Stephanie Winkeljohn Black

Therapeutic alliance, empathy, and genuineness in individual adult psychotherapy: A meta-analytic review

Abstract Objective: Alliance, empathy, and genuineness are each integral parts of the therapeutic relationship. No previous meta-analysis has explored the extent to which therapist empathy and genuineness contribute to the therapeutic alliance. Method: In this meta-analysis, a multifaceted search strategy yielded 53 studies. Forty studies reported alliance/empathy relationships, eight studies reported alliance/genuineness relationships, and five studies reported both. Results: Random effects meta-analyses revealed that therapeutic alliance was significantly related to perceptions of therapist empathy with a mean r = 0.50 (95% CI = 0.42, 0.57). Therapeutic alliance was also significantly related to perceptions of therapist genuineness with a mean r = 0.59 (95% CI = 0.45, 0.71). Tests of publication bias indicated a low likelihood of publication bias affecting the strength and direction of the results. Potential moderating variables were explored, including rater perspective, measure of therapeutic relationship variables, and client race/ethnicity. Conclusions: Therapeutic alliance has a moderate relationship with perceptions of therapist empathy and genuineness. Of note, there may be reason to believe that when rated by the same person, these constructs have significant overlap and lack discreteness. Future directions for study of the therapeutic relationship are discussed. Implications for practice are provided.

Testing Three Different Sequential Mediational Interpretations of Beck's Cognitive Model of the Development of Depression

OBJECTIVES This study tested and compared three sequential interpretations of Becks cognitive model of the development of depression (1996). The causal mediational interpretation identifies dysfunctional attitudes as most distal to depressive symptoms, followed by cognitive distortions, the cognitive triad, and negative automatic thoughts, with each construct successively more proximal to depressive symptoms. By contrast, the symptom model reverses the causal chain with negative automatic thoughts as the most proximal consequence and dysfunctional attitudes as the most distal consequence of depression. The bidirectional model merges both interpretations into one model. Previous studies on sequential interpretations of Becks model have not included cognitive distortions or the cognitive triad and did not test the bidirectional model finding contradictory empirical evidence for the sequential order. METHOD In the 3-wave longitudinal study, 308 German university students without clinically significant depressive symptoms (245 female, average age: 23.69 years) completed self-report questionnaires measuring their dysfunctional attitudes, cognitive distortions, cognitive triad, negative automatic thoughts, and depressive symptoms. RESULTS The bidirectional model with partial mediation fit the data best and cognitive distortions mediated the relationship between dysfunctional attitudes and negative automatic thoughts and vice versa. CONCLUSIONS The findings have important consequences for the prevention of depression. Prevention programs may want to focus on cognitive distortions, the only construct in Becks model that influences every other construct in the model.

Feedback informed treatment: An empirically supported case study of psychodynamic treatment

The use of client feedback, via self-report measures of psychological functioning and working alliance, is an effective way to improve therapy outcomes. Despite this progress, there are many questions about the mechanisms of change for these systems. The current study employed a case study approach to examine the effectiveness of feedback informed treatment within a psychodynamic therapy. We examined the case based on therapy outcomes, alliance processes, and verbatim dialogue of in-session exchanges. We also conducted a semistructured interview with the therapist to understand how she used and interpreted the feedback within her psychodynamic approach. The results demonstrated positive therapy outcomes and that feedback assisted with alliance formation, specifically decision making about therapeutic tasks and managing negative countertransference. The therapist reported that the feedback enhanced her ability to work in the here and now and to identify relational patterns. Implications for theory and practice are discussed.

Understanding Student Drinking Patterns: Does Shame Proneness Matter?

This study (N = 202; mean age = 19.52 years, SD = 1.36 years; 66.5% female) analyzed three structural equation models to determine whether ruminative brooding and negative affect, moderated by shame proneness, explained college student drinking behaviors more than a model without shame proneness. Results indicated a model including shame proneness fit the data best; however, the moderated variables were not significantly associated with other variables in the retained model. Results are discussed alongside clinical recommendations within a university counseling center framework.