This study examines the construct validity of the Social Cognition and Object Relations Scale-Global Rating Method (SCORS-G) by exploring the degree of convergence across different narrative sources (i.e., early memories [EM] and psychotherapy narratives [PT]) using a university-based outpatient sample (n = 101).
To facilitate patient growth, therapists must immerse themselves in the patient’s world while also being able to see what is needed for change. This process requires finding a delicate balance between supporting and pushing patients. Therapists in training are additionally tasked with incorporating supervisors’ suggestions with their own views on what is needed to help their patients. Beginning therapists with tendencies to be overly accommodating may struggle to reconcile these competing demands. Thus, the aim of the present work is to explore how trainee friendly submissiveness (FS) interfaces with psychotherapy. Prior to training, clinical graduate trainee (n = 35) FS was assessed using the Inventory of Interpersonal Problems-32. Process and outcome data were then collected from each therapist’s first training case. Specifically, each trainee was assigned an undergraduate student volunteer with whom they had four non-manualized therapy sessions over the academic semester. After the third session, patients and trainees completed questionnaires assessing session impact and the working alliance, and two expert raters coded third session videotapes for techniques. Following termination, patients rated the overall helpfulness of the therapy. Trainee FS was significantly negatively associated with patient-rated depth, alliance, and overall helpfulness with moderate effects. Findings from a mediation analysis further suggested that trainees with higher FS struggled to focus the therapy in a way that felt productive to patients. Implications for clinical training are discussed.
The goal of the present study was to explore how self-disclosure (SD) and immediacy relate to trainee therapists' personal characteristics. A prospective multitrait multimethod assessment approach was utilized to assess a wide range of trainee characteristics at the beginning of graduate school. Results showed a significant, positive relationship between trainee interpersonal problems and SD for trainees (n ϭ 33) in their third psychotherapy session with their first patient. Moreover, greater use of SD correlated with less session depth, as rated by the trainee. Greater use of immediacy was positively related to trainee undergraduate grade point average and trainee-reported post-session arousal. Notably, all statistically significant findings had a moderate magnitude of effect. Finally, qualitative analyses of the SDs and immediacy statements were included to aid the discussion of potential reasons for the results. Overall, our findings provide preliminary conclusions about which trainees utilize SD and immediacy, what types of SDs and immediacy interventions they tend to use, and how trainees and patients perceived the session in which SD and immediacy were implemented. Implications for supervision and training are discussed. Clinical Impact StatementQuestion: This study explores the association between trainee therapist personality and the use of self-disclosure (SD) and immediacy. Findings: The strongest finding suggests that more problematic trainee interpersonal characteristics are associated with greater use of SDs, and many of the SDs were indicative of the trainee sharing his or her anxiety. Meaning: These results highlight the need for supervisors and trainees to be mindful of using SD in this way, and supervisors may want to caution trainees about keeping the focus on the patient or therapeutic relationship (i.e., use immediacy) if feeling anxious. Next Steps: Future work may explore how SD and immediacy relate to the interaction of patient and trainee characteristics over the course of psychotherapy.
The goal of the present study was to explore the relationship between patients' object relational functioning (Social Cognition and Object Relations Scale‐Global Ratings) as rated by clinicians during the course of outpatient psychodynamic psychotherapy in a university‐based clinic and patient self‐reported interpersonal vulnerabilities (Inventory of Interpersonal Problems‐64). Participants (n = 112) were outpatients entering treatment at a university‐based psychotherapy clinic and were diagnosed primarily with mood disorders as well as Axis II relational problems and features. Participants completed the IIP‐64 prior to receiving therapy, and SCORS‐G ratings were based on patients' level of relational functioning during the evaluation process (i.e., the semistructured interview, follow‐up and feedback) and across the first two psychotherapy sessions. Results showed a significant relationship between the IIP‐64 Total score with SCORS‐GSelf‐Esteem (r = −.21, p < .05) and Affective Quality of Representations (r = −.20, p < .05), wherein self‐reported interpersonal dysfunction was greater among patients who had lower self‐worth and perceived others as more malevolent. These findings suggest that patients who rated themselves as having more significant interpersonal difficulty reported more negative expectations and experiences of relationships in their psychotherapy narratives. The utility of the SCORS‐G and the IIP‐64 as two different avenues of assessing patient relational functioning is explored.
This study examines the construct validity of the Social Cognition and Object Relations Scale-Global Rating Method (SCORS-G; Westen, 1995; see also Stein & Mulford, 2018) by exploring the degree of convergence across different narrative sources (i.e., early memories [EM] and psychotherapy narratives [PT]) in relation to patient-and therapist-rated psychotherapy process measures. Using a universitybased outpatient sample (n = 81), we found limited convergence for SCORS-G ratings across narrative type. First, paired t tests showed that the means for six of the eight SCORS-G dimensions differed significantly between the EM and PT narratives with the majority having a large magnitude of effect. Moreover, despite 29 significant correlations between a SCORS-G dimension and either an alliance or session quality variable, only two of the eight SCORS-G dimensions significantly correlated with the same process variable across narrative type (e.g., patient-rated session depth with SCORS-G Self Esteem [SE] and Identity and Coherence of Self [ICS]). Importantly, the high degree of theoretical coherence in the associations that emerged between the SCORS-G dimensions and the process variables suggest that the lack of convergence was not due to limited validity of the SCORS-G. Instead, the results underscore the importance of multi-method assessment techniques by highlighting that the manner in which a narrative is elicited will impact the object relational content patients provide. Future research and clinical implications related to the SCORS-G, alliance and psychotherapy process are discussed.
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