UMD Theses and Dissertations
Permanent URI for this collectionhttp://hdl.handle.net/1903/3
New submissions to the thesis/dissertation collections are added automatically as they are received from the Graduate School. Currently, the Graduate School deposits all theses and dissertations from a given semester after the official graduation date. This means that there may be up to a 4 month delay in the appearance of a given thesis/dissertation in DRUM.
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Item Decolonizing in Individual Psychotherapy: A Qualitative Exploration(2024) Bansal, Priya; Hill, Clara E; Counseling and Personnel Services; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)We interviewed 12 therapists experienced in practicing decolonizing about their understanding of decolonizing and its relevance to therapy, as well as how they implemented this approach with at least one client. Interviews were analyzed using Consensual Qualitative Research (CQR) and revealed that colonial paradigms had negative individual, relational, and societal impacts; therapists used a range of interventions aligned with decolonizing, including interventions to help clients gain insight about the systemic context of psychological problems and to facilitate client resistance of colonial ideologies; sociocultural identity interactions between therapist and client considerably shaped the therapy work; therapists encountered conceptual, practical, and systemic barriers to decolonizing practice; and clients experienced improvements across intrapersonal and interpersonal functioning. Implications for practice and research are discussed.Item Therapist Cultural Humility, Black LGB Identity Centrality, and Therapeutic Outcomes in Black LGB Adults.(2023) Teran Hernandez, Manuel; Shin, Richard Q.; Counseling and Personnel Services; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Black lesbian, gay, and bisexual (LGB) adults experience discrimination at individual and institutional levels (Page et al., 2020) in part due to simultaneous experiences of anti-Black racism and heterosexism. Despite this, Black LGB adults continue to underutilize therapeutic services and also report high rates of premature termination from therapy (Garrett-Walker & Longmire-Avital, 2018). The current study advances the literature by investigating the association between therapist cultural humility, Black LGB centrality, and therapeutic outcomes among Black LGB adults. A sample of Black LGB adults (N = 157) participated in an online survey to respond to measures on demographic information, therapist cultural humility, centrality with their race x sexual orientation (Black LGB centrality), and therapeutic outcomes. Results showed that therapist cultural humility was a significant predictor of therapist satisfaction but not future utilization of counseling services while controlling for age and socioeconomic status among Black LGB adults. The analyses found that Black LGB centrality was not a significant moderator in the association between therapist cultural humility and therapist satisfaction, and only significant in the relation between future utilization of counseling services for participants who reported high levels of Black LGB centrality. Recommendations for future clinical practice and research efforts are provided.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 Are We Ready to Serve? Couple and Family Therapists’ Attitudes Toward BDSM and Their Perceived Competence Helping BDSM Practitioners(2020) Berman, Zachary Lane; Fish, Jessica N; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Cultural competence is a core component of delivering effective psychotherapy to clients with diverse sexual lifestyles, including BDSM practitioners, who constitute a substantial minority of the population. Couple and Family Therapists (CFTs) are uniquely prepared to explore relationships and power dynamics, but no research has explored CFTs’ psychotherapeutic relationship with BDSM practitioners. This study measures CFTs’ BDSM attitudes, perceived competence, and the relationship between these and related professional factors. Results indicated that CFTs (n = 132) have positive attitudes and moderate perceived competence; attitudes and perceived competence were negatively correlated. Controlling for various professional factors such as AASECT certification, we found that participants with at least three or more hours of BDSM-specific training had significantly more positive attitudes and significantly higher perceived competence. Including these hours in graduate training or continuing education credits could help CFTs to feel more “kink aware” and competent to deliver ethical care for this population.Item THERAPIST COMMON FACTORS’ INFLUENCE ON CLIENT CONSTRUCTIVE COMMUNICATION AND CONFLICT RESOLUTION IN COUPLE THERAPY(2018) Harbison, Liza; Epstein, Norman B; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)This study investigated the relationship between therapist common factors behaviors and changes in client constructive communication during couple therapy. Research suggests that common factors are associated with client improvement, but research on these factors in couple therapy is lacking. This study was a secondary data analysis of 41 couples presenting with mild to moderate psychological and physical partner aggression who received ten sessions of couple therapy at a university family therapy clinic. The study examined the relationship between therapist collaborative behavior and use of systemically based techniques coded from the fourth couple therapy session, and changes in client constructive communication, measured by client cognitions during conflict, client and partner behavior during conflict, and video coding of couple communication. Minimal significant links were found, but unexpectedly, therapist use of systemic techniques was negatively associated with change in female constructive problem solving cognitions. Implications of these findings are discussed.Item Ruptures in Psychotherapy: Experiences of Therapist Trainees with Different Attachment Styles(2017) Kline, Kathryn Kline; Hill, Clara E; Counseling and Personnel Services; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)In this study, we explored therapist trainees’ experiences of rupture events in psychotherapy. Therapists-in-training were interviewed about the antecedents, management, and consequences of a rupture with a client. Data was analyzed using Consensual Qualitative Research (CQR; Hill et al., 1997; 2005). Therapists typically reported broad (i.e., session started in tense state vs. typical session) rather than specific antecedents to the rupture. In terms of management, therapists typically used immediacy and explored the rupture further as repair attempts. Negative consequences included therapists having anxiety about continued work with client and client not attending the next session. However, therapists also reported positive consequences, which included the therapeutic work becoming more productive. There were several meaningful differences found between attachment style subgroups. Implications for future research, doctoral training, and psychotherapy practice are offered.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 The real relationship, therapist immediacy, and client experiencing level: A dyad study of psychotherapy process and connection.(2013) Walden, Tamara Tashiko; Gelso, Charles J; Counseling and Personnel Services; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The present study examined the strength of the real relationship (RR) in relation to session quality, therapist immediacy (T-IMM), and client experiencing level (C-EXP) in six psychotherapy dyads over the course of time-limited treatment. Six clients and three therapists completed measures of RR and session quality immediately after each session. Trained judges rated the amount, appropriateness, depth, quality and resolution of T-IMM and the peak and mode level of C-EXP using audio recordings and transcripts post-treatment. This study used the Actor Partner Interdependence Model (APIM; Kenny & Cook, 1999), Structural Equation Modeling (SEM), and Hierarchical Linear Modeling (HLM) to analyze the data due to nesting and interdepence. No significant associations were detected between therapist or client ratings of RR and session quality, between therapist ratings of RR and T-IMM, or between therapist or client ratings of RR and C-EXP. Client perceptions of RR were significantly related to T-IMM rating dimensions, though not significantly related to T-IMM amount or occurrence. The results indicate that regardless of the amount, when therapist immediacy is used appropriately, with depth, quality or resolution, clients perceive stronger real relationships with their therapists. Implications for practitioners and researchers regarding the findings are discussed. In addition, due to the unique racial/ethnic minority (REM) composition of the majority of the dyads, cultural implications for research and practice are considered.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.