Counselors' attachment anxiety and avoidance and the congruence in clients' and therapists' working alliance ratings

The Role of Therapists' Attachment and Introject in Their Treatment Process and Outcome: A Systematic Review

Previous reviews have examined empirical evidence of the relationship between therapists' internalized relational models, including therapists' attachment styles and Sullivan's notion of introject, and the therapeutic relationship. This review expands upon previous reviews by examining the effect of therapists' internalized relational models on the treatment process (e.g., therapeutic alliance and countertransference) and treatment outcomes (e.g., symptoms and functioning) more broadly. Our systematic search identified 42 empirical studies measuring therapist's internalized relational models, defined as therapist attachment style (i.e., the way the therapist relates to others) and/or introject (i.e., the way the therapist relates to themselves), in relation to therapy process and outcome, including 35 studies on attachment, nine studies on introject and two that examined both constructs. A rigorous quality assessment was conducted; two studies were rated as 'moderate', and 40 were rated as 'weak' in quality. Based on the study findings, it appears that more securely attached therapists may have stronger working alliances and more positive therapeutic processes with their patients. Contrary to expectations, therapist attachment security does not appear to impact treatment outcomes. Therapists who relate to themselves in a more affirming way may have stronger working alliances and better treatment outcomes, but very few studies have addressed this question thus far. More rigorous research, especially on the effect of therapists' introject, is needed. Therapists may consider the potential impact of their internalized relational models on the working alliance and other treatment processes that influence therapeutic outcomes.

Therapy matchmaking: Patient-therapist match in personality traits and attachment style

OBJECTIVE

This study examined the relationships between patient-therapist similarity and therapy outcome. We aimed to explore whether patient-therapist match in personality and attachment styles leads to a better therapy outcome.

METHOD

We collected data from 77 patient-therapist dyads in short-term dynamic therapy. Patients' and therapists' personality traits (Big-5 Inventory) and attachment styles (ECR) were assessed prior to beginning therapy. Outcome was measured on the OQ-45.

RESULTS

When patients and therapists scored either high or low on neuroticism and conscientiousness we found a decrease in symptoms from beginning to end of therapy. When patients' and therapists' combined scores were either high or low on attachment anxiety, we found an increase in symptoms.

CONCLUSION

Match or mismatch on personality and attachment style in therapy dyads contributes to therapy outcome.

Client-therapist congruence in session-helpfulness ratings and its association with therapy outcomes

Objective: The present study aimed to explore client-therapist congruence in helpfulness evaluations session-by-session and its association with therapy outcomes. As suggested by West and Kenny's truth and bias model, we constructed congruence as both temporal congruence (i.e., the correlation between therapists' and clients' helpfulness judgments over time) and directional discrepancy (i.e., the average difference between therapists' and clients' helpfulness judgments).Method: Seventy-eight clients were treated by 22 experienced therapists within a 12-session course of integrative psychotherapy. At the end of each session, clients and therapists rated their perceptions of session helpfulness and, at the beginning of the next session, clients rated their own psychological functioning.Results: Therapists' and clients' helpfulness judgments were temporally congruent across treatment, and therapists' judgments were lower than those of their clients. Moreover, we found that therapists' negative directional discrepancy, but not temporal congruence, was associated with improvement in clients' psychological functioning as well as with clients' global treatment evaluations.Conclusion: Our results highlight the importance of therapists' vigilant assessment of session helpfulness in a course of brief integrative psychotherapy. As such, they strengthen the importance of further research regarding client-therapist congruence (in different aspects of the therapeutic process) and its association with therapy outcomes.Clinical or methodological significance of this article In this study, we found that therapists' tendency to provide lower session-helpfulness assessments than did their clients was associated with better therapeutic outcomes. These results may highlight the importance of therapists' cautious and humble stance when assessing their perception of session helpfulness across treatment.

Client and therapist agreement in moment-to-moment helpfulness ratings in psychotherapy: A microprocess approach

METHOD

Clients (n = 16; M_age  = 32.88 years; 81% female) and their therapists (n = 10; 80% female) from a training clinic provided moment-to-moment ratings while reviewing a video recording of a recent session. West and Kenny's Truth-and-Bias (T&B) model was used to examine agreement in ratings. Multilevel modeling was used to evaluate the agreement-alliance association while controlling for sessions completed.

RESULTS

Consistent with the T&B model, client-therapist ratings were temporally congruent and were not discrepant overall. Greater congruence and smaller discrepancies were linked with stronger alliances.

CONCLUSIONS

The within-session and between-dyad variability in helpfulness ratings highlight the utility of moment-to-moment rating methods. Findings suggest that therapists should attune to client perceptions on a within-session level and attunement may be a target for enhancing the alliance.

Can we agree we just had a rupture? Patient-therapist congruence on ruptures and its effects on outcome in brief relational therapy versus cognitive-behavioral therapy

To draw clinically meaningful evidence-supported implications about the alliance-outcome association, recent studies have investigated patient-therapist congruence on ruptures in alliance. The present study investigated patient-therapist congruence on ruptures and its consequences on subsequent session outcome in 2 types of treatments that differ in the training therapists receive to identify ruptures: brief relational therapy (BRT), in which therapists receive alliance-focused training, and cognitive-behavioral therapy (CBT), in which no training specifically focused on the alliance is provided. We implemented polynomial regression and response surface analysis, and the truth and bias model on data of 162 dyads reporting weekly on their levels of ruptures, for 30 sessions, during either CBT or BRT. Therapists and patients exhibited substantial temporal congruence in their session-by-session rupture ratings. Therapists showed a tendency to detect more ruptures than did their patients. This tendency correlated with higher levels of congruence and was more evident in BRT than in CBT. Agreement and disagreement between patients and therapists on the question of whether a rupture had occurred was found to have a greater effect on subsequent session outcomes in BRT than in CBT. These findings may suggest that therapists who are more attuned to their patients may demonstrate greater vigilance in identifying ruptures than their patients do. This vigilant stance may be taught. Greater congruence may result in better subsequent session outcome throughout treatment in BRT than in CBT. (PsycInfo Database Record (c) 2020 APA, all rights reserved).