Psychology Theses and Dissertations
Permanent URI for this collectionhttp://hdl.handle.net/1903/2801
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Item Meaning-Making in Psychotherapy after Traumatic Loss: Therapists’ Perspectives(2021) Rim, Katie Lee; Hill, Clara E.; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)We interviewed 11 experienced therapists specializing in loss/trauma about their work with one client with whom they successfully facilitated meaning-making after a traumatic loss. Interviews, analyzed using Consensual Qualitative Research (CQR), revealed that the traumatic loss had negatively impacted clients’ relationships, mental health, and beliefs/religion/spirituality; therapists utilized a range of interventions to facilitate meaning-making, including interventions to help clients experience/regulate emotion and interventions to gain insight; clients made meaning in diverse ways that could be broadly categorized under meaning-as-comprehensibility and meaning-as-significance; and clients experienced positive adjustment (in mental health, relationships, etc.) through the meaning-making work. Implications for research and practice are discussed.Item WHEN THERAPY RELATIONSHIPS MAKE A DIFFERENCE: CORRECTIVE RELATIONAL EXPERIENCES OF ADULT CLIENTS IN OPEN-ENDED INDIVIDUAL PSYCHOTHERAPY(2015) Huang, Teresa Chen-Chieh; Hill, Clara E; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The present study examined the antecedents, types, and consequences of Corrective Relational Experiences (CREs), as well as whether these aspects of CREs (antecedents, types, and consequences) differ depending on client attachment anxiety and avoidance. Clients completed a measure of adult attachment (Experiences in Close Relationships scale; ECR; Brennan, Clark, & Shaver, 1998) before starting open-ended, individual psychotherapy at a psychodynamic-interpersonal therapy clinic. After completion of therapy, 31 clients completed post-therapy interviews assessing their therapy experience, including the occurrence and nature of CREs. Interviews were analyzed qualitatively using CQR (Hill, Thompson, & Williams, 1997; Hill et al., 2005; Hill, 2012). Results indicated that CRE antecedents typically included both positive client-therapist relationships as well as difficulties in therapeutic relationships. Therapists typically facilitated CREs by identifying or questioning client behavior patterns, as well as conveying profound trustworthiness (deep care, understanding, nonjudgmentalness, or credibility). Types of corrective shifts typically involved clients gaining a new understanding of behavior patterns or the therapist/therapy. Consequences of CREs generally included improvements in the therapy relationship, and improvements in the clients' intrapersonal well-being. Clients who did not have CREs variantly wished their therapist's theoretical orientation was a better match, while none of the clients who had CREs did so. Non-CRE clients had lower pre-therapy attachment anxiety and avoidance in comparison to clients who reported CREs. Antecedents, types, and consequences of CREs differed depending on client attachment anxiety and avoidance. Clients with high attachment anxiety seemed to have a greater interpersonal focus (e.g., indicated enacting their maladaptive behavior patterns with therapists prior to the CRE, had CREs focused on understanding clients' behavior patterns) while clients high in attachment avoidance seemed to have a greater intrapersonal focus (reported more client facilitators of CREs, especially deep disclosure prior to CREs, and more reduction in unwanted feelings after CREs). Implications for practice and research are discussed.Item Therapist reactions to a client facing terminal illness: a test of ego and countertransference(2013) Hummel, Ann Martha; Gelso, Charles J; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)When a therapy client presents with thoughts, emotions, or behaviors that trigger a therapist's own unresolved conflicts, the therapist may experience countertransference. Client concerns that may trigger countertransference include sexuality, aggression, and death (Gelso, Fassinger, Gomez, & Latts, 1995; Latts & Gelso, 1995; Hayes & Gelso, 1993; Lacocoque & Loeb, 1988). Countertransference has been found to relate negatively with client outcome (Hayes, Gelso, & Hummel, 2011), but countertransference management can mitigate the negative effects of countertransference, and can even result in curative therapeutic responses (Gelso & Hayes, 2007). A phenomenon known as ego depletion may cause a therapist to be more vulnerable to countertransference. Ego depletion occurs when self-resources related to impulse control, decision-making, and willpower are low (Baumeister, Vohs, & Tice, 2007). Because of the relation between ego depletion and impulse control, the effect of ego depletion on countertransference was tested. Forty-five participants were randomly assigned to either a neutral or ego depletion condition, and were then presented with a scripted analogue client who discussed a potential terminal illness diagnosis. Participants responded verbally to the client, and their responses were transcribed and coded for behavioral indicators of countertransference. Participants also completed measures of affective and cognitive countertransference. Countertransference management and ego defense maturity were assessed as potential predictors of resilience to ego depletion. The participants in the ego depletion reported higher levels of content-specific affective countertransference (death anxiety), but general affective (state anxiety), behavioral, and cognitive countertransference did not differ between conditions. Countertransference management and ego defense maturity did not significantly account for variance in the relation between ego depletion and countertransference. However, the relation found between ego defense maturity and countertransference management suggests that ego defense maturity could be a precursor to countertransference management. Overall, ego depletion led to increased death anxiety, but therapists were resilient to having this content-specific reaction generalize to other forms of countertransference.Item PSYCHOTHERAPY ENGAGERS VERSUS NON-ENGAGERS: ATTACHMENT STYLE, OUTCOME EXPECTATIONS, NEED FOR THERAPY, SESSION DURATION, AND THERAPIST HELPING SKILLS IN INTAKE SESSIONS(2011) Huang, Teresa Chen-Chieh; Hill, Clara E; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The present study investigated client attachment style, outcome expectations, need for therapy, intake duration and therapist helping skills associated with psychotherapy engagement. Intake sessions of 16 adults (8 non-engagers, i.e., post-intake dropouts; 8 engagers, i.e., clients who attended at least 8 