A Qualitative Meta-analytic Review of the Therapist Responsiveness Literature: Guidelines for Practice and Training

Wu, Max B.; Levitt, Heidi M.

doi:10.1007/s10879-020-09450-y

Cited by 34 publications

(27 citation statements)

References 82 publications

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“…One principle involved discussion of goals for therapy to assess and adjust the goals themselves, frequency of sessions, and treatment termination. We suggest that our findings might contribute to a further refinement of responsiveness to client goals, which might have implications for and be in line with a process‐oriented training of therapists as suggested by Wu and Levitt (2020).…”

Section: Discussionsupporting

confidence: 81%

“…One way of looking at our analysis is that it describes responsiveness to client future orientation. In their qualitative meta‐analytic review of the literature on therapist responsiveness, Wu and Levitt (2020) identified a number of clinical principles for responsiveness. One principle involved discussion of goals for therapy to assess and adjust the goals themselves, frequency of sessions, and treatment termination.…”

Section: Discussionmentioning

confidence: 99%

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Future orientation in successful therapies: Expanding the concept of goal in the working alliance

et al. 2021

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Objective: To better understand how therapists facilitate client goal attainment in therapy, we analyzed therapists' future-oriented actions in good outcome cases in which clients recorded high ratings on goal items in the Working Alliance Inventory-Short Revised. Method: We selected clients who were within the clinical range (OQ-45.2) at pretreatment, demonstrated reliable change at the end of treatment, and recorded high WAI client goals scores early in treatment. Qualitative analyses of transcripts of the initial three sessions and client posttreatment interviews were integrated into a combined analysis to identify themes across the two separate sets of findings. Results: Therapist future-oriented activity included: (1) Picking up explicit and implicit intentions; (2) using linguistic devices, such as meta-communication, action language, and hedging; (3) using evocative interventions; and (4) nudging the client into practicing change. Core finding: Therapists aligned with clients' directionality in a forwarddriven, gradually evolving process. Conclusion: Conceptual and clinical implications are discussed.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Future orientation in successful therapies: Expanding the concept of goal in the working alliance

et al. 2021

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“…Research from the field of adolescent psychotherapy supports the significant contribution of common factors, like the alliance (Shirk et al, 2011;Fernandez et al, 2016;van Benthem et al, 2020), with some research indicating an interaction between an adolescent's attachment history and alliance, with the working alliance having a stronger relationship to outcomes in adolescent clients with poorer attachment histories (Zack et al, 2015). Empirical support for therapist flexibility and its impact on later client engagement and improvement in therapy has also been reported (Chu and Kendall, 2009), in line with the above-mentioned focus on therapist responsiveness (Hatcher, 2015;Wu and Levitt, 2020). Qualitative studies exploring the adolescent client's perspective on psychotherapy similarly point to the significance of the therapist-as-person (including transparency, benevolence, and authenticity), the therapist's management of key issues, like confidentiality, power imbalance, and client agency, and the client's feeling of being understood, as decisive for the perceived accessibility and usefulness of therapy (Binder et al, 2011;Sagen et al, 2013;Gibson et al, 2016;Lavik et al, 2018;Løvgren et al, 2019;Radez et al, 2021;Stige et al, 2021).…”

Section: Introductionmentioning

confidence: 81%

“…The significance of the initial meeting between therapist and client for the outcome of psychotherapy is reflected in the way early measurements of alliance predicts the outcome of psychotherapy across age groups ( Wampold, 2014 ). To succeed, both in establishing and maintaining alliance and collaboration, the therapist must be flexible and sensitive, accurately assessing what is going on in therapy, accessing the client’s perspective, and adjusting the content and timing of interventions to the individual client (i.e., therapist responsiveness; Stiles et al, 1998 ; Hatcher, 2015 ; Wu and Levitt, 2020 ). Psychotherapy, thus, consists of unique meetings between two persons, where both parties bring with them experiences and expectations that influence the evolving interaction ( Råbu and Moltu, 2020 ), but where the therapist bears particular responsibility – and especially so, in adolescent psychotherapy ( Bolton Oetzel and Scherer, 2003 ).…”

