Reports the retraction of "Client laughter in psychodynamic psychotherapy: Not a laughing matter" by Shudarshana Gupta, Clara E. Hill and Dennis M. Kivlighan Jr. ( Journal of Counseling Psychology, ...2018Jul, Vol 654, 463-473). The following article is being retracted (https://doi.org/10.1037/cou0000272). This retraction is at the request of coauthors Kivlighan and Hill after the results of an investigation by the University of Maryland Institutional Review Board (IRB). The IRB found that the study included data from between one and four therapy clients of the Maryland Psychotherapy Clinic and Research Laboratory (MPCRL) who either had not been asked to provide consent or had withdrawn consent for their data to be included in the research. Gupta was not responsible for obtaining and verifying participant consent but agreed to the retraction of this article. (The following abstract of the original article appeared in record 2018-33326-005.) We studied 814 client laughter events nested within 330 sessions nested within 33 clients nested within 16 therapists at one community clinic in which doctoral student therapists provided psychodynamic psychotherapy to adult community clients. Each laughter event in Sessions 1 to 5 and 16 to 20 was rated for cheerfulness, politeness, reflectiveness, contemptuousness, and nervousness. Across all clients, there was an average of about one laughter even per session. The average laughter event lasted 3.5 seconds, and was characterized primarily by politeness and reflectiveness. Overall amount of client laughter and the characteristics of client laughter did not change across sessions. Most of the variance in the laughter characteristics was at the session level, with less variance attributable to clients and therapists. When client attachment avoidance was high, laughter was less cheerful and more contemptuous. When client attachment anxiety was high, laughter was more nervous. Sessions with more reflective laughter were evaluated more positively by clients, and therapists whose clients had more reflective laughter had more positive client session evaluations. Furthermore, within a therapist’s caseload, clients with the most nervous and contemptuous laughter evaluated sessions most positively. Implications are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
Reports the retraction of "Secrets in psychotherapy: For better or worse" by Ellen C. Marks, Clara E. Hill and Dennis M. Kivlighan Jr. ( Journal of Counseling Psychology, 2019Jan, Vol 661, 70-82). ...The following article is being retracted (https://doi.org/10.1037/cou0000311). This retraction is at the request of coauthors Kivlighan and Hill after the results of an investigation by the University of Maryland Institutional Review Board (IRB). The IRB found that the study included data from between one and four therapy clients of the Maryland Psychotherapy Clinic and Research Laboratory (MPCRL) who either had not been asked to provide consent or had withdrawn consent for their data to be included in the research. Marks was not responsible for obtaining and verifying participant consent but agreed to the retraction of this article. (The following abstract of the original article appeared in record 2018-49842-001.) We investigated how concealment and disclosure of secrets, two related but distinct processes, unfolded over the course of open-ended therapy for 39 clients and 9 therapists, using hierarchical linear modeling to identify longitudinal patterns and investigate relationships with working alliance and session quality. Results indicated that over the course of therapy, 85% of clients disclosed at least one secret and 41% concealed at least one secret, with 18% of sessions including a disclosure and 4% of sessions including concealment. Over time, clients were less likely to disclose secrets, and the secrets they chose to conceal were rated as less significant. Clients rated the working alliance lower after sessions when they disclosed secrets versus when they did not disclose, although the working alliance was not rated as poorly when the disclosed secrets were viewed as significant. Clients rated session quality higher after sessions when they disclosed secrets versus when they did not disclose, particularly when they disclosed preoccupying secrets. Clients tended to feel neutral or positive about their disclosures. Implications for practice and research are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
Reports the retraction of "The triadic effect: Associations among the supervisory working alliance, therapeutic working alliance, and therapy session evaluation" by Judith A. Gerstenblith, Kathryn V. ...Kline, Clara E. Hill and Dennis M. Kivlighan Jr. ( Journal of Counseling Psychology, 2022Mar, Vol 692, 199-210). The following article is being retracted (https://doi.org/10.1037/cou0000567). This retraction is at the request of coauthors Kivlighan and Hill after the results of an investigation by the University of Maryland Institutional Review Board (IRB). The IRB found that the study included data from between one and four therapy clients of the Maryland Psychotherapy Clinic and Research Laboratory (MPCRL) who either had not been asked to provide consent or had withdrawn consent for their data to be included in the research. Gerstenblith and Kline were not responsible for obtaining and verifying participant consent but agreed to the retraction of this article. (The following abstract of the original article appeared in record 2021-88607-001.) Several theorists (Bandura, 1969; Hackney & Goodyear, 1984; Searles, 1955) suggest parallels between the relationship in supervision and the relationship in therapy. We examined supervisor and therapist trainee ratings of supervisory working alliance (SWA) in 1 week predicting client-rated therapeutic working alliance (TWA) and client-rated therapy session evaluation (TSE) in the following week as well as TWA and