sessions) in individual long-term therapy were divided into thirds (beginning, middle, and end of session). Statistical controls for therapist verbal activity level and clients nested within therapists were employed for helping skills analyses. With non-engagers, compared to engagers, therapists used more approval-reassurance in the beginning third of intake sessions, but marginally more reflections of feeling and marginally less information about the helping process in the last third of intakes. Non-engagers had higher pre-therapy anxious attachment and pre-therapy self-rated need for therapy than engagers. In sum, non-engagers versus engagers differed with therapist helping skills, client attachment style, and client need for therapy, but not intake duration or client outcome expectations.Item The Real Relationship, Therapist Self-Disclosure, and Treatment Progress: A Study of Psychotherapy Dyads(2011) Ain, Stacie Claire; Gelso, Charles J; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The present study examined therapists' and clients' perceptions of their real relationships, the amount and relevance of the therapists' self-disclosures, and treatment progress. Sixty-one therapist-client dyads in ongoing psychotherapy completed measures of these variables. Positive correlations were found between the strength of their real relationships and their treatment progress from both perspectives separately, and when perspectives were crossed. From the therapist's perspective, the amount of therapist self-disclosure positively correlated with both the strength of the real relationship and treatment progress. From the client's perspective, the amount of therapist self-disclosure positively correlated with the strength of the real relationship, and the relevance of therapist self-disclosure positively correlated with treatment progress. Overall the results imply that therapists should strive to strengthen their real relationships with their clients, and that appropriate use of therapist self-disclosure is one intervention that may help strengthen this relationship.Item Client Preferences for Insight-Oriented and Action-Oriented Psychotherapy(2006-04-12) Goates-Jones, Melissa Kay; Hill, Clara E; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Client preferences for psychotherapy style have been understudied, despite their value in adding to our understanding of psychotherapy process and outcome. Furthermore, current research trends point towards investigating the match between client and therapist in determining outcome (ATI research). One match that has not been studied as much is the match between client preference for type of therapy and therapist therapy style. Two styles that seem particularly important are insight- and action-oriented therapy, which are often distinct therapy approaches. Clients often come to counseling anticipating either receiving insight or making a plan for action. This research has implications for enhancing client outcome due to its promise to determine better client-therapist matches. The present study employed an experimental laboratory method with two independent variables. The independent variables were client preferences for insight oriented therapy versus action oriented therapy, and counseling style provided (insight oriented therapy vs. action oriented therapy). Dependent variables were changes in target problem, relationship strength (RS), session depth, session evaluation (SES), therapist credibility, and change in preference for insight versus action. Control participants watched a videotape of Carl Rogers performing psychotherapy. Hypothesis 1 was that clients who receive their preferred therapy style will have a more positive outcome than clients who do not receive their preferred therapy style. Result indicated that hypothesis 1 was not supported. Hypothesis 2 was that credibility will be associated with better outcome. Results indicated that hypothesis 2 was partially supported. Hypothesis three was that match between client preferences and treatment received will be a greater predictor of outcome than credibility. Hypothesis 3 was not supported. Hypothesis 4 was that clients who perceive their therapists as credible will shift more towards the style received than clients who do not perceive their therapists as credible. Hypothesis 4 was not supported. Limitations and suggestions for future research are discussed.Item Women Counselors' Countertransference Reactions to Women Clients with Body Image Disturbance(2006-04-25) Doschek, Elizabeth E.; Gelso, Charles J.; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Women may seek counseling for body image concerns because such concerns are common in society. Women counselors may also suffer from body image disturbance, however. Countertransference is a threat to a counselor's ability to help a client and occurs when client presenting style and/or problem taps into unresolved counselor issues. Women counselors' countertransference reactions to women clients with body image concerns were investigated in light of counselors' body image concerns and client physique in an audiovisual analogue counseling session. Counselors interacted with a video of a woman client discussing body image concerns. Client physique was manipulated such that counselors saw either a client whose physique was close to or far from the societal ideal. No significant relationships were found between the two independent variables (counselor body image disturbance and client physique) and countertransference. The nonsignificant findings are discussed in the context of the low body image disturbance in the sample.Item A SURVEY OF UNIVERSITY COUNSELING CENTER THERAPISTS: WORKING WITH CLIENTS WHO HAVE RELIGIOUS/SPIRITUAL ISSUES(2005-08-04) Kellems, Ian Stuart; Hill, Clara E.; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)University counseling center therapists (n = 220) completed an internet survey about one of their recent therapy cases in which the clients' issues involved religion/spirituality (RS). Responses were analyzed quantitatively and qualitatively. Common RS issues for clients involved questioning one's childhood religion, exploring RS beliefs, and using client's RS as a source of strength. The similarity of therapist and client RS values is not related to the strength of the therapeutic relationship. A therapist's religious commitment is related to both the goals that therapist considers important when working with RS issues and to how frequently the therapist uses religiously/spiritually-oriented interventions. Regarding training, therapist self-efficacy in working with RS issues is positively related to the amount of training the therapist has engaged in about how to work with RS issues. Implications for practice, research, and training are discussed.