Therapist Response Research Articles

Accuracy in the Outcomes and Assessment Information Set (OASIS): results of a video simulation.

There is little information regarding the accuracy of the Outcomes and Assessment Information Set (OASIS), the patient assessment tool mandated for use in Medicare-funded home health care. The purposes of this study were to evaluate the accuracy of OASIS completion by home health nurses and rehabilitation therapists, to compare responses of nurses and therapists, and to determine whether dispersion of answers would affect the home health resource group (HHRG) to which patients were assigned for Medicare home health care payments to agencies. Using a video simulation of admission and discharge visits, 436 clinicians from 29 Ohio home health care agencies scored selected OASIS items. Although the majority of the items were rated accurately, discrepancies were found between clinician responses and the "correct" answer on several items. Nurses and therapists provided similar ratings on most items studied, but for most cases in which discrepancies were found, nurses were more likely to agree with the "correct" answer. Discrepancies most often led to patients being assigned to lower-payment HHRGs. Continued monitoring of OASIS data collection accuracy is recommended to maximize the value of the OASIS instrument in home health care research, practice, and policy.

Interaction rules and strategies in psychotherapy.

To examine the presence of interaction rules and strategies used in therapy, the verbal responses of therapists and clients in 26 actual psychotherapy cases were coded using the Interpersonal Communication Rating Scale (ICRS; S. R. Strong, H. Hills, C. Kilmartin, et al., 1988). The conditional response probabilities of these ICRS codes were examined from a rules and strategies perspective according to procedures suggested by S. Duncan (1983). The results supported the presence for rules for both the client and the therapist, and these rules were found to involve complementary interactions. No support was found for the presence of strategies in the interactive behavior of either participant. Finally, there was no relation between the presence of rules and session evaluation. The results are discussed with respect to the definition of rules in counseling and the concept of complementarity.

Flexibility in Manual-Based Psychotherapies: Predictors of Therapist Interventions in Interpersonal and Cognitive-Behavioral Therapy

The goal of the current investigation was to explore the variables that predict therapist responsiveness in implementing specific therapist interventions. The authors found that therapists who were trained to adherence in manualized cognitive-behavioral (CBT) and interpersonal (IPT) psychotherapies demonstrated flexibility in the delivery of specific therapist techniques in response to specific patient characteristics and in-session therapeutic processes. Therapists used more clarifications and restatements with patients who rated the therapeutic empathy higher, more clarifications and questions with patients who rated higher on depression, and more learning statements with patients who provided more complete interpersonal narratives. Differences in responsiveness between treatment groups are discussed.

The Role of the Physical Therapist in Primary Care and Cancer Screening: Integrating Clinical Breast Examination (CBE) in Upper Quarter Examination

As the number of cancer survivors increases in the United States, physical therapists are evaluating and treating people with a past medical history of cancer on an increasing scale. In this context, the question of whether or not clinical breast examination (CBE) should be performed by a physical therapist as part of an upper quadrant screening examination has been raised. At the present time, therapists practicing in areas of oncology, women's health, and lymphedema are most likely to find this information relevant. The consumer now has direct and unrestricted access to the physical therapist in many states. At the same time, the role of the physical therapist as a prevention and education specialist is expanding. Advanced skills are necessary for today's health care environment and for the competencies required at the DPT level. As a result of the increased number of cancer survivors and as part of the physical therapist's response to autonomous practice, CBE is an appropriate assessment tool in the screening process for some clients.

Hamlet at the Millennium: Assisting Today’s Teens Through the Group Psychotherapy Process

This article reviews Shakespeare’s Hamlet and its universal appeal 400 years after it was written. Focusing on the soliloquy “to be or not to be,” the author notes that the play examines the fundamental philosophical question of whether to continue with life, or not. The article then discusses difficulties experienced by adolescents at admission to an inpatient psychiatric program by referring to them as modern day Hamlets. An examination of the theme of ambivalence as it complicates the assessment and treatment process is undertaken. A checklist of therapist responses to ambivalence in the conducting of inpatient group psychotherapy in an adolescent psychiatric hospital unit is offered.

