Therapist Response Research Articles

Dialogical Features, Therapist Responsiveness, and Agency in a Therapy for Psychosis

This study aims to further theoretical and clinical discussions regarding the therapy of psychosis from a dialogical perspective and to contribute to the contemporary research literature that works toward developing methods for studying the dialogical processes in therapy. Three videotaped sessions of a therapy with a heterosexual couple, in which both partners had psychotic experiences, were analyzed using the Dialogical Investigations of Happenings of Change, a method developed with an aim to capture the dialogical qualities of multiactor conversations. The analysis illustrated shifts in the dialogical characteristics of the conversation through the sessions and associated shifts in the clients’ positioning, toward increased agency, as well as enrichment of the narratives regarding their difficulties. The gradual development toward more dialogical conversations, evidenced mainly in increased sharing of dominance and therapist responsiveness and participation, seemed to facilitate the joint construction of new words and meanings, the expression of strong feelings, the narration of difficult experiences, and increased agency. The findings support the view that a client's sense of agency, which can be particularly impoverished in psychosis, can be reconstructed in the context of dialogue, in which clients have a central place in telling their story.

Clinician Emotional Response Toward Narcissistic Patients: A Preliminary Report

Patients with narcissistic personality disorder are among the most difficult to treat in therapy, especially for their strong resistance to treatment and several difficulties in establishing a therapeutic relationship characterized by intimacy, safety, and trust. In particular, therapists’ emotional responses to these patients can be particularly intense and frustrating, as reported in the clinical literature but rarely investigated empirically.The aims of this preliminary study were: 1) to examine the associations between patients’ narcissistic personality disorder and distinct therapists’ countertransference patterns; and 2) to verify whether these clinicians’ emotional reactions were influenced by their theoretical orientation (as well as gender and age).A national sample of psychiatrists and clinical psychologists (N = 250) completed the Therapist Response Questionnaire (TRQ) to identify patterns of therapist emotional response, and the Shedler-Westen Assessment Procedure-200 (SWAP-200) to assess personality disorder and level of psychological functioning in a patient currently in their care and with whom they had worked for a minimum of eight sessions and a maximum of 6 months (one session per week).From the complete therapist sample, we identified a subgroup (N = 35) of patients with narcissistic personality disorder, and we found that this personality pathology was positively associated with criticized/mistreated and disengaged countertransference, but negatively associated with positive therapist response. Moreover, our results confirmed that the relationship between patients’ narcissistic personality disorder and therapists’ emotional responses was not dependent on clinicians’ theoretical approach (as well as their age and gender).These findings are consistent with clinical observations, as well as some empirical contributions, and have meaningful implications for clinical practice of patients suffering from this challenging pathology.

Patient personality and therapist countertransference.

The purpose of this review is to provide a comprehensive and critical examination of the empirical literature about the relation between patient personality and therapist countertransference. The therapist's countertransference can play a crucial role in psychotherapy outcomes, especially in the treatment of personality disorders. The therapist's emotional responses to patients can accomplish the following: inform the clinician about the patient's personality, impact therapy outcome, influence patient resistance and elaboration, mediate the influence of the therapist's interventions and influence therapeutic alliance. In the last years, several studies have empirically demonstrated the presence of a specific pattern of therapist responses that are related to different patient personality disorders. Other works showed how the effects of the therapist's technique depend on the emotional context in which they are delivered and in particular countertransference experiences. Moreover, researchers suggest that the therapist's emotional responses occur across all kinds of therapy and are independent of the therapist's theoretical preferences.

Does the severity of psychopathological symptoms mediate the relationship between patient personality and therapist response?

Countertransference can be viewed as a source of valuable diagnostic and therapeutic information and plays a crucial role in psychotherapy process and outcome. Some empirical researches have showed that patients' specific personality characteristics tend to evoke distinct patterns of emotional response in clinicians. However, to date there have been no studies examining the impact of patients' symptomatology on the association between their personality and therapists' responses. This research aimed to (a) investigate the relationship between patients' symptom severity and clinicians' emotional responses; and (b) explore the possible mediated effect of symptom severity on the relationship between patients' personality pathology and countertransference responses. A sample of psychiatrists and clinical psychologists (N = 198) of different theoretical orientations completed the Shedler-Westen Assessment Procedure-200 and the Therapist Response Questionnaire on a patient currently in their care, who then completed the Symptom Checklist-90-Revised. The findings showed that patients' symptomatology partially mediates the relationship between their specific personality disorders (in particular, schizotypal, borderline, histrionic, and avoidant) and therapists' emotional responses, but in general, the impact of symptom severity is less sizable than one aroused by patients' personality style. Higher levels of patients' symptom severity are most associated with an intense feeling of being overwhelmed, disorganization, helplessness, and frustration in clinicians. These countertransference reactions are not accounted for by therapists' different therapeutic approaches and other variables (as gender, age, profession, and experience). The clinical implications of these results are addressed.

