Client-therapist congruence in session-helpfulness ratings and its association with therapy outcomes.

Objective: The present study aimed to explore client-therapist congruence in helpfulness evaluations session-by-session and its association with therapy outcomes. As suggested by West and Kenny's truth and bias model, we constructed congruence as both temporal congruence (i.e., the correlation between therapists' and clients' helpfulness judgments over time) and directional discrepancy (i.e., the average difference between therapists' and clients' helpfulness judgments).Method: Seventy-eight clients were treated by 22 experienced therapists within a 12-session course of integrative psychotherapy. At the end of each session, clients and therapists rated their perceptions of session helpfulness and, at the beginning of the next session, clients rated their own psychological functioning.Results: Therapists' and clients' helpfulness judgments were temporally congruent across treatment, and therapists' judgments were lower than those of their clients. Moreover, we found that therapists' negative directional discrepancy, but not temporal congruence, was associated with improvement in clients' psychological functioning as well as with clients' global treatment evaluations.Conclusion: Our results highlight the importance of therapists' vigilant assessment of session helpfulness in a course of brief integrative psychotherapy. As such, they strengthen the importance of further research regarding client-therapist congruence (in different aspects of the therapeutic process) and its association with therapy outcomes.Clinical or methodological significance of this article In this study, we found that therapists' tendency to provide lower session-helpfulness assessments than did their clients was associated with better therapeutic outcomes. These results may highlight the importance of therapists' cautious and humble stance when assessing their perception of session helpfulness across treatment.

Therapeutic technique diversity is linked to quality of working alliance and client functioning following alliance ruptures.

OBJECTIVE: The current investigation aimed to examine the possible association between therapists' flexibility in use of therapeutic techniques from different therapy orientations (i.e., therapeutic technique diversity; TTD) and subsequent improvement in client-reported (a) global functioning, as well as (b) quality of the working alliance, following sessions in which alliance ruptures occurred. METHOD: Clients (n = 81) who received time-limited psychodynamic therapy in a community clinic, completed session-by-session reports of working alliance and global functioning. Therapists (n = 56) completed session-by-session reports of working alliance and their use of therapeutic techniques across different therapeutic orientations, using the Multitheoretical List of Interventions (MULTI-30). RESULTS: We found a curvilinear association between TTD in rupture sessions and client-reported global functioning at the sessions subsequent to rupture sessions, such that moderate levels of TTD were associated with greater subsequent improvement in functioning, compared with low and high levels of TTD. However, TTD was not significantly associated with subsequent changes in the quality of working alliance. CONCLUSIONS: Our results suggest that moderate levels of TTD in the face of alliance ruptures are tied to clients' global functioning improvement during psychodynamic psychotherapy. These findings highlight the importance of further investigation of a varied delivery of therapeutic techniques, especially in the face of alliance ruptures. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Enhancement of self compassion in psychotherapy: The role of therapists' interventions.

Aim: Self Compassion (SC) has been consistently linked to decreased emotional distress and is offered as a mechanism of change in several therapeutic approaches. The current study aimed to identify therapists' interventions that enhance clients' SC within individual psychodynamic psychotherapy. We examined a diverse set of interventions as predictors of clients' SC, on treatment and session levels. We hypothesized that improvement in SC will be associated with greater use of directive or common factor interventions. Method: Client/therapist (N = 89) dyads from a university-based community clinic participated in the study. Therapists' interventions and changes in clients' SC level were monitored at each psychotherapy session. Results: Clients' SC in a given session was not predicted by therapist use of interventions from any of the three clusters in the previous session. However, positive change in SC across treatment was predicted by greater use of directive interventions. Furthermore, among clients with low pretreatment SC, a positive change in SC across treatment was predicted by lesser use of common factor interventions. Discussion: The results highlight the importance of understanding clients' pretreatment characteristics when selecting therapeutic interventions and suggest that the integration of directive interventions into the psychodynamic therapeutic practice may be beneficial in enhancing clients' SC.

Moderators of congruent alliance between therapists and clients: A realistic accuracy model.

Congruence between therapists' and their clients' alliance ratings was found to be beneficial to therapeutic processes and outcomes. To date, however, less is known about the possible moderators of such congruence. The current study adapted Funder's (1995) realistic accuracy model to identify a judge characteristic (therapists' affiliative tendencies), a target characteristic (clients' affiliative tendencies), information (time elapsed in therapy), and traits (bond vs. task/goal aspects of the alliance) that may moderate this congruence. These were examined using the innovative truth-and-bias model (West & Kenny, 2011), which allows the simultaneous estimation of two different congruence indices within repeatedly measured data: therapist/client temporal congruence (i.e., the correlation over time between therapists' and their clients' alliance ratings) and directional discrepancy (i.e., the average difference between therapists' and their clients' alliance ratings across sessions). Clients (n = 109) and therapists (n = 62) at a university-based clinic rated their affiliation tendencies at the beginning of treatment and rated their alliance perception after each session. Time elapsed in therapy, as well as therapists' (but not clients') affiliative tendencies were linked to higher therapist/client temporal congruence and to lower therapist directional discrepancy. In addition, congruence was higher for the bond aspect of the therapeutic alliance than for goals/tasks. Consistent with Funder's model, multiple factors (including judge, information, and trait) were associated with therapist/client congruence in alliance. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The association between self-compassion and treatment outcomes: Session-level and treatment-level effects.

OBJECTIVE: Self-compassion (SC) has been consistently linked to less psychopathology; however, the link between changes in client's SC levels and psychotherapy outcomes has yet to be explored. METHOD: Clients at a university-based community clinic completed SC and outcome measures session by session (N = 112) as well as pre- to posttreatment (N = 70). RESULTS: Increases in clients' SC levels across the entire therapeutic process were associated with improvement in all posttreatment outcomes. Additionally, session-to-session increases in SC levels predicted improved symptoms and functioning at the session level; these effects were significant above and beyond the effects of the therapeutic alliance. CONCLUSION: The results of the current study highlight SC as a possible process variable in psychotherapy.

Therapists' recognition of alliance ruptures as a moderator of change in alliance and symptoms.

Therapists' awareness of ruptures in the alliance may determine whether such ruptures will prove beneficial or obstructive to the therapy process. OBJECTIVE: This study investigated the associations between therapists' recognition of these ruptures, and changes in clients' alliance ratings and symptom reports, using time-series data in a naturalistic treatment setting. METHOD: Eighty-four clients treated by 56 therapists completed alliance measures after each session, and the clients also completed symptom measures at the beginning of each session. RESULTS: Therapists' recognition of alliance rupture in non-rupture sessions was positively associated with clients' alliance ratings in the next session and this effect was significantly higher when rupture did occur. There was also a significant interaction effect for functioning ratings: Therapists' recognition of alliance ruptures abolished the negative effect of ruptures on clients' symptom ratings in the following session. CONCLUSION: These results highlight the importance of therapists' recognition of deterioration in the alliance for a repair process to take place that may eventually lead to an improved relationship and outcome.