Examining therapist estimation of client working alliance and client symptom outcome using truth and bias model and response surface analysis.

OBJECTIVE: The aims of this study were to investigate the congruence and discrepancy between Chinese therapist trainees' estimated client working alliance (WA) and their clients' actual WA rating, and how the congruence and discrepancy predicted client symptom outcome. METHODS: Participants were 211 beginning therapist trainees and 1216 clients. Data from their 6888 sessions were analyzed using Truth and Bias Model and Response Surface Model. RESULTS AND CONCLUSIONS: (i) Chinese trainees' estimation of client WA was on average significantly lower than actual client WA. (ii) At the between-person level, whether the trainee generally over- or underestimated client WA was not related to the client's initial symptom level or symptom improvement rate. (iii) At the within-person between-session level, a session where a trainee accurately perceived high client WA, compared to a session where the trainee accurately perceived low client WA, was followed by greater client symptom relief before the next session. In the case of estimation bias, a session where the trainee underestimated client WA was followed by greater client symptom reduction in the next session, rather than the other way around when the trainee overestimated client WA. Implications on therapist training were discussed.

Therapist self-efficacy developmental profiles, supervisory working alliance, and client outcome: A growth mixture analysis.

The aims of this study were to investigate the overall, and subgroups of, developmental profiles of the three domains of counseling self-efficacy (CSE) among beginning therapist trainees in China. Further, the associations between the different CSE developmental profiles and the trainees' perceived supervisory working alliance (SWA) and their clients' reported symptom distress were also examined. Participants included 258 beginning therapist trainees in a master's level counseling training program in China, who completed measures of CSE in three waves throughout the practicum and rated SWA after every supervision session. Clients rated their symptom distress before and after treatment. Growth mixture analysis results indicated that overall, trainees showed the highest initial confidence in helping skills use, followed by in session management, and last in handling counseling challenges, and there were significant increases in all three aspects of self-efficacy. Second, four subgroups of developmental profiles emerged, including beginning moderate with no changes, beginning moderate with moderate increases, beginning low with marked increases, and beginning high with partial minor increase. Third, the beginning moderate with no changes subgroup showed lower ratings of SWA and the lowest average client symptom improvement. Recommendations for future research and implications for training are presented. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Creating a brief form of the Supervisory Working Alliance Inventory in the Chinese cultural context using multilevel factor analyses.

The aim of this study was to examine the multilevel factor structure of the Supervisory Working Alliance Inventory (SWAI; Efstation et al., 1990) and shorten it for routine clinical use in the Chinese cultural context. Participants were 203 (Sample 1) and 97 (Sample 2) beginning counseling trainees from a master's level training program in China. They were given the SWAI after every supervision session, and a subset of Sample 1 trainees also completed measures of their counseling self-efficacy before every client session. With Sample 1, multilevel exploratory factory analysis (M-EFA) showed that for the original 19-item version of SWAI, two factors emerged on the within-trainee level (Rapport and Client Focus) as proposed in Efstation et al. (1990), whereas only one General Alliance factor was identifiable on the between-trainee level. After removing poorly or double-loaded items, a six-item brief version of SWAI (SWAI-Brief) was obtained. Using Sample 2, multilevel confirmatory factor analysis and multilevel bifactor models supported the factor structure found in M-EFA with Sample 1. Empirical evidence also supported the reliability of the SWAI-Brief, as well as its criterion-related concurrent and predictive validity given its significant associations with trainee's counseling self-efficacy at the same week and in the subsequent week. Results suggested that the six-item SWAI-Brief could be a reliable and valid measure for assessing supervisory working alliance in the Chinese cultural context and may be used to continuously track clinical supervision processes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The development of a Brief Working Alliance Inventory for clients and therapists using multilevel factor analysis and item response theory in the United States and China.

