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PubMed1989

Relationship between behavioral marital therapy outcome and process variables.

This study was conducted to identify therapist and client behaviors associated with a positive response to social learning-based behavioral marital therapy. A sample of 32 couples receiving treatment was examined. Immediately after each therapy session, the therapist, husband, and wife independently completed process rating forms that measured therapist and client behaviors during the session. Composite scales, derived from these ratings, were entered into multiple regression equations to examine their relationship with posttherapy marital satisfaction. After controlling for pretherapy marital satisfaction and the other predictor variables, therapists', husbands', and wives' ratings of positive client behavior (i.e., collaboration, active participation, and homework compliance) were positively associated with therapy outcome. Implications for marital therapy and suggestions for future research are discussed.

Adult↗
PubMed1993

Psychosocial treatment research with children and adolescents: methodological issues.

Psychotherapy research with children is based mainly on adult methodologies. Common issues include bias in recruitment of subjects, demographics, developmental concerns, and control group considerations. The advantages and drawbacks of various types of control groups, such as wait-list controls, and placebo conditions are discussed along with ethical issues. Instrument choice, validity and reliability, and standardization of procedures in conducting research are addressed. Finally, the therapist as a variable is reviewed, including selection and assignment of therapists, and therapist bias.

Adolescent↗
PubMed1996

[Interrater studies of evaluating the reliability of somatic findings].

20 patients (11 female, 9 male) without low back pain were included in two interrater studies carried out by three physical therapists. The following variables were investigated: shape of the spine, iliac crest heights, twisting of the pelvis, spine test, length of legs, Patrick sign, Schober test, fingertip-to-floor measurements, flexion and extension of the lumbar spine, straight-leg raising, and length of the iliopsoas and the rectus muscles. Intraclass coefficients for the ordinal variables, and kappa coefficients for the nominal variables were calculated for evaluation of interrater agreement. In both investigations, the Schober sign, lumbar flexion, fingertip-to-floor measurements, straight-leg raising of the left leg, and lengths of both legs were almost perfectly reliable. All other variables exhibited a lower reliability between the three therapists.

Adult↗
PubMed1986

Effect of therapist's title on perceived competence.

A videotaped segment of a therapist and student/client was shown to groups of male and female undergraduates under four conditions. One group saw the tape with the title "Doctor (the therapist's actual name was used) and Client" superimposed at the bottom. The second group saw the same tape with "Mr. (blank) Client" superimposed, the third group had "Timothy (blank) and Client," while the fourth group had no title at the bottom. The 204 students rated the therapist on 11 variables. Analysis showed no effect for title and no interaction. Men rated the therapist higher on nine of the 11 variables, than did women.

Adolescent↗
PubMed1989

Effect of therapist title on perceived competence of a female therapist.

A videotaped segment of a female therapist and female client was shown to groups of male and female undergraduates (N = 278) under six conditions. At the bottom of the screen one of the following six captions was presented: Dr. (name) and client, Ms. (name) and client, Mrs. (name) and client, Miss (name) and client, First and last name and client, and no caption. The students rated the therapist on 11 variables related to competence. Females tended to rate the therapist higher, and isolated effects for title were found; however, the magnitude of the differences was so small as to suggest that no important or meaningful differences had occurred.

Adult↗
PubMed2001

Moderators of trainee therapists' competence in cognitive therapy.

OBJECTIVES: A revised version of the Cognitive Therapy Scale (CTS-R) was developed and used in an ecologically valid study designed to examine the acquisition of competence in cognitive therapy (CT). The relationship of therapist and patient variables to changes in competence was examined. Unlike most previous research, this study defines effectiveness of training in terms of therapist competence rather than patient outcome. DESIGN: A longitudinal design was employed within a naturalistic setting. Trainees' competence (the dependent variable) was sampled on three occasions during a training course. METHODS: Twenty screened out-patients, who had been routinely referred to the Newcastle Cognitive Therapy Centre, were assigned to 20 postgraduate trainees receiving training in CT. Expert raters assessed trainees' competence at three points over the first 12 sessions of treatment using the CTS-R. The relationship of therapist and patient variables to changes in competence was examined. The patient measures used were the Beck Depression Inventory (BDI) and the Suitability for Short-Term Cognitive Therapy (SSCT). RESULTS: Three therapist factors were found to be related to competence: time (trainee therapists improving over the training period), previous experience with CT (those with most experience were most competent), and gender of the therapist (males improving at a greater rate than females). Therapist competence was also related to patients' suitability. CONCLUSIONS: These findings suggest that previous CT experience is an advantage prior to attending an advanced training course, and also that careful patient selection helps trainees to demonstrate therapeutic competence.