TSE ratings in 1 week predicting SWA ratings in the following week. Our data included 663 weeks of therapy nested within 28 trainees nested within 15 supervisors, disaggregated into differences between supervisors, differences within supervisors, and differences within trainees. At the between-supervisor level, when supervisors’ trainees rated the SWA higher on average compared with other supervisors’ trainees’ average SWA ratings, their clients’ average TWA rating was higher. In contrast, when supervisors rated the SWA higher on average compared with other supervisors’ average SWA ratings, their trainees’ clients’ average TSE rating was higher but the average TWA rating was lower. At the within-supervisor level, when trainees rated a higher SWA on average compared with other trainees’ average SWA ratings with the same supervisor, their clients’ average TSE rating was higher. The theoretical prediction of parallel relationships in supervision and therapy was supported, but only for between-supervisor and within-supervisor differences in SWA. We found no evidence that week-to-week changes in SWA or client-rated TWA or TSE reflected parallel relationships. We provide suggestions for further research, including exploring the mechanisms through which supervision relates to the therapy process and outcome. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
In the youth treatment literature, the alliance has been defined and measured as a consensual or collaborative bond. In this article, we review varied definitions of the alliance, enumerate its ...frequent measures, and present clinical examples. We provide a meta-analytic review on the relation between the therapeutic alliance and treatment outcome in child and adolescent psychotherapy. In particular, this review only includes prospective studies of youth therapy that used an explicit measure of alliance. The meta-analysis of 28 studies revealed a weighted random effect size of r = .19 (k = 28, N = 2419, p < .01, 95% confidence interval .13, .25), which is a small to medium effect (equivalent to d = 0.39) consistent with the adult alliance literature and with prior youth meta-analyses. Given that a medium-large amount of heterogeneity was observed in effect sizes (I2 = 64.19%), theory- and method-based moderators were examined. Multiple moderators of the alliance-outcome association were found, including diagnosis class, type of therapy, study design (randomized controlled trials RCT vs. nonrandomized trials non-RCT), and treatment setting (inpatient vs. outpatient). Research limitations, patient contributions, and diversity considerations follow. The article concludes with research-informed practices for building and maintaining the therapeutic alliance with youth.
Clinical Impact Statement
Although many youth treatments have been found effective, less is known about treatment processes that may explain variability in treatment outcomes. Question: This study examined the strength of the correlation between the alliance and youth treatment outcome. Findings: This meta-analysis showed that the therapeutic alliance has a small to medium association to outcome that varies depending upon diagnosis, type of therapy, study design, and treatment setting. Meaning: Alliance formation and maintenance over the course of treatment has the potential to aid clinicians in achieving positive outcomes in youth psychotherapy across disorders. Next Steps: To investigate the effects on the alliance and treatment outcome of clinicians attending to youth and parent characteristics and their own behaviors when attempting to engage them in treatment.
Building on recent theory stressing multicultural orientation, as well as the development of virtues and dispositions associated with multicultural values, we introduce the construct of cultural ...humility, defined as having an interpersonal stance that is other-oriented rather than self-focused, characterized by respect and lack of superiority toward an individual's cultural background and experience. In 4 studies, we provide evidence for the estimated reliability and construct validity of a client-rated measure of a therapist's cultural humility, and we demonstrate that client perceptions of their therapist's cultural humility are positively associated with developing a strong working alliance. Furthermore, client perceptions of their therapist's cultural humility were positively associated with improvement in therapy, and this relationship was mediated by a strong working alliance. We consider implications for research, practice, and training.
A Clinical Practice Review of Crying Research Bylsma, Lauren M.; Gračanin, Asmir; Vingerhoets, Ad J. J. M.
Psychotherapy (Chicago, Ill.),
03/2021, Volume:
58, Issue:
1
Journal Article
Peer reviewed
The goal of this clinical practice review is to assess the current state of the theoretical and empirical literature on emotional crying (i.e., crying in response to an emotional stimulus), a topic ...that has received surprisingly limited attention of behavioral scientists and clinicians. Although the empirical research on emotional crying remains in a nascent state, we draw upon the existing scientific knowledge to provide preliminary suggestions for clinicians on how to interpret and respond to crying in clinical contexts. We also identify research gaps and provide recommendations for further research to improve our understanding of this intriguing and still poorly understood human behavior. We suggest that a better understanding of individual differences in crying behavior and the postulated intraindividual and interindividual functions of crying is of critical importance for clinicians, given its frequent occurrence and notable associations with emotional and social functioning. An improved characterization of this important phenomenon will lead to improvements in clinical assessment, treatment planning, and psychotherapy interventions.