This study aimed to investigate the multilevel factor structure of the therapist and client versions of the 12-item Working Alliance Inventory-Short Revised (WAI; Hatcher & Gillaspy, 2006) in the United States and China, and to create a three-item brief version (WAI-B3) using multilevel factor analysis (M-FA) and multilevel item response theory (M-IRT). We gathered eight data sets from two samples each in United States and China with a total of 21,623 sessions from 376 therapists and 2,455 clients. M-FA results with the first four data sets (two American and two Chinese) suggested that the 12-item WAI across therapist and client versions, and in both United States and China showed a dominant general WA factor with three specific subgroup factors corresponding to the Goal, Task, and Bond items. We then constructed a three-item WAI-B3 by selecting items 11, 10, and 9 through M-IRT, as the best representative of Goal, Task, and Bond subscales, respectively, for both the therapist and client versions in United States and China. With the other four data sets (two American, two Chinese) to test the WAI-B3, we found adequate multilevel reliability, structural validity, and convergent validity with the original 12-item WAI scores. Multilevel measurement invariance tests provided tentative and mixed support for the equivalence of WAI-B3 between the American and Chinese data sets and between therapist and client versions. We recommend that the WAI-B3 be used in routine clinical practice to track therapy process, and that the WAI-B3 be tested with other client and therapist populations and cultures. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The "roller coaster ride": A longitudinal investigation of the dynamic relationship between Chinese counseling trainees' self-efficacy and their clients' outcome and the mediating effects of working alliance and session evaluation.

[Correction Notice: An Erratum for this article was reported in Vol 69(4) of Journal of Counseling Psychology (see record 2022-76740-002). In the article, the scale for the Working Alliance Inventory-Short Revised (WAI-SR) was incorrectly described in the Measures section as a "5-point scale that ranges from 1 to 5." The WAI-SR used the original 7-point scale ranging from 1 to 7. All versions of this article have been corrected.] Based on the social-cognitive theory, this study investigated the dynamic association between counseling trainees' self-efficacy and their clients' outcome (i.e., symptom distress), and the mediating effects of therapist- and client-rated working alliance and session quality. Data set included 1,352 sessions conducted by 87 master's level therapist trainees with their 317 clients in China. Before every session, therapists completed a measure of self-efficacy and clients reported their symptom distress; and after every session, both therapists and clients rated their working alliance and session quality. Results showed that, (a) over the course of therapy, the initial level of therapist self-efficacy did not predict how quickly client symptom declined; (b) the initial level of client distress did not predict how quickly therapist self-efficacy increased; and (c) client distress decline was not related to therapist self-efficacy increase over the course of therapy. However, at the session-to-session level, higher therapist self-efficacy before one session significantly predicted lower client distress before the next session, and higher client distress before one session significantly predicted lower therapist self-efficacy before the subsequent session. Therapist and client perceptions of working alliance were both significant mediators, while their session quality ratings were not. Findings supported the dynamic and reciprocal relationship between therapist self-efficacy and client distress at the immediate session-to-session level rather than the overall trajectory level, and revealed its specific mediating mechanism through the relationship building between therapist and client. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Exploring Therapist Self-Efficacy Change Profiles Using Latent Growth Curve Analysis.

OBJECTIVE: This study investigated the overall developmental trajectories of three conceptually progressive aspects of counseling self-efficacy, including helping skills (HS), session management (SM), and counseling challenges (CH), among beginning therapist trainees in China. METHOD: Participants included 103 beginning therapist trainees in a master's level counselor training programme in China, who filled out measures of counselor self-efficacy in three waves over one year of practicum. RESULTS: (a) Trainees showed highest initial level of HS, followed by SM, with CH being the lowest; and there were significant increases in all three aspects of self-efficacy. (b) Trainee age, gender, and personal therapy hours as a client were associated with the overall self-efficacy developmental trajectories. Specifically, elder therapist trainees reported higher initial levels of self-efficacy in HS and CH; female trainees reported lower initial level but higher increases in CH self-efficacy over practicum; and trainees who had more hours of personal therapy as clients showed higher initial levels on HS but not on other aspects or the change trajectories. CONCLUSION: Results in this study may inform trainers regarding trainees' developmental characteristics, and assist them in planning targeted support to better foster trainee progress.

Challenges and recommendations for mental health providers during the COVID-19 pandemic: the experience of China's First University-based mental health team.

Coronavirus Disease is impacting the entire world. As the first country that has needed to confront this disease, China has responded with unprecedented and hugely successful public health initiatives. Almost simultaneous with the awareness of the potential for widespread loss of life, the first Chinese university recognizing the likely psychological impacts of COVID-19, assembled the first university-based professional team to offer pandemic-related mental health services to the Chinese public. This paper describes the work that we provided and the challenges encountered. The challenges are described in four contexts: the organizational/systemic level, the technical perspective, the therapeutic process, and the ethical aspects. We also provide recommendations on what we can do in the short term, and future improvements that can be made.

Chinese counseling trainees' trait and state mindfulness and client symptom outcome: A longitudinal examination with multilevel and random-intercept cross-lagged panel models.