Adult↗
PubMed1986

Effect of transcutaneous electrical nerve stimulation characteristics on clinical pain.

We compared the effects of four treatment variables on the pain reduction produced by transcutaneous electrical nerve stimulation and attempted to establish indications for TENS based on patient history and pain evaluation items. Treatment variables were the therapist and the three TENS stimulus characteristics--pulse width, frequency, and amplitude. We randomly assigned 192 consecutive adult patients suffering from painful conditions to one of four physical therapists and one of 12 stimulus characteristic combinations. We used a standard evaluation form that included a visual analog scale (VAS) to evaluate pain. Patients were given a 30-minute trial using TENS, followed by reevaluation. The VAS line length change after treatment was the criterion score for comparison of stimulus characteristic effectiveness. Although pain was reduced greatly with TENS (p = .01), a four-way analysis of variance (pulse width, frequency, amplitude, and therapist) attributed little of the treatment effect to the treatment variables or their interactions (r2 = .101). The amplitude effect, however, was borderline (p = .056), and subthreshold stimulation proved more effective than stimulation to tolerance (p = .05). Extensive multiple linear regression analyses failed to provide indications for TENS based on patient information and pain evaluation items. Therefore, pain remains the only indication for TENS, and we recommend subthreshold rather than higher amplitude stimulation on the initial TENS trial.

Analysis of Variance↗
PubMed1997

Variability of forces applied by experienced therapists during spinal mobilization.

OBJECTIVE: To determine the variation in forces used by different therapists during mobilization of the lumbar spine and the repeatability and reproducibility of individual therapists. DESIGN: An instrumented mobilization couch was developed to measure the forces applied to the trunk during spinal mobilization. BACKGROUND: Due to limitations in equipment design and data analysis, previous related studies demonstrate equivocal results. METHODS: The system was used to collect data from a sample of 30 experienced therapists to evaluate variation, repeatability and reproducibility during the application of five mobilization procedures. RESULTS: The variation in forces used by different therapists when performing the same technique was substantial, ranging between 63 and 347 N for one technique. During this procedure, 30% of the therapists were found to be relatively consistent, repeating the magnitude of the force applied at the first session within 5%. Others demonstrated considerable variation, exhibiting a difference as great as 34%. CONCLUSIONS: The inconsistency between experienced therapists has considerable implications for clinical practice. Changes in the magnitude and rate of loading are likely to have different effects due to the inherent viscoelastic behaviour of soft tissues. RELEVANCE: Spinal mobilization and manipulation techniques are frequently used by manual therapists in the treatment of musculoskeletal disorders. Despite the reliance on these techniques in clinical practice, there is little scientific evidence to substantiate their use. Before progress in this area can be made, it is necessary to characterize the forces used during typical mobilization procedures. The results can be used to develop teaching strategies and as a basis for comparative research on the efficacy of these techniques.

Journal Article↗
PubMed1984

Dual perspectives: clients' and therapists' perceptions of therapist responses.

This study compares clients' and therapists' perceptions of individual therapist responses. Three segments of four responses each were sampled from early, middle, and late in actual therapy sessions with 16 client-therapist pairs. Using interpersonal process recall, both therapists and clients independently described their perceptions of the therapist's response intentions in their own session. They also rated the impact of therapist responses according to four variables, including response helpfulness and therapist empathy. Client-therapist agreements on intentions and impacts were computed using indices of both covariation and mean difference. Clients' and therapists' response-by-response reports of therapist intention were positively associated, but their average ratings for the session were not. On the other hand, their response-by-response ratings of impact were not associated, but their average ratings of helpfulness and affective impact were. Correlates of agreement were also studied. Contrary to expectations, length of therapeutic relationship was not correlated with client-therapist agreement: in fact, there was a trend toward lower agreement for client-therapist pairs of longer duration. Therapist experience also did not predict client-therapist agreement.

