Therapist Response Research Articles

Growth in challenging situations: A qualitative investigation of therapists’ experience of delivering emotion-focused therapy

Objective: Psychotherapy does not work equally well for all clients. For research to support clinicians in helping more clients, we need to better understand the process of when therapy become particularly challenging. In this study, we investigated challenging change processes from the therapists’ perspective when applying Emotion-Focused Therapy (EFT). Method: We interviewed 14 therapists trained in EFT about their experiences of difficulties with applying EFT to clients with varying severity of mental health difficulties. Interviews were analyzed using reflexive thematic analysis. Results: Five themes were constructed. Three describing what EFT therapist find challenging; (1) Challenges in the therapeutic relationship, (2) When feelings are too big, too small or difficult to experience, (3) Matching EFT with the client’s challenges, and two describing therapist responses to the challenges: (4) Do I know EFT, and what would I have needed to know more? (5) What do I do when it becomes difficult? A total of 20 subthemes were identified. Conclusion: Reported experiences of applying EFT to a diverse population suggests a need for either model refinement or strengthening of the dissemination process to better enable EFT-therapists to help clients with more severe mental health difficulties.

Therapist responsiveness in psychotherapy: Introduction to the special issue

Therapist responsiveness denotes that therapists provide therapeutic interventions within an emerging context of client manifestations and moment-by-moment internal and external changes. So far, psychotherapy research on explaining how therapy works falls short of operationalizing the sequence of events constituted by therapist responsiveness. The present special section of Psychotherapy Research addresses this conceptual and methodological gap and proposes six original contributions, using several validated assessment protocols, both from a quantitative and qualitative viewpoint, to study therapist responsiveness in psychotherapy. It aims at providing a rigorous conceptual and methodological basis for studying a core principle of change in psychotherapy for the future.

Measuring and training of therapeutic competencies

This article provides an overview of our research concepts on therapeutic competencies with regard to three main questions. The first research question deals with therapists' competencies to succesfully handle transference and countertransference in the cotext of Alliance Ruptures. Research on the Alliance-Focused Training and on subjective countertransference is presented. The second research question deals with therapists' general interpersonal skills. The research approaches outlined here concern the construct of Facilitative Interpersonal Skills (FIS) and the measurement of these skills using the FIS-task. In further studies on this topic, we are focusing on the question of which therapist characteristics are associated with higher interpersonal skills and which linguistic and phonetic features characterise therapist responses that are rated as interpersonally competent. Another study concerns the tendency of therapists to overestimate their interpersonal skills (self-assessment bias). The third main research question deals with the competence to apply therapeutic techniques and to create helpful change processes. An instrument to assess verbal techniques (Psychodynamic Intervention List) and research approaches focusing on the description and the assessment of mediators of change are presented.

The weaving of therapist responses with client storytelling to promote narrative and emotional integration of complex trauma.

The weaving of therapist responses with client storytelling to promote narrative and emotional integration of complex trauma.

Supplemental Material for The Weaving of Therapist Responses With Client Storytelling to Promote Narrative and Emotional Integration of Complex Trauma

Supplemental Material for The Weaving of Therapist Responses With Client Storytelling to Promote Narrative and Emotional Integration of Complex Trauma

Rethinking treatment failures. Research on a group of Italian psychotherapists.

Psychotherapeutic failures involve situational, relational, and personal factors. Dropout refers to a patient's unilateral termination of treatment without the therapist's knowledge or approval. Premature termination occurs when therapy is discontinued before achieving a sufficient reduction in initial problems. This study explores the role of therapist's emotional response (countertransference), gender, psychotherapeutic orientation, and patient diagnosis in the context of psychotherapeutic failures. A mixed-method approach was used. Fifty-nine Italian psychotherapists, practicing mostly privately with at least 5 years of experience, were recruited through Italian professional internet websites. The Therapist Response Questionnaire and the Impasse Interview were administered to each psychotherapist. Each therapist was asked to reflect on their last dropout patient. Quantitative (MANOVA) and qualitative analyses (textual content analysis) were conducted with SPSS and T-LAB, respectively. The quantitative analyses revealed that the most frequent countertransference response was Helpless/Inadequate, with female therapists experiencing this more frequently than male therapists. The qualitative analyses identified two main factors explaining most of the variance in countertransference responses: Parental/Protective versus Hostile/Angry, and Positive/Satisfying versus Helpless/Inadequate, with Helpless/Inadequate central. Additionally, the qualitative analysis of treatment interruption methods revealed two factors explaining over 50% of the variance. Lack of communication was linked to negative themes, while mediated and direct communication were associated with positive terms. Direct communication was characterized as useful, while mediated communication was linked to dropout and attachment figures. Under pressure, psychotherapists' anxiety levels increase, often managed ambivalently or avoidantly. These results suggest that awareness of psychotherapist emotional responses is important to limit psychotherapeutic failures. These findings offer valuable insights for clinical practice.