This study aimed to explore how Chinese counseling trainees' trait and state mindfulness predicted their clients' symptom level over the course of therapy. A data set consisting of 6,888 sessions from 1,216 clients and their 211 master's level beginning therapist trainees in China was used, which included a measure of trainees' trait mindfulness at the beginning of their practicum and their state mindfulness and client-rated symptom distress level at the beginning of each of their therapy sessions. Multilevel modeling and random-intercept cross-lagged panel model results suggested that (a) at the trainee level, a trainee's trait mindfulness did not predict their average client symptom improvement over practicum; (b) at the session-to-session level, higher trainee state mindfulness before one session significantly predicted lower client distress before the next session, and higher client distress before one session did not predict trainee state mindfulness before the subsequent session. Findings suggested that it was the trainees' session-to-session state mindfulness, instead of their general trait mindfulness, that temporally led to greater client symptom reduction. Implications for clinical training were discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Profiles of acculturative adjustment patterns among Chinese international students.

This is the first study to empirically identify distinct acculturative adjustment patterns of new international students over their first 3 semesters in the United States. The sample consisted of 507 Chinese international students studying in the United States. Using psychological distress as an indicator of acculturative adjustment, measured over 4 time points (prearrival, first semester, second semester, and third semester), 4 distinct groups of student adjustment trajectories emerged: (a) a group exhibiting high levels of psychological distress across each time point (consistently distressed; 10%), (b) a group with decreasing psychological distress scores from Time 1 to Time 2 (relieved; 14%), (c), those with a sharp peak in psychological distress at Time 2 and Time 3 (culture-shocked; 11%), and (d) a group with relatively consistent low psychological distress scores (well-adjusted; 65%). Moreover, significant predictors of a better acculturative adjustment pattern included having higher self-esteem, positive problem-solving appraisal, and lower maladaptive perfectionism prior to the acculturation process. In addition, during the first semester of studying in the United States, having a balanced array of social support and using acceptance, reframing, and striving as coping strategies were associated with a better cross-cultural transition. Practical implications and future directions were also discussed.

Conductive Composite Fiber with Optimized Alignment Guides Neural Regeneration under Electrical Stimulation.

Conductivity and alignment of scaffolds are two primary factors influencing the efficacy of nerve repair. Herein, conductive composite fibers composed of poly(ɛ-caprolactone) (PCL) and carbon nanotubes (CNTs) with different orientation degrees are prepared by electrospinning at various rotational speeds (0, 500, 1000, and 2000 rpm), and meanwhile the synergistic promotion mechanism of aligned topography and electrical stimulation on neural regeneration is fully demonstrated. Under an optimized rotational speed of 1000 rpm, the electrospun PCL fiber exhibits orientated structure at macroscopic (mean deviation angle = 2.78°) or microscopic crystal scale (orientation degree = 0.73), decreased contact angle of 99.2° ± 4.9°, and sufficient tensile strength in both perpendicular and parallel directions to fiber axis (1.13 ± 0.15 and 5.06 ± 0.98 MPa). CNTs are introduced into the aligned fiber for further improving conductivity (15.69-178.63 S m-1 ), which is beneficial to the oriented growth of neural cells in vitro as well as the regeneration of injured sciatic nerves in vivo. On the basis of robust cell induction behavior, optimum sciatic nerve function index, and enhanced remyelination/axonal regeneration, such conductive PCL/CNTs composite fiber with optimized fiber alignment may serve as instructive candidates for promoting the scaffold- and cell-based strategies for neural repair.

The Cross-Cultural Loss Scale: development and psychometric evaluation.

The Cross-Cultural Loss Scale (CCLS), a measure of loss associated with crossing national boundaries, was developed across 2 samples of international students. With Sample 1 (N = 262), exploratory factor analyses were used to select the 14 CCLS items and to determine 3 factors: Belonging-Competency (α = .87), National Privileges (α = .68), and Access to Home Familiarity (α = .72). With Sample 2, confirmatory factor analyses (N = 256) cross-validated the 3-factor oblique model as well as a bifactor model. Cronbach alphas of CCLS subscale scores in Sample 2 ranged from .73 to .87. The validity of the CCLS scores was supported by its associations with related variables in the expected directions. Perceived cross-cultural losses were positively associated with negative affect, migration grief and loss, and discrimination and were negatively associated with life satisfaction, positive affect, general self-efficacy, and social connection with mainstream society. Moreover, the CCLS total and 2 subscale scores added significant incremental variance in predicting subjective well-being over and above related constructs. The results indicated measurement invariance and validity equivalency for the CCLS scores between men and women. The overall results from these 2 samples support CCLS as a psychometrically strong measure.