Psychotherapy Theory, Research, Practice, Training

The diversity status of the psychotherapist: Editorial introduction.
During the past decade or so, the multicultural or diversity movement in the United States has begun to deeply affect psychotherapy. Too often, authors admonished readers to pay more attention to, for example, racial and ethnic factors when working with racial/ethnic minority patients without sharing what actually happened in the treatment with actual cases. We also seem to equate multicultural psychotherapy with the patient’s minority or diversity status, seeming to forget that the therapist’s diversity status is also a key element of the treatment process. The psychotherapist/scholars that make up the authors in this special section address four topics. They were asked to provide (1) a description of their diversity status, (2) key clinical issues raised for them as psychotherapists, given their diversity status, (3) key clinical issues raised for their patients given their diversity status, and (4) effective treatment strategies for addressing their diversity status and its impact on the treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
When hearing clients work with a deaf therapist.
Not being able to hear can present significant challenges for the therapist and for the deaf therapist/hearing client dyad. It can also create opportunities. Although the literature indicates that most culturally Deaf therapists work with Deaf clients due to their mutual use of American Sign Language, I describe (a) the background of an audiologically deaf therapist who relies on speech reading rather than sign language, and (b) this therapist's clinical work with hearing clients. Some of the relational dynamics of these treatments are identified, and I conclude by noting how attention to communication can benefit the work of all psychotherapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Perspectives of an Iranian psychologist practicing in America.
My experience as a male psychologist who was born and raised in Iran has had a tremendous impact on my professional practice in the United States. After providing a brief history of Iran to put this article in context, I explore 5 elements of that impact: Description of my diversity status, key practice issues raised for me as an Iranian therapist, my background and its impact on case formulation, key clinical issues raised for my clients given my diversity status, and effective strategies for addressing my diversity status and its impact on the treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
On being a Latina healer: Voice, consciousness, and identity.
A Latina psychotherapist relates her journey of becoming a healer. I discuss how my diversity status impacts on my life and on my approach to psychotherapy. My story offers clinical suggestions for therapists working with multicultural clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Correction to Psychotherapist Mindfulness and the Psychotherapy Process, Bruce et al (2010).
Reports an error in Psychotherapist mindfulness and the psychotherapy process by Noah G. Bruce, Rachel Manber, Shauna L. Shapiro and Michael J. Constantino (Psychotherapy: Theory, Research, Practice, Training, 2010[Mar], Vol 47[1], 83-97). The order of authorship and the affiliations of the authors was incorrectly printed. The correct order and affiliations are as follows: Noah Bruce, Shauna L. Shapiro, Michael J. Constantino, and Rachel Manber; Kaiser Permanente, Santa Clara University, University of Massachusetts, Stanford University. (The following abstract of the original article appeared in record 2010-05168-010.) A psychotherapist’s ability to relate to his or her patients is essential for decreasing patient suffering and promoting patient growth. However, the psychotherapy field has identified few effective means for training psychotherapists in this ability. In this conceptual article, we propose that mindfulness practice may be a means for training psychotherapists to better relate to their patients. We posit that mindfulness is a means of self-attunement that increases one’s ability to attune to others (in this case, patients) and that this interpersonal attunement ultimately helps patients achieve greater self-attunement that, in turn, fosters decreased symptom severity, greater well-being, and better interpersonal relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Cultural influences on the process of conducting psychotherapy: Personal reflections of an ethnic minority psychologist.
I was asked to reflect how being a member of an ethnically diverse minority group, that is, Japanese American, may have influenced my clinical practice as a psychologist and psychotherapist. I first define the various facets of my “diversity status,” followed by an offering of reflections on how being a member of this group impacted both myself as a therapist and my clients. I conclude with several general recommendations geared to enhance a positive therapeutic alliance and client outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Reflections of a gay male psychotherapist.
