Psychotherapy Theory, Research, Practice, Training

Psychotherapist self-disclosure: Ethical and clinical considerations.
Self-disclosure is an ever present and unavoidable aspect of psychotherapy. But, why, how, and when it is done requires careful forethought. The use of self-disclosure is discussed in the context of boundaries, highlighting its ethical and appropriate use in psychotherapy. Rather than avoiding self-disclosure out of a fear of violating ethical and professional standards, a thoughtful approach to addressing self-disclosure is presented. Recommendations for the ethical and effective use of self-disclosure are provided to include the use of ethical decision-making models and thoughtful consideration of contextual factors that include the psychotherapist's motivations, the client's treatment needs and personal history, the psychotherapist's theoretical orientation, and individual differences to include each aspect of the client's and psychotherapist's diversity. Recommendations for psychotherapists considering the use of self-disclosure with clients are made along with specific recommendations for the profession of psychology to provide greater guidance on the ethical, effective, and clinically appropriate use of self-disclosure. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
How does disclosing countertransference affect perceptions of the therapist and the session?
Therapist self-disclosure has been theorized and found to have both positive and negative effects. These effects depend, in part, on the nature of the disclosure. This study sought to examine the differential effects of therapist disclosures of more and less resolved countertransference issues on perceptions of therapists and therapy sessions. Using an analogue method, undergraduate participants (N = 116) were randomly assigned to watch one of two videos in which a therapist disclosed personal issues that were relatively resolved or relatively unresolved. As hypothesized, therapist disclosure of issues that were more resolved caused the therapist to be rated as more attractive and trustworthy and instilled greater hope than therapist disclosure of less resolved issues. The type of therapist disclosure, however, did not affect ratings of the expertness of the therapist, the depth or smoothness of the session, or the perceived universality between client and therapist. Implications of the results for the judicious use of self-disclosure are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Patients' disclosures about therapy: Discussing therapy with spouses, significant others, and best friends.
This study investigated patterns of disclosure by psychotherapy patients about their own therapy to confidants. A total of 135 patients (M age = 29.4; 18 male; 117 female) currently in individual psychotherapy completed the Disclosure About Therapy Inventory (DATI), a questionnaire of 90 Likert-type items designed to investigate patients' experiences of disclosing aspects of their therapy to their spouses, significant others, or best friends. Findings indicate that most patients are moderately self-disclosing to their confidants about their therapy, endorse highly positive attitudes regarding such disclosure, and report primarily positive feelings after disclosing personal information about their therapy to their confidants. In addition, a significant relationship was found between the extent to which patients disclose about their therapy to their confidants and the extent to which they disclose to their therapists. Therapists, it is suggested, might well glean important clinical data from attending to their patients' patterns of disclosing the details of their treatment to others. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Supervisor self-disclosure: Supervisees' experiences and perspectives.
Twelve graduate-level supervisees were interviewed regarding their experiences of supervisor self-disclosure (SRSD); data were analyzed using consensual qualitative research. When describing a specific SRSD experience, supervisees reported a range of antecedents (e.g., difficult clinical situation, self-doubt, tension in supervision relationship) followed by supervisor disclosures about clinical experiences or personal information. Supervisees perceived that their supervisors disclosed primarily to normalize, but also to build rapport and to instruct. The SRSDs had mostly positive effects (e.g., normalization), though some negative effects (e.g., deleterious impact on supervision relationship) were reported. Implications of these findings for supervision, training, and research are addressed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Directions for research on self-disclosure and immediacy: Moderation, mediation, and the inverted U.
The psychotherapist's use of self-disclosure (SD) and immediacy has been a controversial topic over the decades. In this article, some ingredients are described that will help advance knowledge in the area of the therapist SD and immediacy. More than has been the case, researchers in this area should construct clear definitions of the SD/immediacy variables being investigated, and make sure that their operationalizations are consistent with these definitions. In addition, it is argued that if the field is to advance, at this point in time researchers need to examine “who, what, when, and where” questions, making use of in-principle moderation, that is, the study of which SD/immediacy responses are most effective with what patients, suffering from what problems and disorders, when offered by which therapists doing what kinds of psychotherapy? In addition, the study of mediation is suggested, as is researchers' taking into account the operation of the inverted U when studying the frequency, intensity, or duration of SD/immediacy. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Reflections on the meaning of clinician self-reference: Are we speaking the same language?
