Clinical Consensus Strategies to Repair Ruptures in the Therapeutic Alliance.

OBJECTIVE: The alliance been recognized as an essential common factor and robust predictor of outcome. The present study sought to further our knowledge of the alliance and to promote the integration of research and practice by assessing consensus among peer-nominated expert therapists of varying theoretical orientations on the effectiveness of clinical strategies to repair alliance ruptures. METHOD: This study drew on the behavioral-analytic model (Goldfried & D'Zurilla, 1969) and the methodology of the Expert Consensus Guideline Series (Frances, Docherty, & Kahn 1997). In Phase I, 69 therapists submitted clinical situations describing alliance ruptures. In Phase II, 177 therapists generated responses to the situations, and clinical strategies underlying the responses were identified. In Phase III, 134 peer-nominated experts (a mean of 22.3 therapists per situation) rated the effectiveness of these clinical strategies. RESULTS: The experts reached consensus on the use of strategies that validated the client's experience and explored the rupture during the rupture session. Change-oriented interventions (e.g., changing interpersonal interactions; highlighting patterns of behavior, thought, or emotions) were generally rated as less effective to use during the rupture, but effective for use in future sessions. CONCLUSIONS: The findings are consistent with the growing literature on the value of using certain alliance-focused interventions during a rupture. The findings point to the importance of therapists' awareness of the state of the alliance so that they can identify when ruptures are occurring.

Therapist qualities preferred by sexual-minority individuals.

Psychotherapy research concerning lesbian, gay, and bisexual (LGB) individuals has focused on matching clients on gender and sexual orientation, yet has not considered how factors such as therapeutic skill, presenting problem, and cohort membership may influence preference for therapists. This study was designed to identify those therapist qualities that sexual-minority individuals prefer and to determine how the presenting problem influences therapist choice. Forty-two nonheterosexual adults between 18 and 29 years old ranked 63 therapist characteristics from "Extremely Uncharacteristic" to "Extremely Characteristic" when seeking treatment for a problem in which their sexual orientation was salient and one in which it was not. The analyses of both conditions yielded clusters of items reflecting therapist characteristics that participants considered unfavorable, neutral, beneficial, and essential. Participants valued therapists who had LGB-specific knowledge as well as general therapeutic skills, whereas they indicated that they would avoid therapists who held heterocentric views. Application of these findings to clinical practice and future directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Appraisals of daily romantic relationship experiences in individuals with borderline personality disorder features.

The current study examined the relationship between borderline personality disorder (BPD) features and appraisals of daily romantic relationship experiences. The sample included 114 ethnically diverse, young adult dating couples (total N = 228). Participants completed a 14-day daily diary study and reported negative impact and emotional loss to their romantic partner in response to daily positive and negative self-initiated and partner-initiated romantic experiences. Results indicated that BPD features, even when controlling for relationship satisfaction, total number of relationship experiences, and depressive symptoms, were associated with reporting greater negative impact and greater emotional loss to both partner-initiated negative and positive experiences. BPD features were generally not associated with reporting greater negative impact and emotional loss in response to self-initiated negative and positive experiences. The results suggest that individuals with BPD features have a negative interpretation bias to both negative and positive experiences and the effect is generally specific to partner-initiated experiences. Negative appraisals may be one mechanism underlying interpersonal dysfunction in those with BPD features and interventions that directly assess and target these cognitive biases may help improve individual well-being and overall couple functioning.

Clinical consensus strategies for interpersonal problems between young adults and their parents.

OBJECTIVE: Research that identifies areas of agreement among expert therapists can complement findings from clinical trials by highlighting common practices as well as innovations. The present study accessed consensus among expert therapists on the effectiveness of clinical strategies for treating young adults experiencing interpersonal problems with their parents. METHOD: This study drew on the behavioral-analytic model (Goldfried & D'Zurilla, 1969) and the methodology of the Expert Consensus Guideline Series (Frances, Kahn, Carpenter, Ross, & Docherty, 1996). In Phase I, 54 therapists (mean age = 60.32 years; 55.6% women, 44.4% men; 96.3% White/European American) provided clinical situations involving young adult clients and their parents. In Phase II, 171 therapists (mean age = 59.45 years; 47.4% women, 52.0% men; 91.8% White/European American) proposed responses to the situations, and more general clinical strategies underlying the responses were identified. In Phase III, 134 peer-nominated expert therapists (a mean of 22.33 therapists per situation; mean age = 55.46 years; 61.2% women, 34.3% men; 91.0% White/European American) rated the effectiveness of these clinical strategies. RESULTS: Results indicated that the experts reached consensus on strategies rated as highly effective; in particular, they agreed on the value of exploring clients' emotional experience and providing validation. Participants reached greater agreement on strategies for use in future sessions than strategies for immediate use. Exploratory analyses revealed correlations between experts' theoretical orientations and their ratings. CONCLUSIONS: The findings provide converging evidence of the value of exploring emotions and validating clients and, further, demonstrate the feasibility of this method for accessing clinicians' experience.

Therapist self-disclosure in cognitive-behavior therapy.

Although cognitive-behavior therapy emphasizes between-session change, therapist self-disclosure within the session can be an effective tool for strengthening the therapeutic bond and facilitating client change. After noting the use of self-disclosure in other theoretical orientations, we place self-disclosure in the context of cognitive-behavioral theories of reinforcement and modeling. Clinical vignettes illustrate the use of therapist self-disclosure to provide feedback on the interpersonal impact made by the client, enhance positive expectations and motivation, strengthen the therapeutic bond, normalize the client's reaction, reduce the client's fears, and model an effective way of functioning. Therapists need to observe appropriate boundaries when self-disclosing, and in particular, should consider their own motivations for self-disclosing. Although more research is needed on the effects of self-disclosure, cognitive-behavior therapists have found that self-disclosure can be a powerful intervention.