Academic journal article Canadian Journal of Counselling and Psychotherapy

Client and Therapist Interpersonal Behaviour in Cognitive Therapy for Depression/ Comportement Interpersonnel Du Client et Du Therapeute Dans le Cadre De la Therapie Cognitive De la Depression

Academic journal article Canadian Journal of Counselling and Psychotherapy

Client and Therapist Interpersonal Behaviour in Cognitive Therapy for Depression/ Comportement Interpersonnel Du Client et Du Therapeute Dans le Cadre De la Therapie Cognitive De la Depression

Article excerpt

Cognitive therapy (CT) has received substantial empirical support for the treatment of major depressive disorder (MDD; Butler, Chapman, Forman, & Beck, 2006), yet there is evidence to suggest that it is not uniformly beneficial for depressed patients (Beutler, Castonguay, & Follette, 2006; Hardy et al., 2001; Keijsers, Schaap, & Hoogduin, 2000). As a result, a greater emphasis has increasingly been placed on identifying variables that influence the effectiveness of cognitive and other treatments for MDD (Grosse Holtforth et al., 2013; McCullough, 2010; Saatsi, Hardy, & Cahill, 2007). In particular, interpersonal variables have been linked to the etiology, severity, and recurrence of depression, as well as to depressed patients' ability to forge productive therapeutic relationships and experience symptom relief through CT and other forms of therapy (Hardy et al., 2001; McEvoy, Burgess, & Nathan, 2013; Renner et al., 2012).

Research also indicates that therapists' interpersonal style, as well as their use of specific interpersonal strategies, can influence the process and outcome of therapy for depression (Beutler et al., 2006; Keijsers et al., 2000). These studies have examined a variety of therapeutic modalities and have demonstrated that clients who are open, friendly, and forthcoming in their communication experience better outcomes, and that interpersonal hostility typically has a deleterious effect on treatment (Critchfield, Henry, Castonguay, & Borkovec, 2007; Henry, Schacht, & Strupp, 1986, 1990; Tasca & McMullen, 1992; von der Lippe, Monsen, Ronnestad, & Eilertsen, 2008). Interestingly, the prevalence of hostility seems to vary across treatment modalities and is generally less frequent in CT dyads (Ahmed, Westra, & Constantino, 2012; Critchfield et al., 2007). For example, in one study of cognitive-behavioural therapy, Critchfield and colleagues (2007) reported rates of hostility among their poor outcome dyads ranging from 4% to 8%. By contrast, in studies of psychodynamic therapy, means for hostile behaviour have ranged from 9% to 13% for clients and 13% to 16% for therapists among poor outcomes pairs (Coady, 1991; Henry et al., 1986, 1990). Nonetheless, despite fewer instances of hostility in CT, it remained negatively related to treatment benefit (Ahmed et al., 2012; Critchfield et al., 2007). Thus, its deleterious effect appears to persist across modalities. It is possible that variations in the observed levels of interpersonal hostility reflect a divergence in the tempo, tasks, and goals of different treatment approaches. However, it is also possible that interpersonal animosity is manifested differently in CT (Ahmed et al., 2012; Critchfield et al., 2007; Safran et al., 2014).

There is a considerable body of evidence indicating that most clinicians struggle to identify and effectively resolve hostile interpersonal situations in therapy (Binder & Strupp, 1997; Hill, Thompson, & Corbett, 1992). In particular, many therapists respond with dominance and directiveness to covertly hostile client behaviour such as avoidance or submission (Binder & Strupp, 1997; Safran, Crocker, McMain, & Murray, 1990; Safran & Muran, 1995). For example, Castonguay, Goldfried, Wiser, Raue and Hayes (1996) observed that when clients expressed reluctance about the tasks of therapy, clinicians responded by adhering more strongly to their treatment protocols. More recently, Anderson, Knobloch-Fedders, Stiles, Ordonez, and Heckman (2012) identified a "telling rather than listening" pattern (p. 356), whereby therapists in moderate hostility cases adopted an expert stance while simultaneously ignoring or neglecting important aspects of the clients' narrative. Put differently, these findings suggest that therapy suffers when clinicians take a dogmatic approach (Ackerman & Hilsenroth, 2001; Binder & Strupp, 1997). Treatment benefits may also be mitigated when clients are more withdrawn, compliant, or even assertive (Coady, 1991; Henry et al. …

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