Orienting patient to affect, sense of self, and the activation of affect over the course of psychotherapy with cluster C patients.

Ulvenes, Pål; Berggraf, Lene; Wampold, Bruce E.; Hoffart, Asle; Stiles, Tore C.; McCullough, Leigh

doi:10.1037/cou0000028

Cited by 30 publications

(40 citation statements)

References 39 publications

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“…The findings with regard to interpretation and encouragement of emotional expression can inform clinical practice and are consistent with psychodynamic mechanisms of change models (Blagys & Hilsenroth, ; Book, ; Fosha, ; Luborsky, ; Luborsky & Crits‐Christoph, ; Luborsky et al, ; Malan, ; McCullough et al, ; Strupp & Binder, ; Wachtel, ), whereby increasing the patient's awareness of internal processes and encouraging expression of affect, lead to general improvement in well‐being. They are also consistent with previous studies showing that techniques aimed at patients achieving better understanding of themselves (Gibbons et al, , ; Levy et al, ), and encouragement of emotional expression in the session (Diener & Hilsenroth, ; Diener et al, ; Fisher et al, ; Lilliengren et al, ; Ulvenes et al, ; Ulvenes et al, ), are related to improvement within a psychodynamic model of treatment. As most patients in this sample exhibited Axis II co‐morbidity (52% personality disorder diagnosis and 24% subclinical features), this increases the generalizability of these findings to naturalistic settings, whereas many studies on the treatment of depression tend to exclude patients with Axis II co‐morbidity.…”

Section: Discussionsupporting

confidence: 90%

“…Other work suggests that the contribution of therapists encouraging emotional expression and/or exploration in the session may also vary depending on patient characteristics and treatment modality. Ulvenes et al () examined how therapist's affect orientation in therapy interacted with patients' sense of self to contribute to patients' experience of affect in the session and found that both components were related to experiencing of affect in the session. These findings build off of earlier work by Ulvenes et al () who examined therapist actions, therapeutic bond, and outcome in both dynamic and cognitive therapy and had mixed findings with regard to a focus on affect during the session.…”

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confidence: 99%

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Psychodynamic technique early in treatment related to outcome for depressed patients

Katz

Hilsenroth

2017

Clin Psychology and Psychoth

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We examined the relationship between psychodynamic techniques early in treatment with reliable change in depressive symptomatology. Forty-six patients admitted for individual psychodynamic psychotherapy who received a diagnosis representative of a depressive spectrum disorder were assessed pretreatment and posttreatment through self-report of depressive symptoms. Videotapes from two early treatment sessions (3rd and 9th) were independently rated on the Comparative Psychotherapy Process Scale for use of psychodynamic-interpersonal and cognitive-behavioural techniques, with excellent interrater reliability (intraclass correlation coefficient > .75). We found a significant relationship between overall use of psychodynamic technique across early treatment (r = .31, p = .036), as well as specific psychodynamic techniques delivered across early treatment, with change in patient-reported depressive symptoms. Our findings suggest that focusing on affective experiencing and expression, as well as providing interpretations are particularly helpful early in psychodynamic treatment for depression. Clinical implications and future directions are discussed.

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Section: Discussionsupporting

confidence: 90%

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confidence: 99%

Psychodynamic technique early in treatment related to outcome for depressed patients

Katz

Hilsenroth

2017

Clin Psychology and Psychoth

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“…CULTURAL HUMILITY IN PSYCHODYNAMIC PSYCHOTHERAPY findings are in line with Ulvenes et al (2014) conjecture that the most important therapeutic processes are at the within-client level.…”

Section: Therapist-state Cultural Humility Across Sessionssupporting

confidence: 84%

Cultural humility, working alliance, and Outcome Rating Scale in psychodynamic psychotherapy: Between-therapist, within-therapist, and within-client effects.

