Therapist and patient

The present study investigates therapist factors (such as conversation analysis, affectual interactions, and therapist facilitative skills) on client premature termination and the therapeutic relationship. The interactions of clients and therapists in a total sample of 76 psychotherapy sessions were analyzed using Hills Skills System (2017), Gottman, Woodin, and Coan’s (1998) Specific Affect Coding System, and scales of the Working Alliance Inventory (WAI) and Real Relationship Inventory (RRI). Coded data were analyzed using Kruskal-Wallis and Mann-Whitney U tests which found significant differences between clients who dropout and the types of questions being asked in session (HSS). There were also significant differences between clients who dropout and the therapist and client SPAFF scores, SPAFF and HSS scores on the WAI and RRI, as well as the quality of questions being asked (HSS) over time (from initial session to fourth session). Coded data for differences between clients who dropout and the therapist and client assessment of the quality of the working alliance and real relationship were assessed using Kruskal-Wallis and Mann-Whitney U tests and found no significant differences. Analysis of the results support the presence of therapist factors on the therapeutic relationship and client premature termination. These findings can also be added to the literature regarding the outcomes of the therapeutic relationship on client premature termination. The implications for psychotherapy practice, education, and research are discussed.

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.