Client-centered psychotherapy.

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.

The purpose of this quantitative, quasi-experimental study was to examine the
effects of a standardized case conceptualization training workshop on 104 psychotherapy
practitioners recruited from the community. A secondary purpose was to examine the
relationship between participants’ attitudes about evidence-based practice and the effects
of the training. Participants attended two 3-hour training workshops, which taught the
integrative case conceptualization model developed by Sperry (2010b). Pre- and postintervention
case conceptualization skills were assessed using the Case Conceptualization
Evaluation Form (CCEF) 2.0, an updated version of the instrument used in previous
studies. Additionally, participants’ views about case conceptualization were assessed
before and after training using the Views about Case Conceptualization (VACC)
instrument. Participants’ attitudes about evidence-based practice were also examined as a
possible mediating variable between training and effect. These attitudes were assessed
using the Evidence-Based Practice Attitudes Scale (EBPAS). Workshops were separated by four weeks in order to assess whether initial training effects persisted
over time.
Change in case conceptualization skill was analyzed using repeated measures
ANOVA. Participants’ mean CCEF 2.0 scores significantly increased (p < .001) from
pre-test (M = 11.9; SD = 7.74) to post-test (M = 36.7; SD = 7.80) following the first
workshop. The second workshop took place four weeks later with 74 of the original 104
participants. It built on the content of the first workshop and introduced advanced
concepts such as client culture, strengths and protective factors, and predictive ability.
Participants’ mean CCEF 2.0 scores also significantly increased (p < .001) from pre-test
(M = 35.1; SD = 8.11) to post-test (M = 66.3; SD = 10.95) following the second
workshop. There was a small but statistically significant (p < .005) decrease of 1.5 points
in mean scores from the end of Workshop I to Workshop II, indicating that the effects of
the training deteriorate slowly over time. Participants’ attitudes about evidence based
practice and some demographic variables were significantly related to training effects.
Stepwise hierarchical regression analysis determined that these individual variables
account for various portions of the variance in CCEF 2.0 scores. This study’s theoretical,
practice, and research implications are discussed in detail.