Issues of diversity and multiculturalism are typically framed and conceptualized in terms of client characteristics. This is reflected in the literature on competent and ethical treatment of lesbian, gay, bisexual, and transgender (LGBT) individuals. However, when it comes to personal characteristics of the therapists involved, little has been written, save the obvious proscriptions against personal bias and misinformation in conducting psychotherapy. This article represents the personal reflections and feelings of a European American gay male psychologist with 30 years' experience working with the LGBT community. Intersections of sexual orientation and gender identity with race/ethnicity, age, health factors, and socioeconomic status are explored as the effects of therapist characteristics on the therapeutic process are considered. Observations about client differences, as well as therapist differences, are made in such a way that the reader might extrapolate to his or her own practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Diversity within African American, female therapists: Variability in clients' expectations and assumptions about the therapist.
Despite the presence of some literature that has addressed the characteristics of the African American female therapist, most psychotherapy training proceeds with the assumption that therapists are members of dominant groups, and most of the psychological and psychotherapy literature has been written by therapists and psychologists who come from dominant cultural perspectives. Not as much has been written about psychological paradigms or the process of psychotherapy from the perspective of the therapist who is not a dominant group member. This article explores both the common and divergent experiences that we, the authors, share as African American female therapists and the different reactions we frequently elicit in clients. We also explore how individual differences in our physical appearances, personal backgrounds, and different characteristics of our respective practices elicit distinct responses from clients that we believe are based on differences between us, despite the fact that we are both African American women. We believe that many of the stereotypes that affect perceptions of African American female clients also exist for African American female therapists. We will address how the intersection of gender, race, and sexual orientation of the client highlights the complexity of culturally competent practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Changes in trainees' intention use and volunteer clients' evaluations of sessions during early skills training.
Volunteer clients (N = 96) evaluated sessions conducted by prepracticum trainees prior to and after the trainees received instruction in interpersonal–psychodynamic therapy. The relationship between changes in therapeutic style, measured by intension use, and changes in volunteer clients' session evaluations were examined with growth curve analyses. After training, trainees increased their focus on client emotions and on the therapeutic relationship and decreased their verbal activity. Increased session smoothness was related to decreases in trainee verbal activity and to increases in trainee flexibility. Increases in volunteer clients' perceptions of trainee expertness, attractiveness, and trustworthiness were related to trainees' increased focus on client emotions and increased focus on the therapeutic relationship and to decreases in confrontation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Representations of the supervisory dialogue and the development of psychotherapists.
The primary aim of this study was to investigate the ways in which therapists-in-training construct and use mental representations of their relationships with their supervisors in the service of their own professional development. A total of 115 trainees (75% of whom were psychodynamically oriented) completed The Supervisory Representation Inventory, a network of measures designed to assess the forms, functions, and phenomenological properties of internalized representations of that relationship. Results indicate that supervisees tend to evoke representations of their supervisors' spoken words, vocal qualities, and the settings in which they have met; that they evoke these representations to better formulate clinical interventions, especially those perceived as painful or difficult for patients to hear; and that these representations are especially likely to occur when patients behave in ways consistent with a supervisor's view or, when the supervisee is alone and thinking about a patient that has been discussed in supervision. Findings support the hypothesis that representations of the verbal and nonverbal aspects of the supervisory dialogue play an integral role in the acquisition of the skills and professional identity of a psychotherapist. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Therapists' attributions for client premature termination: Are they self-serving?
We conducted two studies of therapist responses to client premature termination from psychotherapy. In Study 1, we surveyed therapists' attributions for client premature termination from therapy using an open response format. Results suggested that therapists showed a self-serving pattern in their attributions (i.e., attributed causality to the client or environment) when considering their own clients compared to when they considered the premature terminations of clients in general. Study 2 was a vignette study in which therapists responded to one of two client presentations that varied relationship to client (your client vs. other's client). Using the attributional categories derived from Study 1, therapists rated the likelihood that each attribution caused the client's premature termination. Again, patterns across groups indicated that therapists are self-serving in their attributions for client premature termination. In addition, differences were found across gender and theoretical orientation; larger effects were found for men compared to women, and psychoanalytic therapists compared to cognitive–behavioral. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Applications of the psychotherapy phase model to clinically significant deterioration.
