Week 3: Client, Therapist and Relationship Factors

Question 1

client factors: 2 types

Answer 1

exit within the client, outside of therapy and are stable and enduring
1) inferred (implicit qualities)
- attitudes towards therapy
- psychosocial functioning
2) objective (externally observable and verifiable)
- sociodemographic factors

Question 2

inferred characteristics (implicit)

Answer 2

• attitudes towards therapy
• psychosocial functioning

Question 3

attitudes towards therapy

Answer 3

• motivation
• outcome expectation
• process expectation
• predilection
• preference

Question 4

outcome expectations

Answer 4

remoralization

Question 5

remoralization

Answer 5

development of hope of a client due to the expected benefits of doing therapy

Question 6

psychosocial functioning

Answer 6

personality disorders
attachment styles
psychological mindedness = person’s ability to understand people and their problems in psychological terms

Question 7

sociodemographic factors

Answer 7

age, ethnicity, SES, sexual orientation, gender, etc.
in general, most demographic factors don’t influence outcomes, BUT: SES does!!
- low income clients are more likely to drop out
- unemployed clients have poorer outcomes
- minorities have poorer outcomes

Question 8

relationship factors

Answer 8

therapeutic alliance
therapist interpersonal skills
therapists clinical skills

Question 9

therapist factors

Answer 9

differences in effectiveness
personal characteristics
sociodemographic factors
professional characteristics

Question 10

transdiagnostic factors

Answer 10

present in people with different psychological problems
- sleep, empowerment

Question 11

personality disorders

Answer 11

clients with COMORBID personality disorders have poorer outcomes
- more disorders –> worse outcomes
- borderline, schizotypal and dependent have particularly poor outcomes

Question 12

therapist effects: impact

Answer 12

explains 5-15% of variance in outcomes
largest effects in naturalistic settings, smallest in RCT

Question 13

what influences therapist effects?

Answer 13

therapists psychological functioning
extreme cases of beliefs/values
age
interpersonal skills
critical and reflective thinking
severity of the client

Question 14

what doesn’t influence therapist effects?

Answer 14

personality
matching on gender, sexual orientation, ethnicity or beliefs/values (EXCEPT when male homosexual client and male heterosexual therapist)
life experience
years of professional experience
level of professional training

Question 15

supervision of therapist has mixed results on outcomes

Answer 15

effects on:
- trainees self-awareness and self-efficacy
- increased confidence, congruence, focus, freedom and safety
50% of trainees has at least 1 ineffective supervisory relationship

Question 16

relational factors

Answer 16

feelings and attitudes that client and therapists have towards each other and the manner in which they are expressed

Question 17

therapeutic alliance

Answer 17

working relationship between client and therapist
- moderate but robust effect on outcome

Question 18

3 components of therapeutic alliance

Answer 18

1) bond = affective part of the relationship
2) agreement on tasks (who does what?)
3) agreement on goals (what are we aiming for?)
last 2 are predictive of outcomes

Question 19

goal consensus

Answer 19

therapist-client agreement on therapy goals and expectations

Question 20

3 therapist interpersonal skills

Answer 20

1) empathy
2) positive regard
3) congruence

Question 21

empathy

Answer 21

having an accurate, felt understanding of clients experience

Question 22

positive regard

Answer 22

warm, unconditional acceptance of the client

Question 23

congruence

Answer 23

being freely and deeply oneself in relationship (no façade)

Question 24

effects on outcome of empathy

Answer 24

• medium to large effect
• stronger predictor in CBT than experiental therapy
• stronger predictor in inexperienced therapists than experienced therapists

Question 25

effects on outcome of positive regard

Answer 25

- valued as something important by clients - mixed effects on outcome

Question 26

effects on outcome of congruence

Answer 26

no relationship with outcome

Question 27

self-disclosure

Answer 27

sharing personal information with the client - much debate about this topic - psychodynamic therapy: therapist must be a blank slate - research suggests that it might be helpful: better outcomes and clients find it helpful

Question 28

Stages of Change model

Answer 28

all sorts of behavioral changes follow 6 stages of change 1: precontemplation (no motivation/intention to change in the near future) 2: contemplation (an intention to change at some point) 3: preparation (intention to change soon) 4: action (behavioral change) 5: maintenance (focus on preventing relapse) 6: termination (total self-control)

Question 29

countertransference

Answer 29

therapists' reactions to clients that are based on therapists' unresolved/past conflicts

Question 30

alliance ruptures

Answer 30

tension/breakdown in collaborative relationship between client and therapist - confrontation - withdrawal

Question 31

transference interpretations

Answer 31

interpretations that try to help the client understand the link between their interactions with the therapist and the interactions they experience with others

Question 32

Lambert's pie

Answer 32

40% of success is due to client variables and extra-therapeutic events