Implementing psychological treatment for symptoms of psychosis in an area mental health service: The response of patients, therapists and managers

The effectiveness and acceptance of a CBT for psychosis intervention that focussed on coping enhancement for voices and delusions, was studied in routine practice in an ordinary mental health service. Twenty-two of 30 referred patients received the intervention. Acceptance by the 22 patients was high, and positive symptom ratings and GAF scores improved following therapy. Eleven of 14 area psychologists availed themselves of training and support opportunities. While uptake of cases was variable, with two therapists accounting for 79% of registered cases, 50% claimed additional limited implementation of CBT principles with non-registered patients. The 14 service managers saw the therapy as effective and considered 36% of service users to be potential candidates for CBT for psychosis. However CBT was not seen as a high service priority and psychologists were generally allocated little additional therapy time. These findings raise issues about the dissemination of innovation into routine practice including management of change and the need to investigate the efficacy of more limited implementation of treatment packages.

Psychotherapy for Massively Traumatized Refugees: The Therapist Variable

In the treatment of severe posttraumatic stress disorder (PTSD), much emphasis is put on techniques, especially behavioral therapies. Such techniques negate the importance of the therapist as an individual in the treatment of complex PTSD as presented in severely traumatized refugees. The specific difficulties encountered by this population and the therapist responses are discussed: the need to tell the trauma story and the therapist's ability to listen; the patient's need for constancy and therapist's ability to stay; the patient's need to give and the therapist's ability to receive; the patient's problem with evil and the therapist's ability to believe. Case examples illustrate the approach and then discuss how generalizable this experience is to other populations. Research implications are suggested.

Therapists of patients who committed suicide reported a wide range of emotional responses

Hendin H, Lipschitz A, Maltsberger JT , et al. Therapists' reactions to patients' suicides. Am J Psychiatry2000 Dec; 157 : 2022 –7. [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] QUESTION: What are the emotional...

Process research in understanding and applying psychological therapies.

Research on the process of psychological therapy aims to demonstrate how therapy works, partly to increase understanding, but primarily to increase effectiveness by pointing to the crucial ingredients which effect change. This paper aims to demonstrate some of the reasons why process research should be undertaken in the attempt to increase therapeutic effectiveness. A model of scientific inquiry suggests three broad types of process research: (1) studies which describe behaviours and processes occurring within therapy sessions (exploratory studies); (2) studies which investigate the links between specific psychotherapy processes and treatment outcome (hypothesis testing); (3) studies which examine the links between specific psychotherapy processes and theories of change (theory development). Using this typology, we describe key aspects of process research: what it is; what has been studied; the limitations of existing research. Descriptive studies have deepened understanding of the therapeutic process; however, a large number of reliable process-outcome links have been hard to establish. Comparative studies have been rare. Studies which are linked to models of change and which attempt to track therapist responsiveness are more complex and have been more promising. Most studies are beset by methodological difficulties. There are a number of promising future research possibilities and methods. Despite methodological challenges, the field is developing and research is encouraging. We argue that process research has a significant place in advancing our understanding of the complexity of therapeutic change, and hence in facilitating theory development and effective therapeutic interventions.

The Role of the Therapist's Affect in the Detection of Empathic Failures, Misunderstandings and Injury

Therapists cannot be expected to always understand their patients or the process of their groups. Using evolving self psychology and theories of intersubjectivity, this manuscript explores the affective responses of therapists as a valuable indication that such misunderstanding is occurring. Clinical vignettes will illustrate three specific reasons for therapist misunderstanding: over-adherence to theory, boundary crossing, and inexperience. Additional examples will illustrate how countertransference can disrupt treatment when the group therapist conveys material or affects outside his or her awareness.

Therapist Empathy and Depth of Interpretation in Response to Potential Alliance Ruptures: The Role of Therapist and Patient Attachment Styles

This analogue study examined the relationship between therapists' resolution of therapeutic alliance ruptures and their attachment styles. Seventy-seven clinical psychology graduate student therapists responded to videotaped statements made by role-played patients displaying four different attachment styles (preoccupied, dismissing, fearful, and secure). Therapist responses were rated on empathy and depth of interpretation. Therapist differences in attachment style were assessed on the two dimensions of anxiety and avoidance, derived from a factor analysis of the Relationship Scales Questionnaire. Overall, more anxious therapists tended to respond less empathically, particularly with the fearful and secure patients. There were no therapist differences in depth of interpretation. As a whole, responses to the fearful and preoccupied patients tended to be deeper and more empathic than those to the dismissing and secure patients.

Skill acquisition in the implementation of functional analysis methodology.