Use of relational strategies to repair alliance ruptures: How responsive supervisors train responsive psychotherapists.

Inasmuch as therapist responsiveness is the crucial ingredient in psychotherapy success, teaching supervisees to be optimally responsive to their clients is the primary function of supervision. Responsive supervision is particularly critical when a trainee experiences a faltering or problematic working alliance with a client. In this article, I describe and illustrate how supervisors can work responsively, both explicitly (through instruction) and implicitly (through modeling) when their supervisees report a serious alliance rupture. Next, I illustrate, with the same case example, how quickly ruptures in the therapeutic alliance can lead to ruptures in the supervisory alliance when the supervisor is not sufficiently responsive to the trainee's needs and, instead, relies exclusively on case management. Throughout the article, I discuss how the construct of responsiveness fits within the substantial body of theory and research on relational processes in supervision.

Perceptions of therapist responses to shame disclosures by clients: A quasi-experimental investigation with non-clinical participants

AbstractBackground: Therapist responses to initial shame disclosure in therapy have received little empirical attention. Aim: This study explored different therapeutic responses to shame disclosures in terms of their perceived helpfulness. Responses ranged from complete withdrawal from the feeling (withdrawal) to completely tuning into it (non-withdrawal). Given the tendency of shame to evoke avoidance, participants higher on shame-proneness (as measured by The Experience of Shame Scale) were expected to perceive withdrawal responses to shame as more helpful than non-withdrawal responses. Methodology: Fifty-five non-clinical participants were assessed for shame-proneness before viewing videos of mock therapy sessions showing clients either disclosing shame (two videos) or shock (control condition). Participants then rated the helpfulness of different therapist responses. The responses differed in the degree they allowed the client to withdraw from their emotions. Results: High shame proneness was associat...

Is Secondary Traumatization a Negative Therapeutic Response?

This study aims to challenge the current conception of secondary traumatization (ST) as a pathological response of therapists working with trauma victims. One hundred two experienced therapists in both public and private practice, treating adult victims of childhood sexual abuse, participated in the study. The results support the main premise of the study; namely, high levels of posttraumatic growth (PTG) are positively associated with therapist ST symptoms, with levels of both positive and negative experiences related to exposure to the abuse in the context of therapy. These results imply that trained therapists might anticipate and process ST and other personal negative responses as a beneficial and empowering phase of therapy, thus ultimately perceiving them positively.

A Questionnaire-Based Survey: Therapists Response towards Upper Limb Disorder Learning Tool

A Questionnaire-Based Survey: Therapists Response towards Upper Limb Disorder Learning Tool

A Questionnaire-Based Survey: Therapists Response towards Upper Limb Disorder Learning Tool

A Questionnaire-Based Survey: Therapists Response towards Upper Limb Disorder Learning Tool

A Questionnaire-Based Survey: Therapists Response towards Upper Limb Disorder Learning Tool

A Questionnaire-Based Survey: Therapists Response towards Upper Limb Disorder Learning Tool

A Questionnaire-Based Survey: Therapists Response towards Upper Limb Disorder Learning Tool

A Questionnaire-Based Survey: Therapists Response towards Upper Limb Disorder Learning Tool

A Questionnaire-Based Survey: Therapists Response towards Upper Limb Disorder Learning Tool

A Questionnaire-Based Survey: Therapists Response towards Upper Limb Disorder Learning Tool

A Questionnaire-Based Survey: Therapists Response towards Upper Limb Disorder Learning Tool

A Questionnaire-Based Survey: Therapists Response towards Upper Limb Disorder Learning Tool

A Questionnaire-Based Survey: Therapists Response towards Upper Limb Disorder Learning Tool

A Questionnaire-Based Survey: Therapists Response towards Upper Limb Disorder Learning Tool

Targeting emotional impact in storytelling: Working with client affect in emotion-focused psychotherapy

Within emotion-focused therapy (EFT), the client’s ability to express and reflect on core emotional experiences is seen as fundamental to constructing the self and to entering into a change process. For this study, we 1) examine storytelling contexts in which clients do not disclose the emotional impact of their narrative, and 2) identify the interactional practices through which EFT therapists subsequently call attention to what the client may have felt. In doing so, we examine client stories drawn from video-taped individual psychotherapy sessions involving clinically depressed clients. Client stories and therapists’ responses to these stories were analysed using conversation analytic methods. Three different therapist response types were identified: eliciting, naming and illustrating the emotional impact of the client’s prior narrative. These responses also were found to differ in terms of how effectively they could display empathy and secure affiliation with clients. The implications of this work for therapeutic practice are discussed.

