Subscribe: Journal of Counseling Psychology - Vol 57, Iss 1
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The Journal of Counseling Psychology publishes empirical research in the areas of (a) counseling activities (including assessment, interventions, consultation, supervision, training, prevention, and psychological education), (b) career development and voc

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Copyright: Copyright 2016 American Psychological Association

Are therapists uniformly effective across patient outcome domains? A study on therapist effectiveness in two different treatment contexts.


As established in several studies, therapists differ in effectiveness. A vital research task now is to understand what characterizes more or less effective therapists, and investigate whether this differential effectiveness systematically depends on client factors, such as the type of mental health problem. The purpose of the current study was to examine whether therapists are universally effective across patient outcome domains reflecting different areas of mental health functioning. Data were obtained from 2 sites: the Research Consortium of Counseling and Psychological Services in Higher Education (N = 5,828) in the United States and from primary and secondary care units (N = 616) in Sweden. Outcome domains were assessed via the Outcome Questionnaire-45 (Lambert et al., 2004) and the CORE-OM (Evans et al., 2002). Multilevel models with observations nested within patients were used to derive a reliable estimate for each patient’s change (which we call a multilevel growth d) based on all reported assessment points. Next, 2 multilevel confirmatory factor analytic models were fit in which these effect sizes (multilevel ds) for the 3 subscales of the OQ-45 (Study 1) and 6 subscales of CORE-OM (Study 2) were indicators of 1 common latent factor at the therapist level. In both data sets, such a model, reflecting a global therapist effectiveness factor, yielded large factor loadings and excellent model fit. Results suggest that therapists effective (or ineffective) within one outcome domain are also effective within another outcome domain. Tentatively, therapist effectiveness can thus be conceived of as a global construct. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

A dynamic systems approach to psychotherapy: A meta-theoretical framework for explaining psychotherapy change processes.


Notwithstanding the many methodological advances made in the field of psychotherapy research, at present a metatheoretical, school-independent framework to explain psychotherapy change processes taking into account their dynamic and complex nature is still lacking. Over the last years, several authors have suggested that a dynamic systems (DS) approach might provide such a framework. In the present paper, we review the main characteristics of a DS approach to psychotherapy. After an overview of the general principles of the DS approach, we describe the extent to which psychotherapy can be considered as a self-organizing open complex system, whose developmental change processes are described in terms of a dialectic dynamics between stability and change over time. Empirical evidence in support of this conceptualization is provided and discussed. Finally, we propose a research design strategy for the empirical investigation of psychotherapy from a DS approach, together with a research case example. We conclude that a DS approach may provide a metatheoretical, school-independent framework allowing us to constructively rethink and enhance the way we conceptualize and empirically investigate psychotherapy. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Interpersonal impacts mediate the association between personality and treatment response in major depression.


Personality, as characterized by the Five-Factor Model, predicts response to psychotherapy for depression. To explain how personality impacts treatment response, the present study investigated patient and therapist interpersonal processes in treatment sessions as an explanatory pathway. A clinical trial was conducted in which 103 outpatients (mean age: 41.17 years, 65% female) with primary major depressive disorder completed 16–20 weeks of cognitive–behavioral or interpersonal therapy. Before treatment, patients completed the Revised NEO Personality Inventory to assess personality domains (neuroticism, extraversion, openness-to-experience, agreeableness, and conscientiousness). After 3 and 13 weeks, patient interpersonal behavior was rated by the therapist and vice versa to determine levels of patient and therapist communal and agentic behaviors. Depression levels were measured before and after treatment. Structural equation modeling supported that patients’ interpersonal behavior during therapy mediated the associations between pretreatment personality and depression treatment outcome. Specifically, extraversion, conscientiousness, and neuroticism (inverse) predicted higher levels of patient communion throughout treatment, which was in turn associated with improved treatment outcomes. Furthermore, patient agreeableness was inversely associated with agency throughout treatment, which was linked to poorer treatment response. Therapist interpersonal behavior was not a significant mediator. Results suggest that patient interpersonal behavior during treatment may be one way that patient personality impacts clinical outcomes in depression. Results underscore the clinical utility of Five-Factor Model domains in treatment process and outcome. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Are you in the mood? Therapist affect and psychotherapy process.


