Peluso, Paul R.

The present study evaluated affective, relational, and emotional behaviors associated with symptom reduction and clinical outcomes in psychotherapy. It relied on 36 therapist-client dyads and assessed client symptoms using the Counseling Center Assessment of Psychological Symptoms (CCAPS-34) as the progress monitoring and outcome assessment tool used by university counseling centers before every psychotherapy session. The research examined the first administration scores and the last administration scores of the CCCAPS to determine the level of clinical improvement. The researcher used the revised Specific Affect Coding System (SPAFF) to code the therapist and client interactions throughout the entire first psychotherapy session. The results revealed significant effects between the affective exchanges in the therapeutic relationship of both the therapist and the client on clinical outcomes. The researcher employed multivariate statistics with appropriate univariate follow-up procedures to determine group differences between SPAFF codes on the symptom outcome groups and CCAPS subscales. The researcher also used path analysis following Actor Partner Independence Model assumptions (Kenny et al., 2020) to examine the interdependent emotional dynamics between therapist and client on client symptom outcomes, and these revealed significant effects between SPAFF scores observed in the first session on client outcomes at the termination of therapy. The results add to the current research literature, highlighting patterns of significant affective behaviors in the first psychotherapy session on client outcomes. The study reveals that the first session cannot be minimized, as it has a greater impact on client outcomes than previously believed. The conclusion also outlines the study’s implications for clinical practice, graduate training, and research.

A quasi-experimental, between groups design was used to evaluate differences in
emotional behavior, as measured by the Specific Affect Coding System (SPAFF),
between professional therapists and their clients and a master therapist and his client.
This coding system also was used to determine how emotional behavior shown by a
master therapist changes over the course of six psychotherapy sessions. The research
team recorded counseling sessions at a university counseling center in the southeastern
United States and coded this video data using SPAFF in real time. Data were analyzed
quantitatively to determine whether significant differences in SPAFF codes exist between
the master therapist, professional therapists at the university counseling center, and their
respective clients. Results indicated that the master therapist showed significantly more
neutral and less negative affect than his counterparts at the university in both sessions one
and four. The master therapist’s client showed significantly more neutral affect and less negative in session one and significantly more positive affect and less negative affect in
session four.

The present study investigates the affectual interaction of three highly competent
therapists using different theoretical approaches with a shared male client and female
client in a professionally recorded video series. The interactions of clients and therapists
in a total sample of six psychotherapy sessions were coded using the twenty code version
of Gottman, Woodin, and Coan’s (1998) Specific Affect Coding System. Coded data
were analyzed using Kruskal-Wallis tests which found no significant differences between
the mean ranks of therapists’ codes between therapists. Significant effects among some
affective behaviors were noted in therapists’ codes when compared by client. Coded data
were also used to create mathematical models using ordinary differential equations for
each of the six sessions. Kruskal-Wallis tests did not reveal significant effects in the
mean ranks of the parameters of the mathematical models, and visual similarities and
differences of these models were discussed. Additional analyses were conducted to examine clients’ affective behaviors as well and significant effects were revealed in the
Kruskal-Wallis tests amongst many coded behaviors. The results support the presence of
common factors and similarities in the therapeutic relationship among different
theoretical approaches. The findings also add to the growing body of literature dedicated
to the use of observational coding and dynamic nonlinear modeling in psychotherapy
research. The implications for psychotherapy practice, education, and research are
discussed.

The increasing diversity of the United States raises
the probability that therapists will encounter clients
with a different cultural background than their
own. Thus, evaluating the relationship between the
culturally different therapists and clients is essential
in producing effective cross-cultural therapy. The
objective of this study is to determine any significant
effects that culturally similar or different clients and
therapists have on the therapeutic alliance. The
alliance was measured using the Working Alliance
Inventory (WAI) for both the clients and therapists. By
using this measure in therapist-client dyads, we are
able to evaluate the influences that cultures have
on the overall therapeutic alliance. The results of
the research can be used to show the importance of
multicultural competence in counseling relationships
in order to provide the best outcomes for culturally
diverse clients.

The present study applies Driver and Gottman’s (2004a) Turning System to
observations of the therapeutic relationship in a quasi-experimental between and within
groups design. A sample of 63 full counseling sessions (21 first sessions with clients who
return for four sessions, 21 first sessions for clients who terminate therapy prior to four
sessions, and 21 fourth sessions) were collected from a university counseling center in
South Florida. Clients and clinicians also completed self report evaluations of the
therapeutic relationship that were also included in this study (Working Alliance Inventory
– Short Form, and the Real Relationship Inventory). A series of multivariate analysis of
the variance (MANOVA) tests were performed to assess for significant differences in
Turning System behavior between return and dropout groups in the first sessions of
therapy, as well as for significant differences between return groups’ first and fourth sessions. Correlation analyses were run for client and therapist self report data and
Turning System codes.
Overall, the Turning System codes did not predict attrition from therapy;
however, significant effects were found for specific behaviors in the return versus
dropout comparisons, including client’s uses of negative bids, high level questions, and
preoccupied away responses. The Turning System also did not predict clear differences
between behaviors in ongoing therapy, though significant effects were again found for
individual behaviors enacted by both clients and therapists. Significant negative
correlations were also found for return group clients between specific behaviors and
ratings of the therapeutic alliance, such as high level questions and preoccupied away
responses. Individual behaviors in the therapist return group, such as high level questions,
negative bids, and interruptions, correlated negatively with ratings of the therapeutic
alliance. The results of this study are presented in an effort to synthesize the data into a
narrative for developing effective therapeutic relationships and guidance for future
research.

Through video recording, clinicians have the ability to further analyze their clients, being provided with micro and macro expressions, vocal cues and body language. The objective of the research is to test whether the size and positioning of a video camera affects the client’s levels of tension while under surveillance and simultaneously receiving therapy. By utilizing contrasting recording methods, it is predicted that the client will feel more comfortable in front of an inconspicuous, wall-mounted camera as opposed to the tripod-mounted camera. The results of this research have the potential to revolutionize the methods used by the therapy and counseling community to further analyze their clients as well as psychotherapeutic methods. Data will be collected from a total of four clients’ fourth sessions in order to rule out anxiety experienced as a result of adjusting to a new therapeutic relationship or other factors inherent to a therapeutic session.

This qualitative case study investigated the impact of sand tray on individuals
diagnosed with Alzheimer’s and other forms of dementia. Four participants successfully
completed the creation of sand trays while the researcher observed, interviewed, and
documented the individual sand trays. The intervention established that sand tray allows
the dementia patient to kinesthetically connect to their inner cognitions through the
intentional symbolic expression offered by this unique therapeutic medium. Using a
series of eight sand trays of varying thematic concepts, the participants were offered a
modality to facilitate a synthesization of their continued individuation, presenting a
possible neural pathway to connect and express thoughts, feelings, emotions, concerns,
challenges, and fears. The findings of this study include the fact that all trays were
classified as “empty” and that the majority of the participants placed objects almost
exclusively on the right side of the tray, which is commonly associated with the concreteor conscious side. The use of sand tray allowed each individual the opportunity to create autobiographies in the sand and literally navigate through time – past, present, and future, confronting fears, expressing hope and possibilities. The results of the research study offer insight into the psychotherapeutic effects of using sand tray with dementia patients, as well as a better understanding of the cognitive and expressive abilities and limitations of an individual with impaired memory. The results also offer insight into the difficulties with short-term memory in this population and possibly indicate a potential means for monitoring cognitive decline. Keywords: Neurocognitive disorder, Alzheimer’s, dementia, sand tray, play therapy