Development and validation of the Barriers to Using Immediacy Scale (BUIS).

Immediacy is a skill therapists use to process the therapeutic relationship in the here and now. Although immediacy has been shown to enhance the therapeutic process, therapists are often reluctant to use it (Hill et al., 2018).

Helping skills training: Outcomes and trainer effects.

We studied whether counseling self-efficacy increases after taking a helping skills course as well as whether trainer (instructor) effects are associated with postclass self-efficacy. We surveyed 551 undergraduate students and 27 trainers in helping skills courses across three semesters at one large mid-Atlantic U.S.

The within-client alliance-outcome relationship: A response surface analysis.

The authors examined how stability/change in working alliance predicted subsequent symptoms, and how stability/change in symptoms predicted subsequent alliance in a sample of 188 adult clients with 44 doctoral student therapists over the course of 893 eight-session time periods of individual psychodynamic psychotherapy. Clients completed the Working Alliance Inventory-Short Revised (WAI-SR; Hatcher & Gillaspy, 2006) after every session and the Outcome Questionnaire-45 (OQ; Lambert et al., 1996) before intake and every eighth session.

Changes in client attachment in relation to client distress: A response surface analysis.

Using multilevel polynomial regression and response surface analysis, we studied the association between Time 1 (T) and Time 2 (T + 1) attachment anxiety and attachment avoidance, and T + 1 psychological distress in 253 nine-session time periods for 65 adult community clients working with 13 doctoral student therapists in open-ended psychodynamic psychotherapy. Results indicated that when client attachment anxiety was consistent and higher from the beginning (T) to the end (T + 1) of a nine-session time period, clients tended to report higher distress at the end of the period; when attachment anxiety was consistent and lower across a time period, clients tended to report lower distress. When attachment anxiety decreased across a time period, clients reported lower distress at the end of the period; when attachment anxiety increased across a time period, clients reported higher distress.

Deliberate practice for the skill of immediacy: A multiple case study of doctoral student therapists and clients.

We examined the effects of deliberate practice training focused on immediacy (Im) for 7 doctoral student trainees. Training included an 8-hr workshop, 4 individual 50-min sessions, and 4 individual 30-min homework sessions. Qualitative results indicated that trainees found the deliberate practice training to be effective, especially in helping them become aware of and manage emotions and countertransference, which had inhibited them from using Im.