The authors discuss the components of consensual qualitative research (CQR) using open-ended questions to gather data, using words to describe phenomena, studying a few cases intensively, recognizing the importance of context, using an inductive analytic process, using a team and making decisions by consensus, using auditors, and verifying results by systematically checking against the raw data. The three steps for conducting CQR are developing and coding domains, constructing core ideas, and developing categories to describe consistencies across cases (cross analysis). Criteria for evaluating CQR are trustworthiness of the method, coherence of the results, representativeness of the results to the sample, testimonial validity, applicability of the results, and replicability across samples. Finally, the authors discuss implications for research, practice, and training.

A Guide to Conducting Consensual Qualitative Research

In this article, we review the existing empirical research on the topic of therapeutic alliance ruptures in psychotherapy. Ruptures in the therapeutic alliance are defined as episodes of tension or breakdown in the collaborative relationship between patient and therapist. Two meta-analyses were conducted. The first reviewed studies examining the relation between rupture-repair episodes and treatment outcome (r = .24, z = 3.06, 95% CI [.09, .39], p = .002, k = 3, N = 148). The second meta-analysis reviewed the research examining the impact on treatment outcome of training therapists in the use of alliance rupture intervention principles (prepost r = .65, z = 5.56, 95% CI [.46, .78], p < .001, k = 8, N = 376). Both meta-analyses provided promising evidence regarding the relevance of alliance rupture-repair processes to therapeutic outcome. The limitations of the research reviewed are discussed as well as practice implications for repairing the inevitable alliance ruptures in psychotherapy.

Repairing alliance ruptures.

Fear of emotions is hypothesized to be a primary reason for individuals' negative attitudes toward seeking psychological treatment. This study examined the effects of emotional openness and other potential predictors of attitudes toward seeking psychological help in a sample of 311 college students. Results of simultaneous multiple regression analyses indicated that gender (male), perception of stigma, discomfort with emotions, and lower psychological distress accounted for 25% of variance in attitudes toward seeking psychological help. The implications of the findings and recommendations for increasing the effectiveness of public education efforts are discussed.

Emotional openness as a predictor of college students' attitudes toward seeking psychological help.

The literature on empathy, primarily from counseling and psychotherapy and secondarily from social and developmental psychology, is reviewed. Obstacles that may account for theoretical confusions and empirical difficulties in studying empathy are highlighted. The decrease in empathy research in recent years appears attributable to the lack of clear focus and effective research tools as well as the shift in interest from empathy to other concepts such as the working alliance. It is argued that there is a need to return to studying empathy. Researchers should distinguish between dispositional and experiential empathy and between intellectual empathy and empathic emotions and indicate whether they are examining therapist or client experience of empathy. Suggestions for future research are offered.

The current state of empathy research

Nondisclosures in supervision were studied for 108 supervisees. Supervisees reported an average of 8.06 nondisclosures ranging in importance level. Negative reactions to the supervisor were the most frequent type of nondisclosure. The most frequent reasons for nondisclosures were perceived unimportance, that the nondisclosure was too personal, negative feelings, and a poor alliance. The manner of nondisclosure was usually passive. Most nondisclosures were discussed with someone else, typically a peer. Supervisor style was related to content of and reasons for nondisclosure. Supervisees were less satisfied when they reported more negative reactions to supervisors and when they did not disclose because of poor alliances, supervisor incompetence, and fear of political suicide. Thus, nondisclosure affects the process of supervision. Further research is needed on how nondisclosures in supervision affect supervision and therapy processes.

Mary C. Cogar

Papers

Beneath the surface of long-term therapy: Therapist and client report of their own and each other's covert processes.

Examining the effects of brief individual dream interpretation.