Functional analysis methodology is a powerful assessment tool for identifying contingencies that maintain a wide range of behavior disorders and for developing effective treatment programs. Nevertheless, concerns have been raised about the feasibility of conducting functional analyses in typical service settings. In this study, we examined the issue of skill acquisition in implementing functional analyses by evaluating an instructional program designed to establish a basic set of competencies. Eleven undergraduate students enrolled in a laboratory course in applied behavior analysis served as participants. Their performance was assessed during scripted simulations in which they played the roles of "therapists" who conducted functional analyses and trained graduate students played the roles of "clients" who emitted self-injurious and destructive behaviors. To approximate conditions under which an individual might conduct an assessment with limited prior training, participants read a brief set of materials prior to conducting baseline sessions. A multiple baseline design was used to assess the effects of training, which consisted of reading additional materials, watching a videotaped simulation demonstrating correct procedural implementation, passing a written quiz, and receiving feedback on performance during sessions. Results showed that participants scored a relatively high percentage of correct therapist responses during baseline, and that all achieved an accuracy level of 95% or higher following training that lasted about 2 hr. These results suggest that basic skills for conducting functional analyses can be acquired quickly by individuals who have relatively little clinical experience.

The treatment rationale in cognitive behavioral therapy: Psychological mechanisms and clinical guidelines

Clinical experience and an accumulating body of research suggest that clients who enthusiastically buy into a cognitive-behavioral treatment (CBT) rationale show more favorable outcomes. But how should a therapist present and discuss a CBT rationale effectively? How does one respond to client concerns and doubts? What are the psychological processes operating when discussing why a client is suffering and what to do about it? We suggest that the treatment rationale is a considerably more subtle and complex process than has previously been assumed. It involves generating expectations, negotiating control and assigning blame, and its function may vary depending on the stage of treatment. We illustrate these points by considering common reactions to a CBT rationale and alternative therapist responses. We conclude that much closer attention should be paid to the treatment rationale in the context of research and clinical practice.

Chapter 7 The Gay Therapist's Response to a Gay Client Practicing Unsafe Sex

The significance of psychoanalytic perspectives for brief psychotherapy is discussed in the report of a gay man practicing unsafe sex (known colloquially as “barebacking.”). The paper focuses both on understanding transference and counter-transference issues in work with this man.

Therapist responsiveness to client attachment styles and issues observed in client-identified significant events in psychodynamic-interpersonal psychotherapy

We analyzed the influences of client interpersonal styles on therapy processes using an attachment theory framework. Ten transcripts of client identified significant therapy events were analyzed fo...

Therapist Responsiveness to Client Attachment Styles and Issues Observed in Client-Identified Significant Events in Psychodynamic-Interpersonal Psychotherapy