Section: Introductionmentioning

confidence: 99%

Negotiating System Requirements to Secure Client Engagement – Therapist Strategies in Adolescent Psychotherapy Initiated by Others

et al. 2021

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Background: Many adolescent clients come to treatment reluctantly, at the initiative of others. Adolescents also quit therapy prematurely more often than adult clients do. This points to the value of finding good ways to engage adolescent clients in treatment and understanding more of what therapists do to achieve this task.Methods: We used focus group methodology to explore therapist strategies and behaviors to engage adolescent clients who come to therapy at the initiative of others. Ten focus group interviews with a total of 51 therapists were conducted with existing treatment teams from seven different clinics in community mental health care for children and youth. Reflexive thematic analysis was used as a framework to guide the analytical process.Findings: Navigating a position allowing the therapist and adolescent to meet and work toward a shared understanding of the situation and what could help was considered the main gateway to client engagement. To do this, therapists had to manage the pull between system requirements and their obligation to the individual adolescent client, represented by the theme Managing system requirements. The process of working with the adolescent to ensure engagement is represented by the four themes: Counteracting initial obstacles for client engagement – “You are not trapped here”; Sharing definitional power – “What does it look like to you?”; Practicing transparency – “I want you to know what I see”; and Tailoring as ideal – “I will design this therapy for you.”Implication and conclusion: Therapists want to understand their adolescent clients’ position better, and subsequently adjust the treatment goals and techniques to establish sufficient common ground to allow both the therapist and adolescent to find the therapeutic project worthwhile. However, system requirements and service organization were found to obstruct and influence these processes in several ways, pointing to the significance of exploring the interplay between system organization and therapeutic practice more thoroughly. There was also a variation between therapist behaviors described by different therapists within the same treatment teams, as well as systematic differences between treatment teams, pointing to the importance of future research differentiating wanted from unwanted variation in treatment.

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“…The majority of these reviews focuses on either qualitative or quantitative studies, with the consequence that it is not possible to compare evidence generated by different methodological approaches. Reviews by Pomerville et al (2016 ), Greenhalgh et al (2018 ) and Wu and Levitt (2020 ) demonstrate how it is possible to incorporate findings of qualitative and quantitative studies in a single review. The Pomerville et al (2016 ) review takes a further pluralistic step in reporting review findings in terms of contrasting interpretative themes rather than a unified model.…”

Section: Pluralistically Oriented Therapy Research: Illustrative Case Examplesmentioning

confidence: 99%

A Pluralistic Perspective on Research in Psychotherapy: Harnessing Passion, Difference and Dialogue to Promote Justice and Relevance

et al. 2021

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The adoption of a pluralistic perspective on research design, processes of data collection and analysis and dissemination of findings, has the potential to enable psychotherapy research to make a more effective contribution to building a just society. A review of the key features of the concept of pluralism is followed by a historical analysis of the ways in which research in counselling, psychotherapy and related disciplines has moved in the direction of a pluralistic position around knowledge creation. Core principles of a pluralistic approach to research are identified and explored in the context of a critical case study of contemporary research into psychotherapy for depression, examples of pluralistically oriented research practices, and analysis of a pluralistic conceptualisation of the nature of evidence. Implications of a pluralistic perspective for research training and practice are discussed. Pluralistic inquiry that emphasises dialogue, collaboration, epistemic justice and the co-existence of multiple truths, creates opportunities for individuals, families and communities from a wide range of backgrounds to co-produce knowledge in ways that support their capacities for active citizenship and involvement in open democratic decision-making. To fulfil these possibilities, it is necessary for psychotherapy research to be oriented towards social goals that are sufficiently relevant to both researchers and co-participants to harness their passion and work together for a common good.

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A Qualitative Meta-analytic Review of the Therapist Responsiveness Literature: Guidelines for Practice and Training

Cited by 34 publications

References 82 publications

Future orientation in successful therapies: Expanding the concept of goal in the working alliance

Future orientation in successful therapies: Expanding the concept of goal in the working alliance

Negotiating System Requirements to Secure Client Engagement – Therapist Strategies in Adolescent Psychotherapy Initiated by Others

A Pluralistic Perspective on Research in Psychotherapy: Harnessing Passion, Difference and Dialogue to Promote Justice and Relevance

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