Self-reference refers to clinician revelations about themselves. Theory and research on self-reference are limited by a lack of uniform conceptualizations. This paper discusses two types of self-reference, self-disclosure, and self-involving responses. Included are definitions of each type of self-reference; description of definitional inconsistencies in the literature; discussion of prevalence, functions, and the multidimensional nature of self-reference; and practice implications and research recommendations. The ideas presented herein are intended to prompt researchers, practitioners, and educators to carefully consider the nature, scope, and functions of self-reference, and in doing so, bring greater conceptual and operational clarity to their work. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Relation of the real relationship and the working alliance to the outcome of brief psychotherapy.
In this study, the (a) association of the client- and therapist-rated strength of the real relationship to the outcome of brief psychotherapy, and (b) extent to which the real relationship predicted outcome above and beyond the predictive power of the working alliance were examined. A total of 50 clients at the counseling center of a university in Italy received brief therapy and completed measures before treatment, after the third session, and at the end of treatment. From the clients' perspective, both the Genuineness element of the real relationship and the Bond scale of the working alliance were found to relate significantly to treatment outcome. When we examined the real relationship and working alliance as predictors in a hierarchical regression format, the client-rated real relationship, especially the Genuineness element, did predict outcome and, moreover, added significantly and substantially to the working alliance in predicting outcome. Neither the strength of the real relationship from the therapist's perspective nor the therapist-rated working alliance was found to relate to outcome. The findings are discussed in the context of methodological differences with other investigations of the real relationship. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Recollections of a secure base in psychotherapy: Considerations of the real relationship.
Empirical research has recently addressed the real or personal relationship between patients and psychotherapists. The present study examined the interrelations of client attachment security, recollections of real relationship, and client attachment to therapist in a sample of 143 college students who had completed at least five sessions of previously terminated psychotherapy. As expected, client-rated real relationship was found to have positive associations with both client attachment security and security of client attachment to therapist. Additional associations were found between client attachment and avoidant attachment tendencies to therapist. The possibilities for future research expanding on these results are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Review of The real relationship in psychotherapy: The hidden foundation of change.
Reviews the book, The Real Relationship in Psychotherapy: The Hidden Foundation of Change by Charles J. Gelso (see record 2010-09297-000). Charlie Gelso’s latest book brings together the output of 25 years of thinking, research, and writing on the real relationship by one of the top scholars in the field. The text is written in a wonderfully engaging and lively style that brings the complexity of the ideas to life and challenges us to reconsider, once again, concepts and constructs about the nature of human encounters and especially the therapeutic relationship in fresh and productive ways. This book will be a valuable resource to students and professionals who are actively engaged in the practice of and research on psychotherapy. The central importance of the therapeutic relationship in facilitating change is indisputable, as researchers and scholars continue to try to better understand the common and specific factors that lead to change. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Relationships among client–therapist personality congruence, working alliance, and therapeutic outcome.
Despite the importance of the working alliance in therapeutic outcome, little is known about the factors associated with its formation. We advance that personality similarity between client and therapist is one such factor pertinent to the working alliance. In this study, personality similarity in 32 client–therapist dyads was examined for its relations to the bond, task, and goal elements of the working alliance (Bordin, 1979, Psychotherapy: Theory, Research, and Practice, 16, 252–260) and therapeutic outcome. Personality similarity was conceptualized using Holland's (1997, Making vocational choices [3rd ed.]) congruence construct. Therapists completed the Self-Directed Search pretreatment and clients completed the Working Alliance Inventory-Short Revised and Self-Directed Search after the third session. Results indicated that (a) client–therapist personality congruence was associated with the bond, (b) bond was associated with task and goal, and (c) task and goal were associated with therapeutic outcome. Congruence was not associated with task, goal, or therapeutic outcome. Holland's theory provides a framework for adapting to clients of varying personality types. By understanding how client–therapist personalities relate to each other in therapy, client–therapist bonds may be more efficiently realized. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
What a man wants: The male perspective on therapeutic alliance formation.
