The Relationship Between Counseling Trainee Perfectionism and the Working Alliance With Supervisor and Client

Understanding non-response in psychotherapy: A meta-synthesis

INTRODUCTION

There is considerable research focusing on the negative outcomes of psychotherapy, however, there remains an overlooked population: those who appear to show no response after treatment. This qualitative evidence synthesis aimed to review the available literature exploring client and therapist experiences of psychotherapy nonresponse.

METHOD

Seven databases were searched for studies using qualitative approaches to explore nonresponse. Twenty-four studies met inclusion criteria and were analysed using Thematic Synthesis.

RESULTS

Six overarching client perspective themes and 18 subthemes were identified: Hopes and fears; A difficult task; A Disconnected relationship; Staying involved; Therapy was not worth the investment and, On a trajectory for improvement. Four overarching therapist perspective themes and 10 subthemes were identified: High expectations; Experiencing a disconnect; Feeling threatened and Holding onto hope.

DISCUSSION

A model of psychotherapy nonresponse is proposed. The experience of nonresponse appears to involve both clients and therapists finding therapy difficult, experiencing problems connecting and not being open in the therapeutic relationship. Importantly, nonresponse appears not to be an absence of effects, but a range of experiences that are potentially harmful, particularly to clients. However, there were varied experiences of nonresponse, which indicates the importance of qualitative outcome measurement.

Recognizing and Managing Performance Anxiety in First-Year Supervised Pastoral Education (SPE) Students: Description, Causes and Remedies

Describes the nature of performance anxiety that can appear in students doing their first clinical placement in Supervised Pastoral Education¹ in the Canadian Association of Spiritual Care. Explores origins of performance anxiety drawing on research, the Diagnostic and statistical manual of mental disorders-5, theology of Paul Tillich and supervisory experiences of authors. Examines Canadian contextual factors like COVID-19, culture and multi-faith. Offers ways students might manage anxiety with help from supervisors and peers.

Therapists’ Emotional Reactions to Patients with Obsessive–Compulsive Disorder: The Role of Therapists’ Orientation and Perfectionism

Therapist’s emotional response towards patients with obsessive–compulsive disorder (OCD) is under-investigated. This aspect might provide valuable information about therapists’ difficulties during sessions and support supervisory practice, since a proportion of OCD patients drop out due to issues related to the therapeutic relationship. In a sample of therapists, we explored the effects of therapists’ orientation (cognitive behavioural versus psychodynamic) and perfectionistic traits on their emotional responses towards patients with OCD, controlling for other variables potentially related to emotional response towards patients (i.e., therapists’ gender/age and patient’s comorbid personality disorders). Ninety-four therapists (74 women and 20 men; mean age = 42.07 ± 10.17 years), of which 47 (50%) had a cognitive behavioural therapy (CBT) and 47 (50%) a psychodynamic orientation matched on gender and age, completed the Therapist Response Questionnaire and Frost Multidimensional Perfectionism Scale. Therapists with a CBT orientation reported less negative emotional responses, i.e., lower overwhelmed/disorganized, hostile/angry, criticised/devalued, parental/protective and special/over-involved emotions towards patients than therapists with a psychodynamic orientation. Therapists with higher perfectionistic traits (i.e., parents’ expectations/evaluation) had higher hostile/angry reactions, those with higher concerns over mistakes and doubts about actions had more intense criticised/devalued emotions, while those with stronger concerns with precision, order and organization had lower disengagement responses. The present study is the first investigation which sheds some light on the emotional responses of therapists towards OCD patients. Therapists’ CBT orientation and lower perfectionistic traits might be associated with better emotions. Therapists’ emotional responses, their psychotherapeutic orientation and levels of perfectionism should be considered during supervisory practice.

Validation of a Brief Form of the Supervisory Working Alliance Inventory

The Supervisory Working Alliance Inventory–Trainee Form (SWAI-T) is among the most frequently used instruments for measuring the quality of supervisor–supervisee relationships within counselor supervision. Although the full-scale SWAI-T instrument has proven utility, there are instances when a shorter form may be useful for research and field applications. The current study used secondary data from a pair of cross-sectional studies to test the utility of a brief form of the SWAI-T in a two-step process: (a) reduction of the SWAI-T based on item analyses from an electronic survey of 87 rehabilitation counselors working in a Western state vocational rehabilitation agency and (b) an initial validation study of the instrument using electronic survey responses from a national sample of 228 rehabilitation counselors working in private rehabilitation. The resultant 5-item scale showed evidence of high internal consistency, convergent validity, and minimal differences in psychometric properties relative to the full-scale instrument. An abbreviated supervisory working alliance scale offers practical advantages for select research purposes and for continuous evaluation of supervisory relationships in field environments.