Morales¹,

Kivlighan²,

Hill³

et al. 2022

Journal of Counseling Psychology

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We examined how client working alliance (CWA) and therapist working alliance (TWA), and client-rated functioning (Outcome Rating Scale, ORS) related to client-perceived Cultural Humility (CH) of their therapist across the course of open-ended psychodynamic psychotherapy for 118 clients and 17 therapists. Clients and therapists completed measures of the WA after every session and clients completed the ORS prior to every session. Clients also judged their therapists' CH at Session 3, 8, and then every 8th session. CH data was partitioned into within-client, within-therapist, and between-therapists components and used to predict CWA, TWA, and ORS in a 4-level Hierarchical Linear Modeling (HLM) growth model. Betweentherapist differences in CH were not related to next session CWA, TWA, or ORS, nor were these differences related to growth in CWA, TWA, and ORS. Within-therapist differences in CH were only related to the next session's CWA. At the within-client level, time-periods with higher CH, compared to clients' average CH, were associated with stronger next session (i.e., the immediate subsequent session) CWA and TWA, and time periods with lower CH, compared to clients' average CH, were associated with linear increase in CWA and TWA. Time-periods with high CH, compared to clients' average CH, were associated with significant increase in client functioning. Results suggest that lower CH weakens CWA and TWA in the next session but both CWA and TWA strengthen subsequently. By contrast, greater CH has no immediate effect on outcome but with greater CH psychological functioning increased over time. Implications for practice and research are discussed. Public Significance StatementWhen clients see their therapist as more humble toward their cultural identity than their therapist usually is, next session alliances are strong but this effect is attenuated over time. When clients see their therapist as less humble toward their cultural identity than their therapist usually is, the immediate subsequent session alliance is weak but strengthens over the next several sessions. Therefore it is important for therapists to find ways to demonstrate cultural humility week-to-week.

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“…A limited number of studies have examined the different effects of counselor interventions on client outcomes at different levels of analyses. For example, Ulvenes et al (2014) found that session-to-session variations in therapists’ focus on affect (a between-session or within-client effect), rather than variations in focusing on affect among a therapist’s clients (a between-client or within-counselor effect), was related to clients expressing more affect. Shafran, Kivlighan, Gelso, Bhatia, and Hill (2016) found that at the between-session level, when therapists used more immediacy in a session, clients gave higher session quality ratings for that session.…”

Section: Associations At Different Levels: a Missing Piece In The Litmentioning

confidence: 99%

Helping Skills, Working Alliance, and Session Depth in China: A Multilevel Analysis

Kivlighan

Hill

et al. 2018

The Counseling Psychologist

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Ninety-five first-year master's-level students in China conducted three helping sessions with two volunteer clients. After every session, clients completed measures assessing trainees' use of helping skills, working alliance, and session depth. Results of a multilevel analysis indicated that: (a) betweentrainee and between-client exploration skill use was related to better working alliance reported by the client, and between-session exploration skill use was related to greater session depth; (b) between-trainee, betweenclient, and between-session insight skill use was related to better working alliance, but none of these components were related to session depth; and (c) between-trainee action skill use was negatively related to client report of working alliance. We discuss theoretical and practical implications from the multilevel framework, considering the Chinese cultural context. Keywords counseling training, working alliance, session depth, Chinese cultural context Helping skills refer to a set of skills, techniques, and interventions that helpers use to assist helpees in exploring thoughts and feelings, gaining insights, and making changes in their lives (Hill, 2014).

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Orienting patient to affect, sense of self, and the activation of affect over the course of psychotherapy with cluster C patients.

Cited by 30 publications

References 39 publications

Psychodynamic technique early in treatment related to outcome for depressed patients

Psychodynamic technique early in treatment related to outcome for depressed patients

Cultural humility, working alliance, and Outcome Rating Scale in psychodynamic psychotherapy: Between-therapist, within-therapist, and within-client effects.

Helping Skills, Working Alliance, and Session Depth in China: A Multilevel Analysis

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