Search results

The results of empirical research on the patient–psychotherapist relationship have led to the fundamental conclusion that the therapeutic alliance is one of the key factors ensuring the positive outcomes of psychotherapy. The main aim of the present study is to determine what variables pertaining to the context of psychotherapy (type of treatment applied in accordance with the psychotherapist’s modality/orientation, type of disorder diagnosed in the patient) differentiated the alliance.

Participants for the main study were recruited from public and private psychotherapy offices across Poland. The working alliance was assessed based on 262 psychotherapist–patient dyads. The sample consisted of 428 participants. To assess the quality of therapeutic alliance, the author used the full version of the Working Alliance Inventory as adapted into Polish.

The results of analyses led to several basic conclusions. The study revealed a differentiating effect of type of psychotherapy on the quality of therapeutic alliance. Alliance quality was not differentiated by the type of disorder diagnosed in patients and treated in the psychotherapeutic process.

The results of analyses presented in this empirical study allowed for exploring the quality of the therapeutic alliance with contextual variables related to the psychotherapeutic process taken into account.

Deliberate practice (DP) is an innovative training method for improving psychotherapy skills acquisition and expertise in the twenty-first century. I introduce the reader to the principles and processes of DP and the rationale for its use. The concept of DP is not new, indeed it is used to support the improvement of performance in diverse areas, from sport to music. However, its application to psychotherapy is still in its infancy. Firstly, I provide the rationale for including DP as a method of therapist training based on research that illustrates that many of the current criteria that we use to identify expertise have little to no added impact on client outcomes. Additionally, some of the limitations of current traditional training regimes are outlined, along with the emerging evidence base for DP as a training method that can help improve the acquisition of therapeutic skills and expertise.

The last chapter examined evidence based relationships from the perspective of emotional expression and the inner experience of the practitioner in relation to the client. In this chapter, I am introducing the first of a number of variables situated in evidence based relationships. Empathy, congruence, unconditional positive regard, and the real relationship will be discussed. I have chosen to categorise these four variables together due to their significant overlap and interaction with each other in terms of practice and research. This chapter does not attempt to provide an exhaustive description of each factor. Rather, I provide a very brief overview of the variable, provide an analysis of the research behind each, and highlight Top Tips that can guide the practitioner in their development.

In the previous chapter, we explored in a broad sense, the idea of various types of expectancy related to processes involved in the delivery of treatment, and the desire of the client for treatment approaches and other important preferences. In this chapter, I discuss four more variables that we can consider to align to the theme of inner experiences, of the practitioner, with a lesser focus on the client. The relationship between outcomes and emotional expression of the client and practitioner, and outcomes related to the practitioner’s counter-transference (CT), self-disclosure (TSD), and use of immediacy (Im) are discussed. As with previous chapter, definitions are provided, the research base is explored, and Top Tips for each variable are outlined for the developing and seasoned practitioner.

In the previous chapter, I introduced the reader to the ideas and research of the common factors. The common factors are varied and have demonstrated to have small to large effect sizes depending on what variable is being examined. In this chapter, I categorise four more evidence based relationship variables which tend to be more task orientated and aligned to the therapeutic alliance. Indeed, the therapeutic alliance, goals and collaboration, alliance rupture–repair, and feedback-informed care are four trans-theoretical factors that can contribute greatly to outcomes. At the same time, when poorly established they can and do impact negatively on client outcomes. This is not an exhaustive overview of the literature, rather each variable is briefly discussed, the evidence supporting the effectiveness is highlighted, and Top Tips are provided to assist the development of the practitioner.

Psychotherapy is perhaps the most known and identifiable with one of the field’s originators Sigmond Freud who is often accredited as being the inventor of the talking cure. However, it was many decades after psychoanalysis was first used by Freud that robust research and evidence was applied to psychotherapy, and its findings used to support practice in various contexts. While psychoanalysis is still practiced, the field has moved on and includes many hundreds if not thousands of approaches to healing. What has not improved, in general, is the between school rivalry regarding the efficacy and effectiveness of the different approaches. While it is now accepted that in general terms all approaches are about equally effective, certain research is often provided with more legitimacy than others. Mainly, the randomised control trial (RCT) is considered the gold standard in research terms, especially when it comes to establishing the efficacy and effectiveness of different psychotherapies. Empirically supported treatments (ESTs) are in prime position to take advantage of these political decisions, and this chapter will introduce the reader to these debates.

Thus far, I have introduced the reader to evidence based practice in a broad sense, and evidence based relationships across important variables. In this chapter, I further build on this by extending the need for evidence based responsiveness as applied to client factors. While the practitioner brings themselves and their bag of tools to the therapy encounter, the client brings not just their presenting problem, but their characteristic way of thinking about their problems and how they manage distress and change. Therefore, the supportive practitioner will be best served to understand how these client factors manifest for each individual that they work with. The purpose of this chapter then, is to discuss coping style, reactant level, stage of change, attachment style, and client preferences, within the context of the practitioner being responsive to these factors as they impact on therapy outcomes.

Despite its growing popularity in applied settings, executive coaching has to date received little attention in empirical research, especially in regard to the coaching process. This paper aims to investigate the effect of working alliance rating discrepancies on the development of coachees' self‐efficacy, a key outcome in leadership development.

The paper reports on a pre‐ post‐test study of a leadership development program taking place in a large North American manufacturing company. Data were collected from two samples: managers receiving coaching over an eight‐month period and internal certified coaches. In total, 30 coach‐coachee dyads were analyzed.

Results from an analysis of covariance did not support the authors' hypothesis, by indicating that coachees having worked with a coach who underestimated the working alliance, in relation to his or her coachee, experienced more growth in self‐efficacy than coachees who worked with a coach who either accurately estimated or overestimated the working alliance.

The results sugges that coaches should coach with an “ongoing and deliberately maintained doubt as their only certainty”. The importance for coaches to be sensitive to signs of what the coachee is experiencing, and to take the initiative to verify the coachee's comfort level with the way coaching is proceeding is addressed.

This study intended to delve deeper into the complexities of the coaching process by linking a key coaching process variable, the relationship, to coaching outcomes.

The paper addresses diversity, multi‐culturalism and mental health. It reports qualitative data from a larger project on multi‐cultural counselling competencies in Portugal which sought to meet the needs identified by specific minority groups by developing integrative, responsive and culturally sensitive treatments. A qualitative study is presented, with the aim of exploring the representations of mental health and illness held by ethnic minority groups in Portugal, as well as their specific needs and obstacles encountered in their interactions with health professionals. Semi‐structured interviews were conducted, and the results indicate that the meanings of health and mental health varied. Meanings of psychological health were related to general well‐being. Help‐seeking behaviours were associated with providing and receiving family and social support, mainly among participants of African descent. Although the great majority of participants had had no experience of counselling or psychotherapy, they expected psychologists to be multiculturally sensitive, as well as knowledgeable about diversity and multi‐culturalism. Implications for development of mental health services for minority clients are discussed.