Trainee attachment to supervisor and perceptions of novice psychotherapist counseling self-efficacy: The moderating role of level of experience.

Clinical supervision is often considered to be one of the important tasks in training psychotherapists. The present study investigated the relation between trainees' attachment to their supervisors and trainees' perceptions of their own counseling self-efficacy (CSE), as potentially moderated by trainee level of experience. Results indicated that trainees with greater avoidant attachment to their supervisors demonstrated lower levels of CSE. Although the results of the moderator analyses were not statistically significant, levels of avoidance significantly predicted levels of CSE even when controlling for level of experience, whereas levels of anxiety were not found to significantly predict levels of CSE. The study also found that individuals who reported greater levels of experience were more likely to report greater levels of CSE. The implications of the study are discussed, and recommendations for clinical supervision process are offered. (PsycINFO Database Record

Supervisory process from a supportive-expressive relational psychodynamic approach.

Substantial theoretical and empirical focus has been placed on detailing the processes that therapists use in psychotherapy. Relatively limited investigation, however, has been conducted into the utility of the various techniques and processes that supervisors use in facilitating the development of trainee competence to conduct psychotherapy. The present article explores 2 sets of supervisory techniques/processes that can be used to assist novice therapists in the development of clinical skills from a supportive-expressive (Luborsky, 1984) relational (Greenberg & Mitchell, 1983) psychodynamic approach: (a) providing systematic and structured training in interpretation, and (b) facilitating trainee use of countertransference. We detail the theoretical underpinnings and research findings for each supervisory process, followed by presentation of vignettes illustrating supervisor-supervisee interactions that demonstrate the use of these processes.

Technique and therapeutic process from a supportive-expressive relational psychodynamic approach.

In the present article, the authors identify three sets of clinical techniques central to the mechanisms of change in a supportive-expressive relational psychodynamic approach: (a) emphasis on patient affective experience, (b) identifying and understanding patient interpersonal patterns, and (c) therapeutic immediacy. Theoretical foundations and research findings supporting the utility of each intervention are outlined and briefly discussed. Clinical exchanges demonstrating the application of these techniques are also provided.

A meta-analysis of psychodynamic psychotherapy outcomes: evaluating the effects of research-specific procedures.

The aim of this research was to examine the extent to which the use of research-specific procedures in psychodynamic psychotherapy impacts upon treatment effectiveness and which variables moderate this potential relationship. Effects of audio/video recording of sessions, use of treatment manuals, and checks of treatment fidelity were examined. A meta-analysis was conducted on randomized controlled trials of psychodynamic psychotherapy. Forty-six independent treatment samples totaling 1615 patients were included. The magnitude of change between pretreatment and posttreatment aggregated across all studies (45 treatment samples) for overall outcome was large (d = 1.01), and further improvement was observed between posttreatment and an average 12.8-month follow-up (d = 0.18). Subgroup analyses comparing studies that used research-specific procedures and those that did not revealed that for posttreatment data no differences in treatment effects were found. However, the use of treatment manuals and fidelity checks were significantly associated with improvement between the end of treatment and follow-up assessment. Within the limitations of analyses, this data offered preliminary evidence that use of research-specific procedures does not contribute in a negative manner to posttreatment outcomes in psychodynamic psychotherapy, and their use contributes to positive differences that emerge with time. These findings, although observational in nature, make a case for reconsidering how dimensions of clinical utility and experimental control may be integrated in psychodynamic psychotherapy to enable further elucidation of principles that evidently work.

Effectiveness of combined individual and group dialectical behavior therapy compared to only individual dialectical behavior therapy: a preliminary study.