Clinical Impact Statement
Question: We review the state of the empirical literature on human crying behavior, with a focus on crying of both patients and therapists in the clinical setting. Findings: Findings may help guide how clinicians interpret and respond to crying in the clinical setting. Meaning: Generally crying of therapists or patients appears to be beneficial in a clinical context, but this seems to depend on a number of contextual factors. Next Steps: As current research on crying in the context of clinical assessment and psychotherapy is still very limited, further research is needed to fully understand how crying of patients and therapists impacts the therapeutic process, as well as how crying behavior manifests in various forms of psychopathology.
Gratitude practice can be a catalyzing and relational healing force, often untapped in clinical practice. In this article, we provide an overview of current thinking about gratitude's defining and ...beneficial properties, followed by a brief review of the research on mental health outcomes that result from gratitude practice. Following an analysis of our case study of the use of gratitude as a psychotherapeutic intervention, we present various self‐strategies and techniques for consciously choosing and cultivating gratitude. We conclude by describing ways in which gratitude might be capitalized upon for beneficial outcomes in therapeutic settings.
Posttraumatic stress disorder (PTSD) is a chronic, debilitating condition for which Prolonged Exposure (PE) therapy is highly efficacious. However, for some individuals, premature dropout and ...residual PTSD symptoms remain obstacles. The neuropeptide oxytocin is a promising candidate to enhance PE due to its ability to enhance 1) prosocial cognition and behavior, which are theorized to promote positive working alliance, and 2) extinction learning, which is the central mechanism of action underlying successful PE treatment. Despite a robust theoretical rationale, no studies to date have combined evidence-based psychotherapy for PTSD with oxytocin. This randomized, placebo-controlled, double-blind pilot trial examined the feasibility, safety, and preliminary efficacy of augmenting PE with oxytocin. Participants were 17 individuals with diverse index traumas. Participants self-administered intranasal oxytocin (40 IU) or matching placebo 45 min prior to each weekly PE therapy session. One adverse event occurred in the placebo group and three individuals dropped out (17.6%; 2 oxytocin group and 1 placebo group). The oxytocin group demonstrated lower PTSD and depression symptoms during PE, and had higher working alliance scores, although these differences did not reach statistical significance. Although preliminary, the findings support the feasibility of oxytocin combined with PE. Adequately powered studies are necessary to determine whether oxytocin enhances PE treatment outcomes and to examine potential mechanisms, such as accelerating extinction learning, enhancing early response, and preventing premature dropout. NCT03238924.
•This study is the first to combine an evidence-based therapy for PTSD with oxytocin.•We augmented Prolonged Exposure therapy with weekly oxytocin doses.•We employed a randomized, placebo-controlled, double-blind design.•Findings support the feasibility and safety of oxytocin combined with PE.•Adequately powered studies are necessary to determine efficacy and mechanisms.
Empathy Elliott, Robert; Bohart, Arthur C; Watson, Jeanne C ...
Psychotherapy (Chicago, Ill.),
03/2011, Volume:
48, Issue:
1
Journal Article
Peer reviewed
Open access
After defining empathy, discussing its measurement, and offering an example of empathy in practice, we present the results of an updated meta-analysis of the relation between empathy and ...psychotherapy outcome. Results indicated that empathy is a moderately strong predictor of therapy outcome: mean weighted
r
= .31 (
p
< .001; 95% confidence interval: .28-.34), for 59 independent samples and 3599 clients. Although the empathy-outcome relation held equally for different theoretical orientations, there was considerable nonrandom variability. Client and observer perceptions of therapist empathy predicted outcomes better than therapist perceptions of empathic accuracy measures, and the relation was strongest for less experienced therapists. We conclude with practice recommendations, including endorsing the different forms that empathy may take in therapy.
A common barrier to healthcare for psychiatric conditions is the stigma associated with these disorders. Perceived stigma prevents many from reporting their symptoms. Stigma is a particularly ...pervasive problem among military service members, preventing them from reporting symptoms of combat-related conditions like posttraumatic stress disorder (PTSD). However, research shows (increased reporting by service members when anonymous assessments are used. For example, service members report more symptoms of PTSD when they anonymously answer the Post-Deployment Health Assessment (PDHA) symptom checklist compared to the official PDHA, which is identifiable and linked to their military records. To investigate the factors that influence reporting of psychological symptoms by service members, we used a transformative technology: automated virtual humans that interview people about their symptoms. Such virtual human interviewers allow simultaneous use of two techniques for eliciting disclosure that would otherwise be incompatible; they afford anonymity while also building rapport. We examined whether virtual human interviewers could increase disclosure of mental health symptoms among active-duty service members that just returned from a year-long deployment in Afghanistan. Service members reported more symptoms during a conversation with a virtual human interviewer than on the official PDHA. They also reported more to a virtual human interviewer than on an anonymized PDHA. A second, larger sample of active-duty and former service members found a similar effect that approached statistical significance. Because respondents in both studies shared more with virtual human interviewers than an anonymized PDHA—even though both conditions control for stigma and ramifications for service members’ military records—virtual human interviewers that build rapport may provide a superior option to encourage reporting.
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