Fluctuations in therapist responsiveness facing clients with borderline personality disorder: Starting therapy on the right foot

Objective The present paper focuses on therapist responsiveness during the initial therapy session with clients with borderline personality disorder (BPD), aiming to analyze therapist responsiveness at short intervals during the initial session and determine if it can predict therapeutic alliance from both therapist and client viewpoints. Method A sample of 47 clients participated in the study for 10 sessions of therapy. Therapeutic alliance from therapists’ and clients’ perspectives was rated after each session; external raters assessed therapist responsiveness during the initial session. Multiple linear regression models and linear mixed models with backward variable selection based on AIC were run to analyze whether specific therapist behaviors during session one predicted therapeutic alliance rated from therapists’ and clients’ perspectives. Results The results indicate that therapists normalizing and validating clients’ experiences during the first session are crucial for establishing therapeutic alliance for BPD clients; however, for therapists, the increase in variability of emotions verbalized by clients during the initial session negatively impacts therapeutic alliance. Conclusion The study contributes to further understand the impact of therapists’ behavior at the beginning of therapy with BPD clients. Therapist responsiveness is crucial for therapy outcome but is methodologically challenging; therefore, efforts in this direction should be pursued.

The assessment of therapist responsiveness in psychotherapy research: a systematic review.

Therapist responsiveness is an emerging construct in psychotherapy research that still lacks a clear definition and, consequently, a unique operationalization. Indeed, there is a great overlap between therapist responsiveness and other variables, such as attunement, flexibility, and empathy. This overlap inevitably hinders the assessment of the therapist's responsiveness, although it is crucial for the effectiveness of the treatments. Therefore, the current systematic review aims at exploring the different methodologies of measurement and analysis of therapist responsiveness, including both direct and indirect instruments. The results confirmed difficulties and divergences in the operationalization of the construct, as shown by the great heterogeneity found in the choice and use of the tools. Furthermore, this review provides guidance for future research, clinical practice, and training of therapists.

The Efficacy of Employing Music-based Interventions to Manage Neurodegenerative Diseases: A Systematic Review of Music Therapy as a Nonpharmacological Method

Among the diseases with no cure lies neurodegenerative diseases, a group of disorders that result from progressive damage to cells and nervous system structures and connections that are essential for mobility, coordination, sensation, cognition, and strength. Research on ways to manage Neurodegenerative Diseases (NDDs) is increasing in its pivotal nature in the modern realm of medicine, because to this date there is no widespread cure for them. This paper assesses the efficacy of using music-based interventions (MBIs) to manage these NDDs. In addition, after reviewing multiple articles, this research paper highlights a systematic review of music therapy (MT) when employed as a nonpharmacological method. These articles are based on relevant topics, which are included as a review of related literature. To make the data visually easier to read, a table was constructed, and visual information, including images, was incorporated. The primary method for going about this research problem was interviewing a music therapist. The interview provided extremely valuable insight from an expert who frequently witnesses the implementation of MBIs to better the quality of life for dementia patients. This includes using music therapy to manage their NDDs. From the primary themes analyzed from the music therapist's responses, the researcher concludes that music therapy is extremely efficient in managing dementia and other such NDDs, as well as, its increasing popularity, relevance, and practicality. However, additional research needs to be conducted on this subject. Additional studies and tests of other nonpharmacological methods and other specific types of music-based interventions are recommended in order to explore this topic further.