Dialectical behavior therapy (DBT) is an effective therapy. However, treating borderline personality disorder (BPD) patients with standard DBT can be problematic in some institutions due to logistical or cost limitations. The aim of this preliminary study is to examine the efficacy of Individual DBT in 37 BPD patients, compared with Combined individual/Group DBT in 14 BPD patients. Outcome measures included suicide attempts, self-harm behaviors, and visits to emergency departments. These variables were examined at pretreatment, 12 months/end of treatment, and at an 18-month follow-up. In addition, dropout rates were examined. Significant improvements on the outcome measures were observed across both versions of DBT treatment, particularly at the 18-month follow-up assessment. No significant differences were observed between Individual DBT and Combined individual/Group DBT on any of the posttreatment evaluations. An individual version of DBT may be an effective and less costly option for BPD treatment. Larger controlled trials are needed to confirm the results.

The relationship between adult attachment style and therapeutic alliance in individual psychotherapy: a meta-analytic review.

The present study examined the relationship between adult attachment style and therapeutic alliance in individual psychotherapy. Search procedures yielded 17 independent samples (total N = 886, average n = 52, standard deviation = 24) for inclusion in the meta-analysis. Results indicated that greater attachment security was associated with stronger therapeutic alliances, whereas greater attachment insecurity was associated with weaker therapeutic alliances, with an overall weighted effect size of r = .17, p < .001 (95% confidence interval = .10-.23). Publication bias analyses did not indicate any cause for concern regarding the results. The data were not demonstrably heterogeneous (Q = 6.10, df = 16, p = .99), and all between-study moderator analyses were nonsignificant (p values > .10) with the exception of the source of alliance ratings; results indicated that patient-rated alliance demonstrated a significantly larger relationship with attachment compared with therapist-rated alliance (Qbetween = 3.95, df = 1, p = .047). Implications for clinical practice and future research are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

A Meta-Analysis of the relationship between the Rorschach Ego Impairment Index (EII) and psychiatric severity.

The present study examined the relationship between the Rorschach Ego Impairment Index (EII) and psychiatric severity. Search procedures yielded 13 independent samples (total N = 1402, average n = 108, standard deviation = 90) for inclusion in the meta-analysis. Inter-rater reliability analyses demonstrated that coding of effect sizes and moderator variables was completed with good to excellent reliability. Results indicated that higher EII scores were associated with greater psychiatric severity, with an overall weighted effect size of r = 0.29, p = 0.000002 (95% confidence interval = 0.17-0.40), supporting the EII's validity as a measure of psychological impairment. Publication bias analyses did not indicate any significant cause for concern regarding the results. The data were demonstrably heterogeneous (Q = 56.82, p = 0.0000001), and results of post-hoc tests indicated that effect sizes with dependent variables obtained via researcher ratings were significantly larger than any of the following: effect sizes with dependent variables obtained via clinician ratings, informant ratings, information about level of treatment or placement status or self-report ratings (p's = 0.0005, 0.003, <0.001, <0.001, respectively). In addition, there was a trend for effect sizes based on performance-based measures to be larger than those based on information about level of treatment or placement status (p = 0.098) as well as those based on self-report measures (p = 0.076). Other moderator analyses were non-significant (p 's > 0.10). Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message: • The Rorschach Ego Impairment Index (EII) demonstrated validity in measuring psychiatric severity across a range of normative, outpatient, residential, and inpatient samples. • The degree of the EII's validity in assessing psychiatric severity compared favorably to the overall validity of the Rorschach and the MMPI. • The EII appears to be most valid in capturing psychiatric severity as measured by researcher ratings of social competency or estimated ego impairment.

Dropout and therapeutic alliance: a meta-analysis of adult individual psychotherapy.

This meta-analytic review of 11 studies examined the relationship between psychotherapy dropout and therapeutic alliance in adult individual psychotherapy. Results of the meta-analysis demonstrate a moderately strong relationship between psychotherapy dropout and therapeutic alliance (d = .55). Findings indicate that clients with weaker therapeutic alliance are more likely to drop out of psychotherapy. The meta-analysis included a total of 1,301 participants, with an average of 118 participants per study, a standard deviation of 115 participants, and a range from 20 to 451 participants per study. Exploratory analyses were conducted to determine the influence of variables moderating the relationship between alliance and dropout. Client educational history, treatment length, and treatment setting were found to moderate the relationship between alliance and dropout. Studies with a larger percentage of clients who completed high school or higher demonstrated weaker relationships between alliance and dropout. Studies with lengthier treatments demonstrated stronger relationships between alliance and dropout. Inpatient settings demonstrated significantly larger effects than both counseling centers and research clinics. No significant differences were found between client-rated, therapist-rated, and observer/staff-rated alliance. Recommendations for clinicians and researchers are discussed.