While previous research on deterioration has focused on identifying individuals at risk for negative outcomes, little is known about the nature or pattern by which deterioration occurs. The problem of deterioration is especially salient in training clinics; a setting in which higher deterioration rates have been reported. Two studies were designed to test the applicability of the phase model to deterioration in a training clinic and to replicate the model with a training clinic referral-base sample. In Study 1, the course of therapy was monitored for 135 clients. For the 38 clients who deteriorated during therapy, a model where increased symptoms (demediation) reliably preceded both decreased functioning (dehabilitation) and decreased well-being (demoralization) was found. In Study 2, the same three phases were prospectively monitored for 914 undergraduate students on a weekly basis throughout a single semester. For the 158 individuals who deteriorated during this time, a model where demediation reliably preceded dehabilitation, which preceded demoralization was found. These results have clinical implications for the use of tailored intervention strategies focusing on the deterioration phases. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Shared traumatic reality in communal disasters: Toward a conceptualization.
The phenomenon variously termed “shared reality,” “shared trauma,” or “shared traumatic reality” refers to situations in which helper and helpee, psychotherapist and client, are exposed to the same communal disaster. This article has two aims. One, pursued in the first part of the article, is to trace the development of the concept; analyze the conditions under which it was acknowledged, articulated, and labeled; and review the changes in the term over time. The other, pursued in the second part, is to offer a conceptualization of the phenomenon based on analysis of the literature. Here, the article shows that the phenomenon is characterized by two distinct dynamics, one pertaining to professionals providing help in the emergency phase, the other to professionals conducting ongoing psychotherapy; to offer a preliminary definition of the phenomenon which covers the shared features of the two dynamics; and to present the distinct features of each. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
What do psychotherapists really do in practice? An Internet study of over 2,000 practitioners.
Over 2,200 North American psychotherapists completed a Web-based survey concerning their clinical work, including theoretical orientation, client characteristics, and use of specific psychotherapy techniques. Psychotherapeutic integration was common, with the majority of respondents identifying with more than one theoretical orientation or as having an eclectic orientation. The modal patient was a White female adult suffering from a mood or anxiety disorder and interpersonal problems. Individual psychotherapy was the preferred treatment modality. The most frequently endorsed techniques were relationship-oriented such as conveying warmth, acceptance, understanding, and empathy. The least frequently endorsed techniques were biofeedback, neurofeedback, body and energy therapies, and hypnotherapy. Efforts to disseminate empirically based therapies require understanding and accommodating clinicians' tendencies to integrate techniques. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Review of Brief psychotherapies: Principles and practices.
Reviews the book, Brief psychotherapies: Principles and practices by Michael F. Hoyt (2009). Despite the evident desire of many clients to address their issues in as time-efficient manner as possible (even one session), most therapists are trained to deliver psychotherapy via longer-term models of practice. Although more graduate programs than in the past are beginning to offer training in brief therapy, in many instances this is a one course elective without related practical experience. Hoyt’s book provides a wide-angle overview of the field of brief therapy, as well as an up close look at one of its most prominent models (Solution-Focused Therapy). In doing so, it could serve as a centerpiece for courses in brief psychotherapy. Time sensitive therapy fits in a time sensitive world—a world in which both the clients and funders of services want problems to be addressed in as focused a way as possible. This book teaches therapists a great deal about how to navigate in that world. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Review of Coasting in the countertransference: Conflicts of self interest between analyst and patient.
Reviews the book, Coasting in the countertransference: Conflicts of self interest between analyst and patient by Irwin Hirsch (see record 2008-02945-000). The term countertransference now often incorporates all the conscious as well as unconscious reactions a therapist has toward their patient, and as such has become a primary source of data about the patient’s intrapsychic and interpersonal experience. In his remarkable book Coasting in the Countertransference, Irwin Hirsch returns us to the earlier more problematic notion of countertransference, only Hirsch’s focus is no longer on the internal drives and resistances of the therapist. For Hirsch, the economic and social circumstances under which psychotherapists practice have a dire—and mostly unacknowledged—impact on clinical processes. This is an absolutely necessary book that forces us to reexamine some of the painful social conundrums of the current state of dynamic psychotherapy as well many of the contemporary technical innovations which we are most smugly pleased with. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Psychotherapy Theory, Research, Practice, Training - Vol 47, Iss 2