PSYCHOTHERAPY ENGAGERS VERSUS NON-ENGAGERS

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Chapter 6: Discussion The present study examined therapist helping skills associated with psychotherapy engagement. Specifically, overall proportions of helping skills used in intake sessions, as well as proportions of helping skills used across thirds of intake sessions, were analyzed. In addition, a number of other variables were examined to help to explicate the results. Overall Helping Skills and Psychotherapy Engagement Descriptively, of the 21 skills, the most frequently used skills in the intake sessions overall were: information about the helping process (28% of all skills used), restatements (19%), and closed questions (19%). Moderately-used skills in the intake included approval-reassurance (10%), open questions about thoughts (7%), and information-facts/data/opinions (7%). Less frequently used skills in the intake included reflections of feeling (3%), immediacy (3%), and disclosure-miscellaneous (1%). Rarely- used skills in the intake (less than 1%) included open questions about feelings, directives, open questions about insight, process advisement, challenge, interpretation, disclosure of feelings, information providing feedback about the client and statements not relevant to the helping situation (i.e. skills falling into the Other category). Never-used or skills in the intake were open questions about action, disclosure of insight, and disclosure of action. Therapists did not significantly differ in their use of the helping skills with engagers versus non-engagers. This null finding contrasts to Tryon’s (2003) findings that therapists used statistically significantly more information and fewer minimal encouragers with engagers than with non-engagers (the present study did not include 107
minimal encouragers since the 2009 version of the HSS was used). This divergence of results regarding therapist use of information could be due to a number of factors. First, the present study controlled for therapist verbal activity level whereas the Tryon (2003) study used raw numbers of skills, so it could be that the effect that Tryon (2003) found might not have turned out to be statistically significant had those analyses included more stringent controls for therapist verbal activity level. Second, perhaps the Tryon (2003) results applied to the particular therapist who participated in that study, since the Tryon (2003) study only had one therapist—the present study included four therapists. Third, the clients from Tryon’s study compared to the clients in the present study were different in terms of demographics and presenting concerns, which may have elicited differing patterns of therapist helping skills. First Third of the Intake: Helping Skills and Psychotherapy Engagement Descriptively, the most-used helping skills in the beginning third of the intake were information about the helping process (25%), restatement (23%), and closed questions (21%). These results suggest that therapists were primarily trying to provide structure and elicit information from clients during this early stage. In terms of differences between engagers and non-engagers, therapists provided significantly more approval-reassurance in the beginning third of the intake. Perhaps they provided more approval-reassurance because non-engagers were higher than engagers on self-reported pre-therapy anxious attachment style and rated themselves as more in need of therapy than engagers. Perhaps the non-engagers appeared more anxious and desperate for help compared to engagers, which elicited more approval-reassurance from the therapists at the beginning of the session. 108
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ABSTRACT Title of Document: PSYCHOT
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PSYCHOTHERAPY ENGAGERS VERSUS NON-E
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Table of Contents List of Tables ..
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Last Third of the Intake: Helping S
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List of Figures Figure 1: Approval-
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therapists (Hill & Lent, 2006), tha
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third of the intake) and types of t
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“completed treatment” - from a
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ange on the OQ-45.2 when beginning
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Wierzbicki and Pekarik (1993) condu
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Enabling factors or barriers refer
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MI evaluation were statistically si
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later dropout (Barrett et al., 2008
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male) at a university counseling ce
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= 12.3, p < .001, and lower rates o
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F(1, 261) = 40.64, p < .001. Limita
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clinic in a medium-sized Midwestern
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Summary. In summary, there are seve
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quality of the technique (e.g., app
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therapist behaviors which may be be
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of the three judges. Based on an ex
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theoretical orientation. Furthermor
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occur after closed questions, and I
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Elliott’s (1985) system used in t
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8 women who were interviewed to det
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lasted 20 minutes for each type, tr
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corresponded to similar categories
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does not provide restatements, refl
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presenting concerns, psychosocial h
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counselors was reported. Minimal fa
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(1991); and Tryon (2003). At the en
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counselor’s emphasis from gatheri
Page 65 and 66: composed of volunteer undergraduate
Page 67 and 68: Table 3 Tryon (2003) Mean Number an
Page 69 and 70: therapy service at the university (
Page 71 and 72: treatment outcome (which means the
Page 73 and 74: Chapter 3: Statement of the Problem
Page 75 and 76: engagement, and f) a definition of
Page 77 and 78: the intake session, and about 4% wi
Page 79 and 80: Research Question 9: Do proportions
Page 81 and 82: Chapter 4: Method The present study
Page 83 and 84: Indian and Portuguese; aged 20-28,
Page 85 and 86: or abandoned by romantic partners.
Page 87 and 88: Intake sessions. When clients arriv
Page 89 and 90: unitizer had a unit in a meaningful
Page 91 and 92: Table 4 Proportions of Helping Skil
Page 93 and 94: Table 6 Proportions of Helping Skil
Page 95 and 96: to the last third of the session, a
Page 97 and 98: second to last third, F(1, 3858) =
Page 99 and 100: Estimated Likelihood (%) 12 10 8 6
Page 101 and 102: significant, F(1, 3856) = 3.95, p =
Page 103 and 104: Research Question 7: Do proportions
Page 107 and 108: Research Question 10: Do proportion
Page 113 and 114: Client Avoidant Attachment Scale Av
Page 115: Client Outcome Expectations How con
Page 119 and 120: In contrast, information about the
Page 121 and 122: duration. This null finding diverge
Page 123 and 124: Limitations Although the present st
Page 125 and 126: for need for therapy and “How con
Page 127 and 128: Appendix A: Preliminary Tests of Th
Page 129 and 130: Barrett, M., Chua, W., Crits-Christ
Page 131 and 132: Dodd, J. (1970). A retrospective an
Page 133 and 134: Hampton-Robb, S., Qualls, R. C., &
Page 135 and 136: Hill, C. E. (2009). Helping skills:
Page 137 and 138: Johansson, H., & Eklund, M. (2005).
Page 139 and 140: Ligiero, D. P., & Gelso, C. J. (200
Page 141 and 142: Pekarik, G. (1983). Follow-up adjus
Page 143 and 144: Stiles, W. B. (1978). Verbal respon
Page 145: Willer, J. (2009). The beginning ps
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PSYCHOTHERAPY ENGAGERS VERSUS NON-ENGAGERS

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