A primer on meta-analysis of correlation coefficients: the relationship between patient-reported therapeutic alliance and adult attachment style as an illustration.

The aim of this article is twofold: to offer an introduction to meta-analysis using correlation coefficients to facilitate greater understanding of meta-analytic findings and to guide those interested in conducting meta-analyses. The authors review calculations for a weighted average effect size, the statistical significance of this effect, a test of homogeneity, confidence intervals, and file drawer analysis. They provide a running example of the relationship between patient-reported therapeutic alliance and adult attachment style. Results (k = 12, N = 581.17, weighted average r = .17, p < .0001, 95% confidence interval=.13-.21) indicated a positive, statistically significant relationship, suggesting that greater attachment security is associated with stronger therapeutic alliances, whereas greater attachment insecurity is associated with weaker therapeutic alliances. File drawer results suggested that some caution is warranted in terms of the size of the effect.

Therapist affect focus and patient outcomes in psychodynamic psychotherapy: a meta-analysis.

OBJECTIVE: The authors systematically examined the relationship between therapist facilitation of patient emotional experience/expression and outcome in psychodynamic psychotherapy. METHOD: Computer and manual searches were conducted for relevant publications, and 10 independent samples of short-term dynamic psychotherapy were included in a meta-analysis. Data analysis included calculation of an overall effect size of the relationship between therapist affect focus and outcome, statistical significance, and test for homogeneity. In addition, moderator analyses were conducted to examine the potential impact of type of outcome construct used and the methodological quality of individual studies. RESULTS: The overall average weighted effect size across all outcome types was statistically significant (r=0.30), and the homogeneity statistic was nonsignificant. Moderator analyses indicated a statistically significant relationship between therapist facilitation of patient emotional experience/expression and outcome when more than one outcome construct was included but not when either a single or an unclear outcome construct was used. There were no significant relationships between methodological quality and the size of the effects, although use of audio- or videotaping for supervision demonstrated a moderate effect. CONCLUSIONS: These data indicate that therapist facilitation of patient affective experience/expression is associated with patient improvement over the course of psychodynamic psychotherapy. Although the size of this relationship was not significantly related to methodological quality, results suggest the importance of close supervision of actual techniques through the use of audio- or videotapes. Additionally, results highlight the importance of defining outcome in a multidimensional way to properly assess theoretically relevant effects.

Multimethod Validity Assessment of the SWAP-200 Dysphoric Q-Factor.

The aim of this study was to investigate the convergent validity of the Shedler-Westen Assessment Procedure Q-Sort Dysphoric Q-Factor with scales from the therapist, the patient, and independent observers. Therapists used the Shedler-Westen Assessment Procedure Q-Sort to describe their patients after the therapeutic assessment and the first two therapy sessions (when available). Independent observers completed a number of symptom distress, global functioning, and Axis II psychopathology measures after watching videotapes of the therapeutic assessment. They also completed a measure of social cognition and object relations after watching videotape of the therapeutic assessment and the first two therapy sessions (when available). Patients completed measures of symptomatology and personality assessment. Results indicated several significant correlations between the Dysphoric Q-Factor and a number of the clinician ratings of depressive symptomatology. In addition, three clinician ratings (Personality Disorder Index, Global Assessment of Functioning scale, and the experience and management of aggressive impulses variable of the Social Cognition and Object Relations Scale) demonstrated unique and nonredundant predictive ability in accounting for the variance of the Dysphoric Q-Factor. The patient self-report measures, however, did not correlate significantly with the Dysphoric Q-Factor, although several correlations demonstrated trends toward statistical significance.