Wednesday, April 13, 2011

Therapist and Client Perceptions of Therapeutic Presence: The Development of a Measure

This post isn't directly related to mindfulness, but the topic overlaps. Most psychotherapists would agree that the therapeutic relationship with clients is very important. There is less agreement, however, in a definition of what makes up a good therapeutic relationship and how it can be measured.

The lab of Dr. Les Greenberg, the core originator of Emotion Focused Therapy, has taken some initial steps to address this issue more empirically. The first author is Dr. Shari Geller.

These researchers from York University in Toronto have developed two measures of what the call therapeutic presence. Therapeutic presence, according to their definition, involves "bringing one’s whole self into the encounter with clients, by being completely in the moment on multiple levels:  physically, emotionally, cognitively, and spiritually."

Therapeutic presence differs from mindfulness, according to the authors, in two ways. The authors consider mindfulness a technique used to cultivate presence rather than presence itself. They also suggest that mindfulness--at least how it's presented in the research literature--is a way of engaging the internal world of one's self and another person, whereas "therapeutic presence is an internal and relational therapeutic stance that includes the therapist's present-centered sensory attention in direct relation to the client's in-the-moment experience.

I found the authors terminology a little imprecise for my tastes. There seemed to be a blurring of technical terms with vaguely defined descriptions; however, it could be that they're drawing from a research literature I'm not all that familiar with. Regardless, I believe it's clinically useful to define therapuetic presence as something separate from mindfulness.

The study went through a series of stages, beginning with creating items and, eventually, using them in an actual clinical setting with clients who met criteria for depression. The researchers developed two versions of a measure they call Therapeutic Presence Inventory. In one version (TPI-C), clients rate the presence of their therapist; in the other (TPI-T), therapists rate themselves.

The client measure predicted the therapeutic relationship and improved outcomes. The therapist version wasn't predictive of either. This supports a long line of research showing that psychotherapists aren't a very good judge of how well therapy is going. Psychotherapists tend to overestimate how much their clients like them! Consequently, the findings for the therapist measure are not too surprising.

The client version, though, is potentially really useful. It's short (only 3 items), and it can give therapists feedback about how clients perceive their relationship. Moreover, this feedback appears to be related to how clients change and improve.

In my own practice, I often give clients the option of filling out a feedback form about how well the session went. When I get the chance, I intend to revise my form to incorporate these three items.

To download the article, click on the full citation below:

Geller, S.M., Greenberg, L.S., & Watson, J.C. (2010). Therapist and Client Perceptions of Therapeutic Presence: The Development of a Measure. Psychotherapy Research, 20(5), 599-610.

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