Studies on therapist factors have mostly focused on therapist traits rather than states such as affect. Research related to therapist affect has often looked at therapist baseline well-being or therapist reactions, but not both. Fifteen therapists and 51 clients rated pre- and postsession affect, as well as postsession working alliance and session quality, for 1,172 sessions of individual psychotherapy at a community clinic. Therapists’ affect became more positive when clients were initially positive and when clients became more positive over the session, and became more negative when clients were initially negative and when clients became more negative over the session. Furthermore, when therapists were initially positive in affect and when therapists became more positive over the session, clients rated the session quality to be high. Conversely, when therapists were initially negative in affect and when therapists became more negative over the session, clients rated the session quality and working alliance low. On open-ended questions, therapists reported mood shifts in 67% of sessions (63% positive, 50% negative). Positive affect change was attributed to collaborating with the client, perceiving the client to be engaged, or being a good therapist. Negative affect change was attributed to having a difficult client, perceiving the client to be in distress, or being a poor therapist. Thus, therapist state affect at presession and change in affect across a session may independently contribute to the process and outcome of therapy sessions. The examination of within-therapist variables over the course of therapy may further our understanding of therapist factors. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Group relationships in early and late sessions and improvement in interpersonal problems.


Groups are more effective when positive bonds are established and interpersonal conflicts resolved in early sessions and work is accomplished in later sessions. Previous research has provided mixed support for this group development model. We performed a test of this theoretical perspective using group members’ (actors) and aggregated group members’ (partners) perceptions of positive bonding, positive working, and negative group relationships measured early and late in interpersonal growth groups. Participants were 325 Italian graduate students randomly (within semester) assigned to 1 of 16 interpersonal growth groups. Groups met for 9 weeks with experienced psychologists using Yalom and Leszcz’s (2005) interpersonal process model. Outcome was assessed pre- and posttreatment using the Inventory of Interpersonal Problems, and group relationships were measured at Sessions 3 and 6 using the Group Questionnaire. As hypothesized, early measures of positive bonding and late measures of positive working, for both actors and partners, were positively related to improved interpersonal problems. Also as hypothesized, late measures of positive bonding and early measures of positive working, for both actors and partners, were negatively related to improved interpersonal problems. We also found that early actor and partner positive bonding and negative relationships interacted to predict changes in interpersonal problems. The findings are consistent with group development theory and suggest that group therapists focus on group-as-a-whole positive bonding relationships in early group sessions and on group-as-a-whole positive working relationships in later group sessions. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Who sits behind the telephone? Interpersonal characteristics of volunteer counselors in telephone emergency services.


Objective: Telephone emergency services (TES) play an important role in suicide prevention across different health care systems around the world. However, little is known about the telephone counselors who often volunteer to provide free and confidential help for people in emotional crises. The current study aims to examine the interpersonal values of volunteer counselor trainees and further investigates their personality traits, life satisfaction and expectations regarding their future counseling style. Method: For the current study, 261 counselor trainees were recruited within the German nationwide organization TelefonSeelsorge at the beginning of their paraprofessional training. Interpersonal values were described according to the interpersonal circumplex (IPC) model with the structural summary method. Results: Compared to a matched nonclinical reference group, trainee counselors reported significantly higher interpersonal values for the scales Harmony (LM) and Helpful Influence (NO). A cluster analysis revealed 3 distinct groups of trainees, which can be described as predominantly submissive-altruistic, helpful-influential, and friendly-harmonious. The 3 groups further differed in the Big Five personality traits Extraversion, Neuroticism and Agreeableness, as well as in self-reported mentalization, attachment anxiety, and avoidance, but not in life satisfaction. Furthermore, the groups differed with regard to their expected future counseling style. Conclusion: The results contribute to an understanding of interpersonal goals and motives of volunteer counselor trainees in TES. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Therapeutic alliance and binge-eating outcomes in a group therapy context.


The therapeutic alliance in individual and group psychotherapy is associated with treatment outcomes for a variety of disorders. However, debate persists about the centrality of the alliance in determining positive outcomes. We examined the alliance–outcome relationship across 20 sessions of emotionally focused group therapy (EFGT) for binge-eating disorder (BED). We hypothesized that (1) previous session alliance increase will predict lower subsequent session binge eating level while controlling for previous session binge eating level; and (2) previous session binge eating decline will predict higher subsequent session alliance level while controlling previous session alliance level. Participants were 118 individuals with BED who received 20 sessions of EFGT in 8 groups. Levels of binge eating and therapeutic alliance to the therapist were measured weekly. Linear growth in alliance during group therapy was associated with reduced binge eating at 6 months’ posttreatment. We also found that the group’s and the individual’s alliance scores and binge-eating episodes were significantly associated across treatment, suggesting a mutual influence of the group’s and individual’s experience of the alliance with the therapist. Regarding the first hypothesis, previous session alliance increase was significantly associated with lower subsequent session binge eating. Regarding the second hypothesis, previous session binge-eating decline was not significantly related to higher subsequent session alliance. The findings provide evidence in a group therapy context for a model in which alliance change influences subsequent symptom levels, but not the other way around. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Dependency and self-criticism in treatments for depression.