The impact of scaffolded and non-scaffolded suicidal virtual human interaction training on clinician emotional self-awareness, empathic communication, and clinical efficacy

BackgroundClinicians working with patients at risk of suicide often experience high stress, which can result in negative emotional responses (NERs). Such negative emotional responses may lead to less empathic communication (EC) and unintentional rejection of the patient, potentially damaging the therapeutic alliance and adversely impacting suicidal outcomes. Therefore, clinicians need training to effectively manage negative emotions toward suicidal patients to improve suicidal outcomes.MethodsThis study investigated the impact of virtual human interaction (VHI) training on clinicians’ self-awareness of their negative emotional responses, assessed by the Therapist Response Questionnaire Suicide Form, clinicians’ verbal empathic communication assessed by the Empathic Communication and Coding System, and clinical efficacy (CE). Clinical efficacy was assessed by the likelihood of subsequent appointments, perceived helpfulness, and overall interaction satisfaction as rated by individuals with lived experience of suicide attempts. Two conditions of virtual human interactions were used: one with instructions on verbal empathic communication and reminders to report negative emotional responses during the interaction (scaffolded); and the other with no such instructions or reminders (non-scaffolded). Both conditions provided pre-interaction instructions and post-interaction feedback aimed at improving clinicians’ empathic communication and management of negative emotions. Sixty-two clinicians participated in three virtual human interaction sessions under one of the two conditions. Linear mixed models were utilized to evaluate the impact on clinicians’ negative emotional responses, verbal empathic communication, and clinical efficacy; and to determine changes in these outcomes over time, as moderated by the training conditions.ResultsClinician participants’ negative emotional responses decreased after two training sessions with virtual human interactions in both conditions. Participants in the scaffolded condition exhibited enhanced empathic communication after one training session, while two sessions were required for participants in the non-scaffolded condition. Surprisingly, after two training sessions, clinical efficacy was improved in the non-scaffolded group, while no similar improvements were observed in the scaffolded group.ConclusionLower clinical efficacy after virtual human interaction training in clinicians with higher verbal empathic communication suggests that nonverbal expressions of empathy are critical when interacting with suicidal patients. Future work should explore virtual human interaction training in both nonverbal and verbal empathic communication.

Determining differences between therapists using an extended version of the facilitative interpersonal skills performance test.

The therapist-facilitative interpersonal skills (FIS) has shown to predict therapy outcomes, demonstrating that high FIS therapists are more effective than low FIS therapists. There is a need for more insight into the variability in strengths and weaknesses in therapist skills. This study investigates whether a revised and extended FIS-scoring leads to more differentiation in measuring therapists'interpersonal skills. Furthermore, we explorative examine whether subgroups of therapists can be distinguished in terms of differences in their interpersonal responses. Using secondary data analysis, 93 therapists were exposed to seven FIS-clips. Responses of therapists using the original and the extended FIS scoring were rated. Three factors were found on the extended FIS scoring distinguishing supportive, expressive, and persuasive interpersonal responses of therapists. A latent profile analysis enlightened the presence of six subgroups of therapists. Using the revised and extended FIS-scoring contributes to our understanding of the role of interpersonal skills in the therapeutic setting by unraveling the question what works for whom.

Changes in mentalization in patients with personality disorders during sequential brief-Adlerian psychodynamic psychotherapy: The role of therapists' technique and countertransference.

The aim of the present work was to study the relationship between therapists' technique, therapists' CT, and patients' mentalization, in a sample of patients with PDs undergoing a 40-session program of sequential brief-adlerian psychodynamic psychotherapy, a psychodynamic therapeutic model specifically developed for the treatment of PDs in public mental health services. Eighty-seven patients with PD and their therapists completed ratings of mentalization (mentalization imbalances scale and reflective functioning questionnaire), CT (therapist response questionnaire), and therapists' intervention (comparative psychotherapy process scale) at five different time points (Sessions 5, 10, 20, 30, and 40). Results showed that patients' mentalizing problematics decreased over time. Moreover, we found a reduction of therapists' disengaged CT, and an increase in positive CT over time. Regarding therapists' techniques, psychodynamic-interpersonal interventions were on average higher than cognitive-behavioral, but both techniques were used increasingly over time. Our results also showed significant and clinically coherent interactions between therapist's CT and techniques and between patient's mentalization imbalance and therapist's response. Our results highlighted the importance of early stages in therapy, since the most significant relationships between the various process variables (patient's mentalizing imbalances, therapist's techniques, and emotional responses) are observed between t₁ and t₂, corresponding to the initial phases of the treatments. Clinical implications will be discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Patient personality and therapist responses in the psychotherapy of adolescents with depressive disorders: toward the Psychodynamic Diagnostic Manual - third edition.

