Development and validation of the Barriers to Using Immediacy Scale (BUIS).

Immediacy is a skill therapists use to process the therapeutic relationship in the here and now. Although immediacy has been shown to enhance the therapeutic process, therapists are often reluctant to use it (Hill et al., 2018). In three studies, we developed and tested a measure to assess reasons that therapists avoid using this skill: the Barriers to Using Immediacy Scale (BUIS). In Study 1, 185 North American therapist trainees completed the 45-item pilot measure. Exploratory factor analysis supported a four-factor structure (Concerns About Client Reactions, Concerns About Therapist Reactions, Negative Beliefs About Immediacy, Lack of Skills for Using Immediacy). In Study 2, with an international sample of 352 therapist trainees and professionals, confirmatory factor analyses supported the original four correlated factors model, as well as alternative models. In Study 3, 89 undergraduate students in a helping skills class completed the BUIS at three points during the semester. Students' total barriers and barriers due to a lack of skills decreased, but other perceived barriers did not decrease after training. Across all three studies, predicted correlations of BUIS scores were found with measures of self-efficacy for using immediacy, adherence to different theoretical orientations, communication style, and attachment style. Incremental validity was supported by the association of BUIS scores with measures of open communication and attachment style, after accounting for self-efficacy for immediacy. Limitations and future directions are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Helping skills training: Outcomes and trainer effects.

We studied whether counseling self-efficacy increases after taking a helping skills course as well as whether trainer (instructor) effects are associated with postclass self-efficacy. We surveyed 551 undergraduate students and 27 trainers in helping skills courses across three semesters at one large mid-Atlantic U.S. public university. We found that students reported greater counseling self-efficacy after taking the course. In addition, trainers accounted for small but significant amount of the variance (7%) in changes in counseling self-efficacy. There was evidence that the instructors' authoritative teaching style but not their facilitative interpersonal skills were associated with increases in students' counseling self-efficacy. Implications for helping skills training are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Changes in client attachment in relation to client distress: A response surface analysis.

Using multilevel polynomial regression and response surface analysis, we studied the association between Time 1 (T) and Time 2 (T + 1) attachment anxiety and attachment avoidance, and T + 1 psychological distress in 253 nine-session time periods for 65 adult community clients working with 13 doctoral student therapists in open-ended psychodynamic psychotherapy. Results indicated that when client attachment anxiety was consistent and higher from the beginning (T) to the end (T + 1) of a nine-session time period, clients tended to report higher distress at the end of the period; when attachment anxiety was consistent and lower across a time period, clients tended to report lower distress. When attachment anxiety decreased across a time period, clients reported lower distress at the end of the period; when attachment anxiety increased across a time period, clients reported higher distress. Neither within-client consistency nor change in attachment avoidance in a time period was significantly related to client distress at the end of the period. Limitations and implications of the present research are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The within-client alliance-outcome relationship: A response surface analysis.

The authors examined how stability/change in working alliance predicted subsequent symptoms, and how stability/change in symptoms predicted subsequent alliance in a sample of 188 adult clients with 44 doctoral student therapists over the course of 893 eight-session time periods of individual psychodynamic psychotherapy. Clients completed the Working Alliance Inventory-Short Revised (WAI-SR; Hatcher & Gillaspy, 2006) after every session and the Outcome Questionnaire-45 (OQ; Lambert et al., 1996) before intake and every eighth session. The authors used multilevel polynomial regression and response surface analyses to examine within-client effects. The authors found that change in the alliance across an eight-session period did not have an immediate temporal effect on symptoms, but when alliance was stable and stronger compared to other periods, subsequent symptoms were lower. Similarly, change in symptoms across an eight-session period did not have an immediate temporal effect on alliance, but when symptoms were stable and lower compared to other periods, subsequent alliance was stronger. These results suggest that sustained improvements in the alliance contribute to subsequent symptom improvements, and vice versa. The authors conclude that it is important to work to improve and maintain improvements in the working alliance and symptoms. Limitations and future directions are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Deliberate practice for the skill of immediacy: A multiple case study of doctoral student therapists and clients.

We examined the effects of deliberate practice training focused on immediacy (Im) for 7 doctoral student trainees. Training included an 8-hr workshop, 4 individual 50-min sessions, and 4 individual 30-min homework sessions. Qualitative results indicated that trainees found the deliberate practice training to be effective, especially in helping them become aware of and manage emotions and countertransference, which had inhibited them from using Im. In addition, there was a moderate and significant effect of training on the trainee's self-efficacy for using Im, a small and significant effect on therapist-rated working alliance, and no significant effect for client-rated working alliance. (PsycInfo Database Record (c) 2020 APA, all rights reserved).