Although the link between client ratings of therapeutic alliance quality and psychotherapy outcome has been well established by previous research, there is still much to be done to clarify what variables are important to clients, particularly men, in the formation of an alliance. Thirty-seven male clients currently undergoing psychotherapy categorized 74 critical incidents for alliance formation in an open-ended manner on the basis of self-perceived relatedness. Multivariate concept-mapping statistical techniques were used to identify the typical way in which the participants conceptualized variables that are important to alliance formation. Nine categories of variables were identified (Bringing out the Issues, Nonverbal Psychotherapist Actions, Emotional Support, Formal Respect, Practical Help, Office Environment, Information, Client Responsibility, and Choice of Professional). Bringing out the Issues emerged as the highest rated and most consistently understood category across the men in this study. The results of this study add to a small but growing body of research on the client's perspective of alliance formation and provide an initial conceptual model of how men understand the variables of common alliance formation. The developed model also provides several hypotheses, which are presented for verification in future research and clinical practice. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Exploration of session process: Relationship to depth and alliance.
This study investigates the relationship between the Depth of elaboration, the therapeutic alliance, and dimensions of the psychotherapy process—the therapist interventions, the patient contributions, and patient/therapist patterns of interaction. Sixty psychotherapy sessions that were audio-taped and transcribed were rated by external judges by using a battery of instruments that included the Psychotherapy Process Q-Set (Jones, 1985, 2000), the Working Alliance Inventory–Observer (Horvath, 1981, 1982; Horvath & Greenberg, 1989), and the Depth Scale of Session Evaluation Questionnaire (Stiles & Snow, 1984a). The results show a significant positive correlation between Depth and therapeutic alliance, as well as between Depth, therapeutic alliance, and some variables of the therapeutic process. The findings indicate the importance of therapist interventions that focus on the patient's affects, relational patterns, and the “here and now” of the relationship in the increase of the Depth of elaboration and therapeutic alliance. The clinical implications of this study will be discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
Alliance-focused therapy for anorexia nervosa: Integrative relational and behavioral change treatments in a single-case experimental design.
Evidence supporting outpatient treatments for anorexia nervosa (AN) is severely lacking, due to low retention and poor outcome. One explanation for drop-out is weak treatment alliances. A single-case experimental analysis accompanied by in-depth qualitative description is presented for Ms. O, who received a novel treatment for AN called Alliance Focused Treatment (AFT) that attends to ruptures in the alliance, interpersonal difficulties and emotional avoidance. At intake Ms. O met diagnostic criteria for AN, Major Depressive Disorder, and Social Phobia. She was characterized as having symptoms of Obsessive Compulsive, Avoidant, and Depressive personality disorders. Treatment began with a Baseline followed by the experimental (AFT) and comparison treatments (Behavioral Change Treatment [BCT]) using a replicated experimental single-case phase change design. Graphs of slopes of kilocalorie and alliance change facilitated observation of treatment effects. Ms. O participated in 16 sessions of AFT and 8 sessions of BCT with specific benefits. Ratings of the treatment alliance were consistently high and she evidenced significant changes in weight, quality of life, and personality pathology. Associations between rupture/repair episodes and kilocalorie increases were observed. The utility of the treatment relationship in facilitating emotional expression was evident. At posttreatment, Ms. O endorsed cognitive AN symptoms, although these were not explicitly treated. This study provides preliminary support for the feasibility and effect of AFT and BCT, and highlights the importance of the alliance in treating adults with AN. Further research on emotion regulation in AN and its effect on the treatment relationship are needed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)

Psychotherapy - Vol 48, Iss 4