Adolescent↗
PubMed1991

Have all won and must all have prizes? Revisiting Luborsky et al.'s verdict.

Although most reviews of comparative psychotherapy literature have failed to find significant differences among treatments, it is premature to give up the search for differential effects. There are a large number of patient, therapist, and treatment variables that may mediate the effects of treatments. Given the enormity of the task of exploring potential interactions among the many patient, therapist, and psychotherapy types, a guiding model is needed by which to narrow our search for variables that mediate between treatment type and outcome. However, theoretical constructs that represent both patient and therapy variations frequently are poorly defined. Tests of treatment selection models that cut across narrow theoretical differences among psychotherapies and that operationalize definitions of patient types hold promise for revealing meaningful Patient x Therapist interaction effects in psychotherapy.

Follow-Up Studies↗
PubMed2000

Client concealment and self-presentation in therapy: comment on Kelly (2000)

The authors disagree with A. E. Kelly's (2000) conclusions that clients conceal things from therapists primarily for self-presentational reasons and that client concealment is positively related to positive therapy process and outcome. They also disagree with A. E. Kelly regarding the implications of self-presentation theory for therapy. Their review of the research suggests that clients do not conceal much from therapists, that what they do conceal involves many different kinds of information hidden for many different reasons, that therapists have wide variability in being able to detect hidden client material, and that the relationship of client concealment and therapist awareness of client concealment with therapy process and outcome is not clear. Finally, the authors discuss their views about implications of client concealment and self-presentation for therapy.

Humans↗
PubMed2004

Revisiting relationships between sex-related variables and continuation in counseling.

This study examined the relationships between three sex-related variables (client sex, therapist sex, and dyad matching on sex) and continuation in counseling. 245 college students who were clients at three university counseling centers participated. Consistent with previous studies, women comprised 68.2% of the clients seeking services at these counseling centers. Clients' sex was significantly related to counseling duration, explaining 2.2% of the common variance. Female clients, on the average, attended 1.8 more sessions than male clients. However, neither the therapists' sex nor dyad matching on sex was significantly related to the duration of counseling. None of the sex-related variables correlated with premature termination of counseling. The results have implications for providing counseling and outreach services to male students. Despite relatively equivalent rates in the incidence of mental health problems, female students continue to comprise the majority of clients. Therefore, university counseling centers need to communicate their services better to male students in need of mental health services.

Attitude to Health↗
PubMed1995

Linking in-session change to overall outcome in short-term cognitive therapy.

To better understand the mechanisms of change in psychotherapy, it is important to validate suboutcome measures that represent intermediate links between more molecular in-session changes and ultimate outcome. The present study involved the collection of pre- and postsession ratings from 53 patients in a 20-session protocol of cognitive therapy, which yielded 5 suboutcome measures: Anxiety Shift, Depression Shift, Cognitive Shift, Optimism Shift, and Therapeutic Alliance. From a series of regression analyses of repeated measures with a generalized estimating equations approach, results regarding the predictive relationship of these variables to a number of patient and therapist-rated outcome criterion variables indicated that change in cognition and quality of the therapeutic alliance were the strongest predictors.

Adult↗
PubMed1982

Psychotherapy: patient-therapist matching reconsidered.

The personality of the therapist does influence the psychotherapeutic process. Given that therapists are human, they do, in fact, bring into the encounter their moral and cultural, and sometimes even racial, attitudes in spite of efforts to maintain objectivity and neutrality. Ignoring the impact of the therapist-client, organismic variables may lead to spurious research findings and impractical interventions. Research and practical intervention, therefore, should be concerned with matching clients with the most appropriate therapist.

Female↗