Predictors and moderators of between-therapists and within-therapist differences in depressed outpatients' experiences of the Rogerian conditions.

The extent to which patients experience their therapists as providing empathy, positive regard and genuineness (the Rogerian Conditions) is an important predictor of outcome in the psychotherapy of depression (Zuroff & Blatt, 2006). Using data from 157 depressed outpatients treated by 27 therapists in the cognitive-behavior therapy, interpersonal therapy, or clinical management with placebo conditions of the Treatment of Depression Collaborative Research Program (Elkin et al., 1989), Zuroff, Kelly, Leybman, Blatt, and Wampold (2010) showed that between-therapists and within-therapist differences in Rogerian Conditions at the second treatment session predicted more rapid reductions in overall maladjustment. We conducted novel analyses intended to identify: 1) predictors of between-therapists and within-therapist differences in Rogerian Conditions and 2) moderators of the effects on maladjustment of between-therapists and within-therapist differences in Rogerian Conditions. Patients with lower levels of self-critical perfectionism, higher levels of an adaptive form of dependency or higher expectations of warmth from their therapists experienced higher levels of Rogerian Conditions than their therapist's average patient. High baseline self-critical perfectionism diminished the between-therapists effect of Rogerian Conditions on maladjustment, whereas baseline adaptive dependency enhanced the within-therapist effect of Rogerian Conditions. Results shed additional light on the centrality of patient characteristics, the Rogerian Conditions, and their transactions and interactions on outcome in brief outpatient therapy for depression.

Conceptualizing and Measuring Self-Criticism as Both a Personality Trait and a Personality State.

Blatt's ( 2004 , 2008 ) conceptualization of self-criticism is consistent with a state-trait model that postulates meaningful variation in self-criticism both between persons (traits) and within person (states). We tested the state-trait model in a 7-day diary study with 99 college student participants. Each evening they completed a 6-item measure of self-criticism, as well as measures of perceived social support, positive and negative affect, compassionate and self-image goals during interactions with others, and interpersonal behavior, including overt self-criticism and given social support. As predicted, self-criticism displayed both trait-like variance between persons and daily fluctuations around individuals' mean scores for the week; slightly more than half of the total variance was between persons (ICC = .56). Numerous associations at both the between-persons and within-person levels were found between self-criticism and the other variables, indicating that individuals' mean levels of self-criticism over the week, and level of self-criticism on a given day relative to their personal mean, were related to their cognitions, affect, interpersonal goals, and behavior. The results supported the construct validity of the daily self-criticism measure. Moreover, the findings were consistent with the state-trait model and with Blatt's theoretical analysis of self-critical personality.

Between-therapist and within-therapist differences in the quality of the therapeutic relationship: effects on maladjustment and self-critical perfectionism.

The relationship between therapeutic outcome and a patient-reported measure of the Rogerian conditions of positive regard, empathy, and genuineness was decomposed into between-therapist effects and within-therapist effects using multilevel modeling. Data were available for 157 depressed outpatients treated by 27 therapists in the cognitive-behavioral therapy, interpersonal therapy, or placebo with clinical management conditions of the Treatment of Depression Collaborative Research Program (Elkin, 1994). Consistent with prior findings of significant between-therapist variability in outcome (e.g., Baldwin, Wampold, & Imel, 2007), patients whose therapists provided high average levels of the perceived Rogerian conditions across the patients in their caseloads experienced more rapid reductions in both overall maladjustment and depressive vulnerability (self-critical perfectionism). Within each therapist's caseload, differences between patients in perceived Rogerian conditions had weaker effects. The results underline the importance of differences between therapists as determinants of outcome in the treatment of depression.

Recalled peer relationship experiences and current levels of self-criticism and self-reassurance.

OBJECTIVES: Numerous studies have shown that personality factors may increase or decrease individuals' vulnerability to depression, but little research has examined the role of peer relationships in the development of these factors. Accordingly, this study examined the role of recalled parenting and peer experiences in the development of self-criticism and self-reassurance. It was hypothesized that, controlling for recalled parenting behaviours, specific recalled experiences of peer relationships would be related to current levels of specific forms of self-criticism and self-reassurance. DESIGN: Hypotheses were tested using a retrospective design in which participants were asked to recall experiences of parenting and peer relationships during early adolescence. This age was chosen as early adolescence has been shown to be a critical time for the development of vulnerability to depression. METHODS: A total of 103 female and 97 male young adults completed measures of recalled parenting, overt and relational victimization and prosocial behaviour by peers, and current levels of self-criticism and self-reassurance. RESULTS: Hierarchical regression analyses showed that parents and peers independently contributed to the development of self-criticism and self-reassurance. Specifically, controlling for parental care and control, overt victimization predicted self-hating self-criticism, relational victimization predicted inadequacy self-criticism, and prosocial behaviour predicted self-reassurance. As well, prosocial behaviour buffered the effect of overt victimization on self-reassurance. CONCLUSIONS: Findings highlight the importance of peers in the development of personality risk and resiliency factors for depression, and suggest avenues for interventions to prevent the development of depressive vulnerabilities in youth. PRACTITIONER POINTS: The nature of a patient's personality vulnerability to depression may be better understood through a consideration of the patient's relationships with their peers as well as with parents during adolescence. An understanding of adult patients' past peer relationships may further the therapist's understanding of the client's core schemas and dysfunctional attitudes, as well as potential transference reactions during therapy. Identifying and helping youth to better cope with peer victimization may help prevent the development of a vulnerable personality style in adulthood. Fostering positive peer relationships in adolescence may buffer the effects of other more negative relationships with peers.