We analyzed the influences of client interpersonal styles on therapy processes using an attachment theory framework. Ten transcripts of client identified significant therapy events were analyzed for evidence of client attachment styles (dismissing, preoccupied, or secure), attachment issues, and therapist responsiveness to attachment issues. The attachment issues identified tended to focus on three themes: concerns about loss or rejection, feelings surrounding conflict and danger, and the need for closeness or proximity. Therapist responses were categorized as (a) providing containment, safety, and structure, (b) reflecting the client emotions and concerns, and (c) interpreting or challenging the client attachment style. It was hypothesized that therapist responses to client attachment issues would be mediated by client attachment styles. In these 10 events there was evidence that therapists responded to preoccupied attachment styles with reflection and to dismissing styles with interpretation, as had been hypothesized. Wir analysierten den Einfluß der interpersonalen Stile von Klienten auf den Therapieprozeß vor dem Hintergrund eines bindungstheoretischen Rahmens. Zehn Transkripte, in denen durch Klienten identificzierte bedeutsame Therapieereignisse niedergeschrieben waren, wurden im Hinblick auf Bindungsstile der Klienten analysiert (abweisend, anklammernd oder sicher), außerdem i Hinblick auf bindungsrelevante Themen und Reaktionen der Therapeuten auf diese Themen. Die bindungsrelevanten Themen, die identifiziert wurden, bezogen sich auf drei Aspekte: die Sorge im Hinblick auf Verluste und Zurückweisungen, Gefühle im Zusammenhang mit Konflikten und Gefahren und das Bedürins nach Nähe. Die Reaktionen der Therapeten wurden folgendermßen kategorisiert: a) Bewahren, Sicherheit und Struktur, b) Reflexion von Emotionen und Befürchtungen und c) Deutungen bzw. Konfrontationen im Hinblick auf den Bindungsstil der Klienten. Es wurde vermutet, daß die Reaktionen der Therapeuten auf bindungsrelevante Themen durch die Bindungsstile der Klienten mediiert würden. Bei den untersuchten zehn Ereignissen deutete sich an, daß die Therapeuten im Falle anklammenrnder Bindungsstile eher mit Spiegelung, im Falle abweisender Bindungsstile eher mit Deutungen reagierten, wie es der Hypothese entsprach. Nous avons analysé l'influence du style itnerpersonnel des clients sur le processurs thérapeutique dans le cadre de la théorie de l'attachment. Dix transcriptions de mments significatifs en thérapie, identifiés par le patient, ont été analysées en fonction du style d'attachment du client (évitant, préoccupé, sûr), des thèmes d'attachement, et l'écho thérapeutique aux thèmes d'attachement. Les thèmes d'attachement identifiés étaient centrés sur trois focus: inquiétudes au sujet d'une perte ou d'un rejet, affects autour de conflits et de dangers, et besoins d'intimité ou de proximité. L'écho thérapeutique a été catégorisé comme a) apportant contention, sécurité et structure, b) mettant en réflexion les émotions et les inquiétudes des clients, et c), interprétant ou mettant ä l'épreuve le style d'attachement des clients. L'hypothèse était que les réponses des thérapeutes aux thémes d'attachement énouncés par les clients se feraient en fonction du styl d'attachement des clients. Les 10 transcriptions de cette étude ont mis en évidence que le thérapeute a répondu par la réflexion aux styles d'attachement préoccupés et par l'interprétation aux styles évitants, ce qui correspond à l'hypothèse. Por medio de la teoría del apego, hemos analizado la influencia de los estilos interpersonales de los clientes sobre los respectivos procesos terapéuticos. Para obtener evidencia del estilo de apego (prescindente (dismissing), preocupado o seguro); de otros problemas de apego; y de la responsividad del terapeuta a estas cuestiones, se analizaron diez transcripciones de acontecimientos vistos como significativos por el cliente. Los problemas de apego identificados se focalizaron en tres temas: preocupaciones por la pérdida o el rechazo; sentmientos relativos al conflicto; y peligroy neceidad de contacto estrecho o proximidad. Las respuestas del terapeuta se categorizaron como a) suministro de continencia, seguridad y estructura; b) reflejo de las emociones y precocupaciones del cliente; c) interpretación o desafío al estilo de apego del cliente. Se formuló la hipótesis de que las respuestas del terapeuta a los problemas de apego del cliente hubo evidencia de que el terapeuta respondía con reflexión a estilos que mostraban precupación, y con interpretación a aquéllos que mostraban prescindencia (dismissing styles).

Supervision of Psychotherapy and Counselling: Making a Place to Think • More Than a Mirror: How Clients Influence Therapists' Lives

Supervision of Psychotherapy and Counselling: Making a Place to Think • More Than a Mirror: How Clients Influence Therapists' Lives

Therapist responsiveness to client interpersonal styles during time-limited treatments for depression.

Effective treatment involves therapists responding appropriately to their clients' varying requirements, including clients' predominant interpersonal styles. In 2 manualized time-limited treatments for depression, psychodynamic-interpersonal (PI) and cognitive-behavioral (CB) clients were assigned to 1 of 3 interpersonal style groups. Therapists, who were not told their clients' interpersonal style, nevertheless responded with systematically different interventions depending on clients' interpersonal style. Consistent with predictions, therapists tended to use more affective and relationship-oriented interventions with overinvolved clients, particularly in PI therapy. Therapists tended to use more cognitive treatment methods with underinvolved clients, particularly in CB therapy. Outcomes of the interpersonal style groups were approximately equivalent, consistent with a view that the differences in treatment implementation reflected appropriate responsiveness to clients' interpersonal styles.

Relationship formation and relational control as correlates of psychotherapy quality and outcome.

This study examined the nature of therapist-client interactions within and across seven psychotherapy cases (a) to test whether therapeutic outcome is a function of a transition from relational incongruence to relational congruence (S. Strong, 1982) and (b) to investigate the relation of relational congruence and control to qualitative aspects of the therapy relationship and to therapy outcome. Measures of therapist and client response patterning served as indices of relational congruence and of relational control. Relationship quality was assessed in terms of therapist and client ratings of their working alliance and of therapy session depth and smoothness. Outcome was operationalized in terms of symptom reduction. Results showed limited support for a relationship between relational congruence and therapy outcome and suggested that relational control is not a significant factor in client or therapist evaluations of relationship quality or therapy outcome.

Therapist, trainee, and child verbal response modes in child group therapy.

Therapist, trainee, and child verbal response modes in child group therapy.