Dependency and self-criticism are vulnerability factors for depression. How these personality factors change with treatment for depression and how they relate to symptom change across different types of treatment require further research. In addition, cultural differences that interact with the dependency/self-criticism–depression relation remain underinvestigated. We randomly assigned 149 adults with major depression to receive active medication (MED; n = 50), supportive–expressive therapy (SET; n = 49), or placebo pill (PBO; n = 50). Participants completed the Depressive Experiences Questionnaire (DEQ; Blatt, D’Afflitti, & Quinlan, 1976) before and after treatment and completed the Hamilton Rating Scale for Depression (Hamilton, 1967) throughout the course of treatment. Self-criticism as measured on the DEQ decreased with treatment similarly across conditions. DEQ Dependency decreased in MED but remained unchanged in SET and PBO. Higher initial dependency, but not higher initial self-criticism, predicted poor treatment response across conditions. Greater reduction in self-criticism was associated with greater reduction in depressive symptoms, but the effect was weaker for racial minorities (vs. White). Increase in connectedness, an adaptive form of dependency, was associated with symptom improvement in SET but not MED. Hence, different pathways of change seem to be implicated in the treatment of depression depending on culture and type of intervention. Implications for future research are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Social cognitive predictors of academic and life satisfaction: Measurement and structural equivalence across three racial/ethnic groups.


Data of 306 Caucasian American, 284 Asian American, and 259 Latino/a American college students were analyzed in this study to test a modified version of Lent and Brown’s (2006, 2008) satisfaction model in the academic context. In addition to the full set of variables hypothesized in the original model, the modified academic satisfaction model also included independent and interdependent self-construals to represent one’s cultural orientations. Comparisons between the hypothesized model and 2 alternative models showed that direct paths from extraversion and emotional stability added significantly to the predictions of academic satisfaction and life satisfaction for all 3 racial/ethnic groups while those from independent and interdependent self-construals also had the same effects for Latino/a American students. The hypothesized model offered excellent fit to the data of all 3 racial/ethnic groups. Consistent with theoretical prediction, academic supports, self-efficacy, outcome expectations, or goal progress formed pathways that mediated the relations of personality traits and self-construals to academic satisfaction or life satisfaction across 3 groups. Although full measurement equivalence (configural invariance and metric invariance) was observed, 4 structural paths and 16 indirect effects differed significantly by race/ethnicity. Most of these differences in structural paths and indirect effects occurred between Caucasian Americans and Asian Americans. On balance, findings of the study provided evidence for the cross-racial/ethnic validity of the modified academic satisfaction model while identifying racial/ethnic differences that might have useful clinical implications. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Posttraumatic stress, effort regulation, and academic outcomes among college students: A longitudinal study.


Entering college with posttraumatic stress disorder (PTSD) symptomatology has been linked to poor academic performance and increased risk for dropping out of college; however, little is known regarding the mechanisms by which PTSD symptoms have deleterious effects on college outcomes. Drawing from a self-regulated learning (SRL) perspective, which suggests that students’ learning behaviors and outcomes can be influenced by contextual and developmental factors, we hypothesized that students who enter college with high PTSD symptomatology may experience difficulties in effort regulation, which in turn, may have deleterious effects on their academic performance and college persistence. These hypothesized relationships, as well as the potential gender differences in these relationships were examined using a longitudinal study design and a multigroup structural equation modeling approach. Of the 928 1st-year students who participated in the study, 484 (52.2%) students who reported lifetime exposure to traumatic events constituted the final sample of the study. The prevalence of PTSD among the trauma-exposed participants was 12.4%. After controlling for participation in on-campus activities and American College Testing (ACT) assessment scores, the relationship between PTSD symptomatology in the 1st semester of college and 2nd-year enrollment was mediated by effort regulation and 1st-year cumulative grade-point average (GPA). Specifically, participants who started college with higher levels of PTSD symptomatology also reported lower levels of effort regulation, which in turn, had a significant indirect effect on 2nd-year enrollment through 1st-year GPA. Results also indicated that the paths in the hypothesized model were not significantly different for men and women. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Outcomes of social class and classism in first- and continuing-generation college students.


The purpose of this study was to examine perceptions of classism that may explain links between social class, first-generation college student status, and academic and well-being outcomes. Specifically, with a sample of 1,225 college students from a public university, we examined social class and first-generation status as predictors of institutionalized, citational, and interpersonal classism and classism as a predictor of life satisfaction, academic satisfaction, and grade point average (GPA). Partially supporting hypotheses, social class and first-generation status predicted institutionalized classism and interpersonal classism, and social class predicted citational classism. In turn, institutionalized classism and citational classism negatively predicted life satisfaction, and institutionalized classism negatively predicted academic satisfaction. Indirect effects were significant from social class to life satisfaction via institutionalized and citational classism, from social class to academic satisfaction via institutionalized classism, and from first-generation status to life satisfaction via institutionalized classism. Social class also had direct effects to life satisfaction, academic satisfaction, and GPA, and first-generation status had direct effects to academic satisfaction and GPA. Implications for research and practice are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)