Journal Watch review of Patient personality and therapist response: an empirical investigation.

Journal Watch review of Patient personality and therapist response: an empirical investigation.

Exploring Client and Therapist Experiences of Sexual Offender Intervention: Developing a Model of "Significant Events".

This research explored the therapeutic events both clients and therapists from community-based treatment interventions for perpetrators of sexual abuse identify as significant in their experience of psychological therapy. A qualitative design was utilized to address this research objective. The sample for the present research is comprised of three different treatment programs for sexual offending. Twenty-five clients and nine therapists participated in the study. Two qualitative measures were used to elicit client and therapist responses. Significant Aspects of Therapy Form was administered every second treatment session during each intervention program. The Significant Aspects Follow-Up Interview was conducted with a sub-sample of participants at the conclusion of each treatment module. Thematic analysis was used to identify significant themes noted by clients and therapists from forms and interviews. Thematic analysis resulted in a model of significant events in therapy. In this model, significant events were categorized into six domains. The six domains were as follows: (a) the process of therapy, (b) making changes and progress in therapy, (c) content and structure of therapy, (d) therapist contributions, (e) negative contributions to therapy, and (f) other factors Each domain further contained between 6 and 18 themes, which are also reported. This study found much overlap and similarity in the experiences of therapy between clients of sexual offender therapy and general psychotherapy. Furthermore, there is overlap between therapists and clients in the aspects of therapy they identify as significant. The implications of these findings on effective service development and comprehensive service evaluations are discussed.

Perceptions of therapist responses to shame disclosures by clients: A quasi-experimental investigation with non-clinical participants

Perceptions of therapist responses to shame disclosures by clients: A quasi-experimental investigation with non-clinical participants

Patient Personality and Therapist Response: An Empirical Investigation

The aim of this study was to examine the relationship between therapists' emotional responses and patients' personality disorders and level of psychological functioning. A random national sample of psychiatrists and clinical psychologists (N=203) completed the Therapist Response Questionnaire to identify patterns of therapists' emotional response, and the Shedler-Westen Assessment Procedure-200 to assess personality disorders and level of psychological functioning in a randomly selected patient currently in their care and with whom they had worked for a minimum of eight sessions and a maximum of 6 months (one session per week). There were several significant relationships between therapists' responses and patients' personality pathology. Paranoid and antisocial personality disorders were associated with criticized/mistreated countertransference, and borderline personality disorder was related to helpless/inadequate, overwhelmed/disorganized, and special/overinvolved countertransference. Disengaged countertransference was associated with schizotypal and narcissistic personality disorders and negatively associated with dependent and histrionic personality disorders. Schizoid personality disorder was associated with helpless/inadequate responses. Positive countertransference was associated with avoidant personality disorder, which was also related to both parental/protective and special/overinvolved therapist responses. Obsessive-compulsive personality disorder was negatively associated with special/overinvolved therapist responses. In general, therapists' responses were characterized by stronger negative feelings when working with lower-functioning patients. Patients' specific personality pathologies are associated with consistent emotional responses, which suggests that clinicians can make diagnostic and therapeutic use of their responses to patients.

A feasibility study using interactive graphic art feedback to augment acute neurorehabilitation therapy

Interactive arts technologies, designed to augment the acute neurorehabilitation provided by expert therapists, may overcome existing barriers of access for patients with low motor and cognitive function. Develop an application prototype to present movement feedback interactively and creatively. Evaluate feasibility of use within acute neurorehabilitation. Record demographics and Functional Independent Measure™ scores among inpatients who used the technology during physical, occupational or recreational therapy. Record exercises performed with the technology, longest exercise duration performed (calculated from sensor data), user feedback, and therapist responses to a validated technology assessment questionnaire. Inpatients (n = 21) between the ages of 19 and 86 (mean 57 ± 18; 12 male/9 female) receiving treatment for motor deficits associated with neuropathology used the application in conjunction with occupational, recreational, or physical therapy during 1 to 7 sessions. Patients classified on the Functional Independence Measure™ as requiring 75%+ assistance for cognitive and motor function were able to use the interactive application. Customized interactive arts applications are appropriate for further study as a therapeutic modality. In addition to providing interactivity to individuals with low motor function, interactive arts applications might serve to augment activity-based medicine among inpatients with low problem-solving and memory function.