Therapist Directives in China

Therapist directives, including homework, advice, suggestions, and recommendations, are believed to have a significant effect on the behavioral and cognitive tendencies of a client. On the other hand, some people maintain that directives may be unnecessary or counteractive to the client's true development. But in Chinese culture, where people of "high" power giving directives to people of "low" power is socially acceptable and expected, the use of therapist directives would be appropriate. The research team studied the quantity and type of directives perceived by clients and therapists and "assessed the degree to which clients reported implementation of the primary directives they perceived." The data was compiled from 96 clients (split among 43 therapists) who each received a minimum of 5 sessions. The amount of directives that clients perceived were higher than the amount of therapists that therapists actually gave in all 5 sessions. The researchers concluded that the majority of directives concentrated on a client's intrapersonal or interpersonal issues. Also, Chinese therapists actually gave fewer directives than a similar American study.


Citation: Duan, C., Hill, C., Jiang, G., Hu, B., Chui, H., Hui, K., Liu, J., & Yu, L. (2012). Therapist directives: Use and outcomes in China. Psychotherapy Research, 1-16.

Experiences of Alliance Ruptures

The main goal of this study was to investigate the therapists' and clients' experiences of alliance rupture, which is defined as "moments of tension or breakdown in the alliance between the therapist and the client." There are two kinds of ruptures: withdrawal ruptures, in which a client tries to avoid or deny talking about their experiences, and confrontation ruptures, in which the client expresses dissatisfaction or attempts to pressure the therapist. Eight therapist-client pairs participated in the study; nine judges coded the therapy sessions using the Rupture Resolution Rating System, and about one week after a rupture, the client and therapist were interviewed separately about the event. The researchers found that the following characteristics were typically common among rupture events: events had occurred in a previous therapy session, events came about from the client's unpreparedness concerning a therapist's intervention, therapists and clients alike experienced confusion, and ambivalence, and confrontation ruptures caused the therapist and client to have intensely negative feelings.


Citation: Coutinho, J., Ribeiro, E., Hill, C. E., & Safran, J. (2011). Therapists' and clients' experiences
of alliance ruptures: A qualitative study. Psychotherapy Research, 21:5, 525-540.

Stress Changes Decision Making

Researchers have discovered that when people experience stress, decision making may be skewed because the perceived balance of risk and reward changes. Scientists fount out that stress causes "people [to] pay more attention to the upside of a possible outcome." Click here to find out more.

The Myth of the Eight-Hour Sleep

Scientists and historians have postulated that the typical eight hour sleep schedule may be unnatural. "Sleeping in one eight-hour chunk is a very recent phenomenon, and lying awake at night could be good for you." Click here to read more about the study.

Problems and Action Ideas in Dreams

Using taped footage from a previous study, the research team looked at interviews with 7 first-generation female Asian students (those who were born and raised in Asia and may be recent immigrants or international students) and with 7 second-generation female Asian students (those who were born and raised in the United States). Each subject participated in one 90-minute dream session, and, using CQR, the researchers investigated the differences between first- and second-generation Asian females in the types of problems and action ideas they discussed in their dream sessions. At the same rate (yet to varying degrees), both groups of subjects similarly mentioned interpersonal problems (maladaptive patterns, family issues, romantic relationships, and problems with peers/friends), academic/post-graduation concerns, and inner conflict (anxiety, autonomy struggles, self-esteem issues, and loneliness). First-generation students discussed immigration and cultural adjustment issues more than second-generation students, and first-generation students discussed physical health distress issues less than second-generation students. Behavioral changes were typical for both types of students, and cognitive/emotional changes were more frequent with first-generation students.


Citation: Wonjin, S., Hill, C. E., Chowdhury, S., Huang, T., Zaman, N., & Talavera, P. (2010). Problems and Action Ideas Discussed by First- and Second-Generation Female East Asian Students During Dream Sessions. Dreaming, 20(1), 42-59.

Therapy Termination

Using consensual qualitative research (CQR), the researchers interviewed 12 clients about their experiences with therapy, most specifically their experiences with the termination of the therapy. The focus of the study was geared toward how clients experience therapy termination, how termination unfolds or is initiated, and how termination affects the therapeutic process and relationship. In cases with positive termination experiences, there was a generally positive effect of therapy on the client, the termination process and post-termination plans were premeditated, and clients felt more comfortable with their relationships and more confident in coping with problems. In cases with negative termination experiences, clients noted more negative elements of therapy (did not feel understood), the termination process was abrupt (often unplanned) and unilateral, and clients were upset with with their therapy experience and hesitant about seeking more therapy. This study truly shows how therapy termination can lead to long-lasting effects and opinions (both positive and negative) about therapy.


Citation: Knox, S., Adrians, N., Everson, E., Hess, S., Hill, C. E., & Crook-Lyon, R. (2011). Clients' perspectives on therapy termination. Psychotherapy Research, 21, 154-167.

Hitting the Wall

A case study was conducted on one client (Krista) and one therapist (P) in order to evaluate the changes in client interpersonal functioning as a result of psychotherapy. Before entering into therapy, Krista reported problems and concerns with her loneliness, lack of a romantic partner, inadequacy in social interactions, and anger towards others. In her 21 sessions with P, Krista told very animated stories about her emotions and behaviors toward her ex-boss, two of her housemates, and others; she even hit the wall to indicate her passion about certain events. After her therapy, client behaviors were coded by counseling psychology doctoral students. They found that, through the course of therapy, Krista felt less shame/guilt in all of her interactions and had a better sense of people's reactions (i.e. responding to others with less confusion and noticing that others complied with her less). In a post-therapy interview, Krista communicated that she had experienced a better sense of self and an increased freedom when expressing her emotions in a healthy and positive way.


Citation: Hill, C.E., Chui, H., Huang, T., Jackson, J., Liu, J., Spangler, P. (2011). Hitting the wall: A case study of interpersonal changes in psychotherapy. Counselling and Psychotherapy Research, 11(1), 34-42.