Depressive disorders in adolescence pose unique challenges for assessment and treatment, particularly due to their high comorbidity with various personality disorders. Moreover, young depressed patients may elicit very intense and difficult-to-manage emotional responses in therapists (in this context, countertransference). This study aimed at empirically identifying specific personality disorders (or subtypes) among adolescents with depressive pathology and exploring distinct countertransference patterns emerging in their psychotherapy: 100 adolescents (58 with depressive disorders; 42 with other clinical conditions) were assessed by their respective clinicians (n=100) using the psychodiagnostic chart-adolescent of the Psychodynamic Diagnostic Manual (PDM) - second edition, and the therapist response questionnaire for adolescents. Results showed that depressed adolescent patients exhibited marked traits of four personality subtypes (i.e., depressive, anxious-avoidant, narcissistic, and borderline) characterized by different levels of mental functioning and personality organization. These subtypes were predictably related to specific clinicians' emotional responses, even when controlling for the intensity of depressive symptomatology. Patients with depressive or anxious-avoidant personality subtypes evoked more positive countertransference responses, whereas patients with narcissistic or borderline subtypes elicited strong and hard-to-face emotional responses in therapists. Consistent with the next edition of the PDM, the study emphasizes the importance of comprehensive psychodynamic assessment in the developmental age, which frames depressive disorders in the context of accurate emerging personality and mental functioning profiles. This approach, which also relies heavily on the clinician's subjective experience in therapy, provides crucial information on how to specifically tailor interventions that more effectively meet the needs of adolescents with these heterogeneous and complex clinical conditions.

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.

Training students to become responsive therapists: implications from a sequential mixed-methods study on situations that therapists find challenging

ObjectiveTo draw implications for training of therapist responsiveness from a sequential mixed-methods study on challenging clinical situations.MethodStudy 1: online survey mapping frequency and perceived difficulty of 15 clinical situations in a representative sample of psychologists. Study 2: online survey mapping frequency and perceived difficulty of 19 clinical situations among therapists in child and adolescent psychiatry. Study 3: focus group study exploring the situations identified through study 1 and 2.ResultsStudy 1 and 2 showed that ratings of each situation varied between individuals and context. Study 3 showed that the degree to which a situation was challenging was described as depending on the characteristics of the therapist and the context. Experientially, challenging situations were characterized by lacking access to necessary information, falling short, and disturbing arousal. Perceiving therapeutic opportunities despite the challenging nature of the situation, collegial support, self-knowledge, and engagement were important resources.ConclusionSix implications of the results from the three studies for training of responsiveness are discussed: (1) building self-awareness and conceptualization skills; (2) personalizing training; (3) transforming disturbing arousal into engagement; (4) being exposed to a broad range of clinical situations; (5) training on commonly encountered situations; and (6) building tolerance for uncertainty and capacity to seek support.

Kontrol Ustalığı Teorisi

The subject of this article is to provide information about Control Mastery Theory (CMT) and to review the therapeutic relationship between therapist and patient from the perspective of CMT. CMT offers a useful, transtheoretical approach that provides case formulation for each patient, empirically tested for over forty years. This theory is a theory of psychopathology and psychotherapy that offers insight into the origins of psychopathology and how patients work in psychotherapy to overcome their problems. At the same time, CMT opens horizons that enable progress on the path of becoming a therapist. The main concepts of KUT including the patient's pathogenic beliefs, his unconscious plan, and the patient's testing methods and the therapist's responsiveness to these tests, are the main topics of this article. Key Words: Control Mastery Theory, Plan Formulation Method

Therapists' responsiveness in the process of ruptures and resolution: Are patients and therapists on the same page?

This study examined the association between the rupture-repair process and patients' and therapists' perceptions of the therapist's responsiveness. We used the Rsupture Resolution Rating System to rate early sessions (3-5) in 35 short-term psychodynamic psychotherapy cases. The patients and therapists rated their perceptions of the therapist's responsiveness after each session using the Patient's Experience of Attunement and Responsiveness (PEAR) Scale. Therapists' contribution to ruptures was negatively associated with both patients' and therapists' PEAR ratings. Confrontation ruptures were negatively associated with patients' PEAR ratings, whereas there was no significant association with withdrawal ruptures. Resolution was positively associated with both patients' and therapists' PEAR ratings. In addition, resolution moderated the negative association between ruptures and patients' PEAR ratings. The findings emphasize the link between therapists' responsiveness and the rupture-repair process. They also highlight the significance of providing therapists with the necessary training to recognize these dynamics and engage in discussions about them with their patients when appropriate.

