Therapist facilitative interpersonal skills and training status: A randomized clinical trial on alliance and outcome.

OBJECTIVES: Therapist effects, independent of the treatment provided, have emerged as a contributor to psychotherapy outcomes. However, past research largely has not identified which therapist factors might be contributing to these effects, though research on psychotherapy implicates relational characteristics. The present Randomized Clinical Trial tested the efficacy of therapists who were selected by their facilitative interpersonal skills (FIS) and training status. METHOD: Sixty-five clients were selected from 2713 undergraduates using a screening and clinical interview procedure. Twenty-three therapists met with 2 clients for 7 sessions and 20 participants served in a no-treatment control group. RESULTS: Outcome and alliance differences for Training Status were negligible. High FIS therapists had greater pre-post client outcome, and higher rates of change across sessions, than low FIS therapists. All clients treated by therapists improved more than the silent control, but effects were greater with high FIS than low FIS therapists. From the first session, high FIS therapists also had higher alliances than low FIS therapists as well as significant improvements on client-rated alliance. CONCLUSIONS: Results were consistent with the hypothesis that therapists' common relational skills are independent contributors to therapeutic alliance and outcome.

An assimilation analysis of clinician-assisted emotional disclosure therapy with survivors of intimate partner sexual assault.

This study examined clinician-assisted emotional disclosure therapy among college women with a history of intimate partner sexual assault. Assimilation analysis, a method for tracking client movement in psychotherapy, was used to document changes in dominant and submissive voices during clients' disclosure of the trauma. Self-blame, traditional gender-role assumptions, and internalized rape myth ideology emerged as prominent themes in clients' formations of problem statements. The two case studies presented illustrate the difficulty in clearly formulating experiences of intimate partner sexual assault as problematic, integrating submissive and dominant voices and empowering adaptive voices that speak for the well-being and self-assertion of the individual. Implications for psychotherapy with survivors of intimate partner sexual assault are discussed.

Narrative as an outcome domain in psychosis.

A recent renewed interest in psychosocial treatments for psychosis has only minimally included considerations of narrative therapy and other interventions based in post-modernism. This lack of attention is curious given the profound narrative disruptions often seen in psychotic illness. In this review article we describe several studies in which narratives and narrative dimensions have been utilized to assess outcomes in psychosis. Valid and reliable measures of narrative change in psychosis are possible and can coexist with and complement traditional outcome measures. Perhaps more significantly, considerations of narrative changes may offer unique insights into the process of recovery from psychosis as well as leading to beneficial psychosocial treatments for the same.

A randomized, controlled trial of emotional disclosure in rheumatoid arthritis: can clinician assistance enhance the effects?

Emotional disclosure by writing or talking about stressful life experiences improves health status in non-clinical populations, but its success in clinical populations, particularly rheumatoid arthritis (RA), has been mixed. In this randomized, controlled trial, we attempted to increase the efficacy of emotional disclosure by having a trained clinician help patients emotionally disclose and process stressful experiences. We randomized 98 adults with RA to one of four conditions: (a) private verbal emotional disclosure; (b) clinician-assisted verbal emotional disclosure; (c) arthritis information control (all of which engaged in four, 30-min laboratory sessions); or (d) no-treatment, standard care only control group. Outcome measures (pain, disability, affect, stress) were assessed at baseline, 2 months following treatment (2-month follow-up), and at 5-month, and 15-month follow-ups. A manipulation check demonstrated that, as expected, both types of emotional disclosure led to immediate (post-session) increases in negative affect compared with arthritis information. Outcome analyses at all three follow-ups revealed no clear pattern of effects for either clinician-assisted or private emotional disclosure compared with the two control groups. There were some benefits in terms of a reduction in pain behavior with private disclosure vs. clinician-assisted disclosure at the 2-month follow-up, but no other significant between group differences. We conclude that verbal emotional disclosure about stressful experiences, whether conducted privately or assisted by a clinician, has little or no benefit for people with RA.