Transference and client attachment to therapist in psychodynamic psychotherapy.

Although there are theorized connections between client transference and their attachment to their therapists (Bowlby, 1969/1982), limited empirical research exists examining their association over the course of psychotherapy. We thus examined the association between positive and negative transference and client attachment to therapist across the course of open-ended psychodynamic psychotherapy for 49 cases with doctoral student therapists and adult community clients who had at least 32 sessions. Using a Bayesian multilevel structural equation model framework, results indicated that client secure attachment increased and avoidant-fearful attachment decreased across the course of psychotherapy. For clients with higher preoccupied-merger attachment at the beginning of therapy, therapists perceived more fluctuation in negative transference over time than for clients with other attachment styles. Implications for research, practice, and therapist training are offered. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The triadic effect: Associations among the supervisory working alliance, therapeutic working alliance, and therapy session evaluation.

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) 2022 APA, all rights reserved).

Some directions for research and theory on countertransference.

The topic of countertransference (CT) has been a controversial one over the decades, and its various, often conflicting, definitions have made it difficult to gather clear and consistent empirical evidence about the phenomenon. The growing awareness that CT occurs across theoretical orientations has fueled the need for research on CT, its effects, how it emerges in treatment, and how it can be used to enhance psychotherapy. In this paper, we reflect on three studies published in the special section on CT that we believe advance the field of CT research. We also provide future directions for CT theory and research, including attending to CT definitions and their rationale in empirical studies, striving for methodological diversity, differentiating acute and chronic CT, and continuing to investigate CT management.

A follow-up of undergraduate students five years after helping skills training.

In a 5-year follow-up assessment, 33 students who had taken an undergraduate helping skills course indicated that they had continued to use the helping skills in both their professional lives and personal relationships. On average, there were no significant changes from pretraining to follow-up on empathy, natural helping ability, or facilitative interpersonal skills. Furthermore, although students had increased in self-efficacy for using the skills during training, on average they maintained their self-efficacy levels at the follow-up. The 15 participants who had further mental health education, however, scored higher at follow-up on empathy, natural helping ability, self-efficacy for using the skills, and facilitative interpersonal skills compared with the 18 participants who had no further mental health education (controlling for pretraining levels), suggesting that continued exposure to and practice using the skills helped them continue to improve their helping abilities. Qualitative data indicated that participants typically had positive experiences in the helping skills course. Implications for training and research are provided. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Facilitating client collaboration and insight through interpretations and probes for insight in psychodynamic psychotherapy: A case study of one client with three successive therapists.

We investigated therapist interpretations (Ints) and probes for insight (PIs) in relation to changes in client collaboration and insight for 1 male client paired with 3 successive doctoral student therapists in psychodynamic psychotherapy for 192 sessions over 5 years. Judges coded client collaboration and insight in the antecedent and subsequent 3 min for all Ints and PIs in each of 6 middle sessions for each treatment. Qualitative analyses showed that PIs were more helpful than Ints for this defended client. More gains in collaboration were found when antecedent client collaboration was high, antecedent client insight was low, and therapists gave PIs instead of Ints, but no differences were found among therapists. More gains in insight were found when antecedent insight in a given session was higher than in other sessions with the same therapist, with Therapist 3 facilitating more insight than Therapist 1; no differences were found between Ints and PIs. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The sister concepts of the working alliance and the real relationship: on their development, rupture, and repair.

Jeremy Safran has presented seminal and widely applicable clinical theory and research around the therapeutic alliance and ruptures in the alliance. We explore areas of agreement with and departure from some of Safran's key conceptualizations on these topics, focusing on overlap and distinctions between two constructs theorized to be fundamentally significant elements of all therapeutic relationships: the working alliance and the real relationship. We share Safran's view that the alliance centrally implicates an emotional bond between patient and therapist, as well as an agreement about the goals of treatment and the tasks needed to attain those goals. We depart from Safran, however, in his belief that the real relationship should be seen as part of the emotional bond of the working alliance. Instead, we argue that the real relationship and the working alliance (including the bond aspect of the alliance) are best viewed as highly interrelated but distinct aspects of the therapeutic relationship. In addition, a distinction is made between the working bond (part of the working alliance) and the personal bond (part of the real relationship). Hence, we examine the concept of rupture in the working alliance, and in the real relationship as well. The nature of ruptures is discussed, as well as what therapists can do to repair them. A more limited definition of ruptures than the broader conception that has evolved in recent years is proposed. It is suggested that, whereas ruptures in the working alliance generally can be repaired to the benefit of the work, ruptures in the real relationship are likely to be more damaging to the treatment.

Silence is golden: A mixed methods investigation of silence in one case of psychodynamic psychotherapy.

We investigated the antecedents, occurrences, and consequences of 183 silence events in the first 5 and last 5 sessions of a 73-session case of successful psychodynamic psychotherapy. Silences generally occurred within client speaking turns, such that the client often paused to reflect while speaking. In the last 5 sessions, as compared with the first 5 sessions, the client was more collaborative before and after silences, silences were shorter, the therapist was more connectional during silences (e.g., shared emotion and meaning with client), and the client was more emotional after silences. Antecedent client collaboration, duration of the silence, therapist behavior during silence events, client behavior during silence events, and who broke the silence all related to change in collaboration from before to after the silence events. We concluded that silence was helpful in this case because of client factors (the client naturally paused a lot during discussion, the client was quite reflective and insightful), therapist factors (the therapist was comfortable with and believed in silence), and relationship factors (there was a strong therapeutic relationship). (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Ruptures in psychotherapy: Experiences of therapist trainees.

Method: We used consensual qualitative research (CQR) to investigate the experiences of therapist trainees who had a rupture with a client. Results: Of 21 trainees who were tracked weekly, 14 experienced a rupture and were interviewed 1 week after the rupture and again 2 weeks later about antecedents, repair attempts, and consequences. Trainees typically reported experiencing tension at the beginning of the rupture session and difficult emotions during the rupture (e.g., anger, depleted self-efficacy). Conclusion: Trainees typically tried to repair the rupture by using immediacy or facilitating exploration about the conflict. Trainees typically reported both negative (e.g., strained therapeutic relationship) and positive consequences (e.g., therapeutic work became more productive). Trainees seemed to be less aware of withdrawal than confrontational ruptures. Implications are that trainees could benefit from learning more about ruptures including how to regulate negative emotions toward clients and acquiring more rupture-repair tools, as well as realizing that ruptures can have some positive as well as negative aspects.