Occupational adaptation of occupational therapists in a global crisis: Lessons learned from a Q-methodology study

ABSTRACT Background: The COVID-19 pandemic demanded that people adapt to meet occupational and environmental challenges. Occupational therapists facing occupational disruption had to adapt to maintain engagement in personal and professional roles. These adaptations highlight occupational science concepts, thus contributing to the epistemology of humans as occupational beings. Aim: A Q-methodology study explored the adaptive responses of South African occupational therapists during early COVID-19 lockdown regulations. Materials and methods: Seventy-eight occupational therapists participated in the study. Data were collected using Q-sorts, where participants ranked 53 statements relating to occupational adaptations. Factor analysis was performed using a Q-methodology platform. Results: Participants’ views loaded onto three viewpoints, namely, occupational adaptation, occupational disengagement, and occupational exhaustion. Sixteen participants did not load onto any of the three themes. Most participants felt they could make a difference whilst others missed interacting with service users. A third group experienced feeling burnt out and numb. The Q-factor analysis explained 30% of the variance representing occupational therapists’ views on occupational adaptation during the pandemic and their ability to engage in occupations. Significance: How occupational therapists applied occupational adaptation to face the challenges during and after the pandemic created tangible lessons for future pandemics or crises such as applying occupational therapy intervention principles to themselves and developing preventative and promotive programmes to influence policy on future pandemic responses. The findings expand the interpretation of occupational science concepts, with contributions to occupational adaptation, occupational disengagement, and liminality. The novel term that emerged from this research, occupational exhaustion, should be further researched.

Rorschach Human Movement and Psychotherapy: Relationship with the Therapist’s Emotional Responses

The emotional responses of psychotherapists to their patients, known as countertransference, can yield valuable insights into the patient’s psychological functioning. Albeit from a different perspective, the Rorschach test also provides information about the patient’s psychological processes. In particular, the Rorschach human movement response (M) has been shown to be a useful measure of higher-level psychological functioning. In an attempt to bridge these two largely different perspectives, the aim of this study was to explore the association between M responses in the Rorschach protocols of psychotherapy patients and emotional responses exhibited by their therapists. To this end, a convenience sample of 149 outpatients were administered the Rorschach according to the Comprehensive System, and their therapists completed the Therapist Response Questionnaire. Through a series of regression models, controlling for response style, response complexity, and degree of psychopathology, M demonstrated a significant association with the therapists’ emotional responses. A lower number of M responses was associated with the therapists’ feelings of disengagement, and a higher number of M responses was associated with the therapists’ feelings of being more involved with the patient. Taken together, these results suggest a potential relationship between the number of M responses the respondent gives in the Rorschach and the subsequent development of the therapeutic alliance between the respondent and their therapist.

Therapist verification of patient self-concepts as a responsive precondition for early alliance development and subsequent introject change

Objective Social psychological research has indicated that people strive for self-consistent feedback and interactions, even if negative, to preserve the epistemic security of knowing themselves. Without such self-verification, any interpersonal exchange may become frustrated, anxiety-riddled, and at risk for deterioration. Thus, it may be important for therapists to meet patients’ self-verification needs as a responsive precondition for early alliance establishment and development. We tested this hypothesis with patients receiving cognitive behavioral therapy for generalized anxiety disorder—a condition that may render one’s self-verification needs especially strong. We also tested the hypothesis that better early alliance quality would relate to subsequent adaptive changes in and posttreatment level of patients’ self-concepts. Method Eighty-four patients rated their self-concepts at baseline and across treatment and follow-up, their postsession recollection of their therapist’s interpersonal behavior toward them during session 2, and their experience of alliance quality rated after sessions 3–6. Results As predicted, the more therapists verified at session 2 a patient’s baseline self-concepts (which trended toward disaffiliative and overcontrolling, on average), the more positively that patient perceived their next-session alliance. Moreover, better session 3 alliance related to more adaptive affiliative and autonomy-granting self-concepts at posttreatment. Conclusion Results are discussed within a therapist responsiveness framework.