and judgment and for the ability to sustain self-improvement efforts.

Clients' Perceptions of the Process and Consequences of Self-Disclosure in Psychotherapy.

The primary aim of this multimethod study was to investigate client perceptions of the process, benefits, difficulties, and consequences of disclosing and withholding material in psychotherapy sessions. Twentyone clients in psychotherapy, most engaged in long-term psychodynamically oriented treatment, participated in semistructured interviews and completed several Likert-type scales. Results indicate that most clients feel that therapy is a safe place to disclose, made especially so by the goodness of the therapeutic relationship; that the disclosure process initially generates shame and anticipatory anxiety but ultimately engenders feelings of safety, pride, and authenticity; that keeping secrets inhibits the work of therapy, whereas disclosing produces a sense of relief from physical as well as emotional tension; that disclosures in therapy facilitate subsequent disclosures to one’s therapist as well as to family members and friends; and that therapists should actively pursue material that is difficult to disclose. Speak to me as to thy thinkings, as thou dost ruminate, and give thy worst of thoughts the worst of words—Shakespeare, Othello Western culture historically has emphasized the importance of revealing secrets. This is perhaps seen most profoundly in the orthodoxy of the Catholic Church, which not only stresses the importance of confessing one’s sins but also requires it for absolution. Still, more so than in many decades, self-disclosure seems to be of intense contemporary interest. In “reality” television programming, talk-show radio, tabloid newspapers, books, and politics, a tell-all mentality now prevails. New and formidable social, economic, and political pressures—including rapid technological advances, failing financial markets, and global terrorism— seem to be increasing the need for individuals to feel intimately connected with others, in part by revealing themselves to others. However, it is within the confines of the psychotherapist’s office that self-disclosure is most expected, emphasized, and valued. The present study aimed to investigate the phenomenology of clients’ disclosures in therapy as they unfold throughout the course of treatment.

The Validity of Childhood Sexual Abuse Checklists in the Popular Psychology Literature: A Barnum Effect?

Because many psychotherapy clients consult popularly available childhood sexual abuse (CSA) checklists to determine whether they have abuse histories, clinicians need to be cognizant of these checklists' potential strengths and weaknesses. In particular, endorsement of CSA checklists may be attributable to the Barnum effect. One hundred ninety-six female undergraduates, 39 with self-reported CSA histories, rated lists of CSA checklist items and Barnum items for self-descriptiveness. CSA and Barnum checklist scores were moderately correlated. The CSA checklist significantly distinguished women with versus without a history of abuse, but not when global distress was controlled. Consequently, clinicians should exert caution when assigning books containing popular CSA checklists.

The Dose-Response Relationship at a College Counseling Center

Most college counseling centers have adopted session limits for their psychotherapy clients though little evidence exists to support such cutoff points. In the past eight years, a few studies have been published using survival analysis statistics for investigating the speed of recovery in psychotherapy. The outcome of clients at a university counseling center was studied to assess change across time, on a session-by-session basis. The analysis of these data showed that 14 sessions of psychotherapy were required for 51% of clients to meet criteria for clinically significant change. Results were interpreted as suggesting that limiting psychotherapy at college counseling centers may result in improvements that are not clinically meaningful for the majority of clients receiving services.

The Personal-Story Approach.

The Personal-Story Approach presented here instructs psychotherapy clients how to listen intelligently and courageously to their own accounts of the events and experiences of their lives, as well as how to listen carefully and compassionately to those with whom they seek intimate connectedness, The approach provides clients with the armamentarium to recognize and face their self-deceptions and the means to work them through in their quest for personal authenticity. A case example is provided.