The Experience of Forming a Therapeutic Relationship from the Client's Perspective: A Metasynthesis †.

OBJECTIVE: This review aimed to synthesize qualitative research exploring clients' perspectives of forming a therapeutic relationship with their therapist or counsellor. METHOD: Noblit and Hare's meta-ethnographic approach was used to guide the synthesis of 13 studies meeting inclusion criteria. The quality of each study was rated using the Critical Appraisal Skills Programme quality rating checklist. RESULTS: Findings demonstrated that clients create a hierarchy of desired therapist characteristics to assess how well the therapy can meet their needs (theme 1: assessing client-therapist match). The formation of the therapeutic relationship is facilitated by an openness from both the therapist and client (theme 2: facilitating openness) and helps to develop a connection through which the client can be fundamentally understood (theme 3: connecting on a deeper level). Displays of disrespectful or disempowering behaviour generate barriers in the formation of a therapeutic relationship (theme 4: empowerment through respect). CONCLUSIONS: The meta-ethnographic approach extended the findings from each individual study to highlight some significant discoveries, including that clients across different settings created a hierarchy of therapist characteristics which were of varying importance to them depending on their perceived needs. Additionally, clients reported that they preferred their therapists to disclose information in order to facilitate the therapeutic relationship.

Personality and cognitive processes: self-criticism and different types of rumination as predictors of suicidal ideation.

Self-criticism and rumination have been related to suicidality. In the present study, we investigated the extent to which different types of rumination (brooding and reflection) mediate the relationship between self-criticism and suicidal ideation. Two hundred and thirty-two healthy adults completed a range of psychological inventories at Time 1 and were followed up approximately 3 months later (Time 2). Brooding was more strongly associated with suicidal ideation than reflection. Hierarchical regression analyses confirmed that among those who completed measures at both time points, brooding rumination fully mediated the self-criticism-Time 2 suicidal ideation relationship. Reflection did not mediate the self-criticism-suicidal ideation link. The findings support a growing corpus of research which highlights the utility of personality and cognitive factors in advancing our understanding of the suicidal process. The theoretical and clinical implications are discussed.